{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:31:14Z","timestamp":1792812674440,"version":"4.5.0"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"15","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2025,10,21]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>Screening for atrial fibrillation (AF) might reduce stroke if it increases long-term AF detection and anticoagulation use compared with usual care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the long-term efficacy of AF screening in older individuals at moderate to high risk of stroke using 14-day, patch-based continuous ambulatory electrocardiogram (ECG) monitoring.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>A parallel-group, unblinded, remote randomized clinical trial recruiting from 27 UK primary care practices from May 2, 2019, to February 28, 2022. All eligible individuals 65 years or older with a CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>VASc score of 3 or higher (men) or 4 or higher (women) with no previous AF or atrial flutter were identified via automated electronic health record searches. Last follow-up was on August 29, 2024, and statistical analysis was conducted from May to July 2025.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>Participants were randomized to receive and return an ECG patch monitor by postal mail (intervention, n\u2009=\u20092520) or usual care (control, n\u2009=\u20092520).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Intention-to-treat analysis of the proportion of participants with AF recorded in primary care records within 2.5 years postrandomization. Exploratory outcomes included exposure to oral anticoagulation and stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 22\u202f044 individuals invited, 5040 (22.9%) were randomized. The participants\u2019 mean (SD) age was 78 (6) years, 47% were female, and the median (IQR) CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>VASc score was 4 (3-5). A total of 2126 participants (84.4%) wore and returned the patch. AF was detected by patch in 89 participants (4.2%), 55% of whom had an AF burden less than 10%. After 2.5 years, a postrandomization record of AF was present in 172 individuals (6.8%) in the intervention group vs 136 (5.4%) in the control group (ratio of proportions, 1.26 [95% CI, 1.02-1.57]; <jats:italic>P<\/jats:italic>\u2009=\u2009.03), with consistent results in prespecified subgroups. Mean exposure to oral anticoagulation by 2.5 years was 1.63 months (95% CI, 1.50-1.76) in the intervention group and 1.14 months (95% CI, 1.01-1.26) in the control group (difference, 0.50 months [95% CI, 0.24-0.75]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Stroke occurred in 69 participants (2.7%) in the intervention group and 64 (2.5%) in the control group (rate ratio, 1.08 [95% CI, 0.76-1.53]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ISRCTN Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.isrctn.com\/ISRCTN15544176?q=15544176&amp;amp;amp;filters=&amp;amp;amp;sort=&amp;amp;amp;offset=1&amp;amp;amp;totalResults=1&amp;amp;amp;page=1&amp;amp;amp;pageSize=10\">15544176<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2025.15440","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T10:30:17Z","timestamp":1756463417000},"page":"1349","source":"Crossref","is-referenced-by-count":21,"title":["Remote Screening for Asymptomatic Atrial Fibrillation"],"prefix":"10.1001","volume":"334","author":[{"given":"Rohan","family":"Wijesurendra","sequence":"first","affiliation":[{"name":"Clinical Trial Service Unit and Epidemiological Studies Unit, Oxford Population Health, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme","family":"Pessoa-Amorim","sequence":"additional","affiliation":[{"name":"Clinical Trial Service Unit and Epidemiological Studies 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