14-day AF screening no better than usual care in stroke prevention

Use of a 14-day continuous electrocardiographic monitor to screen for atrial fibrillation (AF) in older adults seen in primary care practices does not seem to result in fewer hospitalizations for stroke when compared with usual care, reports a recent study.

In this prospective, parallel-group, randomized controlled trial, the investigators determined whether screening for AF in individuals aged ≥70 years using a 14-day single-lead continuous electrocardiographic patch monitor could identify those with undiagnosed AF and prevent stroke. Participants were randomly assigned to screening or usual care. Intention-to-treat analysis was conducted.

Overall, 11,905 participants (median age 75 years, 56.6 percent female) were included in the intention-to-treat population. The COVID-19 pandemic led to premature termination of enrolment. The median follow-up was 15.3 months.

The risk of stroke was 0.7 percent in the screening group and 0.6 percent in the usual care group (hazard ratio [HR], 1.10, 95 percent confidence interval [CI], 0.69‒1.75), while the risk of bleeding was 1.0 percent and 1.1 percent, respectively (HR, 0.87, 95 percent CI, 0.60‒1.26).

In addition, AF diagnosis was 5 percent in the screening group and 3.3 percent in the usual care group, while the initiation of oral anticoagulation following randomization was 4.2 percent and 2.8 percent, respectively.

“Event rates were low, however, and the trial did not enroll the planned sample size,” according to the investigators.

“AF often remains undiagnosed, and it independently raises the risk of ischemic stroke, which is largely reversible by oral anticoagulation,” they noted.