Key result
Patients without cardiovascular implantable electronic devices hospitalized for acute ischemic stroke or transient ischemic attack were significantly more likely to undergo MRI compared to patients with devices (adjusted OR 6.7).
Why the study?
Patients with acute ischemic stroke or transient ischemic attack who have CIEDs may undergo MRI less frequently than patients without devices, despite MRI being safe for most CIED patients.
Does the presence of a cardiovascular implantable electronic device (CIED) reduce MRI utilization in patients hospitalized for acute ischemic stroke or transient ischemic attack?
Cohort (n=417,899)
Yes
Does the presence of a cardiovascular implantable electronic device (CIED) reduce MRI utilization in patients hospitalized for acute ischemic stroke or transient ischemic attack?
Despite a CMS coverage revision that increased MRI use, patients with CIEDs presenting with acute ischemic stroke or TIA remain significantly less likely to receive an MRI compared to those without devices.
CIED patients may still receive fewer MRIs for acute stroke/TIA despite CMS changes; observational data leaves open whether targeted interventions can improve access.
Background and Purpose: Magnetic resonance imaging (MRI) is safe for most patients with cardiovascular implantable electronic devices (CIEDs). However, patients presenting with acute ischemic stroke or transient ischemic attack (AIS/TIA) who have CIEDs may undergo MRI less frequently than patients without devices. We assessed contemporary use of MRI for patients with AIS/TIA and the effect of a recent coverage revision by the Center for Medicare and Medicaid Services (CMS) on MRI utilization. Methods: claims data from January 2012 to June 2019, we performed an interrupted time series analysis of MRI utilization during AIS/TIA hospitalizations with the April 2018 CMS coverage revision serving as the intervention. For patients treated after the coverage revision, we used multivariable logistic regression to determine the association between lack of CIED and MRI utilization for AIS/TIA. Results: We identified 417,899 patient hospitalizations for AIS/TIA, of which 30,425 (7%) had a CIED present (CIED vs non-CIED patients: age 77.6 ± 9.8 vs 72.7 ± 12.3 years; 45.5% vs 54.3% female). From 2012 to 2019, annual MRI utilization increased from 3% to 20% for CIED patients and 58% to 66% for non-CIED patients. The CMS coverage revision was associated with a 4.2% absolute additional increase in MRI utilization for CIED patients. Non-CIED patients treated after the CMS coverage revision were substantially more likely than CIED patients to undergo MRI (adjusted OR 6.7, 95% CI: 6.3-7.1, P<.001). Conclusions: MRI utilization has increased for stroke patients with CIEDs but remains far lower than in similar patients without devices.
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Culbertson et al. (2022) conducted a cohort in Acute ischemic stroke or transient ischemic attack (n=417,899). Absence of cardiovascular implantable electronic device (CIED) vs. Presence of CIED was evaluated on MRI utilization during AIS/TIA hospitalizations (adjusted OR 6.7, 95% CI 6.3-7.1, p=<.001). Patients without cardiovascular implantable electronic devices hospitalized for acute ischemic stroke or transient ischemic attack were significantly more likely to undergo MRI compared to patients with devices (adjusted OR 6.7).
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