214 Impact on patient care of setting up a stroke-cardiology multidisciplinary service

Introduction Stroke is a leading cause of morbidity and mortality in the adult population.[1,2] An European Society of Cardiology position paper supports interdisciplinary care to improve outcomes.[3] Stroke-cardiology multi-disciplinary teams (SC-MDT) are being set up for evaluation of Patent Foramen Ovalis (PFO) Closure, embolic sources in cryptogenic strokes, and risk factor management with initial literature demonstrating positive results.[4–7] We present a proof-of-principle study to assess clinical outcomes, focussing on pathway performance which is under-researched. Methods A monthly SC-MDT meeting was fully set up in October 2022. The SC-MDT included imaging cardiologist, structural interventional cardiologist, stroke physicians, and as-required haematology input. Time from stroke to SC-MDT outcome was assessed. Outcomes for patients cared for by the SC-MDT (October 2022 to December 2023, N=26) were compared to those with prior usual care (December 2019–2021, N=17). Primary outcomes assessed were time from stroke to PFO closure, and number of clinic appointments prior to decision regarding PFO closure. Secondary outcomes were recurrent stroke, transient ischaemia (TIA) and myocardial infarction (MI). Results Patients were referred for consideration of PFO closure (N=23, 88%), interdisciplinary investigation of cryptogenic strokes (N =1, 4%), and advice on secondary prevention (N=2, 8%). Patients referred were 53±13 years old, overweight (BMI 29±5 kg/m2), and predominantly male (85%). Most referrals were for patients with strokes (N=22, 85%) and imaging proof of cortical infarct (N=20, 74%). The median (IQR) time from stroke to SC-MDT outcome was 113 (82–150) days and median (IQR) time from MDT to PFO closure was 140 (74–199) days. There was a trend towards reduced time from stroke to PFO closure with SC-MDT care [median (IQR) 224 days (173–264) vs median 307 (286–368) without SC-MDT (P=0.07), figure 1]. There was a trend towards lower median (IQR) number of outpatient appointments within the SC-MDT pathway [1 (0–1) appointments with SC-MDT vs 2 (2–3) without SC-MDT, P=0.105]. We calculated a projected saving of 51 clinic appointments with the SC-MDT pathway. After a median (IQR) follow-up of 8 (4–12) months following SC-MDT, no patients hit the secondary outcomes of recurrent stroke, TIA or MI even including those patients with PFO who were not recommended closure. There was a trend towards reduced secondary outcomes with the SC-MDT pathway compared to usual care at 8-month follow-up (0% vs 6%) (figure 2). Of 23 patients referred for possible PFO closure, 7 (30%) were recommended closure. One patient developed post-PFO closure atrial fibrillation. Conclusion SC-MDT is feasible and safe with a short processing time of cases in the pathway and an efficient use of existing healthcare resources. Our study shows preliminary evidence supporting the SC-MDT implementation to improve clinical outcomes including reduction of recurrent stroke, TIA or MI. Conflict of Interest Nil to declare