Background

Atrial fibrillation (AF) is a very common cardiac arrhythmia, also in its paroxysmal form of repeated short episodes.  AF increases the risk of ischemic stroke. Paroxysmal AF often remains undetected or is an incidental finding. However, if AF is detected, oral anticoagulation treatment can significantly reduce the risk of stroke. To date, there is insufficient evidence for an optimal screening strategy. AF screening requires an approach that identifies patients at increased risk and optimizes the duration and frequency of ECG monitoring. AF prevalence is known to increase with age and presence of hypertension.

Aim

The project Target-AF aims to improve primary care for older adults at increased risk of stroke through evidence-based, systematic early detection of AF. To this, the project will assess the efficacy of a structured screening intervention for people with a high risk for AF as well as approaches to risk stratification in German general practice. 

Methods

Target-AF is a multi-center, open-label 2-armed (intervention vs. control, 1:1) randomized controlled trial (RCT). General practice patients 70 years old or older with diagnosed hypertension, no previous diagnosis of AF, and no anticoagulant treatment are eligible to enroll in our study. Up to 1000 participants will be recruited in 72 general practices of the FoPraNet Nord. In each of the six regions 12 practices recruit 13-14 patients each. All participants will receive one 24-hour Holter ECG to exclude present AF and to assess for supraventricular ectopy, a potential precursor/risk marker. A blood sample will be taken for measurement of biomarkers potentially predicting AF (NTproBNP, CDT, TSH, and creatinine). Participants are randomized 1:1 to either usual care at the treating physicians’ discretion (control group), or to an intervention of 7-day continuous ECG monitoring at inclusion, after 3, 12, 24, and 36 months, or until detection of AF >30 seconds. At inclusion and after 3, 12, 24, and 36 months, all patients will be surveyed for quality of life, general state of health, cardiovascular and bleeding events and health care utilization. The primary endpoint is the detection of AF (>30 sec) within 36 months. Secondary objective is to assess the predictive value of biomarkers and supraventricular ectopy both individually and in combination.

Project partners

Project partner

• Prof. Dr. Martin Scherer, Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf
• Prof. Dr. Nils Schneider, Institute for General Practice and Palliative Care, Hannover Medical School
• Prof. Dr. Michael Freitag, Division of General Practice, Carl von Ossietzky, University of Oldenburg
• Prof. Dr. Jean-François Chenot, Department of General Practice, Institute for Community Medicine, University Medical Center Greifswald
• Prof. Dr. Ralf Jendyk, Institute of General Practice, Rostock University Medical Center
• Prof. Dr. Rolf Wachter, Clinic and Polyclinic of Cardiology, University Medical Center Leipzig
• Priv.-Doz. Sara Yasemin Nußbeck, Central Biobank, University Medical Center Göttingen
• Prof. Dr. Christian Thies, School of Informatics, Reutlingen University
• Prof. Dr. Markus Bleckwenn, Institute for General Practice, University Medical Center Leipzig
• Prof. Dr. Tim Friede, Institute of Medical Statistics, University Medical Center Göttingen

Funding

The project is funded by the Federal Ministry of Research, Technology, and Space (BMFTR) (grant number 01GK2502A). The project will run for 60 months (May 1, 2026, to April 30, 2031).