scholarly journals Memory Trajectories Before and After First and Recurrent Strokes

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013171
Author(s):  
Wentian Lu ◽  
Marcus Richards ◽  
David Werring ◽  
Martin Bobak
Keyword(s):  
Confidence Interval ◽  
Acute Stroke ◽  
Stroke Care ◽  
Control Group ◽  
Case Group ◽  
Early Assessment ◽  
Acute Stroke Care ◽  
Memory Change ◽  
Before And After ◽  
Recurrent Strokes

Background and objectivesThe evidence on timing of memory change after first and recurrent strokes is limited and inconsistent. We investigated memory trajectories before and after first and recurrent strokes in eighteen European countries, and tested whether the country-level acute stroke care was associated with memory change after stroke.MethodsData were from the Survey of Health, Ageing and Retirement in Europe (2004–2019). Incident first and recurrent strokes were identified among baseline stroke-free individuals. Within each country, each participant with incident stroke (case group) was matched with a stroke-free individual (control group) using the Propensity Score Matching. We applied multilevel segmented linear regression to quantify acute and accelerated memory changes (measured by the sum score of immediate and delayed word recall tests; 0–20 words) before and after first and recurrent strokes in both groups. Associations between stroke and memory were compared between countries with different levels of acute stroke care indicators.ResultsThe final analytical sample included 35,164 participants who were stroke-free at baseline (≥50 years). 2,362 incident first and 341 recurrent strokes between 2004 and 2019 were identified. In case group, mean acute decreases in memory scores were 0.48 (95% confidence interval: 0.31, 0.65) and 1.14 (95% confidence interval: 0.80, 1.48) words after first and recurrent stroke, respectively, independent of a range of confounders. No such acute decreases were observed in control group after a hypothetical non-stroke onset date. In both groups, memory declined over time but decline rates were similar (-0.07 [95% confidence interval: -0.10, -0.05] versus -0.06 [95% confidence interval: -0.08, -0.05] words per year). The mean acute decreases in memory scores after first and recurrent strokes were smaller in countries with better access to endovascular treatment.DiscussionWe found acute decreases but not accelerated declines in memory after first and recurrent strokes. Improved endovascular therapy might be associated with smaller memory loss after stroke but more evidence based on individual-level data is needed. More effort should be made in early assessment and intensive prevention of stroke among the ageing population, and promoting access to and delivery of acute stroke care among patients with stroke.

Abstract W MP104: Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nerses Sanossian ◽  
May A Kim-Tenser ◽  
David S Liebeskind ◽  
Justina Breen ◽  
Scott Hamilton ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Stroke ◽  
Stroke Care ◽  
Care Quality ◽  
Acute Stroke Care ◽  
Phase 3 ◽  
Before And After ◽  
Beneficial Impact ◽  
Mean Time

Background: Primary Stroke Centers (PSC) provide better acute stroke care than non-PSC hospitals, including faster times to imaging and lytic treatment, and higher rates of lytic delivery. Nationwide less than 1 in 3 hospital has achieved this designation. We aimed to determine the extent to which the better performance at PSC is driven by improvements within hospitals after PSC designation versus better baseline hospital care among facilities seeking PSC certification. Methods: From 2005 to 2012, the NIH Field Administration of Stroke Therapy -Magnesium (FAST-MAG) Phase 3 clinical trial enrolled subjects with likely stroke within 2 hours of onset in a study of prehospital start of a neuroprotective agent. Subjects were routed to 59 community and academic centers in Los Angeles and Orange Counties. Of the original 59 centers, 39 eventually achieved PSC status during the study period. Each subject was classified as enrolled at a PSC before certification (pre-PSC), at a PSC post certification (post-PSC), or at a hospital that never achieved PSC (non-PSC). Results: Of 1700 cases, 529 (31%) were enrolled at pre-PSC, 856 (50%) at post-PSC, and 315 (19%) at non-PSC hospitals. Mean time in minutes from ED arrival to first scan was 33 minutes at post-PSC, 47 minutes at pre-PSC and 49 at non-PSCs [p<0.001 by Mann-Whitney]. Among cases of cerebral ischemia (CI) [N=1223], rates of TPA utilization were 43% at post-PSC, 27% at pre-PSC and 28% at non-PSC hospitals [p<0.001 by X2]. Time in minutes from ED arrival to thrombolysis in treated cases was 71 at post-PSC, 98 at pre-PSC, and 95 at non-PSC hospitals [p<0.001 by Mann-Whitney]. Hospitals that achieved PSC showed improvements in pre-PSC and post-PSC performance on door to imaging time, from 47 to 33 minutes [p=0.014]; percent TPA use in CI, from 27% to 43% [p<0.001], and reduced door-to-needle times, from 98 to 71 minutes [p=0.003]. There was no difference in time to imaging [47 vs. 49 minutes], time to thrombolysis [98 vs. 95 minutes] and percent TPA use [27% vs. 28%] between pre-PSC hospitals and non-PSC hospitals. Conclusions: Better performance of Primary Stroke Centers on acute care quality metrics is primarily driven by a beneficial impact of the PSC-certification process, and not better performance prior to seeking PSC status.

scholarly journals Effects of centralizing acute stroke services

Neurology ◽  
2018 ◽  
Vol 91 (3) ◽  
pp. e236-e248 ◽  
Author(s):  
Sidsel Hastrup ◽  
Soren P. Johnsen ◽  
Thorkild Terkelsen ◽  
Heidi H. Hundborg ◽  
Paul von Weitzel-Mudersbach ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Hospital ◽  
Acute Stroke Care ◽  
Difference In Differences ◽  
Stroke Units ◽  
Before And After ◽  
Stroke Services

ObjectiveTo investigate the effects of centralizing the acute stroke services in the Central Denmark Region (CDR).MethodsThe CDR (1.3 million inhabitants) centralized acute stroke care from 6 to 2 designated acute stroke units with 7-day outpatient clinics. We performed a prospective “before-and-after” cohort study comparing all strokes from the CDR with strokes in the rest of Denmark to discover underlying general trends, adopting a difference-in-differences approach. The population comprised 22,141 stroke cases hospitalized from May 2011 to April 2012 and May 2013 to April 2014.ResultsCentralization was associated with a significant reduction in length of acute hospital stay from a median of 5 to 2 days with a length-of-stay ratio of 0.53 (95% confidence interval 0.38–0.75, data adjusted) with no corresponding change seen in the rest of Denmark. Similarly, centralization led to a significant increase in strokes with same-day admission (mainly outpatients), whereas this remained unchanged in the rest of Denmark. We observed a significant improvement in quality of care captured in 11 process performance measures in both the CDR and the rest of Denmark. Centralization was associated with a nonsignificant increase in thrombolysis rate. We observed a slight increase in readmissions at day 30, but this was not significantly different from the general trend. Mortality at days 30 and 365 remained unchanged, as in the rest of Denmark.ConclusionsCentralizing acute stroke care in the CDR significantly reduced the length of acute hospital stay without compromising quality. Readmissions and mortality stayed comparable to the rest of Denmark.

scholarly journals Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals

2020 ◽  
Vol 10 ◽  
Author(s):  
Kristina Shkirkova ◽  
Theodore T. Wang ◽  
Lily Vartanyan ◽  
David S. Liebeskind ◽  
Marc Eckstein ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Before And After

scholarly journals Stroke care in Italy: An overview of strategies to manage acute stroke in COVID-19 time

2020 ◽  
Vol 5 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Marialuisa Zedde ◽  
Francesca Romana Pezzella ◽  
Maurizio Paciaroni ◽  
Francesco Corea ◽  
Nicoletta Reale ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Care Pathways ◽  
National Guidelines ◽  
Acute Stroke Care ◽  
Treatment Pathways ◽  
Delivery Of Care ◽  
Stroke Treatment ◽  
Italian Regions ◽  
Before And After

Purpose To analyse structural and non-structural modifications of acute stroke care pathways undertaken at healthcare institutions across the regions of Italy due to the coronavirus disease 2019 (COVID-19) pandemic. Methods Research on National decrees specific for the pandemic was carried out. The stroke pathways of four Italian regions from North to South, such as Lombardy, Veneto, Lazio and Campania, were analysed before and after the pandemic outbreak. Findings On 29 February 2020, the Italian Minister of Health issued national guidelines on how to address the COVID-19 emergency. Stroke management was affected and required changes, basically resulting in the need to prioritise the ongoing COVID-19 emergency. In the most affected regions, the closure of departments and hospitals led to a complete reorganisation of previously functioning stroke networks. With the closure of several Stroke Units and Stroke Centres, the transportation time to hospital lengthened significantly, especially for the outlying populations. Discussion The COVID-19 pandemic outbreak has been spreading rapidly in Italy and placing an overwhelming burden on healthcare systems. In response to this, political and healthcare decision-makers worked together to develop and implement efforts to sustain the national healthcare system while fighting the pandemic. Stroke care pathways changed during the pandemic and different organisational models were applied in the most affected regions. Conclusions Stroke treatment pathways will need to be redesigned so to guarantee that severe and acute disease patients do not lose their rights to the access and delivery of care during the COVID-19 pandemics.

scholarly journals Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care

Stroke ◽  
2019 ◽  
Vol 50 (6) ◽  
pp. 1525-1530 ◽  
Author(s):  
Dominique A. Cadilhac ◽  
Rohan Grimley ◽  
Monique F. Kilkenny ◽  
Nadine E. Andrew ◽  
Natasha A. Lannin ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Before And After

scholarly journals Impact on Clinical and Cost Outcomes of a Centralized Approach to Acute Stroke Care in London: A Comparative Effectiveness Before and After Model

PLoS ONE ◽  
2013 ◽  
Vol 8 (8) ◽  
pp. e70420 ◽  
Author(s):  
Rachael Maree Hunter ◽  
Charles Davie ◽  
Anthony Rudd ◽  
Alan Thompson ◽  
Hilary Walker ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Comparative Effectiveness ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Before And After ◽  
Cost Outcomes

scholarly journals Break in the Stroke Chain of Survival due to COVID-19

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2307-2314 ◽  
Author(s):  
Joan Montaner ◽  
Ana Barragán-Prieto ◽  
Soledad Pérez-Sánchez ◽  
Irene Escudero-Martínez ◽  
Francisco Moniche ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Descriptive Analysis ◽  
Stroke Care ◽  
Reperfusion Therapy ◽  
Time Of Arrival ◽  
Acute Stroke Care ◽  
Before And After ◽  
Chain Of Survival ◽  
The Impact

Background and Purpose: Emergency measures to treat patients with coronavirus disease 2019 (COVID-19) and contain the outbreak is the main priority in each of our hospitals; however, these measures are likely to result in collateral damage among patients with other acute diseases. Here, we investigate whether the COVID-19 pandemic affects acute stroke care through interruptions in the stroke chain of survival. Methods: A descriptive analysis of acute stroke care activity before and after the COVID-19 outbreak is given for a stroke network in southern Europe. To quantify the impact of the pandemic, the number of stroke code activations, ambulance transfers, consultations through telestroke, stroke unit admissions, and reperfusion therapy times and rates are described in temporal relationship with the rising number of COVID-19 cases in the region. Results: Following confinement of the population, our stroke unit activity decreased sharply, with a 25% reduction in admitted cases (mean number of 58 cases every 15 days in previous months to 44 cases in the 15 days after the outbreak, P <0.001). Consultations to the telestroke network declined from 25 every 15 days before the outbreak to 7 after the outbreak ( P <0.001). The increasing trend in the prehospital diagnosis of stroke activated by 911 calls stopped abruptly in the region, regressing to 2019 levels. The mean number of stroke codes dispatched to hospitals decreased (78% versus 57%, P <0.001). Time of arrival from symptoms onset to stroke units was delayed >30 minutes, reperfusion therapy cases fell, and door-to-needle time started 16 minutes later than usual. Conclusions: The COVID-19 pandemic is disruptive for acute stroke pathways. Bottlenecks in the access and delivery of patients to our secured stroke centers are among the main challenges. It is critical to encourage patients to continue seeking emergency care if experiencing acute stroke symptoms and to ensure that emergency professionals continue to use stroke code activation and telestroke networks.

Abstract WMP63: Outcomes After Regionalization of Acute Stroke Care: Time Trend Analysis From Multiple Counties in the State of California

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Prasanthi Govindarajan ◽  
Steve Shiboski ◽  
Barbara Grimes ◽  
Larry Cook ◽  
David Ghilarducci ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Health Planning ◽  
Patient Discharge ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Before And After ◽  
Independent Association ◽  
Stroke Center ◽  
Status Data ◽  
Phase Iv

Objective: To determine if regionalization of acute stroke care is associated with IV t-PA use over a five year period. Methods: This is a before-after observational study of all ambulance transported patients with a discharge diagnosis of acute ischemic stroke (AIS). We excluded inter-facility transports and direct admissions. Our data sources were the patient discharge abstract file from the Office of Statewide Health Planning and Development and prehospital records. Probabilistic matching was used to link the records. Relative risk regression was performed to study the independent association of regionalization with IV t-PA use after controlling for patient, hospital demographics and stroke center status. Data analysis was performed using SAS 9.2 Results: Number of ambulance transported AIS patients to 13 hospitals in both counties were 4282 in the “before-phase” and 15571 in the “after-phase” (County 1 “after-phase” n=11368 (73%), County 2 “after-phase” n= 4203 (27%). In the “after-phase”, 10189 (65.4%) were transported to primary stroke centers and 14981 (96.2%) were treated at community hospitals. In the “before-phase” IV t-PA was given to 79 patients (1.9%) and in the “after-phase” IV t-PA was given to 514 patients (3.3%). In the model, regionalization was independently associated with higher use of IV t-PA (Overall RR: 2.4 95% CI 1.4, 4.1) aRR for County 1 - 1.2 95% CI 0.82, 1.65 aRR for County 2 - 2.4 95% CI 1.4, 4.1 Conclusions: Regionalization was associated with higher rates of thrombolysis in AIS patients. Figure 1: IV t-PA rates before and after regionalization (County 1/County 2) Table 1: Independent association of regionalization with IV t-PA use

scholarly journals Effect of COVID-19 on Emergent Stroke Care

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
Jessica Hsiao ◽  
Emily Sayles ◽  
Eleni Antzoulatos ◽  
Robert J. Stanton ◽  
Heidi Sucharew ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Mitigation Measures ◽  
Acute Stroke Care ◽  
Healthcare Facilities ◽  
Stroke Team ◽  
Before And After ◽  
Prior Stroke ◽  
Hospital Capacities ◽  
Mortality Analysis

Background and Purpose: Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities. Methods: Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year. Results: Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%–46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%–51%), and specifically thrombolysis by 33% (95% CI, 4%–55%), but this finding had less precision. Conclusions: Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19.

Abstract TP311: Multidisciplinary Stroke Simulation: Novel Team Based Approach to Decrease Door-to-Needle Times

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Christopher A Mutch ◽  
Zachary Threlkeld ◽  
Sara Cole ◽  
Christine Martin ◽  
Benjamin Kozak ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Stroke Care ◽  
Simulated Patients ◽  
Ct Scanner ◽  
Acute Stroke Care ◽  
Before And After ◽  
Care Guidelines ◽  
Multidisciplinary Simulation ◽  
The Impact

Introduction: In acute stroke, time equals brain. Minimizing time to treatment maximizes eligibility and effectiveness of fibrinolytics. Timely treatment of acute stroke requires precise coordination of a multidisciplinary team ranging from first responders to neurointerventionalists. Simulation-based learning allows participants to hone their skills and make mistakes in a controlled environment. To our knowledge, the impact of multidisciplinary stroke simulation has not been reported in literature. Here we describe our initial experience implementing such a simulation. Hypothesis: Participation in stroke simulation will improve knowledge of acute stroke care guidelines and decrease door-to-needle time. Methods: Neurology, emergency medicine and radiology trainees, EMTs, nurses, medical students, technologists, and pharmacists took part in the evaluation and treatment of simulated patients with stroke symptoms in actual clinical settings from ambulance to ED to CT scanner to IR suite. Neurology and neuroradiology faculty debriefed participants following simulations. Questions on stroke care (derived from the 2013 AHA/ASA guideline and 2015 update) were sent to likely participants before and after the simulation; those who completed pre/post quizzes and the simulation were included in analysis. Results: Survey response rate was 86%. All participants had improved scores on the post-simulation quiz, scoring an average of 19% higher, 95% CI [8%, 29%]. For example, correct responses that IV tPA is not contraindicated prior to endovascular therapy improved from 64 to 100% after the simulation; responses correctly identifying the appearance of ischemic penumbra on CT perfusion imaging increased from 27 to 73%. Nearly all (92%) respondents would recommend the simulation to their peers. Conclusions: Simulation of acute stroke scenarios improves participants’ knowledge of acute stroke management guidelines and may improve door-to-needle time. We present a novel framework for multidisciplinary simulation, which could be implemented at other institutions. Further evaluation of simulation effect on door-to-needle time is ongoing.

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