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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

Patient Characteristics and Outcomes After Hemorrhagic Stroke in Pregnancy Original Articles
Conclusions— Pregnant HS patients are younger and have fewer risk factors than their nonpregnant counterparts, and risk-adjusted in-hospital mortality is lower. Our findings suggest possible differences in underlying disease pathophysiology and challenges to identifying at-risk patients.
Source: Circulation: Cardiovascular Quality and Outcomes - October 29, 2015 Category: Cardiology Authors: Leffert, L. R., Clancy, C. R., Bateman, B. T., Cox, M., Schulte, P. J., Smith, E. E., Fonarow, G. C., Schwamm, L. H., Kuklina, E. V., George, M. G. Tags: Epidemiology, Cerebral Aneurysm, Intracranial Hemorrhage 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

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

Insulin Resistance and Risk of Cardiovascular Disease in Postmenopausal Women: A Cohort Study From the Women's Health Initiative Original Articles
Conclusions— Measures of insulin resistance were no longer associated with CVD risk after adjustment for high-density lipoprotein-cholesterol and did not provide independent prognostic information in postmenopausal women without diabetes mellitus. Clinical Trial Registration Information— URL: http://www.clinicaltrial.gov. Unique identifier: NCT00000611.
Source: Circulation: Cardiovascular Quality and Outcomes - May 19, 2015 Category: Cardiology Authors: Schmiegelow, M. D., Hedlin, H., Stefanick, M. L., Mackey, R. H., Allison, M., Martin, L. W., Robinson, J. G., Hlatky, M. A. Tags: Health policy and outcome research, Risk Factors, Acute myocardial infarction, Acute Cerebral Infarction, Epidemiology Original Articles Source Type: research

Abstract 11: Compliance With Risk Factor Optimization and Medical Therapy in Patients With Peripheral Vascular Disease (Peripheral Artery and Ischemic Cerebrovascular Disease) Compared to Ischemic Heart Disease. Session Title: Concurrent Session IIB: Oral Abstracts - Quality of Care
Conclusions: Compliance with OMT was low in all patients. Patients with PAD or ICVD were less likely to receive OMT compared with IHD. Our results suggest potential for improvement in OMT for all CVD patients especially those with PAD and ICVD.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Hira, R. S., Pokharel, Y., Cowart, J., Akeroyd, J. M., Ramsey, D., Nambi, V., Jneid, H., Deswal, A., Denktas, A., Ballantyne, C. M., Petersen, L. A., Virani, S. S. Tags: Session Title: Concurrent Session IIB: Oral Abstracts - Quality of Care 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 24: Acute Cardiac Care in China: A Needs Assessment Session Title: Concurrent Session IIIA: Oral Abstracts - Policy
Conclusion: The delivery of care for acute cardiac event in the two cities were suboptimal. Interventions are urgently needed. In particular, a holistic approach including the promotion of public knowledge, improvement in frontline health workers’ training and support, as well as enhancement of data registry and monitoring are necessary.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Ng, M., Thomson, B., Li, Y., Zhou, M., Wang, L., Philips, B., Brown, J., Roth, G. A., Wang, H., HeartRescue China Tags: Session Title: Concurrent Session IIIA: Oral Abstracts - Policy Source Type: research

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