Can we improve the early detection of atrial fibrillation in a stroke unit? Detection rate of a monitor with integrated detection software.

INTRODUCTION: It is unknown whether monitors that include atrial fibrillation recognition software (AF-RS) increase the rate of early atrial fibrillation (AF) detection in acute stroke. We aimed to evaluate the AF detection rate of an AF-RS monitor and compare it with standard monitoring. METHODS: This was a retrospective, single-centre observational study conducted on consecutive patients with acute transient ischaemic attack or brain infarction attended in a stroke unit (SU) with six beds. Five beds had a standard monitor with a three-lead electrocardiogram (ECG)-tracing monitor that did not automatically detect AF, and one bed had a 12-lead ECG monitor with integrated AF-RS. All patients were monitored for at least 24 h and underwent a daily ECG during their stay in the SU. In case of unknown stroke aetiology, the patients underwent 24 h Holter monitoring. RESULTS: A total of 76 patients were included: 59 patients in the standard monitor group and 17 patients in the AF-RS monitor group. The mean age was 72.11 (±13.09) years, and 59.2% were men. A total of 20 new cases of AF were identified. The AF-RS monitor showed a higher rate of AF detection than the standard devices (57.1% vs 7.7%, p=0.031). The AF-RS monitor showed sensitivity, specificity, positive predictive value, and negative predictive values of 57.1%, 100%, 100% and 76.9%, respectively. For the standard monitors, these values were 7.7%, 100%, 100% and 79.3%, respectively. CONCLUSION: The monitor with AF-RS demonstrated a higher detection rate for AF than standard ECG monitoring in acute stroke patients in a SU.

[Diagnostic accuracy of an automatic blood pressure device for ankle brachial index determination in ischemic stroke patients]. / Precisión diagnóstica de un dispositivo automático en la determinación del índice tobillo-brazo en pacientes con ictus isquémico.

INTRODUCTION: Ankle brachial index (ABI) is not widespread in clinical practice because the need for specific equipment and training. Doing it without these requirements, quicker and with a cheaper method would facilitate their routine use. AIMS: To evaluate sensitivity and specificity of an automatic blood pressure device detecting ABI < 0.90, when technique is performed by nurses. To evaluate agreement between two techniques for the ABI determination. PATIENTS AND METHODS. Diagnostic accuracy study in 30 ischemic stroke patients. For each patient, three measurements were performed with the automatic device, and one with the reference method. RESULTS: The automatic blood pressure device performance detecting ABI < 0.90 was acceptable for each of the three measurements (sensitivity: 78%, 87% and 100%; specificity: 95%, 100% and 100%; positive predictive value: 87%, 100% and 100%; negative predictive value: 91%, 96% y 100%; accuracy: 90%, 97% y 100%). The intraclass correlation coefficients for intra-observer, inter-observer and inter-method variability showed acceptable levels, with results of 0.64, 0.83 and 0.75, respectively. In the Bland Altman test only inter-method comparison had less than 5% of its values out of range. CONCLUSIONS: Sensitivity and specificity of an automatic blood pressure device detecting ABI < 0.90 shows acceptable levels when technique is performed by nurses. This suggests its potential as screening tool in transient ischemic attack/ischemic stroke patients.

El índice tobillo-brazo como predictor de mortalidad vascular / Ankle brachial index as indicator for vascular mortality

El índice tobillo-brazo (ITB) es un parámetro que muestra la relación entre la tensión arterial sistólica de la extremidad superior y la extremidad inferior. Este indicador, ampliamente estudiado y presente en la bibliografía, se ha mostrado como excelente predictor de mortalidad tanto vascular como por causas generales cuando presenta valores fuera del rango establecido como normal (0,90-1,30). En dichas situaciones la utilidad del ITB reside en detectar precozmente la existencia de enfermedad arterial periférica (EAP) durante su fase asintomática y servir como parámetro de corte para el establecimiento de medidas preventivas más contundentes antes de que el daño vascular existente se haga sintomático. Para el profesional de enfermería este parámetro constituye una potente herramienta de valoración, objetiva y cuantitativa, que permite seleccionar aquellos pacientes en los que es preciso potenciar al máximo los cuidados preventivos (AU)

The ankle-brachial index (ABI) is a simple test showing the relationship between systolic blood pressure in the upper and the lower limbs. This parameter widely studied in literature has been reported as an excellent vascular and all-cause death predictor when exceeds the normal values (0.90-1.30). In such situation the ABI can early detect periferic arterial disease (PAD) in asymptomatic phase and be a cutoff parameter to consider more aggressive preventive interventions before the existing vascular damage becomes symptomatic. This test is a powerful assessment tool for nurses to select those patients needing to maximize preventive cares. The nursing staff training for ABI measurement, the provision of suitable equipment by the Health Institutions and the development of reliable and more simple measurement methods are key issues that would facilitate its routinely and systematically use to improve the preventive strategy in vascular diseases (AU)