The Project brought together well-experienced international researchers with a longstanding interest in AF screening as well as opinion leaders, stakeholders and end-users to achieve our ambition “a feasible, screening strategy ready for implementation.
We have developed a data platform that include harmonized datasets of 16 clinical cohorts and RCTs that relate to atrial fibrillation screening strategies and the risk of adverse outcomes. An overall sample size of 244.000 participants and a detailed catalogue with associated variables for baseline data from electrocardiography, basic demography, medical history, and outcomes of AF detection and anticoagulation on all screenees have been set up. We have planned an individual participant data meta-analysis and set up a first pilot meta-analysis that summarized existing evidence from 4 RCTs. The pilot analysis identified that AF screening was associated with a reduction in stroke compared with no screening.
To refine our screening strategy and to reduce the number needed to screen we had access to contemporary European population cohorts. We used known and emerging predictors of AF including ECG markers, genome-wide genetic analyses, metabolome and microbiome information (omics) and classical circulating markers of cardiac stress (natriuretic peptides), autoimmune disorders, inflammation and renal function to identify the high-risk populations.
To identity cost effectiveness of the screening for AF we performed a comprehensive and systematic review of economic evaluation literature that showed that AF screening is in principle cost-effective regardless of strategy and method. In addition, we developed a simulation model estimating the cost-effectiveness of atrial fibrillation screening. The model was then adapted to eight different health care systems. We set up a budget impact analysis (BIA) calculator that estimate the financial impact of implementing a screening program that covers 5 years after implementation. We adapted the calculator to the eight different health care systems in Europe taking into consideration differences in population, treatment praxis and budget holders. This tool could guide regulators to find consensus about AF screening implementation in different settings.
Well implemented AF screening programmes could increase the number of new AF diagnoses and lead to guideline-adherent care, thereby reducing stroke risk. To implement AF Screening at scale we collect data on opportunities and health inequities related to screening across Europe. We set up a qualitative study of stakeholder views in 11 European countries and identified that there is an overall awareness of AF screening.18 Opportunistic screening appears the most feasible across Europe and challenges are health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit and a tailored approach adapted to national realities. To validate the findings we evaluated the perception of general practitioners (GPs) in Europe concerning value and practicalities to implement AF screening in daily clinical practice, focussing on opportunistic single time point screening.
Based on our results we developed a provisional theory that determine the understanding for whom, under what conditions, and how an integrated approach to atrial fibrillation service delivery works.
To summarize our findings the AFFECT-EU consortium has jointly organized with the EHRA/ESC AFNET a conference and published a consensus statement for early diagnosis and precision treatment of AF in the digital era.
AFFECT-EU results addresses the issue towards risk-based screening strategies for AF. The implementation of a risk-based screening allows early detection of AF, an increasingly prevalent, non-communicable disease and have a major impact on healthy aging and wellbeing in older adults across Europe through prompt initiation of already existing effective treatment to prevent stroke and cardiovascular morbidity and mortality.
