Daily Cardiology Research Analysis

FIND-AF 2.0 used age, sex, and 10 comorbidities to predict new AF within 6 months across EHR datasets from the United Kingdom, Japan, Israel, Canada, and China. The model showed good to excellent discrimination, with AUROC values ranging from 0.747 to 0.835 across national cohorts, and was prospectively tested as a tool to guide scalable AF screening.

Impact: This study moves AF screening from a uniform population strategy toward internationally transportable, risk-guided case finding. Its large multinational validation and prospective testing directly address generalizability and implementation, two major barriers to clinical AI adoption.

Clinical Implications: Health systems could use routinely collected EHR data to prioritize individuals for opportunistic or systematic AF screening, potentially improving detection before stroke occurs. Clinical deployment should include local recalibration, equity assessment, workflow integration, and prospective evaluation of effects on AF detection, anticoagulation, stroke, and health-care utilization.

Future Directions: Future studies should report the prospective screening yield, confirmatory testing burden, treatment changes, stroke prevention, cost-effectiveness, and equity impact. Pragmatic trials should compare risk-guided screening with usual care and evaluate recalibration across additional health systems and underrepresented populations.

In the multicenter SAMCRO randomized trial, 123 patients with invasively confirmed coronary microvascular dysfunction and/or coronary vasomotor disorder received endotype-guided therapy with or without structured exercise, Mediterranean dietary counseling, and psychological support. At 12 months, the intervention improved the Seattle Angina Questionnaire summary score by 13.12 points versus control, and clinically meaningful improvement occurred in 77% versus 38% of participants.

Impact: This trial provides randomized evidence that a structured, nonpharmacological, multidomain intervention can improve patient-reported outcomes in a population with substantial symptom burden and historically limited treatment options. It directly supports integrating exercise, diet, and psychological care into endotype-guided ANOCA management.

Clinical Implications: For patients with ANOCA, clinicians should consider structured cardiac rehabilitation, Mediterranean dietary counseling, and psychological support in addition to mechanism-based medical therapy. The findings support multidisciplinary pathways rather than relying solely on antianginal medication or repeated anatomical testing.

Future Directions: Larger pragmatic trials should assess the durability of benefit, adherence, cost-effectiveness, and effects on recurrent health-care use and cardiovascular events. Factorial designs could identify the most effective components, and implementation studies should evaluate delivery through cardiac rehabilitation and primary-care networks.

In this prospective open-label randomized trial of 200 patients with AMI at high risk for heart failure after successful PCI, empagliflozin was compared with no SGLT2 inhibitor therapy. At 6 months, empagliflozin did not reduce infarct size or improve the change in left ventricular end-systolic volume, providing a mechanistically informative negative result despite the broader clinical benefits of SGLT2 inhibitors in other populations.

Impact: The study challenges the assumption that post-MI SGLT2 inhibitor benefit is mediated by smaller infarcts or early reverse remodeling. Its rigorous CMR-based endpoints help refine treatment expectations and redirect mechanistic research toward alternative pathways such as hemodynamic, metabolic, renal, or inflammatory effects.

Clinical Implications: Empagliflozin should not be prescribed after AMI with the expectation that it will reduce infarct size or reverse LV remodeling over 6 months. The result does not negate established heart-failure, kidney, or diabetes indications, but it emphasizes that post-MI use should be guided by demonstrated clinical outcomes rather than presumed effects on infarct morphology.

Future Directions: Further trials should determine whether SGLT2 inhibitors improve post-MI outcomes through mechanisms unrelated to infarct size, including congestion reduction, renal protection, altered myocardial energetics, endothelial effects, and inflammation. Larger blinded or pragmatic trials should link CMR findings with long-term heart-failure events and mortality and identify subgroups most likely to benefit.