Abstract W P191: Patient Compliance High with Long-Term Continuous ECG Monitor

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Judith C Lenane ◽  
Angela J Fought ◽  
Jay H Alexander
Keyword(s):  
San Francisco ◽  
Patient Compliance ◽  
Cryptogenic Stroke ◽  
Standard Of Care ◽  
Interquartile Range ◽  
Ecg Monitoring ◽  
Wear Time ◽  
Stroke Population ◽  
Total Wear

Introduction: Long term ECG monitoring to detect atrial fibrillation in a cryptogenic stroke is now the emerging standard of care. The advent of patch based ECG monitors raises the question of patient compliance with this new modality. Hypothesis: We assessed the hypothesis that patient compliance, as measured by Leads-On detection for patch based ECG monitoring, is constant over time. Methods: We performed a retrospective analysis from ZIO® Patch (Patch) devices (iRhythm, San Francisco, CA). The Patch is a continuous recording single lead ECG monitor that can be worn for up to 14 days. The primary endpoint of Leads-On is the percentage of time the device is applied to the patient during the wear period, which was derived from a second channel in the device. The data are gathered by ZEUS software and exported in a CSV file. The compliance data were analyzed overall and in categories at days: 0-1, 1-2, 2 to 7, >7 to 10 and >10 to 14. A secondary endpoint, percent Analyzable Time (percentage of ECG record that was available for detection by the algorithm during the wear period and signifies signal quality), was assessed for the same time increments. Results: The dataset consisted of 18,885 records. The total wear time ranged from 0.10 up to 14.01 days, with a median of 12.51. The medians and interquartile ranges for the percent Leads On and percent of Analyzable Time were 100% (99.99-100%) and 97.99% (94.64-99.26%). In Table 1, the interquartile ranges for percent Leads On and Analyzable Time was wider when the Patch was worn less than a day, but remains above 74%. Total wear time in days n Percent Leads On Percent Analyzable Time Median Interquartile Range Median Interquartile Range 0.10-<1 105 99.65 86.52-100 92.86 74.19-96.97 1-<2 407 100 99.88-100 97.37 90.96-99.02 2-<7 4124 100 100-100 97.96 94.3-99.26 7-<10 2963 100 99.98-100 97.79 94.33-99.19 10+ 11286 100 100-100 98.07 95.00-99.29 Conclusion: Patient compliance with long term ECG patch monitors is high as measured by Leads-On detection. High patient compliance results in a large volume of quality ECG. Further study is needed to compare patient compliance with ECG patch based monitors with other monitoring modalities, particularly in the cryptogenic stroke population.

scholarly journals EFFICACY OF ATRIAL FIBRILLATION DETECTION IN CRYPTOGENIC STROKE ACCORDING TO DATA OF IMPLANTABLE LOOP RECORDERS: PILOT STUDY

2019 ◽  
Vol 34 (2) ◽  
pp. 47-53
Author(s):  
S. E. Mamchur ◽  
E. A. Ivanitskiy ◽  
O. M. Polikutina ◽  
T. Yu. Chichkova ◽  
I. N. Mamchur ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Ecg Monitoring ◽  
Group Iii ◽  
External Monitoring ◽  
Group I ◽  
Monitoring Group ◽  
Group Ii

Aim. To estimate the efficacy of invasive and non-invasive long-term ECG monitoring in comparison with conventional follow-up for the detection of silent atrial fibrillation (AF)/atrial flutter (AFL)/atrial tachycardia (AT) in patients with a cryptogenic stroke.Methods. The randomized, prospective, two-center study enrolled 36 patients who suffered cryptogenic stroke (CS) or transient ischemic attack (TIA) without past history of AF/AFL/AT. Patients were randomized in a 1:1:1 ratio to one of the three ECG monitoring strategies: standard arrhythmia monitoring (group I, n=12), ECG-monitoring with implantable loop recorder (group II, n=12), and ambulatory noninvasive ECG monitoring (group III, n=12). The primary endpoint was the time to the first detection of AF/AFL/AT. Patients, assigned to the group I, underwent an assessment at scheduled and unscheduled visits and received ambulatory ECG monitoring 28 days and 1 year after randomization. Patients in the group II underwent implantation of Reveal XT (Medtronic, USA) with the daily remote data transmission to CareLink Network. In the group III, for long-term external monitoring, Spyder system (WEB Biotechnology, Singapore) was used for up to 28 days.Results. During the first 28 days of observation, there were no significant differences in AF detection rates between groups I, II, and III: 0 (0%), 1 (8%), and 2 (17%) cases, respectively, р=0.537. During the year of observation, AF/AFL/AT episodes were detected in 1 case (8%) in the group I, 6 cases (50%) in the group II, and 2 cases (17%) in the group III, p=0.0486. The mean time from enrollment into the study to detection of the first AF/AFL/AT episode was 67 days (15; 97) in all groups. In the groups II and III, the first arrhythmia episodes were detected by monitoring devices on days 24 and 6, respectively. In most cases, arrhythmia episodes detected by long-term monitoring were asymptomatic. Recurrent stroke or TIA events occurred in group I and III (1 case in each group), but not in the group with implantable cardiac monitors. Subgroup analysis showed that significantly higher AF/AFL/AT detection rate was associated with stroke, CHA2DS2VASc score ≥2, and the presence of hypertension. For the 12 months of follow-up, the mean AF burden in the group II was 0.4 (0.2; 0.5) hours per day (1.6%). In the patients with recurrent stroke, AF burden was 3.2% compared to 0.9% in the rest of patients.Conclusion. Detection of silent AF with implantable cardiac monitors is superior to standard and long-term external monitoring in cryptogenic stroke patients.

scholarly journals Cost–effectiveness of an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke

2020 ◽  
Author(s):  
Laura M Sawyer ◽  
Klaus K Witte ◽  
Matthew R Reynolds ◽  
Suneet Mittal ◽  
Frank W Grimsey Jones ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Recurrent Stroke ◽  
Anticoagulation Therapy ◽  
Cryptogenic Stroke ◽  
Cost Effective ◽  
Standard Of Care ◽  
Holter Monitoring ◽  
Sensitivity Analyses ◽  
Stroke Population ◽  
Life Years

Background: We assessed cost–effectiveness of insertable cardiac monitors (ICMs) in a US cryptogenic stroke population. Materials & methods: We modelled lifetime costs and quality-adjusted life years for three monitoring strategies post cryptogenic stroke: ICM starting immediately, ICM starting after Holter monitoring (delayed ICM) and standard of care involving intermittent ECG and Holter monitoring. Patient characteristics and detection efficacy were based on the CRYSTAL-AF trial. AF detection altered the modelled anticoagulation therapy and subsequent stroke and bleed risks. Results & conclusion: Immediate ICM was found to be cost-effective versus standard of care and cost-saving versus delayed ICM. Results were robust to sensitivity analyses. ICMs are a cost-effective diagnostic tool for the prevention of recurrent stroke in a US cryptogenic stroke population.

scholarly journals Long-term detection of atrial fibrillation with insertable cardiac monitors in a real-world cryptogenic stroke population

2017 ◽  
Vol 244 ◽  
pp. 175-179 ◽  
Author(s):  
Paul D. Ziegler ◽  
John D. Rogers ◽  
Scott W. Ferreira ◽  
Allan J. Nichols ◽  
Mark Richards ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real World ◽  
Cryptogenic Stroke ◽  
Stroke Population

Abstract WP422: Mechanisms of Recurrent Ischemic Stroke Under Medical versus Device Therapy: Long Term Follow-up in the RESPECT PFO Trial

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
David E Thaler ◽  
John Carroll ◽  
Jeffrey Saver ◽  
Richard Smalling ◽  
Diane Book ◽  
...  
Keyword(s):  
Recurrent Events ◽  
Statistical Significance ◽  
Cryptogenic Stroke ◽  
Standard Of Care ◽  
Primary Analysis ◽  
Intention To Treat ◽  
Long Term Follow Up ◽  
Pfo Closure

Introduction: The RESPECT trial evaluated the superiority of patent foramen ovale (PFO) closure over standard-of-care medical management (MM) in patients with PFO and cryptogenic stroke (CS). Hypothesis: Analysis of stroke mechanisms and topography of recurrent events will provide insight into the clinical efficacy of PFO closure. Methods: RESPECT is a prospective, multicenter, randomized event-driven trial of PFO closure vs. MM in patients with CS and PFO. Patients were randomized to treatment in a 1:1 ratio. The primary results were analyzed and reported when the target of 25 events were adjudicated (NEJM 2013; 368:1092-100). At that time, mean follow-up was 2.6 years, range 0-8.1 years. Prospective follow-up has continued. Recurrent strokes were assigned phenotypes using the ASCOD system by investigators blinded to treatment assignment. Results: 980 subjects were randomized to PFO closure (n=499) or MM (n=481). The primary analysis in the intention-to-treat population after a mean follow-up of 2.6 years exhibited a hazard ratio of 0.49 favoring closure that did not reach statistical significance (p=0.08). The per-protocol cohort demonstrated a significant reduction in the primary endpoint in favor of closure (HR 0.37, p=0.03). Among the initial 25 recurrent ischemic strokes, MM patients more often had superficial or multiple-penetrator territory infarcts (12 vs 4) and infarcts of larger size (69% vs 14%, p=0.06). Since the primary results report, follow-up has continued for an additional 3.5 years and additional recurrent infarcts have been observed. Long-term stroke rates, phenotyping, and topography will be presented. Conclusions: Our prior reports suggest that PFO closure was associated with prevention of stroke subtypes particularly associated with PFO, including superficial and larger infarcts. Long-term safety, efficacy, and stroke mechanisms, with >4000 patient-years of follow-up will be presented.

scholarly journals Comparison of 24 h ECG Holter Monitoring with Real-time Long-term ECG Monitoring System using ECGalert Software and Savvy Single-Lead Patch

2021 ◽  
Vol 9 (B) ◽  
pp. 12-17
Author(s):  
Lidija Poposka ◽  
Marija Vavlukis ◽  
Hristo Pejkov ◽  
Marjan Gusev
Keyword(s):  
Single Channel ◽  
Holter Monitoring ◽  
Ecg Monitoring ◽  
Arrhythmia Detection ◽  
Wear Time ◽  
Total Wear ◽  
System Versus ◽  
Significant Difference ◽  
A Prospective Study ◽  
The University

AIM: The aim of the study was to show non-inferiority of the single-channel ECGalert system to the gold standard (ECG Holter) in the detection of arrhythmias over the total wear time of both devices. METHODS: A prospective study enrolled a total of 165 patients hospitalized at the University Clinic of Cardiology, who underwent simultaneous single-channel ECG recording with ECGAlert system and a conventional 24 h Holter monitor on the 1st day and continued ECGAlert monitoring for few more days, under assignment of the doctor or at the wish of the patient. RESULTS: A total of 165 patients were included in the study, 61.2% male, mean age of 58.4 ± 12.7 years. Mean duration of ECG Holter monitoring was 23.2 ± 0.5 h and mean duration of ECGalert/Savvy monitoring was 64.6 ± 31.2. During the first 24 h of simultaneous ECG monitoring with both methods, no statistically significant difference was found in arrhythmia detection. Over the total wear time of both devices, the ECGalert system detected significantly more AF episodes as compared to Holter (p < 0.000). ECGalert demonstrated significantly lower detection rate of false pauses (0.001). However, false detection of episodes of VT or AF was significantly higher in ECGalert system versus Holter (p < 0.000 and p < 0.000 respectively). Patients were more satisfied with ECGalert system, due to lesser interference in daily activities. CONCLUSION: The ECGalert system demonstrated superiority over traditional Holter monitoring in arrhythmia detection in the total monitoring period, but not in the first 24 h.

scholarly journals Supraventricular Runs in 7-Day Holter Monitoring Are Related to Increased Incidence of Atrial Fibrillation in a 3-Year Follow-Up of Cryptogenic Stroke Patients Free from Arrhythmia in a 24 h-Holter

2021 ◽  
Vol 8 (7) ◽  
pp. 81
Author(s):  
Andrzej Kułach ◽  
Milena Dewerenda ◽  
Michał Majewski ◽  
Anetta Lasek-Bal ◽  
Zbigniew Gąsior
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Holter Monitoring ◽  
Ecg Monitoring ◽  
Stroke Patients ◽  
Long Term Monitoring ◽  
In Cis ◽  
Term Monitoring

Introduction: Silent atrial fibrillation (AF) is a common cause of cryptogenic ischemic stroke (CIS). The 24-h-Holter is insufficient to reveal an occult arrhythmic cause of stroke and the strategy to select the patients for long-term monitoring is missing. Objectives: The aim of the study was to evaluate 7-day-Holter monitoring to identify cases with the arrhythmic cause of stroke in CIS patients in whom 24-h-Holter was free from arrhythmia, and to assess the relation between supraventricular (SV) runs in baseline Holter and the incidence of AF in a 3-year follow-up period. Methods: 78 patients (aged 60 ± 9 years, 45 males) with CIS and no arrhythmic findings in 24-h-Holter were enrolled. All patients had 7-day-Holter monitoring after stroke and were followed up for 36 months, and then 7-day Holter was repeated. We assessed SV runs (≥5 QRS) in the initial 7-day Holter and analyzed the relation of the findings with clinical characteristics of novel AF episodes revealed early after stroke and during a 3-year follow-up. Results: Baseline 7-day-Holter revealed SV runs in 36% of patients and AF in 9% of cases. During a 3-year follow-up, 8 additional cases were confirmed, both in standard care and in repeated Holter (a total of 19% of AF cases). There was no difference with regard to CHADS2VASc score (3.6 ± 1.1 vs. 3.4 ± 1.5; p = NS) and left atrium parameters between patients with SV runs and the non-arrhythmic group. Patients with SV runs had a higher incidence of AF both after stroke and in a 3-year follow-up (46% vs. 4%, RR 11.6, p < 0.001). In 8 cases, patent foramen ovale was detected during follow-up. Conclusions: A strategy of baseline 7-day-Holter monitoring after stroke allows for disclosing SV runs in every third case and AF in 9% of stroke survivors. Patients with SV runs have a higher incidence of AF (RR 11.6, p < 0.001) and should be considered for extended continuous ECG monitoring.

Abstract 16305: Incidence and Timing of High-Risk Arrhythmias With Long-Term Continuous Ambulatory Electrocardiographic Monitoring

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Matthew D Solomon ◽  
Jingrong Yang ◽  
Judy Lenane ◽  
Sue Hee Sung ◽  
Alan S Go
Keyword(s):  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
High Risk ◽  
Heart Block ◽  
Sustained Ventricular Tachycardia ◽  
High Grade ◽  
Ecg Monitoring ◽  
Wear Time ◽  
Electrocardiographic Monitoring

Background: Ambulatory electrocardiographic (ECG) monitoring is the standard of care to screen patients for arrhythmias. However, there is marked variation in the technological features and patient adherence among different ECG monitoring systems. We evaluated a novel adhesive, wireless, single-lead, full-disclosure, up to 14-day ECG monitoring system to measure the burden and timing of high-risk arrhythmias. Methods: We examined data from 122,815 long term continuous ambulatory ECG Monitors. (ZIO® Patch Service, iRhythm Technologies, San Francisco, CA) from 2011-2013 and categorized high-risk arrhythmias into two types: (1) ventricular arrhythmias including non-sustained and sustained ventricular tachycardia and (2) high risk bradyarrhythmias including sinus pauses >3 seconds, atrial fibrillation pauses >5 seconds, and high grade heart block including Mobitz Type II or third-degree heart block. We calculated the proportion of patients with each arrhythmia and the elapsed wear time until each arrhythmia. Results: Of 122,815 Ziopatch recordings, median wear time was 9.9 (IQR 6.8-13.8) days and median analyzable time was 9.1 (IQR 6.4-13.1) days. There were 22,443 (18.3%) with at least one episode of non-sustained ventricular tachycardia (NSVT), 238 (0.2%) with sustained VT, 1,766 (1.4%) with a sinus pause >3 seconds (SP), 520 (0.4%) with a pause during atrial fibrillation >5 seconds (AFP), and 1,486 (1.2%) with high-grade heart block. Median time to first arrhythmia was 74 hours (IQR 26 -149 hours) for NSVT, 22 hours (IQR 5-73 hours) for sustained VT, 22 hours (IQR 7-64 hours) for SP, 31 hours (IQR 11-82 hours) for AFP, and 40 hours (SD 10-118 hours) for high-grade heart block. The yield over time is shown in the Figure 1. Conclusions: A significant percentage of high-risk arrhythmias can be identified by long term continuous monitoring for longer than 24 to 48 hours. The clinical impact from better identification of high-risk arrhythmias warrants further study.

Evaluation of serum triglyceride levels as a marker of long-term patient compliance in diabetes mellitus type

2011 ◽  
Vol 6 (S 01) ◽  
Author(s):  
A Stylianou ◽  
G Lavranos ◽  
A Hatziyianni ◽  
P Georgiou ◽  
G Olymbios
Keyword(s):  
Diabetes Mellitus ◽  
Patient Compliance ◽  
Serum Triglyceride ◽  
Diabetes Mellitus Type

San Francisco's New Deal Murals in Long-Term Perspective

2020 ◽  
Vol 97 (1) ◽  
pp. 3-32
Author(s):  
Robert W. Cherny
Keyword(s):  
High School ◽  
San Francisco ◽  
New Deal ◽  
Public Art ◽  
George Washington ◽  
Art Programs ◽  
City College ◽  
Washington High School ◽  
Treasure Island

The federal art programs of the New Deal produced public art in quantities not seen before or since. Historians have studied many aspects of the New Deal's art programs, but few have considered the long-term history of works produced by them. New Deal art programs produced large numbers of public murals—so many that such murals are often thought of as the typical form of New Deal art. They thus provide readily available examples of the long-term experience of New Deal art. San Francisco has a particularly rich collection of these murals. Some of them have been well cared for over the past eight decades, but public officials have proved negligent stewards—and occasionally destructive stewards—of others. Some of San Francisco's murals were considered so controversial at the time they were created that they were modified or even destroyed. Others became controversial later, with calls for modification or destruction. Some of the latter were covered, some were vandalized, and some have deteriorated. Most of the damaged murals have been restored, sometimes more than once. This article looks at the city's New Deal murals at Coit Tower, the Mothers Building at the Zoo, the Beach Chalet, the University of California San Francisco, the Alemany Health Center, Treasure Island/City College, and Rincon Annex/Center, with special attention to the George Washington High School murals that have recently been highly controversial. Controversies over the murals at Coit Tower, Rincon Annex, and George Washington High School also reveal significant changes in the role of the city's political and civic leadership with regard to public art.

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