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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Stroke
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1428731
This article is part of the Research Topic Advances and controversies in ischemic stroke management: from prevention to diagnosis and acute treatment View all 90 articles

Academic and Community Hospitals Stroke Subtype Classification and Cardiac Monitoring: The DiVERT multi-center cohort study

Provisionally accepted
David Z. Rose David Z. Rose 1*Rushir A Shah Rushir A Shah 2Josh Snavely Josh Snavely 3Marla Hairstone Marla Hairstone 1Stephen Adams Stephen Adams 4Paul D Ziegler Paul D Ziegler 5Sarah C Rosemas Sarah C Rosemas 5Michael Chandler Michael Chandler 5Roberto Carta Roberto Carta 5Karah B Neisen Karah B Neisen 5Noreli C Franco Noreli C Franco 5Thomas G Devlin Thomas G Devlin 4
  • 1 Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States
  • 2 CHI Memorial Neuroscience Institute, Chattanooga, United States
  • 3 Franciscan Neurology Associates at St. Joseph, Virginia Mason Franciscan Health, Tacoma, United States
  • 4 Common Spirit Health System, CHI Memorial Neuroscience Institute, Chattanooga, Tennessee, United States
  • 5 Medtronic (United States), Minneapolis, Minnesota, United States

The final, formatted version of the article will be published soon.

    Background: Cardiac monitoring strategies to detect occult atrial fibrillation (AF) post-stroke differ among healthcare institutions. This may be related to discrepancies in stroke subtype classification/adjudication, and/or consultation of cardiology specialists at Community Hospitals (CoH) and Academic Centers (AcC). Identifying the degree of heterogeneity may encourage development of guideline-directed monitoring protocols, higher AF detection rates and treatments, and fewer strokes. Methods: The DiVERT (SeconDary Stroke PreVEntion ThRough Pathway ManagemenT) study was designed to characterize post-stroke cardiac monitoring practices in a hospital setting. Care pathways were assessed with in-person stakeholder interviews; patient-level data were reviewed using electronic medical records. Results: DiVERT identified 2,475 patients with diagnoses of cryptogenic (83.6% vs. 33.1%, p<0.001), large vessel disease (LVD) (13.3% vs. 37.0%, p<0.001), or small vessel disease (SVD) (3.1% vs. 29.9%, p<0.001) stroke, at CoH and AcC respectively. CoH consulted cardiology significantly less than AcC (12.3% vs. 34.7%, p<0.001) and ordered significantly fewer short-or long-term cardiac monitors than AcC (6.8% vs. 69.2%, p<0.001). CoH had shorter length of stay (5.3 vs. 9.4 days, p<0.001) and patient demographics were significantly different (p<0.001 for age, ethnicity and race). Conclusion: Significant heterogeneity in cardiac monitoring post-stroke exists: CoH reported 2.5-times more cryptogenic stroke than AcC yet ordered 10-times fewer short/long-term cardiac monitors to look for AF. Significant differences in patient demographics among institutions may account for this discrepancy. Regardless, efforts to reduce heterogeneity are warranted to improve AF detection and treatment and prevent recurrent stroke.

    Keywords: Acute ischemic stroke, Cardiac rhythm monitoring, Atrial Fibrillation, anticoagulation, Care pathway

    Received: 06 May 2024; Accepted: 24 Oct 2024.

    Copyright: © 2024 Rose, Shah, Snavely, Hairstone, Adams, Ziegler, Rosemas, Chandler, Carta, Neisen, Franco and Devlin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: David Z. Rose, Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, 33612, Florida, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.