Extended ambulatory ECG monitoring after stroke/TIA had a median 18-day delay to report availability, during which 3 patients experienced recurrent events before anticoagulation initiation.
Observational (n=1,641)
Significant delays in aECG report availability after stroke/TIA create a prolonged high-risk period for recurrent cerebrovascular events before anticoagulation can be initiated.
Abstract Background and aims Extended ambulatory ECG (aECG) monitoring improves detection of atrial fibrillation/flutter (AF/AFl) after ischemic stroke or transient ischemic attack (TIA), enabling targeted secondary prevention. However, delays between AF/AFl detection and anticoagulation initiation may expose patients to avoidable recurrent events. We aimed to quantify delays across the aECG pathway and assess their potential clinical impact. Methods We retrospectively analysed consecutive patients undergoing 14-day patch-based aECG monitoring after ischemic stroke or TIA between February 2024 and May 2025. Patients with known AF, incomplete records, age 18 years, or death during monitoring were excluded. In patients with newly detected AF/AFl, median time intervals from device fitting to report availability and from report availability to physician action (initiation or recommendation of anticoagulation) were calculated. AF/AFl detection timing was classified as early (days 1–7) or late (days 8–14). Recurrent stroke/TIA events occurring prior to anticoagulation were recorded. Results Among 1,641 monitored patients, AF/AFl was identified in 69 (4.2%; median age 79 years; 57% female). Median time from device fitting to report availability was 18 days (IQR 17–19), compared with 3 days (IQR 1–11) from report availability to physician action. AF/AFl was detected early in 41 patients (59%) and late in 28 (41%). Three patients experienced recurrent stroke/TIA before anticoagulation initiation. Conclusions The principal delay occurred prior to report availability, creating a prolonged high-risk period before secondary prevention. Real-time AF/AFl alerts and streamlined review pathways may shorten time to anticoagulation and reduce recurrent cerebrovascular events. Conflict of interest Dipraj Limbu: nothing to disclose; Radim Licenik: nothing to disclose; Amrit Gurung: nothing to disclose Figure 1 - belongs to Methods Figure 2 - belongs to Results
Limbu et al. (2026) conducted an observational in Ischemic stroke or transient ischemic attack (TIA) (n=1,641). 14-day patch-based extended ambulatory ECG (aECG) monitoring was evaluated on Time intervals from device fitting to report availability and from report availability to physician action. Extended ambulatory ECG monitoring after stroke/TIA had a median 18-day delay to report availability, during which 3 patients experienced recurrent events before anticoagulation initiation.