Abstract Details

Title Closing Gaps in Care of Patients with Embolic Stroke of Unknown Source: A Multi-disciplinary approach

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P18 - Poster Session 18 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-003

Background Embolic Stroke of Undetermined Source (ESUS) describes non-lacunar ischemic strokes, with no definite etiology after minimal standard work-up. Approximately 17% of ischemic strokes are ESUS, and patients are generally younger with mild strokes and higher Quality-Adjusted Life Years at stake, given annual 5% recurrence. Additional cardiac evaluation is often required for ESUS evaluation. A Multi-Disciplinary Clinic employing vascular neurology and cardiology may improve diagnosis and outcomes, facilitate shared decision-making, and provide an enhanced clinical experience for patients with ESUS.

Objective N/A

Design/Methods The UTHealth ESUS clinic was established in April 2019, as a monthly half-day clinic. Patients with ESUS (and without known PFO) are referred following ischemic stroke hospitalization or evaluation in the stroke clinic. Patients are seen by a vascular neurologist and a cardiologist (EP specialist) in a single visit to ensure standardized, appropriate secondary stroke prevention. They review cardiac imaging and monitoring data and discuss additional work-up. While some patients present to the clinic with an event monitor or implantable loop recorder (ILR), others are referred for long-term monitoring following the encounter. Patients are also screened for clinical trials. Stroke fellows rotate through the clinic to gain experiences managing this population.

Results A total of 40 patients were evaluated at the ESUS clinic. Median age was 61 (52-71) and 19 (47.5%) patients were women. Patients were seen a median of 33 days from discharge/referral. Long-term cardiac monitoring was performed in (92.5%) of patients, with either a 30-day event monitor (n=15) or ILR (n=22). Atrial fibrillation was detected in two patients, and a different potential cause (PFO, large vessel disease) was detected in 3 others. Five patients were consented for the ARCADIA clinical trial.

Conclusions A Multidisciplinary ESUS Clinic offers a patient-centered approach which may facilitate care coordination for stroke prevention and clinical trial enrollment, while providing learning opportunities for trainees.

Authors/Disclosures
Lamya Ibrahim, MD, MBBS (Hospital of the University of Pennsylvania) PRESENTER	Dr. Ibrahim has nothing to disclose.
Muhammad Bilal Tariq, MBBS (UT health Science Center at Houston)	Dr. Tariq has nothing to disclose.
Mohammad Jamil Ahmad, MD (University of Pittsburgh medical Center)	Dr. Ahmad has nothing to disclose.
	No disclosure on file
Munachi N. Okpala, NP (McGovern Medical School-Division of Adult Neurology, Stroke Team)	Ms. Okpala has nothing to disclose.
Nicole Gonzales, MD (University of Colorado Anschutz Medical Campus)	The institution of Dr. Gonzales has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology.
Anjail Sharrief, MD (University of Texas)	The institution of Dr. Sharrief has received research support from NIH. The institution of Dr. Sharrief has received research support from University of Houston . Dr. Sharrief has a non-compensated relationship as a Consultant with Abbott that is relevant to AAN interests or activities.