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Results from the Find AF clinical trial indicate that enhanced and prolonged Holter-ECG monitoring is superior to standard of care for the detection of atrial fibrillation (AF) when initiated early after ischemic stroke.
Rolf Wachter, MD and colleagues sought to determine whether enhanced monitoring (3 times per day for 10 days) for AF in patients with stroke (≥60 years of age) would yield higher detection rates compared with standard of care.
The prospective, randomized, multicenter trial took place at 4 study centers in Germany from May 2013 to August 2014. Patients were assigned to receive enhanced monitoring (n=200) or standard of care (n=198). CardioMem 3000 (Getemed; Teltow, Germany; 5 leads with continuous recording) was used in the enhanced monitoring group.
The primary end point was to detect AF after 6 months and before a recurrent stroke. AF detection and recurrent strokes after 12 months served as secondary end points. Investigators were able to detect AF in 27 patients (13.5%) of the enhanced monitoring group compared with only 9 (4.5%) in the standard of care group (absolute difference: 9.0%; 95% confidence interval [CI]: 3.5; P=.002).
There were no additional cases found in the enhanced monitoring group between the 6 and 12-month mark, but 4 newly diagnosed patients were discovered in the standard of care group.
However, after 12 months, AF was detected in 13 patients in the standard of care group and 27 patients in the enhanced monitoring group. At that same time, recurrent strokes occurred in 9 patients (5.1%) in the control group vs 5 (2.5%) in the enhanced monitoring group (P=.28).
Investigators also recorded anticoagulation rates after 3, 6, and 12 months. All patients with newly diagnosed AF were started on oral anticoagulants. After 3 months, 8.6% of patients in the enhanced monitoring group were taking anticoagulants vs 2.9% of the standard of care group. Use of anticoagulants was 12.7% vs 4.9% after 6 months and 15.1% vs 6.0% after 12 months.
They study authors acknowledged that “whether patients with AF episodes detected by monitoring should be treated with anticoagulation similar to AF detected on surface ECG is unknown.”
That being said, the researchers concluded that enhanced and prolonged monitoring should be considered for all patients with stroke as the detection of AF is of “therapeutic relevance.”
Disclosures: Several authors report grants and honoraria from various pharmaceutical companies, including Boehringer Ingelheim, which funded this study.
Reference
Wachter R, Groschel K, Gelbrich G, et al; on behalf of the Find-AF Randomized Investigators. LB2. Finding atrial fibrillation in stroke patients: a multicenter randomized evaluation of enhanced and prolonged Holter monitoring (Find-AF Randomized Trial). Presented at the International Stroke Conference; February 17-19, 2016; Los Angeles, CA.
