bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP298: Patterns of In-Hospital Prescribing of Post-Stroke Antidepressants in a Comprehensive Stroke Center
Authors: Azevedo Jessica , Meyer Dawn , Agrawal Kunal , Banerjee Ananya , Geib Teneille , Angeles Theresa , Meyer Brett , Bavarsad Shahripour Reza , Modir Royya , Hemmen Thomas
Published: January 2025

Background:
Post stroke depression (PSD) affects over 33% of stroke survivors with the highest incidence occurring in the first year after stroke. Predictors of PSD include stroke severity, cognitive impairment, age, and physical disability. Antidepressant prescribing patterns during acute ischemic stroke (AIS) hospitalization may be inconsistent. This study evaluated antidepressant prescribing patterns at hospital discharge in acute AIS and hemorrhagic (ICH) stroke patients.

Methods:
We retrospectively examined prospectively collected data from an IRB-approved stroke registry at two academic Comprehensive Stroke Centers (CSC) between 1/1/2013 and 6/30/2024. We included patients with new diagnosis of AIS or ICH with motor hemiparesis. Patients with initial NIHSS 0 and baseline mRS >2 were excluded. A correlation matrix was constructed followed by stepwise linear regression. Logistic regression modeling was then used for any variables with p<0.10. Chi squared was used to examine nominal variables.

Results:
A total of 745 patients met study criteria, and 167 (22.4%) patients were prescribed antidepressants prior to discharge (AIS=137; ICH=30). Variables that were significantly correlated with prescribing antidepressants during stroke hospitalization were White race (p<0.001), length of stay (LOS) (p<0.001), discharge disposition to acute rehabilitation unit (p=0.02), history of smoking (p=0.002), history of substance abuse (p=0.006), history of depression (p<0.001), dementia (p=0.002), and patients with no medical history (p=0.02). Logistic regression model including LOS (p<0.001), history of depression (p=0.03), and no medical history (p=0.04) was significant in predicting prescribing antidepressants (p<0.001; r=0.30; r
2
=0.09).

Conclusion:
In patients hospitalized for AIS or hemorrhagic stroke with motor weakness, key demographic factors, LOS, and discharge to acute rehabilitation units were significant predictors for prescribing antidepressants prior to discharge. The independent predictors in our model account for 9% of the variance in prescribing antidepressants, suggesting that further studies are needed to understand other factors that may influence antidepressant prescribing patterns during stroke hospitalization.
Abstract TP299: Area Deprivation Index Associated with Time to Presentation in Acute Ischemic Stroke and Eligibility for Standard Window versus Late Presenter Thrombolysis
Authors: Fritsche Colette , Corlin Laura , Leung Lester
Published: January 2025

Introduction:
Prior studies have demonstrated social determinants of health (SDH) are associated with reduced rates of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS), including in disadvantaged populations. Mechanisms of disparity may include financial/resource limitations and systemic bias. Neighborhood measures of socioeconomic status are predictors of interest in stroke research, as they may influence emergency response, transportation, and health seeking behaviors. We sought to identify SDH factors influencing time to presentation for AIS.

Methods:
This is a retrospective cohort study of 432 patients ages ≥18 presenting to Tufts comprehensive stroke center with AIS and last known well (LKW) <24hrs from arrival, from 1/1/20-12/31/22. IVT was offered in the standard 0-4.5hr window and 4.5-24hrs through Tufts Late Presenter Thrombolysis protocol. Data were collected from the EHR including demographics, stroke severity, IVT, insurance, and zip codes to obtain Gini coefficient (national inequality) and Area Deprivation Index (ADI, state deciles, dichotomized as low, 1-5, and high, 6-10). Multivariable logistic regression assessed predictors of time to presentation among all patients who presented within 24hrs of LKW. A sensitivity analysis assessed predictors among a subgroup of patients who received IVT. All analyses were performed using RStudio 1.2.1335.

Results:
In an unadjusted analysis, high ADI was associated with increased odds of presenting late [OR 1.62, CI 1.06-2.56]. In an adjusted analysis including demographics and stroke severity, high ADI was similarly associated with increased odds of presenting late [OR 1.65, CI 1.05-2.61]. A second model including Gini demonstrated a similar association for ADI and late presentation [OR 1.67, CI 1.07-2.66]. In an adjusted sensitivity analysis of patients receiving IVT, high ADI was strongly associated with presentation in the later time window [OR 2.67, CI 1.03-7.22].

Conclusions:
Among patients presenting within 24hrs with AIS, individuals living in neighborhoods with greater socioeconomic disadvantage are more likely to present outside the standard time window for thrombolysis. High ADI being associated with late presentation indicates socioeconomic factors prohibit patients in these areas from accessing definitive emergency healthcare services in a timely manner after AIS. Protocols to treat patients outside the standard time window may help mitigate disparities in thrombolysis treatment rates.
Abstract TP31: Intranasal treatment targeting the brain endothelin system attenuates cognitive decline in diabetic rats after ischemic injury
Authors: Edgerton-Fulton Mia , Abdul Yasir , JAMIL SARAH , Li Weiguo , Abdelsaid Kareem , Ergul Adviye
Published: January 2025

Diabetes increases the risk of Vascular Contributions to Cognitive Impairment&Dementia (VCID) and stroke further amplifies this effect. Diabetes also dysregulates the Endothelin (ET) system. Elevated brain ET-1 levels correlate with tissue perfusion status and disease severity in patients with ADRD. There is emerging evidence that ETB receptor agonism improves outcomes in patients with cerebral ischemic stroke, but long-term effects, especially in diabetes, are unknown. Therefore, we hypothesized that intranasal treatment with ETA antagonist or ETB agonist will improve sensorimotor/cognitive outcomes in diabetic animals after ischemic stroke.

Methods:
We used a post-stroke cognitive impairment (PSCI) model of VCID. Male rats underwent 60-min middle cerebral artery occlusion surgery (MCAO) 8 weeks after diabetes onset. Rats that met the preset inclusion criteria (adhesive removal time > 35 sec. and either a modified Bederson score <= 6 on Day 1 or weight loss > 10% on Day 3) were randomized to ETA antagonist BQ-123 (3 µg/100 µl PBS), ETB agonist Sovateltide (5 µg/kg), or vehicle intranasal treatment for 3 days per week until 8 weeks post-stroke (n=6-8). Sensorimotor and cognitive outcomes were monitored for 8 weeks.

Results (Table 1):
Behavior indices from the novel object recognition (NOR) test and Y-Maze test showed that diabetic rats developed cognitive deficits even in the sham group. Sovateltide improved both recognition memory and working spatial memory after stroke. BQ-123 partially prevented the decline in recognition memory. Animals treated with BQ-123 showed an improvement in depressive symptoms after stroke.

Conclusions:
These results suggest that intranasal stimulation of brain ETB receptors or ETA receptor inhibition can prevent the development of progressive cognitive decline after stroke. While further studies are required to better understand how the brain ET system impacts stroke recovery in diabetes, our findings provide novel insights into potential neuroprotective therapies for VCID.
Abstract TP321: Communities Beliefs, Attitudes, Practices And Recommendations For Improving Stroke Prevention And Stroke Care In Rural And Urban Communities In Nigeria.
Authors: Uvere Ezinne , Jenkins Carolyn , Melikam Ezinne Sylvia , Arulogun Oyedunni , Ajala Omotolani , Ayodele Adewale , Adebajo Olayinka , Adeleye Osi , Ogunronbi Mayowa , Nwimo Chukwuemeka , Nichols Michelle , Popoola Oluwafemi , Akinyemi Joshua , Tagge Raelle , Akinyemi Rufus , Akpa Onoja , Salami Ayodeji , Taiwo Olalekan , Adebayo Ayodeji , Olowoyo Paul , Ilori Temitope , Olaniyan Olanrewaju , Walker Richard , Ovbiagele Bruce , Owolabi Mayowa
Published: January 2025

Introduction:
The African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) study is focused on developing an integrated mHealth community-based interactive Stroke Information and Surveillance System. This is the first paper to qualitatively investigate and contrast community beliefs, attitudes, and practices related to stroke prevention, risk factors and care from alternative/complementary medicine providers/healers, orthodox/modern medicine/health care providers, community members and leaders in Nigeria.

Methods:
Six focus groups with community members and leaders (n=57) and key informant interviews with health providers (n=24) from alternative/complementary medicine providers and orthodox/modern medicine providers were conducted to qualitatively explore beliefs, attitudes, practices, and recommendations related to stroke in urban (Ibadan) and rural (Ibarapa) communities in Nigeria. The Health Belief Model and Social Ecological Model guided the questions and thematic analysis of the qualitative data.

Results:
Participants perceived stroke as disabling though manageable but with odds of repeat stroke for survivors. High blood pressure, stress, sleep issues, heredity, and lifestyle factors were some stroke risk factors perceived by participants from both sites although God, witchcraft/evil people were reported by rural participants. Hospital visits and consumption of herbal concoction, self-medication and visit to church for prayers were some actions taken to manage stroke by both urban and rural participants. Low literacy levels, limited funds, fear of and distance to hospitals, and absence of insurance were some barriers to uptake of recommendations from orthodox medicine practitioners which are drivers to unorthodox practitioners. To improve stroke care and prevention across communities, free risk factor screening, indigenous stroke awareness programs via print, audio-visual and electronic media were suggested by all participants.

Conclusion:
Diverse beliefs and practices are related to stroke risk factors, prevention and care and barriers with obtaining care. There is need to work across systems to improve stroke prevention and care in communities.
Abstract TP36: Parvalbumin Inhibitory Interneurons in Post-Stroke Recovery: Insights from Imaging and Optogenetics
Authors: Schloss Kaelyn , Wang Xiaodan , Bice Annie , Lee Jin-moo , Bauer Adam
Published: January 2025

Stroke, the leading cause of adult disability, necessitates new therapeutic strategies informed by a deeper understanding of brain repair mechanisms. This pilot study investigates the role of parvalbumin inhibitory interneurons (PV-INs) in post-stroke recovery using wide-field optical imaging (WFOI) and optogenetics. PV-INs, the largest subclass of GABAergic interneurons, are crucial in regulating cortical excitability and mediating activity-dependent plasticity. However, their specific function in stroke recovery remains unclear.

Here we use 5 aged mice expressing Channelrhodopsin (ChR2) in PV-INs and the red-shifted genetically encoded calcium indicator, jRGECO1a, driven by the Thy1 promoter to allow for simultaneous optogenetic targeting of PV-INs and mesoscopic imaging of excitatory activity. Photothrombosis was induced in the left primary somatosensory forepaw cortex and subsequent optogenetic photostimulation of PV-INs, calcium, and hemodynamic imaging was conducted pre- and post-stroke to map PV-IN circuitry and assess changes in cortical activity.

Preliminary results revealed significant disruptions in homotopic resting-state functional connectivity and cortical activity one-week post-stroke. Power maps indicated reduced activity in the somatosensory, hindpaw, and parietal cortices, with electrical forepaw stimulation showing decreased activity in both left and right primary somatosensory forepaw regions. Contralesional excitation increased in the retrosplenial and parietal cortices during forepaw stimulation. Further, optogenetic stimulation of PV-INs pre-stroke showed increased inhibition, while post-stroke stimulation resulted in less ipsilesional inhibition and more global excitation. Behavioral assessments using the cylinder rearing test indicated a 26% decrease in right forepaw use post-stroke, aligning with imaging findings.

Ongoing studies aim to extend these observations by including a larger cohort of aged mice and a cohort of young mice at 1-, 4-, and 8- weeks post-stroke to examine age-related differences in PV-IN-mediated plasticity during stroke recovery. These studies will elucidate the critical contributions of PV-INs to post-stroke plasticity and recovery, potentially guiding new therapeutic approaches for stroke rehabilitation.
Abstract TP39: A Phase 2a randomized controlled trial of once-daily versus twice-daily remote ischemic conditioning in vascular cognitive impairment (TRIC-VCI)
Authors: Ganesh Aravind , Barber Philip , Black Sandra , Corbett Dale , Field Thalia , Frayne Richard , Hachinski Vladimir , Ismail Zahinoor , Mai Lauren , McCreary Cheryl , Sahlas Demetrios , Sharma Mukul , Swartz Richard , Smith Eric
Published: January 2025

Background:
Cerebral small vessel disease (CSVD) is a leading cause of vascular cognitive impairment (VCI). Remote ischemic conditioning (RIC) is a promising strategy to prevent CSVD progression, but it is unclear what doses of daily RIC are tolerable or adherable for older patients with CSVD-associated VCI.

Methods:
TRIC-VCI (ClinicalTrials.gov NCT04109963) was a prospective, open-label randomized-controlled trial with blinded endpoint assessment. Participants completing a 14-day run-in were randomized to once- or twice-daily RIC for 30 consecutive days. RIC consisted of 4 cycles of blood-pressure cuff inflation to 200mmHg around an arm for 5-minutes followed by 5-minutes deflation using an automated device. Criteria included age 60-85, evidence of CSVD on CT/MRI, Montreal Cognitive Assessment score 13-24, and preserved basic activities of daily living. Outcomes were assessed at 30- and 90-days. The primary outcome for which the trial was powered was adherence (completing ≥80% of sessions). Secondary outcomes included percentage of sessions completed and pain/discomfort scores from patient diaries. Exploratory outcomes included changes in white-matter hyperintensity (WMH) volume and cognitive tests. We explored trial experiences in a focus group with 5 patients and 4 care-partners.

Results:
Among 23 patients entering the run-in, 22 completed it and were randomized. 21/22(95.5%) finished the 30-day treatment period. 7/11(63.6%) in the once-daily RIC group completed ≥80% of sessions vs 10/11(90.9%) in the twice-daily group; median session completion was 93%(IQR:73-98%) vs 98%(IQR:93-98%) respectively. Pain/discomfort ratings were numerically higher in the twice-daily group (median rating/10: 4.2, IQR 1.0-5.0 vs once-daily:1.6, IQR 1.0-3.4, p=0.60). None of the patients developed tissue/neurovascular injury or deep vein thrombosis. Cognitive tests generally did not change significantly or differ between groups; WMH volumes were stable (change at 90-days vs randomization: -0.21 mL, 95%CI -0.54-0.13). Focus group participants opined the device was easy to use, desired greater portability, generally favoured once-daily RIC, and were open to longer treatment courses in future trials.

Conclusion:
RIC was safe and tolerated by patients with CSVD-associated VCI. Patients adhered well to both once- and twice-daily RIC, with no significant differences in outcomes between both groups. We will incorporate participant feedback into device design and future efficacy trials.
Abstract TP40: Multifaceted Assessment of the "Non-Motor" Stroke Symptoms in the Outpatient Setting
Authors: Bou Dargham Tarek , El Husseini Nada
Published: January 2025

Background/Objectives:
More than 50% of stroke survivors experience at least one manifestation of “non-motor” impairment. These impairments impact daily functioning and are often under-recognized. We explored the feasibility of multifaceted assessments in an outpatient setting and the co-occurrence of these symptoms.

Design:
We performed a retrospective chart review of patients evaluated in a stroke behavioral and cognitive recovery clinic at a single tertiary care center. A vascular neurologist evaluated the patients and administered multiple assessments. Moderate to significant fatigue was defined by a score of 36 or higher on the Fatigue Severity Scale, depression by PHQ-9 ≥10, anxiety by GAD-7 ≥10 and, increased daytime sleepiness by Epworth Sleepiness Scale ≥10. A Communicative Participation Item Bank score of ≤17 indicated moderate or severe communication difficulties. Scores ≥3 on each of the 5 dimensions of the EQ-5D-5L describing health-related quality of life, indicate moderate to severe impairments. Descriptive analysis and chi-square tests were used to describe the cohort and the association of the different assessments.

Results:
Twenty-nine encounters were performed. The mean age was 57 years (SD = 11) and 66% were women. The mean NIHSS score at initial presentation was 6 (SD 7.25). Patients were evaluated at a mean of 18 months (SD = 19.4) post- stroke. Of all encounters 82% had at least one, and 62% had at least two moderate or severe “non-motor” symptoms. Post-stroke fatigue was observed in 15 (51.7%), depression in 10 (34.4%), anxiety in 16 (55.1%), increased daytime sleepiness in 10 (34.4%), and communication difficulties in 13 (44.8%) assessments. Moderate to severe impairments on items of the EQ-5D-5L were observed in mobility (31%), self-care (13.7%), usual activities (58.6%), pain/discomfort (34.4%), and anxiety/depression (51.7%). Significant associations were found between anxiety and depression (p = 0.006), anxiety and increased daytime sleepiness (p = 0.005), and anxiety and communicative difficulties (p=0.01). Figure 1 illustrates the distribution and overlap of these symptoms among all the encounters.

Conclusion:
It is feasible to simultaneously assess multiple aspects of stroke patients’ experience in outpatient clinical settings using simple screening tools. “Non-motor” symptoms were common and often co-occurred. Quality of life was mostly impaired by difficulty doing usual activity and depression/anxiety.
Abstract TP400: Defining The Role Of Cortical Disinhibition In The Development Of Post-stroke Neurologic Complications
Authors: Kelly Sean , Robins Olivia
Published: January 2025

Ischemic stroke is a leading cause of death and disability in the US, occurring when the blood supply to an area of the brain is disrupted. Such vascular insults may impact different brain areas responsible for neurologic functions ranging from the generation of movement to language, executive cognitive performance, and mood. Clinicians consider strokes as macroscopic events affecting structures such as cortex, basal ganglia, thalamus, or brainstem. However, each of these is comprised of circuitry involving multiple neuronal cell types, each with stratified metabolic requirements and distinct firing patterns that impact susceptibility to ischemia. Many strokes affect neocortex, a 6-layered cellular sheet containing excitatory glutamatergic pyramidal projection neurons (~80%) and inhibitory local GABAergic interneurons (~18%) assembled into circuits that are elaborated across different cortical areas..

In the weeks following a stroke many patients experience unanticipated neurologic issues that disrupt their recovery and lead to additional suffering. These secondary complications fall into the categories of mood disorders (occurring in 31% of stroke survivors), seizure (3-7%), movement disorders (4%), and cognitive decline (11%). While some therapies exist, complications are often inadequately treated and the causes remain poorly understood as they relate to specific pathologic changes in local cortical circuits. Using a combination of photothrombotic lesions and fluorescent microparticle injection as models for focal ischemic stroke, we designed experiments to define the subpopulations of cortical neuron most susceptible to cell death and dysfunction following ischemic stroke.

Using genetic driver mice to label canonical GABAergic (PV, VIP, SST) and glutamatergic neuronal cell types, we provide the first quantitative evidence that neural subtypes have differential susceptibility to ischemia in peri-infarct regions, and complete
in vivo
2-photon imaging of the onset of ischemic cell death in medial prefrontal cortex and motor cortex using virally-encoded apoptosis markers. Using a combination of Gcamp voltage sensors and EEG. we also present an approach for recurrent monitoring of post-stroke neuronal activity changes leading to organizing network hyperexcitability in ischemic penumbrae. These results lay a foundation for investigation of cell type specific therapies to mitigate the maladaptive effect local cortical disinhibition following stroke.
Abstract TP44: Alpha-1-acid glycoprotein is a potential serum Biomarker for Cerebral Amyloid Angiopathy
Authors: Nishigaki Akisato , Ishikawa Hidehiro , Nishiguchi Yamato , Tachibana Kei , Kato Natsuko , Matsuda Kana , Mori Yurie , UTSUNOMIYA TAKAYA , Matsuyama Hirofumi , Matsuura Keita , Ii Yuichiro , Oikawa Shinji , Tomimoto Hidekazu , Shindo Akihiro
Published: January 2025

Introduction:
Cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease (SVD) caused by amyloid β deposition. It is closely linked to Alzheimer's disease (AD) and predisposes elderly patients to intracerebral hemorrhage and cognitive impairment. However, no effective serum biomarker has been established for early diagnosis or prediction of the disease progression. We discovered that a protein, “alpha1-Acid glycoprotein (α1-AGP),” is a potential serum biomarker for CAA.

Methods:
Proteins in serum samples from CAA patients (n = 10) who meet the modified Boston criteria by a classification of probable or possible and age-matched controls (n = 10) were analyzed exhaustively using two-dimensional differential gel electrophoresis (2D-DIGE) combined with matrix-assisted laser desorption ionization time-of-flight tandem mass spectrometry (MALDI-TOF/TOF/MS). Afterward, each candidate was evaluated quantitatively using the ELISA (Enzyme-Linked Immunosorbent Assay) method.

Results:
Compared with the control group, the expression levels of 4 proteins (Hemopexin, Complement C9, C3, α1-AGP) were increased, and 1 protein (Apolipoprotein A-I) was decreased in the CAA group. We evaluated the expression levels of those 5 proteins by ELISA method and confirmed that the concentration of α1-AGP is significantly increased in the serum samples from the CAA group. Receiver Operatorating Characteristic curve analysis showed that the concentration of α1-AGP could clearly distinguish CAA or not. Moreover, we examined the association between the expression levels of those proteins and the MRI SVD burden (CAA-SVD score) in the same patient group and found a good correlation with α1-AGP (R squared is 0.779).

Conclusion:
Our results suggest that α1-AGP could be a novel serum protein biomarker for diagnosing CAA.
Abstract TP5: Observed to Expected Sex and Racial Makeup of Trial Participants in Completed StrokeNet Trials
Authors: Stanton Robert , Kissela Brett , Khatri Pooja , Broderick Joseph , Skolarus Lesli , Boden Bernadette , Albers Greg , Kamel Hooman , Adeoye Opeolu , Barreto Andrew , Grotta James , Derdeyn Colin , Haverbusch Mary , Robinson David , Aziz Yasmin , Kleindorfer Dawn
Published: January 2025

Introduction:
Successful clinical trials demonstrate that new treatments are safe and efficacious. Adequate representation of underrepresented groups within clinical trials is important to build trust in research institutions and promote fairness in research. We sought to investigate whether participants in recently completed NIH StrokeNet trials were representative by race and sex compared to the expected trial population estimated from a population-based stroke study.

Methods:
Since 2014, in collaboration with NIH StrokeNet, we have prepared feasibility analyses for proposed clinical trials. Thus far, 3 trials have been completed: ARCADIA, DEFUSE 3, and MOST. Our analyses used data from the 2010 epoch of the Greater-Cincinnati/Northern Kentucky Stroke Study (GCNKSS). DEFUSE 3 and MOST investigated acute treatments for ischemic stroke while ARCADIA investigated secondary stroke prevention therapies. Each study's inclusion and exclusion criteria were applied to the GCNKSS population and a percentage of eligible patients was generated. Retrospectively, we calculated the proportion of those eligible patients by race and sex and compared that to the observed proportion from each trial using Chi-square test.

Results:
In 2010, there were 2265 ischemic strokes, of which 248, 74, and 135 were predicted to be eligible for ARCADIA, DEFUSE 3, and MOST, respectively. The application of the I/E criteria for each trial was limited by data available in GCNKSS, and all proposed exclusions were not able to be accounted for (namely, imaging data for DEFUSE 3 and EKG/TTE findings for ARCADIA). All 3 trials enrolled an expected number of females but DEFUSE 3 enrolled less Black participants than would have been expected (O:E ratio 0.3, p-value <0.01). Full results are available in Table 1 and Figure 1.

Conclusion:
We found no statistically significant difference between the proportion of patients predicted to be eligible stratified by race and sex and the actual proportions of those enrolled for ARCADIA and MOST. For DEFUSE 3, the observed enrollment for black participants was lower than expected. All three trials enrolled near or greater than 50% females. Importantly, site selection may impact a trial’s ability to enroll different minority populations and certain clinical trial exclusion criteria may also asymmetrically affect Black patients and women. These findings should reassure that StrokeNet trials enroll a diverse population.
Abstract TP60: Systematic Review and Meta-Analysis Suggests That Race and Ethnicity Are Poorly-Considered in Acute Stroke Blood Biomarker Investigations.
Authors: Smothers Christine , Gandhi Shivam , Chang Julia , Tahir Sadia , Kelley Jarrett , Wang Emily , Fareed Kareem , Mack Hannah , Dong Cindy , Witort Madaline , Armentrout Bethany , Crawford Darynaisha , Martha Sarah , Oconnell Grant
Published: January 2025

Background:
Due to limited diagnostic accuracy in the symptom-based tools currently used by paramedics, triage nurses, and emergency physicians, up to 35% of strokes are missed at initial clinician contact. As a result, there has been a push to identify blood biomarkers that could aid in stroke recognition at triage. There is evidence to suggest stroke is more frequently mistriaged in minority patients than White patients; to avoid perpetuating these disparities as stroke biomarkers move towards clinical use, it is important that involved investigations meaningfully account for race and ethnicity. However, it is unclear how commonly this occurs in practice.

Purpose:
This systematic review and meta-analysis aimed to quantify the degree that race and ethnicity information was reported in prior acute stroke blood biomarker investigations, and assess the effect of racial and ethnic heterogeneity on reported diagnostic performance.

Methods:
An electronic database search to identify published human acute stroke blood biomarker investigations yielded 14,253 articles. After abstract and full-text screening, 189 articles reporting 705 unique diagnostic comparisons were analyzed. For each diagnostic comparison, the reported primary diagnostic statistics were manually extracted, along with the racial and ethnic composition of the study sample if available. Diagnostic statistics were converted to a single diagnostic odds ratio, and race and ethnicity information was used to calculate a Gini diversity index value to represent the demographic heterogeneity of the sample.

Results:
Subject race or ethnicity was only described for 21.8% of diagnostic comparisons. For diagnostic comparisons reporting this information, study populations showed high homogeneity with median Gini diversity indices of 0.33 for race and 0 for ethnicity. We found a negative correlation between Gini diversity index for race and diagnostic odds ratio (Spearman’s rho= -0.17, p=0.14), indicating to some degree that that more homogenous study samples are more likely to produce higher diagnostic performance estimates.

Conclusions:
Findings from acute stroke biomarker investigations are at risk for poor generalizability to the diverse clinical populations that stroke triage serves. To reduce this risk, future work needs to address race and ethnicity more meaningfully in terms of both sampling methods and reporting.
Abstract TP64: Improving Stroke Care with a Nursing Delegate Model in Virtual Neurology Rounds
Authors: Davis Noreen
Published: January 2025

Background and Purpose:
Upon a retrospective review at two community based acute care hospitals our team determined an evidence based orderset was not selected at admission for all patients with an ischemic stroke leading to missed assessments and patient education opportunities. The purpose of this project was to evaluate the impact of a nursing delegate paired with a virtual neurologist on improving utilization of the stroke order set, documentation of Modified Rankin Scale (mRS) and stroke education delivery to patients and caregivers piror to discharge from the hospital.

Methods:
Utilizing the PDSA methodology, we studied the impact of adding a nurse delegate to rounds paired with a virtual neurologist to improve stroke care documentation at two acute care community hospitals. A virtual neurologist rounded on all patient consults using video camera technology and a nurse delegate at the bedside. Beginning in April of 2024 the nurse delegate identified patients with an admission diagnosis of stroke and checked for presence of the ischemic stroke orderset prior to virtual rounds. If the order set was missing, a message reminder was sent to the attending physician team to place the order set, or the neurologist would place during patient rounds. Placement of the order set added reminders to nursing task lists to complete mRS scores and education. The nurse delegate would provide the patient education and document completion prior to the patient discharge if not completed by the primary nurse team.

Results:
Prior to the initiation of the intervention, at hospital A, the baseline date showed of 154 patients with an ischemic stroke only 69 (45%) had a stroke order set on their chart. After the initiation of the nurse delegate the use of the order set improved to 12 out of 15 (80%). This was above the facility stretch goal of 78%. At hospital B, 17 out of 30 stroke patients (56.7%) had documented mRS recorded on admission after the addition of the nurse delegate 24 out of 24 patients had completed scores. At hospital B the stroke education documentation increased from 12 out of 13 (92%) to 12 out of 12 (100%).

Conclusion:
The addition of nursing delegates to virtual neurology rounds in the workflow for stroke patients improved communication,documentation and care coordination between the neurologist and the primary care team members, patients, and caregivers. Early inclusion of the orderset improves documentation of mRS and stroke education.
Abstract TP70: Identifying Risk Factors for Loss to Follow-Up After Stroke at a Large Academic Health System: Implications for Establishing a Holistic Post-Stroke Follow-up Program
Authors: Hwang Soonmyung , Kummer Benjamin , Agarwal Parul , Morozov Masha , Davy Connor , Tosto Mancuso Jenna , Dangayach Neha
Published: January 2025

Introduction:
A significant proportion of stroke patients are lost to follow up (LTFU) after discharge, which may be associated with increased risk of morbidity, mortality, and unnecessary hospitalization. We aimed to identify predictors of post-discharge LTFU and unplanned hospitalizations in a cohort of patients with acute stroke from a large academic hospital system.

Methods:
Using our institutional AHA Get With the Guidelines quality registry, we conducted a retrospective analysis of all patients who were hospitalized for acute stroke between January 1, 2016, and December 31, 2020 at a tertiary-care hospital in New York City. Our primary outcome was post-discharge LTFU, defined as having zero post-discharge encounters within 12 months. Our secondary outcomes included having one or more outpatient visits with a provider, unplanned hospitalizations, and emergency department (ED) visits within 30 days post-discharge. Multiple logistic regression was used to identify factors that were significantly associated with our primary and secondary outcomes, adjusted for confounding demographic and clinical factors.

Results:
We identified 2,597 patients hospitalized for acute stroke, of which 878 (33.8%) were LTFU. Of the 1,719 patients not LTFU, 974 (56.7%) had a provider visit, 405 (23.6%) had an unplanned admission, and 257 (14.9%) had an unplanned ED visit within 30 days post-discharge. Patients who were LTFU were significantly more likely to be male (52.9% vs. 47.4%); have an intracerebral (12.1% vs. 8.9%) hemorrhage; discharged to a skilled nursing facility (19.8% vs. 17.0%); and transferred from another hospital (48.0% vs. 40.7%). Clinically, these patients are more likely to have a history of DVT/PE (3.9% vs. 1.3%); receive catheter-based treatment (12.8% vs. 10.0%); and have a modified Rankin scale (mRS) score of 3 or greater at discharge. In the multivariable logistic regression, patients who were discharged to an acute care facility (adjusted odds ratio (aOR) 3.3), had a history of DVT/PE (aOR 3.1) or a discharge mRS of 3 (aOR 1.8) had significantly higher odds of LTFU, whereas patients who were discharged to an inpatient rehabilitation facility (aOR 0.65), had a family history of stroke (aOR 0.60) or depression (aOR 0.64) had significantly decreased odds of LTFU.

Conclusions:
In this study, patients LTFU after a stroke were more likely to have severe clinical conditions and specific discharge dispositions.
Abstract TP71: Comparison of National and Hospital-Based Stroke Mortality Data in Kentucky: The Paul Coverdell National Acute Stroke Program
Authors: McLouth Christopher , Shumway Lacy , Mullen Aaron , Moore Kari , Mckune Brent , Goldstein Larry
Published: January 2025

Background:
The US Centers for Disease Control and Prevention’s (CDC) Paul Coverdell National Acute Stroke Program (PCNASP) supports state-based efforts to enhance stroke care quality. As part of the PCNASP, Kentucky developed an integrated system linking prehospital Emergency Medical Services and hospital-level data through the American Heart Association’s Get With The Guidelines
®
- Stroke program. To help guide efforts to optimize stroke care processes and reduce disparities, we compared acute poststroke mortality in PCNASP-participating hospitals according to the patient’s county of residence for those residing in CDC-identified low and high stroke mortality counties and based on the county’s level of social deprivation.

Methods:
County-level stroke mortality data (2018-2020) from the CDC and in-hospital data (2021-2023) from PCNASP-participating hospitals were analyzed. The patients’ counties of residence were classified based on CDC stroke mortality rates (high mortality,
>
80.4 per 100,000 population) and Social Deprivation Index (SDI) score tertile. Mixed effects models assessed the relationships between county mortality risk, SDI, and hospital-based stroke mortality.

Results:
There was no difference in age standardized in-hospital mortality between patients residing in high (n=71; 18.3
+
17.9 per 100,000 population) compared to low (n=49; 18.8
+
16.6 per 100,000 population, p=.831) mortality counties or among counties with varying SDI scores (p=.117). Patients residing in higher SDI counties had higher rates of discharge to hospice. Overall, in-hospital mortality decreased between 2021-2023.

Conclusions:
We found that patient-level acute stroke mortality rates in PCNASP participating hospitals do not mirror the mortality rates or degree of social deprivation in their county of residence. This suggests that expected differences in stroke mortality are mitigated for those who obtain acute care in PCNASP participating hospitals. To reduce stroke-related disparities, public health strategies should focus on promoting stroke prevention, public awareness, and facilitating access to high-quality care.
Abstract TP73: Quantifying the Health Equity Impact of Tenecteplase for Acute Ischemic Stroke in the United States: a Distributional Cost-Effectiveness Analysis
Authors: Majda Thomas , Mearns Elizabeth , Lin Shih-Wen , Purdon Barbara , Kowal Stacey
Published: January 2025

Introduction:
Disparities across race, ethnicity and socioeconomic factors exist in acute ischemic stroke (AIS) incident risk, treatment and outcomes. Tenecteplase, given within 4.5 hours of AIS symptom onset, has been shown to be noninferior to alteplase in reducing post-AIS disability, but its equity impacts are unknown. Distributional Cost Effectiveness Analysis (DCEA) is an established method for estimating health equity impacts by evaluating the distribution of health outcomes across equity-relevant subgroups before and after an intervention.

Objective:
Using DCEA, evaluate the impact of tenecteplase use within 4.5 hours of AIS symptom onset on health equity in the US.

Methods:
Leveraging published CEAs of alteplase, a DCEA of tenecteplase given within 4.5 hours of AIS symptom onset was built from a US payer perspective. The US population was divided into 25 equity-relevant subgroups based on race and ethnicity (5 census-based groups) and county-level social vulnerability index (quintiles). Inputs for AIS outcomes, incidence and receipt of tenecteplase were varied across subgroups based on published estimates obtained from a targeted literature review. Scenarios explored robustness of findings to variations in inputs and access assumptions.

Results:
Annually in the US, use of tenecteplase is predicted to improve population health (54,550 QALYs gained) and reduce existing overall inequities. Larger relative health gains are expected in more vulnerable subgroups, specifically within historically marginalized groups and those in geographic areas with higher social vulnerability. Health benefits are driven by cost savings from reduced disability post hospital discharge, while equity benefits are driven by the higher risk of incident AIS in patients who currently have larger health disparities in life expectancy and quality of life. Conclusions were robust to scenario testing. Scenarios that reduced treatment gaps (eg, closing disparities in receipt of treatment and treatment timing) led to larger gains in health and further reduced existing inequalities.

Conclusions:
Under current AIS incidence and thrombolytic utilization patterns in the US, use of tenecteplase given within 4.5 hours of AIS symptom onset is predicted to increase population health while also improving health equity. Closing care gaps to enable more timely and equitable thrombolytic access across race, ethnicity and geography can further improve equity benefits from tenecteplase use.
Abstract TP89: Advancing Stroke Care Efficiency: Impact of AI and Communication Tools on Patient OutcomesAuthors: Fatima Milfred, Ami Roy, Caitlyn Delmor, Aiyush Bansal, Karen Gifford, Kelvin Ma, Mike Mercurio, Dhaval Desai, John Greenert, David Robinson, Jason Choi, Robert Ryan
Authors: Milfred Fatima
Published: January 2025

Introduction:
Pulsara and Viz.ai are advanced technologies designed to streamline acute stroke care. Pulsara facilitates real-time communication and dynamic team building for stroke management, ensuring rapid connection with neurologists and interventionalists. Viz.ai uses AI-powered algorithms to accelerate diagnosis and optimize care pathways, improving outcomes by enhancing coordination between neurology and interventionalist teams. This study evaluates whether these innovations have led to significant reductions in treatment times and length of stay (LOS) in a single center.

Methods:
We conducted a single-center, retrospective analysis comparing acute ischemic stroke and TIA patients across three periods: pre-Pulsara (January 1, 2013–July 31, 2018; n=96), post-Pulsara/pre-Viz (August 1, 2018–April 30, 2022; n=71), and post-Viz (May 1, 2022–December 31, 2023; n=28). We analyzed door-to-CT, door-to-needle, and door-to-puncture times using the Kruskal-Wallis test, followed by pairwise Wilcoxon tests with Bonferroni correction for post-hoc comparisons.

Results:
Significant reductions in treatment times were observed across the three periods. Median door-to-needle time decreased significantly from 59.05 minutes pre-Pulsara to 29.78 minutes post-Viz (p < 0.001). Median door-to-CT time improved from 16.75 minutes pre-Pulsara to 9.54 minutes post-Viz (p < 0.01). Median door-to-puncture time showed substantial reduction from 131.42 minutes pre-Pulsara to 61.69 minutes post-Viz (p < 0.01). However, no significant differences were observed in LOS between the groups.

Conclusion:
The integration of Pulsara and Viz.ai into stroke care significantly reduced critical treatment times, particularly in door-to-needle and door-to-puncture metrics, underscoring the effectiveness of these technologies in enhancing the speed and coordination of acute stroke management. However, no significant impact on length of stay was observed, suggesting that further factors may influence this outcome.
Abstract TP90: Outpatient stroke care quality in VA Teleneurology and Community Care Neurology Consults
Authors: Nobel Lisa , Myers Laura , Daggy Joanne , Kirchgassner Jessica , Bastin Grace , chagwena fadzai , Taylor Stanley , Odrzywoldski Karen , Wilkinson Jayne , Williams Linda
Published: January 2025

Background:
The Mission Act provided VA funding for non-VA care for Veterans under certain conditions where access to care is limited. Comparing the quality of care between outpatient VA Teleneurology (TN) and Community Care Neurology (CCN) stroke consults is important to understand the impact and value of innovative telehealth solutions to increase access to care.

Methods:
Veterans with a completed new consult for stroke/TIA in the TN and in CCN at 13 VA facilities from 2021 to 2022 were included. We collected administrative and chart review data for all neurology consults. 4 process measures were defined a priori: antithrombotic (AT) medication, high or medium potency statin, anticoagulation for atrial fibrillation (AF), and dual antiplatelet therapy (DAPT) 90 days or less after the consult completion. The primary quality measure is the without-fail rate (WFR), which is a dichotomous outcome of whether a patient passes all process measures (yes/no) for which they are eligible. For WFR (without-fail rate), a logistic regression model was fit with the effect of interest consult type (TN vs. CCN) after adjustment for patient characteristics of age, Charlson Comorbidity Index (CCI), gender, race, and rurality. The model accounted for subjects clustered within facilities (site) using a Generalized Estimating Equation (GEE) approach. Inverse-probability of treatment weighting was also used since patients were not randomized to consult type. Similar logistic regression models were used to assess the effect of consult type on the pass rate (yes/no) for each individual process measure.

Results:
Of 828 completed consults, 594 (72%) were CCN. Table 1 shows participant characteristics by TN vs. CCN. The WFR was 56.0% in TN vs. 59.4% in CCN. Median days to complete consults was 37 (IQR 8 to 70) among TN and 82 (IQR 46 to 128) in CCN. Patients who passed all 4 measures vs those that did not were similar with respect to most demographic characteristics (Table 2). After adjustment for demographics and CCI, there was no difference in the WFR for TN vs CCN, OR 0.90, 95% CI (0.70, 1.15). None of the pass rates for the individual process measures significantly differed by consult type (TN vs. CCN) (Table 3). Model results were similar when including stabilized inverse probability weights (data not shown).

Conclusions:
VA teleneurology care may be a way to improve the timeliness to outpatient stroke care without impacting quality of care for outpatient stroke care.
Abstract TP92: An Evaluation of Vascular Neurology Fellowship Websites: How Informed an Applicant Could Be?
Authors: Sivakumar Milan , Degen Nathaniel , Varkey Thomas , Alexandrov Andrei , Singh Savdeep
Published: January 2025

Introduction:
Prospective applicants for Stroke fellowship programs often rely on online resources to make informed decisions. Access to accurate program information is essential for making application decisions. This study aimed to assess the availability of critical application and program information on websites of neurology stroke fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and participating in the National Residency Matching Program (NRMP).

Methods:
Using the Electronic Residency Application Services (ERAS), a list of websites for 112 ACGME-accredited vascular neurology fellowship programs was compiled. Each website was evaluated for 7 components of application information, including deadlines and contact details, and 17 components of program information, such as compensation, rotation schedule, and faculty listings.

Results:
Of the 112 programs, only 5.1% of websites contained all 7 components of application information, while none (0%) provided all 17 components of program information. This significant gap in online data availability suggests that prospective fellows may struggle to find essential information to guide their application process.

Conclusion:
The lack of comprehensive online information poses a challenge for applicants and may hinder the recruitment of qualified candidates. Improving the accessibility and completeness of information on vascular neurology fellowship websites could facilitate better decision-making and ultimately enhance program participation.

Keywords: Neurology, Stroke, Fellowship, Data availability, Program evaluation