2021
Treatment and Outcomes of Patients With Ischemic Stroke During 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. Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19. Stroke 2021, 52: 3225-3232. PMID: 34192897, PMCID: PMC8478095, DOI: 10.1161/strokeaha.120.034414.Peer-Reviewed Original ResearchAcute 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 Research
2019
Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement From the American Stroke Association
Adeoye O, Nyström K, Yavagal D, Luciano J, Nogueira R, Zorowitz R, Khalessi A, Bushnell C, Barsan W, Panagos P, Alberts M, Tiner A, Schwamm L, Jauch E. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement From the American Stroke Association. Stroke 2019, 50: e187-e210. PMID: 31104615, DOI: 10.1161/str.0000000000000173.Peer-Reviewed Original ResearchMeSH KeywordsCertificationEmergency Medical ServicesHumansOrganizational PolicyPractice Guidelines as TopicSocieties, MedicalStrokeUnited StatesConceptsAmerican Stroke AssociationStroke systemsStroke AssociationStroke center certificationMobile stroke unitEmergency medical servicesHospital dischargeSecondary preventionStroke centersEndovascular therapyStroke unitPrimary preventionCenter certificationNeurocritical careAssociation recommendationsCareBasis of improvementStroke recognitionMedical servicesHealthcare agenciesScientific evidenceHealthcare policyAppropriate facilitiesPreventionSignificant changesThrombolysis 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 treatmentTreatmentAdultsAgeOutcomesComponents 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 practiceInternational Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines––Stroke Program
Wangqin R, Laskowitz D, Wang Y, Li Z, Wang Y, Liu L, Liang L, Matsouaka R, Saver J, Fonarow G, Bhatt D, Smith E, Schwamm L, Bettger J, Hernandez A, Peterson E, Xian Y. International Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines––Stroke Program. Journal Of The American Heart Association 2018, 7: e010623. PMID: 30371291, PMCID: PMC6474951, DOI: 10.1161/jaha.118.010623.Peer-Reviewed Original ResearchMeSH KeywordsAge DistributionAgedBrain IschemiaChinaFemaleGuideline AdherenceHumansMaleMiddle AgedPractice Guidelines as TopicQuality ImprovementQuality of Health CareStrokeUnited StatesConceptsChina National Stroke RegistryNational Stroke RegistryAcute ischemic strokeStroke RegistryIschemic strokeChinese patientsDeep venous thrombosis prophylaxisHealth Stroke ScaleVenous thrombosis prophylaxisAcute stroke careAdministration of thrombolyticsEvidence-based guidelinesAmerican Heart AssociationQuality of careBackground AdherenceDischarge antithromboticsThrombosis prophylaxisCessation counselingStroke ProgramStroke ScaleClinical characteristicsHospital arrivalNeedle timePatient characteristicsSecondary preventionIntravenous tPA (Tissue-Type Plasminogen Activator) in Patients With Acute Ischemic Stroke Taking Non–Vitamin K Antagonist Oral Anticoagulants Preceding Stroke
Jin C, Huang R, Peterson E, Laskowitz D, Hernandez A, Federspiel J, Schwamm L, Bhatt D, Smith E, Fonarow G, Xian Y. Intravenous tPA (Tissue-Type Plasminogen Activator) in Patients With Acute Ischemic Stroke Taking Non–Vitamin K Antagonist Oral Anticoagulants Preceding Stroke. Stroke 2018, 49: 2237-2240. PMID: 30354981, PMCID: PMC6706353, DOI: 10.1161/strokeaha.118.022128.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAdministration, OralAntibodies, Monoclonal, HumanizedAnticoagulantsAntidotesAntithrombinsBrain IschemiaDabigatranFactor Xa InhibitorsFibrinolytic AgentsHumansIntracranial HemorrhagesOdds RatioPractice Guidelines as TopicPyrazolesPyridonesRivaroxabanStrokeTissue Plasminogen ActivatorConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeIntravenous tPAIntracranial hemorrhageFavorable outcomeIschemic strokeThrombin timeAnti-Xa assaySensitive laboratory testsNOAC patientsOral anticoagulantsTPA administrationProhibitive riskSymptom onsetPatient characteristicsMedian timeMedication intakeCurrent guidelinesAnticoagulant effectLarge cohortClinical carePatientsOverall observed rateNOACsHemorrhage
2017
Increase in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials
Smith E, Saver J, Cox M, Liang L, Matsouaka R, Xian Y, Bhatt D, Fonarow G, Schwamm L. Increase in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials. Circulation 2017, 136: 2303-2310. PMID: 28982689, DOI: 10.1161/circulationaha.117.031097.Peer-Reviewed Original ResearchMeSH KeywordsCohort StudiesEndovascular ProceduresFemaleHumansMalePractice Guidelines as TopicProspective StudiesSex FactorsStrokeThrombectomyTreatment OutcomeUnited StatesConceptsEndovascular thrombectomyEVT useEligible patientsIschemic strokePivotal trialsCase volumeStroke systemsHealth Stroke Scale scoreGuidelines-Stroke programStroke Scale scoreMean case volumeGuidelines-StrokeEndovascular therapyMore patientsPatient eligibilityPatientsClinical practiceScale scoreHospitalStrokeTrialsNational InstituteStroke durationLinear regressionThrombectomyIs Risk-Standardized In-Hospital Stroke Mortality an Adequate Proxy for Risk-Standardized 30-Day Stroke Mortality Data?
Reeves M, Fonarow G, Xu H, Matsouaka R, Xian Y, Saver J, Schwamm L, Smith E. Is Risk-Standardized In-Hospital Stroke Mortality an Adequate Proxy for Risk-Standardized 30-Day Stroke Mortality Data? Circulation Cardiovascular Quality And Outcomes 2017, 10: e003748. PMID: 29021333, DOI: 10.1161/circoutcomes.117.003748.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedAged, 80 and overBrain IschemiaDatabases, FactualFemaleGuideline AdherenceHospice CareHospital MortalityHospitalsHumansMaleMedicarePatient DischargePractice Guidelines as TopicQuality ImprovementQuality Indicators, Health CareRisk AssessmentRisk FactorsStrokeTime FactorsUnited StatesConceptsRisk-standardized mortality ratesHospital mortalityOutlier hospitalsAcute ischemic stroke casesHospital risk-standardized mortality ratesMortality dataGWTG-Stroke hospitalsHospital stroke mortalityIschemic stroke patientsProportion of hospitalsIschemic stroke casesRisk score modelStroke mortality dataChance-corrected agreementComposite outcomeStroke patientsMean ageStroke casesStroke mortalityMedicare filesHospital levelMortality rateLower mortalityHospitalMortalityRegional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals
Thompson M, Zhao X, Bekelis K, Gottlieb D, Fonarow G, Schulte P, Xian Y, Lytle B, Schwamm L, Smith E, Reeves M. Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003604. PMID: 28798017, DOI: 10.1161/circoutcomes.117.003604.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedBrain IschemiaDatabases, FactualFee-for-Service PlansFemaleGuideline AdherenceHealth ResourcesHealthcare DisparitiesHospitalsHumansInsurance BenefitsMaleMedicarePatient ReadmissionPractice Guidelines as TopicProcess Assessment, Health CareQuality Indicators, Health CareRegistriesRisk FactorsStrokeTime FactorsTreatment OutcomeUnited StatesConceptsReadmission ratesHospital characteristicsHRR levelHealthcare resourcesGuidelines-Stroke hospitalsGuidelines-Stroke registryHealthcare resource dataIschemic stroke outcomeThirty-day mortalityIschemic stroke mortalityHospital referral region levelStroke outcomeHospital factorsPatient characteristicsStroke mortalityCare measuresMedicare beneficiariesMedicare feeMortalityDartmouth AtlasPatientsRegional variationHealth careOutcomesReadmissionThe American Heart Association’s Get With the Guidelines (GWTG)-Stroke development and impact on stroke care
Ormseth CH, Sheth KN, Saver JL, Fonarow GC, Schwamm LH. The American Heart Association’s Get With the Guidelines (GWTG)-Stroke development and impact on stroke care. Stroke And Vascular Neurology 2017, 2: 94. PMID: 28959497, PMCID: PMC5600018, DOI: 10.1136/svn-2017-000092.Peer-Reviewed Original ResearchConceptsStroke care deliveryAmerican Heart AssociationHeart AssociationCare deliveryEvidence-based careContinuous quality improvement initiativesQuality improvement initiativesInpatient outcomesStroke ProgramPatient characteristicsStroke outcomeStroke careStroke developmentVoluntary registryPatient outcomesHospital adherenceImprovement initiativesOutcomesCareGuidelinesAssociationGWTGDeliveryRegistryAmerican Telemedicine Association: Telestroke Guidelines
Demaerschalk BM, Berg J, Chong BW, Gross H, Nystrom K, Adeoye O, Schwamm L, Wechsler L, Whitchurch S. American Telemedicine Association: Telestroke Guidelines. Telemedicine Journal And E-Health 2017, 23: 376-389. PMID: 28384077, PMCID: PMC5802246, DOI: 10.1089/tmj.2017.0006.Peer-Reviewed Original ResearchMeSH KeywordsAmerican Heart AssociationHumansPractice Guidelines as TopicRemote ConsultationSocieties, MedicalStrokeTelemedicineUnited StatesConceptsAcute stroke syndromeStroke patient careAcute care facilitiesTelestroke modelStroke syndromeHemorrhagic strokeNeurologic emergencyAcute phaseHospital encountersNeurological emergencyStroke careTelestroke servicesCare facilitiesClinical practiceClinical protocolsPatient careClinical servicesRemote careHealthcare practitionersCarePatientsStrokeQuality outcomesEntire continuumGuidelinesCurrent Practice Trends for Use of Early Venous Thromboembolism Prophylaxis After Intracerebral Hemorrhage
Cherian L, Smith E, Schwamm L, Fonarow G, Schulte P, Xian Y, Wu J, Prabhakaran S. Current Practice Trends for Use of Early Venous Thromboembolism Prophylaxis After Intracerebral Hemorrhage. Neurosurgery 2017, 82: 85-92. PMID: 28379461, DOI: 10.1093/neuros/nyx146.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnticoagulantsCerebral HemorrhageCohort StudiesFemaleHumansMaleMiddle AgedPost-Exposure ProphylaxisPractice Guidelines as TopicRegistriesRisk FactorsStrokeVenous ThromboembolismConceptsHospital day 2Early chemoprophylaxisIntracerebral hemorrhageVTE prophylaxisDay 2Venous thromboembolismEarly Venous Thromboembolism ProphylaxisEarly VTE prophylaxisGuidelines-Stroke registryMechanical VTE prophylaxisPrior ischemic strokeCP useTransient ischemic attackVenous thromboembolism prophylaxisObservational cohort studyPeripheral artery diseaseMultivariable logistic regressionAcute care facilitiesComfort care measuresCurrent practice trendsIschemic attackProphylaxis statusThromboembolism prophylaxisMechanical prophylaxisCohort studyCoexistent Sickle Cell Disease Has No Impact on the Safety or Outcome of Lytic Therapy in Acute Ischemic Stroke
Adams R, Cox M, Ozark S, Kanter J, Schulte P, Xian Y, Fonarow G, Smith E, Schwamm L. Coexistent Sickle Cell Disease Has No Impact on the Safety or Outcome of Lytic Therapy in Acute Ischemic Stroke. Stroke 2017, 48: 686-691. PMID: 28183857, DOI: 10.1161/strokeaha.116.015412.Peer-Reviewed Original ResearchConceptsSickle cell diseaseAcute ischemic strokeIschemic strokeThrombolytic therapyCell diseaseMultivariable logistic regression modelAdmission National InstitutesGuidelines-Stroke registrySymptomatic intracranial hemorrhageHealth Stroke ScaleIntracranial hemorrhage rateAmerican Stroke AssociationAmerican Heart AssociationNational Heart LungNational InstituteLogistic regression modelsLytic therapyStroke ScaleTPA useBlood pressureDischarge outcomesHemorrhage rateStroke patientsBlood InstituteExchange transfusionImpact of an Expanded Hospital Recognition Program for Stroke Quality of Care
Heidenreich P, Zhao X, Hernandez A, Schwamm L, Smith E, Reeves M, Peterson E, Fonarow G. Impact of an Expanded Hospital Recognition Program for Stroke Quality of Care. Journal Of The American Heart Association 2017, 6: e004278. PMID: 28110310, PMCID: PMC5523627, DOI: 10.1161/jaha.116.004278.Peer-Reviewed Original ResearchMeSH KeywordsAgedAwards and PrizesFemaleGuideline AdherenceHospitalsHumansMalePractice Guidelines as TopicQuality Indicators, Health CareQuality of Health CareStrokeUse 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
Renal Dysfunction Is Associated With Poststroke Discharge Disposition and In-Hospital Mortality
El Husseini N, Fonarow G, Smith E, Ju C, Schwamm L, Hernandez A, Schulte P, Xian Y, Goldstein L. Renal Dysfunction Is Associated With Poststroke Discharge Disposition and In-Hospital Mortality. Stroke 2016, 48: 327-334. PMID: 28034963, PMCID: PMC5268130, DOI: 10.1161/strokeaha.116.014601.Peer-Reviewed Original ResearchConceptsHospital mortalityDischarge dispositionEGFR 15Renal dysfunctionEGFR levelsMultivariable Cox proportional hazards modelsRenal Disease Study equationCox proportional hazards modelAcute ischemic strokeIn-Hospital MortalityIschemic stroke patientsGlomerular filtration rateModification of DietShort-term outcomesNinth Revision codesProportional hazards modelDemographic factorsGuidelines-StrokeCohort studyEGFR 30EGFR 45Ischemic strokeFrequent comorbiditiesTotal cohortStroke patientsTreatment 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 timeImpact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines‐Stroke
Medford‐Davis L, Fonarow G, Bhatt D, Xu H, Smith E, Suter R, Peterson E, Xian Y, Matsouaka R, Schwamm L. Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines‐Stroke. Journal Of The American Heart Association 2016, 5: e004282. PMID: 27930356, PMCID: PMC5210352, DOI: 10.1161/jaha.116.004282.Peer-Reviewed Original ResearchMeSH KeywordsAgedAmbulancesAnticholesteremic AgentsAntihypertensive AgentsBrain IschemiaDiabetes MellitusFemaleGuideline AdherenceHospital MortalityHumansHypercholesterolemiaHypertensionHypoglycemic AgentsInsurance CoverageInsurance, HealthLogistic ModelsMaleMedicaidMedically UninsuredMedicareMiddle AgedMultivariate AnalysisOdds RatioPractice Guidelines as TopicSkilled Nursing FacilitiesStrokeStroke RehabilitationTime FactorsUnited StatesConceptsAcute ischemic strokeIschemic strokeInsurance statusHospital mortalityGuidelines-Stroke programIschemic stroke patientsMultivariable logistic regressionPatient insurance statusGovernment-sponsored insuranceSkilled nursing facilitiesGuidelines-StrokeInpatient rehabPostdischarge destinationHospital outcomesPatient demographicsSymptom onsetAcute treatmentControl medicationDiabetes mellitusStroke patientsHospital characteristicsUninsured patientsHigh cholesterolNursing facilitiesPreventative care