2024
Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study
Dhand A, Reeves M, Mu Y, Rosner B, Rothfeld-Wehrwein Z, Nieves A, Dhongade V, Jarman M, Bergmark R, Semco R, Ader J, Marshall B, Goedel W, Fonarow G, Smith E, Saver J, Schwamm L, Sheth K. Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study. Stroke 2024, 55: 1507-1516. PMID: 38787926, PMCID: PMC11299104, DOI: 10.1161/strokeaha.123.045521.Peer-Reviewed Original ResearchConceptsSocial Vulnerability IndexPrehospital delayHospital arrivalZIP Code Tabulation AreasEmergency medical servicesCommunity-level social vulnerabilityGuidelines-Stroke registryCommunity socioeconomic statusCommunity-level factorsPatient-level factorsNationwide registry studyAmerican Heart AssociationSocial vulnerabilityCox proportional hazards modelsSocially vulnerable areasAssociated with delaySocial determinantsProportional hazards modelAcute stroke treatmentGeospatial mappingSocioeconomic statusMedical servicesIncreased social vulnerabilityPrimary exposureQuartile 3Association of Traditional and Nontraditional Risk Factors in the Development of Strokes Among Young Adults by Sex and Age Group: A Retrospective Case-Control Study
Leppert M, Poisson S, Scarbro S, Suresh K, Lisabeth L, Putaala J, Schwamm L, Daugherty S, Bradley C, Burke J, Ho P. Association of Traditional and Nontraditional Risk Factors in the Development of Strokes Among Young Adults by Sex and Age Group: A Retrospective Case-Control Study. Circulation Cardiovascular Quality And Outcomes 2024, 17: e010307. PMID: 38529631, PMCID: PMC11021148, DOI: 10.1161/circoutcomes.123.010307.Peer-Reviewed Original ResearchConceptsTraditional risk factorsDevelopment of strokeNontraditional risk factorsCase-control studyRisk factorsRetrospective case-control studyAge groupsContribution of traditional risk factorsYoung adultsConditional logistic regression modelsPopulation attributable riskCount of risk factorsStroke-free controlsAll Payer Claims DatabaseAssociation of strokeColorado All Payer Claims DatabaseLogistic regression modelsPayer Claims DatabaseIncreased risk of strokeAttributable riskRisk of strokeStroke eventsYears of ageInsurance typeIncreased riskThrombolysis for Wake-Up Stroke Versus Non–Wake-Up Unwitnessed Stroke: EOS Individual Patient Data Meta-Analysis
Kamogawa N, Miwa K, Toyoda K, Jensen M, Inoue M, Yoshimura S, Fukuda-Doi M, Kitazono T, Boutitie F, Ma H, Ringleb P, Wu O, Schwamm L, Warach S, Hacke W, Davis S, Donnan G, Gerloff C, Thomalla G, Koga M, Investigators O. Thrombolysis for Wake-Up Stroke Versus Non–Wake-Up Unwitnessed Stroke: EOS Individual Patient Data Meta-Analysis. Stroke 2024, 55: 895-904. PMID: 38456303, PMCID: PMC10978262, DOI: 10.1161/strokeaha.123.043358.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageIntracranial hemorrhageIntravenous thrombolysisFavorable outcomeUnwitnessed strokeNon-WUSFrequency of favorable outcomesIndividual patient-data meta-analysisMultivariate logistic regression analysisModified Rankin Scale scoreSafety of intravenous thrombolysisRankin Scale scoreEffect of intravenous thrombolysisIntravenous thrombolysis groupLogistic regression analysisUnknown-onset strokeRandomized controlled trialsNo significant differencePatient-level dataData meta-analysisStandard treatmentInsufficient statistical powerPatientsSafety outcomesControlled trialsReimagining Stroke Quality of Care in the Age of Artificial Intelligence and Digital Enablement
Schwamm L. Reimagining Stroke Quality of Care in the Age of Artificial Intelligence and Digital Enablement. Stroke 2024, 55: 1683-1685. PMID: 38380550, DOI: 10.1161/strokeaha.123.044251.Peer-Reviewed Original ResearchTenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection
Albers G, Jumaa M, Purdon B, Zaidi S, Streib C, Shuaib A, Sangha N, Kim M, Froehler M, Schwartz N, Clark W, Kircher C, Yang M, Massaro L, Lu X, Rippon G, Broderick J, Butcher K, Lansberg M, Liebeskind D, Nouh A, Schwamm L, Campbell B. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. New England Journal Of Medicine 2024, 390: 701-711. PMID: 38329148, DOI: 10.1056/nejmoa2310392.Peer-Reviewed Original ResearchConceptsModified Rankin ScaleSymptomatic intracranial hemorrhageInternal carotid arteryMiddle cerebral arteryRankin ScalePlacebo groupTenecteplase groupIntracranial hemorrhageIncidence of symptomatic intracranial hemorrhageCerebral arteryIncidence of symptomatic intracerebral hemorrhageCarotid arteryPlacebo-controlled trialSymptomatic intracerebral hemorrhageEvidence of occlusionSafety populationDouble-blindPerfusion-imagingMedian timeClinical outcomesIntracerebral hemorrhagePlaceboPerfusion imagingPrimary outcomeOdds ratioCOVID‐19 Infection Is Associated With Poor Outcomes in Patients With Intracerebral Hemorrhage
Renedo D, Leasure A, Young R, Rivier C, Alhanti B, Mac Grory B, Messe S, Reeves M, Hassan A, Schwamm L, de Havenon A, Matouk C, Sheth K, Falcone G. COVID‐19 Infection Is Associated With Poor Outcomes in Patients With Intracerebral Hemorrhage. Journal Of The American Heart Association 2024, 13: e030999. PMID: 38293940, PMCID: PMC11056169, DOI: 10.1161/jaha.123.030999.Peer-Reviewed Original ResearchConceptsOdds of poor outcomeIntracerebral hemorrhageCOVID-19 infectionPoor outcomeHealth care deliverySkilled nursing facilityMultivariate analysisOdds of mortalityConcomitant COVID-19 infectionAssociated with poor outcomesCare deliveryNursing facilitiesPoor functional outcomeCOVID-19OddsICH outcomeImpact of COVID-19No significant differenceObservational studyHemorrhagic strokeWorsen outcomesPatient populationFunctional outcomesStroke dataPatients
2023
Hospital‐Level Variability in Reporting of Ischemic Stroke Subtypes and Supporting Diagnostic Evaluation in GWTG‐Stroke Registry
Mullen M, Gurol M, Prabhakaran S, Messé S, Kleindorfer D, Smith E, Fonarow G, Xu H, Zhao X, Cigarroa J, Schwamm L. Hospital‐Level Variability in Reporting of Ischemic Stroke Subtypes and Supporting Diagnostic Evaluation in GWTG‐Stroke Registry. Journal Of The American Heart Association 2023, 12: e031303. PMID: 38108258, PMCID: PMC10863791, DOI: 10.1161/jaha.123.031303.Peer-Reviewed Original ResearchConceptsHospital-level variabilityDiagnostic evaluationIschemic strokeDiagnostic testingStroke pathogenesisCryptogenic strokeSecondary preventionEtiologic subtypesRisk factorsLarge nationwide registryIschemic stroke subtypesLong-term cardiac rhythm monitoringCardiac rhythm monitoringAdequate diagnostic evaluationIntracranial vascular imagingEvidence-based interventionsNationwide registryStroke subtypesIS subtypesDocumentation ratesRhythm monitoringPatientsCardiac monitoringSubtypesStrokeAntithrombotic 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 medicationMost Promising Approaches to Improve Stroke Outcomes: The Stroke Treatment Academic Industry Roundtable XII Workshop
Wechsler L, Adeoye O, Alemseged F, Bahr-Hosseini M, Deljkich E, Favilla C, Fisher M, Grotta J, Hill M, Kamel H, Khatri P, Lyden P, Mirza M, Nguyen T, Samaniego E, Schwamm L, Selim M, Silva G, Yavagal D, Yenari M, Zachrison K, Boltze J, Yaghi S, Roundtable O. Most Promising Approaches to Improve Stroke Outcomes: The Stroke Treatment Academic Industry Roundtable XII Workshop. Stroke 2023, 54: 3202-3213. PMID: 37886850, DOI: 10.1161/strokeaha.123.044279.Peer-Reviewed Original ResearchPerformance 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 timeInsurance-Based Disparities in Stroke Center Access in California: A Network Science Approach
Zachrison K, Hsia R, Schwamm L, Yan Z, Samuels-Kalow M, Reeves M, Camargo C, Onnela J. Insurance-Based Disparities in Stroke Center Access in California: A Network Science Approach. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009868. PMID: 37746725, PMCID: PMC10592016, DOI: 10.1161/circoutcomes.122.009868.Peer-Reviewed Original ResearchConceptsInsurance-based disparitiesStroke centersEmergency departmentHospital clustersInitial emergency departmentIschemic stroke admissionsHospital emergency departmentClusters of hospitalsLogistic regression modelsStroke admissionsUninsured patientsPatient insuranceLower oddsPatientsLess strokeCenter accessOddsCenter transferHospitalLikelihood of transferInsurance groupsRegression modelsLower proportionDepartmentAssociationOutcomes 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 strategiesDistinguishing Distinct Neural Systems for Proximal vs Distal Upper Extremity Motor Control After Acute Stroke
Lin D, Hardstone R, DiCarlo J, Mckiernan S, Snider S, Jacobs H, Erler K, Rishe K, Boyne P, Goldsmith J, Ranford J, Finklestein S, Schwamm L, Hochberg L, Cramer S. Distinguishing Distinct Neural Systems for Proximal vs Distal Upper Extremity Motor Control After Acute Stroke. Neurology 2023, 101: e347-e357. PMID: 37268437, PMCID: PMC10435065, DOI: 10.1212/wnl.0000000000207417.Peer-Reviewed Original ResearchConceptsDistal motor controlUpper extremity motor deficitsAcute strokeBarthel IndexMotor deficitsMotor controlAcute stroke patientsUpper extremity hemiparesisUpper extremity motor controlRegion of injuryLesion-symptom mappingMotor systemHealthy CNSDays poststrokeDistal injuriesRankin ScaleStroke onsetConsecutive patientsStroke patientsMotor scoresClinical syndromeFunctional outcomeIntact CNSPosterior aspectPrecentral gyrusEffectiveness of a Quality Improvement Intervention on Reperfusion Treatment for Patients With Acute Ischemic Stroke
Wang C, Gu H, Zong L, Zhang X, Zhou Q, Jiang Y, Li H, Meng X, Yang X, Wang M, Huo X, Wangqin R, Bei Y, Qi X, Liu X, Hu S, Wang Z, Zhao X, Wang Y, Liu L, Ma X, Morgan L, Xian Y, Schwamm L, Wang Y, Li Z, Yang Q, Chen G, Ma Q, Li X, Chen J, Zhao X, Wang H, Niu X, Xu J, Zhao L, Wang Z, Huang D, Jin X, Chen S, Li J, Yu J, Liu P, Li G, Hao Y, Yang G, Huang X, Zhou C, Yang J, Gu J, Sun P, Guo Z, Ma G, Chen G, Tang M, Wang N, Chen L, Li J, Li A, Li S, Cao M, Guo J, Ren Y, Li T, Zhang L, Xie Z, Dong J, Kong X, Liang H, Zhang Y. Effectiveness of a Quality Improvement Intervention on Reperfusion Treatment for Patients With Acute Ischemic Stroke. JAMA Network Open 2023, 6: e2316465. PMID: 37266940, PMCID: PMC10238948, DOI: 10.1001/jamanetworkopen.2023.16465.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeQuality improvement interventionsTargeted quality improvement interventionsReperfusion therapy ratesProportion of patientsIschemic strokeEligible patientsStepped-wedge clusterSymptom onsetReperfusion therapyEndovascular thrombectomyImprovement interventionsTherapy ratesUsual careSecondary outcomesPrimary outcomeSecondary hospitalsClinical trialsIntravenous recombinant tissue plasminogen activatorModified Rankin Scale scoreRecombinant tissue plasminogen activatorRankin Scale scoreTissue plasminogen activatorEVT rateHospital mortalityShorter 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 administrationEmerging Management Challenges Posed by Atrial Fibrillation Detected After Stroke
Yaghi S, Schwamm L. Emerging Management Challenges Posed by Atrial Fibrillation Detected After Stroke. Annals Of Neurology 2023, 94: 41-42. PMID: 37062859, DOI: 10.1002/ana.26663.Peer-Reviewed Original ResearchVariation in patterns of telestroke usage during the COVID-19 pandemic
Nakamoto C, Wilcock A, Schwamm L, Zachrison K, Uscher-Pines L, Mehrotra A. Variation in patterns of telestroke usage during the COVID-19 pandemic. Journal Of Stroke And Cerebrovascular Diseases 2023, 32: 107036. PMID: 36791674, PMCID: PMC9899774, DOI: 10.1016/j.jstrokecerebrovasdis.2023.107036.Peer-Reviewed Original ResearchSmoking-Cessation Pharmacotherapy After Stroke and Transient Ischemic Attack: A Get With The Guidelines-Stroke Analysis
Parikh N, Zhang C, Omran S, Restifo D, Carpenter M, Schwamm L, Kamel H. Smoking-Cessation Pharmacotherapy After Stroke and Transient Ischemic Attack: A Get With The Guidelines-Stroke Analysis. Stroke 2023, 54: e63-e65. PMID: 36727507, PMCID: PMC9992306, DOI: 10.1161/strokeaha.122.041532.Peer-Reviewed Original Research
2022
No short-term mortality from benzodiazepine use post-acute ischemic stroke after accounting for bias
Moura L, Yan Z, Donahue M, Smith L, Schwamm L, Hsu J, Newhouse J, Haneuse S, Blacker D, Hernandez-Diaz S. No short-term mortality from benzodiazepine use post-acute ischemic stroke after accounting for bias. Journal Of Clinical Epidemiology 2022, 154: 136-145. PMID: 36572369, PMCID: PMC10033385, DOI: 10.1016/j.jclinepi.2022.12.013.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeRisk differenceIschemic strokeBenzodiazepine useShort-term mortalityImmortal time biasElectronic health recordsAIS admissionsBenzodiazepine initiationStroke RegistryPoststroke mortalityTreatment initiationMortality riskPatientsFurther adjustmentMortalityBenzodiazepinesOlder adultsTime biasHealth recordsImmortal timeStrokeRiskDaysContraindicationsComparative Effectiveness and Safety of Seizure Prophylaxis Among Adults After Acute Ischemic Stroke
Moura L, Donahue M, Yan Z, Smith L, Hsu J, Newhouse J, Schwamm L, Haneuse S, Hernandez-Diaz S, Blacker D. Comparative Effectiveness and Safety of Seizure Prophylaxis Among Adults After Acute Ischemic Stroke. Stroke 2022, 54: 527-536. PMID: 36544249, PMCID: PMC9870933, DOI: 10.1161/strokeaha.122.039946.Peer-Reviewed Original ResearchConceptsSeizure prophylaxisRisk differenceAntiseizure drugsEarly seizure prophylaxisSevere AIS patientsAcute ischemic strokePrespecified subgroup analysisHealth care factorsInverse probability weightsElectronic health recordsAIS admissionsPoststroke mortalityStroke RegistryIschemic strokeAIS patientsStroke settingsCare factorsSubgroup analysisProphylaxisMortality riskHigh riskPatientsComparative effectivenessExcess deathsTrial data