PFO-ACCESS: Augmenting Communications for Medical Care or Closure in the Evaluation of Patients With Stroke With...

Patent foramen ovale (PFO) contributes to a quarter of embolic strokes of undetermined source. Although the benefit of PFO closure in selected patients has been demonstrated, our system workflow still resulted in a low rate of PFO evaluation for closure. The aim of the PFO-ACCESS (Augmenting Communications for Medical Care or Closure in the Evaluation of Stroke Patients With Cardiac Shunts) program (which included implementation of the Viz.ai PFO-specific communications module) was to determine if there was any change in PFO management due to improved communication between stroke and interventional cardiology teams.

In this quality improvement project, we compared pre-PFO ACCESS (December 2022-November 2023) to post-PFO ACCESS periods (November 2023-June 2024) regarding PFO evaluations. The Viz.ai PFO module was implemented for the stroke and interventional cardiology teams without other workflow changes. Key performance indicators included referral frequency, PFO closure rates, and referral time intervals. Statistical comparisons utilized Mann-Whitney U, chi-square, Fisher's exact, and exact Poisson test where appropriate.

The postimplementation period noted a 492% PFO referral increase (11 versus 38,65 [annualized]; P<0.0001). PFO closure number totals showed a 186% nonsignificant increase pre versus post (6 versus 10,17 [annualized]; P = 0.99), with PFO closure of percentage of total referred cases showing a large but nonsignificant decrease (54.55%, 26.32%; P = 0.14). Time comparisons showed a marked but nonsignificant decrease in median "referral sent to referral viewed" (10:37 hours, 1:08 hours; P = 0.73), "referral sent to referral accepted" (10:37 hours, 1:03 hours; P = 0.67) time interval, and "referral sent to closure" time interval (102 days, 97 days; P = 0.55).

The PFO-ACCESS program with Viz.ai PFO module use resulted in a 492% increase in PFO referrals due to enhanced communication and efficiency in managing PFO-related stroke cases. Though the increased number of referrals and closures were observed, the PFO closure percentage of total referred cases showed a marked but nonsignificant decrease indicating selective case management. The higher number of PFO closures shows that more patients are indeed appropriate for PFO closure consideration. Future efforts should focus on expanding outpatient use and increasing provider education to optimize PFO management.