Reimagining Cryptogenic Stroke Care: Collaborative Care and Inpatient Insertable Cardiac Monitors for Detection of...

Area of Science:

• Cardiology
• Neurology
• Stroke Medicine

Background:

• Atrial fibrillation (AF) is a significant risk factor for ischemic stroke, with AF-related strokes being more severe and fatal.
• Insertable cardiac monitors (ICMs) offer higher diagnostic yield for AF detection compared to conventional methods.
• The clinical utility of ICMs is established for various stroke types, including cryptogenic stroke.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of inpatient implantation of ICMs by vascular and interventional neurologists.
• To assess a novel collaborative clinical care pathway involving neurology and cardiology for cryptogenic stroke management.
• To analyze trends in ICM implantation, workflow efficiency, and AF detection rates.

Main Methods:

• A registry-based study reviewed multiyear data from a comprehensive stroke center.
• Data included ICM implantation numbers, trends, setting (inpatient vs. outpatient), and time to implantation.
• AF detection rates were analyzed within a collaborative care pathway framework.

Main Results:

• A total of 290 ICMs were implanted inpatient and 78 outpatient over 3 years.
• Vascular and interventional neurology performed most inpatient ICM implants (n=181), with a 130% increase in ICM use for cryptogenic stroke.
• Average inpatient ICM implantation occurred within 4.1 days post-stroke, with a 36.5% AF detection rate at 24 months.

Conclusions:

• Inpatient ICM implantation by vascular and interventional neurology, in collaboration with cardiology, is safe and efficient.
• The collaborative pathway led to increased ICM utilization and higher AF detection rates.
• These findings support innovative strategies to enhance cryptogenic stroke care and reduce stroke recurrence.