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Source: Circulation: Cardiovascular Quality and Outcomes

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Total 331 results found since Jan 2013.

Importance of Considering Competing Risks in Time-to-Event Analyses: Application to Stroke Risk in a Retrospective Cohort Study of Elderly Patients With Atrial Fibrillation Original Articles
Conclusions: The incidence of death without stroke was 9-fold higher than that of stroke, leading to biased estimates of stroke risk with traditional time-to-event methods. Statistical methods that appropriately account for competing risks should be used to mitigate this bias.
Source: Circulation: Cardiovascular Quality and Outcomes - July 11, 2018 Category: Cardiology Authors: Abdel-Qadir, H., Fang, J., Lee, D. S., Tu, J. V., Amir, E., Austin, P. C., Anderson, G. M. Tags: Atrial Fibrillation, Epidemiology, Primary Prevention, Cerebrovascular Disease/Stroke Original Articles Source Type: research

Association of Multivitamin and Mineral Supplementation and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis Original Articles
Conclusions: Our meta-analysis of clinical trials and prospective cohort studies demonstrates that MVM supplementation does not improve cardiovascular outcomes in the general population.
Source: Circulation: Cardiovascular Quality and Outcomes - July 10, 2018 Category: Cardiology Authors: Kim, J., Choi, J., Kwon, S. Y., McEvoy, J. W., Blaha, M. J., Blumenthal, R. S., Guallar, E., Zhao, D., Michos, E. D. Tags: Cardiovascular Disease, Diet and Nutrition, Meta Analysis, Quality and Outcomes, Cerebrovascular Disease/Stroke Original Articles Source Type: research

Comparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States Original Articles
Conclusions: CSCs and PSCs achieved similar overall care quality for patients with acute ischemic stroke. CSCs exceeded PSCs in timely acute reperfusion therapy for emergency department admissions, whereas PSCs had lower risk-adjusted in-hospital mortality. This information may be important for acute stroke triage and targeted quality improvement.
Source: Circulation: Cardiovascular Quality and Outcomes - May 23, 2018 Category: Cardiology Authors: Man, S., Zhao, X., Uchino, K., Hussain, M. S., Smith, E. E., Bhatt, D. L., Xian, Y., Schwamm, L. H., Shah, S., Khan, Y., Fonarow, G. C. Tags: Quality and Outcomes, Ischemic Stroke Original Articles Source Type: research

Association Between Early Outpatient Visits and Readmissions After Ischemic Stroke Original Articles
Conclusions: Thirty-day outpatient follow-up was associated with a small reduction in hospital readmission among elderly patients with stroke discharged home. Further work should assess how outpatient care may be improved to further reduce readmissions.
Source: Circulation: Cardiovascular Quality and Outcomes - April 13, 2018 Category: Cardiology Authors: Terman, S. W., Reeves, M. J., Skolarus, L. E., Burke, J. F. Tags: Health Services, Quality and Outcomes, Ischemic Stroke Original Articles Source Type: research

Abstract 4: Variation in Published Stroke Rates Results in Wide Variation in the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation Session Title: QCOR 2018 Young Investigator Award Finalists
Conclusion: Using current guidelines, variation in published off-anticoagulation stroke rates results in tenfold variation in the estimated net clinical benefit of anticoagulation. Guidelines should better reflect the uncertainty of the current approach that uses a CHA2DS2-VASc threshold to recommend anticoagulation.
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Shah, S. J., Eckman, M. H., Aspberg, S., Go, A. S., Singer, D. E. Tags: Session Title: QCOR 2018 Young Investigator Award Finalists Source Type: research

Abstract 14: The Influence of Provider Specialty on Anticoagulation Prescription Fills and Stroke Risk in Atrial Fibrillation Patients With History of Cancer Session Title: Poster Session Reception: Young Investigator Award Semi-Finalists
Conclusion: AF patients with cancer were less likely to see a cardiologist, and less likely to fill an anticoagulant prescription than AF patients without cancer. However, cardiology involvement was associated with increased anticoagulant prescription fills and reduced risk of stroke, suggesting a beneficial role for cardiology providers to improve outcomes in AF patients with history of cancer.
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: ONeal, W. T., Claxton, J., MacLehose, R., Chen, L., Bengtson, L. G., Chamberlain, A. M., Norby, F., Lutsey, P., Alonso, A. Tags: Session Title: Poster Session Reception: Young Investigator Award Semi-Finalists Source Type: research

Ethnic Differences in Prevalence of Post-stroke Depression Original Articles
Conclusions: MAs had a higher prevalence of PSD at 90 days than NHWs. The ethnic difference was explained by sociodemographic and health factors, especially low educational attainment.
Source: Circulation: Cardiovascular Quality and Outcomes - January 25, 2018 Category: Cardiology Authors: Dong, L., Sanchez, B. N., Skolarus, L. E., Morgenstern, L. B., Lisabeth, L. D. Tags: Epidemiology, Mental Health, Race and Ethnicity, Risk Factors, Cerebrovascular Disease/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

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

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

Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated: An Opportunity for Better Coordination of Acute Care Original Article
Conclusions— We found no correlation between hospitals’ observed or risk-adjusted DTN and D2B times. Opportunities exist to improve hospitals’ performance of time-critical care processes for AIS and STEMI in a coordinated approach.
Source: Circulation: Cardiovascular Quality and Outcomes - March 10, 2017 Category: Cardiology Authors: Sauser Zachrison, K., Levine, D. A., Fonarow, G. C., Bhatt, D. L., Cox, M., Schulte, P., Smith, E. E., Suter, R. E., Xian, Y., Schwamm, L. H. Tags: Myocardial Infarction, Health Services, Quality and Outcomes, Ischemic Stroke Original Article Source Type: research

Neighborhood Differences in Post-Stroke Mortality Original Article
Conclusions— Neighborhood characteristics predict mortality, but most effects are similar for individuals without stroke. Eliminating disparities in stroke survival may require addressing pathways that are not specific to traditional poststroke care.
Source: Circulation: Cardiovascular Quality and Outcomes - February 22, 2017 Category: Cardiology Authors: Osypuk, T. L., Ehntholt, A., Moon, J. R., Gilsanz, P., Glymour, M. M. Tags: Epidemiology, Lifestyle, Primary Prevention, Secondary Prevention, Cerebrovascular Disease/Stroke Original Article Source Type: research

African American Stroke Survivors: More Caregiving Time, but Less Caregiving Burden Original Article
Conclusions— Black stroke survivors received an average of 11 more hours of care than white stroke survivors without substantial differences in unmet need. Despite providing more hours of care, caregivers of black stroke were more positive about their caregiver role than caregivers of white stroke survivors.
Source: Circulation: Cardiovascular Quality and Outcomes - February 22, 2017 Category: Cardiology Authors: Skolarus, L. E., Freedman, V. A., Feng, C., Burke, J. F. Tags: Race and Ethnicity, Health Services, Cerebrovascular Disease/Stroke Original Article Source Type: research

Hospital Variation in Functional Recovery After Stroke Original Articles
Conclusions— One third of acute ischemic stroke patients were functionally dependent or dead 3 months postacute stroke; functional recovery rates varied considerably among hospitals, supporting the need to better determine which care processes can maximize functional outcomes.
Source: Circulation: Cardiovascular Quality and Outcomes - January 17, 2017 Category: Cardiology Authors: Bettger, J. P., Thomas, L., Liang, L., Xian, Y., Bushnell, C. D., Saver, J. L., Fonarow, G. C., Peterson, E. D. Tags: Health Services, Quality and Outcomes, Ischemic Stroke Original Articles Source Type: research

Atrial Fibrillation Diagnosis Timing, Ambulatory ECG Monitoring Utilization, and Risk of Recurrent Stroke Original Articles
Conclusions— AF diagnosed after stroke is an important hallmark of recurrent stroke risk. Increasing the low utilization of cardiac monitoring after stroke could identify undiagnosed AF earlier, leading to appropriate oral anticoagulation treatment and a reduction in stroke/TIA recurrence.
Source: Circulation: Cardiovascular Quality and Outcomes - January 17, 2017 Category: Cardiology Authors: Lip, G. Y. H., Hunter, T. D., Quiroz, M. E., Ziegler, P. D., Turakhia, M. P. Tags: Arrhythmias, Electrophysiology, Atrial Fibrillation, Ischemic Stroke, Transient Ischemic Attack (TIA) Original Articles Source Type: research

Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice: Findings from Target: Stroke Original Articles
Conclusions— Get With The Guidelines-Stroke hospitals have initiated a majority of Target: Stroke–recommended strategies to reduce DTN times in acute ischemic stroke. Nevertheless, certain strategies were infrequently practiced and represent a potential immediate target for further improvements.
Source: Circulation: Cardiovascular Quality and Outcomes - January 17, 2017 Category: Cardiology Authors: Xian, Y., Xu, H., Lytle, B., Blevins, J., Peterson, E. D., Hernandez, A. F., Smith, E. E., Saver, J. L., Messe, S. R., Paulsen, M., Suter, R. E., Reeves, M. J., Jauch, E. C., Schwamm, L. H., Fonarow, G. C. Tags: Health Services, Quality and Outcomes, Ischemic Stroke Original Articles Source Type: research

Improving Door-to-Needle Times for Acute Ischemic Stroke: Effect of Rapid Patient Registration, Moving Directly to Computed Tomography, and Giving Alteplase at the Computed Tomography Scanner Original Articles
Conclusions— Taking the patient to CT on the emergency medical services stretcher, registering the patient as unknown, STAT stroke protocol, and administering alteplase in CT are associated with lower DTN time.
Source: Circulation: Cardiovascular Quality and Outcomes - January 17, 2017 Category: Cardiology Authors: Kamal, N., Holodinsky, J. K., Stephenson, C., Kashayp, D., Demchuk, A. M., Hill, M. D., Vilneff, R. L., Bugbee, E., Zerna, C., Newcommon, N., Lang, E., Knox, D., Smith, E. E. Tags: Quality and Outcomes, Ischemic Stroke Original Articles Source Type: research

Regional Learning Collaboratives Produce Rapid and Sustainable Improvements in Stroke Thrombolysis Times Original Articles
Conclusions— Using a learning collaborative model at Chicago’s 15 primary stroke centers, we observed major reductions in DTN times within 1 quarter of implementation. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement.
Source: Circulation: Cardiovascular Quality and Outcomes - September 20, 2016 Category: Cardiology Authors: Prabhakaran, S., Lee, J., ONeill, K. Tags: Health Services, Quality and Outcomes, Ischemic Stroke 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 19, 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

Characteristics and Outcomes of Stroke Patients Transferred to Hospitals Participating in the Michigan Coverdell Acute Stroke Registry Original Articles
Conclusions— Transferred patients represent a complex admixture of patient characteristics that result in higher risks of poor outcomes. Our results suggest that it is prudent to account for patient transfer status when comparing hospital outcomes and that stroke registries need to expand their data collection capacity to provide a better understanding of the relative benefits and risks of transferring patients.
Source: Circulation: Cardiovascular Quality and Outcomes - May 17, 2016 Category: Cardiology Authors: Nickles, A. V., Roberts, S., Shell, E., Mitchell, M., Hussain, S., Lyon-Callo, S., Reeves, M. J. Tags: Complications, Mortality/Survival, Quality and Outcomes, Cerebrovascular Disease/Stroke Original Articles Source Type: research

Quantifying Selection Bias in National Institute of Health Stroke Scale Data Documented in an Acute Stroke Registry Original Articles
Conclusions— We demonstrate modest, but important, selection bias in documented NIHSS data, which are missing more often in patients with less severe stroke. The population mean NIHSS score was overestimated by >2 points, which could significantly alter the risk profile of hospitals treating patients with ischemic stroke and subsequent hospital risk–adjusted outcomes.
Source: Circulation: Cardiovascular Quality and Outcomes - May 17, 2016 Category: Cardiology Authors: Thompson, M. P., Luo, Z., Gardiner, J., Burke, J. F., Nickles, A., Reeves, M. J. Tags: Ischemic Stroke Original Articles Source Type: research

Abstract 101: A Learning Collaborative Model to Improve Door to Needle Time for Stroke Thrombolysis in Chicago Session Title: Abstract Poster Session I and Reception
Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 15 PSCs in Chicago, we observed major improvements within a few months. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement.
Source: Circulation: Cardiovascular Quality and Outcomes - February 26, 2016 Category: Cardiology Authors: Prabhakaran, S., ONeill, K., Chicago Primary Stroke Cntrs Tags: Session Title: Abstract Poster Session I and Reception 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

Variation and Trends in the Documentation of National Institutes of Health Stroke Scale in GWTG-Stroke Hospitals Original Articles
Conclusions— Documentation of NIHSS is higher in patients who are thrombolysis candidates. Evidence of modest bias in NIHSS scores was observed but this has lessened as the documentation of NIHSS has improved in recent years.
Source: Circulation: Cardiovascular Quality and Outcomes - October 29, 2015 Category: Cardiology Authors: Reeves, M. J., Smith, E. E., Fonarow, G. C., Zhao, X., Thompson, M., Peterson, E. D., Schwamm, L. H., Olson, D. Tags: Cerebrovascular Disease/Stroke Original Articles Source Type: research

Mobile Phone-Based Questionnaire for Assessing 3 Months Modified Rankin Score After Acute Stroke: A Pilot Study Original Articles
Conclusions— Mobile phone–based automatic assessments of mRS performed well in comparison with clinical visit mRS and could be used as an alternative in stroke follow-up.
Source: Circulation: Cardiovascular Quality and Outcomes - October 29, 2015 Category: Cardiology Authors: Cooray, C., Matusevicius, M., Wahlgren, N., Ahmed, N. Tags: Ethics and Policy, Quality and Outcomes, Cerebrovascular Disease/Stroke Original Articles Source Type: research

Care Trajectories of Veterans in the 12 Months After Hospitalization for Acute Ischemic Stroke Original Articles
Conclusions— Care trajectories after stroke were associated with stroke severity and functional dependency and they had a dramatic impact on subsequent costs.
Source: Circulation: Cardiovascular Quality and Outcomes - October 29, 2015 Category: Cardiology Authors: Arling, G., Ofner, S., Reeves, M. J., Myers, L. J., Williams, L. S., Daggy, J. K., Phipps, M. S., Chumbler, N., Bravata, D. M. Tags: Ethics and Policy, Cerebrovascular Disease/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

Academic-Community Hospital Comparison of Vulnerabilities in Door-to-Needle Process for Acute Ischemic Stroke Original Articles
Conclusions— Although the identification of common critical failures suggests opportunities for a generalizable process redesign, differences in the criticality and nature of failures must be addressed at the individual hospital level, to develop robust and sustainable solutions to reduce DTN time.
Source: Circulation: Cardiovascular Quality and Outcomes - October 29, 2015 Category: Cardiology Authors: Prabhakaran, S., Khorzad, R., Brown, A., Nannicelli, A. P., Khare, R., Holl, J. L. Tags: Treatment, Ethics and Policy, Ischemic Stroke Original Articles Source Type: research

Changes in European Label and Guideline Adherence After Updated Recommendations for Stroke Thrombolysis: Results From the Safe Implementation of Treatments in Stroke Registry Original Articles
Conclusions— After the European guideline update, new recommendations were promptly adopted and nonadherence to the unchanged label increased. Label contraindications should be updated.
Source: Circulation: Cardiovascular Quality and Outcomes - October 29, 2015 Category: Cardiology Authors: Anani, N., Mazya, M. V., Bill, O., Chen, R., Koch, S., Ahmed, N., Wahlgren, N., Prazeres Moreira, T. Tags: Treatment, Cerebrovascular Disease/Stroke, Ischemic Stroke, Transient Ischemic Attack (TIA) Original Articles Source Type: research

Chronic Stroke Outcome Measures for Motor Function Intervention Trials: Expert Panel Recommendations Original Articles
Conclusions— The panel recommends that the Fugl-Meyer Upper and Lower Extremity scales be used as primary outcomes in intervention trials targeting motor function in populations with chronic stroke. The other 6 measures are recommended as secondary outcomes.
Source: Circulation: Cardiovascular Quality and Outcomes - October 29, 2015 Category: Cardiology Authors: Bushnell, C., Bettger, J. P., Cockroft, K. M., Cramer, S. C., Edelen, M. O., Hanley, D., Katzan, I. L., Mattke, S., Nilsen, D. M., Piquado, T., Skidmore, E. R., Wing, K., Yenokyan, G. Tags: Behavioral/Psychosocial Treatment, Quality and Outcomes, Ischemic Stroke Original Articles Source Type: research

Electronic Stroke CarePath: Integrated Approach to Stroke Care Innovations in Care
We describe the development, implementation, and outcomes of the first 2 years of the Electronic Stroke CarePath, an initiative developed for management of ischemic stroke patients in an effort to improve efficiency and quality of care for patients. The CarePath consists of care pathways for ischemic stroke that are integrated within the electronic health record. Patient-reported outcomes are collected using an external software platform. Documentation tools, order sets, and clinical decision support were designed to improve efficiency, optimize process measure adherence, and produce clinical data as a byproduct of care th...
Source: Circulation: Cardiovascular Quality and Outcomes - October 29, 2015 Category: Cardiology Authors: Katzan, I. L., Fan, Y., Speck, M., Morton, J., Fromwiller, L., Urchek, J., Uchino, K., Griffith, S. D., Modic, M. Tags: Ischemic Stroke Innovations in Care Source Type: research

Novel Oral Anticoagulant Use Among Patients With Atrial Fibrillation Hospitalized With Ischemic Stroke or Transient Ischemic Attack Original Articles
Conclusions— NOACs have had modest but growing uptake over time among atrial fibrillation patients hospitalized with stroke or transient ischemic attack and are prescribed to patients with lower stroke risk compared with warfarin.
Source: Circulation: Cardiovascular Quality and Outcomes - July 21, 2015 Category: Cardiology Authors: Patel, P. A., Zhao, X., Fonarow, G. C., Lytle, B. L., Smith, E. E., Xian, Y., Bhatt, D. L., Peterson, E. D., Schwamm, L. H., Hernandez, A. F. Tags: Other anticoagulants, Embolic stroke, Anticoagulants Original Articles Source Type: research

Abstract 206: Aiming to Improve Stroke Care Continuity with Primary Care Follow-up Appointments Scheduled Prior to Hospital Discharge Session Title: Poster Session II
Conclusions: Hospital performance with scheduling primary care follow-up appointments improved significantly; however, only 1 in 4 patients had an appointment scheduled prior to discharge. Case study analysis of missed opportunities may help identify barriers and facilitators associated with access, availability, and awareness that can be addressed in future improvement cycles.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Prvu Bettger, J., Burns, B., Lender, S., Nutter, D., On Behalf of the Ohio Coverdell Stroke Program Leadership, Participating Hosps and Partners Tags: Session Title: Poster Session II 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

Abstract 17: The Use of Thrombolysis among Acute Ischemic Stroke Patients with Limited English Proficiency Session Title: Concurrent Session IIC: Oral Abstracts - Stroke
Conclusion: Contrary to our hypothesis, acute ischemic stroke patients with LEP were more likely to receive IV tPA than English-speaking patients; this seemed to be driven by their worse stroke severity.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Mejia, N., Siddiqui, K. A., Erfe, B., Schwamm, L. Tags: Session Title: Concurrent Session IIC: Oral Abstracts - Stroke Source Type: research

Abstract 18: Determinants of Adequate Blood Pressure Control in Stroke Patients Post-Discharge Session Title: Concurrent Session IIC: Oral Abstracts - Stroke
Conclusions: Contrary to our hypothesis, once daily dosed BP medications did not improve the effectiveness of BP control at follow-up. Elevated SBP at the time of hospital discharge was associated with poor blood pressure control. Those patients receiving outpatient home health and therapy visits after hospital discharge had better blood pressure control. Further studies need to be done to assess medication adherence to determine whether the poor control was related to choice of medication or patient medication-taking behavior.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Bishop, L., Arnan, M., Petryna, E., Bushnell, C. Tags: Session Title: Concurrent Session IIC: Oral Abstracts - Stroke Source Type: research

Abstract 19: Using the Heckman Selection Model to Assess Selection Bias in Ischemic Stroke Patients with Documented NIHSS Session Title: Concurrent Session IIC: Oral Abstracts - Stroke
Conclusions: We found statistically significant albeit weak selection bias in the documentation of NIHSS in stroke patients. The Heckman Selection Model is a novel method that can be used to assess the presence and magnitude of selection bias when missing data is common.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Thompson, M. P., Luo, Z., Gardiner, J., Burke, J. F., Reeves, M. J. Tags: Session Title: Concurrent Session IIC: Oral Abstracts - Stroke Source Type: research

Abstract 20: Patient Characteristics and Outcomes among Early-Arriving Acute Stroke Patients for Whom Alteplase Was Dispensed but Not Administered Session Title: Concurrent Session IIC: Oral Abstracts - Stroke
Conclusion: Delays in tPA initiation are common, and reduce health outcomes after thrombolysis. In our study, early dispensing of tPA prior to the final eligibility assessment produced an overall rate of tPA treatment of >60%. This conversion rate suggests that early tPA dispensing in high likelihood candidates is appropriate and supports the use of this strategy. Reasons for non-treatment were similar to those in unselected patients.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Siddiqui, K. A., Ali, S. F., Anderson, C. D., Rost, N., Schwamm, L. H. Tags: Session Title: Concurrent Session IIC: Oral Abstracts - Stroke Source Type: research

Abstract 21: Stroke Physician Report Cards Improve Physician Response Times for Thrombolytic Treatment Session Title: Concurrent Session IIC: Oral Abstracts - Stroke
Conclusion: The results show that direct, personal and comparative feedback to stroke physicians influences their page-to-response, page-to-needle times and may affect DTN times. There was a clear trend overall, and the page-to-response and page-to-needle times showed significant improvement. Though our numbers were too small to detect statistical significance for individuals, the benefit of improved treatment times is likely clinically significant.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Yanase, L., Corless, L., Stuchiner, T., Baraban, E. Tags: Session Title: Concurrent Session IIC: Oral Abstracts - Stroke Source Type: research

Abstract 106: Defining an International Standard Set of Patient-centered Outcome Measures After Stroke Session Title: Poster Session I
Conclusions: The stroke measure Standard Set is proposed for implementation to permit meaningful comparisons and increase value of stroke care worldwide using a simple, pragmatic strategy.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Salinas, J., ICHOM Stroke Measure Group Tags: Session Title: Poster Session I 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

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

Abstract 7: Risk of Intracranial Hemorrhage Among Acute Ischemic Stroke Patients Receiving Prior Antiplatelet Therapy and Treated with Intravenous Tissue Plasminogen Activator Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics
Conclusion: This study represents the largest clinical experience of the safety of thrombolysis in patients on prior antiplatelet therapy. Despite a higher incidence of sICH, the absolute excess risk appears small (0.67%). These findings support current guideline recommendations regarding use of intravenous tPA in patients on antiplatelet therapy with careful weighing of potential risk and benefit.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Xian, Y., Grau-Spulveda, M., Schwamm, L. H., Bhatt, D. L., Smith, E. E., Reeves, M. J., Federspiel, J., Thomas, L., Bettger, J. P., Laskowitz, D. T., Hernandez, A. F., Fonarow, G. C., Peterson, E. D. Tags: Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics Source Type: research

Abstract 8: Association Between Hospital "Get With The Guidelines-Stroke" Performance Measures And Outcomes Among Patients With Acute Ischemic Stroke In China Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics
Conclusions: A significant association between hospital care process and outcomes was found, supporting the use of GWTG-Stroke performance metrics as a means of assessing and helping improve stroke care quality in China.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Li, Z., Wang, Y., Wang, Y., Zhao, X., Wang, C., Liu, L., Wang, C., Zhang, C., Pan, Y., Yang, X. Tags: Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics 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

Abstract 10: Predictors of Poor Outcome in Acute Ischemic Stroke Patients after Successful Recanalization Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics
Conclusions: Age, occlusion site, high NIHSS, diabetes, not receiving IV t-PA, use of rescue therapy and three or more passes, were associated with poor 90-day outcome despite successful recanalization.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Starosciak, A. K., Linfante, I., Walker, G., Zaidat, O. O., Castonguay, A. C., Lin, E., Dabus, G., NASA Investigators Tags: Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics 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

Abstract 12: Accuracy and Validation of an Automated Electronic Medical Record Algorithm to Identify Patients with Atrial Fibrillation at Risk for Stroke Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics
Discussion: Automated methods can be used to identify patients with prevalent AF indicated for anticoagulation, but may suffer from misclassification of up to 12%. Misclassification is minimized by requiring a diagnosis of AF within the prior year and using a CHA2DS2-Vasc based algorithm. Despite differences in accuracy between definitions, system-wide anticoagulation rates assessed using these definitions were similar. The diagnosis codes validated in this study can be applied for internal quality improvement and observational studies, and might be adapted for use in nationwide quality reporting programs.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Navar-Boggan, A. M., Rymer, J., Piccini, J. P., Shatila, W., Ring, L., Stafford, J., Al-Khatib, S. M., Peterson, E. Tags: Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics Source Type: research

Cross-Sectional Survey of Workload and Burnout Among Japanese Physicians Working in Stroke Care: The Nationwide Survey of Acute Stroke Care Capacity for Proper Designation of Comprehensive Stroke Center in Japan (J-ASPECT) Study Original Articles
Conclusions— The primary risk factors for burnout are heavy workload, short sleep duration, relatively little experience, and low mental quality of life. Prospective research is required to confirm these findings and develop programs for preventing burnout.
Source: Circulation: Cardiovascular Quality and Outcomes - May 20, 2014 Category: Cardiology Authors: Nishimura, K., Nakamura, F., Takegami, M., Fukuhara, S., Nakagawara, J., Ogasawara, K., Ono, J., Shiokawa, Y., Miyachi, S., Nagata, I., Toyoda, K., Matsuda, S., Kataoka, H., Miyamoto, Y., Kitaoka, K., Kada, A., Iihara, K., J-ASPECT Study Group Tags: Behavioral/psychosocial - stroke, Other etiology, Epidemiology Original Articles 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