2024
Evaluating the concordance between International Classification of Diseases, Tenth Revision Code and stroke severity as measured by the National Institutes of Health Stroke Scale
Taha M, Habib M, Lomachinsky V, Hadar P, Newhouse J, Schwamm L, Blacker D, Moura L. Evaluating the concordance between International Classification of Diseases, Tenth Revision Code and stroke severity as measured by the National Institutes of Health Stroke Scale. BMJ Neurology Open 2024, 6: e000831. PMID: 39363950, PMCID: PMC11448239, DOI: 10.1136/bmjno-2024-000831.Peer-Reviewed Original ResearchPaul Coverdell National Acute Stroke ProgramNational Institutes of Health Stroke ScaleInternational Classification of DiseasesClassification of DiseasesHealth Stroke ScaleInternational ClassificationICD-10Acute ischaemic strokeStroke severityICD-10 diagnosis codesStroke ScaleNIHSS scoreMeasures of stroke severityMedicare claims dataIntraclass correlation coefficientNational Institutes of Health Stroke Scale scoreNational InstituteMedicaid Services guidelinesService guidelinesStroke programClinical registryDiagnosis codesClaims dataSampled patientsExpert clinical evaluationEvaluating the Concordance Between International Classification of Diseases, Tenth Revision Code, and Stroke Severity as Measured by the National Institutes of Health Stroke Scale (P1-5.013)
Taha M, Habib M, Torres V, Hadar P, Newhouse J, Schwamm L, Blacker D, Moura L. Evaluating the Concordance Between International Classification of Diseases, Tenth Revision Code, and Stroke Severity as Measured by the National Institutes of Health Stroke Scale (P1-5.013). Neurology 2024, 102 DOI: 10.1212/wnl.0000000000206137.Peer-Reviewed Original ResearchTime 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
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
Linking the Paul Coverdell National Acute Stroke Program to commercial claims to establish a framework for real-world longitudinal stroke research
Patorno E, Schneeweiss S, George M, Tong X, Franklin J, Pawar A, Mogun H, Moura L, Schwamm L. Linking the Paul Coverdell National Acute Stroke Program to commercial claims to establish a framework for real-world longitudinal stroke research. Stroke And Vascular Neurology 2021, 7: 114-123. PMID: 34750282, PMCID: PMC9067267, DOI: 10.1136/svn-2021-001134.Peer-Reviewed Original ResearchConceptsPaul Coverdell National Acute Stroke ProgramAcute Stroke ProgramClaims dataStroke ProgramStroke severityMedication useMedical historyReal-world patientsCare of patientsCommercial claims dataLongitudinal claims dataMedication utilisationStroke hospitalisationsStroke admissionsMost patientsCommercial ClaimsInpatient dataStroke researchDischarge usePatientsHigh quality linkageUnlinked patientsLab valuesStrokeFrequency, 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 emergencyAccess to Mechanical Thrombectomy for Ischemic Stroke in the United States
Kamel H, Parikh N, Chatterjee A, Kim L, Saver J, Schwamm L, Zachrison K, Nogueira R, Adeoye O, Díaz I, Ryan A, Pandya A, Navi B. Access to Mechanical Thrombectomy for Ischemic Stroke in the United States. Stroke 2021, 52: 2554-2561. PMID: 33980045, PMCID: PMC8316281, DOI: 10.1161/strokeaha.120.033485.Peer-Reviewed Original ResearchConceptsIschemic strokeMechanical thrombectomyUnadjusted logistic regression modelsNonfederal emergency departmentsAcute ischemic strokeLarge cerebral vesselsAcute care hospitalsMultiple sensitivity analysesLogistic regression modelsStandard descriptive statisticsIntravenous thrombolysisStroke severityUrban patientsCare hospitalSuch patientsInterhospital transferRural patientsStroke careEmergency departmentPopulation-wide dataCerebral vesselsThrombectomyCalendar year 2016PatientsPrimary analysisPatterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors
Etherton M, Shah S, Haolin X, Xian Y, Maisch L, Hannah D, Lindholm B, Lytle B, Thomas L, Smith E, Fonarow G, Schwamm L, Bhatt D, Hernandez A, O'Brien E. Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors. Stroke And Vascular Neurology 2021, 6: 384-394. PMID: 33526632, PMCID: PMC8485250, DOI: 10.1136/svn-2020-000691.Peer-Reviewed Original ResearchConceptsAntidepressant medicationIschemic strokeCause mortalityClinical outcomesOutcome measuresAD useHealth Stroke Scale scoreHigher admission National InstitutesMajor adverse cardiac eventsAdmission National InstitutesGuidelines-Stroke hospitalsPrior ischemic strokeAdverse cardiac eventsIschemic stroke survivorsStroke Scale scorePoor prognostic signPoor clinical outcomeLogistic regression modelsFalsification endpointsAntidepressant therapyCause readmissionNaïve patientsCardiac eventsPoststroke depressionStroke severity
2020
Safety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months
Shah S, Liang L, Kosinski A, Hernandez A, Schwamm L, Smith E, Fonarow G, Bhatt D, Feng W, Peterson E, Xian Y. Safety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months. Circulation Cardiovascular Quality And Outcomes 2020, 13: e006031. PMID: 31903770, DOI: 10.1161/circoutcomes.119.006031.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedAged, 80 and overBrain IschemiaDatabases, FactualFemaleFibrinolytic AgentsHospital MortalityHumansInfusions, IntravenousIntracranial HemorrhagesMaleMedicareRecurrenceRegistriesRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic stroke patientsPrior ischemic strokeSymptomatic intracranial hemorrhageIschemic stroke patientsPrior strokeHospital mortalityIntravenous tPAIschemic strokeIntracranial hemorrhageStroke patientsGuidelines-Stroke hospitalsHigher stroke severityGood functional outcomeHistory of strokeRetrospective observational studyYears of ageCardiovascular comorbiditiesStroke providersStroke severityUnadjusted riskFunctional outcomeHigh prevalenceObservational studyMedicare claimsElevated risk
2019
Frequency of early rapid improvement in stroke severity during interfacility transfer.
Zachrison K, Leslie-Mazwi T, Boulouis G, Goldstein J, Regenhardt R, Viswanathan A, Lauer A, Siddiqui K, Charidimou A, Rost N, Schwamm L. Frequency of early rapid improvement in stroke severity during interfacility transfer. Neurology Clinical Practice 2019, 9: 373-380. PMID: 31750022, PMCID: PMC6814428, DOI: 10.1212/cpj.0000000000000667.Peer-Reviewed Original ResearchNIHSS scoreInterfacility transferMedian initial NIHSS scoreNIH Stroke Scale scoreHigher initial NIHSSInitial NIHSS scoreNIHSS score changeStroke Scale scoreRapid improvementCSC arrivalInitial NIHSSIndex strokeStroke severityPatient characteristicsMedian changeMultivariable modelingScale scoreScore changeLogistic regressionStrokePatientsScoresComparison of Clinical Care and In-Hospital Outcomes of Asian American and White Patients With Acute Ischemic Stroke
Song S, Liang L, Fonarow G, Smith E, Bhatt D, Matsouaka R, Xian Y, Schwamm L, Saver J. Comparison of Clinical Care and In-Hospital Outcomes of Asian American and White Patients With Acute Ischemic Stroke. JAMA Neurology 2019, 76: 430-439. PMID: 30667466, PMCID: PMC6459126, DOI: 10.1001/jamaneurol.2018.4410.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAsianBrain IschemiaFemaleFibrinolytic AgentsHealthcare DisparitiesHospital MortalityHumansHydroxymethylglutaryl-CoA Reductase InhibitorsIntracranial HemorrhagesLogistic ModelsMaleMiddle AgedMultivariate AnalysisPatient DischargeQuality of Health CareRetrospective StudiesSeverity of Illness IndexStrokeStroke RehabilitationThrombolytic TherapyTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesWhite PeopleConceptsAcute ischemic strokeAsian American patientsIschemic strokeWhite patientsAmerican patientsClinical outcomesHospital mortalityStroke severityAmerican Heart Association/American Stroke AssociationIntravenous tissue plasminogen activator administrationTissue plasminogen activator administrationMultivariable logistic regression modelGreater stroke severityGuidelines-Stroke programGWTG-Stroke hospitalsIntensive statin therapyOverall stroke incidenceIn-Hospital OutcomesSevere ischemic strokeWorse functional outcomeAmerican Stroke AssociationQuality improvement registryLogistic regression modelsRace/ethnicityStatin therapy
2018
Quality of care for ischemic stroke in China vs India: Findings from national clinical registries.
Li Z, Pandian J, Sylaja P, Wang Y, Zhao X, Liu L, Wang C, Khurana D, Srivastava M, Kaul S, Arora D, Schwamm L, Wang Y, Singhal A. Quality of care for ischemic stroke in China vs India: Findings from national clinical registries. Neurology 2018, 91: e1348-e1354. PMID: 30158158, PMCID: PMC6177271, DOI: 10.1212/wnl.0000000000006291.Peer-Reviewed Original ResearchConceptsChina National Stroke Registry IIGreater stroke severityStroke risk factorsRisk factorsStroke severityClinical outcomesStroke careIndian patientsAcademic stroke centerNational clinical registryIschemic stroke patientsBurden of strokeIschemic stroke careDifferent risk factorsQuality of careHospital mortalityIschemic strokeStroke centersAcute managementStroke patientsStroke ProjectChinese patientsClinical registryWorse outcomesAcademic hospital
2017
Incorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization
Schwartz J, Wang Y, Qin L, Schwamm LH, Fonarow GC, Cormier N, Dorsey K, McNamara RL, Suter LG, Krumholz HM, Bernheim SM. Incorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization. Stroke 2017, 48: 3101-3107. PMID: 28954922, DOI: 10.1161/strokeaha.117.017960.Peer-Reviewed Original ResearchConceptsRisk-standardized mortality ratesElectronic health record dataHealth record dataStroke severityClaims dataMortality rateAmerican Heart Association/American Stroke AssociationHealth Stroke Scale scoreRisk variablesMedicaid ServicesRisk adjustmentMedian risk-standardized mortality rateGuidelines-Stroke registryLow-mortality hospitalsStroke Scale scoreAcute ischemic strokeAmerican Stroke AssociationOdds of mortalityMortality measuresRecord dataIschemic stroke hospitalizationsHigh-mortality hospitalsService claims dataRisk-adjustment variablesHospital admissionAssociation of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation
Xian Y, O’Brien E, Liang L, Xu H, Schwamm L, Fonarow G, Bhatt D, Smith E, Olson D, Maisch L, Hannah D, Lindholm B, Lytle B, Pencina M, Hernandez A, Peterson E. Association of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation. JAMA 2017, 317: 1057-1067. PMID: 28291892, DOI: 10.1001/jama.2017.1371.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeHistory of AFAntithrombotic therapyAntiplatelet therapyAntithrombotic treatmentAtrial fibrillationHospital mortalityTherapeutic warfarinTherapeutic anticoagulationSevere strokeIschemic strokeStroke severityLower oddsSubtherapeutic warfarinUnadjusted ratesAcute ischemic stroke severityGuidelines-Stroke programHealth Stroke ScaleIn-Hospital OutcomesHigh-risk patientsPrevalence of patientsRetrospective observational studyTime of strokeIschemic stroke severityHospital outcomes
2016
Relationship Between Language Preference and Intravenous Thrombolysis Among Acute Ischemic Stroke Patients
Erfe B, Siddiqui K, Schwamm L, Mejia N. Relationship Between Language Preference and Intravenous Thrombolysis Among Acute Ischemic Stroke Patients. Journal Of The American Heart Association 2016, 5: e003782. PMID: 27881425, PMCID: PMC5210419, DOI: 10.1161/jaha.116.003782.Peer-Reviewed Original ResearchConceptsLanguage preferencePatients' language preferenceAcute ischemic stroke patientsNon-English languageIschemic stroke patientsNIH Stroke ScaleAIS patientsDifferent languagesInitial NIH stroke scaleIntravenous thrombolysisPatient languageStroke ScaleStroke patientsLanguageStepwise logistic regression modelInitial stroke severityAmerican Heart AssociationEnglishLogistic regression modelsStroke severityMultivariable analysisPatient receiptHeart AssociationThrombolysisPatientsWhy are acute ischemic stroke patients not receiving IV tPA?
Messé S, Khatri P, Reeves M, Smith E, Saver J, Bhatt D, Grau-Sepulveda M, Cox M, Peterson E, Fonarow G, Schwamm L. Why are acute ischemic stroke patients not receiving IV tPA? Neurology 2016, 87: 1565-1574. PMID: 27629092, PMCID: PMC5067546, DOI: 10.1212/wnl.0000000000003198.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAgedAged, 80 and overBrain IschemiaDatasets as TopicFemaleFibrinolytic AgentsHealthcare DisparitiesHumansLogistic ModelsMaleMultivariate AnalysisRegistriesRetrospective StudiesSeverity of Illness IndexStrokeThrombolytic TherapyTissue Plasminogen ActivatorUnited StatesConceptsAcute ischemic strokeTissue plasminogen activatorHours of onsetEligible patientsAcute ischemic stroke patientsNIH Stroke Scale scoreStroke center certificationRetrospective cohort studyStroke Scale scoreIschemic stroke patientsEarlier calendar yearsEquation logistic regressionProsthetic heart valvesEmergency medical servicesGuidelines-StrokePrior strokeCohort studyIschemic strokeOlder patientsStroke onsetStroke severityDiabetes mellitusCenter HospitalStroke patientsAtrial fibrillation
2013
Racial and Ethnic Differences in Outcomes in Older Patients With Acute Ischemic Stroke
Qian F, Fonarow G, Smith E, Xian Y, Pan W, Hannan E, Shaw B, Glance L, Peterson E, Eapen Z, Hernandez A, Schwamm L, Bhatt D. Racial and Ethnic Differences in Outcomes in Older Patients With Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2013, 6: 284-292. PMID: 23680966, DOI: 10.1161/circoutcomes.113.000211.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overBlack or African AmericanBrain IschemiaEthnicityFemaleHealth Status DisparitiesHealthcare DisparitiesHispanic or LatinoHumansLogistic ModelsMaleMedicareMultivariate AnalysisOdds RatioPatient ReadmissionRacial GroupsRegistriesRisk FactorsSeverity of Illness IndexStrokeTime FactorsTreatment OutcomeUnited StatesWhite PeopleConceptsAcute ischemic strokeLong-term outcomesRace/ethnicityCause rehospitalizationOlder patientsIschemic strokeUnadjusted mortalityHispanic patientsGuidelines-Stroke programGuidelines-Stroke registryHealth Stroke ScaleOlder Medicare beneficiariesAmerican Heart AssociationAsian American patientsYears of ageStroke ScaleStroke severityHigher median scoresAsian patientsHeart AssociationHospital characteristicsAmerican patientsUS CentersPrognostic variablesLower oddsComparison of Ischemic Stroke Outcomes and Patient and Hospital Characteristics by Race/Ethnicity and Socioeconomic Status
Hanchate A, Schwamm L, Huang W, Hylek E. Comparison of Ischemic Stroke Outcomes and Patient and Hospital Characteristics by Race/Ethnicity and Socioeconomic Status. Stroke 2013, 44: 469-476. PMID: 23306327, PMCID: PMC3595403, DOI: 10.1161/strokeaha.112.669341.Peer-Reviewed Original ResearchConceptsRace/ethnicityAcute ischemic strokeInpatient mortalityRisk-adjusted ratesIschemic strokeSocioeconomic statusBlack patientsArea patientsNonfederal acute care hospitalsRisk-adjusted inpatient mortalityIschemic stroke outcomeInpatient mortality rateIschemic stroke admissionsCrude inpatient mortality rateLength of stayPatient's zip codeAcute care hospitalsLonger lengthStroke admissionsStroke outcomeStroke severityCare hospitalDischarge outcomesWhite patientsMechanical ventilation
2012
Comparison of 30-Day Mortality Models for Profiling Hospital Performance in Acute Ischemic Stroke With vs Without Adjustment for Stroke Severity
Fonarow G, Pan W, Saver J, Smith E, Reeves M, Broderick J, Kleindorfer D, Sacco R, Olson D, Hernandez A, Peterson E, Schwamm L. Comparison of 30-Day Mortality Models for Profiling Hospital Performance in Acute Ischemic Stroke With vs Without Adjustment for Stroke Severity. JAMA 2012, 308: 257-264. PMID: 22797643, DOI: 10.1001/jama.2012.7870.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeNIHSS scoreInitial stroke severityIschemic strokeStroke severityMedicare beneficiariesClaims-based risk modelsHospital mortality modelMean NIHSS scoreRisk-standardized outcomesHealth Stroke ScaleNet reclassification improvementDiscrimination improvement indexService Medicare beneficiariesHospital mortality risk modelMortality risk modelProfiling Hospital PerformanceGuidelines-StrokeIndex hospitalizationStroke ScaleReclassification improvementRisk modelModel discriminationPotential eligibilityStudy population