Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care
| Autor: | Louise Feldborg Lyckhage, Susanne Lis Larsen, Troels Wienecke, Bente Brendorp, Morten Lock Hansen, Jens Christian Toft, Ari Mohammad Ali |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Holter monitor Time Factors electrocardiography Primary care 030204 cardiovascular system & hematology Palpation Brain Ischemia primary care 03 medical and health sciences 0302 clinical medicine Heart Rate Internal medicine Atrial Fibrillation Humans Mass Screening Medicine atrial fibrillation Prospective Studies cardiovascular diseases Arrhythmias and Sudden Death Stroke Aged Univariate analysis Primary Health Care medicine.diagnostic_test business.industry Atrial fibrillation medicine.disease stroke Number needed to screen Electrocardiography Ambulatory Cardiology Female Cardiology and Cardiovascular Medicine business Electrocardiography 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Lyckhage, L F, Hansen, M L, Toft, J C, Larsen, S L, Brendorp, B, Ali, A M & Wienecke, T 2021, ' Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care ', Heart, vol. 107, no. 8, pp. 635-641 . https://doi.org/10.1136/heartjnl-2020-316904 Heart |
| ISSN: | 1468-201X 1355-6037 |
| Popis: | Background and purposeThe 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.MethodsPatients 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.Results7-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)).ConclusionsA 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. |
| Databáze: | OpenAIRE |
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