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Stroke Rehabilitation and Recovery / Acute Ischemic Stroke Management · Journal article
Heart Rhythm · July 1, 2026
Encouraging direction, but not yet definitive.
Implementation of Guideline-Oriented Neuro-Cardio Pathways significantly increased inpatient cardiology consultations, cardiac monitoring utilization (especially insertable cardiac monitors), anticoagulation prescribing, and reduced outpatient loss-to-follow-up in post-stroke patients. While the improvements in process metrics and pathway adherence are substantial, the lack of randomization, absence of long-term clinical outcomes, and unknown sample sizes limit the strength of evidence for patient-level benefit.
Multicenter, non-randomized, interventional cohort study (phase II implementation comparing retrospective phase I with prospective phase II). Patients with post-stroke presentation (cryptogenic, large-vessel disease, or small-vessel disease) in the inpatient hospital setting across multiple healthcare institutions.. Intervention: Guideline-Oriented Neuro-Cardio Pathways (GO-NCP) implemented for post-stroke cardiac monitoring in the inpatient hospital setting. Compared with: Pre-GO-NCP standard care (phase I retrospective cohort). Multicenter (specific number of centres and countries not stated).
Inpatient cardiology consultations increased from 14.9% to 54.4% (P <.001) after GO-NCP implementation Long-term insertable cardiac monitor use increased 4.5-fold (6.1% to 27.5%, P <.001) Overall cardiac monitoring increased from 24.9% to 32.8% (P =.002)
Long-term clinical outcomes (stroke recurrence, major bleeding, mortality) not reported
Clinicians and health systems should consider adopting standardized post-stroke cardiac monitoring pathways to improve consistency in cardiology consultation, monitoring modality selection, and anticoagulation prescribing. However, the lack of improvement in AF detection rate (despite increased monitoring) and absence of reported long-term clinical outcomes (stroke recurrence, bleeding, mortality) mean the ultimate clinical benefit for patients remains unproven.
A multicenter implementation study demonstrating consistent improvements in cardiac monitoring pathways post-stroke, with significant increases in consultation, monitoring, and anticoagulation, but non-randomized design and lack of long-term clinical outcomes limit strength of evidence.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and health systems should consider adopting standardized post-stroke cardiac monitoring pathways to improve consistency in cardiology consultation, monitoring modality selection, and anticoagulation prescribing. However, the lack of improvement in AF detection rate (despite increased monitoring) and absence of reported long-term clinical outcomes (stroke recurrence, bleeding, mortality) mean the ultimate clinical benefit for patients remains unproven.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
BACKGROUND: Inconsistent cardiac monitoring strategies to detect occult atrial fibrillation (AF) post-stroke were identified among various healthcare institutions in phase I of the DiVERT Stroke study. It is unknown whether Guideline-Oriented Neuro-Cardio Pathways (GO-NCP) may reduce this heterogeneity. OBJECTIVE: To assess whether a stroke care pathway in the inpatient hospital setting reduces inconsistency of cardiac monitoring post-stroke. METHODS: DiVERT-Stroke phase II was an interventional, non-randomized, multicenter cohort study designed to implement a post-stroke cardiac monitoring care pathway in the inpatient hospital setting. The retrospective phase I (pre-GO-NCP development) was compared with the prospective phase II (post-GO-NCP implementation) for patients with cryptogenic, large-vessel disease, or small-vessel disease. Metrics evaluated included rates of inpatient cardiology consultation, secondary prevention medication prescriptions, rate and type of post-stroke cardiac monitoring selected, AF detection, and outpatient "lost-to-follow-up" (LTFU). RESULTS: After GO-NCP implementation, significant increases were seen for inpatient cardiology consultations (phase I: 14.9%, phase II: 54.4%, P <.001) and cardiac monitoring (24.9% vs 32.8%, P =.002), with a 4.5-fold increase in long-term monitoring with insertable cardiac monitors (phase I: 6.1%, phase II: 27.5%, P <.001). AF detection rose from 7.2% to 9.2% (P =.489) and anticoagulation prescriptions increased from 13.9% to 21.6% (P <.001). GO-NCP resulted in significantly less LTFU in clinic (48.1% vs 3.0%; P <.001). CONCLUSION: Implementing a post-stroke GO-NCP significantly reduced previously identified inconsistent cardiac monitoring practices by increasing in-hospital cardiology consultations, antithrombotic prescriptions, and cardiac monitoring for AF, and significantly decreasing outpatient LTFU. CLINICAL TRIAL REGISTRATION: https://www.isrctn.com/ISRCTN43724416; Number: ISRCTN87407792.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.