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Published on: February 26, 2013
Adherence to a handheld device-based atrial fibrillation screening protocol is associated with clinical outcomes
Rachel M J van der Velden1, Carl Bonander2, Harry J G M Crijns3
1Department of Cardiology, Maastricht University Medical Centre+ and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands rachel.vander.velden@mumc.nl.
Insights
Low adherence to handheld ECG screening for atrial fibrillation (AF) increases risks for stroke and dementia. Ensuring consistent ECG measurements is vital for detecting AF and preventing adverse cardiovascular events.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Atrial fibrillation (AF) screening programs utilize handheld ECG devices to detect the condition.
- Adherence and consistency in device usage are critical for the success of these screening programs.
- Understanding factors influencing adherence and their impact on outcomes is essential for optimizing screening strategies.
Purpose of the Study:
- To assess adherence and consistency to handheld ECG screening protocols in two large-scale AF screening programs.
- To investigate the association between adherence/consistency and adverse cerebral and cardiovascular outcomes.
- To identify demographic factors associated with adherence and consistency.
Main Methods:
- Two systematic AF screening programs (STROKESTOP and STROKESTOP II) involving 75- and 76-year-olds in Sweden.
- Participants performed 30-second ECG measurements twice daily (STROKESTOP) or four times daily (STROKESTOP II) for two weeks.
- Adherence defined as measurements performed/requested; consistency defined as days with complete registrations. Outcomes analyzed using Cox proportional hazards models.
Main Results:
- High participation rates (6436 in STROKESTOP, 3712 in STROKESTOP II).
- Median adherence was 100% in STROKESTOP vs. 90% in STROKESTOP II; consistency was 12 days vs. 8 days, respectively.
- Lower adherence and consistency were linked to increased risks of stroke, dementia, and a composite cardiovascular endpoint, particularly in STROKESTOP.
Conclusions:
- Adherence to twice-daily ECG measurements was superior to four-times-daily measurements.
- Female sex and lower educational attainment correlated with higher adherence and consistency.
- Suboptimal adherence and consistency in AF screening are associated with elevated risks of adverse cerebrovascular and cardiovascular events.
Objective:
To evaluate adherence and adherence consistency to the handheld ECG device-based screening protocol and their association with adverse cerebral and cardiovascular outcomes in two systematic atrial fibrillation (AF) screening programmes.
Methods:
In 2012 (Systematic ECG Screening for Atrial Fibrillation Among 75-Year Old Subjects in the Region of Stockholm and Halland, Sweden (STROKESTOP) study) and 2016 (Stepwise mass screening for atrial fibrillation using N-terminal pro b-type natriuretic peptide (STROKESTOP II) study), half of all 75- and 76-year-old inhabitants of up to two Swedish regions were invited to participate in a systematic AF screening programme. Participants were instructed to perform 30-second measurements twice daily in STROKESTOP and four times daily in STROKESTOP II for 2 weeks. Adherence was defined as the number of measurements performed divided by the number of measurements asked, whereas adherence consistency was defined as the number of days with complete registrations.
Results:
In total, 6436 participants (55.7% female) from STROKESTOP and 3712 (59.8% female) from STROKESTOP II were included. Median adherence and adherence consistency were 100 (92-100)% and 12 (11-13) days in STROKESTOP and 90 (75-98)% and 8 (3-11) days in STROKESTOP II. Female sex and lower education were factors associated with both optimal adherence and adherence consistency in both studies. In STROKESTOP, low adherence and adherence consistency were associated with higher risk of adverse cerebral and cardiovascular outcomes (HR for composite primary endpoint 1.30 (1.11 to 1.51), p=0.001), including stroke (HR 1.68 (1.22 to 2.32), p=0.001) and dementia (1.67 (1.27 to 2.19), p<0.001).
Conclusions:
Adherence to twice daily handheld ECG measurements in STROKESTOP was higher than to four times daily measurements in STROKESTOP II. Female sex and lower educational attainment were associated with ≥100% adherence and adherence consistency. Low adherence and adherence consistency were associated with a higher risk of adverse outcomes.
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