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Active screening for AF improves clinical outcomes

Presented by
Dr Steven Steinhubl, Scripps Research Translational Institute, USA
AHA 2020

The 3-year outcomes of the mHealth Screening to Prevent Strokes (mSToPS) trial demonstrated that active screening for atrial fibrillation (AF) by means of an ECG patch was associated with a significant improvement in clinical outcomes compared with standard-of-care controls, including a decrease in stroke and mortality risks [1].

AF is not only an independent risk factor for stroke but also for heart failure and cardiovascular mortality. Since AF is often not recognised until a serious clinical event occurs, earlier screening might result in better patient outcomes, Dr Steven Steinhubl (Scripps Research Translational Institute, USA) explained. The main objective of mSToPS (NCT02506244) was to determine if screening for AF by wearing a self-applied ECG patch can improve clinical outcomes at 3 years after the initiation of screening. The primary efficacy outcome was time to first event of the combined endpoint of death, stroke, systemic embolism, or myocardial infarction.

The analysis included 1,718 participants randomised to active monitoring (1,366 to immediate monitoring and 1,293 to delayed monitoring) and 3,371 matched observational controls. Mean age was 74 years and 41% were women. Median CHA2DS2-VASc score was 3. AF was newly diagnosed in 11.4% (n=196) of actively monitored participants versus 7.7% (n=261) in observational controls (P<0.01). In the actively monitored cohort, 32% of new diagnoses were made by the patch. The rate of initiation of anticoagulation in the experimental and control groups was similarly low: 45.2% versus 44.0% (P=0.84). The time to first event of the combined primary endpoint was lower in the monitored group: 4.5 versus 5.5 per 100 person-years (HR 0.79; P<0.01). In the subset of patients diagnosed with AF, this difference was more substantial: 8.4 versus 13.8 (HR 0.53; P<0.01), driven mainly by an advantage among patients diagnosed via the patch. The rate of hospitalisation for bleeding was lower in the monitored group: 0.32 versus 0.71 (adjusted IRR 0.47; 95% CI 0.26–0.85; P=0.01). “Independent replication of these findings is required,” Dr Steinhubl concluded, “in order to be confident that aggressive pursuit of diagnosing AF is warranted in people at high-risk but without symptoms.”

    1. Steinhubl SR, et al. 3-year Clinical Outcomes in a Nationwide, Randomized, Pragmatic Clinical Trial of Atrial Fibrillation Screening - Mhealth Screening to Prevent Strokes (mSToPS). LBS.06, AHA Scientific Sessions 2020, 13–17 Nov.


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