2020
Association Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke
Man S, Xian Y, Holmes D, Matsouaka R, Saver J, Smith E, Bhatt D, Schwamm L, Fonarow G. Association Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke. JAMA 2020, 323: 2170-2184. PMID: 32484532, PMCID: PMC7267850, DOI: 10.1001/jama.2020.5697.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorAcute ischemic strokeTissue plasminogen activatorCause mortalityNeedle timeCause readmissionIschemic strokeLong-term outcomesShorter doorBetter long-term outcomesImproved long-term outcomesPlasminogen activatorRetrospective cohort studyGood functional outcomeGuidelines-StrokeCohort studyHospital arrivalHospital dischargeMedian doorEarly administrationMedian agePrimary outcomeThrombolytic therapyFunctional outcomeReadmissionAcute ischemic stroke: improving access to intravenous tissue plasminogen activator
Turner A, Schwamm L, Etherton M. Acute ischemic stroke: improving access to intravenous tissue plasminogen activator. Expert Review Of Cardiovascular Therapy 2020, 18: 277-287. PMID: 32323590, DOI: 10.1080/14779072.2020.1759422.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic stroke patientsIschemic strokeStroke patientsTreatment windowAcute ischemic stroke patientsIntravenous tissue plasminogen activatorTreatment ratesUnknown symptom onsetAcute stroke careTissue plasminogen activatorQuality improvement initiativesHealth care resourcesUnited States FoodStroke outcomeSymptom onsetStroke careStroke specialistsStroke systemsTelestroke networkDrug AdministrationAlteplasePatientsPlasminogen activatorStates Food
2019
Thrombolysis in young adults with stroke: Findings from Get With The Guidelines-Stroke.
Dodds J, Xian Y, Sheng S, Fonarow G, Bhatt D, Matsouaka R, Schwamm L, Peterson E, Smith E. Thrombolysis in young adults with stroke: Findings from Get With The Guidelines-Stroke. Neurology 2019, 92: e2784-e2792. PMID: 31092622, DOI: 10.1212/wnl.0000000000007653.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeTissue plasminogen activatorIschemic strokeOlder patientsYounger patientsYears of ageSymptomatic intracranial hemorrhage rateYoung adultsGuidelines-Stroke registryIntracranial hemorrhage rateGuidelines-StrokeHospital mortalityHospital arrivalHemorrhage rateIntracranial hemorrhageMultivariable modelPatientsBetter outcomesStrokePlasminogen activatorTPA treatmentTreatmentAdultsAgeOutcomesIntravenous 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 factors
2018
Participation in Get With the Guidelines–Stroke and Its Association With Quality of Care for Stroke
Howard G, Schwamm LH, Donnelly JP, Howard VJ, Jasne A, Smith EE, Rhodes JD, Kissela BM, Fonarow GC, Kleindorfer DO, Albright KC. Participation in Get With the Guidelines–Stroke and Its Association With Quality of Care for Stroke. JAMA Neurology 2018, 75: 1331-1337. PMID: 30083763, PMCID: PMC6248106, DOI: 10.1001/jamaneurol.2018.2101.Peer-Reviewed Original ResearchConceptsTissue plasminogen activatorIschemic strokeQuality of careGuidelines-StrokeGWTG-StrokeMean ageNonparticipating hospitalsCare measuresRisk factorsPopulation-based cohort studyPlasminogen activatorLipid profile assessmentParticipants 45 yearsStroke risk factorsQuality Improvement ProgramEvidence-based interventionsExercise counselingNeurologist evaluationAntithrombotic therapyCohort studyAntithrombotic useStroke careMAIN OUTCOMELipid evaluationHospitalQuality 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 characteristicsIschemic 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 characterizationAdmissionRegistryStroke
2017
Delays in Door-to-Needle Times and Their Impact on Treatment Time and Outcomes in Get With The Guidelines-Stroke
Kamal N, Sheng S, Xian Y, Matsouaka R, Hill M, Bhatt D, Saver J, Reeves M, Fonarow G, Schwamm L, Smith E. Delays in Door-to-Needle Times and Their Impact on Treatment Time and Outcomes in Get With The Guidelines-Stroke. Stroke 2017, 48: 946-954. PMID: 28228574, DOI: 10.1161/strokeaha.116.015712.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaDelivery of Health CareFemaleFibrinolytic AgentsGuideline AdherenceHospital MortalityHumansIntracranial HemorrhagesMaleMiddle AgedOutcome and Process Assessment, Health CareOutcome Assessment, Health CareStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorConceptsNeedle timeGuidelines-StrokeAcute ischemic stroke patientsSymptomatic intracranial hemorrhageIschemic stroke patientsQuality Improvement ProgramTissue-type plasminogen activatorAcute comorbiditiesHospital mortalityInpatient strokeIntravenous alteplaseLonger doorIndependent ambulationDelay diagnosisIntracranial hemorrhageStroke patientsHospital characteristicsPatient outcomesHigher oddsLower oddsPatientsPlasminogen activatorStroke recognitionHospitalDiagnosisUse of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice
Xian Y, Xu H, Lytle B, Blevins J, Peterson E, Hernandez A, Smith E, Saver J, Messé S, Paulsen M, Suter R, Reeves M, Jauch E, Schwamm L, Fonarow G. Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003227. PMID: 28096207, DOI: 10.1161/circoutcomes.116.003227.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaCross-Sectional StudiesFibrinolytic AgentsGuideline AdherenceHealth Care SurveysHumansInfusions, IntravenousPractice Guidelines as TopicQuality ImprovementQuality Indicators, Health CareStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeConceptsNational quality improvement initiativeGuidelines-Stroke hospitalsAcute ischemic strokeDTN timeIntravenous tPAIschemic strokeNeedle timeTissue-type plasminogen activator administrationMedian DTN timeIschemic stroke patientsEmergency medical services (EMS) providersQuality improvement initiativesTissue-type plasminogen activatorHospital arrivalSymptom onsetStroke patientsMedical service providersClinical practiceHospitalPatientsMost hospitalsPlasminogen activatorPhase IStrokeImprovement initiatives
2016
Baseline Predictors of Poor Outcome in Patients Too Good to Treat With Intravenous Thrombolysis
Ali S, Siddiqui K, Ay H, Silverman S, Singhal A, Viswanathan A, Rost N, Lev M, Schwamm L. Baseline Predictors of Poor Outcome in Patients Too Good to Treat With Intravenous Thrombolysis. Stroke 2016, 47: 2986-2992. PMID: 27834750, DOI: 10.1161/strokeaha.116.014871.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorHealth Stroke ScaleTissue-type plasminogen activatorPoor outcomeIntravenous thrombolysisStroke ScaleMultivariable analysisPlasminogen activatorHigher median National InstitutesConsecutive stroke admissionsCurrent safety profileGuidelines-Stroke databaseInitial National InstitutesMedian National InstitutesThird of patientsVascular risk factorsNational InstituteSkilled nursing facilitiesMultifocal infarctionPoor collateralsStroke admissionsImaging predictorsInpatient rehabilitationSafety profileImaging featuresTreatment With Tissue Plasminogen Activator in the Golden Hour and the Shape of the 4.5-Hour Time-Benefit Curve in the National United States Get With The Guidelines-Stroke Population
Kim J, Fonarow G, Smith E, Reeves M, Navalkele D, Grotta J, Grau-Sepulveda M, Hernandez A, Peterson E, Schwamm L, Saver J. Treatment With Tissue Plasminogen Activator in the Golden Hour and the Shape of the 4.5-Hour Time-Benefit Curve in the National United States Get With The Guidelines-Stroke Population. Circulation 2016, 135: 128-139. PMID: 27815374, DOI: 10.1161/circulationaha.116.023336.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeTissue plasminogen activatorIschemic strokeHospital mortalityIndependent ambulationPlasminogen activatorTissue plasminogen activator-treated patientsIntravenous tissue plasminogen activatorTissue plasminogen activator treatmentIschemic stroke outcomeHours of onsetOdds of dischargePlasminogen activator treatmentMinutes of onsetNational United StatesHemorrhagic complicationsStroke outcomeMedian onsetThrombolytic therapyStroke systemsBetter outcomesPatientsActivator treatmentGolden hourTreatment timeUse and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age
Arora R, Salamon E, Katz J, Cox M, Saver J, Bhatt D, Fonarow G, Peterson E, Smith E, Schwamm L, Xian Y, Libman R. Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age. Stroke 2016, 47: 2347-2354. PMID: 27491734, DOI: 10.1161/strokeaha.116.012241.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAdolescentAdultAge FactorsAgedAged, 80 and overBrain IschemiaFemaleFibrinolytic AgentsHospital MortalityHumansIntracranial HemorrhagesMaleMiddle AgedPractice Patterns, Physicians'PrognosisRegistriesRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeYoung AdultConceptsIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorAcute ischemic strokeSymptomatic hemorrhageTPA useIschemic strokeYounger patientsFunctional outcomeQuality improvement registryGood functional outcomeYears of ageYounger age groupsIntravenous thrombolysisHospital mortalityFibrinolytic therapyAcute rehabilitationIndependent ambulationDischarge outcomesMultivariable analysisHospice dischargePatientsAge groupsHemorrhagePlasminogen activatorMortalityRisks and Benefits Associated With Prestroke Antiplatelet Therapy Among Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator
Xian Y, Federspiel J, Grau-Sepulveda M, Hernandez A, Schwamm L, Bhatt D, Smith E, Reeves M, Thomas L, Webb L, Bettger J, Laskowitz D, Fonarow G, Peterson E. Risks and Benefits Associated With Prestroke Antiplatelet Therapy Among Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator. JAMA Neurology 2016, 73: 1-10. PMID: 26551916, DOI: 10.1001/jamaneurol.2015.3106.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorSymptomatic intracranial hemorrhageAcute ischemic strokePrestroke antiplatelet therapyTissue plasminogen activatorAntiplatelet therapyIschemic strokeGood functional outcomeHospital mortalityFunctional outcomeHigher oddsPlasminogen activatorDual antiplatelet treatmentGuidelines-Stroke registryRisk-adjusted likelihoodCardiovascular risk factorsRankin Scale scoreAmerican Heart AssociationAntiplatelet treatmentRegistry hospitalsRegistry patientsAmbulatory statusTPA administrationAdult patientsAntiplatelet agents
2015
Treatment patterns and short-term outcomes in ischemic stroke in pregnancy or postpartum period
Leffert LR, Clancy CR, Bateman BT, Cox M, Schulte PJ, Smith EE, Fonarow GC, Kuklina EV, George MG, Schwamm LH. Treatment patterns and short-term outcomes in ischemic stroke in pregnancy or postpartum period. American Journal Of Obstetrics And Gynecology 2015, 214: 723.e1-723.e11. PMID: 26709084, DOI: 10.1016/j.ajog.2015.12.016.Peer-Reviewed Original ResearchConceptsAcute stroke reperfusion therapyStroke reperfusion therapyShort-term outcomesTissue plasminogen activatorGuidelines-Stroke registryPregnancy-related strokeReperfusion therapyIschemic stroke patientsIschemic strokeNonpregnant womenPostpartum womenStroke patientsPlasminogen activatorPostpartum periodIntravenous tissue plasminogen activator useIntravenous tissue plasminogen activatorFavorable short-term outcomesTissue plasminogen activator useAcute reperfusion therapyCatheter-based thrombolysisGreater stroke severityMajor systemic bleedingNonpregnant women 18Symptomatic intracranial hemorrhageHistory of hypertensionPerception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke
Lin C, Cox M, Olson D, Britz G, Constable M, Fonarow G, Schwamm L, Peterson E, Shah B. Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke. Journal Of The American Heart Association 2015, 4: e001298. PMID: 26201547, PMCID: PMC4608060, DOI: 10.1161/jaha.114.001298.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAttitude of Health PersonnelBrain IschemiaDelivery of Health CareDrug Administration ScheduleFemaleFibrinolytic AgentsGuideline AdherenceHealth Care SurveysHealth Knowledge, Attitudes, PracticeHumansMaleMiddle AgedPerceptionPractice Guidelines as TopicPractice Patterns, Physicians'Quality ImprovementQuality Indicators, Health CareRegistriesStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsTissue plasminogen activatorIntravenous tissue plasminogen activatorAcute ischemic strokeAcute stroke careMinutes of arrivalLow annual volumeEligible patientsGuidelines hospitalsTPA administrationIschemic strokeStroke outcomeStroke careThrombolytic therapySmall percentageUS hospitalsDifferent hospitalsHospitalPatientsPlasminogen activatorTelephone surveyOne-thirdAdministrationMinutesAnnual volumePercentageEndovascular Clot Retrieval Therapy
Smith E, Schwamm L. Endovascular Clot Retrieval Therapy. Stroke 2015, 46: 1462-1467. PMID: 25944330, DOI: 10.1161/strokeaha.115.008385.Peer-Reviewed Original ResearchConceptsStroke systemsEndovascular acute ischemic stroke therapyIntravenous tissue-type plasminogen activatorAcute ischemic stroke therapyIschemic stroke therapyTissue-type plasminogen activatorCapable centersAppropriate patientsStroke therapyEffective therapyRetrieval therapyMeaningful benefitCommunity settingsTherapyPlasminogen activatorEquitable accessInitial recommendationsData entryPatientsRegistryHospitalTrials
2014
Chronic Kidney Disease and Bleeding Complications After Intravenous Thrombolytic Therapy for Acute Ischemic Stroke
Ovbiagele B, Smith E, Schwamm L, Grau-Sepulveda M, Saver J, Bhatt D, Hernandez A, Peterson E, Fonarow G. Chronic Kidney Disease and Bleeding Complications After Intravenous Thrombolytic Therapy for Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2014, 7: 929-935. PMID: 25249561, DOI: 10.1161/circoutcomes.114.001144.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedBrain IschemiaFemaleFibrinolytic AgentsFollow-Up StudiesGlomerular Filtration RateHemorrhageHospital MortalityHumansIncidenceInjections, IntravenousMaleOdds RatioRegistriesRenal Insufficiency, ChronicRetrospective StudiesThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorUnited StatesConceptsChronic kidney diseaseSerious systemic hemorrhageSymptomatic intracranial hemorrhagePresence of CKDIntravenous tissue-type plasminogen activatorIntracranial hemorrhageSystemic hemorrhageTissue-type plasminogen activatorKidney diseaseFunctional statusTissue-type plasminogen activator administrationPlasminogen activatorAdmission serum creatinineGuidelines-Stroke programIndependent functional statusIntravenous thrombolytic therapyPrimary end pointAcute ischemic strokeIschemic stroke patientsGlomerular filtration rateNormal kidney functionDischarge functional statusHigher unadjusted oddsTissue-type plasminogenHospital mortalityDevelopment and Initial Testing of the Stroke Rapid-Treatment Readiness Tool
Olson D, Cox M, Constable M, Britz G, Lin C, Zimmer L, Fonarow G, Schwamm L, Peterson E. Development and Initial Testing of the Stroke Rapid-Treatment Readiness Tool. Journal Of Neuroscience Nursing 2014, 46: 267-273. PMID: 25099063, PMCID: PMC4165480, DOI: 10.1097/jnn.0000000000000082.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorTissue plasminogen activatorPlasminogen activatorQuality Improvement ProgramGuidelines-StrokeEligible patientsHospital arrivalIschemic strokeNeedle timeHealth systemU.S. hospitalsHospitalReadiness ToolInitial testingLikert scale surveyPatientsActivatorImprovement programsStrokeAdministrationOutcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV‐infected adults
Sweeney E, Thakur K, Lyons J, Smith B, Willey J, Cervantes‐Arslanian A, Hickey M, Uchino K, Haussen D, Koch S, Schwamm L, Elkind M, Shinohara R, Mateen F. Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV‐infected adults. European Journal Of Neurology 2014, 21: 1394-1399. PMID: 25040336, DOI: 10.1111/ene.12506.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeNationwide Inpatient SampleIntravenous tissue plasminogen activatorIV-tPA useIV-tPATissue plasminogen activatorUninfected patientsIschemic strokeAIS patientsUS Nationwide Inpatient SampleSex-adjusted odds ratiosPlasminogen activatorShort-term outcomesRisk of deathIV-tPA administrationProportion of deathsHospital mortalityHospital deathHIV serostatusIntracerebral hemorrhageInpatient SampleOdds ratioHIVAIS casesPatientsStrategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke
Xian Y, Smith E, Zhao X, Peterson E, Olson D, Hernandez A, Bhatt D, Saver J, Schwamm L, Fonarow G. Strategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke. Stroke 2014, 45: 1387-1395. PMID: 24713527, DOI: 10.1161/strokeaha.113.003898.Peer-Reviewed Original ResearchConceptsShorter DTN timesAcute ischemic strokeTissue-type plasminogen activatorDTN timeIschemic strokePlasminogen activatorIntravenous tissue-type plasminogen activatorTissue-type plasminogen activator treatmentTissue-type plasminogen activator administrationGuidelines-Stroke hospitalsMedian DTN timePlasminogen activator treatmentHospital strategiesNeedle timeSymptom onsetMultivariable analysisBaseline useEmergency departmentRapid doorActivator treatmentHospitalStrokeActivation systemAssociationActivator