Abstract TP428: Missed Opportunities for Secondary Stroke Prevention in Embolic Stroke of Undetermined Source Patients in a Community Stroke Unit Setting
Bibliographic record
Abstract
Recent post-hoc analyses of the NAVIGATE ESUS trial suggested a reduction in stroke recurrence with anticoagulation in a subset of embolic stroke of unknown source (ESUS) patients with left atrial enlargement (LAE>4.6 cm). In addition, the recent COMPASS trial demonstrated that anticoagulation using low-dose factor Xa inhibition reduces ischemic stroke in patients with clinically-apparent coronary artery (CAD) and peripheral artery disease (PAD). Currently, the rates of LAE, CAD and PAD among patients sent for prolonged cardiac monitoring and the impact of earlier screening in a community setting is unknown. We examined the prevalence of LAE and COMPASS eligibility in a prior stroke cohort who underwent prolonged cardiac monitoring (PROCAM) and identified gaps in antithrombotic therapy at the time of discharge. Patients admitted to the stroke unit with a suspected cardioembolic stroke/TIA and completed both 30-day cardiac monitoring and a transthoracic echocardiogram were offered participation in PROCAM within 30 days of stroke onset. A Spiderflash-T ECG or Northeast DR 200 monitoring device programmed for detecting AF was used. The primary outcomes were number of patients with ESUS, AF, LAE and COMPASS eligibility. Antithrombotic therapy at the time of discharge was also assessed. Among 296 patients referred for prolonged cardiac monitoring with a mean (SEM) age of 69 (0.8) and left atrial diameter of 3.6 cm (0.04), 131 patients (44%) were considered to have ESUS at the time of discharge. Among those ESUS patients, 10 patients (7.6%) had moderate to severe LAE (>4.6 cm), comparable rates to those observed in NAVIGATE ESUS. Additionally, 13 ESUS patients (9.9%) met COMPASS eligibility criteria and 16 (12.2%) were found to have AF following 30-day cardiac monitoring. 33 patients with ESUS (25.2%) were found to have either LAE, COMPASS criteria or AF following 30-day cardiac monitoring and were discharged on antiplatelet therapy. In conclusion, this research provides insight into the necessity of comprehensive stroke work-up for heterogeneous ESUS patients, with particular consideration to 30-day cardiac monitoring, LAE and COMPASS criteria, given that 25% of ESUS patients in our community-based cohort may benefit from anticoagulation therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".