Rehospitalization Occurrences, Duration, and Costs in Patients Monitored With Implantable Loop Recorders or Mobile Cardiac Outpatient Telemetry Post-Stroke

OBJECTIVES: Guidelines for secondary ischemic stroke (IS) prevention recommend long-term rhythm monitoring with mobile cardiac outpatient telemetry (MCOT), implantable loop recorder (ILR) or other approaches to detect atrial fibrillation, which remains a common, high-risk condition. Differences between ILR and MCOT, including arrhythmia duration requirements, may influence detection and impact care. Our objective was to compare hospital utilization and costs associated with either technology in patients post-IS.

METHODS: Using Optum's de-identified Clinformatics® Data Mart Database, we retrieved data on patients admitted for IS (2017-2020), who received ILR or MCOT within 30 days post-discharge. Over 18 months post-IS, we compared readmission occurrences and hospital days, both by acuity and cause, and rehospitalization costs. Initial IS hospitalization severity subgroups were separately analyzed. Groups were propensity balanced and means regression adjusted.

RESULTS: Among 2,244 patients (1,122 per group), MCOT patients experienced significantly fewer readmissions (59.8 vs 70.3 per 100 patients; Δ10.5[1.3–20.0]), including emergency (Δ9.2[2.3–17.0]); and fewer average hospital days (3.5 vs 4.8, Δ1.3[0.6–2.2]). For recurrent IS, the MCOT group had fewer readmissions (8.6 vs 15.4 per 100 patients; Δ6.8[3.9–11.3]). Average rehospitalization costs (USD) were lower for MCOT patients ($17,566 vs $20,920; Δ$3,354[$941–$6,654]).

Considering initial IS hospitalization severity, MCOT patients had fewer readmissions among patients with complications or comorbidities (CC) Δ12.6[0.8–25.8]; and with major CC (72.4 vs 98.4; Δ26.0[0.5–52.5], including for recurrent IS (8.2 vs 18.9; Δ10.8[0.2–22.1); and non-significant differences among patients without CC (Δ0.2[-15.0–14.7]). Rehospitalization cost differences were only significant among patients with CC (MCOT $17,398, ILR $22,631; Δ$5,233[$33–$9,002]).

CONCLUSIONS: Significant hospital utilization and costs differences were associated with the rhythm monitor chosen post-IS. MCOT monitored patients experienced less readmissions, hospital days, and costs than ILR monitored patients, with consistently significant, more notable differences in patients with CC.