Summary of Relevant AF Screening Trials and ECG-Based Artificial Intelligence Models
| Study | Population | Screening Intervention | Effect of Screening on Newly Diagnosed AF (Time Point) |
|---|---|---|---|
| Randomized trials of general population AF screening | |||
| SAFE (Fitzmaurice et al, 2007)41 | Primary care, aged ≥65 y | 12-lead ECG or irregular pulse-guided 12-lead ECG | RD: 0.59%; 95% CI: 0.20-0.98 (1 y) |
| REHEARSE-AF (Halcox et al, 2017)7 | Primary care, aged >65 y with CHA2DS2-VASc ≥ 2 | Single-lead ECG twice weekly for 1 y | HR: 3.90; 95% CI: 1.4-10.4 (1 y) |
| mSToPS (Steinhubl et al, 2018)42 | Insurance plan members aged ≥ 75 y, aged ≥55 y with male sex and ≥1 AF risk factor, or aged ≥65 y with female sex and ≥1 AF risk factor | Immediate vs delayed (4 mo) 14-d patch monitor | RD: 3.0%; 95% CI: 1.8-4.1 (4 mo) |
| D2AF (Uittenbogaart et al, 2020)33 | Primary care, aged ≥65 y | Pulse palpation, blood pressure measurement with AF algorithm, and single-lead ECG | OR: 1.06; 95% CI: 0.84-1.35 (1 y) |
| LOOP (Svendsen et al, 2021)8 | Aged 70-90 y with ≥1 additional stroke risk factor | Implantable loop recorder | HR: 3.17; 95% CI: 2.81-3.59 (64.5 mo) |
| VITAL-AF (Lubitz et al, 2022)15 | Primary care, aged ≥65 y | Single-lead ECG | RD: 0.13%; 95% CI: −0.16-0.42 (1 y) |
| SAFER (Mant et al, 2024)43 | Primary care, aged ≥70 y | Single-lead ECG 4 times per day for 3 wk | Ongoing (4 y) |
| GUARD:AF (Lopes et al, 2024)10 | Primary care, aged ≥70 y | 14-d patch monitor | RD: 1.7% per y (15.3 mo) |
| AMALFI (Wijesurendra et al, 2025)44 | Primary care, aged ≥65 y with CHA2DS2-VASc ≥3 (men) or CHA2DS2-VASc ≥4 (women) | 14-d patch monitor | Ratio of proportions: 1.26; 95% CI: 1.02-1.57 |
| Study | Model Objective | Model Performance | |
|
| |||
| Studies using ECG-based artificial intelligence to estimate AF risk | |||
| Attia et al12 | Detection of prevalent paroxysmal AF from non-AF ECG | Area under the curve: 0.87 (95% CI: 0.86-0.88) | |
| Raghunath et al13 | Prediction of 1-y incident AF from non-AF ECG | Area under the curve: 0.85 (95% CI: 0.84-0.85) | |
| Khurshid et al14 | Prediction of 5-y incident AF from non-AF ECG | 5-y time-dependent area under the curve: 0.75 (95% CI: 0.74-0.76) | |
AF = atrial fibrillation; AMALFI = Active Monitoring for AtriaL Fibrillation; D2AF = Detecting and Diagnosing Atrial Fibrillation; ECG = electrocardiogram; GUARD-AF = Reducing Stroke by Screening for Undiagnosed Atrial Fibrillation in Elderly Individuals; LOOP = Implantable Loop Recorder Detection of Atrial Fibrillation to Prevent Stroke; mSToPS = mHealth Screening to Prevent Strokes; RD = risk difference; REHEARSE-AF = Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation; SAFE = Screening for Atrial Fibrillation in the Elderly; SAFER = Screening for Atrial Fibrillation with ECG to Reduce stroke; VITAL-AF = Screening for Atrial Fibrillation in Older Adults at Primary Care Visits.