Systematic monitoring for detection of atrial fibrillation in patients with acute ischaemic stroke (MonDAFIS): a randomised, open-label, multicentre study
RCT (n=3465 in German stroke units) found systematic centrally reviewed ECG monitoring increases detection rate in this population, if added to usual diagnostic care (5.8 vs. 4.0%; HR 1·4; 95% CI 1·0–2·0) but there was no effect on rate of oral anticoagulant use after 12 months.
Source:
The Lancet Neurology
SPS commentary:
For the primary outcome, at 12 months, 203 (13·7%) of 1484 patients in the intervention group versus 169 (11·8%) of 1436 in the control group were on oral anticoagulants (OR 1.2; 95% CI 0.9–1.5]; p=0·13), highlighting that further efforts are needed to improve secondary stroke prevention.
A commentary commends the investigators for including relevant clinical endpoints other than atrial fibrillation detection. It notes patients with stroke have a high risk of recurrent stroke, and anticoagulation in patients with AF can reduce this risk by two-thirds, making detection of atrial fibrillation worth pursuing. It adds that in the meantime, until atrial fibrillation can be detected, patients should be given advice about appropriate lifestyle changes and managed according to guidelines on medical therapy for hypertension, hyperlipidaemia, diabetes, patent foramen ovale, and cerebrovascular stenosis. It notes that prevention of the first stroke is crucial too and community-based AF screening has shown a considerable prevalence of undetected cases and might prove to be effective in some populations for primary prevention, but the benefit of anticoagulation for device-detected AF that is asymptomatic has yet to be confirmed.