Response to Letter by Haft
We appreciate Dr Haft’s interest in our systematic review and congratulate him on a very interesting study. The results of their study raise important issues regarding patient selection and build on our observations. Extended cardiac event monitoring is inconvenient for patients, time-consuming and, presently, of limited availability. Clearly, identifying patients at greatest risk of occult atrial fibrillation would allow more efficient clinical application. However, we believe further research is required to develop and validate a simple clinical prediction rule that would categorize patients into low, medium and high-risk of occult atrial fibrillation, based on clinical factors and results of initial investigations.
Screening a wider population of “high-risk” patients without a history of stroke is an exciting prospect. Efficient and accurate approaches to detecting occult atrial fibrillation for primary prevention of stroke would have enormous implications for stroke prevention at a population level. Undoubtedly, this area of research will assume increasing importance with advances in technologies to monitor cardiac rhythms noninvasively.