Abstract TP294: Improving the Prospect of Diagnosing Paroxysmal Atrial Fibrillation After Cryptogenic Stroke to Prevent Recurrent Strokes by Appropriate Counseling, Cardiology Referral and Telephone Follow-Up: a Quality Improvement Initiative From Neurology Residents

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Introduction: 25% of all strokes are Cryptogenic; paroxysmal atrial fibrillation is frequently the underlying cause. Patients with cryptogenic stroke require cardiac event monitoring (CEM) after hospital discharge in order to diagnose paroxysmal atrial fibrillation and switch to anticoagulant therapy from antiplatelet therapy. Very important question remains regarding who is responsible for CEM among healthcare providers. The objectives of our quality improvement project were to understand the barriers and ensure all patients receive CEM after cryptogenic stroke. Methods: All patients with MRI evidence of ischemic stroke and documented transient ischemic attack during a two-month period at an academic comprehensive stroke center were included. Data were recorded and compared for one month prior to (Group A) and one month after (Group B) implementation of the QI project. The QI project included patient counseling about importance of CEM and dual-verification of orders for CEM and cardiology referral. Two members of the stroke team independently verified placement of the CEM order and the referral to cardiology. One month after discharge, patients in the QI project were contacted by telephone to ensure CEM placement. Results: 48 patients suffered ischemic stroke or TIA before and 54 patients after implementation of the QI project. The incidence of cryptogenic stroke was 20.83% (10/48) in group A and 16.66% (9/54) in group B. In Group A, only 2 of 10 patients with cryptogenic stroke received CEM. Major barriers were (1) patient ignorance and concern (2)unapproachable patient (3) lack of follow-up with primary care provider/neurologist. In Group B, after implementation of the QI project, 8 of 9 patients received CEM. One patient in Group B refused cardiac event monitoring. CEM diagnosed paroxysmal atrial fibrillation in one patient in group B and anticoagulation was initiated. Our quality improvement initiative increased the incidence of cardiac event monitoring from 20% in group A to 88.88% in group B. Conclusion: This project highlights that patient’s with cryptogenic stroke face barriers towards receiving cardiac event monitoring which can be improved by proper counseling, ensuring cardiology referral and a telephone follow-up by neurologist.