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Post-Cryptogenic Stroke Pathway

Early detection of post-stroke AF with comprehensive monitoring program

AF patients are at 5x greater risk for stroke1

Detect silent atrial fibrillation (AF) in your cryptogenic stroke patients quicker to lower the risk of a second stroke by using MCOT® (Mobile Cardiac Outpatient Telemetry) technology through our comprehensive monitoring program that provides a simple, noninvasive, outpatient solution that will elevate the standard of care you can offer your patients and streamline the workflow for the practice.

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Benefits
Lower cost of care2
Capture AF more quickly1
Reduce risk of second stroke2

100 %

Proven to detect AF with 100% sensitivity and 100% positive predictivity in the detection of
≥30-second AF episodes. 3

5x better

Proven to be more than five times better at diagnosing post-stroke AF than the ILR after 21 days of monitoring1

8x lower

Almost 8 times lower costs were achieved with improved detection rates and reduction of secondary stroke risk due to new anticoagulant use in subjects with MCOT patch detected AF.2
Philips BioTel Heart comprehensive monitoring program enables your organization to meet the AHA/ASA Guidelines which suggest that for patients who have had an acute ischemic stroke or TIA with no other apparent cause, prolonged AF monitoring (~30 days) is reasonable within 6 months of the event.4

Philips BioTel Heart Post-Crypotgenic Stroke Pathway

Detection of AF in post-cryptogenic stroke patient with a diagnosis of Cerebral Infarction, unspecified.

Female, 65 years old
Diagnosis: Cerebral Infarction, unspecified

Findings: Urgent - New onset atrial fibrillation/flutte

HR: 80

Automatic recording/
no symptoms

Comments: Verbal Notification

Clinical Resources
ORIGINAL RESEARCH

Mobile Cardiac Outpatient Telemetry patch vs Implantable Loop Recorder in cryptogenic stroke patients in the US – cost-minimization model

Authors
Goran Medic,¹,² Nikos Kotsopoulos,³ Mark P Connolly,²,³ Jennifer Lavelle,⁴ Vincent Norlock,⁴ Manish Wadhwa,⁴ Belinda A Mohr,⁵ Wayne M Derkac⁴

¹Chief Medical Office, Philips Healthcare, Eindhoven, Netherlands; ²Department of Pharmacy, University of Groningen, Groningen, ³ Netherlands; Global Market Access Solutions LLC, Charlotte, NC, USA; ⁴BioTelemetry, Inc., A Philips Company, Malvern, PA, USA; ⁵Chief Medical Office, Philips, Cambridge, MA, USA
Source
Med Devices (Auckl). 2021;14:445-458 https://doi.org/10.2147/MDER.S337142
Study Results
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. An initial strategy of 30-day electrocardiogram (ECG) monitoring with MCOT patch in diagnosis of AF in cryptogenic stroke patients realizes significant cost-savings compared to proceeding directly to ILR only.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. In the base case modeling, the MCOT patch arm detected 4.6 more patients with AFs compared to the ILR alone arm in a cohort of 1000 patients (209 vs 45 patients with detected AFs, respectively).
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. Using MCOT patch followed by ILR in half of the patients initially undiagnosed with AF leads to significant cost savings of US$4,083,214 compared to ILR alone in a cohort of 1000 patients.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. Cost per patient with detected AF was significantly lower in the MCOT patch arm $29,598 vs $228,507 in the ILR only arm.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. Almost 8 times lower costs were achieved with improved detection rates and reduction of secondary stroke risk due to new anticoagulant use in subjects with MCOT patch detected AF.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. These results strengthen emerging recommendations for prolonged ECG monitoring in secondary stroke prevention.
MCOT

Atrial fibrillation detected by Mobile Cardiac Outpatient Telemetry (MCOT) in cryptogenic TIA or stroke

Authors
A.H Tayal, MD; M. Tian, RN; K.M Kelly, MD, PhD; S.C. Jones, PhD; D.G.Wright, MD; D. Singh, MD; J. Jarouse, CRNP; J. Brillman, MD; S. Murali, MD; R. Gupta, MD
Source
Neurology®
Volume 71, Number 21, November 2008
Study Results
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. 68 patients in a single center study —retrospective analysis of patients who underwent a 21 day MCOT.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. AF was detected in 13/56 patients = 23%.
  • 5.3% of patients had runs of AF >30 seconds in duration.
  • 85% of patients had runs of AF <30 seconds in duration.
From the *Department of Neurology, Mayo Clinic, Rochester, MN; †Department of biomedical Statistics, May Clinic, Rochester, MN; ‡Department of Neurology, Boston University, Boston, MA, §Department of Neurology, National University of Singapore, Singapore, Singapore; ||Department of Neurology, Cleveland Clinic, Cleveland, OH; ¶Department of Radiology, Mayo Clinic, Rochester, MN
ATRIAL FIBRILLATION IN CRYPTOGENIC STROKE

Outpatient cardiac telemetry detects a high rate of atrial fibrillation in cryptogenic stroke

Authors
Daniel J. Milleraa, Muhib A. Khana, Lonni R. Schultza, Jennifer R. Simpsonb, Angelos M. Katramadosa, Andrew N. Russmana, Panayiotis D. Mitsiasa
aHenry Ford Hospital, Detroit, MI, United States, bUniversity of Colorado, Denver, CO, United States
Source
Journal of the Neurological Sciences 324 (2013), p. 57-61 https://www.ahajournals.org/ doi/10.1161/str.43.suppl_1.A150
Study Results
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. Retrospective analysis of all MCOT records for a period of 18 months (June 2009-January 2011) prescribed by Neurologists at a single Stroke Center.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. AF detected in 27 of 156 patients = 17.3%.
  • Two-thirds (n=18) developed episodes of PAF lasting less than 30 seconds.
  • 26% (n=7) lasting equal to or greater than 30 seconds.
  • 7% (n=2) had persistent AF.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. Mean time to first occurrence of AF was 8.8 days.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. Rate of PAF detection significantly increased from:
  • 3.9% in the initial 48 hours to
  • 9.2% at 7 days,
  • 15.1% at 14 days, and
  • 19.5% by 21 days
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. MCOT provides a high rate of detection of AF in patients with cryptogenic stroke or TIA, and length of monitoring time is strongly associated with an increase in detection rate.
UNIVERSITY OF PENNSYLVANIA STUDY

Predictors of finding occult atrial fibrillation after cryptogenic stroke

Authors
Christopher G. Favilla, MD*; Erin Ingala, MD*; Jenny Jara, BA; Emily Fessler, BA; Brett Cucchiara, MD; Steven R. Messé, MD; Michael T. Mullen, MD; Allyson Prasad, CRNP; James Siegler, MD; Mathew D. Hutchinson, MD; Scott E. Kasner, MD. From the Department of Neurology and Division of Cardiology at University of Pennsylvania .
*Drs. Favilla and Ingala contibuted equally
Source
stroke. 2015;46:1210-1215. DOI:10.1161/STROKEAHA.114.007763. https://www.ahajournals.org/ doi/10.1161/STROKEAHA.114.007763
Study Results
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. 28-day MCOT detected AF in a substantial proportion (14%) of cryptogenic stroke patients.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. 250 patients in a single center study - retrospective analysis of patients who underwent a 28 day MCOT.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. 84% (26 patients) were anticoagulated regardless of AF episode duration. All patients without bleeding history were offered anticoagulation regardless of duration of AF.
CASE-CONTROL STUDY

Paroxysmal atrial fibrillation in cryptogenic stroke

Authors
Alejandro A. Rabenstein, MD,* Jennifer E. Fugate, DO,* Jay Mandrekar, PhD,† Joseph D. Burns, MD,*‡ Raymond C.S. Seet, MD,*§ Stefan A. Dupont, MD,* || Timothy J. Kauffman, MD,¶ Samuel J. Asirvatham, MD,** and Paul A. Friedman, MD**

From the *Department of Neurology, Mayo Clinic, Rochester, MN; †Department of biomedical Statistics, May Clinic, Rochester, MN; ‡Department of Neurology, Boston University, Boston, MA, §Department of Neurology, National University of Singapore, Singapore, Singapore; ||Department of Neurology, Cleveland Clinic, Cleveland, OH; ¶Department of Radiology, Mayo Clinic, Rochester, MN
Source
Journal of Stroke and Cerebrovascular Diseases, 2013
Study Results
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. 128 patients enrolled within 3 months of suffering first stroke.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. Paroxysmal Atrial Fibrillation (PAF) of any duration detected in 25% of total patients with MCOT monitoring.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. ALL episodes were asymptomatic.
  • MCOT. – . n o i t n e v r e t n i t n e m t a e r t d e r i u q e r s t n e i t a p f o % 4 3 – , s n o i t a l b a 4 , s r e k a m e c a p 5 ( e r u d e c o r p l a c i g r u s d e r i u q e r % 2 1 2 ICD implants). – 1/3 of all patients had prior testing with an event or Holter. • and management of patients with suspected arrhythmias. Nearly 20% of all patients (1 in 5) had AF detected in < 30 second episodes.

Frequently Asked Questions

For Patients

Multiple studies have demonstrated that asymptomatic atrial fibrillation commonly occurs in patients following cryptogenic stroke. ECG monitoring plays an important role in the follow-up, as it can help your physician identify if you are at higher risk of a second stroke or requiring antiarrhythmic drug (AAD) therapy.

An estimated 3 million Americans suffer from Atrial Fibrillation (AFib). AFib is an irregular heartbeat, usually fast, caused when the top chambers of the heart quiver erratically. AFib can have a significant negative impact on your quality of life, causing heart palpitations, chronic fatigue, and debilitating pain. Untreated AFib also increases the risk of stroke five-fold.

If you were given a device kit at your physician’s office you should complete the set-up process within 24 hours. If your physician arranged to have you receive your device at home, compete the set-up process the same day. Complete instructions are located in your monitoring kit.

Yes, follow your normal daily routine as directed by your physician

Charges are incurred when you begin monitoring. During or after your service, your insurance company will send you an Explanation of Benefits (EOB). An EOB from your insurance carrier is NOT a bill. For details regarding the specifics of your plan, please contact your insurance company.

References:
1 Sposato LA, Cipriano LE, Saposnik G, et al. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. The Lancet Neurology. 2015;14:377–387
2 Medic G, Kotsopoulos N, Connolly MP, Lavelle J, Norlock V, Wadhwa M, Mohr BA, Derkac WM. Mobile Cardiac Outpatient Telemetry Patch vs Implantable Loop Recorder in Cryptogenic Stroke Patients in the US – Cost-Minimization Model. Med Devices (Auckl). 2021;14:445-458. https://doi.org/10.2147/MDER.S337142
3 Based on MIT-BIH (Massachusetts Institute of Technology-Beth Israel Hospital) Arrhythmia Database testing of ≥30-second AF episodes. (FDA 510k submission)
4 Kernan, WN, et al. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. STROKE. July, 2014; p.5.

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