2024
Trends in the Use of Medications for Secondary Ischemic Stroke Prevention in Denmark, 2005-2021.
Skajaa N, Laugesen K, Lauffenburger J, Schwamm L, Sørensen H, Patorno E. Trends in the Use of Medications for Secondary Ischemic Stroke Prevention in Denmark, 2005-2021. Neurology 2024, 102: e209309. PMID: 38648572, PMCID: PMC11226314, DOI: 10.1212/wnl.0000000000209309.Peer-Reviewed Original ResearchConceptsMedication useOral anticoagulant medicationsGlucose-lowering medication useFactors associated with medication useLipid-lowering medication useSevere strokeIschemic stroke hospitalizationsAntihypertensive medication useAnticoagulant medicationOlder patientsCare of patientsSodium-glucose cotransporter-2 inhibitorsGlucagon-like peptide-1 receptor agonistsStroke preventionAnticoagulant medication useLipid-loweringPeptide-1 receptor agonistsGlucose-loweringReduced life expectancyIschemic strokeCotransporter-2 inhibitorsStroke careCohort of patientsStroke hospitalizationsSecondary ischemic stroke prevention
2019
Thrombolytic therapy in older acute ischemic stroke patients with gastrointestinal malignancy or recent bleeding
Inohara T, Liang L, Kosinski A, Smith E, Schwamm L, Hernandez A, Bhatt D, Fonarow G, Peterson E, Xian Y. Thrombolytic therapy in older acute ischemic stroke patients with gastrointestinal malignancy or recent bleeding. European Stroke Journal 2019, 5: 47-55. PMID: 32232169, PMCID: PMC7092738, DOI: 10.1177/2396987319871784.Peer-Reviewed Original ResearchRecombinant tissue plasminogen activatorRecent gastrointestinal bleedingAcute ischemic strokeGastrointestinal malignanciesIschemic strokeGastrointestinal bleedingHospital mortalityIntravenous recombinant tissue plasminogen activatorOlder acute ischemic stroke patientsAcute ischemic stroke patientsRtPA-treated patientsIschemic stroke patientsTissue plasminogen activatorOutcomes of interestGuidelines-StrokeIndex strokeRecent bleedingSevere strokeObservational cohortClinical outcomesStroke patientsThrombolytic therapyBleedingSystemic hemorrhagePatientsRecent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy
Inohara T, Liang L, Kosinski A, Smith E, Schwamm L, Hernandez A, Bhatt D, Fonarow G, Peterson E, Xian Y. Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy. Journal Of The American Heart Association 2019, 8: e012450. PMID: 31327296, PMCID: PMC6761665, DOI: 10.1161/jaha.119.012450.Peer-Reviewed Original ResearchConceptsRecombinant tissue-type plasminogen activatorRecent myocardial infarctionAcute ischemic strokeHistory of MIRisk of mortalityMyocardial infarctionAIS patientsIschemic strokeIntravenous recombinant tissue-type plasminogen activatorST-segment elevation myocardial infarctionSegment elevation myocardial infarctionMultivariate logistic regression modelGuidelines-Stroke hospitalsOnly medical therapyElevation myocardial infarctionTissue-type plasminogen activatorLogistic regression modelsHospital mortalityHospital outcomesSevere strokeMedical therapyThrombolytic therapyHigh riskInfarctionPatientsIntravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients With History of Stroke Plus Diabetes Mellitus
Ehrlich M, Liang L, Xu H, Kosinski A, Hernandez A, Schwamm L, Smith E, Fonarow G, Bhatt D, Peterson E, Xian Y. Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients With History of Stroke Plus Diabetes Mellitus. Stroke 2019, 50: 1497-1503. PMID: 31035901, PMCID: PMC6538420, DOI: 10.1161/strokeaha.118.024172.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorSymptomatic intracerebral hemorrhageAcute ischemic strokeHistory of strokeTissue-type plasminogen activatorIschemic stroke patientsDiabetes mellitusIschemic strokeIntracerebral hemorrhagePlasminogen activatorStroke patientsUnadjusted ratesAcute ischemic stroke patientsBaseline clinical factorsConcomitant diabetes mellitusECASS III trialGuidelines-Stroke registryPrior ischemic strokeCardiovascular risk factorsHospital mortalityPrior strokeSevere strokeIII trialsClinical factorsRisk factorsMedicare Shared Savings ACOs and Hospice Care for Ischemic Stroke Patients
Kaufman B, O'Brien E, Stearns S, Matsouaka R, Holmes G, Weinberger M, Schwamm L, Smith E, Fonarow G, Xian Y, Taylor D. Medicare Shared Savings ACOs and Hospice Care for Ischemic Stroke Patients. Journal Of The American Geriatrics Society 2019, 67: 1402-1409. PMID: 30835818, DOI: 10.1111/jgs.15852.Peer-Reviewed Original ResearchConceptsIschemic stroke patientsHigher mortality riskHospice enrollmentStroke patientsAccountable care organizationsMortality riskMedicare Shared Savings ProgramComfort measuresLife careIncident ischemic stroke patientsLow-mortality risk groupsGWTG-Stroke hospitalsIncident ischemic strokeMortality risk groupsPalliative care servicesService Medicare beneficiariesQuality of endMedicare hospice benefitSevere strokeIschemic strokePoor prognosisNational registryReduced oddsRisk groupsHospice care
2018
Ischemic Stroke Transfer Patterns in the Northeast United States
Zachrison K, Onnela J, Hernandez A, Reeves M, Camargo C, Cox M, Matsouaka R, Metlay J, Goldstein J, Schwamm L. Ischemic Stroke Transfer Patterns in the Northeast United States. Journal Of Stroke And Cerebrovascular Diseases 2018, 28: 295-304. PMID: 30389376, DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.048.Peer-Reviewed Original ResearchConceptsGuidelines-Stroke registryRegional stroke systemIschemic stroke patientsHospital connectionsTissue plasminogen activatorSevere strokeMore patientsStroke patientsIS patientsReceiving HospitalPatient dischargeStroke systemsPatient transferPatientsHospitalNortheast hospitalsMost hospitalsPlasminogen activatorCareUnited StatesFurther characterizationAdmissionRegistryStrokeEvaluation 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 analysisDiseaseStroke
2017
Association 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 outcomesUse of Intravenous Recombinant Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke Who Take Non–Vitamin K Antagonist Oral Anticoagulants Before Stroke
Xian Y, Federspiel J, Hernandez A, Laskowitz D, Schwamm L, Bhatt D, Smith E, Fonarow G, Peterson E. Use of Intravenous Recombinant Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke Who Take Non–Vitamin K Antagonist Oral Anticoagulants Before Stroke. Circulation 2017, 135: 1024-1035. PMID: 28119380, DOI: 10.1161/circulationaha.116.023940.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAgedAged, 80 and overAnticoagulantsDabigatranFemaleFibrinolytic AgentsHemorrhageHospital MortalityHumansInternational Normalized RatioMalePyrazolesPyridonesRecombinant ProteinsRegistriesRetrospective StudiesRisk FactorsRivaroxabanStrokeTime FactorsTissue Plasminogen ActivatorTreatment OutcomeWarfarinConceptsIntravenous rt-PASymptomatic intracranial hemorrhageIschemic strokeRt-PAIntracranial hemorrhageOdds ratioNon-Vitamin K Antagonist Oral AnticoagulantsIntravenous recombinant tissue plasminogen activatorK Antagonist Oral AnticoagulantsRecombinant tissue plasminogen activatorGuidelines-Stroke registrySerious systemic hemorrhageAcute ischemic strokeAdjusted odds ratioAmerican Heart AssociationTissue plasminogen activatorOutcomes of useHospital mortalityRegistry hospitalsOral anticoagulantsSevere strokeAdverse eventsProhibitive riskRankin ScaleThrombolytic therapy
2016
Hospital Variation in Home-Time After Acute Ischemic Stroke
O'Brien E, Xian Y, Xu H, Wu J, Saver J, Smith E, Schwamm L, Peterson E, Reeves M, Bhatt D, Maisch L, Hannah D, Lindholm B, Olson D, Prvu Bettger J, Pencina M, Hernandez A, Fonarow G. Hospital Variation in Home-Time After Acute Ischemic Stroke. Stroke 2016, 47: 2627-2633. PMID: 27625383, DOI: 10.1161/strokeaha.116.013563.Peer-Reviewed Original ResearchConceptsIschemic strokeStroke survivorsStroke volumeAdmission volumePost dischargeAcute ischemic strokeIschemic stroke survivorsHighest priority outcomesMore comorbiditiesRegistry patientsSevere strokeHospital factorsAdjusted analysisHospital variationHospital characteristicsPost strokeMedicare claimsRural locationsHospitalStrokePatientsRisk adjustmentLinear mixed modelsFirst yearSurvivors
2014
Racial/Ethnic Differences in Process of Care and Outcomes Among Patients Hospitalized With Intracerebral Hemorrhage
Xian Y, Holloway R, Smith E, Schwamm L, Reeves M, Bhatt D, Schulte P, Cox M, Olson D, Hernandez A, Lytle B, Anstrom K, Fonarow G, Peterson E. Racial/Ethnic Differences in Process of Care and Outcomes Among Patients Hospitalized With Intracerebral Hemorrhage. Stroke 2014, 45: 3243-3250. PMID: 25213344, DOI: 10.1161/strokeaha.114.005620.Peer-Reviewed Original ResearchConceptsWhite patientsAsian patientsRace/ethnicityCessation counselingLower oddsDeep venous thrombosis prophylaxisGuidelines-Stroke hospitalsStroke performance measuresVenous thrombosis prophylaxisHospital-level characteristicsMultivariable logistic regressionProcess of careEthnic differencesHospital mortalityThrombosis prophylaxisCause mortalityHospital outcomesSevere strokeDysphagia screeningBlack patientsIntracerebral hemorrhageMedian lengthHigher oddsStroke educationComfort measuresIntravenous Fibrinolysis Eligibility: A Survey of Stroke Clinicians' Practice Patterns and Review of the Literature
De Los Rios F, Kleindorfer D, Guzik A, Ortega-Gutierrez S, Sangha N, Kumar G, Grotta J, Lee J, Meyer B, Schwamm L, Khatri P, Investigators S. Intravenous Fibrinolysis Eligibility: A Survey of Stroke Clinicians' Practice Patterns and Review of the Literature. Journal Of Stroke And Cerebrovascular Diseases 2014, 23: 2130-2138. PMID: 25113084, PMCID: PMC4157964, DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.024.Peer-Reviewed Original ResearchConceptsStroke cliniciansPractice patternsEligible patientsSymptom onsetEuropean Cooperative Acute Stroke Study-III criteriaIntravenous recombinant tissue plasminogen activator useCurrent American Heart Association guidelinesRecombinant tissue plasminogen activator useTissue plasminogen activator useAmerican Heart Association guidelinesHealth Stroke ScaleHeart Association guidelinesHour time frameClinician practice patternsNational InstituteSevere strokeStroke ScaleIschemic strokeMild strokeAssociation guidelinesMost cliniciansElderly individualsEligibility criteriaDrug AdministrationInvestigator meeting
2013
Quality of Care and Outcomes for In-Hospital Ischemic Stroke
Cumbler E, Wald H, Bhatt D, Cox M, Xian Y, Reeves M, Smith E, Schwamm L, Fonarow G. Quality of Care and Outcomes for In-Hospital Ischemic Stroke. Stroke 2013, 45: 231-238. PMID: 24253540, DOI: 10.1161/strokeaha.113.003617.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCohort StudiesComorbidityConfidence IntervalsDatabases, FactualFemaleGuideline AdherenceHumansMaleMiddle AgedOdds RatioQuality ImprovementQuality of Health CareRegistriesRetrospective StudiesSocioeconomic FactorsStrokeThrombolytic TherapyTreatment OutcomeConceptsHospital strokeIschemic strokeSevere strokePatient characteristicsIn-Hospital Ischemic StrokeProcess-based quality measuresCommunity-onset strokeDefect-free careGuidelines-Stroke databaseRetrospective cohort studyThromboembolic risk factorsProportion of patientsHospital ischemic strokeAmerican Heart AssociationTargeted quality improvement effortsQuality of careProsthetic heart valvesQuality improvement effortsHospital mortalityComorbid illnessesCohort studyHeart failureAtrial fibrillationCarotid stenosisHeart AssociationCharacteristics and Outcomes Among Patients Transferred to a Regional Comprehensive Stroke Center for Tertiary Care
Ali S, Singhal A, Viswanathan A, Rost N, Schwamm L. Characteristics and Outcomes Among Patients Transferred to a Regional Comprehensive Stroke Center for Tertiary Care. Stroke 2013, 44: 3148-3153. PMID: 24021682, DOI: 10.1161/strokeaha.113.002493.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIntravenous tissue plasminogen activatorInitial National InstitutesComprehensive stroke centerHospital mortalityIschemic strokeTissue plasminogen activatorStroke centersStroke careDoor patientsHealth Stroke Scale scoreMedian initial National InstitutesAcute ischemic stroke carePlasminogen activatorLonger hospital lengthStroke care centerHealth Stroke ScaleStroke Scale scoreCoronary artery diseaseIschemic stroke careAcute care hospitalsNational InstituteHospital lengthSevere strokeStroke RegistryOutcomes in Severe Middle Cerebral Artery Ischemic Stroke
Walcott BP, Miller JC, Kwon CS, Sheth SA, Hiller M, Cronin CA, Schwamm LH, Simard JM, Kahle KT, Kimberly WT, Sheth KN. Outcomes in Severe Middle Cerebral Artery Ischemic Stroke. Neurocritical Care 2013, 21: 20-26. PMID: 23839704, PMCID: PMC3880600, DOI: 10.1007/s12028-013-9838-x.Peer-Reviewed Original ResearchConceptsMiddle cerebral artery strokeMiddle cerebral artery ischemic strokeCerebral artery involvementMidline brain shiftPatient-centered outcomesLogistic regression analysisPatient-specific variablesArtery involvementEdema subgroupsMCA strokeInfarct volumeSevere strokeUnderwent tracheostomyAdult patientsIschemic strokeLife-sustaining proceduresRetrospective cohortSymptom onsetDecompressive craniectomyArtery strokeStudy criteriaUnderwent gastrostomyExclusion criteriaMortality rateMultivariate analysisPatterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment
Ekundayo O, Saver J, Fonarow G, Schwamm L, Xian Y, Zhao X, Hernandez A, Peterson E, Cheng E. Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment. Circulation Cardiovascular Quality And Outcomes 2013, 6: 262-269. PMID: 23633218, DOI: 10.1161/circoutcomes.113.000089.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overChi-Square DistributionEmergency Medical ServicesEmergency Service, HospitalEthnicityFemaleGuideline AdherenceHealth Knowledge, Attitudes, PracticeHumansMaleMiddle AgedMinority GroupsOdds RatioOutcome and Process Assessment, Health CarePatient Acceptance of Health CarePatient Education as TopicPractice Guidelines as TopicRegistriesRisk FactorsStrokeTime FactorsTime-to-TreatmentTransportation of PatientsTreatment OutcomeUnited StatesConceptsEmergency medical servicesStroke patientsEMS useEmergency medical services useMinority raceHealth Stroke ScoreMedical service useTreatment of strokeTissue-type plasminogen activatorEligible patientsGuidelines-StrokeSevere strokeStroke ScoreHospital arrivalOlder patientsYounger patientsHemorrhagic strokeStroke treatmentMedicare insuranceInsurance statusEMS activationDecreased oddsEMS transportService usePatientsDysphagia Screening and Hospital-acquired Pneumonia in Patients with Acute Ischemic Stroke: Findings from Get with the Guidelines–Stroke
Masrur S, Smith E, Saver J, Reeves M, Bhatt D, Zhao X, Olson D, Pan W, Hernandez A, Fonarow G, Schwamm L. Dysphagia Screening and Hospital-acquired Pneumonia in Patients with Acute Ischemic Stroke: Findings from Get with the Guidelines–Stroke. Journal Of Stroke And Cerebrovascular Diseases 2013, 22: e301-e309. PMID: 23305674, DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.013.Peer-Reviewed Original ResearchConceptsHospital-acquired pneumoniaDysphagia screeningStroke patientsGuidelines-StrokeNIHSS scoreIschemic strokeOral intakeMultivariable analysisHealth Stroke Scale scoreAdmission National InstitutesGuidelines-Stroke hospitalsStroke Scale scoreAcute ischemic strokeIschemic stroke patientsLength of stayEligible patientsHospital mortalitySevere strokeFemale genderNational guidelinesLower riskPatientsScale scorePneumoniaStroke
2012
Risks of Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Receiving Warfarin and Treated With Intravenous Tissue Plasminogen Activator
Xian Y, Liang L, Smith E, Schwamm L, Reeves M, Olson D, Hernandez A, Fonarow G, Peterson E. Risks of Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Receiving Warfarin and Treated With Intravenous Tissue Plasminogen Activator. JAMA 2012, 307: 2600-2608. PMID: 22735429, DOI: 10.1001/jama.2012.6756.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorInternational normalized ratioSymptomatic intracranial hemorrhageTissue plasminogen activatorSerious systemic hemorrhageIschemic strokeIntracranial hemorrhageSICH riskHospital mortalitySystemic hemorrhagePlasminogen activatorBaseline clinical factorsChronic warfarin therapyGuidelines-Stroke registrySecondary end pointsDegree of anticoagulationAmerican Heart AssociationRegistry hospitalsSICH rateSevere strokeWarfarin therapyClinical factorsComorbid conditionsHeart AssociationNormalized ratio
2009
Remote Supervision of IV-tPA for Acute Ischemic Stroke by Telemedicine or Telephone Before Transfer to a Regional Stroke Center Is Feasible and Safe
Pervez M, Silva G, Masrur S, Betensky R, Furie K, Hidalgo R, Lima F, Rosenthal E, Rost N, Viswanathan A, Schwamm L. Remote Supervision of IV-tPA for Acute Ischemic Stroke by Telemedicine or Telephone Before Transfer to a Regional Stroke Center Is Feasible and Safe. Stroke 2009, 41: e18-e24. PMID: 19910552, PMCID: PMC3383769, DOI: 10.1161/strokeaha.109.560169.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overBrain IschemiaFeasibility StudiesFemaleFollow-Up StudiesHospitalizationHumansInfusions, IntravenousMaleMiddle AgedPatient TransferProspective StudiesRemote ConsultationRetrospective StudiesStrokeTelemedicineTelephoneTime FactorsTissue Plasminogen ActivatorYoung AdultConceptsTissue plasminogen activatorOSH patientsCatheter-based reperfusionGuidelines-Stroke databaseAcute ischemic strokeOutcomes of patientsRegional stroke centerDischarge functional statusRSC patientsTelestroke patientsIntravenous thrombolysisIschemic strokeIV-tPARankin scoreSevere strokeStroke centersSymptom onsetTPA infusionRetrospective reviewStroke databaseStroke specialistsFunctional outcomeFunctional statusTelephone consultationsSystemic hemorrhage