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Identifying Strategies to Reduce Poor Outcomes in Women With Stroke Spotlight: Women and Heart Disease
Source: Circulation: Cardiovascular Quality and Outcomes - February 21, 2017 Category: Cardiology Authors: Madsen, T. E., Lisabeth, L. D. Tags: Intracranial Hemorrhage, Ischemic Stroke Spotlight: Women and Heart Disease 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 16, 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 16, 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 16, 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 16, 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

Pace of Progress in Stroke Thrombolysis: Are Hospitals Running To Stand Still? Editorial
Source: Circulation: Cardiovascular Quality and Outcomes - January 16, 2017 Category: Cardiology Authors: Mendelson, S. J., Prabhakaran, S. Tags: Health Services, Quality and Outcomes, Ischemic Stroke Editorial 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 19, 2016 Category: Cardiology Authors: Prabhakaran, S., Lee, J., ONeill, K. Tags: Health Services, Quality and Outcomes, Ischemic Stroke Original Articles Source Type: research

Long-Term Persistence of Newly Initiated Warfarin Therapy in Chinese Patients With Nonvalvular Atrial Fibrillation Original Articles
Conclusions— Nonpersistence of warfarin treatment becomes a serious problem for stroke prevention in Chinese patients with nonvalvular AF. Our findings can be used to identify patients who require closer attention or to develop better management strategy for oral anticoagulation therapy.
Source: Circulation: Cardiovascular Quality and Outcomes - July 18, 2016 Category: Cardiology Authors: Wang, Z.-Z., Du, X., Wang, W., Tang, R.-B., Luo, J.-G., Li, C., Chang, S.-S., Liu, X.-H., Sang, C.-H., Yu, R.-H., Long, D.-Y., Wu, J.-H., Bai, R., Liu, N., Ruan, Y.-F., Dong, J.-Z., Ma, C.-S. Tags: Atrial Fibrillation, Compliance/Adherence, Treatment 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

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 16, 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

Comparative Effectiveness of Carotid Artery Stenting Versus Carotid Endarterectomy Among Medicare Beneficiaries Original Articles
Conclusions— Outcomes after CAS and CEA among Medicare beneficiaries were comparable after adjusting for both patient- and provider-level factors.
Source: Circulation: Cardiovascular Quality and Outcomes - May 16, 2016 Category: Cardiology Authors: Jalbert, J. J., Nguyen, L. L., Gerhard-Herman, M. D., Kumamaru, H., Chen, C.-Y., Williams, L. A., Liu, J., Rothman, A. T., Jaff, M. R., Seeger, J. D., Benenati, J. F., Schneider, P. A., Aronow, H. D., Johnston, J. A., Brott, T. G., Tsai, T. T., White, C. Tags: Revascularization, Stent, Cerebrovascular Procedures, Stenosis 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 16, 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

Safety and Use of Anticoagulation After Aortic Valve Replacement With Bioprostheses: A Meta-Analysis Original Articles
Conclusions— Contrary to the current guidelines, a meta-analysis of previous studies suggests that anticoagulation in the setting of an aortic bioprosthesis significantly increases bleeding risk without a favorable effect on thromboembolic events. Larger, randomized controlled studies should be performed to further guide this clinical practice.
Source: Circulation: Cardiovascular Quality and Outcomes - May 16, 2016 Category: Cardiology Authors: Riaz, H., Alansari, S. A. R., Khan, M. S., Riaz, T., Raza, S., Luni, F. K., Khan, A. R., Riaz, I. B., Krasuski, R. A. Tags: Anticoagulants, Aortic Valve Replacement/Transcatheter Aortic Valve Implantation Original Articles Source Type: research

Dabigatran Versus Warfarin for Atrial Fibrillation in Real-World Clinical Practice: A Systematic Review and Meta-Analysis Original Articles
Conclusions— In real-world clinical practice, dabigatran is comparable with warfarin in preventing ischemic stroke among patients with nonvalvular atrial fibrillation. However, dabigatran is associated with a lower risk for intracranial bleeding relative to warfarin, but—particularly among the elderly—a greater risk for gastrointestinal bleeding. Bleeding outcomes from observational studies are consistent with those from the pivotal Randomized Evaluation of Long-Term Anticoagulation Therapy trial.
Source: Circulation: Cardiovascular Quality and Outcomes - March 15, 2016 Category: Cardiology Authors: Romanelli, R. J., Nolting, L., Dolginsky, M., Kym, E., Orrico, K. B. Tags: Meta Analysis, Ischemic Stroke Original Articles Source Type: research

Reimagining Anticoagulation Clinics in the Era of Direct Oral Anticoagulants Cardiovascular Perspective
Anticoagulation clinics were initially developed to provide safe and effective care for warfarin-treated patients with atrial fibrillation, venous thromboembolism, and mechanical valve replacement. Traditionally, these patients required ongoing laboratory monitoring and warfarin dose adjustment by expert providers. With the introduction of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban), many have questioned the need for anticoagulation clinic. However, we think that the growing number of oral anticoagulant choices creates an urgent need for expanding the traditional role of the anticoagulation...
Source: Circulation: Cardiovascular Quality and Outcomes - March 15, 2016 Category: Cardiology Authors: Barnes, G. D., Nallamothu, B. K., Sales, A. E., Froehlich, J. B. Tags: Atrial Fibrillation, Ethics and Policy, Health Services, Ischemic Stroke, Thrombosis Cardiovascular Perspective Source Type: research

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