-Original-

Improvement in Atrial Fibrillation Detection by Pulse Checking of Patients with Non-Cardioembolic Stroke in Rehabilitation Hospitals: The ESCORT Study

Takehiro Katano¹, Satoshi Suda², Tomohiro Ohta³, Mitsusuke Miyagami⁴, Yuzo Kodaira⁵, Chimori Konaka⁶, Masakazu Nagashima⁷ and Kazumi Kimura¹

¹Department of Neurology, Nippon Medical School Hospital, Tokyo, Japan
²Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Saitama, Japan
³Department of Internal Medicine, Araki Kinen Tokyo River Side Hospital, Tokyo, Japan
⁴Department of Rehabilitation and Neurosurgery, Takenozuka Nohsinkei Rehabilitation Hospital, Tokyo, Japan
⁵Department of Surgery, Flowers & Forest Tokyo Hospital, Tokyo, Japan
⁶Department of Rehabilitation, Akabane Rehabilitation Hospital, Tokyo, Japan
⁷Department of Orthopedics, Katsushika Rehabilitation Hospital, Tokyo, Japan

Background: Rehabilitation therapists are sometimes unaware of the possibility of undiagnosed atrial fibrillation (AF) and the importance of AF detection. Thus, we aimed to increase awareness among rehabilitation therapists of the importance of AF detection at rehabilitation hospitals during regular pulse checks of patients with ischemic stroke.
Methods: In this multicenter prospective observational study, we enrolled patients with noncardiac stroke. The therapists performed pulse checks before, during, and after rehabilitation during the inpatient period. Electrocardiography (ECG) was performed to check for AF when arrhythmia or tachycardia was detected. The characteristics, ECG data, laboratory data, complications such as stroke recurrence, and functional outcomes of the patients were investigated.
Results: Among 158 included patients (97 [61.4%] men, median age 77 [interquartile range {IQR}, 71-84] years), the median stay in stroke centers was 21 (IQR,15-31) days. Regarding medication administered upon admission, 94 (59.5%) patients received single antiplatelet therapy and 14 (8.9%) patients received no antithrombotic medication. Electrocardiography and blood testing were performed on admission in 112 (70.9%) and 136 (87.3%) patients, respectively. The median hospitalization period in the rehabilitation center was 179 (IQR, 90-272) days. Four patients (2.5%) experienced recurrent events. No patients developed AF or palpitations.
Conclusions: Although our results suggest increased awareness of AF detection in rehabilitation centers, AF was not detected. AF detection using pulse checks alone may be challenging; thus, further investigation is warranted.

J Nippon Med Sch 2024; 91: 527-533

Keywords
atrial fibrillation, cryptogenic stroke, rehabilitation hospital, pulse check, multicenter study

Correspondence to
Takehiro Katano, MD, PhD, Department of Neurology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
t-katano@nms.ac.jp

Received, June 25, 2024
Accepted, August 5, 2024