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Is Risk-Standardized In-Hospital Stroke Mortality an Adequate Proxy for Risk-Standardized 30-Day Stroke Mortality Data?: Findings From Get With The Guidelines-Stroke Original Articles
Conclusions— When used to identify outlier hospitals with high or low mortality, the agreement between risk-standardized in-hospital mortality and 30-day mortality was modest. However, the combined outcome of in-hospital mortality or discharge to hospice showed much better agreement with 30-day mortality. This composite outcome could serve as a proxy for 30-day mortality when used to identify low- or high-performing hospitals.
Source: Circulation: Cardiovascular Quality and Outcomes - October 11, 2017 Category: Cardiology Authors: Reeves, M. J., Fonarow, G. C., Xu, H., Matsouaka, R. A., Xian, Y., Saver, J., Schwamm, L., Smith, E. E. Tags: Mortality/Survival, Quality and Outcomes, Cerebrovascular Disease/Stroke Original Articles Source Type: research

Cost-Effectiveness of Hub-and-Spoke Telestroke Networks for the Management of Acute Ischemic Stroke From the Hospitals' Perspectives Original Articles
Conclusions— The results of this study suggest that a telestroke network may increase the number of patients discharged home and reduce the costs borne by the network hospitals. Hospitals should consider their available resources and the network features when deciding whether to join or set up a network.
Source: Circulation: Cardiovascular Quality and Outcomes - January 15, 2013 Category: Cardiology Authors: Switzer, J. A., Demaerschalk, B. M., Xie, J., Fan, L., Villa, K. F., Wu, E. Q. Tags: Acute Cerebral Infarction, Emergency treatment of Stroke, Thrombolysis Original Articles Source Type: research

Racial and Ethnic Differences in Outcomes in Older Patients With Acute Ischemic Stroke Original Articles
Conclusions— Among older Medicare beneficiaries with AIS, there were significant differences in long-term outcomes by race/ethnicity, even after adjustment for stroke severity, other prognostic variables, and hospital characteristics.
Source: Circulation: Cardiovascular Quality and Outcomes - May 21, 2013 Category: Cardiology Authors: Qian, F., Fonarow, G. C., Smith, E. E., Xian, Y., Pan, W., Hannan, E. L., Shaw, B. A., Glance, L. G., Peterson, E. D., Eapen, Z. J., Hernandez, A. F., Schwamm, L. H., Bhatt, D. L. Tags: Health policy and outcome research, Cerebrovascular disease/stroke Original Articles Source Type: research

Temporal Trends in Patient Characteristics and Treatment With Intravenous Thrombolysis Among Acute Ischemic Stroke Patients at Get With the Guidelines-Stroke Hospitals Original Articles
Conclusions— The frequency of IV tPA use among all AIS patients, regardless of contraindications, nearly doubled from 2003 to 2011. Treatment with tPA has expanded to include more patients with mild deficits, nonwhite race/ethnicity, and oldest old age.
Source: Circulation: Cardiovascular Quality and Outcomes - September 17, 2013 Category: Cardiology Authors: Schwamm, L. H., Ali, S. F., Reeves, M. J., Smith, E. E., Saver, J. L., Messe, S., Bhatt, D. L., Grau-Sepulveda, M. V., Peterson, E. D., Fonarow, G. C. Tags: Acute Cerebral Infarction, Embolic stroke, Thrombolysis Original Articles Source Type: research

Assessment of the Completeness and Accuracy of Case Ascertainment in the Michigan Stroke Registry Original Articles
Conclusions— Among registry hospitals, these results revealed relatively high levels of completeness and accuracy. Matching registry data to hospital discharge data identified hospitals that changed their case ascertainment method to a case sampling approach. This study illustrates the value of monitoring case ascertainment in stroke registries using external data sources.
Source: Circulation: Cardiovascular Quality and Outcomes - September 16, 2014 Category: Cardiology Authors: Reeves, M. J., Nickles, A. V., Roberts, S., Hurst, R., Lyon-Callo, S. Tags: Health policy and outcome research, Acute Cerebral Infarction, Other Stroke Treatment - Medical Original Articles Source Type: research

Effectiveness of Left Atrial Appendage Exclusion Procedures to Reduce the Risk of Stroke: A Systematic Review of the Evidence Original Articles
Conclusions— There is limited evidence that the Watchman device may be noninferior to long-term OAC in selected patients. Data on effectiveness of LAA exclusion devices is lacking in patients ineligible for long-term OAC. Percutaneous LAA devices are associated with high rates of procedure-related harms. Although surgical LAA exclusion during heart surgery does not seem to add incremental harm, there is insufficient evidence of benefit.
Source: Circulation: Cardiovascular Quality and Outcomes - July 18, 2016 Category: Cardiology Authors: Noelck, N., Papak, J., Freeman, M., Paynter, R., Low, A., Motuapuaka, M., Kondo, K., Kansagara, D. Tags: Atrial Fibrillation, Anticoagulants, Cardiovascular Surgery, Complications, Ischemic Stroke Original Articles Source Type: research

Efficacy of a Chronic Care-Based Intervention on Secondary Stroke Prevention Among Vulnerable Stroke Survivors: A Randomized Controlled Trial Original Articles
Conclusions This intervention did not improve SBP control beyond that attained in usual care among vulnerable stroke survivors. A community-centered component could strengthen the intervention impact. Clinical Trial Registration URL: https://clinicaltrials.gov. Unique identifier: NCT00861081.
Source: Circulation: Cardiovascular Quality and Outcomes - January 10, 2018 Category: Cardiology Authors: Cheng, E. M., Cunningham, W. E., Towfighi, A., Sanossian, N., Bryg, R. J., Anderson, T. L., Barry, F., Douglas, S. M., Hudson, L., Ayala-Rivera, M., Guterman, J. J., Gross-Schulman, S., Beanes, S., Jones, A. S., Liu, H., Vickrey, B. G. Tags: Risk Factors, Secondary Prevention, Health Services, Quality and Outcomes, Cerebrovascular Disease/Stroke Original Articles Source Type: research

Abstract 11: Temporal Changes in NIHSS Documentation and Stroke Severity among Patients Treated with Thrombolysis in the Massachusetts Coverdell Registry Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics
Discussion: IV tPA use in MA Coverdell patients is increasing and now reaches 25% of all early arriving subjects. NIHSS documentation is increasing as well, especially among subjects with lower NIHSS scores. The median NIHSS in RISS or Too Mild patients is reassuringly low, and decreased significantly among Too Mild patients. These data, coupled with the fact that unadjusted rates of discharge home among IV tPA patients are increasing while severity-adjusted rates are not, suggests that more patients previously felt to be Too Mild are now receiving IV tPA. Further efforts are still warranted.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Schwamm, L., Parkinson, G., Coe, L. Tags: Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics Source Type: research

Fragmentation of Care and the Use of Head Computed Tomography in Patients With Ischemic Stroke Original Articles
Conclusions— Rates of high-intensity CT use for patients with ischemic stroke reflect wide practice patterns across regions and races. Medicare expenditures parallel these disparities. Fragmentation of care is associated with high-intensity CT use.
Source: Circulation: Cardiovascular Quality and Outcomes - May 20, 2014 Category: Cardiology Authors: Bekelis, K., Roberts, D. W., Zhou, W., Skinner, J. S. Tags: Acute Cerebral Infarction, Computerized tomography and Magnetic Resonance Imaging, Pathology of Stroke Original Articles Source Type: research

Does the Volume of Ischemic Stroke Admissions Relate to Clinical Outcomes in the Ontario Stroke System? Original Articles
Conclusions— Hospital IS volume is associated with 30-day mortality in Ontario. Patients admitted to hospitals with annual IS volumes <126 annually are more likely to die within 30 days than patients admitted to hospitals that see on average 300 patients annually. This finding supports centralizing care in stroke-specialized hospitals.
Source: Circulation: Cardiovascular Quality and Outcomes - October 29, 2015 Category: Cardiology Authors: Hall, R. E., Fang, J., Hodwitz, K., Saposnik, G., Bayley, M. T. Tags: Ethics and Policy, Health Services, Quality and Outcomes, Ischemic Stroke Original Articles Source Type: research

Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines-Stroke Hospitals Original Articles
Conclusions— Thirty-day mortality and readmission rates vary substantially across HRRs and exhibit an inverse relationship. While regional variation in 30-day outcomes were explained by patient and hospital factors differently, much of the regional variation in both outcomes remains unexplained.
Source: Circulation: Cardiovascular Quality and Outcomes - August 10, 2017 Category: Cardiology Authors: Thompson, M. P., Zhao, X., Bekelis, K., Gottlieb, D. J., Fonarow, G. C., Schulte, P. J., Xian, Y., Lytle, B. L., Schwamm, L. H., Smith, E. E., Reeves, M. J. Tags: Quality and Outcomes, Ischemic Stroke Original Articles Source Type: research

Abstract 9: Predictors of Poor Outcome in Patients Not Thrombolysed Due to Mild or Resolving Symptoms ("Too Good To Treat") Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics
Conclusion: A substantial percentage of patients deemed "too good" for IV tPA were unable to be discharged home. Factors such as advanced age and higher NIHSS should be considered in tPA decision-making to optimize outcomes. Large, multi-center prospective studies are underway to study the predictors of poor outcomes in this group.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Ali, S. F., Faheem, U., Singhal, A. B., Viswanathan, A., Silverman, S. B., Rost, N. S., Schwamm, L. H. Tags: Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics Source Type: research

Chronic Kidney Disease and Bleeding Complications After Intravenous Thrombolytic Therapy for Acute Ischemic Stroke Original Articles
Conclusions— Presence of CKD among patients with IS treated with intravenous tissue-type plasminogen activator is associated with higher unadjusted odds of symptomatic intracranial hemorrhage or serious systemic hemorrhage, but this is explained by non-CKD related factors.
Source: Circulation: Cardiovascular Quality and Outcomes - November 18, 2014 Category: Cardiology Authors: Ovbiagele, B., Smith, E. E., Schwamm, L. H., Grau-Sepulveda, M. V., Saver, J. L., Bhatt, D. L., Hernandez, A. F., Peterson, E. D., Fonarow, G. C. Tags: Cerebrovascular disease/stroke, Risk Factors, Acute Cerebral Infarction, Thrombolysis Original Articles Source Type: research

Abstract 16: Racial Disparities in Clinical Outcomes and Resource Utilization in Acute Ischemic Stroke Hospitalizations in the United States: Results from the 2012 National Inpatient Sample Session Title: Concurrent Session IIC: Oral Abstracts - Stroke
Conclusions: Blacks hospitalized for AIS have significantly lower in-hospital mortality compared to whites but are significantly less likely to receive thrombolysis compared to whites. Total charges and length of stay are significantly higher for racial minorities. Future studies should investigate mechanisms of this apparent protective effect of black race on in-hospital mortality in AIS.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Kumar, N., Venkatraman, A., Garg, N. Tags: Session Title: Concurrent Session IIC: Oral Abstracts - Stroke Source Type: research

Smoking Paradox in Patients Hospitalized With Coronary Artery Disease or Acute Ischemic Stroke: Findings From Get With The Guidelines Original Articles
Conclusions— Among patients hospitalized with CAD and AIS, smoking is a risk factor for early age of onset, even among those with few vascular risk factors. The persistent association with lower in-hospital mortality after adjusted and stratified analyses probably represents residual unmeasured confounding, although a biological effect of smoking cannot be excluded. Further clinical and prospective population-based studies are needed to explore variables that contribute to outcomes in these patients.
Source: Circulation: Cardiovascular Quality and Outcomes - October 29, 2015 Category: Cardiology Authors: Ali, S. F., Smith, E. E., Reeves, M. J., Zhao, X., Xian, Y., Hernandez, A. F., Bhatt, D. L., Fonarow, G. C., Schwamm, L. H. Tags: Myocardial Infarction, Cerebrovascular Disease/Stroke, Ischemic Stroke, Acute Coronary Syndromes Original Articles Source Type: research

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