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

BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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)). CONCLUSIONS: 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.

[Clinical guidelines for antithrombotic therapy of patients with atrial fibrillation can be implemented in general practice by means of data capture]. / Klinisk vejledning for antitrombotisk behandling ved atrieflimren kan implementeres ved hjælp af datafangst i almen praksis.

Suboptimal treatment with oral anticoagulation therapy of atrial fibrillation is well-documented. The use of clinical guidelines and databases in general practice can improve adherence to the guidelines stipulated by the Danish Society of Cardiology. However, guidelines should be updated continuously, and in approximately 20% of our patients the application of oral anticoagulation therapy turned out to be problematic, even though they had a high thromboembolic risk score.