Samir Saba
Stroke is a major cause of disability and the second leading cause of death in adults. Some strokes are linked to atrial fibrillation (AF), a type of irregular heartbeat. When AF is found, doctors usually prescribe blood-thinning medicines to help prevent another stroke. If AF is not found, patients are usually treated with antiplatelet medicines, such as aspirin. However, AF can be difficult to detect. Because of this, doctors may not know which treatment is best. Our research team has developed computer programs that analyze a normal electrocardiogram (EKG) and predict whether a person may develop AF in the future. These programs have been shown to be highly accurate. The goal of this study is to see how sharing these prediction results affects treatment decisions made by patients who have had an embolic stroke of undetermined source (ESUS) and their neurologist. An ESUS is a type of stroke where the exact cause cannot be identified. Participants in the study will have their normal EKG analyzed using the prediction program. Researchers will then evaluate whether providing these results to the neurologist influences decisions about the patient's care.
Patients presenting to outpatient or inpatient stroke services or to the inpatient cardiac procedure unit for implantation of implantable cardiac monitor at the hospitals of UPMC and who have suffered an ischemic stroke without overt clinical etiology will be considered for participation in this clinical trial. The research coordinator for the trial will screen the inpatient services and outpatient clinics and will verify that any prospective subject meets all the inclusion and none of the exclusion criteria. Once this information is ascertained, the investigator, research coordinator, or both…
Inclusion Criteria: * Patient presenting with embolic stroke of unclear source. * Age at least 18 years. * Patients will be enrolled within 30 days of stroke. Exclusion Criteria: * Prior history of AF * Stroke can be attributed to cancer, hypercoagulable state, or large artery non-stenotic plaque * Contraindication to OAC or antiplatelet therapy, including the presence of hemorrhagic stroke * Patient is already on OAC * Patient had prior procedure or surgery to exclude or excise the left atrial appendage * Patient unable or unwilling to provide written informed consent to participate in res…
Enrolled patients' baseline normal EKG will be analyzed using the UPMC AF Prediction Model and their risk category for developing AF will be determined. The results, which are classified into low, intermediate, and high risk, will be presented to the stroke team. The stroke specialists will then share these risk prediction data with their patient for shared decision-making regarding anticoagulation strategy (OAC vs. Aspirin). Patients will be followed up for 90 days for clinical events. Follow-up at 30 and 90 days will consist of phone calls and review of electronic health records. The rate of use of OAC will be assessed at 30 and 90 days in each AF risk category.
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