Heart failure is common in people who have atrial fibrillation (AF) detected during screening, according to a presentation delivered today at the annual congress of the European Heart Rhythm Association (EHRA; 12–14 April 2026, Paris, France).
“Heart failure and AF have a bidirectional relationship and accelerate each other’s progression, so it is important to identify and treat heart failure early in patients with AF,” explained Gina Sado (Danderyd Hospital, Stockholm, Sweden). “Heart failure has been well-studied in patients with clinically known AF, but little is known about the incidence and timing of heart failure in individuals whose AF has been detected during screening.”
In the Swedish STROKESTOP and STROKESTOP II studies, individuals aged 75–76 years were randomised to receive electrocardiogram (ECG)-based AF screening or to serve as controls.
This post-hoc analysis studied the incidence of new heart failure diagnosis based on a median follow-up of 6.9 years for STROKESTOP and 5.1 years for STROKESTOP II. Data on heart failure diagnoses and mortality were obtained from national registries, and Cox regression was used to estimate the hazard ratios (HRs) for incident heart failure across groups.
Out of 6,824 individuals screened in STROKESTOP, new AF was detected in 252 individuals and, of these, 57 were diagnosed with heart failure (23%) over the follow-up period. Additionally, out of 6,601 individuals screened in STROKESTOP II, new AF was detected in 152 individuals and, of these, 31 were diagnosed with heart failure (20%) over the follow-up period.
In STROKESTOP, screening-detected AF was associated with a threefold increased risk of heart failure compared to individuals without AF (adjusted HR, 3.19; 95% confidence interval [CI], 2.42–4.21) and with a comparable heart failure risk to patients with previously known AF (adjusted HR, 2.86; 95% CI, 2.34–3.5). Similar results were observed in STROKESTOP II; notably, heart failure was diagnosed early, within six months after AF detection in both studies and AF groups.
“In individuals with screening-detected AF, the risk of developing heart failure was threefold that of participants without AF and comparable to that of patients with clinically known AF,” Sado added. “These findings suggest that asymptomatic AF is not a benign condition, and highlight the need for early detection of both AF and heart failure.”
