Capturing atrial fibrillation post acute stroke: stroke unit versus coronary care monitored telemetry

Abstract

Background: The identification and management of atrial fibrillation (AF) is of utmost importance in secondary prevention of stroke. At our institution, Coronary Care Unit monitored telemetry (CCU-T) has been used within the Stroke Unit. Given the limited availability of these units, since July 2016, Stroke Unit monitored telemetry (SSU-T) has been made available. SSU-T has replaced CCU-T for all acute stroke patients except in those at high risk of malignant arrhythmia. We sought to study the pattern of telemetry use and rates of AF detection in the 6 months pre- and post-implementation of SSU-T. Method(s): All patients with the discharge diagnosis of stroke or transient ischaemic attack from January to December 2016 were identified from the stroke unit database. Patients transferred for mechanical thrombectomy, patients not receiving care in the stroke unit and patients who died during their admission were excluded from analysis. Individual medical charts were reviewed for whether telemetry was requested, the presence or absence of the telemetry record and the detection of AF. Result(s): 154 patients had CCU-T between January-June 2016 and 194 had SSU-T between July-December 2016. Both groups were comparable with regard to age, sex and cardiovascular risk factors. When it was clinically indicated 79% and 85% of patients had telemetry during the CCU-T and SSU-T periods respectively (P = 0.31). Mean duration of monitoring increased from 1.0 (95% CI 1.0-1.1) days to 1.6 (95% CI 1.5-1.7) days in the SSU-T period (P < 0.01). Period of incidence of AF detection between the CCU-T and SSU-T periods were comparable, 4.51% vs 5.17% (P = 0.83) respectively. On univariate analysis, tPA administration and length of stay <24 h were associated with telemetry completion. Only tPA remains significant (P = 0.015) on multivariate logistic regression analyses as an independent factor associated with completion of telemetry. Conclusion(s): Implementation of SSU-T increased the average duration of telemetry by 12 h. There was a small absolute increase in AF detection but this was not statistically significant. This may be due to the small sample size of the study but other technical factors relating to monitoring and interpretations of the alarms warrant further investigation. Factors associated with patients not receiving telemetry as stated in the treatment plan also require further study.