Abstract WP278: Underutilization of Outpatient Cardiac Monitoring in Patients With Embolic Stroke of Unknown Source

Abstract

Background: Recent studies have shown that outpatient cardiac monitoring for 30 days or longer increases detection rate of paroxysmal atrial fibrillation (AF) after Embolic Stroke of Unknown Source (ESUS). For patients with AF detected on monitoring, anticoagulation can be initiated to reduce risk of recurrent stroke. In this study, we aim to compare characteristics between patients who received cardiac monitoring and those who did not to further elucidate trends in the use of prolonged outpatient cardiac monitoring following ESUS. Methods: We analyzed a retrospective cohort of patients discharged with a diagnosis of ESUS over a period of 18 months in whom outpatient cardiac monitoring was ordered. Patients who were deceased or without follow-up at 90 days were excluded. Patients were divided into two groups based on whether or not they received outpatient cardiac monitoring. We compared demographic data, clinical risk factors, and NIHSS between the two groups. Results: Out of 282 patients with ESUS, 189 (67.0%) patients had 90 day follow-up data available; 118 (62.4%) underwent cardiac monitoring and 71 (37.6%) did not undergo cardiac monitoring. Of the patients who were monitored, 81.4% (96/118) received a 30 day non-invasive monitor and 43.2% (51/118) patients had an ICM implanted. There were no significant differences in baseline characteristics among patients who underwent cardiac monitoring versus those who did not. Conclusion: More than one-third of patients with ESUS for whom outpatient cardiac monitoring was recommended and ordered did not actually receive it. This finding supports the need for more convenient, effective processes by which patients can follow through with outpatient cardiac monitoring which could perhaps be initiated at discharge.