Abstract P239: Trends in Ischemic Stroke Treatments and Mortality in the United States From 2012-2018

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Sharath Kumar Anand ◽  
William J Benjamin ◽  
Arjun Adapa ◽  
Jiwon V Park ◽  
Badih Daou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Private Health Insurance ◽  
Systems Of Care ◽  
Temporal Trends ◽  
The United States ◽  
First Line ◽  
Chi Square ◽  
Treatment Groups ◽  
Stroke Systems Of Care ◽  
Insurance Database

Introduction: The establishment of mechanical thrombectomy (MT) as a first line treatment for select patients with ischemic stroke (IS) and the resulting expansion of stroke systems of care have been major advancements in the care of IS patients. Our study aims to identify temporal trends in the usage of tPA and MT, as well as mortality for IS patients from 2012-2018. Hypothesis: We hypothesize that not only MT but also tPA utilization increased after 2015 compared to years previous, while mortality likely improved, given enhanced public education and optimization of stroke systems of care. Methods: Using a nation-wide, private health insurance database, we identified 141,959 patients who presented with a primary IS between 2012 and 2018. We evaluated trends in tPA and MT usage, and mortality stratified by treatment group using chi square and Cochran-Armitage testing. Results: Among patients presenting with IS in this population, the average age was 69.00 ± 12.23, and 47.43% were male. Between 2012-2018, the proportional use of tPA and MT increased significantly (tPA: 6.30%% to 11.79%, p<0.0001; MT: 1.57% to 5.69%, p<0.0001). Mortality at 30 days decreased significantly from 2012-2018 in the overall IS population (4.82% to 4.18%, p<0.0001). Mortality following MT saw the greatest improvement (30-day: 16.42% to 9.04%, p=0.0291), followed by tPA (30-day: 8.54% to 4.91%, p<0.0001) and finally by no treatment (30-day: 4.43% to 3.79%, p<0.0001). Conclusion: From 2012-18, we found the use of tPA and MT increased significantly while 30-day mortality decreased in the entire IS population. The most dramatic decrease in mortality was seen in the MT population, followed by tPA and no treatment groups.

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.

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.

Abstract 1122‐000121: Integrated Geomapping Tool of Certified Stroke Centers in United States: A SVIN MT2020+ Committee Collaboration

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Evan Kolesnick ◽  
Evan Kolesnick ◽  
Alfredo Munoz ◽  
Kaiz Asif ◽  
Santiago Ortega‐Gutierrez ◽  
...  
Keyword(s):  
United States ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Healthcare Disparities ◽  
Systems Of Care ◽  
Stroke Care ◽  
The United States ◽  
Time Dependent ◽  
Stroke Systems Of Care ◽  
Stroke Center

Introduction : Stroke is a leading cause of morbidity, mortality and healthcare spending in the United States. Acute management of ischemic stroke is time‐dependent and evidence suggests improved clinical outcomes for patients treated at designated certified stroke centers. There is an increasing trend among hospitals to obtain certification as designated stroke centers. A common source or integrated tool providing both information and location of all available stroke centers in the US irrespective of the certifying organization is not readily available. The objective of our research is to generate a comprehensive and interactive electronic resource with combined data on all geographically‐coded certified stroke centers to assist in pre‐hospital triage and study healthcare disparities in stroke including availability and access to acute stroke care by location and population. Methods : Data on stroke center certification was primarily obtained from each of the three main certifying organizations: The Joint Commission (TJC), Det Norske Veritas (DNV) and Healthcare Facilities Accreditation Program (HFAP). Geographic mapping of all stroke center locations was performed using the ArcGIS Pro application. The most current data on stroke centers is presented in an interactive electronic format and the information is frequently updated to represent newly certified centers. Utility of the tool and its analytics are shown. Role of the tool in improving pre‐hospital triage in the stroke systems of care, studying healthcare disparities and implications for public health policy are discussed. Results : Aggregate data analysis at the time of submission revealed 1,806 total certified stroke centers. TJC‐certified stroke centers represent the majority with 106 Acute Stroke Ready (ASR), 1,040 Primary Stroke Centers (PSCs), 49 Thrombectomy Capable Centers (TSCs) and 197 Comprehensive Stroke Centers (CSCs). A total of 341 DNV‐certified programs including 36 ASRs, 162 PSCs, 16 PSC Plus (thrombectomy capable) and 127 CSCs were identified. HFAP‐certified centers (75) include 16 ASRs, 49 PSCs, 2 TSCs and 8 CSCs. A preliminary map of all TJC‐certified CSCs and TSCs is shown in the figure (1). Geospatial analysis reveals distinct areas with currently limited access to certified stroke centers and currently, access to certified stroke centers is extremely limited to non‐existent in fe States (for example: Idaho, Montana, Wyoming, New Mexico and South Dakota). Conclusions : Stroke treatment and clinical outcomes are time‐dependent and prompt assessment and triage by EMS directly to appropriate designated stroke centers is therefore critical. A readily available electronic platform providing location and treatment capability for all nearby certified centers will enhance regional stroke systems of care, including enabling more rapid inter‐hospital transfers for advanced intervention. Identifying geographic areas of limited access to treatment can also help improve policy and prioritize the creation of a more equitable and well‐distributed network of stroke care in the United States.

Abstract P278: Improving Stroke Systems of Care in Nebraska

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Marco A Gonzalez Castellon ◽  
James A BOBENHOUSE ◽  
David Franco ◽  
Beth L Malina ◽  
Mindy Cook ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Rural Areas ◽  
Systems Of Care ◽  
Stroke Care ◽  
The United States ◽  
Advisory Council ◽  
Management Tool ◽  
Acute Stroke Care ◽  
Stroke Systems Of Care ◽  
Get With The Guidelines

Introduction: Stroke is a leading cause of disability in the United States. Disparities in stroke care between metropolitan and rural areas have long been recognized. Access to high-level timely stroke expertise improves outcomes, but in rural areas this is limited by sparse availability of stroke specialists. Since 2006, the Nebraska Stroke Advisory Council, a statewide coalition of stroke experts and stakeholders, began implementing strategies to improve stroke care. In 2016, the Nebraska legislature approved Bill 722, mandating the development of stroke systems of care. In 2018, the AHA and the Helmsley Charitable Trust launched Mission: Lifeline Stroke, a coordinated 3-year program to enhance stroke systems of care in Nebraska. Purpose: To assess advances in acute stroke care in Nebraska after implementing a statewide stroke system of care focused on rural areas. Methods: The Council joined with AHA to expand public and professional stroke education offerings including workshops, conferences, and EMS trainings. They developed state specific treatment guidelines and created educational reinforcement materials. From 2016 to 2019 Get With The Guidelines® (GWTG) was used for stroke data collection and quality improvement in Nebraska. GWTG participating hospitals expanded from 7 to 40 sites (21 critical access). Results: The number of stroke and Transient Ischemic Attack cases reported more than doubled from 2016 to 2019 (1848 to 3987 cases). The door to CT initiated in < 25 minutes improved by 13%. IV alteplase therapy gains included: utilization increased from 8.7% to 11.3%; median door to drug time reduced from 54 to 42 minutes; and door to drug within 60 minutes of arrival increased from 67% to 80.4%.The number of alteplase monitored patients doubled and mechanical thrombectomy cases increased from 77 in 2017 to 138 in 2019. Conclusion: Implementation of strategies in Nebraska, with an emphasis on rural critical access hospitals, led to significant improvements in acute stroke care. This work represents the authors’ independent analysis of local or multicenter data gathered using the AHA Get With The Guidelines® Patient Management Tool but is not an analysis of the national GWTG dataset and does not represent findings from the AHA GWTG National Program

Abstract 145: Transferred Ischemic Stroke Patients Have Worse Outcomes After Endovascular Therapy

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Malik M Adil ◽  
Shyam Prabhakaran
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Endovascular Treatment ◽  
Endovascular Therapy ◽  
Systems Of Care ◽  
Inpatient Rehabilitation ◽  
Patient Characteristics ◽  
Transferred Patients ◽  
Stroke Systems Of Care

Background and Objective: Ischemic stroke (IS) patients may require inter-facility transfer for higher level of care. Endovascular treatment is the main indication for transfer. We aimed to compare patient characteristics and clinical outcomes amongst transferred vs. non-transferred IS patients who undergo endovascular therapy. Methods: Patients admitted to US hospitals between 2008 and 2011 with a primary discharge diagnosis of IS were identified by ICD-9 codes (433, 434, 436 and 437.1). Mechanical embolectomy (ME) was identified using the ICD-9 procedure code 39.74 or DRG 543 and cerebral angiography (CA) day 0-1 by 88.41. Using logistic regression, we estimated the odds ratio (OR) and 95% confidence intervals (CI) for intracerebral hemorrhage (ICH), in-hospital mortality, and good outcomes (discharge home or inpatient rehabilitation) among transfer vs. non-transfers, adjusting for potential confounders. Results: Of 116,382 patients with IS treated with ME or CA (7.0% of all patients with IS), 10.1% were performed in transferred patients. Atrial fibrillation and hyperlipidemia was significantly higher in IS transfers. In-hospital mortality was higher among IS transfers (9.0% vs. 3.7%; p<0.001) and discharge to home or inpatient rehabilitation was less likely among transferred IS patients (70.2% vs. 80.6%; p<0.001). ICH was higher among IS transfers (4.6% vs. 1.7%; p<0.001). After adjusting for age, gender, race, presence of hypertension, dyslipidemia, atrial fibrillation, renal failure, alcohol abuse, insurance status, and hospital teaching status, transferred patients had higher odds of ICH (OR 2.0, 95% CI 1.5-2.8, p<0.001)] and death (OR 2.0, 95% CI 1.6-2.4, p<0.001) and lower odds of discharge to home/rehabilitation (OR 0.5, 95% CI 0.4-0.7, p<0.001) . Conclusion: Endovascular treatment for acute ischemic stroke may be associated with worse outcomes among inter-hospital transfer patients compared to non-transfers. Organized stroke systems of care may need to consider pre-hospital strategies to increase direct referrals to comprehensive stroke centers and inter-hospital strategies to reduce delays to treatment.

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.

Abstract 187: Temporal Trends in Sex and Age Disparities in Acute Ischemic Stroke Treatment and Outcomes in the United States From 2004 to 2014

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Vasu Saini ◽  
Fadar O Otite ◽  
Priyank Khandelwal ◽  
Dileep R Yavagal ◽  
Seemant Chaturvedi ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Temporal Trends ◽  
The United States ◽  
Stroke Treatment ◽  
Age Disparities

An evaluation of RAS testing and survival among mCRC patients in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15144-e15144
Author(s):  
Enko Kiprilov ◽  
Laura Sangaré ◽  
Kimberly Lowe ◽  
Alexandra Christodoulopoulou
Keyword(s):  
Median Survival ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
The United States ◽  
Current Treatment ◽  
First Line ◽  
Treatment Groups ◽  
The Status ◽  
Ras Family ◽  
Third Line

e15144 Background: The status of mutations in the rat sarcoma viral oncogene homolog ( RAS) family of genes, which includes Kirsten RAS ( KRAS) and Neuroblastoma RAS ( NRAS) predicts response to anti-EGFR therapies in metastatic colorectal cancer (mCRC) patients. Current treatment guidelines recommend all mCRC patients to receive RAS testing prior to initiating treatment with an anti-EGFR agent. This study sought to establish estimates of RAS testing among mCRC patients in the US prior to initiation of first and third lines of treatment, and to describe median survival by treatment groups. Methods: Data from the Oncology Services Comprehensive Electronic Records (OSCER) 2.0 dataset were utilized. Patients diagnosed with mCRC between January 1, 2011 and July 31, 2017 were eligible. Patients were followed for up to 1 year, or until death, following their mCRC diagnosis. Results: A total of 17,387 mCRC patients were included in the analysis, among which 69% were RAS tested and 31% were never tested. Among the RAS tested patients, 23% were tested prior to their mCRC diagnosis 60% received RAS testing following mCRC diagnosis but prior to first line of treatment, 3% were tested following first line treatment but prior to third line, and the remaining 14% were tested following third line. Demographic variables did not differ between tested and untested groups, overall and by line of treatment. The overall median survival of RAS WT patients was 31.1 months (95% CI: 30.0, 32.4). MCRC patients who were not RAS tested had a lower median survival of 20.7 months (95% CI: 19.1, 22.5). Conclusions: The timing of when patients are being tested varies greatly. While nearly 70% of patients had a RAS test, approximately 30% failed to be tested, identifying a large gap in testing practices. Universal RAS testing provides patients and their physicians with knowledge of their anti-EGFR treatment options and may result in improved survival.

Abstract T P137: Temporal Trends in Hospitalization for Ischemic Stroke in the United States, 2000-2010

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nerses Sanossian ◽  
May A Kim-Tenser ◽  
Lucas Ramirez ◽  
Natalie Valle ◽  
Steven Cen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Black Women ◽  
Temporal Trends ◽  
The United States ◽  
Population Based ◽  
Older Individuals ◽  
Hospitalization Rates ◽  
The Us ◽  
Age Adjusted Rates ◽  
Age And Sex

Background: Recent population-based studies have revealed declining ischemic stroke hospitalization rates in the US, particularly among whites, but no study has assessed recent nationwide trends in race/ethnic-, age- and sex-specific stroke hospitalization rates in the US. Aims: To assess temporal trends in race/ethnic-, age-, and sex-specific rates of hospitalization for ischemic stroke in the US. Methods: Temporal trends in hospitalization for ischemic stroke (ICD-9 codes 433.x1, 434, 436) from 2000 to 2010 were assessed among adults ≥25 years using the Nationwide Inpatient Sample. Age-, sex-, and race/ethnic-specific stroke hospitalization rates were calculated using the weighted number of hospitalizations as the numerator and the US civilian population as the denominator. Age-adjusted rates were standardized to the 2000 US Census population. Results: From 2000 to 2010, age-adjusted stroke hospitalization rates decreased from 169 to 138 per 100,000 (overall rate reduction 18.3%). The decline in stroke hospitalizations was driven by the ≥65 age group, with the sharpest decline among 65-84 year olds (Figure). Sex-specific rates showed higher age-adjusted rates in women, with a steeper reduction in women than in men (from 228 to 180 vs. 183 to 157 per 100,000). Race/ethnic-specific trends revealed that hospitalizations decreased for whites and Hispanics but increased for blacks (from 144 to 193 per 100,000 in black men and from 191 to 211 per 100,000 in black women). Discussion: Although overall stroke hospitalizations have decreased in the US, the reduction has been more pronounced among older individuals, whites and Hispanics. Renewed efforts at targeting risk factor control among blacks and middle-aged individuals may be warranted. Figure 1.

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