Population screening of 75- and 76-year-old men and women for silent atrial fibrillation (STROKESTOP)
Open accessAbstract
Atrial fibrillation (AF) is important because it is common and is a major cause of stroke unless treated with oral anticoagulant. The prevalence of AF increases with age as does the risk of stroke. At 75 years the risk from age alone is so high that current guidelines recommend anticoagulation even in the absence of other risk factors. Atrial fibrillation is often asymptomatic and only discovered by chance or when a stroke already has occurred. We have launched a major screening study for silent AF in which 25,000 Swedes aged 75 and 76 years are randomized to either participate in a screening programme using ambulant intermittent electrocardiogram (ECG) recording to detect silent AF, or act as a control group. Patients in whom AF is detected are offered cardiological examination and anticoagulant treatment according to current guidelines. The cohort and the controls will be followed prospectively for 5 years after the inclusion of the first participant. An interim analysis will be made after 3 years. Our hypothesis is that screening for AF will reduce stroke incidence in the screened population, and that this screening will prove to be cost effective. Secondary endpoints are: any thromboembolic event, intracranial bleeding, other major bleeding, first ever diagnosis of dementia, death from any cause, and a composite of these endpoints.
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There is good evidence that prolonged ECG monitoring enhances the detection of undiagnosed AF, for 72 hours after a stroke, for even longer periods, or by daily short-term ECG recording in patients over 75 years of age.
“There is good evidence that prolonged ECG monitoring enhances the detection of undiagnosed AF, for 72 hours after a stroke, 27,127 for even longer periods, 18,128 or by daily short-term ECG recording in patients over 75 years of age 129 (Web Addenda Figure 1).”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [129]
The true prevalence of AF is likely substantially higher than the estimated prevalence because many individuals remain undiagnosed.
“The true prevalence is likely to be substantially higher given that many individuals remain undiagnosed.2”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [2]
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Self-citation
- Authors
- Friberg, L., Engdahl, J., Frykman, V., Svennberg, E., Levin, L.-Å., & Rosenqvist, M.
- Affiliations
- Danderyds sjukhus (SE)
- Hallands sjukhus Halmstad (SE)
- Linköping University (SE)
- Karolinska Institutet (SE)
- Corresponding author
- Friberg, Leif
- Venue
- EP Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-07-11
- Volume
- 15
- Issue
- 1
- Pages
- 135-140
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2019334626
- Cited by
- 100
- References
- 44
- Citations by year
- 2025: 3 · 2024: 6 · 2023: 4 · 2022: 5 · 2021: 6 · 2020: 4 · 2019: 8 · 2018: 11 · 2017: 9 · 2016: 13 · 2015: 14 · 2014: 9 · 2013: 4 · 2012: 3
- FWCI
- 6.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Stockholms Läns Landsting
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- silent atrial fibrillation, atrial fibrillation screening, stroke prevention, oral anticoagulation, older adults, thromboembolic events, intracranial hemorrhage, dementia, cost-effectiveness
- MeSH terms
- Aged, Atrial Fibrillation, Electrocardiography, Female, Humans, Male, Mass Screening, Registries, Risk Factors, Sweden, Comorbidity, Incidence, Stroke, Early Diagnosis
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