Abstract NS8: Interventional Nurse Practitioner-Led Loop Recorder Implantation Program: Impact on Quality of Etiopathogenic Diagnosis of Ischemic Stroke

Abstract

Background: Extended cardiac rhythm monitoring increases the odds of detecting paroxysmal atrial fibrillation (PAF), an important finding in the etiopathogenic evaluation of patients with ischemic stroke. The development of a systematic approach to extended cardiac monitoring in this population is bound to positively influence the quality of diagnostic evaluation and, by extension, the application of tailored protocols for secondary stroke prevention. Methods: We retrospectively analyzed our experience with a cardiac loop recorder implantation program specifically designed for ischemic stroke patients suspected of having cardiogenic embolism, led and implemented by an interventional nurse practitioner in our team. We specifically queried its diagnostic yield as it relates to the quality of etiopathogenic diagnosis of this population. Results: The program has been currently in operation for 21 months, during which, 103 patients have undergone successful implantation of a cardiac loop recorder. The cohort includes 54 women and 49 men, their ages ranging 39-89 years (Mean = 67), 90 (87.38%) of whom had suffered an ischemic stroke, while the remainder had transient ischemic attacks. A total of 12 (11.65%) patients had newly detected PAF during the monitoring period, which varied 12-612 days (Mean = 316). The interval from implantation to PAF detection varied 3-202 days (mean = 90). Only one (0.97%) procedural complication (i.e., site infection) occurred, requiring device explantation without any long-term effects. All instances (100%) of PAF detection resulted in a change in from antiplatelet to anticoagulant agents for secondary stroke prevention. Conclusions: Programmatic implantation of cardiac loop recorders can successfully be carried out by interventional nurse practitioners, and it effectively enhances the etiopathogenic evaluation of ischemic stroke patients. Moreover, its yield for detection of PAF is considerable, and it translates in measurable changes in preventive antithrombotic regimens.