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Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis
Abstract
Background Among patients with atrial fibrillation, the risk of stroke is highest for those with a history of stroke; however, oral anticoagulants can lower the risk of recurrent stroke by two-thirds. No consensus has been reached about how atrial fibrillation should be investigated in patients with stroke, and its prevalence after a stroke remains uncertain. We did a systematic review and meta-analysis to estimate the proportion of patients newly diagnosed with atrial fibrillation after four sequential phases of cardiac monitoring after a stroke or transient ischaemic attack. Methods We searched PubMed, Embase, and Scopus from 1980 to June 30, 2014. We included studies that provided the number of patients with ischaemic stroke or transient ischaemic attack who were newly diagnosed with atrial fibrillation. We stratified cardiac monitoring methods into four sequential phases of screening: phase 1 (emergency room) consisted of admission electrocardiogram (ECG); phase 2 (in hospital) comprised serial ECG, continuous inpatient ECG monitoring, continuous inpatient cardiac telemetry, and in-hospital Holter monitoring; phase 3 (first ambulatory period) consisted of ambulatory Holter; and phase 4 (second ambulatory period) consisted of mobile cardiac outpatient telemetry, external loop recording, and implantable loop recording. The primary endpoint was the proportion of patients newly diagnosed with atrial fibrillation for each method and each phase, and for the sequential combinati…
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“Sequential stratified ECG monitoring detected AF in 24% (95% CI 17-31) of stroke survivors, 151 and in 11.5% (95% CI 8.9%-14.3%) in another meta-analysis, 17 with large variations depending on the timing, duration, and method of monitoring.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [151]
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Metadata
- Authors
- Sposato, L. A., Cipriano, L. E., Saposnik, G., Vargas, E. R., Riccio, P. M., & Hachinski, V.
- Affiliations
- Western University (CA)
- St. Michael's Hospital (CA)
- Corresponding author
- Sposato, Luciano A
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2015-04
- Volume
- 14
- Issue
- 4
- Pages
- 377-387
- ISSN
- 1474-4422 (ISSN-L)
- OpenAlex
- W2050265501
- Cited by
- 694
- References
- 84
- Citations by year
- 2026: 25 · 2025: 49 · 2024: 54 · 2023: 74 · 2022: 88 · 2021: 77 · 2020: 73 · 2019: 61 · 2018: 55 · 2017: 39 · 2016: 57 · 2015: 31
- FWCI
- 10.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- atrial fibrillation, post-stroke atrial fibrillation, transient ischemic attack, ischemic stroke, cardiac monitoring, Holter monitoring, implantable loop recorder, cardiac telemetry, oral anticoagulation, stroke recurrence, ambulatory cardiac monitoring
- MeSH terms
- Atrial Fibrillation, Ischemic Attack, Transient, Electrocardiography, Emergencies, Humans, Telemetry, Electrocardiography, Ambulatory, Stroke
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