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HEALTHCARE UTILIZATION IN CRYPTOGENIC STROKE PATIENTS WITH VS. WITHOUT LONG-TERM CARDIAC MONITORING FOR ATRIAL FIBRILLATION: EVIDENCE FROM REAL-WORLD DATA
Abstract
Background and Aims
This study estimates differences in healthcare utilization in cryptogenic stroke patients with and without long-term monitoring for atrial fibrillation (AF) with insertable cardiac monitor (ICM), across two U.S. claim databases: Optum® de-identified Clinformatics® database 2007-2019, and Medicare Fee-for-service 5% sample 2010-2019.
Methods
Patients included were ≥18 years and had an incident hospitalization for cryptogenic stroke/TIA, with continuous health plan enrollment 12 months prior to index stroke and ≥15 months follow-up post-stroke. The first 3 months post-stroke was used as a sample identification period to assign cohorts: patients with ICM insertion, and those with ambulatory external cardiac monitoring (ECM) only. Patients with prior AF/Flutter, stroke, cardiomyopathy, valvular diseases, or end-stage renal disease were excluded. Annualized healthcare utilization was estimated using general linear models with multiple data distribution considerations. Covariates included patient characteristics and CHA2DS2-VASc score.
Results
A total of 7,239 patients met inclusion criteria (4,844 Optum® and 2,395 Medicare). Cohorts included 6,051 patients (83.6%) who received ECM only and 1,188 (16.4%) who received ICM. Patient characteristics were similar between cohorts at baseline: age 69±12 years, 54.5% female, average CHA2DS2-VASc=2.7. During follow-up, the ICM cohort experienced a greater number of routine outpatient/office/clinic visits, but fewer acute events, with no difference in average length of stay (see table).
Conclusions
Analysis of a real-world cryptogenic stroke population showed that continuous cardiac rhythm monitoring with ICM was associated with more frequent care in routine outpatient-based settings. This closer medical management may have contributed to the observed reduction in acute events which carries important implications for patient quality of life.