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Updated: Sep 9, 2025

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Remote Screening for Asymptomatic Atrial Fibrillation: The AMALFI Randomized Clinical Trial.

Rohan Wijesurendra1, Guilherme Pessoa-Amorim1, Georgina Buck1

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Summary
This summary is machine-generated.

Screening older adults at high stroke risk with ECG patches modestly increased atrial fibrillation (AF) detection over 2.5 years. This AF screening also led to greater oral anticoagulation use compared to usual care.

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Area of Science:

  • Cardiology
  • Public Health
  • Clinical Trials

Background:

  • Atrial fibrillation (AF) is a major cause of stroke.
  • Early detection and anticoagulation can mitigate stroke risk.
  • Screening strategies are crucial for identifying asymptomatic AF in at-risk populations.

Purpose of the Study:

  • To evaluate the long-term effectiveness of AF screening using 14-day, patch-based ambulatory ECG monitoring in older individuals at moderate to high stroke risk.
  • To determine if screening increases AF detection and anticoagulation use compared to usual care.

Main Methods:

  • A remote, randomized clinical trial involving 5040 participants aged 65+ with CHA2DS2VASc scores indicating moderate to high stroke risk.
  • Participants were randomized to receive an ECG patch monitor for 14-day monitoring or usual care.
  • Primary outcome was the proportion of participants with a post-randomization AF diagnosis within 2.5 years.

Main Results:

  • AF was detected in 4.2% of participants via the ECG patch.
  • A post-randomization AF diagnosis occurred in 6.8% of the intervention group versus 5.4% of the control group (ratio of proportions, 1.26; P=.03).
  • Mean oral anticoagulation exposure was significantly higher in the intervention group (1.63 months) compared to the control group (1.14 months; P<.001).

Conclusions:

  • Mail-based AF screening with ECG patches in older, high-stroke-risk individuals results in a modest but statistically significant increase in AF diagnosis over 2.5 years.
  • The screening strategy also enhances the use of oral anticoagulation.
  • These findings support the utility of patch-based ECG monitoring for long-term AF detection in primary care settings.