International Telestroke: The First Five Cases.

Telestroke services can improve access to stroke thrombolysis. To address challenges of night time coverage we explored the feasibility of an international telestroke service between Scotland and New Zealand taking advantage of international time zone differences. After addressing medico-legal, governance, and technical issues we tested this international service model and here we present the first 5 cases. Based on our initial experience this new model of care appears feasible and has the potential to improve patient care through reduced doctor fatigue and improved access to expert care in regions where stroke specialist input is limited.

Atrial fibrillation case finding in over 65 s with cardiovascular risk factors - Results of initial Scottish clinical experience.

BACKGROUND: Atrial fibrillation (AF) is a major preventable risk factor for stroke and may be silent in elderly individuals who are at especially high risk. This paper describes the first phase of implementation of a clinical AF detection programme in a community setting. Objectives were (i) to determine the feasibility of using a handheld ECG recording system for AF detection among individuals aged 65 years or more, who have cardiovascular risk factors. (ii) to estimate the yield of previously undiagnosed atrial fibrillation cases, and the proportion of these who would be suitable for oral anticoagulation. METHODS: a handheld ECG monitor was placed in each of 23 primary care practices across Scotland. Eligible patients attending for annual health checks had ECGs recorded, and the ECGs were transmitted and interpreted by two senior cardiologists. ECG quality was rated, and an adjudication made on the rhythm. For patients confirmed with AF, stroke and bleeding risk were estimated using CHA2DS2-VASc and HAS-BLED scoring tools. RESULTS: single lead ECGs were recorded in 1805 patients (703 female and 1102 male), mean (SD) age 74.9 (7.1) years. Rhythm regularity could be assessed in 98.7% of ECGs recorded. 92 patients (5.1%) were found to have AF. Median [range]CHA2DS2-VASc score was 4 ([2-7) and median [range] HAS-BLED score was 2 (1-5). CONCLUSION: handheld ECG recording can be used to identify AF in the primary care setting, with minimal training. The yield was relatively high.