2022
Use of Prolonged Cardiac Rhythm Monitoring to Identify Atrial Fibrillation After Cryptogenic Stroke
Roy A, Schwamm L, Singhal A. Use of Prolonged Cardiac Rhythm Monitoring to Identify Atrial Fibrillation After Cryptogenic Stroke. Current Cardiology Reports 2022, 24: 337-346. PMID: 35171442, DOI: 10.1007/s11886-022-01652-1.Peer-Reviewed Original ResearchMeSH KeywordsAtrial FibrillationElectrocardiography, AmbulatoryHumansIschemic StrokeStrokeTime FactorsConceptsCryptogenic strokeAtrial fibrillationCardiac monitoringTiming of AFConsideration of anticoagulationCryptogenic stroke patientsCardiac rhythm monitoringAF detectionDetection of AFAnticoagulation initiationClinical outcomesStroke evaluationStroke patientsClinical calculatorsRhythm monitoringRecent FindingsDespiteStrokeLonger durationDefinitive researchFibrillationAdditional researchDurationOptimal typeMore investigationAnticoagulation
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 startNational Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic
Zachrison KS, Sharma R, Wang Y, Mehrotra A, Schwamm LH. National Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic. Journal Of Stroke And Cerebrovascular Diseases 2021, 30: 106035. PMID: 34419836, PMCID: PMC8494566, DOI: 10.1016/j.jstrokecerebrovasdis.2021.106035.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCOVID-19Databases, FactualFemaleFibrinolytic AgentsHumansMaleMiddle AgedPractice Patterns, Physicians'Quality ImprovementQuality Indicators, Health CareRemote ConsultationStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsIschemic stroke patientsTelestroke consultationAlteplase deliveryStroke patientsNumber of patientsNumber of consultsCOVID-19 public health emergencyPublic health emergencyAlteplase useMedian doorNeedle timeStroke severityED arrivalEmergency departmentImaging reviewHospital characteristicsTelestroke networkCT scanHospital participationSpoke sitesProvider groupsPatientsHospital sizeStudy periodHealth emergencyAssociation 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 outcomesReperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity
Wilcock A, Schwamm L, Zubizarreta J, Zachrison K, Uscher-Pines L, Richard J, Mehrotra A. Reperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity. JAMA Neurology 2021, 78: 527-535. PMID: 33646272, PMCID: PMC7922240, DOI: 10.1001/jamaneurol.2021.0023.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeReperfusion treatmentIschemic strokeShort-term acute carePatients 85 yearsLow-volume hospitalsYear of admissionHospital emergency departmentTraditional Medicare beneficiariesClinical characteristicsCritical access hospitalsStroke outcomeAcute careControl hospitalsEmergency departmentMean ageFunctional statusPrimary diagnosisStroke expertiseHospital characteristicsMAIN OUTCOMEMedicare beneficiariesPatientsHospitalCare patternsUsefulness 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-thirdRisk
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 doorDisease Burden Following Non-Cardioembolic Minor Ischemic Stroke or High-Risk TIA: A GWTG-Stroke Study
Kaufman B, Shah S, Hellkamp A, Lytle B, Fonarow G, Schwamm L, Lesén E, Hedberg J, Tank A, Fita E, Bhalla N, Atreja N, Bettger J. Disease Burden Following Non-Cardioembolic Minor Ischemic Stroke or High-Risk TIA: A GWTG-Stroke Study. Journal Of Stroke And Cerebrovascular Diseases 2020, 29: 105399. PMID: 33254370, DOI: 10.1016/j.jstrokecerebrovasdis.2020.105399.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCost-Benefit AnalysisFee-for-Service PlansFemaleFunctional StatusHealth Care CostsHealth Services Needs and DemandHealth Services ResearchHospital CostsHumansIschemic Attack, TransientMaleMedicarePatient DischargeRegistriesRisk AssessmentRisk FactorsSeverity of Illness IndexStrokeTime FactorsTreatment OutcomeUnited StatesConceptsHigh-risk transient ischemic attackTransient ischemic attackMinor ischemic strokeIschemic strokeHigh-risk TIA patientsLimited real-world dataMedicare paymentsBurden of illnessClinical trial populationsMean Medicare paymentsImportant unmet needMedicare spendingIschemic attackTIA patientsAntiplatelet therapyIndex hospitalizationStroke RegistryComposite outcomeCumulative incidenceClinical outcomesTherapeutic optionsTrial populationFunctional statusDisease burdenPatient outcomesEvaluation of stroke incidence with duty‐cycled multielectrode‐phased radiofrequency ablation of persistent atrial fibrillation results of the VICTORY AF Study
Hummel J, Verma A, Calkins H, Schwamm L, Gress D, Wells D, Souza J, Hokanson R, Hemingway L, Stromberg K, Hoyt R, Wickliffe A, DeLurgio D, Boersma L. Evaluation of stroke incidence with duty‐cycled multielectrode‐phased radiofrequency ablation of persistent atrial fibrillation results of the VICTORY AF Study. Journal Of Cardiovascular Electrophysiology 2020, 31: 1289-1297. PMID: 32270538, DOI: 10.1111/jce.14483.Peer-Reviewed Original ResearchConceptsDevice-related strokesAcute procedural successAtrial fibrillationAF trialSecondary outcomesStroke incidenceProcedural successAF studyStroke/transient ischemic attackVitamin K antagonist anticoagulationMajor structural heart diseasePulmonary vein stenosisTransient ischemic attackIncidence of strokeStructural heart diseaseNumber of patientsVitamin K antagonismAtrial fibrillation resultsRigorous clinical evaluationIDE trialIschemic attackNeurologist assessmentPersAF patientsAF burdenPV stenosisTrends in Telestroke Care Delivery
Sharma R, Zachrison KS, Viswanathan A, Matiello M, Estrada J, Anderson CD, Etherton M, Silverman S, Rost NS, Feske SK, Schwamm LH. Trends in Telestroke Care Delivery. Circulation Cardiovascular Quality And Outcomes 2020, 13: e005903. PMID: 32126805, PMCID: PMC7374496, DOI: 10.1161/circoutcomes.119.005903.Peer-Reviewed Original ResearchAcademic Medical CentersAgedAged, 80 and overCooperative BehaviorDelivery of Health Care, IntegratedFemaleFibrinolytic AgentsHumansInterdisciplinary CommunicationMaleMiddle AgedNew EnglandOutcome and Process Assessment, Health CareProgram EvaluationProof of Concept StudyRemote ConsultationRetrospective StudiesStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeWorkflowSafety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months
Shah S, Liang L, Kosinski A, Hernandez A, Schwamm L, Smith E, Fonarow G, Bhatt D, Feng W, Peterson E, Xian Y. Safety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months. Circulation Cardiovascular Quality And Outcomes 2020, 13: e006031. PMID: 31903770, DOI: 10.1161/circoutcomes.119.006031.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedAged, 80 and overBrain IschemiaDatabases, FactualFemaleFibrinolytic AgentsHospital MortalityHumansInfusions, IntravenousIntracranial HemorrhagesMaleMedicareRecurrenceRegistriesRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic stroke patientsPrior ischemic strokeSymptomatic intracranial hemorrhageIschemic stroke patientsPrior strokeHospital mortalityIntravenous tPAIschemic strokeIntracranial hemorrhageStroke patientsGuidelines-Stroke hospitalsHigher stroke severityGood functional outcomeHistory of strokeRetrospective observational studyYears of ageCardiovascular comorbiditiesStroke providersStroke severityUnadjusted riskFunctional outcomeHigh prevalenceObservational studyMedicare claimsElevated risk
2019
Resource utilisation among patients transferred for intracerebral haemorrhage
Zachrison K, Aaronson E, Mahmood S, Rosand J, Viswanathan A, Schwamm L, Goldstein J. Resource utilisation among patients transferred for intracerebral haemorrhage. Stroke And Vascular Neurology 2019, 4: 223. PMID: 32030206, PMCID: PMC6979870, DOI: 10.1136/svn-2019-000255.Peer-Reviewed Original ResearchMeSH KeywordsAcademic Medical CentersAge FactorsAgedAged, 80 and overCerebral HemorrhageCritical CareFemaleGlasgow Coma ScaleHumansIntensive Care UnitsMaleMiddle AgedNeurosurgical ProceduresPatient AdmissionPatient TransferProspective StudiesRegistriesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeConceptsGlasgow Coma ScoreIntracerebral hemorrhageSurgical interventionICH scoreAcademic hospitalBaseline Glasgow Coma ScoreIntensive care unit admissionCare unit admissionSingle academic hospitalPrimary intracerebral hemorrhageUrban academic hospitalLess frequent useCollected registryICU stayUnit admissionComa ScoreConsecutive patientsIntraventricular hemorrhagePrimary outcomePrimary patientsPatientsHospitalLogistic regressionHemorrhageResource utilisationA Network Approach to Stroke Systems of Care
Zachrison K, Dhand A, Schwamm L, Onnela J. A Network Approach to Stroke Systems of Care. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005526. PMID: 31405293, PMCID: PMC6822608, DOI: 10.1161/circoutcomes.119.005526.Peer-Reviewed Original ResearchRecent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy
Inohara T, Liang L, Kosinski A, Smith E, Schwamm L, Hernandez A, Bhatt D, Fonarow G, Peterson E, Xian Y. Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy. Journal Of The American Heart Association 2019, 8: e012450. PMID: 31327296, PMCID: PMC6761665, DOI: 10.1161/jaha.119.012450.Peer-Reviewed Original ResearchConceptsRecombinant tissue-type plasminogen activatorRecent myocardial infarctionAcute ischemic strokeHistory of MIRisk of mortalityMyocardial infarctionAIS patientsIschemic strokeIntravenous recombinant tissue-type plasminogen activatorST-segment elevation myocardial infarctionSegment elevation myocardial infarctionMultivariate logistic regression modelGuidelines-Stroke hospitalsOnly medical therapyElevation myocardial infarctionTissue-type plasminogen activatorLogistic regression modelsHospital mortalityHospital outcomesSevere strokeMedical therapyThrombolytic therapyHigh riskInfarctionPatientsIntravenous 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 factorsRelation of Admission Blood Pressure to In-hospital and 90-Day Outcomes in Patients Presenting With Transient Ischemic Attack
Bangalore S, Schwamm L, Smith E, Hellkamp A, Xian Y, Schulte P, Saver J, Fonarow G, Bhatt D, Committee and Investigators F. Relation of Admission Blood Pressure to In-hospital and 90-Day Outcomes in Patients Presenting With Transient Ischemic Attack. The American Journal Of Cardiology 2019, 123: 1083-1095. PMID: 30685057, DOI: 10.1016/j.amjcard.2018.12.037.Peer-Reviewed Original ResearchConceptsTransient ischemic attackSystolic blood pressureAdmission blood pressureDiastolic blood pressureMean arterial pressureBlood pressureIschemic attackPulse pressureHospital outcomesPostdischarge outcomesArterial pressureLower admission systolic blood pressureAdmission systolic blood pressureHigher admission blood pressureLower systolic blood pressureGuidelines-Stroke registryMajor cardiovascular eventsAdmission systolicPostdischarge mortalityCardiovascular eventsCardiovascular readmissionHospital deathInverse associationHigh riskPatientsComponents and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals
Menon B, Xu H, Cox M, Saver J, Goyal M, Peterson E, Xian Y, Matsuoka R, Jehan R, Yavagal D, Gupta R, Mehta B, Bhatt D, Fonarow G, Schwamm L, Smith E. Components and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals. Circulation 2019, 139: 169-179. PMID: 30586703, DOI: 10.1161/circulationaha.118.036701.Peer-Reviewed Original ResearchConceptsGuidelines-Stroke hospitalsEndovascular therapyHospital-level variablesShorter doorArterial accessCase volumeFirst pass timeArterial puncture timeComprehensive stroke centerLarge vessel occlusionCalendar year quarterWorkflow timesSignificant linear time trendsIschemic strokeLonger doorMedian doorStroke centersArterial punctureDiabetes mellitusMultivariable analysisPuncture timeFaster doorEmergency departmentClinical trialsMultivariable modeling
2018
Evidence-Based Performance Measures and Outcomes in Patients With Acute Ischemic Stroke
Wang Y, Li Z, Zhao X, Liu L, Wang C, Wang C, Peterson E, Schwamm L, Fonarow G, Smith S, Bettger J, Wang D, Li H, Xian Y, Wang Y. Evidence-Based Performance Measures and Outcomes in Patients With Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2018, 11: e001968. PMID: 30557048, DOI: 10.1161/circoutcomes.115.001968.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrain IschemiaChinaClinical CompetenceDisability EvaluationEvidence-Based MedicineFemaleFibrinolytic AgentsGuideline AdherenceHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePractice Guidelines as TopicPractice Patterns, Physicians'Prospective StudiesQuality ImprovementQuality Indicators, Health CareRecovery of FunctionRegistriesRisk FactorsSmoking CessationStrokeStroke RehabilitationThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeConceptsAcute ischemic strokeIschemic strokeOptimal complianceStroke careChina National Stroke RegistryEvidence-based performance measuresMultivariable Cox modelNational Stroke RegistryFavorable functional outcomeProspective cohort studyEvidence-based guidelinesRoutine clinical practiceCause of deathIntravenous tPAStroke recurrenceStroke RegistryCohort studyNationwide registryClinical outcomesFunctional outcomeCare measuresImproved outcomesHospital measuresCox modelClinical practiceIschemic 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 characterizationAdmissionRegistryStrokeEvaluation of the Experience of Spoke Hospitals in an Academic Telestroke Network
Gadhia R, Schwamm L, Viswanathan A, Whitney C, Moreno A, Zachrison K. Evaluation of the Experience of Spoke Hospitals in an Academic Telestroke Network. Telemedicine Journal And E-Health 2018, 25: 584-590. PMID: 30256724, DOI: 10.1089/tmj.2018.0133.Peer-Reviewed Original Research