Continuous Monitoring for Atrial Fibrillation Fails to Improve Stroke or Mortality Outcomes

September 1, 2021
By Alex Morrisson VIRTUAL -- August 30, 2021 -- Patients at risk of atrial fibrillation who were implanted with a continuous loop recorder were more likely than those who received standard of care to be diagnosed with atrial fibrillation and receive treatment with an anticoagulant; however, there was no statistically significant difference in outcomes, according to a study presented at the Virtual 2021 European Society of Cardiology (ESC) Congress. The continuous loop recorders picked up concerning atrial fibrillation in 31.8% of the 1,501 individuals who had the devices implanted compared with just 12.2% of the patients who had atrial fibrillation detected on routine yearly nurse visits (P P = .11). Cardiovascular death occurred in 43 (2.9%) patients in the monitoring group versus 157 (3.5%) patients in the control group (P = .27), and death from any cause occurred in 168 (11.2%) and 507 (11.3%; P = 1.00), respectively. “In a population of high-risk patients, atrial fibrillation was detected and treated much more often in those undergoing continuous loop recorder monitoring,” Dr. Svendsen said. “We found a non-significant 20% reduction in risk of stroke, which was not accompanied by a similar reduction in cardiovascular mortality. More studies are needed but our findings may suggest that not all atrial fibrillation is worth screening for, and not all screen-detected atrial fibrillation merits anticoagulation.” All patients in the study had at least 1 additional stroke risk factor, such as hypertension, diabetes, heart failure, or previous stroke. The mean age was 74.7 years and 47.3% of the population were women. The median duration of monitoring was 39.3 months, and the median follow-up period was 64.5 months. Under the study protocol, the device continuously recorded the heart’s electrical activity. Every night, any electrocardiograms indicating heart rhythm abnormalities were transferred remotely to a server for evaluation by clinicians. If atrial fibrillation lasting more than 6 minutes was diagnosed, patients were advised to start oral anticoagulation. The standard care group had a telephone consultation with a nurse once a year. Funding for this study was provided in part by Medtronic. [Presentation Study: LOOP Study - Screening for AF With an Implantable Loop Recorder to Prevent Stroke]