Impact of a clinical atrial fibrillation risk estimation tool on cardiac rhythm monitor utilization following acute ischemic stroke: A prepost clinical trial

Affiliations

¹ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA. Electronic address: jashburner@mgh.harvard.edu.
² Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA; McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA.
³ Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA; Telemachus and Irene Demoulas Family Foundation Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA; Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA.
⁴ Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
⁵ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA.
⁶ Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA; Telemachus and Irene Demoulas Family Foundation Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA.
⁷ Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA; Sections of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Department of Epidemiology, Boston University Chobanian and Avedisian School of Medicine, Boston University School of Public Heath, Boston, MA.
⁸ Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Medford, MA.
⁹ Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA; McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA.

PMID: 39978665
PMCID: PMC12360245 (available on 2026-06-01)
DOI: 10.1016/j.ahj.2025.02.010

Clinical Trial

Impact of a clinical atrial fibrillation risk estimation tool on cardiac rhythm monitor utilization following acute ischemic stroke: A prepost clinical trial

Jeffrey M Ashburner et al. Am Heart J. 2025 Jun.

. 2025 Jun:284:57-66.

doi: 10.1016/j.ahj.2025.02.010. Epub 2025 Feb 18.

Authors

Affiliations

¹ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA. Electronic address: jashburner@mgh.harvard.edu.
² Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA; McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA.
³ Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA; Telemachus and Irene Demoulas Family Foundation Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA; Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA.
⁴ Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
⁵ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA.
⁶ Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA; Telemachus and Irene Demoulas Family Foundation Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA.
⁷ Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA; Sections of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Department of Epidemiology, Boston University Chobanian and Avedisian School of Medicine, Boston University School of Public Heath, Boston, MA.
⁸ Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Medford, MA.
⁹ Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA; McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA.

PMID: 39978665
PMCID: PMC12360245 (available on 2026-06-01)
DOI: 10.1016/j.ahj.2025.02.010

Abstract

Background: Detection of undiagnosed atrial fibrillation (AF) after ischemic stroke through extended cardiac monitoring is important for preventing recurrent stroke. We evaluated whether a tool that displays clinically predicted AF risk to clinicians caring for stroke patients was associated with the use of extended cardiac monitoring.

Methods: We prospectively included hospitalized ischemic stroke patients without known AF in a preintervention (October 2018 - June 2019) and intervention period (March 11, 2021 - March 10, 2022). The intervention consisted of an electronic health record (EHR)-based best-practice advisory (BPA) alert which calculated and displayed 5-year risk of AF. We used a multivariable Fine and Gray model to test for an interaction between predicted AF risk and period (preintervention vs intervention) with regards to incidence of extended cardiac monitoring. We compared the incidence of extended cardiac monitoring within 6-months of discharge between periods, stratified by BPA completion.

Results: We included 805 patients: 493 in the preintervention cohort and 312 in the intervention cohort. In the intervention cohort, the BPA was completed for 180 (58%) patients. The association between predicted clinical risk of AF and incidence of 6-month extended cardiac monitoring was not different by time period (interaction HR = 1.00 [95% Confidence Interval (CI) 0.98; 1.02]). The intervention period was associated with an increased cumulative incidence of cardiac monitoring (adjusted HR = 1.32 [95% CI 1.03-1.69]).

Conclusions: An embedded EHR tool displaying predicted AF risk in a poststroke setting had limited clinician engagement and predicted risk was not associated with the use of extended cardiac monitoring.

Clinical trial registration: NCT04637087.

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Conflict of interest statement

Disclosures Dr. Lubitz has received sponsored research support from Bristol Myers Squibb, Pfizer, Boehringer Ingelheim, Fitbit, Medtronic, Premier, and IBM, and has consulted for Bristol Myers Squibb, Pfizer, Blackstone Life Sciences, and Invitae, and is a full-time employee of Novartis Institutes for Biomedical Research as of July 2022. Dr. Anderson receives sponsored research support from Bayer AG, National Institutes of Health, the American Heart Association, and Massachusetts General Hospital and has consulted for Apo Pharma. Dr. Ashburner has received sponsored research support from Bristol Myers Squibb / Pfizer. Dr. Ellinor is supported by grants from the National Institutes of Health (RO1HL092577, RO1HL157635), from the American Heart Association (961045), and from the European Union (MAESTRIA 965286). Dr. Ellinor receives sponsored research support from Bayer AG, IBM Research, Bristol Myers Squibb, Pfizer and Novo Nordisk; he has also served on advisory boards or consulted for Bayer AG. Dr. Trinquart received support from AHA 18SFRN34150007. Dr. Singer is supported by the Eliot B. and Edith C. Shoolman Fund of Massachusetts General Hospital, has received research support from Bristol Myers Squibb and has consulted for Bristol Myers Squibb, Fitbit (Google), Medtronic, and Pfizer. Dr. Khurshid receives sponsored research support from Bayer AG. Dr. Atlas has received sponsored research support from Bristol Myers Squibb / Pfizer and American Heart Association (18SFRN34250007). Dr. Atlas has consulted for Bristol Myers Squibb, Pfizer, Premier and Fitbit.

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Impact of a clinical atrial fibrillation risk estimation tool on cardiac rhythm monitor utilization following acute ischemic stroke: A prepost clinical trial

Affiliations

Impact of a clinical atrial fibrillation risk estimation tool on cardiac rhythm monitor utilization following acute ischemic stroke: A prepost clinical trial

Authors

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Abstract

Conflict of interest statement

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