Risk of Atrial Fibrillation, Ischemic Stroke and Cognitive Impairment : Study of a Population Cohort ≥65 Years of Age

To evaluate a model for calculating the risk of AF and its relationship with the incidence of ischemic stroke and prevalence of cognitive decline. It was a multicenter, observational, retrospective, community-based study of a cohort of general population ≥6ct 35 years, between 01/01/2016 and 31/12/2018. Setting: Primary Care. Participants: 46,706 people ≥65 years with an active medical history in any of the primary care teams of the territory, information accessible through shared history and without previous known AF. Interventions: The model to stratify the risk of AF (PI) has been previously published and included the variables sex, age, mean heart rate, mean weight and CHA2DS2VASc score. Main measurements: For each risk group, the incidence density/1000 person/years of AF and stroke, number of cases required to detect a new AF, the prevalence of cognitive decline, Kendall correlation, and ROC curve were calculated. The prognostic index was obtained in 37,731 cases (80.8%) from lowest (Q1) to highest risk (Q4). A total of 1244 new AFs and 234 stroke episodes were diagnosed. Q3-4 included 53.8% of all AF and 69.5% of strokes in men; 84.2% of all AF and 85.4% of strokes in women; and 77.4% of cases of cognitive impairment. There was a significant linear correlation between the risk-AF score and the Rankin score (p < 0.001), the Pfeiffer score (p < 0.001), but not NIHSS score (p 0.150). The overall NNS was 1/19. Risk stratification allows identifying high-risk individuals in whom to intervene on modifiable risk factors, prioritizing the diagnosis of AF and investigating cognitive statu

Evidence Gaps and Lessons in the Early Detection of Atrial Fibrillation: A Prospective Study in a Primary Care Setting (PREFATE Study)

Arrhythmias; Atrial fibrillation; Cardiac/diagnosis; Heart rate determination; Echocardiography/Statistics and numerical data; Electrocardiography; ambulatory/standards; Diagnostic techniques and procedures; Clinical risk scores; Device detected atrial fibrillation; Ischemic strokeArritmias; Fibrilación auricular; Cardíaco/diagnóstico; Determinación de la frecuencia cardíaca; Ecocardiografía/Estadísticas y datos numéricos; Electrocardiografía; ambulatoria/estándares; Técnicas y procedimientos diagnósticos; Puntuaciones de riesgo clínico; Fibrilación auricular detectada por dispositivo; Ictus isquémicoArrítmies; Fibril·lació auricular; Determinació de la freqüència cardíacaBackground/Objectives: In Europe, the prevalence of AF is expected to increase 2.5-fold over the next 50 years with a lifetime risk of 1 in 3-5 individuals after the age of 55 years and a 34% rise in AF-related strokes. The PREFATE project investigates evidence gaps in the early detection of atrial fibrillation in high-risk populations within primary care. This study aims to estimate the prevalence of device-detected atrial fibrillation (DDAF) and assess the feasibility and impact of systematic screening in routine primary care. Methods: The prospective cohort study (NCT05772806) included 149 patients aged 65-85 years, identified as high-risk for AF. Participants underwent 14 days of cardiac rhythm monitoring using the Fibricheck® app (CE certificate number BE16/819942412), alongside evaluations with standard ECG and transthoracic echocardiography. The primary endpoint was a new AF diagnosis confirmed by ECG or Holter monitoring. Statistical analyses examined relationships between AF and clinical, echocardiographic, and biomarker variables. Results: A total of 18 cases (12.08%) were identified as positive for possible DDAF using FibriCheck® and 13 new cases of AF were diagnosed during follow-up, with a 71.4-fold higher probability of confirming AF in FibriCheck®-positive individuals than in FibriCheck®-negative individuals, resulting in a post-test odds of 87.7%. Significant echocardiographic markers of AF included reduced left atrial strain (<26%) and left atrial ejection fraction (<50%). MVP ECG risk scores ≥ 4 strongly predicted new AF diagnoses. However, inconsistencies in monitoring outcomes and limitations in current guidelines, particularly regarding AF burden, were observed. Conclusions: The study underscores the feasibility and utility of AF screening in primary care but identifies critical gaps in diagnostic criteria, anticoagulation thresholds, and guideline recommendations.This research was funded by the Department of Health of the Generalitat of Catalonia in its Strategic Plan in Research and Innovation in Health (PERIS), on the 2021 call (expedient file SLT/21/000027)

Blood-biomarkers and devices for atrial fibrillation screening : Lessons learned from the AFRICAT (Atrial Fibrillation Research In CATalonia) study

AFRICAT is a prospective cohort study intending to develop an atrial fibrillation (AF) screening program through the combination of blood markers, rhythm detection devices, and long-term monitoring in our community. In particular, we aimed to validate the use of NT-proBNP, and identify new blood biomarkers associated with AF. Also, we aimed to compare AF detection using various wearables and long-term Holter monitoring. 359 subjects aged 65-75 years with hypertension and diabetes were included in two phases: Phase I (n = 100) and Phase II (n = 259). AF diagnosis was performed by baseline 12-lead ECG, 4 weeks of Holter monitoring (Nuubo TM), and/or medical history. An aptamer array including 1310 proteins was measured in the blood of 26 patients. Candidates were selected according to p-value, logFC and biological function to be tested in verification and validation phases. Several screening devices were tested and compared: AliveCor, Watch BP, MyDiagnostick and Fibricheck. AF was present in 34 subjects (9.47%). The aptamer array revealed 41 proteins with differential expression in AF individuals. TIMP-2 and ST-2 were the most promising candidates in the verification analysis, but none of them was further validated. NT-proBNP (log-transformed) (OR = 1.934; p<0.001) was the only independent biomarker to detect AF in the whole cohort. Compared to an ECG, WatchBP had the highest sensitivity (84.6%) and AUC (0.895 [0.780-1]), while MyDiagnostick showed the highest specificity (97.10%). The inclusion and monitoring of a cohort of primary care patients for AF detection, together with the testing of biomarkers and screening devices provided useful lessons about AF screening in our community. An AF screening strategy using rhythm detection devices and short monitoring periods among high-risk patients with high NT-proBNP levels could be feasible

MVP Risk score y nuevo diagnóstico de fibrilación auricular: estudio de cohorte prospectivo PREFATE

Fibrilación auricular; MVP risk score; Bloqueo interauricular avanzadoAtrial fibrillation; MVP risk score; Advanced interatrial blockFibril·lació auricular; MVP risk score; Bloqueig interauricular avançatObjetivo: Describir la asociación entre patrones de electrocardiograma (ECG) según MVP risk score (Morphology-Voltage-P-wave duration) y un diagnóstico de fibrilación auricular (FA). Diseno: Estudio de cohorte prospectivo (1/01/2023-31/12/2024). Emplazamiento: Centros de atención primaria. Participantes: Muestra aleatorizada de 150 pacientes entre 65 y 85 anos; ˜ sin diagnóstico previo de FA, ni ictus, ni tratamiento anticoagulante actual; alto riesgo de una futura FA; CHA2DS2-VASc ≥ 2; y capacidad para utilizar la aplicación (App) FibricheckR. Mediciones: A la inclusión, se realizó un ECG basal estándar, puntuación en MVP risk score y monitorización del ritmo cardíaco basal durante 15 días utilizando la App FibricheckR. Las variables dependientes fueron la presencia de patrones de la onda P en el ECG según MVP risk score y un nuevo diagnóstico de FA. Resultados: El diagnóstico de FA fue confirmado en 14 casos (9,3%, IC95% 5,6-15,1), 3 hombres y 11 mujeres. En 3 casos, la arritmia fue diagnosticada en el ECG basal, y en 11 por Holter después de ser informadas como posible FA por FibricheckR App. Se detectó una prevalencia superior de bloqueo interauricular avanzado (BIA-A) atípico (p = 0,007) entre los participantes con FA, así como la prevalencia de onda P < 0,1 mV (p = 0,006). Todos los nuevos diagnósticos de FA se realizaron en puntuaciones ≥4 en el MVP risk score.El presente trabajo ha sido financiado por la beca PERIS 2022 4R22/031 (SLT021/21/000027)

N-Terminal Pro B-Type Natriuretic Peptide's Usefulness for Paroxysmal Atrial Fibrillation Detection Among Populations Carrying Cardiovascular Risk Factors

Copyright © 2019 Palà, Bustamante, Clúa-Espuny, Acosta, Gonzalez-Loyola, Ballesta-Ors, Gill, Caballero, Pagola, Pedrote, Muñoz and Montaner[Background]: Atrial fibrillation (AF) systematic screening studies have not shown a clear usefulness in stroke prevention, as AF might present as paroxysmal and asymptomatic. This study aims to determine the usefulness of some blood-biomarkers to identify paroxysmal atrial fibrillation in the context of a screening programme.[Methods]: A total of 100 subjects aged 65–75 years with hypertension and diabetes were randomly selected. AF was assessed by conventional electrocardiogram (ECG) and 4 weeks monitoring with a wearable Holter device (Nuubo™). N-terminal pro B-type natriuretic peptide (NT-proBNP), apolipoprotein CIII (ApoC-III), von Willebrand factor (vWF), ADAMTS13, urokinase plasminogen activator surface receptor (uPAR), and urokinase plasminogen activator (uPA) were determined in serum/plasma samples and the levels were compared depending on AF presence and mode of detection.[Results]: The AF prevalence in the studied population was found to be 20%. In seven subjects, AF was only detected after 1 month of Holter monitoring (hAF group). NT-proBNP levels were higher in subjects with AF compared with subjects with no AF (p 95 pg/ml cut-off showed high sensitivity and specificity to detect AF (95%, 66.2%) or hAF (85.72%, 66.2%) and was found to be an independent predictor of AF and hAF in a logistic regression analysis. NT-proBNP correlated with AF burden (r = 0.597, p = 0.024).[Conclusion]: NT-proBNP was elevated in AF cases not identified by ECG; thus, it may be used as a screening biomarker in asymptomatic high-risk populations, with a promising cut-off point of 95 pg/ml that requires further validation.The study received a research grant by Fundació Marató de TV3 in the research call La Marató 2014: malalties del cor. Grant number: 201528-30-31-3. AB was supported by a Juan Rodés research contract (JR16/00008) from Instituto de Salud Carlos III. EP has received a predoctoral grant from Vall D’Hebron Institute of Research