To evaluate trends in the utilization of continuous electrocardiogram(ECG) monitoring performed during hospital admission after ischemic stroke(IS) and transient ischemic attack(TIA) across a large network of hospitals in Florida and Puerto Rico(PR).

We identified 46,878 IS/TIA cases admitted to hospital with data on continuous ECG monitoring in the Florida Stroke Registry from 2016-2018. Univariate analysis was performed to determine the rate of continuous ECG monitoring and characteristics of patients receiving cardiac surface monitoring ≤7days and >7days, and implantable cardiac rhythm monitoring. Multivariate logistic regression was performed to identify factors associated with the types of monitoring.

Overall, 39,333 (84%) patients admitted for IS/TIA received continuous ECG monitoring during admission (mean age 71±14 years; 49% female; 63% White, 18% Black, 19% Hispanic). Compared to patients who received ECG monitoring, patients who did not were younger (mean age 70±15 years), PR-Hispanic (24% vs 4.3%), had TIA (13% vs 8%), Medicare insurance (42% vs 35%), large vessel disease (14% vs 9%) and greater admission NIHSS (median score 5 vs 4). After adjustment, smokers and patients >80years were less likely to receive ECG monitoring overall (OR 0.95, 95% CI 0.9-0.99 for both). Black race was associated with extended surface monitoring >7 days (OR 1.15, 95%CI 1.04-1.26), but negatively associated with implantable cardiac monitoring (OR 0.81, 95%CI 0.68-0.96). There were no sex differences observed. Patients with moderate to severe stroke had higher odds of extended surface monitoring >7days (OR 2.29, 95%CI 1.89-2.77), yet lower odds of implantable cardiac monitoring (OR 0.80, 95%CI 0.71-0.89).

Significant differences were found regarding age, race/ethnicity and stroke severity across different types and duration of cardiac monitoring performed after stroke/TIA.