What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Ischemic stroke or transient ischemic attack with negative initial AF screening (n=4531). Intervention: Implantable cardiac monitoring (ICM). Primary outcome: Association of atrial fibrillation detection proportion with monitoring duration (Coefficient 0.015, 95% CI 0.005 to 0.024, p=0.003).

September 30, 2019Open Access

Duration of Implantable Cardiac Monitoring and Detection of Atrial Fibrillation in Ischemic Stroke Patients: A Systematic Review and Meta-Analysis

Key Result

Extended duration of implantable cardiac monitoring and increased patient age were independently associated with a higher proportion of atrial fibrillation detection in ischemic stroke patients.

Study Design

Type

Meta-Analysis (n=4,531)

PICO

Population

Ischemic stroke or transient ischemic attack with negative initial AF screening (n=4,531)

Intervention / Comparator

Implantable cardiac monitoring (ICM)

Primary Outcome

Association of atrial fibrillation detection proportion with monitoring duration — Coefficient 0.015 (0.005 to 0.024), p=0.003

Main Result

Effect estimate: Coefficient 0.015 (95% CI 0.005 to 0.024)

p-value: p=0.003

Limitations

Baseline characteristics of individual patients and study protocol parameters were unavailable in a significant proportion of included studies
Presence of ecological bias cannot be excluded
Could not assess the influence of other parameters on AF detection rates that were not originally provided by included studies
Low statistical power for analyses including a low number of studies
Did not assess the number of AF episodes, false positive AF episodes, cumulative AF episode duration, or the impact of AF detection in patient management and long-term outcomes

Abstract

BACKGROUND AND PURPOSE: Current guidelines do not provide firm directions on atrial fibrillation (AF) screening after ischemic stroke (IS). We sought to investigate the association of implantable cardiac monitoring (ICM) duration with the yield of AF detection in IS patients. METHODS: We included studies reporting AF detection rates by ICM in IS patients with negative initial AF screening. We excluded studies reporting prolonged cardiac monitoring with devices other than ICM, not providing AF detection rates or monitoring duration, and reporting overlapping data for the same population. The random-effects model was used for all pooled estimates and meta-regression analyses. RESULTS: We included 28 studies (4,531 patients, mean age 65 years). In meta-regression analyses, the proportion of AF detection by ICM was independently associated with monitoring duration (coefficient=0.015; 95% confidence interval CI, 0.005 to 0.024) and mean patient age (coefficient=0.009; 95% CI, 0.003 to 0.015). No associations were detected with other patient characteristics, including IS subtype (cryptogenic vs. embolic stroke of undetermined source) or time from IS onset to CM implantation. In subgroup analyses, significant differences (P12 and ≤24 months: 26% 95% CI, 22% to 31%; >24 months: 34% 95% CI, 29% to 39%). CONCLUSION: s Extended duration of ICM monitoring and increased patient age are factors that substantially increase AF detection in IS patients with initial negative AF screening.

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Cite This Study

Tsivgoulis et al. (Mon,) conducted a meta-analysis in Ischemic stroke or transient ischemic attack with negative initial AF screening (n=4,531). Implantable cardiac monitoring (ICM) was evaluated on Association of atrial fibrillation detection proportion with monitoring duration (Coefficient 0.015, 95% CI 0.005 to 0.024, p=0.003). Extended duration of implantable cardiac monitoring and increased patient age were independently associated with a higher proportion of atrial fibrillation detection in ischemic stroke patients.

synapsesocial.com/papers/6a1241c29b33f06ee260d5d0 https://doi.org/https://doi.org/10.5853/jos.2019.01067