The Lead Episode 127: A Discussion of Remote Screening for Asymptomatic Atrial Fibrillation: The AMALFI Randomized Clinical Trial, LIVE at HRX 2025-A Discussion of Remote Screening for Asymptomatic Atrial Fibrillation: The AMALFI Randomized Clinical Trial (Bonus Video)

A Discussion of Remote Screening for Asymptomatic Atrial Fibrillation: The AMALFI Randomized Clinical Trial (Bonus Video)

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Video Summary

In this episode of The LEAD Podcast, experts Melissa Middeldorp, Emma Svenberg, and Rod Pasman discuss the MALFI randomized clinical trial on remote screening for asymptomatic atrial fibrillation (AF) in high-risk adults aged 65+ with CHADS-VA scores ≥3. The UK-based trial mailed 14-day ECG patches to participants, achieving high adherence and detecting 6.8% new AF in the screening group versus 5.7% in controls. Despite the modest difference in detection rates, screening led to earlier AF diagnosis, potentially allowing for earlier intervention. The speakers highlight strengths such as remote monitoring feasibility and good compliance, but emphasize the need for trials linking AF detection to clinical outcomes beyond stroke, including heart failure and AF progression. They note challenges in anticoagulation decisions for brief AF episodes and call for larger studies to define optimal screening intervals, treatment strategies, and impacts on morbidity. The discussion suggests mail-based, targeted screening may improve AF detection, but evidence of outcome benefits is still needed before guideline changes.

Keywords

MALFI randomized clinical trial

remote screening

asymptomatic atrial fibrillation

high-risk adults 65+

ECG patch monitoring