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Arrhythmias and sudden death
Original research
Adherence to a handheld device-based atrial fibrillation screening protocol is associated with clinical outcomes
  1. Rachel M J van der Velden1,
  2. Carl Bonander2,
  3. Harry J G M Crijns1,
  4. Katrin Kemp-Gudmundsdottir3,
  5. Johan Engdahl3,
  6. Dominik Linz1,4,5,
  7. Emma Svennberg6
  1. 1 Department of Cardiology, Maastricht University Medical Centre+ and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
  2. 2 School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
  3. 3 Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
  4. 4 Department of Biomedical Sciences, University of Copenhagen, Kobenhavn, Denmark
  5. 5 Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
  6. 6 Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Rachel M J van der Velden, Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands; rachel.vander.velden{at}mumc.nl

Abstract

Objective To evaluate adherence and adherence consistency to the handheld ECG device-based screening protocol and their association with adverse cerebral and cardiovascular outcomes in two systematic atrial fibrillation (AF) screening programmes.

Methods In 2012 (Systematic ECG Screening for Atrial Fibrillation Among 75-Year Old Subjects in the Region of Stockholm and Halland, Sweden (STROKESTOP) study) and 2016 (Stepwise mass screening for atrial fibrillation using N-terminal pro b-type natriuretic peptide (STROKESTOP II) study), half of all 75- and 76-year-old inhabitants of up to two Swedish regions were invited to participate in a systematic AF screening programme. Participants were instructed to perform 30-second measurements twice daily in STROKESTOP and four times daily in STROKESTOP II for 2 weeks. Adherence was defined as the number of measurements performed divided by the number of measurements asked, whereas adherence consistency was defined as the number of days with complete registrations.

Results In total, 6436 participants (55.7% female) from STROKESTOP and 3712 (59.8% female) from STROKESTOP II were included. Median adherence and adherence consistency were 100 (92–100)% and 12 (11–13) days in STROKESTOP and 90 (75–98)% and 8 (3–11) days in STROKESTOP II. Female sex and lower education were factors associated with both optimal adherence and adherence consistency in both studies. In STROKESTOP, low adherence and adherence consistency were associated with higher risk of adverse cerebral and cardiovascular outcomes (HR for composite primary endpoint 1.30 (1.11 to 1.51), p=0.001), including stroke (HR 1.68 (1.22 to 2.32), p=0.001) and dementia (1.67 (1.27 to 2.19), p<0.001).

Conclusions Adherence to twice daily handheld ECG measurements in STROKESTOP was higher than to four times daily measurements in STROKESTOP II. Female sex and lower educational attainment were associated with ≥100% adherence and adherence consistency. Low adherence and adherence consistency were associated with a higher risk of adverse outcomes.

  • Atrial Fibrillation

Data availability statement

Data are available upon reasonable request. The data underlying this article cannot be shared publicly in order to safeguard the privacy of individuals who participated in the study. Data are available on reasonable request to emma.svennberg@regionstockholm.se.

https://doi.org/10.1136/heartjnl-2023-323522

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    Data availability statement

    Data are available upon reasonable request. The data underlying this article cannot be shared publicly in order to safeguard the privacy of individuals who participated in the study. Data are available on reasonable request to emma.svennberg@regionstockholm.se.

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    Footnotes

    • X @harry_crijns

    • Contributors KK-G, JE and ES were involved in the design and/or conduct of the main study. DL, ES and RMJvdV were involved in drafting the research question for this subanalysis. RMJvdV and CB analysed the data. RMJvdV wrote the manuscript with support from HJGMC, DL and ES. All authors provided critical feedback with regard to the research, analysis and manuscript. RMJvdV acts as guarantor for this publication.

    • Funding The STROKESTOP study was supported by Stockholm County Council, the Swedish Heart & Lung Foundation, King Gustaf V and Queen Victoria’s Freemasons Foundation, the Klebergska Foundation, the Tornspiran Foundation, the Scientific Council of Halland Region, the Southern Regional Healthcare Committee, the Swedish Stroke Fund, Carl Bennet AB, Boehringer Ingelheim, Bayer and Bristol Myers Squibb–Pfizer. The STROKESTOP II study was supported by Roche Diagnostics, Carl Bennet AB, the Swedish Heart and Lung Foundation, the Stockholm County Council and the Swedish Order of St John.

    • Competing interests JE has received personal fees from Bristol Myers Squibb, Pfizer, Boehringer Ingelheim, Merck Sharp & Dohme, BioTel Sweden and Medtronic outside the submitted work. ES has received personal fees from Bayer, Bristol Myers Squibb–Pfizer, Boehringer Ingelheim, Johnson & Johnson, Merck Sharp & Dohme, and Sanofi Aventis outside the submitted work. The other authors have nothing to disclose.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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