2023
Antithrombotic 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 medicationEffectiveness 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 mortality
2022
Differences in Performance on Quality Measures for Thrombectomy‐Capable Stroke Centers Compared With Comprehensive Stroke Centers in 2019 to 2020
Baker D, Schmaltz S, Kolbusz K, Messé S, Jauch E, Schwamm L. Differences in Performance on Quality Measures for Thrombectomy‐Capable Stroke Centers Compared With Comprehensive Stroke Centers in 2019 to 2020. Stroke Vascular And Interventional Neurology 2022, 2 DOI: 10.1161/svin.121.000302.Peer-Reviewed Original ResearchComprehensive stroke centerLarge vessel occlusionMechanical thrombectomyStroke centersSkin punctureCerebral infarctionMedian timeStroke center certificationSymptomatic hemorrhagic complicationsSymptomatic hemorrhagic transformationPercentage of patientsProportion of patientsSuccessful mechanical thrombectomyThrombectomy-capable stroke centersProlonged transport timesWilcoxon rank sum testRank sum testHemorrhagic transformationHemorrhagic complicationsStroke careCenter certificationSigned-rank testCurrent recommendationsPatientsMedian proportionAssociation of Recent Use of Non–Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase
Kam W, Holmes D, Hernandez A, Saver J, Fonarow G, Smith E, Bhatt D, Schwamm L, Reeves M, Matsouaka R, Khan Y, Unverdorben M, Birmingham M, Lyden P, Asimos A, Altschul D, Schoonover T, Jumaa M, Nomura J, Suri M, Moore S, Lafranchise E, Olson D, Peterson E, Xian Y. Association of Recent Use of Non–Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase. JAMA 2022, 327: 760-771. PMID: 35143601, PMCID: PMC8832308, DOI: 10.1001/jama.2022.0948.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeSymptomatic intracranial hemorrhageSecondary functional outcomesSecondary safety outcomesProportion of patientsIntravenous alteplaseIntracranial hemorrhageIschemic strokeFunctional outcomeOral anticoagulantsInpatient mortalitySafety outcomesNon-Vitamin K Antagonist Oral AnticoagulantsK Antagonist Oral AnticoagulantsBaseline clinical factorsGuidelines-Stroke programIntravenous alteplase administrationLong-term anticoagulantsUse of NOACsRetrospective cohort studyUse of anticoagulantsSignificant differencesAlteplase administrationCardiovascular comorbiditiesNOAC groupAssociation Between Endovascular Therapy Time to Treatment and Outcomes in Patients With Basilar Artery Occlusion
Joundi R, Sun J, Xian Y, Alhanti B, Nogueira R, Bhatt D, Fonarow G, Saver J, Schwamm L, Smith E. Association Between Endovascular Therapy Time to Treatment and Outcomes in Patients With Basilar Artery Occlusion. Circulation 2022, 145: 896-905. PMID: 35050693, DOI: 10.1161/circulationaha.121.056554.Peer-Reviewed Original ResearchConceptsBasilar artery occlusionSymptomatic intracranial hemorrhageEndovascular therapySymptom onsetEVT timesHospital mortalityArtery occlusionMedian onsetIntracranial hemorrhageBetter outcomesHealth Stroke Scale scoreIndividual-level patient dataMedian National InstitutesStroke Scale scoreHospital-level factorsProportion of patientsLogistic regression modelsSubstantial reperfusionAnterior circulationPrimary outcomeUS registryMean ageDevastating conditionImproved outcomesTherapy time
2021
Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention
Xian Y, Xu H, Smith E, Saver J, Reeves M, Bhatt D, Hernandez A, Peterson E, Schwamm L, Fonarow G. Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention. Stroke 2021, 53: 1328-1338. PMID: 34802250, DOI: 10.1161/strokeaha.121.035853.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeProportion of patientsIschemic strokeNeedle timeSymptom onsetClinical outcomesNationwide quality improvement initiativePhase IBenefits of tPAGuidelines-Stroke hospitalsMedian DTN timeSecond intervention periodStroke symptom onsetQuality improvement interventionsQuality improvement initiativesPhase IIQuality Improvement ProgramHigh rateMinutes preinterventionBleeding complicationsHospital mortalityDTN timeHospital arrivalTPA useTherapy startThrombolysis 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 InstituteSeverityTeleneurology-Enabled Determination of Death by Neurologic Criteria After Cardiac Arrest or Severe Neurologic Injury.
Matiello M, Turner A, Estrada J, Whitney C, Kitch B, Lee P, Girkar U, Palacios R, Singla P, Schwamm L. Teleneurology-Enabled Determination of Death by Neurologic Criteria After Cardiac Arrest or Severe Neurologic Injury. Neurology 2021, 96: e1999-e2005. PMID: 33637632, DOI: 10.1212/wnl.0000000000011751.Peer-Reviewed Original ResearchConceptsIntensive care unitOrgan donorsNeurologic criteriaSevere neurologic damageSevere neurologic deficitsSevere neurologic injuryProportion of patientsDemographic informationPatient demographic informationPotential organ donorsDetermination of prognosisNumber of referralsProportion of donorsTeleneurology consultationsNeurologic deficitsNeurologic injuryMedian timeNeurologic damageCare unitComatose patientsCardiac arrestPatientsRetrospective dataConsultsOrgan donation
2020
Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries
Man S, Xian Y, Holmes D, Matsouaka R, Saver J, Smith E, Bhatt D, Schwamm L, Fonarow G. Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries. Circulation Cardiovascular Quality And Outcomes 2020, 13: e007150. PMID: 33302714, DOI: 10.1161/circoutcomes.120.007150.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overDatabases, FactualFemaleFibrinolytic AgentsHumansInfusions, IntravenousInsurance BenefitsIschemic StrokeMaleMedicarePatient ReadmissionQuality ImprovementQuality Indicators, Health CareRetrospective StudiesRisk AssessmentRisk FactorsThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsAcute ischemic strokeIschemic strokeNeedle timeIntravenous thrombolysisCardiovascular readmissionCause mortalityThrombolytic treatmentThrombolytic therapyMedicare beneficiariesGuidelines-Stroke hospitalsIntravenous thrombolytic therapyIntravenous thrombolytic treatmentOne-year outcomesProportion of patientsProportional hazards analysisAmerican Heart AssociationQuality InitiativeCause readmissionMedian doorHospital clusteringMedian ageHeart AssociationHospital characteristicsReadmissionImproved door
2019
The Mild and Rapidly Improving Stroke Study (MaRISS): Rationale and design
Romano J, Gardener H, Campo-Bustillo I, Khan Y, Riley N, Tai S, Sacco R, Khatri P, Smith E, Schwamm L. The Mild and Rapidly Improving Stroke Study (MaRISS): Rationale and design. International Journal Of Stroke 2019, 14: 983-986. PMID: 31496438, DOI: 10.1177/1747493019873595.Peer-Reviewed Original ResearchConceptsStroke symptomsStroke Impact Scale-16Actual treatment ratesMild ischemic strokePrimary safety outcomeSymptomatic hemorrhagic transformationProportion of patientsThird of patientsProspective observational studyEffect of alteplaseAcute stroke trialsLong-term outcomesPredictors of outcomeAlteplase treatmentHemorrhagic transformationIschemic strokeRankin ScaleSecondary outcomesBarthel IndexPrimary outcomeResidual disabilityStroke presentationRetrospective studyStroke StudyStroke trials
2018
Implementation of a Rapid, Protocol-based TIA Management Pathway
Jarhult S, Howell M, Barnaure-Nachbar I, Chang Y, White B, Amatangelo M, Brown D, Singhal A, Schwamm L, Silverman S, Goldstein J. Implementation of a Rapid, Protocol-based TIA Management Pathway. Western Journal Of Emergency Medicine 2018, 19: 216-223. PMID: 29560046, PMCID: PMC5851491, DOI: 10.5811/westjem.2017.9.35341.Peer-Reviewed Original ResearchConceptsTransient ischemic attackTotal hospital LOSHospital LOSEmergency departmentED LOSFinal diagnosisRecurrent transient ischemic attacksTertiary care academic centerED observation unitIntermediate-risk patientsHigh-risk patientsProportion of patientsMedian ED LOSInpatient admission ratesNeck CT angiographyBrain magnetic resonanceNeck MR angiographyStandardized clinical protocolUse of neuroimagingIschemic attackCohort studyTIA symptomsConsecutive patientsED lengthSix-month periodAbsence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes
Gonzalez‐Castellon M, Ju C, Xian Y, Hernandez A, Fonarow G, Schwamm L, Smith E, Bhatt D, Reeves M, Willey J. Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes. Journal Of The American Heart Association 2018, 7: e007685. PMID: 29386207, PMCID: PMC5850252, DOI: 10.1161/jaha.117.007685.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaClinical CompetenceFemaleHealth StatusHospitals, TeachingHumansInternship and ResidencyMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AdmissionPatient DischargePersonnel Staffing and SchedulingQuality Indicators, Health CareRegistriesStrokeTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsGuidelines-Stroke programProportion of patientsAcute ischemic strokeIschemic strokeJuly phenomenonHospital outcomesAcute ischemic stroke care qualityMultivariable logistic regression modelCare qualityDefect-free careStroke care qualityStroke performance measuresSymptomatic intracranial hemorrhageHours of admissionLower care qualityLogistic regression modelsNeedle timeIntracranial hemorrhageMultivariable analysisAdverse outcomesNonteaching hospitalsTomography timePatientsClinical metricsHospital
2014
Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative
Fonarow G, Zhao X, Smith E, Saver J, Reeves M, Bhatt D, Xian Y, Hernandez A, Peterson E, Schwamm L. Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative. JAMA 2014, 311: 1632-1640. PMID: 24756513, DOI: 10.1001/jama.2014.3203.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaDecision Support Systems, ClinicalFemaleFibrinolytic AgentsGuideline AdherenceHospital MortalityHospitalsHumansIntracranial HemorrhagesMaleMiddle AgedPatient DischargeQuality ImprovementRegistriesStrokeThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeConceptsAcute ischemic strokeQuality improvement initiativesTissue plasminogen activatorNational quality improvement initiativeSymptomatic intracranial hemorrhageDTN timeTPA administrationIntracranial hemorrhagePostintervention periodIschemic strokeNeedle timeClinical outcomesPreintervention periodImprovement initiativesHospital risk-adjusted mortalityIntravenous tissue plasminogen activatorTissue plasminogen activator administrationMedian DTN timePercentage of patientsProportion of patientsClinical decision support toolRisk-adjusted mortalityGuidelines-StrokeHospital mortalityYear preintervention
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 AssociationRelationship of Race/Ethnicity With Door‐to‐Balloon Time and Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: Findings From Get With the Guidelines–Coronary Artery Disease
Cavender M, Rassi A, Fonarow G, Cannon C, Peacock W, Laskey W, Hernandez A, Peterson E, Cox M, Grau‐Sepulveda M, Schwamm L, Bhatt D. Relationship of Race/Ethnicity With Door‐to‐Balloon Time and Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: Findings From Get With the Guidelines–Coronary Artery Disease. Clinical Cardiology 2013, 36: 749-756. PMID: 24085713, PMCID: PMC6649362, DOI: 10.1002/clc.22213.Peer-Reviewed Original ResearchMeSH KeywordsAgedBlack or African AmericanChi-Square DistributionFemaleGuideline AdherenceHealth Services AccessibilityHealthcare DisparitiesHispanic or LatinoHospital MortalityHumansLinear ModelsLogistic ModelsMaleMiddle AgedMultivariate AnalysisMyocardial InfarctionOdds RatioPercutaneous Coronary InterventionPractice Guidelines as TopicProspective StudiesRegistriesRisk FactorsTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesWhite PeopleConceptsPrimary percutaneous coronary interventionPrimary PCIST-elevation myocardial infarctionDTB timeMedian DTB timeRace/ethnicityPercutaneous coronary interventionCoronary interventionArtery diseaseBalloon timeMyocardial infarctionGuidelines-Coronary Artery DiseaseProportion of patientsAfrican American raceAfrican AmericansAfrican American femalesDifferent races/ethnicitiesHospital mortalityD2B timeHispanic patientsHispanic ethnicityLower oddsAmerican racePatientsCrude differences
2012
Reperfusion Strategies and Quality of Care in 5339 Patients Age 80 Years or Older Presenting With ST‐Elevation Myocardial Infarction: Analysis from Get With The Guidelines‐Coronary Artery Disease
Medina H, Cannon C, Fonarow G, Grau‐Sepulveda M, Hernandez A, Peacock W, Laskey W, Peterson E, Schwamm L, Bhatt D, Committee and Investigators O. Reperfusion Strategies and Quality of Care in 5339 Patients Age 80 Years or Older Presenting With ST‐Elevation Myocardial Infarction: Analysis from Get With The Guidelines‐Coronary Artery Disease. Clinical Cardiology 2012, 35: 632-640. PMID: 22744844, PMCID: PMC6652419, DOI: 10.1002/clc.22036.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAged, 80 and overAngioplasty, Balloon, CoronaryAntihypertensive AgentsConfidence IntervalsCoronary Artery DiseaseFemaleFibrinolytic AgentsHospital MortalityHumansHypolipidemic AgentsMaleMyocardial InfarctionMyocardial ReperfusionOdds RatioPlatelet Aggregation InhibitorsPractice Guidelines as TopicQuality of Health CareRegistriesThrombolytic TherapyConceptsPrimary percutaneous coronary interventionHospital mortalityReperfusion strategyNR patientsPatient ageUse of PCIGuidelines-Coronary Artery Disease databaseGuidelines-Coronary Artery DiseasePatients age 80 yearsST-elevation myocardial infarctionLower body mass indexGWTG-CAD hospitalsMain reperfusion strategyProportion of patientsPercutaneous coronary interventionAge 80 yearsBody mass indexLength of stayEvidence-based therapiesQuality of carePPCI patientsUnderwent thrombolysisHospital outcomesOld presentingRenal insufficiencyUse of Tissue-Type Plasminogen Activator Before and After Publication of the European Cooperative Acute Stroke Study III in Get With The Guidelines-Stroke
Messé S, Fonarow G, Smith E, Kaltenbach L, Olson D, Kasner S, Schwamm L. Use of Tissue-Type Plasminogen Activator Before and After Publication of the European Cooperative Acute Stroke Study III in Get With The Guidelines-Stroke. Circulation Cardiovascular Quality And Outcomes 2012, 5: 321-326. PMID: 22550132, DOI: 10.1161/circoutcomes.111.964064.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overEuropeFemaleFibrinolytic AgentsGuideline AdherenceHumansInfusions, IntravenousLinear ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioOutcome and Process Assessment, Health CarePractice Guidelines as TopicStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic strokeEuropean Cooperative Acute Stroke Study (ECASS) IIIECASS IIITreatment of patientsUse of tPAEligible patientsHours of AISProportion of patientsStudy IIITissue-type plasminogen activatorGuidelines-StrokeIschemic strokeMedian doorNeedle timePatientsClinical practiceTreatment ratesPlasminogen activatorSignificant increaseHoursLater time windowAdverse affectsTPATreatmentProportionTimes From Symptom Onset to Hospital Arrival in the Get With The Guidelines–Stroke Program 2002 to 2009
Tong D, Reeves M, Hernandez A, Zhao X, Olson D, Fonarow G, Schwamm L, Smith E. Times From Symptom Onset to Hospital Arrival in the Get With The Guidelines–Stroke Program 2002 to 2009. Stroke 2012, 43: 1912-1917. PMID: 22539544, DOI: 10.1161/strokeaha.111.644963.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic strokeSymptom onsetDoor timeHospital arrivalIntravenous tissue-type plasminogen activatorAcute ischemic stroke therapyEmergency medical services transportFourth of patientsGuidelines-Stroke programProportion of patientsHospital arrival timeIschemic stroke therapyPlasminogen activator therapyPortion of patientsTissue-type plasminogen activatorEligible patientsStroke therapyActivator therapyAcute interventionNationwide studyTreatment windowPatientsEarly onsetStroke
2011
Timeliness of Tissue-Type Plasminogen Activator Therapy in Acute Ischemic Stroke
Fonarow G, Smith E, Saver J, Reeves M, Bhatt D, Grau-Sepulveda M, Olson D, Hernandez A, Peterson E, Schwamm L. Timeliness of Tissue-Type Plasminogen Activator Therapy in Acute Ischemic Stroke. Circulation 2011, 123: 750-758. PMID: 21311083, DOI: 10.1161/circulationaha.110.974675.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedAged, 80 and overAmerican Heart AssociationBrain IschemiaEmergency Medical ServicesFemaleFibrinolytic AgentsGuideline AdherenceHumansMaleMiddle AgedOutcome Assessment, Health CarePractice Guidelines as TopicRisk FactorsStrokeTime FactorsTissue Plasminogen ActivatorUnited StatesConceptsAcute ischemic strokeIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorIschemic stroke patientsNeedle timeIschemic strokeStroke patientsAcute ischemic stroke patientsGuidelines-Stroke programSimilar stroke severitySymptomatic intracranial hemorrhageTimeliness of reperfusionProportion of patientsPlasminogen activator therapyTreatment initiation timeMinute doorPrior strokeHospital mortalityHospital factorsStroke severitySymptom onsetPatient factorsActivator therapyIntracranial hemorrhageHospital characteristics