Atrial Fibrillation Detected by Continuous ECG Monitoring Using Implantable Loop Recorder to Prevent Stroke in High-risk Individuals.
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 6,000
- 试验地点
- 1
- 主要终点
- Time to adjudicated stroke or systemic arterial embolism
研究概览
简要总结
The LOOP study aims to determine whether screening for atrial fibrillation (AF) with implantable loop recorder and initiation of oral anticoagulation (OAC) if AF is detected will reduce the risk of stroke and systemic arterial embolism in patients with risk factors for stroke.
详细描述
Background:
Ischemic stroke is an increasing health problem world-wide (Heidenreich PA, et al. Circulation 2011; PMID 21262990). At least 20% of ischemic strokes are attributable to atrial fibrillation (AF) (Marini C, et al. Stroke J Cereb Circ 2005; PMID 15879330). Another 30% are so-called cryptogenic, possibly related to undiagnosed AF (Brachmann J, et al. Circ Arrhythm Electrophysiol 2015; PMID 26763225). In approximately 30% of a general population of pacemaker or cardioverter defibrillator patients, previously unknown AF will be detected during the first 2-3 years after implantation (Healey JS, et al. N Engl J Med 2012; PMID 22236222; ASSERT). Although the majority of these AF episodes are short-lasting and asymptomatic, the ASSERT study found that such AF is associated with risk of stroke. Since this was published, screening for AF has received intensified attention by researchers and the industry, although available evidence does not yet support systematic mass screening.
Aims:
The LOOP study will determine whether long-term continuous screening and initiation of OAC for AF episodes lasting ≥6 minutes will reduce the risk of stroke in patients with stroke risk factors.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 70 Years 至 90 Years（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 70-90 years, and
- •Previously diagnosed with ≥1 of:
- •Diabetes mellitus (type 1 or type 2, with or without medical therapy)
- •Hypertension (with or without medical therapy)
- •Heart failure
- •Previous diagnosed stroke (previous transient ischemic attack is not considered an inclusion criterion)
排除标准
- •History of atrial fibrillation or flutter irrespective of type
- •Cardiac pacemaker or defibrillator (with or without re-synchronization therapy)
- •Contraindication to oral anticoagulation therapy
- •Anticoagulation therapy; vitamin K antagonists, direct oral anticoagulants, or (low-molecular) heparins. Therapy with platelet inhibitors such as acetyl-salicylic acid, clopidogrel, persantine is not considered an exclusion criterion
- •Renal failure treated with permanent dialysis
- •Uncorrected congenital heart disease, or severe valvular stenosis, obstructive cardiomyopathy, active myocarditis, or constrictive pericarditis.
- •On a waiting list for major surgery (cardiac, thoracic or abdominal)
- •Cardiac or thoracic surgery has been performed within 3 months from inclusion
- •Any major organ transplant (e.g. lung, liver, heart, or kidney)
- •Cytotoxic or cytostatic chemotherapy and/or radiation therapy for treatment of a malignancy within 6 months before randomization or clinical evidence of current malignancy with the following exceptions: Basal or squamous cell carcinoma of the skin, cervical intraepithelial neoplasia, prostate cancer (if stable, localized disease with a life expectancy of > 2.5 years in the opinion of the investigator)
- •Life-expectancy shorter than 6 months
- •Known to be human immunodeficiency virus (HIV) positive with an expected survival of less than 5 years due to HIV infection
- •Recent (within 3 months) history of alcohol or drug abuse based on self-reporting
- •Any condition (e.g. psychiatric illness, dementia) or situation, that in the investigators opinion could put the subject at significant risk, confound the study results, or interfere significantly with the subject participation in the study
- •Unwillingness to participate or patient does not understand Danish language
结局指标
主要结局
Time to adjudicated stroke or systemic arterial embolism
时间窗: At the completion of the event-driven trial, expected 4 years
Time to the first of one of the components of the combined primary endpoint * adjudicated stroke, or * adjudicated systemic arterial embolism
次要结局
- Time to adjudicated ischemic stroke/transient ischemic attack/systemic arterial embolism(At the completion of the event-driven trial, expected 4 years)
- Time to adjudicated stroke, or systemic arterial embolism, or cardiovascular death(At the completion of the event-driven trial, expected 4 years)
- Time to adjudicated cardiovascular death(At the completion of the event-driven trial, expected 4 years)
- Time to death by any cause(At the completion of the event-driven trial, expected 4 years)
研究者
Jesper Hastrup Svendsen
Professor, MD, DMSc, FESC
Rigshospitalet, Denmark