Checking pulse could help detect risk of a second stroke

Stroke patients and their families can be taught to monitor the patient’s pulse and detect irregular heartbeats that might lead to another stroke, according to a new study.

Of people who have a stroke, 40 per cent will suffer another one within the next ten years, said lead author Dr Bernd Kallmunzer of the Department of Neurology at Universitatsklinikum Erlangen in Germany.

Taking a pulse reading can detect atrial fibrillation, a major risk factor for stroke, and facilitate appropriate treatment to reduce the risk of another stroke or death, Kallmunzer told Reuters Health by e-mail.

The study team tested how accurately patients and their families could detect fibrillation just by taking a pulse.

The study, online July 23 in Neurology, included 256 patients who had suffered a first stroke and were treated at the authors’ stroke unit in Germany in late 2012 or early 2013. While still hospitalised, the patients and in some cases also their relatives were taught to take pulse readings from the radial artery in the left wrist.

The patients and families were also given printed instruction materials and a stopwatch.

During the half-hour tutorial, patients were taught to use the stopwatch to measure pulse rate and to recognise a normal pulse sensation and an irregular sensation that may indicate atrial fibrillation.

Atrial fibrillation feels like a “stumbling” rhythm and may be faster than 100 beats per minute or slower than 50, Kallmunzer said. A normal heartbeat is rhythmic and regular and only changes slightly on inhale and exhale.

The patients were then hooked up to an electrical heart monitor and the screen was covered. A healthcare professional, the patient and the patient’s family all attempted to take a pulse reading.

According to the electrical heart monitor, 172 of the patients had normal heart rhythms and 57 had atrial fibrillations—the rest had another kind of abnormal rhythm. The researchers analysed how often wrist pulse readings achieved the same result as the electrical heart monitor.

Almost 90 per cent of the patients who were mentally able did complete a pulse reading on themselves, and correctly detected 54 per cent of the atrial fibrillations. Health care providers detected 97 per cent of atrial fibrillations.

Only six patients who thought their heart rates were irregular were incorrect. A false-positive rate that low is encouraging, the authors write.

Among patients with atrial fibrillation whose family members took the tutorial, relatives detected the irregular beats 77 per cent of the time by taking the patient’s pulse.

When atrial fibrillation is detected, medication can reduce the risk of a second stroke by 60 to 70 per cent in comparison to not treating patients, according to Rolf Wachter of Universitatsmedizin Gottingen in Germany, who was not involved in the study.

“This is, I would say, one of the most effective therapies in medicine,” he told Reuters Health in an e-mail.

“We do not specifically know whether the approach in this paper is really the best approach. Other methods, including using a machine to monitor heart rhythm, might be better at detecting fibrillations, but they haven’t been compared to each other in a trial,” he said.

“In general, taking your pulse is easy, harmless and free from side effects. Therefore anyone can try to do it,” Kallmunzer said. “In stroke patients with very severe disability, family members, friends or nurses can do the measurements for the patient.”

The risk of a second stroke is highest during the months after the first one, but currently researchers do not know exactly how long this kind of pulse monitoring should go on, he said. (Reuters Health)