{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:52:34Z","timestamp":1787017954683,"version":"build-2736575974"},"reference-count":65,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cerebrovasc Dis"],"abstract":"<jats:p>Introduction: Embolic stroke of undetermined source (ESUS) is frequently attributable to atrial fibrillation (AF), yet remains undetected when episodes are brief or asymptomatic. Digital health-enabled cardiac monitoring offers novel pathways for secondary prevention. Implantable loop recorders (ILRs) provide continuous long-term rhythm surveillance, while wearable electrocardiogram (ECG) devices offer greater accessibility but with uncertain diagnostic yield and economic value. We evaluated the cost-effectiveness of ILR versus wearable AF monitoring and usual care in ESUS. Methods: A cohort-based Markov model simulated 1,000 ESUS patients (mean age 65 years) over a 10-year horizon from the German statutory health insurance perspective. Clinical inputs included AF detection rates (ILR: 15\u201325%; wearables: 5\u201310%), risk reduction in ischemic stroke with oral anticoagulation (OAC), and mortality\/disability utilities. Costs (EUR 2,024, 3% discount) captured device acquisition, implantation, follow-up, stroke care, and OAC therapy. Outcomes included incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit at willingness-to-pay thresholds of EUR 20,000, EUR 30,000, and EUR 50,000\/quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses, including expected value of perfect information (EVPI), were performed. Results: ILR yielded 0.23 additional QALYs compared with wearables at an incremental cost of EUR 2,160, resulting in a base-case ICER of EUR 9,391\/QALY. In a high-risk subgroup, the ICER decreased to EUR 5,520\/QALY. Probabilistic analysis demonstrated &gt;90% probability of cost-effectiveness at EUR 30,000\/QALY, with moderate EVPI. These findings align with meta-analytic evidence (RR 3.88 for AF detection; RR 0.75 for stroke reduction) and indicate that prolonged monitoring (\u226512 months) maximizes yield. Conclusion: Digital health-enabled ILR monitoring is likely cost-effective for AF detection after ESUS, particularly in high-risk patients. Wearables may serve as an adjunct but deliver lower value. Results support targeted ILR implementation in post-ESUS care pathways and integration into digital health-driven guideline and reimbursement frameworks.<\/jats:p>","DOI":"10.1159\/000550005","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T17:00:25Z","timestamp":1765645225000},"page":"1-15","source":"Crossref","is-referenced-by-count":1,"title":["Digital Health-Enabled Monitoring Strategies for Atrial Fibrillation Detection after Embolic Stroke of Undetermined Source: A Cost-Effectiveness Analysis of Implantable Loop Recorders, Wearable Devices, and Usual 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