Atrial fibrillation screening: beneficial in high-risk patients

In the CONSIDERING-AF trial, atrial fibrillation (AF) screening was successful in identifying de novo AF in high-risk patients. Significantly more patients with risk factors in the AF screening group compared with standard-of-care in the general population (≥65 years) had de novo AF after 6 months (P<0.001). The incidence of AF in the high-risk screening group was more than 3 times greater than in the general screening group.

AF confers an increased risk of mortality, stroke, heart failure, and cognitive decline [1]. There is growing interest in AF screening; however, the most suitable population and device for AF detection remain to be explored. Therefore, Dr Emma Sandgren (Karolinksa Institutet Danderyd Hospital, Stockholm, Sweden) and her team wanted to evaluate in the CONSIDERING-AF trial (NCT05838781), whether it is beneficial to perform an AF screening in the elderly (≥65 years) [2]. All inhabitants in the region of Halland (Sweden) in this age group but without diagnosed AF were included in this randomised, controlled, non-blinded trial and divided in 4 parallel arms. The researchers compared AF screening (14 days of continuous ECG patch) versus standard-of-care (n=740 per arm) in both the general population and patients with risk factors (according to a risk-prediction model (RPM). Primary outcome was defined as the incident AF in the different groups [1].

The RPM cohort was older and had more risk factors compared with the general cohort. The participation rate was remarkably high in the study: 44% in the group without risk factors and 41% in the high-risk group. The primary outcome, defined as the incident AF recorded after 6 months, was significantly different between groups: 3.8% of patients in the high-risk intervention group compared with 0.7% in the general control group had incident AF (P< 0.001). As Dr Sandgren pointed out, the results of the per-protocol analysis showed that the risk model was successful in identifying participants at risk.

Prof. Jeff Healey (Population Health Research Institute, Hamilton, Canada), the discussant of the trial, emphasised that there is a lot of interest in screening for AF to prevent stroke amongst other things, but the effect will be small. “So, it becomes really important to drill down into the highest risk populations, in both risk of having the condition atrial fibrillation but also the risk of having the complications like stroke”, he commented. Indeed, in CONSIDERING-AF incidence of AF in the high-risk screening group was more than 3 times greater than in the general screening group.

In summary, CONSIDERING-AF showed that the combination of the risk-prediction model and long-term ECG recording was superior to the standard of care in identifying de novo AF.

1. Etminani F, et al. BMJ Open 2024;14:e080639.
2. Sandgren E, et al. DeteCtiON and Stroke PreventIon by MoDEl ScRreenING for Atrial Fibrillation. Late-breaking science 3, EHRA 2025, 30 March –01 April, Vienna, Austria.

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Posted on 6 May 20256 May 2025