Abstract 14949: Wear Time, Frequency of and Time to First Atrial Fibrillation Detection in Patients With a History of Stroke

Abstract

Introduction: Telemetry monitoring following cryptogenic stroke (CS) is routinely undertaken to rule out atrial fibrillation (AF) as a stroke source. In patients with stroke of known etiology, AF may represent an alternate mechanism for the incident stroke and predicate anticoagulation. Irrespective of classification, a potential limitation of post-stroke monitoring is the patients’ ability to wear an ambulatory monitor for an extended timeframe. Aim: Identify mobile cardiac outpatient telemetry (MCOT, Philips BioTel Heart) monitor wear time, frequency of AF detection, and time to first AF diagnosis in patients with any history of stroke. Methods: A retrospective review of 7,426 patients prescribed 30-day MCOT with ICD-10 diagnosis codes starting with I63 (cerebral infarct, unspecified) was conducted. Data from 2021 was analyzed for MCOT monitor wear time, occurrence of any AF, and time to first AF detection. Monitor wear time was defined as the time from the first to the last telemetry transmission. Results: The percentage of patients with MCOT monitor wear time of 5, 10, 15, 20, 25 and 30 days was 93%, 87%, 82%, 76%, 67% and 44%, respectively. In this cohort, 748 patients (10.1%) were identified with any AF. Of these patients, the first AF detection occurred in 33% (3.3% of total) in days 1-5 of monitoring, 20% (2.0%) in days 6-10, 15% (1.5%) during days 11-15, 14% (1.4%) during days 16-20, 9% (0.9%) during days 21-25, and 9% (0.9%) during days 26-30. Interestingly, 4% of AF detection (0.4% total) occurred on days 29-30. Conclusions: Patients with cerebral infarcts are capable of adhering to extended MCOT wear times, and 10% of patients with any history of stroke demonstrated AF when prescribed MCOT for 30 days. While most patients had first AF detection within 15 days, 32% of patients had first AF detection between days 16-30. These findings suggest that patients with any history of stroke, regardless of etiology, may benefit from extended duration telemetry monitoring.