Adherence to a handheld device-based atrial fibrillation screening protocol is associated with clinical outcomes

van der Velden, RMJ; Bonander, C; Crijns, HJGM; Kemp-Gudmundsdottir, K; Engdahl, J; Linz, D; Svennberg, E

doi:10.1136/heartjnl-2023-323522

Adherence to a handheld device-based atrial fibrillation screening protocol is associated with clinical outcomes

HeartPublished 5 Jan 2024Secondary analysis of the STROKESTOP and STROKESTOP II atrial fibrillation (AF) screening studies

Primary result · Composite primary endpoint, low vs optimal adherence and adherence consistency (STROKESTOP)ResultHazard ratio 1.30 CI 1.11–1.51

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Authors' conclusion

Low adherence and adherence consistency were associated with a higher risk of adverse outcomes.

Study context

Population: 75- and 76-year-old inhabitants of up to two Swedish regions invited to systematic AF screening (2012 and 2016)
Participants: 6,436 vs 3,712

Comparison: Low vs optimal adherence to handheld ECG screening protocol
STROKESTOPn = 6,436
STROKESTOP IIn = 3,712
Primary endpoint: Composite of:
Adverse cerebral
CV outcomes
by adherence and adherence consistency

Methodological detailssystematic population screening, 2 Swedish regions

Systematic population screening
2 Swedish regions

Primary result

As reported in the abstract

Composite primary endpoint, low vs optimal adherence and adherence consistency (STROKESTOP)

Hazard ratio

1.30

CI 1.11–1.51

P = 0.001

Lowvs optimal adherence to handheld ECG screening protocol

HR 1.30 (CI 1.11–1.51); P = 0.001

Further findings

Adherence and adherence consistency · 2 weeks · spread kind not specified in abstract

STROKESTOPmedian 100 %range 92–100

STROKESTOP IImedian 90 %range 75–98

Adherence consistency (median days with complete registrations) STROKESTOP 12 (11-13) days · STROKESTOP II 8 (3-11) days

Stroke, low adherence and adherence consistency (STROKESTOP)

	← Lower ←→ Higher →	HR (CI)	P value
Low adherence and adherence consistency	0.512	1.68 (1.22–2.32)	P = 0.001
	0.512Hazard ratio (log scale)

Outcome	Estimate	P value
Dementia, low adherence and adherence consistency (STROKESTOP)	1.67 (CI 1.27–2.19)	P < 0.001

Factors associated with optimal adherence and adherence consistency

Female sex and lower education associated with optimal adherence and adherence consistency in both studies

Original publication

Adherence to a handheld device-based atrial fibrillation screening protocol is associated with clinical outcomes. Heart. Published 5 January 2024. doi:10.1136/heartjnl-2023-323522

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