Abstract WP090: Heart-brain collaboration and cardiac monitoring for atrial fibrillation in ischemic stroke patients

Introduction: Patients with ischemic stroke of unknown origin may be indicated for long-term insertable cardiac monitoring (ICM) for potential AF. It has been proposed that stroke pathways incorporating a Heart-Brain collaborative approach may improve triaging for appropriate monitoring and prevent loss to follow-up, however little is known about in-hospital patient pathways and associated monitoring utilization in real-world practice. Methods: Patients with ischemic stroke hospitalization during 2020-2023 were identified in the U.S. Medicare Fee-for-service database, with index date assigned as the date of hospitalization. Those with a claim for AF, mechanical heart valve or bacterial endocarditis during index hospitalization were excluded to refine to those more likely to have stroke of unknown origin. Patients were assigned to cohorts based on the physician specialties documented in the claim: Neurology Only, Cardiology Only, or Both Neuro/Card. Those with other or unclassifiable specialties were excluded from the analysis. Patients were followed for 12 months post-hospitalization. Outcome variables included index length of stay (LOS), ICM insertion, and follow-up cardiology visit in patient discharged without a consult. Results: Of 112,436 stroke hospitalizations meeting criteria, 79,603 (70.8%) saw Neurology Only, 29,409 (26.2%) saw Cardiology Only, and 3,424 (3.0%) saw Both (Table 1). ICM implant during stroke hospitalization was observed in a higher proportion of patients with a team approach including Both Neuro/Card (45.2% of patients vs. 28.9% Card Only or 2.3% Neuro Only, p<0.001 both comparisons). Among patients with Neuro/Card, adding ICM implant was not associated with longer LOS (mean 6.0 vs. 6.3 days) (Table 2). Likewise, adding another specialty consultation was not associated with longer LOS (6.0 days vs. 8.2 Neuro Only or 6.1 Card Only). In patients discharged without cardiology, time to consult was 112(94) days. Of patients who receive ICM, those with Both Card/Neuro or Card Only received the device earlier than Neuro Only (mean 7.9-9.1 vs. 73.6 days) and were >2x more likely to be implanted before discharge vs. later in follow-up (92-94% vs. 41%). Conclusions: Heart-brain collaboration in the inpatient stroke setting was associated with increased rate of ICM and did not appear to extend LOS. These data suggest that a multidisciplinary approach in ischemic stroke may help ensure timely evaluation for potential cardiac monitoring for AF.