ABSTRACT NUMBER: ESOC2026A343 IMPACT OF NEUROLOGIST-LED FOCUSED CARDIAC ULTRASOUND IN THE ACUTE STROKE PATHWAY (S-FOCUS): EFFICIENCY AND DIAGNOSTIC VALUE

Abstract Background and aims Contemporary guidelines suggest cardiac echocardiogram for only in selected patients. We evaluated whether a neurologist-led stroke-focused cardiac ultrasound (S-FoCUS) improves diagnostic efficiency and reduces hospital length of stay without compromising diagnostic accuracy. Methods We conducted a retrospective before–after cohort study of acute ischemic stroke patients admitted to our stroke center, comparing two 6-month periods: pre-S-FoCUS: routine cardiology-driven TTE for all patients, and post S-FoCUS: S-FoCUS screening for all patients and cardiologist-driven TTE only for those with abnormal findings. We compared time from admission to first cardiac imaging, length of stay, relative reduction in cardiologist-driven TTE, diagnostic yield between the two periods and estimated in-hospital costs. Results Pre-S-FoCUS period included 245 patients and post-S-FoCUS 246. S-FoCUS protocol reduced cardiologist-driven TTE by 50%, median time to first cardiac imaging in 2 days (median (IQR) 3 (2–5) vs 1 (1–2), p<.001), and median length of stay in 1 days (7 (5–9) vs 6 (3–10), p=0.018). In patients undergoing both S-FoCUS and TTE, we found high interrater agreement for potential cardioembolic sources (mitral stenosis κ=0.78, left-atrial severe enlargement κ=0.74, or depressed LVEF κ=0.88). We found no significant differences in the etiological classification at discharge or proportion of findings in cardiac examination between both periods. Implementation of S-FoCUS was associated with an estimated cost reduction of approximately €917 per patient. Conclusions Neurologist-led S-FoCUS screening in acute stroke patients is feasible and reliable in identifying potential cardioembolic sources, and allows a reduction in time to cardiac assessment and length of stay. Conflict of interest Eduardo Mariño: Nothing to disclose