Advertisement

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?

      In 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.
      • Yaghi S.
      • Furie K
      • Wechsler L
      • et al.
      Differences in inpatient insertable cardiac monitor placement after ischemic stroke.
      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. Therefore, inpatient placement of insertable cardiac monitors has gained momentum in the etiologic evaluation of patients with cryptogenic strokes as recent trials of anticoagulation were not found to be superior to antiplatelet monotherapy in reducing recurrent stroke.
      • Diener H-C
      • Sacco RL
      • Easton JD
      • Granger CB
      • Bernstein RA
      • Uchiyama S
      • et al.
      Dabigatran for prevention of stroke after embolic stroke of undetermined source.
      • Hart RG
      • Sharma M
      • Nundl H
      • et al.
      Rivaroxaban for stroke prevention after embolic stroke of undetermined source.
      Thus, documenting atrial fibrillation remains the prerequisite before initiating anticoagulation in patients with cryptogenic stroke.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Yaghi S.
        • Furie K
        • Wechsler L
        • et al.
        Differences in inpatient insertable cardiac monitor placement after ischemic stroke.
        J Stroke Cerebrovasc Dis. 2021;
        • Diener H-C
        • Sacco RL
        • Easton JD
        • Granger CB
        • Bernstein RA
        • Uchiyama S
        • et al.
        Dabigatran for prevention of stroke after embolic stroke of undetermined source.
        N Engl J Med. 2019; 380: 1906-1917https://doi.org/10.1056/NEJMoa1813959
        • Hart RG
        • Sharma M
        • Nundl H
        • et al.
        Rivaroxaban for stroke prevention after embolic stroke of undetermined source.
        N Engl J Med. 2018; 378: 2191-2201https://doi.org/10.1056/NEJMoa18 02686
        • Morgenstern LB
        • Towfighi A.
        Health equity.
        Stroke. 2021; 52: 2972-2973https://doi.org/10.1161/STROKEAHA.121.033939
        • Song S
        • Burgess RE
        • Kidwell CS.
        Racial differences by ischemic stroke subtype: a comprehensive diagnostic approach.
        Stroke Res Treat. 2012; 2012735097https://doi.org/10.1155/2012/735097
        • Kamel H
        • Longstreth Jr, WT
        • Tirschwell DL
        • et al.
        The atrial cardiopathy and antithrombotic drugs in prevention after cryptogenic stroke randomized trial: rationale and methods.
        Int J Stroke. 2019; 14: 207-214https://doi.org/10.1177/1747493018799981

      Linked Article