Screening for atrial fibrillation in cancer: a randomised controlled clinical trial (SARIC)

Digital recruitment and prevalence of screen-detected atrial fibrillation in nationwide patch-based ECG screening: the NORSCREEN randomized clinical trial.

Screening for atrial fibrillation in older adults in primary care: a cross-sectional pilot study in Qatar

Background Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, and its prevalence is increasing in aging populations. It is a leading cause of acute stroke, heart failure, and other cardiovascular morbidities. AF is often asymptomatic and is frequently diagnosed late, typically after a patient presents with acute stroke. Early detection and treatment can prevent such life-threatening events, making AF screening a public health priority. However, diagnosing asymptomatic AF remains challenging. While international guidelines recommend AF screening, Qatar lacks documented prevalence data and formal screening programs. This study aimed to assess the feasibility of an AF screening program for older adults in Qatar. Methods A cross-sectional study was conducted among individuals aged ≥65 years registered with the Primary Health Care Corporation (PHCC)-Qatar, which serves approximately 70% of Qatar's population. A simple random sample of 139 to 385 individuals was determined to ensure a sampling error of 5% to 3%, assuming a 10% AF prevalence. The participants underwent screening via standard ECG tracing that were reviewed independently by both the family physicians and a cardiologist. Results The prevalence of AF among the study population was 5.4%. Newly diagnosed cases accounted for 2% of the 249 participants screened. All newly detected patients had CHA2DS2-VA scores indicating the need for anticoagulant therapy to reduce stroke risk. Furthermore, compared with cardiologists, the family physicians in primary care successfully identified 75% of AF cases through ECG. Conclusions If implemented nationally among individuals aged ≥65 years, the screening program could identify 747 undiagnosed AF cases among the 37,371. AF screening for individuals aged ≥75 years appears to provide an effective strategy for reducing the cost and supporting the implementation of a targeted screening strategy in Qatar.

Anticoagulation for Atrial Fibrillation with Intermediate Stroke Risk.

BACKGROUND Current U.S. and European guidelines recommend oral anticoagulation as a class IIa indication in patients with atrial fibrillation at intermediate risk for stroke; however, evidence from randomized trials is needed. METHODS We conducted a multicenter, open-label, adjudicator-masked superiority trial in South Korea involving patients with atrial fibrillation and an intermediate risk of stroke (a score of 1 in men and 2 in women on the CHA2DS2-VASc scale; range, 0 to 9, with higher scores indicating a greater risk of stroke). Patients were randomly assigned in a 1:1 ratio to receive either direct oral anticoagulant (DOAC) therapy or no anticoagulation. The primary end point was a composite of stroke, systemic embolism, major bleeding, or death from cardiovascular causes at 24 months. RESULTS Of 1803 patients who underwent randomization, 902 were assigned to receive DOAC therapy and 901 were assigned to receive no anticoagulant therapy. The mean age of the patients was 60.4 years, and 23.7% were women. At 24 months, a primary end-point event had occurred in 4 patients (cumulative incidence, 0.5%) in the DOAC group and in 13 (cumulative incidence, 1.5%) in the no-anticoagulant group (difference, -1.0 percentage points; 95% confidence interval [CI], -2.0 to -0.1; P = 0.03; hazard ratio, 0.31; 95% CI, 0.10 to 0.94). Stroke occurred in 3 patients (cumulative incidence, 0.3%) in the DOAC group and in 10 (cumulative incidence, 1.1%) in the no-anticoagulant group. The incidence of systemic embolism and major bleeding appeared to be similar in the two trial groups, and no deaths from cardiovascular causes occurred in either group. Serious adverse events occurred in 80 patients (8.9%) in the DOAC group and in 84 (9.3%) in the no-anticoagulant group. CONCLUSIONS Among patients with atrial fibrillation at intermediate risk for stroke, DOAC therapy led to a lower risk of stroke, systemic embolism, major bleeding, or death from cardiovascular causes at 24 months than no anticoagulation. (Funded by the Ministry of Health and Welfare, South Korea, and others; SINGLE-AF ClinicalTrials.gov number, NCT04437654.).

Risk-Guided Screening for Atrial Fibrillation Using Electronic Health Records

The EHR-based machine learning model, FIND-AF 2.0, identifies a high-risk subpopulation for AF diagnosis among patients at elevated risk of stroke and could enable scalable, EHR-driven, risk-guided AF screening.

Implantable Cardiac Monitoring for Atrial Fibrillation Detection in Patients with Stroke: A Systematic Review and Meta-Analysis

Background: Atrial fibrillation (AF) is a common but frequently undiagnosed cause of ischemic stroke, particularly among patients with cryptogenic stroke and embolic stroke of undetermined source (ESUS). Implantable cardiac monitors (ICMs) enable prolonged continuous rhythm monitoring and may improve AF detection following ischemic stroke or transient ischemic attack (TIA). This systematic review and meta-analysis aimed to evaluate the diagnostic yield, clinical impact, and safety of prolonged ICM monitoring in patients with ischemic stroke or TIA. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines and registered with PROSPERO (CRD42024573913). PubMed, Google Scholar, and the Cochrane Library were systematically searched. Randomized controlled trials and observational studies evaluating the use of ICMs after ischemic stroke or TIA were included. Randomized evidence was synthesized narratively, whereas single-arm random-effects meta-analyses of observational studies were performed to estimate pooled proportions for AF detection, oral anticoagulation initiation, recurrent ischemic stroke or TIA, and device-related adverse events. Results: Twelve completed studies involving 4563 participants met the inclusion criteria, including two randomized controlled trials and ten observational studies. One additional ongoing randomized controlled trial (Find-AF 2) involving a planned enrollment of 5200 participants was identified and is described narratively. Across the observational studies, the pooled AF detection rate during prolonged ICM monitoring was 25.9% (95% CI, 18.9–33.5%), although substantial heterogeneity was observed (I2 = 95%). Oral anticoagulation was initiated in 94.2% (95% CI, 79.4–100.0%) of patients diagnosed with AF. Device-related complications were uncommon, with a pooled incidence of 3.7% (95% CI, 2.0–6.0%; I2 = 0%), while the pooled rate of recurrent ischemic stroke or TIA during follow-up was 6.2% (95% CI, 3.9–9.2%). Narrative synthesis of the randomized evidence demonstrated that ICMs significantly increased AF detection compared with conventional monitoring but did not demonstrate a significant reduction in recurrent stroke during the available follow-up period. Conclusions: Prolonged implantable cardiac monitoring identifies AF in approximately one-quarter of patients following ischemic stroke or TIA and frequently leads to the initiation of oral anticoagulation, with a favorable safety profile. Although ICMs substantially improve AF detection, current evidence remains insufficient to confirm that increased detection translates into a reduction in recurrent stroke. Large, adequately powered randomized controlled trials are needed to determine the long-term clinical benefits of ICM-guided management and to define the optimal monitoring strategy for patients following ischemic stroke.

Anticoagulation in cancer patients with atrial fibrillation: recent advances.

Atrial fibrillation (AF) and cancer frequently coexist, particularly in elderly patients, creating a complex clinical scenario with both increased thromboembolic and hemorrhagic risk. In these patients, in addition to established risk factors, cancer-related factors, such as thrombocytopenia, organ dysfunction, and drug-drug interactions, should be considered when managing anticoagulant treatment. Despite the growing prevalence of this clinical overlap, cancer patients have been under-represented in randomized controlled trials of direct oral anticoagulants for AF. Consequently, evidence guiding anticoagulation decisions in this population derives largely from post-hoc analyses and observational studies. The CHA₂DS₂-VA(Sc) and HAS-BLED scores, widely used for thromboembolic and bleeding risk stratification in the general AF population, have demonstrated suboptimal predictive performance in cancer patients, underscoring the need for a risk factor based approach specific for cancer patients. Emerging data consistently suggest that direct oral anticoagulants (DOACs) are at least as effective and safe as vitamin K antagonists (VKAs) in cancer patients with AF, with potential advantages in reducing stroke, major and intracranial bleeding, and mortality. However, DOACs use is still debated in some settings such as gastrointestinal and genitourinary cancer, brain metastasis and in case of strong drug-drug interactions. This review summarizes current evidence on ischemic and bleeding risk assessment in cancer patients with AF, evaluates the performance of existing risk stratification tools, identifies cancer-specific bleeding risk factors, and proposes a practical management algorithm for anticoagulation in this challenging population.