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Published on: January 15, 2017
Heart Brain Clinic: An Integrated Approach to Stroke Care
Muhammad Bilal Tariq1, Syed Kalimullah S Qadri1, Anjail Sharrief1
1Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus.
Insights
A new Heart Brain Clinic (HBC) streamlines care for patent foramen ovale (PFO)-associated stroke patients, reducing clinic visits. This multidisciplinary approach may enhance care quality for younger stroke patients.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Patent foramen ovale (PFO) is associated with stroke, particularly in younger individuals.
- Management requires coordinated care between cardiology and neurology specialists.
- Multidisciplinary clinics can improve patient outcomes and care efficiency.
Purpose of the Study:
- To evaluate the feasibility and impact of a multidisciplinary Structural Heart Brain Clinic (HBC) for patients with PFO-associated stroke.
- To compare the efficiency and decision-making process for PFO closure in patients managed through the HBC versus standard care.
Main Methods:
- Retrospective collection of demographic and clinical data for patients with PFO-associated ischemic stroke.
- Comparison of a standard care group with a group managed by the Structural HBC.
- Analysis of outcomes including time to PFO closure and number of clinic visits, using nonparametric and chi-square tests.
Main Results:
- The Structural HBC managed 79 patients, compared to 41 in the standard care group.
- HBC patients required significantly fewer clinic visits before a PFO closure decision (p = 0.001).
- Clinicians were more likely to recommend against PFO closure in the HBC group (p = 0.021), potentially due to selection bias.
Conclusions:
- A multidisciplinary, patient-centered approach through the HBC is feasible for managing PFO-associated stroke.
- This model may improve the quality of care for younger patients with PFO-associated stroke.
- Further research is needed to confirm improvements in broader care aspects and long-term outcomes.
Background And Objectives:
Multidisciplinary clinics have been shown to improve care. Patients with patent foramen ovale (PFO)-associated stroke need evaluation by cardiology and neurology specialists. We report our experience creating a multidisciplinary Structural Heart Brain Clinic (HBC) with a focus on patients with PFO-associated stroke.
Methods:
Demographic and clinical data were retrospectively collected for patients with PFO-associated ischemic stroke. Patients with PFO-associated stroke were divided into a standard care group and Heart Brain Clinic group for analysis. Outcome measures included time from stroke to PFO closure and number of clinic visits before decision regarding closure. Nonparametric analysis evaluated differences in median time to visit and clinical decision, while the chi square analysis compared differences in categorical variables between groups.
Results:
From February 2017 to December 2021, 120 patients were evaluated for PFO-associated stroke. The Structural HBC began in 12/2018 with coordination between Departments of Neurology and Cardiology. For this analysis, 41 patients were considered in the standard care group and 79 patients in the HBC group. During data analysis, 107 patients had received recommendations about PFO closure. HBC patients required fewer clinic visits (p = 0.001) before decision about closure; however, among patients who underwent PFO closure, there was no significant difference in weeks from stroke to PFO closure. Clinicians were more likely to recommend against PFO closure among patients seen in HBC compared with those seen in standard care (p = 0.021).
Discussion:
Our data demonstrate that a multidisciplinary, patient-centered approach to management of patients with PFO-associated ischemic stroke is feasible and may improve the quality of care in this younger patient population. The difference in recommendation to not pursue PFO closure between groups may reflect selection and referral bias. Additional work is needed to determine whether this approach improves other aspects of care and outcomes.
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