Key result
Extended 28-day cardiac rhythm monitoring detects post-stroke AF in ~16% of patients.
Why the study?
Prolonged cardiac rhythm monitoring improves AF detection after ischaemic stroke or TIA but is difficult to implement widely and unnecessary for all patients.
Does a predictive model combining clinical, ECG, blood, and genetic biomarkers accurately identify patients with a low probability of atrial fibrillation after an ischaemic stroke or TIA?
Cohort (n=675)
Yes
Does a predictive model combining clinical, ECG, blood, and genetic biomarkers accurately identify patients with a low probability of atrial fibrillation after an ischaemic stroke or TIA?
Developing and validating a multimodality predictive model for post-stroke AF could safely identify low-risk patients, reducing unnecessary prolonged cardiac monitoring while directing resources to those most likely to benefit.
Answers are grounded in this paper and cite their sources.
Supports the high yield of extended post-stroke monitoring; leaves open whether multimodality predictive modeling.
Cardiac rhythm monitoring is performed to search for atrial fibrillation (AF) after ischaemic stroke or transient ischaemic attack (TIA). Prolonged cardiac rhythm monitoring increases AF detection but is challenging to implement in many healthcare settings and is not needed for all people after ischaemic stroke/TIA. We aimed to develop and validate a model that includes clinical, electrocardiogram (ECG), blood-based, and genetic biomarkers to identify people with a low probability of AF detection after ischaemic stroke or TIA. We will recruit 675 consenting participants who are aged over 18 years, who were admitted with ischaemic stroke or TIA in the 5 days prior, who are not known to have AF, and who would be suitable for anticoagulation if AF is found. We will collect baseline demographic and clinical data, a 12-lead ECG, and a venous blood sample for blood biomarkers (including midregional pro-atrial natriuretic peptide, MRproANP) and genetic data. We will perform up to 28 days of cardiac rhythm monitoring using an R-test or patch device to search for AF in all participants. The sample size of 675 participants is based on true sensitivity of 92.5%, null hypothesis sensitivity of 80%, 80% power, and 5% significance. The primary outcome is AF detection ≥30 s duration during 28 days of cardiac rhythm monitoring. Secondary outcomes are AF detection at 1-year, recurrent cardiovascular events, and mortality and will be identified by electronic linkage and telephone follow-up. The results will guide the development of a more personalized care pathway to search for AF after ischaemic stroke or TIA. This could help to reduce cardiac rhythm monitoring for people with a low probability of AF detection and allow more intensive cardiac monitoring to be focused on people who are more likely to have AF and benefit. Participants will be consented for their data to be used in future research studies, providing a rich resource for stroke and cardiovascular research communities.
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Cameron et al. (2022) conducted a cohort in Ischaemic stroke or transient ischaemic attack (TIA) (n=675). Cardiac rhythm monitoring (up to 28 days) and biomarker profiling was evaluated on Atrial fibrillation detection ≥30 s duration during 28 days of cardiac rhythm monitoring. Prolonged cardiac rhythm monitoring for up to 28 days detected atrial fibrillation in 16% of the first 64 patients completing the ongoing PRECISE study, which aims to develop a predictive model to rule out post-stroke AF.
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