2024
Trends in Stroke Thrombolysis Care Metrics and Outcomes by Race and Ethnicity, 2003-2021
Man S, Solomon N, Mac Grory B, Alhanti B, Saver J, Smith E, Xian Y, Bhatt D, Schwamm L, Uchino K, Fonarow G. Trends in Stroke Thrombolysis Care Metrics and Outcomes by Race and Ethnicity, 2003-2021. JAMA Network Open 2024, 7: e2352927. PMID: 38324315, PMCID: PMC10851100, DOI: 10.1001/jamanetworkopen.2023.52927.Peer-Reviewed Original ResearchConceptsDoor-to-needleDoor-to-needle timeHispanic patientsWhite patientsAssociated with improvementsThrombolysis rateCohort studyEthnic groupsQuality InitiativeCohort study of patientsCare qualityCare metricsPre-testIschemic strokeEthnic disparitiesRetrospective cohort studyMain OutcomesPatient functionIschemic stroke onsetSecondary outcomesPrimary outcomeStudy of patientsOddsAcute ischemic strokeStroke onset
2023
Performance of Thrombectomy-Capable, Comprehensive, and Primary Stroke Centers in Reperfusion Therapies for Acute Ischemic Stroke: Report From the Get With The Guidelines–Stroke Registry
Raychev R, Sun J, Schwamm L, Smith E, Fonarow G, Messé S, Xian Y, Chiswell K, Blanco R, Mac Grory B, Saver J. Performance of Thrombectomy-Capable, Comprehensive, and Primary Stroke Centers in Reperfusion Therapies for Acute Ischemic Stroke: Report From the Get With The Guidelines–Stroke Registry. Circulation 2023, 148: 2019-2028. PMID: 37855118, DOI: 10.1161/circulationaha.123.066114.Peer-Reviewed Original ResearchConceptsComprehensive stroke centerPrimary stroke centerThrombectomy-capable stroke centersAcute ischemic strokeGuidelines-Stroke registryEndovascular thrombectomyStroke centersReperfusion therapyIschemic strokeClinical outcomesHealth Stroke Scale scoreClinical efficacy outcomesStroke Scale scoreHigher National InstitutesOdds of dischargeGoal doorEVT proceduresHospital mortalityIntravenous thrombolysisEfficacy outcomesSuccessful reperfusionCohort studyDischarge destinationNeedle timePuncture timeShorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke
Man S, Solomon N, Mac Grory B, Alhanti B, Uchino K, Saver J, Smith E, Xian Y, Bhatt D, Schwamm L, Hussain M, Fonarow G. Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke. Circulation 2023, 148: 20-34. PMID: 37199147, PMCID: PMC10356148, DOI: 10.1161/circulationaha.123.064053.Peer-Reviewed Original ResearchConceptsIntravenous thrombolytic therapyAcute ischemic strokeGood long-term functional outcomeLong-term functional outcomeShorter DTN timesEndovascular thrombectomyFunctional outcomeDTN timeIschemic strokeCause mortalityNeedle timeThrombolytic therapyCox proportional hazards modelModified Rankin Scale (mRS) 0Older US patientsRankin Scale 0Multivariate logistic regressionProportional hazards modelLongitudinal functional outcomesHome timeEligible patientsEVT candidatesEVT timesGuidelines-StrokeThrombolytic administration
2022
Development and validation of the age-associated dementia policy (AgeD-Pol) computer simulation model in the USA and Europe
Hyle E, Foote J, Shebl F, Qian Y, Reddy K, Mukerji S, Wattananimitgul N, Viswanathan A, Schwamm L, Pandya A, Freedberg K. Development and validation of the age-associated dementia policy (AgeD-Pol) computer simulation model in the USA and Europe. BMJ Open 2022, 12: e056546. PMID: 35793913, PMCID: PMC9260808, DOI: 10.1136/bmjopen-2021-056546.Peer-Reviewed Original ResearchMeSH KeywordsAdultCohort StudiesComputer SimulationDementiaEuropeFemaleHumansMalePolicyUnited StatesConceptsAge-associated dementiaKaiser Permanente Northern CaliforniaCumulative incidenceAAD incidenceInternal validationLifetime cumulative incidenceSex-stratified dataExternal validationFramingham Heart StudyCohort studyRotterdam StudyRotterdam cohortDisease burdenDisease progressionOutcome measuresHeart StudyDATA SOURCESACT cohortAdult ChangesCohort dataNatural historyCohortMortalityHealth systemIncidenceAnalysis of Prescriptions for Dual Antiplatelet Therapy After Acute Ischemic Stroke
Xian Y, Xu H, Matsouaka R, Laskowitz D, Maisch L, Hannah D, Smith E, Fonarow G, Bhatt D, Schwamm L, Mac Grory B, Feng W, Fosbøl E, Peterson E, Johnson M. Analysis of Prescriptions for Dual Antiplatelet Therapy After Acute Ischemic Stroke. JAMA Network Open 2022, 5: e2224157. PMID: 35900761, PMCID: PMC9335137, DOI: 10.1001/jamanetworkopen.2022.24157.Peer-Reviewed Original ResearchConceptsAHA/ASA guidelinesAcute ischemic strokeMinor ischemic strokeUse of DAPTDual antiplatelet therapyIschemic strokeMinor strokeHospital-level variationAntiplatelet therapyASA guidelinesDAPT useCohort studySecondary preventionOdds ratioAmerican Heart Association/American Stroke AssociationMinor acute ischemic strokeMulticenter retrospective cohort studyMultivariable logistic regression analysisSubstantial hospital-level variationAHA/ASAGuidelines-Stroke programIdentical clinical featuresRetrospective cohort studyAmerican Stroke AssociationEvidence-based guidelinesTrends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients
Adcock A, Schwamm L, Smith E, Fonarow G, Reeves M, Xu H, Matsouaka R, Xian Y, Saver J. Trends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients. JAMA Network Open 2022, 5: e2215869. PMID: 35671055, PMCID: PMC9175073, DOI: 10.1001/jamanetworkopen.2022.15869.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeYounger patientsHospital mortalityCohort studyIschemic strokeOlder patientsIntracranial hemorrhageAmerican Heart Association/American Stroke AssociationFunctional independenceHealth Stroke Scale scoreSymptomatic intracranial hemorrhage rateNationwide retrospective cohort studyGuidelines-Stroke programGWTG-Stroke hospitalsIntracranial hemorrhage rateStroke Scale scoreFavorable functional outcomeRetrospective cohort studyAmerican Stroke AssociationQuality improvement registryMeeting study criteriaEVT rateEVT useThrombectomy trials
2021
Thrombolysis in Mild Stroke
Asdaghi N, Romano J, Gardener H, Campo-Bustillo I, Purdon B, Khan Y, Gulati D, Broderick J, Schwamm L, Smith E, Saver J, Sacco R, Khatri P. Thrombolysis in Mild Stroke. Stroke 2021, 52: e586-e589. PMID: 34496619, DOI: 10.1161/strokeaha.120.033466.Peer-Reviewed Original ResearchConceptsNIHSS scoreClinical practiceHealth Stroke Scale scoreMild ischemic stroke patientsMedian NIHSS scoreTrial of thrombolysisStroke Scale scoreIschemic stroke patientsProportion of patientsBroad clinical practiceRoutine clinical practiceSyndromic severityTrial cohortStroke patientsMild strokeMild patientsNeurological syndromeAlteplasePatientsScale scoreLess severityMaRISSComparable deficitsNational InstituteSeverityClinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage
Xian Y, Zhang S, Inohara T, Grau-Sepulveda M, Matsouaka RA, Peterson ED, Piccini JP, Smith EE, Sheth KN, Bhatt DL, Fonarow GC, Schwamm LH. Clinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage. JAMA Network Open 2021, 4: e2037438. PMID: 33591368, PMCID: PMC7887660, DOI: 10.1001/jamanetworkopen.2020.37438.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAnticoagulantsCase-Control StudiesCerebral HemorrhageCohort StudiesDependent AmbulationDrug Therapy, CombinationDual Anti-Platelet TherapyFactor Xa InhibitorsFemaleFunctional StatusHospicesHospital MortalityHumansMaleMiddle AgedOdds RatioPatient DischargePlatelet Aggregation InhibitorsRegistriesRisk FactorsWarfarinConceptsOral anticoagulant useOral anticoagulantsFXa inhibitorsHospital mortalityAnticoagulant useCohort studyIndependent ambulationMRS scoreIntracerebral hemorrhageGuidelines-Stroke registryCardiovascular risk factorsHospital mortality riskFactor Xa inhibitorsConcomitant warfarinOral anticoagulationAnticoagulation therapyAntiplatelet therapyHospital outcomesClinical characteristicsRankin ScaleSecondary outcomesPrimary outcomeRisk factorsWorse outcomesHigh prevalence
2020
Trends in Reperfusion Therapy for In-Hospital Ischemic Stroke in the Endovascular Therapy Era
Akbik F, Xu H, Xian Y, Shah S, Smith E, Bhatt D, Matsouaka R, Fonarow G, Schwamm L. Trends in Reperfusion Therapy for In-Hospital Ischemic Stroke in the Endovascular Therapy Era. JAMA Neurology 2020, 77: 1486-1495. PMID: 32955582, PMCID: PMC7506601, DOI: 10.1001/jamaneurol.2020.3362.Peer-Reviewed Original ResearchConceptsHospital stroke onsetHospital onsetIntravenous thrombolysisStroke onsetEndovascular therapyReperfusion therapyHospital strokeCohort studyIschemic strokeFunctional outcomeNational registryIn-Hospital Ischemic StrokeIntravenous thrombolysis treatmentLimited contemporary dataRetrospective cohort studyAcute ischemic strokeVascular risk factorsWorse functional outcomeEndovascular reperfusion therapyLonger median timeKey patient characteristicsTherapy eraThrombolysis treatmentHospital dischargePatient characteristicsPatterns of anticonvulsant use and adverse drug events in older adults
Moura L, Smith J, Yan Z, Blacker D, Schwamm L, Newhouse J, Hernandez‐Diaz S, Hsu J. Patterns of anticonvulsant use and adverse drug events in older adults. Pharmacoepidemiology And Drug Safety 2020, 30: 28-36. PMID: 33009718, PMCID: PMC7849867, DOI: 10.1002/pds.5139.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnticonvulsantsCohort StudiesDrug-Related Side Effects and Adverse ReactionsEpilepsyHumansMedicareUnited StatesConceptsAdverse drug eventsElectronic health recordsIncident usersAnticonvulsant useDrug eventsMedicare beneficiariesRate of ADEsSeverity of ADEsSignificant adverse drug eventsEligible beneficiariesOlder adultsCohort of communityDuration of useRange of indicationsTraditional Medicare beneficiariesInverse probability weightsADE ratesMonotherapy usersSingle anticonvulsantAnticonvulsant therapyPain reliefCommon indicationOriginal cohortNervous systemOlder adult communityTrends Among Rural and Urban Medicare Beneficiaries in Care Delivery and Outcomes for Acute Stroke and Transient Ischemic Attacks, 2008-2017
Wilcock A, Zachrison K, Schwamm L, Uscher-Pines L, Zubizarreta J, Mehrotra A. Trends Among Rural and Urban Medicare Beneficiaries in Care Delivery and Outcomes for Acute Stroke and Transient Ischemic Attacks, 2008-2017. JAMA Neurology 2020, 77: 863-871. PMID: 32364573, PMCID: PMC7358912, DOI: 10.1001/jamaneurol.2020.0770.Peer-Reviewed Original ResearchConceptsTransient ischemic attackAcute ischemic strokeIschemic attackAcute strokeStroke centersRural-urban disparitiesResidential zip codeIschemic strokeEnd-stage kidney diseaseRural-Urban Commuting Area codesDescriptive observational studyHealth care centersUrban Medicare beneficiariesQuality of careTraditional MedicareNeurologist evaluationOutcome patientsUrban patientsStroke careNeurology consultationKidney diseaseMean ageCare centerStroke systemsObservational study
2019
Recent 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 riskInfarctionPatients
2018
Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission
El Husseini N, Fonarow G, Smith E, Ju C, Sheng S, Schwamm L, Hernandez A, Schulte P, Xian Y, Goldstein L. Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission. Stroke 2018, 49: 2896-2903. PMID: 30571413, PMCID: PMC6338440, DOI: 10.1161/strokeaha.118.022011.Peer-Reviewed Original ResearchConceptsPoststroke mortalityIschemic strokeDialysis statusHospital readmissionKidney functionPoststroke outcomesMultivariable Cox proportional hazards modelsCox proportional hazards modelService Medicare patientsGlomerular filtration rateHospital readmission ratesRisk stratification modelProportional hazards modelEGFR 15Guidelines-StrokeIndex hospitalizationPostdischarge mortalityEGFR 30EGFR 45Readmission ratesRehospitalization ratesCohort studyKidney diseaseFiltration rateIndependent associationQuality of Care and Outcomes for Patients With Stroke in the United States Admitted During the International Stroke Conference
Messé S, Mullen M, Cox M, Fonarow G, Smith E, Saver J, Reeves M, Bhatt D, Matsouaka R, Schwamm L. Quality of Care and Outcomes for Patients With Stroke in the United States Admitted During the International Stroke Conference. Journal Of The American Heart Association 2018, 7: e009842. PMID: 30376750, PMCID: PMC6404171, DOI: 10.1161/jaha.118.009842.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorTissue plasminogen activatorAcute ischemic strokeInternational Stroke ConferencePlasminogen activatorWorse outcomesGuideline-adherent careGuidelines-Stroke hospitalsRetrospective cohort studyHours of onsetMinutes of arrivalExperience worse outcomesQuality of careSame quality careAverage weekly numberGuidelines-StrokeAcute strokeBackground PatientsCohort studyConclusions PatientsIschemic strokeClinical outcomesMean ageStroke cliniciansHospital characteristicsFactors associated with 1-year mortality after discharge for acute stroke: what matters?
Magdon-Ismail Z, Ledneva T, Sun M, Schwamm L, Sherman B, Qian F, Bettger J, Xian Y, Stein J. Factors associated with 1-year mortality after discharge for acute stroke: what matters? Topics In Stroke Rehabilitation 2018, 25: 576-583. PMID: 30281414, DOI: 10.1080/10749357.2018.1499303.Peer-Reviewed Original ResearchConceptsInpatient rehabilitation facilitySkilled nursing facilitiesAcute strokeDischarge destinationHealth Stroke ScaleHigher National InstitutesRetrospective cohort studyLong-term outcomesLong-term survivalCause mortalityStroke ScaleCohort studyIschemic strokeAmbulation statusIntracerebral hemorrhageMean ageMultivariate regression modelClinical dataNursing facilitiesRehabilitation facilityTherapeutic targetOlder ageMortalityStrokeNational InstituteIncidence 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 ControlsPatientsQuality of care for ischemic stroke in China vs India: Findings from national clinical registries.
Li Z, Pandian J, Sylaja P, Wang Y, Zhao X, Liu L, Wang C, Khurana D, Srivastava M, Kaul S, Arora D, Schwamm L, Wang Y, Singhal A. Quality of care for ischemic stroke in China vs India: Findings from national clinical registries. Neurology 2018, 91: e1348-e1354. PMID: 30158158, PMCID: PMC6177271, DOI: 10.1212/wnl.0000000000006291.Peer-Reviewed Original ResearchConceptsChina National Stroke Registry IIGreater stroke severityStroke risk factorsRisk factorsStroke severityClinical outcomesStroke careIndian patientsAcademic stroke centerNational clinical registryIschemic stroke patientsBurden of strokeIschemic stroke careDifferent risk factorsQuality of careHospital mortalityIschemic strokeStroke centersAcute managementStroke patientsStroke ProjectChinese patientsClinical registryWorse outcomesAcademic hospital
2017
Increase in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials
Smith E, Saver J, Cox M, Liang L, Matsouaka R, Xian Y, Bhatt D, Fonarow G, Schwamm L. Increase in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials. Circulation 2017, 136: 2303-2310. PMID: 28982689, DOI: 10.1161/circulationaha.117.031097.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomyEVT useEligible patientsIschemic strokePivotal trialsCase volumeStroke systemsHealth Stroke Scale scoreGuidelines-Stroke programStroke Scale scoreMean case volumeGuidelines-StrokeEndovascular therapyMore patientsPatient eligibilityPatientsClinical practiceScale scoreHospitalStrokeTrialsNational InstituteStroke durationLinear regressionThrombectomyImmediate Vascular Imaging Needed for Efficient Triage of Patients With Acute Ischemic Stroke Initially Admitted to Nonthrombectomy Centers
Boulouis G, Siddiqui K, Lauer A, Charidimou A, Regenhardt R, Viswanathan A, Leslie-Mazwi T, Rost N, Schwamm L. Immediate Vascular Imaging Needed for Efficient Triage of Patients With Acute Ischemic Stroke Initially Admitted to Nonthrombectomy Centers. Stroke 2017, 48: 2297-2300. PMID: 28687641, DOI: 10.1161/strokeaha.117.017607.Peer-Reviewed Original ResearchConceptsThrombectomy-capable stroke centersEndovascular thrombectomyVascular imagingCurrent guidelinesAlberta Stroke Program Early CT ScoreUnnecessary transfersHealth Stroke ScaleAcute ischemic strokeMain outcome variablesBaseline vascularStroke ScaleIschemic strokeStroke centersCT scoreFutile transfersPatientsEfficient triageHospitalYielded sensitivityOutcome variablesOptimal selection criteriaNational InstituteStrokeImagingOcclusion levelCurrent Practice Trends for Use of Early Venous Thromboembolism Prophylaxis After Intracerebral Hemorrhage
Cherian L, Smith E, Schwamm L, Fonarow G, Schulte P, Xian Y, Wu J, Prabhakaran S. Current Practice Trends for Use of Early Venous Thromboembolism Prophylaxis After Intracerebral Hemorrhage. Neurosurgery 2017, 82: 85-92. PMID: 28379461, DOI: 10.1093/neuros/nyx146.Peer-Reviewed Original ResearchConceptsHospital day 2Early chemoprophylaxisIntracerebral hemorrhageVTE prophylaxisDay 2Venous thromboembolismEarly Venous Thromboembolism ProphylaxisEarly VTE prophylaxisGuidelines-Stroke registryMechanical VTE prophylaxisPrior ischemic strokeCP useTransient ischemic attackVenous thromboembolism prophylaxisObservational cohort studyPeripheral artery diseaseMultivariable logistic regressionAcute care facilitiesComfort care measuresCurrent practice trendsIschemic attackProphylaxis statusThromboembolism prophylaxisMechanical prophylaxisCohort study