Key result
Post-TIA discharge rhythm monitoring yields new AF in only ~3% of patients.
Why the study?
Patients evaluated for TIA in the EDOU are often discharged with long-term rhythm monitors, but the diagnostic yield for identifying AF and AFL in this setting needed assessment.
What is the diagnostic yield of long-term rhythm monitoring for new atrial fibrillation or atrial flutter in patients evaluated for TIA in an emergency department observation unit?
Cohort (n=523)
No
What is the diagnostic yield of long-term rhythm monitoring for new atrial fibrillation or atrial flutter in patients evaluated for TIA in an emergency department observation unit?
Long-term rhythm monitoring in patients discharged from an emergency department observation unit after TIA evaluation has a low diagnostic yield (3.1%) for new atrial fibrillation or flutter, suggesting it may be overprescribed.
Low yield in EDOU TIA patients suggests selective prescribing; leaves open whether targeted monitoring improves outcomes.
BACKGROUND: Patients evaluated for transient ischemic attack (TIA) in the emergency department observation unit (EDOU) may be discharged with a long-term rhythm monitor to assess for atrial fibrillation (AF) and atrial flutter (AFL). We aimed to assess the diagnostic yield of long-term rhythm monitoring for diagnosing AF and AFL in an EDOU cohort of patients evaluated for TIA. METHODS: We conducted an observational cohort study, in which patients ≥18 years old who were evaluated in the EDOU TIA Protocol at an academic tertiary care center from July 1, 2021 to December 1, 2023 were accrued. This analysis included patients who received a long-term rhythm monitor (Zio Patch) at the time of EDOU discharge. Monitor results were reviewed for diagnoses of AF or AFL. Diagnostic yield, defined as the proportion receiving monitoring who had a new diagnosis of AF or AFL, was calculated with an exact 95% confidence interval (95% CI) and used to determine the number needed to test. RESULTS: Of the 523 EDOU TIA protocol patients, 59.7% (312/523) were female, 29.6% (155/523) were non-White, and the mean age was 65.9 ± 14.9 years. At discharge, 18.4% (96/523) received long-term rhythm monitoring, which identified AF in 5.2% (5/96) and AFL in 1.0% (1/96). However, 3 of these patients already had known AF/AFL. Thus, the yield for diagnosing new AF/AFL was 3.1% (3/96, 95% CI, 0.7%-8.9%), with a number needed to test of 32. CONCLUSIONS: The diagnostic yield of long-term rhythm monitoring for diagnosing AF/AFL among discharged EDOU TIA protocol patients was low, suggesting it may be overprescribed in this population.
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Lumia et al. (2025) conducted a cohort in Transient ischemic attack (TIA) (n=523). Long-term rhythm monitoring (Zio Patch) was evaluated on New diagnosis of atrial fibrillation (AF) or atrial flutter (AFL) (95% CI 0.7-8.9). Long-term rhythm monitoring in patients discharged from an emergency department observation unit after TIA had a low diagnostic yield for new atrial fibrillation or flutter (3.1%; 95% CI, 0.7%-8.9%).
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