Extent of routine diagnostic cardiac work-up at certified German stroke units participating in the prospective MonDAFIS study
Abstract Background About 25% of all ischaemic strokes are related to cardio-embolism, most often due to atrial fibrillation (AF). Little is known about the extent and standardization of routine cardiac diagnostic work-up at certified stroke-units in Germany. Methods The MonDAFIS study included non-...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-06-01
|
| Series: | Neurological Research and Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42466-023-00246-8 |
| _version_ | 1827933100971130880 |
|---|---|
| author | Manuel C. Olma Serdar Tütüncü Ulrike Grittner Claudia Kunze Muhammad Jawad-Ul-Qamar Paulus Kirchhof Joachim Röther Götz Thomalla Roland Veltkamp Ulrich Laufs Darius G. Nabavi Peter U. Heuschmann Matthias Endres Karl Georg Haeusler |
| author_facet | Manuel C. Olma Serdar Tütüncü Ulrike Grittner Claudia Kunze Muhammad Jawad-Ul-Qamar Paulus Kirchhof Joachim Röther Götz Thomalla Roland Veltkamp Ulrich Laufs Darius G. Nabavi Peter U. Heuschmann Matthias Endres Karl Georg Haeusler |
| author_sort | Manuel C. Olma |
| collection | DOAJ |
| description | Abstract Background About 25% of all ischaemic strokes are related to cardio-embolism, most often due to atrial fibrillation (AF). Little is known about the extent and standardization of routine cardiac diagnostic work-up at certified stroke-units in Germany. Methods The MonDAFIS study included non-AF patients with acute ischaemic stroke or transient ischaemic attack (TIA) at 38 certified stroke-units in Germany. Here, we analysed routine diagnostic work-up and disregarded study-related Holter-ECG monitoring. We compared duration of stroke-unit stay, number of 24-h Holter-ECGs, and echocardiography performed between university-based comprehensive stroke centres (UCSC, 12 hospitals, 1606 patients), non university-based comprehensive stroke centres (nUCSC, 14 hospitals, 892 patients), and primary stroke centres at non-university hospitals (PCS, 12 hospitals, 933 patients) using multivariable mixed regression analyses. Detection of a first AF episode in-hospital was also compared between hospitals of different stroke-unit levels. Results In 3431 study patients (mean age 66.2 years, 39.5% female, median NIHSS = 2 on admission), median duration of the stroke-unit stay was 72 h (IQR 42–86). Stroke-unit stay was longer (categorised ≤ 24/ > 24- ≤ 72/ > 72 h) for patients with severe stroke (NIHSS score ≥ 5/ < 5: OR = 1.6, 95%CI 1.3–2.0) and for patients with ischaemic stroke vs. TIA (OR = 1.7, 95%CI 1.4–2.1). Overall, 2149/3396 (63.3%) patients underwent at least one additional 24-h Holter-ECG (median 1 [IQR 0–1], range 0–7). Holter-ECG rate was 47% in UCSC, 71% in nUCSC, and 84% in PCS. Compared to PCS, AF was less often detected in-hospital in UCSC (OR = 0.65, 95%CI 0.45–0.93) and nUCSC (OR = 0.69, 95%CI 0.46–1.04). Transoesophageal echocardiography (TEE) only was performed in 513/3391 (15.1%) study patients, transthoracic echocardiography (TTE) only in 1228/3391 (36.2%), and TEE combined with TTE in 1020/3391 (30.1%) patients. Patients younger than 60 years (vs. ≥ 60 years) underwent TEE more often than those older than 60 years (OR = 3.44, 95%CI 2.67–4.42). TEE (IQR 34–65%) and TTE rate (IQR 40–85%) varied substantially among study centres. Echocardiography rate (TTE and/or TEE) was 74.0% in UCSC, 85.4% in nUCSC, and 90.3% in PSC, respectively. Conclusions In the MonDAFIS study, the routine use of echocardiography and Holter-ECG monitoring varied in participating stroke centres and at stroke-unit level, if grouped according to stroke-unit certification grade and hospitals´ university status. Trial registration Clinical Trials, NCT02204267. Registered 30 July 2014, https://clinicaltrials.gov/ct2/show/NCT02204267 . |
| first_indexed | 2024-03-13T07:19:52Z |
| format | Article |
| id | doaj.art-2fb67f91b34542b08109e63fc29205bc |
| institution | Directory Open Access Journal |
| issn | 2524-3489 |
| language | English |
| last_indexed | 2024-03-13T07:19:52Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Neurological Research and Practice |
| spelling | doaj.art-2fb67f91b34542b08109e63fc29205bc2023-06-04T11:42:26ZengBMCNeurological Research and Practice2524-34892023-06-015111110.1186/s42466-023-00246-8Extent of routine diagnostic cardiac work-up at certified German stroke units participating in the prospective MonDAFIS studyManuel C. Olma0Serdar Tütüncü1Ulrike Grittner2Claudia Kunze3Muhammad Jawad-Ul-Qamar4Paulus Kirchhof5Joachim Röther6Götz Thomalla7Roland Veltkamp8Ulrich Laufs9Darius G. Nabavi10Peter U. Heuschmann11Matthias Endres12Karl Georg Haeusler13Center for Stroke Research Berlin, Charité - Universitätsmedizin BerlinCenter for Stroke Research Berlin, Charité - Universitätsmedizin BerlinInstitute for Biometry Und Clinical Epidemiology, Charité - Universitätsmedizin BerlinCenter for Stroke Research Berlin, Charité - Universitätsmedizin BerlinInstitute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of BirminghamInstitute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of BirminghamDepartment of Neurology, Asklepios Hospital AltonaDepartment of Neurology, University Medical Center Hamburg-EppendorfDepartment of Neurology, Alfried Krupp HospitalDepartment of Cardiology, University Hospital, Leipzig UniversityDepartment of Neurology, Vivantes Hospital NeuköllnInstitute of Clinical Epidemiology and Biometry, University WürzburgCenter for Stroke Research Berlin, Charité - Universitätsmedizin BerlinDepartment of Neurology, University Hospital WürzburgAbstract Background About 25% of all ischaemic strokes are related to cardio-embolism, most often due to atrial fibrillation (AF). Little is known about the extent and standardization of routine cardiac diagnostic work-up at certified stroke-units in Germany. Methods The MonDAFIS study included non-AF patients with acute ischaemic stroke or transient ischaemic attack (TIA) at 38 certified stroke-units in Germany. Here, we analysed routine diagnostic work-up and disregarded study-related Holter-ECG monitoring. We compared duration of stroke-unit stay, number of 24-h Holter-ECGs, and echocardiography performed between university-based comprehensive stroke centres (UCSC, 12 hospitals, 1606 patients), non university-based comprehensive stroke centres (nUCSC, 14 hospitals, 892 patients), and primary stroke centres at non-university hospitals (PCS, 12 hospitals, 933 patients) using multivariable mixed regression analyses. Detection of a first AF episode in-hospital was also compared between hospitals of different stroke-unit levels. Results In 3431 study patients (mean age 66.2 years, 39.5% female, median NIHSS = 2 on admission), median duration of the stroke-unit stay was 72 h (IQR 42–86). Stroke-unit stay was longer (categorised ≤ 24/ > 24- ≤ 72/ > 72 h) for patients with severe stroke (NIHSS score ≥ 5/ < 5: OR = 1.6, 95%CI 1.3–2.0) and for patients with ischaemic stroke vs. TIA (OR = 1.7, 95%CI 1.4–2.1). Overall, 2149/3396 (63.3%) patients underwent at least one additional 24-h Holter-ECG (median 1 [IQR 0–1], range 0–7). Holter-ECG rate was 47% in UCSC, 71% in nUCSC, and 84% in PCS. Compared to PCS, AF was less often detected in-hospital in UCSC (OR = 0.65, 95%CI 0.45–0.93) and nUCSC (OR = 0.69, 95%CI 0.46–1.04). Transoesophageal echocardiography (TEE) only was performed in 513/3391 (15.1%) study patients, transthoracic echocardiography (TTE) only in 1228/3391 (36.2%), and TEE combined with TTE in 1020/3391 (30.1%) patients. Patients younger than 60 years (vs. ≥ 60 years) underwent TEE more often than those older than 60 years (OR = 3.44, 95%CI 2.67–4.42). TEE (IQR 34–65%) and TTE rate (IQR 40–85%) varied substantially among study centres. Echocardiography rate (TTE and/or TEE) was 74.0% in UCSC, 85.4% in nUCSC, and 90.3% in PSC, respectively. Conclusions In the MonDAFIS study, the routine use of echocardiography and Holter-ECG monitoring varied in participating stroke centres and at stroke-unit level, if grouped according to stroke-unit certification grade and hospitals´ university status. Trial registration Clinical Trials, NCT02204267. Registered 30 July 2014, https://clinicaltrials.gov/ct2/show/NCT02204267 .https://doi.org/10.1186/s42466-023-00246-8Ischaemic strokeTransient ischaemic attack, atrial fibrillationStroke-unit monitoring, echocardiography, Holter-ECG |
| spellingShingle | Manuel C. Olma Serdar Tütüncü Ulrike Grittner Claudia Kunze Muhammad Jawad-Ul-Qamar Paulus Kirchhof Joachim Röther Götz Thomalla Roland Veltkamp Ulrich Laufs Darius G. Nabavi Peter U. Heuschmann Matthias Endres Karl Georg Haeusler Extent of routine diagnostic cardiac work-up at certified German stroke units participating in the prospective MonDAFIS study Neurological Research and Practice Ischaemic stroke Transient ischaemic attack, atrial fibrillation Stroke-unit monitoring, echocardiography, Holter-ECG |
| title | Extent of routine diagnostic cardiac work-up at certified German stroke units participating in the prospective MonDAFIS study |
| title_full | Extent of routine diagnostic cardiac work-up at certified German stroke units participating in the prospective MonDAFIS study |
| title_fullStr | Extent of routine diagnostic cardiac work-up at certified German stroke units participating in the prospective MonDAFIS study |
| title_full_unstemmed | Extent of routine diagnostic cardiac work-up at certified German stroke units participating in the prospective MonDAFIS study |
| title_short | Extent of routine diagnostic cardiac work-up at certified German stroke units participating in the prospective MonDAFIS study |
| title_sort | extent of routine diagnostic cardiac work up at certified german stroke units participating in the prospective mondafis study |
| topic | Ischaemic stroke Transient ischaemic attack, atrial fibrillation Stroke-unit monitoring, echocardiography, Holter-ECG |
| url | https://doi.org/10.1186/s42466-023-00246-8 |
| work_keys_str_mv | AT manuelcolma extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT serdartutuncu extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT ulrikegrittner extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT claudiakunze extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT muhammadjawadulqamar extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT pauluskirchhof extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT joachimrother extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT gotzthomalla extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT rolandveltkamp extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT ulrichlaufs extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT dariusgnabavi extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT peteruheuschmann extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT matthiasendres extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy AT karlgeorghaeusler extentofroutinediagnosticcardiacworkupatcertifiedgermanstrokeunitsparticipatingintheprospectivemondafisstudy |