Journal ArticleDOI
Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AFRANDOMISED): an open-label randomised controlled trial
Rolf Wachter,Klaus Gröschel,Götz Gelbrich,Gerhard F. Hamann,Pawel Kermer,Jan Liman,Joachim Seegers,Katrin Wasser,Anna Schulte,Falko Jürries,Anna Messerschmid,Nico Behnke,Sonja Gröschel,Timo Uphaus,Anne Grings,Tugba Ibis,Sven Klimpe,Michaela Wagner-Heck,Magdalena Arnold,Evgeny Protsenko,Peter U. Heuschmann,David Conen,Mark Weber-Krüger +22 more
Reads0
Chats0
TLDR
Find-AFrandomised supports the consideration of all patients aged 60 years or older with stroke for prolonged monitoring if the detection of atrial fibrillation would result in a change in medical management (eg, initiation of anticoagulation).Abstract:
Summary Background Atrial fibrillation is a major risk factor for recurrent ischaemic stroke, but often remains undiagnosed in patients who have had an acute ischaemic stroke. Enhanced and prolonged Holter-electrocardiogram-monitoring might increase detection of atrial fibrillation. We therefore investigated whether enhanced and prolonged rhythm monitoring was better for detection of atrial fibrillation than standard care procedures in patients with acute ischaemic stroke. Methods Find-AF randomised is an open-label randomised study done at four centres in Germany. We recruited patients with acute ischaemic stroke (symptoms for 7 days or less) aged 60 years or older presenting with sinus rhythm and without history of atrial fibrillation. Patients were included irrespective of the suspected cause of stroke, unless they had a severe ipsilateral carotid or intracranial artery stenosis, which were the exclusion criteria. We used a computer-generated allocation sequence to randomly assign patients in a 1:1 ratio with permuted block sizes of 2, 4, 6, and 8, stratified by centre, to enhanced and prolonged monitoring (ie, 10-day Holter-electrocardiogram [ECG]-monitoring at baseline, and at 3 months and 6 months of follow-up) or standard care procedures (ie, at least 24 h of rhythm monitoring). Participants and study physicians were not masked to group assignment, but the expert committees that adjudicated endpoints were. The primary endpoint was the occurrence of atrial fibrillation or atrial flutter (30 sec or longer) within 6 months after randomisation and before stroke recurrence. Because Holter ECG is a widely used procedure and not known to harm patients, we chose not to assess safety in detail. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01855035. Findings Between May 8, 2013, and Aug 31, 2014, we recruited 398 patients. 200 patients were randomly assigned to the enhanced and prolonged monitoring group and 198 to the standard care group. After 6 months, we detected atrial fibrillation in 14% of 200 patients in the enhanced and prolonged monitoring group (27 patients) versus 5% in the control group (nine of 198 patients, absolute difference 9·0%; 95% CI 3·4–14·5, p=0·002; number needed to screen 11). Interpretation Enhanced and prolonged monitoring initiated early in patients with acute ischaemic stroke aged 60 years or older was better than standard care for the detection of atrial fibrillation. These findings support the consideration of all patients aged 60 years or older with stroke for prolonged monitoring if the detection of atrial fibrillation would result in a change in medical management (eg, initiation of anticoagulation). Funding Boehringer Ingelheim.read more
Citations
More filters
Journal ArticleDOI
2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).
Gerhard Hindricks,Tatjana S. Potpara,Nikolaos Dagres,Elena Arbelo,Jeroen J. Bax,Carina Blomström-Lundqvist,Giuseppe Boriani,Manuel Castellá,Gheorghe Andrei Dan,Polychronis Dilaveris,Laurent Fauchier,Gerasimos Filippatos,Jonathan M. Kalman,Jonathan M. Kalman,Mark La Meir,Deirdre A. Lane,Jean-Pierre Lebeau,Maddalena Lettino,G. Y. H. Lip,Fausto J. Pinto,G. Neil Thomas,Marco Valgimigli,Isabelle C. Van Gelder,Isabelle C. Van Gelder,Bart P. Van Putte,Caroline L Watkins +25 more
TL;DR: The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only and no commercial use is authorized.
Journal ArticleDOI
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
TL;DR: These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks.
Book ChapterDOI
Guidelines for Prevention, I
TL;DR: In most cultures, there are strong standards regarding sexual behavior which differ for men and women, and cultural differences also affect the extent to which early sexual behavior is considered acceptable.
Journal ArticleDOI
2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,O.M. Adevoe,Nicholas C. Bambakidis,Kyra J. Becker +5 more
TL;DR: I alteplase treatment should be administered within 3 hours of acute ischemic stroke in appropriate patients and should not be delayed while waiting for hematologic or coagulation testing if there is no reason to suspect an abnormal test.
Journal ArticleDOI
2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association
Dawn Kleindorfer,Amytis Towfighi,Seemant Chaturvedi,Kevin M. Cockroft,Jose Gutierrez,Debbie Lombardi-Hill,Hooman Kamel,Walter N. Kernan,Steven J. Kittner,Enrique C. Leira,Olive Lennon,James F. Meschia,Thanh N. Nguyen,Peter M. Pollak,Pasquale Santangeli,Anjail Sharrief,Sidney C. Smith,Tanya N. Turan,Linda S. Williams +18 more
References
More filters
Journal ArticleDOI
Transthoracic Echocardiography to Rule Out Paroxysmal Atrial Fibrillation as a Cause of Stroke or Transient Ischemic Attack
Raoul Stahrenberg,Frank T. Edelmann,Beatrice Haase,Rosine Lahno,Jochen Seegers,Mark Weber-Krüger,Meinhard Mende,Janin Wohlfahrt,Pawel Kermer,Dirk Vollmann,Gerd Hasenfuß,Klaus Gröschel,Rolf Wachter +12 more
TL;DR: LAVI/a′ <2.3 can effectively rule out PAF in patients with cerebral ischemia, and this cut-off had 92% sensitivity, 55.8% specificity, and 98% negative predictive value for PAF.
Journal ArticleDOI
Natriuretic Peptides for the Detection of Paroxysmal Atrial Fibrillation in Patients with Cerebral Ischemia – the Find-AF Study
Rolf Wachter,Rosine Lahno,Beatrice Haase,Mark Weber-Krüger,Joachim Seegers,Frank T. Edelmann,Janin Wohlfahrt,Götz Gelbrich,Anke Görlitz,Pawel Kermer,Dirk Vollmann,Gerd Hasenfuß,Klaus Gröschel,Raoul Stahrenberg +13 more
TL;DR: BNP is independently predictive of paroxysmal AF detected by prolonged ECG monitoring in patients with cerebral ischemia and may be used to effectively select patients for prolonged Holter monitoring.
Journal ArticleDOI
Excessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.
Mark Weber-Krüger,Klaus Gröschel,Meinhard Mende,Joachim Seegers,Rosine Lahno,Beatrice Haase,Cord-Friedrich Niehaus,Frank T. Edelmann,Gerd Hasenfuß,Rolf Wachter,Raoul Stahrenberg +10 more
TL;DR: ESVEA discriminated PAF from non-PAF beyond clinical factors including LAVI/a’ in patients with cerebral ischemia, and may help selecting patients for extended ECG-monitoring, especially in combination with echocardiographic markerLAVI/ a’.
Journal Article
Global Survey of the Diagnostic Evaluation and Management of Cryptogenic Ischemic Stroke
Jackie Bosch,Mohana Giruparajah,K Mattina,Thomas Vanassche,Stuart J. Connolly,Robert G. Hart +5 more
TL;DR: Based on self-selected respondents from a large number of international stroke centers, transesophageal echocardiography and prolonged (>24 h) cardiac rhythm monitoring are not routinely performed in cryptogenic stroke patients, even in high-income countries.
Related Papers (5)
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Paulus Kirchhof,Stefano Benussi,Dipak Kotecha,Anders Ahlsson,Dan Atar,Barbara Casadei,Manuel Castellá,Hans-Christoph Diener,Hein Heidbuchel,Jeroen M.L. Hendriks,Gerhard Hindricks,Antonis S. Manolis,Jonas Oldgren,Bogdan A. Popescu,Ulrich Schotten,Bart P. Van Putte,Panagiotis Vardas,Stefan Agewall,John Camm,Gonzalo Barón Esquivias,Werner Budts,Scipione Carerj,Filip Casselman,Antonio Coca,Raffaele De Caterina,Spiridon Deftereos,Dobromir Dobrev,José M. Ferro,Gerasimos Filippatos,Donna Fitzsimons,Bulent Gorenek,Maxine Guenoun,Stefan H. Hohnloser,Philippe Kolh,Gregory Y.H. Lip,Athanasios J. Manolis,John J.V. McMurray,Piotr Ponikowski,Raphael Rosenhek,Frank Ruschitzka,Irina Savelieva,Sanjay Sharma,Piotr Suwalski,Juan Tamargo,Clare J Taylor,Isabelle C. Van Gelder,Adriaan A. Voors,Stephan Windecker,José Luis Zamorano,Katja Zeppenfeld +49 more