In this state-of-the-art review, we critically examine major AF screening trials across opportunistic, systematic and consumer-driven strategies, focusing on design features, population selection, monitoring strategies and outcomes. Variability in trial design, particularly in randomisation timing, participation rates and intensity of monitoring, significantly affects both AF detection and clinical outcomes.
Systematic screening shows promise, but many trials were underpowered for hard outcomes. Opportunistic screening is easy to implement, but typically yields modest benefits, likely due to single timepoint assessments. Consumer-led, wearable-based screening shows high positive predictive value, but further evaluation in high-risk populations is needed. The success of AF screening hinges on reaching at-risk individuals and selecting effective monitoring strategies. Precision-based approaches and artificial intelligence-guided targeting may ensure that screening yields clinical and economical benefit.
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