Professor Freedman says in up to a quarter of strokes or mini-strokes, AF is known beforehand. In a further quarter of strokes, AF can be found in the days after the stroke using electrocardiogram (ECG) monitoring. The more intense and prolonged the monitoring, the more likely for AF to be found.
“Once it’s discovered, these AF patients go onto anticoagulant blood thinners, rather than the usual stroke treatment of aspirin, and are therefore less likely to have another AF-related stroke,” the specialist says. “That is because aspirin is not really effective in preventing AF-related strokes”.
AF may be a marker of a heart muscle abnormality of the atrium called atrial myopathy. “More research is required to understand the causes and diagnosis of this myopathy, which could guide us on how intensively we should search for AF after stroke,” says Professor Freedman.
The white paper authored by 45 AF-SCREEN members, reviewed current research and found ECG monitoring should be continued for 72 hours after stroke to detect AF. “Even just routine monitoring for a full 24 hours after stroke would pick up a considerable number in this at-risk group,” says Professor Freedman, the corresponding author of the paper. “Unfortunately, it takes time and is more costly to use an ECG on a patient, so in many countries, it’s simply not an economic possibility to monitor them that long.”
The paper urges health authorities around the world to reconsider their ECG monitoring practices in the case of stroke, and calls for further research to build knowledge of this important health concern.
