Publications by authors named "Schwamm L"
Purpose Of Review: Significant inequities persist in hypertension detection and control, with minoritized populations disproportionately experiencing organ damage and premature death due to uncontrolled hypertension. Remote blood pressure monitoring combined with telehealth visits (RBPM) is proving to be an effective strategy for controlling hypertension. Yet there are challenges related to technology adoption, patient engagement and social determinants of health (SDoH), contributing to disparities in patient outcomes.
View Article and Find Full Text PDFIntroduction: The effects of imaging-based intravenous thrombolysis on outcomes based on patient sex remain unclear. We aimed to investigate whether outcomes among patients with stroke with an unknown onset time and treated with imaging-based intravenous thrombolysis are influenced by their sex.
Patients And Methods: This study was a pooled analysis of individual patient-level data acquired from the Evaluation of unknown Onset Stroke thrombolysis trials.
Article Synopsis
- * Factors such as higher education and income were linked to better PROMs, while specific brain injuries affected performance ratings differently, highlighting the impact of socioeconomics and brain health on recovery perceptions.
- * The research identified a connection between parietal lobe damage and poorer self-reported outcomes, suggesting that injuries affecting self-awareness can distort patients' assessments of their own capabilities.
Background: Patients with premorbid dementia have been generally excluded from trials of stroke therapies, and their dementia diagnosis may affect the care received. There are few data on the quality of stroke care and outcomes in these patients.
Methods: We compared the quality of care and outcomes for acute ischemic stroke patients with versus without premorbid dementia using national data from the Get With The Guidelines-Stroke registry between July 1, 2020, and December 31, 2021.
Article Synopsis
- Clinical trials indicate that using a mobile stroke unit (MSU) for prehospital management can lead to better outcomes for acute ischemic stroke patients who may need thrombolysis, but real-world data is limited.
- This study aimed to compare the effects of prehospital MSU management versus standard emergency services (EMS) on patient disability levels at the time of hospital discharge.
- The analysis included over 19,000 patients treated across multiple hospitals, revealing that those managed in an MSU had improved functional outcomes compared to those receiving standard EMS care.*
Background And Objectives: Mounting evidence points to a strong connection between cardiovascular risk during middle age and brain health later in life. The American Heart Association's Life's Essential 8 (LE8) constitutes a research and public health construct capturing key determinants of cardiovascular health. However, the overall effect of the LE8 on global, clinically relevant metrics of brain health is still unknown.
View Article and Find Full Text PDFBackground: The Get With The Guidelines-Stroke program is a quality improvement initiative designed to enhance adherence to evidence-based stroke care. Since its inception in 2003, over 2800 hospitals in the United States have participated in the program.
Methods: We examined patient characteristics, adherence to performance measures, and in-hospital outcomes in patients hospitalized for acute ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack in The Get With The Guidelines-Stroke hospitals from 2003 through 2022.
Article Synopsis
- Benzodiazepines are often prescribed to older patients after an acute ischemic stroke, despite guidelines advising against this for those aged 65 and over.
- An analysis of Medicare claims from 2013 to 2021 showed that 4.9% of stroke survivors started benzodiazepine treatment, with higher initiation rates among females and in the southeastern US.
- Although there was a slight decline in new prescriptions over the years, many patients received overly long prescriptions, indicating a need for better prescribing policies.
Background: The National Institutes of Health Stroke Scale (NIHSS) scores have been used to evaluate acute ischaemic stroke (AIS) severity in clinical settings. Through the International Classification of Diseases, Tenth Revision Code (ICD-10), documentation of NIHSS scores has been made possible for administrative purposes and has since been increasingly adopted in insurance claims. Per Centres for Medicare & Medicaid Services guidelines, the stroke ICD-10 diagnosis code must be documented by the treating physician.
View Article and Find Full Text PDFArticle Synopsis
- A study was conducted to evaluate the necessity of routine head CT scans 24 hours after acute stroke treatments in patients who are stable or showing improvement, aiming to identify predictors that could reduce unnecessary imaging.
- The study analyzed data from 1,461 stroke patients, finding that 22.2% had stroke-related abnormalities on CT scans, with 12.5% showing clinically meaningful results that influenced treatment decisions.
- Key predictors for significant CT findings included the patient's NIHSS score at admission, age, and blood glucose levels, leading to the creation of a scoring system to prioritize imaging needs.
Importance: Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care.
Objective: To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non-small cell lung cancer (NSCLC).
Design, Setting, And Participants: Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers.
Rationale: Despite guideline warnings, older acute ischemic stroke (AIS) survivors still receive benzodiazepines (BZD) for agitation, insomnia, and anxiety despite being linked to severe adverse effects, such as excessive somnolence and respiratory depression. Due to polypharmacy, drug metabolism, comorbidities, and complications during the sub-acute post-stroke period, older adults are more susceptible to these adverse effects. We examined the impact of receiving BZDs within 30 days post-discharge on survival among older Medicare beneficiaries after an AIS.
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- AI large language models (LLMs) can generate essays similar in quality to human authors, raising questions about authorship in scientific writing.
- A 2024 essay contest featured human and AI entries on controversial medical topics, with evaluations done by a panel of experts blinded to the authors' identities.
- Reviewers found it challenging to identify AI-generated essays, often scoring them higher for composition but showing bias against those perceived as less relevant or "best in topic." Scientific journals may need to educate reviewers about AI's role in writing and establish guidelines for its use.
Importance: The incidence of hospital encounters for acute myocardial infarction (AMI) decreased sharply early in the COVID-19 pandemic and has not returned to prepandemic levels. There has been an ongoing debate about what mechanism may underlie this decline, including patients avoiding the hospital for treatment, excess mortality from COVID-19 among patients who would otherwise have had an AMI, a reduction in the incidence or severity of AMIs due to pandemic-related changes in behavior, or a preexisting temporal trend of lower AMI incidence.
Objective: To describe drivers of changing incidence in AMI hospital encounters during the COVID-19 pandemic.
Article Synopsis
- * A clinical trial in China found that 33% of patients treated with tenecteplase had low disability scores after 90 days, compared to 24% of those receiving standard treatment, indicating tenecteplase may be more effective.
- * Safety results showed similar mortality rates (around 13%) for both treatments, but the tenecteplase group had a slightly higher rate of symptomatic intracranial hemorrhage (3%) compared to standard treatment (0.8%).
Article Synopsis
- A study investigated whether tenecteplase is more effective and safe than alteplase for treating acute ischemic stroke (AIS) in patients aged 80 and older.
- The analysis was based on data from a clinical trial involving elderly patients who received either 0.25 mg/kg tenecteplase or the standard 0.9 mg/kg alteplase within 4.5 hours of stroke symptoms.
- Results showed that tenecteplase led to a higher proportion of patients achieving a favorable outcome at 90 days, and both treatments had similar rates of symptomatic intracranial hemorrhage, suggesting tenecteplase is a viable alternative for this age group.
Article Synopsis
- Delays in hospital presentation for stroke patients were linked not only to individual factors but also to broader community-level social vulnerabilities, indicating a need for better support in these areas.
- The study analyzed over 149,000 ischemic stroke patients and found that those in socially vulnerable neighborhoods took longer to arrive at hospitals, with an average delay of about 15.6 minutes compared to those from less vulnerable areas.
- Mapping these delays revealed overlapping zones of delay and vulnerability, highlighting the impact of socioeconomic conditions and community resources on timely medical care.
Importance: Intravenous alteplase (IV-tPA) can be administered to patients with acute ischemic stroke but is associated with symptomatic intracerebral hemorrhage (sICH). It is unclear if patients taking prestroke dual antiplatelet therapy (DAPT) are at higher risk of sICH.
Objective: To determine the associated risk of sICH in patients taking prestroke dual antiplatelet therapy receiving alteplase for acute ischemic stroke using propensity score matching analysis.
Determining acute ischemic stroke (AIS) etiology is fundamental to secondary stroke prevention efforts but can be diagnostically challenging. We trained and validated an automated classification tool, StrokeClassifier, using electronic health record (EHR) text from 2039 non-cryptogenic AIS patients at 2 academic hospitals to predict the 4-level outcome of stroke etiology adjudicated by agreement of at least 2 board-certified vascular neurologists' review of the EHR. StrokeClassifier is an ensemble consensus meta-model of 9 machine learning classifiers applied to features extracted from discharge summary texts by natural language processing.
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- The Get With The Guidelines-Stroke program is a major U.S. disease registry that has been improving stroke care and patient outcomes for 20 years.
- This narrative review covers the program's history, key achievements, and significant impacts on stroke care.
- It also explores future challenges and opportunities for enhancing the program over the next two decades.
Background And Objectives: Understanding trends in the use of medications for secondary stroke prevention is crucial for identifying areas for improvement in stroke care. We examined the use of lipid-lowering, antihypertensive, glucose-lowering, oral anticoagulant, and antiplatelet medications after ischemic stroke hospitalization, from 2005 to 2021.
Methods: Using nationwide registries in Denmark, we identified a cohort of patients discharged from hospital with a first-time or recurrent ischemic stroke (N = 150,744).
Background: Despite women having fewer traditional risk factors (eg, hypertension, diabetes), strokes are more common in women than men aged ≤45 years. This study examined the contributions of traditional and nontraditional risk factors (eg, migraine, thrombophilia) in the development of strokes among young adults.
Methods: This retrospective case-control study used Colorado's All Payer Claims Database (2012-2019).
Article Synopsis
- The study examines the differences in the effectiveness and safety of intravenous thrombolysis (IVT) for treating strokes of unknown onset, dividing patients into two categories: wake-up stroke (WUS) and non-wake-up unwitnessed stroke (non-WUS).
- Using data from two trials, researchers analyzed 634 patients to see how IVT compared to control treatments, looking at outcomes like functional independence and adverse events like bleeding and mortality.
- Results showed that for WUS, IVT led to better outcomes than control, while for non-WUS, the differences were not significant; overall, the mode of stroke onset did not significantly impact the treatment effect.