Related Experiment Video
Updated: Jul 15, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Usefulness of cardiovascular investigations in stroke management: clinical relevance and economic implications
Insights
Routine cardiovascular investigations like transthoracic echocardiography (TTE) and Holter monitors are costly and low-yield in stroke patients. These tests rarely change treatment, suggesting a need for cost-effective criteria in stroke management.
Area of Science:
- Cardiology
- Neurology
- Health Economics
Background:
- Limited prospective randomized studies exist on routine cardiovascular investigations in stroke patients.
- Ambulatory stroke clinics face challenges in optimizing diagnostic strategies.
Purpose of the Study:
- To evaluate the utilization, clinical relevance, and economic impact of cardiovascular investigations in an ambulatory stroke clinic.
- To assess the yield of transthoracic echocardiography (TTE) and Holter monitoring in stroke patients.
Main Methods:
- Retrospective analysis of 200 stroke/transient ischemic attack patients.
- Assessed TTE for thrombus, cardiac dysfunction, and structural abnormalities.
- Defined relevance by treatment paradigm shift; ECG/Holter relevant for atrial fibrillation/flutter.
Main Results:
- TTE and Holter monitoring were used in over 70% of cases, constituting 94% of cardiovascular costs.
- Clinically relevant TTE findings occurred in only 4% of patients and did not alter antithrombotic therapy.
- ECG and Holter identified only 2 new cases of atrial fibrillation.
Conclusions:
- Transthoracic echocardiography and Holter monitoring appear to be low-yield, high-cost procedures in this stroke clinic setting.
- Prospective studies are needed to establish cost-effective criteria for selecting cardiovascular investigations in stroke management.
Background And Purpose:
There are no prospective randomized studies assessing the clinical relevance of routine cardiovascular investigations in stroke patients. The objective of this study was to evaluate the utilization, relevance, and economics of cardiovascular investigations in an ambulatory stroke clinic.
Methods:
The outcome of cardiovascular investigations in 200 patients with stroke/transient ischemic attack diagnosed in a stroke prevention clinic was assessed. Transthoracic echocardiography (TTE) was assessed for detection of thrombus or mass, poor left ventricle function, and other structural abnormalities. ECG and Holter monitor were felt to be relevant if they showed atrial fibrillation/flutter. Investigations were deemed to be clinically pertinent if they brought about a shift treatment paradigm.
Results:
TTE and Holter were performed in >70% of cases and accounted for approximately 94% of total cardiovascular cost. Relevant TTE findings were identified in 6 (4%) patients, which did not alter antithrombotic therapy. Only 2 new cases of atrial fibrillation were identified by both ECG and Holter.
Conclusions:
TTE and Holter appear to be costly low-yield procedures in this clinical setting. Prospective analyses may help to provide cost effective criteria for selection of appropriate cardiovascular studies in stroke management.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:26Atherosclerosis III: Management