Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Department of Research and Support, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Korean J Intern Med. 2024 May;39(3):469-476. doi: 10.3904/kjim.2023.479. Epub 2024 Apr 18.
BACKGROUND/AIMS: The reimbursement policy for cryptogenic stroke (CS) was expanded in November 2018 from recurrent strokes to the first stroke episode. No reports have demonstrated whether this policy change has affected trends in implantable loop recorder (ILR) utilization.
We identified patients who received an ILR implant using the Korea Health Insurance Review and Assessment Service database between July 2016 and October 2021. Patients meeting all the following criteria were considered to have CS indication: 1) prior stroke history, 2) no previous history of atrial fibrillation or flutter (AF/AFL), and 3) no maintenance of oral anticoagulant for ≥4 weeks within a year before ILR implant. AF/AFL diagnosed within 3 years after ILR implant or before ILR removal was considered ILR-driven.
Among 3,056 patients, 1,001 (32.8%) had CS indications. The total ILR implant number gradually increased for both CS and non-CS indications and the number of CS indication significantly increased after implementing the expanded reimbursement policy. The detection rate for AF/AFL was 26.3% in CS patients over 3 years, which was significantly higher in patients implanted with an ILR within 2 months after stroke than those implanted later.
The expanded coverage policy for CS had a significant impact on the number of ILR implantation for CS indication. The diagnostic yield of ILR for AF/AFL detection seems better when ILR is implanted within 2 months than later. Further investigation is needed to demonstrate other clinical benefits and the optimal ILR implantation timing.
背景/目的：2018 年 11 月，将 cryptogenic stroke（CS）的报销政策从复发性中风扩大到首次中风发作。尚无报告表明这一政策变化是否影响了植入式循环记录仪（ILR）的使用趋势。
我们使用韩国健康保险审查和评估服务数据库，确定了 2016 年 7 月至 2021 年 10 月期间接受 ILR 植入的患者。符合以下所有标准的患者被认为具有 CS 指征：1）既往中风史，2）无先前的心房颤动或房扑（AF/AFL）病史，且 3）ILR 植入前一年内，无口服抗凝药物维持≥4 周。ILR 植入后 3 年内或 ILR 移除前诊断为 AF/AFL 被认为是 ILR 驱动的。
在 3056 名患者中，有 1001 名（32.8%）具有 CS 指征。CS 和非 CS 指征的总 ILR 植入数量逐渐增加，并且在实施扩大报销政策后，CS 指征的数量显著增加。CS 患者在 3 年内的 AF/AFL 检出率为 26.3%，在中风后 2 个月内植入 ILR 的患者明显高于稍后植入的患者。
CS 覆盖范围扩大的政策对 CS 指征的 ILR 植入数量有显著影响。ILR 对 AF/AFL 检测的诊断率似乎在 ILR 植入后 2 个月内比以后更好。需要进一步研究以证明其他临床益处和最佳 ILR 植入时机。
