Abstract TP348: Crytogenic Stroke and Paroxysmal Atrial Fibrillation: Criteria for Long Term Cardiac Monitoring
Background: Cryptogenic stroke represents 30% of all ischemic strokes. Undetected atrial fibrillation may be a cause of cryptogenic stroke and may lead to ineffective secondary stroke prevention. Long term cardiac monitoring assists in identifying atrial fibrillation. The purpose of this performance improvement project was to develop a protocol for long term cardiac monitoring for patients with cryptogenic stroke.
Methods: Stroke faculty, cardiology and stroke nurses developed a protocol for long term cardiac monitoring. A 14 day “event monitor” is placed electronically on day of discharge. Inclusion and exclusion criteria were identified. Inclusion: diagnosis stroke/TIA; EKG has not shown atrial fibrillation/flutter; vascular imaging of the extracranial and intracranial circulation excludes significant large vessel occlusive disease; evidence of abdominal or pelvic embolic on CT scan; echocardiography excludes thrombus or structural heart disease. Exclusion: documented atrial fibrillation/flutter; etiological diagnosis for the qualifying stroke/TIA event has been determined, i.e. probable small-vessel disease, probable large vessel disease, arterial dissection, venous sinus thrombosis, hypercoagulable states; echocardiography reveals indication for long-term anticoagulation; absolute indication for oral anticoagulation therapy; contraindications to oral anticoagulation therapy.
Results: This protocol was effective in providing patients with long term cardiac monitoring. Patients are scheduled in the stroke discharge clinic for diagnostic review.
Conclusions: This protocol assists in identifying patients who have paroxysmal atrial fibrillation and need anticoagulation for secondary prevention. The following process improvements are needed: 1) process for follow up, 2) improve communication with PMD, 3) improve transition of care when patients are transferred to rehabilitation, 4) costs can be prohibitive and, 5) 14 days may not be effective in detecting atrial fibrillation.
- © 2012 by American Heart Association, Inc.