Abstract WMP36: Closing Gaps In Care Of Patients With Embolic Stroke Of Unknown Source: A Multi-disciplinary Approach

Abstract

Introduction: Embolic Stroke of Undetermined Source (ESUS) describes non-lacunar ischemic strokes, with no definite etiology after minimal standard work-up. Approximately 17% of ischemic strokes are ESUS, and patients are generally younger with mild strokes and higher Quality-Adjusted Life Years at stake, given annual 5% recurrence. Additional cardiac evaluation is often required for ESUS evaluation. A Multi-Disciplinary Clinic (MDC) employing vascular neurology and cardiology may improve diagnosis and outcomes, facilitate shared decision-making, and provide an enhanced clinical experience for patients with ESUS. We describe our experience. Methods: The UTHealth ESUS clinic was established in April 2019, as a monthly half-day clinic. Patients with ESUS (and without known PFO) are referred following ischemic stroke hospitalization or after evaluation in the stroke clinic. Patients are seen by a vascular neurologist and a cardiologist (EP specialist) in a single visit to ensure standardized, appropriate secondary stroke prevention. The specialists review cardiac imaging and monitoring data and discuss the need for additional work-up. While some patients present to the clinic with an event monitor or implantable loop recorder (ILR) in place, others are referred for long-term monitoring following the encounter. Patients are also screened for clinical trials, and stroke fellows rotate through the clinic to gain experiences managing this patient population. Results: A total of 36 patients have been evaluated at the ESUS clinic. Median age was 63 (52-71) and 15 (41%) patients were women. Patients were seen a median of 30 days from discharge/referral. Long-term cardiac monitoring was performed in (95%) of patients, including with either a 30-day event monitor (n=15) or ILR (n=20). Two patients were found to have atrial fibrillation, and a different potential cause (PFO, large vessel disease) was detected in 3 others. Five patients were consented for the ARCADIA clinical trial. Conclusion: A Multidisciplinary ESUS Clinic offers a patient-centered approach which may facilitate care coordination for stroke prevention and clinical trial enrollment, while providing learning opportunities for trainees.