Dr Rohan Wijesurendra on the AMALFI study

 

ESC Congress 2025 | AMALFI: Dr Rohan Wijesurendra  presented the AMALFI study during the Hot Line Session 1 on August 29. In the interview, he outlines the main findings about active monitoring for atrial fibrillation and the implications for clinical practice.

 

(Duration: 4 minutes) 

By:

Romy Martínez

HERZMEDIZIN editorial team

 

2025-09-01

 

Image source (image above): Songquan Deng / Shutterstock.com


AMALFI: Key facts

 

In the randomised AMALFI trial 5,040 individuals without a previous diagnosis of AF (≥65 years with a CHA2DS2VASc stroke risk score ≥3 for men or ≥4 for women) were randomised either to receive and return by postal mail an ECG patch monitor or to usual care (control).

 

At baseline, participants had a mean age of 78 years, 47 % were female and 19 % had a prior stroke or transient ischaemic attack. There was a modest increase in AF diagnosis at 2.5 years with the ECG patch. A post-randomisation primary care record of AF was present in 6.8% of individuals in the intervention arm and 5.4% in the control arm (ratio of proportions 1.26; 95%CI 1.02 to 1.57; p=0.03). Patchdetected AF burden was bimodally distributed, with 33% of cases having 100% burden (the entire monitoring period was spent in AF), while 55% had an AF burden <10%. At 2.5 years, mean exposure to oral anticoagulation was 1.63 months in the intervention arm and 1.14 months in the control arm (difference 0.50 months; 95%CI 0.24 to 0.75; p<0.0001). Stroke occurred in 2.7% of participants in the intervention arm and 2.5% in the control arm (event rate ratio 1.08; 95%CI 0.76 to 1.53).

 

Conclusion: Remote AF screening with an ECG patch monitor in older patients at moderate-to-high stroke risk leads to a modest increase in AF diagnosis and anticoagulation exposure. However, AF diagnosis unrelated to the patch occurred more commonly than anticipated, and over half of the patch-detected AF burden was low burden. Therefore, AF screening in this setting may have limited impact on stroke events. 

More on this topic

  • Bowman L. AMALFI: Active Monitoring for Atrial Fibrillatio. Hot Line 1, 19.08.2025, Madrid, ESC 2025
  • Wijesurendra R. et al. Active Monitoring for AtriaL FIbrillation (AMALFI): rationale, protocol, and pilot for a pragmatic, randomized, controlled trial of remote screening for asymptomatic atrial fibrillation. Am Heart J. 2025; doi:10.1016/j.ahj.2025.07.004.

To the overview page ESC Congress 2025

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