TY - JOUR
T1 - Screening for atrial fibrillation to prevent stroke in elderly individuals with or without preexisting cardiovascular disease
T2 - A post hoc analysis of the randomized LOOP Study
AU - Xing, Lucas Yixi
AU - Diederichsen, Søren Zöga
AU - Højberg, Søren
AU - Krieger, Derk W.
AU - Graff, Claus
AU - Olesen, Morten S.
AU - Brandes, Axel
AU - Køber, Lars
AU - Haugan, Ketil Jørgen
AU - Svendsen, Jesper Hastrup
N1 - Publisher Copyright:
© 2022 The Author(s)
PY - 2023
Y1 - 2023
N2 - Background: An evidence-based approach for risk stratification of subclinical atrial fibrillation (AF) and hereby AF screening is lacking. This study aimed to investigate whether established cardiovascular diseases (CVD) could help to identify the population more likely to benefit from AF screening. Methods: The LOOP Study randomized AF-naïve individuals aged ≥70 years and with additional stroke risk factors to either screening with implantable loop recorder (ILR) and subsequent anticoagulation upon detection of new-onset AF episodes ≥6 min, or usual care. In this sub-study, all participants were divided into two risk groups according to the presence/absence of CVD (defined as ischemic heart disease, heart failure, previous stroke, valvular heart disease, or peripheral artery disease). Results: A total of 1997 (33.3%) had CVD at baseline and experienced higher incidences of stroke or systemic arterial embolism (SAE), ischemic stroke, stroke/SAE/cardiovascular death, and all-cause death (adjusted HR 1.34 [1.06–1.69], 1.31 [1.02–1.69], 1.49 [1.23–1.79], and 1.59 [1.36–1.85], respectively) than those without. For ILR screening versus usual care, there was no decrease in stroke/SAE, ischemic stroke, or stroke/SAE/cardiovascular death among participants with CVD (adjusted p-values >0.05), whereas significant reductions in these outcomes were obtained by screening among those without CVD (adjusted HR 0.64 [0.44–0.93], 0.54 [0.35–0.82], 0.64 [0.46–0.87], respectively); adjusted p-values for interaction ≤0.05. Conclusions: In an elderly, at-risk population, ILR screening did not prevent stroke significantly in individuals with CVD, whereas screening was associated with approximately 40% stroke risk reduction among those without CVD. However, these findings should be considered as hypothesis-generating and warrant further study.
AB - Background: An evidence-based approach for risk stratification of subclinical atrial fibrillation (AF) and hereby AF screening is lacking. This study aimed to investigate whether established cardiovascular diseases (CVD) could help to identify the population more likely to benefit from AF screening. Methods: The LOOP Study randomized AF-naïve individuals aged ≥70 years and with additional stroke risk factors to either screening with implantable loop recorder (ILR) and subsequent anticoagulation upon detection of new-onset AF episodes ≥6 min, or usual care. In this sub-study, all participants were divided into two risk groups according to the presence/absence of CVD (defined as ischemic heart disease, heart failure, previous stroke, valvular heart disease, or peripheral artery disease). Results: A total of 1997 (33.3%) had CVD at baseline and experienced higher incidences of stroke or systemic arterial embolism (SAE), ischemic stroke, stroke/SAE/cardiovascular death, and all-cause death (adjusted HR 1.34 [1.06–1.69], 1.31 [1.02–1.69], 1.49 [1.23–1.79], and 1.59 [1.36–1.85], respectively) than those without. For ILR screening versus usual care, there was no decrease in stroke/SAE, ischemic stroke, or stroke/SAE/cardiovascular death among participants with CVD (adjusted p-values >0.05), whereas significant reductions in these outcomes were obtained by screening among those without CVD (adjusted HR 0.64 [0.44–0.93], 0.54 [0.35–0.82], 0.64 [0.46–0.87], respectively); adjusted p-values for interaction ≤0.05. Conclusions: In an elderly, at-risk population, ILR screening did not prevent stroke significantly in individuals with CVD, whereas screening was associated with approximately 40% stroke risk reduction among those without CVD. However, these findings should be considered as hypothesis-generating and warrant further study.
KW - Atrial fibrillation
KW - Cardiovascular disease
KW - Continuous rhythm monitoring
KW - Stroke prevention
U2 - 10.1016/j.ijcard.2022.10.167
DO - 10.1016/j.ijcard.2022.10.167
M3 - Journal article
C2 - 36328113
AN - SCOPUS:85141860542
VL - 370
SP - 197
EP - 203
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -