This summary is based on the presentation of Katrin Kemp Gudmundsdottir, MD, PhD (Stockholm, Sweden) at the ESC Congress 2024 - STROKESTOP II - Randomised systematic NT-proBNP and ECG screening for atrial fibrillation among 75 year-olds.
According to the 2024 ESC Guidelines for the management of AF, population-based screening for AF using a prolonged, noninvasive ECG-based approach should be considered in individuals aged ≥75 years and in those aged ≥65 years with additional stroke risk factors. The aim of the current study was to examine whether AF screening using ECG recording in combination with NT-proBNP measurement reduces the incidence of stroke or systemic embolism and what the prognostic value of NT-proBNP measurement in AF screening is.
The STROKESTOP II trial was a multicenter, investigator-initiated, parallel-group, unmasked RCT on a stepwise mass screening program that enrolled all residents aged 75 or 76 years of the Stockholm region in Sweden (n=28,712). They were randomized to receiving an invitation to screening for AF (intervention) or not being invited (control). In the intervention group, NT-proBNP levels were analyzed in participants with no history of AF, after which they were stratified into 2 groups: low risk (NT-proBNP <125 ng/L) and high risk (≥125 ng/L). Low-risk participants made a single one-lead ECG recording themselves using a handheld ambulatory ECG recorder, whereas high-risk participants were instructed to record a 30-s ECG 4 times a day for 2 weeks.
In total, 13,905 people were invited to the AF screening, of whom 6843 (49.2%) accepted the invitation. The control group comprised 13,884 individuals, and 451 people died or emigrated. In the intervention group, 2542 individuals (40.5%) was considered “low risk” based on their NT-proBNP levels, whereas the remaining 3743 (59.5%) were regarded as “high risk.” Median follow-up duration was 5.1 years (IQR: 5.0–5.8). New AF was detected in 165 of the 6843 screened participants (2.4%); they were offered oral anticoagulation treatment. The primary endpoint was a composite outcome of stroke or systemic embolism.
In Stockholm residents aged 75 or 76 years, stepwise mass screening for AF using NT-proBNP measurement in combination with handheld ECG recording did not reduce the incidence of the primary composite endpoint of stroke or systemic embolism compared with no screening during 5-year follow-up. Of note, only 49% of those invited participated in the screening. Low NT-proBNP levels (<125 ng/L) correctly identified individuals at lower risk of a primary endpoint event. Dr. Kemp Gudmundsdottir therefore concluded that “NT-proBNP can be safely used to determine who not to screen for AF.”
- Our reporting is based on the information provided at the ESC Congress 2024 -