{"id":"5e0c4772bd1c","type":"article","url":"https://hartvaat.nl/2025/10/21/amalfi-remote-screening-voor-asymptomatisch-af-gerandomiseerde-trial/","title":"AMALFI: remote screening voor asymptomatisch AF — gerandomiseerde trial","title_en":"Remote Screening for Asymptomatic Atrial Fibrillation: The AMALFI Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["primaire-preventie"],"journal":"JAMA","doi":"10.1001/jama.2025.15440","source_url":"https://doi.org/10.1001/jama.2025.15440","authors":["Rohan Wijesurendra","Guilherme Pessoa-Amorim","Georgina Buck","Charlie Harper","Richard Bulbulia","Alison Offer","Nicholas R Jones","Christine A'Court","Rijo Kurien","Karen Taylor","Barbara Casadei","Louise Bowman"],"significance":7,"published":"2025-10-21","source_date":"2025-10-21","image":"","kennis":[],"congress":"","summary_en":"The AMALFI trial evaluated remote AF screening using wearable devices in the general population, providing data on the feasibility, detection yield, and downstream clinical impact of technology-enabled arrhythmia screening.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T13:30:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De AMALFI-trial onderzocht remote AF-screening in de algemene populatie. De resultaten informeren de implementatie en kosteneffectiviteit van grootschalige AF-screening.","abstract_original":"IMPORTANCE: Screening for atrial fibrillation (AF) might reduce stroke if it increases long-term AF detection and anticoagulation use compared with usual care. OBJECTIVE: To investigate the long-term efficacy of AF screening in older individuals at moderate to high risk of stroke using 14-day, patch-based continuous ambulatory electrocardiogram (ECG) monitoring. DESIGN, SETTING, AND PARTICIPANTS: A parallel-group, unblinded, remote randomized clinical trial recruiting from 27 UK primary care practices from May 2, 2019, to February 28, 2022. All eligible individuals 65 years or older with a CHA2DS2VASc score of 3 or higher (men) or 4 or higher (women) with no previous AF or atrial flutter were identified via automated electronic health record searches. Last follow-up was on August 29, 2024, and statistical analysis was conducted from May to July 2025. INTERVENTION: Participants were randomized to receive and return an ECG patch monitor by postal mail (intervention, n = 2520) or usual care (control, n = 2520). MAIN OUTCOMES AND MEASURES: Intention-to-treat analysis of the proportion of participants with AF recorded in primary care records within 2.5 years postrandomization. Exploratory outcomes included exposure to oral anticoagulation and stroke. RESULTS: Of the 22 044 individuals invited, 5040 (22.9%) were randomized. The participants' mean (SD) age was 78 (6) years, 47% were female, and the median (IQR) CHA2DS2VASc score was 4 (3-5). A total of 2126 participants (84.4%) wore and returned the patch. AF was detected by patch in 89 participants (4.2%), 55% of whom had an AF burden less than 10%. After 2.5 years, a postrandomization record of AF was present in 172 individuals (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 = .03), with consistent results in prespecified subgroups. Mean exposure to oral anticoagulation by 2.5 years was 1.63 months (95% CI, 1.50-1.76) in the intervention group and 1.14 months (95% CI, 1.01-1.26) in the control group (difference, 0.50 months [95% CI, 0.24-0.75]; P < .001). 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]). CONCLUSIONS AND RELEVANCE: In this remote randomized clinical trial, mail-based AF screening with an ECG patch in older patients at moderate to high risk of stroke led to a modest long-term increase in AF diagnosis at 2.5 years. TRIAL REGISTRATION: ISRCTN Identifier: 15544176."}