Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care

Abstract

<jats:sec><jats:title>Background and purpose</jats:title><jats:p>The diagnostic benefit of using continuous ECG (cECG) for poststroke atrial fibrillation (AF) screening in a primary care setting is unclear. We aimed to assess the diagnostic yield from screening patients who previously had a stroke with a 7-day Holter monitor.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients older than 49 years, naive to AF, with an ischaemic stroke over 1 year before enrolment were included. In a primary care setting, all patients were screened for AF using pulse palpation, 12-lead ECG and 7-day Holter monitoring. Further, NT-proBNP was determined at baseline.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>7-day Holter monitoring uncovered AF in 17 of 366 patients (4.6% (95% CI 2.7 to 7.3)). The number needed to screen was 22 patients (14–37). 12-lead ECG uncovered AF in 3 patients (0.82% (95% CI 0.17 to 2.4)), and 122 patients had irregular pulse during pulse palpation (33.5% (95% CI 28.7 to 38.2)). When using 7-day Holter monitoring as reference standard, the sensitivity of pulse palpation and 12-lead ECG was 47% (95% CI 23% to 72%) and 18% (95% CI 4% to 43%). High levels (≥400 pg/mL) of NT-proBNP versus low levels (≤200 pg/mL) were not associated with AF in the univariate analysis nor when adjusted for age (OR 2.4 (95% CI 0.5 to 8.4) and 1.6 (95% CI 0.3 to 6.0)).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>A relevant proportion of patients with stroke more than 1 year before inclusion were diagnosed with AF through 7-day Holter monitoring. Given the low sensitivities of pulse palpation and 12-lead ECG, additional cECG may be considered during poststroke primary care follow-up.</jats:p></jats:sec>

Prevalence of atrial fibrillation in the 65 or over Polish population. Report of cross-sectional NOMED-AF study

“…Existing national estimates of the proportion and numbers of AF patients are derived from analyses of registry data and modeling studies rather than direct surveys [1,3], often including only diagnosed cases of AF [4]. More detailed studies are available for selected subgroups such as post-stroke patients [5], subjects with implanted pacemakers or implantable cardioverter defibrillators [6], voluntary screening program participants [7], smartwatch users [8,9], and local communities. While these estimates are often generalized to national populations, unproven assumptions of negligible selection bias make them less trustworthy.…”