ESC Congress 24 — AF screening with a wearable ECG device increases diagnosis by over 50% but did not significantly reduce hospitalisation rates for stroke.

We are joined onsite at ESC Congress 2024 by Dr Renato Lopes (Duke University Medical Center, NC) to discuss the findings from the GUARD-AF Trial (NCT04126486, Bristol-Myers Squibb), which was designed to determine if screening for undiagnosed atrial fibrillation (AF) or atrial flutter (AFL) in patients aged 70 and above can reduce the incidence of strokes as compared to those receiving standard of care without screening. The trial involved 11,931 participants across 176 locations, and used the Zio® XT monitor to detect AF or AFL.

The primary outcome of the GUARD-AF study is to measure the incidence of all strokes leading to hospitalization, comparing the effectiveness of the Zio® XT monitor intervention in detecting undiagnosed atrial fibrillation (AF) or atrial flutter (AFL) against usual care without screening. Secondary outcomes include the incidence of bleeding events leading to hospitalization. These outcomes are assessed over a period of 2.5 to 5 years, aiming to determine whether early detection and management of AF or AFL can significantly reduce the risk of stroke and monitor any associated risks such as bleeding.

Findings showed that over a median follow up of 15 months, a 52% increase in cases of atrial fibrillation were diagnosed over a maximum of 2.5 years of follow-up, an increase in uptake of oral anticoagulants, no increase in hospitalisation rates and no significant reduction in stroke hospitalisation as compared to usual care. It should be noted that these results cannot be considered conclusive, as the trial was stopped early due to the COVID-19 pandemic. 

Interview Questions:

1. How can atrial fibrillation or atrial flutter contribute to stroke risk in elderly individals?
2. Can you tell us about the study design and patient population?
3. What were the key findings?
4. How should these findings impact clinical practice?
5. What further research is needed, and what are the next steps?

Recorded on-site at ESC Congress 2024, London.

Editors: Jordan Rance and Mirjam Boros.
Videographers: Mike Knight, Dan Brent, Oliver Miles, Tom Green, David-Ben-Harosh.

Support: This is an independent interview produced by Radcliffe Cardiology.