Key result
ILR screening cuts stroke or SAE ~36% in patients without CVD but lacks benefit in CVD.
Why the study?
An evidence-based approach for risk stratification of subclinical AF and AF screening is lacking, prompting investigation into whether established CVD helps identify populations likely to benefit from screening.
Does ILR screening for AF reduce stroke or systemic arterial embolism in elderly individuals with or without preexisting cardiovascular disease?
RCT
Does ILR screening for AF reduce stroke or systemic arterial embolism in elderly individuals with or without preexisting cardiovascular disease?
Hazard Ratio: 0.64 (95% CI 0.44–0.93)
Implantable loop recorder screening for atrial fibrillation may reduce stroke risk in elderly individuals without established cardiovascular disease, but appears to offer no significant stroke prevention benefit in those with preexisting CVD.
ILR screening warrants caution in elderly with CVD; extends LOOP evidence by supporting selective benefit and targeted trials in those without CVD.
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.
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Xing et al. (2022) conducted an RCT in Subclinical atrial fibrillation (AF). Screening with implantable loop recorder (ILR) vs. Usual care was evaluated on Stroke or systemic arterial embolism (SAE) in participants without cardiovascular disease (adjusted HR 0.64, 95% CI 0.44-0.93). Implantable loop recorder screening did not prevent stroke in individuals with cardiovascular disease, but reduced stroke or systemic arterial embolism in those without CVD (HR 0.64; 95% CI 0.44-0.93).
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