Medtronic has announced the first results from its DiVERT clinical study, which showed that post-stroke workflow protocols and cardiac monitoring vary significantly across community hospitals and academic centres. These data were presented at the 14th annual World Stroke Congress (WSC 2022, 26–29 October, Singapore).
According to the company, this “first-of-its kind” multicentre study evaluated more than 7,600 cryptogenic, large-artery and small-vessel stroke patients across 12 US hospitals, and found more than 75% of cryptogenic stroke patients at large academic centres received some form of cardiac monitoring (i.e. external cardiac monitor, implantable loop recorders) versus 5% of cryptogenic stroke patients at community hospitals. It also found that community hospitals were half as likely to consult cardiology than academic centres (16% vs 34%; p<0.001).
“Our findings from phase one of DiVERT underscore the need for stronger, standardised care pathways in both academic and community centres to ensure that stroke patients receive guideline-directed therapy,” said David Rose (Tampa General Hospital, Tampa, USA). “We all need to do a better job detecting hidden atrial fibrillation in these patients because treatment will change—starting anticoagulation prevents recurrent stroke. Phase two of the study will address these workflow deficiencies in a standardised post-stroke protocol for anyone to use at any stroke-capable hospital. While this protocol may not be the ultimate answer, it is a much-needed first step.”
Other findings from the study included:
- Community hospitals were more likely to diagnose cryptogenic stroke (93.2%) than large-artery (5.4%) or small-vessel (1.4%) stroke while academic centres diagnosed stroke subtypes evenly (32.1%, 37%, and 29.9%, respectively).
- Some 65.5% of patients from academic centres who received cardiac monitoring post-stroke received short-term monitoring while 10.5% received long-term monitoring.
- Community hospitals were less likely to order short-term (1%) and/or long-term (4.3%) monitoring in their patients.
- Patient attrition was higher in academic centres than community hospitals (54.2% vs 45.2%; p<0.001).
- The six-month recurrent stroke rate was similar in both groups (9.1% in academic centres compared to 7.4% in community hospitals; p=0.115).
Multiple clinical studies have shown that cryptogenic stroke patients are at high risk of atrial fibrillation post-stroke and, for many stroke patients, it could take more than 80 days for atrial fibrillation to appear—reinforcing the importance of long-term, continuous monitoring, a Medtronic press release details. Long-term cardiac monitoring, compared to conventional cardiac monitoring, leads to increased incidence of atrial fibrillation detection, increased incidence of anticoagulation initiation and a 55% decreased risk of recurrent stroke.
In DiVERT, post-stroke care pathways were assessed using stakeholder interviews, while patient data were collected using electronic medical records. Statistical analyses were exploratory only. The objective of the DiVERT study is to identify workflow deficiencies in phase one, and address those workflow deficiencies in phases two and three, the release concludes.