Discussion
stroke, death, ventricular dysfunction
STROKE, HEART FAILURE, VENTRICULAR DYSFUNCTION
This is the first study to assess the effects of AF screening on clinical outcomes according to NT-proBNP levels. In the present post hoc analysis of 5819 older individuals with additional stroke risk factors enrolled in a large AF screening trial, we reported the following major findings: (1) participants with higher levels of NT-proBNP were at higher risk of AF, stroke, and death; and (2) compared with usual care, ILR screening was associated with a significant reduction in stroke risk among participants with baseline NT-proBNP above median (>15 pmol/L) but not among those having lower levels.While NT-proBNP is an established biomarker for the diagnosis and risk stratification of heart failure,The latest guidelines from the European Society of Cardiology recommend considering systematic electrocardiogram screening in individuals aged ≥75 years or those at high stroke risk as assessed by the CHAOf note, although the arbitrary cutoff of NT-proBNP >15 pmol/L appeared useful in the present exploratory analysis, the optimal cutoff to implement for AF screening in clinical practice has yet to be defined and validated. Indeed, according to our analyses of continuous NT-proBNP, a stroke risk reduction for ILR screening versus usual care already emerged at an NT-proBNP level from 9 pmol/L. However, it is worth mentioning that both European and American guidelines recommend using 125 pg/mL (ie, 15 pmol/L) as the threshold to rule out ventricular dysfunction in nonacute settings.