Abstract Details

Title Collaborative Care in Stroke Centers: Role of Neurologists in Implanting Loop Recorders for Detection of Atrial Fibrillation

Topic Practice, Policy, and Ethics

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-065

Objective To report on feasibility, required credentials/privileges, and value of Neurologists implanting loop recorders in-collaboration with Cardiology for detection of atrial fibrillation (AF) in stroke and impact on quality and continuity of patient care.

Background Neurologists, often with subspecialty training in vascular neurology, play an integral role in managing ischemic stroke patients. In patients with suspected embolic strokes, detection of atrial fibrillation (AF) is essential to prevent recurrence. In eligible stroke patients, use of implantable loop recorders (ILRs) increases detection of AF and has significant clinical implications. Collaborative care in cryptogenic stroke is critical and there is growing interest among Neurologists in implanting ILRs.

Design/Methods Registry of all in-patient ILR procedures performed in a comprehensive stroke center was reviewed. Institutional protocol for implanting ILRs was developed through collaboration between specialties. After approval from committee for hospital privileges, interventional neurologist (credentialed) implanted ILRs in patients identified by vascular neurology. Initial programing of device was performed prior to discharge. Follow up and rhythm monitoring was performed by Cardiology. ILR procedure details including complications, billing, reimbursement, etc. are reported.

Results Total of 80 ILR procedures were performed over 10 months (Dec'17-Sep’18). All patients were followed by outpatient cardiology. CPT code 33282 used for device insertion with 2017 Medicare physician work RVUs of 3.25 reported. Diagnosis codes of 163.9 or G45.9 are frequently utilized. Quarterly data for 2017-18 (16 vs. 23, 12 vs. 33, and 13 vs. 35) indicated average increase by ~130% (p<0.001) in implantation of ILRs for cryptogenic stroke. No complications were reported and atrial fibrillation was detected in 9/80 (11%).

Conclusions

Hospital-based collaborative care increases ILR use in cryptogenic stroke. ILR procedure can be performed safely by trained and qualified physician in the stroke team prior to discharge. Additionally, an effective multidisciplinary collaboration adds value by ensuring continuity of care and patient retention in the health-system.

Authors/Disclosures
Nabeel Herial, MD, MPH, FAAN (Albany Medical Center) PRESENTER	Dr. Herial has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic.
	No disclosure on file
Robin N. Dharia, MD	Dr. Dharia has nothing to disclose.
Diana Tzeng, MD (Thomas Jefferson University)	Dr. Tzeng has nothing to disclose.
Shaista Alam, MD (Jefferson University Hospital)	Dr. Alam has nothing to disclose.
Fred Rincon, MD (Thomas Jefferson University)	Dr. Rincon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for NeuroCrit, LLC. Dr. Rincon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for NeuroCrit LLC.
	No disclosure on file
Rodney D. Bell, MD (Thomas Jefferson Medical College)	Dr. Bell has received publishing royalties from a publication relating to health care.
	No disclosure on file

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