2023
Development and validation of a model predicting mild stroke severity on admission using electronic health record data
Waddell K, Myers L, Perkins A, Sico J, Sexson A, Burrone L, Taylor S, Koo B, Daggy J, Bravata D. Development and validation of a model predicting mild stroke severity on admission using electronic health record data. Journal Of Stroke And Cerebrovascular Diseases 2023, 32: 107255. PMID: 37473533, DOI: 10.1016/j.jstrokecerebrovasdis.2023.107255.Peer-Reviewed Original ResearchConceptsInitial stroke severityStroke severityElectronic health record dataHealth record dataSevere strokeIschemic strokeStroke careSample patientsMortality risk stratificationRecord dataVeterans Affairs hospitalMild stroke severityMultiple logistic regressionObservational cohortStroke outcomeIndependent predictorsRisk stratificationEHR data elementsPrimary analysisLogistic regressionStrokeValidation sampleSeverityPotent modifierEHR data
2022
Pairing regression and configurational analysis in health services research: modelling outcomes in an observational cohort using a split-sample design
Miech EJ, Perkins AJ, Zhang Y, Myers LJ, Sico JJ, Daggy J, Bravata DM. Pairing regression and configurational analysis in health services research: modelling outcomes in an observational cohort using a split-sample design. BMJ Open 2022, 12: e061469. PMID: 35672067, PMCID: PMC9174826, DOI: 10.1136/bmjopen-2022-061469.Peer-Reviewed Original ResearchConceptsTransient ischemic attackLogistic regression modelsHealth services researchSet of patientsOverall sample prevalenceObservational cohortLogistic regressionSample prevalenceRecurrent ischemic strokeVeterans Affairs hospitalRegression modelsServices researchIschemic attackRecurrent strokeCause mortalityCombined endpointIschemic strokePatient outcomesDeath outcomesCare outcomesPatientsSecondary analysisPrevalenceOutcomesCohortBlood Pressure Trajectories and Outcomes for Veterans Presenting at VA Medical Centers with a Stroke or Transient Ischemic Attack
Arling G, Perkins A, Myers LJ, Sico JJ, Bravata DM. Blood Pressure Trajectories and Outcomes for Veterans Presenting at VA Medical Centers with a Stroke or Transient Ischemic Attack. The American Journal Of Medicine 2022, 135: 889-896.e1. PMID: 35292287, DOI: 10.1016/j.amjmed.2022.02.012.Peer-Reviewed Original ResearchConceptsSystolic blood pressure trajectoriesTransient ischemic attackSystolic blood pressureBlood pressure trajectoriesBlood pressureAntihypertensive medicationsIschemic attackPressure trajectoriesHigher systolic blood pressureLower systolic blood pressureCox proportional hazards modelBlood pressure reductionBlood pressure controlEmergency department visitsHazard of mortalityProportional hazards modelVA Medical CenterMedication intensificationCause mortalityVascular eventsIschemic strokeRetrospective cohortDepartment visitsHypertension managementIndex event
2021
Benefits and Risks of Dual Versus Single Antiplatelet Therapy for Secondary Stroke Prevention: A Systematic Review for the 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack
Brown DL, Levine DA, Albright K, Kapral MK, Leung LY, Reeves MJ, Sico J, Strong B, Whiteley WN, Council O. Benefits and Risks of Dual Versus Single Antiplatelet Therapy for Secondary Stroke Prevention: A Systematic Review for the 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke 2021, 52: e468-e479. PMID: 34024115, DOI: 10.1161/str.0000000000000377.Peer-Reviewed Original ResearchConceptsDual antiplatelet therapySingle antiplatelet therapyTransient ischemic attackHigh-risk transient ischemic attackIschemic stroke preventionRecurrent ischemic strokeIschemic attackIschemic strokeAntiplatelet therapyStroke preventionMajor bleedingRelative riskTreatment durationAmerican Heart Association/American Stroke AssociationSystematic reviewSecondary ischemic stroke preventionSecondary stroke preventionPrevention of strokeUnadjusted relative riskAmerican Stroke AssociationSecondary ischemic strokeDuration of treatmentLonger duration treatmentShort-duration trialsRecurrent stroke
2019
Modelling care quality for patients after a transient ischaemic attack within the US Veterans Health Administration
Arling G, Sico JJ, Reeves MJ, Myers L, Baye F, Bravata DM. Modelling care quality for patients after a transient ischaemic attack within the US Veterans Health Administration. BMJ Open Quality 2019, 8: e000641. PMID: 31909209, PMCID: PMC6937041, DOI: 10.1136/bmjoq-2019-000641.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAdultAgedAged, 80 and overEmergency Service, HospitalFemaleHumansIschemic Attack, TransientMaleMiddle AgedNeurologyPatient AdmissionQuality of Health CareReferral and ConsultationRetrospective StudiesStrokeTime FactorsUnited StatesUnited States Department of Veterans AffairsVeteransConceptsTransient ischemic attackCharlson Comorbidity IndexVeterans Health AdministrationHigher Charlson comorbidity indexUS Veterans Health AdministrationInpatient admissionsNeurological consultationNeurology consultationEmergency departmentIschemic attackPreventive careHealth AdministrationCare qualitySpeech deficitsHigher CCI scoresModerate potency statinRecurrent vascular eventsStroke center designationHistory of dementiaPreventive care qualityAntithrombotic medicationComorbidity indexCCI scoreED visitsRetrospective cohortPolysomnography Utilization in Veterans Presenting Acutely with Ischemic Stroke or Transient Ischemic Attack
Koo BB, Sico JJ, Myers LJ, Perkins AJ, Levine D, Miech EJ, Damush TM, Rattray N, Homoya B, Ferguson J, Myers J, Zhang Y, Bravata DM. Polysomnography Utilization in Veterans Presenting Acutely with Ischemic Stroke or Transient Ischemic Attack. Cerebrovascular Diseases 2019, 48: 179-183. PMID: 31722335, DOI: 10.1159/000504406.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaComorbidityFemaleHealth Services AccessibilityHealth StatusHumansIschemic Attack, TransientMaleMiddle AgedPolysomnographyPractice Guidelines as TopicPractice Patterns, Physicians'Predictive Value of TestsPrognosisRisk FactorsSleep Apnea, ObstructiveStrokeTime FactorsUnited StatesUnited States Department of Veterans AffairsVeterans HealthConceptsTransient ischemic attackAcute ischemic strokeObstructive sleep apneaVeterans Administration Medical CenterTreatment of OSAIschemic strokeIschemic attackClinical dataExact testVA Corporate Data WarehouseCerebrovascular risk factorsMixed-effects logistic regressionFisher's exact testCorporate Data WarehouseEffects logistic regressionTwo-sample t-testAcute strokeClinical characteristicsHospital dischargeHeart failureSleep apneaFunctional outcomeRisk factorsUS veteransRecent guidelinesPosttraumatic Stress Disorder and Risk for Stroke in Young and Middle-Aged Adults
Rosman L, Sico JJ, Lampert R, Gaffey AE, Ramsey CM, Dziura J, Chui PW, Cavanagh CE, Brandt C, Haskell S, Burg MM. Posttraumatic Stress Disorder and Risk for Stroke in Young and Middle-Aged Adults. Stroke 2019, 50: 2996-3003. PMID: 31619151, DOI: 10.1161/strokeaha.119.026854.Peer-Reviewed Original ResearchConceptsTransient ischemic attackIncident transient ischemic attackPosttraumatic stress disorderEffects of PTSDIschemic strokeIncident strokeHealthcare utilizationIncidence of TIAStress disorderYoung adultsMiddle-aged veteransStroke risk factorsMultivariate Cox modelIschemic stroke riskAge-specific prevention strategiesVeterans Health AdministrationMiddle-aged adultsIschemic attackStroke riskPsychological factorsUnadjusted analysesRisk factorsEffect modificationCox modelPsychiatric disordersProcesses of Care Associated With Risk of Mortality and Recurrent Stroke Among Patients With Transient Ischemic Attack and Nonsevere Ischemic Stroke
Bravata DM, Myers LJ, Reeves M, Cheng EM, Baye F, Ofner S, Miech EJ, Damush T, Sico JJ, Zillich A, Phipps M, Williams LS, Chaturvedi S, Johanning J, Yu Z, Perkins AJ, Zhang Y, Arling G. Processes of Care Associated With Risk of Mortality and Recurrent Stroke Among Patients With Transient Ischemic Attack and Nonsevere Ischemic Stroke. JAMA Network Open 2019, 2: e196716. PMID: 31268543, PMCID: PMC6613337, DOI: 10.1001/jamanetworkopen.2019.6716.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaEligibility DeterminationFemaleHumansIschemic Attack, TransientLong Term Adverse EffectsMaleMiddle AgedMortalityOutcome and Process Assessment, Health CarePatient Care ManagementPrognosisRecurrenceRisk AssessmentRisk FactorsSeverity of Illness IndexStrokeUnited StatesVeterans Health ServicesConceptsTransient ischemic attackRecurrent ischemic strokeIschemic strokeRisk of deathRecurrent strokeProcess of careLower oddsMedication intensificationIschemic attackAtrial fibrillationVeterans Affairs emergency departmentAntihypertensive medication classesMortality 1 yearManagement of patientsMultivariable logistic regressionRisk of mortalityMultiple comparisonsCarotid artery imagingCause mortalityLipid managementMedication classesStatin medicationStatin therapyCohort studyStroke risk
2018
Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease
Bravata DM, Sico J, Fragoso C, Miech EJ, Matthias MS, Lampert R, Williams LS, Concato J, Ivan CS, Fleck JD, Tobias L, Austin C, Ferguson J, Radulescu R, Iannone L, Ofner S, Taylor S, Qin L, Won C, Yaggi HK. Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease. Journal Of The American Heart Association 2018, 7: e008841. PMID: 30369321, PMCID: PMC6201384, DOI: 10.1161/jaha.118.008841.Peer-Reviewed Original ResearchConceptsContinuous positive airway pressure usePositive airway pressure useTransient ischemic attackRankin Scale scoreIschemic stroke/transient ischemic attackStroke/transient ischemic attackBackground Obstructive sleep apneaHealth Stroke ScaleIschemic attackScale scoreStroke ScaleIschemic strokeTreat analysisSleep apneaAcute ischemic stroke/transient ischemic attackHealth Stroke Scale scoreNational InstituteContinuous positive airway pressureModified Rankin Scale scoreNeurological functioningNeurological symptom severityRecent ischemic strokeStroke Scale scoreAcute cerebrovascular diseaseAcute ischemic strokeQuality of Care for Veterans With Transient Ischemic Attack and Minor Stroke
Bravata DM, Myers LJ, Arling G, Miech EJ, Damush T, Sico JJ, Phipps MS, Zillich AJ, Yu Z, Reeves M, Williams LS, Johanning J, Chaturvedi S, Baye F, Ofner S, Austin C, Ferguson J, Graham GD, Rhude R, Kessler CS, Higgins DS, Cheng E. Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke. JAMA Neurology 2018, 75: 419-427. PMID: 29404578, PMCID: PMC5885264, DOI: 10.1001/jamaneurol.2017.4648.Peer-Reviewed Original ResearchConceptsTransient ischemic attackMinor strokeEmergency departmentElements of careDay 2Ischemic attackDay 7Federal fiscal year 2014Intensive care unit stayDeep vein thrombosis prophylaxisVeterans Health Administration systemCare qualityReceipt of thrombolysisRecurrent vascular eventsStroke care qualityVHA emergency departmentGuideline-concordant careLength of stayGuideline-recommended processesProcess of careHealth Administration systemQuality of careHemoglobin A1c measurementsElectronic quality measuresHealth care systemPost‐stroke hypertension control and receipt of health care services among veterans
Kohok DD, Sico JJ, Baye F, Myers L, Coffing J, Kamalesh M, Bravata DM. Post‐stroke hypertension control and receipt of health care services among veterans. Journal Of Clinical Hypertension 2018, 20: 382-387. PMID: 29397583, PMCID: PMC8031130, DOI: 10.1111/jch.13194.Peer-Reviewed Original ResearchConceptsPrimary careHypertension managementRecurrent stroke rateGoal blood pressureRetrospective cohort studyAcute ischemic strokeIschemic stroke patientsIschemic stroke admissionsFuture intervention studiesHealth care servicesBP controlBP trajectoriesPC visitsGoal BPHypertension controlStroke admissionsCohort studyIschemic strokeBlood pressureMean BPHealthcare utilizationMedian timeStroke patientsStroke ratePatients
2017
Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction
Bravata DM, Daggy J, Brosch J, Sico JJ, Baye F, Myers LJ, Roumie CL, Cheng E, Coffing J, Arling G. Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction. Stroke 2017, 49: 296-303. PMID: 29284738, DOI: 10.1161/strokeaha.117.017142.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionRisk factor controlIncident ischemic strokeBlood pressure controlIschemic stroke patientsIschemic strokeStroke patientsGlycemic controlAMI patientsMyocardial infarctionPressure controlIncident acute myocardial infarctionChronic obstructive pulmonary diseaseVascular risk factor controlFacility-level covariatesTransient ischemic attackAcute ischemic strokeCongestive heart failureObstructive pulmonary diseaseVeterans Health AdministrationFactor controlFacility covariatesIschemic attackHypertension controlStroke preventionDevelopment, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea
Sico JJ, Yaggi HK, Ofner S, Concato J, Austin C, Ferguson J, Qin L, Tobias L, Taylor S, Fragoso C, McLain V, Williams LS, Bravata DM. Development, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea. Journal Of Stroke And Cerebrovascular Diseases 2017, 26: 1745-1754. PMID: 28416405, PMCID: PMC6006998, DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.042.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overArea Under CurveBrain IschemiaDecision Support TechniquesFemaleHumansIschemic Attack, TransientMaleMiddle AgedPolysomnographyPredictive Value of TestsPrevalencePrognosisReproducibility of ResultsRisk AssessmentRisk FactorsROC CurveSleepSleep Apnea, ObstructiveStrokeSurveys and QuestionnairesTime FactorsUnited StatesConceptsObstructive sleep apneaTransient ischemic attackHigh negative predictive valueEpworth Sleepiness ScaleNegative predictive valueIschemic strokeSleep apneaPresence of OSASleep InventoryPredictive valueSleep Apnea Clinical ScoreValidation study populationHigh blood pressureBody mass indexIschemic attackObserved apneaBerlin questionnaireStroke severityBlood pressureOvernight polysomnographyMass indexRandomized trialsClinical scoresSleep QuestionnaireMedical history
2016
Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke?
Chaturvedi S, Ofner S, Baye F, Myers LJ, Phipps M, Sico JJ, Damush T, Miech E, Reeves M, Johanning J, Williams LS, Arling G, Cheng E, Yu Z, Bravata D. Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke? Neurology 2016, 88: 237-244. PMID: 27927939, PMCID: PMC5272790, DOI: 10.1212/wnl.0000000000003503.Peer-Reviewed Original ResearchConceptsTIA/minor strokeDays of presentationMinor strokeDiffusion-weighted imagingPrevious guidelinesHospital complexityCoronary artery diseaseMinor stroke patientsVeterans Affairs hospitalPreferred imaging modalityUse of MRISubset of hospitalsFacility-level variablesPerformance of MRINational Health SystemPrior strokeSymptom durationChart abstractionArtery diseaseBlood pressureHeart failureNeurologic consultationStroke patientsAtrial fibrillationClinical variablesCrossing the Communication Chasm: Challenges and Opportunities in Transitions of Care from the Hospital to the Primary Care Clinic
Rattray NA, Sico JJ, Cox LM, Russ AL, Matthias MS, Frankel RM. Crossing the Communication Chasm: Challenges and Opportunities in Transitions of Care from the Hospital to the Primary Care Clinic. The Joint Commission Journal On Quality And Patient Safety 2016, 43: 127-137. PMID: 28334591, DOI: 10.1016/j.jcjq.2016.11.007.Peer-Reviewed Original ResearchMeSH KeywordsCommunicationContinuity of Patient CareHospitals, UniversityHumansInterprofessional RelationsIschemic Attack, TransientOrganizational CulturePatient Care PlanningPatient Care TeamPatient DischargePrimary Health CareStrokeTransitional CareUnited StatesUnited States Department of Veterans AffairsConceptsTransitions of careClinical providersAcute settingDischarge documentationOutpatient providersStroke/transient ischemic attack patientsAcute stroke/TIATransient ischemic attack patientsVeterans Affairs Medical CenterStroke/TIAOutpatient primary carePrimary care clinicsPrimary care providersCare clinicsAcute careLongitudinal managementCare transitionsInpatient providersPrimary careProvider communicationAttack patientsTeaching hospitalComplete medicationMedical CenterDischarge communicationObservational Study of Obstructive Sleep Apnea in Wake-Up Stroke: The SLEEP TIGHT Study
Koo BB, Bravata DM, Tobias LA, Mackey JS, Miech EJ, Matthias MS, Stahl SM, Sico JJ, Fragoso C, Williams LS, Lampert R, Qin L, Yaggi HK. Observational Study of Obstructive Sleep Apnea in Wake-Up Stroke: The SLEEP TIGHT Study. Cerebrovascular Diseases 2016, 41: 233-241. PMID: 26811929, DOI: 10.1159/000440736.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersBlood PressureBlood Pressure Monitoring, AmbulatoryBrain IschemiaChi-Square DistributionCholesterol, LDLConnecticutCross-Sectional StudiesFemaleHumansIndianaIschemic Attack, TransientLogistic ModelsMaleMiddle AgedOdds RatioOxygenPolysomnographyPrevalenceRandomized Controlled Trials as TopicRisk FactorsSeverity of Illness IndexSex FactorsSleepSleep Apnea, ObstructiveStrokeSympathetic Nervous SystemWakefulnessConceptsObstructive sleep apneaDiastolic blood pressureSevere obstructive sleep apneaLow-density lipoproteinBlood pressureSleep apneaSerum catecholaminesAmbulatory blood pressure monitoringBaseline diastolic blood pressureMean body mass indexB-type natriuretic peptideHigher diastolic blood pressureMore oxygen desaturationTransient ischemic attackIschemic stroke patientsAmbulatory blood pressureHistory of strokeBody mass indexC-reactive proteinBlood pressure monitoringOxygen desaturation eventsGender-stratified analysesCross-sectional analysisIschemic attackOSA frequencyUsing Radiological Data to Estimate Ischemic Stroke Severity
Sico JJ, Phipps MS, Concato J, Brandt C, Wells CK, Lo AC, Nadeau SE, Williams LS, Gorman M, Boice JL, Bravata DM. Using Radiological Data to Estimate Ischemic Stroke Severity. Journal Of Stroke And Cerebrovascular Diseases 2016, 25: 792-798. PMID: 26794264, DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.002.Peer-Reviewed Original ResearchConceptsStroke severityHospital mortalityStroke patientsC-statisticAcute ischemic stroke patientsStroke care qualityIschemic stroke patientsChart review dataIschemic stroke severityElectronic health recordsAdmission headSevere strokePoststroke mortalityAbnormal findingsValid measurePatient levelRadiographic scoresRadiological dataRadiographic dataRadiographic measuresCare qualityRisk adjustmentSeverityHealth recordsMortality
2015
HIV status and the risk of ischemic stroke among men
Sico J, Chang C, So-Armah K, Justice A, Hylek E, Skanderson M, McGinnis K, Kuller L, Kraemer K, Rimland D, Bidwell Goetz M, Butt A, Rodriguez-Barradas M, Gibert C, Leaf D, Brown S, Samet J, Kazis L, Bryant K, Freiberg M, Chang C, So-Armah K, Justice A, Hylek E, Skanderson M, McGinnis K, Kuller L, Kraemer K, Rimland D, Goetz M, Butt A, Rodriguez Barradas M, Gibert C, Leaf D, Brown S, Samet J, Kazis L, Bryant K, Freiberg M. HIV status and the risk of ischemic stroke among men. Neurology 2015, 84: 1933-1940. PMID: 25862803, PMCID: PMC4433456, DOI: 10.1212/wnl.0000000000001560.Peer-Reviewed Original ResearchConceptsIschemic stroke riskVeterans Aging Cohort Study Virtual CohortIschemic stroke risk factorsStroke risk factorsHIV infectionUninfected veteransIschemic strokeStroke riskMale veteransComorbid diseasesRisk factorsSubstance useBaseline cardiovascular diseaseIschemic stroke rateRace/ethnicityHIV biomarkersMedian followStroke eventsHIV statusCardiovascular diseaseStroke rateClinical sitesHIVInfectionStroke
2013
Circumstances and consequences of falls among people with chronic stroke
Schmid AA, Yaggi HK, Burrus N, McClain V, Austin C, Ferguson J, Fragoso C, Sico JJ, Miech EJ, Matthias MS, Williams LS, Bravata DM. Circumstances and consequences of falls among people with chronic stroke. The Journal Of Rehabilitation Research And Development 2013, 50: 1277-1286. PMID: 24458967, DOI: 10.1682/jrrd.2012.11.0215.Peer-Reviewed Original ResearchConceptsChronic strokeCircumstances of fallsConsequences of fallsPoststroke fallsHealthcare utilizationSecondary data analysisDaily livingMedical careInjuryStrokeStroke characteristicsParticipants' descriptionsFallAlarming rateParticipantsComorbiditiesFallersFall eventsMental statesCarePreventionDemographics
2012
Thrombocytopenia and In-hospital Mortality Risk among Ischemic Stroke Patients
Sico JJ, Phipps MS, Concato J, Wells CK, Lo AC, Nadeau SE, Williams LS, Peixoto AJ, Gorman M, Boice JL, Bravata DM. Thrombocytopenia and In-hospital Mortality Risk among Ischemic Stroke Patients. Journal Of Stroke And Cerebrovascular Diseases 2012, 22: e99-e102. PMID: 22974703, DOI: 10.1016/j.jstrokecerebrovasdis.2012.08.005.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic stroke patientsHospital mortalityIschemic strokeStroke patientsHealth Stroke Scale scoreAcute ischemic stroke patientsStroke Scale scorePredictors of mortalityLogistic regression modelingAdmission thrombocytopeniaRetrospective cohortAntiplatelet effectUnadjusted analysesRisk factorsOdds ratioMortality riskThrombocytopeniaPatientsScale scoreHigh mortalityMortalityU.S. hospitalsStrokeNational Institute