Abstract W MP106: Temporal Trends in Stroke Investigations and Their Effect on Management

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Vivian T Ng ◽  
Ahmed M Bayoumi ◽  
Jiming Fang ◽  
Kirsteen R Burton ◽  
Melissa Stamplecoski ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Temporal Trends ◽  
Trend Test ◽  
Carotid Revascularization ◽  
Stroke Registry ◽  
Armitage Trend Test ◽  
Suspected Stroke ◽  
One Year ◽  
The Cost ◽  
Over Time

Background: Current guidelines recommend that patients with suspected stroke undergo neuroimaging to confirm the diagnosis and that those with ischemic stroke or TIA receive carotid imaging and cardiac investigations to determine stroke etiology. It is not known how rates of investigations have changed over time, and if those trends have led to changes in medical or surgical management. We used a clinical stroke registry to evaluate temporal trends in stroke investigations in Ontario, Canada. Methods: We used the Ontario Stroke Registry to identify patients who presented with stroke and TIA to 11 stroke centers between 2003 and 2012. The primary outcome was the proportion of patients who received CT, MRI, CTA, MRA, carotid doppler, and echocardiography in each year. Secondary outcomes were (1) the total number of neuroimaging procedures per patient; (2) the proportion of patients with ischemic stroke/TIA prescribed antithrombotics at discharge; and (3) the proportion who had carotid revascularization. The characteristics of study participants, rates of investigations and interventions, and test for trends over one year intervals were completed using a Cochran-Armitage trend test. Results: The study sample included 42,738 patients. From 2003 to 2012, the proportion receiving any type of neuroimaging increased from 96% to 99%, those receiving an MRI increased from 10% to 49%, those receiving carotid imaging increased from 62% to 88% and those receiving echocardiography increased from 52% to 70% (P<0.0001 for all comparisons). The total number of neuroimaging procedures per patient also increased, from a median of 1 in 2003 to 3 in 2011 (P<0.0001), and with almost 40% undergoing three or more neuroimaging procedures in 2011. In those with ischemic stroke or TIA, rates of antithrombotic therapy increased from 83% to 91%, as did the rate of carotid endarterectomy, from 0.7% to 0.8%. (P< 0.009). Conclusions: Rates of neuroimaging, carotid imaging and cardiac investigations after stroke have markedly increased over time. It is uncertain whether the increased rates of MRI and neuroimaging per patient are associated with improved outcomes. Further research is needed to evaluate the cost-effectiveness of current patterns of investigations following stroke.

scholarly journals Temporal trends in clozapine use at time of discharge among people with schizophrenia at two public psychiatric hospitals in Taiwan, 2006–2017

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ching-Hua Lin ◽  
Hung-Yu Chan ◽  
Chun-Chi Hsu ◽  
Feng-Chua Chen
Keyword(s):  
Temporal Trends ◽  
Psychiatric Hospitals ◽  
Trend Test ◽  
Anticholinergic Medication ◽  
Clozapine Treatment ◽  
Augmentation Strategy ◽  
Hospital Stays ◽  
Treatment Changes ◽  
Armitage Trend Test ◽  
Over Time

Abstract Clozapine treatment remains the gold standard for treatment-resistant schizophrenia. This study aimed to describe temporal trends in clozapine use at discharge among patients with schizophrenia at two of the largest public psychiatric hospitals in Taiwan over a twelve-year period. Patients with schizophrenia discharged from the two study hospitals between 2006 and 2017 (n = 24,101) were included in the analysis. Antipsychotic augmentation was defined as concomitant use of a second antipsychotic as augmentation to clozapine treatment. Changes in the rate of clozapine use and antipsychotic augmentation at discharge over time were analyzed using the Cochran-Armitage trend test. Patients discharged on clozapine had significantly longer hospital stays than other patients. The rate of clozapine use at discharge increased from 13.8% to 20.0% over time (Z = 6.88, p < .0001). Concomitant use of anticholinergic medication was more common in patients receiving antipsychotic augmentation than clozapine antipsychotic monotherapy. Among patients discharged on clozapine, the rate of augmentation with a second antipsychotic increased from 19.1% to 36.2% over time (Z = 6.58, p < .0001). Among patients receiving antipsychotic augmentation, use of another second-generation antipsychotic as the augmentation agent grew from 32.6% to 65.5% over time (Z = 8.90, p < .0001). The increase in clozapine use was accompanied by an increase in concomitant use of a second antipsychotic as augmentation during the study period. Further studies are warranted to clarify the risk/benefit of this augmentation strategy. Clozapine may still be underutilized, and educational programs are needed to promote clinical use of clozapine.

Increased prevalence of psychosis in patients who get admitted with atrial fibrillation with worse outcomes

2017 ◽  
Vol 41 (S1) ◽  
pp. S575-S576
Author(s):  
Z. Mansuri ◽  
S. Patel ◽  
P. Patel ◽  
O. Jayeola ◽  
A. Das ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Admissions ◽  
Temporal Trends ◽  
International Classification Of Diseases ◽  
Trend Test ◽  
Classification Of Diseases ◽  
Competing Interest ◽  
Armitage Trend Test ◽  
The Impact

ObjectiveTo determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis.BackgroundWhile post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year's 2002–2012. We identified AF and psychosis as primary and secondary diagnosis respectively using validated international classification of diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 3.887.827AF hospital admissions from 2002–2012 of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis.ConclusionsOur study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract 4: Variation and Temporal Trends in the Characteristics of US Hospitals Treating Acute Ischemic Stroke Patients with IV-tPA: Findings from GWTG-Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Lee H Schwamm ◽  
Syed F Ali ◽  
Mathew J Reeves ◽  
Eric E Smith ◽  
Jeffrey L Saver ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Systems Of Care ◽  
Team Building ◽  
Temporal Trends ◽  
High Volume ◽  
Wilcoxon Test ◽  
Chi Square ◽  
Over Time ◽  
Iv Tpa

Introduction: Utilization of IV tPA is challenging for many hospitals. Using data from the national Get With The Guidelines-Stroke program, we analyzed changes over time in the characteristics of the hospitals that treated patients with tPA. Methods: We analyzed patient-level data from 2003-2011 at 1600 GWTG hospitals that joined the program at any time during the study period and admitted any acute ischemic stroke (AIS) patients arriving ≤ 2 hr of onset and eligible for tPA. Descriptive trends by time were analyzed by chi-square or Wilcoxon test for continuous data. Results: IV tPA was given within 3 hr at 1394 sites to 50,798/ 75,115 (67.6%) eligible AIS patients arriving ≤ 2 hr; 206 (14.8%) sites had a least one eligible patients but no tPA use. IV tPA treatment rates varied substantially across hospitals (median 61.2%, range 0-100%), with > 200 hospitals providing tPA < 10% of the time (Figure). Over time, more patients and a larger proportion of patients were treated at smaller (median bed size 407 vs. 372, p< 0.001), non-academic, Southern hospitals, and those with lower annualized average ischemic stroke volumes (252.4 vs. 235.2, p< 0.001) (Table). While more than half of all tPA patients were treated at Primary Stroke Centers, this proportion did not change over time. The proportion of patients treated at high volume tPA treatment sites (average > 20/year) increased over time (31.9 vs. 34.5, p< 0.007). Conclusion: Over the past decade, while primary stroke centers still account for more than half of all treatments, tPA has been increasingly delivered in smaller, non-academic hospitals. These data support the continued emphasis on stroke team building and systems of care at US hospitals.

scholarly journals Developing an adapted Charlson comorbidity index for ischemic stroke outcome studies

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ruth E. Hall ◽  
Joan Porter ◽  
Hude Quan ◽  
Mathew J. Reeves
Keyword(s):  
Ischemic Stroke ◽  
Charlson Comorbidity Index ◽  
Cox Model ◽  
Comorbid Conditions ◽  
Stroke Registry ◽  
C Statistic ◽  
Hazard Ratios ◽  
Comorbidity Index ◽  
Cci Model ◽  
One Year

Abstract Background The Charlson comorbidity index (CCI) is commonly used to adjust for patient casemix. We reevaluated the CCI in an ischemic stroke (IS) cohort to determine whether the original seventeen comorbidities and their weights are relevant. Methods We identified an IS cohort (N = 6988) from the Ontario Stroke Registry (OSR) who were discharged from acute hospitals (N = 100) between April 1, 2012 and March 31, 2013. We used hospital discharge ICD-10-CA data to identify Charlson comorbidities. We developed a multivariable Cox model to predict one-year mortality retaining statistically significant (P < 0.05) comorbidities with hazard ratios ≥1.2. Hazard ratios were used to generate revised weights (1–6) for the comorbid conditions. The performance of the IS adapted Charlson comorbidity index (ISCCI) mortality model was compared to the original CCI using the c-statistic and continuous Net Reclassification Index (cNRI). Results Ten of the 17 Charlson comorbid conditions were retained in the ISCCI model and 7 had reassigned weights when compared to the original CCI model . The ISCCI model showed a small but significant increase in the c-statistic compared to the CCI for 30-day mortality (c-statistic 0.746 vs. 0.732, p = 0.009), but no significant increase in c-statistic for in-hospital or one-year mortality. There was also no improvement in the cNRI when the ISCCI model was compared to the CCI. Conclusions The ISCCI model had similar performance to the original CCI model. The key advantage of the ISCCI model is it includes seven fewer comorbidities and therefore easier to implement in situations where coded data is unavailable.

Abstract W P310: National Trends in Carotid Artery Stenting and Endarterectomy by Sex, Race, and Region: 2007-2011

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Judith H Lichtman ◽  
Erica C Leifheit-Limson ◽  
Yun Wang ◽  
Virginia J Howard ◽  
Thomas G Brott ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Temporal Trends ◽  
Stroke Patients ◽  
North East ◽  
The Us ◽  
Central Regions ◽  
Geographic Regions ◽  
Over Time

Background: CREST, a randomized trial comparing carotid artery stenting (CAS) with endarterectomy (CEA) in symptomatic and asymptomatic patients, reported in 2010 that the two procedures were similar for the composite endpoint of stroke, myocardial infarction, or death. Data on temporal trends in the use of these procedures in the US are limited, particularly by sex, race, and geographic region. We reviewed trends in utilization of CAS and CEA for ischemic stroke patients. Methods: Ischemic stroke hospitalizations (ICD-9 433, 434, 436) were identified for patients aged ≥18 years from the Nationwide Inpatient Sample 2007-2011 (N=480,375). Annual trends of CAS and CEA were estimated using mixed models that adjusted for patient age and comorbidities. Models were stratified by sex, race (white, black, other), and 9 geographic regions. Results: Overall, the proportion of stroke patients who received CAS remained relatively stable over time (2.7% in 2007 to 2.8% in 2011) while the proportion who received CEA decreased (from 21.0% to 16.3%). CAS rates increased in the three Central Regions (East North, East South, and West South) but decreased in New England; CEA declines were similar across regions. In adjusted analyses, CAS rates increased slightly for white men, decreased for men and women of other race, but remained stable for the remaining groups (Figure); CEA rates decreased for all sex-race groups. These patterns by sex and race subgroups were generally consistent across geographic regions. Conclusions: The proportion of hospitalized stroke patients receiving CEA decreased over time while CAS rates remained relatively stable, with slight increases seen in the Central regions of the US. There are sex-race differences in the proportion of patients who receive these procedures, but these patterns are largely similar across regions.

Abstract WMP94: Temporal Trends in Racial, Age, and Sex-Specific Utilization of Decompressive Hemicraniectomy Among Acute Ischemic Stroke Patients in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sai P Polineni ◽  
Fadar O Otite ◽  
Seemant Chaturvedi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Temporal Trends ◽  
Age Groups ◽  
The United States ◽  
Decompressive Hemicraniectomy ◽  
Study Results ◽  
Over Time ◽  
Age And Sex

Background: The aim of this study is to evaluate current trends in racial, age, and sex-specific utilization of decompressive hemicraniectomy (HC) in acute ischemic stroke (AIS) patients in the United States over the last decade. Methods: All adult patients with a diagnosis of AIS were identified from the 2004-2015 Nationwide Inpatient Sample (weighted N=4,792,428) using International Classification of Diseases Ninth revision (ICD-9) codes. Proportion of patients undergoing HC in various age, race, and sex groups were ascertained using ICD-9 procedural codes. Temporal trends were mapped by year in order to track changes in utilization over time. Analysis of utilization disparities and trends within age, sex, and race subgroups was conducted via multivariate logistic regression. Results: Of all eligible AIS patients from 2004-2015, 0.25% underwent HC (.08 in 2004 to .46 in 2015). Increased utilization over time was seen in both men (.13 to .57) and women (.08 to .54), with women showing comparable odds of utilization to men [OR: 0.95 (95% CI: .87-1.04, p=0.27)]. Similarly, increased utilization trends were seen in all age groups (Figure 1) with the highest rates in the 18-39 subgroup (1.41%). Compared to trends in this younger subgroup (.43 to 2.12), patients aged 60-79 experienced a similar overall increase but at lower utilization rates (.06 to .37). Compared to white patients in multivariate models, blacks did not show significant differences in odds of HC [1.09 (.96-1.24, p=0.20)], while patients from Hispanic [1.25 (1.03-1.51, p=0.02)] and other [1.26 (1.04-1.52, p=0.02)] race-ethnic groups showed increased odds. Conclusions: From 2004-2015, hemicraniectomy rates have seen substantial increases in all age, sex, and race groups. The increasing rates of hemicraniectomies among those over age 60 suggest that there has been at least partial acceptance of DESTINY 2 study results.

Abstract TMP71: Timing of Carotid Revascularization Procedures After Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ajay Gupta ◽  
Gino Gialdini ◽  
Ankur Pandya ◽  
Babak Navi ◽  
Hooman Kamel
Keyword(s):  
Ischemic Stroke ◽  
Temporal Trends ◽  
Administrative Claims ◽  
Chi Square ◽  
Carotid Revascularization ◽  
Symptomatic Carotid ◽  
Asymptomatic Patients ◽  
Index Stroke ◽  
Chi Square Test ◽  
Nonparametric Correlation

Background: A 2004 report from two trials of carotid endarterectomy (CEA) indicated that its benefit was greatest when performed within 2 weeks of stroke onset. In 2006, the AHA recommended that carotid revascularization generally occur within 2 weeks of stroke. Hypothesis: Since 2005, the time between stroke and CEA or carotid artery stenting (CAS) has decreased and the proportion of patients undergoing CEA or CAS within 2 weeks has increased. Methods: Using administrative claims data from all nonfederal hospitals in CA, FL, and NY, we identified patients hospitalized with ischemic stroke between 2005 and 2012. We excluded those who did not undergo CEA or CAS within 90 days of admission for the index stroke. When stroke and CEA/CAS were documented in the same hospitalization, we included only strokes coded as present on admission so as to exclude periprocedural strokes in previously asymptomatic patients. All diagnoses and procedures were identified using previously validated ICD-9-CM codes. Our outcomes were the number of days between stroke and CEA/CAS and the proportion of patients who underwent CEA/CAS within the recommended 2-week period. Temporal trends were assessed using nonparametric correlation, chi-square test for trend, and logistic regression. Results: We identified 14,414 patients with ischemic stroke who underwent CEA or CAS within 90 days. The median (interquartile range [IQR]) number of days from stroke to CEA/CAS decreased from 25 (5-48) in 2005 to 6 (3-24) in 2012 (P <0.001; Figure 1A). The proportion of patients who underwent CEA/CAS within 2 weeks of stroke increased from 40.1% in 2005 to 69.9% in 2012 (P <0.001; Figure 1B). The temporal trends in both outcomes were significant even after adjustment for patient demographics, state of residence, and comorbidities. Conclusions: Since 2005, revascularization for symptomatic carotid disease has been progressively occurring sooner after presentation with stroke.

scholarly journals Fasting and Non-Fasting Triglycerides in Patients With Acute Ischemic Stroke

2021 ◽  
Author(s):  
Jun Yup Kim ◽  
Keon-Joo Lee ◽  
Jihoon Kang ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Primary Outcome ◽  
Stroke Recurrence ◽  
Stroke Registry ◽  
Premature Coronary Heart Disease ◽  
Clinical Events ◽  
Younger Age ◽  
All Cause Mortality ◽  
One Year

Abstract Introduction: Clinical implications of elevated fasting triglycerides (FTG) and non-fasting triglycerides (NFTG) in acute ischemic stroke (AIS) remain unknown. We aimed to elucidate the correlation and clinical significance of FTG and NFTG levels in AIS patients. Methods Using a multicenter prospective stroke registry, we identified AIS patients hospitalized within 24h of onset with available NFTG results. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all-cause mortality up to one year. Results This study analyzed 2,176 patients. The prevalence of fasting and non-fasting hypertriglyceridemia was 11.5% and 24.6%, respectively. Multivariate analysis revealed that younger age, diabetes, higher body mass index and initial systolic blood pressure were independently associated with both fasting and non-fasting hypertriglyceridemia (all p < 0.05). Patients with higher quartiles of NFTG were more likely to be male, younger, ever-smokers, diabetic, and have family histories of premature coronary heart disease and stroke (all p < 0.05). Similar tendencies were observed for FTG. The composite outcome was not associated with FTG or NFTG quartiles. Conclusion The fasting and non-fasting hypertriglyceridemia were prevalent in AIS patients and showed similar clinical characteristics and outcomes. High FTG and NFTG levels were not associated with occurrence of subsequent clinical events up to one year.

Abstract 2545: Does Participation in a Stroke Registry Improve tPA Administration Rates?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Moges Ido ◽  
Lydia Clarkson ◽  
Deborah Camp ◽  
Kerrie Krompf ◽  
Michael Frankel
Keyword(s):  
Quality Improvement ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Patient Care ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Hospital Size ◽  
Stroke Registry ◽  
Over Time ◽  
Iv Tpa

Background: The purpose of the Georgia Coverdell Acute Stroke Registry (GCASR) is to improve the quality of patient care. GCASR conducts regular quality improvement activities to educate hospital staff and improve systems and processes. Administration of intravenous tissue plasminogen activator (IV tPA) is standard treatment for eligible acute ischemic stroke patients and can dramatically improve outcomes. Purpose: To determine whether GCASR hospitals were more likely to administer tPA to acute ischemic stroke patients than non-GCASR hospitals. Methods: Hospitalization data from acute care hospitals in Georgia was provided by the Georgia Hospital Association for November 2005 through December 2009. Acute ischemic stroke patients receiving tPA were identified using ICD-9 codes (433 and 434), procedure codes (9910), and healthcare common procedure system codes (J2997). A hospital was defined as a GCASR facility if it was actively participating in the registry at the time of patient hospitalization. A generalized estimating equation with robust variance estimation was applied using the SAS GLIMMIX procedure. “Hospital” was treated as a random variable. Relative risks for receiving tPA were estimated and adjusted for demographics, co-morbidities, hospital size, urbanicity, and length of stay. Results: A total of 55,403 patients were admitted with a principal diagnosis of acute ischemic stroke during the study period, and two percent (1,231) received tPA. Three percent of patients (871) seen at registry facilities received tPA, compared to 1.4% (360) of those seen at non-GCASR facilities. Age, gender, race, length of stay, hospital size, and participation in the registry all predicted tPA administration, either at or near significant levels (p-values from <0.0001 to 0.0646). Although IV tPA administration has increased over time in both hospital groups, patients treated at GCASR facilities were more likely to receive tPA after controlling for confounders (OR=1.64; 95% CI: 0.97-2.78), which approached significance (p=0.0646). Approximately 340 fewer people would have received tPA had all study patients been treated at non-GCASR facilities. Conclusions: Although all Georgia hospitals have improved their rate of tPA administration over time, GCASR hospitals maintained a higher rate than non-GCASR hospitals. This may be due in part to the quality improvement activities that registry facilities participate in and the assistance they receive. These results support the stroke registry model as a method of improving stroke patient care and outcomes.

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