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September 5, 2026EP EuropaceOpen Access

Screening-detected AF linked to ~219% higher risk of incident HF versus no AF.

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Why the study?

Atrial fibrillation increases risks of stroke, heart failure, and death, with heart failure being more frequent and a major contributor to mortality, prompting assessment of the incidence and timing of heart failure in screening-detected atrial fibrillation.

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

Participants aged 75–76 years without prior heart failure from STROKESTOP and STROKESTOP II

Comparison

Screening-detected atrial fibrillation vs known atrial fibrillation vs no atrial fibrillation

Design

Post hoc analysis of randomized screening studies

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 SadoKarolinska University HospitalCBCarl BonanderNational Academy of MedicineKGKatrin Kemp GudmundsdottirKarolinska University Hospital

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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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Heart failure over time in patients with screening detected atrial fibrillation - a postdoc analysis of the STROKESTOP and STROKESTOP II studies2026
  2. 2Incidence and Impact of Atrial Fibrillation in Heart Failure Patients: Real-World Data in a Large Community2022 · 35 citations
  3. 3Incidence and Predictors of Heart Failure in Patients With Atrial Fibrillation2021 · 20 citations
  4. 4Stroke incidence in heart failure and atrial fibrillation: a population-based retrospective cohort study2025 · 2 citations
  5. 5Impact of atrial fibrillation in patients with heart failure and reduced, mid-range or preserved ejection fraction2020 · 74 citations