Early extended cardiac monitoring in ischaemic stroke increases rate of paroxysmal atrial fibrillation detection-a two year retrospective study

By:

Bhargava, M

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Publication details: 2017Uniform titles:

Cerebrovascular Diseases

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Summary: Paroxysmal atrial fibrillation (PAF) is a common cause of cardioembolic stroke and detection is important to guide post-stroke management. Cardiac monitoring is advised in clinical guidelines but the modality, timing and length of such monitoring is often poorly defined. We hypothesized that early, extended cardiac monitoring improves PAF detection and have explored this through retrospective study of acute stroke unit patients over a two year period. We identified 193 inpatients with no history of PAF who, following an ischaemic stroke, underwent cardiac three-lead holter monitoring for up to 72 hours at the earliest inpatient opportunity. Next, we quantified the rate of PAF and performed descriptive statistical analysis. We then compared this cohort with a group of 53 stroke patients who had outpatient cardiac monitoring. Fifty-eight of 193 patients (30.0%) were found to have PAF with a mean time of 10.8 days between stroke onset and testing. Patients with PAF were significantly older than patients with no PAF defected (77.3 vs 71.5 years, p<0.05). There was no significant difference between timing of monitoring after stroke (11.4 days vs 10.5 days, p>0.5) or sex (61.4% vs. 60.0% male, yl p>0.05). 86.0% of PAF patient were anti-coagulated prior to discharge. The rate of PAF detection within the inpatient cohort was significantly higher than outpatients (30% vs. 0.6%, p<0.05) who often had monitoring performed several weeks after stroke onset. Our findings suggest early, extended cardiac monitoring in ischaemic stroke is effective in identifying PAF and has cost-benefit implications for using three-lead holter monitoring. [Conference abstract]

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NMUH Staff Publications

Paroxysmal atrial fibrillation (PAF) is a common cause of cardioembolic stroke and detection is important to guide post-stroke management. Cardiac monitoring is advised in clinical guidelines but the modality, timing and length of such monitoring is often poorly defined. We hypothesized that early, extended cardiac monitoring improves PAF detection and have explored this through retrospective study of acute stroke unit patients over a two year period. We identified 193 inpatients with no history of PAF who, following an ischaemic stroke, underwent cardiac three-lead holter monitoring for up to 72 hours at the earliest inpatient opportunity. Next, we quantified the rate of PAF and performed descriptive statistical analysis. We then compared this cohort with a group of 53 stroke patients who had outpatient cardiac monitoring. Fifty-eight of 193 patients (30.0%) were found to have PAF with a mean time of 10.8 days between stroke onset and testing. Patients with PAF were significantly older than patients with no PAF defected (77.3 vs 71.5 years, p&lt;0.05). There was no significant difference between timing of monitoring after stroke (11.4 days vs 10.5 days, p&gt;0.5) or sex (61.4% vs. 60.0% male, yl p&gt;0.05). 86.0% of PAF patient were anti-coagulated prior to discharge. The rate of PAF detection within the inpatient cohort was significantly higher than outpatients (30% vs. 0.6%, p&lt;0.05) who often had monitoring performed several weeks after stroke onset. Our findings suggest early, extended cardiac monitoring in ischaemic stroke is effective in identifying PAF and has cost-benefit implications for using three-lead holter monitoring.&nbsp;[Conference abstract]

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