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Monitoring for atrial fibrillation in discharged stroke and transient ischemic attack patients. Recommendations

Author: Gino De Angelis; Canadian Agency for Drugs and Technologies in Health,
Publisher: Ottawa (ON) : Canadian Agency for Drugs and Technologies in Health, March 2016.
Series: CADTH optimal use report, v. 5, issue 2c.
Edition/Format:   eBook : Document : English
Summary:
An ischemic stroke is caused by thrombosis of the cerebral vessels or by emboli from a proximal arterial source or the heart. This blockage deprives the brain cells of vital oxygen and nutrients leading to cell death. A transient ischemic attack (TIA) is a neurological deficit lasting less than 24 hours, caused by cerebral ischemia. Atrial fibrillation (AF) is a type of cardiac arrhythmia, which causes pooling of  Read more...
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Details

Genre/Form: Practice Guideline
Material Type: Document, Internet resource
Document Type: Internet Resource, Computer File
All Authors / Contributors: Gino De Angelis; Canadian Agency for Drugs and Technologies in Health,
OCLC Number: 956966186
Notes: "Recommendations report."
Description: 1 online resource (1 PDF file (10 pages))
Series Title: CADTH optimal use report, v. 5, issue 2c.
Other Titles: Recommendations
Responsibility: Gino De Angelis, Karen Cimon, Alison Sinclair, Kelly Farrah, John Cairns, Adrian Baranchuk, Lauren E. Cipriano, A. Omar Akhtar, Laura Weeks, Tamara Rader, Sarah Garland.

Abstract:

An ischemic stroke is caused by thrombosis of the cerebral vessels or by emboli from a proximal arterial source or the heart. This blockage deprives the brain cells of vital oxygen and nutrients leading to cell death. A transient ischemic attack (TIA) is a neurological deficit lasting less than 24 hours, caused by cerebral ischemia. Atrial fibrillation (AF) is a type of cardiac arrhythmia, which causes pooling of blood that leads to thrombosis formation and may cause a stroke or TIA. Patients with AF but no history of stroke have a stroke risk of 4.5% per year; however, anticoagulation therapy, can reduce this risk to 1.4% per year. Often patients with AF will not have any symptoms, and therefore they are difficult to identify. Roughly 30% to 40% of first-time ischemic strokes are due to an unknown cause, and are referred to as an embolic stroke of undetermined source (ESUS). Patients who have experienced ESUS may have undiagnosed, or occult, AF. Determining whether they do have AF can be important to help prevent future strokes or TIAs. Long-term electrocardiography (ECG) monitoring using outpatient cardiac monitoring devices can identify occult AF that is undetectable by other means. To this end, outpatient cardiac monitoring devices providing increased mobility for patients and the ability to transmit data wirelessly have been developed, and allow for longer-term surveillance outside the hospital setting. These devices include ambulatory Holter monitors, external loop recorders (ELRs), mobile cardiac outpatient telemetry (MCOT) devices, and implantable loop recorders (ILRs). CADTH conducted a health technology assessment (HTA) on the clinical effectiveness and cost-effectiveness of cardiac monitoring devices in patients discharged from hospital following a stroke or TIA, to help inform decisions about these devices. Patient perspectives and experiences regarding the value and impact of outpatient AF cardiac monitoring devices were also considered.

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