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Introduction: Atrial fibrillation (AF) is the most common arrhythmia and confers an increased risk of mortality, stroke, heart failure and cognitive decline. There is growing interest in AF screening; however, the most suitable population and device for AF detection remains to be elucidated. Here, we present the design of the CONSIDERING-AF (deteCtiON and Stroke preventIon by moDEl scRreenING for Atrial Fibrillation) study., Methods and Analysis: CONSIDERING-AF is a randomised, controlled, siteless, non-blinded diagnostic superiority trial with four parallel groups and a primary endpoint of identifying AF during a 6-month study period set in Region Halland, Sweden. In each group, 740 individuals aged≥65 years will be included. The primary objective is to compare the intervention of AF screening enrichment using a risk prediction model (RPM), followed by 14 days of a continuous ECG patch, with no intervention (standard care). Primary outcome is defined as the incident AF recorded in the Region Halland Information Database after 6 months as compared with standard care. Secondary endpoints include the difference in incident AF between groups enriched or not by the RPM, with and without an invitation to 14 days of continuous ECG recording, and the proportions of oral anticoagulation treatment in the four groups., Ethics and Dissemination: This study has ethical approval from the Swedish Ethical Review Authority. Results will be published in peer-reviewed international journals., Trial Registration Number: NCT05838781., Competing Interests: Competing interests: JE has received consultant or lecture honoraria from Pfizer, Bristol Myers Squibb, Boehringer Ingelheim, Merck Sharp & Dome, Roche Diagnostics, Philips and Piotrode. JH and AM are employed at Pfizer AB. PM, LS, AS and SK are employed at Bristol Myers Squibb. PP and MW are employees of Philips., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Silent atrial fibrillation (AF) episodes are common but the role of anticoagulation treatment is under debate., Methods: Consecutive patients with dual-chamber pacemakers for sinus node disease or AV block/bundle branch block were retrospectively enrolled and the development of silent AF, any anticoagulation and the incidence of ischaemic stroke and dementia were recorded., Results: In total 411 patients without and 267 with known AF at implant were included. During a median follow-up of 38 months, 30% (125/411) of patients without known AF at implant were diagnosed with silent AF, 62% of those had or were prescribed anticoagulation. Heart failure (p = 0.03) and age >75 years (p = 0.0002) were risk markers for incident silent AF. In patients with known AF at implant, 80% (216/267) were on anticoagulation at implant. The annual stroke incidence was 2.1% in patients with known AF at implant, as compared to 1.9% in patients who developed silent AF during follow-up, and 1.4% in patients without AF. Vascular dementia developed in 11.2% and 6.2% respectively in patients with known AF versus no AF (p = 0.048) as well as in 5.6% of those with silent AF (p = 0.09)., Conclusion: The stroke risk in our study population with an incident silent AF diagnosis may have been significantly decreased by the high proportion of anticoagulation treatment. This could imply that without this treatment the stroke risk might have been high enough to justify anticoagulation. Development of vascular dementia was twice as common among patients with known AF as compared to those witht silent AF or no AF. More data is needed to inform the optimal treatment for these patients., Competing Interests: Emma Sandgren and Nils Edwardsson has nothing to declare. Cecilia Rorsman has received consultant fees from Medtronic. John Engdahl has received speaker fees from Boehringer Ingelheim, Bayer, AstraZeneca, Bristol Myers Squibb, Roche, Merek Sharp and Dome and Consunltant fees from Sanofi, Pfizer and Merek Sharp and Dome. This does note alter our adherence to PLOS ONE policies on sharing data and materials.