Home-Based Screening for Early Detection of Atrial Fibrillation in Primary Care Patients Aged 75 Years and Older

NCT ID: NCT02392754

Last Updated: 2020-01-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

856 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-04-01

Study Completion Date

2020-01-21

Brief Summary

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Atrial fibrillation (AF) is a major treatable risk factor for stroke, but it may be hard to detect because it is frequently silent and intermittent. New ambulatory cardiac monitoring technologies have the potential to improve early detection of AF. This trial investigates AF screening in primary care patients using the ZIO XT Patch, a wearable adhesive patch monitor that provides continuous ECG recording for up to 14 days, in addition to the WatchBP home blood pressure monitor that has built-in AF screening capability.

Detailed Description

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SCREEN-AF is an investigator-initiated, multicenter, open-label, two-group randomized controlled trial investigating non-invasive, home-based AF screening. The trial targets patients aged 75 years or older with a history of hypertension and without known AF who would be potential anticoagulant candidates if AF were detected. Eligible participants will be recruited from primary care practices and randomly allocated (1:1) to one of two groups:

* The control group will receive standard care for 6 months (including a pulse check and heart auscultation by a physician at baseline and 6 months).
* The intervention group will undergo ambulatory screening for AF with a 2-week continuous ECG patch monitor worn at baseline and again at 3 months, in addition to standard care for 6 months (including a pulse check and heart auscultation by a physician at baseline and 6 months). The intervention group will also receive a home BP monitor with automatic AF detection capability to be used twice daily for 2 weeks during the ECG monitoring blocks.

The hypothesis is that continuous ambulatory cardiac rhythm monitoring using an adhesive ECG patch monitor will be superior to standard care for AF detection. The overall aim of this research is to establish a practical and cost-effective screening strategy that could be applied in primary care for early detection of AF in patients who would benefit from anticoagulant therapy if AF were detected. The ultimate goal of this primary prevention initiative is to prevent more strokes, and stroke-related deaths, disability, dementia, hospitalizations and institutionalization, through the early detection and treatment of AF.

Conditions

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Atrial Fibrillation Hypertension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SCREENING

Blinding Strategy

NONE

Study Groups

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Screening

The intervention group receives AF screening with a 2-week ambulatory ECG patch monitor (ZIO XT Patch) worn at baseline and again at 3 months, in addition to standard care for 6 months. The intervention group also receives a home BP monitor with automatic AF detection capability to be used twice daily for 2 weeks during the ECG monitoring periods.

Group Type EXPERIMENTAL

Screening: Intervention - Atrial fibrillation screening (ZIO XT ECG monitor, Watch-BP)

Intervention Type DEVICE

The intervention group receives AF screening with a 2-week ambulatory ECG patch monitor (ZIO XT Patch) worn at baseline and again at 3 months, in addition to standard care for 6 months. The intervention group also receives a home BP monitor with automatic AF detection capability to be used twice daily for 2 weeks during the ECG monitoring periods.

Control

The control group receives standard care for 6 months (including a pulse check and heart auscultation by a physician at 6 months).

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Screening: Intervention - Atrial fibrillation screening (ZIO XT ECG monitor, Watch-BP)

The intervention group receives AF screening with a 2-week ambulatory ECG patch monitor (ZIO XT Patch) worn at baseline and again at 3 months, in addition to standard care for 6 months. The intervention group also receives a home BP monitor with automatic AF detection capability to be used twice daily for 2 weeks during the ECG monitoring periods.

Intervention Type DEVICE

Other Intervention Names

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ZIO XT Patch ambulatory ECG patch monitor Watch BP-Home A blood pressure monitor

Eligibility Criteria

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Inclusion Criteria

1. Age ≥75 years without known atrial fibrillation or atrial flutter.
2. The participant is clinically in sinus rhythm (both heart auscultation and 30- second pulse palpation have been performed by the enrolling physician and neither detects an irregular rhythm suggestive of atrial fibrillation).
3. History of hypertension requiring antihypertensive medication.
4. Written informed consent from the participant.

Exclusion Criteria

1. Any previously documented atrial fibrillation or atrial flutter ≥30 seconds.
2. Implanted pacemaker, cardiac defibrillator, cardiac loop recorder, or deep brain stimulator.
3. Likely to be poorly compliant or unreliable using home screening devices or with study follow-up requirements because of cognitive or other issues, or life expectancy \<6 months due to concomitant disease.
4. Has a condition which in the opinion of the enrolling physician would not permit chronic treatment with oral anticoagulant therapy.
5. Patient already taking long-term oral anticoagulant therapy.
6. Known allergic reaction/intolerance to skin adhesives.
Minimum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Canadian Stroke Prevention Intervention Network

OTHER

Sponsor Role collaborator

Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

Heart and Stroke Foundation of Canada

OTHER

Sponsor Role collaborator

Canadian Stroke Network

OTHER

Sponsor Role collaborator

iRhythm Technologies, Inc.

INDUSTRY

Sponsor Role collaborator

Microlife

INDUSTRY

Sponsor Role collaborator

University of Leipzig

OTHER

Sponsor Role collaborator

Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK)

OTHER

Sponsor Role collaborator

Population Health Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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David J. Gladstone, MD PhD FRCPC

Role: PRINCIPAL_INVESTIGATOR

Sunnybrook Research Institute, University of Toronto

Locations

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Crowfoot Village Family Practice

Calgary, Alberta, Canada

Site Status

Smith Clinic

Camrose, Alberta, Canada

Site Status

Edmonton Oliver PCN

Edmonton, Alberta, Canada

Site Status

Peaks to Praries PCN

Olds, Alberta, Canada

Site Status

Henry Vlaar FP

Ayr, Ontario, Canada

Site Status

LMC / Manna Research

Burlington, Ontario, Canada

Site Status

Humber River FHT - Dixon Site

Etobicoke, Ontario, Canada

Site Status

Halton Hills FHT

Georgetown, Ontario, Canada

Site Status

Haileybury FHT

Haileybury, Ontario, Canada

Site Status

Hamilton Medical Clinic

Hamilton, Ontario, Canada

Site Status

Queen's Family Health Team

Kingston, Ontario, Canada

Site Status

Ken Ng FP / Total Health Management

Markham, Ontario, Canada

Site Status

St. Lawrence Medical Clinic

Morrisburg, Ontario, Canada

Site Status

SKDS Research Inc.

Newmarket, Ontario, Canada

Site Status

OakMed FHT

Oakville, Ontario, Canada

Site Status

Mark Robertson Family Practice

Owen Sound, Ontario, Canada

Site Status

Garden City FHT

Saint Catherines, Ontario, Canada

Site Status

Michael Kopp Family Practice / N Fung & M Kopp Medicine Professional Corporation

St. Catharines, Ontario, Canada

Site Status

Health for All FHT

Stouffville, Ontario, Canada

Site Status

Port Arthur Health Centre

Thunder Bay, Ontario, Canada

Site Status

Keele Medical Place

Toronto, Ontario, Canada

Site Status

Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

Site Status

Women's College Hospital

Toronto, Ontario, Canada

Site Status

Mount Dennis Weston Health Centre

Toronto, Ontario, Canada

Site Status

Sameh Fikry Medicine Professional Corporation

Waterloo, Ontario, Canada

Site Status

Goethe University Frankfurt am Main

Frankfurt am Main, , Germany

Site Status

Universitätsmedizin Göttingen

Göttingen, , Germany

Site Status

Hamburg University Medical School

Hamburg, , Germany

Site Status

Countries

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Canada Germany

References

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Gladstone DJ, Wachter R, Schmalstieg-Bahr K, Quinn FR, Hummers E, Ivers N, Marsden T, Thornton A, Djuric A, Suerbaum J, von Grunhagen D, McIntyre WF, Benz AP, Wong JA, Merali F, Henein S, Nichol C, Connolly SJ, Healey JS; SCREEN-AF Investigators and Coordinators. Screening for Atrial Fibrillation in the Older Population: A Randomized Clinical Trial. JAMA Cardiol. 2021 May 1;6(5):558-567. doi: 10.1001/jamacardio.2021.0038.

Reference Type DERIVED
PMID: 33625468 (View on PubMed)

Related Links

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http://www.cspin.ca/studies/piaaf/piaaf-home-screen-af/

This website explains the SCREEN AF study and the C-SPIN network

Other Identifiers

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SCREEN-AF

Identifier Type: -

Identifier Source: org_study_id

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