Abstract 4370730: Increased Evidence-Based Cardiovascular Post-Stroke Diagnostic Evaluation, Identification of Stroke Etiology and Cardiology and Neurology Collaboration: Durable Impact of the American Heart Association’s Getting to the Heart of Stroke ^TM Initiative

Abstract

Background: Nearly one million individuals in the U.S. experience acute ischemic stroke (AIS) annually and one-year recurrent stroke risk may exceed 10%. American Heart Association (AHA) Get-With-The-Guidelines-Stroke® Registry (GWTG-S) data suggest that up to 40% of AIS patients are discharged with an undocumented or cryptogenic etiology which may lead to suboptimal secondary prevention. Consequently, evidence-based post-stroke evaluation and improved cardiology and neurology collaboration may help identify stroke etiology, reduce recurrent stroke risk, and improve outcomes. Hypothesis: Implementing an evidence-based post-stroke diagnostic evaluation that enhances cardiology and neurology collaboration will improve the identification of stroke etiology. Methods: In 2022, the AHA, in collaboration with HCA Healthcare and HCA Healthcare Foundation, designed and launched Getting to the Heart Of Stroke TM (GTTHOS) in 10 HCA Healthcare comprehensive stroke centers to improve: 1) cardiology and neurology stroke care collaboration, 2) evidence-based post-stroke diagnostic evaluation and 3) assessment of social determinants of health and barriers to care. Components included a learning collaborative model, virtual performance improvement consultations, Plan-Do-Study-Acts, multidisciplinary teams, custom and existing GWTG-S metrics, and performance improvement feedback. Results compare 2022 (pre-initiative; baseline; N=4,981) to 2024 (initiative 2 nd year; follow-up; N=3,831). Results: Using existing and custom GWTG-S data, GTTHOS centers increased rates of documented stroke etiology (63.04% vs. 48.62%), while decreasing cryptogenic stroke rates (31.51% vs. 34.89%) and lack of a documented stroke etiology (5.46% vs. 16.48%) (all comparisons on discharge, follow-up vs. baseline, p<0.0001). The use of evidence-based post-stroke diagnostic evaluation increased and was sustained in GTTHOS centers, including intracranial vascular and carotid imaging, echocardiography, short-term and extended (surface, implantable) cardiac monitoring (Table). Conclusion: In this novel AHA GTTHOS initiative in patients with AIS, which includes improved cardiology and neurology collaboration, rates of identified stroke etiology increased, while cryptogenic stroke and lack of a documented stroke etiology decreased. Furthermore, evidence-based post-stroke diagnostic evaluation, including imaging, echocardiography and short- and long-term surface and implantable cardiac monitoring, increased.