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  • Ovid Technologies (Wolters Kluwer Health)  (5)
  • 1
    Online Resource
    Online Resource
    Evolution of a US County System for Acute Comprehensive Stroke Care
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 5 ( 2018-05), p. 1217-1222
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 5 ( 2018-05), p. 1217-1222
    Abstract: In Orange County, California, patients with suspected acute stroke are taken to stroke neurology receiving centers that are designated by County Emergency Medical Services authorities as either hubs or spokes based on endovascular treatment capability. We examined relationships between stroke details, reperfusion therapies, hospital transfers, and their change over time. Methods— All patients from January 1, 2013, to December 31, 2015, for whom 911 was called within 7 hours of onset in whom Emergency Medical Services personnel suspected acute stroke were evaluated. Results— Among 6132 patients, 3924 (64%) had confirmed diagnosis of stroke (74% ischemic/26% hemorrhagic), yielding diagnostic precision of 64% in the field. Of the 2892 patients with acute ischemic stroke, acute reperfusion therapy was given to 29.2% (21.7% intravenous tPA [tissue-type plasminogen activator] only and 7.5% endovascular treatment). Rates of endovascular treatment of patients with ischemic stroke increased over time, more than doubling from 5.6% in 2013 to 12.5% (odds ratio per 3-month quarter=1.09; 95% confidence interval, 1.04–1.14; P 〈 0.0001). Only 3.4% of patients with acute ischemic stroke were transferred from a spoke to a hub hospital; transfer rates were inversely related to age ( P 〈 0.0001), and reperfusion therapy rates did not vary according to transfer status. Conclusions— Favorable features of this acute stroke care system include reperfusion therapy in 29.2% of patients with ischemic stroke and substantial increases in endovascular treatment rates over time. Continued efforts to optimize acute stroke systems of care can be directed toward improving access to best acute stroke therapies.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.020620
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Abstract P272: The Association Between Sleep Apnea and Left Ventricular Structure and Function: The ECHO-SOL Ancillary Study
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation Vol. 139, No. Suppl_1 ( 2019-03-05)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 139, No. Suppl_1 ( 2019-03-05)
    Abstract: Background: Obstructive sleep apnea (OSA) initiates a range of pathophysiologic mechanisms which may promote cardiac disease, but few studies have examined the association of OSA with global longitudinal strain (GLS) and diastolic function, especially among middle aged and older Hispanics/Latinos in the United States. Methods: We examined cross-sectional data from adults aged 18-64 in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011-2014), a representative subsample of the parent study. OSA was assessed using an ARES Unicorder sleep apnea monitor for one night; the apnea-hypopnea index (AHI) was obtained. Echocardiographic measures evaluated left ventricular (LV) structure (LV mass index [LVMI], left atrial volume index), systolic function (ejection fraction, GLS) and diastolic function (E’ and E/e’ ratio). Potential confounders included age, sex, ethnicity, and body mass index. Multivariable linear regression was used to model the association between AHI and the echocardiographic outcomes. All analyses accounted for the complex survey design. Results: Among 1,506 participants (median age 55.0, interquartile range 49.0, 62.0, 58.3% female) with both sleep and echo data, 17.9% had an AHI ≥15 and 3.2% had an ejection fraction 〈 50%. Each 10-unit higher AHI was associated with 1.4 (95% CI 0.3, 2.5) g/m2 greater LVMI, 0.1 (0.0, 0.3) worse GLS, 0.2 (0.1, 0.3) lower E’, and 0.3 (0.1, 0.5) greater E/E’ ratio. There were no associations between AHI and left atrial volume index or ejection fraction. Conclusion: OSA was associated with poorer LV GLS and diastolic function indices, but associations with structure and ejection fraction were less consistent. Subclinical LV dysfunction may precede the onset of symptomatic disease in this at-risk population. Further studies are needed to determine the longitudinal association of OSA and cardiac remodeling.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.139.suppl_1.P272
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1466401-X
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  • 3
    Online Resource
    Online Resource
    Response by Genuardi et al to Letter Regarding Article, “Association Between Sleep Disordered Breathing and Left Ventricular Function: a Cross-Sectional Analysis of the ECHO-SOL Ancillary Study”
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation: Cardiovascular Imaging Vol. 13, No. 9 ( 2020-09)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 13, No. 9 ( 2020-09)
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.120.011428
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2440475-5
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  • 4
    Online Resource
    Online Resource
    Abstract WP273: Evolution of a U.S. County System for Acute Comprehensive Stroke Care
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Introduction: In an effort to maximize provision of acute stroke therapies, the Emergency Medical Services (EMS) in Orange County, CA (6 th most populous U.S. county) established a system of care whereby patients with suspected acute stroke are taken to hub sites with endovascular treatment (EVT) capability or to spoke hospitals. Patients at spokes with acute ischemic stroke (AIS) and suspected large vessel occlusion (LVO) are transferred by EMS to hubs. Here we examined the relationship between stroke features, hospital transfers, and mortality; and their change over time. Methods: All patients during 2013-2015 were included for whom 911 was called within 7 hours of onset, and EMS personnel declared “acute stroke" at end of initial evaluation. Results: A total of 6,188 patients (mean age 72) had suspected stroke, of which 54.9% were AIS and 19.4% hemorrhagic stroke. Across all patients, transfer rates into hub sites increased over time (OR 1.12 per 3-months, p 〈 0.0001) and differed by diagnosis (p 〈 0.0001), with transfer in 12.0% of hemorrhages (n=122) but only 3.5% of AIS (n=101). Among patients with AIS only, transfer rates into a hub site increased over time (OR 1.08, p 〈 0.0001), spiking mid-2015. Acute reperfusion therapy was given to 28.3% (20.9% IV tPA only, 3.6% IA therapy only, 3.8% IV tPA+IA), but its usage was unrelated to transfer status, and only 11% of all transferred AIS patients received EVT. Across all patients, mortality during acute hospitalization was 8.2% and did not differ by transfer status, but did differ by diagnosis (p 〈 0.0001): 23.6% of hemorrhages vs. 5.4% of AIS. Over time, mortality decreased only among patients with AIS (OR 0.95, p=0.03). Conclusions: There were several favorable features of this acute stroke care system, including that 28.3% of AIS patients received reperfusion therapy and that mortality decreased over time. However, while transfer to EVT-ready sites increased, rates of IA therapy were low. Continued efforts to optimize acute stroke systems of care should be tailored toward increasing EVT by early recognition of LVO and timely triage to hub facilities.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.wp273
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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    Online Resource
  • 5
    Online Resource
    Online Resource
    Association Between Sleep Disordered Breathing and Left Ventricular Function : A Cross-Sectional Analysis of the ECHO-SOL Ancillary Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation: Cardiovascular Imaging Vol. 13, No. 5 ( 2020-05)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 13, No. 5 ( 2020-05)
    Abstract: Prior studies have found that sleep-disordered breathing (SDB) is common among those with left ventricular (LV) dysfunction and heart failure. Few epidemiological studies have examined this association, especially in US Hispanic/Latinos, who may be at elevated risk of SDB and heart failure. Methods: We examined associations between SDB and LV diastolic and systolic function using data from 1506 adults aged 18 to 64 years in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011–2014). Home sleep testing was used to measure the apnea-hypopnea index, a measure of SDB severity. Echocardiography was performed a median of 2.1 years later to quantify LV diastolic function, systolic function, and structure. Multivariable linear regression was used to model the association between apnea-hypopnea index and echocardiographic measures while accounting for the complex survey design, demographics, body mass, and time between sleep and echocardiographic measurements. Results: Each 10-unit increase in apnea-hypopnea index was associated with 0.2 (95% CI, 0.1–0.3) lower E′, 0.3 (0.1–0.5) greater E/E′ ratio, and 1.07-fold (1.03–1.11) higher prevalence of diastolic dysfunction as well as 1.3 (0.3–2.4) g/m 2 greater LV mass index. These associations persisted after adjustment for hypertension and diabetes mellitus. In contrast, no association was identified between SDB severity and subclinical markers of LV systolic function. Conclusions: Greater SDB severity was associated with LV hypertrophy and subclinical markers of LV diastolic dysfunction. These findings suggest SDB in Hispanic/Latino men and women may contribute to the burden of heart failure in this population.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.119.009074
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2440475-5
    Location Call Number Limitation Availability
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