1-07-32 Outcome of ischemic stroke in Poland and in the United States in regard to stroke severity

1997 ◽  
Vol 150 ◽  
pp. S14
Author(s):  
D. Ryglewicz ◽  
D. Hier ◽  
M. Wiszniewska ◽  
M. Barańska-Gieruszczak ◽  
S. Cichy ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
The United States ◽  
Stroke Severity

scholarly journals Access to Mechanical Thrombectomy for Ischemic Stroke in the United States

Stroke ◽  
2021 ◽  
Author(s):  
Hooman Kamel ◽  
Neal S. Parikh ◽  
Abhinaba Chatterjee ◽  
Luke K. Kim ◽  
Jeffrey L. Saver ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
The United States ◽  
Sensitivity Analyses ◽  
Stroke Severity ◽  
Discharge Data ◽  
Cerebral Vessel

Background and Purpose: Mechanical thrombectomy helps prevent disability in patients with acute ischemic stroke involving occlusion of a large cerebral vessel. Thrombectomy requires procedural expertise and not all hospitals have the staff to perform this intervention. Few population-wide data exist regarding access to mechanical thrombectomy. Methods: We examined access to thrombectomy for ischemic stroke using discharge data from calendar years 2016 to 2018 from all nonfederal emergency departments and acute care hospitals across 11 US states encompassing 80 million residents. Facilities were classified as hubs if they performed mechanical thrombectomy, gateways if they transferred patients who ultimately underwent mechanical thrombectomy, and gaps otherwise. We used standard descriptive statistics and unadjusted logistic regression models in our primary analyses. Results: Among 205 681 patients with ischemic stroke, 100 139 (48.7% [95% CI, 48.5%–48.9%]) initially received care at a thrombectomy hub, 72 534 (35.3% [95% CI, 35.1%–35.5%]) at a thrombectomy gateway, and 33 008 (16.0% [95% CI, 15.9%–16.2%]) at a thrombectomy gap. Patients who initially received care at thrombectomy gateways were substantially less likely to ultimately undergo thrombectomy than patients who initially received care at thrombectomy hubs (odds ratio, 0.27 [95% CI, 0.25–0.28]). Rural patients had particularly limited access: 27.7% (95% CI, 26.9%–28.6%) of such patients initially received care at hubs versus 69.5% (95% CI, 69.1%–69.9%) of urban patients. For 93.8% (95% CI, 93.6%–94.0%) of patients with stroke at gateways, their initial facility was capable of delivering intravenous thrombolysis, compared with 76.3% (95% CI, 75.8%–76.7%) of patients at gaps. Our findings were unchanged in models adjusted for demographics and comorbidities and persisted across multiple sensitivity analyses, including analyses adjusting for estimated stroke severity. Conclusions: We found that a substantial proportion of patients with ischemic stroke across the United States lacked access to thrombectomy even after accounting for interhospital transfers. US systems of stroke care require further development to optimize thrombectomy access.

scholarly journals Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States

2020 ◽  
Vol 13 ◽  
pp. 175628642097189
Author(s):  
Clare Lambert ◽  
Durgesh Chaudhary ◽  
Oluwaseyi Olulana ◽  
Shima Shahjouei ◽  
Venkatesh Avula ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Competing Risk ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Central Pennsylvania ◽  
All Cause Mortality

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention

Stroke ◽  
2021 ◽  
Author(s):  
Ying Xian ◽  
Haolin Xu ◽  
Eric E. Smith ◽  
Jeffrey L. Saver ◽  
Mathew J. Reeves ◽  
...  
Keyword(s):  
United States ◽  
Quality Improvement ◽  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Phase I ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
The United States

Background and Purpose: The benefits of tPA (tissue-type plasminogen activator) in acute ischemic stroke are time-dependent. However, delivery of thrombolytic therapy rapidly after hospital arrival was initially occurring infrequently in hospitals in the United States, discrepant with national guidelines. Methods: We evaluated door-to-needle (DTN) times and clinical outcomes among patients with acute ischemic stroke receiving tPA before and after initiation of 2 successive nationwide quality improvement initiatives: Target: Stroke Phase I (2010–2013) and Target: Stroke Phase II (2014–2018) from 913 Get With The Guidelines-Stroke hospitals in the United States between April 2003 and September 2018. Results: Among 154 221 patients receiving tPA within 3 hours of stroke symptom onset (median age 72 years, 50.1% female), median DTN times decreased from 78 minutes (interquartile range, 60–98) preintervention, to 66 minutes (51–87) during Phase I, and 50 minutes (37–66) during Phase II ( P <0.001). Proportions of patients with DTN ≤60 minutes increased from 26.4% to 42.7% to 68.6% ( P <0.001). Proportions of patients with DTN ≤45 minutes increased from 10.1% to 17.7% to 41.4% ( P <0.001). By the end of the second intervention, 75.4% and 51.7% patients achieved 60-minute and 45-minute DTN goals. Compared with the preintervention period, hospitals during the second intervention period (2014–2018) achieved higher rates of tPA use (11.7% versus 5.6%; adjusted odds ratio, 2.43 [95% CI, 2.31–2.56]), lower in-hospital mortality (6.0% versus 10.0%; adjusted odds ratio, 0.69 [0.64–0.73]), fewer bleeding complication (3.4% versus 5.5%; adjusted odds ratio, 0.68 [0.62–0.74]), and higher rates of discharge to home (49.6% versus 35.7%; adjusted odds ratio, 1.43 [1.38–1.50]). Similar findings were found in sensitivity analyses of 185 501 patients receiving tPA within 4.5 hours of symptom onset. Conclusions: A nationwide quality improvement program for acute ischemic stroke was associated with substantial improvement in the timeliness of thrombolytic therapy start, increased thrombolytic treatment, and improved clinical outcomes.

scholarly journals Burden of Atrial Fibrillation–Associated Ischemic Stroke in the United States

2018 ◽  
Vol 4 (5) ◽  
pp. 618-625 ◽  
Author(s):  
Mohamad Alkhouli ◽  
Fahad Alqahtani ◽  
Sami Aljohani ◽  
Muhammad Alvi ◽  
David R. Holmes
Keyword(s):  
United States ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
The United States

Abstract 504: Regional Variations of Ischemic Stroke in The United States

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Prateeth Pati ◽  
Adnan Khalif ◽  
Balaji Shanmugam
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Seasonal Variation ◽  
Acute Ischemic Stroke ◽  
Geographic Distribution ◽  
The United States ◽  
Categorical Variables ◽  
The South ◽  
Admission Rates ◽  
Chi Square Analysis

Geographic Distribution of Acute Ischemic Stroke admissions in the United States Background: The geographic distribution of acute ischemic stroke in the United States has not been evaluated, unlike the association shown with acute MI by Patel et al., (International Journal of Cardiology, 2014, 172.3). Our study looked at the geographic distribution and seasonal variation of acute ischemic stroke using the National Inpatient Sample (NIS) from 2011 - 2013. Methods: Adult admissions with a primary diagnosis of acute ischemic stroke were extracted from the NIS database using the ICD 9 code 434.91 from 2011 - 2013. Admission information included hospital region (West, South, Mid-Atlantic and Northwest) and seasonal admission rates (Winter=December-February, Spring=March-May, Summer=June-August, Fall=September-November). A Chi square analysis was used to analyze differences in categorical variables (we assumed a normal distribution of 25% per region). Results: A total of 120714 admissions were identified (weighted = 603361). There were more cases of acute ischemic stroke in the South (41.52 percent of admissions) compared to the mid Atlantic (21.4), Northwest (17.98) or West (19.08) with a p value < 0.0001. Each year between 2011 to 2013 showed a higher rate of admissions for acute ischemic stroke in the South. Taking the years into summation showed no statistically significant difference in seasonal variation in any of the regions. Conclusion: Our study shows a higher number of admissions for acute ischemic stroke in the South, but failed to show any seasonal differences. However, there are several studies that suggest a preponderance of admissions for acute myocardial infarction during the winter season, Spencer et al., (Journal of the American College of Cardiology, 1998, 31.2.) Further studies are needed to identify why there is a significant regional difference in the admission rates for acute ischemic stroke.

Abstract 45: Thrombolytic Treatment for In-Hospital Ischemic Strokes in United States

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Tenbit Emiru ◽  
Malik M Adil ◽  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Clinical Characteristics ◽  
The United States ◽  
Treated Group ◽  
Hospital Charges ◽  
Thrombolytic Treatment

BACKGROUND: Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital acute ischemic stroke, there is little data on rates and outcomes of patients receiving thrombolytics for in-hospital ischemic strokes. OBJECTIVE: To determine the rates of in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated with thrombolytics on admission. DESIGN/METHODS: We analyzed a seven-year data (2002-2009) from the National Inpatient Survey (NIS), a nationally representative inpatient database in the United States. We identified patients who had in-hospital ischemic strokes (defined by thrombolytic treatment after one day of hospitalization) and those who received thrombolytics on the admission day. We compared demographics, baseline clinical characteristics, in hospital complications, length of stay, hospitalization charges, and discharge disposition, between the two patient groups. RESULT: A total of 18036 (21.5%) and 65912 (78.5%) patients received thrombolytics for in-hospital and on admission acute ischemic stroke, respectively. In hospital complications such as pneumonia (5.0% vs. 3.4%, p=0.0006), deep venous thrombosis (1.9% vs. 0.6%, p<0.0001) and pulmonary embolism (0.8% vs. 0.4%, p=0.01) were significantly higher in the in-hospital group compared to on admission thrombolytic treated group. Hospital length of stay and mean hospital charges were not different between the two groups. Patients who had in-hospital strokes had had higher rates of in hospital mortality (12.1% vs. 10.6%, p=0.02). In a multivariate analysis, in-hospital thrombolytic treated group had higher in-hospital mortality after adjustment for age, gender and baseline clinical characteristics (odds ratio 0.84, 95% confidence interval 0.74-0.95, p=0.008). CONCLUSION/RELEVANCE: In current practice, one out of every five acute ischemic stroke patients treated with thrombolytics is receiving treatment for in-hospital strokes. The higher mortality and complicated hospitalization in such patients needs to be recognized.

Abstract TP77: Race/Ethnic Disparity Trends in tPA Administration in the United States

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Michelle P Lin ◽  
Steven Cen ◽  
Amytis Towfighi ◽  
May Kim-Tenser ◽  
William Mack ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Rate Ratio ◽  
The United States ◽  
Racial Groups ◽  
Primary Analysis ◽  
Targeted Interventions ◽  
Yearly Change ◽  
Administration Rate

Introduction: Prior studies have shown racial disparities in tPA use for acute ischemic stroke. With the implementation of nationwide quality improvement measures, we sought to describe the temporal change in racial disparity in tPA administration. Hypothesis: Disparity in tPA administration improved across all racial groups in the past decade Methods: Data were obtained from all US states that contributed to the Nationwide Inpatient Sample. All patients (N=5,932,175) admitted to hospitals between 2000 and 2010 with a discharge diagnosis of ischemic stroke (ICD9 codes) were included. Primary analysis was the proportion of patients who received tPA administration stratified by race (white, black, Hispanic, Asian) temporally. Survey-weighted Poisson regression was used to estimate the rate ratio and compare the trend for yearly change between race categories. Results: Of the patients with ischemic stroke, 55.4% were white, black 11.89%, Hispanic 5.32%, Asian 1.89%, others 1.77%, missing race 23.31%. tPA administration rate increased from 2000 to 2010 regardless of race. In 2000, tPA administration rate was 0.96%, 0.40%, 0.73%, 0.59% in white, black, Hispanic, Asian, respectively. In 2010, tPA administration rate was 4.0%, 2.14%, 2.09%, 2.13% respectively. The relative change was the greatest in black with rate ratio of 6.7 (5.95-7.54), compared to other racial groups, Asian 5.36 (4.23-6.78), Hispanic 3.93 (3.42-4.51), and white 3.88 (3.74-4.03). Conclusions: Over the last decade, the rate of tPA administration for acute ischemic stroke in the United States have increased for every racial group. There is a lasting but improved disparity in tPA administration in non-white race. Targeted interventions designed to increase treatment and close disparity gap focusing on culturally tailored education and communications to address barriers need to be further explored.

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