Department of Brain Sciences, Imperial College London, London, UK
Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK.
BMJ Open Qual. 2022 Feb;11(1). doi: 10.1136/bmjoq-2021-001433.
The vast majority of the transient ischaemic attacks (TIA) services in UK reported significant delays in the initiation of the routine cardiac monitoring that may result in a significant number of missed atrial fibrillation (AF) paroxysms and increased long-term risk of recurrent stroke. Automated continuous ECG monitoring (ACEM) system has shown promising results in terms of AF detection but it is unclear if ACEM improves AF detection in a rapid outpatient TIA service.
We assessed ACEM in patients with TIA with the aim to significantly reduce the delay to initiate the cardiac monitoring and to enhance the yield of AF detection in these patients. We also aimed to determine the impact of a more rapid initiation of ACEM on the 6-month risk of recurrent stroke/TIA.
This is an observational, prospective before (phase 1: 1 July to 31 December 2018) versus after (phase 2: 1 January to 30 June 2019) study of the effect of ACEM, compared with routine initiation of 24h-Holter ECG, in patients with TIA assessed in our service.
The phase 1 (n=136) and phase 2 (n=105) cohorts did not differ with regards to age, risk factors, duration of cardiac monitoring. The rate of newly detected AF was significantly higher in phase 2 compared with phase 1 (9.52% vs 2.21%, p<0.001). The 6-month risk of recurrent stroke/TIA was significantly lower in phase 2 compared with phase 1 (7.4% vs 1%, p=0.018).
Early initiation of ACEM improves AF detection after TIA in a rapid TIA service and is associated with a reduced risk of recurrent TIA/stroke.
在英国，绝大多数短暂性脑缺血发作（TIA）服务报告称，在开始常规心脏监测方面存在显著延迟，这可能导致大量房性颤动（AF）发作漏诊，并增加长期复发中风的风险。自动连续心电图监测（ACEM）系统在 AF 检测方面显示出有希望的结果，但尚不清楚 ACEM 是否能提高快速门诊 TIA 服务中 AF 的检测率。
我们评估了 TIA 患者中 ACEM 的应用，旨在显著缩短开始心脏监测的时间延迟，并提高这些患者中 AF 的检测率。我们还旨在确定更快速启动 ACEM 对 6 个月内复发中风/TIA 的风险的影响。
这是一项观察性、前瞻性的研究，比较了在我们的服务中评估的 TIA 患者中，与常规启动 24 小时 Holter ECG 相比，ACEM 的效果（第 1 阶段：2018 年 7 月 1 日至 12 月 31 日；第 2 阶段：2019 年 1 月 1 日至 6 月 30 日）。
第 1 阶段（n=136）和第 2 阶段（n=105）队列在年龄、危险因素、心脏监测持续时间方面无差异。与第 1 阶段相比，第 2 阶段新发现的 AF 发生率显著更高（9.52% vs 2.21%，p<0.001）。与第 1 阶段相比，第 2 阶段 6 个月内复发中风/TIA 的风险显著降低（7.4% vs 1%，p=0.018）。
在快速 TIA 服务中，早期启动 ACEM 可提高 TIA 后的 AF 检测率，并降低复发 TIA/中风的风险。
