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, 60 and 72 months, respectively. Patients with a high risk to develop AF (defined as excessive supraventricular ectopic activity (Binici et al., Circulation 2010) will receive continuous ECG monitoring by an implantable cardiac monitor. A total of 5,227 patients with recent stroke have been randomised in a 1:1 fashion (enhanced, prolonged and intensified heart rhythm monitoring or usual care) between July 2020 and July 2024. The study will finish after all patients are followed up for at least two years and 640 primary endpoint events have occured. As of July 2025, we have 480 primary endpoint events and expect the final study visits to take place between 07/2026 and 03/2027. We aim to present the data on the primary endpoint in Q3/2027.

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