bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP140: Functional Independence Scores of Acute Stroke Patients is Associated With Discharge Directly to Home
Authors: Kawano Hiroyuki , Johno Takashi , Torii Masataka , Kamiyama Hiroshi , Amano Tatsuo , Honda Yuko , Suzuki Rieko , Okano Haruko , Unno Yoshiko , Yamada Shin , Okajima Yasutomo , Shiokawa Yoshiaki , Hirano Teruyuki
Published: October 2018

Background and purpose:
Functional Independence Measure (FIM) is a valid tool to estimate the level of ADL. However, there were few studies whether FIM score in acute stroke patients is associated with the short-term outcome. Our aim is to reveal whether FIM scores within 3 days from admission to a stroke unit can predict the short-term good outcome (discharge directly to home).

Method:
We used data from a prospectively collected observational registry in a single stroke center between January 2016 and March 2017. Baseline NIHSS score, acute FIM score (= within 3 days from admission to the stroke unit), discharge FIM score (= at discharge from the stroke unit) were collected. FIM efficiency was calculated from (discharge FIM - acute FIM)/ the length of hospital stay. Logistic regression analysis was used to determine the independent predictors of discharge directly to home.

Results:
Of 678 patients were admitted to our stroke center due to acute stroke, 410 patients whose clinical data could be obtained (60%; mean age, 74±13 years; male, 57%; the median of length of hospital stay, 21 days; 75% with ischemic stroke) were enrolled. The median of the baseline NIHSS score, acute FIM score, and FIM efficiency were 5 (interquartile range [IQR], 2-16), 53 (IQR 22-83), and 0.88 (IQR 0.10-1.73), respectively. In univariate logistic regression analysis, male sex, acute ischemic stroke, baseline NIHSS score, acute FIM score, discharge FIM score, the length of hospital stay, and FIM efficiency were associated with discharge directly to home. In multivariate logistic regression analysis, acute FIM score (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.03-1.06; p<0.01) and FIM efficiency (OR 1.63; 95% CI 1.32-2.08; p<0.01) were independent predictors of discharge directly to home. Discharge FIM score was excluded from the multivariate model because discharge FIM strongly correlated with FIM efficiency (ρ=0.71; p<0.01). The optimal cut-off point of acute FIM score to predict discharge to home was >71, with a sensitivity of 72%, specificity of 88%, and an area under the curve of 0.86 (p<0.01).

Conclusions:
FIM scores within 3 days from admission to a stroke unit can predict discharge directly to home, which can help stroke physicians to expect the short-term outcomes.
Abstract WP142: Baseline and Demographic Factors Associated With Improvements in Physical Activity, Cognition and Mood: Preliminary Data from the Bugher Foundation’s Stroke and Exercise Study
Authors: Junco Barbara , Tiozzo Eduard , Flothmann Marti , Lages Lucas , Yu Andrew , Chang Nathalie , De La Cruz Frank , Ruiz Anabel , Simonetto Marialaura , Gutierrez Carolina M , Dong Chunhai , Rundek Tatjana , Loewenstein David , Sacco Ralph L , Koch Sebastian
Published: October 2018

Background:
The Bugher Stroke and Exercise Study examines the impact of a structured exercise and cognitive training program after stroke. In this preliminary analysis we investigated baseline predictors and demographics related to physical, cognitive and affective improvements.

Methods:
Participants with recent stroke and limited physical activity ≥ 3 months prior to enrollment were randomized to one of two arms of a 3-month intervention. Arm 1 (N=62) received exercise (strength & cardiovascular) and cognitive training. Arm 2 (N=35) received light stretching and sham cognitive training. Outcome measures included depression (CES-D), cognition (MoCA), stroke impact scale (SIS), impairment (NIHSS), degree of disability (mRS), and physical measures of hand grip (HG), time up and go (TUG), 30-second chair stand test, 6-minute walk, waist circumference, BMI and blood pressure (BP). The trial is ongoing, therefore treatment group comparisons were not available. T-tests evaluated change in outcome measures among all participants. Regression analyses evaluated demographic variables and baseline factors (i.e., time-since-stroke, ischemic vs. hemorrhagic, & pre-stroke physical activity) associated with change in outcome measures.

Results:
To date, 97 participants were enrolled (
M
age 59±11 years; 34% women; 53% white, 49% Hispanic, 39% black & 7% other). Participants demonstrated significant improvement on the CES-D (p=.005), MoCA (p=.005), NIHSS (p<.001), SIS (p=.015), mRS (p<.001), HG (p=.002), TUG (p=.004), 30-second chair (p<.001), 6-minute walk (p=.001), waist circumference (p=.010), and both systolic (p=.009) and diastolic (p<.001) BP. Regression analyses revealed that older adults were less likely to improve in MoCA scores (p=.010), 6-minute walk (p=.041), and systolic BP (p=.032). Participants with more pre-stroke physical activity demonstrated greater improvement in 6-minute walk (p=.024). Black participants saw less decline in systolic BP (p=.033) while participants with hemorrhagic (vs. ischemic) stroke saw less decline in diastolic BP (p=.039).

Conclusions:
Participation in an exercise and cognitive training intervention benefit stroke survivors; however, improvement may depend on baseline and demographic factors.
Abstract WP143: Computational Analysis of Movement for Evaluation of Motor Functional Impairment After Stroke
Authors: Gutiérrez Zúñiga Raquel , Alonso de Leciñana María , Díez Alejandro , Pascual Alejandro , Valkov Valko , Ruiz-Ares Gerardo , Rodríguez Pardo Jorge , Fuentes-Gimeno Blanca , Díez-Tejedor Exuperio
Published: October 2018

Motion capture systems (MCS) are used in neurological rehabilitation and for diagnosis of movement disorders. We aimed to explore the usefulness of MCS to obtain an objective measurement of functional status after stroke, especially in patients with minor or without deficit when measured by current motor clinical scales.

Methods:
Prospective observational case-control pilot study using Microsoft Kinect® analyzed with the software Akira®. Patients after acute stroke were included. All subjects performed the same exercises (standing, walking, sitting position, abduction of the upper limb in pronation and supination during 5 seconds each position and flexion of the upper limbs) that were recorded in a three-dimensional space. Joint angles and time of execution were registered and analyzed. The differences in execution between both sides of the body were compared between cases and controls. The relationship with the NIHSS score was analyzed with linear regression analysis and the mRS score with Pearson’s correlation coefficient (PCC).

Results:
50 controls and 33 stroke patients were analyzed. The median NIHSS score was 2 (rank 0-12) and the median mRS was 0 (rank 0-4). The measurements that showed better discrimination capacity were those obtained from abduction of the upper limb: shift of the joint angles were different between cases and controls in the frontal plane for the elbow in pronation (p=0.01) and in supination (p< 0.001); and for the shoulder both in pronation and supination (p=0.01). These differences were independent of the NIHSS score, but were moderately correlated to the mRS score at the moment of the evaluation: elbow in pronation (PCC=0.48 IC=0.051-0.12) and in supination (PCC=0.61 IC=0.16-0.29); and shoulder in pronation (PCC=0.39 IC=0.02-0.08) and in supination (PCC=0.63 IC=0.13-0.25).

Conclusion:
Computational analysis of movement could be a useful tool for evaluation of upper limb function in stroke patients with slight deficit underestimated using current motor clinical scales and this is correlated with mRS. Further studies are needed to determine the better exercises to be considered and the relationship with functional outcome.
Abstract WP146: Predictors of Recovery From Acute Aphasia
Authors: Kernbach Julius , Chenausky Karen , Norton Andrea , Schlaug Gottfried
Published: October 2018

Introduction:
Making accurate predictions about a stroke patient’s language/speech-motor outcome and recovery potential is a challenge. We previously showed that a combined variable of lesion site and size pertinent to relevant white matter language structures, the Arcuate Fasciculus lesion load (AF-LL), correlated highly with measures of speech fluency in chronic aphasic patients (Marchina et al., 2011; Wang et al., 2013). However, studies in motor recovery and other domains have shown that behavioral measures in the acute stroke phase might be equal or better predictors of recovery compared to lesion measures. Whether or not any of these measures follow a proportional recovery rule, has not been established.

Hypothesis:
To evaluate whether acute aphasia measures (overall WAB score) and/or acute lesion measures (e.g., AF-Lesion Load) predict recovery from aphasia.

Methods:
Over a period of several years, patients presenting with acute aphasia were evaluated using a bedside version of the Western Aphasia Battery complemented by picture naming tests, automatic speech measures, and custom-made word/phrase spoken and sung test. A total of 100 acute patients were assessed of which 56 followed up at 3 months. Lesion maps drawn on diffusion-weighted images were used to calculate lesion loads of a probabilistic Arcuate Fasciculus (AF) tract derived from matched elderly healthy control subjects. Analyses included correlations between recovery potential and actual recovery and other predictors of 3 months outcome. AF-LL was regressed with the overall WAB score, measures of speech fluency and naming ability (using the Boston Naming Test).

Results:
The overall bedside WAB score in the acute stroke period was the best predictor of the overall WAB score at 3 months (R2=0.60). This predictor was slightly improved when a measure of speaking-singing dissociation was added to the model. Lesion-load of the AF was also a good predictor of WAB score at 3 months (R2=0.48), but did not improve outcome predictions of the WAB score by itself. Overall acute aphasic patients followed a proportional recovery rule, but only recovered about 56% of what was theoretically possible.

Conclusion:
Language and Speech-Motor Outcome after stroke can be predicted best by a bedside WAB score.
Abstract WP150: Functional Connectivity Changes and Behavioral Gains Following Brain-Computer Interface Therapy for Stroke Rehabilitation
Authors: Sinha Anita , Nair Veena , Remsik Alexander , Advani Hemali , Jacobson Tyler , Mcmillan Matthew , Walczak Matthew , Williams Justin , Prabhakaran Vivek
Published: October 2018

While most survivors have some spontaneous recovery after stroke, they reach a functional plateau and are left with persistent motor impairments. An emerging therapy, EEG-based Brain-Computer Interface (BCI), shows promise in promoting neural reorganization and facilitating additional motor recovery after stroke, however, the relationships between the neuroplastic changes and behavioral outcomes following this therapy are not fully understood. We examined changes in resting-state functional connectivity (rsFC) in the motor network and behavioral measures, including Stroke Impact Scale (SIS) and Action Research Arm Test (ARAT), over the course this therapy and investigated functional connectivity - behavior correlations. Twenty-six stroke patients with mild to severe upper extremity impairment completed EEG-based BCI therapy. Resting fMRI and anatomical scans were acquired on a GE 3T MRI Scanner before therapy, mid-, post- and one-month post-therapy, along with a neuropsychology battery. MRI scans of right hemisphere stroke patients were flipped to treat all subjects as left lesion hemisphere patients. We performed whole network, inter-hemispheric and intra-hemispheric seed region based connectivity analyses to study changes in rsFC over time and identify correlations between changes in rsFC and behavior over time. After therapy, a significant increase in network connectivity (p =0.000003) and intra-hemispheric connectivity (p = 0.047) from pre- to one-month post-therapy was observed. Additionally, inter-hemispheric connectivity increased and trended towards significance (p = 0.058). A significant positive correlation was observed between changes in network-level rsFC and SIS ADL (p = 0.005). Changes in intra-hemispheric rsFC correlated with ARAT for the affected arm (p = 0.001) and SIS Mobility (p = 0.003). The results suggest that EEG-based BCI therapy facilitates changes in rsFC in the motor network in stroke survivors, and these changes in connectivity are correlated with improvements in behavioral outcomes. This analysis provides a foundation for furthering our understanding of the potential of EEG-based BCI as a therapeutic modality for stroke rehabilitation to promote neurophysiological changes and motor recovery.
Abstract WP153: Depressive Symptom Trajectories Are Associated With Blood Pressure Reduction Among Stroke Survivors
Authors: Goldmann Emily , Boden-Albala Bernadette
Published: October 2018

Little is known about the longitudinal course of post-stroke depression and its impact on vascular risk reduction, a key secondary prevention strategy. Data for this study came from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial of a skills-based intervention to reduce vascular risk in 552 mild/moderate stroke/TIA patients. Depressive symptom severity was measured pre-discharge and at 6 and 12 months post-discharge as the total score on the Center for Epidemiologic Studies - Depression (CES-D) scale (range 0-60). Discrete mixture models identified distinct trajectories of depressive symptom severity over time and assigned patients to trajectory groups. Poisson models with linear and quadratic parameters were run to select the best-fitting model based on Bayesian information criterion and interpretability. The outcome, systolic blood pressure (BP) reduction, was defined as the difference between BP at baseline and 12 months post-discharge (mmHg). The association between trajectory group membership and BP reduction was examined using ANOVA and multinomial logistic regression adjusted for trial arm, baseline BP, sex, age, race/ethnicity, marital status, and NIH Stroke Scale score. A total of 465 individuals completed at least 1 depression assessment. A model was selected with four distinct trajectories: 1) resistance - low depressive symptom levels at all waves (35% of patients); 2) recovery - clinically significant baseline symptom levels (CES-D>16), dropping to low levels at subsequent waves (32%); 3) delayed - low levels at baseline, increasing to clinically significant levels (20%); 4) chronic - high levels at all waves (13%). Mean BP reduction was significantly higher in the resistance group compared to the other trajectory groups (10.7 vs. 2.3 in recovery group, 2.3 in delayed group, 4.5 in chronic group, p=0.017) and remained significantly higher compared to each of the other trajectory groups in the adjusted model (betas = 5.0-5.5 mmHg, all p<0.05). Mean BP reduction did not differ significantly between other trajectory groups. Rapid reduction of depressive symptoms and prevention of symptom onset following stroke may be important targets for helping stroke survivors reduce vascular risk.
Abstract WP154: Early Functional Independence Measure Scores Are Associated With 3-Month Quality of Life
Authors: Lin Chen , Katkar Mansi , Lee Jungwha , Harvey Richard L , Roth Elliot , Prabhakaran Shyam
Published: October 2018

Introduction:
Limited data exists for inpatient rehabilitation outcomes predicting health-related quality of life (HRQOL) in stroke patients. We evaluated the association between Functional Independence Measure (FIM) scores during inpatient rehabilitation and HRQOL scores at 3 months.

Methods:
Between 2012 and 2014, consecutive patients admitted to an inpatient rehabilitation hospital with ischemic stroke were consented in a prospective registry with 3-month follow-up. The admission FIM score were recorded. The Neuro-QOL questionnaire was used to assess 3-month HRQOL in 4 domains: upper extremity (UE), lower extremity (LE), executive functions (EF), and general concerns (GC). Impaired HRQOL was defined as T-scores <45 for each domain. We analyzed the unadjusted and adjusted association between FIM scores and impaired HRQOL.

Results:
One-hundred thirteen patients (mean age 67.3±15.8 years; 50% male; 56.6% white) were included in final analysis. The median time from stroke onset to admission FIM score was 7 days (IQR 4.6-12.4). Median FIM score was 51 points (IQR 35-62). On unadjusted analysis, a 1-point increase in admission FIM scores resulted in less likelihood of impaired 3-month HRQOL domains: 6% for GC (OR 0.94, 95% CI 0.91-0.98, p<0.001), 7% for EF (OR 0.93, 95% CI 0.90-0.96 p<0.001), 4% for LE function (OR 0.96, 95% CI 0.93-0.98, p=0.001), and 3% for UE function (OR 0.97, 95% CI 0.95-0.99, p=0.01). In analyses adjusting for age, sex, time from stroke to FIM evaluation, race, baseline mRS, initial NIHSS, insurance, past medical history (atrial fibrillation, hypertension, renal disease, diabetes mellitus, cardiac disease, and prior stroke), a 1-point increase in admission FIM scores had similar effects on HRQOL domains: 6% for GC (OR 0.94, 95% CI 0.91-0.99, p=0.01), 7% for EF (OR 0.93, 95% CI 0.89-0.97 p=0.001), 5% for LE function (OR 0.95, 95% CI 0.92-0.99, p=0.004), and 3% for UE function (OR 0.97, 95% CI 0.94-0.99, p=0.01).

Conclusions:
There is a strong association between FIM scores at admission to inpatient rehabilitation and 3-month HRQOL across multiple HRQOL domains. These findings indicate that long-term HRQOL can be predicted earlier in a patient’s course during inpatient rehabilitation.
Abstract WP157: Leukoaraiosis and Hemorrhagic Transformation After Intravenous Thrombolysis in Acute Ischemic Stroke
Authors: NA Wei L
Published: October 2018

Objective:
To investigate the relationship between leukoaraiosis (LA)and hemorrhagic transformation(HT)and neurological outcome at 3 months after recombinant tissue plasminogen activator(rt-PA) treatment in patients with acute ischemic stroke.

Methods:
Prospective clinical,1aboratory, and radiological data from patients with acute ischemic stroke who had received intravenous rt-PA therapy in our hospital were retrospectively reviewed. The severity ratings of LA were evaluated by Age-related white matter changes scale (ARWMC) scale. In order to detect hemorrhagic transformation, all the patients in thrombolysis group had the second head CT scan at 24 h after thrombolysis. sICH was assessed according to the European Collaborative Acute Stroke Study II (ECASS II) criteria. Hemorrhagic transformation after thrombolytic therapy and clinical neurological outcome based on modified Rankin scale(mRS)at 3 months were also analyzed. Favorable outcome as mRS 0-1 and unfavorable outcome as mRS 2-6 were defined.

Results:
584 patients receiving intravenous rt-PA treatment in this study were finally enrolled. The mean age was (63.1 ± 9.7) years and 250 cases (42.9%) in women. Door to needle time was (170.4 ± 44.4) min, pretreatment National Institutes of Health Stroke Scale score was 13.76 ± 6.18. Hemorrhagic transformation was found in 83 cases (14.2%). Logistic regression analysis showed that the severity of LA was associated with hemorrhagic transformation, the odds ratios ranged from 2.017(95%
CI
1.419 ~ 2.915) to 2.541 (95%
CI
1.714 ~ 3.368). Dicho-Logistic regression analysis showed that WMHs Score was the independent risk factor of unfavorable neurological outcome (
OR
= 1.735, 95%
CI
1.236 ~ 2.442).

Conclusion:
The severity of LA is associated with an increased risk of sICH and poor functional outcome after IV or intra-arterial thrombolysis for acute ischemic stroke.
Abstract WP162: Outcomes and Long-Term Mortality After Ischemic Stroke in the Young: A Preliminary Analysis From the Greater Cincinnati/Northern Kentucky Stroke Study
Authors: Kissela Brett M , Khoury Jane C , Alwell Kathleen , Moomaw Charles J , Haverbusch Mary , Woo Daniel , Flaherty Matthew L , Star Michael J , Demel Stacie L , Ferioli Simona , Mackey Jason , De Los Rios La Rosa Felipe , Walsh Kyle , Gillow Sabreena , Kleindorfer Dawn O
Published: October 2018

Introduction:
There is a trend towards ischemic stroke (IS) occurring at younger ages. We sought to better characterize outcomes and mortality over 3 years by age at time of stroke within a large, biracial population.

Methods:
Incident IS were ascertained during the 2005 and 2010 study periods of our population based epidemiology study via ICD-9 codes 430-436. Research nurse coordinators performed medical record abstraction on all potential events, which were then adjudicated by study physicians as case/not a case. Abstractions included discharge or 30-day outcomes (if available) as measured by modified Rankin scale (mRS). Mortality for IS events out to 3 years was determined via all available information including the Social Security Death Index. We compared the outcomes and post-stroke mortality by 20-55 (young stroke) versus >55 years, and by decade. Descriptive statistics are reported as n (%), and mean (SD) or median (25
th
and 75
th
%ile) as appropriate. The primary analysis examined the effect of age, race and sex using regression, life table and proportional hazards models.

Results:
Results are shown in the table. IS in the young occurred more frequently among black cases. The median rNIHSS was 3 although the NIHSS distribution trended towards more severe IS in the older age group. Young strokes had lower baseline and 30-day mRS. The mortality rate was greater in the older ages, at each time point and overall. After adjusting for race, sex and stroke severity the hazard ratio for lower survival in the strokes >55 years old was 4.03 (95% CI 3.15, 5.17).

Conclusion:
IS patients < 55 years old are less likely to die after stroke. Young stroke occurs in demographically different populations than older strokes and this group would benefit from further study.
Abstract WP164: Spontaneous Cervical Artery Dissection in Individuals of African Ancestry
Authors: Green Ilana E , Owens Debra L , Lescure Tyler N , Rahman Shareena A , Worrall Bradford B , Southerland Andrew M
Published: October 2018

Introduction:
The pathogenesis of spontaneous cervical artery dissection (sCeAD), a common cause of stroke in young adults, is poorly understood. The majority of published data in sCeAD derive from populations of European ancestry, including a recent genome-wide study identifying an association with the rs9349379 polymorphism of the PHACTR1 gene. Little is known about sCeAD in individuals of African ancestry despite robust epidemiological data showing increased risk of stroke at younger ages, partially explained by higher prevalence of traditional vascular risk factors. We hypothesize that people of African ancestry with sCeAD have different epidemiology and clinical profiles compared to those of European ancestry, and a different genetic architecture related to rs9349379 of the PHACTR1 gene.

Methods:
We searched a single-center database of sCeAD (n=278) to identify individuals of African and European ancestry. We compared differential prevalence of sCeAD versus all young stroke (≤ 60) between patients of African and European ancestry at our center. We characterized clinical profiles, confirmed by electronic medical record review. Data include descriptive statistics reported as medians or percentages as appropriate. We also used the publicly available HapMap Project to obtain allele frequencies of rs9349379 in different ancestral populations.

Results:

Conclusion:
Individuals of African Ancestry account for a relatively smaller proportion of sCeAD cases compared to the proportion of all young stroke cases. Despite similar ages at time of event, individuals of African ancestry suffering sCeAD have higher prevalence of vascular risk factors compared to individuals of European Ancestry. Reviewing HapMap data demonstrates striking differences in allele frequencies for rs9349379 in the PHACTR1 gene between ancestral populations. Further prospective research is needed to clarify these associations and disparities in the pathogenesis of sCeAD.
Abstract WP173: A Systematic Review of Clinical Prediction Models for Patients With Stroke
Authors: Paulus Jessica K , Wessler Benjamin S , Lundquist Christine M , Kent David M
Published: October 2018

Introduction:
Clinical prediction models (CPMs) estimate the probability of clinical outcomes and hold the potential to improve decision-making and individualize care. We aim to conduct a systematic study of published CPMs predicting mortality, functional outcome or stroke recurrence for patients with stroke.

Methods:
The Tufts PACE CPM Registry is based on a systematic review of cerebrovascular and cardiovascular CPMs published in English-language articles from 1/1990-3/2015, and includes 1084 unique CPMs extracted from 747 articles. CPMs predicting outcomes for patients with stroke were characterized based on index condition (hemorrhagic, ischemic or all stroke) and outcome (mortality, functional outcome or stroke recurrence). We identified the most commonly occurring covariates in models grouped by index condition-outcome pair (I-O pair).

Results:
Among 1084 total models in the registry, 116 (11%) predicted mortality, functional outcomes or stroke recurrence among patients with stroke. The top three most frequent models predicted functional outcomes among ischemic stroke patients (n=23), mortality among all stroke patients (n=19), and mortality among patients with hemorrhagic stroke (n=18). The median reported C statistic was 0.84 (among n=78 models reporting this measure). About half (45%) of models reported internal validations, with only 25% reporting external validations. The most commonly occurring covariates in the models were age (77%), stroke severity (51%), and functional status (26%) (see Figure). Neuroimaging findings were included relatively infrequently (21%), but were included in all 9 models predicting functional outcome among hemorrhagic stroke patients.

Conclusions:
There is an abundance of CPMs to predict clinically important outcomes in stroke populations. More work is needed to understand how this prognostic information might be used to improve decision making and outcomes for stroke patients.
Abstract WP175: Neighborhood Differences in Stroke Knowledge, Self-efficacy, and Barriers to Calling 9-1-1 in Chicago
Authors: Song Sarah Y , Kwon Soyang , Wymore Erin , Kandula Namratha , Brown Jen , Eisenstein Amy , Richards Christopher T , Mason Maryann , Beckstrom Heather , Jones Peggy , Washington Knitasha , Aggarwal Neelum T , Prabhakaran Shyam
Published: October 2018

Introduction:
Differences in self-efficacy, stroke knowledge, and symptom recognition during acute stroke may affect calling 9-1-1, time to hospital arrival, and stroke outcomes. In a segregated city like Chicago, with significant disparities in stroke outcomes, comparing differences between geographic neighborhoods could reveal important areas for focused interventions.

Methods:
The ongoing Community Engagement in Early Recognition and Immediate Action in Stroke (CEEERIAS) study is a community- and patient-partnered intervention to improve early hospital arrival for stroke patients in Chicago. As part of study analysis, we conducted surveys of a sample of Chicago residents to assess stroke knowledge, self-efficacy, and barriers to calling 9-1-1. Subjects, recruited at community events, were separated into North Side (N) and South Side (S) groups by subject zip code. Surveys included the validated Stroke Action Test (STAT) for knowledge, self-efficacy scales for willingness to call 9-1-1 for stroke, and the Health Care Trust Survey for trust.

Results:
A total of 364 subjects participated (199 in N group and 165 in S group; 55% female [S: 63.6% vs. N: 48.3%]). The N group was more educated while the S group had greater interest in participating in the CEERIAS study, more health problems, and more recent hospital visits. Though stroke knowledge using the STAT was similar, the N group felt more confident recognizing a stroke (p<0.0001). The S group was less likely to believe that immediate hospital care improved post-stroke survival and more likely to believe doctors treated that black patients differently than whites, that hospitals covered up mistakes, and that hospitals experimented on people without consent. The S group was more likely to not call 9-1-1 for fear of financial costs, compared to the N group (23.5% vs. 4.5%, p<0.001).

Conclusion:
Though both neighborhoods had similar levels of stroke knowledge, the subjects living on the South Side had higher mistrust of hospitals and were less likely to call 9-1-1 due to financial costs. Understanding neighborhood-level perceptions of healthcare and barriers allows for development and implementation of targeted, nuanced community-partnered interventions to reduce disparities in stroke outcomes.
Abstract WP176: Temporal Trends in Public Awareness of Stroke: Knowledge is Key
Authors: Rademacher Eric W , Khoury Jane C , Kissela Brett M , Woo Daniel , Flaherty Matthew , Khatri Pooja , Adeoye Opeolu , Ferioli Simona , Pancioli Arthur M , Broderick Joseph P , Kleindorfer Dawn O
Published: October 2018

Introduction:
Recognition of stroke symptoms is vital for accessing medical care and administration of thrombolytics and/or endovascular therapy for ischemic stroke. Awareness of stroke warning signs and risk factors is key to treatment and prevention, respectively.

Methods:
Surveys were conducted in 1995, 2000, 2005, 2011 and 2016 to respondents randomly drawn to reflect the age, race and sex distribution of the ischemic stroke population in the Greater Cincinnati/ Northern Kentucky Stroke Study. All surveys are based in the same biracial population of 1.3 million, subjects were contacted using random-digit dialing. Open-ended questions regarding stroke risk factors and warning signs were asked and demographic and stroke risk factor information collected. Multiple regression was used to examine changes over time and adjust for covariates.

Results:
Over the 20-year period, 10,393 surveys were completed. Survey respondents were 60% female, 27% black, with median age 67 years. As depicted in the Table, knowledge of risk factors and warning signs has significantly increased over time, however not within the past 5 years. This is also true after adjustment for age, race, sex and education of the respondents. Female sex and higher education levels were significantly associated with higher knowledge, but age and race had no independent effect.

Conclusions:
Public awareness of stroke risk factors and warning signs has improved over the past 20 years, although progress has slowed during the past five years despite numerous national and regional stroke awareness campaigns. Knowledge of risk factors continues to be significantly worse than knowledge of warning signs. Further study of the effectiveness of stroke public awareness campaigns are needed.
Abstract WP179: Recurrent Stroke in Minor Ischemic Stroke or TIA With Metabolic Syndrome and/or Diabetes Mellitus
Authors: Chen Weiqi , Pan Yuesong , Wang Yilong , Wang Yongjun
Published: October 2018

Background:
We aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack (TIA) from the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial.

Methods and Results:
A total number of 3044 patients were included. Patients were stratified into four groups: neither, METS only, DM only, or both. METS was defined using Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definition. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. Multivariable Cox regression model was used to assess the relationship of METS/DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8% and 9.8% of patients were diagnosed as neither, METS only, DM only and both conditions, respectively. After 90 days of follow up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% vs 6.8%; adjusted Hazard Ratio = 2.50, 95% confidence interval 1.89-3.39) and both (17.1% vs 6.8%; adjusted HR = 2.76, 95% CI 1.98-3.86) had significantly increased rate of recurrent stroke. No interaction effect of antiplatelet therapy by different METS/DM status for the risk of recurrent stroke (p for interaction =0.82 in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results.

Conclusions:
Concurrent METS and DM was associated with an increased risk of recurrent stroke in minor stroke and TIA patients.
Abstract WP18: Tirofiban Cannot Prevent the Early Re-Occlusion After Endovascular Therapy in Acute Ischemic Stroke Patients
Authors: Che Ruiwen , Zhao Wenbo , Jiang Fang , Ji Xunming
Published: October 2018

Endothelial injury is inevitable after Endovascular thrombectomy (ET) in acute ischemic stroke, which may lead to early re-occlusion and attenuate the beneficial effects of ET. Tirofiban, a Glycoprotein(GP) IIb/IIIa antagonist, is often used to prevent local platelet aggregation and early re-occlusion. However, its effectiveness in preventing early re-occlusion is still unknown. Here, we investigate the efficacy of tirofiban in preventing early re-occlusion after ET. This observational study was based on a registry study. AIS patients treated with ET were recruited if they met one of the following criteria: treated with permanent intracranial stenting, balloon angioplasty, or >3 passes with retriever during thrombectomy. If used, a low dose bolus tirofiban (0.25 to 0.5 mg) was administrated intraarterially, followed by intravenous tirofiban continuously at a rate of 0.2 to 0.25 mg/h for 12 to 24 hours. Re-occlusion was defined as an in-situ re-thrombosis assessed by TCD and/or CTA within 7 days after ET. The primary outcome was the incidence of early re-occlusion within 7 days post-treatment. Eight one subjects (aged 60.6±12.2 years old) were included. There were 48 subjects treated with tirofiban and 33 subjects not treated with tirofiban. The median NIHSS at admission was 18 (12.5-25.5). Compared with 3 subjects (9.1%) treated without tirofiban, 4 subjects (8.0%) treated with tirofiban experience re-occlusion (
p
=0.905). In Multivariate logistic regression analysis, tirofiban was also not associated with early re-occlusion (
p
>0.05). 15 subjects (31.3%) experienced ICH in tirofiban group, compared with 13 (39.4%) in non-tirofiban group (
p
=0.449). For sICH, 2 subjects (4.2%) from the tirofiban group versus 6 (18.2%) subjects from the tirofiban group (
p
=0.089). At 3 months follow-up, compared with subjects treated without tirofiban, more subjects treated with tirofiban achieved independent walking ability (mRS 0-3) (18.2% vs. 2.0%,
P
=0.033). For a long term follow-up with a median time of 16 (2.5-28.0) months, no significant differences were found between two groups (
p
>0.05). In conclusion, adjunct tirofiban in AIS patients treated with ET may not prevent early re-occlusion. But it may improve the functional outcome at 3 months after ET.
Abstract WP182: Perioperative Atrial Fibrillation Increased Risks of Stroke and Mortality: A Meta-Analysis
Authors: Lin Meng-Hsin , Kamel Hooman , Singer Daniel E , Wu Yi-Ling , Lee Meng
Published: October 2018

Background:
Although perioperative atrial fibrillation is believed to be self-limited, several studies have shown an association between perioperative atrial fibrillation and higher risk of perioperative stroke and mortality.

Objectives:
To perform a systematic review and meta-analysis to - 1) comprehensively evaluate the qualitative and quantitative relationships of perioperative atrial fibrillation with subsequent risk of stroke and mortality; 2) assess any differences in outcomes among major subgroups.

Methods:
We searched PudMed and EMBASE for articles published from 1966 to December 2016. We included studies that assessed and reported quantitative estimates of the multivariate adjusted hazard ratio (HR) and 95% confidence interval (CI) for subsequent stroke and mortality associated with perioperative or postoperative atrial fibrillation, or both. We excluded studies that had a cross-sectional or case-control design, that included patients with preexisting atrial fibrillation before surgery, and that did not report 95% CI.

Result:
There were eight articles included in our primary analysis: three articles included both stroke and mortality as endpoints, four articles only assessed mortality, and one article only evaluated stroke. Pooling results using a random-effect model showed an association between perioperative atrial fibrillation and both subsequent stroke risk (HR, 1.6; 95% CI, 1.3-2.0) and mortality risk (HR, 1.3; 95% CI, 1.2-1.3) (Figure). In subgroup analyses, the association between perioperative atrial fibrillation and stroke was stronger in patients who underwent non-cardiac surgery (HR, 2.0; 95% CI, 1.8-2.3) than in those who received cardiac surgery (HR, 1.5; 95% CI, 1.2-1.8).

Conclusions:
New onset perioperative atrial fibrillation is associated with an increased risk of both stroke and mortality. This association is stronger among those undergoing non-cardiac surgery than cardiac surgery.
Abstract WP184: Association Between Heart Failure With Preserved Ejection Fraction and Ischemic Stroke
Authors: Salehi Omran Setareh , Merkler Alexander E , Diaz Ivan , Azary Saeedeh , Goyal Parag , Navi Babak , Kamel Hooman
Published: October 2018

Background:
While stroke risk in heart failure with reduced ejection fraction is well established, it is uncertain whether heart failure with preserved ejection fraction (HFpEF) is associated with an increased risk of ischemic stroke.

Methods:
We performed a retrospective cohort study using inpatient and outpatient data from a nationally representative 5% sample of Medicare beneficiaries ≥66 years of age from 2008-2015. Our exposure of interest was a diagnosis of HFpEF, and our primary outcome was ischemic stroke. Both variables were ascertained using previously validated
ICD-9-CM
diagnosis codes. Patients were censored at the time of ischemic stroke, death, end of Medicare coverage, or September 30, 2015. Survival statistics were used to calculate stroke incidence and Cox proportional hazards analysis was used to compare the association of HFpEF with ischemic stroke after adjustment for demographics, stroke risk factors, and Charlson comorbidities. Since patients with HFpEF face a particularly increased risk of atrial fibrillation, in a secondary analysis, we censored patients at the time of atrial fibrillation diagnosis to attempt to better isolate the association between HFpEF and ischemic stroke.

Results:
Among 1,709,029 Medicare beneficiaries, 58,929 (3.45%) were diagnosed with HFpEF. Compared to patients without HFpEF, patients with HFpEF were older (mean age, 78.9 versus 73.1 years), more often female, and had more stroke risk factors. Over 4.6 (±2.3) years of follow-up, 81,981 (4.8%) patients developed an ischemic stroke. The annual incidence of ischemic stroke in patients with HFpEF was 2.2% (95% CI, 2.1-2.3%) compared to 1.0% (95% CI, 1.0-1.0%) in patients without HFpEF. After adjustment for demographics, stroke risk factors, and Charlson comorbidities, HFpEF was not substantially associated with ischemic stroke (HR, 1.08; 95% CI, 1.04-1.13). Our results were similar when censoring patients at the time of atrial fibrillation diagnosis (HR, 1.06; 95% CI, 1.00-1.12).

Conclusions:
In a nationally representative cohort of Medicare beneficiaries, we found no clinically significant association between HFpEF and risk of ischemic stroke.
Abstract WP190: Gamma-Glutamyl Transferase, Atrial Fibrillation, and Cardioembolic Stroke
Authors: Yang Wookjin , Kim Do Yeon , Jeong Han-Gil , Kang Dong-Wan , Park Eun-Sun , Lee Seung-Hoon
Published: October 2018

Introduction:
Recent studies have consistently reported that gamma-glutamyl transferase (GGT) is correlated with higher risk of stroke independent of stroke risk factors and alcohol intake. However, it remains to be further elucidated why GGT is associated with stroke. To clarify the question, we focused on atrial fibrillation (AF), which has also been noted to have a close relationship with GGT.

Hypothesis:
GGT may be associated with cardioembolic stroke through AF.

Methods:
From a prospective stroke registry of Seoul National University Hospital, acute ischemic stroke patients who had checked GGT within 7 days from the admission were selected for analysis. The binary logistic regression was used to investigate the relationship between GGT, AF, and cardioembolic stroke.

Results:
Among 958 eligible patients, 134 patients (13.99%) had AF and 269 (28.08%) patients were classified as cardioembolism according to the TOAST system. GGT was significantly associated with AF in ischemic stroke patients (Adjusted OR, 2.43; 95% CI, 1.32-4.52). Patients with elevated GGT were more likely to be assigned to cardioembolism compared to other TOAST classifications, after adjustment for all potential confounders except for AF (OR, 2.14; 95% CI, 1.31-3.52). When an additional adjustment for AF was made, the increasing trend in OR according to increasing GGT quartile was lost and the association between GGT and cardioembolism was considerably attenuated, although the relationship remained significant (OR, 1.79; 95% CI, 1.01-3.2).

Conclusions:
GGT showed significant correlation with cardioembolic stroke, potentially owing in large part to its relationship with AF. It may be a possible answer to explain the association between GGT and stroke.
Abstract WP194: Seasonality of Influenza and Stroke- Are the Seasonal Fluctuations Related?
Authors: Canning Michelle , Kulick Erin , Parikh Neal S , Elkind Mitchell S , Boehme Amelia K
Published: October 2018

Background and Purpose:
Influenza has been identified as a trigger for stroke, and prior work demonstrated a decreased risk of stroke in people vaccinated for influenza. We aimed to identify the relationship between seasonal influenza rates, stroke rates, and the year-to-year variability in influenza vaccination effectiveness (VE).

Methods:
Using data from 2004-2015 from the New York Department of Health Statewide Planning and Research Cooperative System (SPARCS), we removed any common temporal patterns using cross correlation functions to assess potential correlations between influenza rates and total stroke (ischemic and hemorrhagic) rates, with a sub-analysis investigating ischemic stroke and hemorrhagic stroke rates separately. Time series regression models (autoregressive integrated moving average: ARIMA) and time series forecasting systems were used to assess the interrelationship of influenza rates, stroke rates, and VE. Validated ICD-9 codes were used to identify emergency department and hospital visits for influenza and stroke, and influenza VE data for each year were available publically from the CDC.

Results:
In the raw data, stroke hospitalizations appeared to increase shortly after increases in influenza. The cross correlation function for all stroke yielded a significant lag of 1 month, suggesting that stroke hospitalizations increased one month after an increase in influenza presentations. Accounting for seasonality and the lag, peaks in influenza rates were significantly related to peaks in stroke hospitalizations (P=0.04). When investigating ischemic and hemorrhagic stroke separately, there appeared to be a similar but non-statistically significant relationship with a 1 month lag of both stroke subtype peaks after influenza peaks (p=0.1195 and p=0.1921, respectively). Time forecasting analysis did not support a relationship between VE and stroke hospitalization rates; however, VE estimates were based on national data presented by the CDC and may differ for New York State specifically, in addition to varying vaccination rates.

Conclusion:
The seasonality of stroke may be attributed to the seasonality in influenza, though influenza vaccine effectiveness was not associated with the seasonality of stroke.
Abstract WP195: Current Status of Reperfusion Therapy and Functional Outcome in Acute Ischemic Stroke Patients With Non-Valvular Atrial Fibrillation: a Single-Center, Six-Year Experience of Consecutive 546 Patients
Authors: Suda Satoshi , Sakamoto Yuki , Aoki Junya , Shimoyama Takashi , Kanamaru Takuya , Suzuki Kentaro , Okubo Seiji , Nishiyama Yasuhiro , Mishina Masahiro , Kimura Kazumi
Published: October 2018

Background:
The concept and tools of oral anticoagulation (OAC) therapy for preventing stroke in patients with non-valvular atrial fibrillation (NVAF) and their use as part of an acute treatment regimen in patients experiencing large-vessel occlusive stroke have grossly changed in the last 10 years. The aim of this study was therefore to evaluate the changes in reperfusion therapy and the clinical outcomes in acute ischemic stroke (AIS) patients with NVAF during a six-year time period.

Methods:
From March 2011 to March 2017, consecutive patients with AIS with NVAF who were admitted to our department were retrospectively analyzed. Patients were divided into three groups according to the year of their initial visit: 2011-2012 (n=136), 2013-2014 (n=206), and 2015-2016 (n=204). Reperfusion therapy including intravenous thrombolysis and endovascular therapy, and functional outcome, were compared between the three time periods.

Results:
The rate of reperfusion therapy increased steadily from 19.9% in 2011-2012 to 42.7% in 2015-2016 (
P
< 0.0001). Parenchymal hematoma (PH) occurrence increased slightly from 5.9% in 2011-2012 to 9.8% in 2015-2016, but there was no significant difference (
P
= 0.4301). Although there was no difference with respect to National Institutes of Health Stroke Scale (NIHSS) score at admission between the 2011-2012 and 2015-2016 groups (8 vs. 7,
P
= 0.3926), and CHA
2
DS
2
-VASc score was significantly higher in 2015-2016 compared with in 2011-2012 (4 vs 3,
P
= 0.0062), and discharge NIHSS score in 2015-2016 was significantly lower compared with that in 2011-2012 (2 vs. 4;
P
= 0.0093). The percentage of modified Rankin Scale 0-1 upon discharge was significantly higher in patients treated with reperfusion therapy than in those who were treated without it, among moderate-severe stroke patients (initial NIHSS ≥ 8) (15.4 vs. 2.8%,
P
= 0.0002). Moreover, hospital mortality rate significantly decreased from 11.0% in 2011-2012 to 3.4% in 2015-2016 (
P
= 0.0167).

Conclusions:
According to the six-year trend, the use of reperfusion therapy increased steadily and this increase appears to be factor in improvement of functional outcome and mortality in patients with AIS with NVAF.