TY - JOUR
T1 - Heart Failure Events After Long-term Continuous Screening for Atrial Fibrillation
T2 - Results From the Randomized LOOP Study
AU - Xing, Lucas Yixi
AU - Højberg, Søren
AU - Krieger, Derk W
AU - Graff, Claus
AU - Olesen, Morten S
AU - Healey, Jeff S
AU - McIntyre, William F
AU - Brandes, Axel
AU - Køber, Lars
AU - Haugan, Ketil Jørgen
AU - Svendsen, Jesper Hastrup
AU - Diederichsen, Søren Zöga
PY - 2024/8
Y1 - 2024/8
N2 - BACKGROUND: Mounting evidence indicates that even device-detected subclinical atrial fibrillation is associated with a higher risk of heart failure (HF). However, the potential impact of atrial fibrillation screening on HF remains unknown.METHODS: The LOOP Study (Atrial Fibrillation detected by Continuous ECG Monitoring using Implantable Loop Recorder to prevent Stroke in High-risk Individuals) evaluated the effects of atrial fibrillation screening on stroke prevention using an implantable loop recorder (ILR) versus usual care in older individuals with additional stroke risk factors. In this secondary analysis, we explored the following HF end points: (1) HF event or cardiovascular death; (2) HF event; (3) event with HF with reduced ejection fraction (HFrEF); and (4) HFrEF event or cardiovascular death. Outcomes were assessed in a Cox model both as time-to-first events and as total (first and recurrent) events analyzed using the Andersen-and-Gill method.RESULTS: Of 6004 participants (mean age 74.7 and 52.7% men), 1501 were randomized to ILR screening and 4503 to the control group. In total, 77 (5.1%) in the ILR group versus 295 (6.6%) in the control group experienced the primary outcome of an HF event or cardiovascular death. Compared with usual care, ILR screening was associated with a nonsignificant reduction in the primary outcome for the time-to-first event analysis (hazard ratio, 0.78 [95% CI, 0.61-1.01]) and the total event analysis (hazard ratio, 0.77 [95% CI, 0.59-1.01]). Similar results were obtained for the HF event. A significant risk reduction in total events was observed in the ILR group for the composite of HFrEF event or cardiovascular death and for HFrEF event (hazard ratio, 0.74 [95% CI, 0.56-0.98] and 0.65 [95% CI, 0.44-0.97], respectively).CONCLUSIONS: In an older population with additional stroke risk factors, ILR screening for atrial fibrillation tended to be associated with a lower rate of total HF events and cardiovascular death, particularly those related to HFrEF. These findings should be considered hypothesis-generating and warrant further investigation.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02036450.
AB - BACKGROUND: Mounting evidence indicates that even device-detected subclinical atrial fibrillation is associated with a higher risk of heart failure (HF). However, the potential impact of atrial fibrillation screening on HF remains unknown.METHODS: The LOOP Study (Atrial Fibrillation detected by Continuous ECG Monitoring using Implantable Loop Recorder to prevent Stroke in High-risk Individuals) evaluated the effects of atrial fibrillation screening on stroke prevention using an implantable loop recorder (ILR) versus usual care in older individuals with additional stroke risk factors. In this secondary analysis, we explored the following HF end points: (1) HF event or cardiovascular death; (2) HF event; (3) event with HF with reduced ejection fraction (HFrEF); and (4) HFrEF event or cardiovascular death. Outcomes were assessed in a Cox model both as time-to-first events and as total (first and recurrent) events analyzed using the Andersen-and-Gill method.RESULTS: Of 6004 participants (mean age 74.7 and 52.7% men), 1501 were randomized to ILR screening and 4503 to the control group. In total, 77 (5.1%) in the ILR group versus 295 (6.6%) in the control group experienced the primary outcome of an HF event or cardiovascular death. Compared with usual care, ILR screening was associated with a nonsignificant reduction in the primary outcome for the time-to-first event analysis (hazard ratio, 0.78 [95% CI, 0.61-1.01]) and the total event analysis (hazard ratio, 0.77 [95% CI, 0.59-1.01]). Similar results were obtained for the HF event. A significant risk reduction in total events was observed in the ILR group for the composite of HFrEF event or cardiovascular death and for HFrEF event (hazard ratio, 0.74 [95% CI, 0.56-0.98] and 0.65 [95% CI, 0.44-0.97], respectively).CONCLUSIONS: In an older population with additional stroke risk factors, ILR screening for atrial fibrillation tended to be associated with a lower rate of total HF events and cardiovascular death, particularly those related to HFrEF. These findings should be considered hypothesis-generating and warrant further investigation.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02036450.
KW - Aged
KW - Aged, 80 and over
KW - Atrial Fibrillation/diagnosis
KW - Electrocardiography, Ambulatory
KW - Female
KW - Heart Failure/diagnosis
KW - Heart Rate
KW - Humans
KW - Male
KW - Mass Screening/methods
KW - Predictive Value of Tests
KW - Risk Assessment
KW - Risk Factors
KW - Stroke Volume
KW - Stroke/prevention & control
KW - Time Factors
KW - heart failure
KW - risk factors
KW - control group
KW - stroke
KW - atrial fibrillation
UR - http://www.scopus.com/inward/record.url?scp=85199288652&partnerID=8YFLogxK
U2 - 10.1161/CIRCEP.124.012764
DO - 10.1161/CIRCEP.124.012764
M3 - Journal article
C2 - 39022823
SN - 1941-3149
VL - 17
JO - Circulation. Arrhythmia and Electrophysiology
JF - Circulation. Arrhythmia and Electrophysiology
IS - 8
M1 - e012764
ER -