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Published on: July 20, 2022
Is Stroke risk analysis (SRA) a reliable method for predicting atrial fibrillation? A systematic review
Rafael Alessandro Ferreira Gomes1, Michel Pompeu Barros de Oliveira Sá1, Marcela Vasconcelos Montenegro1
1University of Pernambuco, Recife, Pernambuco, Brazil.
Insights
Stroke Risk Analysis (SRA) software effectively identifies high-risk patients for paroxysmal atrial fibrillation, a key stroke cause. This tool aids in selecting patients for further cardiac monitoring, improving stroke risk assessment.
Area of Science:
- Cardiology
- Neurology
- Medical Informatics
Background:
- Atrial fibrillation is a significant cause of cardioembolic stroke, contributing 17-30% of stroke etiologies.
- Stroke Risk Analysis (SRA) software analyzes continuous electrocardiograms to identify patients at high risk for paroxysmal atrial fibrillation.
Purpose of the Study:
- To systematically review the effectiveness of the SRA method in predicting stroke risk due to paroxysmal atrial fibrillation.
- Evaluate SRA's role in identifying patients who may benefit from further investigation.
Main Methods:
- Systematic review following the International Prospective Register of Systematic Reviews Protocol (CRD42021253974).
- Searched BMJB, PubMed/MEDLINE, Science Direct, and LILACS databases.
- Included six cohort studies with 2,088 stroke participants comparing SRA with continuous ECG monitoring (1-48h).
Main Results:
- SRA demonstrated a high negative predictive value (96-99.1%) in detecting paroxysmal atrial fibrillation.
- SRA can assist in selecting high-risk patients for implantable cardiac monitoring.
Conclusions:
- Sequential use of SRA and implantable cardiac monitoring is a promising strategy for diagnosing undiagnosed paroxysmal atrial fibrillation.
- SRA serves as a cost-effective pre-selection tool for identifying stroke patients who may benefit from implantable cardiac monitoring.
- The absence of randomized controlled trials is a noted limitation.
Introduction:
Atrial fibrillation is responsible for a considerable number of cases of cardioembolism, accounting for 17% to 30% of the etiologies of all strokes. The software known as Stroke Risk Analysis (SRA) detects patients at high risk of paroxysmal atrial fibrillation by analyzing a continuous electrocardiogram recorded over different periods of time.
Objectives:
This article aims to carry out a systematic review investigating the effectiveness of the SRA method in predicting the risk of stroke patients having paroxysmal atrial fibrillation as the cause of the event.
Methods:
The methods correspond to the format of the International Prospective Register of Systematic Reviews Protocol, according to CRD Identification Code: CRD42021253974. A systematic search was carried out in BMJB, PubMed/MEDLINE, Science Direct and LILACS. Six cohort studies met the inclusion criteria, representing a total of 2,088 participants with stroke, and compared the detection of patients with paroxysmal atrial fibrillation on the continuous recording electrocardiogram with a time variation of 1 to 48h with the use of SRA.
Results:
Studies have shown that SRA has a high negative predictive value (between 96 and 99.1%) and can contribute to the selection of patients at high risk of paroxysmal atrial fibrillation to be referred for implantable cardiac monitoring to continue the investigation.
Conclusions:
A sequential combination of SRA with implantable cardiac monitoring is a promising strategy for detecting undiagnosed paroxysmal atrial fibrillation. Thus, the SRA can act as a cost-effective pre-selection tool to identify patients at higher risk of having paroxysmal atrial fibrillation as a possible cause of stroke and who may benefit from implantable cardiac monitoring. However, the lack of randomized studies is a limitation that must be considered.
