AIMS Assessing bedside cardiac monitoring outcomes in acute ischaemic stroke patients, specifically detecting new Atrial Fibrillation (AF) and subsequent initiation of anticoagulation therapy. Secondary objectives include evaluating the negative predictive value (NPV) of cardiac monitoring and estimating cost savings by reducing event monitoring devices.
METHODS Data recorded from EMR of patients admitted to the Stroke Unit from August 2024 to January 2025. Patients without acute ischaemic stroke were excluded. Bedside cardiac monitoring was performed for 24–48 hours on patients without known AF in the Acute Stroke Unit and other wards, unless low risk of cardio-embolism or poor prognosis, due to limited monitoring beds. Rhythm was interpreted and anticoagulation started if AF detected. Patients with undetermined stroke aetiology but high AF suspicion underwent Holter, loop recorder, or HeartBug monitoring. Based on the Medicare Benefit Schedule, a Holter costs $190.85 and a loop recorder $334.05. A HeartBug costs $55.00.
RESULTS 146 patients admitted, 100 had ischaemic stroke. 19.0% had known AF. Cardiac monitoring in 77 patients detected new AF in 15 (19.5%), resulting in anticoagulation initiation in 13 (86.6%). Nine patients underwent subsequent event monitoring; six completed it with no AF detected (100% NPV). Remaining three have pending appointments. Estimated savings from avoiding event devices (68 patients) ranged from $4,235 to $25,721.85, depending on device used.
CONCLUSION Study highlights the importance of bedside cardiac monitoring for detecting new AF in stroke patients, enabling timely initiation of anticoagulation therapy while demonstrating high NPV and potential cost savings by reducing event monitoring devices.