Improving detection and management of atrial fibrillation after ischaemic stroke in Glasgow (IMPROVE-AF): A quality improvement project

Author:

Johnston Fiona C1,Cameron Alan C2,Colquhoun Elizabeth2,Murdoch David L3,Dawson Jesse2,Abdul-Rahim Azmil H4

Affiliation:

1. Medical School, University of Glasgow, Glasgow, UK

2. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK

3. Cardiology Department, Queen Elizabeth University Hospital, Glasgow, UK

4. Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK

Abstract

Background: The use of cardiac monitoring to detect atrial fibrillation (AF) is routine after ischaemic stroke but is often delayed leaving patients at risk from undetected AF. We sought to improve the detection of AF by delivering early prolonged ‘in-house’ cardiac monitoring. Methods: We collected 3-months of data of people with stroke/transient ischaemic attack (TIA), but without AF, who underwent cardiac monitoring (Phase 1, pre-quality improvement project (QIP)). We then implemented an ‘in-house’ 7-day cardiac monitoring service for 12 months (Phase 2, during QIP). Results: We included 244 people in Phase 1 and 172 in Phase 2. In Phase 1, 232 (95%) people completed cardiac monitoring. Of these, new AF was detected in 10 (4%). Median time from stroke/TIA onset to availability of the monitoring report in Phase 1 was 50 (interquartile range (IQR): 24–123) days. In Phase 2, 166 (97%) of people completed 7-day cardiac monitoring, with new AF detected in 17 (10%). Median time from onset to availability of the report in Phase 2 was 12 (IQR: 9–15) days. In people with AF detected, ‘in-house’ monitoring reduced the time of stroke/TIA onset to anticoagulant commencement from 41 (Phase 1) to 14 (Phase 2) days. Discussion: The QIP has improved AF detection, reduced delays associated with conventional cardiac monitoring and prompted early initiation of oral anticoagulation.

Publisher

SAGE Publications

Subject

Education,General Medicine

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