Atrial Fibrillation Diagnosis Timing, Ambulatory ECG Monitoring Utilization, and Risk of Recurrent Stroke

Abstract

Background-The risk of recurrence after an initial ischemic stroke or transient ischemic attack (TIA) may be impacted by undiagnosed atrial fibrillation (AF). We therefore assessed the impact of AF diagnosis and timing on stroke/TIA recurrence rates in a large real-world sample of patients. Methods and Results-Using commercial claims data (Truven Health Analytics MarketScan), we performed a retrospective cohort study of patients with an index stroke or TIA event recorded in years 2008 through 2011. Patients were characterized by baseline oral anticoagulation, CHADS 2 and CHA 2 DS 2 -VASc scores, AF diagnosis and timing with respect to the index stroke, and presence or absence of post-index ambulatory cardiac monitoring. The primary outcome was the recurrence of an ischemic stroke or TIA. Of 179 160 patients (age 67±16.2 years; 53.7% female), the Kaplan-Meier estimate for stroke/TIA recurrence within 1 year was 10.6%. Not having oral anticoagulation prescribed at baseline and having AF first diagnosed >7 days post-stroke (late AF) was highly associated with recurrent stroke/TIA (hazard ratio, 2.0; 95% confidence interval, 1.9-2.1). Among patients with at least 1 year of follow-up, only 2.6% and 9.7% had ambulatory ECG monitoring in the 7 days and 12 months post-stroke, respectively. Conclusions-AF diagnosed after stroke is an important hallmark of recurrent stroke risk. Increasing the low utilization of cardiac monitoring after stroke could identify undiagnosed AF earlier, leading to appropriate oral anticoagulation treatment and a reduction in stroke/TIA recurrence. (Circ Cardiovasc Qual Outcomes.

Combined Nonlinear Analysis of Atrial and Ventricular Series for Automated Screening of Atrial Fibrillation

“…To overcome this problem, the automatic identification of AF from continuous monitoring of the electrocardiogram (ECG) has been proposed [17]. In a similar line, the use of automatic algorithms to detect the early appearance of AF after ischemic stroke has also been recently suggested as a key measure to reduce additional attacks [18]. In fact, although the presence of brief AF episodes has not been associated with an increased risk of clinical events in patients with pacemakers and implantable cardioverter defibrillators [19], it is an accepted marker of recurrent risk of stroke [18].…”

“…In fact, although the presence of brief AF episodes has not been associated with an increased risk of clinical events in patients with pacemakers and implantable cardioverter defibrillators [19], it is an accepted marker of recurrent risk of stroke [18]. Considering these aspects, many authors have identified personal monitoring devices, massively developed in last years, as extremely helpful tools for premature identification of silent AF [18,20].…”

“…However, these metrics have to be computed from time intervals with at least several dozens of beats, thus introducing a delay in the identification of AF and burying the detection of short episodes [23]. Bearing in mind that the occurrence of brief asymptomatic episodes often conforms the typical advent of AF [14] and that this fact has been closely associated with an elevated risk of thrombus formation [24] and ischemic stroke recurrence [18], this limitation involves a serious drawback in RR time series-based methods.…”

ECG Monitoring Systems: Review, Architecture, Processes, and Key Challenges

“…Arrhythmia diagnosis is one of the most common diseases diagnosed based on ECG signals [171][172][173][174]. Real-time Cloud-based ECG monitoring systems for arrhythmia detection were proposed in [175,176], whereas AF is commonly diagnosed based on ECG signals [57,67,[177][178][179]. ECG signals contribute to the detection of several cardiovascular abnormalities, which were addressed in [180][181][182].…”

Positionspapier zur Detektion von Vorhofflimmern nach ischämischem Schlaganfall

“…Vorhofflimmern tritt bei einem relevanten Anteil der Betroffenen jedoch nur intermittierend auf und verläuft häufig asymptomatisch, was auch für die Mehrzahl der Schlaganfallpatienten zutrifft, bei denen im weiteren Verlauf erstmals ein Vorhofflimmern detektiert wird [6]. Die Detektion von Vorhofflimmern nach ischämischem Schlaganfall ist aus folgenden Gründen relevant: ▪ Schlaganfallpatienten mit (unentdecktem) Vorhofflimmern haben unbehandelt ein vergleichsweise hohes Rezidivrisiko für einen ischämischen Schlaganfall [5,7]. ▪ Schlaganfälle, die bestimmte Hirnareale (wie beispielsweise die Inselregion) betreffen, können möglicherweise das Auftreten von Vorhofflimmern begünstigen [8,9].…”