Influencing factors of AF detection in cryptogenic stroke: A survey among neurologists in China

Background and Purpose— Atrial fibrillation (AF) detection is a cornerstone of cardioembolic stroke prevention and is especially recommended in patients initially diagnosed cryptogenic stroke, but few data exist about the extent of AF detection. This study aimed to investigate influencing factors of AF detection for cryptogenic stroke patients from neurologists’ perspective. Methods— A questionnaire survey was conducted from October 2016 to March 2018 and included neurologists from 42 hospitals in China. Respondents’ demographic characteristics, AF-related knowledge and education, attitude to AF detection and daily AF detection practice were surveyed. Pearson chi-square tests and logistic regression were used to identify neurologists characteristics independently associated with AF detection. Results— 611 neurologists were surveyed in this study and 53.0% reported always detecting AF among cryptogenic stroke patients. The main obstacles of AF detection were insufficient knowledge, high expense and inactive attitude. Those who received continuing medical education (training program) about AF detection (OR=2.25, CI[1.57, 3.23], p<0.001), who had positive attitude (OR=3.25,CI [2.24, 4.71], p<0.001) and who acquired graduate degree (OR=2.48, CI[1.21, 5.07], p=0.013) were more likely to detect AF in cryptogenic stroke patients. Neurologists who had worked in neurology over 20 years (OR=3.59, CI[1.61, 8.05], p=0.002), and who received continuing medical education (OR=1.82, CI[1.21, 2.58], p=0.001) were more likely to have an positive attitude to AF detection. Conclusions— Our survey suggested inadequate AF detection among neurologists, and continuing medical education was associated with neurologists’ attitude and AF detection behavior. More continuing medical education is required to increase the effective detection of AF and improve the quality of clinical practice.