- Question
- Does remote screening for asymptomatic atrial fibrillation (AF) with a 14-day ECG patch increase long-term AF detection and anticoagulation use in older adults at moderate to high stroke risk, compared with usual care?
- Design
- Parallel-group, unblinded, remote randomized clinical trial of 5040 participants recruited from 27 UK primary care practices between May 2019 and February 2022. Last follow-up was in August 2024, with intention-to-treat analysis.
- Population
- Individuals aged 65 years or older with a CHA2DS2VASc score of 3 or higher (men) or 4 or higher (women) and no prior AF or atrial flutter, identified through automated electronic health record searches. Mean age was 78 years and 47% were women.
- Intervention
- Receiving and returning by postal mail a 14-day continuous ambulatory ECG patch monitor (2520 participants).
- Control
- Usual care (2520 participants).
- Primary outcome
- Proportion of participants with AF recorded in primary care records within 2.5 years after randomization.
- Results
- At 2.5 years, AF was recorded in 172 participants (6.8%) in the intervention group vs 136 (5.4%) in the control group (ratio of proportions 1.26; 95% CI 1.02-1.57; P = 0.03). Mean oral anticoagulation exposure was 1.63 months vs 1.14 months (difference 0.50 months; 95% CI 0.24-0.75; P < 0.001).
- Safety
- Stroke occurred in 69 participants (2.7%) in the intervention group and 64 (2.5%) in the control group (rate ratio 1.08; 95% CI 0.76-1.53), with no clear difference, though this was an exploratory outcome.
- Conclusion
- Mail-based AF screening with an ECG patch in older adults at moderate to high stroke risk led to a modest increase in AF diagnosis at 2.5 years.
- Why it matters
- It provided randomized evidence on remote AF screening in primary care, showing it increases diagnosis and anticoagulation, although an effect on stroke could not be established in this trial.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026