Remote monitoring for atrial fibrillation: lots of detection, little stroke prevention?

Atrial fibrillation (AF) is often asymptomatic, increases stroke risk and can be treated with anticoagulation – so the logic of screening seems compelling. New patches, loop recorders and smartwatches promise to detect hidden fibrillation before the first stroke occurs. However, the randomized AMALFI study presented at ESC Congress 2025 joins a series of high-quality investigations showing a sobering pattern: more technology detects more atrial fibrillation – but with hardly any reduction in strokes. This article places AMALFI in the context of the evidence and asks why the gap between detection and clinical benefit is so persistent.