Loop trial

[HGates]

There was a post yesterday about an increase in prevalence of AF in recent times. Many of the replies suggested that it would be a good thing if we routinely screened for AF & that by doing so, thousands of people could be saved from having a stroke. I just wanted to draw your attention to the LOOP trial where they studied this hypothesis. Here are details of the trial:

thelancet.com/journals/lanc...

And here is a post on the study by Dr John Mandrola:

johnmandrola.substack.com/p...

It is extraordinary how often randomised trials end up not endorsing what seems to be an entirely logical hypothesis.

[mjames1]

Thanks so much for posting. I'll let Mandrola's words do most of the talking. But in short, no difference in stroke rates between standard of care patients and those found by loop recorder to have asymptomtic afib.

"...The idea is classic screening: pick up a disease early, treat it and make people better. Here…most AF is unknown to the patient; detecting it would be a good thing because we could start anticoagulant drugs, and this would prevent stroke.

Yet the primary results of LOOP showed that it did not work. Compared with the standard of care, patients in the ILR (implantable loop recorder) arm had AF detected three-fold more often. Check. This led to nearly three-fold more anticoagulant drugs in older high-risk patients. Check.

Except that after five years the rate of strokes and major bleeding did not significantly differ in the two groups.

[mjames1]

I think you should also post this in the other thread, to balance it out a bit. Let me know if you don't want to and I will. Thanks,

Jim

[HGates in reply to mjames1]

Do go ahead & post. The only reason I didn’t is because I don’t post much & I thought it might get lost as it seemed a popular thread.

[mjames1 in reply to HGates]

Posted.

[mary70]

thelancet.com/journals/

Loop trial finding presented

"InterpretationIn individuals with stroke risk factors, ILR screening resulted in a three-times increase in atrial fibrillation detection and anticoagulation initiation but no significant reduction in the risk of stroke or systemic arterial embolism.....

These findings might imply that not all atrial fibrillation is worth screening for, and not all screen-detected atrial fibrillation merits anticoagulation."

"And here is a post on the study by Dr John Mandrola:"

[Auriculaire in reply to mary70]

It is an interesting finding. Maybe it implies that afib caused pooling of blood is not the only factor in the strokes and there is some other element that anticoagulation is not addressing.

[MarkS]

This was very interesting. AF is an inflammatory condition, and a stroke is also associated with inflammation of the heart. Inflammation increases as people age. The trial was on people aged 70-80. Anticoagulants only work well against clots produced from AF. So I wonder whether clots produced from general inflammation has evened things out?