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Abstract 260: Patient Characteristics, In-hospital Mortality and the Use of Comfort-Focused Care among Patients presenting with Acute Ischemic Stroke Session Title: Poster Session II
Conclusion: While comfort-focused care was provided to only 10% of stroke admissions, it occurred in over 80% of all patients who died in-hospital. Early CMO patients received aggressive intervention with IA therapy less often and appear to have had fewer infectious complications, suggesting that poor initial neurologic prognosis and advanced directives may have contributed more than progressive deterioration to the decision to change care goals. Larger prospective studies are needed to better understand the drivers of decision-making in this population, and set realistic expectations about the likely duration of patient s...
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Ali, S. F., Faheem, U., Cohen, A. S., Singhal, A. B., Schwamm, L. H. Tags: Session Title: Poster Session II Source Type: research

Abstract 265: TeleStroke: Expanding Access and Coordination of Care from Acute Stroke to Follow-up Session Title: Poster Session II
The objective of this study was to develop a novel pathway for follow-up care after inpatient admissions for acute ischemic stroke (AIS) utilizing the existing telestroke infrastructure, with the goals of improving quality outcomes, reducing patient costs, and increasing access to care.Methods: Utilizing LEAN methodology, the existing care model was process-mapped to assess for potential areas of improvement. Over one month in 2013, a convenience sample of 27 inpatients admitted with AIS were surveyed to assess for potential barriers associated with travel to appointments, as well as for attitudes towards utilizing tele-he...
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Hannon, P. M., Austin, J., McCauley, M. J., Smith, D., Smith, A. G., Salari, A., Majersik, J. J. Tags: Session Title: Poster Session II Source Type: research

Abstract 266: No Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke Session Title: Poster Session II
Conclusions: In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes. Given that these systems often create significant added burden for clinicians, further work to ensure that they are better integrated with care and fully evidence-driven is critical.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Joynt, K. E., Bhatt, D. L., Schwamm, L. H., Xian, Y., Heidenreich, P. A., Fonarow, G. C., Smith, E. E., Grau-Sepulveda, M. V., Hernandez, A. F. Tags: Session Title: Poster Session II Source Type: research

Abstract 269: Does Functional Recovery After Stroke Vary by Hospital Type? Session Title: Poster Session II
Conclusions: A third of acute ischemic stroke patients had moderate-severe disability three months after hospital discharge and these rates varied considerably among U.S. hospitals. Receiving stroke care at a teaching or primary stroke center hospital was associated with significantly better post discharge functional status.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Prvu Bettger, J., Liang, L., Thomas, L., Bushnell, C., Xian, Y., Wu, J., Peterson, E. D. Tags: Session Title: Poster Session II Source Type: research

Abstract 271: Anti-coagulation and Ischemic Stroke Risk in Patients with Chronic Kidney Disease and Atrial Fibrillation: Insights from the Kaiser Permanente Colorado Atrial Fibrillation Registry Session Title: Poster Session II
Conclusion: 1 in 3 patients with atrial fibrillation have CKD. There were similar reductions in the risk of stroke associated with warfarin use for CKD and non-CKD patients. These findings reinforce current clinical practice guidelines, which recommend warfarin use based on thromboembolic risk without consideration for CKD status.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Schneider, P. M., Tavel, H. M., Witt, D. M., Kauffman, Y. S., Shetterly, S. M., Go, A. S., Ho, P. M., Magid, D. J. Tags: Session Title: Poster Session II Source Type: research

Abstract 272: Preliminary Data from RESOLVE (Rapid Evaluation for Stroke Outcomes using Lytics in Vascular Events) Study Session Title: Poster Session II
Conclusions: Preliminary findings showed that less than half of the patients and CG felt the education was clear. However additional interviews are planned. Preliminary insights suggest an opportunity to use an individualized risk and benefit decision tool to inform and engage patients and CG regarding treatment decisions. We believe this can be accomplished without increasing the door to needle time in administration of rt-PA.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Summers, D., Chhatriwalla, E., Gialde, E., Spertus, J., Decker, C. Tags: Session Title: Poster Session II Source Type: research

Abstract 274: Prevalence of undiagnosed non-valvular atrial fibrillation in the United States Session Title: Poster Session II
Conclusions: Among elderly and working adult U.S. populations, a substantial proportion of individuals with undiagnosed AF have moderate to high risk of stroke. Screening for AF could favorably impact the disease burden.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Turakhia, M. P., Shafrin, J., Bognar, K., Brown, J. B., Trocio, J., Wiederkehr, D., Goldman, D. P. Tags: Session Title: Poster Session II Source Type: research

Abstract 276: Asymmetric Dimethylarginine Is A Potential Risk Factor For Transient Ischemic Attack Session Title: Poster Session II
Conclusion: ADMA and VEGF are absolutely increased in TIAs. There is no correlation between ADMA, VEGF, age, sex, blood pressure, glucose and ABCD2 in this small sample size population. But ADMA is probably associated with risk of TIA with no-stroke history. Thus, these findings reveal a possibly new challenging potential of the ADMA and VEGF role in the pathogenesis of TIA.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Zhang, Y., Laskowitz, D., Fan, D. Tags: Session Title: Poster Session II Source Type: research

Abstract 277: Conveying Risks and Benefits of rt-PA: the Eyes Have It Session Title: Poster Session II
Conclusions: Our preliminary data suggest that stacked bar graphs facilitate better understanding of the risks and benefits of rt-PA in acute IS. Presenting data in this format could better engage patients and families in making treatment decisions in the setting of IS.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Decker, C., Poirier, M. W., Chhatriwalla, E., Gialde, E., Spertus, J. A., Mayhugh, T. M., Schleicher, K. M., McDowd, J. M. Tags: Session Title: Poster Session II Source Type: research

Abstract 304: Nonfatal Outcomes Following Incident Atrial Fibrillation: A Community Study Session Title: Poster Session III
Conclusions: In the community, adverse outcomes are frequent after AF, and HF occurs more frequently than IS/TIA. Risk factors differed for IS/TIA and HF, suggesting that pathways to the occurrence of these outcomes, as well as prevention strategies, may differ. Finally, the occurrence of these outcomes did not decline over the last decade, highlighting the importance of continued rigorous surveillance of adverse outcomes in AF.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Chamberlain, A. M., Gersh, B. J., Alonso, A., Brown, R. D., Weston, S. A., Roger, V. L. Tags: Session Title: Poster Session III Source Type: research

Abstract 28: Readmissions after Carotid Artery Revascularization in the Medicare Population Session Title: Concurrent III Session A: Oral Abstracts on Outcomes Issues
Conclusions: Almost 10% of Medicare patients undergoing carotid revascularization were readmitted within 30 days of discharge. Compared with CEA, CAS was associated with higher 30-day readmission rates. However, hospitals’ RSRR did not differ by their proportional use of CAS volume. Efforts to identify readmission risk factors are needed to reduce rates of readmissions following carotid revascularization.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Al-Damluji, M. S., Zhang, W., Stilp, E., Geary, L., Mena-Hurtado, C., Curtis, J. P. Tags: Session Title: Concurrent III Session A: Oral Abstracts on Outcomes Issues Source Type: research

Abstract 162: Treatment Patterns and Health Resource Utilization among Patients with Atrial Fibrillation in United Arab Emirates and Saudi Arabia Session Title: Poster Session I
CONCLUSIONS: Patients with AF in UAE and KSA were relatively young compared to age distributions reported in other regions. Treatments and health resources used by AF patients varied between KSA and UAE. Warfarin monotherapy was widely used in UAE, while a variety of monotherapy and combination therapy regimens were used in KSA. Health care resource utilization was high in this population, particularly hospitalization rates in KSA. While some differences may result from differences in patient and disease characteristics, they likely also reflect variation in management strategies across the regions.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Johnston, K. M., Osenenko, K. M., Donato, B. M., Qatami, L., Alsheikh-Ali, A., Binbrek, A. S., Hersi, A. S., Mould, J. F., Levy, A. R. Tags: Session Title: Poster Session I Source Type: research

Abstract 163: Hurry Acute Stroke Treatment and Evaluation (HASTE): Improving Door-to-Needle Times and Reducing Variation for Acute Ischemic Stroke using a Six-Sigma Approach Session Title: Poster Session I
Conclusions: The use of quality improvement approaches such as six-sigma can result in significant improvement in DTN. The data-driven approach of six-sigma allowed the Calgary Stroke Program to identify and improve various processes that effect the DTN time, which resulted in a lower average DTN time and a reduction in variation.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Kamal, N., Smith, E. E., Demchuk, A. M., Hill, M. D., Stephenson, C., Suddes, M., Kashyap, D. Tags: Session Title: Poster Session I Source Type: research

Abstract 169: The Role Of Clinical Prediction Factors On Anticoagulant Selection In Atrial Fibrillation Session Title: Poster Session I
Conclusions: Despite controlling for other patient characteristics, bleeding risk was strongly associated with the selection of a specific anticoagulant. However, the extent of selection explained by predictions of treatment harm was minimal. Providers appear to base anticoagulant selection on factors other than predictions of treatment benefit, which has implications for studying the anticoagulants’ comparative effectiveness.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Lauffenburger, J. Tags: Session Title: Poster Session I Source Type: research

Abstract 201: Gemfibrozil In Combination With Statin Is Associated With Reduction In All Cause Mortality: A Retrospective Cohort Study Session Title: Poster Session II
Conclusion: Combination of gemfibrozil with statin is associated with greater reduction in all cause mortality compared to statins alone.Keywords: gemfibrozil, mortality
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Aryal, S. R., Newman, W. Tags: Session Title: Poster Session II Source Type: research

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