PO-03-177 IMPLEMENTATION OF A MULTIDISCIPLINARY, EVIDENCE-BASED ALGORITHM FOR MANAGEMENT OF EMBOLIC STROKE OF UNDETERMINED SOURCE: A SINGLE CENTER EXPERIENCE

Embolic stroke of undetermined source (ESUS) is a poorly understood subtype. The recent secondary prevention guidelines provide new clarity properly defining, evaluating, and treating this In particular, appropriate selection patients requiring additional evaluation by TEE or extended cardiac rhythm monitoring via implantable loop recorder (ILR) was emphasized to improve diagnostic yield resource utilization. We aimed quality efficiency care for with ESUS hospitalized at Baylor University Medical Center, Dallas, Texas, through creating multidisciplinary, evidence-based institutional algorithm. A database compiling baseline patient characteristics utilization tests using algorithm established. Herein, we present our initial experience. Multidisciplinary team including non-invasive cardiologists, electrophysiologists, neurologists, hematologist internal medicine hospitalists established an (Fig. 1) based on 2021 AHA/ASA Secondary Stroke Prevention Guidelines. subtype initially determined neurologist all diagnosed were evaluated electrophysiologist who appropriateness versus ILR. Baseline along results as part the 109 between May 2022 September included in analysis. cohort are found Table 1. Of patients, 62 (56.9%) underwent TEE. Diagnostic those 5 (4.6%) embolus detected 19 (17%) evidence PFO. ILR implanted 70 (64.2%). Average time from index event implant 5.7 days 70% within days. An multi-disciplinary approach very effective ensuring consistent workup single center Our focuses maximize Serial metrics should be performed ensure safety efficacy management Larger sample size longer follow up needed establish impact system-based guideline implementation clinical outcomes.Tabled 1Algorithm Performance (n=109)Age59.9 ± 13.7TEE Performed62 (57%)Cardiac Source Embolus Discovered5 (5%)PFO Discovered19 (17%)DVT Discovered +PFO2 (11%)ILR Implanted70 (64%) Open table tab