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. 2020 Sep;22(3):387-395.
doi: 10.5853/jos.2020.00689. Epub 2020 Sep 29.

Nurse Led Smartphone Electrographic Monitoring for Atrial Fibrillation after Ischemic Stroke: SPOT-AF

Bernard Yan  1 , Hans Tu  2 , Christina Lam  1 , Corey Swift  1 , Ma Sze Ho  3 , Vincent C T Mok  3 , Yi Sui  4 , David Sharpe  5 , Darshan Ghia  5 , Jim Jannes  6 , Stephen Davis  1 , Xinfeng Liu  7 , Ben Freedman  8
Affiliations

Nurse Led Smartphone Electrographic Monitoring for Atrial Fibrillation after Ischemic Stroke: SPOT-AF

Bernard Yan et al. J Stroke. 2020 Sep.

Abstract

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.

Keywords: Atrial fibrillation; Electrocardiography; Smartphone; Stroke.

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Figures

Figure 1.
Figure 1.
AliveCor Kardia mobile electrocardiogram (ECG) device, showing index finger of right and left hand touching the respective electrode. Recorded ECG rhythm strip shows sinus rhythm.
Figure 2.
Figure 2.
Smartphone-enabled handheld ECG (iECG) showing slow atrial fibrillation, with automated diagnosis of possible atrial fibrillation.
Figure 3.
Figure 3.
Patient flow diagram. iECG, smartphone-enabled handheld ECG; AF, atrial fibrillation.
See this image and copyright information in PMC

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