Abstract 164: Variation in Acute Ischemic Stroke Metrics for Nationally Certified versus Self-Attested Comprehensive Stroke Centers in the Florida Stroke Registry

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Erika T Marulanda-Londono ◽  
Antonio Bustillo ◽  
Charles Sand ◽  
Mark D Landreth ◽  
Carolina Gutierrez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Systems Of Care ◽  
Recent Change ◽  
National Agency ◽  
Healthcare Facilities ◽  
Stroke Registry ◽  
Treatment Measures ◽  
Stroke Systems Of Care ◽  
Hospital Registry

Background: The Florida Stroke Act set criteria for comprehensive stroke centers (CSC). Hospitals could be certified by a national agency (The Joint Commission (TJC), Det Norske Veritas (DNV), Healthcare Facilities Accreditation Program (HFAP)) or could self-attest as fulfilling CSC criteria. This study aimed to evaluate whether nationally certified (NC) and self-attested hospitals (SA) have similar quality of care in acute ischemic stroke (AIS). Methods: The study population included AIS cases from 37 CSCs (74% of FL CSCs) in the FL-Stroke Registry, a multi-hospital registry using Get With the Guidelines-Stroke data from Jan 2013-Dec 2018. Hospital and patient level characteristics and stroke metrics were evaluated using unadjusted and adjusted (age, sex, race and NIH) analyses. Results: 13 NC-CSCs with 32,061 AIS cases and 24 SA-CSCs with 46,363 AIS cases were included. NCs were larger, with younger patients (71 (60-81) vs 72 (61-82)) and more severe strokes (median NIH; 5 vs 4, NIH ≥ 16; 15.4 vs 11.9% p <.0001). Overall IV tPA utilization (15.4% vs 13.9% p <.0001) and EVT treatment (9.8% vs 7.3% p <.0001) were better in NC CSCs. Median door to CT (23 min (11-76) vs 30 (12-75) p <.001) and door to needle time (38 min (27-51) vs 43(30-56) p <.001) were faster in NC CSCs. In adjusted analysis those arriving to NC by 3 hrs were more likely to get tPA in extended 3-4.5-hour window (OR 1.65, 95% CI 1.10, 2.47 p =.01). Conclusion: Among FL-Stroke Registry CSCs, AIS performance and treatment measures are superior in NC CSC when compared to SA CSCs. These findings have crucial implications for stroke systems of care in Florida and supported recent change in legislation regarding CSC center certification.

scholarly journals Emerging therapies in acute ischemic stroke

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 546
Author(s):  
Nicholas Liaw ◽  
David Liebeskind
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Collateral Circulation ◽  
Mechanical Thrombectomy ◽  
Systems Of Care ◽  
Stroke Units ◽  
Emerging Therapies ◽  
Number Of Patients ◽  
Care Models ◽  
Stroke Systems Of Care

Thrombolysis and mechanical thrombectomy have revolutionized the care of patients with acute ischemic stroke. The number of patients who can benefit from these treatments continues to increase as new studies demonstrate that not just time since stroke onset but also collateral circulation influences outcome. Technologies such as telestroke, mobile stroke units, and artificial intelligence are playing an increasing role in identifying and treating stroke. Stroke-systems-of-care models continue to streamline the delivery of definitive revascularization in the age of mechanical thrombectomy.

Abstract WP272: Impact of Stroke Legislation on Developing Stroke Systems of Care and Improving Acute Therapy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Elizabeth Kim ◽  
Peggy Jones ◽  
Christopher T Richards ◽  
Shyam Prabhakaran ◽  
Tracy Love ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
State Government ◽  
Routing Protocols ◽  
Systems Of Care ◽  
The State ◽  
Advisory Council ◽  
Stroke Patients ◽  
Acute Therapy ◽  
Stroke Registry

Background: Stroke is the 4th leading cause of death in Illinois and the leading cause of disability. In 2009, Illinois passed stroke legislation to establish a Stroke Advisory Sub-committee to advise the State EMS Advisory Council. Legislation also created 11 multidisciplinary EMS Regional Stroke Advisory Subcommittees, recognition of certified Primary Stroke Centers, state designation of Emergent Stroke Ready hospitals and updating of EMS routing protocols. In 2014, updated legislation was passed to include state recognition of nationally certified Comprehensive Stroke Centers (CSC), updating of EMS routing protocols to include CSC’s and establish a state stroke fund created from hospital designation fees. Hypothesis: Implementation of Illinois’s stroke legislation by EMS region enhances systems of care collaboration between hospitals and EMS providers and improves timely intervention for patients with acute ischemic stroke. Methods: We queried the state-wide AHA’s Get With The Guideline stroke registry, which captured 72% of Illinois stroke discharges from 2009 through 2015. In total, 90 hospitals entered data, 57 from PSCs, 8 from CSCs, and 25 from Emergent Stroke Ready hospitals. All patients included in the registry as confirmed stroke were included for analysis. Hospital time and treatment data were recorded in an aggregate manner. Descriptive statistics were used to report results. Results: The total number of confirmed stroke patients treated was 123,859 Median door-to-needle (DTN) times for IV tPA therapy went from 85 minutes in 2009 to 56 in 2015 . The percent of acute ischemic stroke patients with a door-to-needle time of 60 minutes or less increased from 18.0% in 2009 to 62.9% in 2015. Conclusions: The decrease in DTN from 2009 to 2015 is an indicator of improved care due to the Illinois stroke system of care model. This is a good example of all system stakeholders including state government and EMS working collaboratively to improve care. Which elements of a stroke system are responsible for this improvement (hospital designation, routing, EMS training) will require further research. Regional coordination of resources and state hospital designation may impact prehospital routing of suspected strokes and may improve patient outcomes.

scholarly journals The Neurointerventional Revolution

Neurology ◽  
2021 ◽  
Vol 97 (20 Supplement 2) ◽  
pp. S1-S5
Author(s):  
Ashutosh P. Jadhav ◽  
Maxim Mokin ◽  
Sunil A. Sheth ◽  
Ameer E. Hassan
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Systems Of Care ◽  
Unmet Need ◽  
Related Factors ◽  
Vessel Occlusion ◽  
Short Period ◽  
Recent Developments ◽  
Stroke Systems Of Care

Purpose of the ReviewIn a short period of time, the field of interventional neurology has been transformed. Supported by strong Class IA evidence, the vascular and interventional neurology community has been empowered to realign systems of care to address the new challenges that have been introduced. Given the recent developments and accelerating pace of the field, the Society of Vascular and Interventional Neurology has collaborated with the American Academy of Neurology to provide an updated supplemental edition of Neurology® focused on endovascular therapy for acute ischemic stroke.Recent FindingsIn this supplemental edition, the authors discuss the unmet need for endovascular therapy, emerging trends in stroke systems of care, the role of imaging in patient selection, prognostication and treatment-related factors, procedural considerations, current top tier guidelines, recent advances in neuroprotection, and future directions of the field.SummaryThe field of interventional neurology continues to grow and advance, particularly since the seminal stroke trials published between 2015 and 2018. Whereas this progress has significantly improved the ability to alter outcomes after acute ischemic stroke due to large vessel occlusion, important new hurdles present themselves to the neurology community.

scholarly journals Trends in acute ischemic stroke treatments and mortality in the United States from 2012 to 2018

2021 ◽  
Vol 51 (1) ◽  
pp. E2
Author(s):  
Sharath Kumar Anand ◽  
William J. Benjamin ◽  
Arjun Rohit Adapa ◽  
Jiwon V. Park ◽  
D. Andrew Wilkinson ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Systems Of Care ◽  
Temporal Trends ◽  
The United States ◽  
Tissue Type ◽  
Type Plasminogen Activator ◽  
Stroke Systems Of Care ◽  
The Relationship

OBJECTIVE The establishment of mechanical thrombectomy (MT) as a first-line treatment for select patients with acute ischemic stroke (AIS) and the expansion of stroke systems of care have been major advancements in the care of patients with AIS. In this study, the authors aimed to identify temporal trends in the usage of tissue-type plasminogen activator (tPA) and MT within the AIS population from 2012 to 2018, and the relationship to mortality. METHODS Using a nationwide private health insurance database, 117,834 patients who presented with a primary AIS between 2012 and 2018 in the United States were identified. The authors evaluated temporal trends in tPA and MT usage and clinical outcomes stratified by treatment and age using descriptive statistics. RESULTS Among patients presenting with AIS in this population, the mean age was 69.1 years (SD ± 12.3 years), and 51.7% were female. Between 2012 and 2018, the use of tPA and MT increased significantly (tPA, 6.3% to 11.8%, p < 0.0001; MT, 1.6% to 5.7%, p < 0.0001). Mortality at 90 days decreased significantly in the overall AIS population (8.7% to 6.7%, p < 0.0001). The largest reduction in 90-day mortality was seen in patients treated with MT (21.4% to 14.1%, p = 0.0414) versus tPA (11.8% to 7.0%, p < 0.0001) versus no treatment (8.3% to 6.3%, p < 0.0001). Age-standardized mortality at 90 days decreased significantly only in patients aged 71–80 years (11.4% to 7.8%, p < 0.0001) and > 81 years (17.8% to 11.6%, p < 0.0001). Mortality at 90 days stagnated in patients aged 18 to 50 years (3.0% to 2.2%, p = 0.4919), 51 to 60 years (3.8% to 3.9%, p = 0.7632), and 61 to 70 years (5.5% to 5.2%, p = 0.2448). CONCLUSIONS From 2012 to 2018, use of tPA and MT increased significantly, irrespective of age, while mortality decreased in the entire AIS population. The most dramatic decrease in mortality was seen in the MT-treated population. Age-standardized mortality improved only in patients older than 70 years, with no change in younger patients.

Pre-Stroke Cholinesterase Inhibitor Treatment Is Beneficially Associated with Functional Outcome in Patients with Acute Ischemic Stroke and Pre-Stroke Dementia: The Fukuoka Stroke Registry

2021 ◽  
pp. 1-7
Author(s):  
Yoshinobu Wakisaka ◽  
Ryu Matsuo ◽  
Kuniyuki Nakamura ◽  
Tetsuro Ago ◽  
Masahiro Kamouchi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Neurological Deterioration ◽  
Stroke Outcome ◽  
Matched Cohort ◽  
Poor Functional Outcome ◽  
Stroke Registry ◽  
Chei Treatment

Introduction: Pre-stroke dementia is significantly associated with poor stroke outcome. Cholinesterase inhibitors (ChEIs) might reduce the risk of stroke in patients with dementia. However, the association between pre-stroke ChEI treatment and stroke outcome remains unresolved. Therefore, we aimed to determine this association in patients with acute ischemic stroke and pre-stroke dementia. Methods: We enrolled 805 patients with pre-stroke dementia among 13,167 with ischemic stroke within 7 days of onset who were registered in the Fukuoka Stroke Registry between June 2007 and May 2019 and were independent in basic activities of daily living (ADLs) before admission. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale [mRS] score: 3–6) at 3 months after stroke onset and neurological deterioration (≥2-point increase in the NIH Stroke Scale [NIHSS] during hospitalization), respectively. Logistic regression analysis was used to evaluate associations between pre-stroke ChEI treatment and study outcomes. To improve covariate imbalance, we further conducted a propensity score (PS)-matched cohort study. Results: Among the participants, 212 (26.3%) had pre-stroke ChEI treatment. Treatment was negatively associated with poor functional outcome (odds ratio: 0.68 [95% confidence interval: 0.46–0.99]) and neurological deterioration (0.52 [0.31–0.88]) after adjusting for potential confounding factors. In the PS-matched cohort study, the same trends were observed between pre-stroke ChEI treatment and poor functional outcome (0.61 [0.40–0.92]) and between the treatment and neurological deterioration (0.47 [0.25–0.86]). Conclusions: Our findings suggest that pre-stroke ChEI treatment is associated with reduced risks for poor functional outcome and neurological deterioration after acute ischemic stroke in patients with pre-stroke dementia who are independent in basic ADLs before the onset of stroke.

Plasma Retinol Binding Protein 4 as a Biomarker for Detecting Progressive Stroke and Prediction of Early Prognosis in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 18 ◽  
Author(s):  
Shuqiong Liu ◽  
Jiande Li ◽  
Xiaoming Rong ◽  
Yingmei Wei ◽  
Ying Peng ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Independent Risk Factor ◽  
Binding Protein ◽  
Multivariate Logistic Regression Analysis ◽  
Retinol Binding Protein ◽  
Retinol Binding Protein 4 ◽  
Treatment Measures ◽  
Plasma Retinol

Aim and purpose: Progressive stroke (PS) lacks effective treatment measures and leads to serious disability or death. Retinol binding protein 4 (RBP4) could be closely associated with acute ischemic stroke(AIS). We aimed to explore plasma RBP4 as a biomarker for detecting the progression in patients with AIS. Methods: Participants of this retrospective study were 234 patients with AIS within the 48 h onset of disease. The primary endpoint was to ascertain if there was PS through the National Institute of Health stroke scale (NIHSS), early prognosis was confirmed through the modified Rankin scale score (mRS) at discharge or 14 days after the onset of stroke, and determine the significance of demographic characteristics and clinical data . Results: In this study, 43 of 234 patients demonstrated PS. . The level of plasma RBP4 in patients with progressive stroke was significantly lower (29 mg/L, 22.60－40.38 mg/L) than that without progression (38.70 mg/L, 27.28－46.40 mg/L, P = 0.003). In patients with lower plasma RBP4, he proportion of patients with progression (c2 = 9.63, P = 0.008) and with mRS scores ≥2 (c2 = 6.73, P = 0.035) were significantly higher Multivariate logistic regression analysis showed that a lower RBP4 level on admission was an independent risk factor for progressive stroke during hospitalization with an OR value of 2.70 (P = 0.03, 95% CI: 1.12－6.52). Conclusion: A low plasma RBP4 level on admission could be an independent risk factor of PS during hospitalization.

Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II

2017 ◽  
Vol 12 (3) ◽  
pp. 254-263 ◽  
Author(s):  
Janet Prvu Bettger ◽  
Zixiao Li ◽  
Ying Xian ◽  
Liping Liu ◽  
Xingquan Zhao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Multivariable Analysis ◽  
Thrombosis Prophylaxis ◽  
Stroke Patients ◽  
Multivariable Logistic Regression Model ◽  
Recommended Care ◽  
Stroke Registry ◽  
Factors Associated ◽  
Rehabilitation Assessment

Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p < 0.05) included disability prior to stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.

Abstract 160: Paradoxical Effect of Smoking on Mortality in the patients Admitted with Acute Ischemic Stroke

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Lee H Schwamm
Keyword(s):  
Ischemic Stroke ◽  
Myocardial Ischemia ◽  
Acute Ischemic Stroke ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Oral Intake ◽  
Lower Mortality ◽  
Paradoxical Effect ◽  
Multicenter Studies ◽  
Stroke Registry

Introduction: Compared to those who never smoked, a paradoxical effect of smoking on reducing mortality in patients admitted with myocardial ischemia has been reported. We sought to determine if this effect was present in patients hospitalized with ischemic stroke. Methods: Using the local Get with the Guidelines-Stroke registry, we analyzed 4,305 consecutively admitted ischemic stroke patients (Mar 2002-Dec 2011). The sample was divided into smokers vs. ex or non-smokers. The main outcome of interest was the overall inpatient mortality. Multivariable analysis included factors significant at p<0.05 in univariate analysis. Results: Compared to non-smokers, tobacco smokers were younger, more frequently male and presented with fewer stroke risk factors such as hypertension, hyperlipidemia, diabetes, coronary artery disease and atrial fibrillation. Smokers also had a lower median NIHSS and fewer received tPA. Patients in both groups had similar adherence to early antithrombotics, dysphagia screening prior to oral intake and DVT prophylaxis (Table 1). Smoking was associated with lower all cause in-hospital mortality (6.6% vs. 12.4%; unadjusted OR 0.46; CI [0.34 - 0.63]; p < 0.05). In multivariable analysis, adjusted for age, gender, ethnicity, HTN, DM, HL, CAD, A.fib, NIHSS and tPA at an outside hospital, smoking remained independently associated with lower mortality (adjusted OR 0.66; CI [0.44-0.98]; p < 0.05). (Table 2) Conclusion: Similar to myocardial ischemia, smoking was independently associated with lower mortality in acute ischemic stroke. This effect may be due to tobacco induced changes in cerebrovascular resting tone or vasoreactivity, or may be due in part to residual confounding (e.g., differences in predicted outcome from stroke subtypes, or wishes regarding life sustaining therapies). Larger, multicenter studies are needed to confirm the finding and determine the role of in hospital complications and the effect on 30 day and 1 year mortality.

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