Title : The Effects of atrial fibrillation detection by nurses in a stroke unit on patients with suspected cardioembolic stroke on admission
Abstract:
Introduction Detecting atrial fibrillation (AF) is crucial for understanding stroke mechanisms and preventing secondary strokes. A key role of nurses in acute stroke units (ASU) is to monitor electrocardiographic rhythms. This study aims to evaluate the effectiveness of nurses' detection of AF in a stroke unit and its influence on the occurrence of subsequent cerebral infarctions.
Method Acute ischemic stroke patients admitted to ASU and diagnosed as embolic stroke of undetermined source (ESUS) was enrolled. Cardiac workups including cardiac rhythm monitoring during admission to the ASU was performed. Factors associated with detection of AF detection and AF detection by nurse in the ASU were investigated. Working years in neurology, detected dates and shifts were considered as nurse’s factors.
Result Among 235 patients initially classified as ESUS, 114 (48.5%) were found to have AF. Hypertension (OR 1.913, 95% CI 1.049-3.489), admission heart rate (OR 1.016, 95% CI 0.999-1.034), and NIHSS score (OR 1.069, 95% CI 1.016-1.124) were significantly associated with AF detection. Nurses at the ASU identified 24 cases (10.2%) with suspicious AF, of which 13 (54.2%) were confirmed. Among patients ultimately diagnosed with AF, higher Troponin I levels were more likely associated with nurse detection (p=.005). Screening indicators such as premature atrial contraction (92.9% vs. 0.0%) and short runs of atrial tachycardia (28.6% vs. 8.0%, p=0.031) on holter monitoring were significantly more prevalent in the nurse-detected group. Of the 112 nurses in the ASU, those with 10+ years of experience detected the highest rate of cardiac abnormalities (48.9%, p=0.006), with 83.3% confirmed as AF (p=.044). Nurse-detected AF cases had shorter stays (7.38 vs. 10.12 days, p=.030), lower uncompensated costs ($217.40 vs. $462.60, p=.001), and avoided invasive tests like loop recorders.
Conclusion Nurse detection of AF led to shorter hospital stays, reduced costs, and minimized invasive testing. Experience in neurology improved AF detection rates. ECG monitoring by nurses in stroke units is crucial for patient care and should be supported by specialized training.
