Abstract 183: Trends in Hospitalizations and Cost Associated with Acute Ischemic Stroke by Age, United States 2003-2012

Introduction: Stroke mortality has decreased from 4 th to 5 th leading cause of death in the U.S. However, it is still a leading cause of disability and the disease burden associated with stroke by age is not well known. Methods: The study population consisted of 2003-2012 adult hospitalizations from the National Inpatient Sample of the Healthcare Cost and Utilization Project. Acute ischemic stroke (AIS) hospitalizations were identified by the principal diagnosis ICD-9-CM code. We estimated national acute ischemic stroke hospitalization rates and associated inflation-adjusted hospital costs across five consecutive 2-year time intervals (2003-04 through 2011-12), stratified by six age groups: 18-34 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years, and ≥75 years. Results: The hospitalization rates per 100,000 persons with a principal diagnosis of AIS increased significantly among persons aged 18 to 54 years, but decreased significantly among those aged≥65 years. The largest increase was observed among ages 35-44 years. The average per-hospitalization cost increased 7%-19% across all 6 age groups after adjusting for inflation and the estimated total national cost increased 18% for AIS from 2003-04 to 2011-12. The estimated total cost for AIS hospitalization reached $12.55 billion in 2011-12. Conclusions: While AIS hospitalizations among ages ≥65 declined from 2003 to 2012, the hospitalization rates increased significantly among ages 18-54. The estimated hospital costs increased across all age groups during the study period, indicating the rising economic burden of stroke in the health care system.

Download Full-text

Abstract WMP50: Age-Specific Female-Male Disparities in Endovascular Thrombectomy Use for Acute Ischemic Stroke in the United States

Stroke ◽

10.1161/str.51.suppl_1.wmp50 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Hamidreza Saber ◽

Amytis Towfighi ◽

David S Liebeskind ◽

Jeffrey L Saver

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Age Groups ◽

Reperfusion Therapy ◽

The United States ◽

National Inpatient Sample ◽

Endovascular Thrombectomy ◽

Age Related ◽

The Us ◽

Age And Sex

Introduction: Studies have suggested sex-related and age-related variations in frequency of reperfusion therapy, but have been limited by constrained geographic scope, data from before the modern thrombectomy era, and incomplete exploration of sex-related differences in discrete age ranges. We therefore analyzed sex-, age-, and sex-age interaction in the frequency of endovascular thrombectomy (EVT) for acute ischemic stroke in the US National Inpatient Sample. Methods: In the National Inpatient Sample , we identified all adult ischemic stroke EVT hospitalizations from 2010-2016, using ICD-9-CM and ICD-10-CM codes. Patient age was categorized as: <50y, 50-59y, 60-69y, 70-79y and ≥80ys. Rates of use of EVT were assessed standardized to the 2010 US Census population. Results: Among 50,573 EVT hospitalizations, 50.1% were female. The number of EVTs increased from 4091 in 2010 to 12,875 in 2016. Over the entire 7y time period, a sex-age interaction was noted: 49% in <50y; 37% in 50-59y; 35% in 60-69y; 53% in 70-79y; and 66% in ≥80y. This sex-age interaction was present as well for EVT rates per 100,000 individuals in the population, with the total ratio of female to male rate of EVT per 100,000: 0.93 for in <50y; 0.52 in 50-59y; 0.58 in 60-69y; 0.91 in 70-79y; and 1.1 in ≥80y. EVT utilization rates increased substantially over time in both men and women in all age groups. However, the ratio of women to men per 100,000 receiving EVT changed for only one age range, decreasing among <50y from 0.98 in 2010 to 0.79 in 2016 (P<0.05). Conclusion: While half of all endovascular thrombectomies in the US are performed in women, there are major age-related sex-specific variations in EVT rates, with rates of EVT much lower among women than men in 50-70 age group. Determinants of these age-specific female-male disparities in EVT treatment merit detailed investigation. Figure: Age- and sex-specific female to male thrombectomy utilization rates.

Download Full-text

Alcohol withdrawal is associated with poorer outcome in acute ischemic stroke

Neurology ◽

10.1212/wnl.0000000000008518 ◽

2019 ◽

Vol 93 (21) ◽

pp. e1944-e1954

Author(s):

Emmanuel O. Akano ◽

Fadar Oliver Otite ◽

Seemant Chaturvedi

Keyword(s):

Ischemic Stroke ◽

Length Of Stay ◽

Acute Ischemic Stroke ◽

Alcohol Withdrawal ◽

Age Groups ◽

The United States ◽

Medical Complications ◽

National Inpatient Sample ◽

Mortality Cost ◽

Multivariable Adjustment

ObjectiveTo determine the association between alcohol abuse (AA) and alcohol withdrawal (AW) with acute ischemic stroke (AIS) outcomes.MethodsAll adult AIS admissions in the United States from 2004 to 2014 were identified from the National Inpatient Sample (weighted n = 4,438,968). Multivariable-adjusted models were used to evaluate the association of AW with in-hospital medical complications, mortality, cost, and length of stay in patients with AIS.ResultsOf the AA admissions, 10.6% of patients, representing 0.4% of all AIS, developed AW. The prevalence of AA and AW in AIS increased by 45.2% and 40.0%, respectively, over time (p for trend <0.001). Patients with AA were predominantly men (80.2%), white (65.9%), and in the 40- to 59-year (44.6%) and 60- to 79-year (45.6%) age groups. After multivariable adjustment, AIS admissions with AW had >50% increased odds of urinary tract infection, pneumonia, sepsis, gastrointestinal bleeding, deep venous thrombosis, and acute renal failure compared to those without AW. Patients with AW were also 32% more likely to die during their AIS hospitalization compared to those without AW (odds ratio 1.32, 95% confidence interval 1.11–1.58). AW was associated with ≈15-day increase in length of stay and ≈$5,000 increase in hospitalization cost (p < 0.001).ConclusionAW is associated with increased cost, longer hospitalizations, and higher odds of medical complications and in-hospital mortality after AIS. Proactive surveillance and management of AW may be important in improving outcomes in these patients.

Download Full-text

Abstract WP212: Trends in Acute Ischemic Stroke Hospitalizations by Age Groups, Length of Stay, Mortality and Hospital Costs in the United States From 2000-2014

Stroke ◽

10.1161/str.50.suppl_1.wp212 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Prashanth Rawla ◽

Anantha Vellipuram ◽

Rakesh Khatri ◽

Alberto Maud ◽

Gustavo J Rodriguez ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Length Of Stay ◽

Acute Ischemic Stroke ◽

Hospital Costs ◽

Age Groups ◽

The United States

Download Full-text

Abstract 3418: Acute Care Nurse Practicioner Led Critical Care Transport Team Leads to Improved Door to Imaging Time in Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.43.suppl_1.a3418 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Michelle M Winfield ◽

Julie A McNeil ◽

Stephanie L Steiner ◽

Christopher F Manacci ◽

Damon Kralovic ◽

...

Keyword(s):

Critical Care ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Patient Outcomes ◽

Care Transitions ◽

Cleveland Clinic ◽

Stroke Patients ◽

Time Intervals ◽

Care Nurse ◽

Transport Team

Background: In evaluating the acute ischemic stroke (AIS) patient, targeting time intervals for imaging and treatment times are paramount in optimizing outcomes. Initial evaluation by skilled providers who can facilitate the extension of a tertiary care facility can positively influence patient outcomes. A collaborative approach with a hospital based Critical Care Transport (CCT) Team can extend primary stroke program care out to a referring facility’s bedside. In the Cleveland Clinic Health System, the suspicion of a large vessel occlusion causing AIS in patients at an outside hospital triggers an “Auto Launch” process, bypassing typical transfer processes to expedite care transitions for patients with time sensitive emergencies. Referring facilities contact a CCT Coordinator, with immediate launching of the transport team that consists of an Acute Care Nurse Practitioner (ACNP) who evaluates the patient at outside facility, performs NIHSS and transitions the patient directly to CT/MRI upon return to Cleveland Clinic facility. Patient is met by the Stroke Neurology Team at CT scanner for definitive care. A CCT Team with an ACNP on board can augment not only door to CT and MRI times, but also time to evaluation by a stroke neurologist and time to intervention, bypassing the Emergency Department upon their arrival and proceeding directly to studies and/or time sensitive intervention as appropriate. Objective: To describe a stroke program with a coordinated approach with a CCT Team to facilitate rapid care transitions as well as decreased time to imaging in patients with AIS by having an ACNP on board during transport and throughout the continuum of care. Methods: A retrospective audit of a database of patients undergoing hyperacute evaluation of acute ischemic stroke symptoms from April 30, 2010 to July 31, 2011 was performed. Demographic information, types of imaging performed, hyperacute therapies administered and time intervals to imaging modalities and treatment were collected and analyzed. Results: 107 patients total, 28 males, and 36 females with a mean age of 70 were included in the analysis. 60% [64] of patients transferred via the CCT Team over 26.42 average nautical miles. The mean time of call to arrival was 1 hr and 19 min. The CCT Team monitored tPA infusion in 27 patients and initiated tPA infusion in 2 patients. 64 patients had CT imaging performed and 64 had MRI performed following the CT. [The average door to CT completion was 22 min, the average door to MRI completion was 1 hr and 29 min, compared to 1 hr and 8 min and 2 hr and 36 min, respectively, in patients not arriving by CCT Team], p<0.05. Conclusion: Collaboration between the Stroke Neurology Team and CCT Team has allowed acute ischemic stroke patients to be taken directly to CT/MRI scanner, allowing for rapid evaluation, definitive treatment decisions, and the potential for improved patient outcomes by decreasing the door to imaging time.

Download Full-text

Abstract WMP94: Readmission Within 30 days After Acute Ischemic Stroke, United States 2013

Stroke ◽

10.1161/str.48.suppl_1.wmp94 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Xin Tong ◽

Mary G George ◽

Sallyann M Coleman King ◽

Cathleen Gillespie ◽

Robert Merritt

Keyword(s):

United States ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Readmission Rate ◽

Hospital Readmissions ◽

The United States ◽

Artery Occlusion ◽

Principal Diagnosis ◽

Readmission Rates ◽

The Cost

Introduction: Hospital readmissions contribute significantly to the cost of medical care and reflect the burden of disease. Limited data have been reported on national hospital readmission after acute ischemic stroke. Methods: Among 2013 adult hospitalizations from the National Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD), we identified acute ischemic stroke (AIS) hospitalizations using principal diagnosis ICD-9-CM codes. We provided national estimates of AIS non-elective readmission rates within 30 days. Results: In 2013, there were a total of 489,813 adult index AIS admissions in the United States. The readmission rate within 30 days for a new AIS as the principal diagnosis was 2.1% of index AIS admissions, and was 10.2% of all readmissions. The readmission rate for all non-elective reasons increased with age, with the lowest readmission rate (8.9%) among ages 18-44, and the highest (11.7%).among ages 85+. The readmission rate was higher among patients with public insurance (11.1%) as compared to private (7.4%) or others (7.9%). Recurrent AIS (20.2%) was the most common reason for readmission, including unspecified cerebral artery occlusion with infarction (ICD9-CM=434.91, 13.0%) and cerebral embolism with infarction (ICD9-CM=434.11, 3.1%). In addition, infections were among the most common causes (Septicemia 5.7%, UTI 2.7%, and pneumonia 2.2%) and TIA (2.4%). Conclusions: The findings have important implications for identifying groups and conditions at high-risk for readmission. The large number of recurrent AIS within 30 days of index AIS highlights the need for improved patient follow-up and secondary prevention treatment.

Download Full-text

Abstract 16: Racial Disparities in Clinical Outcomes and Resource Utilization in Acute Ischemic Stroke Hospitalizations in the United States: Results from the 2012 National Inpatient Sample

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.16 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Nilay Kumar ◽

Anand Venkatraman ◽

Neetika Garg

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Length Of Stay ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Racial Minorities ◽

National Inpatient Sample ◽

The Us ◽

To Receive ◽

Total Charges

Background and objectives: There are limited data on racial differences in clinical and economic outcomes of acute ischemic stroke (AIS) hospitalizations in the US. We sought to ascertain the effect of race on AIS outcomes in a population based retrospective cohort study. Methods: We used the 2012 National Inpatient Sample (NIS), which is the largest database of inpatient stays in the US, to identify cases of AIS using ICD9-CM codes 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91 and 437.1 in patients >=18 years of age. Cases with missing data on race were excluded (5% of study sample). Primary outcome was in-hospital mortality. Secondary outcomes included proportion receiving endovascular mechanical thrombectomy (EMT) or thrombolysis, mean inflation adjusted charges and length of stay. Linear and logistic regression was used to test differences in continuous and categorical outcomes respectively. Survey techniques were used for all analyses. Results: There were 452, 330 hospitalizations for AIS in patients >=18 years in 2012. In univariate logistic regression using race as predictor, in-hospital mortality was significantly lower for Blacks (p<0.001), Hispanics (p=0.025) and Native Americans (p=0.047) compared to Whites. However, after adjusting for age, sex, Charlson comorbidity index, EMT and thrombolysis only blacks had a significantly lower mortality compared to whites (OR 0.74, 95% CI 0.66 - 0.82, p<0.001). Black patients were less likely to receive thrombolysis (OR 0.87, 95% CI 0.79 - 0.95; p=0.003) whereas Asian or Pacific Islanders were more likely to receive thrombolysis (OR 1.20, 95% CI 1.01 - 1.44; p=0.043) compared to whites. There was no difference in rates of EMT by race (p=0.18). Total charges and length of stay were significantly higher in racial minorities compared to whites (table). Conclusions: Blacks hospitalized for AIS have significantly lower in-hospital mortality compared to whites but are significantly less likely to receive thrombolysis compared to whites. Total charges and length of stay are significantly higher for racial minorities. Future studies should investigate mechanisms of this apparent protective effect of black race on in-hospital mortality in AIS.

Download Full-text

Optimization of CT Scan to Angiography Time Can Reduce Variability in Time Intervals from Symptom Onset to Recanalization in Acute Ischemic Stroke Patients (P06.213)

Neurology ◽

10.1212/wnl.78.1_meetingabstracts.p06.213 ◽

2012 ◽

Vol 78 (Meeting Abstracts 1) ◽

pp. P06.213-P06.213

Author(s):

S. Hassan ◽

A. Hassan ◽

S. Chaudhry ◽

N. Rostambeigi ◽

G. Rodriguez ◽

...

Keyword(s):

Ischemic Stroke ◽

Ct Scan ◽

Acute Ischemic Stroke ◽

Symptom Onset ◽

Stroke Patients ◽

Time Intervals

Download Full-text

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

Stroke ◽

10.1161/str.51.suppl_1.wmp94 ◽

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.

Download Full-text