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Stroke prevention - post operative atrial fibrillation

Heart Research Institute

Grant:
  • Early-Mid Career Fellowship
Organ System:
  • Cardiovascular
Date Funded:
  • 1 February, 2017
Chief Investigator/s:
  • Dr. Nicole Lowres

This screening and secondary prevention project could help reduce the burden of stroke worldwide by introducing a novel, scalable, cost-effective technology to screen for post-operative atrial fibrillation (POAF) following cardiac surgery discharge. This project could influence policy and AF management guidelines to include routine monitoring for POAF recurrence.

POAF occurs in 25-40 per cent of cardiac surgery patients, and is associated with increased mortality and stroke risk. POAF is thought to be transient and self-correcting, thus patients discharged in stable sinus rhythm are rarely followed up. POAF recurrence is often missed as it is largely asymptomatic or has non-specific symptoms. Additionally, patient knowledge of the extent of AF symptoms is poor despite inpatient education. In my systematic review (n=6 studies) active monitoring post-discharge identified POAF recurrence in 33 per cent of patients with transient in-hospital POAF, and late-onset POAF in ~4 per cent with no prior POAF. I have shown self-monitoring for POAF recurrence is feasible using a smartphone handheld ECG (iECG).

The outcomes from this study will assist development of a risk score to better identify patients at highest risk of devastating complications, such as stroke, allowing clinicians to better target effective preventative therapy. The project aims to:
1. Determine the incidence and predictors, and explore the prognostic significance of recurrent POAF and late-onset POAF
2. Determine if education using a ‘graphic app’ improves patient knowledge, particularly awareness of POAF symptoms
3. Determine scalability of self-monitoring using an iECG.