Cost-Effective Detection of Poststroke Atrial Fibrillation Identified in STROKE-AF Trial: David Z. Rose, MD

WATCH TIME: 4 minutes

"This says that it is not only better for the patient to know they have atrial fibrillation to change management to prevent more strokes, but it is also economically beneficial to insert loop recorders in these patients whether it be in the hospital or after they're discharged from their stroke."

In stroke, detecting atrial fibrillation (AF) in patients is essential for implementing secondary stroke prevention through the use of guideline-recommended oral anticoagulation. This was observed in a the randomized STROKE-AF trial (NCT02700945) which assessed patients with ischemic stroke attributed to large-artery or small-vessel disease (LAD/SVD).¹ In the findings, investigators reported that the use of insertable cardiac monitors (ICMs) were more likely to detect AF in comparison with standard of care using intermittent external ECG monitors.

In a recent analysis of STROKE AF presented at the 2024 International Stroke Conference (ISC), held February 7-9, in Phoenix, Arizona, by coauthor David Z. Rose, MD, and colleagues, results showed that ICMs had significantly more cost-effectiveness compared with the standard of care in patients with ischemic stroke who had LAD/SVD, especially in those with high CHA2DS2-VASc scores and a high risk of AF.^1,2 In the study, investigators observed an association between ICM and a gain of 0.17 quality-adjusted life years compared with standard of care (6.63 vs. 6.46), driven by higher incidence of oral anticoagulation and consequent reduction in lifetime ischemic strokes. 

Rose, professor of neurology at University of South Florida, sat down with NeurologyLive® after the meeting to discuss how the cost-effectiveness of using loop recorders in detecting atrial fibrillation impacts patient management in stroke care. He also talked about how the specific findings from the STROKE AF trial analysis contributes to the argument for the economic viability of loop recorders. Additionally, Rose spoke about how subgroup analyses, considering factors like CHA2DS2-VASc score and congestive heart failure, can influence the cost-effectiveness of loop recorder insertion.

Click here for more coverage of ISC 2024.

REFERENCES
1.Yaghi S, Pollitt V, Bernstein RA, et al. Cost-Effectiveness of Insertable Cardiac Monitors to Identify Atrial Fibrillation After Stroke Attributed to Large-Artery or Small-Vessel Disease. Presented at: International Stroke Conference; February 7-9, 2024; Abstract 138.
2. Medtronic LINQ Insertable Cardiac Monitors prove cost-effective compared to standard of care in ischemic stroke patients with suspected atrial fibrillation. News Release. Medtronic. Published February 7, 2024. Accessed February 22, 2024. https://news.medtronic.com/Medtronic-LINQ-Insertable-Cardiac-Monitors-prove-cost-effective-compared-to-standard-of-care-in-ischemic-stroke-patients-with-suspected-atrial-fibrillation