Detecting atrial fibrillation in people who have had a stroke

Recent evidence from two randomised controlled trials suggest that longer term cardiac monitoring (over 30 days) can improve detection rates for paroxysmal atrial fibrillation after stroke. NICE's April edition of 'Eyes on Evidence' has published a summary of theese studies and current NICE guidance on atril fibrillation after stroke. You can register for their monthly newsletter at http://www.nice.org.uk/news/nice-newsletters-and-alerts NICE reports that these studies by Sanna et al (2014)and Gladstone et al (2014) clearly show that we need to look harder and look longer for underlying atrial fibrillation in patients presenting with stroke, before labelling someone as having ‘cryptogenic stroke’. The diagnosis of ‘cryptogenic stroke’ is really a diagnosis of exclusion, after very strenuous efforts to exclude atrial fibrillation. Many patients with paroxysmal atrial fibrillation are asymptomatic, and relying on symptoms alone is inadequate for diagnosis. Nurses involved in investigating for atrial fibrillation after stroke or TIA may wish to consider this evidence with their stroke teams, as it may impact on the type of monitoring used for AF detection.