Nurse Led Smartphone Electrographic Monitoring for Atrial Fibrillation after Ischemic Stroke: SPOT-AF

Area of Science:

• Cardiology
• Neurology
• Digital Health

Background:

• Paroxysmal atrial fibrillation (PAF) is often undetected in acute stroke patients using standard electrocardiogram (ECG) and Holter monitoring.
• Early detection of PAF is crucial for preventing recurrent strokes.

Purpose of the Study:

• To evaluate the effectiveness of a nurse-led, in-hospital intermittent ECG monitoring strategy for detecting PAF in stroke patients.
• To compare the PAF detection rate and time to diagnosis using intermittent handheld ECG (iECG) versus 24-hour Holter monitoring.

Main Methods:

• A prospective, multi-center observational study involving hospitalized stroke/transient ischemic attack patients without a prior AF history.
• Patients underwent nurse-led iECG monitoring during routine nursing observations alongside standard 24-hour Holter monitoring.
• Primary outcome: comparison of AF detection rates between iECG and Holter; Secondary outcome: oral anticoagulant commencement at 3 months.

Main Results:

• iECG detected AF in 8.5% (25/294) of patients, significantly higher than 2.8% (8/294) detected by Holter (P<0.001).
• Median time to AF detection was shorter with iECG (3 days) compared to Holter (7 days) (P=0.02).
• AF was detected in 8.8% of patients undergoing iECG only.

Conclusions:

• Nurse-led in-hospital iECG surveillance is a feasible and effective method for increasing PAF detection rates in stroke patients.
• This approach facilitates earlier diagnosis and timely initiation of guideline-recommended anticoagulation therapy.
• Integrating iECG into routine post-stroke nursing care can improve PAF diagnosis and stroke prevention strategies.