Patient-reported feasibility of chest and thumb ECG after cryptogenic stroke in Sweden: an observational study

OBJECTIVES: The aim of this study was to assess the feasibility, based on a questionnaire, of the chest and thumb ECG system Coala Heart Monitor in patients who recently had a stroke. DESIGN: Observational study. SETTING: Two stroke units, Region Gävleborg, Sweden. PARTICIPANTS AND INTERVENTIONS: This study, Transient ECG Assessment in Stroke Evaluation (TEASE), included patients who had a stroke between 2017 and 2019. Patients eligible for anticoagulation in the presence of atrial fibrillation were scheduled for 28 days monitoring. PRIMARY AND SECONDARY OUTCOME MEASURES: The questionnaire regarding feasibility of monitoring included seven questions, using a 100 mm Visual Analogue Scale which covered overall satisfaction, technical feasibility, remember to monitor, physical application, feeling of security, help from others and recommendation to others. A lower score indicated better outcome. RESULTS: The prespecified number of 100 patients underwent the monitoring and 83 out of the 97 alive patients returned the questionnaire (response rate 85.6%). The median age was 69.5 years, mean CHA(2)DS(2)-VASc score was 4.4±1.3 points and 59.0% were men (n=49). The median time from index stroke to start of monitoring was 7.0 days. Patients performed on average 90.1%±15.0% of scheduled ECG-transmissions. In all seven questions, the median score ranged from 4 to 8. The vast majority reported acceptable outcomes, that is, the 95th percentile ranged from 30 to 54. There was no significant difference between men and women with regard to any of the seven questions (p values ranging from 0.117 to 0.849). Two of the seven outcome scores correlated significantly to patient age (Spearman’s r=−0.238 and r=−0.308, and p values 0.031 and 0.005 for ‘overall satisfaction’ and ‘remember to monitor’, respectively). CONCLUSION: In stroke survivors, chest and thumb ECG two times per day over a period of 4 weeks is feasible from a patient’s perspective. The Coala Heart Monitor provides a valuable and convenient tool for monitoring after stroke. TRIAL REGISTRATION NUMBER: NCT03301662.