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Large variations in atrial fibrillation screening practice after ischemic stroke and transient ischemic attack in
Kajsa Strååt1,2, Eva Isaksson3, Ann Charlotte Laska3
1Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. kajsa.straat@ki.se.
Insights
Atrial fibrillation (AF) screening practices vary significantly across Swedish stroke units following ischemic stroke or TIA. This highlights an urgent need for standardized, evidence-based recommendations for effective AF detection.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Clinical guidelines prioritize atrial fibrillation (AF) screening post-ischemic stroke or TIA.
- Current recommendations lack specificity regarding patient selection, ECG modality, and screening duration.
- Variability in practice necessitates investigation into real-world implementation.
Purpose of the Study:
- To investigate current clinical practices for AF screening in Swedish stroke units after ischemic stroke or TIA.
- To identify variations in screening methods and durations employed.
- To inform the development of evidence-based guidelines.
Main Methods:
- A digital survey was developed in collaboration with Riksstroke stakeholders.
- The survey underwent testing and revision by stroke consultants.
- The survey was distributed to medical directors of all 72 stroke units in Sweden.
Main Results:
- All 72 stroke units responded, indicating high engagement.
- Most units screen ≥75% of eligible ischemic stroke/TIA patients for AF.
- Inpatient telemetry ECG is the primary method (81%), but access varies; Holter ECG is second (17%), with diverse monitoring durations.
Conclusions:
- Significant heterogeneity exists in AF screening methods and monitoring durations across Swedish stroke units.
- The findings underscore an urgent need for evidence-based recommendations to standardize AF screening protocols.
- Standardization is crucial for improving early detection and management of AF post-stroke/TIA.
Background:
Atrial fibrillation (AF) screening after ischemic stroke or transient ischemic attack (TIA) is given high priority in clinical guidelines. However, patient selection, electrocardiogram (ECG) modality and screening duration remains undecided and current recommendations vary.
Methods:
The aim of this study was to investigate the clinical practice of AF screening after ischemic stroke or TIA at Swedish stroke units. In collaboration with the stakeholders of the Swedish Stroke Register (Riksstroke) a digital survey was drafted, then tested and revised by three stroke consultants. The survey consisted of 17 multiple choice/ free text questions and was sent by e-mail to the medical directors at all stroke units in Sweden.
Results:
All 72 stroke units in Sweden responded to the survey. Most stroke units reported that ≥ 75% of ischemic stroke (69/72 stroke units) or TIA patients (67/72 stroke units), without previously known AF, were screened for AF. Inpatient telemetry ECG was the method of first-choice in 81% of the units, but 7% reported lack of access. A variety of standard monitoring durations were used for inpatient telemetry ECG. The second most common choice was Holter ECG (17%), also with considerable variations in monitoring duration. Other AF screening modalities were used as a first-choice method (handheld and patch ECG) but less frequently.
Conclusions:
Clinical practice for AF screening after ischemic stroke or TIA differed between Swedish stroke units, both in choice of AF screening methods as well as in monitoring durations. There is an urgent need for evidence and evidence-based recommendations in this field.
Trial Registration:
Not applicable.
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