Medtronic has announced results from DiVERT Stroke study, which showed that post-stroke workflow protocols and cardiac monitoring are varied across community hospitals and academic centres.
The DiVERT Stroke is a multi-centre study that evaluated more than 7,600 cryptogenic, large-artery and small-vessel stroke patients across 12 hospitals in the US.
The objective of the study was to identify workflow shortcomings in Phase 1 and address those workflow deficiencies in Phases 2 and 3.
In the study, more than 75% of cryptogenic stroke patients at large academic centres received cardiac monitoring, such as external cardiac monitors and implantable loop recorders.
Meanwhile, only 5% of cryptogenic stroke patients at community hospitals had access to cardiac monitoring.
In addition, the study found that community hospitals were half as likely to consult cardiology than academic centres.
University of South Florida Morsani College of Medicine vascular neurology associate professor David Z Rose said: “Our findings from Phase I 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.
“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 II of the study will address these workflow deficiencies in a standardized 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.”
The study found that community hospitals were more likely to diagnose cryptogenic stroke than large-artery or small-vessel stroke.
In contrast, academic centres diagnosed all stroke subtypes equally.
Around 65.5% of patients from academic centres who received cardiac monitoring post-stroke received short-term monitoring while 10.5% received long-term monitoring.
The community hospitals were found less likely to order short-term and/or long-term monitoring of their patients.
Long-term cardiac monitoring enables increased AF detection, anticoagulation initiation and a 55% decreased risk of recurrent stroke, compared to conventional cardiac monitoring.
Furthermore, the study results showed that patient attrition was higher in academic centres than in community hospitals, and the six-month recurrent stroke rate was similar in both.
