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A retrospective review of 103 acute admissions of overseas visitors to a central London hospital was performed. Admissions were most commonly due to infection (43 admissions) and to recurrence of preexisting disease (40 admissions). Patients over 60 years were frequently admitted with new diagnoses. Groups at risk of admission were identified and strategies to reduce admissions discussed. [ABSTRACT FROM AUTHOR]

Background: Detection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is challenging due to its paroxysmal nature. We sought to assess AF detection with an insertable cardiac monitor (ICM) and to perform cost analysis for various AF monitoring strategies post-ESUS We applied this cost analysis modeling to recently published Stroke AF and Per Diem trials., Methods: Retrospective chart review was performed in consecutive hospitalized patients with ESUS who had ICM placed prior to discharge. Utilizing rate of ICM-detected AF and Medicare average payments, we modeled 30-day per-patient diagnostic costs of Immediate ICM insertion prior to discharge versus using a wearable monitor followed by ICM in patients with ESUS, from Medicare and patient out-of-pocket perspectives. Similar modeling strategy and cost analysis was applied to the Stroke AF and Per Diem trials., Results: In 192 ESUS patients, AF detection increased with length of monitoring: 7.3 % at 14 days, 9.4 % at 30 days, and 17.2 % after a median ~ 6 months (189 days). Cost modeling predicted that immediate ICM leads to $3683-$4070 lower Medicare payments per-patient and $1425-$1503 lower patient out-of-pocket costs compared to Wearable-to-ICM strategies. Using similar modeling in the PER DIEM and STROKE AF trials, the additive costs of the 30-day ELR to ICM strategy ranged from $3786-$3946 from a payer perspective and $1472-$1503 from a patient out-of-pocket perspective., Conclusions: Use of ICM immediately after ESUS is cost-saving compared to Wearable-to-ICM strategies, due to the cost and low diagnostic yield of short-term wearable cardiac monitoring., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Nagib Chalfoun reports statistical analysis and writing assistance were provided by Medtronic Inc. Sarah Rosemas (employee of medtronic) reports financial support was provided by Medtronic Inc. Sarah Rosemas reports a relationship with Medtronic Inc. that includes: employment and equity or stocks. Nagib Chalfoun reports a relationship with Medtronic Inc. that includes: consulting or advisory, non-financial support, and speaking and lecture fees. Andre Gauri reports a relationship with Medtronic Inc. that includes: consulting or advisory, non-financial support, and speaking and lecture fees. Muhib Khan reports a relationship with Medtronic Inc. that includes: funding grants and travel reimbursement. Shelly Rosema reports a relationship with Medtronic Inc. that includes: speaking and lecture fees. John Fox reports a relationship with Medtronic Inc. that includes: consulting or advisory. NC and AG are consultants to Medtronic. SCR is an employee and stockholder of Medtronic. MK has received grant to attend conference from Medtronic. SR has been adjunct speaker for Medtronic. JF has served on advisory Board for Medtronic., (© 2022 The Authors.)

Background: Pulmonary vein isolation (PVI) using cryoballoon ablation (PVI-C) is increasingly performed as a first-line strategy for the treatment of patients with persistent atrial fibrillation (PersAF); however, follow-up data and predictors of procedural success are lacking., Objective: To study the efficacy of PVI-C in patients with PersAF, focusing on predictors of procedural success., Methods: By retrospective review, 148 consecutive patients with PersAF who underwent PVI-C were analyzed. The impact of several variables on outcome was evaluated in univariate and multivariate analyses and Cox proportional hazards regression models., Results: After a mean follow-up of 19.2±10.9 months, 75 (50.7%) patients remained arrhythmia-free without the need for antiarrhythmic drug therapy. Patients with a normal left atrial volume index (LAVI) achieved a 71.0% arrhythmia-free survival. LAVI was the most powerful predictor of procedural success., Conclusions: Arrhythmia-free survival after PVI-C in select patients with PersAF are promising. Moreover, LAVI is a valuable measurement to help guide ablation strategy and predict outcome when using cryoballoon ablation.