Sadly, ARTESIA Doesn't Answer a Common Question in Cardiology

What a super study. A great effort.

ARTESIA investigators randomized more than 4000 patients with short-duration asymptomatic atrial fibrillation (AF) to receive either apixaban or aspirin. They measured an important low-bias endpoint: stroke and systemic embolism. Trial conduct was excellent.

Yet, even when combined with the similar NOAH-AFNET 6 trial, the results do not provide a clear answer on how best to treat patients with these common arrhythmias.

There will be no algorithms or quality measures for treating patients with subclinical AF. Despite two large trials, clinicians will have to stop, think, listen to their patients, and align care with each patient's specific goals and preferences — just as the late David Sackett, MD, laid out when he pioneered modern-day evidence-based medicine.

The ARTESIA Trial

Patients with device-detected asymptomatic short-duration AF were recruited from nearly 250 sites in 16 European and North American locations.

The average age was 77 years, and slightly more than one third of the patients were female. The mean CHA₂DS₂-VASc score was 3.9. The median duration of AF was 1.5 hours. Only 20% of patients had AF duration longer than 6 hours.

A primary endpoint occurred in 55 of 2015 patients in the apixaban arm vs 86 of 1997 patients in the aspirin arm (0.78% vs 1.24% per patient-year). This difference of only 31 stroke events in a trial of more than 4000 patients yielded a statistically significant relative risk reduction of 37% (HR, 0.63; 95% CI, 0.45- 0.88;