HCPs in Discussion

CRYPTOGENIC STROKE PATHWAY PLANNING GUIDE

Multidisciplinary collaboration for cryptogenic stroke care

WHAT IS A CRYPTOGENIC STROKE PATHWAY?

A Cryptogenic Stroke Pathway is a consistent approach to a follow-up plan and transition of care for patients with a stroke of unknown source. This implementation guide is intended to extend your acute stroke protocol to include a monitoring plan for cryptogenic stroke patients. It includes monitoring for AF with the best monitoring mechanisms available to optimise outcomes.

Why Establish a Cryptogenic Stroke Pathway?

After initial stroke discharge, many patients are not receiving any additional cardiac monitoring. Establishing a monitoring pathway to detect and treat AF can significantly reduce a patient’s risk for another stroke. The ability to identify AF in patients with cryptogenic stroke has profound implications for long-term medical management.

Crystal AF Chart 123

Ensure a Standard of Care

Many cryptogenic stroke patients are lost to follow-up. Pathways for transition of care and follow-up help to ensure these patients receive better care.

A Cryptogenic Stroke Pathway allows all healthcare professionals involved in the continuum to ensure a standard of care. Through this pathway, hospitals can:

  • Provide underserved patient population a better risk reduction strategy to prevent a secondary stroke
  • Establish cross-functional healthcare professional relationships to ensure integrated care delivery
  • Ensure multidisciplinary stroke care involving both neurological and cardiovascular care
  • Enhance hospital reputation in providing exemplary stroke care

CRYPTOGENIC STROKE PATHWAY PLANNING

Stroke Pathway Steps 1-2

Stroke Pathway Steps 3-4


THINGS TO CONSIDER

INVOLVE ALL STAKEHOLDERS

When developing the Cryptogenic Stroke Pathway, it is important to involve all stakeholders involved in the care of the patient.

Stroke Pathway Multidisciplinary Team

KEY CONSIDERATIONS

Foundational Considerations

  • Who will champion this effort?
  • How is cryptogenic stroke defined at your hospital?
  • You have an acute stroke protocol, but do you have a cryptogenic stroke pathway in place?
  • Once a patient is deemed cryptogenic, what is the multidisciplinary pathway, transition of care, and follow-up plan in place for that patient?

Execution of Cryptogenic Stroke Pathway

  • Do you have the infrastructure and staff in place to support the implementation?
  • What else needs to be developed to support your plan?

Metrics

  • Could this be a quality or process improvement project for your hospital?
  • What will you measure in your pathway?
  • What is your definition of success?

CHECKLIST FOR SUCCESS

Physician Champion and Multidisciplinary Buy-In

  • Ideal to have both neurology and cardiology champions
  • Ongoing communication among all specialties involved in the stroke care of the patient.
    • It is essential to establish patient ownership, coordination of care, and a transition of care plan
  • The cardiac monitoring plan must be very clear at the onset and consistent throughout the continuum
    • Ensures patients are not lost to follow-up and all parties are aware of where the patient is within the continuum

Ongoing Education of All Stakeholders

Patient/Caregivers

  • Tell the patient/caregivers about the cardiac monitoring plan and why it is important to look for AF after a cryptogenic stroke
  • Designate nurse responsible for patient education throughout the care continuum (bedside nurse, nurse educator, nurse navigator, etc.)

Healthcare Professional Team

  • Identify and educate whole care team on Cryptogenic Stroke Pathway (including hospitalists, nurses, fellows, PCPs, etc.)
  • Use in-services and existing educational vehicles at hospital for continued education
  • Develop Stroke Care Team Communication Plan
  • Communication is important prior to insertion, after insertion, when AF doesn’t/does occur, and prior to OAC initiation (if deemed necessary)
  • Consider EMR notification
  • Develop feedback loop
  • Hold monthly interdisciplinary “Workflow” assessment meetings involving inpatient and outpatient care to ensure standardisation of the process

Partner with Medtronic

  • Understand available resources to assist your team in planning and implementation
  • Learn best practices for utilising Reveal LINQ™ ICM for cryptogenic stroke

CRYPTOGENIC STROKE PATHWAY

Cryptogenic Stroke Pathway Algorithm

Medtronic Disclosure Statement: This pathway is provided for educational purposes and should not be considered the exclusive source for this type of information. It is the responsibility of the practitioner to exercise independent clinical judgment.

Refer to the brief statement for indications, warnings/precautions, and complications for the Reveal LINQ ICM.


1

Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. September 1987;147(9):1561-1564.

2

Lin HJ, Kelly-Hayes M, Beiser AS, et al. Stroke Severity in Atrial Fibrillation: The Framingham Study. Stroke. 1996; 27: 1760-1764.

3

Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation. August 1991;84(2):527-539.