Implantable loop recorder screening for AF may reduce stroke in elderly patients with higher NT-proBNP levels

Denmark: A new study has found that N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be a useful marker for screening individuals for atrial fibrillation (AF) and stroke prevention, according to a study published in Circulation: AHA Journal.

The NT-proBNP has been found to be a powerful predictor of atrial fibrillation (AF) and stroke. The purpose of this study was to investigate NT-proBNP as a potential marker for screening efficacy in terms of AF yield and stroke prevention.

The study, which was conducted on a group of 6,004 AF-naïve individuals aged 70-90 years with additional stroke risk factors and was randomized 1:3, to investigate the efficacy of continuous screening with implantable loop recorder (ILR) and anticoagulation initiation upon detection of AF episodes ≥6 minutes, compared to usual care.

The study concluded with the following clinical takeaways:

1. NT-proBNP above the median was associated with an increased risk of AF diagnosis in both the ILR and Control groups.

2. Participants with NT-proBNP above the median had a higher risk of clinical events, including stroke or systemic embolism, stroke/SE/cardiovascular death, and all-cause death.

3. ILR screening was associated with significant reductions in stroke/SE and stroke/SE/cardiovascular death among participants with NT-proBNP above the median compared to usual care.

4. Analyzing NT-proBNP as a continuous variable yielded similar findings.

These findings suggest that NT-proBNP may be a useful marker for identifying individuals who would benefit from ILR screening for AF and subsequent anticoagulation therapy to prevent stroke. However, the authors caution that further studies are needed before clinical implementation.

“The study underscores the importance of early detection and management of AF in individuals with stroke risk factors, particularly in the elderly population. AF is a common heart condition that affects millions of people worldwide and is a major risk factor for stroke. Anticoagulation therapy has been shown to significantly reduce the risk of stroke in individuals with AF, but early detection and management are crucial for optimal outcomes.” said the researchers of the study.

Reference:

Xing L., Diederichsen S., Højberg S., Krieger D., et al.; Effects of Systematic Atrial Fibrillation Screening According to N-Terminal Pro-B-Type Natriuretic Peptide: a Secondary Analysis of the Randomized LOOP Study; Circulation. 2023;0; doi: https://doi.org/10.1161/CIRCULATIONAHA.123.064361