Heart Brain Clinic: An Integrated Approach to Stroke Care

Muhammad Bilal Tariq; Syed Kalimullah S Qadri; Anjail Sharrief; Kathleen Tulod; Abhijeet Dhoble; Sidhanta Gurung; Maria Jamilla Lacap; Munachi Okpala; Bharti Manwani; Richard W Smalling; Nicole Gonzales

doi:10.1212/CPJ.0000000000200206

Heart Brain Clinic: An Integrated Approach to Stroke Care

Neurol Clin Pract. 2023 Dec;13(6):e200206. doi: 10.1212/CPJ.0000000000200206. Epub 2023 Nov 6.

Affiliation

¹ Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus.

PMID: 38495079
PMCID: PMC10942000 (available on 2024-12-01)
DOI: 10.1212/CPJ.0000000000200206

Abstract

Background and objectives: Multidisciplinary clinics have been shown to improve care. Patients with patent foramen ovale (PFO)-associated stroke need evaluation by cardiology and neurology specialists. We report our experience creating a multidisciplinary Structural Heart Brain Clinic (HBC) with a focus on patients with PFO-associated stroke.

Methods: Demographic and clinical data were retrospectively collected for patients with PFO-associated ischemic stroke. Patients with PFO-associated stroke were divided into a standard care group and Heart Brain Clinic group for analysis. Outcome measures included time from stroke to PFO closure and number of clinic visits before decision regarding closure. Nonparametric analysis evaluated differences in median time to visit and clinical decision, while the chi square analysis compared differences in categorical variables between groups.

Results: From February 2017 to December 2021, 120 patients were evaluated for PFO-associated stroke. The Structural HBC began in 12/2018 with coordination between Departments of Neurology and Cardiology. For this analysis, 41 patients were considered in the standard care group and 79 patients in the HBC group. During data analysis, 107 patients had received recommendations about PFO closure. HBC patients required fewer clinic visits (p = 0.001) before decision about closure; however, among patients who underwent PFO closure, there was no significant difference in weeks from stroke to PFO closure. Clinicians were more likely to recommend against PFO closure among patients seen in HBC compared with those seen in standard care (p = 0.021).

Discussion: Our data demonstrate that a multidisciplinary, patient-centered approach to management of patients with PFO-associated ischemic stroke is feasible and may improve the quality of care in this younger patient population. The difference in recommendation to not pursue PFO closure between groups may reflect selection and referral bias. Additional work is needed to determine whether this approach improves other aspects of care and outcomes.