Comparing the outcomes and costs of cardiac monitoring with implantable loop recorders and mobile cardiac outpatient telemetry following stroke using real-world evidence
Summary
Aim: Patients with ischemic stroke (IS) commonly undergo monitoring to identify atrial fibrillation with mobile cardiac outpatient telemetry (MCOT) or implantable loop recorders (ILRs). The authors compared readmission, healthcare cost and survival in patients monitored post-stroke with either MCOT or ILR. Materials & methods: The authors used claims data from Optum’s de-identified Clinformatics® Data Mart Database to identify patients with IS hospitalized from January 2017 to December 2020 who were prescribed ambulatory cardiac monitoring via MCOT or ILR. They compared the costs associated with the initial inpatient visit as well as the rate and causes of readmission, survival and healthcare costs over the following 18 months. Datasets were balanced using patient baseline and hospitalization characteristics. Multivariable generalized linear gamma regression was used for cost comparisons. Cox proportional hazard regression was used for survival and readmission analysis. Sub-cohorts were analyzed based on the severity of the index IS. Results: In 2244 patients, readmissions were significantly lower in the MCOT monitored group (30.2%) compared with the ILR group (35.4%) (hazard ratio [HR] 1.23; 95% CI: 1.04–1.46). Average cost over 18 months starting with the index IS was $27,429 (USD) lower in the MCOT group (95% CI: $22,353–$32,633). Survival difference bordered on statistical significance and trended to lower mortality in MCOT (8.9%) versus ILR (11.3%) (HR 1.30; 95% CI: 1:00–1.69), led by significance in patients with complications or comorbidities with the index event (MCOT 7.5%, ILR 11.5%; HR 1.62; 95% CI: 1.11–2.36). Conclusion: The use of MCOT versus ILR as the primary monitor following IS was associated with significant decreases in readmission, lower costs for the initial IS and total care over the next 18 months, significantly lower mortality for patients with complications and comorbidities at the index stroke, and a trend toward improved survival across all patients.
Plain language summary
What is this study about?
This study compares the health and economic outcomes of using mobile cardiac outpatient telemetry (MCOT) and implantable loop recorders (ILRs) for long-term monitoring following an inpatient visit in patients who have had a stroke by analyzing Optum’s de-identified Clinformatics® Data Mart Database claims for hospital admissions between 2017 and 2020.
What were the main results of the claims analysis?
The use of MCOT as the primary arrhythmia monitor following an initial stroke was associated with a decreased rate of readmissions across all patients, along with reduced healthcare costs for both the index stroke event and for total cost of care incurred over the 18 months following the index event. A significant reduction in mortality was seen in patients who suffered complications and comorbidities with the index stroke, with a trend toward improved survival across all patients.
What do the results mean?
Significant differences in readmission and healthcare costs were associated with the choice of post-stroke ambulatory arrhythmia monitoring.