Inform your secondary stroke prevention strategies.
One in four stroke survivors will experience another stroke within five years.1 Are you doing everything you can to find risk factors that could lead to another ischemic stroke in your patients?
- Atrial fibrillation (AF) was found in 30% of patients with cryptogenic stroke up to three years post-stroke.2
- AF was found in 12.1% of large- and small-vessel stroke patients at 12 months post-stroke.3
- 45.5% of first recurrent strokes have a different subtype than the index stroke.4
AF is a major risk factor for stroke. AF detection matters.
Find AF. Treat AF. Prevent stroke.
The use of prolonged cardiac monitoring (PCM) has a potential impact on secondary stroke prevention, as patients with cryptogenic stroke/TIA undergoing PCM compared to conventional cardiac monitoring show5:
- 2.5x increased incidence of AF detection.
- 2.1x increased incidence of anticoagulant initiation.
- 55% decreased risk of recurrent stroke.
Neurology and cardiology guidelines recommend ICM for AF detection in cryptogenic stroke patients.6-9
Compared to external cardiac monitoring (ECM), ICM use was associated with10,11:
- Faster time to AF diagnosis
- Faster time to OAC initiation
- Reduced readmissions
- Reduced rate of mortality
Based on real-world claims data analysis.10,11
The first step in creating a multidisciplinary stroke pathway is to identify the right stakeholders. Collaborating with colleagues in neurology, cardiology, electrophysiology, and other disciplines to develop a consistent and reproducible stroke pathway can result in a better risk reduction strategy to prevent secondary strokes. For patients, a stroke pathway ensures coordinated, integrated, and quality post-stroke patient care. Establishing a monitoring pathway to detect and treat AF can significantly reduce a patient’s risk for another stroke.5
LINQ™ family of ICMs. Accuracy matters.
Patients with a LINQ insertable cardiac monitor (ICM) experienced fewer secondary strokes two years following a cryptogenic stroke.12
The LINQ family of ICMs (Reveal LINQ™ ICM and LINQ II™ ICM) detect asymptomatic AF while tracking daily AF burden and ventricular rates in stroke patients13 and may enable subsequent medical decisions and long-term management of AF.2,14 They also allow for higher diagnostic yield and better patient compliance compared to external monitoring in stroke patients.2,11,12
References
1
Mohan KM, Wolfe CDA, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke. May 2011;42(5):1489-1494.
2
Sanna T, Diener HC, Passman RS, et al. Cryptogenic Stroke and Underlying Atrial Fibrillation (CRYSTAL AF). N Engl J Med. June 26, 2014;370(26):2478-2486.
3
Bernstein RA, Kamel H, Granger CB, et al. Effect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease: The STROKE-AF Randomized Clinical Trial. JAMA. June 1, 2021;325(21):2169-2177.
4
Hillen T, Coshall C, Tilling K, et al. Cause of stroke recurrence is multifactorial: patterns, risk factors, and outcomes of stroke recurrence in the South London Stroke Register. Stroke. June 2003;34(6):1457-1463.
5
Tsivgoulis G, Katsanos AH, Mac Grory B, et al. Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia. Stroke. August 2019;50(8):2175-2180.
6
Rubiera M, Aires A, Antonenko K, et al. European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin. European Stroke Journal. May 2022.
7
Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. July 2021;52(7):e364-e467.
8
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. February 1, 2021;42(5):373-498.
9
January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. July 9, 2019;74(1):104-132.
10
Yaghi S, Ryan MP, Gunnarsson CL, et al. Longitudinal outcomes in cryptogenic stroke patients with and without long-term cardiac monitoring for atrial fibrillation. Heart Rhythm O2. February 13, 2022;3(3):223-230.
11
Yaghi S, et al. Healthcare Utilization in Cryptogenic Stroke Patients With vs. Without Long-term Cardiac Monitoring for Atrial Fibrillation: Evidence from Real World Data. Presented at World Stroke Congress 2021.
12
Triantafyllou S, Katsanos AH, Dilaveris P, et al. Implantable Cardiac Monitoring in the Secondary Prevention of Cryptogenic Stroke. Ann Neurol. November 2020;88(5):946-955.
13
Sawyer LM, Witte KK, Reynolds M, et al. Cost-effectiveness of an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke. J Comp Eff Res. February 2021;10(2):127-141.
14
Andrade JG, Yao RRJ, Deyell MW, et al. Clinical assessment of AF pattern is poorly correlated with AF burden and post ablation outcomes: A CIRCA-DOSE sub-study. J Electrocardiol. May-June 2020;60:159-164.