# Risk-Guided Atrial Fibrillation Surveillance in Ischemic Stroke

> **NIH NIH K23** · BOSTON MEDICAL CENTER · 2021 · $164,559

## Abstract

PROJECT SUMMARY
Atrial fibrillation (AF) is an important ischemic stroke risk factor, increasing the risk 5-fold and accounting for 1
in every 4 ischemic strokes. Extended rhythm monitoring for AF following ischemic stroke is recommended
because 10-20% experience recurrent stroke due to undetected AF and up to 30% of patients with ischemic
stroke are diagnosed with new AF after hospital discharge. Since 25-50% of AF cases are due to paroxysmal
AF, opportunistic screening with bedside electrocardiogram will miss a substantial portion of AF cases.
Implantable loop recorders (ILRs) are guideline-endorsed, long-term rhythm monitors that detect paroxysmal
AF. But universal ILR placement is suboptimal because ILRs are resource-intensive and only 30% of patients
who receive ILR after stroke are diagnosed with AF. An alternative, yet untested, strategy is to calculate patient
risk of AF in order to identify patients who are most likely to have undetected AF and will derive the most
clinical benefit from ILR monitoring. Using individual AF risk estimates can improve the appropriateness of
overall ILR use in a resource-effective manner. To test our hypothesis, the specific objectives of the current
application are to identify healthcare settings in which a risk-guided approach will be most impactful, develop a
post-stroke AF risk estimation tool, and pilot test the tool to assess acceptability, adoption, and validity of our
intervention prior to its testing in a randomized trial. Through the Mentored Career Development Award, the
candidate will undergo training in research with large healthcare databases, advanced prediction modeling,
and clinical trial methodology to facilitate transition to an independent investigator with expertise in prevention
and treatment of AF and its complication. The information produced from the proposed project will address
important knowledge gaps in healthcare utilization for prevention of AF-related stroke and inform future
effectiveness trials designed to directly inform selection of appropriate AF monitoring strategy following
ischemic stroke.

## Key facts

- **NIH application ID:** 10215843
- **Project number:** 1K23HL151903-01A1
- **Recipient organization:** BOSTON MEDICAL CENTER
- **Principal Investigator:** Darae Ko
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $164,559
- **Award type:** 1
- **Project period:** 2021-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10215843

## Citation

> US National Institutes of Health, RePORTER application 10215843, Risk-Guided Atrial Fibrillation Surveillance in Ischemic Stroke (1K23HL151903-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10215843. Licensed CC0.

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