Holter ECG monitoring for the evaluation of stroke in the internal medicine department

Background: Holter electrocardiogram (ECG) monitoring is commonly used to reveal an underling arrhythmia in stroke patients and can influence treatment and prognosis. While many patients with stroke are admitted to the internal medicine department, evidence for the role of Holter ECG in this setting is scarce. Objective: determine the diagnostic value of Holter ECG monitoring for evaluation of stroke in internal medicine department. Methods: We included consecutive patients admitted to one of nine internal medicine departments in a tertiary center between 2018 and 2021, who completed a 24-hour Holter ECG as part of the evaluation of stroke. The primary outcome was a diagnostic Holter monitoring with recording of a new atrial fibrillation or flutter, not evident in previous ECG. Results: 271 patients completed a Holter monitoring for the evaluation of stroke. Four patients (1.5%) met the primary outcome, and anticoagulation treatment was initiated for all of them. Accordingly, the number needed to change decision was 67. Two additional patients (0.7%) had a non-diagnostic Holter finding which effected treatment plan. Mean time from hospital admission to Holter was 3.01 ±3.44 days, and longer time to Holter initiation correlated with a longer hospital stay duration (r (270) =0.692, p<0.001). Conclusion: Conducting a routine Holter ECG monitorig for hospitalized patients with stroke in the internal medicine department carry a negligible yield, and may result in an extended hospitalization with possible harm.