Abstract
BackgroundAtrial fibrillation (AF), an important cause of thromboembolic events, is often silent and intermittent, thus presenting a diagnostic challenge. The aim of this study was to assess whether the plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) is related to the presence of AF and thereby might be used to facilitate screening programs for AF in primary care.MethodsThis was a cross sectional screening study. A population of 70–74-year-old individuals registered at a single primary care center in Stockholm were invited to AF screening. Intermittent ECG recording, 30 seconds twice a day using a hand-held device over 2 weeks, was offered to participants without previously known AF. Of the 324 participating persons, 34 patients had already known AF and 16 new cases of AF were detected by screening. Plasma NT-proBNP was measured in patients with previously known AF, newly detected AF, and 53 control participants without AF.FindingsThe median NT-proBNP was 697 ng/L in patients with previously known AF, 335 ng/L in new cases of AF, and 146 ng/L in patients without AF. After adjustment for several clinical variables and morbidities, the differences of median NT-proBNP levels were statistically significant between cases of previously known AF and new cases of AF as well as between new cases of AF and those without AF. The area under receiver operating characteristic curve of detection of new AF was 0.68 (95% CI 0.56 to 0.79) yielding a cut-off point of 124 ng/L with 75% sensitivity, 45% specificity, and 86% negative predictive value.ConclusionsThe NT-proBNP plasma levels among patients with known AF are higher than those with newly detected AF, and the latter have higher levels than those without AF. Therefore NT-proBNP might be a useful screening marker for the detection of AF and its persistence.
Highlights
A population of 70–74-year-old individuals registered at a single primary care center in Stockholm were invited to Atrial fibrillation (AF) screening
Atrial fibrillation (AF) is a common cardiac arrhythmia carrying a high risk for ischemic stroke [1]
53 (18%) individuals were selected from the 274 individuals with no detected AF and NT-proBNP and AF (S1 Table)
Summary
Atrial fibrillation (AF) is a common cardiac arrhythmia carrying a high risk for ischemic stroke [1]. Oral anticoagulant therapy reduces the risk of stroke by at least 60% and is recommended for most patients with AF [1]. Early identification of AF and initiation of oral anticoagulant therapy might prevent stroke. Opportunistic screening for AF using pulse–palpation is recommended in persons above the age of 65 according to the European Society of Cardiology guidelines [1]. By single timepoint screening of individuals aged 65 years and older, 1.4% new AF cases can be detected [2]. Atrial fibrillation (AF), an important cause of thromboembolic events, is often silent and intermittent, presenting a diagnostic challenge. The aim of this study was to assess whether the plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) is related to the presence of AF and thereby might be used to facilitate screening programs for AF in primary care
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