Using insertable cardiac monitors (ICMs) to identify atrial fibrillation (AF) in a population at high risk for stroke guides both immediate and long-term patient management.
The findings were from an analysis of REVEAL-AF, and were published in the American Journal of Cardiology. Atul Verma (Southlake Regional Health Centre, Ontario, Canada) et al found that detecting AF with the devices brought about changes in patient management.
REVEAL AF was a prospective, single-arm, open-label, multicentre clinical study. It found a high incidence of previously undetected AF using ICMs in patients with risk factors for AF and stroke. The investigators concluded that these high-risk patients would not be detected using conventional IM strategies and that they therefore may not be optimally managed for stroke prevention.
Verma et al aimed to determine in their analysis whether ICM monitoring led to changes in clinical management following AF detection.
Participants were those who had CHADS2 score ≥3—or who had CHADS2 score 2 with ≥one additional AF risk factor—but no history of AF. They received an ICM and were followed for 18–30 months. Changes in clinical management in response to AF detection were recorded at follow-up visits, both scheduled (every six months) and unscheduled. Changes in clinical management included oral anticoagulation (OAC), rhythm or rate control pharmacotherapy, cardioversion, ablation, and cardiac sub-specialist referral.
Of the 387 participants who met the inclusion criteria and who received an ICM, 115 were found to have AF. In 87 (76%) of these patients a change in clinical management was made; in 80 this occurred at the first visit following AF detection, and 31 patients (27%) with AF had ≥two visits at which changes in clinical management were made.
The most common change was initiation of an oral anticoagulant (OAC) (n=73, 63% of patients with AF). Those whose change in clinical management occurred at the first visit after AF detection tended to have longer episodes of AF and a higher maximal daily AF burden compared to AF patients for whom no change was taken (longest episode: 52 minutes vs. 28 minutes; maximal daily AF burden:112 minutes vs. 23 minutes, respectively). Changes in management more frequently occurred at visits where patients reported AF-compatible symptoms (65% vs. 46% of visits, p=0.01).
Verma et al conclude that ICMs can be used to influence decisions on optimal patient care both immediately and on a longer-term basis.