Usefulness of the stroke risk analysis in routine clinical practice for predicting risk of atrial fibrilation in patients with acute stroke or transient ischemic attack

Introduction

Atrial fibrillation (AF) stands as one of the most frequent causes of ischemic stroke. Therefore, its prompt detection carries considerable importance. Stroke risk analysis (SRA) is an ECG monitoring system that allows the detection of AF and identifies patterns with high or low risk of suffering paroxysmal AF.

The objective of this study is to analyse the usefulness of SRA routine clinical practice for the search for AF in patients after cerebral ischemia.

Methods

We conducted a single-center retrospective study that includes patients with transient ischemic attack (TIA) or recent ischemic stroke in whom the search for AF was initially negative. Vascular risk factors were recorded together with the clinical and neuroimaging characteristics of stroke. The presence of AF in the low- and high-risk groups was reassessed over a one-year follow-up period.

Results

We enrolled 708 patients (58% male, median age 73,0, IQR 62,0-82,0) among whom 576 suffered a stroke (81%) and 132 (19%) a TIA. The registry indicated a low risk of AF in 537 (76%), while 171 (24%) displayed an elevated risk. One year later, follow-up was conducted on 693 patients, revealing that 32 individuals had developed AF, accounting for 5.1% of the total cohort; 23/171 (13%) of patients classified as high risk versus 9/537 (1,7%) of those classified as low risk. Patients diagnosed with AF were older, had a higher frequency of Embolic Stroke of Undetermined Source (ESUS), greater left atrial dilation, and a risk of AF development based on SRA findings. This group also suffered more strokes during the year of follow-up.

Conclusions

In routine clinical practice, the Holter-SRA emerges as a valuable instrument that, combined with other clinical data and complementary tests, can help prioritize the search for paroxysmal AF following cerebral ischemic events.