Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke

Resource impact statement

No significant resource impact is anticipated

We do not expect this guidance to have a significant impact on resources; that is, the resource impact of implementing the recommendations in England will be less than £1 million per year (or £1,800 per 100,000 population)

This is because we do not think practice will change substantially as a result of this guidance because this technology (implantable cardiac monitor) is increasingly in routine use in the NHS.

In areas where implantable cardiac monitors are not currently used, comissioners should be advised that the tariff, which covers the cost of both the procedure and the Reveal LINQ device, is around £2,300 (EY12 – all tariffs quoted from Consultation version of the National Tariff 2020/21). Most people will have their Reveal LINQ device removed within 3 years and the cost of removing the device is around £500 (EY13).

Current practice in these areas involves limited testing for atrial fibrillation if this is not detected by short-term non-invasive electrocardiogram (ECG) monitoring after cryptogenic stroke, with people potenitally receiving single time point ECG at around £120 (EY51Z) per test, along with, in some cases, outpatient appointments at around £80 (WF01A – TFC 320) each.

For providers, the cost of continuous monitoring with Reveal LINQ devices are higher in comparison to the current diagnostic pathway of receiving intermittent single time point ECG monitoring after cryptogenic stroke. For every 1,000 people being given a Reveal LINQ device after cryptogenic stroke (and after available non-invasive ECG monitoring has been done), we expect that around 50 strokes could be prevented.

The technology is commissioned by clinical commissioning groups. Providers are NHS hospital trusts.