Highlights
- •Holter monitoring diagnosed atrial fibrillation in 1.5% of the patients.
- •Holter monitoring findings effected treatment in 2.2% of the patients overall.
- •Mean duration to Holter initiation was more than 3 days.
- •Longer time to Holter initiation correlated with extended hospitalizations.
Abstract
Background
Holter electrocardiogram (ECG) monitoring is commonly used to reveal an underling
arrhythmia in stroke patients and can influence treatment and prognosis. While many
patients with stroke are admitted to the internal medicine department, evidence for
the role of Holter ECG in this setting is scarce.
Objective
determine the diagnostic value of Holter ECG monitoring for evaluation of stroke in
internal medicine department.
Methods
We included consecutive patients admitted to one of nine internal medicine departments
in a tertiary center between 2018 and 2021, who completed a 24-hour Holter ECG as
part of the evaluation of stroke. The primary outcome was a diagnostic Holter monitoring
with recording of a new atrial fibrillation or flutter, not evident in previous ECG.
Results
271 patients completed a Holter monitoring for the evaluation of stroke. Four patients
(1.5%) met the primary outcome, and anticoagulation treatment was initiated for all
of them. Accordingly, the number needed to change decision was 67. Two additional
patients (0.7%) had a non-diagnostic Holter finding which effected treatment plan.
Mean time from hospital admission to Holter was 3.01 ±3.44 days, and longer time to Holter initiation correlated with a longer hospital
stay duration (r (270) =0.692, p<0.001).
Conclusion
Conducting a routine Holter ECG monitorig for hospitalized patients with stroke in
the internal medicine department carry a negligible yield, and may result in an extended
hospitalization with possible harm.
Keywords
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Article info
Publication history
Published online: October 14, 2022
Accepted:
September 19,
2022
Received in revised form:
September 18,
2022
Received:
April 19,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106802
Copyright
© 2022 Elsevier Inc. All rights reserved.
