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Stroke, Volume 56, Issue Suppl_1, Page ATP90-ATP90, February 1, 2025. Background:The Mission Act provided VA funding for non-VA care for Veterans under certain conditions where access to care is limited. Comparing the quality of care between outpatient VA Teleneurology (TN) and Community Care Neurology (CCN) stroke consults is important to understand the impact and value of innovative telehealth solutions to increase access to care.Methods:Veterans with a completed new consult for stroke/TIA in the TN and in CCN at 13 VA facilities from 2021 to 2022 were included. We collected administrative and chart review data for all neurology consults. 4 process measures were defined a priori: antithrombotic (AT) medication, high or medium potency statin, anticoagulation for atrial fibrillation (AF), and dual antiplatelet therapy (DAPT) 90 days or less after the consult completion. The primary quality measure is the without-fail rate (WFR), which is a dichotomous outcome of whether a patient passes all process measures (yes/no) for which they are eligible. For WFR (without-fail rate), a logistic regression model was fit with the effect of interest consult type (TN vs. CCN) after adjustment for patient characteristics of age, Charlson Comorbidity Index (CCI), gender, race, and rurality. The model accounted for subjects clustered within facilities (site) using a Generalized Estimating Equation (GEE) approach. Inverse-probability of treatment weighting was also used since patients were not randomized to consult type. Similar logistic regression models were used to assess the effect of consult type on the pass rate (yes/no) for each individual process measure.Results:Of 828 completed consults, 594 (72%) were CCN. Table 1 shows participant characteristics by TN vs. CCN. The WFR was 56.0% in TN vs. 59.4% in CCN. Median days to complete consults was 37 (IQR 8 to 70) among TN and 82 (IQR 46 to 128) in CCN. Patients who passed all 4 measures vs those that did not were similar with respect to most demographic characteristics (Table 2). After adjustment for demographics and CCI, there was no difference in the WFR for TN vs CCN, OR 0.90, 95% CI (0.70, 1.15). None of the pass rates for the individual process measures significantly differed by consult type (TN vs. CCN) (Table 3). Model results were similar when including stabilized inverse probability weights (data not shown).Conclusions:VA teleneurology care may be a way to improve the timeliness to outpatient stroke care without impacting quality of care for outpatient stroke care.

Stroke, Volume 56, Issue Suppl_1, Page ATP71-ATP71, February 1, 2025. Background:The US Centers for Disease Control and Prevention’s (CDC) Paul Coverdell National Acute Stroke Program (PCNASP) supports state-based efforts to enhance stroke care quality. As part of the PCNASP, Kentucky developed an integrated system linking prehospital Emergency Medical Services and hospital-level data through the American Heart Association’s Get With The Guidelines®- Stroke program. To help guide efforts to optimize stroke care processes and reduce disparities, we compared acute poststroke mortality in PCNASP-participating hospitals according to the patient’s county of residence for those residing in CDC-identified low and high stroke mortality counties and based on the county’s level of social deprivation.Methods:County-level stroke mortality data (2018-2020) from the CDC and in-hospital data (2021-2023) from PCNASP-participating hospitals were analyzed. The patients’ counties of residence were classified based on CDC stroke mortality rates (high mortality, >80.4 per 100,000 population) and Social Deprivation Index (SDI) score tertile. Mixed effects models assessed the relationships between county mortality risk, SDI, and hospital-based stroke mortality.Results:There was no difference in age standardized in-hospital mortality between patients residing in high (n=71; 18.3+17.9 per 100,000 population) compared to low (n=49; 18.8+16.6 per 100,000 population, p=.831) mortality counties or among counties with varying SDI scores (p=.117). Patients residing in higher SDI counties had higher rates of discharge to hospice. Overall, in-hospital mortality decreased between 2021-2023.Conclusions:We found that patient-level acute stroke mortality rates in PCNASP participating hospitals do not mirror the mortality rates or degree of social deprivation in their county of residence. This suggests that expected differences in stroke mortality are mitigated for those who obtain acute care in PCNASP participating hospitals. To reduce stroke-related disparities, public health strategies should focus on promoting stroke prevention, public awareness, and facilitating access to high-quality care.

Stroke, Volume 56, Issue Suppl_1, Page ATP83-ATP83, February 1, 2025. Introduction:Alabama has among the highest stroke prevalence and mortality in the US. Strokes due to large vessel occlusion (LVO) have the largest morbidity among ischemic strokes. Stroke STAT is an observational trial designed to evaluate the sequential implementation of severity-based stroke triage (SBST) across Alabama’s six Emergency Medical Services (EMS) regions. The primary aim of Stroke STAT is to improve access of patients with LVO to reperfusion therapies.Methods:A statewide collaborative education program was an integral part of Stroke STAT. The educational program was a collaboration between an academic medical center, the state department of public health, and a multi-disciplinary association of health care professionals involved in the care of stroke patients. Key elements of the educational program included symposium hosted by each of Alabama’s six EMS regions; development of a standardized continuing medical education curriculum for Stroke Coordinators (SCs) including Stroke Certified Registered Nurse (SCRN) certification, physicians, and EMS providers; and timing of symposia in each region to spur development of region-specific plans for implementation of SBST. Participants completed structured evaluations before and after each symposium. The evaluations comprised eight questions assessing the participants self-perceived knowledge competency, using a Likert Scale from “not at all” to “very much so.”Results:A total of 137 Registered Nurses (RNs) attended the symposiums across the state, with 131 completing the post-course evaluations, achieving a 95.6% response rate. Out of all attendees 81% affirmed that “the information in this activity will help me do my job.” Additionally, 63 physicians and advanced practice providers (APPs), along with 154 EMS personnel, attended the symposiums. A total of 30 physicians and APPs completed a course evaluation achieving a 47.6% response rate. Of the providers 86.7% stated, “I will apply what I learned in this activity.” Prior to the symposium 55% of RNs reported minimal topic familiarity, post-symposium 98% of RNs and 87% of physicians and APPs reported significant improvement in knowledge.Conclusions:A traveling statewide collaborative education program was able to reach many stroke providers across Alabama. This educational model successfully engaged SCs and EMS personnel but was less effective in engaging physicians and APPs. We plan to explore reasons for differences in provider engagement.

Stroke, Volume 56, Issue Suppl_1, Page AWP401-AWP401, February 1, 2025. Introduction:Aging is accompanied by a gradual increase in inflammation, oxidative stress and immune system dysfunction. Our previous work with heterochronic parabiosis, in which the circulatory systems of young and aged mice are shared, provided insights into how systemic factors influence brain aging. Notably, our findings revealed that aged blood induces a reactive oxygen species-induced senescence pathway in the young brain, while young blood activates a selenium network pathway in the aged brain. Wehypothesizethat selenium deficiency increases oxidative stress and ROS-induced senescence in microglia, thereby contributing to neuroinflammation and cognitive decline.Methods:We fed aged (16-month) C57BL/6 male mice either a selenium deficient or control diet (n = 9-10/grp) for 3 months. Cognition and motor activity were assessed at 1- and 3-months with the novel object recognition test (NORT) and open field (OF). Brain and spleen were harvested after 3 months for flow cytometric (FC) analysis and immunohistochemistry (IHC). Additionally, we explored the potential therapeutic effects of selenium supplementation on senescence markers in primary microglial cell cultures, which were assessed by qPCR and stained for senescence activity (beta-galactosidase).Results:After one month, selenium deficient mice had significantly impaired locomotor activity in the OF (p=.0010) and an increase in cognitive impairment in the NORT (p=.0792). Surprisingly, these deficits normalized to levels seen in the control group after 3 months of selenium deficient diet, raising the possibility of an adaptive or compensatory redox signaling mechanism in the aged brain. FC analysis at 3 months revealed only mild alterations in microglia, brain endothelial cells, and splenic neutrophils, consistent with the behavioral outcomes.In vitroexperiments demonstrated that treatment with selenomethionine (p=.0134) and selenium nanoparticles (p=.0176) alleviated senescence-associated phenotypes in microglia post-H2O2 stimulation.Conclusion:We have established an important role for dietary selenium in healthy brain aging and novel evidence for a delayed compensatory redox mechanism to mitigate the detrimental effects of chronic selenium deficiency in aged mice. By elucidating the role of dietary selenium in brain aging, this study aims to identify novel therapeutic targets for preventing or delaying the cognitive decline associated with aging.

Stroke, Volume 56, Issue Suppl_1, Page AWP402-AWP402, February 1, 2025. Background:Patients with hypertension (HTN) are almost 3 times more likely to have a stroke than non-hypertensive individuals. HTN is associated with oxidative stress (OS), exacerbated inflammation, and vascular remodeling. In experimental models, normotensive Sprague-Dawley (SD) and Spontaneously Hypertensive Rats (SHR) show different susceptibilities and outcomes to ischemic stroke. We propose that better understanding of the modulation in gene expression profile in HTN brains may provide critical insight into this complex process.Methods:We focused on transcriptomic characterization of OS, inflammatory, and apoptosis pathway specific genes in SD and SHR brains before and after ischemic stroke. Middle Cerebral Artery Occlusion was used to induce focal ischemia/reperfusion injury (I/R). Using pathway specific arrays containing 84 selected genes, we performed a transcriptome analysis in the brain cortical regions. Fold-changes in gene expression were determined using the 2−ΔΔCtmethod.Results:In no-stroke SHR brain, HTN was associated with increased levels of pro-inflammatory genes including chemokine ligand (CCL)5 (3.0-fold), IL-6 (3.3-fold), and TNF superfamily member 7 (14-fold) as compared to normotensive SD rats without stroke. On the other hand, Mitogen-activated protein kinase 13, involved in tissue remodeling and cell proliferation was significantly decreased in SHR brains. However, following I/R, expression of redox signaling genes including aldehydeoxidase1 (3.4 fold), dual oxidase 1 (2.5-fold), and lactoperoxidase (3.3-fold) were upregulated in SHR brains as compared to SD rat brains. This was linked to a dysregulation in inflammatory response genes including SELE (2.8-fold), IL-1β (2-fold), and CCL21 (3.2-fold). The downstream effects of OS and inflammation on apoptotic process was supported by an upregulated expression of pro-apoptotic genes, including caspases-3,6,12 (2.1,1.7, 3.4-fold), CIDEA (1.7-fold), FAS (1.7-fold), and PYCARD (2-fold). These data indicate that OS and inflammatory pathways are further over-activated in hypertensive rat brains.Conclusion:Our data show that the expression of genes involved in OS and inflammation are coordinately upregulated as a function of HTN, which may worsen the outcome of ischemic stroke by likely regulating vascular remodeling, neuronal apoptosis, and blood brain barrier functions. Further studies focusing on these key genes may open up new ways to mitigate HTN-linked post-stroke brain damage.

Stroke, Volume 56, Issue Suppl_1, Page ATP92-ATP92, February 1, 2025. Introduction:Prospective applicants for Stroke fellowship programs often rely on online resources to make informed decisions. Access to accurate program information is essential for making application decisions. This study aimed to assess the availability of critical application and program information on websites of neurology stroke fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and participating in the National Residency Matching Program (NRMP).Methods:Using the Electronic Residency Application Services (ERAS), a list of websites for 112 ACGME-accredited vascular neurology fellowship programs was compiled. Each website was evaluated for 7 components of application information, including deadlines and contact details, and 17 components of program information, such as compensation, rotation schedule, and faculty listings.Results:Of the 112 programs, only 5.1% of websites contained all 7 components of application information, while none (0%) provided all 17 components of program information. This significant gap in online data availability suggests that prospective fellows may struggle to find essential information to guide their application process.Conclusion:The lack of comprehensive online information poses a challenge for applicants and may hinder the recruitment of qualified candidates. Improving the accessibility and completeness of information on vascular neurology fellowship websites could facilitate better decision-making and ultimately enhance program participation.Keywords: Neurology, Stroke, Fellowship, Data availability, Program evaluation

Stroke, Volume 56, Issue Suppl_1, Page ATP39-ATP39, February 1, 2025. Background:Cerebral small vessel disease (CSVD) is a leading cause of vascular cognitive impairment (VCI). Remote ischemic conditioning (RIC) is a promising strategy to prevent CSVD progression, but it is unclear what doses of daily RIC are tolerable or adherable for older patients with CSVD-associated VCI.Methods:TRIC-VCI (ClinicalTrials.gov NCT04109963) was a prospective, open-label randomized-controlled trial with blinded endpoint assessment. Participants completing a 14-day run-in were randomized to once- or twice-daily RIC for 30 consecutive days. RIC consisted of 4 cycles of blood-pressure cuff inflation to 200mmHg around an arm for 5-minutes followed by 5-minutes deflation using an automated device. Criteria included age 60-85, evidence of CSVD on CT/MRI, Montreal Cognitive Assessment score 13-24, and preserved basic activities of daily living. Outcomes were assessed at 30- and 90-days. The primary outcome for which the trial was powered was adherence (completing ≥80% of sessions). Secondary outcomes included percentage of sessions completed and pain/discomfort scores from patient diaries. Exploratory outcomes included changes in white-matter hyperintensity (WMH) volume and cognitive tests. We explored trial experiences in a focus group with 5 patients and 4 care-partners.Results:Among 23 patients entering the run-in, 22 completed it and were randomized. 21/22(95.5%) finished the 30-day treatment period. 7/11(63.6%) in the once-daily RIC group completed ≥80% of sessions vs 10/11(90.9%) in the twice-daily group; median session completion was 93%(IQR:73-98%) vs 98%(IQR:93-98%) respectively. Pain/discomfort ratings were numerically higher in the twice-daily group (median rating/10: 4.2, IQR 1.0-5.0 vs once-daily:1.6, IQR 1.0-3.4, p=0.60). None of the patients developed tissue/neurovascular injury or deep vein thrombosis. Cognitive tests generally did not change significantly or differ between groups; WMH volumes were stable (change at 90-days vs randomization: -0.21 mL, 95%CI -0.54-0.13). Focus group participants opined the device was easy to use, desired greater portability, generally favoured once-daily RIC, and were open to longer treatment courses in future trials.Conclusion:RIC was safe and tolerated by patients with CSVD-associated VCI. Patients adhered well to both once- and twice-daily RIC, with no significant differences in outcomes between both groups. We will incorporate participant feedback into device design and future efficacy trials.

Stroke, Volume 56, Issue Suppl_1, Page ATP62-ATP62, February 1, 2025. Introduction:Education for post-acute stroke patients is crucial for several reasons: recovery and rehabilitation, prevention of recurrence, empowerment, caregiver support, and health literacy. Education equips patents and their families with the knowledge/tools needed to manage the long-term effects of a stroke and overall well-being.Background:Mary Greeley Medical Center (MGMC) leadership identified a lack of compliance in patient education in the post-acute setting for stoke survivors. In 2019, only 60% of stoke patients in the MGMC Acute Rehabilitation Unit (ARU) received the necessary education to be successful at discharge.Objective:To use the best practices outlined by the American Heart Association’s (AHA) guidelines and increase our compliance to greater than 75% of all stroke patients in the ARU setting receiving education on; stroke warning signs, individualized risk factors, prevention, medication management, caregiver education, and after visit follow up.Methods:Our intervention involved implementing a standardized checklist in stroke patients’ rooms, clearly outlining essential educational components. This streamlined approach facilitated real-time assessment of education needs by both staff and patients. Upon admission, stroke patients received an informative packet containing AHA materials. We upgraded patient entertainment systems to include stroke-related educational videos. All educational documentation was integrated into the electronic medical record, enhancing accessibility for both staff and patients via MyChart. Caregivers can access this education via mobile devices. Nursing leaders engaged with patients during rounds to ensure effective utilization of these educational tools.Results:Over a five-year period, the implementation of improved patient education strategies led to a consistent increase in the proportion of patients receiving stroke education in the MGMC ARU. Starting from a baseline of 60% in 2019, the rate rose to 84% during 2020/2021, and further to 91% in 2022. The data for 2023 reflects a continuation of this positive trend. Leadership played a pivotal role by regularly assessing adherence to the education protocol and making continuous enhancements to the educational delivery process.Conclusions:The standardization of educational requirements and increasing the accessibility of a variety of learning platforms has increased staff compliance with providing the necessary education to stroke patients in the MGMC ARU.

Stroke, Volume 56, Issue Suppl_1, Page ATP84-ATP84, February 1, 2025. Access to acute stroke care varies widely worldwide, with significant gaps in low- and middle-income countries and in rural areas. Ensuring equitable access requires a standardized approach to identify current coverage and potential sites for new stroke centers. In the U.S., stroke center distribution is inconsistent across states, with around 77% of rural counties deemed “medical deserts” due to a lack of healthcare services.Methods:We conducted a comprehensive survey of hospitals in Oklahoma to assess accessibility to acute stroke therapies. We gathered data on the availability of critical resources like thrombolysis, computerized tomography (CT), and neurology services at over 200 facilities. We performed quantitative spatial analysis using a geographic mapping tool to analyze travel distances from each area to the nearest three hospitals capable of providing acute reperfusion therapies to identify regions with limited access.Results:We showed that while most hospitals offer emergency services (82%), the availability of specialized stroke care varies markedly (Fig1). For instance, CT/radiology support is available 24/7 in over 80% of hospitals, which is crucial during stroke alerts. However, there is a gap in the availability of advanced stroke interventions, specifically, only 4% of hospitals offer mechanical thrombectomy (MT). Additionally, the availability of Neuro ICU and in-person Neurology support 24/7 is very limited, further emphasizing the disparity in advanced stroke care statewide. Although thrombolysis is available in 77% of the hospitals, their distribution is uneven, with rural and less densely populated areas, particularly in the southeastern region, facing significant challenges in accessing timely stroke care. In these regions, patients face lengthy travel times over one hour to reach hospitals capable of providing basic stroke care, significantly delaying their access to treatments (Fig2).DiscussionLimited thrombolysis availability and long travel times to access acute stroke care were found in some regions, placing underserved areas at higher risk of poor outcomes due to these delays. We highlight the need for improved access to stroke treatments, particularly MT, to better serve stroke patients across Oklahoma. Initiatives that apply computational strategies analyzing actual stroke coverage, like the MAPSTROKE project, can guide better placement of future stroke units and standardize stroke center locations to address this issue

Stroke, Volume 56, Issue Suppl_1, Page ATP80-ATP80, February 1, 2025. Introduction:Delays in IV thrombolysis (IVT) via telestroke may occur because of limited access to direct communication between providers. A direct secure messaging system between requesting telestroke sites and telestroke physicians may streamline the process.Methods:Retrospective analysis of telestroke patients treated with IVT in the emergency department across twenty hospitals between June 2018 and June 2024. A direct secure messaging system was implemented in December 2023, which allowed requesting hospital staff the ability to directly page and message the telestroke physician obviating the need for phone calls to coordinate care. Summary statistics and outcomes compared telestroke notifications via a call center (phone) to a direct secure messaging system (direct message). Patients that developed disabling symptoms after arrival and with missing data were excluded. Primary outcome compared telestroke paging times and secondary outcomes compared page to video and door to needle (DTN) times with quantile (median) regression analyses adjusted for variables identified in univariate analyses: average telestroke volume, age, NIHSS and time of day. DTN time was also adjusted for door to telestroke request times and delays in treating IVT due to hypertension. Subgroup analysis evaluated differences in door in door out time between groups.Results:In the seven months after implementing a direct messaging system, 2435 (1739 initial telestroke requests and 696 follow-up communications) messages were sent directly to telestroke physicians from telestroke sites, reducing 3131 calls to and from the call center. A total of 829 patients were treated with IVT during the entire study period and after exclusions, 777 (93.7%) were included in the study. Median paging times via direct message were quicker than via phone by 1.86 minutes [95% Confidence Interval (CI) 1.47, 2.24], p

Stroke, Volume 56, Issue Suppl_1, Page ATP73-ATP73, February 1, 2025. Introduction:Disparities across race, ethnicity and socioeconomic factors exist in acute ischemic stroke (AIS) incident risk, treatment and outcomes. Tenecteplase, given within 4.5 hours of AIS symptom onset, has been shown to be noninferior to alteplase in reducing post-AIS disability, but its equity impacts are unknown. Distributional Cost Effectiveness Analysis (DCEA) is an established method for estimating health equity impacts by evaluating the distribution of health outcomes across equity-relevant subgroups before and after an intervention.Objective:Using DCEA, evaluate the impact of tenecteplase use within 4.5 hours of AIS symptom onset on health equity in the US.Methods:Leveraging published CEAs of alteplase, a DCEA of tenecteplase given within 4.5 hours of AIS symptom onset was built from a US payer perspective. The US population was divided into 25 equity-relevant subgroups based on race and ethnicity (5 census-based groups) and county-level social vulnerability index (quintiles). Inputs for AIS outcomes, incidence and receipt of tenecteplase were varied across subgroups based on published estimates obtained from a targeted literature review. Scenarios explored robustness of findings to variations in inputs and access assumptions.Results:Annually in the US, use of tenecteplase is predicted to improve population health (54,550 QALYs gained) and reduce existing overall inequities. Larger relative health gains are expected in more vulnerable subgroups, specifically within historically marginalized groups and those in geographic areas with higher social vulnerability. Health benefits are driven by cost savings from reduced disability post hospital discharge, while equity benefits are driven by the higher risk of incident AIS in patients who currently have larger health disparities in life expectancy and quality of life. Conclusions were robust to scenario testing. Scenarios that reduced treatment gaps (eg, closing disparities in receipt of treatment and treatment timing) led to larger gains in health and further reduced existing inequalities.Conclusions:Under current AIS incidence and thrombolytic utilization patterns in the US, use of tenecteplase given within 4.5 hours of AIS symptom onset is predicted to increase population health while also improving health equity. Closing care gaps to enable more timely and equitable thrombolytic access across race, ethnicity and geography can further improve equity benefits from tenecteplase use.

Stroke, Volume 56, Issue Suppl_1, Page ATP42-ATP42, February 1, 2025. Introduction:Aging and chronic cerebral hypoperfusion (CCH) are major risk factors for Vascular contribution to cognitive impairment and dementia (VCID), which is a heterogeneous group of disorders characterized by cognitive deficits secondary to cerebrovascular pathology. Importantly, patients with CCH show enhanced brain iron deposition and iron metabolism dysregulation, which have been associated with different types of dementia and neurodegenerative disorders, such as Alzheimer’s disease, Huntington’s disease, VCID, etc. Recent studies have proposed different mechanisms involved in VCID induced by CCH in young small rodents. However, no study has elucidated the molecular changes that occur in CCH models using aged animals. Thus, we hypothesize that brain iron metabolism is dysregulated in an aged mouse model of VCID.Methodology:We induced CCH through bilateral carotid artery stenosis (BCAS) by ligating carotid arteries with 0.18 mm diameter coils in 17-18 months C57BL/6 mice of both sexes. Sham mice underwent the same surgery without coil ligation. After surgery, mice were maintained for 5 months; then, they were tested for open field, elevated plus maze, and fear conditioning. After behavior tests, their brains were analyzed for histochemistry analysis and qPCR.Results:We observed that BCAS mice showed increased velocity (p=0.016) and distance moved (p=0.009) in the open field test, and they showed a higher number of visits to open arms (p=0.026) in the elevated plus maze, compared with sham mice. Furthermore, the percentage of freezing time in the fear conditioning test was significantly reduced in BCAS mice (p=0.037), compared with sham mice. We also found that the number (p=0.039) and size (p=0.003) of iron deposits increased in the striatum of BCAS mice, compared with sham mice. Interestingly, the relative expression of genes involved in iron metabolism such asNcoa4(codes mediator of ferritinophagy) andFtl1(coding for iron storage protein ferritin light-chain), were significantly reduced (p=0.007, p=0.001, respectively) in the striatum, but not in the cortex, of BCAS mice, compared with sham mice.Conclusion:Our data indicates that BCAS mice showed enhanced anxiety-like behavior and impaired conditioning memory, increased iron deposition, and impaired iron metabolism in their striatum, compared with sham mice. Next, we will determine if restoring brain iron metabolism in BCAS mice can mitigate CCH-induced phenotype.

Stroke, Volume 56, Issue Suppl_1, Page AWP287-AWP287, February 1, 2025. Introduction:Effective blood pressure (BP) control post-stroke is a critical secondary prevention strategy. Research shows that social determinants of health (SDOH) may influence this process by addressing underlying factors contributing to health disparities. We conducted a secondary analysis using data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study to investigate the cumulative effect of multiple SDOH domains on BP reduction in stroke survivors, with a particular focus on sex-specific outcomes.Methods:We applied the Healthy People 2020 framework to identify SDOH across the following domains: economic factors, education, social context, healthcare access, and neighborhood characteristics. Stroke survivors in the DESERVE skill-based intervention study completed a 6-month follow-up (n=361) and were classified into two groups based on the number of negative factors:

Stroke, Volume 56, Issue Suppl_1, Page AWP231-AWP231, February 1, 2025. Introduction:Intracerebral hemorrhage (ICH) imposes a significant health burden due to the associated morbidity and mortality. Evaluation of the burden of ICH, and the temporal trends of this burden, is of paramount significance in determining the shifting paradigms and in the introduction of effective measures at both, preventative and therapeutic levels, particularly in developing Middle Eastern nations with limited resources such as Jordan.Methods:The burden of ICH in Jordan over the period 1990-2019 was evaluated by initially retrieving relevant data, including age-standardized rates per 100,000 persons, regarding the mortality, incidence, prevalence, disability-adjusted life years (DALYs), and years lived with disability (YLDs) from the Global Burden of Disease database. Temporal trends were evaluated by calculating the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) using Joinpoint Analysis software.Results:An estimated total of 20,294 ICH-related mortalities with a female predominance of approximately 52.7% were reported in Jordan over a span of around 30 years. There is an overall decline in ICH-related age-standardized mortality rate with an AAPC of -3.36 (95CI% -3.45 to -3.26; p

Stroke, Volume 56, Issue Suppl_1, Page AWP288-AWP288, February 1, 2025. Background:The COVID-19 pandemic disrupted healthcare systems and altered patient behaviors, potentially affecting stroke prevalence and outcomes. This study examines trends in stroke-related hospitalizations by age and sex in California from 2016 to 2022, focusing on the pandemic years (2020-2022).Methods:A retrospective analysis of patient discharge data from the California Department of Health Care Access and Information was conducted, screening nearly 25 million inpatient events for stroke-related ICD-10-CM codes (I60-I63) among individuals aged 20 and older. Age-and-sex-standardized hospitalization rates per 100,000 population were calculated. Multivariate logistic regression (MLR) assessed the impact of pre- and post-COVID-19 periods on stroke-related admissions, adjusting for age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR).Results:The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). From 2016 to 2019, stroke-related hospitalization rates were stable (257.7 to 259.2 per 100,000). A significant decrease to 242.6 occurred in 2020, followed by an increase to 253.7 in 2021, coinciding with peak COVID-19 cases. By 2022, the rate slightly declined to 251.0, indicating stabilization but not a return to pre-pandemic levels. While the overall trend from 2016 to 2022 was not statistically significant (p=0.400), fluctuations reflect the pandemic’s impact, particularly in 2021.Age and gender analyses showed distinct trends. The age-adjusted rate for males remained stable (p=0.774), while females faced a notable decrease (p=0.018). Among those aged 20-44, stroke-related hospitalizations increased by 19% (RR=1.19, p

Stroke, Volume 56, Issue Suppl_1, Page AWP235-AWP235, February 1, 2025. Introduction:Insurance status may serve as an indicator of social and financial barriers that impede access to quality care. Disparities in outcomes of patients with ischemic stroke have been associated with insurance coverage. However, there are few studies investigating the impact of insurance status on outcomes in patients with intracerebral hemorrhage (ICH).Methods:We performed a post-hoc analysis of the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study to investigate the impact of insurance status on good functional outcome (modified Rankin Scale score of 0-3 at 90 days after ICH). A logistic regression model was adjusted for age, sex, race, mechanical ventilation, systolic blood pressure, smoking status, diabetes mellitus, atrial fibrillation, hypertension, congestive heart failure, Glasgow Coma Scale, ICH location (side and deep), ICH volume on CT, and presence of intraventricular hemorrhage. VA patients were excluded from analysis due to small sample size.Results:Among 1874 patients included in this study, 428 patients (22.8%) had Medicare, 347 patients (18.5%) had Medicaid, 183 patients (9.8%) had HMO, 568 patients (30.3%) had private insurance, and 348 patients (18.6%) were self-pay. Table 1 illustrates demographics by insurance status. The odds ratio for good outcome in those with private insurance was significantly higher in comparison to Medicare (OR 1.47, 95% CI 1.06-2.03, p=0.022, Figure 1). When comparing private insurance to all other insurance types, the odds ratio was 1.42 (95% CI 1.09-1.84, p=0.009).Conclusion:Amongst patients in the ERICH study, private insurance was associated with a higher likelihood of good outcome (mRS 0-3 at 90 days) in ICH patients compared to Medicare or other insurance status. Further study is needed to establish if this observation is causal or an epiphenomenon.