Evaluating 48-hour ambulatory ECG monitoring effectiveness for atrial fibrillation detection against NICE's 72-hour recommendation – a service evaluation

This service evaluation assesses the effectiveness of a 48-hour ambulatory electrocardiography (AECG) monitoring protocol implemented at NWAFT for the detection of atrial fibrillation (AF) and paroxysmal atrial fibrillation (PAF). By challenging the current National Institute for Health and Care Excellence (NICE) recommendations of 72-hour monitoring, this study explores the potential for a more personalised approach to AECG, aimed at improving both diagnostic efficiency and patient outcomes. Prior to 2022, no standardized duration for AECG monitoring was established for AF/PAF detection within the stroke pathway at NWAFT. In 2022, a 48-hour monitoring protocol was introduced.

Data were collected from Spacelabs software, spanning the years 2020 and 2022, and comprising 3047 participants. The dataset included demographic information such as gender, age, referral reason (cardiology vs. stroke), and ECG monitoring duration. Statistical analyses were conducted to identify predictors for AF/PAF detection. In 2020, results indicated that all variables, except for the referral indication, were statistically significant (p < 0.05). In contrast, by 2022, only age and referral indication remained significant predictors of AF/PAF detection.

Both 2020 and 2022 data demonstrated that AF/PAF was predominantly detected within the first 24 hours of AECG monitoring, suggesting that 48 hours is sufficient for accurate detection, with no need for extending the monitoring duration. However, further analysis revealed a significant gender-based difference, with males presenting with AF/PAF more frequently than females (41 vs. 7 in 2020, respectively), despite a higher number of female participants. Additionally, females were more likely to have AF/PAF detected over longer monitoring periods.

These findings suggest that AECG monitoring durations could be tailored based on gender, considering the observed differences in AF/PAF prevalence and prognosis, particularly in relation to stroke outcomes. Future evaluations are needed to further investigate gender-specific trends and assess the broader prevalence of AF/PAF for refining the monitoring protocol.