{
  "abstract": "Introduction Fourteen-day ambulatory ECG patch monitoring is increasingly used following stroke and transient ischaemic attack (TIA) and detects a broader range of arrhythmias than traditional short-duration Holter monitoring. While atrial fibrillation can often be managed directly by stroke teams, interpretation of complex or high-risk ECG findings frequently requires cardiology input. In district general hospitals, traditional referral pathways may result in delayed referrals, prolonged waits for specialist review, and inefficient triage. We introduced a Heart and Brain multidisciplinary team (MDT) meeting to streamline cardiology decision-making and improve management of complex cardiac findings after stroke and TIA.Methods We conducted a retrospective service evaluation at an acute stroke centre within a district general hospital. During the pre-MDT period (March–August 2025), cardiology referrals following review of 14-day ECG patch reports in stroke and TIA patients were made via routine outpatient pathways. From September 2025, patients with complex or uncertain ECG findings were discussed in a dedicated Heart and Brain MDT meeting attended by stroke consultants, stroke registrars and a cardiology consultant, with 36 consecutive stroke and TIA patients reviewed between September 2025 and January 2026. Outcomes included time from ECG report availability to referral initiation and specialist review, management decisions, and need for urgent intervention.Results During the pre-MDT period, 24 stroke and TIA patients were referred to cardiology following ECG patch monitoring. Delays were observed both in referral initiation after ECG report availability and in subsequent specialist review. Many patients experienced waits exceeding six months, with some approaching one year before cardiology assessment. Several patients with high-grade conduction abnormalities experienced prolonged delays prior to definitive management, including permanent pacemaker implantation.Following MDT implementation, all cases were reviewed within two weeks of ECG report availability. The MDT enabled structured triage into no further action, routine cardiology clinic review, targeted investigations, or urgent intervention. Patients with high-risk atrioventricular block or symptomatic bradyarrhythmias were promptly identified and fast-tracked for permanent pacemaker implantation. The MDT also provided a forum to address additional cardiology issues relevant to stroke and TIA care, including echocardiographic abnormalities and structural heart disease. Over time, improved triage reduced the number of cases requiring MDT discussion, allowing meeting frequency to reduce from weekly to fortnightly.Conclusions and Implications A Heart and Brain MDT meeting improves the timeliness and appropriateness of cardiology input for complex cardiac findings after stroke and TIA in a district general hospital setting. This model reduces delays to intervention for high-risk arrhythmias, avoids unnecessary referrals, and supports integrated cardiovascular decision-making. The pathway is scalable and could be adopted by other acute stroke services to improve post-stroke and post-TIA cardiac evaluation and patient safety.",
  "authors": [
    {
      "affiliations": [
        "Peterborough City Hospital/North West Anglia NHS Foundation Trust, Peterborough, United Kingdom"
      ],
      "name": "Dipraj Limbu"
    },
    {
      "affiliations": [
        "Peterborough City Hospital/North West Anglia NHS Foundation Trust, Peterborough, United Kingdom"
      ],
      "name": "Radim Licenik"
    },
    {
      "affiliations": [
        "Peterborough City Hospital/North West Anglia NHS Foundation Trust, Peterborough, United Kingdom"
      ],
      "name": "Amrit Gurung"
    }
  ],
  "title": "421 Bridging stroke and cardiology: impact of a heart and brain MDT meeting on cardiac decision-making after stroke and TIA",
  "uid": "6a85bf51-7eae-58a4-9826-dfb615a2bd7d"
}