Genetic Risk-Based Atrial Fibrillation Screening (GeneAF Study)
- Conditions
- Genetic PredispositionAtrial Fibrillation
- Interventions
- Diagnostic Test: Resting ECG (if first visit is done on site only)Diagnostic Test: 24-hour ambulatory electrocardiographic monitoring (Holter) (if first visit done on site only)Diagnostic Test: 3-month AF detection monitoring using the Apple Watch
- Registration Number
- NCT04932798
- Lead Sponsor
- Montreal Heart Institute
- Brief Summary
AF is the most common sustained arrhythmia in adults and its prevalence increases with advancing age.
In this study, we aim to determine whether the published genome-wide polygenic scores for atrial fibrillation (GPSAF) can facilitate AF screening by accurately discriminating between patients with low and high risk for AF.
All included patients are participating in the MHI biobank, an ongoing funded institutional DNA bank and clinical registry approved by the research ethics board where included patients consent for future genetic research.
The study will compare AF detection rate using a 3 months near continuous monitoring in individuals with a high GPSAF with matched individuals from the bottom GPSAF.
- Detailed Description
In Canada, 50,000 strokes occur every year and can have devastating consequences on patients. Approximately 15% of strokes are attributable to an undiagnosed arrhythmia, atrial fibrillation (AF). Strokes due to AF are more severe and lethal but are preventable with anti-coagulation. Most patients who suffer from AF are asymptomatic and thus don't come spontaneously to medical attention. The diagnosis can be made by electrocardiographical (ECG) recording. As longer recordings spanning on weeks and months are often required, it is not possible to apply this intense screening to the entire population. The GeneAF project thus aims to use genetic information to identify and target patients who benefit the most from a more intensive screening approach. A previously published genetic polygenic risk score (GPS) for AF has been shown to be associated with prevalent AF in the UK biobank population. Participants in the top 5 percentile were three times more likely to have a history of AF (prevalent AF).
The aim of this project is to determine if the use of this previously published GPS score for prevalent AF can be used to screen for silent incident AF in our population.
Primary objective: To assess the association of GPSAF with silent AF and compare AF detection rates in patients with a high GPSAF to matched controls.
Secondary objectives: To determine the proportion of patients with identified AF who will be prescribed anticoagulation during follow-up.
Methods:
The GeneAF study is a cohort study comparing AF detection rate using a 3 months near-continuous monitoring in individuals with a high GPSAF (top 5%; High Risk group) with matched individuals from the bottom 95% GPSAF (Lower Risk group). All included subjects are current participants in the MHI biobank. Only candidates who would be considered for anticoagulation in case AF is detected (actionable AF; CHADS-65 \> 1. We estimate that approximately 350 patients per group will be needed.
Recruitment & Eligibility
- Status
- ENROLLING_BY_INVITATION
- Sex
- All
- Target Recruitment
- 726
- Having a CHADS65 score>1, which requires either:
Age >= 65 and/or A prior Stroke or TIA and/or Hypertension and/or A history of heart failure and/or Diabetes
- Already on oral anticoagulation
- Any prior history of AF or atrial flutter (AFl)
- Patients currently having an implantable device (pacemaker, defibrillator or loop recorder) that allows detection of AF/AFl
- Refusing testing with the "Apple Watch"
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Low-Risk group 24-hour ambulatory electrocardiographic monitoring (Holter) (if first visit done on site only) Montreal Heart Institute biobank participants with a low specific genome-wide polygenic risk scores for atrial fibrillation G High-Risk group 24-hour ambulatory electrocardiographic monitoring (Holter) (if first visit done on site only) : Montreal Heart Institute biobank participants with a high specific genome-wide polygenic risk scores for atrial fibrillation G High-Risk group 3-month AF detection monitoring using the Apple Watch : Montreal Heart Institute biobank participants with a high specific genome-wide polygenic risk scores for atrial fibrillation G High-Risk group Resting ECG (if first visit is done on site only) : Montreal Heart Institute biobank participants with a high specific genome-wide polygenic risk scores for atrial fibrillation G Low-Risk group Resting ECG (if first visit is done on site only) Montreal Heart Institute biobank participants with a low specific genome-wide polygenic risk scores for atrial fibrillation G Low-Risk group 3-month AF detection monitoring using the Apple Watch Montreal Heart Institute biobank participants with a low specific genome-wide polygenic risk scores for atrial fibrillation G
- Primary Outcome Measures
Name Time Method Detection of atrial fibrillation/atrial flutter (Y/N) 3 months Atrial Fibrillation will be diagnosed according to the standard definition: "at least one 30-second recording with irregular rhythm without p waves". This will be accomplished either through the baseline ECG, Holter or during the 3 months monitoring with the Apple watch.
The diagnostic of AF with the "Apple watch" requires:
1. Detection of irregular heart rate (photopletysmography)
2. Confirmation of the rhythm with a real time single lead 30 seconds ECG with the Apple Watch.
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (1)
Montreal Heart Institute
🇨🇦Montréal, Quebec, Canada