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 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

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.

scholarly journals 137-02: Temporal Trends in Hospitalization Rates for Acute Ischemic Stroke among Nonagenarians with Atrial Fibrillation in the United States: A 15 Year Experience

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i177-i177
Author(s):  
Ghanshyam Palamaner Subash Shantha ◽  
Hardik Doshi ◽  
Anita Kumar ◽  
Siva Krothapalli ◽  
Gopi Dandamudi ◽  
...  
Keyword(s):  
United States ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Temporal Trends ◽  
The United States ◽  
Hospitalization Rates

scholarly journals Recombinant Tissue-Type Plasminogen Activator Use for Ischemic Stroke in the United States

Stroke ◽  
2011 ◽  
Vol 42 (7) ◽  
pp. 1952-1955 ◽  
Author(s):  
Opeolu Adeoye ◽  
Richard Hornung ◽  
Pooja Khatri ◽  
Dawn Kleindorfer
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
The United States ◽  
Tissue Type ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator

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.

Abstract WMP49: Temporal Trends in the Burden of Atrial Fibrillation in Acute Ischemic Stroke and Transient Ischemic Attack in the United States

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Fadar O Otite ◽  
Priyank Khandelwal ◽  
Seemant Chaturvedi ◽  
Jose G Romano ◽  
Ralph L Sacco ◽  
...  
Keyword(s):  
United States ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Large Scale ◽  
Temporal Trends ◽  
The United States ◽  
Hospital Size ◽  
Ischemic Attack

Background: Large scale data on atrial fibrillation (AF) prevalence in acute ischemic stroke (AIS) is sparse since approval of dabigatran for non-valvular AF in 2010. We studied recent trends in prevalence of AF in AIS and transient ischemic attack (TIA) in the United States (US) and association of AF with in-hospital mortality, cost and length of stay (LOS) in AIS. Methods: Adults admitted to US hospitals from 2007-2012 with diagnosis of AIS (n=3,427,806) and TIA (n=502,820) were identified from the Nationwide Inpatient Sample. Weighted prevalence of AF in AIS and TIA by demographics and region was computed. Multivariate logistic regression was used to evaluate association of AF with other clinical factors and mortality in AIS. Association of AF with LOS and cost was assessed using generalized linear models. Results: AF prevalence increased by 11.5% in AIS (22%-24.5%, p<0.001) and by 29% in TIA (13.5%-17.4%, p<0.001) from 2007-2012. AF prevalence varied by age (AIS: 7% in 50-59yo vs 38% in >80yo; TIA: 5% in 50-59yo vs 27% in >80yo), sex (AIS: 20% in M vs 25% in F); TIA: 16% in M vs 15% in F), race (AIS: whites 26% vs blacks 12%) and region (AIS: Northeast 25% vs South 21%). AF prevalence increased in all subgroups over time (p<0.001) except AIS <40yo and TIA<50yo (Figure 1). Advancing age, female sex, white race, high income, Medicare insurance, CHA 2 DS 2 -VASc score and large hospital size were associated with increased odds of AF in AIS. AF was positively associated with death (OR=1.60, 95%CI 1.56-1.64) but mortality in AIS with AF decreased from 13.2% in 2007 to 10.7% in 2012 (p<0.001). AF was associated with increased cost of $2,631 and LOS 1.1 days in AIS. Conclusion: Prevalence of AF in AIS and TIA has continued to increase. Disparity in AF prevalence in AIS and TIA exists by patient and hospital factors. AF is associated with increased mortality, LOS and hospital cost in AIS but mortality in AIS with AF is decreasing. More AIS preventive efforts are needed in AF patients especially in the elderly.

Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention

Stroke ◽  
2021 ◽  
Author(s):  
Ying Xian ◽  
Haolin Xu ◽  
Eric E. Smith ◽  
Jeffrey L. Saver ◽  
Mathew J. Reeves ◽  
...  
Keyword(s):  
United States ◽  
Quality Improvement ◽  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Phase I ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
The United States

Background and Purpose: The benefits of tPA (tissue-type plasminogen activator) in acute ischemic stroke are time-dependent. However, delivery of thrombolytic therapy rapidly after hospital arrival was initially occurring infrequently in hospitals in the United States, discrepant with national guidelines. Methods: We evaluated door-to-needle (DTN) times and clinical outcomes among patients with acute ischemic stroke receiving tPA before and after initiation of 2 successive nationwide quality improvement initiatives: Target: Stroke Phase I (2010–2013) and Target: Stroke Phase II (2014–2018) from 913 Get With The Guidelines-Stroke hospitals in the United States between April 2003 and September 2018. Results: Among 154 221 patients receiving tPA within 3 hours of stroke symptom onset (median age 72 years, 50.1% female), median DTN times decreased from 78 minutes (interquartile range, 60–98) preintervention, to 66 minutes (51–87) during Phase I, and 50 minutes (37–66) during Phase II ( P <0.001). Proportions of patients with DTN ≤60 minutes increased from 26.4% to 42.7% to 68.6% ( P <0.001). Proportions of patients with DTN ≤45 minutes increased from 10.1% to 17.7% to 41.4% ( P <0.001). By the end of the second intervention, 75.4% and 51.7% patients achieved 60-minute and 45-minute DTN goals. Compared with the preintervention period, hospitals during the second intervention period (2014–2018) achieved higher rates of tPA use (11.7% versus 5.6%; adjusted odds ratio, 2.43 [95% CI, 2.31–2.56]), lower in-hospital mortality (6.0% versus 10.0%; adjusted odds ratio, 0.69 [0.64–0.73]), fewer bleeding complication (3.4% versus 5.5%; adjusted odds ratio, 0.68 [0.62–0.74]), and higher rates of discharge to home (49.6% versus 35.7%; adjusted odds ratio, 1.43 [1.38–1.50]). Similar findings were found in sensitivity analyses of 185 501 patients receiving tPA within 4.5 hours of symptom onset. Conclusions: A nationwide quality improvement program for acute ischemic stroke was associated with substantial improvement in the timeliness of thrombolytic therapy start, increased thrombolytic treatment, and improved clinical outcomes.

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.

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