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Published on: February 26, 2013
Heart Failure Events After Long-term Continuous Screening for Atrial Fibrillation: Results From the Randomized LOOP
Lucas Yixi Xing1,2,3, Søren Højberg4, Derk W Kriegerg5,6
1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark (L.Y.X., M.S.O., L.K., J.H.S., S.Z.D.).
Insights
Device screening for atrial fibrillation may lower heart failure (HF) risk in older adults. Implantable loop recorder screening showed a significant reduction in HF events related to reduced ejection fraction (HFrEF).
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Devices
Background:
- Subclinical atrial fibrillation detected by devices is linked to increased heart failure (HF) risk.
- The effect of atrial fibrillation screening on HF outcomes is not well understood.
Purpose of the Study:
- To investigate the impact of atrial fibrillation screening using implantable loop recorders (ILR) on heart failure endpoints.
- To analyze HF events, cardiovascular death, and heart failure with reduced ejection fraction (HFrEF) events in the LOOP Study.
Main Methods:
- Secondary analysis of the LOOP Study, comparing ILR screening to usual care in high-risk individuals.
- Outcomes assessed included HF events, cardiovascular death, and HFrEF events.
- Cox models were used for time-to-first and total (recurrent) event analyses.
Main Results:
- ILR screening was associated with a nonsignificant trend toward reduced HF events or cardiovascular death.
- A significant risk reduction in total events was observed for HFrEF events or cardiovascular death and for HFrEF events specifically.
- The ILR group showed a lower incidence of the primary outcome (HF event or cardiovascular death) compared to the control group.
Conclusions:
- Implantable loop recorder screening for atrial fibrillation may reduce total heart failure events and cardiovascular death in older, high-risk individuals.
- The observed reduction was particularly notable for heart failure with reduced ejection fraction (HFrEF).
- These findings are hypothesis-generating and suggest a need for further research.
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.
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