Background: Identifying paroxysmal atrial fibrillation (AFib) as the etiology of a transient ischemic attack (TIA) or stroke has implications for treatment as well as secondary prevention. Currently, there is not a universal, practical way to help determine which patients would benefit from prolonged cardiac monitoring to establish the diagnosis of AFib.
Dr. Rusty Phillips
Study design: Logistic regression analysis of three prospective multicenter trials examining TIA and stroke patients who received Holter-ECG monitoring.
Setting: Patients who presented with TIA or stroke in Central Europe.
Synopsis: Using data from 1,556 patients, the authors identified age and NIH stroke scale score as being predictive of which patients were at highest risk for AFib detection within 72 hours of Holter-ECG monitor initiation. The authors developed a formula, titled AS5F; this formula scores each year of age as 0.76 points and then an NIH stroke scale score of 5 or less as 9 points or greater than 5 as 21 points. The authors found that the high-risk group (defined as those with AS5F scores of 67.5 or higher) had a predicted risk of 5.2%-40.8%, with a number needed to screen of 3. Given that a majority of the European patients included in the study were white, generalizability to other populations is unclear.
Bottom line: AS5F score may be able to predict those TIA and stroke patients who are most likely to be diagnosed with AFib with 72-hour cardiac monitoring.
Citation: Uphaus T et al. Development and validation of a score to detect paroxysmal atrial fibrillation after stroke. Neurology. 2019 Jan 8. doi. 10.1212/WNL.0000000000006727.
Dr. Phillips is a hospitalist at Beth Israel Deaconess Medical Center and instructor in medicine at Harvard Medical School.
