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Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care
Louise Feldborg Lyckhage1, Morten Lock Hansen2,3, Jens Christian Toft4
1Department of Neurology, Zealand University Hospital, Roskilde, Denmark llyckhage@hotmail.com llyckhage@hotmail.com.
Insights
Continuous ECG screening detected atrial fibrillation in 4.6% of post-stroke patients. Standard methods like pulse checks and 12-lead ECG showed low sensitivity for diagnosing this condition.
Area of Science:
- Cardiology
- Neurology
- Primary Care Medicine
Background:
- Screening for atrial fibrillation (AF) after stroke is crucial for preventing recurrent events.
- The diagnostic utility of continuous electrocardiography (cECG) in primary care settings for post-stroke AF detection remains under investigation.
Purpose of the Study:
- To evaluate the diagnostic yield of a 7-day Holter monitor for screening atrial fibrillation in patients with a history of ischemic stroke.
- To compare the effectiveness of 7-day Holter monitoring with standard methods like pulse palpation and 12-lead ECG.
Main Methods:
- Inclusion of patients over 49 years old with ischemic stroke >1 year prior to enrollment, naive to AF.
- Screening in primary care using pulse palpation, 12-lead ECG, and 7-day Holter monitoring.
- Baseline NT-proBNP levels were measured for all participants.
Main Results:
- 7-day Holter monitoring identified AF in 4.6% of 366 patients (Number Needed to Screen: 22).
- 12-lead ECG detected AF in only 0.82% of patients, and irregular pulse was noted in 33.5% during palpation.
- The sensitivity of pulse palpation and 12-lead ECG was significantly lower (47% and 18%, respectively) compared to 7-day Holter monitoring.
Conclusions:
- A significant proportion of stroke patients were diagnosed with AF using 7-day Holter monitoring.
- The low sensitivity of pulse palpation and 12-lead ECG suggests that incorporating continuous ECG monitoring may improve post-stroke AF detection in primary care.
Background And Purpose:
The diagnostic benefit of using continuous ECG (cECG) for poststroke atrial fibrillation (AF) screening in a primary care setting is unclear. We aimed to assess the diagnostic yield from screening patients who previously had a stroke with a 7-day Holter monitor.
Methods:
Patients older than 49 years, naive to AF, with an ischaemic stroke over 1 year before enrolment were included. In a primary care setting, all patients were screened for AF using pulse palpation, 12-lead ECG and 7-day Holter monitoring. Further, NT-proBNP was determined at baseline.
Results:
7-day Holter monitoring uncovered AF in 17 of 366 patients (4.6% (95% CI 2.7 to 7.3)). The number needed to screen was 22 patients (14-37). 12-lead ECG uncovered AF in 3 patients (0.82% (95% CI 0.17 to 2.4)), and 122 patients had irregular pulse during pulse palpation (33.5% (95% CI 28.7 to 38.2)). When using 7-day Holter monitoring as reference standard, the sensitivity of pulse palpation and 12-lead ECG was 47% (95% CI 23% to 72%) and 18% (95% CI 4% to 43%). High levels (≥400 pg/mL) of NT-proBNP versus low levels (≤200 pg/mL) were not associated with AF in the univariate analysis nor when adjusted for age (OR 2.4 (95% CI 0.5 to 8.4) and 1.6 (95% CI 0.3 to 6.0)).
Conclusions:
A relevant proportion of patients with stroke more than 1 year before inclusion were diagnosed with AF through 7-day Holter monitoring. Given the low sensitivities of pulse palpation and 12-lead ECG, additional cECG may be considered during poststroke primary care follow-up.
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