ArticleJournal of stroke2020
Nurse Led Smartphone Electrographic Monitoring for Atrial Fibrillation after Ischemic Stroke: SPOT-AF.
Article in Journal of stroke, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.
- Does a nurse-led interventional program improve clinical outcomes in patients with atrial fibrillation? A meta-analysis.BMC cardiovascular disorders · 2024Pooled it
- Effectiveness of Nurse-Led atrial Fibrillation Detection for Patients With Embolic Stroke of Unknown Source in Stroke Units: A Retrospective Study.Nursing in critical care · 2026Article
- An efficient approach for detecting atrial fibrillation in ischemic stroke patients using a wearable device: a prospective multicenter substudy of the STABLED trial.Frontiers in neurology · 2025Article
- Searching for atrial fibrillation post stroke: is it time for digital devices?Frontiers in cardiovascular medicine · 2023Review
- ESC Working Group on e-Cardiology Position Paper: accuracy and reliability of electrocardiogram monitoring in the detection of atrial fibrillation in cryptogenic stroke patientsEuropean heart journal. Digital health · 2022Review
- How to use digital devices to detect and manage arrhythmias: an EHRA practical guide.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2022Article
- Cost-Effectiveness of Monitoring Patients Post-Stroke With Mobile ECG During the Hospital Stay.Journal of the American Heart Association · 2022Article
- 2021 Asia Pacific Heart Rhythm Society (APHRS) practice guidance on atrial fibrillation screening.Journal of arrhythmia · 2022Article
- Clinical Implications of Atrial Fibrillation Detection Using Wearable Devices in Patients With Cryptogenic Stroke (CANDLE-AF) Trial: Design and Rationale.Frontiers in cardiovascular medicine · 2022Article
- Cryptogenic Stroke and Embolic Stroke of Undetermined Source: Risk Factors and Approaches for Detection of Atrial Fibrillation.Current cardiology reviews · 2022Review
- Searching for atrial fibrillation post-stroke with prolonged monitoring: Do it early, but should we be looking for something else?International journal of cardiology. Heart & vasculature · 2021Article
Corrections and comments
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Authors and funding
13 authors at 8 institutions in 2 countries.
Funding
Abstract
background and purposeParoxysmal atrial fibrillation (PAF) underlying acute stroke frequently evades detection by standard practice, considered to be a combination of routine electrocardiogram (ECG) monitoring, and 24-hour Holter recordings. We hypothesized that nurse-led in-hospital intermittent monitoring approach would increase PAF detection rate.
methodsWe recruited patients hospitalised for stroke/transient ischemic attack, without history of atrial fibrillation (AF), in a prospective multi-centre observational study. Patients were monitored using a smartphone-enabled handheld ECG (iECG) during routine nursing observations, and underwent 24-hour Holter monitoring according to local practice. The primary outcome was comparison of AF detection by nurse-led iECG versus Holter monitoring in patients who received both tests: secondary outcome was oral anticoagulant commencement at 3-month following PAF detection.
resultsOne thousand and seventy-nine patients underwent iECG monitoring: 294 had iECG and Holter monitoring. AF was detected in 25/294 (8.5%) by iECG, and 8/294 (2.8%) by 24-hour Holter recordings (P<0.001). Median duration from stroke onset to AF detection for iECG was 3 days (interquartile range [IQR], 2 to 6) compared with 7 days (IQR, 6 to 10) for Holter recordings (P=0.02). Of 25 patients with AF detected by iECG, 11 were commenced on oral anticoagulant, compared to 5/8 for Holter. AF was detected in 8.8% (69/785 patients) who underwent iECG recordings only (P=0.8 vs. those who had both iECG and 24-hour Holter).
conclusionsNurse-led in-hospital iECG surveillance after stroke is feasible and effective and detects more PAF earlier and more frequently than routine 24-hour Holter recordings. Screening with iECG could be incorporated into routine post-stroke nursing observations to increase diagnosis of PAF, and facilitate institution of guideline-recommended anticoagulation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.