Key result
Nurse-led smartphone ECG monitoring detected atrial fibrillation in 8.5% of post-stroke patients compared to 2.8% with routine 24-hour Holter monitoring (P<0.001).
Why the study?
Paroxysmal AF underlying acute stroke frequently evades detection by standard practice combining routine ECG monitoring and 24-hour Holter recordings.
Does nurse-led in-hospital intermittent monitoring using a smartphone-enabled handheld ECG increase atrial fibrillation detection compared to 24-hour Holter monitoring in patients hospitalized for stroke/TIA without prior AF?
Observational (n=1,079)
Yes
Does nurse-led in-hospital intermittent monitoring using a smartphone-enabled handheld ECG increase atrial fibrillation detection compared to 24-hour Holter monitoring in patients hospitalized for stroke/TIA without prior AF?
Absolute Event Rate: 8.5% vs 2.8%
p-value: p=<0.001
Nurse-led in-hospital intermittent smartphone ECG monitoring detects paroxysmal atrial fibrillation more frequently and earlier than routine 24-hour Holter monitoring in patients with acute stroke or TIA.
May support earlier AF detection post-stroke; leaves open whether this improves anticoagulation decisions or outcomes.
BACKGROUND AND PURPOSE: Paroxysmal atrial fibrillation (PAF) underlying acute stroke frequently evades detection by standard practice, considered to be a combination of routine electrocardiogram (ECG) monitoring, and 24-hour Holter recordings. We hypothesized that nurse-led in-hospital intermittent monitoring approach would increase PAF detection rate. METHODS: We recruited patients hospitalised for stroke/transient ischemic attack, without history of atrial fibrillation (AF), in a prospective multi-centre observational study. Patients were monitored using a smartphone-enabled handheld ECG (iECG) during routine nursing observations, and underwent 24-hour Holter monitoring according to local practice. The primary outcome was comparison of AF detection by nurse-led iECG versus Holter monitoring in patients who received both tests: secondary outcome was oral anticoagulant commencement at 3-month following PAF detection. RESULTS: One thousand and seventy-nine patients underwent iECG monitoring: 294 had iECG and Holter monitoring. AF was detected in 25/294 (8.5%) by iECG, and 8/294 (2.8%) by 24-hour Holter recordings (P<0.001). Median duration from stroke onset to AF detection for iECG was 3 days (interquartile range [IQR], 2 to 6) compared with 7 days (IQR, 6 to 10) for Holter recordings (P=0.02). Of 25 patients with AF detected by iECG, 11 were commenced on oral anticoagulant, compared to 5/8 for Holter. AF was detected in 8.8% (69/785 patients) who underwent iECG recordings only (P=0.8 vs. those who had both iECG and 24-hour Holter). CONCLUSIONS: Nurse-led in-hospital iECG surveillance after stroke is feasible and effective and detects more PAF earlier and more frequently than routine 24-hour Holter recordings. Screening with iECG could be incorporated into routine post-stroke nursing observations to increase diagnosis of PAF, and facilitate institution of guideline-recommended anticoagulation.
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Yan et al. (2020) conducted an observational in Stroke or transient ischemic attack (n=1,079). Nurse-led smartphone-enabled handheld ECG (iECG) monitoring vs. 24-hour Holter monitoring was evaluated on Atrial fibrillation detection in patients who received both tests (p=<0.001). Nurse-led smartphone ECG monitoring detected atrial fibrillation in 8.5% of post-stroke patients compared to 2.8% with routine 24-hour Holter monitoring (P<0.001).
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