Multiple Choice Questions on FIND-AF Trial: Detection and Management of Atrial Fibrillation
The FIND-AF trial is a pivotal study focused on early detection and management of atrial fibrillation to prevent stroke and other cardiovascular complications. Based on current guidelines and evidence, here are comprehensive MCQs covering key aspects of AF detection and management.
Detection of Atrial Fibrillation
According to current guidelines, which of the following is considered sufficient for the diagnosis of atrial fibrillation?
- A) Irregular pulse detected by palpation
- B) Patient-reported palpitations
- C) Any arrhythmia with ECG characteristics of AF lasting at least 30 seconds on a rhythm strip
- D) Atrial high-rate episodes detected by pacemaker lasting 1 minute
In the FIND-AF approach to screening for AF, which age group should be considered for prolonged non-invasive ECG-based screening?
- A) All adults over 50 years
- B) Adults aged ≥75 years, or ≥65 years with additional CHA₂DS₂-VA risk factors
- C) Only patients with previous stroke
- D) Only patients with heart failure
Which of the following statements about single timepoint "snapshot" screening for AF is correct?
- A) It has been proven superior to usual care in multiple RCTs
- B) It is the recommended first-line approach for AF screening
- C) Meta-analyses show it does not increase detection of AF compared to usual care
- D) It is only effective in patients under 65 years
Risk Stratification and Stroke Prevention
Which risk stratification tool is currently recommended by guidelines for assessing stroke risk in patients with AF?
- A) CHADS₂ score
- B) CHA₂DS₂-VASc score
- C) HAS-BLED score
- D) FIND-AF score
For a patient with newly diagnosed AF and a CHA₂DS₂-VASc score of 3, which of the following is the recommended approach to stroke prevention?
- A) Aspirin therapy alone
- B) Oral anticoagulation
- C) No anticoagulation needed
- D) Dual antiplatelet therapy
In the context of the FIND-AF trial approach, which of the following statements about anticoagulation in AF is correct?
- A) Direct oral anticoagulants (DOACs) are recommended over warfarin for most patients
- B) Anticoagulation should be reserved only for patients with persistent AF
- C) Aspirin provides similar stroke prevention benefits as oral anticoagulants
- D) Anticoagulation is only needed for patients with symptomatic AF
Management Strategies
According to current guidelines, which of the following represents the most appropriate holistic approach to AF management?
- A) Rate control only
- B) Rhythm control only
- C) The ABC pathway: Anticoagulation/Avoid stroke, Better symptom management, Cardiovascular risk and Comorbidity optimization
- D) Focusing exclusively on anticoagulation
In the early rhythm control strategy advocated by the FIND-AF approach, which of the following is true?
- A) It should be initiated only after rate control fails
- B) It has been shown to potentially reduce cardiovascular complications when applied early after diagnosis
- C) It is contraindicated in patients over 75 years
- D) It has no impact on cognitive function
Which of the following monitoring strategies is most appropriate for detecting asymptomatic paroxysmal AF in a patient with cryptogenic stroke?
- A) 12-lead ECG during clinic visits
- B) Patient-activated event recorder for 24 hours
- C) Prolonged monitoring with implantable loop recorder
- D) Annual 24-hour Holter monitoring
Risk Factor Modification
Which of the following lifestyle modifications is recommended for primary prevention of AF according to current guidelines?
- A) Complete abstinence from physical activity
- B) Maintaining normal weight (BMI 20-25 kg/m²)
- C) Increasing sodium intake
- D) Moderate alcohol consumption (1-2 drinks daily)
In the context of the FIND-AF approach to AF management, how often should stroke and bleeding risk be reassessed in patients with AF?
- A) Only at initial diagnosis
- B) Annually
- C) Regularly, as these risks are dynamic and change over time
- D) Only when symptoms worsen
Which of the following statements about asymptomatic AF is correct?
- A) It carries a lower stroke risk than symptomatic AF
- B) It is common even in patients who also experience symptomatic episodes
- C) It does not require anticoagulation
- D) It is easily detected through routine physical examination
Special Considerations
For a patient with embolic stroke of undetermined source (ESUS), which approach is recommended according to current guidelines?
- A) Immediate initiation of oral anticoagulation without documented AF
- B) Prolonged monitoring for AF to inform treatment decisions
- C) Aspirin therapy only
- D) No specific monitoring or anticoagulation needed
Which of the following is a key aspect of the FIND-AF trial's approach to early rhythm control therapy?
- A) Exclusive use of antiarrhythmic drugs
- B) Combination of usual care plus rhythm control therapy (antiarrhythmic drugs, catheter ablation, and ECG monitoring)
- C) Avoiding anticoagulation in patients receiving rhythm control
- D) Limiting rhythm control to patients under 65 years
According to current guidelines, what is the recommended approach for a pregnant patient with AF who has elevated thromboembolic risk?
- A) Avoid all anticoagulation during pregnancy
- B) Therapeutic anticoagulation with LMWHs or VKAs (except VKAs for the first trimester or beyond Week 36)
- C) Aspirin therapy only
- D) Direct oral anticoagulants throughout pregnancy