REMOTE screening for asymptomatic atrial fibrillation (AF) through a patch-based continuous ambulatory ECG monitor could help increase AF diagnosis in individuals at moderate to high risk of stroke. If this leads to increased long-term AF detection and anticoagulation use, it could reduce stroke occurrences.
This parallel-group, unblinded, remote RCT included 5,040 individuals 65 years or older (mean age: 78 years) with a CHA2DS2VASc score of 3 or higher (men) or 4 or higher (women) and no history of AF or atrial flutter. They were randomised to usual care (control; n=2,520) or an ECG patch monitor received and returned by postal mail and used for 14 days (intervention; n=2,520). The median CHA2DS2VASc score was 4 and 47% were female.
A total of 2,126 participants used the patch, leading to detection of AF in 89 participants (4.2%), with 55% having an AF burden lower than 10%. A post-randomisation record showed that 172 individuals had AF after 2.5 years in the intervention group, compared to 136 in the control group (ratio of proportions: 1.26; 95% CI: 1.02–1.57; P=0.03). Furthermore, by 2.5 years, mean exposure to oral anticoagulation was 1.63 months (95% CI: 1.50–1.76) in the intervention group versus 1.14 months (95% CI: 1.01–1.26) in the control group (difference: 0.50 months; 95% CI: 0.24–0.75; P<0.001). A total of 69 participants in the intervention group (2.7%) and 64 in the control group (2.5%) had a stroke (rate ratio: 1.08; 95% CI: 0.76–1.53). The patches also picked up other serious heart rhythm problems, such as advanced heart block and sustained ventricular tachycardia, which were fed back urgently to GPs and promptly treated.
Researchers concluded that AF screening with an ECG patch led to a modest increase in AF diagnosis at 2.5 years, although this may have a limited impact on stroke events.
Reference
Wijesurendra R et al. Remote screening for asymptomatic atrial fibrillation. JAMA. 2025;DOI:10.1001/jama.2025.15440.
