Title: The feasibility and cost benefits of cardiac event recorders in stroke and TIA patients
Funder: Department of Health (England)

Abstract: Background Stroke and Transient Ischaemic Attack (TIA) are very common clinical conditions and account for over 67,000 deaths per year in the UK. In addition, 300,000 people are living with moderate or severe disabilities due to the effects of stroke. One of the major underlying diseases associated with stroke is atrial fibrillation (AF), yet standard investigations (such as ECG and Holter monitor) performed post-cardiac event can often fail to identify AF, leading to mistreatment and increased mortality rates. If AF is diagnosed and appropriate treatment is administered early, the risk of further stroke is reduced by 50%. Aims The study aims to explore the potential benefits of a new cardiac event recorder (Merlin), a device which looks and feels like a wristwatch but can record ECG. If the patient is suffering from symptoms of suggestive AF (eg. palpitations), then a hand placed over the device will record the ECG for a pre-determined period of time. This information can subsequently be downloaded to a computer and analysed. This study plans to compare the number of cases of AF found using the Merlin device with those identified using standard investigations, and to postulate the cost and benefits of early AF diagnosis - patients will also wear an automatic cardiac event recorder, in many ways the potential ‘gold standard’ for detection of cardiac rhythm abnormalities. Plan of Investigation Over a three-year period the study will recruit hospital assessed patients who have suffered an ischaemic stroke or TIA. All patients will undergo simultaneous Holter monitor, Merlin event recorder and automatic event recorder. The number of cases of AF detected in the three groups will be compared, and in collaboration with a health economist at the University of East Anglia (UEA), it will be possible to analyse the cost benefits. Secondary investigations would include the feasibility of use for the patient and the technical reliability of the device. We would plan to involve Professor J Potter in this project (he started as Professor in Medicine for elderly in October 2006). Other links would include to medical statistics at UEA. Potential Impact Stroke and TIA are a major cause of NHS admissions and AF is a primary risk factor for further events. Detection of this condition may lead to improved treatments (for example anticoagulation with warfarin). The associated reduction in future stroke risk will be of clear benefit to the individual, for whom a stroke could be devastating. Lower admission rates, less investigations and lower usage of long term care because of disability would be the potential health service benefits. The potential resource savings to the NHS are great if implemented on a wide scale. It is therefore necessary to investigate the potential benefit and cost-effectiveness of the Merlin event recorder, and automatic cardiac event recorder in a clinical setting. This is in many ways classical translational research.


Research activity codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: STROKE;CARDIOVASCULAR