Could screening for atrial fibrillation help prevent strokes?

Researchers from the University of Cambridge, leading a consortium of academic partners, are beginning work this month in East Anglia on the largest trial to date of screening for atrial fibrillation.

Atrial fibrillation (AF) is a heart condition that causes an irregular heartbeat. It affects up to 1 in 10 people over the age of 65 but does not necessarily cause symptoms. Having AF increases the risk of having a stroke 5-fold and is associated with heart attacks and premature death from other causes. Many people who have AF are not aware they have it. In fact, 10% of strokes occur in people unaware they have AF. However, treatment with medication can significantly lower the risk of stroke as well as lowering the risk of having a heart attack.

The researchers aim to discover if the number of strokes will be reduced when GP surgeries screen for AF in people aged 65 and over and then treat those who have it. They will also work out whether the screening is good value for money for the NHS. The results will help the NHS decide whether to start a national screening programme for AF.

Ultimately 120,000 patients aged 65 and over in 300 general practices across England will take part in the research, which will be the largest ever randomised controlled trial (RCT) of screening for AF.

Practices taking part in the research will be randomly assigned to either 'screening' or 'non-screening'. Patients aged 65 and over in the screening practices will be invited to join the trial and to be screened for AF. Researchers will then be able to compare the health of the patients in the 'screening' practices with that of patients in the 'non-screening' practices. Over the following five years they will measure whether the screening and the treatment that is offered makes a difference to people’s health and leads to a reduction in the number of strokes, heart attacks, and deaths in people who are screened.

The researchers have begun working with GPs and nurses in 12 GP practices around Cambridge, Peterborough, Norfolk and Hertfordshire to fine tune the screening process before embarking on the main trial.

Patients undergoing screening will use a handheld device to record their ECG. The device, which is small and easy to use, will be loaned to patients for use at home. Some people have AF that comes and goes at different times, and this home screening technique will detect cases of intermittent AF that otherwise would be missed in a one-off test at a GP appointment.

Caroline Mellstig Theimer, who heads up business development at Zenicor, the company that make the device, said: "We are very proud to be part of the SAFER study that has the potential to support the NHS to decide on screening for atrial fibrillation in high risk population. It’s been a pleasure to do the training of the first GP practices where the staff have partaken with great energy and a positive attitude. We’re confident this first phase of the study will provide us with valuable insight to how we can facilitate smooth large-scale implementation in the main trial."

Marie Corcoran, National Institute for Health Research (NIHR) nurse, is supporting GP practices taking part in the early phase of the study. She said: "We are about to start recruitment of patients to take part in the study, 12 GP practices in the Eastern area will be involved in this first stage, including the one I am at today, Granta medical practices at the Sawston site in Cambridgeshire. The GPs are hoping that the project will be an effective way to improve their AF detection and treatment rates."

"The use of the  device is simple to explain  to patients, and overall we are excited to be paving the way for the start of the main trial – which will currently be the largest AF screening trial in the world," said Marie Corcoran.

"Nurses, like Marie, are absolutely central to this research, and we are ensuring the support we give enables them to deliver the study as smoothly as possible", said Professor Jonathan Mant who is the senior investigator for the research programme. He added: "We need to determine whether it is feasible to implement this new model of screening in general practice before we begin the main trial because it is so large and will involve so many people – 120,000 patients and 300 GP practices. We will also find out how patients respond to our invitation to take part in the study and what it is like for them to attend screening."

The AF study, which is called SAFER, is funded by the National Institute for Health Research.

Learn more

Learn more on the SAFER study website

or

Contact the SAFER Study Coordinator.

Photo credit: Nick Saffell, University of Cambridge