In-patient cardiac monitoring following a stroke or transient ischemic attack (TIA) captures only a fraction of occult atrial fibrillation (AF) cases, and substantial evidence suggests that the detection rate increases with prolonged monitoring time. To inform decision-makers about the appropriate use of outpatient cardiac monitoring devices in patients who have experienced a stroke or TIA, CADTH conducted a health technology assessment (HTA) on the clinical effectiveness and cost-effectiveness of cardiac monitoring devices in outpatient stroke or TIA patients. Patient perspectives and experiences regarding the value and impact of outpatient AF cardiac monitoring devices were also considered.

Contents

• Reviewers
• Authorship
• Acknowledgements
• Conflicts of Interest
• Abbreviations
• Executive Summary
• 1. Introduction
  • 1.1 Ambulatory Holter Monitors
  • 1.2 External Loop Recorders
  • 1.3 Implantable Loop Recorders
  • 1.4 Mobile Cardiac Outpatient Telemetry
• 2. Objectives
  • 2.1 Research Questions
  • 2.2 Supplementary Questions
• 3. Clinical Review
  • 3.1 Methods
  • 3.2 Results
  • 3.3 Summary of Results
• 4. Economic Evaluation
  • 4.1 Methods
  • 4.2 Results
  • 4.3 Summary of Results
• 5. Patient Preferences and Experience Review
  • 5.1 Methods
  • 5.2 Results
  • 5.3 Summary of Results
• 6. Supplementary Questions
  • 6.1 Methods
  • 6.2 Results
• 7. Discussion
  • 7.1 Generalizability of Findings
  • 7.2 Limitations
  • 7.3 Directions for Future Research
• 8. Conclusions
• References
• Appendix 1 Analytical Framework
• Appendix 2 Literature Search Strategy — Clinical Review
• Appendix 3 Full Text Screening Checklist — Clinical Review
• Appendix 4 Data Abstraction Form — Clinical Review
• Appendix 5 Study Selection Flow Diagram — Clinical Review
• Appendix 6 Study and Patient Characteristics — Clinical Review
• Appendix 7 Detailed Outcome Data — Clinical Review
• Appendix 8 Critical Appraisal — Clinical Review
• Appendix 9 List of Studies Excluded and the Reasons for Exclusion — Clinical Review
• Appendix 10 Literature Search Strategy — Patient Preferences Review
• Appendix 11 Data Extraction Form — Patient Preferences Review
• Appendix 12 Study Selection Flow Diagram — Patient Preferences Review
• Appendix 13 Characteristics of Included Studies — Patient Preferences Review
• Appendix 14 Characteristics of Study Participants — Patient Preferences Review
• Appendix 15 Quality Assessment of Included Studies — Patient Preferences Review
• Appendix 16 Descriptive Themes and Associated Categories

About CADTH: CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs, medical devices, diagnostics, and procedures in our health care system.

Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec. Views: The views expressed herein are those of CADTH and do not necessarily reflect the views of our funders.

Suggested citation:

Monitoring for Atrial Fibrillation in Discharged Stroke and Transient Ischemic Attack Patients: A Clinical and Cost-Effectiveness Analysis and Review of Patient Preferences. Ottawa: CADTH; 2016 Mar. (CADTH optimal use report; vol.5, no.2b).

This report is prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). This report contains a comprehensive review of existing public literature, studies, materials, and other information and documentation (collectively the “source documentation”) available to CADTH at the time it was prepared, and it was guided by expert input and advice throughout its preparation.

The information in this report is intended to help health care decision-makers, patients, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. The information in this report should not be used as a substitute for the application of clinical judgment in respect to the care of a particular patient or other professional judgment in any decision-making process, nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of this report to ensure that its contents are accurate, complete, and up-to-date, CADTH does not make any guarantee to that effect. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or as a result of the use (or misuse) of any information contained in or implied by the information in this report.

CADTH takes sole responsibility for the final form and content of this report. The statements, conclusions, and views expressed herein do not necessarily represent the view of Health Canada or any provincial or territorial government.

Production of this report is made possible through a financial contribution from Health Canada.

PROSPERO Registration Number: CRD42015025934