The ABC‐Stroke Risk Score and Effects of Atrial Fibrillation Screening on Stroke Prevention: Results From the Randomized LOOP Study

Author:

Xing Lucas Yixi12ORCID,Diederichsen Søren Zöga13ORCID,Højberg Søren3ORCID,Krieger Derk W.45ORCID,Graff Claus6ORCID,Frikke‐Schmidt Ruth78ORCID,Platonov Pyotr G.9ORCID,Olesen Morten S.110ORCID,Brandes Axel111213ORCID,Køber Lars18ORCID,Haugan Ketil Jørgen2ORCID,Svendsen Jesper Hastrup18ORCID

Affiliation:

1. Department of Cardiology Copenhagen University Hospital–Rigshospitalet Copenhagen Denmark

2. Department of Cardiology Zealand University Hospital–Roskilde Roskilde Denmark

3. Department of Cardiology Copenhagen University Hospital–Bispebjerg Copenhagen Denmark

4. Department of Neurology, Mediclinic City Hospital Dubai United Arabic Emirates

5. Department of Neuroscience Mohammed Bin Rashid University of Medicine and Health Science Dubai United Arabic Emirates

6. Department of Health Science and Technology Aalborg University Gistrup Denmark

7. Department of Clinical Biochemistry Copenhagen University Hospital–Rigshospitalet Copenhagen Denmark

8. Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

9. Section II–Cardiology, Department of Clinical Sciences Lund University Lund Sweden

10. Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Denmark

11. Department of Clinical Research, Faculty of Health Sciences University of Southern Denmark Odense Denmark

12. Department of Cardiology Odense University Hospital Odense Denmark

13. Department of Cardiology Esbjerg Hospital–University Hospital of Southern Denmark Esbjerg Denmark

Abstract

Background The ABC‐stroke score is a risk scheme for prediction of stroke or systemic embolism (SE) in atrial fibrillation (AF). This study sought to examine whether the score could be useful in predicting stroke in AF‐naïve individuals and risk stratifying for AF screening. Methods and Results The LOOP (Atrial Fibrillation Detected by Continuous ECG Monitoring Using Implantable Loop Recorder to Prevent Stroke in High‐Risk Individuals) study randomized 6004 AF‐naïve individuals aged 70 to 90 years with stroke risk factors to either screening with an implantable loop recorder and anticoagulation upon detection of new‐onset AF episodes ≥6 minutes, or usual care. A total of 5781 participants had available ABC‐stroke score at baseline and were included in this secondary analysis: 4170 (72.1%) with an estimated stroke/SE risk ≤1%/year versus 1611 (27.9%) with an estimated stroke/SE risk >1%/year. Having an annual ABC‐stroke risk >1% was associated with stroke/SE, stroke/SE/cardiovascular death, and all‐cause death (hazard ratio, 1.82 [95% CI, 1.44–2.21], 2.17 [95% CI, 1.80–2.62], and 2.19 [95% CI, 1.87–2.56], respectively). For screening with implantable loop recorder versus usual care, no significant reduction in these study outcomes was obtained in any ABC‐stroke risk groups ( P >0.0500 for all), with no signal toward interaction ( P interaction >0.2500 for all). Similar findings were yielded when assessing the ABC‐stroke score as a continuous variable. Conclusions In an elderly, AF‐naïve population with additional stroke risk factors, a higher ABC‐stroke score could identify individuals with increased stroke risk. However, this risk score may not be useful in pinpointing those more likely to benefit from AF screening and subsequent preventive treatment. These findings should be considered as hypothesis generating and warrant further study. Registration URL: https://www.clinicaltrials.gov ; unique identifier: NCT02036450.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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