2023
Development and validation of a model predicting mild stroke severity on admission using electronic health record data
Waddell K, Myers L, Perkins A, Sico J, Sexson A, Burrone L, Taylor S, Koo B, Daggy J, Bravata D. Development and validation of a model predicting mild stroke severity on admission using electronic health record data. Journal Of Stroke And Cerebrovascular Diseases 2023, 32: 107255. PMID: 37473533, DOI: 10.1016/j.jstrokecerebrovasdis.2023.107255.Peer-Reviewed Original ResearchConceptsInitial stroke severityStroke severityElectronic health record dataHealth record dataSevere strokeIschemic strokeStroke careSample patientsMortality risk stratificationRecord dataVeterans Affairs hospitalMild stroke severityMultiple logistic regressionObservational cohortStroke outcomeIndependent predictorsRisk stratificationEHR data elementsPrimary analysisLogistic regressionStrokeValidation sampleSeverityPotent modifierEHR data
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 ResearchConceptsTransient 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 analysisPrevalenceOutcomesCohortBlood Pressure Trajectories and Outcomes for Veterans Presenting at VA Medical Centers with a Stroke or Transient Ischemic Attack
Arling G, Perkins A, Myers LJ, Sico JJ, Bravata DM. Blood Pressure Trajectories and Outcomes for Veterans Presenting at VA Medical Centers with a Stroke or Transient Ischemic Attack. The American Journal Of Medicine 2022, 135: 889-896.e1. PMID: 35292287, DOI: 10.1016/j.amjmed.2022.02.012.Peer-Reviewed Original ResearchConceptsSystolic blood pressure trajectoriesTransient ischemic attackSystolic blood pressureBlood pressure trajectoriesBlood pressureAntihypertensive medicationsIschemic attackPressure trajectoriesHigher systolic blood pressureLower systolic blood pressureCox proportional hazards modelBlood pressure reductionBlood pressure controlEmergency department visitsHazard of mortalityProportional hazards modelVA Medical CenterMedication intensificationCause mortalityVascular eventsIschemic strokeRetrospective cohortDepartment visitsHypertension managementIndex event
2021
Benefits and Risks of Dual Versus Single Antiplatelet Therapy for Secondary Stroke Prevention: A Systematic Review for the 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack
Brown DL, Levine DA, Albright K, Kapral MK, Leung LY, Reeves MJ, Sico J, Strong B, Whiteley WN, Council O. Benefits and Risks of Dual Versus Single Antiplatelet Therapy for Secondary Stroke Prevention: A Systematic Review for the 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke 2021, 52: e468-e479. PMID: 34024115, DOI: 10.1161/str.0000000000000377.Peer-Reviewed Original ResearchConceptsDual antiplatelet therapySingle antiplatelet therapyTransient ischemic attackHigh-risk transient ischemic attackIschemic stroke preventionRecurrent ischemic strokeIschemic attackIschemic strokeAntiplatelet therapyStroke preventionMajor bleedingRelative riskTreatment durationAmerican Heart Association/American Stroke AssociationSystematic reviewSecondary ischemic stroke preventionSecondary stroke preventionPrevention of strokeUnadjusted relative riskAmerican Stroke AssociationSecondary ischemic strokeDuration of treatmentLonger duration treatmentShort-duration trialsRecurrent strokeDeintensification 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 riskOut with the Old and In with the New - Understanding Barriers and Facilitators in Obtaining “New” Blood Pressure Goal for Patients with Ischemic Stroke (P5.3-001)
Sico J, Burrone L, Bottomley S, Keefner L, Damush T, Hurd P, Fenton B. Out with the Old and In with the New - Understanding Barriers and Facilitators in Obtaining “New” Blood Pressure Goal for Patients with Ischemic Stroke (P5.3-001). Neurology 2019, 92 DOI: 10.1212/wnl.92.15_supplement.p5.3-001.Peer-Reviewed Original Research
2018
Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease
Bravata DM, Sico J, Fragoso C, Miech EJ, Matthias MS, Lampert R, Williams LS, Concato J, Ivan CS, Fleck JD, Tobias L, Austin C, Ferguson J, Radulescu R, Iannone L, Ofner S, Taylor S, Qin L, Won C, Yaggi HK. Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease. Journal Of The American Heart Association 2018, 7: e008841. PMID: 30369321, PMCID: PMC6201384, DOI: 10.1161/jaha.118.008841.Peer-Reviewed Original ResearchConceptsContinuous positive airway pressure usePositive airway pressure useTransient ischemic attackRankin Scale scoreIschemic stroke/transient ischemic attackStroke/transient ischemic attackBackground Obstructive sleep apneaHealth Stroke ScaleIschemic attackScale scoreStroke ScaleIschemic strokeTreat analysisSleep apneaAcute ischemic stroke/transient ischemic attackHealth Stroke Scale scoreNational InstituteContinuous positive airway pressureModified Rankin Scale scoreNeurological functioningNeurological symptom severityRecent ischemic strokeStroke Scale scoreAcute cerebrovascular diseaseAcute ischemic strokeAssociation between admission haematocrit and mortality among men with acute ischaemic stroke
Sico JJ, Myers LJ, Fenton BJ, Concato J, Williams LS, Bravata DM. Association between admission haematocrit and mortality among men with acute ischaemic stroke. Stroke And Vascular Neurology 2018, 3: 160. PMID: 30294472, PMCID: PMC6169611, DOI: 10.1136/svn-2018-000149.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic strokeAdmission haematocritAdjusted ORsChronic Health Evaluation IIIVeterans Health Administration facilitiesFirst year post strokeHours of admissionRisk of deathHaematocrit valuesMultivariate logistic regressionYear post strokeAcute PhysiologyHospital mortalityMedical comorbiditiesPoststroke mortalityStroke severityBlood transfusionSevere anemiaPost strokeHeart diseaseMedical recordsPatient outcomesCardiovascular conditionsPatientsPost‐stroke hypertension control and receipt of health care services among veterans
Kohok DD, Sico JJ, Baye F, Myers L, Coffing J, Kamalesh M, Bravata DM. Post‐stroke hypertension control and receipt of health care services among veterans. Journal Of Clinical Hypertension 2018, 20: 382-387. PMID: 29397583, PMCID: PMC8031130, DOI: 10.1111/jch.13194.Peer-Reviewed Original ResearchConceptsPrimary careHypertension managementRecurrent stroke rateGoal blood pressureRetrospective cohort studyAcute ischemic strokeIschemic stroke patientsIschemic stroke admissionsFuture intervention studiesHealth care servicesBP controlBP trajectoriesPC visitsGoal BPHypertension controlStroke admissionsCohort studyIschemic strokeBlood pressureMean BPHealthcare utilizationMedian timeStroke patientsStroke ratePatients
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
Taking care of volunteers in a stroke trial: a new assisted-management strategy
Stuart AC, Sico JJ, Viscoli CM, Tayal AH, Inzucchi SE, Ford GA, Furie KL, Cote R, Spence JD, Tanne D, Kernan WN. Taking care of volunteers in a stroke trial: a new assisted-management strategy. Stroke And Vascular Neurology 2016, 1: 108. PMID: 28959471, PMCID: PMC5435205, DOI: 10.1136/svn-2016-000029.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnticholesteremic AgentsAntihypertensive AgentsBiomarkersBlood CoagulationBlood PressureCholesterol, LDLDouble-Blind MethodEuropeFemaleFibrinolytic AgentsHumansHypoglycemic AgentsInsulin ResistanceIschemic Attack, TransientIschemic StrokeIsraelMaleMiddle AgedNorth AmericaPioglitazoneRecurrenceRisk AssessmentRisk FactorsRisk Reduction BehaviorSecondary PreventionTime FactorsTreatment OutcomeConceptsPersonal healthcare providerBlood pressureStroke trialsPreventive careTrial participantsLow-density lipoprotein cholesterolPrevention goalsInsulin Resistance InterventionTransient ischemic attackPrevention of strokeSecondary prevention goalsEvidence-based careProportion of participantsIschemic attackAntithrombotic therapyIschemic strokeLipoprotein cholesterolSecondary preventionAntithrombotic useStroke therapyInsulin sensitisersMyocardial infarctionAnnual visitsHealthcare providersResistance Intervention
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 ResearchConceptsObstructive 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
2014
HIV Infection and Cardiovascular Disease in Women
Womack JA, Chang C, So‐Armah K, Alcorn C, Baker JV, Brown ST, Budoff M, Butt AA, Gibert C, Goetz MB, Gottdiener J, Gottlieb S, Justice AC, Leaf D, McGinnis K, Rimland D, Rodriguez‐Barradas M, Sico J, Skanderson M, Tindle H, Tracy RP, Warner A, Freiberg MS. HIV Infection and Cardiovascular Disease in Women. Journal Of The American Heart Association 2014, 3: e001035. PMID: 25324353, PMCID: PMC4323817, DOI: 10.1161/jaha.114.001035.Peer-Reviewed Original ResearchMeSH KeywordsAdultAge DistributionAgedCardiovascular DiseasesCase-Control StudiesComorbidityConfidence IntervalsFemaleHIV InfectionsHumansLongitudinal StudiesMiddle AgedPrevalenceProportional Hazards ModelsProspective StudiesRisk AssessmentSeverity of Illness IndexSurvival AnalysisUnited StatesUser-Computer InterfaceVeteransConceptsRisk of CVDCVD eventsCardiovascular diseaseHIV infectionVeterans Aging Cohort StudyCox proportional hazards modelHIV uninfected womenIncident CVD eventsIncident cardiovascular diseaseIndependent risk factorAging Cohort StudyClinical Modification codesFirst clinical encounterDeath certificate dataProportional hazards modelSubstance use/abuseUse/abuseRace/ethnicityUninfected womenHepatitis CHIV- womenLast followCohort studyIschemic strokeUnstable angina
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