London, United Kingdom 2013 18 Stroke prevention B 17:20 - 17:30 Factors influencing uptake of atrial fibrillation screening aiming at stroke prevention: geo-mapping of target population and non-participation J. Engdahl1, A. Holmén2, M. Rosenqvist3, U. Strömberg4 Dept of Medicine, Halland Hospital, Halmstad, SWEDEN1,Department of Research and Development, Halland Hospital, Halmstad, SWEDEN2, Department of Clinical Science and Education, Karolinska Institute, Danderyds Hospital, Stockholm, SWEDEN3, Department of Research and Development, Halland Hospital, Halmstad, SWEDEN4 Background: Atrial fibrillation (AF) is the most frequently encountered clinical arrhythmia and a frequent source of cardiac emboli in ischemic stroke. Oral anticoagulation therapy lowers stroke risk in AF patients by two thirds. However, AF is often present without symptoms. In a screening study for silent atrial fibrillation, the proportion of non-participants was consid-erable and their clinical profile differed from the participants’ profile. We addressed screening uptake. Method: In the municipality of Halmstad, Sweden, all residents born in 1934-1935 were invit-ed to the screening study during April 2010 to February 2012. The total study group included 848 participants and 367 non-participants from 12 parishes. Geo-maps displaying participation, along with target-population-based geo-maps displaying proportion of immigrants and ischemic stroke incidence, were used. Results: Smoothed non-participation ratios (SmNPR) varied from 0.81 to 1.24 across different parishes (SmNRP = 1 corresponds to the expected participation based on the total study group) (Figure 1). Among high risk individuals, the geographical variation was more pronounced (SmNPR range 0.75–1.51) (Figure 2). Two parishes with higher share of immigrants and ele-vated population-based ischemic stroke incidence showed markedly lower participation, partic-ularly among high-risk individuals. Participation was lower in parishes with the highest stroke incidence. Conclusion. Participation in a screening study for AF in a 75-year old population showed a markedly geographical variation, associated with proportion of immigrants as well as stroke incidence. Geo-mapping of target population and non-participation yielded useful information needed to intervene for improved screening uptake. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 163 17 Stroke prevention B 17:10 - 17:20 Barcelona-AsIA (Asymptomatic Intracranial Atherosclerosis) study: REGICOR, Inti-ma- media thickness and ankle-arm index as predictors of asymptomatic cervicocerebral atherosclerosis E. López-Cancio1, L. Dorado2, M. Jiménez3, M. Hernández4, M.T. Alzamora5, A. Suñol6, M. Gomis7, N. Pérez de la Ossa8, M. Millán9, A. Dávalos10, J.F. Arenillas11 Department of Neurosciences, Stroke Unit, Germans Trias i Pujol University Hospital, Badalona, SPAIN1,Department of Neurosciences, Stroke Unit, Germans Trias i Pujol Univer-sity Hospital, Badalona, SPAIN2, Department of Neurosciences, Stroke Unit, Germans Trias i Pujol University Hospital, Badalona, SPAIN3, Department of Neurosciences, Stroke Unit, Germans Trias i Pujol University Hospital, Badalona, SPAIN4, Primary Healthcare Research Support Unit Metropolitana Nord, ICS-IDIAP Jordi Gol,, Mataró, SPAIN5, Department of Neu-rosciences, Stroke Unit, Germans Trias i Pujol University Hospital, Badalona, SPAIN6, De-partment of Neurosciences, Stroke Unit, Germans Trias i Pujol University Hospital, Badalona, SPAIN7, Department of Neurosciences, Stroke Unit, Germans Trias i Pujol University Hospital, Badalona, SPAIN8, Department of Neurosciences, Stroke Unit, Germans Trias i Pujol Universi-ty Hospital, Badalona, SPAIN9, Department of Neurosciences, Stroke Unit, Germans Trias i Pujol University Hospital, Badalo-na, SPAIN10, Stroke Unit. University Hospital of Valladolid, Valladolid, SPAIN11 BACKGROUND: Cervico-cerebral atherosclerosis (CCA) is one of the most important causes of stroke. However, diagnosis of CCA is usually made after stroke and therefore, primary pre-vention strategies are rarely applied. Primary prevention requires the identification of factors that can discriminate in-risk asymptomatic subjects. This subestudy of AsIA project assessed the predictive value of vascular risk function REGICOR (Framingham function validated for Spanish population), intima-media thickness (IMT) and ankle-arm index (AAI) in the detection of subjects with subclinical carotid and intracranial atherosclerosis. METHODS: From our ref-erence population, we selected a random sample of 933 subjects (64% men, mean age 66 years) without prior stroke and with a moderate-high vascular risk (REGICOR>5). Presence and de-gree of carotid and intracranial atherosclerosis were screened with cervical and transcranial ECO-Doppler, being stenosis> 50% confirmed by Magnetic Resonance Angiography. Potential risk factors for atherosclerosis were defined as follows: REGICOR ≥ 10, IMT ≥ 0.9 mm and AAI ≤ 0.9. We performed adjusted logistic regression analyses including the three factors in the same model. RESULTS: Subclinical CCA of any degree was present in 52% of subjects and 6% had a significant carotid and/or intracranial stenosis>50% (SCCA). REGICOR≥10, high IMT and low AAI were independently associated with the presence of CCA of any degree (OR 1.63, 1.96 and 2.64 respectively, all p<0.01). Low AAI was independently associated with the pres-ence of a SCCA (OR 5.45 (2.78-10.67), p<0.001). CONCLUSION: We identified useful and non-invasive tools in the prediction of subclinical carotid and intracranial atherosclerosis in our population. AAI measurement seems to discriminate in-risk subjects even better than classical vascular functions. These findings may contribute to the development of primary prevention strategies in the stroke field.
Karger_ESC London_2013
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