Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care
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Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care. / Lyckhage, Louise Feldborg; Hansen, Morten Lock; Toft, Jens Christian; Larsen, Susanne Lis; Brendorp, Bente; Ali, Ari Mohammad; Wienecke, Troels.
I: Heart, Bind 107, Nr. 8, 2021, s. 635-641.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care
AU - Lyckhage, Louise Feldborg
AU - Hansen, Morten Lock
AU - Toft, Jens Christian
AU - Larsen, Susanne Lis
AU - Brendorp, Bente
AU - Ali, Ari Mohammad
AU - Wienecke, Troels
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - atrial fibrillation
KW - electrocardiography
KW - primary care
KW - stroke
U2 - 10.1136/heartjnl-2020-316904
DO - 10.1136/heartjnl-2020-316904
M3 - Journal article
C2 - 32620555
AN - SCOPUS:85103434828
VL - 107
SP - 635
EP - 641
JO - Heart
JF - Heart
SN - 1355-6037
IS - 8
ER -
ID: 259882247