Delayed diagnosis of atrial fibrillation after first‐ever stroke increases recurrent stroke risk: a 5‐year nationwide follow‐up study

Chou, Ping-Song; Ho, Bo-Lin; Chan, Yi‐Hsin; Wu, Min‐Hsien; Hu, Han‐Hwa; Chao, A-Ching

doi:10.1111/imj.13686

Cited by 14 publications

(8 citation statements)

References 26 publications

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“…Notably, a good proportion of ESUS patients may harbor undiagnosed AF (Wachter & Freedman, 2017). Early detection of AF is, in turn, important as delayed diagnosis of AF after stroke itself increases the risk of recurrent stroke (Chou et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Continuous 4‐week ECG monitoring with adhesive electrodes reveals AF in patients with recent embolic stroke of undetermined source

Lumikari

Putaala

Kerola

et al. 2019

Noninvasive Electrocardiol

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BackgroundAtrial fibrillation (AF) frequently escapes routine stroke workup due to its unpredictable and often asymptomatic nature, leaving a significant portion of patients at high risk of recurrent stroke. Recent trials emphasized continuous electrocardiogram (ECG) monitoring in the detection of occult AF. We screened AF in patients meeting the embolic stroke of unknown source (ESUS) criteria using an external miniaturized recorder with an adhesive electrode.MethodsPatients aged ≥50 with recent ESUS were prospectively screened and assigned to wear a 1‐lead ECG device capable to record continuous ECG for up to 4 weeks. Electrodes were replaced every 3–4 days. Primary outcome was proportion of patients completing at least 80% of monitoring. Secondary outcome measures included incidence of AF and initiation of oral anticoagulation therapy after AF detection.ResultsFifty‐seven patients were monitored (mean age 64.5 ± 8.2 years, median delay from stroke to the start of monitoring 8 days, IQR 4–44). Of these, 51 patients (89.5%) completed at least 80% of the desired monitoring period. We detected AF ≥30 s in seven patients (12.3%), all of whom initiated anticoagulation therapy. Atrial fibrillation was revealed in six patients (85.7%) within the first week of monitoring. Compared to patients without AF, patients with AF were older (70.6 ± 5.1 vs. 63.6 ± 8.3 years, p < 0.011) and more obese (body mass index 30.0 ± 3.4 vs. 26.6 ± 4.6, p < 0.039).ConclusionsProlonged ECG monitoring with an external device using adhesive electrodes is feasible in ESUS patients, since nine out of ten patients used the device appropriately and AF was detected in one out of eight patients.

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Section: Introductionmentioning

confidence: 99%

Continuous 4‐week ECG monitoring with adhesive electrodes reveals AF in patients with recent embolic stroke of undetermined source

Lumikari

Putaala

Kerola

et al. 2019

Noninvasive Electrocardiol

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“…Supplementary diagnostic procedures should be initiated as soon as possible following the occurrence of stroke, in order to maximise the benefits of potentially indicated anticoagulation. A delayed diagnosis of atrial fibrillation after the first ischaemic stroke is related to a 1.5-fold higher risk of recurrence [23]. It also needs to be emphasised that the curves of survival free of another stroke diverge already in the first year of follow-up, later becoming almost parallel [23].…”

Section: Therapeutic Problemmentioning

confidence: 99%

“…A delayed diagnosis of atrial fibrillation after the first ischaemic stroke is related to a 1.5-fold higher risk of recurrence [23]. It also needs to be emphasised that the curves of survival free of another stroke diverge already in the first year of follow-up, later becoming almost parallel [23].…”

Section: Therapeutic Problemmentioning

confidence: 99%

Statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of implantable cardiac monitors in patients after ischaemic embolic stroke of undetermined source

Farkowski

Karliñski

Kaźmierczak

et al. 2018

Neurol Neurochir Pol.

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Introduction. Stroke remains one of the main causes of death and the most common cause of long-term disability in adults. Embolic strokes of undetermined source (ESUS) amount to a significant proportion of all ischaemic strokes. Detection of atrial fibrillation (AF) in this group of patients would allow for a major therapeutic decision to switch from antiplatelets to oral anticoagulants and therefore significantly reduce the risk of recurrence. State of the Art. Current technology allows long-term continuous ECG monitoring with different systems, including implantable cardiac monitors (ICM). However, in Poland lack of reimbursement does not allow their use in everyday clinical practice. Clinical Implications. This is a statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of ICM in patients after ischaemic embolic strokes of undetermined source. The aim was to develop reasonable and comprehensive guidance on how to select and manage candidates for ICM in order to obtain the maximum benefit for Polish public health. Future Directions. This expert opinion is not intended as a guideline but it provides advice as to how to optimise the potential use of ICM in patients after ESUS in the Polish setting.

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“…Once diagnosed, the stroke risk of AF can be effectively reduced with oral anticoagulation therapy (Kirchhof et al, 2016). The threshold of AF burden to cause marked risk of recurrent stroke is still to be defined, but there is clear evidence that poststroke detected AF increases the risk of recurrent stroke, leading to a need to establish AF diagnosis and initiate anticoagulation without delays (Chou et al, 2018;Noseworthy et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Prolonged ECG with a novel recorder utilizing electrode belt and mobile device in patients with recent embolic stroke of undetermined source: A pilot study

Lumikari

Pirinen

Putaala

et al. 2020

Noninvasive Electrocardiol

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Background: Paroxysmal atrial fibrillation (pAF) is a major risk factor for ischemic stroke, but challenging to detect with routine short-term monitoring methods. In this pilot study, we present a novel method for prolonged ECG and screening for pAF in patients with a recent embolic stroke of unknown source (ESUS). Methods: Fifteen patients aged ≥ 50 years with a recent ESUS were assigned to wear an external electrode belt-based 1-lead ECG device (Beat2Phone) continuously for 2 weeks (wear time). The device was operated via a mobile phone application in nonhospital conditions. The primary outcome was patient adherence to monitoring. Secondary outcomes were incidence of new pAF, quality-wise comparison to Holter, and usability of the novel ECG monitoring method with Systems Usability Scale (SUS). We also performed a 24-to 48-hr comparison between simultaneous Beat2Phone ECG and a standard Holter in 6 patients. Results: Wear time of Beat2Phone device was over 80% in 5 (33.3%) patients, 50%-80% in 7 (46.6%) patients, and less than 50% in 3 (20%) patients. We detected pAF ≥ 30 s in 1 patient (6.7%). In the simultaneous monitoring with Beat2Phone and Holter, there were a total of 817 (out of 1979) analyzable periods of sinus rhythm or premature atrial or ventricular beats (Cohen's Kappa coefficient 0.92 ± 0.02 between Beat2Phone and Holter), and no pAF events. Beat2Phone ECG showed remarkable SUS scores in user evaluations (average score: 81.4 out of 100 on SUS). Conclusions: Beat2Phone device was easy to use among ESUS patients and in optimal conditions provided high-quality 1-lead ECG signal for diagnosing pAF. Clinical trial registration: The study was not registered, as it was a nonrandomized single-arm pilot study.

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Delayed diagnosis of atrial fibrillation after first‐ever stroke increases recurrent stroke risk: a 5‐year nationwide follow‐up study

Abstract: Delayed diagnosis of AF after stroke increased the risk of recurrent stroke, particularly in men.

Cited by 14 publications

References 26 publications

Continuous 4‐week ECG monitoring with adhesive electrodes reveals AF in patients with recent embolic stroke of undetermined source

Continuous 4‐week ECG monitoring with adhesive electrodes reveals AF in patients with recent embolic stroke of undetermined source

Statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of implantable cardiac monitors in patients after ischaemic embolic stroke of undetermined source

Prolonged ECG with a novel recorder utilizing electrode belt and mobile device in patients with recent embolic stroke of undetermined source: A pilot study

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