Effectiveness, utilisation and cost associated with implantable loop recorders versus external monitors after...

Area of Science:

• Cardiology
• Neurology
• Health Services Research

Background:

• Implantable loop recorders (ILRs) are used for long-term rhythm monitoring post-stroke to detect atrial fibrillation (AF).
• Early AF detection can guide oral anticoagulation initiation to mitigate adverse outcomes.
• Effectiveness of different monitoring strategies requires evaluation.

Purpose of the Study:

• To compare the effectiveness of implantable loop recorders (ILRs) versus other rhythm monitoring strategies.
• To assess outcomes including mortality, AF diagnosis, and oral anticoagulation initiation.
• To analyze healthcare costs associated with different monitoring approaches.

Main Methods:

• Retrospective cohort analysis of 48,901 patients with ischaemic or cryptogenic stroke.
• Stratification by monitoring strategy: ILR, long-term external monitor (>48h to 30d), or Holter monitor (≤48h).
• Primary outcome: 12-month all-cause mortality; secondary outcomes: AF diagnosis, anticoagulation, bleeding, costs.

Main Results:

• ILR use was associated with a higher likelihood of AF diagnosis and oral anticoagulant initiation (aOR 2.27).
• No significant difference in 12-month all-cause mortality between ILR and long-term external monitor groups (HR 1.00).
• ILR group incurred higher baseline and follow-up costs compared to long-term external monitors.

Conclusions:

• ILR placement increases AF diagnosis and oral anticoagulation initiation in stroke patients.
• ILR monitoring does not demonstrate a mortality benefit over long-term external monitoring.
• Higher costs associated with ILRs warrant consideration in clinical decision-making.