Abstract Body: Background
Nearly one million individuals in the U.S. experience ischemic stroke annually and one-year recurrent stroke risk may exceed 10%. The American Heart Association (AHA) Get-With-The-Guidelines-Stroke® Registry (GWTG-S) suggests that more than 40% of patients with stroke are discharged with a cryptogenic or undocumented etiology which may lead to suboptimal secondary prevention. Consequently, improved neurology and cardiology collaboration and evidence-based post-stroke evaluation may help identify stroke etiology, reduce recurrences and improve outcomes.

Methods
In 2022, the AHA, in collaboration with HCA Healthcare and HCA Healthcare Foundation, designed and launched Getting to the Heart Of Stroke^TM in 10 HCA Healthcare advanced stroke centers (GTTHOS) to improve neurology and cardiology collaboration, evidence-based post-stroke diagnostic evaluation and assessment of social determinants of health and barriers to care. Components included a learning collaborative model, virtual performance improvement consultations, Plan-Do-Study-Acts, multidisciplinary teams and performance improvement feedback. This analysis compared GTTHOS centers to the rest of HCA Healthcare’s GWTG-S centers (Non-GTTHOS; n=112) at baseline (2022) and follow-up (2023), using custom and existing GWTG-S metrics.

Results
At follow-up, GTTHOS documented higher stroke etiology rates (58.06% vs. 48.63%), lower cryptogenic stroke (31.01% vs. 34.89%) and lower undocumented stroke etiology (10.93% vs. 16.48%)(all vs. baseline; p<0.0001). GTTHOS also demonstrated significantly increased use of evidence-based post-stroke diagnostic evaluation, including intracranial vascular and carotid imaging, echocardiography, short-term and extended (surface, implantable) cardiac monitoring. Lastly, GTTHOS documented significantly higher stroke etiology rates, lower cryptogenic stroke, lower undocumented stroke etiology and higher rates of several components of evidence-based post-stroke diagnostic evaluation at follow-up vs. Non-GTTHOS (Table; Figure 1, 2).

Conclusion
In this novel AHA initiative, assessed in over 100 U.S. centers, Getting to the Heart Of Stroke^TM is associated with improved determination of stroke etiology and use of evidence-based post-stroke diagnostic evaluation. These findings suggest that the initiative, which includes improved neurology and cardiology collaboration, may contribute to improved diagnosis of stroke etiology, improve secondary prevention and clinical outcomes.