Evidence map›Paper›PMID 38670614›Full record

ArticleBMJ open2024

Randomised controlled trial of population screening for atrial fibrillation in people aged 70 years and over to reduce stroke: protocol for the SAFER trial.

Jonathan Mant, Rakesh N Modi, Andrew Dymond, Natalie Armstrong, Jenni Burt, Peter Calvert, Martin Cowie, Wern Yew Ding, Duncan Edwards, Ben Freedman and 19 more

Open access · goldAbstract readClinical Trial Protocol
In one paragraph

Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 1 pooled it
5.2field-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

13 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

  1. Key stakeholder views on atrial fibrillation screening: a systematic mixed-studies review and interpretive analysis.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
    Pooled it
  2. Digital recruitment and prevalence of screen-detected atrial fibrillation in nationwide patch-based ECG screening: the NORSCREEN randomized clinical trial.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
  3. The impact of screening-detected atrial fibrillation and associated outcomes on quality of life.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2025
    Trial
  4. Trial
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  13. The NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial: rationale and design of a randomized controlled trial.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
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

29 authors at 11 institutions in 4 countries.

Jonathan MantPrimary Care Unit, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.
Rakesh N ModiPrimary Care Unit, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK rnm30@medschl.cam.ac.uk.ORCID 0000-0001-9651-6690
Andrew DymondPrimary Care Unit, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.
Natalie ArmstrongDepartment of Population Health Sciences, University of Leicester, Leicester, UK.ORCID 0000-0003-4046-0119
Jenni BurtTHIS Labs, Cambridge, UK.
Peter CalvertLiverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
Martin CowieSchool of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK.
Wern Yew DingLiverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
Duncan EdwardsPrimary Care Unit, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.
Ben FreedmanCharles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
Simon J GriffinInstitute of Public Health, University of Cambridge Primary Care Unit, Cambridge, UK.
Sarah HoareDepartment of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, UK.
F D Richard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Rachel JohnsonUniversity of Bristol, Bristol, UK.
Stephen KaptogeCambridge Biomedical Campus, Cambridge, UK.
Gregory Y H LipLiverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.ORCID 0000-0002-7566-1626
Trudie LobbanArrhythmia Alliance and AF Association, Stratford upon Avon, UK.
Mark LownSchool of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.ORCID 0000-0001-8309-568X
Jenny LundPrimary Care Unit, Department of Public Health & Primary Care, Strangeways Research Laboratory, Cambridge, UK.
Richard J McManusNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID 0000-0003-3638-028X
Mark T MillsLiverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
Stephen MorrisDepartment of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, UK.ORCID 0000-0002-5828-3563
Alison PowellTHIS Institute, University of Cambridge, Cambridge, UK.
Riccardo ProiettiLiverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
Stephen SuttonDepartment of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, UK.ORCID 0000-0003-1610-0404
Mike SweetingCambridge Biomedical Campus, Cambridge, UK.
Howard ThomUniversity of Bristol, Bristol, UK.
Kate WilliamsPrimary Care Unit, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.ORCID 0000-0002-6188-9363
SAFER author group
University of Cambridge · GBUniversity of Liverpool · GBUniversity of Bristol · GBUniversity of Oxford · GBGlobal Inkjet Systems (United Kingdom) · GBKing's College London · GBMedical Prescription Services · GBPrimary Health Care · QAThe University of Sydney · AUUniversity of Leicester · GBUniversity of Southampton · GB

Funding

Wellcome Trust
6 · The paper itself

Abstract

introductionThere is a lack of evidence that the benefits of screening for atrial fibrillation (AF) outweigh the harms. Following the completion of the Screening for Atrial Fibrillation with ECG to Reduce stroke (SAFER) pilot trial, the aim of the main SAFER trial is to establish whether population screening for AF reduces incidence of stroke risk. METHODS AND ANALYSIS: Approximately 82 000 people aged 70 years and over and not on oral anticoagulation are being recruited from general practices in England. Patients on the palliative care register or residents in a nursing home are excluded. Eligible people are identified using electronic patient records from general practices and sent an invitation and consent form to participate by post. Consenting participants are randomised at a ratio of 2:1 (control:intervention) with clustering by household. Those randomised to the intervention arm are sent an information leaflet inviting them to participate in screening, which involves use of a handheld single-lead ECG four times a day for 3 weeks. ECG traces identified by an algorithm as possible AF are reviewed by cardiologists. Participants with AF are seen by a general practitioner for consideration of anticoagulation. The primary outcome is stroke. Major secondary outcomes are: death, major bleeding and cardiovascular events. Follow-up will be via electronic health records for an average of 4 years. The primary analysis will be by intention-to-treat using time-to-event modelling. Results from this trial will be combined with follow-up data from the cluster-randomised pilot trial by fixed-effects meta-analysis. ETHICS AND DISSEMINATION: The London-Central National Health Service Research Ethics Committee (19/LO/1597) provided ethical approval. Dissemination will include public-friendly summaries, reports and engagement with the UK National Screening Committee. TRIAL REGISTRATION NUMBER: ISRCTN72104369.

Indexed as

Atrial FibrillationMass ScreeningStrokeAgedAged, 80 and overAnticoagulantsElectrocardiographyEnglandFemaleHumansMaleRandomized Controlled Trials as TopicAnticoagulantsCARDIOLOGYMass ScreeningPrimary CareRandomized Controlled TrialStroke

Identifiers

PMID38670614
PMCPMC11057258
OpenAlexW4395670363

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

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.