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Published on: February 26, 2013
Blood-biomarkers and devices for atrial fibrillation screening: Lessons learned from the AFRICAT (Atrial Fibrillation
Elena Palà1, Alejandro Bustamante1,2, Josep Lluis Clúa-Espuny3,4
1Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain.
Insights
This study found NT-proBNP to be a key biomarker for detecting atrial fibrillation (AF) in high-risk patients. Combining NT-proBNP with rhythm detection devices shows promise for community AF screening programs.
Area of Science:
- Cardiology
- Biomarker Discovery
- Medical Devices
Background:
- Atrial fibrillation (AF) screening is crucial for preventing stroke.
- The AFRICAT study aimed to develop an effective AF screening program.
- Focus on combining blood markers, rhythm detection devices, and long-term monitoring.
Purpose of the Study:
- Validate NT-proBNP as an AF biomarker.
- Identify novel blood biomarkers for AF detection.
- Compare the efficacy of various wearable devices and Holter monitoring for AF detection.
Main Methods:
- Prospective cohort study of 359 hypertensive and diabetic patients aged 65-75.
- AF diagnosis via ECG, 4-week Holter monitoring, and medical history.
- Aptamer array analysis of 1310 proteins in 26 patients; testing of AliveCor, Watch BP, MyDiagnostick, and Fibricheck devices.
Main Results:
- AF prevalence was 9.47% (34/359 subjects).
- NT-proBNP was the only independent biomarker for AF detection (OR=1.934, p<0.001).
- WatchBP demonstrated highest sensitivity (84.6%) and AUC (0.895); MyDiagnostick showed highest specificity (97.1%).
Conclusions:
- Community AF screening is feasible using rhythm detection devices and short monitoring periods.
- High NT-proBNP levels identify high-risk patients suitable for screening.
- The study provides valuable insights for implementing AF screening strategies.
Background And Objective:
AFRICAT is a prospective cohort study intending to develop an atrial fibrillation (AF) screening program through the combination of blood markers, rhythm detection devices, and long-term monitoring in our community. In particular, we aimed to validate the use of NT-proBNP, and identify new blood biomarkers associated with AF. Also, we aimed to compare AF detection using various wearables and long-term Holter monitoring.
Methods:
359 subjects aged 65-75 years with hypertension and diabetes were included in two phases: Phase I (n = 100) and Phase II (n = 259). AF diagnosis was performed by baseline 12-lead ECG, 4 weeks of Holter monitoring (NuuboTM), and/or medical history. An aptamer array including 1310 proteins was measured in the blood of 26 patients. Candidates were selected according to p-value, logFC and biological function to be tested in verification and validation phases. Several screening devices were tested and compared: AliveCor, Watch BP, MyDiagnostick and Fibricheck.
Results:
AF was present in 34 subjects (9.47%). The aptamer array revealed 41 proteins with differential expression in AF individuals. TIMP-2 and ST-2 were the most promising candidates in the verification analysis, but none of them was further validated. NT-proBNP (log-transformed) (OR = 1.934; p<0.001) was the only independent biomarker to detect AF in the whole cohort. Compared to an ECG, WatchBP had the highest sensitivity (84.6%) and AUC (0.895 [0.780-1]), while MyDiagnostick showed the highest specificity (97.10%).
Conclusion:
The inclusion and monitoring of a cohort of primary care patients for AF detection, together with the testing of biomarkers and screening devices provided useful lessons about AF screening in our community. An AF screening strategy using rhythm detection devices and short monitoring periods among high-risk patients with high NT-proBNP levels could be feasible.
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