scholarly journals Treatment of cryptogenicstroke patients with atrial fibrillation detected by insertable cardiac monitors reduces recurrent stroke risk to background levels

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Kloosterman ◽  
M.R Rosenbaum ◽  
E.J.B Berkowitz ◽  
N.K Kloosterman ◽  
J Rosman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Stroke Rate ◽  
Stroke Patients ◽  
Background Levels ◽  
Significant Difference ◽  
Recurrent Strokes

Abstract Background Atrial fibrillation (AF) is a well-known risk factor for ischemic stroke with a reported increased incidence range of 2.5 to 5-fold. However, it is not well established whether treatment of cryptogenic stroke patients with AF detected by insertable cardiac monitors (ICM) reduces the risk of recurrent stroke. Objective To compare recurrent stroke rates between cryptogenic stroke patients who have AF detected by ICMs and thus started on oral anticoagulation (OAC) treatment and those without detected AF. Methods We performed a retrospective analysis of consecutive patients who received an ICM for the purpose of AF monitoring following a cryptogenic stroke between July 2015 and March 2019. Patients with prior documented AF history were excluded. We calculated the rates of AF detection and OAC initiation. We also compared recurrent stroke rates between patients with and without AF detected. Results A total of 298 cryptogenic stroke patients receiving an ICM and home remote monitoring were studied (mean age: 77 SD: 11.7; Female/Male: 147 (49%)/151; virtual CHA2DS2-VASc: 4.96 SD: 1.28). AF was newly detected in 91 (29.6%) patients over a mean follow-up of 46 months. Of these patients 68 (72.4%) were started on OAC, 12 (15.3%) were already on OAC and 11 (12.2%) remained not anticoagulated. Of the total patients evaluated, 22 patients (7.3%) developed recurrent strokes for an annualized stroke rate of 1.926%. Of those, 8 occurred among the 91 patients with newly detected AF, for an annualized stroke rate of 1.72%. The remining 14 recurrent strokes occurred among the 207 patients without AF detected, for an annualized stroke rate of 1.76%; (p=0.87). One recurrent stroke occurred in an AF patient not anticoagulated due to a prior bleeding event. No hemorrhagic strokes were reported in the AF-OAC group. Conclusion Our study found that newly AF was detected by ICM in almost 1/3 (29%) of cryptogenic stroke patients (consistent with previous studies), and the vast majority of them (88%) accordingly received oral anticoagulation. There was not a significant difference in recurrent stroke rates among patients with AF detected on OAC and those without AF detected. This suggests that rigorous arrhythmia monitoring with ICMs can help identify cryptogenic stroke patients with new AF and initiate oral anticoagulation accordingly, to reduce their risk of recurrent stroke to background levels. Annualized Stroke Risk Funding Acknowledgement Type of funding source: None

Abstract W MP65: Moderate to Severe Left Atrial Enlargement is Associated with Cardioembolic or Cryptogenic Stroke Recurrence in a Multiethnic Cohort: The Northern Manhattan Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Yeseon P Moon ◽  
Consuelo Mora-McLaughlin ◽  
Joshua Z Willey ◽  
Marco R Di Tullio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Left Atrial ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Cardioembolic Stroke ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Stroke Subtypes ◽  
Multiethnic Cohort

Background: While left atrial (LA) enlargement increases incident stroke risk, the association with recurrent stroke is unclear. Our aim was to determine the association of LA enlargement (LAE) with stroke recurrence risk and recurrent stroke subtypes likely related to embolism (cryptogenic or cardioembolic). Methods: We enrolled 655 first ischemic stroke patients in the Northern Manhattan Stroke Study. LA size was measured by two-dimensional echocardiogram as part of the clinical evaluation and patients were followed annually for up to 5 years. LA size adjusted for sex and body surface area was categorized into three groups: normal (52.7%), mild LAE (31.6%), and moderate to severe LAE (15.7%). The outcomes were total recurrent stroke, and recurrent combined cryptogenic or cardioembolic stroke. Cox proportional hazard models assessed the association between LA size and risk of stroke recurrence. Results: Of 655 patients, LA size data was present in 529 (81%). Mean age was 69 ± 13 years; 46% were male and 18% had atrial fibrillation. Over a median of 4 years, recurrent stroke occurred in 83 patients (16%), 29 were cardioembolic or cryptogenic stroke. After adjusting for baseline demographics and risk factors including atrial fibrillation and congestive heart failure, compared to normal LA size, moderate to severe LAE was associated with greater risk of recurrent combined cardioembolic or cryptogenic stroke (adjusted HR 2. 99, 95% CI 1. 10 to 8.13), but not with risk of total stroke recurrence (adjusted HR 1.18, 95% CI 0.60 to 2.32). Mild LAE was not associated with either total stroke recurrence or the combined recurrent cryptogenic or cardioembolic stroke subtypes. Conclusion: Moderate to severe LAE is an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Future research is needed to determine if anticoagulant use reduces the risk of recurrence in ischemic stroke patients with moderate to severe LAE.

012 Cost-effectiveness of long-term continuous monitoring with an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke: an australian payer perspective

2018 ◽  
Vol 89 (6) ◽  
pp. A6.2-A6 ◽  
Author(s):  
Vincent Thijs ◽  
Carmel Guarnieri ◽  
Koji Makino ◽  
Dominic Tilden ◽  
Marianne Huynh
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Continuous Monitoring ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Cost Effective ◽  
Cardiac Monitor ◽  
Payer Perspective ◽  
Insertable Cardiac Monitor

IntroductionDetection of atrial fibrillation (AF) is required to initiate oral anticoagulation (OAC) after cryptogenic stroke. However, paroxysmal AF can be difficult to diagnose with short term cardiac monitoring. Taking an Australian payer perspective, we evaluated whether long-term continuous monitoring with an insertable cardiac monitor (ICM) is cost-effective for preventing recurrent stroke in patients with cryptogenic stroke.MethodsA lifetime Markov model was developed to simulate the follow-up of patients, comparing long-term continuous monitoring with an ICM to monitoring by conventional care. We used a linked evidence approach to estimate the rates of recurrent stroke when AF detection leads to initiation of oral anticoagulation, as detected using ICM during the lifetime of the device, or as detected using usual care. All diagnostic and patient management costs were modelled. Other model inputs were determined by literature review. Probabilistic sensitivity analysis (PSA) was undertaken to explore the effect of parameter uncertainty according to CHADS2 score and oral anticoagulation treatment effect.ResultsIn the base-case analysis, the model predicted an incremental cost-effectiveness ratio (ICER) of A$29 570 per quality adjusted life year (QALY). Amongst CHADS2sub-groups analyses, the ICER ranged from A$26,342/QALY (CHADS2=6) to A$42,967/QALY (CHADS2=2). PSA suggested that the probabilities of ICM strategy being cost-effective were 53.4% and 78.7%, at thresholds of $30 000 (highly cost-effective) and $50 000 per QALY (cost-effective), respectively.ConclusionLong-term continuous monitoring with ICM is a cost-effective intervention to prevent recurrent stroke in patients following cryptogenic stroke in the Australian context.

scholarly journals Hypertension Risk Factor Control Effort In Post Stroke Patients

2022 ◽  
Vol 4 (2) ◽  
pp. 639-644
Author(s):  
Yosi Suryarinilsih ◽  
Hendri Budi ◽  
Netti Netti ◽  
Wiwi Sartika
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Health Education ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Post Stroke ◽  
Stroke Risk Factors ◽  
Breathing Exercises ◽  
Significant Difference

Post-stroke patients have risk factors for recurrent stroke. The main risk factor is hypertension. The purpose of this community service activity is to improve the ability of the community, especially post-stroke patients, to control hypertension as a risk factor for recurrent stroke through identification of risk factors, health education and the application of light activity and deep breathing exercises. Before education is given, post-stroke patients and their families are given prestest first and after education, posttest returns to evaluate the patient's understanding. The results of the activity, there was a significant difference between the knowledge before and after being given education to post-stroke patients and their families with p value <0.05. To the head of the room and the neuroscientific nurse, dr. M. Djamil Padang can continue the activity of identifying recurrent stroke risk factors and health education related to control of recurrent stroke risk factors in post-stroke patients by involving the Health Promotion (Promkes) department of Dr. M. Djamil Padang.

Recurrent Stroke Risk in Pilots with Atrial Fibrillation

2020 ◽  
Vol 91 (4) ◽  
pp. 352-357
Author(s):  
Jessica Tedford ◽  
Valerie Skaggs ◽  
Ann Norris ◽  
Farhad Sahiar ◽  
Charles Mathers
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Recurrent Events ◽  
Stroke Risk ◽  
Event Rate ◽  
Recurrent Stroke ◽  
Previous History ◽  
Recurrent Event ◽  
Recurrence Rates ◽  
Medical Certification

INTRODUCTION: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in the general population and is considered disqualifying aeromedically. This study is a unique examination of significant outcomes in aviators with previous history of both AF and stroke.METHODS: Pilots examined by the FAA between 2002 and 2012 who had had AF at some point during his or her medical history were reviewed, and those with an initial stroke or transient ischemic attack (TIA) during that time period were included in this study. All records were individually reviewed to determine stroke and AF history, medical certification history, and recurrent events. Variables collected included medical and behavior history, stroke type, gender, BMI, medication use, and any cardiovascular or neurological outcomes of interest. Major recurrent events included stroke, TIA, cerebrovascular accident, death, or other major events. These factors were used to calculate CHA2DS2-VASc scores.RESULTS: Of the 141 pilots selected for the study, 17.7% experienced a recurrent event. At 6 mo, the recurrent event rate was 5.0%; at 1 yr, 5.8%; at 3 yr 6.9%; and at 5 yr the recurrent event rate was 17.3%. No statistical difference between CHA2DS2-VASc scores was found as it pertained to number of recurrent events.DISCUSSION: We found no significant factors predicting risk of recurrent event and lower recurrence rates in pilots than the general population. This suggests CHA2DS2-VASc scores are not appropriate risk stratification tools in an aviation population and more research is necessary to determine risk of recurrent events in aviators with atrial fibrillation.Tedford J, Skaggs V, Norris A, Sahiar F, Mathers C. Recurrent stroke risk in pilots with atrial fibrillation. Aerosp Med Hum Perform. 2020; 91(4):352–357.

scholarly journals B-PO01-028 UTILIZATION OF CARDIAC MONITORING FOR ATRIAL FIBRILLATION IN CRYPTOGENIC STROKE PATIENTS

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S62
Author(s):  
Matthew R. Reynolds ◽  
Candace L. Gunnarsson ◽  
Michael P. Ryan ◽  
Sarah Rosemas ◽  
Paul D. Ziegler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Stroke Patients

Abstract P630: Detection of Atrial Fibrillation by Prolonged Cardiac Monitoring in Cryptogenic and Known Stroke Etiology

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michal krawczyk ◽  
Sebastián Fridman ◽  
Maria Bres Bullrich ◽  
Palak Shah ◽  
Juan C Vargas-Gonzalez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Cryptogenic Stroke ◽  
Left Atrial Volume ◽  
Cardiac Monitoring ◽  
Volume Index ◽  
Multivariate Logistic Regression Model ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Therapeutic Decisions

Introduction: Approximately 25% of strokes are classified as cryptogenic (CS), while greater than 50% have an identifiable or ‘known’ etiology (KS). Several studies have demonstrated that prolonged cardiac monitoring (PCM) after cryptogenic stroke substantially increases the detection of atrial fibrillation (AF), but the yield of PCM in KS stroke is unknown. As a result, the majority of guidelines recommend restricting PCM to patients with cryptogenic stroke. If the detection of AF in KS is no different to cryptogenic stroke, it would suggest that this group too would similarly benefit from PCM, with the potential to impact therapeutic decisions (e.g. initiating anticoagulation). Methods: In a cross-sectional study, we compared AF detection by PCM (minimum of 48 hrs) between CS and KS patients without a previous diagnosis of AF. We developed a multivariate logistic regression model by including known and significant clinical, echocardiographic, and radiological factors known to be associated with the detection of AF. We reported results as odds ratios (OR) and 95% confidence intervals (95% CI). Results: We included 561 ischemic stroke patients, 376 with CS and 185 with KS. The median duration of PCM was 167h for CS and 48h for KS. AF was detected in 30 of 376 (8%) CS patients, and 20 of 185 (7.9%) KS patients. Age, history of thyroid disease, clinical presentation of dysarthria, wake-up stroke, and left atrial volume index on echocardiography were significantly associated with a new diagnosis of AF after stroke in the univariable analysis and were thus included in the logistic regression analysis. Additionally, duration of PCM was included in the multivariate model. After adjustment for potential confounders, AF detection by PCM was not significantly higher for CS than KS (OR 0.95, 95% CI 0.25-3.32, P=0.94). Conclusion: To the best of our knowledge this is the first study directly comparing the incidence of AF between CS and KS as the pre-specified primary outcome. Our findings suggest that CS and KS patients have similar rates of AF detection by PCM. Future prospective research is required to confirm these findings and to determine the cost-effectiveness of PCM in non-cryptogenic stroke patients.

scholarly journals A Modified Anatomical-Functional-RoPE (AF-RoPE) Score Improves Patient Selection for Patent Foramen Ovale Closure

2018 ◽  
Vol 12 ◽  
Author(s):  
Gianluca Rigatelli ◽  
Marco Zuin ◽  
Fabio Dell'Avvocata ◽  
Luigi Pedon ◽  
Roberto Zecchel ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Stepwise Logistic Regression ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Stepwise Logistic Regression Analysis ◽  
Grade 5 ◽  
Risk Patients ◽  
Selection For ◽  
Pfo Closure

Background: RoPE score calculator has been proposed to stratify the patients in whom PFO may be considered not a confounding but presumably a causative factor.Objectives To implement the RoPE score calculator.Methods.  We reviewed the medical data of 1040 consecutive patients (mean age 47.3±17.1 years) prospectively enrolled in two centres over a 13 years period for management of PFO in order to select anatomic and functional parameters to be incorporated in a modified RoPE score. A scoring system (AF-RoPE) was build up and applied in a prospective blind fashion to a cohort of  406 consecutive patients (mean age 43.6 ±17. 5 years, 264 females)  with cryptogenic stroke and PFO comparing its performance with the standard RoPE.Results. Multiple stepwise logistic regression analysis demonstrated that right-to-left  (R-L) shunt at rest (OR 5.9), huge ASA (> 20 mm) (OR 3.9), long tunnelized PFO (> 12 mm) (OR 3.5), and massive R-L shunt (grade 5 by TCD) (OR 1.9) conferred the highest risk of recurrent stroke. The AF-RoPE score  resulted in a more precise separation of patients with RoPE score 8-10. Patients with AF-RoPE score > 11 had more stroke recurrences and more diffuse area of stroke on MRI in the medical history than those ranging 10 to 7 or less.Conclusion. The AF-RoPE score discriminates cryptogenic stroke patients who are more likely to develop recurrent stroke compared with a RoPE score between 8-10.  These highest risk patients may be more likely to benefit from PFO closure.

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