Ischaemic stroke Circulatory System Stroke, not specified as haemorrhage or infarction
Conditions
Interventions
Control: standard care
Intervention: two additional 12-lead ECGs plus 3 - 7 days' continuous ECG event monitoring
Duration of intervention: 7 days
Duration of follow-up: 1 year direct
5 years electronic
Sponsors
NHS Greater Glasgow & Clyde (UK)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Diagnosis of acute ischaemic stroke or confirmed transient ischaemic attack, within one week of symptom onset (participants are of any age and sex) 2. Brain imaging completed prior to enrolment is consistent with acute ischaemic damage and has excluded an alternative cause for symptoms 3. Sinus rhythm on screening ECG 4. Consent to participate from patient or approved proxy
Exclusion criteria
Exclusion criteria: 1. Clinical decision or expressed refusal to consider long term anticoagulation at a future date if cardio-embolism may be diagnosed 2. Pre-morbid condition or concomitant disease that would render subsequent secondary prevention of stroke inappropriate 3. Documented atrial fibrillation in past 4. Known durable cardiac source of embolism (eg mitral stenosis) or left ventricular akinesia, that would represent an indication for anticoagulation 5. Existing treatment with long term anticoagulation 6. Unlikely to be available for completion of study procedures
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Absolute number of patients with AF or atrial flutter detected within two weeks of stroke. | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary outcomes: 1. Absolute number of patients with AF or atrial flutter detected within 90 days and one year of stroke 2. Absolute number of patients commenced on oral anticoagulation within two weeks and one year of stroke 3. Marginal cost of investigation 4. Marginal cost of treatment 5. Patient acceptability 6. Time to recognition of AF/flutter Tertiary outcomes: 1. Stroke recurrence within one year 2. Distribution of modified Rankin scale at one year (assessed centrally by recorded interview to ensure objectivity) 3. 'Home time' over 90 days - an objective measure of early functional outcome 4. EQ-5D quality of life at one year (in patients who can complete this, or by proxy) 5. Five-year survival (by flagging with ONS) 6. Predictors of AF amongst eligible patients 7. AF duration 'threshold' for use of anticoagulation | — |
Countries
United Kingdom
Outcome results
None listed