Collaborative neurocardiology board meetings for decision-making in stroke care: a real-world experience

TL;DR

A collaborative approach between neurologists and cardiologists through monthly meetings improved stroke care decisions, especially for procedures like PFO closure and LAAO.

Contribution

Establishment and evaluation of a real-world structured neurocardiology board for collaborative stroke care decisions.

Findings

46 board meetings were held, discussing 255 patients, with referrals increasing from 32 in 2021 to 89 in 2024.

PFO closure was not recommended in 43.4% of cases due to lack of causality for stroke.

For LAAO patients, 68.8% were recommended for participation in a randomized controlled trial.

Abstract

Interdisciplinary collaboration between neurologists and cardiologists is needed to provide state-of-the art stroke care and individualized decisions about secondary prevention strategies. This highlights the need to establish working structures for joint decision-making between cardiologists and stroke neurologists. At present, studies describing the real-world decision-making as part of such brain-heart teams are scarce.

We established a structured heart–brain team approach with monthly virtual neurocardiology board (NCB) meetings within a neurovascular network. We conducted a retrospective analysis of the implementation phase of NCB meetings between 2021 and 2024. We describe the structure of board meetings, patient characteristics and therapeutic and diagnostic recommendations.

During the study period, 46 board meetings were held, and 255 patients were discussed. The number of referred patients increased from 32 in 2021 to 89 in 2024. The majority of patients were evaluated for patent foramen ovale (PFO) closure (n = 189, 74.1%, median age 56 years, 59.8% female) and left atrial appendage occlusion (LAAO) (n = 32, 12.5%, median age 83 years, 50% female). Further questions centered around other individual secondary prevention strategies. Among patients referred to discuss PFO closure, closure was not recommended in 43.4% of patients (n = 82), recommended depending on additional diagnostic measures in 13.8% (n = 26), considered optional in 19.6% (n = 37) and clrearly recommended in 23.3% (n = 44). Patients for whom it was not recommended were older, had more cardiovascular risk factors and were less likely to have a large PFO shunt. The main reason for the recommendation against closure was that the PFO was not considered causal for the stroke (80.5%). Among LAAO patients, participation in a randomized controlled trial was recommended in 68.8%.

We successfully established and steadily expanded regular NCB meetings to provide a platform for interdisciplinary exchange and personalized stroke treatment, in particular discussion of indications for interventional procedures against cardiac embolism. Our approach may serve as a blueprint for similar collaborative approaches. Future studies are needed to assess adherence to recommendations and patient outcomes as this study lacks follow-up data.

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