Abstract
Background and Purpose
Cryptogenic stroke accounts for 30% of ischemic stroke and in such patients, cardiac
monitoring leads to increased detection of AF, increased utilization of anticoagulation,
and decreased risk of recurrent stroke. We aim to identify differences in inpatient
utilization of implantable cardiac monitors (ICMs) in patients with ischemic stroke.
Methods
This is an analysis of the National Inpatient Sample. We included all ischemic stroke
hospitalizations nation-wide between Jan 1st 2016 and Dec 31st 2018. We excluded patients with history of atrial fibrillation or atrial flutter.
We compared survey weighted baseline demographics and characteristics between patients
who received an inpatient ICM versus those who didn't using logistic regression models.
Results
We identified a weighted total 1,069,395 patients who met the inclusion criteria;
2.2% received an inpatient ICM. In multivariable analyses, factors associated with
decreased odds of inpatient ICM placement including Black race (OR 0.76 95% CI 0.68
– 0.84, p < 0.001), residence in a micropolitan area (OR 0.79 95% CI 0.67 – 0.94,
p = 0.008), hospital region [Midwest (OR 0.74 95% CI 0.61 – 0.90, p = 0.002), South
(OR 0.68 95% CI 0.57 – 0.81, p < 0.001), and West (OR 0.37 95% CI 0.29 – 0.45, p <
0.001)], hospital bed size [small (OR 0.38 95% CI 0.39-0.46, p < 0.001) and medium
hospital bed size (OR 0.73 95% CI 0.63 – 0.84, p < 0.001)], insurance status [Medicaid
(OR 0.86 95% CI 0.76 – 0.98, p = 0.02) and self-pay (OR 0.51 95% CI 0.41 – 0.62, p
< 0.001)], and non-teaching hospital (OR 0.52 95% CI 0.47 - 0.60, p < 0.001).
Conclusions
There are important differences in inpatient ICM placement in patients with ischemic
stroke highlighting disparities in inpatient care for patients hospitalized with ischemic
stroke. More studies are needed to validate our findings.
Key Words
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Article info
Publication history
Published online: October 18, 2021
Accepted:
September 14,
2021
Received in revised form:
August 22,
2021
Received:
June 5,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106124
Copyright
© 2021 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Health Inequities in Insertable Cardiac Monitoring: Can We Close the Gaps in Monitoring Disparities, or should We Determine Which Patients May Benefit from Anticoagulation at an Earlier Diagnostic Stage?Journal of Stroke and Cerebrovascular DiseasesVol. 31Issue 1
- PreviewIn this issue of the Journal of Stroke and Cerebrovascular Diseases, and Dr. Yaghi and colleagues retrospectively analyze data from the National Inpatient Sample to highlight disparities in inpatient placement of insertable cardiac monitors after ischemic stroke.1 Inpatient placement of insertable cardiac monitors affords providers and patients the ability to monitor the greatest length of time after ischemic stroke for paroxysmal atrial fibrillation without missing critical periods if placement is deferred to the outpatient setting.
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