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Joint Commission Primary Stroke Centers Utilize More rt-PA in the Nationwide Inpatient Sample Stroke
Conclusions Subjects evaluated at PSCs were more likely to receive rt-PA than those evaluated at non-PSCs. This association was significant after adjustment for patient and hospital-level variables. Systems of care are necessary to ensure stroke patients have rapid access to PSCs throughout the United States.
Source: JAHA:Journal of the American Heart Association - March 26, 2013 Category: Cardiology Authors: Mullen, M. T., Kasner, S. E., Kallan, M. J., Kleindorfer, D. O., Albright, K. C., Carr, B. G. Tags: Stroke Source Type: research

Contemporary Trends and Predictors of Postacute Service Use and Routine Discharge Home After Stroke Stroke
Conclusions Four in 10 stroke patients are discharged home without services. Although little has changed overall in PAC use since 2003, further research is needed to explain the shift in service use by type and its effect on outcomes.
Source: JAHA:Journal of the American Heart Association - February 23, 2015 Category: Cardiology Authors: Prvu Bettger, J., McCoy, L., Smith, E. E., Fonarow, G. C., Schwamm, L. H., Peterson, E. D. Tags: Stroke Source Type: research

Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke Health Services and Outcomes Research
The objective was to determine whether patients without insurance or with government‐sponsored insurance had worse quality of care or in‐hospital outcomes in acute ischemic stroke.Methods and ResultsMultivariable logistic regressions with generalized estimating equations stratified by age under or at least 65 years were adjusted for patient demographics and comorbidities, presenting factors, and hospital characteristics to determine differences in in‐hospital mortality and postdischarge destination. We included 589 320 ischemic stroke patients treated at 1604 US hospitals participating in the Get With The Guideline...
Source: JAHA:Journal of the American Heart Association - November 13, 2016 Category: Cardiology Authors: Medford-Davis, L. N., Fonarow, G. C., Bhatt, D. L., Xu, H., Smith, E. E., Suter, R., Peterson, E. D., Xian, Y., Matsouaka, R. A., Schwamm, L. H. Tags: Ischemic Stroke Original Research Source Type: research

Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation Arrhythmia and Electrophysiology
Conclusions Adherence to anticoagulation is poor in practice and may be modestly improved with NOACs. Adherence to therapy appears to be most important in patients with CHA2DS2-VASc score ≥2, whereas the benefits of anticoagulation may not outweigh the harms in patients with CHA2DS2-VASc score 0 or 1.
Source: JAHA:Journal of the American Heart Association - February 23, 2016 Category: Cardiology Authors: Yao, X., Abraham, N. S., Alexander, G. C., Crown, W., Montori, V. M., Sangaralingham, L. R., Gersh, B. J., Shah, N. D., Noseworthy, P. A. Tags: Arrhythmias, Atrial Fibrillation, Secondary Prevention, Intracranial Hemorrhage, Ischemic Stroke Arrhythmia and Electrophysiology Source Type: research

Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers Stroke
Conclusions Racial disparities in intravenous rt-PA use were not reduced by presentation to PSCs. Black patients were less likely to receive thrombolytic treatment than white patients at both non-PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt-PA in the fully adjusted model.
Source: JAHA:Journal of the American Heart Association - October 14, 2015 Category: Cardiology Authors: Aparicio, H. J., Carr, B. G., Kasner, S. E., Kallan, M. J., Albright, K. C., Kleindorfer, D. O., Mullen, M. T. Tags: Stroke Source Type: research

Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study Epidemiology
Conclusions Proximal depressive symptoms were associated with incident fatal and nonfatal stroke and CVD death even after controlling for multiple explanatory factors, further supporting the urgent need for timely management of depressive symptoms.
Source: JAHA:Journal of the American Heart Association - August 11, 2016 Category: Cardiology Authors: Moise, N., Khodneva, Y., Richman, J., Shimbo, D., Kronish, I., Safford, M. M. Tags: Quality and Outcomes Epidemiology Source Type: research

Effectiveness and Safety of Dabigatran, Rivaroxaban, and Apixaban Versus Warfarin in Nonvalvular Atrial Fibrillation Health Services and Outcomes Research
Conclusions In patients with nonvalvular atrial fibrillation, apixaban was associated with lower risks of both stroke and major bleeding, dabigatran was associated with similar risk of stroke but lower risk of major bleeding, and rivaroxaban was associated with similar risks of both stroke and major bleeding in comparison to warfarin.
Source: JAHA:Journal of the American Heart Association - June 12, 2016 Category: Cardiology Authors: Yao, X., Abraham, N. S., Sangaralingham, L. R., Bellolio, M. F., McBane, R. D., Shah, N. D., Noseworthy, P. A. Tags: Atrial Fibrillation, Secondary Prevention, Anticoagulants, Transplantation, Cerebrovascular Disease/Stroke Health Services and Outcomes Research Source Type: research

Comparative Effectiveness and Safety of Dabigatran and Rivaroxaban in Atrial Fibrillation Patients Arrhythmia and Electrophysiology
ConclusionsRivaroxaban therapy was associated with a statistically significant increase in all‐cause death compared with dabigatran therapy in atrial fibrillation patients.
Source: JAHA:Journal of the American Heart Association - April 24, 2017 Category: Cardiology Authors: Lai, C.-L., Chen, H.-M., Liao, M.-T., Lin, T.-T., Chan, K. A. Tags: Arrhythmias, Anticoagulants, Pharmacology, Cerebrovascular Disease/Stroke Original Research Source Type: research

Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA2DS2-VASc Score of 1 (Men) or 2 (Women)? Arrhythmia and Electrophysiology
ConclusionsFor atrial fibrillation patients aged 20 to 49 years with 1 risk factor in addition to sex, non–vitamin K antagonist OACs should be considered for stroke prevention to minimize the risk of a potentially fatal or disabling event.
Source: JAHA:Journal of the American Heart Association - October 3, 2016 Category: Cardiology Authors: Hung, Y., Chao, T.-F., Liu, C.-J., Tuan, T.-C., Lin, Y.-J., Chang, S.-L., Lo, L.-W., Hu, Y.-F., Liao, J.-N., Chung, F.-P., Lin, W.-Y., Lin, W.-S., Cheng, S.-M., Chen, T.-J., Lip, G. Y. H., Chen, S.-A. Tags: Atrial Fibrillation Original Research Source Type: research

Clinical Characteristics, Oral Anticoagulation Patterns, and Outcomes of Medicaid Patients With Atrial Fibrillation: Insights From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF I) Registry Health Services and Outcomes Research
Conclusions In a contemporary AF cohort, use of OAC overall and use of NOACs were not significantly lower among Medicaid patients relative to others. However, among warfarin users, Medicaid patients spent less time in therapeutic range compared with those with other forms of insurance.
Source: JAHA:Journal of the American Heart Association - May 3, 2016 Category: Cardiology Authors: O'Brien, E. C., Kim, S., Thomas, L., Fonarow, G. C., Kowey, P. R., Mahaffey, K. W., Gersh, B. J., Piccini, J. P., Peterson, E. D. Tags: Atrial Fibrillation, Primary Prevention, Health Services, Quality and Outcomes Health Services and Outcomes Research Source Type: research

Short-Term Risk of Bleeding During Heparin Bridging at Initiation of Vitamin K Antagonist Therapy in More Than 90 000 Patients With Nonvalvular Atrial Fibrillation Managed in Outpatient Care Epidemiology
BackgroundSeveral studies have recently examined the risks of bleeding and of ischemic stroke and systemic embolism associated with perioperative heparin bridging anticoagulation in patients with nonvalvular atrial fibrillation. However, few studies have investigated bridging risks during vitamin K antagonist initiation in outpatient settings.Methods and ResultsA retrospective cohort study was conducted on individuals starting oral anticoagulation between January 2010 and November 2014 for nonvalvular atrial fibrillation managed in outpatient care and identified from French healthcare insurance. Bleeding and ischemic strok...
Source: JAHA:Journal of the American Heart Association - October 30, 2016 Category: Cardiology Authors: Bouillon, K., Bertrand, M., Boudali, L., Ducimetiere, P., Dray-Spira, R., Zureik, M. Tags: Atrial Fibrillation, Epidemiology Original Research Source Type: research

Early Adoption of Dabigatran and Its Dosing in US Patients With Atrial Fibrillation: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation Health Services and Outcomes Research
Conclusions Patients receiving dabigatran were younger and at a lower risk of stroke and bleeding. Patients appeared to drive switching from warfarin, whereas clinical characteristics influenced de novo start of dabigatran. These data suggest cautious early uptake of dabigatran, and more careful attention to dosing adjustments is warranted. Clinical Trial Registration URL: Clinicaltrials.gov. Unique identifier: NCT01165710.
Source: JAHA:Journal of the American Heart Association - November 25, 2013 Category: Cardiology Authors: Steinberg, B. A., Holmes, D. N., Piccini, J. P., Ansell, J., Chang, P., Fonarow, G. C., Gersh, B., Mahaffey, K. W., Kowey, P. R., Ezekowitz, M. D., Singer, D. E., Thomas, L., Peterson, E. D., Hylek, E. M., The Outcomes Registry for Better Informed Treatme Tags: Health Services and Outcomes Research Source Type: research

Long-Term Risk of Cardiovascular Events in Patients With Chronic Kidney Disease Who Have Survived Sepsis: A Nationwide Cohort Study Epidemiology
ConclusionsOur findings highlight the association of sepsis with a significantly increased long‐term risk of cardiovascular events among survivors in the chronic kidney disease population.
Source: JAHA:Journal of the American Heart Association - February 10, 2017 Category: Cardiology Authors: Shih, C.-J., Chao, P.-W., Ou, S.-M., Chen, Y.-T. Tags: Cardiovascular Disease, Epidemiology, Risk Factors Original Research Source Type: research