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 3
2022
Functional status at 30 and 90 days after mild ischaemic stroke
Gardener H, Romano L, Smith E, Campo-Bustillo I, Khan Y, Tai S, Riley N, Sacco R, Khatri P, Alger H, Mac Grory B, Gulati D, Sangha N, Olds K, Benesch C, Kelly A, Brehaut S, Kansara A, Schwamm L, Romano J. Functional status at 30 and 90 days after mild ischaemic stroke. Stroke And Vascular Neurology 2022, 7: 375-380. PMID: 35474180, PMCID: PMC9614160, DOI: 10.1136/svn-2021-001333.Peer-Reviewed Original ResearchModified Rankin ScaleMild ischemic strokeIschemic strokeMRS 0Stroke severityStudy populationDisability statusGreater stroke severityIschemic stroke participantsAlteplase treatmentClinical characteristicsHealth StrokeHospital arrivalRankin ScaleStroke StudyMild strokeFunctional statusMedical recordsFunctional improvementStroke participantsMultivariable modelFunctional declineLong-term recoveryIdentifies predictorsStudy participants
2021
Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention
Xian Y, Xu H, Smith E, Saver J, Reeves M, Bhatt D, Hernandez A, Peterson E, Schwamm L, Fonarow G. Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention. Stroke 2021, 53: 1328-1338. PMID: 34802250, DOI: 10.1161/strokeaha.121.035853.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeProportion of patientsIschemic strokeNeedle timeSymptom onsetClinical outcomesNationwide quality improvement initiativePhase IBenefits of tPAGuidelines-Stroke hospitalsMedian DTN timeSecond intervention periodStroke symptom onsetQuality improvement interventionsQuality improvement initiativesPhase IIQuality Improvement ProgramHigh rateMinutes preinterventionBleeding complicationsHospital mortalityDTN timeHospital arrivalTPA useTherapy start
2020
Language preference does not influence stroke patients' symptom recognition or emergency care time metrics
Zachrison K, Natsui S, Luan Erfe B, Mejia N, Schwamm L. Language preference does not influence stroke patients' symptom recognition or emergency care time metrics. The American Journal Of Emergency Medicine 2020, 40: 177-180. PMID: 33168382, DOI: 10.1016/j.ajem.2020.10.064.Peer-Reviewed Original ResearchConceptsResearch Patient Data RegistrySymptom recognitionDTN timeHospital arrivalSymptom discoveryAIS patientsEMS utilizationGuidelines-Stroke registryPatients' language preferenceConsecutive AIS patientsPatient Data RegistryUse of EMSEmergency medical servicesLanguage preferenceAcute strokeNeedle timeSymptom onsetEP patientsData registryAcademic centersPatientsPrior reportsMedical servicesSignificant differencesRegistryAssociation Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke
Man S, Xian Y, Holmes D, Matsouaka R, Saver J, Smith E, Bhatt D, Schwamm L, Fonarow G. Association Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke. JAMA 2020, 323: 2170-2184. PMID: 32484532, PMCID: PMC7267850, DOI: 10.1001/jama.2020.5697.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorAcute ischemic strokeTissue plasminogen activatorCause mortalityNeedle timeCause readmissionIschemic strokeLong-term outcomesShorter doorBetter long-term outcomesImproved long-term outcomesPlasminogen activatorRetrospective cohort studyGood functional outcomeGuidelines-StrokeCohort studyHospital arrivalHospital dischargeMedian doorEarly administrationMedian agePrimary outcomeThrombolytic therapyFunctional outcomeReadmission
2019
Association Between Time to Treatment With Endovascular Reperfusion Therapy and Outcomes in Patients With Acute Ischemic Stroke Treated in Clinical Practice
Jahan R, Saver J, Schwamm L, Fonarow G, Liang L, Matsouaka R, Xian Y, Holmes D, Peterson E, Yavagal D, Smith E. Association Between Time to Treatment With Endovascular Reperfusion Therapy and Outcomes in Patients With Acute Ischemic Stroke Treated in Clinical Practice. JAMA 2019, 322: 252-263. PMID: 31310296, PMCID: PMC6635908, DOI: 10.1001/jama.2019.8286.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeEndovascular reperfusion therapySymptomatic intracranial hemorrhageLarge vessel occlusionRoutine clinical practiceHospice dischargePuncture timeClinical practiceSubstantial reperfusionIschemic strokeArterial punctureVessel occlusionLarge vessel occlusion acute ischemic strokeMedian pretreatment scoreHealth Stroke ScaleRetrospective cohort studyRandomized clinical trialsHigher likelihoodAssociation of speedAmbulatory statusReperfusion therapyStroke ScaleAdverse eventsCohort studyHospital arrivalThrombolysis in young adults with stroke: Findings from Get With The Guidelines-Stroke.
Dodds J, Xian Y, Sheng S, Fonarow G, Bhatt D, Matsouaka R, Schwamm L, Peterson E, Smith E. Thrombolysis in young adults with stroke: Findings from Get With The Guidelines-Stroke. Neurology 2019, 92: e2784-e2792. PMID: 31092622, DOI: 10.1212/wnl.0000000000007653.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeTissue plasminogen activatorIschemic strokeOlder patientsYounger patientsYears of ageSymptomatic intracranial hemorrhage rateYoung adultsGuidelines-Stroke registryIntracranial hemorrhage rateGuidelines-StrokeHospital mortalityHospital arrivalHemorrhage rateIntracranial hemorrhageMultivariable modelPatientsBetter outcomesStrokePlasminogen activatorTPA treatmentTreatmentAdultsAgeOutcomes
2018
International Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines––Stroke Program
Wangqin R, Laskowitz D, Wang Y, Li Z, Wang Y, Liu L, Liang L, Matsouaka R, Saver J, Fonarow G, Bhatt D, Smith E, Schwamm L, Bettger J, Hernandez A, Peterson E, Xian Y. International Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines––Stroke Program. Journal Of The American Heart Association 2018, 7: e010623. PMID: 30371291, PMCID: PMC6474951, DOI: 10.1161/jaha.118.010623.Peer-Reviewed Original ResearchConceptsChina National Stroke RegistryNational Stroke RegistryAcute ischemic strokeStroke RegistryIschemic strokeChinese patientsDeep venous thrombosis prophylaxisHealth Stroke ScaleVenous thrombosis prophylaxisAcute stroke careAdministration of thrombolyticsEvidence-based guidelinesAmerican Heart AssociationQuality of careBackground AdherenceDischarge antithromboticsThrombosis prophylaxisCessation counselingStroke ProgramStroke ScaleClinical characteristicsHospital arrivalNeedle timePatient characteristicsSecondary preventionNeuroimaging Paradigms to Identify Patients for Reperfusion Therapy in Stroke of Unknown Onset
Etherton M, Barreto A, Schwamm L, Wu O. Neuroimaging Paradigms to Identify Patients for Reperfusion Therapy in Stroke of Unknown Onset. Frontiers In Neurology 2018, 9: 327. PMID: 29867736, PMCID: PMC5962731, DOI: 10.3389/fneur.2018.00327.Peer-Reviewed Original ResearchReperfusion therapyIschemic strokeSalvageable ischemic tissueAcute ischemic strokePivotal clinical trialsTreatment of patientsNumber of patientsRisk of infarctionLow treatment ratesUnwitnessed strokeIntravenous alteplaseEndovascular thrombectomyHospital arrivalStroke onsetRevascularization therapySalvageable tissueUnknown onsetClinical trialsClinical dilemmaIschemic tissueStroke researchPatientsTreatment ratesStrokeTherapyAssociation of Intracerebral Hemorrhage Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality
Inohara T, Xian Y, Liang L, Matsouaka R, Saver J, Smith E, Schwamm L, Reeves M, Hernandez A, Bhatt D, Peterson E, Fonarow G. Association of Intracerebral Hemorrhage Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality. JAMA 2018, 319: 463-473. PMID: 29372247, PMCID: PMC5839299, DOI: 10.1001/jama.2017.21917.Peer-Reviewed Original ResearchConceptsHospital mortalityDual antiplatelet agentsIntracerebral hemorrhagePrior useOral anticoagulantsAntiplatelet agentsLower riskVitamin K Antagonist Oral AnticoagulantsK Antagonist Oral AnticoagulantsNon-vitamin K antagonistsGuidelines-Stroke hospitalsPrior antiplatelet therapyHospital mortality rateOral anticoagulant useRetrospective cohort studyWarfarin-treated patientsUse of OACInteraction p valuePrior strokeAnticoagulation therapyAntiplatelet therapyK antagonistsAnticoagulant useCohort studyHospital arrival
2017
Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice
Xian Y, Xu H, Lytle B, Blevins J, Peterson E, Hernandez A, Smith E, Saver J, Messé S, Paulsen M, Suter R, Reeves M, Jauch E, Schwamm L, Fonarow G. Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003227. PMID: 28096207, DOI: 10.1161/circoutcomes.116.003227.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaCross-Sectional StudiesFibrinolytic AgentsGuideline AdherenceHealth Care SurveysHumansInfusions, IntravenousPractice Guidelines as TopicQuality ImprovementQuality Indicators, Health CareStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeConceptsNational quality improvement initiativeGuidelines-Stroke hospitalsAcute ischemic strokeDTN timeIntravenous tPAIschemic strokeNeedle timeTissue-type plasminogen activator administrationMedian DTN timeIschemic stroke patientsEmergency medical services (EMS) providersQuality improvement initiativesTissue-type plasminogen activatorHospital arrivalSymptom onsetStroke patientsMedical service providersClinical practiceHospitalPatientsMost hospitalsPlasminogen activatorPhase IStrokeImprovement initiatives
2014
Development and Initial Testing of the Stroke Rapid-Treatment Readiness Tool
Olson D, Cox M, Constable M, Britz G, Lin C, Zimmer L, Fonarow G, Schwamm L, Peterson E. Development and Initial Testing of the Stroke Rapid-Treatment Readiness Tool. Journal Of Neuroscience Nursing 2014, 46: 267-273. PMID: 25099063, PMCID: PMC4165480, DOI: 10.1097/jnn.0000000000000082.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorTissue plasminogen activatorPlasminogen activatorQuality Improvement ProgramGuidelines-StrokeEligible patientsHospital arrivalIschemic strokeNeedle timeHealth systemU.S. hospitalsHospitalReadiness ToolInitial testingLikert scale surveyPatientsActivatorImprovement programsStrokeAdministration
2013
Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment
Ekundayo O, Saver J, Fonarow G, Schwamm L, Xian Y, Zhao X, Hernandez A, Peterson E, Cheng E. Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment. Circulation Cardiovascular Quality And Outcomes 2013, 6: 262-269. PMID: 23633218, DOI: 10.1161/circoutcomes.113.000089.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overChi-Square DistributionEmergency Medical ServicesEmergency Service, HospitalEthnicityFemaleGuideline AdherenceHealth Knowledge, Attitudes, PracticeHumansMaleMiddle AgedMinority GroupsOdds RatioOutcome and Process Assessment, Health CarePatient Acceptance of Health CarePatient Education as TopicPractice Guidelines as TopicRegistriesRisk FactorsStrokeTime FactorsTime-to-TreatmentTransportation of PatientsTreatment OutcomeUnited StatesConceptsEmergency medical servicesStroke patientsEMS useEmergency medical services useMinority raceHealth Stroke ScoreMedical service useTreatment of strokeTissue-type plasminogen activatorEligible patientsGuidelines-StrokeSevere strokeStroke ScoreHospital arrivalOlder patientsYounger patientsHemorrhagic strokeStroke treatmentMedicare insuranceInsurance statusEMS activationDecreased oddsEMS transportService usePatients
2012
Times From Symptom Onset to Hospital Arrival in the Get With The Guidelines–Stroke Program 2002 to 2009
Tong D, Reeves M, Hernandez A, Zhao X, Olson D, Fonarow G, Schwamm L, Smith E. Times From Symptom Onset to Hospital Arrival in the Get With The Guidelines–Stroke Program 2002 to 2009. Stroke 2012, 43: 1912-1917. PMID: 22539544, DOI: 10.1161/strokeaha.111.644963.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic strokeSymptom onsetDoor timeHospital arrivalIntravenous tissue-type plasminogen activatorAcute ischemic stroke therapyEmergency medical services transportFourth of patientsGuidelines-Stroke programProportion of patientsHospital arrival timeIschemic stroke therapyPlasminogen activator therapyPortion of patientsTissue-type plasminogen activatorEligible patientsStroke therapyActivator therapyAcute interventionNationwide studyTreatment windowPatientsEarly onsetStroke
2002
T HE E VOLVING R OLE OF H ELICOPTER E MERGENCY M EDICAL S ERVICES IN THE T RANSFER OF S TROKE P ATIENTS TO S PECIALIZED C ENTERS
Thomas S, Kociszewski C, Schwamm L, Wedel S. T HE E VOLVING R OLE OF H ELICOPTER E MERGENCY M EDICAL S ERVICES IN THE T RANSFER OF S TROKE P ATIENTS TO S PECIALIZED C ENTERS. Prehospital Emergency Care 2002, 6: 210-214. PMID: 11962569, DOI: 10.1080/10903120290938562.Peer-Reviewed Original ResearchConceptsHospital arrivalERA patientsIschemic strokeThrombolysis eraSymptom onsetThrombolytic therapyInterfacility transportHEMS activationHelicopter emergency medical services (HEMS) programsE MERGENCY M EDICAL S ERVICESHospital requestsLogistic regression analysisHelicopter EMS (HEMS) transportEmergency medical services programPearson chi-squarePatient demographicsHEMS transportRetrospective studyStroke patientsInterfacility transferP atientsEMS transportHelicopter transportPatientsDrug Administration