DIGITAL atrial fibrillation screening identified previously undiagnosed atrial fibrillation in 1.9% of screened participants in the nationwide NORSCREEN randomised clinical trial. Among those who received a new diagnosis, 95.8% subsequently initiated anticoagulation therapy.
Findings suggest a fully digital, site-less approach could provide a practical way to screen older adults at increased risk of stroke. The strategy combined digital recruitment with 7 days of continuous electrocardiogram monitoring using a mailed patch-based sensor.
Participants were aged ≥65 years and had at least one additional stroke risk factor. Individuals with previous atrial fibrillation, anticoagulation use, implantable cardiac electronic devices, or without smartphone access were excluded.
A total of 551,555 Norwegian residents received a digital invitation. Of these, 139,596 completed the digital eligibility assessment, 74,956 were eligible, and 50,549 were randomised equally to screening or usual care.
Participants assigned to screening received a mailed patch-based electrocardiogram sensor for 7 days of continuous monitoring without requiring attendance at a study site.
Among the 19,723 participants in the screening group who completed the study procedures, previously undiagnosed atrial fibrillation was identified in 382 individuals, representing 1.9% of those screened.
The screened population had a median age of 75 years, with an interquartile range of 69–78 years. Women accounted for 46.4% of participants, while the mean CHA2DS2-VA risk score was 2.6±0.9.
These findings indicate that a digitally delivered atrial fibrillation screening pathway can be implemented at substantial scale among an at-risk population, while maintaining participation through remote monitoring.
The data also showed high initial adherence to therapeutic recommendations. Of the 382 participants in whom previously undiagnosed atrial fibrillation was detected, 366, or 95.8%, initiated anticoagulation therapy after being advised to contact their general practitioner to begin appropriate treatment.
The findings support the feasibility and effectiveness of fully digital atrial fibrillation screening, particularly where conventional screening approaches may face considerable resource and logistical demands.
For clinicians, the results highlight the potential of remote recruitment and patch-based continuous electrocardiographic monitoring to identify previously undiagnosed atrial fibrillation in older adults with additional stroke risk factors. The high uptake of anticoagulation among participants with newly detected disease also suggests that screening could be linked effectively with subsequent therapeutic management.
Reference
Boskovic M et al. Digital recruitment and prevalence of screen-detected atrial fibrillation in nationwide patch-based ECG screening: the NORSCREEN randomized clinical trial. Europace. 2026;28(8):euag140.
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