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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 162 Research Studies DisplayedUrdaneta A, Fisk C, Tandel MD
Air medical transport for acute ischemic stroke patients: a retrospective cohort study of national trends over an 8-year period.
This study examined patterns of air transport for acute ischemic stroke patients over a period of 8 years (2007-2014). The authors abstracted a 20% national sample of Medicare data from patients ≥ 66 years of age hospitalized with a primary diagnosis of acute ischemic stroke who presented to the emergency department by ambulance (air or ground). They analyzed data from 149,751 hospitalized stroke patients who had a mean age of 81.6 years (standard deviation = 8.0 years), 62.1% female (n = 93,007), and 86.3% White (n = 129,268). Of these, 3.7% used any form of air ambulance. Air ambulance use (2007: 2.5%, 2014: 4.9%) and arrival at certified stroke centers (2007: 40.3%, 2014: 63.2%) increased over time. Air ambulance use was less likely among older patients (76-85 years and >85 years vs. 66-75 years; odds ratio [OR] = 0.68 and OR = 0.34, respectively) and all racial minorities except American Natives (OR = 2.07) and more likely among sicker patients (Charlson Comorbidity Index ≥ 2 vs. 1, OR = 1.23) and rural residents (OR = 1.34). After adjustment for covariates, air ambulance use was associated with higher odds of thrombolysis (adjusted OR = 2.57).
AHRQ-funded; HS026207.
Citation: Urdaneta A, Fisk C, Tandel MD .
Air medical transport for acute ischemic stroke patients: a retrospective cohort study of national trends over an 8-year period.
Air Med J 2023 Nov-Dec; 42(6):423-28. doi: 10.1016/j.amj.2023.06.007..
Keywords: Stroke, Cardiovascular Conditions, Emergency Medical Services (EMS)
Zachrison KS, Hsia RY, Schwamm LH
Insurance-based disparities in stroke center access in california: a network science approach.
The purpose of this study was to examine whether there is a relationship between ischemic stroke patient insurance and probability of transfer to a stroke center overall as well as whether hospital cluster modified the relationship between insurance and likelihood of stroke center transfer. The study included 332,995 total ischemic stroke encounters, with 3.5% transferred from the initial ED. The study found that of 52,316 participants presenting to a non-stroke center, 7.1% were transferred. Compared to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups. Within the 14 identified hospital clusters, there was variation in insurance-based disparities in transfer. The largest hospital was also the lowest performing cluster which fully explained the insurance-based disparity in odds of stroke center transfer. The study concluded that uninsured patients had lower stroke center access through transfer than patients with insurance, with the variation primarily explained by patterns in 1 specific hospital cluster.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hsia RY, Schwamm LH .
Insurance-based disparities in stroke center access in california: a network science approach.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009868. doi: 10.1161/circoutcomes.122.009868..
Keywords: Access to Care, Stroke, Cardiovascular Conditions, Disparities, Health Insurance, Uninsured
Reistetter T, Hreha K, Dean JM
The pre-adaptation of a stroke-specific self-management program among older adults.
To understand the management of multimorbidity in aging stroke survivors and to examine the complex relationships between comorbidities, researchers used visual analytics to identify patient subgroup. Five significant subgroups of comorbidities such as obesity and cancer were identified. An interdisciplinary team constructed six vignettes that highlighted multimorbidity to customize a self-management program that fitted the needs of older adult stroke survivors.
AHRQ-funded; HS026133.
Citation: Reistetter T, Hreha K, Dean JM .
The pre-adaptation of a stroke-specific self-management program among older adults.
J Aging Health 2023 Oct; 35(9):632-42. doi: 10.1177/08982643231152520..
Keywords: Stroke, Cardiovascular Conditions, Elderly, Patient Self-Management
Troy AL, Herzig SJ, Trivedi S
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
This study investigated prevalence of oral anticoagulant initiation for newly diagnosed US older adults with atrial fibrillation within 7 days of hospital discharge. The authors used a 20% national sample of Medicare fee-for-service beneficiaries, identifying patients aged 65 years or older newly diagnosed with atrial fibrillation while hospitalized in 2016. Among 38,379 older adults newly diagnosed with atrial fibrillation while hospitalized (mean age 78.2; 51.8% female; 83.3% white), 36,633 (95.4%) had an indication for anticoagulation and 24.6% (9011) of those initiated an oral anticoagulant following discharge. Higher CHA(2) DS(2) -VASc score was associated with a small increase in oral anticoagulant initiation (predicted probability 20.5% for scores <2 and 24.9% for ≥4). Elevated HAS-BLED score was associated with a small decrease in probability of anticoagulant initiation (25.4% for score <2 and 23.1% for ≥3). Frailty was associated with decreased likelihood of oral anticoagulant initiation (24.7% for non-frail and 18.1% for moderately-severely frail). Anticoagulant initiation varied by primary reason for hospitalization, with predicted probability highest among patients with a primary diagnosis of atrial fibrillation (46.1%) and lowest among those with non-cardiovascular conditions (13.8%) and bleeds (3.6%).
AHRQ-funded; HS026215.
Citation: Troy AL, Herzig SJ, Trivedi S .
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
J Am Geriatr Soc 2023 Sep; 71(9):2748-58. doi: 10.1111/jgs.18375..
Keywords: Elderly, Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Stroke
Tarnutzer AA, Gold D, Wang Z
Impact of clinician training background and stroke location on bedside diagnostic test accuracy in the acute vestibular syndrome - a meta-analysis.
Researchers conducted a systematic review to assess the accuracy of bedside diagnosis of acute dizziness/vertigo to differentiate peripheral vestibular from central neurologic causes. Their review indicated that the Head Impulse, Nystagmus, Test of Skew (HINTS) examination by trained clinicians can differentiate peripheral from central causes and show higher diagnostic accuracy for stroke in the first 24-48 hours than MRI diffusion-weighted imaging. They concluded that these techniques should be disseminated to clinicians evaluating dizziness/vertigo.
AHRQ-funded; HS029350.
Citation: Tarnutzer AA, Gold D, Wang Z .
Impact of clinician training background and stroke location on bedside diagnostic test accuracy in the acute vestibular syndrome - a meta-analysis.
Ann Neurol 2023 Aug; 94(2):295-308. doi: 10.1002/ana.26661..
Keywords: Diagnostic Safety and Quality, Training, Education: Continuing Medical Education, Provider: Clinician, Stroke, Cardiovascular Conditions
Patel PB, Marcaccio CL, Swerdlow NJ
Thoracoabdominal aortic aneurysm life-altering events following endovascular aortic repair in the Vascular Quality Initiative.
This study’s objective was to examine the rates of postoperative mortality and morbidity stratified by type of endovascular aortic aneurysm repair (EVAR). The authors identified all patients who underwent EVAR in the Vascular Quality Initiative registry from January 2011 to May 2022. Patients were then stratified by repair type: infrarenal EVAR, complex EVAR, thoracic endovascular aortic repair (TEVAR), extent I to III thoracoabdominal aortic aneurysm (TAAA) repair, or aortic arch repair. Primary outcomes across the different treatment groups was postoperative thoracoabdominal aortic aneurysm life-altering events (TALE). They identified a total of 52,592 EVARs, 3768 complex EVARs, 3899 TEVARs, 1139 extent I to III TAAA repairs, and 479 arch repairs, with TALE observed in 1.2% of EVARs, 4.8% of complex EVARs, 6.0% of TEVARs, 10% of extent I to III TAAA repairs, and 14% of arch repairs. More proximal landing zone was associated with higher odds of TALE after complex EVAR, TEVAR, and extent I to III TAAA repair. Aortic diameter >65 mm was associated with higher odds of TALE after infrarenal EVAR, complex EVAR, TEVAR, and arch repair. The use of parallel grafting technique (chimney/snorkel/periscope) during extent I to III TAAA repair was also associated with higher odds of TALE. Preoperative chronic kidney disease was also associated with higher odds of TALE after infrarenal EVAR, complex EVAR, TEVAR, and extent I to III TAAA repair.
AHRQ-funded; HS027285.
Citation: Patel PB, Marcaccio CL, Swerdlow NJ .
Thoracoabdominal aortic aneurysm life-altering events following endovascular aortic repair in the Vascular Quality Initiative.
J Vasc Surg 2023 Aug; 78(2):269-77.e3. doi: 10.1016/j.jvs.2023.03.499..
Keywords: Surgery, Stroke, Cardiovascular Conditions
Derington CG, Goodrich GK, Xu S
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
This study investigated the impact of an anticoagulation management service (AMS) on clinical outcomes of adults with atrial fibrillation (AF). This retrospective cohort study was conducted in 3 Kaiser Permanente regions, with each region taking a slightly different approach to direct oral anticoagulant (DOAC) care. These approaches included (1) usual care (UC) by the prescribing clinician, (2) UC plus an automated population management tool (PMT), or (3) pharmacist-managed AMS care. The study included 44,746 adults with a diagnosis of AF who initiated DOAC or warfarin between August 2016 and January 1, 2020, 6182 in the UC model, 33,624 in the UC plus PMT care model, and 4939 in the AMS care model. Baseline characteristics (mean age, 73.1 years, 56.1% male, 67.2% non-Hispanic White, median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, female sex] score of 3 [IQR, 2-5]) were well balanced after inverse probability of treatment weighting (IPTW). The cohort was followed over a median of 2 years, and patients who received the UC plus PMT or AMS care model did not have significantly better outcomes than those who received only UC.
AHRQ-funded; HS026156.
Citation: Derington CG, Goodrich GK, Xu S .
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
JAMA Netw Open 2023 Jul; 6(7):e2321971. doi: 10.1001/jamanetworkopen.2023.21971..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Outcomes, Stroke
Wang SX, Marcaccio CL, Patel PB
Distal embolic protection use during transfemoral carotid artery stenting is associated with improved in-hospital outcomes.
Researchers sought to assess in-hospital outcomes in patients who had undergone transfemoral carotid artery stenting (tfCAS) with and without embolic protection using a distal filter. Patients undergoing tfCAS were identified in the Vascular Quality Initiative and those who received proximal embolic balloon protection were excluded. Outcomes of interest were stroke, death, composite stroke/death, myocardial infarction, transient ischemic attack, and hyperperfusion syndrome. Results indicated that tfCAS performed without attempted distal embolic protection was associated with higher risk of in-hospital stroke and death; tfCAS after a failed attempt at filter placement had equivalent stroke/death to patients with no filter attempted, but higher risk of stroke/death compared with those with successfully placed filters. The researchers concluded that these findings support current Society for Vascular Surgery guidelines and, if a filter cannot be safely placed, alternative approaches to carotid revascularization should be considered.
AHRQ-funded; HS027285.
Citation: Wang SX, Marcaccio CL, Patel PB .
Distal embolic protection use during transfemoral carotid artery stenting is associated with improved in-hospital outcomes.
J Vasc Surg 2023 Jun; 77(6):1710-19.e6. doi: 10.1016/j.jvs.2023.01.210..
Keywords: Cardiovascular Conditions, Outcomes, Stroke
Marcaccio CL, Patel PB, Rastogi V
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
This study’s objective was to examine the efficacy and safety of preoperative single antiplatelet therapy (AP) therapy vs double antiplatelet therapy (DAPT) in patients who had undergone transfemoral CAS (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who had undergone tfCAS or TCAR in the Vascular Quality Initiative database from 2016 to 2021. A total of 18,570 tfCAS patients were included, of which 70% had received DAPT, 5.6% no AP therapy, 10% ASA only, 8.0% ASA + AP loading dose, 4.6% P2Y12 inhibitor (P2Yi) only, and 2.9% P2Yi + AP loading dose. After adjustment, compared with DAPT, the incidence of stroke/death was higher with no AP therapy, ASA only, and ASA + AP loading dose, but was similar with P2Yi only, and P2Yi + AP loading dose. No differences were found in the incidence of bleeding rates between the treatment groups after tfCAS or TCAR. These findings support the current guidelines recommending DAPT before CAS but also suggest that P2Yi monotherapy might confer thromboembolic benefits similar to those with DAPT.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Rastogi V .
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
J Vasc Surg 2023 May; 77(5):1434-46.e11. doi: 10.1016/j.jvs.2022.12.034..
Keywords: Blood Thinners, Medication, Medication: Safety, Cardiovascular Conditions, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Liberman AL, Holl JL, Romo E
Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis.
The authors conducted a failure modes, effects, and criticality analysis (FMECA) of the emergency department (ED)-based acute stroke diagnostic process at three health systems in Chicago. The FMECA was designed to identify and rank order failures in the processes of care. The authors found that failure to use existing screening scales to identify patients with large-vessel occlusions early in the ED course ranked highest; other highly ranked failures were obtaining an accurate history of the index event, suspecting acute stroke in triage, and using established stroke screening tools at ED arrival to identify potential stroke patients. They concluded that these results highlight the crucial importance of the first steps in the diagnostic process.
AHRQ-funded; HS025359; HS027264.
Citation: Liberman AL, Holl JL, Romo E .
Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis.
Acad Emerg Med 2023 Mar; 30(3):187-95. doi: 10.1111/acem.14648..
Keywords: Stroke, Cardiovascular Conditions, Diagnostic Safety and Quality
De Roo AC, Ha J, Regenbogen SE
Impact of Medicare eligibility on informal caregiving for surgery and stroke.
The purpose of this study was to assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at 65. Researchers used Health and Retirement Study survey data covering a 20-year period to compare informal care received by patients who had been hospitalized for stroke, heart surgery, or joint surgery, and who were stratified into propensity-weighted pre- and post-Medicare eligibility cohorts. Their results showed that onset of Medicare eligibility was associated with a substantial decrease in family and friend caregiving use received by stroke patients, but not in the other acute care cohorts. They concluded that this effect of Medicare coverage on informal caregiving had implications for patient function and caregiver burden, and should be considered in episode-based reimbursement models that alter professional rehabilitative care intensity.
AHRQ-funded; HS000053.
Citation: De Roo AC, Ha J, Regenbogen SE .
Impact of Medicare eligibility on informal caregiving for surgery and stroke.
Health Serv Res 2023 Feb; 58(1):128-39. doi: 10.1111/1475-6773.14019..
Keywords: Medicare, Caregiving, Surgery, Stroke, Cardiovascular Conditions
Anjorin AC, Marcaccio CL, Rastogi V
Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative.
This study evaluated the outcomes of carotid artery stenosis (CAS) patients using statin therapy before undergoing carotid revascularization in the Vascular Quality Initiative registry. The authors identified all patients who underwent carotid endarterectomy (CEA), transfemoral carotid artery stenting (tfCAS), or transcarotid artery revascularization (TCAR) in the Vascular Quality Initiative registry from January 2016 to September 2021. Compared with statin use, no statin use was associated with a higher risk of in-hospital stroke or death and 5-year mortality among CEA and tfCAS patients, although there was no significant difference in outcomes among TCAR patients.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Rastogi V .
Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative.
J Vasc Surg 2023 Jan;77(1):158-69.e8. doi: 10.1016/j.jvs.2022.08.019..
Keywords: Cardiovascular Conditions, Medication, Stroke, Surgery, Outcomes
Marcaccio CL, Anjorin A, Patel PB
In-hospital outcomes after upper extremity versus transfemoral and transcarotid access for carotid stenting in the Vascular Quality Initiative.
This comparative study examined outcomes for treatment of patients at high risk of carotid endarterectomy using different approaches of carotid artery stenting (CAS). The study compared the effects of transradial or transbrachial (tr/tbCAS) versus more established transfemoral (tfCAS) or transcarotid (TCAR) CAS procedures. Patients were identified from the Quality Initiative registry from January 2016 to December 2021. Among 40,835 CAS identified patients, 962 underwent tr/tbCAS, 28,850 underwent tfCAS, and 21,033 underwent TCAR. Among matched patients who underwent tr/tbCAS versus tfCAS, there was no significant difference in the risk of stroke/death (4.1% vs 2.9), but tr/tbCAS was associated with a higher risk of death (2.4% vs 1.3). In the symptomatic subgroup, tr/tbCAS was associated with a higher risk of stroke/death (6.1% vs 3.9%) and death (3.6% vs 1.7%), but there were no differences in asymptomatic patients. After adjustment for Modified Rankin Scale in patients with preoperative stroke, there were no significant differences in stroke/death or death between groups.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Anjorin A, Patel PB .
In-hospital outcomes after upper extremity versus transfemoral and transcarotid access for carotid stenting in the Vascular Quality Initiative.
J Vasc Surg 2022 Dec;76(6):1603-14.e7. doi: 10.1016/j.jvs.2022.05.030..
Keywords: Stroke, Cardiovascular Conditions, Outcomes, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research
Solomon Y, Rastogi V, Marcaccio CL
Outcomes after transcarotid artery revascularization stratified by preprocedural symptom status.
In this study, researchers examined contemporary perioperative outcomes in patients who underwent transcarotid artery revascularization (TCAR) stratified by specific preprocedural symptom status. Using data from the Vascular Quality Initiative, they found that, after TCAR, compared with asymptomatic status, a recent stroke and a recent hemispheric TIA were associated with higher stroke/death rates, whereas a recent ocular TIA was associated with similar stroke/death rates. In addition, a formerly symptomatic status was associated with higher stroke/death rates compared with an asymptomatic status. The researchers concluded that their findings suggested that classifying patients undergoing TCAR as symptomatic versus asymptomatic may be an oversimplification and that patients' specific preoperative neurologic symptoms should instead be used in risk assessment and outcome reporting for TCAR.
AHRQ-funded; HS027285.
Citation: Solomon Y, Rastogi V, Marcaccio CL .
Outcomes after transcarotid artery revascularization stratified by preprocedural symptom status.
J Vasc Surg 2022 Nov;76(5):1307-15.e1. doi: 10.1016/j.jvs.2022.05.024..
Keywords: Cardiovascular Conditions, Surgery, Stroke, Outcomes
Mihandoust S, Joseph A, Madathil KC
Comparing sources of disruptions to telemedicine-enabled stroke care in an ambulance.
This study investigated the nature and source of disruptions in an ambulance during the telemedicine-based caregiving process for stroke patients to enhance the ambulance design for supporting telemedicine-based care. Thirteen simulated telemedicine-based stroke consults were video recorded and then coded and analyzed using an existing systems-based flow disruption (FD) taxonomy. Factors that impacted disruptions included seat size, arrangement of assessment equipment, location of telemedicine equipment, and design of the telemedicine camera. The left ambulance seat zone and head of the patient bed had more environmental hazard-related disruptions, while the right zone was more prone to interruptions and communication-related disruptions.
AHRQ-funded; HS026809.
Citation: Mihandoust S, Joseph A, Madathil KC .
Comparing sources of disruptions to telemedicine-enabled stroke care in an ambulance.
HERD 2022 Apr;15(2):96-115. doi: 10.1177/19375867211054759..
Keywords: Telehealth, Health Information Technology (HIT), Stroke, Cardiovascular Conditions, Emergency Medical Services (EMS)
Marcaccio CL, Patel PB, Liang P
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
This study’s objective was to compare the efficacy and safety of perioperative dual antiplatelet therapy with aspirin/ticagrelor vs aspirin/clopidogrel in patients undergoing transfemoral carotid artery stenting (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who underwent tfCAS or TCAR in the Vascular Quality Initiative registry from January 2016 to March 2021. They stratified patients by procedure and assessed outcomes using 1:3 propensity score-matched cohorts of patients who received perioperative aspirin/ticagrelor vs aspirin/clopidogrel. Among the cohort of 17,731 tfCAS patients, 593 (3.3%) received aspirin/ticagrelor and 11,404 (64%) received aspirin/clopidogrel. For the 2065 matched patients, no significant differences were found in the composite endpoint of stroke/death (aspirin/ticagrelor, 4.1%; vs aspirin/clopidogrel, 2.6%) or in the individual endpoints of stroke (2.9% vs 1.8%) or death (1.7% vs 1.1%). However, aspirin/ticagrelor was associated with a higher risk of bleeding (5.8% vs 2.8%). In a subgroup analysis of 297 tfCAS patients (14%) who received intraoperative protamine, no differences remained in stroke/death (1.5% vs 3.9%), and there was no longer a difference in bleeding (3.0% vs 2.6%). Among 17,946 TCAR patients, 453 (2.5%) received aspirin/ticagrelor and 13,696 (76%) received aspirin/clopidogrel. With the 1618 matched patients, no differences were found in stroke/death (0.7% vs 1.4%), stroke (0.2% vs 1.2%), death (0.5% vs 0.2%), or bleeding (1.2% vs 1.6%). For the 1429 TCAR patients (88%) who received protamine, no differences were found in stroke/death (0.8% vs 1.2%) or bleeding (0.6% vs 1.4%).
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Liang P .
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
J Vasc Surg 2022 Apr; 75(4):1293-303.e8. doi: 10.1016/j.jvs.2021.09.045..
Keywords: Cardiovascular Conditions, Medication, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Surgery
Meng T, Trickey AM, Harris AHS
Lessons learned from the historical trends on thrombolysis use for acute ischemic stroke among Medicare beneficiaries in the United States.
The authors’ objectives were to assess and validate the change in intravenous thrombolysis (IVT) utilization in a national sample of Medicare beneficiaries and to examine the effect of patient, stroke center designation, and geography on IVT utilization. They found that, between 2007 and 2014, the frequency of IVT for patients with acute ischemic stroke increased substantially, though differences persisted in the form of less frequent treatment associated with certain characteristics.
AHRQ-funded; HS026207.
Citation: Meng T, Trickey AM, Harris AHS .
Lessons learned from the historical trends on thrombolysis use for acute ischemic stroke among Medicare beneficiaries in the United States.
Front Neurol 2022 Mar 4;13:827965. doi: 10.3389/fneur.2022.827965..
Keywords: Stroke, Cardiovascular Conditions, Blood Thinners
Yan Z, Nielsen V, Song G
Integration of regional hospitalizations, registry and vital statistics data for development of a single statewide ischemic stroke database.
The scope of population-based studies is often limited because databases rarely include detailed clinical variables and vital statistics such as death rates. The study team demonstrated a comprehensive process for integrating three clinical variable, vital statistics, and hospitalization databases into one single, statewide, ischemic stroke database. Using databases spanning 2007-2017, the authors identified and validated linkages between stroke admissions in a hospitalization database (47,713 admissions) and admissions in the stroke registry (43,487 admissions), resulting in 38,493 linked cases (80.7% of total cases) of which 95% were validated. Of the 38,493 linked cases, the authors linked 10,660 to deaths from the vital statistics database, resulting in a comprehensive assessment of cumulative mortality from ischemic strokes over a 7-year period among all registry-linked ischemic stroke hospitalization records. The authors concluded that comprehensive, accurate integration of the clinical registry, statewide hospitalizations, and vital statistics databases is achievable, and may have value for outcomes research on a larger scale.
AHRQ-funded; HS024561.
Citation: Yan Z, Nielsen V, Song G .
Integration of regional hospitalizations, registry and vital statistics data for development of a single statewide ischemic stroke database.
J Stroke Cerebrovasc Dis 2022 Mar;31(3):106236. doi: 10.1016/j.jstrokecerebrovasdis.2021.106236..
Keywords: Stroke, Cardiovascular Conditions, Registries
Glober N, Supples M, Persaud S
A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.
This paper describes the outcomes of a pilot study that used novel emergency medical services (EMS) protocol to expedite transfer of patients with large vessel occlusions (LVOs) to a comprehensive stroke center (CSC). The pilot study took place from Oct. 1, 2020 to Feb. 22, 2021 with Indianapolis EMS providers. In patients with possible LVO, the providers remained at the bedside until the clinical assessment and CT angiography were complete. This 5-month mixed methods study measured case-control assessment of the protocol, number of transfers, safety during transport, and time saved in transfer compared to emergency transfers via conventional interfacility transfer agencies. The protocol was used 42 times during the study period, with four patients found to have LVOs and transferred to a CSC. Median time from decision-to-transfer to arrival at the CSC was 27.5 minutes compared to 314.5 minutes for acute non-stroke transfers during the same period.
AHRQ-funded; HS026390.
Citation: Glober N, Supples M, Persaud S .
A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.
PLoS One 2022 Feb;17(2):e0264539. doi: 10.1371/journal.pone.0264539..
Keywords: Emergency Medical Services (EMS), Stroke, Cardiovascular Conditions, Critical Care
KS Cash, RE Adeoye, O
AHRQ Author: Zachrison
Estimated population access to acute stroke and telestroke centers in the US, 2019.
In order to provide an update on population-level access to stroke care, the investigators estimated the proportion of the US population with access to an ED with acute stroke capabilities and assessed the specific contribution of telestroke services to US population access. They observed a substantial increase in population access to acute stroke care in this cross-sectional study relative to previous reports using alternative methods, likely due to the extensive and ongoing work to improve stroke systems of care, including greater stroke center accreditation and expansion of telestroke capacity.
AHRQ-funded; HS024561.
Citation: KS Cash, RE Adeoye, O .
Estimated population access to acute stroke and telestroke centers in the US, 2019.
JAMA Netw Open 2022 Feb;5(2):e2145824. doi: 10.1001/jamanetworkopen.2021.45824..
Keywords: Telehealth, Health Information Technology (HIT), Stroke, Cardiovascular Conditions, Critical Care, Access to Care
Mallela DP, Canner JK, Zarkowsky DS
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
This study investigated the association of race on carotid endarterectomy (CEA) outcomes. Perioperative outcomes (at 30 days) were compared for Black vs. White patients adjusting for age/sex, comorbidities and disease characteristics. Out of 16,764 patients from the ACS-NSQIP targeted vascular database (2011-2019), 95.2% were White and 4.8% were Black. Black patients were slightly younger and more frequently (79.5% vs 74.0%) had high-grade carotid artery stenosis compared to White patients. Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients. Crude perioperative stroke and stroke/death were higher for Black patients, but myocardial infarction leading to death were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke and stroke/death remained significantly higher for Black patients than White patients.
AHRQ-funded; HS024547.
Citation: Mallela DP, Canner JK, Zarkowsky DS .
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
J Am Coll Surg 2022 Jan;234(1):65-73. doi: 10.1097/xcs.0000000000000016..
Keywords: Racial and Ethnic Minorities, Surgery, Cardiovascular Conditions, Stroke, Risk, Adverse Events
Boehme AK, Oka M, Cohen B
Readmission rates in stroke patients with and without infections: incidence and risk factors.
Investigators examined whether an infection acquired during the initial stroke admission contributed to increased risk of readmission and infection during readmission. Their a retrospective cohort study incorporated all adult ischemic stroke patients 2006-2016 from three New York City hospitals. They found that, among stroke patients, healthcare-associated infections and infections present on admission were predictors of readmission within 60 days and infection during readmission.
AHRQ-funded; HS024915.
Citation: Boehme AK, Oka M, Cohen B .
Readmission rates in stroke patients with and without infections: incidence and risk factors.
J Stroke Cerebrovasc Dis 2022 Jan;31(1):106172. doi: 10.1016/j.jstrokecerebrovasdis.2021.106172..
Keywords: Stroke, Cardiovascular Conditions, Hospital Readmissions, Risk, Healthcare-Associated Infections (HAIs)
Zachrison KS, Schwamm LH, Xu H
Frequency, characteristics, and outcomes of endovascular thrombectomy in patients with stroke beyond 6 hours of onset in US clinical practice.
In 2018, 2 randomized controlled trials showed the benefit of endovascular thrombectomy (EVT) in acute ischemic stroke patients treated 6 to 24 hours from last known well using imaging-guided selection. However, little is known about outcomes in contemporary nontrial settings. In this study, the investigators assessed the frequency of EVT and outcomes beyond 6 hours in the US Get With The Guidelines-Stroke clinical registry.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Schwamm LH, Xu H .
Frequency, characteristics, and outcomes of endovascular thrombectomy in patients with stroke beyond 6 hours of onset in US clinical practice.
Stroke 2021 Dec;52(12):3805-14. doi: 10.1161/strokeaha.121.034069..
Keywords: Stroke, Cardiovascular Conditions, Surgery, Outcomes
Rogers H, Madathil KC, Joseph A
An exploratory study investigating the barriers, facilitators, and demands affecting caregivers in a telemedicine integrated ambulance-based setting for stroke care.
This study investigates the impact of telemedicine on workload, teamwork, workflow, and communication of geographically distributed caregivers delivering stroke care in ambulance-based telemedicine. Simulated stroke sessions were conducted with selected caregivers, then followed with a survey and interviews. Findings showed that barriers included frustration with equipment, the loss of personal connection of the neurologists with the patients, and physical constraints in the ambulance. Facilitators included live visual communication increasing teamwork and efficiency, the ease of access to neurologist, increased flexibility, and high overall satisfaction and usability.
AHRQ-funded; HS026809.
Citation: Rogers H, Madathil KC, Joseph A .
An exploratory study investigating the barriers, facilitators, and demands affecting caregivers in a telemedicine integrated ambulance-based setting for stroke care.
Appl Ergon 2021 Nov;97:103537. doi: 10.1016/j.apergo.2021.103537..
Keywords: Telehealth, Health Information Technology (HIT), Caregiving, Stroke, Cardiovascular Conditions, Emergency Medical Services (EMS)
Prabhakaran S, Khorzad R, Parnianpour Z
Door-in-door-out process times at primary stroke centers in Chicago.
This study sought to identify modifiable predictors of door-in-door-out times for transfer of acute stroke patients from primary stroke centers to comprehensive stroke centers using 3 Chicago-region primary stroke centers as a model. A retrospective analysis of consecutive patients with acute stroke from February 2018 to January 2020 who required transfer from 1 of 3 primary stroke centers to 1 of 3 affiliated comprehensive stroke centers was conducted. Of 191 total patients, 67.9% arrived by emergency medical services and 57.4% during off-hours. Telestroke was performed in 84.2% of patients, 30.5% received alteplase, and 48.4% underwent a computed tomography (CT) at the primary stroke center. The median door-in-door-out time was 148.5 minutes. The largest contributors to longer door-in-door-out times were CT to CT angiography time, transfer center contact to ambulance request time, ambulance request to arrive time, and transfer ambulance at primary stroke center. Other factors included CT angiography performed at the primary stroke center, walk-in arrival mode, administration of intravenous alteplase request by primary stroke center, and ambulance request by the primary stroke center.
AHRQ-funded; HS025359.
Citation: Prabhakaran S, Khorzad R, Parnianpour Z .
Door-in-door-out process times at primary stroke centers in Chicago.
Ann Emerg Med 2021 Nov;78(5):674-81. doi: 10.1016/j.annemergmed.2021.06.018..
Keywords: Stroke, Cardiovascular Conditions, Healthcare Delivery, Emergency Department