Preventing Recurrent Cardioembolic Stroke
Research type
Research Study
Full title
Preventing Recurrent Cardioembolic Stroke – Right Approach, Right Patient (The PRECISE Study)
IRAS ID
299796
Contact name
Alan Cameron
Contact email
Sponsor organisation
NHS Greater Glasgow and Clyde
Duration of Study in the UK
2 years, 11 months, 28 days
Research summary
Summary of Research
Atrial fibrillation (AF) is a heart rhythm that increases the risk of blood clots and strokes. Heart rhythm monitors are worn for 1-3 days in people after an ischaemic stroke or transient ischaemic attack (TIA) to search for AF and anticoagulant drugs reduce the risk of a second stroke by two-thirds if AF is found. There are delays to these tests in many NHS settings since more tests are requested than cardiac departments can do and the vast majority of people tested (~96%) do not have AF. This means we are potentially doing a large number of unnecessary 3 day heart monitors in people who are very unlikely to have AF after stroke. In addition, new heart monitors that are worn for longer find more people with AF but are costly and are not needed for all people. A possible solution is to identify people who are unlikely to have AF and who do not need extensive testing. There are new techniques that may allow us to predict people who do not have AF without the need to do a 3 day heart monitor, including detailed analysis of standard heart traces (electrocardiograms / ECGs) and new blood tests. This approach could will reduce testing for many stroke survivors while allowing higher risk people to benefit from the newer, longer heart monitors.We will use clinical data, advanced ECG analysis and a new blood test called MRproANP to identify people who are unlikely to have AF on detailed testing with a 30 day heart rhythm monitoring after an ischaemic stroke or TIA.
Summary of Results
: BACKGROUND Atrial fibrillation (AF) is an irregular heartbeat that can cause blood clots and strokes. Anticoagulant medicines that stop blood clots can stop strokes in people who have AF.In the NHS, heart monitors are worn for 3 days after a stroke to identify people who have AF and will benefit from anticoagulant medicines to stop future strokes. Heart monitors that are worn for 28 days identify more people with AF but are not routinely available in the NHS.
The PRECISE study aimed to develop a way to identify people who have had a stroke and who are most likely to have AF and benefit from a 28 day heart monitor.
WHAT WE DID
677 people who had been admitted to one of five hospitals in Scotland with an ischaemic stroke or transient ischaemic attack (TIA) from 2021 to 2024 took part in the study.People who took part had an electrocardiogram (ECG), a heart blood test called MR-proANP and a 28 day heart monitor.
We developed a risk score using people’s clinical information, ECG and MR-proANP blood test to identify people who are most likely to have AF and benefit from a 28 day heart monitor.
WHAT WE FOUND
We detected AF in 97 people who took part in the study (14.3%). The risk score had excellent accuracy to identify people who are most likely to have AF.If the risk score was used in the NHS, it could reduce the number of people who need 28 day heart monitors by 46%. This would free resource to allow 28 day heart monitors to be used for people who are most likely to have AF and benefit.
HOW THE RESULTS WILL HELP
The results will help introduce longer heart monitors in the NHS to detect people after a stroke who have AF and will benefit from anticoagulant medicines to stop future strokes.FUNDING
The study was funded by a charity called Heart Research UK. Funding to support the study was also received from the Royal College of Physicians and Surgeons of Glasgow, the Mason Medical Research Trust, the University of Glasgow, NHS Greater Glasgow and Clyde and the RS Macdonald Charitable Trust.FURTHER RESEARCH
The results helped us to design a study called the OASIS study that is now running across seven hospitals in Scotland. The OASIS study assesses using heart blood tests to select people who have had a stroke for a 28 day heart monitor in the NHS. The OASIS study is funded by the Stroke Association.THANKS
We would like to thank everyone who took part in the study.REC name
West of Scotland REC 3
REC reference
21/WS/0064
Date of REC Opinion
15 Jul 2021
REC opinion
Further Information Favourable Opinion