New early atrial fibrillation (AF) detection by an automated remote monitoring system on hyperacute stroke unit (HASU)

Introduction: Many patients have cardiac monitoring on HASUs across the UK in current practice. An appropriate question would be how good are those monitoring systems at AF detection? We installed a Nihon Kohden monitoring system with remote rhythm analysis for AF detection (Apolplex). Every night rhythm is remotely analysed. An email report is generated. By the time of the HASU ward round the analysis is available for review

Methods: We retrospectively analysed positive AF reports for 4 months in 2016. Notes were reviewed to confirm that new AF was detected. Demographics and anticoagulation plans were recorded.

Results: 30 positive cases were identified via Apoplex report. 2 cases were identified as false positive. Of the remaining 28 cases there were 17 new AF cases, 11 previously known. The average cohort age was 83 y. The patients were monitored for an average of 22.9 hours. 43% were TACS. Out of 17 new AF cases 10 were anticoagulated.

Conclusion: This is a novel system with evidence based AF detection. UK Stroke units are using serendipitous AF detection via cardiac monitoring systems – eg. tachycardia alarms or clinician recognition of irregular rhythm. Our system has proved effective in AF detection and easy to integrate into daily HASU care. This retrospective analysis confirms new AF detection in 17 cases allowing early anticoagulation, also avoiding outpatient 24 h tapes. There may be clinical and cost benefit of this system.