title: N-terminal pro B-type natriuretic peptide in systematic screening for atrial fibrillation.
abstract: Screening for atrial fibrillation (AF) in individuals aged 65 and above is recommended by the European Society of Cardiology. Increased levels of the biomarker N-terminal pro B-type natriuretic peptide (NT-proBNP) has in cohort studies been associated with incident AF.The aim of this study was to assess whether NT-proBNP could be useful for AF detection in systematic screening.
  
  
  
  The Strokestop study entailed 7173 Swedish residents aged 75/76 that were screened for AF using twice daily intermittent ECG recordings during 2 weeks. In a substudy of 886 participants, the last 815 consecutive participants and 71 individuals with newly detected AF, levels of NT-proBNP were determined.
  
  
  
  Participants with newly detected AF (n=96) had a median NT-proBNP of 330 ng/L (IQR 121;634). In individuals without AF (n=742), median NT-proBNP was 171 ng/L (IQR 95;283), p<0.001. The CHA2DS2-VASc parameters did not differ significantly between individuals with newly detected AF and without AF nor between newly detected AF in the NT-proBNP cohort compared with the cohort where NT-proBNP was not assessed. Using an NT-proBNP cut-off of ≥125 ng/L in a non-acute setting yielded a negative predictive value of 92%, meaning that 35% fewer participants would need to be screened when applied to systematic AF screening. Adding weight to NT-proBNP further reduced participants needed to be screened with a preserved sensitivity.
  
  
  
  NT-proBNP was increased in individuals with newly detected AF. Prospective studies could clarify if NT-proBNP can be used to correctly select individuals that benefit most from AF screening.
  
  
  
  ClinicalTrials.gov. Identifier: NCT01593553.
authors.affiliation: Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden.
authors.forename: Emma
authors.initials: E
authors.lastname: Svennberg
authors.affiliation: Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Henriksson
authors.affiliation: Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Engdahl
authors.affiliation: Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Hijazi
authors.affiliation: Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden.
authors.forename: Faris
authors.initials: F
authors.lastname: Al-Khalili
authors.affiliation: Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Friberg
authors.affiliation: Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden.
authors.forename: Viveka
authors.initials: V
authors.lastname: Frykman
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Atrial Fibrillation; Epidemiology; Stroke