DiVERT Stroke Study Shows Differences in Poststroke Workflow Protocols and Cardiac Monitoring

October 28, 2022—Medtronic announced first results from the DiVERT Stroke clinical study, which showed that poststroke workflow protocols and cardiac monitoring vary significantly across community hospitals and academic centers.

According to the company, the objective of the study is to identify workflow deficiencies in phase I and address those workflow deficiencies in phases II and III. Poststroke care pathways were assessed using stakeholder interviews while patient data were collected using electronic medical records. Statistical analyses were exploratory only. The multicenter study evaluated > 7,600 cryptogenic, large-artery, and small-vessel stroke patients across 12 hospitals in the United States.

The data were presented at the 14th World Stroke Congress held October 26-29 in Singapore.

Medtronic stated that the investigators found that > 75% of cryptogenic stroke patients at large academic centers received some form of cardiac monitoring (ie, external cardiac monitor, implantable loop recorders) versus 5% of cryptogenic stroke patients at community hospitals. The investigators also found that academic centers were twice as likely to consult cardiology than community hospitals (34% vs 16%; P < .001).

Medtronic outlined the following additional findings from the study:

• Community hospitals were more likely to diagnose cryptogenic stroke (93.2%) than large-artery (5.4%) or small-vessel (1.4%) stroke while academic centers diagnosed stroke subtypes evenly (32.1%, 37.0%, and 29.9%, respectively).
• 65.5% of patients from academic centers who received cardiac monitoring poststroke received short-term monitoring while 10.5% received long-term monitoring.
• Community hospitals were less likely to order short-term (1%) and/or long-term (4.3%) monitoring in their patients.
• Patient attrition was higher in academic centers than in community hospitals (54.2% vs 45.2%; P < .001).
• The 6-month recurrent stroke rate was similar in both groups (9.1% in academic centers vs 7.4% in community centers; P = .115).

The company further advised that multiple clinical studies have shown that cryptogenic stroke patients are at high risk of atrial fibrillation (AF) poststroke, and for many stroke patients, it could take > 80 days for AF to appear, reinforcing the importance of long-term, continuous monitoring. Long-term cardiac monitoring, compared to conventional cardiac monitoring, leads to increased incidence of AF detection, increased incidence of anticoagulation initiation, and 55% decreased risk of recurrent stroke.

“Our findings from phase I of DiVERT underscore the need for stronger, standardized care pathways in both academic and community centers to ensure that stroke patients receive guideline-directed therapy,” commented David Z. Rose, MD. “We all need to do a better job detecting hidden AF in these patients because treatment will change—starting anticoagulation prevents recurrent stroke.”

Dr. Rose, who is Associate Professor of Vascular Neurology at University of South Florida Morsani College of Medicine at Tampa General Hospital in Tampa, Florida, added, “Phase II of the study will address these workflow deficiencies in a standardized poststroke protocol for anyone to use at any stroke-capable hospital. While this protocol may not be the ultimate answer, it’s a much-needed first step.”