Key result
30-day smartphone ECG monitoring significantly improved the detection of atrial fibrillation compared with 24-h Holter monitoring in patients with recent stroke or TIA (9.5% vs. 2.0%; P=0.024).
Why the study?
Atrial fibrillation is a preventable cause of ischaemic stroke that often remains undiagnosed, and the utility of smartphone ECG for AF detection after ischaemic stroke was unknown.
Does 30-day smartphone ECG monitoring improve the detection of atrial fibrillation in patients ≥55 years with a recent ischaemic stroke or TIA compared to 24-h Holter monitoring?
RCT (n=203)
Open-label
randomly assigned
Yes
Does 30-day smartphone ECG monitoring improve the detection of atrial fibrillation in patients ≥55 years with a recent ischaemic stroke or TIA compared to 24-h Holter monitoring?
Effect estimate: Absolute difference 7.5%
Absolute Event Rate: 9.5% vs 2%
Absolute Risk Reduction: 7.5%
Number Needed to Treat: 13
p-value: p=0.024
A 30-day smartphone ECG monitoring strategy significantly increases the detection of atrial fibrillation and subsequent oral anticoagulation initiation compared to standard 24-hour Holter monitoring in patients with recent cryptogenic stroke or TIA.
Supports smartphone ECG monitoring after stroke or TIA; extends RCT evidence for prolonged AF detection.
AIMS: Atrial fibrillation (AF) is a preventable cause of ischaemic stroke but it is often undiagnosed and undertreated. The utility of smartphone electrocardiogram (ECG) for the detection of AF after ischaemic stroke is unknown. The aim of this study is to determine the diagnostic yield of 30-day smartphone ECG recording compared with 24-h Holter monitoring for detecting AF ≥30 s. METHODS AND RESULTS: In this multicentre, open-label study, we randomly assigned 203 participants to undergo one additional 24-h Holter monitoring (control group, n = 98) vs. 30-day smartphone ECG monitoring (intervention group, n = 105) using KardiaMobile (AliveCor®, Mountain View, CA, USA). Major inclusion criteria included age ≥55 years old, without known AF, and ischaemic stroke or transient ischaemic attack (TIA) within the preceding 12 months. Baseline characteristics were similar between the two groups. The index event was ischaemic stroke in 88.5% in the intervention group and 88.8% in the control group (P = 0.852). AF lasting ≥30 s was detected in 10 of 105 patients in the intervention group and 2 of 98 patients in the control group (9.5% vs. 2.0%; absolute difference 7.5%; P = 0.024). The number needed to screen to detect one AF was 13. After the 30-day smartphone monitoring, there was a significantly higher proportion of patients on oral anticoagulation therapy at 3 months compared with baseline in the intervention group (9.5% vs. 0%, P = 0.002). CONCLUSIONS: Among patients ≥55 years of age with a recent cryptogenic stroke or TIA, 30-day smartphone ECG recording significantly improved the detection of AF when compared with the standard repeat 24-h Holter monitoring.
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Koh et al. (2021) conducted an RCT in ischaemic stroke or transient ischaemic attack (n=203). 30-day smartphone ECG monitoring vs. 24-h Holter monitoring was evaluated on detection of AF ≥30 s (Absolute difference 7.5%, p=0.024). 30-day smartphone ECG monitoring significantly improved the detection of atrial fibrillation compared with 24-h Holter monitoring in patients with recent stroke or TIA (9.5% vs. 2.0%; P=0.024).
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