Mass Screening for Untreated Atrial Fibrillation: The STROKESTOP Study
Abstract
BACKGROUND: The aims of the present study were to define the prevalence of untreated atrial fibrillation (AF) in a systematic screening program using intermittent ECG recordings among 75- to 76-year-old individuals and to study the feasibility of initiating protective oral anticoagulant (OAC) treatment. METHODS AND RESULTS: Half of the 75- to 76-year-old population in 2 Swedish regions were invited to a screening program for AF. Participants without a previous diagnosis of AF underwent intermittent ECG recordings over 2 weeks. If AF was detected, participants were offered OAC. During the 28-month inclusion period, 13 331 inhabitants were invited. Of these, 7173 (53.8%) participated. Of the participants, 218 (3.0%; 95% confidence interval [CI], 2.7-3.5) were found to have previously unknown AF, and of these, AF was found in 37 (0.5% of the screened population) on their first ECG. The use of intermittent ECGs increased new AF detection 4-fold. A previous diagnosis of AF was known in 9.3% (n=666; 95% CI, 8.6-10.0). Total AF prevalence in the screened population was 12.3%. Of participants with known AF, 149 (2.1%; 95% CI, 1.8-2.4) had no OAC treatment. In total, 5.1% (95% CI, 4.6-5.7) of the screened population had untreated AF; screening resulted in initiation of OAC treatment in 3.7% (95% CI, 3.3-4.2) of the screened population. More than 90% of the participants with previously undiagnosed AF accepted initiation of OAC treatment. CONCLUSIONS: Mass screening for AF in a 75- to 76-year-old population identifies a significant proportion of participants with untreated AF. Initiation of stroke prophylactic treatment was highly successful in individuals with newly diagnosed AF. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01593553.
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Clinical trials to determine any benefit for opportunistically detected AF have not yet been completed but are underway.
“clinical trials to determine any benefit for opportunistically detected AF have not yet been completed but are underway (Gudmundsdottir 2020, Steinhubl 2018, Svennberg 2015; Heartline Study: www.heartline.com).”
From 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society (2021) · cites this paper as Svennberg 2015
By focusing on older patients (75-76 years of age) at greater risk, Swedish studies identified new AF in 3% of study participants and up to 7.4% when additional risk factors beyond age were required.
“By focusing on older patients (75–76 years of age) at greater risk, Swedish studies identified new AF in 3% of study participants and up to 7.4% when additional risk factors beyond age were required (Engdahl 2013, Gudmundsdottir 2019, Svennberg 2015).29–31”
From 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society (2021) · cites this paper as Svennberg 2015
Patient-operated ECG devices, smartphones, and other technologies may be very useful to detect silent, undiagnosed AF.
“These may be very useful to detect silent, undiagnosed AF.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [157]
Technological advances allow screening for an irregular pulse using patient-operated ECG devices, smartphones, and a variety of other technologies.
“Technological advances allow screening for an irregular pulse using patient-operated ECG devices, smartphones, and a variety of other technologies.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [157]
The overall prevalence of AF varies by ancestry.
“The overall prevalence of AF varies by ancestry; prevalence studies of Asian populations have been less consistent than those of North American and European poulations.”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [20]
In two large cross-sectional studies of Chinese cohorts, age-adjusted prevalence of AF was similar in women and men.
“Two large cross-sectional studies of Chinese cohorts reported that age-adjusted prevalence of AF was similar in women and men (0.76% versus 0.78% and 0.63% versus 0.66%),20,21”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [20]
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- Authors
- Svennberg, E., Engdahl, J., Al-Khalili, F., Friberg, L., Frykman, V., & Rosenqvist, M.
- Affiliations
- Danderyds sjukhus (SE)
- From Karolinska Institutet, Department of Clinical Sciences, Cardiology Unit, Danderyd’s University Hospital, Stockholm, Sweden (E.S., F.A.-K., L.F., V.F., M.R.); Department of Medicine, Halland’s Hospital, Halmstad, Sweden (J.E.); and Stockholm Heart Center, Sweden (F.A.-K.).
- Venue
- Circulation
- Published
- 2015-06
- Volume
- 131
- Issue
- 25
- Pages
- 2176-2184
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2020682484
- Cited by
- 605
- References
- 57
- Citations by year
- 2026: 35 · 2025: 29 · 2024: 42 · 2023: 47 · 2022: 55 · 2021: 97 · 2020: 68 · 2019: 63 · 2018: 61 · 2017: 50 · 2016: 51 · 2015: 7
- FWCI
- 40.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, mass screening, oral anticoagulation, stroke prevention, prevalence, older adults, newly diagnosed atrial fibrillation, treatment initiation
- MeSH terms
- Aged, Atrial Fibrillation, Electrocardiography, Female, Humans, Male, Mass Screening, Prospective Studies, Risk Factors, Sweden, Stroke
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