Longer duration of electrocardiographic monitoring after cryptogenic stroke is associated with a greater detection of AF .
BACKGROUND Atrial fibrillation ( AF ) is a major cause of stroke .
Although st and ard investigations after an event include electrocardiographic monitoring , the optimal duration to detect AF is unclear .
We performed a systematic review and meta- analysis to determine whether the duration of electrocardiographic monitoring after an ischemic event is related to the detection of AF .
Cost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemia
Abstract Background and purpose Prolonged Holter monitoring of patients with cerebral ischemia increases the detection rate of paroxysmal atrial fibrillation ( PAF ) ; this leads to improved antithrombotic regimens aim ed at preventing recurrent ischemic strokes . The aim of this study was to compare a 7-day-Holter monitoring ( 7-d-Holter ) alone or in combination with prior selection via transthoracic echocardiography ( TTE ) to a st and ard 24-h-Holter using a cost-utility analysis . Methods Lifetime cost , quality -adjusted life years ( QALY ) , and incremental cost-effectiveness ratios ( ICER ) were estimated for a cohort of patients with acute cerebral ischemia and no contraindication to oral anticoagulation . A Markov model was developed to simulate the long-term course and progression of cerebral ischemia considering the different diagnostic algorithms ( 24-h-Holter , 7-d-Holter , 7-d-Holter after pre selection by TTE ) . Clinical data for these algorithms were derived from the prospect i ve observational Find-AF study ( IS RCT N 46104198 ) . Results Predicted lifelong discounted costs were 33,837 € for patients diagnosed by the 7-d-Holter and 33,852 € by the st and ard 24-h-Holter . Cumulated QALYs were 3.868 for the 7-d-Holter compared to 3.844 for the 24-h-Holter . The 7-d-Holter dominated the 24-h-Holter in the base-case scenario and remained cost-effective in extensive sensitivity analysis of key input parameter with a maximum of 8,354 € /QALY gained . Pre selecting patients for the 7-d-Holter had no positive effect on the cost-effectiveness . Conclusions A 7-d-Holter to detect PAF in patients with cerebral ischemia  is cost-effective . It increases the detection which leads to improved antithrombotic regimens ; therefore , it avoids recurrent strokes , saves future costs , and decreases quality of life impairment . Pre selecting patients by TTE does not improve cost-effectiveness
Longer duration of electrocardiographic monitoring after cryptogenic stroke is associated with a greater detection of AF .
BACKGROUND Atrial fibrillation ( AF ) is a major cause of stroke .
Although st and ard investigations after an event include electrocardiographic monitoring , the optimal duration to detect AF is unclear .
We performed a systematic review and meta- analysis to determine whether the duration of electrocardiographic monitoring after an ischemic event is related to the detection of AF .