Prolonged cardiac monitoring (>7 days) reduced ischemic stroke occurrence compared to conventional monitoring (Risk Ratio 0.76; 95% CI 0.59-0.96).
Meta-Analysis (n=9,048)
Does prolonged cardiac monitoring for more than 7 days reduce ischemic stroke occurrence in patients with cardiovascular risk factors compared to conventional monitoring?
Prolonged cardiac monitoring (>7 days) significantly reduces the risk of ischemic stroke in patients with cardiovascular risk factors, likely driven by increased detection of subclinical atrial fibrillation and subsequent anticoagulation.
Effect estimate: Risk Ratio 0.76 (95% CI 0.59-0.96)
Abstract Introduction: Prolonged cardiac monitoring (PCM) substantially improves the detection of subclinical atrial fibrillation (AF) among patients with history of ischemic stroke (IS), leading to prompt initiation of anticoagulants. However, whether PCM may lead to IS prevention remains equivocal. Patients and methods: In this systematic review and meta-analysis, randomized-controlled clinical trials (RCTs) reporting IS rates among patients with known cardiovascular risk factors, including but not limited to history of IS, who received PCM for more than 7 days versus more conservative cardiac rhythm monitoring methods were pooled. Results: Seven RCTs were included comprising a total of 9048 patients with at least one known cardiovascular risk factor that underwent cardiac rhythm monitoring. PCM was associated with reduction of IS occurrence compared to conventional monitoring (Risk Ratio: 0.76; 95% CI: 0.59–0.96; I 2 = 0%). This association was also significant in the subgroup of RCTs investigating implantable cardiac monitoring (Risk Ratio: 0.75; 95% CI: 0.58–0.97; I 2 = 0%). However, when RCTs assessing PCM in both primary and secondary prevention settings were excluded or when RCTs investigating PCM with a duration of 7 days or less were included, the association between PCM and reduction of IS did not retain its statistical significance. Regarding the secondary outcomes, PCM was related to higher likelihood for AF detection and anticoagulant initiation. No association was documented between PCM and IS/transient ischemic attack occurrence, all-cause mortality, intracranial hemorrhage, or major bleeding. Conclusion: PCM may represent an effective stroke prevention strategy in selected patients. Additional RCTs are warranted to validate the robustness of the reported associations.
Tsivgoulis et al. (Mon,) conducted a meta-analysis in Cardiovascular risk factors including history of ischemic stroke (n=9,048). Prolonged cardiac monitoring (PCM) vs. Conventional monitoring was evaluated on Ischemic stroke occurrence (Risk Ratio 0.76, 95% CI 0.59-0.96). Prolonged cardiac monitoring (>7 days) reduced ischemic stroke occurrence compared to conventional monitoring (Risk Ratio 0.76; 95% CI 0.59-0.96).