2024
Thrombolysis for Wake-Up Stroke Versus Non–Wake-Up Unwitnessed Stroke: EOS Individual Patient Data Meta-Analysis
Kamogawa N, Miwa K, Toyoda K, Jensen M, Inoue M, Yoshimura S, Fukuda-Doi M, Kitazono T, Boutitie F, Ma H, Ringleb P, Wu O, Schwamm L, Warach S, Hacke W, Davis S, Donnan G, Gerloff C, Thomalla G, Koga M, Investigators O. Thrombolysis for Wake-Up Stroke Versus Non–Wake-Up Unwitnessed Stroke: EOS Individual Patient Data Meta-Analysis. Stroke 2024, 55: 895-904. PMID: 38456303, PMCID: PMC10978262, DOI: 10.1161/strokeaha.123.043358.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageIntracranial hemorrhageIntravenous thrombolysisFavorable outcomeUnwitnessed strokeNon-WUSFrequency of favorable outcomesIndividual patient-data meta-analysisMultivariate logistic regression analysisModified Rankin Scale scoreSafety of intravenous thrombolysisRankin Scale scoreEffect of intravenous thrombolysisIntravenous thrombolysis groupLogistic regression analysisUnknown-onset strokeRandomized controlled trialsNo significant differencePatient-level dataData meta-analysisStandard treatmentInsufficient statistical powerPatientsSafety outcomesControlled trialsTenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection
Albers G, Jumaa M, Purdon B, Zaidi S, Streib C, Shuaib A, Sangha N, Kim M, Froehler M, Schwartz N, Clark W, Kircher C, Yang M, Massaro L, Lu X, Rippon G, Broderick J, Butcher K, Lansberg M, Liebeskind D, Nouh A, Schwamm L, Campbell B. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. New England Journal Of Medicine 2024, 390: 701-711. PMID: 38329148, DOI: 10.1056/nejmoa2310392.Peer-Reviewed Original ResearchConceptsModified Rankin ScaleSymptomatic intracranial hemorrhageInternal carotid arteryMiddle cerebral arteryRankin ScalePlacebo groupTenecteplase groupIntracranial hemorrhageIncidence of symptomatic intracranial hemorrhageCerebral arteryIncidence of symptomatic intracerebral hemorrhageCarotid arteryPlacebo-controlled trialSymptomatic intracerebral hemorrhageEvidence of occlusionSafety populationDouble-blindPerfusion-imagingMedian timeClinical outcomesIntracerebral hemorrhagePlaceboPerfusion imagingPrimary outcomeOdds ratio
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 medicationRecent 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 useShorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke
Man S, Solomon N, Mac Grory B, Alhanti B, Uchino K, Saver J, Smith E, Xian Y, Bhatt D, Schwamm L, Hussain M, Fonarow G. Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke. Circulation 2023, 148: 20-34. PMID: 37199147, PMCID: PMC10356148, DOI: 10.1161/circulationaha.123.064053.Peer-Reviewed Original ResearchConceptsIntravenous thrombolytic therapyAcute ischemic strokeGood long-term functional outcomeLong-term functional outcomeShorter DTN timesEndovascular thrombectomyFunctional outcomeDTN timeIschemic strokeCause mortalityNeedle timeThrombolytic therapyCox proportional hazards modelModified Rankin Scale (mRS) 0Older US patientsRankin Scale 0Multivariate logistic regressionProportional hazards modelLongitudinal functional outcomesHome timeEligible patientsEVT candidatesEVT timesGuidelines-StrokeThrombolytic administrationTenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial
Wang Y, Li S, Pan Y, Li H, Parsons M, Campbell B, Schwamm L, Fisher M, Che F, Dai H, Li D, Li R, Wang J, Wang Y, Zhao X, Li Z, Zheng H, Xiong Y, Meng X, Investigators T, Li R, Wang D, Wang Y, Chen S, Deng D, Zhang H, Wang J, Chen H, Zhang H, Wu Y, Liu H, Lu G, Zhao L, Zhu R, Liu Y, Yi F, Gao J, Dai H, Hao J, Che F, Cai X, Duan Z, Yu H, Wei T, Tang Y, Peng Z, Zhang B, Song Y, Chen X, Liu Y, Liu J, Li D, Zhao W, Wei X, Xue Q, Liu X, Yang Y, zhao C, Chen J, Sui Y, Sheng G, Zhang Y, Liu J, Zhang L, Wang W, Guo Z, Li H, Hu R, Chen G, Liang Z, Chen J, Xia L, Long Z. Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial. The Lancet 2023, 401: 645-654. PMID: 36774935, DOI: 10.1016/s0140-6736(22)02600-9.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeAlteplase groupTenecteplase groupNon-inferiority marginNon-inferiority trialIschemic strokeModified intentionTreat populationEndovascular thrombectomyIntracranial hemorrhageRisk ratioScale scoreAcute ischemic cerebrovascular eventsHealth Stroke Scale scoreMedical Sciences (CAMS) Innovation FundStandard intravenous thrombolysisIschemic cerebrovascular eventsPrimary efficacy outcomePrimary safety outcomeStroke Scale scoreRankin Scale scoreProportion of participantsIntravenous tenecteplaseIntravenous thrombolysis
2022
The promise of tenecteplase in acute stroke: Within reach or beyond approval?
Zachrison K, Schwamm L. The promise of tenecteplase in acute stroke: Within reach or beyond approval? Med 2022, 3: 651-655. PMID: 36202099, DOI: 10.1016/j.medj.2022.09.005.Peer-Reviewed Original ResearchOutcomes After Endovascular Thrombectomy With or Without Alteplase in Routine Clinical Practice
Smith E, Zerna C, Solomon N, Matsouaka R, Mac Grory B, Saver J, Hill M, Fonarow G, Schwamm L, Messé S, Xian Y. Outcomes After Endovascular Thrombectomy With or Without Alteplase in Routine Clinical Practice. JAMA Neurology 2022, 79: 768-776. PMID: 35696198, PMCID: PMC9194745, DOI: 10.1001/jamaneurol.2022.1413.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeEndovascular thrombectomyObservational cohort studyRoutine clinical practiceAlteplase treatmentIschemic strokeIntravenous alteplaseCohort studyDischarge destinationPrespecified outcomesHigh riskClinical practiceCerebral Infarction grade 2bHealth Stroke Severity scoreCerebral infarction (TICI) gradeIntravenous alteplase treatmentLarge nationwide registryStroke severity scoresRandomized clinical trialsEmergency medical servicesGood reperfusionGuidelines-StrokeHospital strokeCertain comorbiditiesImproving Population Access to Stroke Expertise Via Telestroke: Hospitals to Target and the Potential Clinical Benefit
Richard J, Mehrotra A, Schwamm L, Wilcock A, Uscher‐Pines L, Majersik J, Zachrison K. Improving Population Access to Stroke Expertise Via Telestroke: Hospitals to Target and the Potential Clinical Benefit. Journal Of The American Heart Association 2022, 11: e025559. PMID: 35435016, PMCID: PMC9238444, DOI: 10.1161/jaha.122.025559.Peer-Reviewed Original ResearchA Phase III, prospective, double-blind, randomized, placebo-controlled trial of thrombolysis in imaging-eligible, late-window patients to assess the efficacy and safety of tenecteplase (TIMELESS): Rationale and design
Albers G, Campbell B, Lansberg M, Broderick J, Butcher K, Froehler M, Schwamm L, Nouh A, Liebeskind D, Toy F, Yang M, Massaro L, Schoeffler M, Purdon B. A Phase III, prospective, double-blind, randomized, placebo-controlled trial of thrombolysis in imaging-eligible, late-window patients to assess the efficacy and safety of tenecteplase (TIMELESS): Rationale and design. International Journal Of Stroke 2022, 18: 237-241. PMID: 35262424, DOI: 10.1177/17474930221088400.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeInternal carotid arteryPlacebo-controlled trialRankin Scale scoreSymptom onsetDay 90Scale scoreMiddle cerebral artery occlusionEfficacy of tenecteplaseLate-window patientsSafety of tenecteplaseSymptomatic intracranial hemorrhageCerebral artery occlusionLarge vessel occlusionPhase IIIPrimary efficacy objectiveBetter clinical outcomesAdverse eventsArtery occlusionEndovascular thrombectomyIschemic strokeMCA occlusionClinical outcomesIntracranial hemorrhageSalvageable tissueIn a hub-and-spoke network, spoke-administered thrombolysis reduces mechanical thrombectomy procedure time and number of passes
Kraft A, Awad A, Rosenthal J, Dmytriw A, Vranic J, Bonkhoff A, Bretzner M, Hirsch J, Rabinov J, Stapleton C, Schwamm L, Rost N, Leslie-Mazwi T, Patel A, Regenhardt R. In a hub-and-spoke network, spoke-administered thrombolysis reduces mechanical thrombectomy procedure time and number of passes. Interventional Neuroradiology 2022, 29: 315-320. PMID: 35317663, PMCID: PMC10369105, DOI: 10.1177/15910199221087498.Peer-Reviewed Original ResearchMeSH KeywordsArterial Occlusive DiseasesBrain IschemiaFibrinolytic AgentsHumansMechanical ThrombolysisStrokeThrombectomyThrombolytic TherapyTreatment OutcomeConceptsLarge vessel occlusion strokeIntravenous thrombolysisIVT-treated patientsMechanical thrombectomyProcedure timePuncture timeImproved reperfusionBaseline characteristicsTICI 2bIVT patientsOcclusion strokeOperative reportsProcedural characteristicsTelestroke networkPatientsReperfusionIncreased proportionThrombolysisTechnical difficultiesNIHSSThrombectomyHospitalStrokeMinRace-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 ResearchConceptsTissue 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 study
2021
Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure
Lusk J, Xu H, Peterson E, Bhatt D, Fonarow G, Smith E, Matsouaka R, Schwamm L, Xian Y. Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure. Stroke 2021, 52: e777-e781. PMID: 34702067, PMCID: PMC8608737, DOI: 10.1161/strokeaha.121.034622.Peer-Reviewed Original ResearchMeSH KeywordsAgedAspirinDual Anti-Platelet TherapyFemaleFibrinolytic AgentsHumansIschemic StrokeMaleSecondary PreventionTreatment FailureConceptsAspirin treatment failureDual antiplatelet therapyIschemic strokeAspirin monotherapyClopidogrel monotherapyAntiplatelet therapyAntithrombotic therapyTreatment failureAntithrombotic treatment patternsAspirin/dipyridamoleGuidelines-Stroke registryIschemic stroke survivorsAcute ischemic strokeHalf of patientsAmerican Heart AssociationComplex clinical scenariosNonvitamin KOral anticoagulantsStroke preventionStroke RegistryOlder patientsPreventive therapyTreatment patternsHeart AssociationStroke survivorsThrombolysis 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 InstituteSeverityTenecteplase Reperfusion therapy in Acute ischaemic Cerebrovascular Events-II (TRACE II): rationale and design
Li S, Campbell B, Schwamm L, Fisher M, Parsons M, Li H, Pan Y, Wang Y, . Tenecteplase Reperfusion therapy in Acute ischaemic Cerebrovascular Events-II (TRACE II): rationale and design. Stroke And Vascular Neurology 2021, 7: 71-76. PMID: 34446531, PMCID: PMC8899655, DOI: 10.1136/svn-2021-001074.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaFibrinolytic AgentsHumansProspective StudiesReperfusionStrokeTenecteplaseTreatment OutcomeUnited StatesConceptsAcute ischemic strokeExcellent functional outcomeFunctional outcomeReperfusion therapyRt-PAAcute ischemic cerebrovascular eventsIntravenous thrombolysis therapyMajor neurological improvementSecondary efficacy outcomesHealth Stroke ScaleIschemic cerebrovascular eventsSymptomatic intracranial hemorrhageFavorable functional outcomeIschemic stroke onsetPrimary study outcomeRankin Scale 0Non-inferiority studyTissue-type plasminogen activatorCerebrovascular eventsNeurological improvementStroke ScaleEfficacy outcomesIschemic strokeStroke onsetThrombolysis therapyNational 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 emergencyReperfusion 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 patterns
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