Amalfi Trial Finds Small Increase In Af Diagnosis With Mail-based Ecg Patch Monitoring

A mail-based atrial fibrillation (AF) screening programme pinch ECG-patch monitoring led to a humble semipermanent summation successful AF test and anticoagulation vulnerability successful older patients astatine moderate-to-high changeable risk, according to a late-breaking proceedings presented successful a Hot Line convention coming astatine ESC Congress 2025 and simultaneously published successful JAMA (The Journal of nan American Medical Association).

Explaining nan rationale, AMALFI Chief Investigator, Professor Louise Bowman, from Oxford Population Health, United Kingdom, said: "AF is associated pinch an accrued consequence of stroke, but AF tin beryllium difficult to observe arsenic it often occurs without symptoms and/or infrequently. Screening for AF has been projected arsenic a measurement to forestall strokes but galore short aliases infrequent asymptomatic AF episodes whitethorn beryllium missed. The advent of caller monitoring exertion has enabled longer-duration screening. The AMALFI proceedings was designed to measure nan semipermanent efficacy of distant screening for asymptomatic AF successful older individuals astatine accrued consequence of changeable utilizing a 14-day continuous ECG monitoring patch."

In nan investigator-initiated, parallel-arm unblinded randomized controlled AMALFI trial, eligible individuals were identified from 27 superior attraction practices successful nan UK via automated physics wellness grounds searches. Participants were aged ≥65 years pinch a CHA2DS2VASc changeable consequence people ≥3 for men aliases ≥4 for women. The cardinal removal criterion was a erstwhile test of AF aliases atrial flutter.

Participants were randomized 1:1 either to person and return by postal message an ECG spot show aliases to accustomed attraction (control). The superior result was nan proportionality of participants pinch nan beingness of AF successful superior attraction records wrong 2.5 years aft randomization, which was analysed utilizing an intention-to-treat approach.

A full of 5,040 individuals were randomized. At baseline, participants had a mean property of 78 years, 47% were female and 19% had a anterior changeable aliases transient ischaemic attack.

There was a humble summation successful AF test astatine 2.5 years pinch nan ECG patch. A post-randomization superior attraction grounds of AF was coming successful 6.8% of individuals successful nan involution limb and 5.4% successful nan power limb (ratio of proportions 1.26; 95% assurance interval [CI] 1.02 to 1.57; p=0.03). Patch-detected AF load was bimodally distributed, pinch 33% of cases having 100% load (the full monitoring play was spent successful AF), while 55% had an AF load <10%.

At 2.5 years, mean vulnerability to oral anticoagulation was 1.63 months successful nan involution limb and 1.14 months successful nan power limb (difference 0.50 months; 95% CI 0.24 to 0.75; p<0.0001). Stroke occurred successful 2.7% of participants successful nan involution limb and 2.5% successful nan power limb (event complaint ratio 1.08; 95% CI 0.76 to 1.53).

Our proceedings shows that distant AF screening pinch an ECG spot show successful older patients astatine moderate-to-high changeable consequence leads to a humble summation successful AF test and anticoagulation exposure. However, AF test unrelated to nan spot occurred much commonly than anticipated and complete half of nan patch-detected AF load was debased load (below 10%). This suggests that AF screening successful this mounting whitethorn person constricted effect connected changeable events; longer-term and cost-effectiveness analyses of AMALFI are planned and will supply much penetration successful owed course."

Doctor Rohan Wijesurendra, AMALFI Investigator, Oxford Population Health