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Abstract 195: Statin Use and Its Facility Level Variation in Patients With Ischemic Cerebrovascular Disease: Insights From the Department of Veterans Affairs Session Title: Poster Session II
Conclusions: The use of statin and especially guideline-recommended statin intensity is suboptimal in ICVD patients, especially patients without concomitant IHD or PAD. There is significant facility-level variation in receipt of guideline directed statin therapy in ICVD patients. Interventions are needed to improve guideline directed moderate to high-intensity statin use and reduce variation in care in this high risk group.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: McBride, C. L., Akaroyd, J., Ramsey, D. J., Nambi, V., Nasir, K., Michos, E. D., Birtcher, K. K., Morris, P. B., Bittner, V. A., Ballentyne, C. M., Peterson, L. A., Virani, S. S. Tags: Session Title: Poster Session II Source Type: research

Abstract 200: Is Risk-standardized In-hospital Stroke Mortality an Adequate Proxy for Risk-standardized 30-day Stroke Mortality Data? Findings From the GWTG-Stroke Program Session Title: Poster Session II
Conclusions: When used to identify outlier hospitals with high or low ischemic stroke mortality the agreement between in-hospital mortality and 30-day mortality was only modest. Using in-hospital mortality data proved to be a poor proxy for 30-day mortality.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Reeves, M. J., Fonarow, G. C., Xu, H., Matsouaka, R., Xian, Y., Saver, J., Schwamm, L. H., Smith, E. E. Tags: Session Title: Poster Session II Source Type: research

Abstract 211: Implications of the PEGASUS-TIMI 54 Trial for U.S. Clinical Practice Session Title: Poster Session II
Conclusions: In contemporary clinical practice, a minority of patients are on a P2Y12inhibitor beyond 1-year post-MI. Applying PEGASUS trial findings to clinical practice would result in a large increase in P2Y12 inhibitor use with a cost per ischemic event averted that is strongly influenced by the choice of therapy.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Bradley, S. M., Hess, G., Stewart, P., Armstrong, E., Farmer, S., Wasfy, J., Valle, J., Sandhu, A., Maddox, T. Tags: Session Title: Poster Session II Source Type: research

Abstract 222: Use of a Decision Support Tool for Ischemic Stroke Treatment in a Telehealth System Session Title: Poster Session II
Conclusions: The preliminary results showed the rural hospital providers saw value in the RESOLVE tool while discussing the risks and benefits with patient/family. Future strategies would include process changes to expedite the faxing of the RESOLVE tool.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Summers, D., Gialde, E., Spertus, J. A., Decker, C. Tags: Session Title: Poster Session II Source Type: research

Abstract 226: Strokes Worse in Women at 24 hours but Severity Reduced in Younger Women With Hormone Therapy Session Title: Poster Session II
Conclusion: Women in this study had more severe 24 hour AIS outcomes than men but this improved with HRT use in women younger than 80 years. This cannot be fully explained by age differences as there could be other underlying factors. Improving 24 hour NIHSS may correctly predict later outcomes following AIS. Further study of HRT use in AIS outcomes is justified.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Brown, A., Onteddu, S., Joiner, R., Benton, T., Culp, W., Lowery, C. Tags: Session Title: Poster Session II Source Type: research

Abstract 246: Length of Stay and Its Association With Get With the Guidelines-stroke Award Recognition Session Title: Poster Session II
Conclusions: This study demonstrated that GWTG-Stroke award winning hospitals have a shorter ALOS for ICH and a higher ALOS for SAH than non-award winning hospitals. Those hospitals that have attained gold award status more closely align with national ALOS. Thus, hospitals that are more adherent to guideline recommended care via a quality improvement program may be more efficient when providing care, which impacts hospitals costs.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Hamm, T., Overton, A., Thomas, K., Sednew, R. Tags: Session Title: Poster Session II Source Type: research

Abstract 122: Quality of Care for Patients With Acute Ischemic Stroke as a Function of Hospital Intravenous Thrombolysis With Recombinant Tissue Plasminogen Activator Capability: Insights From China National Stroke Registry II Session Title: Poster Session I
Conclusions: The CNSR II hospitals were associated with better performance in some of the hospitals but not all of them. The difference in conformity between rt-PA-capable hospitals and rt-PA-incapable hospitals was modest for performance measures of stroke care. However, more room for improvement still exists in key quality performance measures and further studies should be explored.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Rao, Z., Li, Z., Gu, H., Wang, Y., Wang, Y. Tags: Session Title: Poster Session I Source Type: research

Abstract 123: Temporal Variation Affect Stroke Unit Admission Rates, Observations From the National Swedish Stroke Register Session Title: Poster Session I
Discussion: There are several patterns of time affecting admission rates to a SU from the ED. Some of the variation seen in this study could possibly be explained by healthcare organizational factors such as hospital crowding. More studies are however needed to elucidate the mechanisms behind temporal variations as well as the magnitude of these effects on the quality of stroke care. Finally, we believe quality improvement efforts should focus on reducing temporal variation.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Darehed, D., Blom, M., Glader, E.-L., Niklasson, J., Norrving, B., Eriksson, M. Tags: Session Title: Poster Session I Source Type: research

Abstract 140: Effects of Smoking Co-Morbidities and Obesity on NonHemorrhagic Stroke Outcomes Session Title: Poster Session II
Conclusion: Smokers present with non-hemorrhagic stroke at a significantly younger age than non-smokers and die at much younger age during follow-up. While in our cohort smoking was not linked to other traditional risk factors for non-hemorrhagic stroke, it was associated with increased mortality in patients with decreased BMI, dyslipidemia, and with renal disease. "Protective" effect of increased BMI was not observed in smokers.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Amato, D., Pieper, J., Ashamalla, M., Torosoff, M. Tags: Session Title: Poster Session II Source Type: research

Abstract 150: Machine Learning Methodology Predicts Comorbidities are Associated With Increased Total Healthcare Costs Among Patients With Severe Peripheral Artery Disease Session Title: Poster Session II
Conclusion: In this study, the presence of chronic ulcers in the lower extremities and CKD were two factors most predictive of increased all-cause total HC in a geographically diverse population of severe PAD patients.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Berger, J. S., Haskell, L., Ting, W., Lurie, F., Eapen, Z., Valko, M., Alas, V., Rich, K., Crivera, C., Schein, J. Tags: Session Title: Poster Session II Source Type: research

Abstract 159: Evaluation of Clinical Outcomes among Nonvalvular Atrial Fibrillation Patients Treated With Warfarin or Rivaroxaban Stratified by Presence or Absence of CKD in a Claims Database Session Title: Poster Session II
Conclusions: This study suggests that, in an adult population with NVAF, rivaroxaban-treated patients had fewer ischemic strokes across all patients, including patients with renal impairment. Rivaroxaban-treated patients also had significantly better outcomes for the composite (VTE, MI, or stroke) measure across all groups. Bleeding rates were comparable across all groups.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Weir, M. R., Haskell, L., Berger, J. S., Ashton, V., Laliberte, F., Crivera, C., Brown, K., Lefebvre, P., Schein, J. Tags: Session Title: Poster Session II Source Type: research

Abstract 160: Impact of Medication Adherence on Risk of Stroke, Major Bleeding and Other Outcomes in Atrial Fibrillation Patients Using Novel Oral Anticoagulants (Dabigatran and Rivaroxaban) Session Title: Poster Session II
Conclusion: In our sample, adherence to NOACs was associated with a reduction in stroke and DVTPE risk but did not substantially increase bleeding risk. Further studies with newer NOACs are warranted.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Deshpande, C. G., Willey Temkin, C., Laforge, R., Kogut, S. Tags: Session Title: Poster Session II Source Type: research

Abstract 161: Lean Process Improvements Reduce Door to CT and Door to Needle Times for Acute Ischemic Stroke Patients Session Title: Poster Session II
Conclusions: Lean process improvement methodology significantly reduces door to CT and door to needle times, supporting current AHA Target: Stroke goals and allowing faster treatment of patients with acute ischemic stroke. Incorporating time-outs into standardized processes that aim to deliver care more quickly may improve patient safety without substantially slowing down DTN times. Further investigation is required to determine whether the new process improved safety and clinical outcomes.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: McCann, C., Tkach, A., de Havenon, A., Loosli, J., Troyer, J., Bennett, A., Wold, J., Jex, A., Majersik, J. J. Tags: Session Title: Poster Session II 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

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 9, 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

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