Insertable cardiac monitoring results in higher rates of atrial fibrillation diagnosis and oral anticoagulation prescription after ischaemic stroke.

Aims: After an ischaemic stroke, atrial fibrillation (AF) detection allows for improved secondary prevention strategies. This study aimed to compare AF detection and oral anticoagulant (OAC) initiation in patients with an insertable cardiac monitor (ICM) vs. external cardiac monitor (ECM) after ischaemic stroke.
Methods and Results: Medicare Fee-for-Service (FFS) insurance claims and Abbott Labs device registration data were used to identify patients hospitalized with an ischaemic stroke in 2017-2019 who received an ICM or ECM within 3 months. Patients with continuous Medicare FFS insurance and prescription drug enrolment in the prior year were included. Patients with prior AF, atrial flutter, cardiac devices, or OAC were excluded. Insertable cardiac monitor and ECM patients were propensity score matched 1:4 on demographics, comorbidities, and stroke hospitalization characteristics. The outcomes of interest were AF detection and OAC initiation evaluated with Kaplan-Meier and Cox proportional hazard regression analyses. A total of 5702 Medicare beneficiaries (ICM, n = 444; ECM, n = 5258) met inclusion criteria. The matched cohort consisted of 2210 Medicare beneficiaries (ICM, n = 442; ECM, n = 1768) with 53% female, mean age 75 years, and mean CHA₂DS₂-VASc score 4.6 (1.6). Insertable cardiac monitor use was associated with a higher probability of AF detection [(hazard ratio (HR) 2.88, 95% confidence interval (CI) (2.31, 3.59)] and OAC initiation [HR 2.91, CI (2.28, 3.72)] compared to patients monitored only with ECM.
Conclusion: Patients with an ischaemic stroke monitored with an ICM were almost three times more likely to be diagnosed with AF and to be prescribed OAC compared to patients who received ECM only.
Competing Interests: Conflict of interest: G.B. received small speaker’s fees from Abbott, Bayer, Boston, Boehringer, Daiichi Sankyo, Janssen, and Sanofi, outside of the submitted work. A.A, is a consultant to Abbott, Boston Scientific, Cairdac, EP Solutions, Hylomorph, Medtronic, and XSpline; has received speaker fees from Boston Scientific, Medtronic, Microport CRM, and Philips; participates in clinical trials sponsored by Abbott, Boston Scientific, EPD-Philips, EP Solutions, Medtronic, Philips, and XSpline; and holds intellectual properties with Boston Scientific, Biosense Webster, and Microport CRM. G.L.B. has received speaker fees (small amount) from Abbott, Biotronik, Boston Scientific, Medtronic, and Microport CRM. J.P.P. is supported by R01AG074185 from the National Institutes of Aging. He also receives grants from Abbott, the American Heart Association, the Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, iRhythm, and Philips and serves as a consultant to Abbott, Abbvie, ARCA biopharma, Bayer, Boston Scientific, Element Science, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, Sanofi, Philips, and Up-to-Date. J.M.J., G.J.R., A.G., and Y.N. are employed by Abbott.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)