Digital recruitment and prevalence of screen-detected atrial fibrillation in nationwide patch-based ECG screening: the NORSCREEN randomized clinical trial.
Boskovic M, Haraldsen M, et al. • 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
The NORSCREEN trial demonstrates that fully digital, large-scale, site-less AF screening is feasible and effective in an at-risk population, identifying previously undiagnosed AF in 1.9% of screened individuals and showing high adherence to therapeutic recommendations.
Key Findings
Results
A fully digital recruitment strategy successfully invited over half a million Norwegian residents and enrolled approximately 50,000 participants into a randomized AF screening trial.
551,555 Norwegian residents were digitally invited to participate
139,596 (25.3%) completed the digital eligibility assessment
74,956 (53.7%) of those assessed were found eligible
50,549 (67.4%) of eligible individuals were randomized to screening or usual care
Exclusion criteria included prior AF, anticoagulation use, implantable cardiac electronic devices, or lack of smartphone access
Results
Previously undiagnosed atrial fibrillation was identified in 1.9% of screened participants using a 7-day patch-based ECG sensor.
382 out of screened participants were found to have previously undiagnosed AF, representing a prevalence of 1.9%
Screening involved a mailed patch-based electrocardiogram sensor for site-less continuous monitoring over 7 days
19,723 (78.1%) of participants allocated to screening completed the study procedures
The study population had a median age of 75 years (IQR: 69–78) and a mean CHA2DS2-VA risk score of 2.6 ± 0.9
Results
The vast majority of participants with screen-detected AF initiated anticoagulation therapy following a recommendation to contact their general practitioner.
366 of 382 participants (95.8%) with newly diagnosed AF initiated anticoagulation therapy
Participants were advised to contact their general practitioner to initiate appropriate therapy after AF diagnosis
This finding reflects high initial adherence to therapeutic recommendations following screen-detected AF
Results
The trial population was predominantly older adults with elevated stroke risk, including a near-equal sex distribution.
Median age was 75 years (IQR: 69–78)
23,445 participants (46.4%) were female
Mean CHA2DS2-VA risk score was 2.6 ± 0.9
Eligibility required age ≥65 years with ≥1 additional risk factor for stroke and no prior AF diagnosis
Background
The NORSCREEN trial used a fully digital, site-less design to overcome resource and logistical demands typical of conventional AF screening modalities.
Recruitment was conducted digitally from the general Norwegian population
Patch-based ECG sensors were mailed directly to participants, enabling site-less monitoring
The randomized controlled design allocated participants 1:1 to screening or usual care
The trial was registered under NCT05914883
What This Means
This research describes the NORSCREEN trial, a large Norwegian study that tested whether it is possible to screen hundreds of thousands of people for an irregular heart rhythm called atrial fibrillation (AF) using a fully digital and remote approach. People aged 65 and older with at least one additional stroke risk factor were invited by digital means, completed online eligibility checks, and those who qualified were randomly assigned either to receive a wearable heart monitor patch by mail or to continue with their usual medical care. The patch recorded their heart rhythm continuously for 7 days without any need to visit a clinic.
The study found that 1.9% of the people who completed screening were found to have AF that had not been previously diagnosed. This is notable because AF significantly raises the risk of stroke, and most of these individuals — nearly 96% — went on to start blood-thinning medication (anticoagulation therapy) after being told to consult their doctor. The digital recruitment process successfully engaged millions of people, with roughly one in four invited individuals completing the eligibility assessment and about two-thirds of eligible people agreeing to participate.
This research suggests that large-scale, fully remote AF screening programs are practical and can reach a high-risk population without requiring participants to visit hospitals or clinics. The high rate of medication uptake among those newly diagnosed with AF indicates that people are responsive to acting on screening results when provided with guidance. These findings may have implications for how future population-level heart rhythm screening programs are designed and delivered.
Boskovic M, Haraldsen M, Berge T, Grenne B, Skretteberg P, Engdahl J, et al.. (2026). 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. https://doi.org/10.1093/europace/euag140