- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03911986
Risk-Based Screening for the Evaluation of Atrial Fibrillation Trial (R-BEAT)
Risk-Based Screening for the Evaluation of Atrial Fibrillation Trial (R-BEAT)
- To determine whether a risk-based screening programme for occult paroxysmal atrial fibrillation, involving extended cardiac monitoring in adults with CHA2DS2-VASc score of 3 or greater, increases the detection of new atrial fibrillation/flutter.
- To determine whether a risk-based screening programme for occult paroxysmal atrial fibrillation, involving extended cardiac monitoring in adults with CHA2DS2-VASc score of 3 or greater, is cost-effective.
- To determine the sensitivity, specificity, positive predictive value and negative predictive values of self-monitoring of pulse in adults for detection of atrial fibrillation.
- To determine the cost, cost effectiveness, and budget impact of a risk-based screening programme for occult paroxysmal atrial fibrillation, relative to a control of usual care in general practice.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Stroke is a leading cause of death and disability. A first diagnosis of atrial fibrillation may occur at the time of stroke (e.g. about 45% of patients with acute stroke). Undiagnosed atrial fibrillation is therefore a major care-gap in stroke prevention.
Against this backdrop, oral anticoagulant therapy is extremely effective at reducing the risk of ischemic stroke in atrial fibrillation, associated with a two-thirds risk reduction. Therefore, a major care gap in stroke prevention is the prevalence of undetected atrial fibrillation in the community. Traditional pulse screening in all patients > 65 years detects new atrial fibrillation in about 1% of people.
The CHA2DS2-VASc score was developed and validated to risk-stratify patients with atrial fibrillation into low, intermediate and high risk of stroke. The Investigators believe that the CHA2DS2-VASc score represents an opportunity to identify patients at high risk of atrial fibrillation, but also identifies this at highest risk of stroke, and therefore those that will derive greatest benefit from anticoagulant therapy.
The advent of external-worn event loop recorders (ELRs) present a more convenient and efficient method of detecting atrial fibrillation. Loop recorders have an in-built diagnostic algorithm that identifies atrial fibrillation, and initiates recordings before and after the event-trigger. This rhythm strip is then examined and confirmed by the trial cardiac technician. The investigators will examine if using external loop recorders in patients identified as high risk will improve the detection rate of paroxysmal atrial fibrillation.
The study is a randomised controlled cross-over multi-centered clinical trial in General Practice. Ethical approval has been sought from the Galway University Hospitals research ethics committee. The investigators have also engaged with Clinical Research Patient and Public Involvement.
The investigators primary research question is whether extended cardiac rhythm monitoring (with ELR for 1 week), compared to standard care, in patients pre-identified to be at high-risk of atrial fibrillation (defined by CHA2DS2-VASc score >2) increases the detection of new atrial fibrillation resulting in introduction of oral anticoagulant therapy, that is efficient, acceptable to patients and cost-effective.
All participating general practices will require the Socrates software package. The investigators will run analyses to identify patients with a CHA2DS2-VASc of 3 or greater. The investigators will exclude all patients with known atrial fibrillation, those in whom contraindications to oral anticoagulant therapy exist, and those who are deemed unsuitable for extended monitoring.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
County Galway
-
Galway, County Galway, Ireland, H91 YR71
- HRB Clinical Research Facility Galway
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Signed a study specific Informed Consent Form
- 55 years of age or older
- Attending one of the participating General Practices in the R-BEAT Trial
- Attended at least one GP appointment within the past 12 months
- CHA2DS2-VASc Score >2
Exclusion Criteria:
Contraindication to oral anticoagulant therapy
- History of intracerebral haemorrhage
Prior intolerance or refusal of oral anticoagulant therapy
*(If intolerant or refused warfarin, may be included if considered suitable for non vitamin-K oral anticoagulant, NOAC)
- Gastrointestinal haemorrhage of unexplained or unmodifiable aetiology (i.e. risk of haemorrhage has not been reduced)
- Other major bleed that would exclude oral anticoagulant therapy
- Known Atrial fibrillation/flutter
- Currently prescribed oral anticoagulant therapy
- Unsuitable for anticoagulant therapy, in opinion of attending general practitioner
- Unsuitable for cardiac monitoring, in opinion of attending general practitioner
- Allergies to plasters or adhesives
- Has had cardiac monitoring for >48 hours within the last 12 months, has an implantable loop recorder, or scheduled to have cardiac monitoring/ILR.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Screening
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Immediate External Loop Recorder
Participants randomized to the Immediate External Loop Recorder group will be monitored for the duration of the first week of the study using the Novacor R-Test 4.
|
The R-Test 4 is an externally worn, re-usable, battery-powered, lightweight ECG monitor, which records events triggered by cardiac arrhythmias.
It is worn for 7 days.
Cardiac monitoring is triggered by tachycardia or detection of irregular pulses or patient may trigger recording, if the participant experience symptoms (e.g.
palpitations).
The patient wears 2 chest leads (on one, the R-Test device is attached, weight 42g).
The R-Test 4 is CE marked, and uses an FDA-approved algorithm for automatic detection of atrial fibrillation, and permits 5 minutes of pre-event recording and 5 minutes of post-event recording.
|
Other: Delayed External Loop Recorder
Participants randomized to the Delayed External Loop Recorder group will be monitored for the duration of the second week of the study using the Novacor R-Test 4.
|
The R-Test 4 is an externally worn, re-usable, battery-powered, lightweight ECG monitor, which records events triggered by cardiac arrhythmias.
It is worn for 7 days.
Cardiac monitoring is triggered by tachycardia or detection of irregular pulses or patient may trigger recording, if the participant experience symptoms (e.g.
palpitations).
The patient wears 2 chest leads (on one, the R-Test device is attached, weight 42g).
The R-Test 4 is CE marked, and uses an FDA-approved algorithm for automatic detection of atrial fibrillation, and permits 5 minutes of pre-event recording and 5 minutes of post-event recording.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
New detected (and centrally confirmed) cases of atrial fibrillation/flutter > 2 minutes
Time Frame: 2 years
|
New detected (and centrally confirmed) cases of atrial fibrillation/flutter > 2 minutes in duration using a built in diagnostic algorithm that identifies probable atrial fibrillation.
The identified instances will be reviewed by a cardiologist for confirmation of atrial fibrillation/atrial flutter
|
2 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Initiation of oral anticoagulation
Time Frame: 3 months
|
prescription
|
3 months
|
Collaborators and Investigators
Collaborators
Investigators
- Study Chair: Colin Hardy, BSc, Project Officer and Site Management Coordinator
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 17-CRFG 17
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Atrial Fibrillation and Flutter
-
Vivek ReddyEnrolling by invitationAtrial Fibrillation and Flutter | Atrial Flutter Typical | Atrial Fibrillation, Paroxysmal or PersistentUnited States
-
Angelo BivianoCompleted
-
Kaiser PermanenteActive, not recruitingAtrial Fibrillation and FlutterUnited States
-
Oman Medical Speciality BoardNot yet recruitingAtrial Fibrillation With Rapid Ventricular Response | Atrial Flutter With Rapid Ventricular ResponseOman
-
University of PennsylvaniaWithdrawnTypical Atrial Flutter | Risk Factors With Future Development of Atrial FlutterUnited States
-
Boston Scientific CorporationWithdrawnAtrial Tachycardia (Including Atrial Flutter) Post Atrial Fibrillation Ablation or Cardiac SurgeryChina
-
R-PharmFSBI "National Medical Research Center of Cardiology named after academician...CompletedAtrial Flutter | Paroxysmal Atrial Fibrillation | Persistent Atrial FibrillationRussian Federation
-
Johannes Gutenberg University MainzBoehringer Ingelheim; Atrial Fibrillation NetworkTerminatedAtrial Fibrillation or Atrial Flutter | Thrombosis of Left Atrial AppendageGermany
-
Adagio MedicalRecruitingAtrial Fibrillation | Atrial Flutter | Paroxysmal Atrial Fibrillation | Persistent Atrial FibrillationNetherlands, Germany, Belgium
-
Fundació Institut de Recerca de l'Hospital de la...RecruitingAtrial Arrhythmia | Atrial Fibrillation and Flutter | Atrial Fibrillation RecurrentSpain
Clinical Trials on R Test 4 External Loop Recorder
-
Medtronic BRCMedtronicCompletedPost MI Left Ventricular DysfunctionIndia
-
University of SurreyRoyal Surrey County Hospital NHS Foundation TrustCompletedStroke | Paroxysmal Atrial FibrillationUnited Kingdom
-
University of CalgaryNot yet recruiting
-
University College, LondonBarts & The London NHS TrustRecruitingHeart Failure | Aortic Stenosis | Non-Sustained VTUnited Kingdom
-
Newcastle-upon-Tyne Hospitals NHS TrustCompleted
-
Memorial Sloan Kettering Cancer CenterCompleted
-
University Hospital Hradec KraloveRecruitingBrain Damage | Hydrocephalus | General Anesthetics ToxicityCzechia
-
University of Alabama at BirminghamNational Heart, Lung, and Blood Institute (NHLBI)Recruiting
-
Children's Oncology GroupNational Cancer Institute (NCI)Active, not recruitingStage 4S Neuroblastoma | Ganglioneuroblastoma | Stage 2A Neuroblastoma | Stage 2B Neuroblastoma | Stage 3 Neuroblastoma | Stage 4 Neuroblastoma | Stage 1 Neuroblastoma | Stage 2 NeuroblastomaUnited States, Canada, Australia, New Zealand
-
Children's Oncology GroupNational Cancer Institute (NCI)CompletedRecurrent Neuroblastoma | Localized Resectable Neuroblastoma | Localized Unresectable Neuroblastoma | Regional Neuroblastoma | Stage 4S Neuroblastoma | Stage 4 NeuroblastomaUnited States, Canada, Australia, New Zealand, Puerto Rico, Switzerland