Key result
Insertable cardiac monitors significantly increased atrial fibrillation detection compared to standard care in patients with recent ischemic stroke (HR 6.00; 95% CI 3.40-10.58; p<0.001).
Why the study?
Precise recommendations for poststroke AF monitoring are lacking, including the optimal timing, duration, and method of electrocardiography monitoring.
Does an insertable cardiac monitor improve the detection of atrial fibrillation in patients with a recent ischemic stroke?
Meta-Analysis (n=1,233)
Does an insertable cardiac monitor improve the detection of atrial fibrillation in patients with a recent ischemic stroke?
Insertable cardiac monitors significantly increase the detection of poststroke atrial fibrillation and subsequent anticoagulation initiation, but this does not translate into a reduced incidence of recurrent ischemic stroke.
May support ICM for post-stroke AF detection; leaves open effects on recurrent events or mortality.
INTRODUCTION: We compared the use of insertable cardiac monitor (ICM) versus non-ICM methods of cardiac monitoring in ischemic stroke patients on the detection of atrial fibrillation (AF) and other clinical outcomes. Current guidelines recommend the routine use of 12-lead electrocardiography or Holter monitoring for AF detection after ischemic stroke. Recent randomized controlled trials have investigated the impact of ICM versus non-ICM methods of cardiac monitoring for AF detection in this population. However, precise recommendations for monitoring poststroke AF are lacking, including the optimal timing, duration, and method of electrocardiography monitoring. METHODS: A systematic search was conducted on Embase and PubMed from database inception until October 27, 2022, to include randomized controlled trials that compared ICM with non-ICM methods of cardiac monitoring for poststroke AF detection. This yielded 3 randomized controlled trials with a combined cohort of 1,233 patients with a recent ischemic stroke. Individual patient data (IPD) were then reconstructed from Kaplan-Meier curves and analyzed using the shared-frailty Cox model. An aggregate data meta-analysis was conducted for 1,233 patients across all 3 studies for outcomes that could not be reconstructed using IPD. RESULTS: One-stage meta-analysis demonstrated an increase in the hazard ratio (6.00 95% CI: 3.40-10.58; 195 p < 0.001) of AF detection in patients undergoing monitoring via ICM compared to standard care. The cumulative incidence curves of AF events in patients undergoing ICM and non-ICM separated significantly at 24 days. Aggregate data meta-analysis revealed a significant increase in initiation of anticoagulation (RR: 2.76, 95% CI: 1.89-4.02, p < 0.00001) in the ICM group. However, no significant differences in the incidence of recurrent ischemic stroke, transient ischemic attack, or death were found. CONCLUSIONS: In this meta-analysis, we found that the use of ICM increased the detection rate of poststroke AF and the rate of anticoagulation initiation in ischemic stroke patients. However, this did not translate into a reduced incidence of recurrent ischemic stroke.
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Wong et al. (2023) conducted a meta-analysis in ischemic stroke (n=1,233). Insertable cardiac monitor (ICM) vs. Standard care / non-ICM methods was evaluated on Detection of atrial fibrillation (AF) (HR 6.00, 95% CI 3.40-10.58, p=< 0.001). Insertable cardiac monitors significantly increased atrial fibrillation detection compared to standard care in patients with recent ischemic stroke (HR 6.00; 95% CI 3.40-10.58; p<0.001).
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