What question did this study set out to answer?

July 26, 2019European journal of medical researchOpen Access

Early prolonged ambulatory cardiac monitoring in stroke (EPACS): an open-label randomised controlled trial

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Why the study?

Cardioembolism in paroxysmal atrial fibrillation causes preventable TIA or ischaemic stroke, but short-duration Holter monitoring may miss many events due to their transient nature.

Does early 14-day patch-based ECG monitoring improve the detection of paroxysmal atrial fibrillation in patients with recent cryptogenic stroke or TIA compared to short-duration Holter monitoring?

Comparison

Patch-based monitoring vs short-duration Holter monitoring

Design

Open-label randomised controlled trial

Follow-up

90 days

Authors

LSL. SztrihaKing's College Hospital FCFong Kum ChanKing's College London JAJohn Aeron‐ThomasTemple College

Discussion

Member takes

Implication

Strengthens the case for early 14-day patch monitoring after cryptogenic stroke or TIA; confirms and extends prior prolonged-monitoring trials to adhesive devices.

Key Points

To determine whether early, prolonged patch-based cardiac monitoring improves the detection of paroxysmal atrial fibrillation compared to standard short-duration Holter monitoring following an ischemic stroke or transient ischemic attack.
Open-label randomized controlled trial (N=116; ISRCTN 50253271) comparing prolonged patch-based monitoring (n=56) against short-duration Holter monitoring (n=60) with 90 days of follow-up.
Evaluated the primary outcome of at least one ECG-confirmed episode of paroxysmal atrial fibrillation lasting 30 seconds or longer within 90 days, supplemented by a healthcare budget impact analysis.
Paroxysmal atrial fibrillation at 90 days was detected in 16.3% (7/43) of patients in the patch-monitoring arm compared to 2.1% (1/47) in the Holter-monitoring arm (odds ratio 8.9; 95% CI 1.1–76.0; P = 0.026).
Healthcare economic modeling projected that adoption of the patch service would prevent 10.8 additional strokes per year, saving £113,630 annually in direct medical costs and £162,491 over 5 years.

Structured PICO

Does early 14-day patch-based ECG monitoring improve the detection of paroxysmal atrial fibrillation in patients with recent cryptogenic stroke or TIA compared to short-duration Holter monitoring?

Population

116 adults (≥18 years of age) with cryptogenic ischaemic non-lacunar stroke or TIA within the past 72 hours, mean age 70.4, 38.9% female, UK-based. Key exclusions: history of atrial fibrillation or atrial flutter, carotid stenosis >50%, pre-existing indication or contraindication for permanent anticoagulation therapy, or unable to provide informed consent.

Intervention

14-day continuous patch-based ECG monitor (ZioPatch) applied to the anterior chest wall, plus standard practice short-duration Holter monitoring.

Comparator

Conventional medical therapy of short-duration ambulatory Holter monitoring only (duration determined by treating physician, usually 24 hours).

Outcome

Detection of one or more episodes of ECG-documented paroxysmal atrial fibrillation (PAF) lasting at least 30 seconds within 90 days.surrogate

Early, prolonged 14-day patch-based ECG monitoring significantly increases the detection of paroxysmal atrial fibrillation compared to standard short-duration Holter monitoring in patients with recent cryptogenic stroke or TIA.

Limitations

High drop-out rate for Holter ECGs due to patient refusal for outpatient short-duration ECG monitor placement
Insufficient information on clinical outcomes to support a cost-utility model given the limited 90-day follow-up period

Cite This Study

Sztriha et al. (2019) studied this question.

synapsesocial.com/papers/6a80d0cdb5fee548463c6388 https://doi.org/10.1186/s40001-019-0383-8

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF AF ablation outcomes

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Implication

Strengthens the case for early 14-day patch monitoring after cryptogenic stroke or TIA; confirms and extends prior prolonged-monitoring trials to adhesive devices.

Early prolonged ambulatory cardiac monitoring in stroke (EPACS): an open-label randomised controlled trial

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Early prolonged ambulatory cardiac monitoring in stroke (EPACS): an open-label randomised controlled trial

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

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