2022
Pairing regression and configurational analysis in health services research: modelling outcomes in an observational cohort using a split-sample design
Miech EJ, Perkins AJ, Zhang Y, Myers LJ, Sico JJ, Daggy J, Bravata DM. Pairing regression and configurational analysis in health services research: modelling outcomes in an observational cohort using a split-sample design. BMJ Open 2022, 12: e061469. PMID: 35672067, PMCID: PMC9174826, DOI: 10.1136/bmjopen-2022-061469.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaCohort StudiesHealth Services ResearchHumansIschemic Attack, TransientStrokeConceptsTransient ischemic attackLogistic regression modelsHealth services researchSet of patientsOverall sample prevalenceObservational cohortLogistic regressionSample prevalenceRecurrent ischemic strokeVeterans Affairs hospitalRegression modelsServices researchIschemic attackRecurrent strokeCause mortalityCombined endpointIschemic strokePatient outcomesDeath outcomesCare outcomesPatientsSecondary analysisPrevalenceOutcomesCohort
2021
Deintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack
Dearborn-Tomazos JL, Hu X, Bravata DM, Phadke MA, Baye FM, Myers LJ, Concato J, Zillich AJ, Reeves MJ, Sico JJ. Deintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack. Stroke 2021, 52: 2521-2529. PMID: 34015937, DOI: 10.1161/strokeaha.120.030089.Peer-Reviewed Original ResearchConceptsTransient ischemic attackIschemic strokeIschemic attackHospital dischargeHospital admissionHigh mortalityVeterans Health Administration facilitiesHigh-potency statinsUnderutilization of statinsHigh potencyStatin doseStatin medicationBaseline characteristicsMost patientsPrescribed statinsStatin treatmentPharmacy filesStatin potencyAtherosclerotic originUS veteransPractice guidelinesStudy populationHigher oddsPatientsStatins
2019
Polysomnography Utilization in Veterans Presenting Acutely with Ischemic Stroke or Transient Ischemic Attack
Koo BB, Sico JJ, Myers LJ, Perkins AJ, Levine D, Miech EJ, Damush TM, Rattray N, Homoya B, Ferguson J, Myers J, Zhang Y, Bravata DM. Polysomnography Utilization in Veterans Presenting Acutely with Ischemic Stroke or Transient Ischemic Attack. Cerebrovascular Diseases 2019, 48: 179-183. PMID: 31722335, DOI: 10.1159/000504406.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaComorbidityFemaleHealth Services AccessibilityHealth StatusHumansIschemic Attack, TransientMaleMiddle AgedPolysomnographyPractice Guidelines as TopicPractice Patterns, Physicians'Predictive Value of TestsPrognosisRisk FactorsSleep Apnea, ObstructiveStrokeTime FactorsUnited StatesUnited States Department of Veterans AffairsVeterans HealthConceptsTransient ischemic attackAcute ischemic strokeObstructive sleep apneaVeterans Administration Medical CenterTreatment of OSAIschemic strokeIschemic attackClinical dataExact testVA Corporate Data WarehouseCerebrovascular risk factorsMixed-effects logistic regressionFisher's exact testCorporate Data WarehouseEffects logistic regressionTwo-sample t-testAcute strokeClinical characteristicsHospital dischargeHeart failureSleep apneaFunctional outcomeRisk factorsUS veteransRecent guidelinesPosttraumatic Stress Disorder and Risk for Stroke in Young and Middle-Aged Adults
Rosman L, Sico JJ, Lampert R, Gaffey AE, Ramsey CM, Dziura J, Chui PW, Cavanagh CE, Brandt C, Haskell S, Burg MM. Posttraumatic Stress Disorder and Risk for Stroke in Young and Middle-Aged Adults. Stroke 2019, 50: 2996-3003. PMID: 31619151, DOI: 10.1161/strokeaha.119.026854.Peer-Reviewed Original ResearchConceptsTransient ischemic attackIncident transient ischemic attackPosttraumatic stress disorderEffects of PTSDIschemic strokeIncident strokeHealthcare utilizationIncidence of TIAStress disorderYoung adultsMiddle-aged veteransStroke risk factorsMultivariate Cox modelIschemic stroke riskAge-specific prevention strategiesVeterans Health AdministrationMiddle-aged adultsIschemic attackStroke riskPsychological factorsUnadjusted analysesRisk factorsEffect modificationCox modelPsychiatric disordersProcesses of Care Associated With Risk of Mortality and Recurrent Stroke Among Patients With Transient Ischemic Attack and Nonsevere Ischemic Stroke
Bravata DM, Myers LJ, Reeves M, Cheng EM, Baye F, Ofner S, Miech EJ, Damush T, Sico JJ, Zillich A, Phipps M, Williams LS, Chaturvedi S, Johanning J, Yu Z, Perkins AJ, Zhang Y, Arling G. Processes of Care Associated With Risk of Mortality and Recurrent Stroke Among Patients With Transient Ischemic Attack and Nonsevere Ischemic Stroke. JAMA Network Open 2019, 2: e196716. PMID: 31268543, PMCID: PMC6613337, DOI: 10.1001/jamanetworkopen.2019.6716.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaEligibility DeterminationFemaleHumansIschemic Attack, TransientLong Term Adverse EffectsMaleMiddle AgedMortalityOutcome and Process Assessment, Health CarePatient Care ManagementPrognosisRecurrenceRisk AssessmentRisk FactorsSeverity of Illness IndexStrokeUnited StatesVeterans Health ServicesConceptsTransient ischemic attackRecurrent ischemic strokeIschemic strokeRisk of deathRecurrent strokeProcess of careLower oddsMedication intensificationIschemic attackAtrial fibrillationVeterans Affairs emergency departmentAntihypertensive medication classesMortality 1 yearManagement of patientsMultivariable logistic regressionRisk of mortalityMultiple comparisonsCarotid artery imagingCause mortalityLipid managementMedication classesStatin medicationStatin therapyCohort studyStroke risk
2017
Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction
Bravata DM, Daggy J, Brosch J, Sico JJ, Baye F, Myers LJ, Roumie CL, Cheng E, Coffing J, Arling G. Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction. Stroke 2017, 49: 296-303. PMID: 29284738, DOI: 10.1161/strokeaha.117.017142.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionRisk factor controlIncident ischemic strokeBlood pressure controlIschemic stroke patientsIschemic strokeStroke patientsGlycemic controlAMI patientsMyocardial infarctionPressure controlIncident acute myocardial infarctionChronic obstructive pulmonary diseaseVascular risk factor controlFacility-level covariatesTransient ischemic attackAcute ischemic strokeCongestive heart failureObstructive pulmonary diseaseVeterans Health AdministrationFactor controlFacility covariatesIschemic attackHypertension controlStroke preventionDevelopment and Validation of Electronic Quality Measures to Assess Care for Patients With Transient Ischemic Attack and Minor Ischemic Stroke
Bravata DM, Myers LJ, Cheng E, Reeves M, Baye F, Yu Z, Damush T, Miech EJ, Sico J, Phipps M, Zillich A, Johanning J, Chaturvedi S, Austin C, Ferguson J, Maryfield B, Snow K, Ofner S, Graham G, Rhude R, Williams LS, Arling G. Development and Validation of Electronic Quality Measures to Assess Care for Patients With Transient Ischemic Attack and Minor Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003157. PMID: 28912200, DOI: 10.1161/circoutcomes.116.003157.Peer-Reviewed Original ResearchConceptsTransient ischemic attackElectronic quality measuresMinor ischemic strokeProportion of patientsIschemic attackIschemic strokeEHR dataDeep vein thrombosis prophylaxisVeterans Health Administration facilitiesCoronary risk assessmentInternational normalized ratioElectronic health record dataIschemic stroke careHealth record dataQuality of careSubstance abuse referralAntihypertensive classesMedication intensificationThrombosis prophylaxisLipid managementChart reviewStroke careAtrial fibrillationNeurology consultationNormalized ratioDevelopment, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea
Sico JJ, Yaggi HK, Ofner S, Concato J, Austin C, Ferguson J, Qin L, Tobias L, Taylor S, Fragoso C, McLain V, Williams LS, Bravata DM. Development, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea. Journal Of Stroke And Cerebrovascular Diseases 2017, 26: 1745-1754. PMID: 28416405, PMCID: PMC6006998, DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.042.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overArea Under CurveBrain IschemiaDecision Support TechniquesFemaleHumansIschemic Attack, TransientMaleMiddle AgedPolysomnographyPredictive Value of TestsPrevalencePrognosisReproducibility of ResultsRisk AssessmentRisk FactorsROC CurveSleepSleep Apnea, ObstructiveStrokeSurveys and QuestionnairesTime FactorsUnited StatesConceptsObstructive sleep apneaTransient ischemic attackHigh negative predictive valueEpworth Sleepiness ScaleNegative predictive valueIschemic strokeSleep apneaPresence of OSASleep InventoryPredictive valueSleep Apnea Clinical ScoreValidation study populationHigh blood pressureBody mass indexIschemic attackObserved apneaBerlin questionnaireStroke severityBlood pressureOvernight polysomnographyMass indexRandomized trialsClinical scoresSleep QuestionnaireMedical history
2016
Observational Study of Obstructive Sleep Apnea in Wake-Up Stroke: The SLEEP TIGHT Study
Koo BB, Bravata DM, Tobias LA, Mackey JS, Miech EJ, Matthias MS, Stahl SM, Sico JJ, Fragoso C, Williams LS, Lampert R, Qin L, Yaggi HK. Observational Study of Obstructive Sleep Apnea in Wake-Up Stroke: The SLEEP TIGHT Study. Cerebrovascular Diseases 2016, 41: 233-241. PMID: 26811929, DOI: 10.1159/000440736.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersBlood PressureBlood Pressure Monitoring, AmbulatoryBrain IschemiaChi-Square DistributionCholesterol, LDLConnecticutCross-Sectional StudiesFemaleHumansIndianaIschemic Attack, TransientLogistic ModelsMaleMiddle AgedOdds RatioOxygenPolysomnographyPrevalenceRandomized Controlled Trials as TopicRisk FactorsSeverity of Illness IndexSex FactorsSleepSleep Apnea, ObstructiveStrokeSympathetic Nervous SystemWakefulnessConceptsObstructive sleep apneaDiastolic blood pressureSevere obstructive sleep apneaLow-density lipoproteinBlood pressureSleep apneaSerum catecholaminesAmbulatory blood pressure monitoringBaseline diastolic blood pressureMean body mass indexB-type natriuretic peptideHigher diastolic blood pressureMore oxygen desaturationTransient ischemic attackIschemic stroke patientsAmbulatory blood pressureHistory of strokeBody mass indexC-reactive proteinBlood pressure monitoringOxygen desaturation eventsGender-stratified analysesCross-sectional analysisIschemic attackOSA frequencyUsing Radiological Data to Estimate Ischemic Stroke Severity
Sico JJ, Phipps MS, Concato J, Brandt C, Wells CK, Lo AC, Nadeau SE, Williams LS, Gorman M, Boice JL, Bravata DM. Using Radiological Data to Estimate Ischemic Stroke Severity. Journal Of Stroke And Cerebrovascular Diseases 2016, 25: 792-798. PMID: 26794264, DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.002.Peer-Reviewed Original ResearchConceptsStroke severityHospital mortalityStroke patientsC-statisticAcute ischemic stroke patientsStroke care qualityIschemic stroke patientsChart review dataIschemic stroke severityElectronic health recordsAdmission headSevere strokePoststroke mortalityAbnormal findingsValid measurePatient levelRadiographic scoresRadiological dataRadiographic dataRadiographic measuresCare qualityRisk adjustmentSeverityHealth recordsMortality
2015
Infarct location and sleep apnea: evaluating the potential association in acute ischemic stroke
Stahl SM, Yaggi HK, Taylor S, Qin L, Ivan CS, Austin C, Ferguson J, Radulescu R, Tobias L, Sico J, Fragoso C, Williams LS, Lampert R, Miech EJ, Matthias MS, Kapoor J, Bravata DM. Infarct location and sleep apnea: evaluating the potential association in acute ischemic stroke. Sleep Medicine 2015, 16: 1198-1203. PMID: 26429745, PMCID: PMC4592521, DOI: 10.1016/j.sleep.2015.07.003.Peer-Reviewed Original ResearchMeSH KeywordsBrainBrain InfarctionBrain IschemiaFemaleHumansMaleMiddle AgedPolysomnographyRisk FactorsSleep Apnea, ObstructiveConceptsObstructive sleep apneaApnea-hypopnea indexAcute ischemic strokeIschemic stroke patientsStroke patientsStroke locationOSA presenceIschemic strokeSleep apneaPrevalence of OSASeverity of OSAAcute ischemic stroke patientsTransient ischemic attackObstructive respiratory eventsMeasures of hypoxiaHigh overall prevalenceBrain imaging reportsIschemic attackPolysomnographic findingsOSA severityComplete polysomnographyRespiratory eventsInfarct locationOverall prevalenceVascular territoriesHIV status and the risk of ischemic stroke among men
Sico J, Chang C, So-Armah K, Justice A, Hylek E, Skanderson M, McGinnis K, Kuller L, Kraemer K, Rimland D, Bidwell Goetz M, Butt A, Rodriguez-Barradas M, Gibert C, Leaf D, Brown S, Samet J, Kazis L, Bryant K, Freiberg M, Chang C, So-Armah K, Justice A, Hylek E, Skanderson M, McGinnis K, Kuller L, Kraemer K, Rimland D, Goetz M, Butt A, Rodriguez Barradas M, Gibert C, Leaf D, Brown S, Samet J, Kazis L, Bryant K, Freiberg M. HIV status and the risk of ischemic stroke among men. Neurology 2015, 84: 1933-1940. PMID: 25862803, PMCID: PMC4433456, DOI: 10.1212/wnl.0000000000001560.Peer-Reviewed Original ResearchConceptsIschemic stroke riskVeterans Aging Cohort Study Virtual CohortIschemic stroke risk factorsStroke risk factorsHIV infectionUninfected veteransIschemic strokeStroke riskMale veteransComorbid diseasesRisk factorsSubstance useBaseline cardiovascular diseaseIschemic stroke rateRace/ethnicityHIV biomarkersMedian followStroke eventsHIV statusCardiovascular diseaseStroke rateClinical sitesHIVInfectionStroke
2012
Thrombocytopenia and In-hospital Mortality Risk among Ischemic Stroke Patients
Sico JJ, Phipps MS, Concato J, Wells CK, Lo AC, Nadeau SE, Williams LS, Peixoto AJ, Gorman M, Boice JL, Bravata DM. Thrombocytopenia and In-hospital Mortality Risk among Ischemic Stroke Patients. Journal Of Stroke And Cerebrovascular Diseases 2012, 22: e99-e102. PMID: 22974703, DOI: 10.1016/j.jstrokecerebrovasdis.2012.08.005.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic stroke patientsHospital mortalityIschemic strokeStroke patientsHealth Stroke Scale scoreAcute ischemic stroke patientsStroke Scale scorePredictors of mortalityLogistic regression modelingAdmission thrombocytopeniaRetrospective cohortAntiplatelet effectUnadjusted analysesRisk factorsOdds ratioMortality riskThrombocytopeniaPatientsScale scoreHigh mortalityMortalityU.S. hospitalsStrokeNational Institute
2011
Anemia is Associated with Poor Outcomes in Patients with Less Severe Ischemic Stroke
Sico JJ, Concato J, Wells CK, Lo AC, Nadeau SE, Williams LS, Peixoto AJ, Gorman M, Boice JL, Bravata DM. Anemia is Associated with Poor Outcomes in Patients with Less Severe Ischemic Stroke. Journal Of Stroke And Cerebrovascular Diseases 2011, 22: 271-278. PMID: 22100828, DOI: 10.1016/j.jstrokecerebrovasdis.2011.09.003.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAnemiaBrain IschemiaChi-Square DistributionDisability EvaluationFemaleHospice CareHospital MortalityHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPatient AdmissionPatient DischargePredictive Value of TestsPrognosisRetrospective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexStrokeUnited StatesYoung AdultConceptsAcute ischemic strokeSevere ischemic strokeSevere strokeHospital mortalityIschemic strokeConsecutive ischemic stroke patientsHealth Stroke Scale scoreAdmission National InstitutesRole of anemiaStroke Scale scoreChronic kidney diseaseIschemic stroke patientsCongestive heart failureAcute myocardial infarctionAdmission anemiaCombined endpointRetrospective cohortStroke severitySymptom onsetHeart failureHospital admissionStroke patientsPoor outcomeKidney diseaseMyocardial infarction