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 recognitionHospitalDiagnosisHealthcare Resource Availability, Quality of Care, and Acute Ischemic Stroke Outcomes
O'Brien E, Wu J, Zhao X, Schulte P, Fonarow G, Hernandez A, Schwamm L, Peterson E, Bhatt D, Smith E. Healthcare Resource Availability, Quality of Care, and Acute Ischemic Stroke Outcomes. Journal Of The American Heart Association 2017, 6: e003813. PMID: 28159820, PMCID: PMC5523738, DOI: 10.1161/jaha.116.003813.Peer-Reviewed Original ResearchConceptsHealthcare resource availabilityHospital referral regionsQuality of careReferral regionsHealthcare resourcesAcute ischemic stroke outcomesAcute ischemic stroke treatmentGuidelines-Stroke hospitalsIschemic stroke outcomeIschemic stroke patientsIschemic stroke treatmentMultivariable logistic regressionLength of stayHospital-based resourcesGuidelines-StrokeHospital mortalityHospital outcomesStroke outcomeStroke careStroke treatmentStroke patientsCare resourcesHealth care dataHospital qualityStroke quality
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 featuresDesmoteplase 3 to 9 Hours After Major Artery Occlusion Stroke
von Kummer R, Mori E, Truelsen T, Jensen J, Grønning B, Fiebach J, Lovblad K, Pedraza S, Romero J, Chabriat H, Chang K, Dávalos A, Ford G, Grotta J, Kaste M, Schwamm L, Shuaib A, Albers G. Desmoteplase 3 to 9 Hours After Major Artery Occlusion Stroke. Stroke 2016, 47: 2880-2887. PMID: 27803391, DOI: 10.1161/strokeaha.116.013715.Peer-Reviewed Original ResearchConceptsPlacebo-treated patientsSymptomatic intracranial hemorrhageSerious adverse eventsAdverse eventsMRS scoreTreatment armsIntracranial hemorrhagePooled analysisDay 90Major artery occlusionIschemic stroke patientsRankin Scale scoreMajor cerebral arteriesHigh-grade stenosisSignificant clinical benefitExtended time windowIntravenous desmoteplaseArterial recanalizationArtery occlusionIntravenous treatmentIschemic strokePrimary outcomeCerebral arteryRecanalization rateStroke patientsSex and Age Interactions and Differences in Outcomes After Intracerebral Hemorrhage
James M, Cox M, Xian Y, Smith E, Bhatt D, Schulte P, Hernandez A, Fonarow G, Schwamm L. Sex and Age Interactions and Differences in Outcomes After Intracerebral Hemorrhage. Journal Of Women's Health 2016, 26: 380-388. PMID: 27754758, DOI: 10.1089/jwh.2016.5849.Peer-Reviewed Original ResearchConceptsIntracerebral hemorrhageSex-based interactionsTotal study populationWorse neurological deficitsAge/sexSex differencesAntiplatelet therapyHospital mortalityIschemic strokeNeurological deficitsPatient ageIndependent ambulationICH patientsStroke databaseAtrial fibrillationEarly outcomesPoor outcomeStudy populationCholesterol reducersLogistic regressionWomenTreatment differencesAgeMenHemorrhageDistinct Short-Term Outcomes in Patients With Mild Versus Rapidly Improving Stroke Not Treated With Thrombolytics
Romano J, Smith E, Liang L, Gardener H, Campo-Bustillo I, Khatri P, Bhatt D, Fonarow G, Sacco R, Schwamm L. Distinct Short-Term Outcomes in Patients With Mild Versus Rapidly Improving Stroke Not Treated With Thrombolytics. Stroke 2016, 47: 1278-1285. PMID: 26987870, DOI: 10.1161/strokeaha.115.011528.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCohort StudiesFemaleHumansMaleMiddle AgedOutcome Assessment, Health CareRegistriesRetrospective StudiesStrokeConceptsHealth Stroke ScaleShort-term outcomesMild strokeHome dischargeIndependent ambulationStroke ScaleHealth Stroke Scale 0National InstituteGuidelines-Stroke registryVascular risk factorsLength of stayHospital mortalityHospital deathIschemic strokeSymptom onsetDischarge outcomesStroke presentationStroke symptomsHospital covariatesAdjusted outcomesRisk factorsWorse outcomesMultivariable modelRetrospective analysisGreater severity
2015
Future of Quality and Outcomes Research in Stroke
Fonarow G, Kapral M, Schwamm L. Future of Quality and Outcomes Research in Stroke. Circulation Cardiovascular Quality And Outcomes 2015, 8: s66-s68. PMID: 26515211, DOI: 10.1161/circoutcomes.115.002309.Peer-Reviewed Original ResearchElectronic Health RecordsEvidence-Based MedicineHumansOutcome Assessment, Health CarePatient-Centered CarePovertyRegistriesStrokeLack of Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke
Joynt K, Bhatt D, Schwamm L, Xian Y, Heidenreich P, Fonarow G, Smith E, Neely M, Grau-Sepulveda M, Hernandez A. Lack of Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke. Journal Of The American College Of Cardiology 2015, 65: 1964-1972. PMID: 25953748, DOI: 10.1016/j.jacc.2015.02.059.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overElectronic Health RecordsFemaleHospital Bed CapacityHospital MortalityHospitals, TeachingHumansLength of StayMaleMiddle AgedOutcome Assessment, Health CarePatient DischargePractice Guidelines as TopicQuality of Health CareStrokeTime-to-TreatmentTissue Plasminogen ActivatorUnited StatesConceptsElectronic health recordsIschemic strokeGWTG-Stroke hospitalsHealth recordsBetter clinical outcomesLogistic regression analysisAmerican Hospital Association Annual SurveyQuality of careOutcomes of interestHigh-quality careGuidelines-StrokeHospital mortalityStroke centersClinical outcomesStroke careSimilar oddsHospital characteristicsOutcome measuresTimely careHospitalPatientsStudy periodCareU.S. hospitalsStrokeTrends in Endovascular Therapy and Clinical Outcomes Within the Nationwide Get With The Guidelines-Stroke Registry
Menon B, Saver J, Goyal M, Nogueira R, Prabhakaran S, Liang L, Xian Y, Hernandez A, Fonarow G, Schwamm L, Smith E. Trends in Endovascular Therapy and Clinical Outcomes Within the Nationwide Get With The Guidelines-Stroke Registry. Stroke 2015, 46: 989-995. PMID: 25681065, DOI: 10.1161/strokeaha.114.007542.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageEndovascular therapyClinical outcomesPatient characteristicsIntracerebral hemorrhageBaseline National InstitutesEndovascular therapy useGuidelines-Stroke hospitalsGuidelines-Stroke registryHealth Stroke ScaleAcute ischemic strokeProportion of hospitalsNew thrombectomy deviceHospital mortalityStroke ScaleIschemic strokeIndependent ambulationNumber of hospitalsTherapy useMultivariable analysisPatient outcomesThrombectomy devicesHospitalTherapyStudy period
2014
Severity of leukoaraiosis, leptomeningeal collaterals, and clinical outcomes after intra-arterial therapy in patients with acute ischemic stroke
Giurgiutiu D, Yoo A, Fitzpatrick K, Chaudhry Z, Leslie-Mazwi T, Schwamm L, Rost N. Severity of leukoaraiosis, leptomeningeal collaterals, and clinical outcomes after intra-arterial therapy in patients with acute ischemic stroke. Journal Of NeuroInterventional Surgery 2014, 7: 326. PMID: 24721756, DOI: 10.1136/neurintsurg-2013-011083.Peer-Reviewed Original ResearchConceptsIntra-arterial therapyProximal artery occlusionAcute ischemic strokeSeverity of leukoaraiosisGood functional outcomeLA volumeCollateral gradeRecanalization statusArtery occlusionIschemic strokeFunctional outcomeIntravenous tissue plasminogen activator useHealth Stroke Scale scoreLarge cerebral artery occlusionPoor post-stroke outcomesIschemic white matter lesionsTissue plasminogen activator useGood collateral gradesGreater LA volumeGuidelines-Stroke databasePoor collateral gradeStroke Scale scoreSymptomatic intracranial hemorrhageCerebral artery occlusionCerebral small vesselsStroke Outcomes Measures Must Be Appropriately Risk Adjusted to Ensure Quality Care of Patients
Fonarow G, Alberts M, Broderick J, Jauch E, Kleindorfer D, Saver J, Solis P, Suter R, Schwamm L. Stroke Outcomes Measures Must Be Appropriately Risk Adjusted to Ensure Quality Care of Patients. Stroke 2014, 45: 1589-1601. PMID: 24523036, DOI: 10.1161/str.0000000000000014.Peer-Reviewed Original ResearchMeSH KeywordsAdvisory CommitteesAmerican Heart AssociationCenters for Medicare and Medicaid Services, U.S.HumansOutcome Assessment, Health CareSocieties, MedicalStrokeUnited StatesConceptsAmerican Heart Association/American Stroke AssociationAmerican Stroke AssociationStroke Outcome MeasureOutcome measuresAdequate risk adjustmentIschemic strokeStroke patientsStroke AssociationAcute ischemic stroke patientsMedicaid ServicesRisk adjustmentHealth Stroke ScaleHospital-level outcomesAcute ischemic strokeIschemic stroke patientsEvidence-based careCause of deathStroke severity measuresRisk-adjusted outcome measuresStroke ScaleStroke careStroke mortalityReadmission measuresPatientsCase mix
2013
When in Rome, Do Like the Romans: Certifying Stroke Centers With the Rod of Aesculapius or the Medical Caduceus of Hermes?
Schwamm L. When in Rome, Do Like the Romans: Certifying Stroke Centers With the Rod of Aesculapius or the Medical Caduceus of Hermes? Journal Of The American Heart Association 2013, 2: e000120. PMID: 23557752, PMCID: PMC3647263, DOI: 10.1161/jaha.113.000120.Peer-Reviewed Original ResearchConceptsStroke centers
2012
Achievement of Guideline-Concordant Care and In-Hospital Outcomes in Patients With Coronary Artery Disease in Teaching and Nonteaching Hospitals
Tam L, Fonarow G, Bhatt D, Grau-Sepulveda M, Hernandez A, Peterson E, Schwamm L, Giugliano R. Achievement of Guideline-Concordant Care and In-Hospital Outcomes in Patients With Coronary Artery Disease in Teaching and Nonteaching Hospitals. Circulation Cardiovascular Quality And Outcomes 2012, 6: 58-65. PMID: 23233750, DOI: 10.1161/circoutcomes.112.965525.Peer-Reviewed Original ResearchMeSH KeywordsAgedAmerican Heart AssociationCoronary Artery DiseaseDrug Therapy, CombinationEvidence-Based PracticeFemaleGuideline AdherenceGuidelines as TopicHospital MortalityHospitalsHospitals, TeachingHumansInpatientsMaleMiddle AgedOutcome Assessment, Health CareQuality Assurance, Health CareRetrospective StudiesSecondary PreventionTreatment OutcomeUnited StatesConceptsGuideline-concordant careGuidelines-Coronary Artery Disease programSecondary prevention therapiesCoronary artery diseaseTeaching hospitalHospital mortalityArtery diseasePrevention therapyAngiotensin-converting enzyme inhibitors/angiotensin receptor blockersEnzyme inhibitors/angiotensin receptor blockersEvidence-based secondary prevention therapiesDisease programsGuideline-recommended therapiesAngiotensin receptor blockersIn-Hospital OutcomesLength of stayLow-density lipoproteinGreatest incremental improvementReceptor blockersSystolic dysfunctionPrimary outcomeSmoking cessationLipid therapyOdds ratioNonteaching hospitalsComparison of 30-Day Mortality Models for Profiling Hospital Performance in Acute Ischemic Stroke With vs Without Adjustment for Stroke Severity
Fonarow G, Pan W, Saver J, Smith E, Reeves M, Broderick J, Kleindorfer D, Sacco R, Olson D, Hernandez A, Peterson E, Schwamm L. Comparison of 30-Day Mortality Models for Profiling Hospital Performance in Acute Ischemic Stroke With vs Without Adjustment for Stroke Severity. JAMA 2012, 308: 257-264. PMID: 22797643, DOI: 10.1001/jama.2012.7870.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeNIHSS scoreInitial stroke severityIschemic strokeStroke severityMedicare beneficiariesClaims-based risk modelsHospital mortality modelMean NIHSS scoreRisk-standardized outcomesHealth Stroke ScaleNet reclassification improvementDiscrimination improvement indexService Medicare beneficiariesHospital mortality risk modelMortality risk modelProfiling Hospital PerformanceGuidelines-StrokeIndex hospitalizationStroke ScaleReclassification improvementRisk modelModel discriminationPotential eligibilityStudy population
2011
Stroke Quality Metrics
Parker C, Schwamm L, Fonarow G, Smith E, Reeves M. Stroke Quality Metrics. Stroke 2011, 43: 155-162. PMID: 21980213, DOI: 10.1161/strokeaha.111.635011.Peer-Reviewed Original ResearchMeSH KeywordsHumansOutcome Assessment, Health CarePatient SatisfactionQuality ImprovementStrokeTreatment OutcomeConceptsPatient-centered outcomesQuality of carePublic reportingStroke metricsAcute hospital settingHigh-quality studiesPositive associationQuality improvement activitiesStroke outcomeStroke unitEmbase databasesEligible studiesPatient outcomesHospital settingEligibility criteriaSystematic reviewReported associationsHospital certificationProvider reimbursementOutcomesAssociationLimited associationCareQuality improvementComplianceThe American Heart Association's Recommendations for Expanding the Applications of Existing and Future Clinical Registries
Bufalino VJ, Masoudi FA, Stranne SK, Horton K, Albert NM, Beam C, Bonow RO, Davenport R, Girgus M, Fonarow GC, Krumholz HM, Legnini MW, Lewis WR, Nichol G, Peterson ED, Rosamond W, Rumsfeld J, Schwamm L, Shahian D, Spertus J, Woodard P, Yancy C. The American Heart Association's Recommendations for Expanding the Applications of Existing and Future Clinical Registries. Circulation 2011, 123: 2167-2179. PMID: 21482960, DOI: 10.1161/cir.0b013e3182181529.Peer-Reviewed Original ResearchTimeliness 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
2010
Persistence With Stroke Prevention Medications 3 Months After Hospitalization
Bushnell C, Zimmer L, Pan W, Olson D, Zhao X, Meteleva T, Schwamm L, Ovbiagele B, Williams L, LaBresh K, Peterson E. Persistence With Stroke Prevention Medications 3 Months After Hospitalization. JAMA Neurology 2010, 67: 1456-1463. PMID: 20697032, PMCID: PMC10197116, DOI: 10.1001/archneurol.2010.190.Peer-Reviewed Original ResearchMeSH KeywordsAgedCohort StudiesFactor Analysis, StatisticalFemaleHospitalizationHumansIschemic Attack, TransientMaleMiddle AgedObsessive BehaviorOutcome Assessment, Health CarePatient DischargeSecondary PreventionStrokeConceptsSecondary prevention medicationsPrevention medicationsLong-term secondary stroke preventionGuidelines-Stroke programStroke prevention medicationsLipid-lowering therapyPatients 18 yearsSecondary stroke preventionTransient ischemic attackMonths of hospitalizationObservational cohort designAmerican Heart AssociationMedication-taking behaviorCombination of patientQuality of lifeSystem-level factorsAntihypertensive therapyIschemic attackAntiplatelet therapyDiabetes medicationsMedication classesStroke preventionAcute strokeHospital dischargeIschemic stroke
2009
Influence of stroke subtype on quality of care in the Get With The Guidelines–Stroke Program
Smith E, Liang L, Hernandez A, Reeves M, Cannon C, Fonarow G, Schwamm L. Influence of stroke subtype on quality of care in the Get With The Guidelines–Stroke Program. Neurology 2009, 73: 709-716. PMID: 19720978, PMCID: PMC2734292, DOI: 10.1212/wnl.0b013e3181b59a6e.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCerebral HemorrhageEmergency Medical ServicesFemaleGuideline AdherenceHospitalsHumansMaleMiddle AgedOutcome Assessment, Health CarePractice Guidelines as TopicQuality Assurance, Health CareQuality of Health CareRisk Reduction BehaviorSmoking CessationStrokeSubarachnoid HemorrhageUnited StatesVenous ThrombosisConceptsQuality of careIS/TIAIntracerebral hemorrhageIschemic strokeStroke subtypesTIA admissionsHemorrhagic strokeCare measuresDeep venous thrombosis preventionHospital-based acute careGuidelines-Stroke databaseGuidelines-Stroke programGWTG-Stroke programVenous thrombosis preventionSmoking cessation therapyMeasures of careLogistic regression modelsDVT preventionIneligible patientsNational GetDysphagia screeningCessation therapySAH patientsAcute careICH patientsRecommendations for the Implementation of Telemedicine Within Stroke Systems of Care
Schwamm L, Audebert H, Amarenco P, Chumbler N, Frankel M, George M, Gorelick P, Horton K, Kaste M, Lackland D, Levine S, Meyer B, Meyers P, Patterson V, Stranne S, White C. Recommendations for the Implementation of Telemedicine Within Stroke Systems of Care. Stroke 2009, 40: 2635-2660. PMID: 19423851, DOI: 10.1161/strokeaha.109.192361.Peer-Reviewed Original Research