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  1. Article ; Online: Validation of a neurovascular comorbidity index for risk adjustment of comorbid conditions among ischemic stroke patients receiving reperfusion treatment.

    Asaithambi, Ganesh / Martins, Summer L

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2023  Volume 32, Issue 8, Page(s) 107189

    Abstract: Objective: To validate a comorbidity index specific to neurovascular patients and determine its performance relative to the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) among ischemic stroke patients receiving reperfusion ... ...

    Abstract Objective: To validate a comorbidity index specific to neurovascular patients and determine its performance relative to the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) among ischemic stroke patients receiving reperfusion treatments.
    Methods: Patients with ischemic stroke were identified in the National Inpatient Sample from Quarter 4 2015 to Quarter 4 2017. Ischemic stroke patients receiving reperfusion treatment, either with intravenous thrombolysis (IVT) only or mechanical thrombectomy (MT), were studied. The accuracy of the neurovascular comorbidities index (NCI) was compared to both the CCI and ECI in predicting in-hospital death and poor outcome (defined as death prior to discharge or discharge to a short-term hospital, a skilled nursing facility, an intermediate care facility, another long-term facility, or home health care).
    Results: There were 25,147 ischemic stroke patients who received reperfusion therapy with either IVT only or MT (with or without IVT). Approximately 6.9% of patients died during their hospitalization, and 65.4% of patients were classified as having a poor outcome based on their discharge disposition. The NCI outperformed both the CCI and ECI in predicting in-hospital death (IVT only, p<0.0001; MT, p<0.0001) and poor outcomes (IVT only, p<0.0001; MT, p<0.0001).
    Conclusion: The NCI is a more powerful predictor of in-hospital death and poor outcomes when compared to the CCI or ECI among ischemic stroke patients receiving reperfusion therapies. Further validation studies are needed to confirm the accuracy of the NCI among other neurovascular patient populations.
    MeSH term(s) Humans ; Stroke/therapy ; Stroke/drug therapy ; Thrombolytic Therapy/adverse effects ; Ischemic Stroke/diagnosis ; Ischemic Stroke/epidemiology ; Ischemic Stroke/therapy ; Brain Ischemia/diagnosis ; Brain Ischemia/epidemiology ; Brain Ischemia/therapy ; Risk Adjustment ; Hospital Mortality ; Treatment Outcome ; Thrombectomy/adverse effects ; Inpatients ; Comorbidity ; Retrospective Studies ; Fibrinolytic Agents
    Chemical Substances Fibrinolytic Agents
    Language English
    Publishing date 2023-06-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2023.107189
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    Zs.A 3519: Show issues Location:
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  2. Article ; Online: Sex-specific racial and ethnic variations in short-term outcomes among patients with first or recurrent ischemic stroke: Paul Coverdell National Acute Stroke Program, 2016-2020.

    Asaithambi, Ganesh / George, Mary G / Tong, Xin / Lakshminarayan, Kamakshi

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2024  Volume 33, Issue 4, Page(s) 107560

    Abstract: Background and purpose: To understand the association of sex-specific race and ethnicity on the short-term outcomes of initial and recurrent ischemic stroke events.: Methods: Using the Paul Coverdell National Acute Stroke Program from 2016-2020, we ... ...

    Abstract Background and purpose: To understand the association of sex-specific race and ethnicity on the short-term outcomes of initial and recurrent ischemic stroke events.
    Methods: Using the Paul Coverdell National Acute Stroke Program from 2016-2020, we examined 426,062 ischemic stroke admissions from 629 hospitals limited to non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic patients. We performed multivariate logistic regression analyses to assess the combined effects of sex-specific race and ethnicity on short-term outcomes for acute ischemic stroke patients presenting with initial or recurrent stroke events. Outcomes assessed include rates of in-hospital death, discharge to home, and symptomatic intracranial hemorrhage (sICH) after reperfusion treatment.
    Results: Among studied patients, the likelihood of developing sICH after reperfusion treatment for initial ischemic stroke was not significantly different. The likelihood of experiencing in-hospital death among patients presenting with initial stroke was notably higher among NHW males (AOR 1.59 [95 % CI 1.46, 1.73]), NHW females (AOR 1.34 [95 % CI 1.23, 1.45]), and Hispanic males (AOR 1.57 [95 % CI 1.36, 1.81]) when compared to NHB females. Hispanic females were more likely to be discharged home when compared to NHB females after initial stroke event (AOR 1.32 [95 % CI 1.23, 1.41]). NHB males (AOR 0.90 [95 % CI 0.87, 0.94]) and NHW females (AOR 0.89 [95 % CI 0.86, 0.92]) were less likely to be discharged to home. All groups with recurrent ischemic strokes experienced higher likelihood of in-hospital death when compared to NHB females with the highest likelihood among NHW males (AOR 2.13 [95 % CI 1.87, 2.43]). Hispanic females had a higher likelihood of discharging home when compared to NHB females hospitalized for recurrent ischemic stroke, while NHB males and NHW females with recurrent ischemic stroke hospitalizations were less likely to discharge home.
    Conclusions: Sex-specific race and ethnic disparities remain for short-term outcomes in both initial and recurrent ischemic stroke hospitalizations. Further studies are needed to address disparities among recurrent ischemic stroke hospitalizations.
    MeSH term(s) Female ; Humans ; Male ; Black or African American ; Hospital Mortality ; Ischemic Stroke/diagnosis ; Ischemic Stroke/therapy ; Stroke/diagnosis ; Stroke/therapy ; White People ; White ; Hispanic or Latino
    Language English
    Publishing date 2024-01-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2024.107560
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  3. Article ; Online: Trends in intravenous thrombolysis utilization for acute ischemic stroke based on hospital size: Paul Coverdell National Acute Stroke Program, 2010-2019.

    Asaithambi, Ganesh / Tong, Xin / Lakshminarayan, Kamakshi

    The American journal of emergency medicine

    2023  Volume 67, Page(s) 51–55

    Abstract: Introduction: The rate of intravenous thrombolysis (IVT) utilization in acute ischemic stroke (AIS) has been increasing, and this has coincided with improved door-to-needle times (DNTs). Smaller hospitals have been observed to utilize IVT less ... ...

    Abstract Introduction: The rate of intravenous thrombolysis (IVT) utilization in acute ischemic stroke (AIS) has been increasing, and this has coincided with improved door-to-needle times (DNTs). Smaller hospitals have been observed to utilize IVT less frequently or even not at all. Using a multistate stroke registry, we sought to determine the impact of hospital size on trends in IVT utilization for AIS.
    Methods: Utilizing data from the Paul Coverdell National Acute Stroke Program (PCNASP), we studied trends in IVT for AIS patients between 2010 and 2019 based on hospital size. Hospitals were grouped into quartiles based on size. We studied the impact of hospital size on DNTs and overall IVT utilization.
    Results: During the study period, there were 530,828 AIS patients (mean age 70.3 ± 0.02 years, 50.4% men) from 540 participating hospitals. We did not identify a significant trend in IVT utilization among hospitals within the first quartile (p = 0.1005), but there were significantly increased trends within the hospitals belonging to the second, third, and fourth quartiles (p < 0.001 for all). All quartiles were observed to have significantly increased trends in DNTs ≤60 min (p < 0.0001), but only hospitals within the second, third, and fourth quartiles experienced significantly increased trends in DNTs ≤45 min (p < 0.0001).
    Conclusion: In our registry-based analysis, we observed an increased trend in IVT utilization for AIS among larger hospitals. There was an overall improvement in rates of DNTs ≤60 min, but only larger hospitals were observed to have improved DNTs ≤45 min.
    MeSH term(s) Male ; Humans ; Aged ; Female ; Fibrinolytic Agents/therapeutic use ; Ischemic Stroke/drug therapy ; Brain Ischemia/drug therapy ; Thrombolytic Therapy ; Health Facility Size ; Stroke/drug therapy ; Treatment Outcome
    Chemical Substances Fibrinolytic Agents
    Language English
    Publishing date 2023-02-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2023.02.009
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  4. Article ; Online: Effect of Intensive Glucose Control on Outcomes of Hyperglycemic Stroke Patients Receiving Mechanical Thrombectomy: Secondary Analysis of the SHINE Trial.

    Asaithambi, Ganesh / Tipps, Megan E

    Journal of neurosurgical anesthesiology

    2021  Volume 34, Issue 4, Page(s) 415–418

    Abstract: Background: Hyperglycemia is common among patients presenting with acute ischemic stroke (AIS) and is associated with poor clinical outcomes. We studied the effects of intensive blood glucose control among AIS patients presenting with hyperglycemia ... ...

    Abstract Background: Hyperglycemia is common among patients presenting with acute ischemic stroke (AIS) and is associated with poor clinical outcomes. We studied the effects of intensive blood glucose control among AIS patients presenting with hyperglycemia treated with mechanical thrombectomy (MT).
    Methods: We analyzed publicly available data from the Stroke Hyperglycemia Insulin Network Effort trial. In this nonpreplanned secondary analysis, we compared hyperglycemic AIS patients treated with MT who received intensive blood glucose control (80 to 130 mg/dL) with those who received standard blood glucose control (80 to 179 mg/dL). Outcomes included rates of favorable 90-day outcome (modified Rankin Scale score ≤2) and death.
    Results: This analysis included 146 patients (74 in the intensive treatment group and 72 in the standard treatment group). Intensive blood glucose was not associated with higher rates of 90-day favorable outcomes (intensive 31.1% vs. standard 30.6%, P =1.0; odds ratio 1.025, 95% confidence interval 0.51 to 2.07) or a decrease in rates of death (intensive 20.3% vs. standard 22.2%, P =0.84; odds ratio 0.98, 95% confidence interval 0.40 to 1.97).
    Conclusions: Intensive blood glucose control among AIS patients presenting with hyperglycemia and treated with MT was not associated with lower rates of death or higher rates of long-term favorable outcomes when compared with standard treatment.
    MeSH term(s) Blood Glucose ; Brain Ischemia/complications ; Brain Ischemia/therapy ; Humans ; Hyperglycemia ; Ischemic Stroke ; Stroke/complications ; Stroke/therapy ; Thrombectomy ; Treatment Outcome
    Chemical Substances Blood Glucose
    Language English
    Publishing date 2021-08-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1018119-2
    ISSN 1537-1921 ; 0898-4921
    ISSN (online) 1537-1921
    ISSN 0898-4921
    DOI 10.1097/ANA.0000000000000795
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    Zs.A 2656: Show issues Location:
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  5. Article ; Online: Feasibility of advanced composite endpoint analysis: Post-hoc insights from the vitamin intervention for stroke prevention randomized control trial.

    Asaithambi, Ganesh / Castro-Pearson, Sandra / Meyer, Marie K / Barthel, Brandon

    Nutrition, metabolism, and cardiovascular diseases : NMCD

    2023  Volume 33, Issue 12, Page(s) 2440–2443

    Abstract: Background and aims: Stroke is a major cause of mortality and disability, highlighting the importance of prevention. Clinical trials play an important role in evaluating interventions that can maximize stroke prevention. Traditional composite endpoints ( ...

    Abstract Background and aims: Stroke is a major cause of mortality and disability, highlighting the importance of prevention. Clinical trials play an important role in evaluating interventions that can maximize stroke prevention. Traditional composite endpoints (TCE) used in clinical trials have limitations, as they pool together events of varying clinical importance. Weighted composite endpoints (WCE) have emerged as a solution to address these limitations and provide more accurate assessments of outcomes. In this study, we investigate the use of WCE in a previously reported negative clinical trial for stroke prevention.
    Methods and results: We analyzed data from the Vitamin Intervention for Stroke Prevention (VISP) trial, which compared high dose and low dose multivitamin therapy. We utilized weighted methods to analyze time-to-event outcomes with censoring. The primary outcomes of interest were time to nonfatal stroke, nonfatal coronary events, and death. We calculated modified Kaplan-Meier (KM) curves for each intervention group. We also performed a modified log-rank test to assess significant differences based on the weighted KM curves. The analysis included 3668 VISP trial participants, and most remained event-free throughout the study period. The TCE KM curve showed no significant difference in outcomes between high dose and low dose groups. Similarly, the WCE KM curves, with different weights assigned to each outcome, did not reveal significant differences in outcomes between the studied groups.
    Conclusion: This post-hoc analysis confirms the negative trial results of VISP and demonstrates the feasibility of using WCE in assessing nutrition-based interventions for stroke prevention.
    MeSH term(s) Humans ; Vitamins/therapeutic use ; Feasibility Studies ; Stroke/diagnosis ; Stroke/epidemiology ; Stroke/prevention & control ; Research Design
    Chemical Substances Vitamins
    Language English
    Publishing date 2023-07-22
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1067704-5
    ISSN 1590-3729 ; 0939-4753
    ISSN (online) 1590-3729
    ISSN 0939-4753
    DOI 10.1016/j.numecd.2023.07.028
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    Zs.A 3149: Show issues Location:
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  6. Article ; Online: Predictive value of discharge destination for 90-day outcomes among ischemic stroke patients eligible for endovascular treatment: Post-hoc analysis of DEFUSE 3.

    Asaithambi, Ganesh / Tipps, Megan E

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2020  Volume 29, Issue 8, Page(s) 104902

    Abstract: Background: The endovascular treatment (ET) for acute ischemic stroke (AIS) is increasing among eligible patients. To help address care quality, administrative data sets are utilized but do not usually include formal outcome scales. We explore the ... ...

    Abstract Background: The endovascular treatment (ET) for acute ischemic stroke (AIS) is increasing among eligible patients. To help address care quality, administrative data sets are utilized but do not usually include formal outcome scales. We explore the predictive ability of discharge destination from acute hospitalizations for long-term disability among AIS patients eligible for ET within a clinical trial.
    Methods: We analyzed publicly available data from the DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) trial. We evaluated patients who survived beyond the time of discharge from their acute hospitalizations. We calculated positive and negative predictive values and accompanying likelihood ratios for patients discharged to home, inpatient rehabilitation facility (IRF), or subacute nursing facility (SNF) for unfavorable outcome as defined by modified Rankin Scale (mRS) scores ≥3 at 90-days.
    Results: Our final analysis included 127 patients (median age 67 [23-89] years, 51.2% men). There were 23.6% patients discharged home, 53.5% to IRF, and 22.8% to SNF. Approximately 61% of patients had 90-day post-stroke mRS scores ≥3. Patients discharged to SNF had the highest positive predictive value (93.1%) and positive likelihood ratio (8.77 [CI 95% 2.18-35.25]) for unfavorable outcome. Discharge to home had the highest negative likelihood ratio (2.09 [CI 95% 1.54-2.83]) for unfavorable outcome.
    Conclusions: Among AIS patients eligible for ET within the DEFUSE 3 trial, discharge destination can provide high predictive value of 90-day functional outcomes. A discharge to SNF is highly predictive of long-term unfavorable outcomes.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Brain Ischemia/diagnosis ; Brain Ischemia/physiopathology ; Brain Ischemia/therapy ; Disability Evaluation ; Eligibility Determination ; Endovascular Procedures/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Patient Discharge ; Randomized Controlled Trials as Topic ; Recovery of Function ; Skilled Nursing Facilities ; Stroke/diagnosis ; Stroke/physiopathology ; Stroke/therapy ; Stroke Rehabilitation ; Time Factors ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2020-05-28
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2020.104902
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  7. Article ; Online: Quality of life among ischemic stroke patients eligible for endovascular treatment: analysis of the DEFUSE 3 trial.

    Asaithambi, Ganesh / Tipps, Megan E

    Journal of neurointerventional surgery

    2020  Volume 13, Issue 8, Page(s) 703–706

    Abstract: Background: The endovascular treatment (ET) for acute ischemic stroke is increasing among eligible patients. Assessing patients' perspectives on quality of life (QOL) can supplement the use of formal outcome scales and enable the assessment of outcomes ... ...

    Abstract Background: The endovascular treatment (ET) for acute ischemic stroke is increasing among eligible patients. Assessing patients' perspectives on quality of life (QOL) can supplement the use of formal outcome scales and enable the assessment of outcomes across multiple domains affected by stroke.
    Methods: We analyzed publicly available data from the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke (DEFUSE 3) trial. We evaluated patients who survived beyond the time of discharge from their acute hospitalizations and completed all Neuro-QOL short forms at 90-day follow-up.
    Results: Our final analysis included 128 patients (median age 67 [range 23-90] years, 50.8% men). As modified Rankin Scale (mRS) scores increased, there was a consistent increase in the severity of Neuro-QOL measures. T-scores for mobility, cognitive function, and the ability to participate in social roles declined significantly while depression T-scores increased significantly. We found that QOL T-scores for patients with mRS 3 did not differ significantly from T-scores for patients with mRS 2 in any domain.
    Conclusions: Among ischemic stroke patients eligible for ET, QOL scores help validate and supplement quantitatively measured outcomes.
    MeSH term(s) Aged ; Cognition ; Endovascular Procedures/adverse effects ; Endovascular Procedures/methods ; Female ; Humans ; Ischemic Stroke/diagnostic imaging ; Ischemic Stroke/psychology ; Ischemic Stroke/surgery ; Male ; Nervous System Diseases/diagnosis ; Nervous System Diseases/etiology ; Nervous System Diseases/psychology ; Outcome Assessment, Health Care/methods ; Outcome Assessment, Health Care/standards ; Patient Discharge/statistics & numerical data ; Patient Outcome Assessment ; Postoperative Complications/diagnosis ; Postoperative Complications/psychology ; Quality of Life ; Social Interaction ; Survivors/psychology
    Language English
    Publishing date 2020-08-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 2514982-9
    ISSN 1759-8486 ; 1759-8478
    ISSN (online) 1759-8486
    ISSN 1759-8478
    DOI 10.1136/neurintsurg-2020-016399
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  8. Article ; Online: Venous thromboembolism among Medicare acute ischaemic stroke patients with and without COVID-19.

    Tong, Xin / Yang, Quanhe / Asaithambi, Ganesh / Merritt, Robert K

    Stroke and vascular neurology

    2022  Volume 8, Issue 3, Page(s) 259–262

    Abstract: Background: COVID-19 is associated with an increased risk of venous thromboembolism (VTE). This study examined the prevalence of VTE among acute ischaemic stroke (AIS) patients with and without a history of COVID-19.: Methods: We identified AIS ... ...

    Abstract Background: COVID-19 is associated with an increased risk of venous thromboembolism (VTE). This study examined the prevalence of VTE among acute ischaemic stroke (AIS) patients with and without a history of COVID-19.
    Methods: We identified AIS hospitalisations of Medicare fee-for-service (FFS) beneficiaries aged ≥65 years from 1 April 2020 to 31 March 2022. We compared the prevalence and adjusted prevalence ratio of VTE among AIS patients with and without a history of COVID-19.
    Results: Among 283 034 Medicare FFS beneficiaries with AIS hospitalisations, the prevalence of VTE was 4.51%, 2.96% and 2.61% among those with a history of hospitalised COVID-19, non-hospitalised COVID-19 and without COVID-19, respectively. As compared with patients without a history of COVID-19, the prevalence of VTE among patients with a history of hospitalised or non-hospitalised COVID-19 were 1.62 (95% CI 1.54 to 1.70) and 1.13 (95% CI 1.03 to 1.23) times greater, respectively.
    Conclusions: There appeared to be a notably higher prevalence of VTE among Medicare beneficiaries with AIS accompanied by a current or prior COVID-19. Early recognition of coagulation abnormalities and appropriate interventions may help improve patients' clinical outcomes.
    MeSH term(s) Humans ; Aged ; United States/epidemiology ; Medicare ; Venous Thromboembolism/diagnosis ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/therapy ; Brain Ischemia ; Stroke/diagnosis ; Stroke/epidemiology ; Stroke/therapy ; COVID-19/diagnosis ; COVID-19/complications ; Ischemic Stroke/diagnosis ; Ischemic Stroke/epidemiology ; Ischemic Stroke/therapy
    Language English
    Publishing date 2022-11-15
    Publishing country England
    Document type Journal Article
    ISSN 2059-8696
    ISSN (online) 2059-8696
    DOI 10.1136/svn-2022-001814
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  9. Article ; Online: Contemporary Trends in the Treatment of Mild Ischemic Stroke with Intravenous Thrombolysis: Paul Coverdell National Acute Stroke Program.

    Asaithambi, Ganesh / Tong, Xin / Coleman King, Sallyann M / George, Mary G

    Cerebrovascular diseases (Basel, Switzerland)

    2021  Volume 51, Issue 1, Page(s) 60–66

    Abstract: Background: Presentation with mild symptoms is a common reason for intravenous thrombolysis (IVT) nonuse among acute ischemic stroke (AIS) patients. We examined the impact of IVT on the outcomes of mild AIS over time.: Methods: Using the Paul ... ...

    Abstract Background: Presentation with mild symptoms is a common reason for intravenous thrombolysis (IVT) nonuse among acute ischemic stroke (AIS) patients. We examined the impact of IVT on the outcomes of mild AIS over time.
    Methods: Using the Paul Coverdell National Stroke Program data, we examined trends in IVT utilization from 2010 to 2019 among AIS patients presenting with National Institutes of Health Stroke Scale (NIHSS) scores ≤5. Outcomes adjudicated included rates of discharge to home and ability to ambulate independently at discharge. We used generalized estimating equation models to examine the effect of IVT on outcomes of AIS patients presenting with mild symptoms and calculated adjusted odds ratio (AOR) with 95% confidence intervals (CI).
    Results: During the study period, 346,762 patients presented with mild AIS symptoms. Approximately 6.2% were treated with IVT. IVT utilization trends increased from 3.7% in 2010 to 7.7% in 2019 (p < 0.001). Patients treated with IVT had higher median NIHSS scores upon presentation (IVT 3 [2, 4] vs. no IVT 2 [0, 3]). Rates of discharge to home (AOR 2.06, 95% CI: 1.99-2.13) and ability to ambulate at time of discharge (AOR 1.82, 95% CI: 1.76-1.89) were higher among those treated with IVT.
    Conclusion: There was an increased trend in IVT utilization among AIS patients presenting with mild symptoms. Utilization of IVT increased the odds of being discharged to home and the ability to ambulate at discharge independently in patients with mild stroke.
    MeSH term(s) Administration, Intravenous ; Brain Ischemia/diagnosis ; Brain Ischemia/drug therapy ; Fibrinolytic Agents ; Humans ; Ischemic Stroke/diagnosis ; Ischemic Stroke/drug therapy ; Stroke/diagnosis ; Stroke/drug therapy ; Thrombolytic Therapy/adverse effects ; Treatment Outcome
    Chemical Substances Fibrinolytic Agents
    Language English
    Publishing date 2021-08-17
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 1069462-6
    ISSN 1421-9786 ; 1015-9770
    ISSN (online) 1421-9786
    ISSN 1015-9770
    DOI 10.1159/000517969
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  10. Article ; Online: Outcomes of Homeless Ischemic Stroke Patients Receiving Intravenous Thrombolysis in the United States.

    Asaithambi, Ganesh / Marino, Emily H / Ho, Bridget M / Tipps, Megan E

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2021  Volume 30, Issue 8, Page(s) 105862

    Abstract: Background: Morbidity and mortality among homeless people with cardiovascular diseases and stroke in the United States is high. Adverse outcomes within the homeless population may be the result of seeking care too late to receive time-sensitive ... ...

    Abstract Background: Morbidity and mortality among homeless people with cardiovascular diseases and stroke in the United States is high. Adverse outcomes within the homeless population may be the result of seeking care too late to receive time-sensitive interventions. We sought to investigate the impact of homelessness on ischemic stroke patients who received intravenous thrombolysis (IVT).
    Methods: We determined rates of post-thrombolytic intracranial hemorrhage (ICH), in-hospital death, and development of moderate to severe disability among homeless ischemic stroke patients treated with IVT. Patients were identified using the Nationwide (National) Inpatient Sample between 2002 and 2017. We compared rates of the various outcomes to non-homeless ischemic stroke patients treated with IVT.
    Results: There were 514 homeless (mean age 54.7 ± 10.2 years, 20.4% women) and 364,408 non-homeless (mean age 68.6 ± 14.7 years, 49.7% women) ischemic stroke patients who received IVT. There was no difference in post-thrombolytic ICH rates between the two groups (6.6% homeless versus 8.8% non-homeless, p = 0.09). Homeless patients were more frequently discharged to self-care (p = 0.003). Homeless patients were less likely than non-homeless patients to suffer in-hospital death (AOR 0.499 [95% CI 0.30-0.84], p = 0.009) and moderate to severe disability (AOR 0.423 [95% CI 0.29 - 0.62], p < 0.001).
    Conclusion: Homeless ischemic stroke patients who receive IVT are not at an increased risk of developing post-thrombolytic ICH or in-hospital death. Efforts are needed to encourage this unique population to seek medical attention as soon as possible for time-sensitive interventions that may decrease the risk of permanent disability or death associated with ischemic stroke.
    Language English
    Publishing date 2021-05-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2021.105862
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