Improving detection and management of atrial fibrillation after ischaemic stroke in glasgow (improve-AF): A quality improvement project

Background and Aims: The use of prolonged cardiac monitoring is usually sub-optimal especially during the Covid pandemic, leaving people with recent ischaemic stroke/TIA at risk from undetected atrial fibrillation (AF). We sought to improve the detection of AF through a quality improvement project (QIP) to deliver early prolonged 'in-house' cardiac monitoring in our stroke unit. Methods:We collected 3 months data of consecutive people with acute stroke/TIA, but without AF, admitted to the local stroke unit, who underwent cardiac monitoring (Phase 1, pre-QIP). We then implemented a structured 'in-house' 7-day cardiac monitoring service using Novacor! R-test devices for 12 months (Phase 2, during QIP). We compared the performance data for both phases. Results:We included 244 people in Phase 1 and 121 in Phase 2. In Phase 1, 232(95%) people completed cardiac monitoring of variable durations. Of these, new AF was detected in 10 (4%). Median time from stroke/TIA onset to availability of formal monitoring report in Phase 1 was 50 (IQR:24-123) days. In Phase 2, 119(98%) people completed 7-day cardiac monitoring, with new AF detected in 13 (10%). Median time from onset to availability of formal report in Phase 2 was 11 (IQR:9-14) days. In people with new AF detected, the provision of 'in-house' monitoring reduced the time of stroke/TIA onset to oral anticoagulant commencement from 40 (Phase 1) to 14 days (Phase 2). Conclusions: The QIP has improved AF detection and reduced delays associated with conventional cardiac monitoring. It also prompted early initiation of oral anticoagulant. The change to 'in-house' cardiac monitoring is feasible.