TY  - JOUR
A1  - Albers, Gregory W.
A1  - Bernstein, Richard A.
A1  - Brachmann, Johannes
A1  - Camm, John
A1  - Easton, Donald
A1  - Fromm, Peter
A1  - Goto, Shinya
A1  - Granger, Christopher B.
A1  - Hohnloser, Stefan H.
A1  - Hylek, Elaine
A1  - Jaffer, Amir K.
A1  - Krieger, Derk Wolfgang
A1  - Passman, Rod
A1  - Pines, Jesse M.
A1  - Reed, Shelby D.
A1  - Rothwell, Peter M.
A1  - Kowey, Peter R.
T1  - Heart rhythm monitoring strategies for cryptogenic stroke : 2015 diagnostics and monitoring stroke focus group report
T2  - Journal of the American Heart Association
N2  - Stroke is a major public health issue worldwide. The prevalence of stroke in 2010 was 33 million, with 16.9 million people having a first stroke.1 Stroke was the second‐leading cause of death behind heart disease globally, accounting for over 10% of total deaths worldwide.
Stroke is a heterogeneous condition that can be due to rupture of a blood vessel (hemorrhagic) or to blockage of a vessel (ischemic). About 85% of strokes are ischemic in origin and these are often classified by mechanism. This should be distinguished from risk factors such as hypertension, diabetes, smoking, etc. Risk factors increase the risk of stroke but do not necessarily explain the mechanism of a particular stroke. About 25% of ischemic strokes have a radiographic appearance similar to that seen in patients with cardioembolic sources (such as atrial fibrillation [AF], prosthetic valves, valvular prolapse, or mitral valve regurgitation), but no embolic source is found. These "cryptogenic strokes" (CS; also called embolic strokes of undetermined source) pose a particular clinical challenge in that the optimal antithrombotic therapy to reduce recurrence is uncertain. Since there are currently no data to support long‐term oral anticoagulation (OAC) in CS, but also no specific trials that have addressed this question, guidelines recommend antiplatelet therapy. Identification of AF in these patients changes the most likely mechanism to cardioembolism, and thus changes the recommended antithrombotic therapy to OAC, which is extremely effective in preventing stroke in patients with AF.
This report is based on discussions held at The Diagnostics and Monitoring Stroke Focus Group, a meeting held on January 15 to 17, 2015. The meeting focused on CS as a healthcare issue, and the utility of extended cardiac monitoring for AF in patients with strokes of unknown origin. The objectives of the meeting were to review existing information on the subject, define areas where knowledge was lacking or limited, and discuss study designs by which information gaps might be filled.
KW  - anticoagulants
KW  - atrial fibrillation
KW  - diagnosis
KW  - electrocardiography
KW  - insertable cardiac monitor
KW  - stroke prevention
Y1  - 2017
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/44267
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-442676
SN  - 2047-9980
N1  - Copyright & Usage: © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
VL  - 5
IS  - 3, e002944
SP  - 1
EP  - 11
PB  - American Heart Association
CY  - New York, NY
ER  -