Potential Cost-Effectiveness of Ambulatory Cardiac Rhythm Monitoring After Cryptogenic Stroke

Introduction: Atrial fibrillation (AF) related cardioembolic stroke accounts for over 20% of ischemic stroke. Recent reports using prolonged cardiac rhythm monitoring (PCRM) in cryptogenic stroke reveal paroxysmal AF (PAF) in an additional 20% of patients. We report our findings with PCRM in patients with and without cryptogenic stroke patients in whom an initial 24-h Holter was negative. Methods: Patients admitted to the stroke service with no previous history of AF and no AF on Holter monitoring were enrolled for 3 weeks of PCRM. We used a PAF predictive score to determine the risk of the arrhythmia. All studies were interpreted by the stroke team prior to final review by the cardiologist. Results: Between Sept 2012 and June 2013, 96 patients were evaluated. Over all PAF was diagnoses in 37.5 % of patients. PAF was diagnosed in 32% of patients with cryptogenic stroke and 36 % of patients where an additional etiology may account for the stroke diagnosis. The AF prediction score was not useful in the recognition of patients that were more likely to be at risk for AF. 96 of 98 recordings were correctly identified by the stroke team prior to final diagnosis by the cardiologist. Interpretation: PAF is more common in stroke patients than was previously suspected. It occurs with similar frequency in patients with and without cryptogenic stroke. Our data strongly supports the need for prolonged cardiac rhythm monitoring in all stroke patients to diagnose this important preventable cause of ischemic stroke.

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Cost-Effectiveness of Extended Electrocardiogram Monitoring for Atrial Fibrillation After Stroke

Stroke ◽

10.1161/strokeaha.120.029340 ◽

2020 ◽

Vol 51 (7) ◽

pp. 2244-2248 ◽

Cited By ~ 3

Author(s):

Derek S. Chew ◽

Elissa Rennert-May ◽

Eldon Spackman ◽

Daniel B. Mark ◽

Derek V. Exner

Keyword(s):

Atrial Fibrillation ◽

Cost Effectiveness ◽

Standard Care ◽

Cryptogenic Stroke ◽

Cost Utility ◽

Economic Evaluations ◽

Ecg Monitoring ◽

The Cost ◽

Monitoring Devices ◽

Rhythm Monitoring

Background and Purpose: Management of cryptogenic stroke involves the identification of modifiable risk factors, such as atrial fibrillation (AF). Extended rhythm monitoring increases AF detection rates but at an increased device cost compared with conventional Holter monitoring. The objective of the study was to identify and synthesize the existing literature on the cost-effectiveness of prolonged rhythm monitoring devices for AF detection in cryptogenic stroke. Methods: We conducted a systematic review of available economic evaluations of prolonged ECG monitoring for AF detection following cryptogenic stroke compared with standard care. Results: Of the 530 unique citations, 8 studies assessed the cost-utility of prolonged ECG monitoring compared with standard care following cryptogenic stroke. The prolonged ECG monitoring strategies included 7-day ambulatory monitoring, 30-day external loop recorders or intermittent ECG monitoring, and implantable loop recorders. The majority of cost-utility analyses reported incremental cost-effectiveness ratios below $50 000 per QALY gained; and two studies reported a cost-savings. Conclusions: There is limited economic literature on the cost-effectiveness of extended ECG monitoring devices for detection of atrial fibrillation in cryptogenic stroke. In patients with cryptogenic stroke, extended ECG monitoring for AF detection may be economically attractive when traditional willingness-to-pay thresholds are adopted. However, there was substantial variation in the reported ICERs. The direct comparison of cost-effectiveness across technologies is limited by heterogeneity in modeling assumptions.

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Cryptogenic Stroke: Cardiac Rhythm Monitoring as An Indispensable Screening Modality

Indonesian Journal of Cardiology ◽

10.30701/ijc.1143 ◽

2021 ◽

Vol 42 (3) ◽

Author(s):

Sunu Budhi Raharjo ◽

Sarah Humaira ◽

Lies Dina Liastuti

Keyword(s):

Cardiac Rhythm ◽

Detection Rate ◽

Digital Health ◽

Cryptogenic Stroke ◽

Cost Effective ◽

Handheld Devices ◽

Ecg Monitoring ◽

Current Recommendation ◽

Short Period ◽

Rhythm Monitoring

The prevalence of stroke in Indonesia increased overtime. CS ranges from 15 to 40% from all ischemic strokes. Finding the etiology of ischemic stroke is important to prevent recurrence. AF is predicted as the etiology behind CS. The current recommendation only supports short period of ECG monitoring. However, studies have shown that a higher detection rate can be achieved with longer duration of monitoring. ICM, a diagnostic tool with the highest detection rate, is still considered cost-effective when the calculation takes into account the QALY gained. Digital health tools such as handheld devices and smartwatch ECG have revolutionized the screening of AF however it is still considered as pre-diagnostic and verification is needed to confirm the rhythm generated.

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Atrial fibrillation and treatment changes in cryptogenic stroke patients with an implantable loop recorder for continuous cardiac rhythm monitoring

European Heart Journal ◽

10.1093/eurheartj/eht307.p387 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P387-P387 ◽

Cited By ~ 1

Author(s):

A. Ungar ◽

G. Rieger ◽

T. West ◽

H. Purerfellner ◽

J. Bucx ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Rhythm ◽

Cryptogenic Stroke ◽

Implantable Loop Recorder ◽

Stroke Patients ◽

Loop Recorder ◽

Treatment Changes ◽

Rhythm Monitoring

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Role of Outpatient Cardiac Rhythm Monitoring in Cryptogenic Stroke: A Systematic Review and Meta-Analysis

Pacing and Clinical Electrophysiology ◽

10.1111/pace.12688 ◽

2015 ◽

Vol 38 (10) ◽

pp. 1236-1245 ◽

Cited By ~ 25

Author(s):

MUHAMMAD R. AFZAL ◽

SAMPATH GUNDA ◽

SALMAN WAHEED ◽

NANDHINI SEHAR ◽

RYAN J. MAYBROOK ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Rhythm ◽

Meta Analysis ◽

Cryptogenic Stroke ◽

Rhythm Monitoring

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Wearing Your Heart on Your Sleeve: the Future of Cardiac Rhythm Monitoring

Current Cardiology Reports ◽

10.1007/s11886-019-1223-8 ◽

2019 ◽

Vol 21 (12) ◽

Cited By ~ 4

Author(s):

Mostafa A. Al-Alusi ◽

Eric Ding ◽

David D. McManus ◽

Steven A. Lubitz

Keyword(s):

Cardiac Rhythm ◽

The Future ◽

Rhythm Monitoring

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Acceptability and Feasibility of a Mindfulness Intervention Delivered via Videoconferencing for People With Parkinson’s

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988720988901 ◽

2021 ◽

pp. 089198872098890

Author(s):

Angeliki Bogosian ◽

Catherine S. Hurt ◽

John V. Hindle ◽

Lance M. McCracken ◽

Debora A. Vasconcelos e Sa ◽

...

Keyword(s):

Quality Of Life ◽

Cost Effectiveness ◽

Qualitative Interviews ◽

Quality Adjusted Life Year ◽

Secondary Outcome ◽

Structured Interviews ◽

Potential Cost ◽

Mindfulness Intervention ◽

Related Quality

Mindfulness-based group therapy is a rapidly growing psychological approach that can potentially help people adjust to chronic illness and manage unpleasant symptoms. Emerging evidence suggests that mindfulness-based interventions may benefit people with Parkinson’s. The objective of the paper is to examine the appropriateness, feasibility, and potential cost-effectiveness of an online mindfulness intervention, designed to reduce anxiety and depression for people with Parkinson’s. We conducted a feasibility randomized control trial and qualitative interviews. Anxiety, depression, pain, insomnia, fatigue, impact on daily activities and health-related quality of life were measured at baseline, 4, 8, and 20 weeks. Semi-structured interviews were conducted at the end of the intervention. Participants were randomized to the Skype delivered mindfulness group (n = 30) or wait-list (n = 30). Participants in the mindfulness group were also given a mindfulness manual and a CD with mindfulness meditations. The intervention did not show any significant effects in the primary or secondary outcome measures. However, there was a significant increase in the quality of life measure. The incremental cost-effectiveness ratio was estimated to be £27,107 per Quality-Adjusted Life Year gained. Also, the qualitative study showed that mindfulness is a suitable and acceptable intervention. It appears feasible to run a trial delivering mindfulness through Skype, and people with Parkinson’s found the sessions acceptable and helpful.

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Potential cost-effectiveness of therapeutic drug monitoring in patients with resistant hypertension

Journal of Hypertension ◽

10.1097/hjh.0000000000000346 ◽

2014 ◽

Vol 32 (12) ◽

pp. 2411-2421 ◽

Cited By ~ 31

Author(s):

Oliver Chung ◽

Wanpen Vongpatanasin ◽

Klaus Bonaventura ◽

Yair Lotan ◽

Christian Sohns ◽

...

Keyword(s):

Cost Effectiveness ◽

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Resistant Hypertension ◽

Therapeutic Drug ◽

Potential Cost

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Cost Effectiveness of a Home-Based Intervention That Helps Functionally Vulnerable Older Adults Age in Place at Home

Journal of Aging Research ◽

10.1155/2012/680265 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 25

Author(s):

Eric Jutkowitz ◽

Laura N. Gitlin ◽

Laura T. Pizzi ◽

Edward Lee ◽

Marie P. Dennis

Keyword(s):

Cost Effectiveness ◽

Community Dwelling ◽

Sensitivity Analyses ◽

Model Parameters ◽

Potential Cost ◽

Functional Difficulties ◽

Age In Place ◽

Home Based ◽

Occupational And Physical Therapy ◽

Home Based Intervention

Evaluating cost effectiveness of interventions for aging in place is essential for adoption in service settings. We present the cost effectiveness of Advancing Better Living for Elders (ABLE), previously shown in a randomized trial to reduce functional difficulties and mortality in 319 community-dwelling elders. ABLE involved occupational and physical therapy sessions and home modifications to address client-identified functional difficulties, performance goals, and home safety. Incremental cost-effectiveness ratio (ICER), expressed as additional cost to bring about one additional year of life, was calculated. Two models were then developed to account for potential cost differences in implementing ABLE. Probabilistic sensitivity analyses were conducted to account for variations in model parameters. By two years, there were 30 deaths (9: ABLE; 21: control). Additional costs for 1 additional year of life was $13,179 for Model 1 and $14,800 for Model 2. Investment in ABLE may be worthwhile depending on society's willingness to pay.

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