This Article Full Text Full Text (PDF) All Versions of this Article: 38/6/1956    most recent STROKEAHA.106.477760v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Douen, A. Articles by Medic, S. Search for Related Content PubMed PubMed Citation Articles by Douen, A. Articles by Medic, S. Related Collections Secondary prevention Echocardiography Acute Cerebral Infarction Arrhythmias, clinical electrophysiology, drugs Anticoagulants Antiplatelets Transient Ischemic Attacks

(Stroke. 2007;38:1956.)
© 2007 American Heart Association, Inc.

Research Letters

Usefulness of Cardiovascular Investigations in Stroke Management

Clinical Relevance and Economic Implications

Andre Douen, MD, PhD, FRCPC; Nicole Pageau, RN, BSc Sejla Medic, RN

From Department of Neurology (A.D., N.P., S.M.), Trillium Health Centre and Division of Neurology (A.D.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.

Correspondence to André G. Douen, MD, PhD, FRCPC, Adjunct Professor, University of Ottawa, Director, Stroke Clinic, Department of Neurology, Trillium Health Centre, 100 Queensway West, Mississauga, ON L5B 1B8, Canada. E-mail adouen{at}thc.on.ca

Abstract

Background and Purpose— There are no prospective randomized studies assessing the clinical relevance of routine cardiovascular investigations in stroke patients. The objective of this study was to evaluate the utilization, relevance, and economics of cardiovascular investigations in an ambulatory stroke clinic.

Methods— The outcome of cardiovascular investigations in 200 patients with stroke/transient ischemic attack diagnosed in a stroke prevention clinic was assessed. Transthoracic echocardiography (TTE) was assessed for detection of thrombus or mass, poor left ventricle function, and other structural abnormalities. ECG and Holter monitor were felt to be relevant if they showed atrial fibrillation/flutter. Investigations were deemed to be clinically pertinent if they brought about a shift treatment paradigm.

Results— TTE and Holter were performed in >70% of cases and accounted for 94% of total cardiovascular cost. Relevant TTE findings were identified in 6 (4%) patients, which did not alter antithrombotic therapy. Only 2 new cases of atrial fibrillation were identified by both ECG and Holter.

Conclusions— TTE and Holter appear to be costly low-yield procedures in this clinical setting. Prospective analyses may help to provide cost effective criteria for selection of appropriate cardiovascular studies in stroke management.

Key Words: ECG • ECHO • Holter • stroke • TIA

This article has been cited by other articles:

				J. D. Easton, J. L. Saver, G. W. Albers, M. J. Alberts, S. Chaturvedi, E. Feldmann, T. S. Hatsukami, R. T. Higashida, S. C. Johnston, C. S. Kidwell, et al. Definition and Evaluation of Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease: The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke, June 1, 2009; 40(6): 2276 - 2293. [Abstract] [Full Text] [PDF]

				A. H. Tayal, M. Tian, K. M. Kelly, S. C. Jones, D. G. Wright, D. Singh, J. Jarouse, J. Brillman, S. Murali, and R. Gupta Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke Neurology, November 18, 2008; 71(21): 1696 - 1701. [Abstract] [Full Text] [PDF]

				A. G. Douen, N. Pageau, and S. Medic Serial Electrocardiographic Assessments Significantly Improve Detection of Atrial Fibrillation 2.6-Fold in Patients With Acute Stroke Stroke, February 1, 2008; 39(2): 480 - 482. [Abstract] [Full Text] [PDF]