Daily Literature Update
Opportunistic Screening for Atrial Fibrillation With Continuous ECG Monitoring in the Emergency Department
Bismuth E, Jin BT, Molins E, et al. Opportunistic Screening for Atrial Fibrillation With Continuous ECG Monitoring in the Emergency Department. Ann Emerg Med. 2025 Jul;:-. doi: S0196-0644(25)00386-5. PMID: 40650644.
Introduction
Continuous ECG monitoring in the ED can detect undiagnosed atrial fibrillation, a key risk factor for stroke.
Study Overview
Study Type: Retrospective cohort study
Population: 65,244 adult ED patients with continuous ECG monitoring
Intervention: Opportunistic AF screening via continuous ECG
Outcomes: Undiagnosed AF prevalence, stroke risk, anticoagulation eligibility
Key Findings
- 3.0% discharged with undiagnosed AF detected by monitoring
- 71.2% eligible for anticoagulation
- Undiagnosed AF patients younger, more often female, higher Medicaid/uninsured prevalence
- Ischemic stroke rate: 2.6 per 100 person-years
- Adjusted stroke risk HR 3.00 vs no AF, 1.32 vs known AF
Context & Related Research
- European Society of Cardiology, 2024: Guidelines recommend opportunistic screening with continuous ECG monitoring (PMID: forthcoming), endorsing this study’s approach.
- Vandermolen et al., 2018: Stroke risk stratification guides anticoagulation in ED AF patients (PMCID: PMC6207234), supporting clinical decision frameworks.
- Svendsen et al., 2023 (LOOP trial): Increased AF detection and anticoagulation did not significantly reduce stroke (PMID:37458602), highlighting gaps in evidence for outcome benefits.
- Bismuth et al., 2025: Demonstrates high undiagnosed AF prevalence and stroke risk in underserved ED populations (PMID:40650644), advocating for screening implementation.
Clinical Implications
- Adopt ED continuous ECG monitoring to identify undiagnosed AF early.
- Initiate anticoagulation in eligible patients based on stroke risk scores.
- Address healthcare disparities to ensure equitable AF diagnosis and management.
Strengths & Limitations
| Strengths | Limitations |
|---|---|
| Large sample size allowing robust prevalence estimates | Retrospective design limits causal conclusions |
| Comprehensive data on demographic disparities | Single-center study may limit generalizability |
| Stroke incidence outcomes through 2024 | Potential confounders and missing data on post-ED anticoagulation |
Future Directions
Prospective randomized trials are needed to assess stroke reduction benefits of ED-based continuous ECG AF screening and to evaluate the cost-effectiveness of widespread implementation.
Conclusion
Opportunistic continuous ECG monitoring in the Emergency Department uncovers a significant burden of undiagnosed atrial fibrillation, predominantly among underserved populations, highlighting a critical opportunity for early anticoagulation and stroke prevention.
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