# AMALFI: remote screening voor asymptomatisch AF — gerandomiseerde trial

*geplaatst 2025-10-21 · Atriumfibrilleren · JAMA · doi 10.1001/jama.2025.15440 · https://hartvaat.nl/2025/10/21/amalfi-remote-screening-voor-asymptomatisch-af-gerandomiseerde-trial/*

De AMALFI-trial onderzocht remote AF-screening in de algemene populatie. De resultaten informeren de implementatie en kosteneffectiviteit van grootschalige AF-screening.

## English: Remote Screening for Asymptomatic Atrial Fibrillation: The AMALFI Randomized Clinical Trial.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: JAMA, https://doi.org/10.1001/jama.2025.15440. Bijgewerkt 2026-07-03T13:30:55Z. 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.