Screening for Atrial Fibrillation in the Older Population: A Randomized Clinical Trial

Area of Science:

• Cardiology
• Preventive Medicine
• Medical Devices

Background:

• Atrial fibrillation (AF) is a primary cause of preventable strokes.
• Screening asymptomatic individuals for AF can enhance anticoagulant use for stroke prevention.

Purpose of the Study:

• To evaluate two distinct home-based AF screening interventions.
• To assess the efficacy of continuous electrocardiographic (cECG) patch monitors and automated home blood pressure (BP) machines for AF detection.

Main Methods:

• A multicenter randomized clinical trial involving 856 participants aged 75+ with hypertension, randomized to standard care or screening.
• The screening group utilized a 2-week cECG patch monitor and automated BP machines for twice-daily AF screening.
• Primary outcome was AF detection via cECG or clinical diagnosis within 6 months.

Main Results:

• AF detection was significantly higher in the screening group (5.3%) compared to the control group (0.5%), a tenfold increase (RR, 11.2; P<.001).
• Anticoagulant therapy was initiated in 75% of patients with cECG-detected AF, with overall prescription rates higher in the screening group (4.1% vs 0.9%; P=.003).
• Home BP monitor screening demonstrated lower sensitivity (35.0%) and positive predictive value (8.9%) for detecting paroxysmal AF compared to cECG.

Conclusions:

• Home-based AF screening with wearable cECG monitors is well-tolerated and significantly improves AF detection in older adults with hypertension.
• This screening method prompts timely initiation of anticoagulant therapy, potentially reducing stroke risk.
• Continuous ECG monitoring is superior to intermittent oscillometric screening for detecting paroxysmal AF; further trials are needed to confirm clinical benefits and harms.