Clinical use of continuous electrocardiogram (cECG) for detecting atrial fibrillation (AF) after stroke is unclear. In a Danish nationwide cohort we described post-stroke time trends in outpatient cECG usage and atrial fibrillation incidences and characterized factors associated with cECG use.
Patients without AF discharged after their first ischemic stroke between 2010 and 2016 were identified from Danish nationwide registries. cECG included Holter or event recording within 120 days from discharge. Cumulative incidence analysis and multivariable adjusted logistic regression were used to assess time trends and factors associated with cECG usage and AF.
The study population comprised 39,641 patients. Cumulative use of cECG increased three-fold from 3.3% [95% confidence interval (CI) 2.8-3.8] in 2010 to 10.5% [95% CI 9.7-11.3] in 2016. Correspondingly, cumulative incidences of post-stroke AF increased from 1.9% [95% CI 1.5-2.3] to 2.8% [95% CI 2.4-3.2]. Of all cECG-evaluated 6.3% received an AF diagnosis vs. 2.2% of the unevaluated. Receiving cECG was associated with increased odds of AF [odds ratio 3.4 (95% CI 2.8-4.0)]. Lower age, milder strokes, and less comorbidity was associated with increased odds of receiving cECG. In contrast, risk factors for AF were increasing age and more comorbidity.
Post-stroke outpatient cECG use and AF incidences have increased over time, but screening rates were low. cECG use was associated with tripled odds of detecting AF. There was a disparity between factors associated with cECG use and risk factors of AF. This questions the appropriateness of the current clinical approach to post-stoke AF detection.

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