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)