Risk-Based Screening for the Evaluation of Atrial Fibrillation Trial (R-BEAT)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 755
- 试验地点
- 2
- 主要终点
- New detected (and centrally confirmed) cases of atrial fibrillation/flutter > 2 minutes
研究概览
简要总结
- To determine whether a risk-based screening programme for occult paroxysmal atrial fibrillation, involving extended cardiac monitoring in adults with CHA2DS2-VASc score of 3 or greater, increases the detection of new atrial fibrillation/flutter.
- To determine whether a risk-based screening programme for occult paroxysmal atrial fibrillation, involving extended cardiac monitoring in adults with CHA2DS2-VASc score of 3 or greater, is cost-effective.
- To determine the sensitivity, specificity, positive predictive value and negative predictive values of self-monitoring of pulse in adults for detection of atrial fibrillation.
- To determine the cost, cost effectiveness, and budget impact of a risk-based screening programme for occult paroxysmal atrial fibrillation, relative to a control of usual care in general practice.
详细描述
Stroke is a leading cause of death and disability. A first diagnosis of atrial fibrillation may occur at the time of stroke (e.g. about 45% of patients with acute stroke). Undiagnosed atrial fibrillation is therefore a major care-gap in stroke prevention.
Against this backdrop, oral anticoagulant therapy is extremely effective at reducing the risk of ischemic stroke in atrial fibrillation, associated with a two-thirds risk reduction. Therefore, a major care gap in stroke prevention is the prevalence of undetected atrial fibrillation in the community. Traditional pulse screening in all patients > 65 years detects new atrial fibrillation in about 1% of people.
The CHA2DS2-VASc score was developed and validated to risk-stratify patients with atrial fibrillation into low, intermediate and high risk of stroke. The Investigators believe that the CHA2DS2-VASc score represents an opportunity to identify patients at high risk of atrial fibrillation, but also identifies this at highest risk of stroke, and therefore those that will derive greatest benefit from anticoagulant therapy.
The advent of external-worn event loop recorders (ELRs) present a more convenient and efficient method of detecting atrial fibrillation. Loop recorders have an in-built diagnostic algorithm that identifies atrial fibrillation, and initiates recordings before and after the event-trigger. This rhythm strip is then examined and confirmed by the trial cardiac technician. The investigators will examine if using external loop recorders in patients identified as high risk will improve the detection rate of paroxysmal atrial fibrillation.
The study is a randomised controlled cross-over multi-centered clinical trial in General Practice. Ethical approval has been sought from the Galway University Hospitals research ethics committee. The investigators have also engaged with Clinical Research Patient and Public Involvement.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Screening
- 盲法
- None
盲法说明
There is no masking.
入排标准
- 年龄范围
- 55 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Signed a study specific Informed Consent Form
- •55 years of age or older
- •Attending one of the participating General Practices in the R-BEAT Trial
- •Attended at least one GP appointment within the past 12 months
- •CHA2DS2-VASc Score >2
排除标准
- •Contraindication to oral anticoagulant therapy
- •History of intracerebral haemorrhage
- •Prior intolerance or refusal of oral anticoagulant therapy
- •*(If intolerant or refused warfarin, may be included if considered suitable for non vitamin-K oral anticoagulant, NOAC)
- •Gastrointestinal haemorrhage of unexplained or unmodifiable aetiology (i.e. risk of haemorrhage has not been reduced)
- •Other major bleed that would exclude oral anticoagulant therapy
- •Known Atrial fibrillation/flutter
- •Currently prescribed oral anticoagulant therapy
- •Unsuitable for anticoagulant therapy, in opinion of attending general practitioner
- •Unsuitable for cardiac monitoring, in opinion of attending general practitioner
- •Allergies to plasters or adhesives
- •Has had cardiac monitoring for >48 hours within the last 12 months, has an implantable loop recorder, or scheduled to have cardiac monitoring/ILR.
研究组 & 干预措施
Immediate External Loop Recorder
Participants randomized to the Immediate External Loop Recorder group will be monitored for the duration of the first week of the study using the Novacor R-Test 4.
干预措施: R Test 4 External Loop Recorder (Device)
Delayed External Loop Recorder
Participants randomized to the Delayed External Loop Recorder group will be monitored for the duration of the second week of the study using the Novacor R-Test 4.
干预措施: R Test 4 External Loop Recorder (Device)
结局指标
主要结局
New detected (and centrally confirmed) cases of atrial fibrillation/flutter > 2 minutes
时间窗: 2 years
New detected (and centrally confirmed) cases of atrial fibrillation/flutter \> 2 minutes in duration using a built in diagnostic algorithm that identifies probable atrial fibrillation. The identified instances will be reviewed by a cardiologist for confirmation of atrial fibrillation/atrial flutter
次要结局
- Initiation of oral anticoagulation(3 months)
研究者
Ruairi Waters
Associate Specialist in Stroke Medicine
National University of Ireland, Galway, Ireland