A team approach with both neurology and cardiology increased ICM implantation rates in ischemic stroke patients without extending hospital length of stay (45.2% vs. 28.9%).
Does a multidisciplinary Heart-Brain collaborative approach increase insertable cardiac monitoring rates and affect length of stay in patients with ischemic stroke?
A multidisciplinary Heart-Brain collaborative approach in ischemic stroke patients is associated with increased rates of insertable cardiac monitoring for atrial fibrillation without extending hospital length of stay.
Absolute Event Rate: 0% vs 0%
Introduction: Patients with ischemic stroke of unknown origin may be indicated for long-term insertable cardiac monitoring (ICM) for potential AF. It has been proposed that stroke pathways incorporating a Heart-Brain collaborative approach may improve triaging for appropriate monitoring and prevent loss to follow-up, however little is known about in-hospital patient pathways and associated monitoring utilization in real-world practice. Methods: Patients with ischemic stroke hospitalization during 2020-2023 were identified in the U.S. Medicare Fee-for-service database, with index date assigned as the date of hospitalization. Those with a claim for AF, mechanical heart valve or bacterial endocarditis during index hospitalization were excluded to refine to those more likely to have stroke of unknown origin. Patients were assigned to cohorts based on the physician specialties documented in the claim: Neurology Only, Cardiology Only, or Both Neuro/Card. Those with other or unclassifiable specialties were excluded from the analysis. Patients were followed for 12 months post-hospitalization. Outcome variables included index length of stay (LOS), ICM insertion, and follow-up cardiology visit in patient discharged without a consult. Results: Of 112,436 stroke hospitalizations meeting criteria, 79,603 (70.8%) saw Neurology Only, 29,409 (26.2%) saw Cardiology Only, and 3,424 (3.0%) saw Both (Table 1). ICM implant during stroke hospitalization was observed in a higher proportion of patients with a team approach including Both Neuro/Card (45.2% of patients vs. 28.9% Card Only or 2.3% Neuro Only, p2x more likely to be implanted before discharge vs. later in follow-up (92-94% vs. 41%). Conclusions: Heart-brain collaboration in the inpatient stroke setting was associated with increased rate of ICM and did not appear to extend LOS. These data suggest that a multidisciplinary approach in ischemic stroke may help ensure timely evaluation for potential cardiac monitoring for AF.
Masoud et al. (Thu,) reported a other. A team approach with both neurology and cardiology increased ICM implantation rates in ischemic stroke patients without extending hospital length of stay (45.2% vs. 28.9%).