In a report published in Frontiers in Neurology, researchers presented their Screening for Atrial Fibrillation scale (SAFE), “a novel and simple strategy for selecting ischemic stroke patients at higher risk of having atrial fibrillation (AF) who can benefit from a more thorough etiological evaluation,” according to the lead author, Laura Amaya Pascasio.
The study enrolled a total of 460 consecutive patients with ischemic stroke without documented AF. All patients had clinical, laboratory, and brain/cardiac imaging measures collected. The participants also underwent at least 72 hours of cardiac monitoring via transthoracic echocardiogram, blood biomarkers, and intracranial vessels imaging—except in cases where AF was already diagnosed. The research group used logistic regression with these measures to develop the SAFE predictive tool.
Atrial Fibrillation Prediction Components
In the article, the authors explained the seven items used to derive a score ranging from zero to 10: age ≥ 65 years (2 points); history of chronic obstructive pulmonary disease or obstructive sleep apnea (1 point); thyroid disease (1 point); NT-proBNP ≥ 250 pg/ml (2 points); left atrial enlargement (2 points); cortical topography of stroke, including hemispheric or cerebellar cortex (1 point); and intracranial large vessel occlusion (1 point). A score of five identified cases of paroxysmal AF with a sensitivity of 83% and a specificity of 80%, the authors wrote.
The report noted that the study was limited by its retrospective nature, possible patient selection bias due to monocentric recruitment, lack of prolonged monitoring for all patients, and heterogenous etiological approaches—though these were selected at the discretion of the neurologist in charge.
In their conclusion, the authors supported the value of the novel SAFE tool; however, they acknowledge that “external validation of SAFE in a multicenter study, with a larger number of patients, is warranted.”
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