Cryptogenic Stroke And suspected atrial fibrillation
Latest Evidence and Guidance for Diagnosing Atrial Fibrillation in Cryptogenic Stroke Patients.
ATRIAL FIBRILLATION IS THE SINGLE MOST POWERFUL PREDICTOR OF STROKE1
- Up to 30% of patients with cryptogenic stroke may have previously undetected paroxysmal AF.2
- There is a 5-fold increase in ischemic stroke risk for AF patients.3
- 2 x more likely for AF-related ischemic stroke to be fatal than non-AF stroke.4
REVEAL LINQ™ INSERTABLE CARDIAC MONITOR IS THE ONLY ICM TO HAVE SUFFICIENT EVIDENCE TO BE RECOMMENDED BY NICE DIAGNOSTICS GUIDANCE 415
Reveal LINQ™ is recommended as an option to help detect atrial fibrillation after cryptogenic stroke, including transient ischaemic attacks (TIA), only if:
- non-invasive electrocardiogram (ECG) monitoring has been done and
- a cardiac arrhythmic cause of stroke is still suspected6.
REVEAL LINQ™ IS LIKELY TO BE A COST-EFFECTIVE USE OF NHS RESOURCES
- When compared to conventional follow-up, Reveal LINQ™ was found to have an ICER of £10,342 (Threshold for NICE DG 41 recommendation is less than £20,000)6.
- FOCUSON™ monitoring & triaging service was also determined to be a cost- effective use of NHS resources6.
Read the full guidance: Visit the NICE website.
THE ECONOMIC MODEL USED BY NICE DG41 ESTIMATES THAT THE NUMBER OF STROKES THAT COULD BE AVOIDED BY USING AN ICM IS 52 per 1,000 people with cryptogenic stroke6
ESC 2016 ATRIAL FIBRILLATION GUIDELINES
Additional ECG monitoring by long-term non-invasive ECG monitors or ICMs should be considered to document silent AF and prevent secondary stroke.10
In a known AF patient population. % Full-time Employee 100 Patient Clinic, 40 hours per week, 44 weeks/year.
Direct and indirect cost of stroke over 5 years6, 7
| AREA OF SPEND | COST |
|---|---|
|
Acute Stroke: |
£14,522 (Year 1)6 |
|
Mean social care costs attributable to stroke in the first year: |
£8,977 (Year 1)7 |
|
Chronic/post-stroke management per year: |
£4,514 (Year 2-5)6 |
|
Mean social care costs attributable to stroke per year: |
£4,775 (Year 2-5)7 |
|
Total = |
£60,655 |
NICE Cost Effectiveness Comparison8
| INTERVENTION | COST-EFFECTIVENESS (COST/QALY) MID-POINT |
|---|---|
|
ILR – Cryptogenic Stroke with FocusON (DG41) |
£12,934 |
|
ILR – Syncope |
£17,400 |
|
Cholesterol management |
£21,246 |
|
Cardiac Resynchronization Therapy |
£22,763 |
|
Hypertension medication (DBP >105 mmHg) |
£24,281 |
|
Dialysis in end-stage renal disease |
£60,702 |
LEARN MORE ABOUT THIS NEW GUIDANCE - WATCH THE RADCLIFFE CARDIOLOGY WEBINAR
This webinar discusses the implications for NHS healthcare systems and healthcare providers based on the NICE recommendations. Key opinion leaders in the field of stroke care share their perspectives on the new Diagnostic Guidance and explain how these recommendations should guide use of ICMs in the treatment of stroke patients.
Key learning objectives:
- What is the NICE Diagnostic Assessment Programme (DAP)?
- What evidence led to the recommendations?
- How to practically implement the guidance into your practice.
RADCLIFFE CARDIOLOGY WEBINAR Ensuring its value VALIDATED COST EFFECTIVENESS OF MEDTRONIC REVEAL LINQTM
Presented by: Dr Klaus Witte, Dr Matthew Reynolds, Dr Paul Guyler
learn more about the clinical impact of NICE DG41
Learn moreDISCOVER HOW MEDTRONIC DEVICES HELP YOU MEET YOUR GOALS
Learn moreReferences
1
Tsivgoulis G, et al. Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia. Stroke. Published online June 20, 2019. same as reference
2
Sanna T, et al. N Engl J Med. 2014;370:2478-2486.
3
Wolf PA, et al. Arch Intern Med. 1987;147:1561-1564.
4
Lin HJ, et al. Stroke. 1996; 27:1760-1764
5
Chew d, et al. Journal of the American College of Cardiology. 2020;75(11) 315
6
NICE Diagnostics Guidance 41: Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke. September 2020 © NICE 2020. View full guidance.
7
Xu X. et al "The economic burden of stroke care in England, Wales and Northern Ireland: Using a national stroke register to estimate and report patient-level health economic outcomes in stroke." European Stroke Journal 2018, Vol.3(1) 82-91 ©European Stroke Organisation 2017. DOI: 10.1177/2396987317746516
8
Diamantopoulos A, et al. Journal of Stroke. 2016: 0(0): 1-11.