New Trial to Determine Whether Atrial Fibrillation Screening Reduces Stroke Risk

The GUARD-AF trial is a large, randomized screening trial that seeks to clarify whether atrial fibrillation (AF) screening in older individuals leads to a reduction in stroke. The new trial, which was announced at the American Heart Association 2019 Scientific Sessions, will include an estimated 52,000 participants over the age of 70 who have no prior history of AF.

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Daniel Singer, MD, internist at Massachusetts General Hospital, spoke to MD Magazine about the trial. He explained that AF increases the risk of ischemic stroke fivefold and that many older patients receive a diagnosis of AF after they present with a stroke.

The GUARD-AF study is partly motivated by a lack of clear evidence that screening for AF reduces stroke risk. Dr. Singer said that the United States Preventative Services Task Force has been holding off on approving or recommending screening for AF until that evidence becomes sufficient.

The GUARD-AF trial will randomly assign 26,000 patients to receive usual care and 26,000 to use a 14-day continuous monitoring patch. Dr. Singer indicated that very large screening studies are required to demonstrate a clinical endpoint reduction.

Patients wearing the patch who show AF during the screening period will receive further guidance from a referring physician about the possibility of using anticoagulants to prevent the risk of stroke.

Dr. Singer emphasized that GUARD-AF is a screening trial, not a drug trial, and that one of its primary objectives is to prompt discussions between physicians and patients with AF about the risks and benefits of taking anticoagulants.

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