Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT05838781 |
Other study ID # |
CV185-837 |
Secondary ID |
|
Status |
Completed |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
December 4, 2023 |
Est. completion date |
May 16, 2024 |
Study information
Verified date |
May 2024 |
Source |
Bristol-Myers Squibb |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Atrial fibrillation (AF) is the most common clinical arrhythmia and the prevalence increases
with age. AF increases the risk of ischaemic stroke fivefold and accounts for almost
one-third of all strokes. As AF is often asymptomatic there are many undetected cases. It is
important to find patients with AF and additional risk factors for stroke in order to
initiate oral anticoagulation treatment, which can reduce the risk of an ischaemic stroke by
60-70%. Screening is recommended in European guidelines, however the most suitable population
and the most suitable device for AF detection remain to be defined.
The main objective of this study is to test the hypothesis that AF screening with 14-days
continuous ECG monitoring in high-risk individuals identified with a risk prediction model is
more effective than routine care in identifying patients with undetected AF.
Effectively detecting AF among patients with risk factors for ischaemic stroke has the
potential to decrease mortality and morbidity, stroke burden and costs for the society as a
whole.
Description:
Objective(s): To compare the yield of atrial fibrillation (AF) using 14-days continuous ECG
in a population aged ≥ 65 years with an increased risk for AF incidence according to the risk
prediction model compared with standard of care in Region Halland.
Study Population: Residents in Region Halland age 65 and above.
Data Collection Methods: Electronic Health Records from Region Halland and 14-days continuous
ECG recording using an ECG patch.
Study design:
Step 1:
To calibrate the BMS/Pfizer risk prediction model (RPM), we will extract two cohorts
retrospectively: the AF cohort with an AF diagnosis (patients with a record of incident AF
diagnosis between January 1, 2016, and December 31, 2019 as an observation period), and the
control cohort without any AF diagnosis in their history. We will include patients ≥45 years
of age at index date, which is the first date of an AF diagnosis recorded in the observation
period and a random pseudo index date during the observation period for the control group, to
follow the original study. Specifically, we are looking to calibrate the intercept (α) for
the logistic regression where we already have the 13 odd ratios for the 13 risk factors from
the original study. Then in the next step for the prospective study, applying the RPM on the
RPM cohort, the at-risk group will be extracted for randomization step, using the recommended
cut-off value.
Step 2:
The population in Region Halland aged 65 years and above and free from AF will be randomized
into two halves, creating a general cohort and an RPM cohort. In the general cohort, 1480
individuals will be further randomized into two arms, general/control and
general/intervention. In the RPM cohort, the risk of incident AF will be calculated according
to the Pfizer/BMS RPM. Those with a predicted risk for incident AF above a pre-specified
threshold will then be randomly extracted into two arms, RPM/control and RPM/intervention
(figure 1).
Those randomized to the two intervention arms (general/intervention and RPM/intervention,
n=740 each) will be invited to an AF screening intervention of 14-days continuous ECG using a
patch device. Those randomized to the control groups (general/control and RPM/control, n=740
each) will not receive any information or intervention.
The primary endpoint will be the difference in yield of newly diagnosed AF between the
RPM/intervention and the general/control arms, where the latter will represent standard of
care. Participants with newly diagnosed AF in the intervention arms will be offered
consultation aiming at AF work-up and initiation of oral anticoagulation treatment.