P1455Atrial fibrillation detection by integrated trans-telephonic ECG monitoring after cryptogenic stroke in the years 2016–2018 in the Czech and Slovak Republics

Background

Cryptogenic strokes can be estimated to ∼3500 patients in the Czech (CZ) and 2000 patients in Slovak (SK) republics. Systematic screening in these patients and methods of ECG monitoring are generally uneven across different hospitals and districts.

Purpose

Assessment of integrated screening for atrial fibrillation (AF) after cryptogenic stroke was launched in collaboration with Czech Society of Cardiology and stroke centers in the year 2016.

Methods

Patients with stroke of unknown source within the last 3 weeks, and without AF/atrial tachycardia (AT) detected during in-hospital ECG monitoring, were referred by stroke centers into integrated database of the MDT center, who subsequently contacted the patients and shipped the loop/continuous ECG recorder (Vitaphone, Faros, ECGPocket) with automatic data transmission over cell phone to them directly home or into aftercare unit. ECG monitoring was scheduled for 3 weeks, and the data were regularly edited and evaluated to inform the referring stroke centers in case of AF detection. Upon termination of ECG monitoring, the device was returned to the MDT center, and the final report was sent to the referring physician for eventual treatment decision.

Results

The project involved 36 stroke centers in the CZ and 11 centers in SK. A total of 3.120 patients (65±17 years, 46% females) were monitored for 21.6±5.3 days. AF was detected in 308 (9.9%) patients. Additional findings included: AV block II-III in 62 (2%), NSVT over 5 QRS complexes in 249 (8%), sinus pauses over 4 seconds in 17 (0.5%), and regular SVT over 5 minutes in 69 (2.2%) patients. Total monitoring costs amounted to 374 400 € (120 €/patient). In CZ, the counts of monitored patients in 2016, 2017, 2018 were 302, 754, and 1148, which accounted for ∼10%, 21%, and 32%, respectively, of eligible patients.

Conclusion

Systematic screening of patients after cryptogenic stroke with integrated ECG monitoring has become adopted within 3 years to cover 39% of eligible patients in CZ. Besides approximately 10% AF/AT detection, clinically significant arrhythmias were identified in another 13% of patients.