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Risk of Ischemic Stroke After an Acute Myocardial Infarction in Patients With Diabetes Mellitus Original Articles
Conclusions— Ischemic stroke is a fairly common complication after an AMI in patients with diabetes mellitus, but the risk of stroke has decreased during recent years. The increased use of evidence-based therapies contributes importantly to this risk reduction, but there is still room for improvement.
Source: Circulation: Cardiovascular Quality and Outcomes - January 21, 2014 Category: Cardiology Authors: Jakobsson, S., Bergstrom, L., Bjorklund, F., Jernberg, T., Soderstrom, L., Mooe, T. Tags: Secondary prevention, Type 1 diabetes, Type 2 diabetes, Acute myocardial infarction, Acute Cerebral Infarction Original Articles Source Type: research

Abstract 213: The Smoking Paradox in Acute Ischemic Stroke: Findings from Get With The Guidelines - Stroke Poster Session II
Conclusion: Smoking continues to be a major risk factor for presenting with acute ischemic stroke at a much younger age and with fewer vascular risk factors. The association with lower in-hospital mortality, even after covariate adjustment, may represent residual confounding due to the marked age differences and unmeasured confounding or it may reflect a protective association. Further research is warranted.
Source: Circulation: Cardiovascular Quality and Outcomes - May 15, 2013 Category: Cardiology Authors: Ali, S. F., Smith, E. E., Bhatt, D. L., Pan, W., Fonarow, G. C., Schwamm, L. H. Tags: Poster Session II Source Type: research

Abstract 214: Improvement Among All Hospital Types and Reduced Hospital Level Variation in Use of Intravenous tPA for Acute Ischemic Stroke 2003-2011: Findings from Get With The Guideline-Stroke Poster Session II
Conclusion: Significant increases in IV tPA treatment among patients arriving < 2hr have occurred over the past decade, and rates of increase vary by hospital characteristics. The profile of tPA treated eligible patients also changes across the range of hospital tPA use rates, with highest performing sites reporting NIHSS in >90% of tPA patients, and treating greater numbers of patients who are non-white or with more severe strokes. Low performing sites may benefit from greater focus on NIHSS assessment and timeliness of care. .
Source: Circulation: Cardiovascular Quality and Outcomes - May 15, 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: Poster Session II Source Type: research

Abstract 215: Differing Perspectives Between Physicians, Patients And Caregivers On The Value Of An Individualized Estimate Of The Benefits Of Thrombolysis At The Time Of Acute Ischemic Stroke: Designing The Resolve (Rapid Evaluation for Stroke Outcomes using Lytics in Vascular Event) Decision Aid Poster Session II
Conclusions: Preliminary findings suggest reluctance by emergency physicians to share data about the benefits of rt-PA to stroke patients and their caregivers, despite the desire of the latter for such information. While the additional planned interviews will be needed to confirm these findings, preliminary insights suggest a compelling need to overcome the reticence of emergency physicians to use clinical data to better engage patients in making a shared decision about rt-PA in AIS.
Source: Circulation: Cardiovascular Quality and Outcomes - May 15, 2013 Category: Cardiology Authors: Decker, C. J., Chhatriwalla, E., Garavalia, B., Spertus, J. A., Chen, E., Gialde, E. Tags: Poster Session II Source Type: research

Abstract 266: No Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke Session Title: Poster Session II
Conclusions: In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes. Given that these systems often create significant added burden for clinicians, further work to ensure that they are better integrated with care and fully evidence-driven is critical.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Joynt, K. E., Bhatt, D. L., Schwamm, L. H., Xian, Y., Heidenreich, P. A., Fonarow, G. C., Smith, E. E., Grau-Sepulveda, M. V., Hernandez, A. F. Tags: Session Title: Poster Session II Source Type: research

Intracranial Hemorrhage After Ischemic Stroke: Incidence, Time Trends, and Predictors in a Swedish Nationwide Cohort of 196 765 Patients Original Articles
Conclusions— The incidence of ICrH within 1 year after ischemic stroke was 2% per year at risk, about 15 times higher compared with the reference population. Over the study period, ICrH risk increased within the first 30 days but decreased thereafter. Previous ICrH, thrombolysis, and male sex affected the risk, whereas an increased use of antithrombotic treatments and statins did not.
Source: Circulation: Cardiovascular Quality and Outcomes - July 21, 2015 Category: Cardiology Authors: Ogren, J., Irewall, A.-L., Bergstrom, L., Mooe, T. Tags: Acute Cerebral Hemorrhage, Acute Cerebral Infarction, Epidemiology Original Articles Source Type: research

Patient-Centered Decision Support in Acute Ischemic Stroke: Qualitative Study of Patients' and Providers' Perspectives Original Articles
Conclusions— This study suggests that a positively framed risk–benefit tool with graphical presentations of general and patient-specific risk estimates could support patients and providers in considering r-tPA for acute ischemic stroke. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01864928.
Source: Circulation: Cardiovascular Quality and Outcomes - October 29, 2015 Category: Cardiology Authors: Decker, C., Chhatriwalla, E., Gialde, E., Garavalia, B., Summers, D., Quinlan, M. E., Cheng, E., Rymer, M., Saver, J. L., Chen, E., Kent, D. M., Spertus, J. A. Tags: Cardiopulmonary Resuscitation and Emergency Cardiac Care Original Articles Source Type: research

Abstract 219: What factors influence the decision to refer patients to a stroke center in an Emergency Medical Service Dispatch Center? Poster Session II
Conclusion: in our study 26% of callers were referred to a SC, age and delay influenced this decision. Enforced implementation of recent recommendations and standard training in stroke recognition will improve EMS pathways to SC.
Source: Circulation: Cardiovascular Quality and Outcomes - May 15, 2013 Category: Cardiology Authors: FREDERIC, M., Ozguler, A., Loeb, T., Baer, M. Tags: Poster Session II Source Type: research

Abstract 265: TeleStroke: Expanding Access and Coordination of Care from Acute Stroke to Follow-up Session Title: Poster Session II
The objective of this study was to develop a novel pathway for follow-up care after inpatient admissions for acute ischemic stroke (AIS) utilizing the existing telestroke infrastructure, with the goals of improving quality outcomes, reducing patient costs, and increasing access to care.Methods: Utilizing LEAN methodology, the existing care model was process-mapped to assess for potential areas of improvement. Over one month in 2013, a convenience sample of 27 inpatients admitted with AIS were surveyed to assess for potential barriers associated with travel to appointments, as well as for attitudes towards utilizing tele-he...
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Hannon, P. M., Austin, J., McCauley, M. J., Smith, D., Smith, A. G., Salari, A., Majersik, J. J. Tags: Session Title: Poster Session II Source Type: research

Abstract 202: The NIH Stroke Scale Can Miss Improvement After IV tPA For Acute Ischemic Stroke Session Title: Poster Session II
Conclusion: The NIHSS may inadequately capture functional improvement post-treatment, especially in the days immediately following intervention.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Marsh, E. B., Lawrence, E., Llinas, R. H. Tags: Session Title: Poster Session II Source Type: research

Abstract 050: Improvements in Door to Groin Puncture Time for Surgical Stroke After Quality Protocol Interventions at the University of California, San Diego Session Title: Poster Session I
Conclusion: UCSD’s quality improvement process effected dramatic, statistically significant improvement in DGPT. This analysis demonstrates the utility of a formal quality improvement system at a large, academic comprehensive stroke center.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Wali, A. R., Santiago-Dieppa, D. R., Cheung, V., Steinberg, J., Hirshman, B., Abraham, P., Porras, K., Brandel, M., Jurf, J., Botts, E., Pannell, S., Khalessi, A. Tags: Session Title: Poster Session I Source Type: research

Abstract 176: Door to Needle Targets in the Real World: A Dynamic Statistical Tool for Institutional Stroke Code Metrics Session Title: Poster Session II
Conclusions: This simple statistical tool is a novel solution for generating an institution-specific goal DTN based on unique organizational data, experiences, and nuances in order to meet the recommended mean DTN. Additionally, these individualized goals may further motivate stroke teams to carry out more efficient clinical care rather than consistently aiming for DTN values < 60 minutes. The tool presented here is easily adaptable to future changes in recommended target goals and can be seamlessly incorporated into institution-wide systems planning.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Andrew, B. Y., Ehrlich, M. E., Stack, C. M., Yang, J. P., Dodds, J. A. Tags: Session Title: Poster Session II Source Type: research

Development and Validation of Electronic Quality Measures to Assess Care for Patients With Transient Ischemic Attack and Minor Ischemic Stroke Original Articles
Conclusions— It is feasible to construct valid eQMs for processes of transient ischemic attack and minor ischemic stroke care. Healthcare systems with EHRs should consider using electronic data to evaluate care for their patients with transient ischemic attack and to complement and expand quality measurement programs currently focused on patients with stroke.
Source: Circulation: Cardiovascular Quality and Outcomes - September 14, 2017 Category: Cardiology Authors: Bravata, D. M., Myers, L. J., Cheng, E., Reeves, M., Baye, F., Yu, Z., Damush, T., Miech, E. J., Sico, J., Phipps, M., Zillich, A., Johanning, J., Chaturvedi, S., Austin, C., Ferguson, J., Maryfield, B., Snow, K., Ofner, S., Graham, G., Rhude, R., William Tags: Quality and Outcomes, Transient Ischemic Attack (TIA) Original Articles Source Type: research

Abstract 260: Patient Characteristics, In-hospital Mortality and the Use of Comfort-Focused Care among Patients presenting with Acute Ischemic Stroke Session Title: Poster Session II
Conclusion: While comfort-focused care was provided to only 10% of stroke admissions, it occurred in over 80% of all patients who died in-hospital. Early CMO patients received aggressive intervention with IA therapy less often and appear to have had fewer infectious complications, suggesting that poor initial neurologic prognosis and advanced directives may have contributed more than progressive deterioration to the decision to change care goals. Larger prospective studies are needed to better understand the drivers of decision-making in this population, and set realistic expectations about the likely duration of patient s...
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Ali, S. F., Faheem, U., Cohen, A. S., Singhal, A. B., Schwamm, L. H. Tags: Session Title: Poster Session II Source Type: research

Abstract 272: Preliminary Data from RESOLVE (Rapid Evaluation for Stroke Outcomes using Lytics in Vascular Events) Study Session Title: Poster Session II
Conclusions: Preliminary findings showed that less than half of the patients and CG felt the education was clear. However additional interviews are planned. Preliminary insights suggest an opportunity to use an individualized risk and benefit decision tool to inform and engage patients and CG regarding treatment decisions. We believe this can be accomplished without increasing the door to needle time in administration of rt-PA.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Summers, D., Chhatriwalla, E., Gialde, E., Spertus, J., Decker, C. Tags: Session Title: Poster Session II Source Type: research

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