Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet, 398(10310), 1463–1465. https://doi.org/10.1016/S0140-6736(21)01750-5 The Lancet, 398(10310), 1507–1516. https://doi.org/10.1016/S0140-6736(21)01698-6 Dr. Jesper Svendsen et al
Points
- The LOOP trial was conducted in order to check the safety and efficacy of monitoring atrial fibrillation with the help of an implantable loop recorder in patients at high risk of strokes with an unknown history of AF.
- The trial results indicate that there are no significant differences in continuous monitoring of AF with ILR compared to usual care for the reduction of strokes in patients at high risk with an unknown history of AF.
- While in the trials that were conducted for screening purposes, there was a statistically significant high rate of atrial fibrillation with active screening.
Summary
A trial study was conducted in order to check the safety and efficacy of monitoring atrial fibrillation with the help of ILR in patients at high risk of strokes. For this purpose, 6,205 patients were selected in a 1:3 ratio fashion, in which there were 1,501 patients in the ILR group and 4,503 patients in the usual care group. For the study of usual care, annual interviews with nurses and standard contact with practitioners were also carried out. Patients from the age range 70-90years having diabetes, hypertension, heart failure, or previous stroke were selected, and those with a previous diagnostic record of stroke, atrial fibrillation (past or current), contra-indication to oral anticoagulation, oral anticoagulation, or pacemaker were not included.
The results indicated that usual care is equal to continuous monitoring for AF with ILR to reduce systemic embolism or strokes in patients who are at high risk of strokes but with an unknown history of AF. The bleeding rate in monitoring for AF versus usual care was also not significantly different. While in the trials that were conducted for screening purposes, there was a statistically significant high rate of atrial fibrillation with active screening. In addition, the results also do not indicate any significant benefits for cardiovascular patients or all-cause mortality.
Link/s to the articles: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01698-6/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01750-5/fulltext
References Diederichsen, S. Z., Frederiksen, K. S., Xing, L. Y., Haugan, K. J., Højberg, S., Brandes, A., Graff, C., Olesen, M. S., Krieger, D., Køber, L., & Svendsen, J. H. (2022). Severity and etiology of incident stroke in patients screened for atrial fibrillation vs usual care and the impact of prior stroke: A post hoc analysis of the loop randomized clinical trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2022.3031 Lowres, N., & Freedman, B. (2021). Population screening for atrial fibrillation to prevent stroke. The Lancet, 398(10310), 1463–1465. https://doi.org/10.1016/S0140-6736(21)01750-5 Svendsen, J. H., Diederichsen, S. Z., Højberg, S., Krieger, D. W., Graff, C., Kronborg, C., Olesen, M. S., Nielsen, J. B., Holst, A. G., Brandes, A., Haugan, K. J., & Køber, L. (2021). Implantable loop recorder detection of atrial fibrillation to prevent stroke (The loop study): A randomised controlled trial. The Lancet, 398(10310), 1507–1516. https://doi.org/10.1016/S0140-6736(21)01698-6
