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. 2020 Sep;20(5):480-485.
doi: 10.7861/clinmed.2020-0322.

Quality Improvement in Atrial Fibrillation detection after ischaemic stroke (QUIT-AF)

Amit K Kishore  1 , Susan Fletcher  2 , Denise Mason  3 , Christopher Ashton  4 , Jane Molloy  2 , Alan Fitchet  3
Affiliations

Quality Improvement in Atrial Fibrillation detection after ischaemic stroke (QUIT-AF)

Amit K Kishore et al. Clin Med (Lond). 2020 Sep.

Abstract

Background: Paroxysmal atrial fibrillation (PAF) is a frequent cause of recurrent stroke but can be difficult to detect because of its episodic and often asymptomatic nature. We sought to improve rate of PAF detection through a quality improvement project (QIP) to deliver early prolonged inpatient cardiac monitoring on the stroke unit (SU).

Methods: A structured protocol for cardiac monitoring using 5-day event recorders was established. 'In-house' cardiac monitoring was implemented. Performance data on this change in service was analysed prospectively and summary statistics obtained.

Results: One-hundred and two ischaemic stroke (IS) patients undertook 5-day event recorder monitoring. Provision of monitors as an inpatient (IP) increased from 20% (pre-QIP pilot 2018) to 65.7% (during QIP). New AF was detected in 15 patients (14.7% vs 8.6% pre-QIP pilot 2018) with majority of new AF (13 patients; 19%) detected when monitors applied early (IP) after IS.

Conclusion: Although this study had a number of limitations, it did demonstrate that early and prolonged non-invasive IP cardiac monitoring could be delivered 'in-house' on the SU and improve AF detection rates.

Keywords: Ischaemic stroke; anticoagulation; cardiac monitoring; paroxysmal atrial fibrillation.

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Figures

Fig 1.
Fig 1.
Process map to understand the logistics behind the delivery and interpretation of cardiac monitoring. CRI = cardiorespiratory investigations unit; MDT = multidisciplinary team.
Fig 2.
Fig 2.
Standard protocol for inpatient cardiac monitoring requests after acute ischaemic stroke or transient ischaemic attack. AF = atrial fibrillation; ECG = electrocardiography; ESD = early supported discharge; EPR = electronic patient record; TIA = transient ischaemic attack.
Fig 3.
Fig 3.
a) Days to transcription for event recorder inpatient monitoring. b) Days to transcription for event recorder outpatient monitoring. c) Proportion of patients receiving cardiac monitoring and new paroxysmal atrial fibrillation detection. QIP = quality improvement project.
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