2024
Cost-effectiveness of atrial fibrillation detection with insertable cardiac monitors in large-artery or small-vessel disease stroke in the United Kingdom
Witte K, Schwamm L, Bernstein R, Reynolds M, Rose D, Lip G, Ozturk E, Villinger J, Rosemas S, Ziegler P, Yaghi S. Cost-effectiveness of atrial fibrillation detection with insertable cardiac monitors in large-artery or small-vessel disease stroke in the United Kingdom. EP Europace 2024, 26: euae102.603. PMCID: PMC11120381, DOI: 10.1093/europace/euae102.603.Peer-Reviewed Original ResearchQuality-adjusted life yearsInsertable cardiac monitorCHA2DS2-VASc scoreContinuous cardiac monitoringStroke eventsAtrial fibrillationCardiac monitoringNational Health Service (NHSBase case incremental cost-effectiveness ratioCHA2DS2-VAScInsertable cardiac monitor implantationDetection of AFHealth-related benefitsRisk of AFUnited KingdomCost-effectiveLarge-arteryRisk of cerebrovascular eventsIschemic strokeWillingness-to-pay thresholdsDetect atrial fibrillationIncremental cost-effectiveness ratioCost-effectiveness analysisProbabilistic sensitivity analysesSmall vessel disease stroke
2023
Antithrombotic and Statin Prescription After Intracerebral Hemorrhage in the Get With The Guidelines-Stroke Registry
Murthy S, Zhang C, Shah S, Schwamm L, Fonarow G, Smith E, Bhatt D, Ziai W, Kamel H, Sheth K. Antithrombotic and Statin Prescription After Intracerebral Hemorrhage in the Get With The Guidelines-Stroke Registry. Stroke 2023, 54: 2972-2980. PMID: 37942641, PMCID: PMC10842167, DOI: 10.1161/strokeaha.123.043194.Peer-Reviewed Original ResearchConceptsIschemic vascular diseaseProportion of patientsGuidelines-Stroke registryLipid-lowering therapyIntracerebral hemorrhageVascular diseaseStatin therapyAnticoagulation therapyCardiovascular eventsAtrial fibrillationFuture major cardiovascular eventsLower admission National InstitutesPrevious lipid-lowering therapyAdmission National InstitutesFavorable discharge outcomeIschemic cardiovascular eventsHealth Stroke ScaleMajor cardiovascular eventsLipid-lowering medicationsCross-sectional studyMultiple logistic regressionLogistic regression analysisAntiplatelet medicationsAntiplatelet therapyStatin medicationOutcomes of recurrent stroke in patients with atrial fibrillation according to presumed etiology
Pedreira B, Zachrison K, Singhal A, Yan Z, Oliveira-Filho J, Schwamm L. Outcomes of recurrent stroke in patients with atrial fibrillation according to presumed etiology. Arquivos De Neuro-Psiquiatria 2023, 81: 616-623. PMID: 37336506, PMCID: PMC10371407, DOI: 10.1055/s-0043-1769124.Peer-Reviewed Original ResearchConceptsUndetermined stroke etiologyAtrial fibrillationRecurrent strokeStroke etiologyAF patientsFavorable outcomeAcademic comprehensive stroke centerHealth Stroke Scale scoreMedian National InstitutesSingle-center sampleComprehensive stroke centerRecurrent ischemic strokeStroke Scale scoreHistory of strokePotent risk factorDifferent treatment strategiesHospital mortalitySecondary prophylaxisReperfusion therapyCardioembolic strokeIschemic strokeStroke centersDischarge outcomesRisk factorsTreatment strategies
2022
Frequency, predictors and cardiovascular outcomes associated with transthoracic echocardiographic findings during acute ischaemic stroke hospitalisation
Sharma R, Silverman S, Patel S, Schwamm LH, Sanborn DY. Frequency, predictors and cardiovascular outcomes associated with transthoracic echocardiographic findings during acute ischaemic stroke hospitalisation. Stroke And Vascular Neurology 2022, 7: 482-492. PMID: 35697387, PMCID: PMC9811598, DOI: 10.1136/svn-2021-001170.Peer-Reviewed Original ResearchConceptsStroke risk factorsAcute ischemic strokeStroke hospitalisationsTransthoracic echocardiographyRisk factorsClinical utilityAbnormal transthoracic echocardiographyHigh stroke riskCardiac event riskCoronary artery diseaseTransthoracic echocardiographic findingsNet reclassification improvementCategory ICardioembolic sourceRecurrent strokeTTE findingsCardiovascular outcomesEchocardiographic findingsCardiac eventsIschemic strokeOlder patientsStroke riskArtery diseaseSingle centerAtrial fibrillationUse of Prolonged Cardiac Rhythm Monitoring to Identify Atrial Fibrillation After Cryptogenic Stroke
Roy A, Schwamm L, Singhal A. Use of Prolonged Cardiac Rhythm Monitoring to Identify Atrial Fibrillation After Cryptogenic Stroke. Current Cardiology Reports 2022, 24: 337-346. PMID: 35171442, DOI: 10.1007/s11886-022-01652-1.Peer-Reviewed Original ResearchConceptsCryptogenic strokeAtrial fibrillationCardiac monitoringTiming of AFConsideration of anticoagulationCryptogenic stroke patientsCardiac rhythm monitoringAF detectionDetection of AFAnticoagulation initiationClinical outcomesStroke evaluationStroke patientsClinical calculatorsRhythm monitoringRecent FindingsDespiteStrokeLonger durationDefinitive researchFibrillationAdditional researchDurationOptimal typeMore investigationAnticoagulation
2021
Frequency, Characteristics, and Outcomes of Endovascular Thrombectomy in Patients With Stroke Beyond 6 Hours of Onset in US Clinical Practice
Zachrison K, Schwamm L, Xu H, Matsouaka R, Shah S, Smith E, Xian Y, Fonarow G, Saver J. Frequency, Characteristics, and Outcomes of Endovascular Thrombectomy in Patients With Stroke Beyond 6 Hours of Onset in US Clinical Practice. Stroke 2021, 52: 3805-3814. PMID: 34470490, DOI: 10.1161/strokeaha.121.034069.Peer-Reviewed Original ResearchConceptsAcute ischemic stroke patientsEndovascular thrombectomyIschemic stroke patientsStroke patientsEVT casesGuidelines-Stroke hospitalsUS clinical practiceLower stroke severityClinical practice settingEVT outcomesEVT timesHospital mortalityNontrial settingDischarge dispositionIschemic strokePatient characteristicsStroke severityAtrial fibrillationFunctional outcomeClinical registryHospital characteristicsPatientsClinical practicePractice settingsStudy periodEffect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease
Bernstein R, Kamel H, Granger C, Piccini J, Sethi P, Katz J, Vives C, Ziegler P, Franco N, Schwamm L, Acosta I, Jamnadas P, Manda S, Alimohammad R, Arias V, Tempro K, Ward K, Asi K, Choudhuri I, Guerrero W, Kalia J, Niazi I, Sajjad R, Thavapalan V, Assar M, Banchs J, Black J, Cheung P, Donsky A, Graybeal D, Hasan R, Mir O, Nguyen C, Olsovsky G, Rasmussen J, Hasabnis S, Reeves R, Rowley C, Sharma J, Smith M, Bonyak K, Sackett M, Allred J, Sethi P, Jung R, Lynch J, Rowe S, Dash S, Glotzer T, Jamal S, Radoslovich G, Shukla G, Zimmerman J, Hussein H, Zhu D, Krueger K, Ostrander M, Ramirez D, Shultz J, Simonson J, Cucchiara B, Deo R, Frankel D, Jia J, Kasner S, Luciano J, Messe S, Mullen M, Santangeli P, Schaller R, Yuan Q, Bledsoe D, Cajavilca C, Chiu D, Gadhia R, Grimes M, Katz L, Moye S, Rami T, Thomas A, Volpi J, Al Balushi A, Boyd C, Choudry S, Dhamoon M, Dukkipati S, Goltz D, Hao Q, Horowitz D, Kaur G, Koruth J, Kurian C, Langan M, Matos Diaz I, Miller M, Reddy V, Sheinart K, Stein L, Tansy A, Tuhrim S, Weinberger J, Whang W, Cross J, Kreger H, Saltzman M, Zide K, Bansal S, Bernabei M, Flaster M, Barrett C, Etherton M, Heist E, Lubitz S, Regenhardt R, Sharma R, Silverman S, Sloane K, Viswanathan A, Doshi A, Logan W, Malik M, Rempe D, Arora R, Beldner S, Epstein L, Ismail H, Jadonath R, Katz J, Libman R, Moussavi M, Patel A, Patel A, Willner J, Wright P, Caprio F, Kim S, Mendelson S, Passman R, Ruff I, Alsorogi M, Chaudhary G, Morris K, Mullins S, Talpur N, Thomas K, Chancellor B, Chinitz L, Culpepper A, Fara M, Ishida K, Lillemoe K, Lord A, Torres J, Zhang C, Abi-Samra F, Bernard M, Carter J, Chokhawala H, Downey A, Khatib S, Morin D, Polin G, Rogers P, Vidal G, Zweifler R, Belt G, Felberg R, Furer S, Hanna J, McCall-Brown A, Seeger S, Reddy R, Skalabrin E, Soik D, Wilder M, Kearney M, LaFranchise E, Parker B, Pickett R, Bonaguidi H, Gibson D, Kalafut M, Mattera B, Olson N, Parker M, Rogers J, Uddin P, Chang C, Graner S, Kipta J, Salem R, Singh D, Al-Awwad A, Beaver B, Chaudhary S, Clayton S, Delpirou Nouh C, Garabelli P, Gordon D, Pakala A, Ray B, Saucedo S, Sidorov E, Stavrakis S, Ching M, Deline C, Hourihane J, Kandel A, Kim C, Magun R, Mowla A, Sawyer R, Switzer D, Badhwar N, Lee R, Meisel K, Smith W, Alkahalifah M, Aroor S, Asdaghi N, Bhatt N, Del Brutto V, Dillon G, Gadient P, Koch S, Lambrakos L, Malik A, Marulanda-Londono E, Memon Z, Mendoza I, Mitrani R, Ortiz G, Ramano J, Sur N, Torres L, Daniels J, Johnson M, Magadan A, Shang T, Mcclelland N, Merriam T, Neisen K. Effect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease. JAMA 2021, 325: 2169-2177. PMID: 34061145, PMCID: PMC8170544, DOI: 10.1001/jama.2021.6470.Peer-Reviewed Original ResearchConceptsSmall vessel diseaseAtrial fibrillationUsual careCardiac monitoringIndex strokeICM groupControl groupAdditional stroke risk factorsProcedure-related adverse eventsAF incidence ratesMore atrial fibrillationCHA2DS2-VASc scorePrimary end pointStroke risk factorsIncident atrial fibrillationMulticenter clinical trialAF detectionContinuous cardiac monitoringLong-term cardiac monitoringEligible patientsAdverse eventsIschemic strokeHolter monitoringRisk factorsClinical trialsOral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation
Saeed O, Zhang S, Patel S, Jorde U, Garcia M, Bulcha N, Gupta T, Xian Y, Matsouaka R, Shah S, Smith E, Schwamm L, Fonarow G. Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation. Journal Of Cardiac Failure 2021, 27: 857-864. PMID: 33975786, PMCID: PMC8355019, DOI: 10.1016/j.cardfail.2021.02.017.Peer-Reviewed Original ResearchConceptsOral anticoagulationRecurrent ischemic strokeAcute ischemic strokeIschemic strokeHeart failureAtrial fibrillationOlder patientsHistory of HFInitiation of OACCox proportional hazard ratiosProportional hazard ratiosHeart failure patientsKaplan-Meier curvesClinical registry dataCause bleedingEligible patientsAdverse eventsCumulative incidenceFailure patientsHazard ratioSuch patientsYear mortalityAdverse outcomesClinical covariatesRegistry data
2020
Left Atrial Mechanics Assessed Early during Hospitalization for Cryptogenic Stroke Are Associated with Occult Atrial Fibrillation: A Speckle-Tracking Strain Echocardiography Study
Deferm S, Bertrand PB, Churchill TW, Sharma R, Vandervoort PM, Schwamm LH, Yoerger Sanborn DM. Left Atrial Mechanics Assessed Early during Hospitalization for Cryptogenic Stroke Are Associated with Occult Atrial Fibrillation: A Speckle-Tracking Strain Echocardiography Study. Journal Of The American Society Of Echocardiography 2020, 34: 156-165. PMID: 33132019, DOI: 10.1016/j.echo.2020.09.009.Peer-Reviewed Original ResearchConceptsMobile cardiac outpatient telemetryOccult atrial fibrillationBooster pump functionAtrial fibrillationCryptogenic strokeAtrial mechanicsStrain echocardiographyReservoir strainPump functionBaseline cardiovascular risk profileLA booster pump functionPresence of AFCardiovascular risk profileLA volume indexReceiver operator curve analysisOperator curve analysisSpontaneous cardioversionEmbolic strokeClinical characteristicsRetrospective cohortEchocardiography studyLA sizeMedian timeStroke hospitalizationsEchocardiographyAntiplatelet patterns and outcomes in patients with atrial fibrillation not prescribed an anticoagulant after stroke
Chang K, Xian Y, Zhao X, Mi X, Matsouaka R, Schwamm L, Shah S, Lytle B, Smith E, Bhatt D, Fonarow G, Hsu J. Antiplatelet patterns and outcomes in patients with atrial fibrillation not prescribed an anticoagulant after stroke. International Journal Of Cardiology 2020, 321: 88-94. PMID: 32805327, DOI: 10.1016/j.ijcard.2020.08.011.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeAntiplatelet therapyAntithrombotic therapyIschemic strokeTherapy prescriptionOral anticoagulationUnadjusted ratesGuidelines-Stroke registryService beneficiaries 65Retrospective cohort studyOral anticoagulant therapyAnticoagulant therapyCohort studyComposite endpointPrimary outcomeAtrial fibrillationAtrial flutterPotential confoundersNeurologic/Medicare beneficiariesMedicare feeTherapyStrokePatientsMortalityEvaluation of stroke incidence with duty‐cycled multielectrode‐phased radiofrequency ablation of persistent atrial fibrillation results of the VICTORY AF Study
Hummel J, Verma A, Calkins H, Schwamm L, Gress D, Wells D, Souza J, Hokanson R, Hemingway L, Stromberg K, Hoyt R, Wickliffe A, DeLurgio D, Boersma L. Evaluation of stroke incidence with duty‐cycled multielectrode‐phased radiofrequency ablation of persistent atrial fibrillation results of the VICTORY AF Study. Journal Of Cardiovascular Electrophysiology 2020, 31: 1289-1297. PMID: 32270538, DOI: 10.1111/jce.14483.Peer-Reviewed Original ResearchConceptsDevice-related strokesAcute procedural successAtrial fibrillationAF trialSecondary outcomesStroke incidenceProcedural successAF studyStroke/transient ischemic attackVitamin K antagonist anticoagulationMajor structural heart diseasePulmonary vein stenosisTransient ischemic attackIncidence of strokeStructural heart diseaseNumber of patientsVitamin K antagonismAtrial fibrillation resultsRigorous clinical evaluationIDE trialIschemic attackNeurologist assessmentPersAF patientsAF burdenPV stenosis
2019
Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke
Xian Y, Xu H, O’Brien E, Shah S, Thomas L, Pencina M, Fonarow G, Olson D, Schwamm L, Bhatt D, Smith E, Hannah D, Maisch L, Lytle B, Peterson E, Hernandez A. Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke. JAMA Neurology 2019, 76: 1192-1202. PMID: 31329212, PMCID: PMC6647003, DOI: 10.1001/jamaneurol.2019.2099.Peer-Reviewed Original ResearchDirect oral anticoagulantsAcute ischemic strokeMajor adverse cardiovascular eventsAdverse cardiovascular eventsIschemic strokeLong-term outcomesAtrial fibrillationCardiovascular eventsOral anticoagulantsClinical effectivenessHigh riskHealth Stroke Scale scoreBetter long-term outcomesFirst year postdischargeStroke Scale scorePatient-centered outcomesPatient-centered measuresDOAC useGuidelines-StrokeCardiovascular readmissionCause readmissionGastrointestinal bleedingStroke preventionWarfarin prescriptionBaseline characteristicsANTIPLATELET THERAPY PRESCRIPTION PATTERNS AND ASSOCIATIONS WITH CLINICAL OUTCOMES IN MEDICARE BENEFICIARIES WITH ATRIAL FIBRILLATION PRESCRIBED NO ORAL ANTICOAGULATION AFTER ACUTE ISCHEMIC STROKE
Chang K, Xian Y, Zhao X, Matsouaka R, Schwamm L, Fonarow G, Bhatt D, Shah S, Lytle B, Smith E, Hsu J. ANTIPLATELET THERAPY PRESCRIPTION PATTERNS AND ASSOCIATIONS WITH CLINICAL OUTCOMES IN MEDICARE BENEFICIARIES WITH ATRIAL FIBRILLATION PRESCRIBED NO ORAL ANTICOAGULATION AFTER ACUTE ISCHEMIC STROKE. Journal Of The American College Of Cardiology 2019, 73: 364. DOI: 10.1016/s0735-1097(19)30972-6.Peer-Reviewed Original Research
2018
Evaluation of a score for the prehospital distinction between cerebrovascular disease and stroke mimic patients
Geisler F, Ali S, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, Weber J, Wendt M, Winter B, Schwamm L, Audebert H. Evaluation of a score for the prehospital distinction between cerebrovascular disease and stroke mimic patients. International Journal Of Stroke 2018, 14: 400-408. PMID: 30303808, DOI: 10.1177/1747493018806194.Peer-Reviewed Original ResearchConceptsStroke mimic patientsIndividual patient characteristicsMimic patientsCerebrovascular diseaseStroke mimicsPatient characteristicsFocal neurological deficitsCerebrovascular disease patientsCertain patient characteristicsMobile stroke unitPre-hospital settingSevere strokeArterial hypertensionNeurological deficitsStroke unitAtrial fibrillationDisease patientsSudden onsetEmergency physiciansHospital destinationPatientsDiscriminative valueFinal analysisDiseaseStrokeIncidence of Atrial Fibrillation in Patients With Recent Ischemic Stroke Versus Matched Controls
Witsch J, Merkler AE, Chen ML, Navi BB, Sheth KN, Freedman B, Schwamm LH, Kamel H. Incidence of Atrial Fibrillation in Patients With Recent Ischemic Stroke Versus Matched Controls. Stroke 2018, 49: 2529-2531. PMID: 30355110, PMCID: PMC6205716, DOI: 10.1161/strokeaha.118.022826.Peer-Reviewed Original ResearchConceptsAtrial fibrillation/flutterIschemic strokeHemorrhagic strokeAF incidenceAF diagnosisRisk factorsAF-free patientsNew AF diagnosisVascular risk factorsNonstroke diagnosisAutonomic dysfunctionCharlson comorbidityStroke cohortAtrial fibrillationCox regressionNinth RevisionOutpatient claimsIncidental findingClinical ModificationHigh riskInternational ClassificationMedicare beneficiariesSurvival statisticsMatched ControlsPatients
2017
Ischemic Stroke Profile, Risk Factors, and Outcomes in India
Sylaja P, Pandian J, Kaul S, Srivastava M, Khurana D, Schwamm L, Kesav P, Arora D, Pannu A, Thankachan T, Singhal A. Ischemic Stroke Profile, Risk Factors, and Outcomes in India. Stroke 2017, 49: 219-222. PMID: 29167386, PMCID: PMC5742046, DOI: 10.1161/strokeaha.117.018700.Peer-Reviewed Original ResearchConceptsAdmission National InstitutesHealth Stroke ScaleStroke ScaleIschemic strokeDiabetes mellitusRisk factorsHealth Stroke Scale scoreLower admission National InstitutesMedian admission National InstitutesNational InstituteRankin Scale score 0Stroke etiologic subtypesIntra-arterial thrombolysisStroke Scale scoreAcademic tertiary hospitalCommon risk factorsMagnetic resonance imagingHospital mortalityEtiologic subtypesStroke careStroke ProjectTertiary hospitalAtrial fibrillationStroke guidelinesMean ageStroke of Known Cause and Underlying Atrial Fibrillation (STROKE-AF) randomized trial: Design and rationale
Bernstein R, Kamel H, Granger C, Kowal R, Ziegler P, Schwamm L. Stroke of Known Cause and Underlying Atrial Fibrillation (STROKE-AF) randomized trial: Design and rationale. American Heart Journal 2017, 190: 19-24. PMID: 28760209, DOI: 10.1016/j.ahj.2017.04.007.Peer-Reviewed Original ResearchConceptsApparent atrial fibrillationInsertable cardiac monitorSmall vessel diseaseLarge vessel atherosclerosisStandard of careVessel diseaseIschemic strokeAtrial fibrillationPost-market clinical trialArrhythmia monitoringSecondary stroke preventionOral anticoagulation therapyContinuous arrhythmia monitoringAntithrombotic treatmentOral anticoagulationAnticoagulation therapyStroke preventionIntracranial atherosclerosisStroke etiologyClinical trialsIncidence rateCardiac monitorPatientsCardiac monitoringStrokeAssociation of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation
Xian Y, O’Brien E, Liang L, Xu H, Schwamm L, Fonarow G, Bhatt D, Smith E, Olson D, Maisch L, Hannah D, Lindholm B, Lytle B, Pencina M, Hernandez A, Peterson E. Association of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation. JAMA 2017, 317: 1057-1067. PMID: 28291892, DOI: 10.1001/jama.2017.1371.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeHistory of AFAntithrombotic therapyAntiplatelet therapyAntithrombotic treatmentAtrial fibrillationHospital mortalityTherapeutic warfarinTherapeutic anticoagulationSevere strokeIschemic strokeStroke severityLower oddsSubtherapeutic warfarinUnadjusted ratesAcute ischemic stroke severityGuidelines-Stroke programHealth Stroke ScaleIn-Hospital OutcomesHigh-risk patientsPrevalence of patientsRetrospective observational studyTime of strokeIschemic stroke severityHospital outcomes
2016
Sex and Age Interactions and Differences in Outcomes After Intracerebral Hemorrhage
James M, Cox M, Xian Y, Smith E, Bhatt D, Schulte P, Hernandez A, Fonarow G, Schwamm L. Sex and Age Interactions and Differences in Outcomes After Intracerebral Hemorrhage. Journal Of Women's Health 2016, 26: 380-388. PMID: 27754758, DOI: 10.1089/jwh.2016.5849.Peer-Reviewed Original ResearchConceptsIntracerebral hemorrhageSex-based interactionsTotal study populationWorse neurological deficitsAge/sexSex differencesAntiplatelet therapyHospital mortalityIschemic strokeNeurological deficitsPatient ageIndependent ambulationICH patientsStroke databaseAtrial fibrillationEarly outcomesPoor outcomeStudy populationCholesterol reducersLogistic regressionWomenTreatment differencesAgeMenHemorrhageSubstantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China
Li Z, Wang C, Zhao X, Liu L, Wang C, Li H, Shen H, Liang L, Bettger J, Yang Q, Wang D, Wang A, Pan Y, Jiang Y, Yang X, Zhang C, Fonarow G, Schwamm L, Hu B, Peterson E, Xian Y, Wang Y, Wang Y. Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China. Stroke 2016, 47: 2843-2849. PMID: 27758941, DOI: 10.1161/strokeaha.116.014143.Peer-Reviewed Original ResearchConceptsChina National Stroke RegistryIntravenous thrombolytic therapyNational Stroke RegistryQuality Improvement ProgramHigher composite scoresStroke RegistryDysphagia screeningStroke careThrombolytic therapyAtrial fibrillationSmoking cessationLeading causeStroke educationMultivariate analysisStudy periodAdherenceComposite scoreHospitalPhase 2Phase 1CareRegression modelsOddsOverall qualitySignificant improvement