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Stepwise mass screening for atrial fibrillation using N-terminal pro b-type natriuretic peptide: the STROKESTOP II
Johan Engdahl1,2, Emma Svennberg1, Leif Friberg1
1Department of Clinical Sciences, Karolinska Institute, Cardiology Unit, Danderyd's University Hospital, SE-18288 Stockholm, Sweden.
Insights
This study investigates using NT-proBNP biomarker levels to guide atrial fibrillation (AF) screening in older adults. Elevated NT-proBNP levels trigger prolonged ECG monitoring, aiming to improve early detection of AF and prevent strokes.
Area of Science:
- Cardiology
- Biomarkers
- Public Health
Background:
- Atrial fibrillation (AF) is a common arrhythmia and a significant risk factor for ischemic stroke.
- Oral anticoagulants (OACs) effectively reduce stroke risk in AF patients.
- Diagnosing AF can be challenging due to its often asymptomatic and paroxysmal nature.
Purpose of the Study:
- To evaluate the utility of N-terminal pro b-type natriuretic peptide (NT-proBNP) as an adjunct biomarker in population-based atrial fibrillation screening.
- To assess if NT-proBNP-guided screening improves the detection of AF compared to standard methods.
Main Methods:
- A randomized, population-based study (STROKESTOP II trial) involving 28,712 individuals aged 75-76 in Sweden.
- Intervention group: NT-proBNP levels guide the duration of ambulatory ECG recording (single ECG for NT-proBNP ≤ 125 pg/L, prolonged monitoring for NT-proBNP ≥ 125 pg/L).
- Primary endpoint: Incidence of stroke or systemic embolism over a 5-year follow-up period, comparing the screening intervention group to the control group.
Main Results:
- Study is ongoing; primary results are not yet available.
Conclusions:
- The study aims to determine if NT-proBNP-guided screening is an effective strategy for detecting atrial fibrillation in a large population.
- Findings may inform future guidelines for AF screening and stroke prevention in at-risk populations.
Aim:
Atrial fibrillation (AF) is the most prevalent clinical arrhythmia and a major risk factor for ischaemic stroke. Treatment with oral anticoagulants (OACs) reduces the risk of stroke by two thirds in AF patients with risk factors. Due to its often paroxysmal and asymptomatic presentation, AF is sometimes challenging to diagnose. So far, AF screening studies have applied opportunistic or systematic screening, most often using a single 12-lead electrocardiogram (ECG) recording or ambulatory ECG. We hypothesise that the biomarker N-terminal pro b-type natriuretic peptide (NT-proBNP) is a valuable adjunct in population based AF screening.
Methods:
We are conducting a randomized population-based study on AF screening using ambulatory ECG recording where the decision to use prolonged intermittent ECG recording is directed by NT-proBNP levels, the STROKESTOP II trial. The entire population of inhabitants 75 or 76 years of age (n = 28 712) in the capital region of Sweden will be randomized 1:1 to intervention or control group. In the intervention group NT-proBNP will be analysed in all without previously known AF. Those with NT-proBNP ≤ 125 pg/L will make a single one lead ECG recording, participants with NTproBNP ≥ 125 np/L will be instructed to record ECG for 30 s at least twice daily for 2 weeks with a handheld ambulatory ECG recorder. Participants with newly diagnosed or undertreated AF will be referred to a cardiologist and offered OAC treatment. Primary endpoint is incidence of stroke or systemic embolus, during a 5 year follow-up period in the control group vs the group invited to screening.
