All subjects will receive the invitation via mail, including information and instructions to download an app onto their smartphones. The app will enable participants to carry out the home-based tests, including the heart rhythm test to check for the heart rhythm disorder atrial fibrillation. Participants are also instructed to collect a urine sample and send this sample via the mail to the laboratory for the analyses of albuminuria, as indicator of chronic kidney disease. In addition, a subset of participants will be asked to complete a short questionnaire via the app.
All participants with a positive home-based screening test will be invited for a detailed follow-up examination at a regional diagnostic center to identify cardiovascular diseases, chronic kidney disease, type 2 diabetes, and their risk factors. The diagnostic procedures will include physical measurements (such as anthropometrics and blood pressure), blood tests (including lipid profile, glucose, HbA1c, creatinine, and NT-proBNP), urine tests (albumin-to-creatinine ratio), an ECG, and a questionnaire.
Participants with abnormalities detected during the diagnostic screening will be referred to their general practitioners for appropriate care, including lifestyle advice and/or medication. To address the low participation in the care phase observed in previous studies and to alleviate the burden on primary care, an alternative care pathway will also be assessed. In this pathway, participants will receive treatment at a regional treatment facility as part of the screening process.
Home-based screening tests
Several home-based screening tests will be implemented in the screening program. In the first region, region Breda, we will start with the following tests:
The PeeSpot urine collection device.
Standard strategy versus alternative strategies
In the three phases of the study, a distinction is made between standard screening strategies and alternative strategies. Standard screening strategies include established techniques that can be implemented in practice based on previous research, while the alternative strategies involve more innovative methods that, for example, still need to be developed or validated in a specific population, which will occur as part of the project.
