New Data Reveals Link Between Total AF Burden and Stroke Risk


New data shows that an increase in the burden of AF is independently associated with a higher risk of ischemic stroke and arterial thromboembolism in patients who have not received anticoagulant medication.

Results from the KP-RHYTHM study, which utilized the iRhythm Technology’s Zio continuous cardiac monitoring system, were published this morning in JAMA Cardiology.

The research was led by Dr Alan Go, Chief, Cardiovascular and Metabolic Conditions Research at Kaiser Permanente. Zio’s extended continuous cardiac monitoring capabilities enabled measurement of True atrial fibrillation (AF) Burden.

The Zio system was used to provide a comprehensive picture of the burden of AF in patients. Combining this new data with electronic health record data, the researchers concluded that an increase in the burden of AF is independently associated with a higher risk of ischemic stroke and arterial thromboembolism in patients who have not received anticoagulant medication.

A retrospective cohort of 1,965 individuals provided the data for the Kaiser Permanente Real-World Heart Monitoring Strategy Evaluation Treatment Patterns and Health Metrics in Atrial Fibrillation (KP-RHYTHM) study. Patients at 2 large integrated health care delivery systems who underwent up to 14 days of continuous ambulatory electrocardiogram (ECG) monitoring using Zio and were found to have paroxysmal (intermittent) AF were included.

As detected and measured by the Zio platform, True AF burden gives physicians a complete understanding of the amount of time a patient’s heart spends in AF over the extended monitoring period, considering Zio’s longer wear time and ability to bridge AF episodes that might be separated by noise or artifact. Results of the study demonstrate that the total burden of AF was the key indicating factor for stroke risk, compared to longer individual AF episodes with smaller overall burden. The results demonstrate that an AF burden lasting more than 11% of the total time their heart rhythm was monitored was discovered to be linked with a 3-fold increase in stroke risk, independent of other known risk factors in those patients.

“There is an emerging recognition of the importance of AF burden as a potentially better measure of stroke risk, which is underscored by the recent AHA Scientific Statement ‘Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity’,” said Dr. Elsayed Z. Soliman [Professor and Director, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston Salem, NC].

Strokes associated with AF are likely to be more severe and are associated with higher mortality. By providing a more in-depth understanding of the link between burden of AF with risk of stroke, results from this study can have a direct impact on the clinical decision making required to prevent stroke, as it offers another stroke risk indicator that physicians can use to evaluate and share with their patients while discussing stroke prevention.

“Studies like the KP-RHYTHM Study demonstrate how advances in cardiac monitoring technology enhance our understanding of AF burden, which could help improve the current standards of care and improve patient outcomes,” Dr Soliman said.

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