A cost comparison of atrial fibrillation monitoring strategies after embolic stroke of undetermined source

Chalfoun, Nagib; Pierobon, Jessica; Rosemas, Sarah; Fox, John P.; Albano, Alfred; Banno, Joseph; Brunner, Michael; Corner, Kristin; Dahu, Musa; Dandamudi, Sanjay; Davis, Alan T.; Elmouchi, Darryl; Jawad, Wassim; Khan, Muhib; Jiao, Min; Rai, Vivek; Rosema, Shelly; Sagorski, Ryan; Gauri, Andre

doi:10.1016/j.ahjo.2022.100195

American Heart Journal Plus: Cardiology Research and Practice

2022

DOI: 10.1016/j.ahjo.2022.100195

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A cost comparison of atrial fibrillation monitoring strategies after embolic stroke of undetermined source

Nagib Chalfoun

Jessica Pierobon

Sarah Rosemas

et al.

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2024

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Cited by 3 publications

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A Patient‐Centered Approach to Cardiac Monitoring After Cryptogenic Stroke: A Review

Hassani,

El Husseini,

Feng

et al. 2024

SVIN

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Due to the variety of cardiac monitoring devices available after cryptogenic stroke to screen for atrial fibrillation, there is a need to understand the challenges and perceptions of these devices for patients. This article reviews in detail the cardiac monitoring technologies available to screen for atrial fibrillation after cryptogenic stroke/transient ischemic attack, with a focus on what is known regarding patient preferences and compliance in real‐world settings. As the optimal type of device and duration of time to screen for atrial fibrillation after cryptogenic stroke continues to be studied, a shared decision‐making approach that incorporates patient preferences with regard to the monitoring device chosen should be considered. Clinicians should explain to patients the uncertainty about the clinical impact of invasive monitoring, and future studies should aim to qualitatively delineate the viewpoints and comfort levels of patients with stroke regarding the use of implantable versus noninvasive cardiac monitoring.

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A Patient‐Centered Approach to Cardiac Monitoring After Cryptogenic Stroke: A Review

Hassani,

El Husseini,

Feng

et al. 2024

SVIN

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

Herial,

Frisch,

Miller

et al. 2024

SVIN

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BACKGROUND Atrial fibrillation (AF) is a known risk factor of ischemic stroke, and AF‐related stroke is twice more likely to be fatal. Long‐term cardiac rhythm monitoring using insertable cardiac monitors (ICMs) has greater diagnostic yield compared with conventional monitoring in detecting AF, and the clinical utility of ICMs is established in cryptogenic stroke, strokes attributable to large‐artery atherosclerosis, and strokes attributable to small‐vessel disease. A registry‐based study was conducted to evaluate the inpatient implantation of ICMs and the feasibility of vascular and interventional neurologists as implanters using novel collaborative clinical care pathway for cryptogenic stroke. METHODS Multiyear data from a hospital‐based registry at a comprehensive stroke center were reviewed to evaluate inpatient ICM implantation and test feasibility of vascular and interventional neurologists as implanters of ICMs together with cardiology using a novel collaborative care pathway. Reviewed data included the number of ICMs, implantation trend, inpatient versus outpatient setting, time to ICM implantation, inpatient workflow, including defined roles of team members, and AF detection rate. RESULTS A total of 290 ICMs for cryptogenic stroke were implanted when patients were in the hospital and 78 as outpatients after discharge during the study period of 3 years. Most inpatient ICM implants were performed by vascular and interventional neurology (n = 181), and ICM use for cryptogenic stroke increased by 130%. The average time to inpatient ICM implant was 4.1 days, with 77% in 5 days and 95.5% within 10 days poststroke. The average time to out‐patient ICM placement was 57 days. AF detection rate of 36.5% was noted at 24 months with a collaborative care pathway. CONCLUSION Inpatient implantation of ICMs is feasible and was performed safely and efficiently by vascular and interventional neurology together with cardiology using a collaborative care pathway. An increase in use of ICMs and higher AF detection rates were noted. Findings support innovative efforts to improve access and close the gaps in the delivery of cryptogenic stroke care to ultimately reduce the secondary stroke burden.

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A Comprehensive Review of Cryptogenic Stroke and Atrial Fibrillation: Real-World Insights Into the Role of Insertable Cardiac Monitors

Khan,

Varma,

Negandhi

et al. 2024

Cureus

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Cryptogenic stroke, a subtype of ischemic stroke with no identifiable cause after comprehensive evaluation, presents a unique challenge in stroke prevention. Atrial fibrillation (AF), a common risk factor for ischemic stroke, is often underdiagnosed in these patients due to its intermittent, asymptomatic nature. Early detection of AF is critical, as anticoagulation therapy significantly reduces the risk of recurrent stroke in AF patients. However, traditional short-term monitoring methods frequently fail to identify paroxysmal AF. Insertable cardiac monitors (ICMs) offer a novel solution by providing continuous, long-term heart rhythm monitoring, which has proven effective in detecting occult AF. Real-world data further support the clinical value of ICMs in guiding the initiation of anticoagulation therapy, ultimately improving stroke prevention strategies. Despite some limitations, such as false positives and the invasive nature of the device, ICMs have emerged as a critical tool in modern stroke management. As technology evolves, future advancements may further enhance AF detection by integrating artificial intelligence and wearable devices. This review provides a comprehensive overview of the role of AF in cryptogenic stroke, the importance of early detection, and the growing significance of ICMs in clinical practice.

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A cost comparison of atrial fibrillation monitoring strategies after embolic stroke of undetermined source

Cited by 3 publications

References 26 publications

A Patient‐Centered Approach to Cardiac Monitoring After Cryptogenic Stroke: A Review

A Patient‐Centered Approach to Cardiac Monitoring After Cryptogenic Stroke: A Review

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

A Comprehensive Review of Cryptogenic Stroke and Atrial Fibrillation: Real-World Insights Into the Role of Insertable Cardiac Monitors

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