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Digital recruitment and compliance to treatment recommendations in the Norwegian Atrial Fibrillation self-screening
Edvard Liljedahl Sandberg1,2, Sigrun Halvorsen2,3, Trygve Berge2,4
1Department of Cardiology, Sorlandet Hospital, Arendal, Sykehusveien 1, 4838 Arendal, Norway.
Insights
Digital screening for atrial fibrillation (AF) is feasible, with high follow-up rates for anticoagulation therapy. However, this method may introduce selection bias, necessitating further research into its efficacy and cost-effectiveness.
Area of Science:
- Cardiology
- Digital Health
- Public Health Screening
Background:
- Atrial fibrillation (AF) is a common condition often diagnosed late, increasing stroke risk.
- Current guidelines advocate for screening high-risk individuals for AF.
- The Norwegian Atrial Fibrillation self-screening pilot study aimed to assess digital recruitment and follow-up.
Purpose of the Study:
- To evaluate the digital recruitment process for atrial fibrillation screening.
- To assess compliance with follow-up recommendations in participants with screen-detected AF.
- To determine the feasibility of a digital approach to AF screening.
Main Methods:
- Recruitment of Norwegians aged 65+ via digital platforms (Facebook, web) and newspapers.
- Digital consent and electrocardiogram (ECG) self-screening for AF.
- Tracking of participant follow-up, including general practitioner consultations and initiation of anticoagulation therapy.
Main Results:
- Facebook ads reached over 84,000 users, with 2,118 participants providing digital consent.
- The mean participant age was 70 years, with 74% being women.
- AF was detected in 2.2% of participants; 95% consulted a doctor, and 83% initiated anticoagulation therapy.
Conclusions:
- Digital recruitment and AF screening are feasible, leading to high rates of anticoagulation initiation.
- Potential selection bias in age and gender exists with digital recruitment methods.
- Larger studies are required to establish the efficacy and cost-effectiveness of fully digital AF screening programs.
Aims:
Atrial fibrillation (AF) is prevalent, undiagnosed in approximately one-third of cases, and is associated with severe complications. Guidelines recommend screening individuals at increased risk of stroke. This report evaluated the digital recruitment procedure and compliance with the follow-up recommendations in participants with screen-detected AF in the Norwegian Atrial Fibrillation self-screening pilot study.
Methods And Results:
Norwegians ≥65 years were invited through Facebooks posts, web pages, and newspapers to participate in the study. Targeted Facebook posts promoted over 11 days reached 84 208 users and 10 582 visitors to the study homepage. This accounted for 51% of the total homepage visitors (n = 20 704). A total of 2118 (10%) of the homepage visitors provided digital consent to participate after they met the inclusion criteria. The mean (standard deviation) age of the participants was 70 (4) years, and the majority [n = 1569 (74%)] were women. A total of 1849 (87%) participants completed the electrocardiogram self-screening test, identifying AF in 41 (2.2%) individuals. Of these, 39 (95%) participants consulted a general practitioner, and 34 (83%) participants initiated anticoagulation therapy.
Conclusion:
Digital recruitment and inclusion in digital AF screening with a high rate of initiation of anticoagulation therapy in AF positive screening cases are feasible. However, digital recruitment and inclusion may introduce selection bias with regard to age and gender. Larger studies are needed to determine the efficacy and cost-effectiveness of a fully digital AF screening.
Trial Registration:
Clinical trials: NCT04700865.
