ROUTINE screening for Helicobacter pylori infection using a urea breath test in patients hospitalised with acute myocardial infarction did not significantly reduce the risk of upper gastrointestinal bleeding, according to the HELP-MI SWEDEHEART trial. The study followed over 18,000 patients and found no significant benefit from adding routine screening to standard care.
Upper gastrointestinal bleeding is a recognised complication in patients recovering from heart attacks, often exacerbated by antithrombotic therapies. Helicobacter pylori, a common gastric infection, is a well-established risk factor for peptic ulcers and bleeding, making it a potential target for intervention. However, whether universal screening for H. pylori should be part of standard care for heart attack patients has not been settled due to limited clinical trial evidence.
The nationwide Swedish cluster randomised crossover trial enrolled 18,466 patients admitted for myocardial infarction across 35 hospitals. Hospitals were randomised to either implement routine H. pylori screening with the urea breath test or continue with usual care for a year, then switch after a washout period. During screening, 70 percent of patients were tested, and 24 percent tested positive for H. pylori. Patients were observed for a median of 1.9 years. The primary outcome, upper gastrointestinal bleeding, occurred at rates of 16.8 events per 1,000 person-years in the screening group and 19.2 in the control group, a non-significant difference (rate ratio 0.90, p=0.18). Subgroup analysis hinted at some benefit among those with more severe anaemia, but this was not conclusive.
For clinicians, these results indicate that routine H. pylori screening after myocardial infarction cannot be recommended for all patients, as it does not meaningfully lower the risk of gastrointestinal bleeding. The findings reinforce the importance of targeting preventative interventions to higher-risk groups, such as patients with significant anaemia or gastrointestinal history, and individualising care to optimise safety and outcomes.
Reference
Hofmann R et al. Helicobacter pylori screening after acute myocardial infarction: the cluster randomized crossover HELP-MI SWEDEHEART trial. JAMA. 2025;DOI:10.1001/jama.2025.15047.
