Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts.
Am J Cardiol. 2021 May 15;147:44-51. doi: 10.1016/j.amjcard.2021.01.038. Epub 2021 Feb 20.
We characterized monitor utilization in stroke survivors and assessed associations with underlying clinical atrial fibrillation (AF) risk. We retrospectively analyzed consecutive patients with acute ischemic stroke 10/2018-6/2019 without prevalent AF and assessed the 6-month incidence of monitor utilization (Holter/ECG, event/patch, implantable loop recorder [ILR]) using Fine-Gray models accounting for the competing risk of death. We assessed for predictors of monitor utilization using cause-specific hazards regression adjusted for the Cohorts for Heart and Aging Research in Genomic Epidemiology AF (CHARGE-AF) score, stroke subtype, and discharge disposition. Of 493 patients with acute ischemic stroke (age 65±16; 47% women), the 6-month incidence of monitor utilization was 36.5% (95% CI 31.7, 41.3), and 6-month mortality was 13.6% (10.4, 16.8). Monitoring was performed with Holter/event (n = 107; 72.3%), ILR (n = 34; 23.0%) or both (n = 7; 4.7%). Monitoring was more likely after cryptogenic (hazard ratio [HR] 4.53 [3.22, 6.39]; 6-month monitor incidence 70.6%) and cardioembolic (HR 2.43 [1.28, 4.62]; incidence 47.7%) stroke, versus other/undocumented (incidence 22.7%). Among patients with cryptogenic stroke, the 6-month incidence of ILR was 27.5% [18.5, 36.5]. Monitoring was more likely after discharge home (HR 1.80 [1.29, 2.52]; incidence 46.1%) versus facility (incidence 24.9%). Monitoring was not associated with CHARGE-AF score (HR 1.08 per 1-SD increase [0.91, 1.27]), even though CHARGE-AF was associated with incident AF (HR 1.56 [1.03, 2.35]). In conclusion, rhythm monitors are utilized after one-third of ischemic strokes. Monitoring is more frequent after cryptogenic strokes, though ILR use is low. Monitor utilization is not associated with AF risk.
我们描述了卒中幸存者中监测仪的使用情况，并评估了其与潜在临床房颤（AF）风险的关系。我们回顾性分析了 2018 年 10 月至 2019 年 6 月期间无明显 AF 的急性缺血性卒中连续患者，并使用 Fine-Gray 模型评估了 6 个月内监测仪的使用情况（动态心电图/心电图、事件/补丁、植入式环路记录器[ILR]），该模型考虑了死亡的竞争风险。我们使用特定于原因的风险回归评估了监测仪使用的预测因素，该回归针对 CHARGE-AF 评分、卒中亚型和出院处置进行了调整。在 493 名急性缺血性卒中患者（年龄 65±16 岁；47%为女性）中，监测仪的 6 个月使用率为 36.5%（95%CI 31.7，41.3），6 个月死亡率为 13.6%（10.4，16.8）。监测仪的使用包括动态心电图/事件（n=107；72.3%）、ILR（n=34；23.0%）或两者（n=7；4.7%）。在隐源性（危险比[HR]4.53[3.22，6.39]；6 个月监测仪发生率 70.6%）和心源性栓塞性（HR 2.43[1.28，4.62]；发生率 47.7%）卒中后，监测仪的使用更有可能，而非其他/未记录的（发生率 22.7%）。在隐源性卒中患者中，ILR 的 6 个月发生率为 27.5%[18.5，36.5]。出院回家（HR 1.80[1.29，2.52]；发生率 46.1%）与住院（发生率 24.9%）相比，监测仪的使用更有可能。监测仪的使用与 CHARGE-AF 评分无关（每增加 1-SD 评分 HR 增加 1.08[0.91，1.27]），尽管 CHARGE-AF 与 AF 事件相关（HR 1.56[1.03，2.35]）。总之，三分之一的缺血性卒中后会使用节律监测仪。隐源性卒中后监测更频繁，但 ILR 的使用率较低。监测仪的使用与 AF 风险无关。
