TY  - JOUR
AU  - Yan, B
AU  - Tu, H
AU  - Lam, C
AU  - Swift, C
AU  - Ho, S
AU  - Mok, VCT
AU  - Sui, Y
AU  - Sharpe, D
AU  - Ghia, D
AU  - Jannes, J
AU  - Davis, S
AU  - Liu, X
AU  - Freedman, B
Y2  - 2020/11/17
Y1  - 2020/09/01
SN  - 2287-6391
UR  - http://hdl.handle.net/11343/251687
AB  - Background and Purpose
Paroxysmal atrial fibrillation (PAF) underlying acute stroke frequently evades detection by standard practice, considered to be a combination of routine electrocardiogram (ECG) monitoring, and 24-hour Holter recordings. We hypothesized that nurse-led in-hospital intermittent monitoring approach would increase PAF detection rate.
Methods
We recruited patients hospitalised for stroke/transient ischemic attack, without history of atrial fibrillation (AF), in a prospective multi-centre observational study. Patients were monitored using a smartphone-enabled handheld ECG (iECG) during routine nursing observations, and underwent 24-hour Holter monitoring according to local practice. The primary outcome was comparison of AF detection by nurse-led iECG versus Holter monitoring in patients who received both tests: secondary outcome was oral anticoagulant commencement at 3-month following PAF detection.
Results
One thousand and seventy-nine patients underwent iECG monitoring: 294 had iECG and Holter monitoring. AF was detected in 25/294 (8.5%) by iECG, and 8/294 (2.8%) by 24-hour Holter recordings (P<0.001). Median duration from stroke onset to AF detection for iECG was 3 days (interquartile range [IQR], 2 to 6) compared with 7 days (IQR, 6 to 10) for Holter recordings (P=0.02). Of 25 patients with AF detected by iECG, 11 were commenced on oral anticoagulant, compared to 5/8 for Holter. AF was detected in 8.8% (69/785 patients) who underwent iECG recordings only (P=0.8 vs. those who had both iECG and 24-hour Holter).
Conclusions
Nurse-led in-hospital iECG surveillance after stroke is feasible and effective and detects more PAF earlier and more frequently than routine 24-hour Holter recordings. Screening with iECG could be incorporated into routine post-stroke nursing observations to increase diagnosis of PAF, and facilitate institution of guideline-recommended anticoagulation.
LA  - English
PB  - KOREAN STROKE SOC
T1  - Nurse Led Smartphone Electrographic Monitoring for Atrial Fibrillation after Ischemic Stroke: SPOT AF
DO  - 10.5853/jos.2020.00689
IS  - Journal of stroke
VL  - 22
IS  - 3
SP  - 387-395
L1  - /bitstream/handle/11343/251687/PMC7568969.pdf?sequence=1&isAllowed=y
ER  -