Supplementary table: Comparing the outcomes and costs of cardiac monitoring with implantable loop recorders and mobile cardiac outpatient telemetry following stroke using real-world evidence

These are peer-reviewed supplementary materials for the article 'Comparing the outcomes and costs of cardiac monitoring with implantable loop recorders and mobile cardiac outpatient telemetry following stroke using real-world evidence.' published in the Journal of Comparative Effectiveness Research.Supplementary table A1: Balance DiagnosticsAim: Patients with ischemic stroke (IS) commonly undergo monitoring to identify atrial fibrillation with mobile cardiac outpatient telemetry (MCOT) or implantable loop recorders (ILRs). The authors compared readmission, healthcare cost and survival in patients monitored post-stroke with either MCOT or ILR. Materials & methods: The authors used claims data from Optum’s de-identified Clinformatics Data Mart Database to identify patients with IS hospitalized from January 2017 to December 2020 who were prescribed ambulatory cardiac monitoring via MCOT or ILR. They compared the costs associated with the initial inpatient visit as well as the rate and causes of readmission, survival and healthcare costs over the following 18 months. Datasets were balanced using patient baseline and hospitalization characteristics. Multivariable generalized linear gamma regression was used for cost comparisons. Cox proportional hazard regression was used for survival and readmission analysis. Sub-cohorts were analyzed based on the severity of the index IS. Results: In 2244 patients, readmissions were significantly lower in the MCOT monitored group (30.2%) compared with the ILR group (35.4%) (hazard ratio [HR] 1.23; 95% CI: 1.04–1.46). Average cost over 18 months starting with the index IS was $27,429 (USD) lower in the MCOT group (95% CI: $22,353–$32,633). Survival difference bordered on statistical significance and trended to lower mortality in MCOT (8.9%) versus ILR (11.3%) (HR 1.30; 95% CI: 1:00–1.69), led by significance in patients with complications or comorbidities with the index event (MCOT 7.5%, ILR 11.5%; HR 1.62; 95% CI: 1.11–2.36). Conclusion: The use of MCOT versus ILR as the primary monitor following IS was associated with significant decreases in readmission, lower costs for the initial IS and total care over the next 18 months, significantly lower mortality for patients with complications and comorbidities at the index stroke, and a trend toward improved survival across all patients.

本数据集为发表在《比较疗效研究杂志》上的文章《比较使用真实世界证据评估植入式环状记录器和移动心电监护在卒中后心脏监测的结局和成本》的同行评审补充材料。补充表A1：平衡诊断
目标：缺血性卒中（IS）患者常通过移动心电监护（MCOT）或植入式环状记录器（ILR）进行监测，以识别房颤。本研究作者比较了使用MCOT或ILR进行卒中后监测的患者再入院率、医疗保健成本和生存情况。研究方法：作者利用Optum匿名化 Clinformatics 数据库中的索赔数据，识别了2017年1月至2020年12月期间住院的IS患者，并接受了通过MCOT或ILR进行的门诊心脏监测。他们比较了首次住院访问的成本以及随后的18个月内再入院率、生存情况和医疗保健成本。数据集通过患者基线和住院特征进行平衡。使用多变量广义线性伽马回归进行成本比较。使用Cox比例风险回归进行生存和再入院分析。亚组分析基于首次IS的严重程度。结果：在2244名患者中，与ILR监测组（35.4%）相比，MCOT监测组的再入院率显著降低（30.2%）（风险比[HR] 1.23；95% CI：1.04–1.46）。从首次IS开始计算，18个月内的平均成本在MCOT组中比ILR组低27,429美元（USD）（95% CI：$22,353–$32,633）。生存差异接近统计学意义，且MCOT（8.9%）与ILR（11.3%）相比显示出较低的死亡率趋势（HR 1.30；95% CI：1.00–1.69），尤其是在有并发症或合并症的指数事件患者中，这一差异具有显著性（MCOT 7.5%，ILR 11.5%；HR 1.62；95% CI：1.11–2.36）。结论：与ILR相比，使用MCOT作为缺血性卒中后的主要监测手段，与显著降低再入院率、首次IS及随后的18个月总医疗成本相关，对于并发症和合并症的指数卒中患者，显著降低死亡率，并且所有患者生存率有提高的趋势。