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Stroke, Volume 56, Issue Suppl_1, Page ATP127-ATP127, February 1, 2025. Introduction:Stroke is the leading cause of long-term disability and fifth leading cause of death in the United States. Social isolation (SI) and loneliness are known risk factors for stroke and may be linked to worse functional outcomes. Previous animal studies have demonstrated enhanced outcomes associated with socialization. The impact of SI following stroke may be clinically relevant for therapeutic intervention.Hypothesis:Stroke patients experiencing social isolation will exhibit worse outcomes compared to those with social support networks.Aim:This retrospective analysis aims to compare stroke outcomes during the COVID-19 visitation restrictions with outcomes during the preceding years when visitation was permitted.Methods:Data were collected from the Patient Cohort Explorer, a de-identified database within our institution’s Research Data Warehouse. Patients were divided into two groups based on date: the isolation group and the control group. The control group included patients admitted from December 1, 2018, to January 1, 2019, during normal visitation policies, while the isolation group comprised patients admitted from December 1, 2020, to January 1, 2021, during visitation restrictions. Two-proportion Z-tests were conducted to analyze differences in demographic data, and two-sample T-tests were used to assess outcomes, including length of stay and discharge disposition.Results:A total of 725 unique patients met the inclusion criteria, with demographic characteristics such as sex and race well-matched between the isolated and control groups, except for a notable age difference (p-value .011). Significant differences in mortality rates were observed, with the control group showing a higher likelihood of returning home (p-value < .001) and the isolation group having a greater proportion of deaths (p-value .003). Additionally, there was a statistically significant difference in hospital stay length, with the control group able to discharge earlier (p-value .001).Conclusion:Social isolation can result in longer hospital stays, poorer outcomes, and increased mortality for patients with acute infarcts. Since the data was gathered during the COVID-19 pandemic, it's challenging to eliminate the virus as a confounding factor in these outcomes. However, the findings suggest that patients lacking social support may face worse functional recovery and different recovery trajectories compared to those with support.

Stroke, Volume 56, Issue Suppl_1, Page ATP128-ATP128, February 1, 2025. Background:Postoperative complication rates of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid artery stenosis are recommended to be maintained below a certain threshold. While the association between hospital volume and the complications has been reported, the situation is uncertain in Japan, one of the countries with the highest density of neuro-specialists. This study aimed to investigate the association between hospital volume and outcomes in patients who underwent CEA or CAS in Japan.Methods:We retrospectively analyzed data from the Japanese nationwide inpatient database on CEA and CAS procedures performed between 2018 and 2021. Hospitals were categorized into four quartiles based on surgical volume, ranging from highest (Q1) to lowest (Q4), with approximately equal numbers of procedures in each quartile. The association between hospital volume and moderate to severe disability (modified Rankin scale > 2 at discharge), in-hospital mortality, perioperative stroke, perioperative pneumonia, and length of hospital stay (LHS) was investigated using multivariate logistic regression and other appropriate analyses.Results:The analysis included 26,675 CEA or CAS procedures performed in 681 hospitals. The overall rates of disability, mortality, perioperative stroke, and pneumonia were 7.4%, 0.5%, 6.6%, and 5.0%, respectively. The rates of disability in Q1, Q2, Q3, and Q4 quartiles were 6.0%, 7.5%, 8.5%, and 7.4%, respectively (Table 1). After adjusting for covariates, Q3 and Q4 were associated with a higher risk of disability (Q3: odds ratio [OR] 1.41, 95% confidence interval [CI] 1.22 – 1.64, Q4: OR 1.41, 95% CI 1.00 – 1.37). Furthermore, Q2, Q3, and Q4 quartiles were associated with a higher risk of perioperative stroke (Q2: OR 1.46, 95% CI 1.26 – 1.70, Q3: OR 1.45, 95% CI 1.25 – 1.69, Q4: OR 2.04, 95% CI 1.77 – 2.36) and pneumonia (Q2: OR 2.01, 95% CI 1.68 – 2.39, Q3: OR 1.89, 95% CI 1.59 – 2.26, Q4: OR 1.79, 95% CI 1.50 – 2.14). The mortality rate was comparable among the four quartiles (Table 2). Additionally, Q2, Q3, and Q4 quartiles were associated with longer LHS. Similar results were observed in patients aged 80 and above.Conclusions:Our findings suggest an association between lower hospital volume and poorer patient outcomes following CEA or CAS. This study indicates the importance of considering surgical volume as a factor to improve outcomes of CEA and CAS in Japan.

Stroke, Volume 56, Issue Suppl_1, Page ATP334-ATP334, February 1, 2025. Introduction:Studies have reported racial disparities in acute stroke treatment and follow-up care in young patients which lead to less desirable outcomes for minorities. This study aimed to identify potentially modifiable factors for better stroke treatment and prevention in minority populations.Methods:Young patients aged 18-50 years who were admitted with ischemic stroke during 09/2016-12/2022 were retrospectively identified and stratified as non-Hispanic White (WH), non-Hispanic Black (BL), and Hispanic (HS). Racial differences in risk factors, stroke etiology, acute intervention, and follow-ups were examined using Chi-square and Kruskal-Wallis tests as appropriate. Cumulative probabilities of stroke recurrence were estimated using the Kaplan-Meier (KM) method and tested with the Log-rank (Mantel-Cox) test. A logistic regression was used to evaluate the odds ratio of favorable functional outcomes (mRS ≤2) by 90 days. A backward stepwise Cox regression was conducted to identify predictors of stroke recurrence reported as hazard ratio (HR) and a 95% confidence interval (CI).Results:A total of 318 patients were identified with a median age of 43 and 57.5% male, covering 57.2% WH, 22.3% BL, and 20.4% HS. Compared to WH, more BL and HS were comorbid with diabetes, hypertension, and prior stroke (p

Stroke, Volume 56, Issue Suppl_1, Page AWP97-AWP97, February 1, 2025. Introduction:Prior attempts to assess risk of symptomatic intracranial hemorrhage (sICH) after endovascular thrombectomy have been limited by reliance on information obtained after thrombectomy (such as TICI reperfusion) and lack of generalizability to routine clinical practice.Methods:Patients presenting to GWTG-Stroke participating hospitals between July 2021 and June 2023 with last known well within six hours prior to presentation, who received endovascular thrombectomy were included. The primary outcome was sICH; secondary outcomes included in-hospital mortality, mRS at discharge, and length of stay. The study population was divided into a derivation and validation cohort with 70:30 partition. According to a pre-specified statistical analysis plan, a full model of 31 candidate variables and subsequently a highly parsimonious model including only variables measured before EVT deployment was fit for each endpoint, with variable retention guided by multiple factor analysis (MFA). Models were then externally validated in the HERMES clinical trial population.Results:31,668 patients (median age 71 [Q1: 61, Q3: 81]) were included, of whom 1,799 (5.7%) developed sICH. In the validation cohort, the area under the receiver operating characteristics curve (AUC) for the full model was 0.649 (Table 1), and the AUC for the simplified points score was 0.589 (Table 2). At the conference, we will present results of external validation and secondary endpoints, details of model calibration, and direct comparisons to existing risk scores.Conclusions:A risk score for sICH after thrombectomy for acute stroke devised using routinely collected data known prior to intervention had good performance compared to existing approaches.

Stroke, Volume 56, Issue Suppl_1, Page ATP158-ATP158, February 1, 2025. Background:Research suggests that the absolute number of strokes among people with diabetes is increasing as the population with diabetes grows. Stroke patients with poorly controlled diabetes are more likely to experience poor functional recovery, longer recovery times, recurrent stroke, and higher risk of death. In response to a finding from the 2021 Joint Commission survey for not addressing an HbA1c=9.3, we launched a quality improvement project to enhance diabetic management among patients admitted for ischemic stroke.Methods:This interdisciplinary collaboration involved endocrinology, hospital medicine, and neurology. For patients admitted to our Thrombectomy-Capable Stroke Center for ischemic stroke with an HbA1c ≥ 9.0% or blood glucose glucoses≥250mg/dl, a mandatory inpatient endocrine consult would be provided, in addition to diabetic educator consult. The patient’s HbA1c levels were followed every 3 months for a year.Results:A total of 66 patients were admitted in 2022 (n=32) and 2023 (n= 34) for ischemic stroke with HbA1c ≥ 9.0%. The median HbA1C for 2022 cohort dropped from 11.2% (range 9.0% – 16.6%) to 8.5% (range 5.0% – 14.1%) in a year (p

Stroke, Volume 56, Issue Suppl_1, Page A23-A23, February 1, 2025. Background:Functional impairments following stroke remain a significant therapeutic challenge. Vivistim, FDA-approved since 2021, has shown consistent results, providing 2-3 more improvement in arm and hand function compared to intensive rehabilitation alone. At Atlantic Health System, 25 patients underwent Vivistim implantation and received Paired VNS rehabilitation.Methods:A multidisciplinary team at AHS identified, educated, and implanted Vivistim in 25 post-acute stroke patients with moderate-to-severe motor impairments in the arm and hand. Post-implantation, patients were referred to one of 11 sites. Regular follow-ups were conducted by the implanting team to monitor side effects, safety and efficacy of this novel intervention.Results:All 25 patients successfully underwent outpatient implantation, with no reported infections at the implant sites. One patient developed a hematoma that resolved without intervention. Another required device explantation approximately 410 days post-therapy due to tingling sensations near the implant site likely unrelated to the device. This patient maintained a 25-point improvement on the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) despite explantation, indicating sustained benefits. Of the 25, 22 completed the therapy protocol. The remaining three discontinued therapy due to unrelated complications: one experienced two grand mal seizures linked to changes in seizure medication, another sustained an arm injury from a fall, and the third developed double vision, impairing her ability to drive. Patient ages ranged from 40 to 80 years (mean 62.6), with time to implantation post-stroke ranging from 1 to 11 years (mean 3.6). The interval from implantation to therapy initiation varied from 8 to 32 days (mean 15.3). The baseline FMA-UE score averaged 33 (range 19-56), with an average post-therapy score of 43 (range 24-63), for a mean improvement of 9.53 points. Notably, the patient with the longest follow-up (22 months) showed continued progress, reducing her 9-Hole Peg Test time by 61.42 seconds over her assessment 6 months prior.Conclusion:This case series represents the largest cohort reported to date from a single implanting site in a real-world setting. Vivistim was implanted safely, with no infections or surgical complications. Patients showed positive responses to Paired VNS despite an average of 3.6 years post-stroke, supporting the efficacy of this innovative treatment in the chronic stroke population.

Stroke, Volume 56, Issue Suppl_1, Page ATMP66-ATMP66, February 1, 2025. Introduction:The 2022 AHA/ASA Guidelines for Nontraumatic ICH recommend initiating blood pressure (BP) reduction within 2 hours of onset and achieving a target systolic BP of 130-150 mmHg within one hour of initiating a BP medication. This study evaluates the effectiveness of implementing ICH-specific time intervals, modeled after TARGET: STROKE, coupled with provider education to improve the timeliness of BP reduction in ICH patients.Methods:Data were retrospectively collected at a CSC from 01/1/2021 to 12/31/2022 (pre-intervention) and from 1/1/2023 to 5/31/2024 (post-intervention). Emergency Department (ED) code stroke patients with an ICH were included. ED providers were given education on which BP intervals would be measured, and how to improve the timeliness of BP reduction. Baseline demographics, NIHSS, ICH volume, ICH score, 90-day mRS and door-to-BP reduction-related time metrics were collected. The data were analyzed using Kruskal-Wallis and Chi-square tests.Results:91 code stroke patients presented to the ED with ICH. 32 pre- and 59 post-intervention. There were no differences between mean age, gender, race/ethnicity, NIHSS, ICH score or time from last known well to ED arrival between groups. Both groups had similar median ICH volumes; post- 18.4ml (IQR 5.2-44.7) vs. pre-intervention: 19.7ml (IQR 5.3-44.3) vs. (p=1.0). Door to first BP medication ordered was reduced to 13 (IQR 10.0-21.0) minutes post vs. 19 (IQR 14.5-25.5) minutes pre-intervention (p=0.007). Door to first BP medication administered was reduced to 21.0 (IQR 14.0-34.0) minutes post vs 29.5 (IQR 18.5-47.5) minutes pre-intervention (p=0.03). Time from first BP medication administration to goal SBP in rage of 130-150 improved to 43 minutes (IQR 33-52.3) post vs. 75 minutes (IQR 46.7-80) minutes pre-intervention. Door to first SBP in range of 130-150 mmHg improved to 60 minutes (IQR 46.0-80.0) post vs 98 minutes (IQR 69.5-141.0) pre-intervention p

Stroke, Volume 56, Issue Suppl_1, Page ATMP96-ATMP96, February 1, 2025. Introduction:Pediatric arterial ischemic stroke (AIS) affects 1-2 per 100,000 children. Although rare, mortality and morbidity is significant with approximately 10% recurrence rate within the first year. Despite this, evidence-based treatment and prevention guidelines of pediatric AIS remain insufficient. Direct oral anticoagulants (DOACs) are approved in many countries for the treatment and prevention of pediatric venous thrombosis but its use in pediatric arterial thrombosis is less established. This study is the first to evaluate the off-label use of rivaroxaban in pediatric AIS.Methods:A retrospective chart review was approved by Cook Children’s Medical Center (CCMC) institutional review board. Patients (0 to

Stroke, Volume 56, Issue Suppl_1, Page ATP154-ATP154, February 1, 2025. Introduction:The initial 1-3 months following a Transient Ischemic Attack (TIA) or acute stroke are critical for patient management and recovery. Timely follow-up care is recommended to reduce the risk of recurrent stroke and address ongoing health issues. Prolonged hospital stays can hinder prompt outpatient follow-up. We present a pilot model of secured slots for urgent stroke referrals and follow-up for TIA and acute stroke patients.Methods:A three-year pilot study was conducted within the Geisinger Medical Center Vascular Neurology and Stroke Clinic from October 2021 to June 2024. Dedicated 3:00 PM time slots were established for urgent referrals and follow-ups of patients with TIA and acute stroke from the Emergency Department(ED). Three neurology physicians shared these slots. The study evaluated slot utilization, including time from discharge to clinic visit, 90-day unplanned stroke readmission rates, and the percentage of inappropriate slot use. An integrated assessment was performed to determine the program’s impact on clinic workflow and patient outcomes.Result:An initial review of the first 200 patients revealed the following utilization of secured slots: 21.5% for urgent referrals, 22% for ED follow-ups, 20.5% at provider discretion, 15% allocated by triage team decision, and 18.5% for routine follow-ups. No-shows and scheduling errors accounted for 2.5% of the slots. For urgent referrals and ED follow-ups, there were no unplanned hospital admissions within 90 days. The time to clinic visits after ED discharge ranged from 1 to 21 days (mean 6.9 days), compared to the national average of 2-8 weeks. Many patients underwent partial stroke workups in the ED or hospital. Outpatient testing such as TTE, and ambulatory rhythm monitoring were coordinated to reduce hospital stays. Limitations included challenges in scheduling appointments within 24-72 hours due to provider availability, weekends, and patient scheduling conflicts.Conclusion:Secured stroke clinic slots provide a timely opportunity for high-risk patients to receive immediate follow-up care after ED visits for stroke or TIA. This model significantly reduces hospital costs and improves patient readmission rates, and burden of prolonged hospital stays, without compromising care. Future studies are encouraged to focus on streamlining referrals, reducing scheduling errors, and integrating this model with other stroke-related services, such as rehabilitation to further enhance overall patient care.

Stroke, Volume 56, Issue Suppl_1, Page ADP1-ADP1, February 1, 2025. Background:Cerebral amyloid angiopathy (CAA) is a hemorrhagic cerebrovascular disease that is thought to be due to excess protein deposition in vessel walls that lead to fragility and increase the risk of rupture. Whether intravenous thrombolysis (IVT) is safe and effective for acute ischemic stroke (AIS) patients with CAA is largely unknown.Methods:This was an explorative analysis of a nationwide database of hospitalizations in the United States. AIS patients with CAA were identified by ICD-10 codes and included in the study, and cases were divided into IVT and no-IVT groups. Propensity score matching was performed to balance treatment groups, and additional multivariable logistic regressions were used for doubly robust analyses. Primary outcome was routine discharge to home with self-care. Secondary outcomes include discharge to home, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH).Results:5,100 patients were identified; 498 (9.8%) received IVT. After propensity score matching and doubly robust analyses with additional multivariable logistic regression, IVT was associated with better discharge outcomes (Figure 1), with significantly higher odds of routine discharge (adjusted OR 1.77 [95%CI 1.12-2.80], p=0.015) despite higher odds of ICH (aOR 4.00 [95%CI 2.79 to 5.75], p

Stroke, Volume 56, Issue Suppl_1, Page ATMP94-ATMP94, February 1, 2025. Introduction:Previous single-center studies have found a higher prevalence of mental health disorders in parents of children with pediatric stroke compared to general population prevalences of 5% with depression and 6% with anxiety. Social determinants of health may influence mental health outcomes. We aimed to measure associations between social determinants of health and parental report of mental health symptoms following their child’s diagnosis of ischemic stroke.Methods:We performed a multicenter, international prospective study through the International Pediatric Stroke Study (IPSS). From 2016 to 2021, parents of children within 3.5 years after arterial ischemic stroke enrolled and completed validated and standardized surveys on anxiety (Beck’s Anxiety Inventory II), depression (Beck’s Depression Inventory), post-traumatic stress disorder (PTSD) (Post-Traumatic Stress Disorder Checklist for DSM-5), severity of their child’s stroke deficits (Recovery and Recurrence Questionnaire), and social determinants of health. For our statistical analysis we employed a linear mixed-effects model, both unadjusted and adjusted.Results:Fifty-two parents (13 fathers, 39 mothers) of 39 children enrolled. Of the 39 children 21 (54%) had perinatal stroke and 18 (46%) had childhood stroke. Median time from stroke diagnosis to parental survey completion was 1.3 years (interquartile range [IQR] 1.0-2.0). On parental surveys, parents scored in the clinical range for: depression in 35% of mothers and 23% of fathers; anxiety in 2% of mothers and 0% of fathers; PTSD in 26% of mothers and 8% of fathers. Lower parental education was significantly associated with higher levels of depression both in our unadjusted (0.02) and adjusted (0.03) models. Interestingly, the child’s functional outcome and parental income were not significantly associated with any parental mental health outcomes.Conclusion:Among social determinants of health, parental education level may be associated with depression in parents of children with pediatric arterial ischemic stroke and needs further exploration. Parents of children with pediatric arterial ischemic stroke had higher rates of depression and PTSD compared to general population estimates. Further research in this area will help facilitate understanding and development of interventions to prevent these mental health outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATP136-ATP136, February 1, 2025. Background:The STRACK project aims to improve post-stroke patient management and the transition from acute to primary care thanks to improvements in patient pathways and monitoring cardiovascular risk factors: heart failure, diabetes, atrial fibrillation, dyslipidemia and hypertension. Collaboration between primary care centers and hospital staff was essential for the project’s success by delivering personalized care and home monitoring devices to patients through access to a digital platform. STRACK was launched with a european value-based contracting process and Roche Diag. as partner.Methods:The three-year project was launched in May 2021, during first year all specialties and professionals participated in the development and planning of the project and were trained in the use of the devices and own digital platform.First STRACK patient was enrolled in May 2022. Once these post-stroke patients have been identified, they are given a personalized monitoring plan depending on the individuals’ risk factors, the personalized care and rehabilitation plans are tracked and followed. For a year post-discharge, a nursing and administrative team follows the data that the patient enters remotely or is automatically available on their mobile application.Results:STRACK has evolved the continuum of care by 421patient in July 2024 and ongoing, by integrating comprehensive monitoring of cardiometabolic risk factors (heart failure, diabetes, atrial fibrillation, dyslipidemia, hypertension) into a patient discharge plan, identified as key to avoiding stroke recurrence and improving control of vascular risk factors are monitored.Preliminary results of 231 patients (May 2022-2023) with full one year follow-up comparing with historical cohort (May 2018-2019) showed: Reduction in unnecessary visits (weighted): -26,3%. Reduction in admissions for stroke recurrence or related to stroke, (heart attack, angina, peripheral embolism, etc.): Stroke, 30days: -100%; Related to stroke, (365d: -47,7%; 30d: -57,0%). Reduction in cardiovascular admissions ( 30d: -100%; 365d: -31,4%). Best treatment adherence: 81,2% (72% previously)Conclusion:The great value of STRACK is knowing the evolution of stroke patients post-discharge through strict self-monitoring of clinical parameters, following prior health education. STRACK has managed to achieve reduction in stroke recurrence and adverse events and readmissions for cardiovascular risk factors, reducing emergency visits for vascular events.

Stroke, Volume 56, Issue Suppl_1, Page ATMP97-ATMP97, February 1, 2025. Background:Racial differences in postoperative atrial fibrillation (POAF) and stroke rates following noncardiac surgery are not well understood and may be influenced by varying betablocker prescription patterns.1Methods:This multicentric retrospective observational study included 205,886 adult patients without pre-existing atrial fibrillation who underwent non-cardiac surgery between 2005 and 2021 at two tertiary care academic healthcare networks in the Bronx, New York, and Boston, Massachusetts. The study population consisted of 133,500 (65%) Non-Hispanic White (NHW), 38,237 (19%) Non-Hispanic Black (NHB), and 34,149 (17%) Hispanic individuals. The exposure variable was self-identified race and ethnicity with NHW patients serving as the reference group. The incidence of POAF within 30 days of surgery and postoperative stroke within the first year after the procedure were assessed. Modified Poisson regression with robust error variances was used to evaluate the association between race/ethnicity and POAF and postoperative stroke, adjusting for pre-defined confounders. Mediation analysis was used to determine whether beta-blocker use modified the association between race/ethnicity and stroke.Results:NHB and Hispanic patients were less likely to develop POAF than NHW patients (NHB: RRadj = 0.59; 95%CI: 0.52-0.68; P < .001; Hispanic: RRadj = 0.65; 95%CI: 0.56-0.76; P < .001) but more likely to experience postoperative stroke (NHB: RRadj = 1.39; 95%CI, 1.30-1.49; P < .001; Hispanic: RRadj = 1.34; 95%CI, 1.24-1.46; P < .001). NHB and Hispanic patients were also more likely to be on preexisting beta-blocker therapy than NHW patients (NHB: RRadj = 1.10; 95%CI: 1.07-1.14; P < .001; Hispanic: RRadj = 1.07; 95%CI: 1.03-1.12; P < .001). Beta-blocker use was significantly associated with an increased risk of postoperative stroke (RRadj = 1.17; 95%CI: 1.11-1.24; P < .001) and explained 16% (95%CI: 14%-20%) and 20% (95%CI: 16%-26%) of the variability in postoperative stroke rates among NHB and Hispanic patients, respectively.Conclusion:NHB and Hispanic patients are at higher risk of developing postoperative stroke following noncardiac surgery compared to NHW patients, despite having a lower risk of POAF. This increased stroke risk may be partially attributable to the higher likelihood of preoperative beta-blocker prescriptions in these populations.Reference1 - POISE Study Group. The Lancet. 2008 May 31;371(9627):1839-47.

Stroke, Volume 56, Issue Suppl_1, Page AWMP1-AWMP1, February 1, 2025. Purpose:In acute ischemic stroke, the typically employed 620×10-6mm2/s ADC threshold to automatically delineate the core on diffusion-weighted imaging (DWI) was established by overlaying the manually defined core onto the baseline ADC (ADC0) in recanalized patients following intravenous thrombolysis. However, recanalization was assessed 3-6hrs after treatment, which may entail substantial core growth, and follow-up imaging was at 90 days, implying infarct underestimation due to atrophy. Other studies typically used day 2-5 follow-up MRI (FU-MRI) but did not correct for vasogenic edema, implying infarct overestimation. We re-evaluated the ADC core threshold in patients with early recanalization following EVT, and applied edema correction on 24h post-EVT MRI.Methods:From our center’s EVT registry (2012-2021), all consecutive mothership patients with mTICI2c-3 recanalization within 90min after baseline MRI (MRI0) and who underwent FU-MRI at 24h post-EVT were included. Basilar occlusions and small DWI lesion (

Stroke, Volume 56, Issue Suppl_1, Page AWP69-AWP69, February 1, 2025. Objective:Stroke patients with tube feeding have a high probability of feeding problems when they had regained oral intake ability. Assisting patients with eating is a major task for caregivers and they require better training. We developed an intervention to engage caregiver in feeding patients prior to feeding tube removal and examined the impact on oral feeding resumption in rehabilitation among stroke survivor.Methods:A total of 61 stroke patients with dysphagia recovery were enrolled in rehabilitation hospital from Jan. 2021 to Jul. 2024. They all recovered from tube feeding to complete oral feeding before discharge. Inclusion criteria included 1) Stroke patients with feeding tube. 2) Impaired oral intake which was defined as viscosity of pudding ≥5 ml and sum of three viscosities ≤15 ml based on the modified Volume-viscosity Swallow Test (V-VST). An intervention for caregivers, which engaged them on feeding practices was introduced from Jan 2023 to Jul 2024. The intervention program for feeding practices was primarily carried out by ward nurses. It consisted of thickener preparation and feeding patients skills training. Outcomes were compared between an intervention group of 28 patients and a historical control group of 33 patients recruited between Jan 2021 to Jul 2022. We compared the baseline characteristics and the length of oral feeding resumption between the groups. Volume change of three viscosities was represented by bar graphs.Results:The length of patients who could remove the tube feeding and completed oral feeding resumption was significantly shorter in the intervention group compared with the control group (24.57±11.04 days vs 31.09±12.61 days, P=0.038). 22/28 (78.6%) patients in the intervention group had their feeding tubes removed within one week. The volume growth of three different viscosities was demonstrated following the intervention. Swallowing function of stroke patients in the intervention group improved more quickly comparedConclusion:Our data indicated that effective caregiver engagement is necessary. Successful caregiver engagement has the potential to reduce costs and enhance patient outcomes.

Stroke, Volume 56, Issue Suppl_1, Page A64-A64, February 1, 2025. Introduction:Previous studies have established the safety and economic benefits of outpatient Transient Ischemic Attack (TIA) management, highlighting reduced expenses for outpatient evaluation. This context underscores the potential advantages of refined outpatient TIA management, a focus of our study, through the implementation of a novel expedited outpatient TIA workflow and assessment of its economic, administrative and clinical impact.Methods:We implemented a novel TIA pathway including streamlined assessments by emergency department (ED) physicians, a structured expedited set of diagnostic tests and outpatient follow-up with vascular neurologists within 48-72 hours of ED presentation. We conducted a retrospective cost-efficacy analysis, contrasting two phases: pre-implementation (standard ED-to-hospital admission TIA workflow from May 1, 2020 – December 31, 2020) and post-implementation (ED-to- outpatient TIA workflow from May 1, 2021 – December 31, 2021). We also compared the clinical outcomes of patients with a final diagnosis of TIA or minor ischemic stroke syndrome from the implementation cohort (May 2021-May 2022) with those from an ABCD2-matched inpatient TIA cohort evaluated in the pre-implementation period (2017-2021).Results:The newly implemented outpatient TIA workflow resulted in a 7% decrease in admissions to hospital observation status, 14.8% reduction in hospital admissions, whereas ED discharge rates rose by 20.4%. Within 8 months, these changes equated to 21 fewer hospitalizations or admissions, reducing costs by approximately $103,320 (Figure1). Laboratories, diagnostic imaging, and neurology evaluations were completed faster in the inpatient pathway.Both pathways had similar vascular risk factors and outcomes regarding final diagnosis, – diagnostic testing achieved, preventative treatments prescribed, stroke/TIA recurrences, re-admissions, TIA-related morbidity and mortality, and related ED return visits (Table 1).Conclusion:The deployment of an optimized outpatient TIA management workflow at Mayo Clinic Arizona had demonstrated improved administrative and cost efficiency, with similar clinical outcomes as inpatient TIA pathway. This investigation corroborates the efficacy of workflow enhancements in outpatient TIA settings and suggests a scalable model for analogous strategies in other medical centers.