Digital recruitment and compliance to treatment recommendations in the Norwegian Atrial Fibrillation self-screening pilot study

Atrial fibrillation (AF) is prevalent, undiagnosed in approximately one-third of cases, and is associated with severe complications. Guidelines recommend screening individuals at increased risk of stroke. This report evaluated the digital recruitment procedure and compliance with the follow-up recommendations in participants with screen-detected AF in the Norwegian Atrial Fibrillation self-screening pilot study. Norwegians ≥65 years were invited through Facebooks posts, web pages and newspapers to participate in the study. Targeted Facebook posts promoted over 11 days reached 84,208 users, and 10,582 visitors to the study homepage. This accounted for 51% of the total homepage visitors (n=20,704). A total of 2,118 (10%) of the homepage visitors provided digital consent to participate after they met the inclusion criteria. The mean (SD) age of the participants was 70 (4) years, and the majority (n=1,569 (74%)) were women. A total of 1,849 (87%) participants completed the ECG self-screening test, identifying AF in 41 (2.2%) individuals. Of these, 39 (95%) participants consulted a general practitioner (GP), and 34 (83%) participants initiated anticoagulation therapy. Digital recruitment and inclusion in digital AF screening with a high rate of initiation of anticoagulation therapy in AF positive screening cases are feasible. However, digital recruitment and inclusion may introduce selection bias with regard to age and gender. Larger studies are needed to determine the efficacy and cost-effectiveness of a fully digital AF screening.