The Scottish Health Technologies Group (SHTG) is a national health technology assessment (HTA) agency providing advice to NHSScotland on the use of new and existing health technologies (excluding medicines), likely to have a significant impact on healthcare. NHSScotland is required to consider SHTG advice.
In the second quarter of 2021, SHTG published only one assessment on detection of paroxysmal atrial fibrillation in patients with newly diagnosed ischaemic stroke.
The key research question was the most clinically and cost-effective strategy to detect paroxysmal atrial fibrillation (PAF) in patients with newly diagnosed ischaemic stroke who are selected to have prolonged electrocardiogram (ECG) monitoring. One of the additional questions was comparative clinical and cost-effectiveness of ambulatory ECG monitoring technologies (Holter, event recorder, patch technologies) in the detection of PAF in patients with newly diagnosed ischaemic stroke selected to have prolonged ECG monitoring.
It was stated that there is insufficient evidence to make clear conclusions on the comparative clinical and cost-effectiveness of ambulatory ECG monitoring technologies. Drawing conclusions is challenging as the technology in this area is rapidly evolving. For patch technologies, the existing evidence is inconclusive and requires validation in larger diagnostic studies. NICE medical technologies guidance states that patch technology Zio XT is recommended (with caveats) as an option for people with suspected cardiac arrhythmias who would benefit from ambulatory ECG monitoring for longer than 24 hours. Evidence from randomized controlled trials comparing electronic loop recorders (ELRs) and ambulatory Holters in people with cryptogenic stroke is insufficient to distinguish the relative clinical effectiveness of the different devices.
There is insufficient evidence to define the optimal duration of long-term monitoring. Advice from Canada (CADTH, 2016) recommended seven days of continuous ambulatory cardiac monitoring with either a Holter monitor or external loop recorder for patients who have been discharged from the hospital after a stroke or TIA and who did not undergo continuous cardiac monitoring while in hospital.
The National Planning atrial fibrillation group will consider this SHTG assessment to inform more consistent practice across health boards.
See the full details in English here.
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