Arrhythmias & electrophysiology
Remote Screening for Asymptomatic Atrial Fibrillation: The AMALFI Randomized Clinical Trial
Primary resultResult — go to the resultRatio of proportions 1.26 95% CI 1.02–1.57Authors' conclusion
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.
Study context
- Population
- Adults ≥65 years with CHA2DS2VASc ≥3 (men) or ≥4 (women), no previous atrial fibrillation (AF) or atrial flutter, UK primary care
- Participants
- 5,040 adults
- Comparison
- Mail-based electrocardiogram (ECG) patch AF screening vs usual care
- Interventionn = 2,520
- Controln = 2,520reference
- Primary endpoint
- Proportion with AF recorded in primary care records
- Follow-up
- 2.5 years postrandomization
Methodological detailsparallel-group, unblinded, remote, 27 UK primary care practices
- Parallel-group
- Unblinded
- Remote
- 27 UK primary care practices
Primary result
As reported in the abstract
2.5 years
Ratio of proportions
1.26
95% CI 1.02–1.57
P = 0.03
Events by treatment group
Further findings
Mean, months
| Outcome | Intervention | Control | Difference (months) (95% CI) | P value | |
|---|---|---|---|---|---|
| Mean exposure to oral anticoagulation (exploratory) · 2.5 years | 1.63 (95% CI 1.50–1.76) | 1.14 (95% CI 1.01–1.26) | 0.50 (0.24–0.75) | P < 0.001 | |
| −0.500.51Difference, months (linear scale) |
| Outcome | Intervention | Control | Rate ratio (95% CI) | P value | |
|---|---|---|---|---|---|
| Stroke (exploratory) | 2.7% | 2.5% | 1.08 (0.76–1.53) | ||
| 0.512Rate ratio (log scale) |
AF detected by patch
- AF detected by patch, participants (%)
- 89 (4.2%)
- Of these, AF burden less than 10%
- 55%
- 2126 participants (84.4%) wore and returned the patch
AF record, prespecified subgroups
- Consistent results in prespecified subgroups
Original publication
Remote Screening for Asymptomatic Atrial Fibrillation: The AMALFI Randomized Clinical Trial. JAMA. Published 21 October 2025. doi:10.
Summarised from the published abstract; every number is checked against it