2024
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
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 ResearchMeSH KeywordsAdultCase-Control StudiesFemaleHumansHypertensionMaleMigraine DisordersRetrospective StudiesRisk FactorsSex FactorsStrokeYoung AdultConceptsTraditional 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 riskTrends in Stroke Thrombolysis Care Metrics and Outcomes by Race and Ethnicity, 2003-2021
Man S, Solomon N, Mac Grory B, Alhanti B, Saver J, Smith E, Xian Y, Bhatt D, Schwamm L, Uchino K, Fonarow G. Trends in Stroke Thrombolysis Care Metrics and Outcomes by Race and Ethnicity, 2003-2021. JAMA Network Open 2024, 7: e2352927. PMID: 38324315, PMCID: PMC10851100, DOI: 10.1001/jamanetworkopen.2023.52927.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCohort StudiesEthnicityFemaleHumansIschemic StrokeMaleMiddle AgedRacial GroupsRetrospective StudiesThrombolytic TherapyConceptsDoor-to-needleDoor-to-needle timeHispanic patientsWhite patientsAssociated with improvementsThrombolysis rateCohort studyEthnic groupsQuality InitiativeCohort study of patientsCare qualityCare metricsPre-testIschemic strokeEthnic disparitiesRetrospective cohort studyMain OutcomesPatient functionIschemic stroke onsetSecondary outcomesPrimary outcomeStudy of patientsOddsAcute ischemic strokeStroke onset
2023
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
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 ResearchMeSH KeywordsBrain IschemiaCohort StudiesEndovascular ProceduresHumansIschemic StrokeRegistriesReperfusionRetrospective StudiesStrokeThrombectomyTreatment OutcomeConceptsComprehensive 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 proportionDepartmentAssociationRecent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke
Mac Grory B, Holmes D, Matsouaka R, Shah S, Chang C, Rison R, Jindal J, Holmstedt C, Logan W, Corral C, Mackey J, Gee J, Bonovich D, Walker J, Gropen T, Benesch C, Dissin J, Pandey H, Wang D, Unverdorben M, Hernandez A, Reeves M, Smith E, Schwamm L, Bhatt D, Saver J, Fonarow G, Peterson E, Xian Y. Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke. JAMA 2023, 329: 2038-2049. PMID: 37338878, PMCID: PMC10282891, DOI: 10.1001/jama.2023.8073.Peer-Reviewed Original ResearchConceptsRisk of sICHSymptomatic intracranial hemorrhageVitamin K antagonistsAcute ischemic strokeSecondary end pointsEndovascular thrombectomyVKA useIschemic strokeHospital mortalityEnd pointIntracranial hemorrhageOral vitamin K antagonistsVitamin K antagonist useGuidelines-Stroke programPrior VKA usePrimary end pointObservational cohort studyLarge vessel occlusionRisk of complicationsAmerican Heart AssociationUse of anticoagulantsSignificant differencesHospital presentationSICH riskAntagonist use
2022
Analysis of Prescriptions for Dual Antiplatelet Therapy After Acute Ischemic Stroke
Xian Y, Xu H, Matsouaka R, Laskowitz D, Maisch L, Hannah D, Smith E, Fonarow G, Bhatt D, Schwamm L, Mac Grory B, Feng W, Fosbøl E, Peterson E, Johnson M. Analysis of Prescriptions for Dual Antiplatelet Therapy After Acute Ischemic Stroke. JAMA Network Open 2022, 5: e2224157. PMID: 35900761, PMCID: PMC9335137, DOI: 10.1001/jamanetworkopen.2022.24157.Peer-Reviewed Original ResearchMeSH KeywordsAgedAspirinClopidogrelCohort StudiesHumansIschemic StrokeMalePlatelet Aggregation InhibitorsPrescriptionsRetrospective StudiesStrokeUnited StatesConceptsAHA/ASA guidelinesAcute ischemic strokeMinor ischemic strokeUse of DAPTDual antiplatelet therapyIschemic strokeMinor strokeHospital-level variationAntiplatelet therapyASA guidelinesDAPT useCohort studySecondary preventionOdds ratioAmerican Heart Association/American Stroke AssociationMinor acute ischemic strokeMulticenter retrospective cohort studyMultivariable logistic regression analysisSubstantial hospital-level variationAHA/ASAGuidelines-Stroke programIdentical clinical featuresRetrospective cohort studyAmerican Stroke AssociationEvidence-based guidelinesTrends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients
Adcock A, Schwamm L, Smith E, Fonarow G, Reeves M, Xu H, Matsouaka R, Xian Y, Saver J. Trends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients. JAMA Network Open 2022, 5: e2215869. PMID: 35671055, PMCID: PMC9175073, DOI: 10.1001/jamanetworkopen.2022.15869.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeYounger patientsHospital mortalityCohort studyIschemic strokeOlder patientsIntracranial hemorrhageAmerican Heart Association/American Stroke AssociationFunctional independenceHealth Stroke Scale scoreSymptomatic intracranial hemorrhage rateNationwide retrospective cohort studyGuidelines-Stroke programGWTG-Stroke hospitalsIntracranial hemorrhage rateStroke Scale scoreFavorable functional outcomeRetrospective cohort studyAmerican Stroke AssociationQuality improvement registryMeeting study criteriaEVT rateEVT useThrombectomy trialsRace-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke
Mendelson S, Zhang S, Matsouaka R, Xian Y, Shah S, Lytle B, Solomon N, Schwamm L, Smith E, Saver J, Fonarow G, Holl J, Prabhakaran S. Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke. Neurology 2022, 98: e1596-e1604. PMID: 35228335, PMCID: PMC9052571, DOI: 10.1212/wnl.0000000000200138.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaEthnicityFemaleFibrinolytic AgentsHumansIschemic StrokeMaleRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorConceptsTissue plasminogen activatorNon-Hispanic black patientsTPA-eligible patientsRace/ethnicityBlack patientsNon-Hispanic black race/ethnicityNon-Hispanic white patientsBlack race/ethnicityAsian race/ethnicityGuidelines-Stroke registryPrimary stroke centerSingle-center studyMultivariable logistic regressionRace-ethnic disparitiesNon-Hispanic whitesEligible patientsHospital factorsNationwide registryPatient demographicsStroke centersSymptom onsetWhite patientsMultivariable analysisStroke careAsian patientsAssociation 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 groupAcute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns
Baker AD, Schwamm LH, Sanborn DY, Furie K, Stretz C, Mac Grory B, Yaghi S, Kleindorfer D, Sucharew H, Mackey J, Walsh K, Flaherty M, Kissela B, Alwell K, Khoury J, Khatri P, Adeoye O, Ferioli S, Woo D, Martini S, La Rosa F, Demel SL, Madsen T, Star M, Coleman E, Slavin S, Jasne A, Mistry EA, Haverbusch M, Merkler AE, Kamel H, Schindler J, Sansing LH, Faridi KF, Sugeng L, Sheth KN, Sharma R. Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns. Stroke 2022, 53: 1883-1891. PMID: 35086361, PMCID: PMC10214981, DOI: 10.1161/strokeaha.121.036706.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionAcute ischemic strokeDepressed left ventricular ejection fractionVentricular ejection fractionSinus rhythmIschemic strokeEjection fractionPooled prevalenceHealth Stroke Severity ScaleSecondary stroke prevention strategiesMultivariable logistic regression modelAntithrombotic treatment regimensHospital-based cohortRetrospective cohort studySecondary stroke preventionStroke prevention strategiesMulti-center cohortStroke Severity ScaleLogistic regression modelsEchocardiographic characteristicsHospitalization dischargeAntiplatelet therapyStroke preventionCardiac thrombusCohort studyAssociation 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
Associations of Medicaid Expansion With Access to Care, Severity, and Outcomes for Acute Ischemic Stroke
McGee B, Seagraves K, Smith E, Xian Y, Zhang S, Alhanti B, Matsouaka R, Reeves M, Schwamm L, Fonarow G. Associations of Medicaid Expansion With Access to Care, Severity, and Outcomes for Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2021, 14: e007940. PMID: 34587752, DOI: 10.1161/circoutcomes.121.007940.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeLow-income cohortSkilled nursing facilitiesIschemic strokeMedicaid expansionStroke admissionsNonexpansion statesNursing facilitiesLow-income US populationHigh stroke burdenPrimary stroke preventionOdds of dischargeIschemic stroke admissionsExpansion statesSeverity of presentationLevel of disabilityReceipt of rehabilitationHealth insurance statusHealth insurance coverageHospital mortalityUninsured hospitalizationsStroke preventionDischarge dispositionStroke burdenStroke outcomeFrequency, 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 Between Hospital Volumes and Clinical Outcomes for Patients With Nontraumatic Subarachnoid Hemorrhage
Leifer D, Fonarow G, Hellkamp A, Baker D, Hoh B, Prabhakaran S, Schoeberl M, Suter R, Washington C, Williams S, Xian Y, Schwamm L. Association Between Hospital Volumes and Clinical Outcomes for Patients With Nontraumatic Subarachnoid Hemorrhage. Journal Of The American Heart Association 2021, 10: e018373. PMID: 34325522, PMCID: PMC8475679, DOI: 10.1161/jaha.120.018373.Peer-Reviewed Original ResearchConceptsAnnual case volumeComprehensive Stroke Center (CSC) certificationStroke center certificationNational Inpatient SampleSubarachnoid hemorrhageNontraumatic subarachnoid hemorrhageCase volumeHospital mortalityClinical outcomesPoor outcomeCenter certificationSAH casesBetter outcomesVolume thresholdHospital annual case volumeHospital case volumeCases/yearBackground Previous studiesLogistic regression modelsSAH hospitalizationsHospital volumeAneurysm obliterationInpatient SampleOdds ratioImproved outcomes'Drip-and-ship' intravenous thrombolysis and outcomes for large vessel occlusion thrombectomy candidates in a hub-and-spoke telestroke model
Regenhardt R, Rosenthal J, Awad A, Martinez-Gutierrez J, Nolan N, McIntyre J, Whitney C, Alotaibi N, Dmytriw A, Vranic J, Stapleton C, Patel A, Rost N, Schwamm L, Leslie-Mazwi T. 'Drip-and-ship' intravenous thrombolysis and outcomes for large vessel occlusion thrombectomy candidates in a hub-and-spoke telestroke model. Journal Of NeuroInterventional Surgery 2021, 14: 650-653. PMID: 34326197, PMCID: PMC8799754, DOI: 10.1136/neurintsurg-2021-017819.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomyIntravenous thrombolysisIntracerebral hemorrhageDay mRSEVT candidatesFunctional independenceHealth Stroke Scale scoreEmergent large vessel occlusionRisk of ICHMedian National InstitutesStroke Scale scoreLarge vessel occlusionOutcomes of interestAlteplase useDischarge mRSTelestroke modelThrombectomy candidatesEligible patientsIntravenous alteplaseTICI 2bAdequate reperfusionMedian ageSpoke hospitalsCT scoreVessel occlusionPatient 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 proficiencyAcute Ischemic Stroke in Patients With COVID-19
Srivastava P, Zhang S, Xian Y, Xu H, Rutan C, Alger H, Walchok J, Williams J, de Lemos J, Decker-Palmer M, Alhanti B, Elkind M, Messé S, Smith E, Schwamm L, Fonarow G. Acute Ischemic Stroke in Patients With COVID-19. Stroke 2021, 52: 1826-1829. PMID: 33728926, DOI: 10.1161/strokeaha.121.034301.Peer-Reviewed Original ResearchTeleneurology-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 ResearchMeSH KeywordsAgedBrain DeathFemaleHeart ArrestHumansMaleMiddle AgedNeurologic ExaminationNeurologyReferral and ConsultationRetrospective StudiesTelemedicineTissue DonorsConceptsIntensive 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 donationUsefulness of Rhythm Monitoring Following Acute Ischemic Stroke
Khurshid S, Li X, Ashburner J, Lipsanopoulos A, Lee P, Lin A, Ko D, Ellinor P, Schwamm L, Benjamin E, Atlas S, Singer D, Anderson C, Trinquart L, Lubitz S. Usefulness of Rhythm Monitoring Following Acute Ischemic Stroke. The American Journal Of Cardiology 2021, 147: 44-51. PMID: 33617814, DOI: 10.1016/j.amjcard.2021.01.038.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic strokeCryptogenic strokeCause-specific hazards regressionCHARGE-AF scoreAtrial fibrillation riskRisk of deathFine-Gray modelCHARGE-AFIncident AFPrevalent AFDischarge dispositionStroke subtypesConsecutive patientsAF riskHazards regressionStroke survivorsAssessed associationsRhythm monitoringStrokeAF scorePatientsIncidenceOne-thirdRiskRegional Changes in Patterns of Stroke Presentation During the COVID-19 Pandemic
Etherton M, Zachrison K, Yan Z, Sveikata L, Bretzner M, Estrada J, Viswanathan A, Singhal A, Schwamm L. Regional Changes in Patterns of Stroke Presentation During the COVID-19 Pandemic. Stroke 2021, 52: 1398-1406. PMID: 33588592, PMCID: PMC8992369, DOI: 10.1161/strokeaha.120.031300.Peer-Reviewed Original Research