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STROKESTOP: Benefits of systematic screening for atrial fibrillation

Presented by
Dr Emma Svennberg, Karolinska Institute, Danderyd Hospital, Sweden
Conference
EHRA 2021
Trial
STROKESTOP
Results from a systematic atrial fibrillation screening study including almost 28,000 elderly individuals showed that population-based screening for atrial fibrillation (AF) reduced the risk of ischaemic and haemorrhagic stroke, systemic embolism, and death, leading to a significant net clinical benefit.

Patients with AF have a 5-fold increased risk of ischaemic stroke and 10% of stroke patients have undetected atrial fibrillation, leading to a 1.5-3-fold increased risk of death. The risk of ischaemic stroke and death can be reduced when AF is diagnosed and patients receive treatment with oral anticoagulants.

The aim of the STROKESTOP study (NCT01593553) was to evaluate whether early detection and treatment of AF can reduce the risk of ischaemic stroke and death without an excess risk of bleeding. All residents aged 75 and 76 years in two Swedish regions were identified and randomised 1:1 into a screening (n=13,979) and a control group (n=13,996). The follow-up period was 5 years and the combined primary endpoint was ischaemic stroke or systemic thromboembolism, all-cause mortality, and severe bleeding. Subjects invited for screening were initially examined via single-lead ECG and followed up systematically.

Results showed a small but statistically significant favourable outcome in the screening arm. Evaluation of the pre-defined secondary endpoint, the as-treated analysis, showed a significantly better outcome than controls or non-participants. However, the participants were overall healthier than non-participants and so this result has to be viewed with caution.

Dr Emma Svennberg (Karolinska Institute, Danderyd Hospital, Sweden) concluded that population-based screening for AF provided a net clinical benefit in an elderly population.


    1. Svennberg E. Benefits of systematic screening for atrial fibrillation - the STROKESTOP-study. 2021 EHRA Congress, 23-25 April.




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