Characteristics, Performance Measures, and In-Hospital Outcomes of the First One Million Stroke and Transient Ischemic Attack Admissions in Get With The Guidelines-Stroke

2010 ◽  
Vol 2010 ◽  
pp. 19-20
Author(s):  
A. Rabinstein
Keyword(s):  
Performance Measures ◽  
Transient Ischemic Attack ◽  
Hospital Outcomes ◽  
Ischemic Attack ◽  
Get With The Guidelines

Outcomes of Carotid Revascularization in the Treatment of Restenosis After Prior Carotid Endarterectomy

Stroke ◽  
2021 ◽  
Author(s):  
Nadin Elsayed ◽  
Ganesh Ramakrishnan ◽  
Isaac Naazie ◽  
Sharvil Sheth ◽  
Mahmoud B. Malas
Keyword(s):  
Carotid Endarterectomy ◽  
Transient Ischemic Attack ◽  
Multivariate Logistic Regression Analysis ◽  
Hospital Outcomes ◽  
Lower Odds ◽  
Carotid Revascularization ◽  
Increased Risk ◽  
Significant Difference ◽  
Ischemic Attack ◽  
Stroke Death

Background and Purpose: Restenosis after carotid endarterectomy (CEA) is associated with an increased risk of ipsilateral stroke. The optimal procedural modality for this indication has yet to be determined. Here, we evaluate the in-hospital outcomes of transcarotid artery revascularization (TCAR), redo-CEA, and transfemoral carotid artery stenting (TFCAS) in a large contemporary cohort of patients who underwent treatment for restenosis after CEA. Methods: We performed a retrospective analysis of all patients in the vascular quality initiative database who underwent TCAR, redo-CEA, or TFCAS after ipsilateral CEA between September 2016 and April 2020. Patients with prior ipsilateral CAS were excluded from this analysis. In-hospital outcomes following TCAR versus CEA and TCAR versus TFCAS were evaluated using multivariate logistic regression analysis. Results: A total of 4425 patients were available for this analysis. There were 963 (21.8%) redo-CEA, 1786 (40.4%) TFCAS, and 1676 (37.9%) TCAR. TCAR was associated with lower odds of in-hospital stroke/death (odds ratio [OR], 0.41 [95% CI, 0.24–0.70], P =0.021), stroke (OR, 0.46 [95% CI, 0.23–0.93], P =0.03), myocardial infarction (MI; OR, 0.32 [95% CI, 0.14–0.73], P =0.007), stroke/transient ischemic attack (OR, 0.42 [95% CI, 0.24–0.74], P =0.002), and stroke/death/MI (OR, 0.41 [95% CI, 0.24–0.70], P =0.001) when compared with redo-CEA. There was no significant difference in the odds of death between the 2 groups (OR, 0.99 [95% CI, 0.28–3.5], P =0.995). TCAR was also associated with lower odds of stroke/transient ischemic attack (OR, 0.37 [95% CI, 0.18–0.74], P =0.005) when compared with TFCAS. There was no significant difference in the odds of stroke, death, MI, stroke/death, or stroke/death/MI between TCAR and TFCAS. Conclusions: TCAR was associated with significantly lower odds of in-hospital stroke, MI, stroke/transient ischemic attack, stroke/death, and stroke/death/MI when compared with redo-CEA and lower odds of in-hospital stroke/transient ischemic attack when compared with TFCAS. Additional long-term studies are warranted to establish the role of TCAR for the treatment of restenosis after CEA.

scholarly journals Get With the Guidelines–Stroke Is Associated With Sustained Improvement in Care for Patients Hospitalized With Acute Stroke or Transient Ischemic Attack

Circulation ◽  
2009 ◽  
Vol 119 (1) ◽  
pp. 107-115 ◽  
Author(s):  
Lee H. Schwamm ◽  
Gregg C. Fonarow ◽  
Mathew J. Reeves ◽  
Wenqin Pan ◽  
Michael R. Frankel ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Sustained Improvement ◽  
Ischemic Attack ◽  
Get With The Guidelines

scholarly journals Get With The Guidelines®–Stroke performance indicators in patients with transient ischemic attack

2018 ◽  
Vol 76 (9) ◽  
pp. 599-602
Author(s):  
Lorena Souza Viana Schneider ◽  
Vinicius Boaratti Ciarlariello ◽  
Renata Carolina Acri Nunes Miranda ◽  
Andreia Heins Vaccari ◽  
Rodrigo Meirelles Massaud ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Transient Ischemic Attack ◽  
Performance Indicators ◽  
Stroke Care ◽  
Lipid Lowering ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
Ischemic Attack ◽  
Get With The Guidelines ◽  
Antithrombotic Medication

ABSTRACT Get With The Guidelines®–Stroke is an in-hospital program for improving stroke care by promoting adherence to scientific guidelines. Of the patients with transient ischemic attack (TIA), 10-15% have a stroke within three months, and many patients do not receive the recommended interventions to prevent this outcome. Objective: The goal of this study was to assess the adherence to stroke quality indicators in patients with TIA. Methods: This retrospective observational study evaluated consecutive patients admitted to a primary stroke center with TIA or acute ischemic stroke (AIS) from August 2008 to December 2013. Six quality indicators applicable to both TIA and AIS were analyzed and compared between groups. Results: A total of 357 patients with TIA and 787 patients with AIS were evaluated. Antithrombotic medication use within 48 hours of admission, discharge use of anticoagulation for atrial fibrillation and counseling for smoking cessation were similar between groups. In the TIA group, discharge use of antithrombotic medication (95% versus 98%; p = 0.01), lipid-lowering treatment (57.7% versus 64.1%; p < 0.01) and stroke education (56.5% versus 74.5%; p < 0.01) were all less frequently observed compared with patients with AIS. Conclusions: The adherence to some of the Get With The Guidelines®–Stroke quality indicators was lower in patients with TIA than in patients with AIS. Measures should be undertaken to reinforce the importance of such clinical interventions in patients with TIA.

Abstract 11: Use of Novel Anticoagulants Among Atrial Fibrillation Patients Hospitalized with Ischemic Stroke or Transient Ischemic Attack: A Get With The Guidelines-Stroke Registry Analysis

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Priyesh A Patel ◽  
Xin Zhao ◽  
Gregg C Fonarow ◽  
Barbara L Lytle ◽  
Eric E Smith ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Thrombin Inhibitor ◽  
Stroke Registry ◽  
Novel Anticoagulants ◽  
Ischemic Attack ◽  
Get With The Guidelines

Background: The FDA recently approved the direct thrombin inhibitor dabigatran (DTI) and factor Xa inhibitor rivaroxaban for atrial fibrillation (AF) stroke prophylaxis based on large randomized trials showing non-inferiority to warfarin for stroke prevention. However, real-world utilization patterns and predictors of use for these novel anticoagulants (NAC) remain poorly characterized. Methods: Using the AHA Get With The Guidelines Stroke Registry, we analyzed patients with AF who were hospitalized for ischemic stroke or transient ischemic attack (TIA) and discharged on warfarin or NAC. The first NAC approved by the FDA was dabigatran in 10/2010, so we chose a 2-year study period from 10/2010-9/2012. We excluded patients with contraindications for anticoagulation. Patient and hospital variables associated with discharge anticoagulant use were evaluated using Pearson chi-square and Wilcoxon tests. Results: Of 61,655 patients meeting inclusion criteria, 6,835 (11.1%) were discharged on NAC, of which 86.7% were prescribed DTI. Warfarin was prescribed in 54,820 (88.9%) patients. For patients discharged on NAC vs. warfarin, 51.8% vs. 53.3% (p=0.016) were female and median age was 77 [IQR 69-84] vs. 79 [IQR 70-85] (p<0.001). The majority of patients discharged on NAC or warfarin were white (82.7% vs. 80.8% respectively, p=0.005). Slightly higher proportions of patients discharged on NAC vs. warfarin had private/HMO insurance (41.7% vs. 37.6%, p<0.001) than Medicare (39.0% vs. 42.3%, p<0.001). Patients discharged on NAC vs. warfarin had less severe ischemic stroke (NIH stroke scale=3 [IQR 1-8] vs. 5 [IQR 2-11], p<0.001), shorter length of stay (3 [IQR 2-5] vs. 4 [IQR 2-6] days, p<0.001), and higher proportions of patients who could ambulate at admission (32.5% vs. 26.1%, p<0.001) and discharge (47.5% vs. 39.2%, p<0.001). CHADS2 scores were lower among those discharged on NAC (Figure). More patients discharged on NAC were discharged to home (65.0%) than a healthcare facility, compared to 52.4% of patients prescribed warfarin being discharged to home (p<0.001). Conclusion: Among patients with AF and acute ischemic stroke or TIA discharged on oral anticoagulants, NAC use remains low and is prescribed to younger, more functional, and lower risk patients.

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