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September 5, 2026EP EuropaceOpen Access

Incident heart failure in patients with screening-detected atrial fibrillation: a post hoc analysis of the STROKESTOP and STROKESTOP II studies

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Why the study?

Does screening-detected atrial fibrillation increase the risk of incident heart failure compared to no atrial fibrillation or known atrial fibrillation in older adults?

Population

Individuals aged 75-76 years without prior heart failure from the STROKESTOP and STROKESTOP II randomized…

Comparison

Screening-detected atrial fibrillation vs Known atrial fibrillation and no atrial…

Design

Cohort

Key result

Screening-detected atrial fibrillation was associated with a higher risk of incident heart failure compared to no atrial fibrillation (adjusted HR 3.19 in STROKESTOP and 4.73 in STROKESTOP II).

Authors

GSGina SadoCBCarl BonanderKGKatrin Kemp Gudmundsdottir

Discussion

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Overview

Screening-detected AF may warrant closer HF monitoring in older adults; extends known associations but leaves causal and screening implications open.

Key Points

  • To determine the incidence and risk of developing heart failure among older adults with screening-detected atrial fibrillation compared to those with known or no atrial fibrillation.
  • Post hoc analysis of participants without prior heart failure from the STROKESTOP and STROKESTOP II randomized screening studies of individuals aged 75–76 years undergoing intermittent ECG-based screening.
  • Incident heart failure diagnoses were identified from national health registries, with incidence rates calculated per 100 person-years and risk quantified using adjusted Cox proportional hazards regression models.
  • In STROKESTOP, 23% of individuals with screening-detected atrial fibrillation developed heart failure (3.76 per 100 person-years vs. 4.43 for known atrial fibrillation and 1.08 for no atrial fibrillation; adjusted HR 3.19 vs. no atrial fibrillation).
  • In STROKESTOP II, 20% of participants with screening-detected atrial fibrillation developed heart failure (4.19 per 100 person-years vs. 3.52 for known atrial fibrillation and 0.93 for no atrial fibrillation; adjusted HR 4.73 vs. no atrial fibrillation).

Study Design

Type

Cohort

Multicenter

Yes

Structured PICO

Does screening-detected atrial fibrillation increase the risk of incident heart failure compared to no atrial fibrillation or known atrial fibrillation in older adults?

P
Population
Older adults aged 75-76 years without prior heart failure who underwent ECG-based screening for atrial fibrillation in two large studies.
E
Exposure
Screening-detected atrial fibrillation (via ECG-based screening)
C
Comparator
Known atrial fibrillation and no atrial fibrillation
O
Outcome
Incident heart failure diagnoses obtained from national registrieshard clinical

Main Result

Hazard Ratio: 3.19

Absolute Event Rate: 3.76% vs 1.08%

Screening-detected atrial fibrillation in older adults is not a benign condition and carries a high risk of incident heart failure, comparable to or higher than that of known atrial fibrillation.

Cite This Study

Sado et al. (2026) conducted a cohort in Atrial fibrillation. Screening-detected atrial fibrillation vs. No atrial fibrillation was evaluated on Incident heart failure (HR 3.19). Screening-detected atrial fibrillation was associated with a higher risk of incident heart failure compared to no atrial fibrillation (adjusted HR 3.19 in STROKESTOP and 4.73 in STROKESTOP II).

synapsesocial.com/papers/6a9bd4216b95aff0620eb96dhttps://doi.org/10.1093/europace/euag250
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