Effects of Atrial Fibrillation Screening According to Thyroid Function: Post Hoc Analysis of the Randomized LOOP Study
Primary result · Stroke or SE, by TSH tertileResult — go to the resultHazard ratio 0.52 95% CI 0.30–0.90Authors' conclusion
AF screening and subsequent treatment was associated with decreased stroke risk among participants with low TSH, though the yield of screening was similar across TSH levels. TSH may be useful as a marker to indicate benefit from AF screening vs overdiagnosis and overtreatment. These findings should be considered exploratory and warrant further study.
Study context
- Population
- LOOP atrial fibrillation (AF) screening trial participants with baseline thyroid-stimulating hormone (TSH); mean age 74.7 ± 4.1 years, 2836 (47%) womenTSH available, of 6004
- Participants
- 6,003 participants
- Comparison
- Implantable loop recorder (ILR) screening for AF vs usual care, by baseline TSH
- ILRn = 1,500
- Usual caren = 4,503reference
- Primary endpoint
- Stroke or systemic embolism (SE)
Methodological detailssubgroup analysis by baseline TSH tertiles
- Subgroup analysis by baseline TSH tertiles
Primary result
Stroke or SE, by TSH tertile
Hazard ratio
0.52
95% CI 0.30–0.90
P = 0.02
ILRvs Usual care
HR 0.52 (95% CI 0.30–0.90); P = 0.02
As reported in the abstract
- Adjusted P interaction
- .03
Secondary outcomes
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Stroke, SE, or CV death, by TSH tertileFirst TSH tertile | 0.54 (0.34–0.84) | P = 0.006 | |
| 0.20.5125Hazard ratio (log scale) |
- Stroke, SE, or CV death, by TSH tertile — Adjusted P interaction
- .01
Stroke, SE, or CV death, by TSH tertile
- No effect among participants with higher TSH
AF detection across TSH tertiles
- Adjusted P interaction
- 0.44
- AF detection approximately triple for ILR vs usual care across TSH tertiles
Other outcomes (all-cause death)
- No effect on other outcomes
Sensitivity analyses
- Continuous TSH or excluding abnormal TSH or thyroid medication showed similar results
Original publication
Effects of Atrial Fibrillation Screening According to Thyroid Function: Post Hoc Analysis of the Randomized LOOP Study. J Clin Endocrinol Metab. Published 4 September 2024. doi:10.
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