2022
Acute 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
Rising to the challenges of the pandemic: Telehealth innovations in U.S. emergency departments
Uscher-Pines L, Sousa J, Mehrotra A, Schwamm L, Zachrison K. Rising to the challenges of the pandemic: Telehealth innovations in U.S. emergency departments. Journal Of The American Medical Informatics Association 2021, 28: 1910-1918. PMID: 34022045, PMCID: PMC8194856, DOI: 10.1093/jamia/ocab092.Peer-Reviewed Original ResearchMeSH KeywordsAftercareCOVID-19Emergency Service, HospitalHumansPandemicsPatient DischargeSARS-CoV-2TelemedicineUnited StatesConceptsEmergency departmentTelehealth programED leadersU.S. emergency departmentsCoronavirus disease 2019 (COVID-19) pandemicDisease 2019 pandemicPersonal protective equipmentTelehealth applicationsPostdischarge assessmentsAcute careVirus exposureVisit volumeOngoing COVID-19Telehealth implementationTele-triageMaximum variation samplingProtective equipmentTelehealth innovationCOVID-19Tele-consultationCOVID-19 pandemicImplementation supportCarePandemicLiterature reviewAccess 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 patternsPatterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors
Etherton M, Shah S, Haolin X, Xian Y, Maisch L, Hannah D, Lindholm B, Lytle B, Thomas L, Smith E, Fonarow G, Schwamm L, Bhatt D, Hernandez A, O'Brien E. Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors. Stroke And Vascular Neurology 2021, 6: 384-394. PMID: 33526632, PMCID: PMC8485250, DOI: 10.1136/svn-2020-000691.Peer-Reviewed Original ResearchMeSH KeywordsAftercareAgedAntidepressive AgentsBrain IschemiaHumansIschemic StrokeMedicarePatient DischargeStrokeSurvivorsUnited StatesConceptsAntidepressant medicationIschemic strokeCause mortalityClinical outcomesOutcome measuresAD useHealth Stroke Scale scoreHigher admission National InstitutesMajor adverse cardiac eventsAdmission National InstitutesGuidelines-Stroke hospitalsPrior ischemic strokeAdverse cardiac eventsIschemic stroke survivorsStroke Scale scorePoor prognostic signPoor clinical outcomeLogistic regression modelsFalsification endpointsAntidepressant therapyCause readmissionNaïve patientsCardiac eventsPoststroke depressionStroke severityClinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage
Xian Y, Zhang S, Inohara T, Grau-Sepulveda M, Matsouaka RA, Peterson ED, Piccini JP, Smith EE, Sheth KN, Bhatt DL, Fonarow GC, Schwamm LH. Clinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage. JAMA Network Open 2021, 4: e2037438. PMID: 33591368, PMCID: PMC7887660, DOI: 10.1001/jamanetworkopen.2020.37438.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAnticoagulantsCase-Control StudiesCerebral HemorrhageCohort StudiesDependent AmbulationDrug Therapy, CombinationDual Anti-Platelet TherapyFactor Xa InhibitorsFemaleFunctional StatusHospicesHospital MortalityHumansMaleMiddle AgedOdds RatioPatient DischargePlatelet Aggregation InhibitorsRegistriesRisk FactorsWarfarinConceptsOral anticoagulant useOral anticoagulantsFXa inhibitorsHospital mortalityAnticoagulant useCohort studyIndependent ambulationMRS scoreIntracerebral hemorrhageGuidelines-Stroke registryCardiovascular risk factorsHospital mortality riskFactor Xa inhibitorsConcomitant warfarinOral anticoagulationAnticoagulation therapyAntiplatelet therapyHospital outcomesClinical characteristicsRankin ScaleSecondary outcomesPrimary outcomeRisk factorsWorse outcomesHigh prevalence
2020
Disease 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 outcomesEstablishment of an internationally agreed minimum data set for acute telestroke
Cadilhac D, Bagot K, Demaerschalk B, Hubert G, Schwamm L, Watkins C, Lightbody C, Kim J, Vu M, Pompeani N, Switzer J, Caudill J, Estrada J, Viswanathan A, Hubert N, Ohannessian R, Hargroves D, Roberts N, Ingall T, Hess D, Ranta A, Padma V, Bladin C. Establishment of an internationally agreed minimum data set for acute telestroke. Journal Of Telemedicine And Telecare 2020, 27: 582-589. PMID: 31937198, DOI: 10.1177/1357633x19899262.Peer-Reviewed Original ResearchMeSH KeywordsAftercareHumansPatient DischargeReferral and ConsultationStrokeTelemedicineThrombolytic TherapyConceptsTelestroke programsMinimum datasetExpert panelProcess of careGeneral clinical careInternational expert panelReliable international comparisonsTelestroke consultationThrombolysis treatmentPatient characteristicsEndovascular treatmentAcute careClinical managementPatient outcomesClinical careNeurosurgery treatmentDischarge informationInitial scoping reviewCareScoping ReviewTelestrokeHospitalTreatmentAustralasia-Pacific regionDelphi technique
2019
The Medicare Shared Savings Program and Outcomes for Ischemic Stroke Patients: a Retrospective Cohort Study
Kaufman B, O’Brien E, Stearns S, Matsouaka R, Holmes G, Weinberger M, Song P, Schwamm L, Smith E, Fonarow G, Xian Y. The Medicare Shared Savings Program and Outcomes for Ischemic Stroke Patients: a Retrospective Cohort Study. Journal Of General Internal Medicine 2019, 34: 2740-2748. PMID: 31452032, PMCID: PMC6854149, DOI: 10.1007/s11606-019-05283-1.Peer-Reviewed Original ResearchConceptsAccountable care organizationsIschemic strokeRecurrent strokeMSSP accountable care organizationsIndex hospital stayIncident ischemic strokeRetrospective cohort studyAcute care utilizationIschemic stroke patientsMedicare Shared Savings Program Accountable Care OrganizationsModerate ischemic strokeConclusionsAmong patientsMain MeasuresOutcomesCause readmissionHospital stayCohort studyHome dischargeCare utilizationStroke patientsTransitional careProbability of dischargeCare coordinationPatient outcomesMedicare claimsService beneficiariesComparison of Clinical Care and In-Hospital Outcomes of Asian American and White Patients With Acute Ischemic Stroke
Song S, Liang L, Fonarow G, Smith E, Bhatt D, Matsouaka R, Xian Y, Schwamm L, Saver J. Comparison of Clinical Care and In-Hospital Outcomes of Asian American and White Patients With Acute Ischemic Stroke. JAMA Neurology 2019, 76: 430-439. PMID: 30667466, PMCID: PMC6459126, DOI: 10.1001/jamaneurol.2018.4410.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAsianBrain IschemiaFemaleFibrinolytic AgentsHealthcare DisparitiesHospital MortalityHumansHydroxymethylglutaryl-CoA Reductase InhibitorsIntracranial HemorrhagesLogistic ModelsMaleMiddle AgedMultivariate AnalysisPatient DischargeQuality of Health CareRetrospective StudiesSeverity of Illness IndexStrokeStroke RehabilitationThrombolytic TherapyTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesWhite PeopleConceptsAcute ischemic strokeAsian American patientsIschemic strokeWhite patientsAmerican patientsClinical outcomesHospital mortalityStroke severityAmerican Heart Association/American Stroke AssociationIntravenous tissue plasminogen activator administrationTissue plasminogen activator administrationMultivariable logistic regression modelGreater stroke severityGuidelines-Stroke programGWTG-Stroke hospitalsIntensive statin therapyOverall stroke incidenceIn-Hospital OutcomesSevere ischemic strokeWorse functional outcomeAmerican Stroke AssociationQuality improvement registryLogistic regression modelsRace/ethnicityStatin therapy
2018
Factors associated with 1-year mortality after discharge for acute stroke: what matters?
Magdon-Ismail Z, Ledneva T, Sun M, Schwamm L, Sherman B, Qian F, Bettger J, Xian Y, Stein J. Factors associated with 1-year mortality after discharge for acute stroke: what matters? Topics In Stroke Rehabilitation 2018, 25: 576-583. PMID: 30281414, DOI: 10.1080/10749357.2018.1499303.Peer-Reviewed Original ResearchConceptsInpatient rehabilitation facilitySkilled nursing facilitiesAcute strokeDischarge destinationHealth Stroke ScaleHigher National InstitutesRetrospective cohort studyLong-term outcomesLong-term survivalCause mortalityStroke ScaleCohort studyIschemic strokeAmbulation statusIntracerebral hemorrhageMean ageMultivariate regression modelClinical dataNursing facilitiesRehabilitation facilityTherapeutic targetOlder ageMortalityStrokeNational InstituteAbsence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes
Gonzalez‐Castellon M, Ju C, Xian Y, Hernandez A, Fonarow G, Schwamm L, Smith E, Bhatt D, Reeves M, Willey J. Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes. Journal Of The American Heart Association 2018, 7: e007685. PMID: 29386207, PMCID: PMC5850252, DOI: 10.1161/jaha.117.007685.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaClinical CompetenceFemaleHealth StatusHospitals, TeachingHumansInternship and ResidencyMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AdmissionPatient DischargePersonnel Staffing and SchedulingQuality Indicators, Health CareRegistriesStrokeTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsGuidelines-Stroke programProportion of patientsAcute ischemic strokeIschemic strokeJuly phenomenonHospital outcomesAcute ischemic stroke care qualityMultivariable logistic regression modelCare qualityDefect-free careStroke care qualityStroke performance measuresSymptomatic intracranial hemorrhageHours of admissionLower care qualityLogistic regression modelsNeedle timeIntracranial hemorrhageMultivariable analysisAdverse outcomesNonteaching hospitalsTomography timePatientsClinical metricsHospitalPrestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke
Etherton M, Siddiqui K, Schwamm L. Prestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke. Stroke And Vascular Neurology 2018, 3: 9. PMID: 29600002, PMCID: PMC5870643, DOI: 10.1136/svn-2017-000119.Peer-Reviewed Original ResearchConceptsSelective serotonin reuptake inhibitorsAcute ischemic strokeIschemic strokeLength of staySSRI useFunctional outcomeSelective serotonin reuptake inhibitor useSerotonin reuptake inhibitor useGuidelines-Stroke registrySerotonin reuptake inhibitorsMultivariate regression analysisAmbulatory statusSymptomatic hemorrhageConsecutive patientsInhibitor useMotor recoveryReuptake inhibitorsFunctional recoveryStroke recoveryUnivariate analysisData registryDrug listMultivariate analysisStrokeLower likelihood
2017
Is 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 mortalityHospitalMortalityImproving transitions in acute stroke patients discharged to home: the Michigan stroke transitions trial (MISTT) protocol
Reeves M, Hughes A, Woodward A, Freddolino P, Coursaris C, Swierenga S, Schwamm L, Fritz M. Improving transitions in acute stroke patients discharged to home: the Michigan stroke transitions trial (MISTT) protocol. BMC Neurology 2017, 17: 115. PMID: 28623892, PMCID: PMC5474297, DOI: 10.1186/s12883-017-0895-1.Peer-Reviewed Original ResearchMeSH KeywordsAdultCaregiversHumansMichiganPatient DischargeQuality of LifeStrokeStroke RehabilitationSurvivorsConceptsAcute stroke patientsCase management programPatient Activation MeasureStroke patientsCaregiver outcomesTransition trialsRehabilitation facilityAdult acute stroke patientsBakas Caregiving Outcomes ScalePrimary caregiversOutcome 3 monthsPrimary patient outcomePatient's primary caregiverEvidence-based standardsHealth-related challengesUsual careHospital dischargeSuperiority trialEligible participantsOutcome ScaleTrial protocolPatient outcomesStudy interventionMichigan hospitalsOutcome data
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 patientsBaseline 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 featuresHospital Variation in Home-Time After Acute Ischemic Stroke
O'Brien E, Xian Y, Xu H, Wu J, Saver J, Smith E, Schwamm L, Peterson E, Reeves M, Bhatt D, Maisch L, Hannah D, Lindholm B, Olson D, Prvu Bettger J, Pencina M, Hernandez A, Fonarow G. Hospital Variation in Home-Time After Acute Ischemic Stroke. Stroke 2016, 47: 2627-2633. PMID: 27625383, DOI: 10.1161/strokeaha.116.013563.Peer-Reviewed Original ResearchConceptsIschemic strokeStroke survivorsStroke volumeAdmission volumePost dischargeAcute ischemic strokeIschemic stroke survivorsHighest priority outcomesMore comorbiditiesRegistry patientsSevere strokeHospital factorsAdjusted analysisHospital variationHospital characteristicsPost strokeMedicare claimsRural locationsHospitalStrokePatientsRisk adjustmentLinear mixed modelsFirst yearSurvivorsAssessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries
Fonarow G, Liang L, Thomas L, Xian Y, Saver J, Smith E, Schwamm L, Peterson E, Hernandez A, Duncan P, O'Brien E, Bushnell C, Prvu Bettger J. Assessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries. Stroke 2016, 47: 836-842. PMID: 26892279, DOI: 10.1161/strokeaha.115.011599.Peer-Reviewed Original ResearchConceptsModified Rankin ScaleIschemic strokeMedicare beneficiariesIschemic stroke Longitudinal (AVAIL) registryMedian Modified Rankin ScaleAcute ischemic strokePatient-centered outcomesSkilled nursing facilitiesGuidelines-StrokeMRS 0Older patientsRankin ScaleStroke careInpatient rehabilitationStroke survivorsC-indexOutcome measuresNursing facilitiesFunctional independenceAdherence evaluationStrokePatientsSimilar findingsMeaningful outcomesPearson correlation coefficient
2015
Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient‐Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study
O'Brien E, Greiner M, Xian Y, Fonarow G, Olson D, Schwamm L, Bhatt D, Smith E, Maisch L, Hannah D, Lindholm B, Peterson E, Pencina M, Hernandez A. Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient‐Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study. Circulation 2015, 132: 1404-1413. PMID: 26246175, DOI: 10.1161/circulationaha.115.016183.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCardiovascular DiseasesDose-Response Relationship, DrugFemaleFollow-Up StudiesHospitalizationHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMedicaidMedical RecordsMedicarePatient DischargePatient Outcome AssessmentPatient ReadmissionRecurrenceRegistriesTreatment OutcomeUnited StatesConceptsMajor adverse cardiovascular eventsAdverse cardiovascular eventsStatin therapyTime of admissionCardiovascular eventsIschemic strokePatient prefersCause mortalityHemorrhagic strokeOlder ischemic stroke patientsGuidelines-Stroke registryHigh-intensity doseIschemic stroke patientsModerate-intensity statinsPatient-centered outcomesReal-world effectivenessYears of ageOutcomes Research InstituteEffectiveness researchCoprimary outcomesCardiovascular readmissionCause readmissionSecondary outcomesStroke patientsClinical effectiveness