Abstract Number: Esoc2026a391 Clinician Attitudes Toward Brain Imaging for Silent Brain Infarction to Inform Anticoagulation in Atrial Fibrillation

Abstract Background and aims This study examined Australian clinicians’ attitudes toward incorporating brain imaging to detect silent brain infarction (SBI) in patients with atrial fibrillation (AF) without prior stroke in Australia based on the braIn iMaging evaluAtion to optimise anticoaGulation managEment in Atrial Fibrillation (IMAGE-AF) study. Methods A mixed-methods design combined a clinician survey and a focus group discussion. The survey assessed clinicians’ views on the potential value of brain imaging for SBI detection to guide anticoagulation decisions in patients with AF and low-to-intermediate stroke risk, and their willingness to order brain CT or MRI. A focus group with two general practitioners and one neurologist explored perceived benefits and challenges. Discussions were audio-recorded, transcribed, and analysed thematically. Results Between August and December 2025, 149 clinicians completed the survey (37% female; 48% practising in regional or rural areas; 80% general practitioners, 8% cardiologists, and 7% geriatricians). Overall, 62.4% rated research on SBI detection using brain imaging as promising/very promising. Thirty-eight percent indicated they would consider ordering brain CT or MRI for patients with AF and low-to-intermediate stroke risk, while 13% reported they would not. Focus group participants viewed brain imaging as a reasonable risk stratification tool but expressed concerns about limited evidence of clinical benefit and potential out-of-pocket costs. Conclusions A substantial proportion of clinicians support the potential value of brain imaging to detect SBI in patients with AF and low-to-intermediate stroke risk. However, stronger evidence is needed to guide clinical practice, and the economic burden of this approach requires careful consideration. Conflict of interest Z.Z. and O.M.: reports holding the 2025 UNSW Collaborative Seed Grant that supports this study; D.N.C., J.X., F.H., J.Y., C.H.: nothing to disclose.