title: Stepwise mass screening for atrial fibrillation using N-terminal pro b-type natriuretic peptide: the STROKESTOP II study design.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is the most prevalent clinical arrhythmia and a major risk factor for ischaemic stroke. Treatment with oral anticoagulants (OACs) reduces the risk of stroke by two thirds in AF patients with risk factors. Due to its often paroxysmal and asymptomatic presentation, AF is sometimes challenging to diagnose. So far, AF screening studies have applied opportunistic or systematic screening, most often using a single 12-lead electrocardiogram (ECG) recording or ambulatory ECG. We hypothesise that the biomarker N-terminal pro b-type natriuretic peptide (NT-proBNP) is a valuable adjunct in population based AF screening.
  
  
  METHODS
  We are conducting a randomized population-based study on AF screening using ambulatory ECG recording where the decision to use prolonged intermittent ECG recording is directed by NT-proBNP levels, the STROKESTOP II trial. The entire population of inhabitants 75 or 76 years of age (n = 28 712) in the capital region of Sweden will be randomized 1:1 to intervention or control group. In the intervention group NT-proBNP will be analysed in all without previously known AF. Those with NT-proBNP ≤ 125 pg/L will make a single one lead ECG recording, participants with NTproBNP ≥ 125 np/L will be instructed to record ECG for 30 s at least twice daily for 2 weeks with a handheld ambulatory ECG recorder. Participants with newly diagnosed or undertreated AF will be referred to a cardiologist and offered OAC treatment. Primary endpoint is incidence of stroke or systemic embolus, during a 5 year follow-up period in the control group vs the group invited to screening.
authors.affiliation: Department of Clinical Sciences, Karolinska Institute, Cardiology Unit, Danderyd's University Hospital, SE-18288 Stockholm, Sweden.|Department of Medicine, Hallands Hospital Halmstad, SE-30185 Halmstad, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Engdahl
authors.affiliation: Department of Clinical Sciences, Karolinska Institute, Cardiology Unit, Danderyd's University Hospital, SE-18288 Stockholm, Sweden.
authors.forename: Emma
authors.initials: E
authors.lastname: Svennberg
authors.affiliation: Department of Clinical Sciences, Karolinska Institute, Cardiology Unit, Danderyd's University Hospital, SE-18288 Stockholm, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Friberg
authors.affiliation: Department of Clinical Sciences, Karolinska Institute, Cardiology Unit, Danderyd's University Hospital, SE-18288 Stockholm, Sweden.|Stockholm Heart Center, Kungsgatan 34, SE-11135 Stockholm, Sweden.
authors.forename: Faris
authors.initials: F
authors.lastname: Al-Khalili
authors.affiliation: Department of Clinical Sciences, Karolinska Institute, Cardiology Unit, Danderyd's University Hospital, SE-18288 Stockholm, Sweden.
authors.forename: Viveka
authors.initials: V
authors.lastname: Frykman
authors.affiliation: Department of Clinical Sciences, Karolinska Institute, Cardiology Unit, Danderyd's University Hospital, SE-18288 Stockholm, Sweden.
authors.forename: Katrin
authors.initials: K
authors.lastname: Kemp Gudmundsdottir
authors.affiliation: Department of Clinical Sciences, Karolinska Institute, Cardiology Unit, Danderyd's University Hospital, SE-18288 Stockholm, Sweden.
authors.forename: Tove
authors.initials: T
authors.lastname: Fredriksson
authors.affiliation: Department of Clinical Sciences, Karolinska Institute, Cardiology Unit, Danderyd's University Hospital, SE-18288 Stockholm, Sweden.
authors.forename: Mårten
authors.initials: M
authors.lastname: Rosenqvist
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D015415:Biomarkers; D002985:Clinical Protocols; D015716:Electrocardiography, Ambulatory; D004617:Embolism / Q000517:prevention & control; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018579:Patient Selection; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012107:Research Design; D020521:Stroke / Q000517:prevention & control; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Atrial fibrillation; Biomarker; NT-proBNP; Natriuretic peptides; Oral anticoagulants; Prevention; Screening; Stroke