Objective:

To assess the utilization of Viz in the workflow of inpatient implantable loop recorder (ILR) referrals. 

Background:

Cryptogenic strokes are 25 to 30% of all ischemic strokes. Meta-analysis shows that atrial fibrillation(Afib) was detected in 24% of embolic strokes of undetermined source. The conventional monitoring pathway of external cardiac monitors followed by ILR causes lapses in monitoring due to many factors. Viz Connect is a new module in the Viz.ai application, with the potential to facilitate inpatient stroke workflow. 

Design/Methods:

Viz Connect was approved by our institution’s Chief Medical Information Officer and launched for a pilot term for inpatient ILR referrals. Data was collected in two cohorts: 6 months before (Nov 2021 to April 2022) and after (May to Oct 2022) the launch and compared using Fisher’s exact test. 

Results:

After the launch, among the inpatient cardiac monitor referrals and placements, the rate of ILR referrals increased from 3.6 % to 43.4 % (p < 0.00005), and the rate of ILR placements increased from 3.7 % to 23.2 % (p= 0.029). Among the inpatient and outpatient ILR referrals and placements, the rate of inpatient ILR referrals and placements significantly increased as well (p<0.005). Overall, in the yearlong study period, 14 patients were detected with Afib, of which 8 were detected on ILR and started on anticoagulation. The average time to detect Afib on external cardiac monitors and ILRs was 32.3 days. 

Conclusions:

After Viz Connect implementation, a significant increase in the rate of inpatient ILR referrals and placements was noted. The average time to detect Afib falls outside the typical 30 days monitoring range of external cardiac monitors but falls within the monitoring time range of ILRs. Using technology to streamline the inpatient ILR referral process for cryptogenic stroke patients is beneficial in identifying the appropriate stroke mechanism and secondary stroke prevention.