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Validity of International Classification of Disease Codes to Identify Ischemic Stroke and Intracranial Hemorrhage Among Individuals With Associated Diagnosis of Atrial Fibrillation Original Articles
Conclusions— Using ICD-9 stroke and AF codes to identify patients with stroke plus AF resulted in inaccuracies. Given the expanded financial and policy implications of patient-oriented research, conclusions derived solely from administrative data without validation of outcome events should be interpreted with caution.
Source: Circulation: Cardiovascular Quality and Outcomes - January 20, 2015 Category: Cardiology Authors: Thigpen, J. L., Dillon, C., Forster, K. B., Henault, L., Quinn, E. K., Tripodis, Y., Berger, P. B., Hylek, E. M., Limdi, N. A. Tags: Health policy and outcome research, Acute Cerebral Hemorrhage, Acute Cerebral Infarction Original Articles Source Type: research

Conflicting Results Between Randomized Trials and Observational Studies on the Impact of Proton Pump Inhibitors on Cardiovascular Events When Coadministered With Dual Antiplatelet Therapy: Systematic Review Original Articles
Conclusions— Large, well-conducted observational studies of PPIs and randomized controlled trials of omeprazole seem to provide conflicting results for the effect of PPIs on cardiovascular outcomes when coadministered with DAPT. Prospective trials that directly compare pharmacodynamic parameters and clinical events among specific PPI agents in patients with unstable angina/non–ST-segment–elevation myocardial infarction treated with DAPT are warranted.
Source: Circulation: Cardiovascular Quality and Outcomes - January 20, 2015 Category: Cardiology Authors: Melloni, C., Washam, J. B., Jones, W. S., Halim, S. A., Hasselblad, V., Mayer, S. B., Heidenfelder, B. L., Dolor, R. J. Tags: Secondary prevention Original Articles Source Type: research

Age-Specific Performance of the Revised Cardiac Risk Index for Predicting Cardiovascular Risk in Elective Noncardiac Surgery Original Articles
Conclusions— In a nationwide unselected cohort, the performance of the RCRI was similar to that of the original cohort. Having ≥1 risk factor was of moderate sensitivity, but high negative predictive value for all ages.
Source: Circulation: Cardiovascular Quality and Outcomes - January 20, 2015 Category: Cardiology Authors: Andersson, C., Wissenberg, M., Jorgensen, M. E., Hlatky, M. A., Merie, C., Jensen, P. F., Gislason, G. H., Kober, L., Torp-Pedersen, C. Tags: Other diagnostic testing Original Articles Source Type: research

{beta}-Blockers and Cardiovascular Events in Patients With and Without Myocardial Infarction: Post Hoc Analysis From the CHARISMA Trial Original Articles
Conclusions— β-blocker use in patients with prior MI but no heart failure was associated with a lower composite cardiovascular outcome driven by lower risk of recurrent MI with no difference in mortality. However, β-blocker use was not associated with lower cardiovascular events in those without MI, with a suggestion of inferior outcome with regard to stroke risk. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00050817.
Source: Circulation: Cardiovascular Quality and Outcomes - November 18, 2014 Category: Cardiology Authors: Bangalore, S., Bhatt, D. L., Steg, P. G., Weber, M. A., Boden, W. E., Hamm, C. W., Montalescot, G., Hsu, A., Fox, K. A. A., Lincoff, A. M. Tags: Secondary prevention Original Articles 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

Improving Quality Measurement for Anticoagulation: Adding International Normalized Ratio Variability to Percent Time in Therapeutic Range Original Articles
Conclusions— Unstable anticoagulation predicts warfarin adverse effects independent of TTR. Moreover, knowledge about anticoagulation stability further stratifies the risk for adverse events at given levels of TTR.
Source: Circulation: Cardiovascular Quality and Outcomes - September 16, 2014 Category: Cardiology Authors: Razouki, Z., Ozonoff, A., Zhao, S., Jasuja, G. K., Rose, A. J. Tags: Coagulation, Coumarins, Thrombosis risk factors, Embolic stroke, Anticoagulants 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

Validity of Claims-Based Stroke Algorithms in Contemporary Medicare Data: Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study Linked With Medicare Claims Methods Paper
Conclusions— Claims-based algorithms to identify stroke in a contemporary Medicare cohort had high positive predictive value and specificity, supporting their use as outcomes for etiologic and comparative effectiveness studies in similar populations. These inpatient algorithms are unsuitable for estimating stroke incidence because of low sensitivity.
Source: Circulation: Cardiovascular Quality and Outcomes - July 15, 2014 Category: Cardiology Authors: Kumamaru, H., Judd, S. E., Curtis, J. R., Ramachandran, R., Hardy, N. C., Rhodes, J. D., Safford, M. M., Kissela, B. M., Howard, G., Jalbert, J. J., Brott, T. G., Setoguchi, S. Tags: Health policy and outcome research, Acute Cerebral Hemorrhage, Acute Cerebral Infarction Methods Paper 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 15: Frequency and Predictors of Inappropriate Aspirin Prescribing for Primary Prevention of Cardiovascular Disease: Insights from the NCDR(R) PINNACLE Registry. Session Title: Concurrent I Session C: Young Investigator Award Finalists Oral Abstract Presentations
Conclusion: Inappropriate aspirin prescribing occurs in approximately one third of patients receiving aspirin for primary prevention. There is modest but significant practice-level variation. Our findings identify opportunities to improve evidence-based aspirin prescribing in primary CVD prevention.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Hira, R. S., Kennedy, K. F., Nambi, V., Jneid, H., Alam, M., Basra, S. S., Ho, M., Deswal, A., Ballantyne, C. M., Petersen, L. A., Virani, S. S. Tags: Session Title: Concurrent I Session C: Young Investigator Award Finalists Oral Abstract Presentations Source Type: research

Abstract 17: Hospital Variation in Thrombolysis Times in Acute Ischemic Stroke Patients: the Contributions of Door-to-Imaging Time and Imaging-to-Needle Time Session Title: Concurrent I Session C: Young Investigator Award Finalists Oral Abstract Presentations
Conclusion: Compared to door-to-imaging time, imaging-to-needle time was more closely correlated with DTN and a much greater contributor to variability in hospital door-to-needle times. More attention to systems changes that can decrease imaging-to-needle time for acute ischemic stroke patients is now needed.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Sauser, K., Levine, D. A., Nickles, A. V., Reeves, M. J. Tags: Session Title: Concurrent I Session C: Young Investigator Award Finalists Oral Abstract Presentations Source Type: research

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