Abstract 15744: Contemporary Rhythm Monitor Utilization Following Acute Ischemic Stroke

Introduction: Post-stroke rhythm monitoring can detect occult AF, but contemporary utilization is not well-understood. We sought to quantify monitor deployment in a real-world stroke population and assess whether it is calibrated to clinical AF risk. Methods: We performed a single-center analysis of consecutive patients with acute ischemic stroke 10/2018-6/2019 and no AF history and assessed monitor utilization (Holter/ECG, event/patch, and implantable loop recorder [ILR]) at 6 months. We evaluated predictors of monitor deployment using Cox proportional hazards modeling with the Cohorts for Heart and Aging Research in Genomic Epidemiology AF (CHARGE-AF) AF risk score, stroke subtype, and discharge disposition. We estimated the cumulative incidence of monitoring both overall and in stroke subtype and discharge disposition subgroups, accounting for the competing risk of death and with adjustment for other factors using inverse probability weighting. Results: Of 532 acute stroke patients (mean age 65, 47% female), the 6-month incidence of monitoring was 36.2% (95% CI 31.5-40.9, Figure ). Monitoring included Holter/event monitor (74.3%), ILR (21.2%) or both (4.5%). Monitoring was more likely after cryptogenic (hazard ratio 4.36, 95%CI 3.12-6.1; 6-month monitor incidence 69.3%) and cardioembolic (1.80, 1.00-3.22; 37.3%) stroke, as opposed to other/unknown subtype (24.3%). Monitoring was also more likely after discharge home (1.92, 1.39-2.66; 47.6%) versus facility (27.7%). Monitoring was not associated with AF risk (1.08, 0.93-1.27, per 1 SD increase in CHARGE-AF), even though AF risk was associated with AF (1.67, 1.3-2.15, per 1 SD increase in CHARGE-AF). Conclusions: Rhythm monitors are underutilized after stroke. Interventions to encourage monitor deployment according to AF risk may improve the efficiency of post-stroke monitoring. Figure. Cumulative incidence of monitoring overall and within strata of stroke subtype and discharge disposition