{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:17:58Z","timestamp":1785406678596,"version":"3.56.0"},"reference-count":26,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012818","name":"Comunidad de Madrid","doi-asserted-by":"publisher","award":["TEC-2024\/TEC-43"],"award-info":[{"award-number":["TEC-2024\/TEC-43"]}],"id":[{"id":"10.13039\/100012818","id-type":"DOI","asserted-by":"publisher"}]},{"award":["TEC-2024\/TEC-43"],"award-info":[{"award-number":["TEC-2024\/TEC-43"]}],"id":[{"id":"https:\/\/ror.org\/040scgh75","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Although comprehensive transthoracic echocardiography (TTE) is part of the diagnostic workup in acute ischemic stroke, it is not cost-effective to use it for all patients. Guidelines recommend using it only for selected patients to guide secondary prevention. Neurologist-led, stroke-focused cardiac ultrasound (S-FoCUS) is an emerging bedside screening tool that optimizes cardiac evaluation in acute stroke care. We hypothesize that the implementation of S-FoCUS screening may reduce resource utilization in terms of hospital stay and TTE procedures. Methods: We conducted a retrospective before-and-after cohort study of patients with suspected acute ischemic stroke or TIA admitted to our comprehensive stroke center. We compared two 6-month periods: the pre-S-FoCUS period, during which patients underwent TTE as the initial cardiac imaging modality; and the post-S-FoCUS period, during which patients initially underwent S-FoCUS, with subsequent TTE performed only in the presence of abnormal findings or at the clinician\u2019s discretion. We compared the time from admission to first cardiac ultrasound assessment, length of stay, relative reduction in TTE procedures and estimated in-hospital costs. Results: The pre-S-FoCUS period included 224 patients, and the post-S-FoCUS period included 229 patients. The S-FoCUS protocol reduced the median time to first cardiac ultrasound assessment by two days (median [IQR] 3 [2\u20135] vs. 1 [1\u20132], p &lt; 0.001) and the median length of stay by one day (6 [4\u20139] vs. 5 [3\u201310], p = 0.014). Implementing the S-FoCUS protocol was associated with an exploratory estimate of lower in-hospital costs (approximately \u20ac716 per screened patient) driven mainly by a shorter length of stay. The distribution of the frequency of predefined cardioembolic sources was similar between both periods. There was a high agreement rate between the S-FoCUS and TTE findings in patients who underwent both tests: mitral stenosis (\u03ba = 0.78), left atrial severe enlargement (\u03ba = 0.74), left ventricular hypokinesia\/akinesia (\u03ba = 0.84), and depressed LVEF (\u03ba = 0.88). Conclusions: Neurologist-led S-FoCUS is a feasible triage strategy to improve efficiency in the acute stroke pathway.<\/jats:p>","DOI":"10.3390\/diagnostics16101491","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:04:09Z","timestamp":1778763849000},"page":"1491","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficiency of Neurologist-Led Focused Cardiac Ultrasound in the Acute Stroke Pathway (S-FoCUS)"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0446-0813","authenticated-orcid":false,"given":"Eduardo","family":"Mari\u00f1o","sequence":"first","affiliation":[{"name":"Department of Neurology , Stroke Center, La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Pulido Fraiz","sequence":"additional","affiliation":[{"name":"Department of Neurology , Stroke Center, La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0659-444X","authenticated-orcid":false,"given":"Carlos","family":"Herv\u00e1s-Testal","sequence":"additional","affiliation":[{"name":"Department of Neurology , Stroke Center, La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Rigual","sequence":"additional","affiliation":[{"name":"Department of Neurology , Stroke Center, La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo","family":"Ruiz-Ares","sequence":"additional","affiliation":[{"name":"Department of Neurology , Stroke Center, La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Casado","sequence":"additional","affiliation":[{"name":"Department of Neurology , Stroke Center, La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0363-862X","authenticated-orcid":false,"given":"Blanca","family":"Fuentes","sequence":"additional","affiliation":[{"name":"Department of Neurology , Stroke Center, La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5331-1473","authenticated-orcid":false,"given":"Esther","family":"P\u00e9rez-David","sequence":"additional","affiliation":[{"name":"Cardiac Image Unit, Department of Cardiology, La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1077-7959","authenticated-orcid":false,"given":"Gabriela","family":"Guzm\u00e1n-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Cardiac Image Unit, Department of Cardiology, La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4302-6580","authenticated-orcid":false,"given":"Mar\u00eda","family":"Alonso de Leci\u00f1ana","sequence":"additional","affiliation":[{"name":"Department of Neurology , Stroke Center, La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8926-1287","authenticated-orcid":false,"given":"Jorge","family":"Rodr\u00edguez-Pardo","sequence":"additional","affiliation":[{"name":"Department of Neurology , Stroke Center, La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"20","author":"Feigin","year":"2021","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1161\/STROKEAHA.117.020031","article-title":"Distribution and temporal trends from 1993 to 2015 of ischemic stroke subtypes: A systematic review and meta-analysis","volume":"49","author":"Ornello","year":"2018","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kato, Y., Tsutsui, K., Nakano, S., Hayashi, T., and Suda, S. (2024). Cardioembolic stroke: Past advancements, current challenges, and future directions. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25115777"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"CVII\u2013CXXXIX","DOI":"10.1177\/23969873221099478","article-title":"European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin","volume":"7","author":"Rubiera","year":"2022","journal-title":"Eur. Stroke J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack","volume":"52","author":"Kleindorfer","year":"2021","journal-title":"Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Harris, J., Yoon, J., Salem, M., Selim, M., Kumar, S., and Lioutas, V.A. (2020). Utility of transthoracic echocardiography in diagnostic evaluation of ischemic stroke. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.00103"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e024989","DOI":"10.1161\/JAHA.121.024989","article-title":"Yield of echocardiography in ischemic stroke and patients with transient ischemic attack with established indications for long-term direct oral anticoagulant therapy: A cross-sectional diagnostic cohort study","volume":"11","author":"Meinel","year":"2022","journal-title":"J. Am. 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Echocardiogr."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1491\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:21:10Z","timestamp":1778764870000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":26,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16101491"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16101491","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}