Design of the Dutch multicentre study on opportunistic screening of geriatric patients for atrial fibrillation using asmartphone PPG app: the Dutch-GERAF study.

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Screening of high-risk patients is advocated to achieve early detection and treatment of clinical atrial fibrillation (AF). The Dutch-GERAF study will address two major issues. Firstly, the effectiveness and feasibility of an opportunistic screening strategy for clinical AF will be assessed in frail older patients and, secondly, observational data will be gathered regarding the efficacy and safety of oral anticoagulation (OAC). This is amulticentre study on opportunistic screening of geriatric patients for clinical AF using asmartphone photoplethysmography (PPG) application. Inclusion criteria are age ≥ 65years and the ability to perform at least three PPG recordings within 6months. Exclusion criteria are the presence of acardiac implantable device, advanced dementia or asevere tremor. The PPG application records patients' pulse at their fingertip and determines the likelihood of clinical AF. If clinical AF is suspected after apositive PPG recording, aconfirmatory electrocardiogram is performed. Patients undergo acomprehensive geriatric assessment and afrailty index is calculated. Risk scores for major bleeding (MB) are applied. Standard laboratory testing and additional laboratory analyses are performed to determine the ABC-bleeding risk score. Follow-up data will be collected at 6months, 12months and 3years on the incidence of AF, MB, hospitalisation, stroke, progression of cognitive disorders and mortality. The Dutch-GERAF study will focus on frail older patients, who are underrepresented in randomised clinical trials. It will provide insight into the effectiveness of screening for clinical AF and the efficacy and safety of OAC in this high-risk population. NCT05337202.