b'PRACTICAL INNOVATIONChipping Away at AFib CardiometabolicDetection in Stroke Patients SolutionsPHYSICIAN LEADS THE TRIAL: Stroke of Knowna known cause of stroke couldPHYSICIAN LEADS THE TRIAL: Coordinate Diabetes than most in that its not studying Cause and Underlying Atrialalso have AFib as a contributingmedicine against a placebo and Fibrillation (STROKE AF) factor for current or futureTHE PROBLEM: More than 32comparing patient outcomes. Pramod P. Sethi, MDstrokes? The trial sent 492Bridgette million people in the U.S. haveInstead, the team is using unique Medical Director, THE PROBLEM: Many stroke people who had strokesevenChristopher, MD, PhD type 2 diabetes, and patientsteaching tools to help more Cone Health Stroke Center patients dont benefit from those with another known causeCardiologist with diabetes are twice as likelythan 30 patients in the study to James Allred, MDlong-term monitoring for Atrialof strokehome with a smallCristina Gherghe, MD to have heart disease as thoseunderstand the importance of Medical Director, Fibrillation (AFib), a fast and heart-monitor chip placed underEndocrinologist without diabetes. Although theguideline-directed medical therapy. Atrial Fibrillation Clinic, irregular heart rhythm that oftenthe skin. They found a muchNo. 1 cause of death in diabeticIts designed more for caregivers Cone Health Heart & leads to initial and subsequenthigher rate of AFibabout 10patients is cardiovascular disease,and focused around intensive strokes. When a link betweentimes higherin patients withthe link between the metaboliceducation, Dr. Christopher says. Vascular Center strokes and AFib is detected,strokes from known causes than32 disorders present in diabeticWe touch base with the patients doctors can prescribe strongerin the same kind of patients wherepatients and cardiac issues hasand see what the barriers are. Our blood thinners to help preventtraditional short-term monitoringmillion been tough to manage acrossgoal is to measure over the course 35% subsequent strokes, but unlesswas done in an office or hospital.medical disciplines. Many diabeticof a year our success rate, not just the presence of AFib is confirmed,patients have never seen ain getting patients on important OF STROKE PATIENTS those stronger medications arentTHE IMPACT: The teams findingsPEOPLE IN THE U.S.cardiologist. Wrangling a complexmedications but keeping them on. advised due to their increasedmean thousands of additionalset of cardiometabolic conditionsIn addition to studying WHO HAVE NO KNOWNbleeding risk and cost. Currentstroke patients each year willHAVE TYPE 2 DIABETES can be overwhelming for patientstechniques to help keep patients CAUSE HAVE SHOWNpractice is to long-term monitorreceive life-saving AFib-and a challenge for their primaryon medications, the trial is for AFib only in stroke patientsprevention medication. The and specialty care providers.monitoring patient outcomes, AFIB ACTIVITY who have no known cause of theirJournal of the American Medicalincluding whether they stay out of initial stroke. In these longer-termAssociation and Science magazineHOW THE COORDINATE the hospital. The multidisciplinary monitored cases, about 35% ofare among several publicationsDIABETES TRIAL HELPS: approach and focus on patients have shown AFib activity. to report on the study,Overseen by the LeBauer- communication have revealed thecoauthored with other leadingBrodie Center in partnershipbenefits of working together across HOW THE STROKE AF TRIALneurologists and cardiologistswith Duke Clinical Researchdisciplines instead of isolating the HELPED: The team wanted to from health systems includingInstitute (DCRI), the Coordinatetreatment of sugar-related issues see if AFib might be affectingMassachusetts General HospitalDiabetes trial is a bit differentand cardiovascular disease. stroke patients beyond those and Northwestern Universitywith no known cause for their firstFeinberg School of Medicine.LOOKING AHEAD: My long-term stroke. Dr. Sethi notes, We askedWere really pleased to begoal is to start a cardiometabolicourselves, What if patients with advancing knowledge of theclinic, Dr. Christopher says. relationship between AFib andPeople who have diabetes stroke, Dr. Allred says. More thanfrequently have metabolic anything, we want adults in oursyndrome, which is a very specific community over 40 to get annualpattern of blood pressure, lipids, checkups with their primary careobesity. We know that these provider, where irregular heartsyndromes run together, and rhythms or other indicators ofweve been very focused on heart and vascular concerns cantraditional cardiovascular risk be identified early enough tofactors, and the cardiometabolic prevent strokes and manage AFib. piece needs a similar focus.HEART & VASCULAR / 15'