Abstract 1122‐000226: Collaborative Stroke Pathway for In‐Patient Implantation of Long‐Term Cardiac Rhythm Monitors for Atrial Fibrillation Detection

Abstract

Introduction: Atrial fibrillation (AF) is a recognized risk factor of ischemic stroke and AF‐related stroke is twice more likely to prove fatal. Long‐term cardiac rhythm monitoring has greater diagnostic yield compared to conventional monitoring in detecting AF. Utility of implantable loop recorder (ILR) in detecting AF was established not only in patients with cryptogenic stroke but more recently in strokes due large artery atherosclerosis and small vessel disease Stroke AF trial. We present a collaborative care pathway and share multi‐year data on ILR implantation. Methods: A review of prospectively collected registry of ILR implantations performed at a Comprehensive stroke center was conducted. Data from 2017–2019 of in‐patient and out‐patient implantation was analyzed. Eligible patients identified by vascular neurology (VN) underwent in‐patient implantation primarily by interventional neurology (IN) and as out‐patient by electrophysiology Cardiology. In‐patient implant and programming were done on the day of discharge. Continuous monitoring was followed by EP Cardiology. AF detection was urgently communicated by EP Cardiology and anticoagulation initiated by VN. Patients lost to follow up or lacking information in medical records were excluded from analysis. Results: Total of 428 ILR implantations were performed over a period of 3 years (1/2017 ‐ 12/2019) with majority implants as in‐patient prior to discharge 290 (67.8%) and out‐patient 78 (32.2%). Inpatient ILR placement was noted to be 75% in 2017, 78% in 2018 and 80% in 2019. 57.2% of in‐patient ILRs were placed by IN and 42.8% by EP. Average time to in‐patient ILR was 4.1 days with 77% within 5, 18.5% within 10, and <5% within 11 or more days post‐stroke. Average time to out‐patient ILR placement was 57 days with only 16% within 15, 29% within 30 day and 53% in more than 30 days from stroke. Over the course of 2 years of monitoring, AFib was detected in 33% with false detection in 1.5% (19.6% in 2017, 26% in 2018 and 36.5% in 2019). Conclusions: A multispecialty collaborative care pathway to increase implantation rate in eligible patients is recommended. In‐patient implantation allows establishing continuity of care, patient retention, prevents lost to follow‐up, avoids delay in monitoring, and importantly decreases the risk of stroke recurrence by early initiation of anticoagulation.

Keywords

• Acute Stroke
• Medical Management
• Clinical Trial