2024
Twenty Years of Sustained Improvement in Quality of Care and Outcomes for Patients Hospitalized With Stroke or Transient Ischemic Attack: Data From The Get With The Guidelines-Stroke Program
Xian Y, Li S, Jiang T, Beon C, Poudel R, Thomas K, Reeves M, Smith E, Saver J, Sheth K, Messé S, Schwamm L, Fonarow G. Twenty Years of Sustained Improvement in Quality of Care and Outcomes for Patients Hospitalized With Stroke or Transient Ischemic Attack: Data From The Get With The Guidelines-Stroke Program. Stroke 2024, 55: 2599-2610. PMID: 39429153, PMCID: PMC11518659, DOI: 10.1161/strokeaha.124.048174.Peer-Reviewed Original ResearchConceptsGuidelines-Stroke programEvidence-based stroke careDoor-to-needle timeTransient ischemic attackGuidelines-Stroke hospitalsEvidence-based careQuality of careSmoking cessation counselingSustained improvementQuality improvement initiativesSkilled nursing facilityIndependence of patientsAcute ischemic strokeIschemic strokeRelevant to patientsIschemic attackDoor-to-puncture timeCessation counselingGuidelines-StrokeAssociated with sustained improvementStroke careDysphagia screeningNursing facilitiesHospital characteristicsImprovement initiativesTime to Anticoagulation Reversal and Outcomes After Intracerebral Hemorrhage
Sheth K, Solomon N, Alhanti B, Messe S, Xian Y, Bhatt D, Hemphill J, Frontera J, Chang R, Danelich I, Huang J, Schwamm L, Smith E, Goldstein J, Mac Grory B, Fonarow G, Saver J. Time to Anticoagulation Reversal and Outcomes After Intracerebral Hemorrhage. JAMA Neurology 2024, 81: 363-372. PMID: 38335064, PMCID: PMC11002694, DOI: 10.1001/jamaneurol.2024.0221.Peer-Reviewed Original ResearchDoor-to-treatment timeDoor-to-treatmentUS hospitalsQuality improvement registryOnset-to-treatment timeAmerican Heart AssociationFunctional outcomesLogistic regression modelsAssociated with decreased mortalityGuidelines-StrokeIntracerebral hemorrhageHospital characteristicsImprovement registryIntervention statusMain OutcomesAnticoagulation-associated intracerebral hemorrhageSystolic blood pressureInpatient mortalityRandom interceptCohort studyWhite raceSecondary outcomesStroke subtypesStroke severityWorkflow times
2021
Frequency, Characteristics, and Outcomes of Endovascular Thrombectomy in Patients With Stroke Beyond 6 Hours of Onset in US Clinical Practice
Zachrison K, Schwamm L, Xu H, Matsouaka R, Shah S, Smith E, Xian Y, Fonarow G, Saver J. Frequency, Characteristics, and Outcomes of Endovascular Thrombectomy in Patients With Stroke Beyond 6 Hours of Onset in US Clinical Practice. Stroke 2021, 52: 3805-3814. PMID: 34470490, DOI: 10.1161/strokeaha.121.034069.Peer-Reviewed Original ResearchConceptsAcute ischemic stroke patientsEndovascular thrombectomyIschemic stroke patientsStroke patientsEVT casesGuidelines-Stroke hospitalsUS clinical practiceLower stroke severityClinical practice settingEVT outcomesEVT timesHospital mortalityNontrial settingDischarge dispositionIschemic strokePatient characteristicsStroke severityAtrial fibrillationFunctional outcomeClinical registryHospital characteristicsPatientsClinical practicePractice settingsStudy periodNational Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic
Zachrison KS, Sharma R, Wang Y, Mehrotra A, Schwamm LH. National Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic. Journal Of Stroke And Cerebrovascular Diseases 2021, 30: 106035. PMID: 34419836, PMCID: PMC8494566, DOI: 10.1016/j.jstrokecerebrovasdis.2021.106035.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCOVID-19Databases, FactualFemaleFibrinolytic AgentsHumansMaleMiddle AgedPractice Patterns, Physicians'Quality ImprovementQuality Indicators, Health CareRemote ConsultationStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsIschemic stroke patientsTelestroke consultationAlteplase deliveryStroke patientsNumber of patientsNumber of consultsCOVID-19 public health emergencyPublic health emergencyAlteplase useMedian doorNeedle timeStroke severityED arrivalEmergency departmentImaging reviewHospital characteristicsTelestroke networkCT scanHospital participationSpoke sitesProvider groupsPatientsHospital sizeStudy periodHealth emergencyReperfusion 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 patterns
2020
Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries
Man S, Xian Y, Holmes D, Matsouaka R, Saver J, Smith E, Bhatt D, Schwamm L, Fonarow G. Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries. Circulation Cardiovascular Quality And Outcomes 2020, 13: e007150. PMID: 33302714, DOI: 10.1161/circoutcomes.120.007150.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overDatabases, FactualFemaleFibrinolytic AgentsHumansInfusions, IntravenousInsurance BenefitsIschemic StrokeMaleMedicarePatient ReadmissionQuality ImprovementQuality Indicators, Health CareRetrospective StudiesRisk AssessmentRisk FactorsThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsAcute ischemic strokeIschemic strokeNeedle timeIntravenous thrombolysisCardiovascular readmissionCause mortalityThrombolytic treatmentThrombolytic therapyMedicare beneficiariesGuidelines-Stroke hospitalsIntravenous thrombolytic therapyIntravenous thrombolytic treatmentOne-year outcomesProportion of patientsProportional hazards analysisAmerican Heart AssociationQuality InitiativeCause readmissionMedian doorHospital clusteringMedian ageHeart AssociationHospital characteristicsReadmissionImproved doorCryptogenic stroke: Contemporary trends, treatments, and outcomes in the United States.
Prabhakaran S, Messé S, Kleindorfer D, Smith E, Fonarow G, Xu H, Zhao X, Lytle B, Cigarroa J, Schwamm L. Cryptogenic stroke: Contemporary trends, treatments, and outcomes in the United States. Neurology Clinical Practice 2020, 10: 396-405. PMID: 33299667, PMCID: PMC7717635, DOI: 10.1212/cpj.0000000000000736.Peer-Reviewed Original ResearchCryptogenic strokeIschemic strokeStroke etiologyDischarge outcomesHospital treatmentHospital characteristicsMultivariable logistic regressionGWTG-StrokeStroke RegistryNationwide registryMultivariable analysisPatientsLower mortalityHigh mortalityNationwide dataLogistic regressionSubtypesStrokeNational InstituteScale scaleOutcomesTreatmentRegistryHospitalEtiology
2019
Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States
Zachrison K, Onnela J, Reeves M, Hernandez A, Camargo C, Zhao X, Matsouaka R, Goldstein J, Metlay J, Schwamm L. Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States. Journal Of The American Heart Association 2019, 9: e011575. PMID: 31888430, PMCID: PMC6988147, DOI: 10.1161/jaha.118.011575.Peer-Reviewed Original ResearchMeSH KeywordsCatchment Area, HealthDatabases, FactualDelivery of Health Care, IntegratedFibrinolytic AgentsHospitalsHospitals, High-VolumeHospitals, Low-VolumeHumansMedicarePatient TransferPractice Patterns, Physicians'Quality Indicators, Health CareRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorUnited StatesConceptsAcute ischemic strokeAlteplase administrationIschemic strokeUS hospitalsHospital qualityHospital stroke volumeTransfer destinationsHospital referral regionsHospital factorsNumber of hospitalsStroke patientsHospital characteristicsStroke volumeMedicare claimsReferral regionsHospitalLogistic regressionStrokePatientsHospital performancePotential strategyAdministrationHome timeResult dataConnected dyads
2018
Quality of Care and Outcomes for Patients With Stroke in the United States Admitted During the International Stroke Conference
Messé S, Mullen M, Cox M, Fonarow G, Smith E, Saver J, Reeves M, Bhatt D, Matsouaka R, Schwamm L. Quality of Care and Outcomes for Patients With Stroke in the United States Admitted During the International Stroke Conference. Journal Of The American Heart Association 2018, 7: e009842. PMID: 30376750, PMCID: PMC6404171, DOI: 10.1161/jaha.118.009842.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorTissue plasminogen activatorAcute ischemic strokeInternational Stroke ConferencePlasminogen activatorWorse outcomesGuideline-adherent careGuidelines-Stroke hospitalsRetrospective cohort studyHours of onsetMinutes of arrivalExperience worse outcomesQuality of careSame quality careAverage weekly numberGuidelines-StrokeAcute strokeBackground PatientsCohort studyConclusions PatientsIschemic strokeClinical outcomesMean ageStroke cliniciansHospital characteristics
2017
Unexplained Variation for Hospitals’ Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke
Xian Y, Thomas L, Liang L, Federspiel J, Webb L, Bushnell C, Duncan P, Schwamm L, Stein J, Fonarow G, Hoenig H, Montalvo C, George M, Lutz B, Peterson E, Bettger J. Unexplained Variation for Hospitals’ Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke. Stroke 2017, 48: 2836-2842. PMID: 28830975, DOI: 10.1161/strokeaha.117.016904.Peer-Reviewed Original ResearchConceptsInpatient rehabilitation facilitySkilled nursing facilitiesAcute ischemic strokeHospital-level variationIschemic strokeNursing facilitiesGuidelines-Stroke hospitalsMultilevel logistic regression modelsMedian odds ratioGeographic availabilityLogistic regression modelsIRF patientsHospital complicationsSNF patientsClinical characteristicsComorbid conditionsInpatient rehabilitationHospital characteristicsClinical registryOdds ratioRehabilitation facilityHospital useMedicare beneficiariesPatientsHospitalRegional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals
Thompson M, Zhao X, Bekelis K, Gottlieb D, Fonarow G, Schulte P, Xian Y, Lytle B, Schwamm L, Smith E, Reeves M. Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003604. PMID: 28798017, DOI: 10.1161/circoutcomes.117.003604.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedBrain IschemiaDatabases, FactualFee-for-Service PlansFemaleGuideline AdherenceHealth ResourcesHealthcare DisparitiesHospitalsHumansInsurance BenefitsMaleMedicarePatient ReadmissionPractice Guidelines as TopicProcess Assessment, Health CareQuality Indicators, Health CareRegistriesRisk FactorsStrokeTime FactorsTreatment OutcomeUnited StatesConceptsReadmission ratesHospital characteristicsHRR levelHealthcare resourcesGuidelines-Stroke hospitalsGuidelines-Stroke registryHealthcare resource dataIschemic stroke outcomeThirty-day mortalityIschemic stroke mortalityHospital referral region levelStroke outcomeHospital factorsPatient characteristicsStroke mortalityCare measuresMedicare beneficiariesMedicare feeMortalityDartmouth AtlasPatientsRegional variationHealth careOutcomesReadmissionAssociation Between Previous Use of Antiplatelet Therapy and Intracerebral Hemorrhage Outcomes
Khan N, Siddiqui F, Goldstein J, Cox M, Xian Y, Matsouaka R, Heidenreich P, Peterson E, Bhatt D, Fonarow G, Schwamm L, Smith E. Association Between Previous Use of Antiplatelet Therapy and Intracerebral Hemorrhage Outcomes. Stroke 2017, 48: 1810-1817. PMID: 28596454, DOI: 10.1161/strokeaha.117.016290.Peer-Reviewed Original ResearchConceptsAntiplatelet therapyIntracerebral hemorrhageHospital mortalityPrevious useDiagnosis of ICHCombination antiplatelet therapyGuidelines-Stroke hospitalsPrestroke antiplatelet therapyTerms of comorbiditiesOral anticoagulant therapyIntracerebral hemorrhage outcomesAPT groupHigh-risk profileHospital presentationAnticoagulant therapyBaseline characteristicsAntiplatelet agentsHospital characteristicsHigh riskPatientsRisk profileMortalityTherapyAPT useComorbiditiesEarly transition to comfort measures only in acute stroke patients
Prabhakaran S, Cox M, Lytle B, Schulte P, Xian Y, Zahuranec D, Smith E, Reeves M, Fonarow G, Schwamm L. Early transition to comfort measures only in acute stroke patients. Neurology Clinical Practice 2017, 7: 194-204. PMID: 28680764, PMCID: PMC5490382, DOI: 10.1212/cpj.0000000000000358.Peer-Reviewed Original ResearchIntracerebral hemorrhageIschemic strokeStroke patientsHospital characteristicsComfort measuresCMO orderGuidelines-Stroke registryHospital days 0Acute stroke patientsMultivariable logistic regressionRisk-adjusted mortalityLife-sustaining interventionsLife-sustaining treatmentAcute strokeNonambulatory statusHospital factorsMultivariable analysisStudy criteriaFemale sexStroke typeWhite racePatientsDay 0Older ageLogistic regressionDelays in Door-to-Needle Times and Their Impact on Treatment Time and Outcomes in Get With The Guidelines-Stroke
Kamal N, Sheng S, Xian Y, Matsouaka R, Hill M, Bhatt D, Saver J, Reeves M, Fonarow G, Schwamm L, Smith E. Delays in Door-to-Needle Times and Their Impact on Treatment Time and Outcomes in Get With The Guidelines-Stroke. Stroke 2017, 48: 946-954. PMID: 28228574, DOI: 10.1161/strokeaha.116.015712.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaDelivery of Health CareFemaleFibrinolytic AgentsGuideline AdherenceHospital MortalityHumansIntracranial HemorrhagesMaleMiddle AgedOutcome and Process Assessment, Health CareOutcome Assessment, Health CareStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorConceptsNeedle timeGuidelines-StrokeAcute ischemic stroke patientsSymptomatic intracranial hemorrhageIschemic stroke patientsQuality Improvement ProgramTissue-type plasminogen activatorAcute comorbiditiesHospital mortalityInpatient strokeIntravenous alteplaseLonger doorIndependent ambulationDelay diagnosisIntracranial hemorrhageStroke patientsHospital characteristicsPatient outcomesHigher oddsLower oddsPatientsPlasminogen activatorStroke recognitionHospitalDiagnosis
2016
Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines‐Stroke
Medford‐Davis L, Fonarow G, Bhatt D, Xu H, Smith E, Suter R, Peterson E, Xian Y, Matsouaka R, Schwamm L. Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines‐Stroke. Journal Of The American Heart Association 2016, 5: e004282. PMID: 27930356, PMCID: PMC5210352, DOI: 10.1161/jaha.116.004282.Peer-Reviewed Original ResearchMeSH KeywordsAgedAmbulancesAnticholesteremic AgentsAntihypertensive AgentsBrain IschemiaDiabetes MellitusFemaleGuideline AdherenceHospital MortalityHumansHypercholesterolemiaHypertensionHypoglycemic AgentsInsurance CoverageInsurance, HealthLogistic ModelsMaleMedicaidMedically UninsuredMedicareMiddle AgedMultivariate AnalysisOdds RatioPractice Guidelines as TopicSkilled Nursing FacilitiesStrokeStroke RehabilitationTime FactorsUnited StatesConceptsAcute ischemic strokeIschemic strokeInsurance statusHospital mortalityGuidelines-Stroke programIschemic stroke patientsMultivariable logistic regressionPatient insurance statusGovernment-sponsored insuranceSkilled nursing facilitiesGuidelines-StrokeInpatient rehabPostdischarge destinationHospital outcomesPatient demographicsSymptom onsetAcute treatmentControl medicationDiabetes mellitusStroke patientsHospital characteristicsUninsured patientsHigh cholesterolNursing facilitiesPreventative careHospital 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 yearSurvivors
2015
Lack of Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke
Joynt K, Bhatt D, Schwamm L, Xian Y, Heidenreich P, Fonarow G, Smith E, Neely M, Grau-Sepulveda M, Hernandez A. Lack of Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke. Journal Of The American College Of Cardiology 2015, 65: 1964-1972. PMID: 25953748, DOI: 10.1016/j.jacc.2015.02.059.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overElectronic Health RecordsFemaleHospital Bed CapacityHospital MortalityHospitals, TeachingHumansLength of StayMaleMiddle AgedOutcome Assessment, Health CarePatient DischargePractice Guidelines as TopicQuality of Health CareStrokeTime-to-TreatmentTissue Plasminogen ActivatorUnited StatesConceptsElectronic health recordsIschemic strokeGWTG-Stroke hospitalsHealth recordsBetter clinical outcomesLogistic regression analysisAmerican Hospital Association Annual SurveyQuality of careOutcomes of interestHigh-quality careGuidelines-StrokeHospital mortalityStroke centersClinical outcomesStroke careSimilar oddsHospital characteristicsOutcome measuresTimely careHospitalPatientsStudy periodCareU.S. hospitalsStrokeDrip and Ship Thrombolytic Therapy for Acute Ischemic Stroke
Sheth KN, Smith EE, Grau-Sepulveda MV, Kleindorfer D, Fonarow GC, Schwamm LH. Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke. Stroke 2015, 46: 732-739. PMID: 25672784, DOI: 10.1161/strokeaha.114.007506.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorSymptomatic intracranial hemorrhageTPA useAcute strokeIschemic strokeIntracranial hemorrhageHealth Stroke Scale scoreReal-world practice patternsGuidelines-Stroke programStroke Scale scoreAcute ischemic strokeCharacteristics of patientsLower National InstitutesPatient selection biasConventional thrombolysisHospital mortalityHospital outcomesSymptom onsetInterhospital transferThrombolytic therapyHospital characteristicsPractice patternsShip paradigmMAIN OUTCOME
2014
Hospital Case Volume Is Associated With Mortality in Patients Hospitalized With Subarachnoid Hemorrhage
Prabhakaran S, Fonarow G, Smith E, Liang L, Xian Y, Neely M, Peterson E, Schwamm L. Hospital Case Volume Is Associated With Mortality in Patients Hospitalized With Subarachnoid Hemorrhage. Neurosurgery 2014, 75: 500-508. PMID: 24979097, DOI: 10.1227/neu.0000000000000475.Peer-Reviewed Original ResearchConceptsHospital case volumeHospital mortalitySubarachnoid hemorrhageCase volumeSAH volumeSAH patientsHospital characteristicsMedian annual case volumeGuidelines-Stroke registryLarge nationwide registryMultivariable logistic regressionLength of stayAnnual case volumeContemporary national dataIndependent ambulatory statusAmbulatory statusExperienced centersNationwide registryDischarge diagnosisOptimized careImproved outcomesRelevant patientsPatientsHospitalMortalitySecondary Prevention after Ischemic Stroke or Transient Ischemic Attack
Bangalore S, Schwamm L, Smith E, Singh I, Liang L, Fonarow G, Bhatt D, Committee and Investigators G. Secondary Prevention after Ischemic Stroke or Transient Ischemic Attack. The American Journal Of Medicine 2014, 127: 728-738. PMID: 24681258, DOI: 10.1016/j.amjmed.2014.03.011.Peer-Reviewed Original ResearchConceptsTransient ischemic attackIschemic attackIschemic strokeSecondary prevention measuresEvidence-based therapiesSecondary preventionRecurrent strokeEvidence-based secondary preventionInitial transient ischemic attackGuidelines-Stroke registryIntensive statin therapyLipid-lowering medicationsLDL cholesterol measurementsWeight loss recommendationsPrevention measuresCessation counselingStatin therapyAtrial fibrillationHospital characteristicsHospital adherenceObservational studyStroke educationLower oddsPatientsCholesterol measurement