TY - JOUR
T1 - Prolonged Cardiac Monitoring to Detect Atrial Fibrillation after Cryptogenic Stroke or Transient Ischemic Attack
T2 - A Meta-Analysis of Randomized Controlled Trials
AU - Dahal, Khagendra
AU - Chapagain, Bikas
AU - Maharjan, Raju
AU - Farah, Hussam W.
AU - Nazeer, Ayesha
AU - Lootens, Robert J.
AU - Rosenfeld, Alan
N1 - Publisher Copyright:
© 2015 Wiley Periodicals, Inc.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background: The cause of ischemic stroke or transient ischemic attack (TIA) remains unclear after initial cardiac monitoring in approximately one-third of patients. Randomized controlled trials (RCTs) showed that the prolonged cardiac monitoring of patients with cryptogenic stroke or TIA increased detection of atrial fibrillation (AF). We aimed to perform a meta-analysis of all RCTs that evaluated the prolonged monitoring ≥7 days in patients with cryptogenic stroke or TIA. Methods: We searched PubMed, EMBASE, Cochrane CENTRAL, and relevant references for RCTs without language restriction (inception through December 2014) and performed meta-analysis using random effects model. Detection of AF, use of anticoagulation at follow-up, recurrent stroke or TIA, and mortality were major outcomes. Results: Four RCTs with 1149 total patients were included in the meta-analysis. Prolonged cardiac monitoring ≥7 days compared to shorter cardiac monitoring of ≤48 hours duration increased the detection of AF (≥30 seconds duration) in patients after cryptogenic stroke or TIA (13.8% vs. 2.5%; odds ratio [OR], 6.4; 95% confidence interval [CI], 3.50–11.73; P < 0.00001; I2, 0%]. It also increased the odds of AF detection of any duration (22.6% vs. 5.2%; 5.68[3.3–9.77]; P < 0.00001; I2, 0%). The patients who underwent prolonged monitoring were more likely to be on anticoagulation at follow-up (2.21[1.52–3.21]; P < 0.0001; I2, 0%). No differences in recurrent stroke or TIA (0.78[0.40–1.55]; P = 0.48; I2, 0%) and mortality (1.33[0.29–6.00]; P = 0.71; I2, 0%] were observed between two strategies. Conclusion: Prolonged cardiac monitoring improves detection of atrial fibrillation and anti-coagulation use after cryptogenic stroke or TIA and therefore should be considered instead of shorter duration of cardiac monitoring.
AB - Background: The cause of ischemic stroke or transient ischemic attack (TIA) remains unclear after initial cardiac monitoring in approximately one-third of patients. Randomized controlled trials (RCTs) showed that the prolonged cardiac monitoring of patients with cryptogenic stroke or TIA increased detection of atrial fibrillation (AF). We aimed to perform a meta-analysis of all RCTs that evaluated the prolonged monitoring ≥7 days in patients with cryptogenic stroke or TIA. Methods: We searched PubMed, EMBASE, Cochrane CENTRAL, and relevant references for RCTs without language restriction (inception through December 2014) and performed meta-analysis using random effects model. Detection of AF, use of anticoagulation at follow-up, recurrent stroke or TIA, and mortality were major outcomes. Results: Four RCTs with 1149 total patients were included in the meta-analysis. Prolonged cardiac monitoring ≥7 days compared to shorter cardiac monitoring of ≤48 hours duration increased the detection of AF (≥30 seconds duration) in patients after cryptogenic stroke or TIA (13.8% vs. 2.5%; odds ratio [OR], 6.4; 95% confidence interval [CI], 3.50–11.73; P < 0.00001; I2, 0%]. It also increased the odds of AF detection of any duration (22.6% vs. 5.2%; 5.68[3.3–9.77]; P < 0.00001; I2, 0%). The patients who underwent prolonged monitoring were more likely to be on anticoagulation at follow-up (2.21[1.52–3.21]; P < 0.0001; I2, 0%). No differences in recurrent stroke or TIA (0.78[0.40–1.55]; P = 0.48; I2, 0%) and mortality (1.33[0.29–6.00]; P = 0.71; I2, 0%] were observed between two strategies. Conclusion: Prolonged cardiac monitoring improves detection of atrial fibrillation and anti-coagulation use after cryptogenic stroke or TIA and therefore should be considered instead of shorter duration of cardiac monitoring.
UR - http://www.scopus.com/inward/record.url?scp=84978166156&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84978166156&partnerID=8YFLogxK
U2 - 10.1111/anec.12319
DO - 10.1111/anec.12319
M3 - Article
C2 - 26524619
AN - SCOPUS:84978166156
VL - 21
SP - 382
EP - 388
JO - Annals of Noninvasive Electrocardiology
JF - Annals of Noninvasive Electrocardiology
SN - 1082-720X
IS - 4
ER -