Utilisation of cardiac holter monitoring and echocardiography following acute ischemic stroke or transient ischemic attack

Abstract

BACKGROUND: The audit was conducted at Mater Dei Hospital in Malta, assessing the adherence to guidelines and the effectiveness of current practices. The audit aimed to evaluate the time interval between stroke events and outpatient cardiac holter monitoring and transthoracic echocardiography (TTE), as well as scrutinize the detection of subclinical atrial fibrillation (AF) in secondary stroke prevention, as per European Stroke Organisation (ESO) recommendations.

METHODOLOGY: Retrospective data was obtained from patient records, documenting the number of patients with an ordered outpatient cardiac holter and/or outpatient TTE following an ischaemic stroke or TIA.

RESULTS: The findings reveal that a significant number of patients are experiencing prolonged waiting times. Of the 63 scheduled holters, 71% of patients waited for over 200 days. This delay is concerning, especially considering the high contribution of AF to stroke-related morbidity and mortality. Of the 71 scheduled TTEs, 53.5% of patients waited over 100 days.

The audit discovered that, from the 54 performed outpatient cardiac holters, no patients were identified with previously undiagnosed AF during monitoring and from the 71 performed outpatient TTEs 1 identified new onset AF. This emphasizes the potential benefits of extended monitoring durations.

CONCLUSION: This audit highlights the necessity for enhanced strategies in outpatient cardiac monitoring and echocardiography following ischemic stroke or TIA. Implementing the provided recommendations can significantly enhance AF detection, mitigate the risk of recurrent strokes, and ultimately lead to improved patient outcomes.