Search

Background: Cerebrovascular disease has significant gaps in translational and outcomes research. We provide the framework for a neuro-informatics pipeline, “Registry for Neurological Endpoints Assessment Among Patients with Ischemic and Hemorrhagic Stroke (REINAH)”, aimed at harnessing ‘big data’ across a 7-hospital certified stroke healthcare system. Methods: An automated extract, transform, load (ETL) process imports all clinical inpatient and outpatient data for patients with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), transient ischemic attack (TIA), subarachnoid hemorrhage (SAH), cerebral amyloid angiopathy (CAA) and matched controls. Following validation, a 2 nd stage ETL merges geocoding data for area deprivation index and generates domain specific dashboards. Neuroimaging and physiological wave form data are imported and analyzed for infarct / hemorrhage characteristics, cerebral small vessel disease burden, and hemodynamic variability. Cross linkages between REINAH and Medicare claims data have been established with > 98% overlap. Functional, cognitive, and quality of life outcomes are collected up till 365-days after discharge. Results: As of August 5, 2022, REINAH hosts data on 18,746 patients, including primary encounters for 1,863 ICH, 13,964 AIS, 1,264 SAH, and 3,307 TIA patients. Median (IQR) age for patients is 69 [58-79] years, including 51.7% Female, 15.6% Hispanic, 64.4% White, 24.6% Black, 5.4% Asian. Median Glasgow Coma Scale scores for AIS and ICH are 15 [14-15] and 13.5 [7-15], respectively. The successful contact rate for outcomes assessment is 70.9%, with 69.8% of responders providing consent for follow up. REINAH layout and demographics are shown in Figure. Conclusions: Mature data pipelines are needed to support validated and rapid evidence synthesis. REINAH provides a highly curated, clinically focused platform for stroke research that may impact patient care and post-stroke outcomes.

Intro: Incidence of intracerebral hemorrhage (ICH) in the young is increasing but risk factors and outcomes are not well characterized. Methods: Using a stroke-specific bioinformatics pipeline across a 7-hospital certified stroke healthcare system, we identified adult non-traumatic ICH cases between 05/16 and 08/22 and flagged young ICH patients (YIP) aged 18 – 45. We compared sociodemographic, comorbidity, clinical, imaging, and treatment characteristics, and outcomes between YIP and non-YIP using logistic regression. Results: Among 1 869 ICH patients, 187 (10%) were YIP. YIP (vs. Non-YIP) were predominantly privately insured (71.1 % vs. 29.8 %), non-Hispanic Black (33.7% vs. 22.2%), Hispanic (26.7% vs. 21.7%), and single (41.2% vs. 20.5%). A higher proportion of YIP were obese and a lower proportion had pre-existing comorbidities (Figure). A lower proportion of YIP were on statins, antiplatelets, or anticoagulants prior to ICH. A significantly smaller proportion of YIP had large hemorrhage volumes (> 30 ml) and experienced lower rates of in-hospital complications such as delirium and SIRS. A significantly greater proportion of YIP underwent craniotomy and had longer lengths of stay. After adjusting for important clinical and sociodemographic correlates of in-hospital mortality, YIP had a 59% lower likelihood of in-hospital mortality or hospice discharge OR (CI): 0.41 (0.20 – 0.82). Additionally, for outcome assessment, YIP were more likely to be contacted [2.9 (1.26, 8.08)], consented [3.7 (1.8, 7.8)], and complete follow-up survey [1.9 (1.0, 3.8)] than non-YIP. Though 50.5% of YIP had a 90-day mRS >3, there was a 51% lower likelihood of severe disability or death in YIP vs. non-YIP. Conclusion: YIP poses a high morbidity burden and understanding long-term functional and cognitive outcomes is important. High follow-up rates provide an opportunity for engaging this often overlooked and underrepresented cohort of critically ill patients in future research.

Background: Systolic blood pressure variability (SBPV) has been associated with poor outcomes among patients with intracerebral hemorrhage (ICH). Intravenous nicardipine (IVN) is frequently used for blood pressure management among hospitalized ICH patients, however SBPV in response to IVN has not been characterized. Methods: Data for primary ICH patients who received IVN were retrieved from a stroke-specific bioinformatics pipeline. SBPV was quantified as the coefficient of variation (CV) of cuff-measured systolic blood pressure, and CV was calculated over the time periods 0-24 hrs prior to (Pre24), 0-24 hrs after (Post24), and 24-48 hrs after (Post48) initial IVN administration. Group differences were assessed using Friedman’s Test and Bonferroni-corrected Wilcoxon Signed-rank tests. Contributions of SBPV at each timepoint to poor in-hospital mortality or discharge to hospice (poor outcome) were assessed in separate multivariable logistic regression models adjusted for patient characteristics. Adjusted Odds ratios (aOR) and 95% confidence intervals (CI) are reported. Results: Data included 370 ICH patients with a median [interquartile range] age of 65 [54 - 76]. Patients included were 46.0% female, 41.1% Non-Hispanic White, 25.1% Non-Hispanic Black, 23.8% Hispanic, 8.1% Asian, and 1.9% other. Patients had a median CV of 9.2 [6.1-13.6] in the Pre24 period, 11.6 [9.46 - 13.9] in Post24, and 9.5 [7.6 - 12.1] in Post48. SPBV showed significant differences across timepoints (p=0.000), with Post24 showing elevated SBPV (vs. Pre24 (p=0.000) or Post48 (p=0.000), Figure 1A, B). In multivariable modelling, patients in the highest quartile of SPBV during the Post24 period showed increased risk of poor outcome: aOR (CI) 2.91 (1.06-8.01), Figure 1C. Conclusions: SBPV increases over the first 24 hours of IVN administration and patients with higher SPBV during this time are at higher risk for in-hospital mortality. SPBV management protocols need to be evaluated.

Intro: To address gaps in intracerebral hemorrhage (ICH) outcomes, acquisition of long-term data is necessary and resource intensive. We present our experience from follow-up of ICH patients across a 7-hospital certified stroke healthcare system. Methods: From 01/21 to 07/22, follow-up calls were made to adult non-traumatic ICH patients at 30, 90, 180, and 365-day timepoints (TP) post discharge. Consent was obtained at first successful contact, followed by collection of functional, cognitive, and quality of life outcomes. Trained research staff made multiple attempts (calls per patient) to complete assessment at each TP. An attempt was deemed successful if contact was made with a patient/proxy. We report overall and TP-specific rates of successful contact, consent, and completion using logistic regression. We also report the association of individual call success with attempt number and day of week. Results: Overall, 2,214 call attempts were made for 375 patients, of whom 246 (70.7%) were successfully contacted at least once. Of contacted, 173 (70.3%) consented, and 147 consented patients (85.0%) completed all assessments at one or more TPs (Fig A). Proportion of successful contact at 365-day (60.7%) was significantly higher compared to other TPs (Fig B). Consent rate was non-significantly higher for 30 and 90-day TPs (74.4%) compared to 180 and 365-day (68.1%). Conversely, patients were significantly less likely to complete assessments at the first three TPs compared to 365-day. For individual call attempts, first attempts were 1.5-2.4 times more likely to be successful than subsequent attempts, and calls made on Thursdays were 42-52% more likely to be successful. Conclusion: We demonstrate the need to consent patients early in their recovery when they are likely most motivated. As completion rates were lower at early vs. late TPs, we recommend curtailing laborious assessments at early TPs to decrease patient burden and continuing longitudinal follow-up.

Background: The evidence of association between Intracerebral Hemorrhage (ICH) outcomes and hypercholesterolemia (HC) is equivocal. We provide nationwide estimates of ICH in-hospital mortality (IHM) among patients with HC, across race/ethnicity subgroups. Methods: In a pooled cross-sectional analysis of adult (≥ 18 years) primary ICH patients in the National Inpatient Sample (2004 - 2018), we used ICD 9 / 10 codes to identify patients with HC. We fit survey design multivariable logistic regression models to provide nationwide estimates of the association between IHM and HC as adjusted odds ratio (aOR) and 95% confidence interval (CI). Results: Among a total of 803,230 ICH hospitalizations, we identified 56,635 HC ICH patients. HC patients, compared to patients with no hypercholesterolemia (NHC), were older (72.3 vs. 68.7 years), had higher proportional (%) burden of diabetes (35.8 vs. 26.4), hypertension (90.0 vs. 80.9), obesity (9.2 vs. 8.0), atrial fibrillation (22.1 vs. 19.3) and past / current use of anticoagulation (11.9 vs. 9.8). However, HC patients (vs. NHC) were less likely to have extreme loss of function (21.4 vs. 28.7) or receive invasive treatment, including extra-ventricular drain (5.2 vs. 7.6), invasive ventilation (5.7 vs. 7.9), tracheostomy (2.4 vs. 4.2) and gastric tube placement (6.0 vs. 8.5). Overall, and non-Hispanic whites (NHW), non-Hispanic black and Hispanic, HC patients (vs. NHC) had lower IHM (aOR, CI for overall effect: 0.85, 0.81 - 0.90) (Figure 1). The HC - IHM association was significantly modified by age among NHW, whereby the likelihood of IHM among HC (vs. NHC) significantly increased with advancing age (aOR, CI: 1.01, 1.00 - 1.02) (Figure 2). Conclusion: HC is associated with lower ICH severity and IHM, albeit with significant race/ethnic variations. Further evaluation of potential role of genetic, environmental and treatment factors, across race/ethnicity sub-groups, in the relationship between HC and ICH outcomes is warranted.

Background: We evaluated the frequency and outcomes of Coronavirus Disease 2019 (COVID-19) associated stroke (ischemic and hemorrhagic) and myocardial infarction (MI) in a global research network. Methods: All adult (≥ 18 years) patients with ICD-10 diagnoses of COVID-19 were included and those with a stroke (ischemic stroke, intracerebral hemorrhage [ICH], transient ischemic attach [TIA] or subarachnoid hemorrhage [SAH]) or myocardial infarction (MI) ± 28 days from COVID-19 diagnosis were flagged. Individuals with a prior history of stroke / MI were excluded. COVID-19 associated stroke (CAS) and MI (CAM) frequencies were compared to prior AHA-reported population-based incidences. Severe COVID-19 disease (use of ventilator, intubation, or life support) and 90-day mortality were evaluated among no-stroke/MI and stroke/MI subgroups utilizing general linear models adjusted for age, sex, race/ethnicity, and Charlson Comorbidity Index scores. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. Results: Between Jan 2020 and Jul 2021, we identified 637,820 COVID-19 patients of whom 4,559 (0.71%) had a CAS and 6,972 (1.09%) had a CAM. COVID-19 was associated with significantly higher stroke/MI rates compared to population based reported incidence (ORs, CI for CAS 1.99, 1.93 - 2.05 and CAM 3.09, 3.01 - 3.16). Severe COVID disease was observed among 1.07% of COVID-19 only patients, 11.25% of CAS patients (aOR, CI: 4.82, 4.35 - 5.34), and 14.81% of CAM patients (aOR, CI: 5.77, 5.34 - 5.22). 90-Day mortality was 1.92% for COVID-19 only patients, 14.35% for CAS patients (aOR, CI: 3.16, 2.87 - 3.46), and 20.52% for CAM patients (aOR, CI: 4.12, 3.85 - 4.41). Group specific demographic and outcome proportions are reported (Figure). Conclusion: The COVID-19 pandemic has tremendously exacerbated the burden of cerebrovascular and cardiovascular disease globally. Continued work is needed to understand drivers of poor outcomes among COVID-19 patients.

Introduction: There is limited data on real-world efficacy of left atrial appendage closure (LAAC) procedures compared to anticoagulants (AC) for stroke prevention among patients with atrial fibrillation (AF). Methods: We utilized a retrospective cohort of over 63 million patients from 51 healthcare organizations across 6 countries via a harmonized electronic medical record-based research data platform. Utilizing international classification of disease version 10 and current procedural terminology codes, adult (≥ 18 years) patients with AF (I48) were identified and grouped by treatment type (LAAC (33340, 02L73DK) vs AC (1015112, Z79.0, BL110)). Patients with a history of stroke prior to AC initiation or LAAC procedure were excluded. Subjects were followed for 5 years for incident ischemic stroke (I63), intracerebral hemorrhage (I61), and all-cause mortality. Treatment groups were propensity score matched by age, sex, race, ethnicity, and comorbidities. Risk ratio(RR) and 95% confidence intervals(CI) among unmatched and matched populations are reported. Results: Among a total of 1,980,130 AF patients; 1,374,013 were flagged for AC use and 8,004 were treated via LAAC. Treatment cohorts were propensity score matched by age, race, sex, hyperlipidemia, and hypertension resulting in an exact 1:1 matched cohort of 8,004 subjects, across all co-variates. In the matched population the mean (SD) age was 75.2 (8.05) years, 63.2% were male; 86.6% were white, 4.4% black, 0.89% Asian, and 3.5% Hispanic; with 64.4% hyperlipidemic and 79.2% hypertensive. Prior to matching, AC (vs. LAAC) was significantly associated with a higher 5-year risk of ischemic stroke, intracerebral hemorrhage, and all-cause mortality. The protective effect of LAAC (vs. AC) was maintained for 5-year risk of ischemic stroke (RR, CI: 0.68, 0.58 - 0.79) and all-cause mortality (RR, CI: 0.42, 0.39 - 0.45). However, the difference in 5-year risk for intracerebral hemorrhage for LAAC (vs. AC) was not statistically lower (RR, CI: 0.72, 0.50 - 1.05). Conclusion: Notwithstanding the possibility of residual confounding in our analyses, LAAC seems to be associated with a lower long-term risk of ischemic stroke and all-cause mortality as compared to AC treated AF patients in large real-world data.

Introduction: Intraventricular thrombolysis (IVT) for hematoma evacuation among eligible intracerebral hemorrhage (ICH) patients is a promising modality to improve outcomes. Methods: We analyzed deidentified pooled data from a network of 40 healthcare organizations (Aug 2010 - Jul 2020). Using ICD-10 diagnosis / procedure, current procedural terminology codes, and medications; we identified index ICH events for extra ventricular drain (EVD) placement with or without IVT. Non adult (< 18 years) patients with thrombolysis use or conditions requiring thrombolysis (cerebral / myocardial infarction, pulmonary embolism, hemodialysis) within 3-days prior to the index event were excluded. IVT and non-IVT patients were propensity score (PS) matched for demographic, comorbidity and clinical variables. Match adequacy was assessed by standardized mean difference (SMD). Risk Ratios (RR), 95% Confidence Intervals (CI) were calculated for mortality at 7,30, and 90-days. Kaplan-Meier (KM) analysis with log rank test (LRT) was performed. Results: Among 109,754 patients with an index ICH event 76,608 met the inclusion criteria. Of whom, 7,539 (9.8%) were coded for EVD presence, and 1,688 (22.4%) received IVT. Significant differences in demographic and clinical parameters were observed between IVT and non-IVT groups (graphic). At 90-days 28.4% of non-IVT and 23.2% of IVT ICH patients had died. PS algorithm yielded a 1:1 optimally matched sample (94% SMD reduction) of 1,163 IVT and non-IVT ICH patients each, without significant differences across any co-variates. In the matched sample, the mortality risk was significantly lower for the IVT group at all three timepoints. RR (CI) for 7-day: 0.62(0.50 - 0.77), for 30-day: 0.76(0.65 - 0.88), and for 90-day 0.85(0.74 - 0.97). LRT p < 0.001 for all timepoints, KM curve for 30-day outcome shown in the graphic. Conclusion: Real world utilization of IVT for eligible ICH patients demonstrates significant reduction in early mortality.

Introduction: Neurotropism of the SARS-CoV-2 has been reported. We evaluated the risk of poor outcomes associated with preexisting neurological disease (PEND) among COVID-19 patients. Methods: We analyzed data from COVID-19 Outcomes Registry (CURATOR) at Houston Methodist. All adult (≥ 18 years) patients tested for SARS-CoV-2 RNA in nasopharyngeal specimens were included. Utilizing ICD-10 diagnoses codes, we classified PEND patients as those with documented history of ischemic or hemorrhagic stroke, transient ischemic attack, mild cognitive impairment, Alzheimer’s disease and related dementias including vascular dementia, primary and metastatic brain tumors, epilepsy, motor neuron disease, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s disease, spinal cord injury, and traumatic brain injury. Logistic regression models were fitted to assess the odds of COVID-19 mortality associated with PEND. Odds ratios (OR) and 95% Confidence Intervals (CI) are reported. Results: Between March 3 and August 10, 2020, 86,614 individuals were tested for SARS-CoV-2, of whom 14,233 (16.4%) tested positive, with 4,473 (31.4%) hospitalizations, and 431 (9.6%) deaths. Overall 11,473 (13.2%) individuals had PEND, of whom 1,458 (12.7%) tested positive, 966 (66.3%) were hospitalized and 165 (17.1%) died. Among positive cases, PEND (vs. non-PEND) patients were older (67.1 vs. 46.4 years) and had a higher overall comorbidity burden (median Charlson Comorbidity Index: 6 vs. 1). The proportion of PEND patients was significantly higher among COVID-19 patients who died (vs. those who were discharged alive) (38.3% vs. 19.8%, crude OR, CI: 2.51, 2.03 - 3.09). In the fully adjusted model for socio-demographic, comorbidity and clinical factors, PEND was independently associated with higher risk of COVID-19 mortality OR (CI): 1.42 (1.04, 1.95) (graphic). Conclusions: Biological mechanisms of higher COVID-19 mortality among patients with PEND need to be evaluated.

Introduction: Overall poor COVID-19 outcomes have been reported among males. We evaluated sex differences in mortality among patients with stroke related to COVID-19. Methods: Utilizing pooled deidentified data from 30 healthcare organizations, we identified COVID-19 patients via ICD-10 diagnosis or documented laboratory confirmation of SARS-CoV-2 RNA or antibodies. Patients with ICD-10 diagnoses of ischemic stroke or intracerebral hemorrhage within 30 days before or after the COVID-19 event were flagged. Male and female patients were propensity score (PS) matched on other demographic and comorbidity variables. Risk Ratio (RR) and 95% Confidence Interval (CI) for association between sex and 90-day mortality is reported. Kaplan-Meier analyses with log rank test (LRT) were conducted for time-to-death. As a sensitivity analysis, we only included a smaller sub-set with first instance of IS or ICH ± 30-days of COVID-19 diagnosis. Results: Among 149,410 COVID-19 patients, 1,618 (1.1%) had a stroke diagnosis ± 30-days of confirmed COVID-19. Of whom, 1,609 patients (847 males and 762 females) were included in primary analyses. Females were older (67.7 vs. 65.7 years) and were more likely to be of black race (34.1% vs. 27.6%). Females had a significantly higher proportion of chronic pulmonary disease (38.8% vs. 28.8%) and obesity (34.2% vs. 24.8%); whereas males had higher proportion of alcohol abuse (8.5% vs. 3.8%). A 1:1 PS algorithm yielded an optimally matched sample of 634 males and females each, balanced on all covariates. In the matched sample, 11.7% of females and 15.8% of males experienced 90-day mortality; RR (CI): 1.35 (1.02 - 1.78), LRT p value 0.04. Higher risk of 90-day mortality among males with COVID-19 and stroke was maintained in the sensitivity analyses, RR (CI): 1.47 (1.06 - 2.00), LRT p value = 0.03 (graphic). Conclusion: Future studies examining the socio-demographic and biological mechanisms for poor stroke outcomes among males with COVID-19 are needed.

Introduction: We evaluated the burden of SARS-CoV-2 susceptibility and COVID-19 mortality associated with Mild Cognitive Impairment (MCI) or Dementia (MCID). Methods: We analyzed data from COVID-19 Outcomes Registry (CURATOR) at Houston Methodist; a tertiary healthcare system in greater Houston. All adult (≥ 18 years) patients tested for SARS-CoV-2 RNA in nasopharyngeal swabs were included. Utilizing validated ICD-10 codes (MCI, Alzheimer’s Disease, Vascular and Other Dementias) and use of MCID specific medications, we flagged patients with preexisting MCID. Logistic regression models were fitted to evaluate the odds of SARS-CoV-2 susceptibility and COVID-19 mortality associated with preexisting MCID. Odds ratios (OR) and 95% Confidence Intervals (CI) are reported. Results: Between March 3 and August 10, 2020; 86,614 individuals were tested, of whom 14,233 (16.4%) tested positive, with 4,473 (31.4%) hospitalizations, and 431 (9.6%) deaths. Overall 3,069 individuals had preexisting MCID; among whom 518 (16.9%) tested positive. Among all SARS-CoV-2 positive cases, MCID patients (vs. non MCID group) were older (79.9 vs. 47.3 years) and had higher overall comorbidity burden (median Charlson Comorbidity Index: 6 vs. 0), with higher proportion (%) of hypertension (90.3 vs. 39.0), heart failure (37.8 vs. 7.5), diabetes (69.3 vs. 28.2), and cancer (14.5 vs. 4.8). Mortality among MCID patients (vs. non MCID) was 22.3% vs. 8.6%. In fully adjusted models (demographics, comorbidities, clinical / laboratory parameters, complications, treatment and ICU admission), pre-existing MCID was independently associated with higher SARS-CoV-2 susceptibility, OR (CI) 1.62 (1.46-1.80) and in-hospital mortality OR (CI): 1.79 (1.23-2.61) among COVID-19 patients (graphic). Conclusions: Regardless of age, MCID is a potential risk factor for SARS-CoV-2 infection and COVID-19 mortality. Targeted prevention and management strategies are warranted for this high-risk group.

Introduction: Despite emerging evidence, trajectories of cognitive impairment (CI) among patients with spontaneous intracerebral hemorrhage (ICH) are not well characterized. Methods: We conducted a systematic review of literature within PubMed, using keywords [“Intracerebral hemorrhage” OR “ICH”] AND “Cognitive Impairment,” after 2010. Articles reporting assessments of post ICH CI were included. Articles limited to pre-clinical (animal) studies, non-English literature, other intracranial hemorrhages, traumatic ICH, narrative reviews, and patient under 18 years were excluded. Results: Based on selection criteria, we included 16 articles (graphic) that provide an assessment of post-ICH CI. Post-ICH CI had a reported incidence of up to 85% within the first 2 weeks. The proportion of ICH patients who experience an incident CI across a longer follow up time period have been reported with a high degree of variability; with reports at 3 (32.5 - 71%), 4 (78%), 6 (37 - 63.3%), 9 (47.1 - 100%), 18 (51%), 30 (25.8%), 40 (23%), 45.6 (52 - 64%) and 60 (37.4%) months. Though the assessment scales utilized are variable; 12 (75%) reports employed a version of Montreal Cognitive Assessment or Information Questionnaire on Cognitive Decline in the Elderly. Lobar ICH was well identified, while non-lobar ICHs were variably grouped. Imaging markers have been reported in 10 (62.5%) reports. Though most studies report comorbidities and sociodemographic factors; stroke-specific severity / functional scales and genetic factors have only been considered by 2 (12.5%) articles each. Conclusions: At least 1 in 3 ICH survivors experience post-ICH CI over 12 months. There is an overall paucity of data on post-ICH CI, which highlights a critical need to characterize the natural history of post ICH CI in prospective cohorts and develop standardized assessment protocols for CI among ICH patients.

Introduction: Location specific Intracerebral Hemorrhage (ICH) characteristics and outcomes are important for risk stratification and clinical trial design. However, they have not been described at the population level. Methods: We analyzed the National Inpatient Sample (90% of US hospitalizations) from 09/2015 to 12/2017 and utilized ICD-10 codes to identify ICH patients with a primary diagnosis of either supra-tentorial (ST) or infra-tentorial (IT) hemorrhage; excluding intraventricular or unspecified location. Utilizing sampling weights, nationally representative proportions of ST and IT ICH patients across demographic, comorbidity, healthcare utilization, disease acuity and outcomes are provided. We fit survey design logistic regression models for in-hospital mortality (IHM) and home discharge (HD). Odds Ratios (OR) and 95% confidence Intervals (CI) are reported. Results: Across the analysis time period, a total of 161,395 ICH patients were identified, of whom 51,025 (31.6%) and 20,135(12.5%) had ST and IT ICH respectively. IT ICH patients (vs. ST ICH) were younger (66.9 vs. 67.9 years), with higher proportions of Black (19.1% vs. 17.6%) and un-insured (5.9% vs. 4.7%). A significantly greater proportion of IT ICH patients had prior myocardial infarction, congestive heart failure, atrial fibrillation, renal disease and hypertension. Whereas the prior cerebrovascular disease, dementia, depression and alcohol abuse was associated with ST ICH. Smaller proportion of IT ICH patients (vs. ST ICH) were treated in urban teaching hospitals (81.4% vs. 83.2%). A greater proportion of IT ICH underwent invasive mechanical ventilation (58.1% vs. 46.7%), ventriculostomy (18.2% vs. 10.2%), and tracheostomy (6.4% vs. 4.6%). The total charges and charges per day were significantly higher for IT ICH patients. The overall IHM was 22.6%. A greater proportion of IT ICH patients (vs. ST ICH) experienced IHM (28.2% vs. 17.3%) and smaller proportion had HD (16.7% vs. 20.7%). In the fully adjusted models, IT ICH was associated with a significantly higher IHM (OR, CI: 1.47, 1.26 - 1.71) and lower likelihood of HD (OR, CI: 0.56, 0.46 - 0.68). Conclusion: ST and IT ICH patients have distinctive risk factor and demographic profiles. IT ICH is associated with poor outcomes.

Introduction: The contribution of preexisting mild cognitive impairment (MCI) or dementia (MCID) towards long term mortality in Ischemic Stroke (IS) patients is under studied. Methods: We conducted a propensity score (PS) matched analysis of pooled data from 39 healthcare organizations to evaluate the association between MCID and post stroke mortality (PSM) through a 5-year period. Using ICD-10 codes for MCI, Alzheimer disease, vascular/other dementias, and MCID specific medications; we flagged preexisting MCID diagnoses up till 1 month prior to the index IS event (MCID group). The non-MCID group had no documented MCID diagnoses till after 1 month of the index event. Groups were PS matched on demographic (age, sex, race, ethnicity) and comorbidity variables. Risk Ratios (RR) and 95% confidence intervals (CI) were calculated. Results: Among 544,700 IS patients, 124,892 (22.9%) had preexisting MCID. MCID patients (vs. non-MCID) were older (mean age: 67.8 vs. 64.8 years), had higher proportion (%) of females (52.8 vs. 49.4) and Blacks (21.1 vs. 17.1). A higher proportion (%) of MCID patients had hypertension (77.3 vs. 36.0), diabetes (36.9 vs. 17.4), ischemic heart disease (31.6 vs 13.5), chronic kidney disease (21.4 vs. 7.8) and liver disease (9.5 vs. 3.1). Optimal co-variate balance was achieved post PS match (figure). In the unmatched sample, 8.6% of MCID and 6.0% of non-MCID patients experienced PSM by the 1-year time point; representing 56.2% and 64.2% of the total 5-year PSM, respectively. Matched and unmatched RR (CI) for PSM at 3 month and 1,3,5-year are reported (figure). An increasing risk of PSM was observed across the four time-points which was significantly higher for years 1,3, and 5 in the matched sample. Conclusion: A 24% long term increased risk of PSM was observed in a large national sample of IS patients with preexisting MCID. Majority of PSM burden is experienced by 1 year. MCID screening and exploring mechanisms of MCID-linked PSM is critical among IS patients.

Introduction: COVID-19 is associated with incident cerebrovascular disease (CVD). We evaluated the association between preexisting CVD and COVID-19 mortality. Methods: Utilizing deidentified pooled data from 40 healthcare organizations, adult (≥ 18 years) COVID-19 patients were identified based on ICD-10 diagnostic codes and documentation of laboratory positivity for SARS-CoV-2 RNA or antibodies. Among COVID-19 patients, those with documented ICD-10 diagnoses for cerebral infarction / ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and transient ischemic attack (TIA) at least 30-days before the index COVID-19 event were classified as the CVD group. The CVD and non-CVD groups were propensity score (PS) matched on demographic and comorbidity variables. Pre and post-match risk ratios (RR) and 95% confidence intervals (CI) for 30 and 90-day mortality were calculated. Mortality rates for CVD subgroups (ICH, SAH, AIS, TIA) are also reported. Results: Among a total of 140,034 COVID-19 cases, 4,614 (3.3%) had prevalent CVD. CVD patients were significantly older and were predominantly males of either white or black race (vs. other). CVD patients also had a higher comorbidity burden (vs. non-CVD patients) (graphic). A 1:1 PS algorithm yielded an optimally matched sample of 8,218 COVID-19 patients (4,109 CVD and non-CVD patients each). In the matched sample, 30-day mortality was 8.4% among CVD patients and 7.0% among non-CVD patients RR (CI): 1.20 (1.03 - 1.39). 90-day mortality among CVD patients (vs. Non-CVD patients) remained significantly elevated (9.7% vs. 8.2%), RR (CI): 1.20 (1.04 - 1.37). Among CVD subgroups, 30 and 90-day mortality was higher for patients with preexisting ICH (11.8% and 13.7%, respectively) compared to IS (8.7% and 10.2%, respectively). Conclusion: Preexisting CVD significantly increases the mortality risk in COVID-19 patients. Mechanisms for poor COVID-19 outcomes among CVD patients need to be evaluated.