Randomized Invitation to Systematic NT-proBNP and ECG Screening in 75-Year-Olds to Detect Atrial Fibrillation:...

Area of Science:

• Cardiology
• Public Health
• Clinical Trials

Background:

• Atrial fibrillation screening is recommended for early treatment and to prevent adverse clinical events.
• NT-proBNP (N-terminal pro-B-type natriuretic peptide) may enhance atrial fibrillation screening efficiency.
• Previous studies suggest potential benefits of early atrial fibrillation detection.

Purpose of the Study:

• To evaluate if NT-proBNP-enhanced atrial fibrillation screening reduces stroke or systemic embolism incidence.
• To assess the safety and efficacy of prolonged screening for individuals with elevated NT-proBNP.
• To determine if low NT-proBNP concentrations allow for reduced screening intensity.

Main Methods:

• A randomized controlled trial involving 75- and 76-year-olds in Stockholm, Sweden.
• Participants were randomized to an intervention (screening) or control group.
• NT-proBNP levels guided screening intensity: single ECG for NT-proBNP <125 ng/L, prolonged ECG monitoring for NT-proBNP ≥125 ng/L.

Main Results:

• No significant difference in stroke or systemic embolism incidence between the intervention and control groups after 5.1 years (HR, 0.96).
• The low NT-proBNP group (<125 ng/L) showed a significantly reduced risk of stroke/systemic embolism (HR, 0.59).
• The high NT-proBNP group (≥125 ng/L) had a higher risk of stroke/systemic embolism compared to the low NT-proBNP group (HR, 1.57).

Conclusions:

• NT-proBNP-enhanced screening for atrial fibrillation did not lower the overall risk of stroke or systemic embolism.
• Screening was safe for identifying low-risk individuals with low NT-proBNP concentrations.
• Moderate participation rates were observed in the intervention group.