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. 2024 Jun 25;19(6):e0305339.
doi: 10.1371/journal.pone.0305339. eCollection 2024.

Is Stroke risk analysis (SRA) a reliable method for predicting atrial fibrillation? A systematic review

Rafael Alessandro Ferreira Gomes  1 , Michel Pompeu Barros de Oliveira Sá  1 , Marcela Vasconcelos Montenegro  1 , Ludmila Cristina Camilo Furtado  1 , José Henrique Cardoso Ferreira da Costa  1 , Daniel Barros Coutinho  1 , Johnnes Henrique Vieira Silva  1 , Dário Celestino Sobral Filho  1
Affiliations

Is Stroke risk analysis (SRA) a reliable method for predicting atrial fibrillation? A systematic review

Rafael Alessandro Ferreira Gomes et al. PLoS One. .

Abstract

Introduction: Atrial fibrillation is responsible for a considerable number of cases of cardioembolism, accounting for 17% to 30% of the etiologies of all strokes. The software known as Stroke Risk Analysis (SRA) detects patients at high risk of paroxysmal atrial fibrillation by analyzing a continuous electrocardiogram recorded over different periods of time.

Objectives: This article aims to carry out a systematic review investigating the effectiveness of the SRA method in predicting the risk of stroke patients having paroxysmal atrial fibrillation as the cause of the event.

Methods: The methods correspond to the format of the International Prospective Register of Systematic Reviews Protocol, according to CRD Identification Code: CRD42021253974. A systematic search was carried out in BMJB, PubMed/MEDLINE, Science Direct and LILACS. Six cohort studies met the inclusion criteria, representing a total of 2,088 participants with stroke, and compared the detection of patients with paroxysmal atrial fibrillation on the continuous recording electrocardiogram with a time variation of 1 to 48h with the use of SRA.

Results: Studies have shown that SRA has a high negative predictive value (between 96 and 99.1%) and can contribute to the selection of patients at high risk of paroxysmal atrial fibrillation to be referred for implantable cardiac monitoring to continue the investigation.

Conclusions: A sequential combination of SRA with implantable cardiac monitoring is a promising strategy for detecting undiagnosed paroxysmal atrial fibrillation. Thus, the SRA can act as a cost-effective pre-selection tool to identify patients at higher risk of having paroxysmal atrial fibrillation as a possible cause of stroke and who may benefit from implantable cardiac monitoring. However, the lack of randomized studies is a limitation that must be considered.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart for identifying the studies in the systematic review.
Fig 2
Fig 2. Analysis scheme using the SRA.
See this image and copyright information in PMC

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