Improving detection and management of atrial fibrillation after ischaemic stroke in Glasgow (IMPROVE-AF): a quality improvement project

Johnston, F. C., Cameron, A. C., Colquhoun, E., Murdoch, D. L., Dawson, J. and Abdul-Rahim, A. H. (2022) Improving detection and management of atrial fibrillation after ischaemic stroke in Glasgow (IMPROVE-AF): a quality improvement project. Journal of the Royal College of Physicians of Edinburgh, 52(3), pp. 213-219. (doi: 10.1177/14782715221120133) (PMID:36369810)

Abstract

Introduction: The use of cardiac monitoring to detect atrial fibrillation (AF) is routine after ischaemic stroke but is often delayed leaving patients at risk from undetected AF. We sought to improve the detection of AF by delivering early prolonged ‘in-house’ cardiac monitoring. Patients and methods: We collected 3-months of data of people with stroke/transient ischaemic attack (TIA), but without AF, who underwent cardiac monitoring (Phase 1, pre-quality improvement project (QIP)). We then implemented an ‘in-house’ 7-day cardiac monitoring service for 12 months (Phase 2, during QIP). Results: We included 244 people in Phase 1 and 172 in Phase 2. In Phase 1, 232 (95%) people completed cardiac monitoring. Of these, new AF was detected in 10 (4%). Median time from stroke/TIA onset to availability of the monitoring report in Phase 1 was 50 (interquartile range (IQR): 24–123) days. In Phase 2, 166 (97%) of people completed 7-day cardiac monitoring, with new AF detected in 17 (10%). Median time from onset to availability of the report in Phase 2 was 12 (IQR: 9–15) days. In people with AF detected, ‘in-house’ monitoring reduced the time of stroke/TIA onset to anticoagulant commencement from 41 (Phase 1) to 14 (Phase 2) days. Conclusions: The QIP has improved AF detection, reduced delays associated with conventional cardiac monitoring and prompted early initiation of oral anticoagulation.

• Item Type: Articles
• Additional Information: The QIP was funded by BMS-Pfizer Alliance: UK AF Stroke Reduction competitive grant 2019.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Abdul-Rahim, Dr Azmil and Murdoch, Dr David and Dawson, Professor Jesse and Cameron, Dr Alan and Colquhoun, Ms Elizabeth
• Authors: Johnston, F. C., Cameron, A. C., Colquhoun, E., Murdoch, D. L., Dawson, J., and Abdul-Rahim, A. H.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing; College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Journal Name: Journal of the Royal College of Physicians of Edinburgh
• Publisher: SAGE Publications
• ISSN: 1478-2715
• ISSN (Online): 2042-8189
• Published Online: 22 August 2022
• Copyright Holders: Copyright © 2022 The Royal College of Physicians of Edinburgh
• First Published: First published in Journal of the Royal College of Physicians of Edinburgh 52(3): 213-219
• Publisher Policy: Reproduced under a Creative Commons license