Evidence map›Paper›PMID 36691194›Full record

ArticleBMJ open2022

Cluster randomised controlled trial of screening for atrial fibrillation in people aged 70 years and over to reduce stroke: protocol for the pilot study for the SAFER trial.

Kate Williams, Rakesh Narendra Modi, Andrew Dymond, Sarah Hoare, Alison Powell, Jenni Burt, Duncan Edwards, Jenny Lund, Rachel Johnson, Trudie Lobban and 17 more

Open access · goldAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed
4.6field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 28 citations in OpenAlex.

  1. Population reach and participation rate in opportunistic vs. systematic atrial fibrillation screening: STROKESTOP III.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Trial
  2. Trial
  3. Article
  4. Article
  5. Screening for atrial fibrillation: a narrative review.The British journal of cardiology · 2025
    Article
  6. Review
  7. Article
  8. Review
  9. Innovative approaches to atrial fibrillation prediction: should polygenic scores and machine learning be implemented in clinical practice?Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024
    Review
  10. Screening and detection of atrial fibrillation in primary care: current practice and future perspectives.European heart journal supplements : journal of the European Society of Cardiology · 2024
    Article
  11. Article
  12. Article
  13. The feasibility of population screening for paroxysmal atrial fibrillation using hand-held electrocardiogram devices.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024
    Article
  14. Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation.Health expectations : an international journal of public participation in health care and health policy · 2023
    Article
  15. Review
  16. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors at 9 institutions in 3 countries.

Kate WilliamsStrangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Rakesh Narendra ModiStrangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK rnm30@medschl.cam.ac.uk.ORCID 0000-0001-9651-6690
Andrew DymondStrangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Sarah HoareTHIS (The Healthcare Improvement Studies) Institute, University of Cambridge, Cambridge, UK.ORCID 0000-0002-8933-217X
Alison PowellTHIS (The Healthcare Improvement Studies) Institute, University of Cambridge, Cambridge, UK.
Jenni BurtTHIS (The Healthcare Improvement Studies) Institute, University of Cambridge, Cambridge, UK.
Duncan EdwardsStrangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Jenny LundStrangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Rachel JohnsonBristol Medical School, University of Bristol, Bristol, UK.
Trudie LobbanHeart Arrhythmia Alliance, Chipping Norton, UK.
Mark LownPrimary Care Population Sciences and Medical Education, University of Southampton School, Southampton, UK.ORCID 0000-0001-8309-568X
Michael J SweetingDepartment of Health Sciences, George Davies Centre, University of Leicester, Leicester, UK.
H ThomBristol Medical School, University of Bristol, Bristol, UK.
Stephen KaptogeDepartment of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Francesco FuscoStrangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Stephen MorrisStrangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.ORCID 0000-0002-5828-3563
Gregory LipLiverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.ORCID 0000-0002-7566-1626
Natalie ArmstrongDepartment of Health Sciences, George Davies Centre, University of Leicester, Leicester, UK.ORCID 0000-0003-4046-0119
Martin R CowieGuy's & St Thomas' NHS Foundation Trust, Royal Brompton Hospital, London, UK.ORCID 0000-0001-7457-2552
David A FitzmauriceHealth Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
Ben FreedmanHeart research Institute, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.ORCID 0000-0002-3809-2911
Simon J GriffinStrangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Stephen SuttonStrangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Fd Richard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Richard J McManusNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID 0000-0003-3638-028X
Jonathan MantStrangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
The Safer Authorship GroupStrangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
University of Cambridge · GBUniversity of Bristol · GBUniversity of Leicester · GBUniversity of Oxford · GBKing's College London · GBThe University of Sydney · AUUniversity of Liverpool · GBUniversity of Southampton · GBUniversity of Warwick · GB

Funding

Department of Health RP-PG0217-20007Department of Health SPCR-2014-10043Medical Research Council MC_UU_00006/6Medical Research Council MC_UU_12015/4Wellcome TrustWellcome Trust 203921/Z/16/Z
6 · The paper itself

Abstract

introductionAtrial fibrillation (AF) is a common arrhythmia associated with 30% of strokes, as well as other cardiovascular disease, dementia and death. AF meets many criteria for screening, but there is limited evidence that AF screening reduces stroke. Consequently, no countries recommend national screening programmes for AF. The Screening for Atrial Fibrillation with ECG to Reduce stroke (SAFER) trial aims to determine whether screening for AF is effective at reducing risk of stroke. The aim of the pilot study is to assess feasibility of the main trial and inform implementation of screening and trial procedures. METHODS AND ANALYSIS: SAFER is planned to be a pragmatic randomised controlled trial (RCT) of over 100 000 participants aged 70 years and over, not on long-term anticoagulation therapy at baseline, with an average follow-up of 5 years. Participants are asked to record four traces every day for 3 weeks on a hand-held single-lead ECG device. Cardiologists remotely confirm episodes of AF identified by the device algorithm, and general practitioners follow-up with anticoagulation as appropriate. The pilot study is a cluster RCT in 36 UK general practices, randomised 2:1 control to intervention, recruiting approximately 12 600 participants. Pilot study outcomes include AF detection rate, anticoagulation uptake and other parameters to incorporate into sample size calculations for the main trial. Questionnaires sent to a sample of participants will assess impact of screening on psychological health. Process evaluation and qualitative studies will underpin implementation of screening during the main trial. An economic evaluation using the pilot data will confirm whether it is plausible that screening might be cost-effective. ETHICS AND DISSEMINATION: The London-Central Research Ethics Committee (19/LO/1597) and Confidentiality Advisory Group (19/CAG/0226) provided ethical approval. Dissemination will be via publications, patient-friendly summaries, reports and engagement with the UK National Screening Committee. TRIAL REGISTRATION NUMBER: ISRCTN72104369.

Indexed as

Atrial FibrillationStrokeAgedAged, 80 and overAnticoagulantsElectrocardiographyHumansPilot ProjectsPragmatic Clinical Trials as TopicRandomized Controlled Trials as TopicAnticoagulantsAdult cardiologyPRIMARY CAREPUBLIC HEALTHSTROKE MEDICINE

Identifiers

PMID36691194
PMCPMC9472173
OpenAlexW4297450576

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.