Reducing Inconsistencies of Post-Stroke Cardiac Monitoring with Standardized, Guideline-Oriented Neuro-Cardiac Pathways.

BACKGROUND: Inconsistent cardiac monitoring strategies to detect occult atrial fibrillation (AF) post-stroke were identified among various healthcare institutions in phase I of the DiVERT Stroke study. It is unknown whether Guideline-Oriented Neuro-Cardio Pathways (GO-NCP) may reduce this heterogeneity. OBJECTIVE: To assess whether a stroke care pathway in the inpatient hospital setting reduces inconsistency of cardiac monitoring post-stroke. METHODS: DiVERT-Stroke phase II was an interventional, non-randomized, multicenter cohort study designed to implement a post-stroke cardiac monitoring care pathway in the inpatient hospital setting. The retrospective phase I (pre-GO-NCP development) was compared to the prospective phase II (post-GO-NCP implementation) for patients with cryptogenic, large-vessel disease (LVD), or small-vessel disease (SVD). Metrics evaluated included rates of inpatient cardiology consultation, secondary prevention medication prescriptions, rate and type of post-stroke cardiac monitoring selected, AF detection, and outpatient "lost-to-follow-up" (LTFU). RESULTS: After GO-NCP implementation, significant increases were seen for inpatient cardiology consultations (phase I: 14.9%, phase II: 54.4%, p<0.001), and cardiac monitoring (24.9% vs. 32.8%, p=0.002), with a 4.5-fold increase in long-term monitoring with insertable cardiac monitors (phase I: 6.1%, phase II: 27.5%, p<0.001). AF detection rose from 7.2% to 9.2% (p=0.489) and anticoagulation prescriptions increased from 13.9% to 21.6% (p<0.001). GO-NCP resulted in significantly less LTFU in clinic (48.1% vs. 3.0%; p<0.001). CONCLUSION: Implementing a post-stroke GO-NCP significantly reduced previously identified inconsistent cardiac monitoring practices by increasing in-hospital cardiology consultations, antithrombotic prescriptions, cardiac monitoring for AF, and significantly decreases outpatient LTFU.