PMID- 33053954
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201023
IS  - 2287-6391 (Print)
IS  - 2287-6405 (Electronic)
IS  - 2287-6391 (Linking)
VI  - 22
IP  - 3
DP  - 2020 Sep
TI  - Nurse Led Smartphone Electrographic Monitoring for Atrial Fibrillation after 
      Ischemic Stroke: SPOT-AF.
PG  - 387-395
LID - 10.5853/jos.2020.00689 [doi]
AB  - BACKGROUND AND PURPOSE: Paroxysmal atrial fibrillation (PAF) underlying acute 
      stroke frequently evades detection by standard practice, considered to be a 
      combination of routine electrocardiogram (ECG) monitoring, and 24-hour Holter 
      recordings. We hypothesized that nurse-led in-hospital intermittent monitoring 
      approach would increase PAF detection rate. METHODS: We recruited patients 
      hospitalised for stroke/transient ischemic attack, without history of atrial 
      fibrillation (AF), in a prospective multi-centre observational study. Patients 
      were monitored using a smartphone-enabled handheld ECG (iECG) during routine 
      nursing observations, and underwent 24-hour Holter monitoring according to local 
      practice. The primary outcome was comparison of AF detection by nurse-led iECG 
      versus Holter monitoring in patients who received both tests: secondary outcome 
      was oral anticoagulant commencement at 3-month following PAF detection. RESULTS: 
      One thousand and seventy-nine patients underwent iECG monitoring: 294 had iECG 
      and Holter monitoring. AF was detected in 25/294 (8.5%) by iECG, and 8/294 (2.8%) 
      by 24-hour Holter recordings (P<0.001). Median duration from stroke onset to AF 
      detection for iECG was 3 days (interquartile range [IQR], 2 to 6) compared with 7 
      days (IQR, 6 to 10) for Holter recordings (P=0.02). Of 25 patients with AF 
      detected by iECG, 11 were commenced on oral anticoagulant, compared to 5/8 for 
      Holter. AF was detected in 8.8% (69/785 patients) who underwent iECG recordings 
      only (P=0.8 vs. those who had both iECG and 24-hour Holter). CONCLUSIONS: 
      Nurse-led in-hospital iECG surveillance after stroke is feasible and effective 
      and detects more PAF earlier and more frequently than routine 24-hour Holter 
      recordings. Screening with iECG could be incorporated into routine post-stroke 
      nursing observations to increase diagnosis of PAF, and facilitate institution of 
      guideline-recommended anticoagulation.
FAU - Yan, Bernard
AU  - Yan B
AD  - The Melbourne Brain Centre at the Royal Melbourne Hospital and the University of 
      Melbourne, Parkville, Australia.
FAU - Tu, Hans
AU  - Tu H
AD  - Department of Neurology and Medicine, Western Health, The University of 
      Melbourne, Footscray, Australia.
FAU - Lam, Christina
AU  - Lam C
AD  - The Melbourne Brain Centre at the Royal Melbourne Hospital and the University of 
      Melbourne, Parkville, Australia.
FAU - Swift, Corey
AU  - Swift C
AD  - The Melbourne Brain Centre at the Royal Melbourne Hospital and the University of 
      Melbourne, Parkville, Australia.
FAU - Ho, Ma Sze
AU  - Ho MS
AD  - Lui Che Woo Institute of Innovative Medicine, Therese Pei Fong Chow Research 
      Centre for Prevention of Dementia, Prince of Wales Hospital, and Department of 
      Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
FAU - Mok, Vincent C T
AU  - Mok VCT
AD  - Lui Che Woo Institute of Innovative Medicine, Therese Pei Fong Chow Research 
      Centre for Prevention of Dementia, Prince of Wales Hospital, and Department of 
      Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
FAU - Sui, Yi
AU  - Sui Y
AD  - Department of Neurology, Shenyang First People's Hospital, Shenyang, China.
FAU - Sharpe, David
AU  - Sharpe D
AD  - Neurology Department, Concord General Hospital, Sydney, Australia.
FAU - Ghia, Darshan
AU  - Ghia D
AD  - Neurology Department, Concord General Hospital, Sydney, Australia.
FAU - Jannes, Jim
AU  - Jannes J
AD  - Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia.
FAU - Davis, Stephen
AU  - Davis S
AD  - The Melbourne Brain Centre at the Royal Melbourne Hospital and the University of 
      Melbourne, Parkville, Australia.
FAU - Liu, Xinfeng
AU  - Liu X
AD  - Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 
      Nanjing, China.
FAU - Freedman, Ben
AU  - Freedman B
AD  - Heart Research Institute Charles Perkins Centre, and Concord Hospital Cardiology, 
      University of Sydney, Sydney, Australia.
LA  - eng
GR  - Boehringer Ingelheim/
PT  - Journal Article
DEP - 20200929
PL  - Korea (South)
TA  - J Stroke
JT  - Journal of stroke
JID - 101602023
PMC - PMC7568969
OTO - NOTNLM
OT  - Atrial fibrillation
OT  - Electrocardiography
OT  - Smartphone
OT  - Stroke
EDAT- 2020/10/16 06:00
MHDA- 2020/10/16 06:01
PMCR- 2020/09/01
CRDT- 2020/10/15 03:29
PHST- 2020/03/04 00:00 [received]
PHST- 2020/06/17 00:00 [accepted]
PHST- 2020/10/15 03:29 [entrez]
PHST- 2020/10/16 06:00 [pubmed]
PHST- 2020/10/16 06:01 [medline]
PHST- 2020/09/01 00:00 [pmc-release]
AID - jos.2020.00689 [pii]
AID - jos-2020-00689 [pii]
AID - 10.5853/jos.2020.00689 [doi]
PST - ppublish
SO  - J Stroke. 2020 Sep;22(3):387-395. doi: 10.5853/jos.2020.00689. Epub 2020 Sep 29.