2024
Factors Underlying Reduced Hospitalizations for Myocardial Infarction During the COVID-19 Pandemic
Wilcock A, Zubizarreta J, Wadhera R, Yeh R, Zachrison K, Schwamm L, Mehrotra A. Factors Underlying Reduced Hospitalizations for Myocardial Infarction During the COVID-19 Pandemic. JAMA Cardiology 2024, 9 PMID: 39083317, PMCID: PMC11292572, DOI: 10.1001/jamacardio.2024.2031.Peer-Reviewed Original ResearchHospital encountersAcute myocardial infarctionCare avoidanceShort-term acute careAcute myocardial infarction incidenceAcute myocardial infarction ratesTemporal trendsCOVID-19 pandemicPatient characteristicsTraditional Medicare claimsCross-sectional studyPandemic-related changesAMI incidenceCOVID-19 death ratesAcute careMyocardial infarctionMedicare claimsMain OutcomesExcess deathsExcess mortalityStudy samplePrepandemic levelsTraditional MedicareUnited StatesCOVID-19
2021
Association of Physician Characteristics With Early Adoption of Virtual Health Care
Zachrison K, Yan Z, Samuels-Kalow M, Licurse A, Zuccotti G, Schwamm L. Association of Physician Characteristics With Early Adoption of Virtual Health Care. JAMA Network Open 2021, 4: e2141625. PMID: 34967876, PMCID: PMC8719243, DOI: 10.1001/jamanetworkopen.2021.41625.Peer-Reviewed Original ResearchConceptsVirtual health careCross-sectional studyHealth care systemPatient characteristicsHealth carePhysician characteristicsLarge regional health care systemRetrospective cross-sectional studyBehavioral healthCare systemSurgical specialtiesHealth system databasePhysician-level variationRegional health care systemAmbulatory visitsPrimary careHealth physiciansPatient's abilityAmbulatory careMAIN OUTCOMEGreater oddsAmbulatory practiceBivariate comparisonsPhysiciansHospital affiliationFrequency, 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 periodAssociation of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks
Zachrison K, Richard J, Wilcock A, Zubizaretta J, Schwamm L, Uscher-Pines L, Mehrotra A. Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks. JAMA Network Open 2021, 4: e2126612. PMID: 34554236, PMCID: PMC8461501, DOI: 10.1001/jamanetworkopen.2021.26612.Peer-Reviewed Original ResearchConceptsHospital stroke volumeControl hospitalsStroke volumeStroke centersStroke symptomsStroke systemsCase mixTransient ischemic attack admissionsHospital pairsInitial hospital presentationThrombectomy-capable hospitalsComprehensive stroke centerTransient ischemic attackPrimary stroke centerCross-sectional studyMajor teaching hospitalObserved patient characteristicsBed sizeHospital presentationIschemic attackInitial hospitalCritical access hospitalsPatient characteristicsInterhospital transferPostimplementation periodPatient characteristics associated with the successful transition to virtual care: Lessons learned from the first million patients
Zachrison K, Yan Z, Sequist T, Licurse A, Tan-McGrory A, Erskine A, Schwamm L. Patient characteristics associated with the successful transition to virtual care: Lessons learned from the first million patients. Journal Of Telemedicine And Telecare 2021, 29: 621-631. PMID: 34120506, DOI: 10.1177/1357633x211015547.Peer-Reviewed Original ResearchConceptsVirtual participantsVirtual participationBehavioral health visitsVirtual carePatient characteristicsHealth visitsInternet accessElectronic health record dataVideoNon-Hispanic black raceLarge integrated health systemHealth record dataAmbulatory care patientsIntegrated health systemVisit frequencyUse of telehealthOutcomes of interestPatient portalsAmbulatory visitsCare patientsBlack raceVisit typeVulnerable patientsCOVID patientsLimited English proficiency
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 characteristicsEstablishment of an internationally agreed minimum data set for acute telestroke
Cadilhac D, Bagot K, Demaerschalk B, Hubert G, Schwamm L, Watkins C, Lightbody C, Kim J, Vu M, Pompeani N, Switzer J, Caudill J, Estrada J, Viswanathan A, Hubert N, Ohannessian R, Hargroves D, Roberts N, Ingall T, Hess D, Ranta A, Padma V, Bladin C. Establishment of an internationally agreed minimum data set for acute telestroke. Journal Of Telemedicine And Telecare 2020, 27: 582-589. PMID: 31937198, DOI: 10.1177/1357633x19899262.Peer-Reviewed Original ResearchConceptsTelestroke programsMinimum datasetExpert panelProcess of careGeneral clinical careInternational expert panelReliable international comparisonsTelestroke consultationThrombolysis treatmentPatient characteristicsEndovascular treatmentAcute careClinical managementPatient outcomesClinical careNeurosurgery treatmentDischarge informationInitial scoping reviewCareScoping ReviewTelestrokeHospitalTreatmentAustralasia-Pacific regionDelphi technique
2019
Frequency of early rapid improvement in stroke severity during interfacility transfer.
Zachrison K, Leslie-Mazwi T, Boulouis G, Goldstein J, Regenhardt R, Viswanathan A, Lauer A, Siddiqui K, Charidimou A, Rost N, Schwamm L. Frequency of early rapid improvement in stroke severity during interfacility transfer. Neurology Clinical Practice 2019, 9: 373-380. PMID: 31750022, PMCID: PMC6814428, DOI: 10.1212/cpj.0000000000000667.Peer-Reviewed Original ResearchNIHSS scoreInterfacility transferMedian initial NIHSS scoreNIH Stroke Scale scoreHigher initial NIHSSInitial NIHSS scoreNIHSS score changeStroke Scale scoreRapid improvementCSC arrivalInitial NIHSSIndex strokeStroke severityPatient characteristicsMedian changeMultivariable modelingScale scoreScore changeLogistic regressionStrokePatientsScores
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 analysisDiseaseStrokeInternational Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines––Stroke Program
Wangqin R, Laskowitz D, Wang Y, Li Z, Wang Y, Liu L, Liang L, Matsouaka R, Saver J, Fonarow G, Bhatt D, Smith E, Schwamm L, Bettger J, Hernandez A, Peterson E, Xian Y. International Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines––Stroke Program. Journal Of The American Heart Association 2018, 7: e010623. PMID: 30371291, PMCID: PMC6474951, DOI: 10.1161/jaha.118.010623.Peer-Reviewed Original ResearchConceptsChina National Stroke RegistryNational Stroke RegistryAcute ischemic strokeStroke RegistryIschemic strokeChinese patientsDeep venous thrombosis prophylaxisHealth Stroke ScaleVenous thrombosis prophylaxisAcute stroke careAdministration of thrombolyticsEvidence-based guidelinesAmerican Heart AssociationQuality of careBackground AdherenceDischarge antithromboticsThrombosis prophylaxisCessation counselingStroke ProgramStroke ScaleClinical characteristicsHospital arrivalNeedle timePatient characteristicsSecondary preventionIntravenous tPA (Tissue-Type Plasminogen Activator) in Patients With Acute Ischemic Stroke Taking Non–Vitamin K Antagonist Oral Anticoagulants Preceding Stroke
Jin C, Huang R, Peterson E, Laskowitz D, Hernandez A, Federspiel J, Schwamm L, Bhatt D, Smith E, Fonarow G, Xian Y. Intravenous tPA (Tissue-Type Plasminogen Activator) in Patients With Acute Ischemic Stroke Taking Non–Vitamin K Antagonist Oral Anticoagulants Preceding Stroke. Stroke 2018, 49: 2237-2240. PMID: 30354981, PMCID: PMC6706353, DOI: 10.1161/strokeaha.118.022128.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAdministration, OralAntibodies, Monoclonal, HumanizedAnticoagulantsAntidotesAntithrombinsBrain IschemiaDabigatranFactor Xa InhibitorsFibrinolytic AgentsHumansIntracranial HemorrhagesOdds RatioPractice Guidelines as TopicPyrazolesPyridonesRivaroxabanStrokeTissue Plasminogen ActivatorConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeIntravenous tPAIntracranial hemorrhageFavorable outcomeIschemic strokeThrombin timeAnti-Xa assaySensitive laboratory testsNOAC patientsOral anticoagulantsTPA administrationProhibitive riskSymptom onsetPatient characteristicsMedian timeMedication intakeCurrent guidelinesAnticoagulant effectLarge cohortClinical carePatientsOverall observed rateNOACsHemorrhage
2017
Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals
Thompson M, Zhao X, Bekelis K, Gottlieb D, Fonarow G, Schulte P, Xian Y, Lytle B, Schwamm L, Smith E, Reeves M. Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003604. PMID: 28798017, DOI: 10.1161/circoutcomes.117.003604.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedBrain IschemiaDatabases, FactualFee-for-Service PlansFemaleGuideline AdherenceHealth ResourcesHealthcare DisparitiesHospitalsHumansInsurance BenefitsMaleMedicarePatient ReadmissionPractice Guidelines as TopicProcess Assessment, Health CareQuality Indicators, Health CareRegistriesRisk FactorsStrokeTime FactorsTreatment OutcomeUnited StatesConceptsReadmission ratesHospital characteristicsHRR levelHealthcare resourcesGuidelines-Stroke hospitalsGuidelines-Stroke registryHealthcare resource dataIschemic stroke outcomeThirty-day mortalityIschemic stroke mortalityHospital referral region levelStroke outcomeHospital factorsPatient characteristicsStroke mortalityCare measuresMedicare beneficiariesMedicare feeMortalityDartmouth AtlasPatientsRegional variationHealth careOutcomesReadmissionThe American Heart Association’s Get With the Guidelines (GWTG)-Stroke development and impact on stroke care
Ormseth CH, Sheth KN, Saver JL, Fonarow GC, Schwamm LH. The American Heart Association’s Get With the Guidelines (GWTG)-Stroke development and impact on stroke care. Stroke And Vascular Neurology 2017, 2: 94. PMID: 28959497, PMCID: PMC5600018, DOI: 10.1136/svn-2017-000092.Peer-Reviewed Original ResearchConceptsStroke care deliveryAmerican Heart AssociationHeart AssociationCare deliveryEvidence-based careContinuous quality improvement initiativesQuality improvement initiativesInpatient outcomesStroke ProgramPatient characteristicsStroke outcomeStroke careStroke developmentVoluntary registryPatient outcomesHospital adherenceImprovement initiativesOutcomesCareGuidelinesAssociationGWTGDeliveryRegistry
2016
Patient-reported financial barriers to adherence to treatment in neurology
Moura L, Schwamm E, Moura V, Seitz M, Hoch D, Hsu J, Schwamm L. Patient-reported financial barriers to adherence to treatment in neurology. ClinicoEconomics And Outcomes Research 2016, Volume 8: 685-694. PMID: 27895506, PMCID: PMC5117903, DOI: 10.2147/ceor.s119971.Peer-Reviewed Original ResearchMedication adherenceFinancial barriersPatient-reported failuresEffective medical therapyRoutine outpatient carePatient-reported dataCross-sectional surveyNeurology appointmentPatient characteristicsMedical therapyNeurology clinicMean agePrescription medicationsOutpatient careNeurological conditionsClinical informationNeurological diseasesNeurological disordersPatientsDemographic characteristicsAdherenceNonadherenceTherapyPreferred languageMedications
2015
Patient Characteristics and Outcomes After Hemorrhagic Stroke in Pregnancy
Leffert LR, Clancy CR, Bateman BT, Cox M, Schulte PJ, Smith EE, Fonarow GC, Schwamm LH, Kuklina EV, George MG. Patient Characteristics and Outcomes After Hemorrhagic Stroke in Pregnancy. Circulation Cardiovascular Quality And Outcomes 2015, 8: s170-s178. PMID: 26515206, DOI: 10.1161/circoutcomes.115.002242.Peer-Reviewed Original ResearchConceptsStroke risk factorsSubarachnoid hemorrhage patientsHemorrhagic strokeRisk factorsHS patientsHospital mortalityHemorrhage patientsDiseases-Ninth Revision codesBlood pressure criteriaGuidelines-Stroke registryPregnancy-related strokeAssociation of pregnancyNonpregnant female patientsConditional logistic regressionFisher's exact testWilcoxon rank sum testRank sum testGuidelines-StrokeSevere preeclampsiaHome dischargeIschemic strokeNonpregnant womenPatient characteristicsRisk patientsIndependent ambulationRacial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines–Stroke Registry
Mochari-Greenberger H, Xian Y, Hellkamp A, Schulte P, Bhatt D, Fonarow G, Saver J, Reeves M, Schwamm L, Smith E. Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines–Stroke Registry. Journal Of The American Heart Association 2015, 4: e002099. PMID: 26268882, PMCID: PMC4599467, DOI: 10.1161/jaha.115.002099.Peer-Reviewed Original ResearchMeSH KeywordsAgedAsianBlack or African AmericanChi-Square DistributionEmergency Medical ServicesFemaleHealth Knowledge, Attitudes, PracticeHispanic or LatinoHospitalizationHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPatient Acceptance of Health CareRegistriesSex FactorsStrokeTransportation of PatientsUnited StatesWhite PeopleConceptsEmergency medical servicesStroke patientsStroke symptomsEMS useRace/ethnicityHospitalized acute stroke patientsEmergency medical services transportWhite womenGuidelines-Stroke registryAcute stroke patientsMultivariable logistic regressionLevel of consciousnessSex differencesGuidelines-StrokeNational GetIschemic strokeStroke outcomePatient characteristicsPotential confoundersMedical historyEMS transportSex disparitiesPatientsHispanic menLogistic regressionPatient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the patient-driven research paradigm to aid decision making in stroke care
Xian Y, O’Brien E, Fonarow G, Olson D, Schwamm L, Hannah D, Lindholm B, Maisch L, Lytle B, Greiner M, Wu J, Peterson E, Pencina M, Hernandez A. Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the patient-driven research paradigm to aid decision making in stroke care. American Heart Journal 2015, 170: 36-45.e11. PMID: 26093862, DOI: 10.1016/j.ahj.2015.04.008.Peer-Reviewed Original ResearchMeSH KeywordsActivities of Daily LivingAgedAged, 80 and overAnticoagulantsAntidepressive AgentsCohort StudiesDecision MakingDepressionFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPatient Care PlanningPatient Outcome AssessmentPatient PreferencePatient SatisfactionProspective StudiesQuality of LifeRetrospective StudiesSecondary PreventionStrokeTreatment OutcomeConceptsComparative effectiveness researchPatient prefersStroke careStroke patientsTreatment optionsEffectiveness researchMajor adverse cardiovascular eventsAdverse cardiovascular eventsIndividual patient preferencesHealth care providersOutcomes Research InstitutePatient-centered comparative effectiveness researchOutcomes research studiesHealth care communityGuidelines-StrokeCardiovascular eventsOral anticoagulantsPatient-centered outcomes research studiesStatin therapyPatient characteristicsPrimary outcomeClinical effectivenessComparative safetyPatient preferencesClinical trialsTrends in Endovascular Therapy and Clinical Outcomes Within the Nationwide Get With The Guidelines-Stroke Registry
Menon B, Saver J, Goyal M, Nogueira R, Prabhakaran S, Liang L, Xian Y, Hernandez A, Fonarow G, Schwamm L, Smith E. Trends in Endovascular Therapy and Clinical Outcomes Within the Nationwide Get With The Guidelines-Stroke Registry. Stroke 2015, 46: 989-995. PMID: 25681065, DOI: 10.1161/strokeaha.114.007542.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageEndovascular therapyClinical outcomesPatient characteristicsIntracerebral hemorrhageBaseline National InstitutesEndovascular therapy useGuidelines-Stroke hospitalsGuidelines-Stroke registryHealth Stroke ScaleAcute ischemic strokeProportion of hospitalsNew thrombectomy deviceHospital mortalityStroke ScaleIschemic strokeIndependent ambulationNumber of hospitalsTherapy useMultivariable analysisPatient outcomesThrombectomy devicesHospitalTherapyStudy period
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 AssociationComparison of Performance Achievement Award Recognition With Primary Stroke Center Certification for Acute Ischemic Stroke Care
Fonarow G, Liang L, Smith E, Reeves M, Saver J, Xian Y, Hernandez A, Peterson E, Schwamm L, Committee & Investigators G. Comparison of Performance Achievement Award Recognition With Primary Stroke Center Certification for Acute Ischemic Stroke Care. Journal Of The American Heart Association 2013, 2: e000451. PMID: 24125846, PMCID: PMC3835260, DOI: 10.1161/jaha.113.000451.Peer-Reviewed Original ResearchConceptsPrimary stroke center certificationStroke center certificationAcute ischemic strokeHospital characteristicsIschemic strokeCenter certificationAcute ischemic stroke careStroke performance measuresIschemic stroke careAmerican Heart AssociationPSC certificationPatient characteristicsStroke careStroke measuresHeart AssociationCare measuresHigher oddsPatientsHospitalPSC statusStroke qualityHospital certificationStrokeCare