National Healthcare Quality and Disparities Report
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Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (1)
- Adverse Events (2)
- Blood Thinners (1)
- Cardiovascular Conditions (10)
- Comparative Effectiveness (1)
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- Emergency Medical Services (EMS) (2)
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- Healthcare-Associated Infections (HAIs) (1)
- Health Information Technology (HIT) (2)
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- Risk (2)
- (-) Stroke (10)
- Surgery (3)
- Telehealth (2)
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 10 of 10 Research Studies DisplayedMarcaccio 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)