2024
Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study
Dhand A, Reeves M, Mu Y, Rosner B, Rothfeld-Wehrwein Z, Nieves A, Dhongade V, Jarman M, Bergmark R, Semco R, Ader J, Marshall B, Goedel W, Fonarow G, Smith E, Saver J, Schwamm L, Sheth K. Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study. Stroke 2024, 55: 1507-1516. PMID: 38787926, PMCID: PMC11299104, DOI: 10.1161/strokeaha.123.045521.Peer-Reviewed Original ResearchConceptsSocial Vulnerability IndexPrehospital delayHospital arrivalZIP Code Tabulation AreasEmergency medical servicesCommunity-level social vulnerabilityGuidelines-Stroke registryCommunity socioeconomic statusCommunity-level factorsPatient-level factorsNationwide registry studyAmerican Heart AssociationSocial vulnerabilityCox proportional hazards modelsSocially vulnerable areasAssociated with delaySocial determinantsProportional hazards modelAcute stroke treatmentGeospatial mappingSocioeconomic statusMedical servicesIncreased social vulnerabilityPrimary exposureQuartile 3Trends in the Use of Medications for Secondary Ischemic Stroke Prevention in Denmark, 2005-2021.
Skajaa N, Laugesen K, Lauffenburger J, Schwamm L, Sørensen H, Patorno E. Trends in the Use of Medications for Secondary Ischemic Stroke Prevention in Denmark, 2005-2021. Neurology 2024, 102: e209309. PMID: 38648572, PMCID: PMC11226314, DOI: 10.1212/wnl.0000000000209309.Peer-Reviewed Original ResearchConceptsMedication useOral anticoagulant medicationsGlucose-lowering medication useFactors associated with medication useLipid-lowering medication useSevere strokeIschemic stroke hospitalizationsAntihypertensive medication useAnticoagulant medicationOlder patientsCare of patientsSodium-glucose cotransporter-2 inhibitorsGlucagon-like peptide-1 receptor agonistsStroke preventionAnticoagulant medication useLipid-loweringPeptide-1 receptor agonistsGlucose-loweringReduced life expectancyIschemic strokeCotransporter-2 inhibitorsStroke careCohort of patientsStroke hospitalizationsSecondary ischemic stroke preventionTrends 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 ResearchConceptsDoor-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
2022
Association 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 group
2021
Association of Physician Characteristics With Early Adoption of Virtual Health Care
Zachrison K, Yan Z, Samuels-Kalow M, Licurse A, Zuccotti G, Schwamm L. Association of Physician Characteristics With Early Adoption of Virtual Health Care. JAMA Network Open 2021, 4: e2141625. PMID: 34967876, PMCID: PMC8719243, DOI: 10.1001/jamanetworkopen.2021.41625.Peer-Reviewed Original ResearchConceptsVirtual health careCross-sectional studyHealth care systemPatient characteristicsHealth carePhysician characteristicsLarge regional health care systemRetrospective cross-sectional studyBehavioral healthCare systemSurgical specialtiesHealth system databasePhysician-level variationRegional health care systemAmbulatory visitsPrimary careHealth physiciansPatient's abilityAmbulatory careMAIN OUTCOMEGreater oddsAmbulatory practiceBivariate comparisonsPhysiciansHospital affiliationChanges in Virtual and In-Person Health Care Utilization in a Large Health System During the COVID-19 Pandemic
Zachrison K, Yan Z, Schwamm L. Changes in Virtual and In-Person Health Care Utilization in a Large Health System During the COVID-19 Pandemic. JAMA Network Open 2021, 4: e2129973. PMID: 34705016, PMCID: PMC8552053, DOI: 10.1001/jamanetworkopen.2021.29973.Peer-Reviewed Original ResearchOutcomes of Endovascular Therapy in Patients With Prestroke Mobility Impairment
Beekman R, Sun JL, Alhanti B, Schwamm LH, Smith EE, Bhatt DL, Xian Y, Shah S, Lytle BL, Fonarow GC, Sheth KN. Outcomes of Endovascular Therapy in Patients With Prestroke Mobility Impairment. Stroke 2021, 52: e725-e728. PMID: 34517771, DOI: 10.1161/strokeaha.121.034464.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomyGuidelines-Stroke registrySymptomatic intracranial hemorrhageMobility impairmentsLogistic regression modelsHospital deathEndovascular therapyClinical benefitIntracranial hemorrhageAdverse outcomesClinical trialsThrombectomyPatientsOutcomesFurther studiesImpairmentRegression modelsNational data setsSafetyHemorrhageRegistryTherapyPopulationHospiceTrialsIdiopathic primary intraventricular hemorrhage and cerebral small vessel disease
Das A, Regenhardt R, Gokcal E, Horn M, Daoud N, Schwab K, Rost N, Viswanathan A, Kimberly W, Goldstein J, Biffi A, Schwamm L, Rosand J, Greenberg S, Gurol M. Idiopathic primary intraventricular hemorrhage and cerebral small vessel disease. International Journal Of Stroke 2021, 17: 645-653. PMID: 34427471, PMCID: PMC10947797, DOI: 10.1177/17474930211043957.Peer-Reviewed Original ResearchConceptsCerebral small vessel diseaseCerebral amyloid angiopathyPrimary intraventricular hemorrhageIdiopathic primary intraventricular hemorrhageProbable cerebral amyloid angiopathyAmyloid angiopathySmall vessel diseaseIntraventricular hemorrhageVessel diseaseMean initial blood pressureNon-traumatic intracerebral hemorrhageBrain magnetic resonance imagingInitial blood pressurePrimary intraparenchymal hemorrhageSingle referral centerBrain magnetic resonanceMagnetic resonance imagingCSVD subtypesBoston criteriaReferral centerBlood pressureConsecutive patientsCerebral amyloidIntracerebral hemorrhageIntraparenchymal hemorrhageThrombolysis 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 InstituteSeverityFrequency, 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 periodSeizure Prophylaxis After Spontaneous Intracerebral Hemorrhage
Jones F, Sanches P, Smith J, Zafar S, Blacker D, Hsu J, Schwamm L, Newhouse J, Westover M, Moura L. Seizure Prophylaxis After Spontaneous Intracerebral Hemorrhage. JAMA Neurology 2021, 78: 1128-1136. PMID: 34309642, PMCID: PMC8314179, DOI: 10.1001/jamaneurol.2021.2249.Peer-Reviewed Original ResearchConceptsEarly seizure prophylaxisSpontaneous intracerebral hemorrhageAdverse drug reactionsRisk-guided strategyLate seizuresLong-term therapyHigh riskSeizure prophylaxisPrimary prophylaxisIntracerebral hemorrhageLower riskLong-term adverse drug reactionsLow-risk patientsShort-term prophylaxisDecision analytical modelSecondary therapyProphylaxis strategiesDrug reactionsProphylaxisMAIN OUTCOMESeizuresPatientsClinical decisionTherapyAverage riskNational 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 emergency'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 occlusionAnticonvulsant Primary and Secondary Prophylaxis for Acute Ischemic Stroke Patients
Jones F, Sanches P, Smith J, Zafar S, Hernandez-Diaz S, Blacker D, Hsu J, Schwamm L, Westover M, Moura L. Anticonvulsant Primary and Secondary Prophylaxis for Acute Ischemic Stroke Patients. Stroke 2021, 52: 2782-2791. PMID: 34126758, PMCID: PMC8384723, DOI: 10.1161/strokeaha.120.033299.Peer-Reviewed Original ResearchConceptsQuality-adjusted life expectancySecondary prophylaxisAdverse drug reactionsADR riskLate seizuresPrimary prophylaxisMale patientsFemale patientsLifetime riskLS riskAcute ischemic stroke hospitalizationsLong-term secondary prophylaxisAcute ischemic stroke patientsHigher ADR risksAcute ischemic strokeIschemic stroke patientsIschemic stroke hospitalizationsCommon clinical scenariosShort-term therapyAnticonvulsant prophylaxisLifetime prophylaxisPersistent seizuresSeizure prophylaxisEarly seizuresIschemic strokeEffect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease
Bernstein R, Kamel H, Granger C, Piccini J, Sethi P, Katz J, Vives C, Ziegler P, Franco N, Schwamm L, Acosta I, Jamnadas P, Manda S, Alimohammad R, Arias V, Tempro K, Ward K, Asi K, Choudhuri I, Guerrero W, Kalia J, Niazi I, Sajjad R, Thavapalan V, Assar M, Banchs J, Black J, Cheung P, Donsky A, Graybeal D, Hasan R, Mir O, Nguyen C, Olsovsky G, Rasmussen J, Hasabnis S, Reeves R, Rowley C, Sharma J, Smith M, Bonyak K, Sackett M, Allred J, Sethi P, Jung R, Lynch J, Rowe S, Dash S, Glotzer T, Jamal S, Radoslovich G, Shukla G, Zimmerman J, Hussein H, Zhu D, Krueger K, Ostrander M, Ramirez D, Shultz J, Simonson J, Cucchiara B, Deo R, Frankel D, Jia J, Kasner S, Luciano J, Messe S, Mullen M, Santangeli P, Schaller R, Yuan Q, Bledsoe D, Cajavilca C, Chiu D, Gadhia R, Grimes M, Katz L, Moye S, Rami T, Thomas A, Volpi J, Al Balushi A, Boyd C, Choudry S, Dhamoon M, Dukkipati S, Goltz D, Hao Q, Horowitz D, Kaur G, Koruth J, Kurian C, Langan M, Matos Diaz I, Miller M, Reddy V, Sheinart K, Stein L, Tansy A, Tuhrim S, Weinberger J, Whang W, Cross J, Kreger H, Saltzman M, Zide K, Bansal S, Bernabei M, Flaster M, Barrett C, Etherton M, Heist E, Lubitz S, Regenhardt R, Sharma R, Silverman S, Sloane K, Viswanathan A, Doshi A, Logan W, Malik M, Rempe D, Arora R, Beldner S, Epstein L, Ismail H, Jadonath R, Katz J, Libman R, Moussavi M, Patel A, Patel A, Willner J, Wright P, Caprio F, Kim S, Mendelson S, Passman R, Ruff I, Alsorogi M, Chaudhary G, Morris K, Mullins S, Talpur N, Thomas K, Chancellor B, Chinitz L, Culpepper A, Fara M, Ishida K, Lillemoe K, Lord A, Torres J, Zhang C, Abi-Samra F, Bernard M, Carter J, Chokhawala H, Downey A, Khatib S, Morin D, Polin G, Rogers P, Vidal G, Zweifler R, Belt G, Felberg R, Furer S, Hanna J, McCall-Brown A, Seeger S, Reddy R, Skalabrin E, Soik D, Wilder M, Kearney M, LaFranchise E, Parker B, Pickett R, Bonaguidi H, Gibson D, Kalafut M, Mattera B, Olson N, Parker M, Rogers J, Uddin P, Chang C, Graner S, Kipta J, Salem R, Singh D, Al-Awwad A, Beaver B, Chaudhary S, Clayton S, Delpirou Nouh C, Garabelli P, Gordon D, Pakala A, Ray B, Saucedo S, Sidorov E, Stavrakis S, Ching M, Deline C, Hourihane J, Kandel A, Kim C, Magun R, Mowla A, Sawyer R, Switzer D, Badhwar N, Lee R, Meisel K, Smith W, Alkahalifah M, Aroor S, Asdaghi N, Bhatt N, Del Brutto V, Dillon G, Gadient P, Koch S, Lambrakos L, Malik A, Marulanda-Londono E, Memon Z, Mendoza I, Mitrani R, Ortiz G, Ramano J, Sur N, Torres L, Daniels J, Johnson M, Magadan A, Shang T, Mcclelland N, Merriam T, Neisen K. Effect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease. JAMA 2021, 325: 2169-2177. PMID: 34061145, PMCID: PMC8170544, DOI: 10.1001/jama.2021.6470.Peer-Reviewed Original ResearchConceptsSmall vessel diseaseAtrial fibrillationUsual careCardiac monitoringIndex strokeICM groupControl groupAdditional stroke risk factorsProcedure-related adverse eventsAF incidence ratesMore atrial fibrillationCHA2DS2-VASc scorePrimary end pointStroke risk factorsIncident atrial fibrillationMulticenter clinical trialAF detectionContinuous cardiac monitoringLong-term cardiac monitoringEligible patientsAdverse eventsIschemic strokeHolter monitoringRisk factorsClinical trialsAccess to Mechanical Thrombectomy for Ischemic Stroke in the United States
Kamel H, Parikh N, Chatterjee A, Kim L, Saver J, Schwamm L, Zachrison K, Nogueira R, Adeoye O, Díaz I, Ryan A, Pandya A, Navi B. Access to Mechanical Thrombectomy for Ischemic Stroke in the United States. Stroke 2021, 52: 2554-2561. PMID: 33980045, PMCID: PMC8316281, DOI: 10.1161/strokeaha.120.033485.Peer-Reviewed Original ResearchConceptsIschemic strokeMechanical thrombectomyUnadjusted logistic regression modelsNonfederal emergency departmentsAcute ischemic strokeLarge cerebral vesselsAcute care hospitalsMultiple sensitivity analysesLogistic regression modelsStandard descriptive statisticsIntravenous thrombolysisStroke severityUrban patientsCare hospitalSuch patientsInterhospital transferRural patientsStroke careEmergency departmentPopulation-wide dataCerebral vesselsThrombectomyCalendar year 2016PatientsPrimary analysisReperfusion 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 patternsCognitive Demands Influence Upper Extremity Motor Performance During Recovery From Acute Stroke
Lin D, Erler K, Snider S, Bonkhoff A, DiCarlo J, Lam N, Ranford J, Parlman K, Cohen A, Freeburn J, Finklestein S, Schwamm L, Hochberg L, Cramer S. Cognitive Demands Influence Upper Extremity Motor Performance During Recovery From Acute Stroke. Neurology 2021, 96: e2576-e2586. PMID: 33858997, PMCID: PMC8205451, DOI: 10.1212/wnl.0000000000011992.Peer-Reviewed Original ResearchMeSH KeywordsAgedCognitionFemaleHumansMaleMiddle AgedPsychomotor PerformanceRecovery of FunctionStrokeUpper ExtremityConceptsIpsilesional upper extremityAcute strokeUpper extremity motor performanceGrip strength performanceUpper extremityCognitive dysfunctionMotor performanceMotor tasksAcute ischemic strokeVoxel-based lesion-symptom mappingGrip strength scoresDorsal anterior insulaBlock performanceBallistic motor taskLesion-symptom mappingIschemic strokeGrip strengthNeuroanatomic sitesCognitive impairmentSensorimotor regionsSymptom mappingStrokeCognitive functionAnterior insulaInjuryAcute 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 ResearchConceptsIntensive 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 donation