Do Sequential Cardiac Monitoring Methods Detect More Cases of Atrial Fibrillation in Post-Stroke Patients Compared to...

Background and purpose There is currently a lack of formal guidelines on the optimal strategy for detecting atrial fibrillation (AF) post-stroke, with respect to the type and length of cardiac monitoring. The primary objective of this study was to determine if sequential methods of cardiac monitoring detect more cases of AF in post-stroke patients compared to non-sequential methods; the secondary objective was to determine if sequential methods of cardiac monitoring reduce the time taken to reach a diagnosis of AF in post-stroke patients compared to non-sequential methods. Methods A retrospective cohort study was conducted on data collected from 102 patients seen in the United Kingdom, at a district general hospital, at an outpatient stroke clinic, with a confirmed diagnosis of ischaemic stroke from 2019 to 2021. Data was collected on whether patients had sequential or non-sequential methods of cardiac monitoring and if AF was detected. Sequential cardiac monitoring was defined as one or more methods of cardiac monitoring (e.g., Holter monitoring, implantable loop recorder) with a stepwise progression to a longer form of cardiac monitoring if no AF was detected.  Results A total of 41% of participants in the sequential monitoring group (number, n=18/44) had AF detected during the study period, compared to 22% in the non-sequential group (n=13/58) (hazard ratio 2.23, 95% confidence interval 1.02 to 4.85; p-value, p=0.04). 20% of the cases of AF in the sequential monitoring group (n=8.8/44) were detected 328 days earlier than 20% of AF cases in the non-sequential group (n=11.8/58) (p=0.047). Conclusion Sequential cardiac monitoring can detect more cases of AF and can reduce the time taken to reach a diagnosis of AF compared to conventional methods. The practicality and potential risks of implementing this method of sequential monitoring for all patients should, however, be considered.