Adherence to a mobile health-based atrial fibrillation screening program: a subanalysis from STROKESTOP I and II

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Other. Main funding source(s): Stockholm County Council, the Swedish Heart & Lung Foundation INTRODUCTION: Atrial fibrillation (AF) is associated with an increased risk of stroke, which may be reduced through timely and adequate treatment initiation. Consequently, early detection of AF is important. In a recent European Heart Rhythm Association practical guide on the use of digital devices, systematic screening for AF of those ≥75 years is recommended. PURPOSE: To 1) evaluate adherence and adherence consistency to a handheld electrocardiography (ECG)-based device for AF screening and 2) evaluate factors associated with optimal adherence and adherence consistency. METHODS: In STROKESTOP I and II, half of the 75- and 76-year old population in up to two regions in Sweden were invited to an AF screening program. Participants without previously known AF and without AF during baseline visit, were asked to perform 30-seconds recordings using a handheld ECG-based device for a period of two weeks twice daily in STROKESTOP I and four times a day in STROKESTOP II. Adherence was defined as the number of recordings performed per number of recordings that were asked from the participant over the entire screening period. Adherence consistency was defined as full screening days, i.e. the number of screening days on which the asked number of recordings was performed. Since baseline date was excluded from analysis, the total screening period consisted of 13 days. RESULTS: In total, 6436 participants from STROKESTOP I (3585 females (55.7%)) and 3712 participants from STROKESTOP II (2218 females (59.8%)) were included in the current analysis. Median adherence was 100% [92-100%] and 90% [75-98%] in STROKESTOP I and II, respectively. The median number of full screening days was 12 [11-13] in STROKESTOP I and 8 [3-11] in STROKESTOP II. In STROKESTOP I, female sex, region of inclusion, income in 1st to 3rd quartile and no university or college education were factors independently associated with both optimal adherence and adherence consistency (Figure 1). In addition, no previous stroke or transient ischemic attack and the use of beta blockers were associated with optimal adherence, whereas no diabetes and low alcohol index were associated with optimal adherence consistency. In STROKESTOP II, socioeconomic factors were not available at the time of the current analysis. Other associations (female sex, absence of diabetes) were comparable to STROKESTOP I. CONCLUSIONS: In this screening program for AF, median adherence was optimal in case of twice daily measurements, and nearly optimal in case of measurements four times a day. Several demographic and socioeconomic factors, as well as low alcohol index and the absence of diabetes and previous stroke were associated with optimal adherence and/or adherence consistency. [Figure: see text]