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Nurse Led Smartphone Electrographic Monitoring for Atrial Fibrillation after Ischemic Stroke: SPOT-AF

Journal of Stroke 2020년 22권 3호 p.387 ~ 395
Yan Bernard, Tu Hans, Lam Christina, Swift Corey, Ho Ma Sze, Mok Vincent C. T., Sui Yi, Sharpe David, Ghia Darshan, Jannes Jim, Davis Stephen, Liu Xinfeng, Freedman Ben,
소속 상세정보
 ( Yan Bernard ) - University of Melbourne Royal Melbourne Hospital Melbourne Brain Centre
 ( Tu Hans ) - University of Melbourne Western Health Department of Neurology and Medicine
 ( Lam Christina ) - University of Melbourne Royal Melbourne Hospital Melbourne Brain Centre
 ( Swift Corey ) - University of Melbourne Royal Melbourne Hospital Melbourne Brain Centre
 ( Ho Ma Sze ) - Chinese University of Hong Kong Department of Medicine and Therapeutics
 ( Mok Vincent C. T. ) - Chinese University of Hong Kong Department of Medicine and Therapeutics
 ( Sui Yi ) - Shenyang First People’s Hospital Department of Neurology
 ( Sharpe David ) - Concord General Hospital Neurology Department
 ( Ghia Darshan ) - Concord General Hospital Neurology Department
 ( Jannes Jim ) - Royal Adelaide Hospital Department of Neurology
 ( Davis Stephen ) - University of Melbourne Royal Melbourne Hospital Melbourne Brain Centre
 ( Liu Xinfeng ) - Nanjing University Medical School Jinling Hospital Department of Neurology
 ( Freedman Ben ) - University of Sydney Concord Hospital Cardiology Heart Research Institute Charles Perkins Centre

Abstract


Background and Purpose: Paroxysmal atrial fibrillation (PAF) underlying acute stroke frequently evades detection by standard practice, considered to be a combination of routine electrocardiogram (ECG) monitoring, and 24-hour Holter recordings. We hypothesized that nurse-led in-hospital intermittent monitoring approach would increase PAF detection rate.

Methods: We recruited patients hospitalised for stroke/transient ischemic attack, without history of atrial fibrillation (AF), in a prospective multi-centre observational study. Patients were monitored using a smartphone-enabled handheld ECG (iECG) during routine nursing observations, and underwent 24-hour Holter monitoring according to local practice. The primary outcome was comparison of AF detection by nurse-led iECG versus Holter monitoring in patients who received both tests: secondary outcome was oral anticoagulant commencement at 3-month following PAF detection.

Results: One thousand and seventy-nine patients underwent iECG monitoring: 294 had iECG and Holter monitoring. AF was detected in 25/294 (8.5%) by iECG, and 8/294 (2.8%) by 24-hour Holter recordings (P<0.001). Median duration from stroke onset to AF detection for iECG was 3 days (interquartile range [IQR], 2 to 6) compared with 7 days (IQR, 6 to 10) for Holter recordings (P=0.02). Of 25 patients with AF detected by iECG, 11 were commenced on oral anticoagulant, compared to 5/8 for Holter. AF was detected in 8.8% (69/785 patients) who underwent iECG recordings only (P=0.8 vs. those who had both iECG and 24-hour Holter).

Conclusions: Nurse-led in-hospital iECG surveillance after stroke is feasible and effective and detects more PAF earlier and more frequently than routine 24-hour Holter recordings. Screening with iECG could be incorporated into routine post-stroke nursing observations to increase diagnosis of PAF, and facilitate institution of guideline-recommended anticoagulation.

키워드

Atrial fibrillation; Stroke; Smartphone; Electrocardiography

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