Cardiac monitoring after stroke in covid 19-time to move to wearables, and early experience with zio patches

Background and Aims: Atrial fibrillation (AF) is present in as many as 30% of cases of ischaemic stroke and early detection and anticoagulation reduces further stroke risk. COVID-19 presented new challenges in outpatient cardiac monitoring, preventing hospital re-attendances and lowering the risk of infection transmission. COVID funding provided access to Zio patches, and enabled comparison of current practice with these wearable devices. Methods: 580 patients admitted in 2019 were assessed to see if they had AF, and type and duration of cardiac monitoring used. Time taken from the tape being requested to the test being performed and anticoagulation started were calculated. 78 patients in late 2020 had a Zio patch fitted and a direct comparison made. Results: In 2019 29/580 patients (5%) had AF detected using 24hr, 48hr, 72hr, 7 day tapes and R tests. Average time from request to test was 38 days and request to anticoagulation 48 days. 78 patients had a Zio patch fitted for 14 days after admission. AF was detected in 11 patients (14%), and average 20.7 days from the monitor being fitted to the result being posted. Conclusions: Wearable technologies such as Zio patches show considerable promise in early post stroke AF detection. Monitoring starts within 24-48hrs, with a higher diagnostic yield as it occurs closer to the index stroke event. Patches are applied prior to hospital discharge, sent back to the cardiac team preventing further hospital attendance and rapid analysis and detection facilitates much earlier anticoagulation. The next step is a comprehensive business case to introduce into routine clinical practice.