We therefore examined the cost-effectiveness of outpatient cardiac monitoring to detect AF after ischemic stroke.īecause the yield of outpatient cardiac monitoring after ischemic stroke was a key input in our model, we estimated this parameter using a systematic review of the English-language literature. 2 On the other hand, monitoring patients with stroke for >24 hours incurs additional cost and inconvenience, and its cost-effectiveness is unknown.
6–11 Anticoagulation has been proven to reduce the risk of recurrent stroke in patients with AF, and it follows that the detection and appropriate treatment of more cases of paroxysmal AF through the use of more prolonged cardiac monitoring will lead to better clinical outcomes. More prolonged outpatient cardiac monitoring, however, is not widely accepted 5 despite studies suggesting that it increases the chance of detecting paroxysmal AF. 3 To address this, clinical guidelines recommend that patients with ischemic stroke undergo at least 24 hours of inpatient cardiac monitoring to detect underlying AF. However, AF is frequently paroxysmal and asymptomatic, making its diagnosis difficult. 2 Thus, it is important to determine whether patients who have had an ischemic stroke have underlying AF. AF causes approximately 15% of strokes, 1 and treatment with anticoagulation reduces the annual risk of recurrent stroke in patients with AF by two thirds. The optimal duration and method of monitoring is unknown.Ītrial fibrillation (AF) is a common and treatable cause of ischemic stroke. Outpatient monitoring remained cost-effective throughout a wide range of model inputs in sensitivity analyses, including changes in the cost and yield of monitoring.Ĭonclusions- By identifying patients with paroxysmal atrial fibrillation who will benefit from anticoagulation, outpatient cardiac monitoring is cost-effective after ischemic stroke over a wide range of model inputs. Therefore, the cost-utility ratio of outpatient cardiac monitoring would be $13 000 per quality-adjusted life-years gained. This would result in a gain of 34 quality-adjusted life-years at a net cost of $440 000. Results- Outpatient cardiac monitoring would detect 44 new cases of atrial fibrillation for every 1000 patients monitored. Meta-analysis was used to determine the yield of outpatient cardiac monitoring. Methods- Using a Markov model, we determined the lifetime cost and utility of warfarin therapy in a hypothetical cohort of 70-year-old patients with atrial fibrillation, prior stroke, and no contraindication to warfarin therapy. Therefore, we performed a cost-utility analysis of outpatient cardiac monitoring after ischemic stroke. Customer Service and Ordering Informationīackground and Purpose- Extending the duration of continuous electrocardiography after ischemic stroke detects more new cases of atrial fibrillation, which is an important and treatable cause of stroke, but the cost-effectiveness of this approach is unknown.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
0 kommentar(er)
