AMALFI: Active monitoring for atrial fibrillation
| ISRCTN | ISRCTN15544176 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN15544176 |
| ClinicalTrials.gov (NCT) | Nil known |
| Clinical Trials Information System (CTIS) | Nil known |
| Integrated Research Application System (IRAS) | 234837 |
| Protocol serial number | CPMS 41053 |
| Sponsor | University of Oxford |
| Funders | NIHR Oxford Biomedical Research Centre, British Heart Foundation |
- Submission date
- 20/05/2019
- Registration date
- 21/05/2019
- Last edited
- 01/09/2025
- Recruitment status
- No longer recruiting
- Overall study status
- Ongoing
- Condition category
- Circulatory System
Plain English summary of protocol
Background and study aims
AMALFI is a randomized trial of screening for undiagnosed atrial fibrillation (AF - a type of irregular heartbeat) in people thought to be at high risk of having the condition.
Who can participate?
Anyone over 64 years old with a CHA2DS2-VASc score > = 3 in men or > = 4 in women. (CHA2DS2-VASc = Congestive heart failure, Hypertension, Age, Diabetes, Stroke, Vascular disease).
What does the study involve?
The trial aims to randomize 2500 participants in the UK, half of which will wear a CE-marked medical device called the Zio Patch. This is a self-applied ECG monitor that is worn for 2 weeks to assess for signs of AF even if the participant feels well. The intention is to assess the rate of undiagnosed AF to see if earlier detection (and therefore treatment) of undiagnosed AF is worthwhile and results in improved healthcare. If eligible and randomized to wear a patch, they will be sent the device and instructions on how to apply it. After wearing the device for two weeks, it will be returned for analysis and the results sent to their GP who may use the information to decide on the appropriate management. Those not randomized to wear a patch will continue on their usual care.
What are the possible benefits and risks of participating?
Benefits:
Participants who are randomized to receive a Zio Patch will either be reassured that their heart is functioning normally
or they will have a previously undiagnosed AF bought to their GP's attention and therefore their risk of having a stroke
may have been substantially lowered.
If the research is successful, there is a possibility that it may result in a national screening programme that would
benefit everyone.
Risks:
Some participants who are randomized to the group who do not wear the Zio Patch may be disappointed that having volunteered to help, they are not allocated a patch to wear. They may also worry about their chance of having an irregular heart beat that is not detected. Our gratitude for their contribution and the importance of having a control group is made clear in the literature and on the website, so hopefully they will understand the importance of their role. Advice on AF is available in the information provided and if they are still concerned, we recommend that they should see their GP in the usual way.
For those randomized to wear the Zio Patch; there is a chance that the patch may cause a minor irritation to the skin and therefore may cause some unforeseen discomfort to some participants. Individuals with certain skin conditions are recommended not to participate in the study. There is information available in the literature and on the website; we also have a 24-hour Freephone service for anyone who is worried and needs medical or practical advice about the Zio Patch.
If AF is diagnosed from the patch report and an individual's GP decided that treatment is required, the medication can carry some potential risks. However, the care is standard throughout the UK and would have been offered to the participant if AF became apparent to the GP outside of the study. Although earlier diagnosis may mean that the participant receives a longer period on medication, their risk of having a stroke with its associated risks may have been substantially lowered
Where is the study run from?
Clinical Trial Service Unit, Nuffield Department of Public Health, University of Oxford, UK.
When is the study starting and how long is it expected to run for?
The study starts in May 2019 and data collection will continue for up to 25 years.
Who is funding the study?
1. NIHR Oxford Biomedical Research Centre (UK)
2. British Heart Foundation (UK)
Who is the main contact?
1. Ms Karen Taylor (public)
amalfi@ndph.ox.ac.uk
2. Prof. Louise Bowman (scientific)
amalfi@ndph.ox.ac.uk
Contact information
Scientific
Clinical Trial Service Unit
Nuffield Department of Health
University of Oxford
Old Road Campus
Roosevelt Drive
Oxford
OX3 7LF
United Kingdom
| Phone | +44 (0)1865 743884 |
|---|---|
| amalfi@ndph.ox.ac.uk |
Scientific
Clinical Trial Service Unit
Nuffield Department of Health
University of Oxford
Old Road Campus
Roosevelt Drive
Oxford
OX3 7LF
United Kingdom
 ORCID ID |
0000-0003-1125-8616 |
|---|---|
| Phone | +44 (0)1865 743884 |
| amalfi@ndph.ox.ac.uk |
Study information
| Primary study design | Interventional |
|---|---|
| Study design | Interventional randomized controlled trial |
| Secondary study design | Randomised controlled trial |
| Study type | Participant information sheet |
| Scientific title | AMALFI (Active Monitoring for AtriaL Fibrillation): A randomized controlled trial of screening for silent atrial fibrillation in high-risk individuals. |
| Study acronym | AMALFI |
| Study objectives | To assess the effect of 2 weeks of continuous monitoring using Zio Patch on the proportion of participants diagnosed with atrial fibrillation (AF) compared to usual care at 2.5 years of follow up from randomization (i.e. at around the midpoint of a proposed 5-year screening interval). |
| Ethics approval(s) | Approved 30/01/2019 London - Bromley REC (Metropolitan Police Hayes Sports Club, The Warren, Croydon Road, BR2 7AL; 0207 104 8209; nrescommittee.london-bromley@nhs.net) ref: 19/LO/0220. |
| Health condition(s) or problem(s) studied | Atrial fibrillation |
| Intervention | Eligible participants will be identified via an electronic search of GP practice data, identifying individuals with risk factors (such as diabetes or high blood pressure) that put them at an increased risk of having a stroke. Men and women aged 65 and over, with a high-risk score, will be approached by mail by their GP and offered the opportunity to participate in the study. If eligible and randomized to wear a patch, they will be sent the device and instructions on how to apply it. After wearing the device for two weeks, it will be returned for analysis and the results sent to their GP who may use the information to decide on the appropriate management. Those not randomized to wear a patch will continue on their usual care. If allocated to the study arm that is not required to wear the patch, the participant will receive a letter thanking them for their contribution. No further input is required from the participant. Following the initial phase, all participants will continue with their normal care. At 1, 2½ and 5 years after randomization data will be collected from the GP records to assess the proportion of participants diagnosed with AF (as recorded in the electronic GP record) and to see if having AF diagnosed earlier, made a difference to their medical care and stroke rate. |
| Intervention type | Other |
| Primary outcome measure(s) |
To assess the effect of 2 weeks of continuous monitoring using Zio Patch on the proportion of participants diagnosed with AF compared to usual care at 2.5 years of follow up from randomization (i.e. at around the midpoint of a proposed 5-year screening interval). |
| Key secondary outcome measure(s) |
Following the initial phase, all participants will continue with their normal care. At 1, 2½ and 5 years after randomization data will be collected from the GP records to assess the proportion of participants diagnosed with AF (as recorded in the electronic GP record) and to see if having AF diagnosed earlier, made a difference to their medical care and stroke rate. |
| Completion date | 01/09/2044 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Senior |
| Lower age limit | 65 Years |
| Sex | All |
| Target sample size at registration | 5000 |
| Total final enrolment | 5043 |
| Key inclusion criteria | 1. Male or Female, aged > = 65 years old. 2. CHA2DS2-VASc score > = 3 in men or > = 4 in women. 3. Willing and able to give informed consent for participation in the study. |
| Key exclusion criteria | 1. Known to have AF or atrial flutter 2. Latex allergy (given the potential for an allergic reaction to the Zio Patch) |
| Date of first enrolment | 01/05/2019 |
| Date of final enrolment | 31/01/2022 |
Locations
Countries of recruitment
- United Kingdom
- England
Study participating centre
Old Road Campus
Roosesvelt Drive
Headington
Oxford
OX3 7LF
United Kingdom
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|---|
| IPD sharing plan summary | Data sharing statement to be made available at a later date |
| IPD sharing plan | The current data sharing plans for this study are unknown and will be available at a later date |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Results article | 29/08/2025 | 01/09/2025 | Yes | No | |
| HRA research summary | 28/06/2023 | No | No | ||
| Participant information sheet | Participant information sheet | 11/11/2025 | 11/11/2025 | No | Yes |
| Protocol file | 11/04/2019 | 21/05/2019 | No | No | |
| Protocol file | version 1.2 | 09/09/2019 | 03/01/2020 | No | No |
| Protocol file | version 2.0 | 08/06/2021 | 20/02/2025 | No | No |
| Study website | Study website | 11/11/2025 | 11/11/2025 | No | Yes |
Additional files
- ISRCTN15544176_PROTOCOL_11Apr2019.pdf
- uploaded 21/05/2019
- ISRCTN15544176_PROTOCOL_v1.2_09Sep2019.pdf
- Protocol file
- ISRCTN15544176_PROTOCOL_V2.0_08Jun21.pdf
- Protocol file
Editorial Notes
01/09/2025: Publication reference added.
20/02/2025: The following changes were made to the study record:
1. Protocol uploaded.
2. IRAS number added.
3. British Heart Foundation added as a funder.
4. Sponsor details updated.
03/10/2022: The following changes were made to the trial record:
1. The target number of participants was changed from 2500 to 5000.
2. The total final enrolment was added.
3. The recruitment end date was changed from 31/12/2020 to 31/01/2022.
4. The intention to publish date was changed from 01/09/2023 to 01/09/2025.
29/01/2020: The following changes have been made:
1. The recruitment end date has been changed from 01/09/2020 to 31/12/2020.
2. The overall trial end date has been changed from 01/09/2020 to 01/09/2044.
03/01/2020: Uploaded updated protocol (not peer reviewed)
07/06/2019: Internal review.
21/05/2019: Uploaded protocol (not peer reviewed)
20/05/2019: Trial’s existence confirmed by NIHR.
