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Johnston FC, Cameron AC, Colquhoun E, Murdoch DL, Dawson J, Abdul-Rahim AH. Improving detection and management of atrial fibrillation after ischaemic stroke in Glasgow (IMPROVE-AF): A quality improvement project. J R Coll Physicians Edinb 2022; 52:213-219. [DOI: 10.1177/14782715221120133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: The use of cardiac monitoring to detect atrial fibrillation (AF) is routine after ischaemic stroke but is often delayed leaving patients at risk from undetected AF. We sought to improve the detection of AF by delivering early prolonged ‘in-house’ cardiac monitoring. Patients and methods: We collected 3-months of data of people with stroke/transient ischaemic attack (TIA), but without AF, who underwent cardiac monitoring (Phase 1, pre-quality improvement project (QIP)). We then implemented an ‘in-house’ 7-day cardiac monitoring service for 12 months (Phase 2, during QIP). Results: We included 244 people in Phase 1 and 172 in Phase 2. In Phase 1, 232 (95%) people completed cardiac monitoring. Of these, new AF was detected in 10 (4%). Median time from stroke/TIA onset to availability of the monitoring report in Phase 1 was 50 (interquartile range (IQR): 24–123) days. In Phase 2, 166 (97%) of people completed 7-day cardiac monitoring, with new AF detected in 17 (10%). Median time from onset to availability of the report in Phase 2 was 12 (IQR: 9–15) days. In people with AF detected, ‘in-house’ monitoring reduced the time of stroke/TIA onset to anticoagulant commencement from 41 (Phase 1) to 14 (Phase 2) days. Conclusions: The QIP has improved AF detection, reduced delays associated with conventional cardiac monitoring and prompted early initiation of oral anticoagulation.
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Affiliation(s)
| | - Alan C Cameron
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Elizabeth Colquhoun
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - David L Murdoch
- Cardiology Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Azmil H Abdul-Rahim
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
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Muggeridge D, Callum K, Macpherson L, Howard N, Graune C, Megson I, Giangreco A, Gallacher S, Campbell L, Williams G, Macaden A, Leslie SJ. Clinical and health economic evaluation of a post-stroke arrhythmia monitoring service. THE BRITISH JOURNAL OF CARDIOLOGY 2022; 29:15. [PMID: 36212791 PMCID: PMC9534108 DOI: 10.5837/bjc.2022.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Atrial fibrillation (AF) is a major cause of recurrent stroke and transient ischaemic attack (TIA) in the UK. As many patients can have asymptomatic paroxysmal AF, prolonged arrhythmia monitoring is advised in selected patients following a stroke or TIA. This service evaluation assessed the clinical and potential health economic impact of prolonged arrhythmia monitoring post-stroke using R-TEST monitoring devices. This was a prospective, case-controlled, service evaluation in a single health board in the North of Scotland. Patients were included if they had a recent stroke or TIA, were in sinus rhythm, and did not have another indication for, or contraindication to, oral anticoagulation. A health economic model was developed to estimate the clinical and economic value delivered by the R-TEST monitoring. Approval to use anonymised patient data in this service evaluation was obtained. During the evaluation period, 100 consecutive patients were included. The average age was 70 ± 11 years, 46% were female. Stroke was the presenting complaint in 83% of patients with the other 17% having had a TIA. AF was detected in seven of 83 (8.4%) patients who had had a stroke and one of 17 (5.9%) patients with a TIA. Health economic modelling predicted that adoption of R-TEST monitoring has a high probability of demonstrating both clinical and economic benefits. In conclusion, developing a post-stroke arrhythmia monitoring service using R-TEST devices is feasible, effective at detecting AF, and represents a probable clinical and economic benefit.
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Affiliation(s)
- David Muggeridge
- Lecturer in Exercise Physiology Institute of Health Research and Innovation, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH
| | - Kara Callum
- Cardiac Physiologist Institute of Health Research and Innovation, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH
| | - Lynsey Macpherson
- Cardiac Physiologist NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Nick Howard
- Cardiac Physiologist NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Claudia Graune
- Cardiac Physiologist NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Ian Megson
- Head of Health Research and Innovation Institute of Health Research and Innovation, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH
| | - Adam Giangreco
- Director of Health and Life Sciences Innovation Institute of Health Research and Innovation, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH
| | - Susan Gallacher
- Stroke Audit Facilitator NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Linda Campbell
- Stroke Co-ordinator NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Gethin Williams
- Stroke Physician NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Ashish Macaden
- Rehabilitation Medicine and Stroke Physician NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
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Affiliation(s)
- Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (M.F.K.).,The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (M.F.K.)
| | - Dawn M Bravata
- Precision Monitoring to Transform Care Quality Enhancement Research Initiative, Health Services Research and Development, Department of Veterans Affairs, Indianapolis, IN (D.M.B.).,Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Department of Veterans Affairs, Indianapolis, IN (D.M.B.).,Medicine Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN (D.M.B.).,Departments of Medicine and of Neurology, Indiana University School of Medicine, Indianapolis (D.M.B.).,William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, IN (D.M.B.)
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Wang T, Qin Y. A novel multi-scale convolutional network with attention-based bidirectional gated recurrent unit for atrial fibrillation discrimination. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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