瑞典卡罗林斯卡医学院Emma Svennberg团队研究了老年人群进行心房颤动系统筛查的临床结局。这一研究成果于2021年8月29日发表在《柳叶刀》杂志上。
心房颤动是缺血性卒中的主要原因。早期发现房颤可以使抗凝治疗降低缺血性卒中和死亡的风险。这项针对老年人群的随机研究旨在评估与不进行筛查相比，对房颤进行系统筛查是否能降低死亡率和发病率。
研究组在瑞典哈兰和斯德哥尔摩进行了一项多中心、平行组、无掩蔽、随机对照试验。居住在这两个地区的所有75-76岁的老年人被随机分配（1：1）接受心房颤动筛查或标准护理对照。当地筛查中心要求那些没有房颤病史的参与者记录14天的间歇性心电图（ECG）。如果检测到或未治疗心房颤动时，则给予口服抗凝剂治疗。研究组对所有随机分配的参与者进行至少为期5年的意向治疗分析，以了解缺血性或出血性卒中、全身性栓塞、导致住院的出血和全因死亡的主要复合终点。
2012年3月1日至2014年5月28日，研究组共招募了28768名参与者进行资格评估，其中14387名接受系统筛查，14381名为对照组。干预组排除了408人，对照组排除了385人，原因是邀请前死亡或搬迁。后续无失访者。在受邀参加筛查的患者中，13979名患者中有7165名（51.3%） 实际参与。在平均随访6.9年后，干预组的主要终点事件发生率为31.9%，显著低于对照组的33.0%，差异具有统计学意义。
研究结果表明，与标准护理相比，房颤筛查显示出较小的净临床受益，表明筛查在老年人群中是安全和有益的。
附：英文原文
Title: Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial
Author: Emma Svennberg, Leif Friberg, Viveka Frykman, Faris Al-Khalili, Johan Engdahl, Mrten Rosenqvist
Issue&Volume: 2021-08-29
Abstract:
Background
Atrial fibrillation is a leading cause of ischaemic stroke. Early detection of atrial fibrillation can enable anticoagulant therapy to reduce ischaemic stroke and mortality. In this randomised study in an older population, we aimed to assess whether systematic screening for atrial fibrillation could reduce mortality and morbidity compared with no screening.
Methods
STROKESTOP was a multicentre, parallel group, unmasked, randomised controlled trial done in Halland and Stockholm in Sweden. All 75–76-year-olds residing in these two regions were randomly assigned (1:1) to be invited to screening for atrial fibrillation or to a control group. Participants attended local screening centres and those without a history of atrial fibrillation were asked to register intermittent electrocardiograms (ECGs) for 14 days. Treatment with oral anticoagulants was offered if atrial fibrillation was detected or untreated. All randomly assigned individuals were followed up in the intention-to-treat analysis for a minimum of 5 years for the primary combined endpoint of ischaemic or haemorrhagic stroke, systemic embolism, bleeding leading to hospitalisation, and all-cause death. This trial is registered with ClinicalTrials.gov, NCT01593553.
Findings
From March 1, 2012, to May 28, 2014, 28768 individuals were assessed for eligibility and randomly assigned to be invited to screening (n=14387) or the control group (n=14381). 408 individuals were excluded from the intervention group and 385 were excluded from the control group due to death or migration before invitation. There was no loss to follow-up. Of those invited to screening, 7165 (51·3%) of 13979 participated. After a median follow-up of 6·9 years (IQR 6·5–7·2), significantly fewer primary endpoint events occurred in the intervention group (4456 [31·9%] of 13979; 5·45 events per 100 years [95% CI 5·52–5·61]) than in the control group (4616 [33·0%] of 13996; 5·68 events per 100 years [5·52–5·85]; hazard ratio 0·96 [95% CI 0·92–1·00]; p=0·045).
Interpretation
Screening for atrial fibrillation showed a small net benefit compared with standard of care, indicating that screening is safe and beneficial in older populations.
DOI: 10.1016/S0140-6736(21)01637-8
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01637-8/fulltext
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本期文章：《柳叶刀》：Online/在线发表
