2021
Hospital Factors, Performance on Process Measures After Transient Ischemic Attack, and 90-Day Ischemic Stroke Incidence
Levine DA, Perkins AJ, Sico JJ, Myers LJ, Phipps MS, Zhang Y, Bravata DM. Hospital Factors, Performance on Process Measures After Transient Ischemic Attack, and 90-Day Ischemic Stroke Incidence. Stroke 2021, 52: 2371-2378. PMID: 34039034, PMCID: PMC8238890, DOI: 10.1161/strokeaha.120.031721.Peer-Reviewed Original ResearchConceptsIschemic stroke incidenceStroke incidenceHospital factorsPhysician staffingTIA patientsHypertension controlProcess measuresModerate potency statinTransient ischemic attackDays of dischargeEmergency department dischargeVeterans Affairs hospitalEligible patientsIschemic attackStatin useAntithrombotic useEmergency departmentEmergency physiciansInpatient unitDay 2HospitalPatient volumeFiscal year 2015PatientsIncidenceDeintensification 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
2020
Community‐Acquired Pneumonia and Risk of Cardiovascular Events in People Living With HIV
Zifodya JS, Duncan MS, So‐Armah K, Attia EF, Akgün KM, Rodriguez‐Barradas M, Marconi VC, Budoff MJ, Bedimo RJ, Alcorn CW, Hoo G, Butt AA, Kim JW, Sico JJ, Tindle HA, Huang L, Tate JP, Justice AC, Freiberg MS, Crothers K. Community‐Acquired Pneumonia and Risk of Cardiovascular Events in People Living With HIV. Journal Of The American Heart Association 2020, 9: e017645. PMID: 33222591, PMCID: PMC7763776, DOI: 10.1161/jaha.120.017645.Peer-Reviewed Original ResearchConceptsCommunity-acquired pneumoniaCVD risk factorsCVD eventsRisk factorsCAP severityHIV infectionHIV statusSevere community-acquired pneumoniaVeterans Aging Cohort StudyIncident CVD eventsCardiovascular disease eventsMultivariable-adjusted modelsAging Cohort StudyCox regression analysisDate of admissionMultivariable-adjusted analysesHigher mortality riskBackground HospitalizationCAP hospitalizationsHIV-uninfectedCardiovascular eventsIncident CVDCohort studyCVD riskUS veteransAssessment of the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) Program for Improving Quality of Care for Transient Ischemic Attack
Bravata DM, Myers LJ, Perkins AJ, Zhang Y, Miech EJ, Rattray NA, Penney LS, Levine D, Sico JJ, Cheng EM, Damush TM. Assessment of the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) Program for Improving Quality of Care for Transient Ischemic Attack. JAMA Network Open 2020, 3: e2015920. PMID: 32897372, PMCID: PMC7489850, DOI: 10.1001/jamanetworkopen.2020.15920.Peer-Reviewed Original ResearchConceptsTransient ischemic attackQuality of careIschemic attackElectronic health record toolsRecurrent vascular eventsDiverse medical centersGuideline-recommended processesQuality improvement interventionsProportion of veteransHealth care systemImplementation periodIntervention associationsQI supportVascular eventsMost patientsPrimary outcomeMean ageCare existIntervention periodSymptom interventionMedical CenterQI interventionsMAIN OUTCOMEHigh riskTimely managementAtypical case of Miller-Fisher syndrome presenting with severe dysphagia and weight loss
Patel K, Nussbaum E, Sico J, Merchant N. Atypical case of Miller-Fisher syndrome presenting with severe dysphagia and weight loss. BMJ Case Reports 2020, 13: e234316. PMID: 32467120, PMCID: PMC7259814, DOI: 10.1136/bcr-2020-234316.Peer-Reviewed Case Reports and Technical NotesConceptsMiller Fisher syndromeAtypical casesLower extremity muscle weaknessWeight lossExtremity muscle weaknessFormal swallow evaluationThorough neurological examinationResolution of symptomsAlbuminocytological dissociationIntravenous immunoglobulinPresenting symptomProgressive dysphagiaSevere dysphagiaSwallow evaluationSymptom onsetExtraocular movementsNeurological examinationMuscle weaknessPhysical examinationAntibody titresDysphagiaCerebrospinal fluidGait stabilityPatientsSyndromePrevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward
Diaz MM, Hu X, Fenton BT, Kimuli I, Lee A, Lindsey H, Bigelow JK, Maiser S, Altalib HH, Sico JJ. Prevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward. BMC Neurology 2020, 20: 42. PMID: 32005185, PMCID: PMC6995141, DOI: 10.1186/s12883-020-1627-5.Peer-Reviewed Original ResearchConceptsNeurology wardHead traumaHospital mortalityWorse survivalCommon diagnosisMultivariate Cox proportional hazard modelingSub-Saharan African hospitalsCox proportional hazard modelingKaplan-Meier survival curvesConclusionsIn-hospital mortalityPatient-level predictorsHigh-risk groupProportional hazard modelingDiagnosis of infectionTime of deathIndex hospitalizationHospital admissionMulago HospitalNeurologic illnessAfrican hospitalsNeurologic diseaseSurvival curvesPatientsHazard modelingMortality
2019
Modelling care quality for patients after a transient ischaemic attack within the US Veterans Health Administration
Arling G, Sico JJ, Reeves MJ, Myers L, Baye F, Bravata DM. Modelling care quality for patients after a transient ischaemic attack within the US Veterans Health Administration. BMJ Open Quality 2019, 8: e000641. PMID: 31909209, PMCID: PMC6937041, DOI: 10.1136/bmjoq-2019-000641.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAdultAgedAged, 80 and overEmergency Service, HospitalFemaleHumansIschemic Attack, TransientMaleMiddle AgedNeurologyPatient AdmissionQuality of Health CareReferral and ConsultationRetrospective StudiesStrokeTime FactorsUnited StatesUnited States Department of Veterans AffairsVeteransConceptsTransient ischemic attackCharlson Comorbidity IndexVeterans Health AdministrationHigher Charlson comorbidity indexUS Veterans Health AdministrationInpatient admissionsNeurological consultationNeurology consultationEmergency departmentIschemic attackPreventive careHealth AdministrationCare qualitySpeech deficitsHigher CCI scoresModerate potency statinRecurrent vascular eventsStroke center designationHistory of dementiaPreventive care qualityAntithrombotic medicationComorbidity indexCCI scoreED visitsRetrospective cohortPolysomnography 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 guidelinesMicrovascular Disease, Peripheral Artery Disease and Amputation
Beckman JA, Duncan MS, Damrauer SM, Wells QS, Barnett JV, Wasserman DH, Bedimo RJ, Butt AA, Marconi VC, Sico JJ, Tindle HA, Bonaca MP, Aday AW, Freiberg MS. Microvascular Disease, Peripheral Artery Disease and Amputation. Circulation 2019, 140: 449-458. PMID: 31280589, PMCID: PMC6682431, DOI: 10.1161/circulationaha.119.040672.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAmputation, SurgicalComorbidityDiabetes ComplicationsDisease SusceptibilityExtremitiesFemaleFollow-Up StudiesHumansIschemiaKidney DiseasesMaleMicrocirculationMiddle AgedPeripheral Arterial DiseasePeripheral Nervous System DiseasesPrevalenceProcedures and Techniques UtilizationProportional Hazards ModelsProspective StudiesRetinal DiseasesRisk FactorsVeteransConceptsPeripheral artery diseaseRisk of amputationMicrovascular diseaseArtery diseaseRisk factorsVeterans Aging Cohort StudyCox proportional hazards regressionAdverse limb eventsPrevalent microvascular diseaseCardiovascular risk factorsTraditional risk factorsAging Cohort StudyMultivariable-adjusted analysesProportional hazards regressionLower limb amputationIncident amputationsPrior amputationCohort studyAmputation eventsHazards regressionLarge cohortElevated riskLimb amputationLimb eventsAmputation
2018
Survey Analysis of the Use, Effectiveness, and Patient‐Reported Tolerability of Inhaled Oxygen Compared With Injectable Sumatriptan for the Acute Treatment of Cluster Headache
Schindler EAD, Wright DA, Weil MJ, Gottschalk CH, Pittman BP, Sico JJ. Survey Analysis of the Use, Effectiveness, and Patient‐Reported Tolerability of Inhaled Oxygen Compared With Injectable Sumatriptan for the Acute Treatment of Cluster Headache. Headache The Journal Of Head And Face Pain 2018, 58: 1568-1578. PMID: 30221765, DOI: 10.1111/head.13405.Peer-Reviewed Original ResearchConceptsInjectable sumatriptanCluster headacheAcute treatmentMedication responseOxygen deliverySide effectsPatient-reported side effectsSecondary analysisTherapeutic response rateCigarette smoking historyOptimization of therapyOptimal oxygen deliveryPositive predictorSmoking historyOxygen therapyCigarette smokingHeadache clinicTherapeutic optionsPatient populationPharmacologic interventionsTriptan medicationsComparable efficacyDaily attacksMale genderTherapeutic responseDiagnosing 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 conditionsPatientsQuality of Care for Veterans With Transient Ischemic Attack and Minor Stroke
Bravata DM, Myers LJ, Arling G, Miech EJ, Damush T, Sico JJ, Phipps MS, Zillich AJ, Yu Z, Reeves M, Williams LS, Johanning J, Chaturvedi S, Baye F, Ofner S, Austin C, Ferguson J, Graham GD, Rhude R, Kessler CS, Higgins DS, Cheng E. Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke. JAMA Neurology 2018, 75: 419-427. PMID: 29404578, PMCID: PMC5885264, DOI: 10.1001/jamaneurol.2017.4648.Peer-Reviewed Original ResearchConceptsTransient ischemic attackMinor strokeEmergency departmentElements of careDay 2Ischemic attackDay 7Federal fiscal year 2014Intensive care unit stayDeep vein thrombosis prophylaxisVeterans Health Administration systemCare qualityReceipt of thrombolysisRecurrent vascular eventsStroke care qualityVHA emergency departmentGuideline-concordant careLength of stayGuideline-recommended processesProcess of careHealth Administration systemQuality of careHemoglobin A1c measurementsElectronic quality measuresHealth care systemAssociation of neurologist care with headache expenditures: A population-based, longitudinal analysis
Ney JP, Sico JJ, Klein BC, Magliocco B, Callaghan BC, Esper G. Association of neurologist care with headache expenditures: A population-based, longitudinal analysis. Cephalalgia 2018, 38: 1876-1884. PMID: 29504480, DOI: 10.1177/0333102418762572.Peer-Reviewed Original ResearchConceptsNeurologist careAmbulatory care visitsLongitudinal cohort studyMedical Expenditure Panel SurveyResults Eight hundredHealth care costsMean annual expenditureCare visitsCohort studyHealthcare utilizationClinical variablesDiagnostic codesAdjusted associationsCare costsHeadache sufferersHealthcare expendituresYear oneCareHeadacheSignificant reductionAdult respondentsLongitudinal analysisAssociationYear twoAnnual expenditurePost‐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 historyDiagnosing and managing sleep apnea in patients with chronic cerebrovascular disease: a randomized trial of a home-based strategy
Bravata DM, McClain V, Austin C, Ferguson J, Burrus N, Miech EJ, Matthias MS, Chumbler N, Ofner S, Foresman B, Sico J, Vaz Fragoso CA, Williams LS, Agarwal R, Concato J, Klar Yaggi H. Diagnosing and managing sleep apnea in patients with chronic cerebrovascular disease: a randomized trial of a home-based strategy. Sleep And Breathing 2017, 21: 713-725. PMID: 28386781, PMCID: PMC5585280, DOI: 10.1007/s11325-017-1494-5.Peer-Reviewed Original ResearchConceptsContinuous positive airway pressureAuto-titrating continuous positive airway pressureChronic cerebrovascular diseaseTransient ischemic attackSleep apneaCerebrovascular diseaseHypertension controlUsual careControl patientsBlood pressureObstructive sleep apnea treatmentBaseline blood pressurePositive airway pressureBackgroundObstructive sleep apneaSleep apnea treatmentBlood pressure assessmentHome-based strategiesIschemic attackUnattended polysomnographyUndiagnosed OSARandomized patientsAirway pressureCPAP adherenceCPAP useApnea treatment
2016
Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke?
Chaturvedi S, Ofner S, Baye F, Myers LJ, Phipps M, Sico JJ, Damush T, Miech E, Reeves M, Johanning J, Williams LS, Arling G, Cheng E, Yu Z, Bravata D. Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke? Neurology 2016, 88: 237-244. PMID: 27927939, PMCID: PMC5272790, DOI: 10.1212/wnl.0000000000003503.Peer-Reviewed Original ResearchConceptsTIA/minor strokeDays of presentationMinor strokeDiffusion-weighted imagingPrevious guidelinesHospital complexityCoronary artery diseaseMinor stroke patientsVeterans Affairs hospitalPreferred imaging modalityUse of MRISubset of hospitalsFacility-level variablesPerformance of MRINational Health SystemPrior strokeSymptom durationChart abstractionArtery diseaseBlood pressureHeart failureNeurologic consultationStroke patientsAtrial fibrillationClinical variables