Intensive rhythm monitoring to decrease ischemic stroke and systemic embolism – the Find-AF 2 study

• Applicant: Professor Dr. Rolf Wachter
• Subject Area: Cardiology, Angiology ; Clinical Neurology; Neurosurgery and Neuroradiology
• Term: since 2019
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 426336050

Atrial fibrillation (AF) is a strong risk factor for stroke, but frequently escapes routine diagnostics in its intermittent (paroxysmal) presentation. Randomised trials in patients with acute stroke have convincingly shown that prolonged heart rhythm monitoring detects more cases of AF. However, it is unclear whether changes in medical treatment induced by increased AF detection (i. e. anticoagulation) reduces the risk of recurrent (ischemic) stroke and peripheral embolism. Patients with only one episode of AF shortly after stroke have been excluded from large anticoagulation trials because frequently two episodes of AF were required. Hence, the scientific data from randomised trials for anticoagulation in newly detected AF is scarce. Find-AF 2 aims to close this gap in answering the question whether prolonged, improved and intensified heart rhythm monitoring reduces future cardioembolism (defined as recurrent ischemic stroke or systemic embolism) by tailoring anticoagulation to more patients with paroxysmal AF instead of antiplatelet therapy. The intensity of heart rhythm monitoring will be risk-adapted: Patients with a low risk for AF will receive 7-day Holter ECG right after randomisation, after 3, 12, 24, 36, 48 and 60 months, respectively. Patients with a high risk to develop AF (defined as excessive supraventricular ectopic activity (Binici et al., Circulation 2010) will receive an implantable cardiac monitor. A total of 5,200 patients with recent stroke will be included and randomised in a 1:1 fashion (enhanced, prolonged and intensified heart rhythm monitoring or usual care) . Currently (27-Jul-2022), 2267 patients in 50 German study centers have been randomised. We expect the end or recruitment in Q2/2024 and the end of follow-up by mid 2026.

• DFG Programme: Clinical Trials
• Co-Investigator: Professor Dr. Klaus Gröschel