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Stroke, Volume 56, Issue Suppl_1, Page AWP4-AWP4, February 1, 2025. Introduction:Previous studies have shown the efficacy and safety of time-based intravenous thrombolysis (IVT) in elderly patients with ischemic stroke. However, there are safety concerns about bleeding associated with IVT due to their low body weight, renal dysfunction, and the concomitant use of antithrombotic drugs. Robust evidence on the effect of IVT, particularly in elderly patients with unknown onset stroke, is limited. This study aimed to evaluate the efficacy and safety of imaging-based IVT in this population.Methods:Patients with an unknown onset stroke were evaluated using an individual patient-level database of randomized controlled trials comparing IVT with placebo or standard treatment from the Evaluation of unknown Onset Stroke thrombolysis trials (EOS) collaboration. The primary outcome was favorable outcome, defined as a mRS score of 0-1 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) at 22–36 hours and 90-day mortality. The effect of IVT was evaluated in each of patients aged ≥85 and

Stroke, Volume 56, Issue Suppl_1, Page AWP143-AWP143, February 1, 2025. Introduction:The majority of patients with cerebral venous thrombosis (CVT) achieve functional independence (modified Rankin Score [mRS] 0-2), although many continue to experience residual symptoms that negatively impact quality of life. Patient-reported outcome measures (PROMs) provides a means to assess these symptoms, capturing aspects of health often missed by clinician-reported assessments. We evaluated differences in PROMs across several health domains between patients with CVT and ischemic stroke.Methods:This observational cohort study included patients hospitalized for ischemic stroke or CVT who had a follow-up visit in a cerebrovascular clinic January 1, 2019 to April 30, 2024 and completed at least one PROM within three months of their last cerebrovascular event. Routinely collected PROMs included Patient Health Questionnaire-9, PROMIS Global Health, NeuroQoL computer adaptive testing (CAT) cognitive function, and the following PROMIS CAT scales: pain interference, physical function, satisfaction with social roles, fatigue, self-efficacy and sleep disturbance. Propensity score matching was used to pair CVT patients with ischemic stroke patients in 1:3 ratio based on demographic characteristics, mRS, Charlson comorbidity index, and time since last cerebrovascular event.Results:Out of 72 CVT and 2,533 ischemic stroke patients who met study criteria, 69 CVT and 196 ischemic stroke patients were matched and analyzed (average age 47.5±17.0 yrs, 62.6% female, 74.7% white race). Evidence of brain tissue injury on MRI was present in 22 (30.6%) of CVT patients. The median mRS of both CVT and ischemic stroke patients was 1 [IQR 0,1]. Except for sleep disturbance, PROMIS scores for both groups were meaningfully worse than the general population mean of 50. Worst scores were seen with physical function followed by fatigue and satisfaction with social roles. Pain interference scores were significantly worse in patients with CVT than those with ischemic stroke (58.0±10.5 vs 53.8±10.4; p=0.008); domain scores were otherwise similar between groups (Table).Conclusion:Despite low rate of brain injury on MRI, CVT patients had worse pain interference and similar severity and pattern of other PROM scores compared to a matched sample of ischemic stroke patients. This suggests that a holistic care approach addressing pain and the broader spectrum of outcomes, in addition to the primary vascular pathology, could be beneficial in the management of patients with CVT.

Stroke, Volume 56, Issue Suppl_1, Page ATP284-ATP284, February 1, 2025. Enrichment is the prospective use of any patient characteristic to select a study population at higher risk in which detection of a drug effect is more likely than it would be in an unselected population. Patients with post-stroke cognitive impairment (PSCI) found to have higher risk of stroke recurrence in a recently completed meta-analysis. The goal of this study is to test whether PSCI based patient selection may represent enrichment strategy for secondary stroke prevention clinical trial. This is a subgroup analysis of Insulin Resistance Intervention after Stroke (IRIS) trial. In IRIS trial, patients were randomized to receive pioglitazone vs. placebo and had a baseline Modified Mini-Mental State Examination (3MS, where 3MS ≤ 88 was indicative of global PSCI. The primary endpoint of the study was recurrent stroke or MI. We estimated the hazard ratio (HR) for the effect of pioglitazone among those with global PSCI. To determine the sample size for a subsequent trial enriched by including only subjects with global PSCI, we make the following assumptions: (1) time to event follows an exponential distribution in both the pioglizone and placebo groups where the hazard rate for the placebo group is assumed to be the same as in the IRIS trial among those with global PSCI; (2) hazards for the pioglitizon and placebo groups are proportional over the course of the study; and (3) subjects are randomized to pioglitazone or placebo in equal proportions.Data on n = 3,338 patients of original cohort of n = 3,876 were analyzed, and n = 473 among them had PSCI at baseline. During 5-years of follow-up, n=246 patients experienced recurrent stroke, and n = 118 had MI. In patients with PSCI HR was 0.56 (95% CI 0.34 – 0.92) suggesting a 44% reduction in the hazard rate for secondary stroke or MI after 5 years of follow-up in the pioglitizone group compared to the placebo. If we conservatively assume that the true HR = 0.56 (closer to the null of HR = 1 than what was observed in the IRIS trial), then a total sample size of n= 967 willl proivde 90% power using a two-sided log-rank test at the 5% significance level. This conservative sample size corresponds to a 75% reduction in the sample size that was required for the IRIS Trial. PSCI screening may represent enrichment strategy for secondary stroke prevention clinical trial potentially reducing sample size by 75%. PSCI screening-based enrichment can be tested in phase 2 secondary stroke prevention trial.

Stroke, Volume 56, Issue Suppl_1, Page ADP44-ADP44, February 1, 2025. Introduction:Patient reported outcomes post-stroke may be more sensitive to meaningful differences than the modified Rankin Scale (mRS). We aimed to compare patient reported outcomes (PROMs) in Mexican Americans (MAs) and non-Hispanic Whites (NHWs) in a community-based study. We also explored the correlation of PROMs with the mRS at 3 months post-stroke.Methods:All patients with ischemic and hemorrhagic stroke (ICH) from mid 2019-2023 in the Brain Attack Surveillance in Corpus Christi (BASIC) project were enrolled. PROMs and mRS were assessed at 3 months post-stroke. PROMs were assessed by the Patient-Reported Outcomes Measurement Information System, (PROMIS), Work and Social Adjustment Scale (WSAS), Economic Quality of Life Survey (EQOL) and ability to return to work and driving.For unadjusted analyses, medians and IQRs were reported for continuous and ordinal variables, with t-test p-values. Chi-squared tests were used for binary variables. For adjusted models, logistic, multinomial, or proportional-odds cumulative logit models were used as appropriate. Multitier inverse probability weighting (IPW) addressed sample attrition, and covariates included age, sex, initial NIHSS, comorbidity count, ischemic vs ICH, and previous stroke.Results:A total of 913 patients were included. Table 1 provides the main results. In the adjusted analysis, MA had significantly lower (worse) PROMIS Global Mental Health score (mean ethnic difference: -2.24, 99% CI: -3.93 to -0.54, p

Stroke, Volume 56, Issue Suppl_1, Page ATP259-ATP259, February 1, 2025. Background:Endovascular treatment (EVT) is an effective treatment for acute ischemic stroke in anterior large vessel occlusions. Despite successful reperfusion, many patients still have unfavorable outcomes even in the presence of favorable arterial collaterals. We determined patient characteristics, treatment details and imaging characteristics associated with favorable outcome in patients with good collaterals who had successful EVT.Methods:In a post hoc analysis of the prospective CRISP 2 study, we identified patients with successful reperfusion following EVT (TICI 2b-3) and good collaterals (Tan ≥2). These patients were dichotomized into favorable (mRS 0-2) and unfavorable outcome (mRS 3-6) groups. Multivariate analyses were performed to identify clinical, imaging, and treatment predictors of favorable outcome.Results:92 patients were included, and 31 patients (33.7%) had favorable outcomes. There were no differences in the number of females (16 patients [52%] versus 33 patients [54%]; p=0.821) or age (71 years, [IQR 56-79] versus 68 years [IQR 57-79]; p=0.859) in favorable versus unfavorable groups, respectively. Favorable outcome patients had lower pre-treatment mRS (p

Stroke, Volume 56, Issue Suppl_1, Page ATP65-ATP65, February 1, 2025. Background and Purpose:In 2023, High Point Medical Center implemented a quality improvement initiative to enhance outcomes for hospitalized patients experiencing strokes. This initiative was created after review of cases entered in a patient event reporting system. Root cause analyses of the reported events identified multiple opportunities for improvement. An interdisciplinary initiative was launched that engaged stakeholders from patient safety, the stroke team, and nursing education. The project team concentrated on implementing hospital-wide strategies aimed at preventing harm by enhancing stroke symptom recognition, stroke alert activations, and the execution of the code stroke protocol for inpatient stroke alerts. The purpose of this quality improvement initiative was to increase the quantity and quality of code stroke activations among hospitalized patients.Methods:Patient volumes from 2022 and 2023 were trended in Get with The Guidelines and compared to the Stroke Data Bank. Our intervention consisted of comprehensive education for all clinical staff including symptom recognition, stroke simulations, and empowering nurses to activate stroke alerts immediately upon suspicion of stroke. Interventions were initiated in quarter two of 2023 and continued throughout the year.Results:Initial analysis of patient volumes determined that our hospital had fewer recognized inpatient strokes than anticipated for our size. Reported safety events concluded that stroke events were not consistently recognized or implemented in a timely manner. After the intervention, surveys indicated that staff experienced a heightened awareness of signs of stroke and knowledge of their roles in the code stroke process. Inpatient code stroke activations tripled from quarter one to quarter four after the interventions. The number of patients receiving intervention quadrupled by the end of quarter four. Nurses identified stroke symptoms and had gained the confidence to independently activate a code stroke. A culture of stroke advocacy and reporting of events was formed.Conclusions:Increasing stroke symptom awareness through symptom recognition, stroke simulation, and empowering nurses to activate stroke alerts improved patient care and outcomes for those who experienced a stroke while hospitalized. Staff recognition of stroke symptoms increased, resulting in more inpatient stroke alerts, thrombolytic administrations, and thrombectomies for acute ischemic strokes.

Stroke, Volume 56, Issue Suppl_1, Page ATP77-ATP77, February 1, 2025. Background and Issues:Timely diagnosis and treatment are essential for optimal outcomes in acute stroke care. The lack of EMS integration into the stroke system of care is leading to delays in treatment resulting in poor outcomes. The absence of centralized resources at the Comprehensive Stroke Center (CSC) results in delayed patient care and worsened outcomes.Purpose:This project aimed to enhance EMS stroke recognition and improve triage to appropriate stroke centers, thereby reducing treatment times. The successful integration of EMS with an optimized CSC triage protocol seeks to reduce hospital stays, mortality rates, direct costs, and long term disability.Method:Effective integration of EMS into the stroke system of care was achieved by developing triage protocols with local EMS leaders. Adoption of a standardized stroke triage assessment tool was implemented. Centralizing resources at the CSC was a multidisciplinary approach to streamline the identification and treatment of stroke patients in a definitive location near CT scan. Stroke triage education and mock drills were provided to local EMS agencies and the acute stroke team. Outcomes were measured using pre and post intervention data for TNK administrations and endovascular therapy.Results:Outcomes were measured in two groups of acute stroke patients who received TNK, mechanical thrombectomy, or both. 115 patients from 2022 prior to project initiation and 131 patients from 2023 after its initiation. TNK door-to-needle time decreased from 37 to 32 minutes. Thrombectomy door-to-revascularization time dropped from 118 to 85 minutes. Average hospital stay reduced from 8 to 7 days. Mortality rates fell from 13.04% to 3.94%. Direct costs decreased from $27,989 to $24,109. Thrombectomy mortality decreased from 17.14% to 6.06%. 90-day modified Rankin score 2 or less improved from 45% to 49%. Average EMS first contact to revascularization went from 152 minutes to 120 minutes. Average EMS first contact to TNK administration went from 70 minutes to 67 minutes.Conclusion:The implementation of standardized EMS triage protocols and centralized resources at the CSC led to significant improvements in acute stroke care. The interventions resulted in faster treatment times, reduced hospital days, lower mortality rates, decrease in direct costs, and improved long-term functional outcomes. These findings highlight the significance of EMS integration and resource centralization to improve patient outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATP89-ATP89, February 1, 2025. Introduction:Pulsara and Viz.ai are advanced technologies designed to streamline acute stroke care. Pulsara facilitates real-time communication and dynamic team building for stroke management, ensuring rapid connection with neurologists and interventionalists. Viz.ai uses AI-powered algorithms to accelerate diagnosis and optimize care pathways, improving outcomes by enhancing coordination between neurology and interventionalist teams. This study evaluates whether these innovations have led to significant reductions in treatment times and length of stay (LOS) in a single center.Methods:We conducted a single-center, retrospective analysis comparing acute ischemic stroke and TIA patients across three periods: pre-Pulsara (January 1, 2013–July 31, 2018; n=96), post-Pulsara/pre-Viz (August 1, 2018–April 30, 2022; n=71), and post-Viz (May 1, 2022–December 31, 2023; n=28). We analyzed door-to-CT, door-to-needle, and door-to-puncture times using the Kruskal-Wallis test, followed by pairwise Wilcoxon tests with Bonferroni correction for post-hoc comparisons.Results:Significant reductions in treatment times were observed across the three periods. Median door-to-needle time decreased significantly from 59.05 minutes pre-Pulsara to 29.78 minutes post-Viz (p < 0.001). Median door-to-CT time improved from 16.75 minutes pre-Pulsara to 9.54 minutes post-Viz (p < 0.01). Median door-to-puncture time showed substantial reduction from 131.42 minutes pre-Pulsara to 61.69 minutes post-Viz (p < 0.01). However, no significant differences were observed in LOS between the groups.Conclusion:The integration of Pulsara and Viz.ai into stroke care significantly reduced critical treatment times, particularly in door-to-needle and door-to-puncture metrics, underscoring the effectiveness of these technologies in enhancing the speed and coordination of acute stroke management. However, no significant impact on length of stay was observed, suggesting that further factors may influence this outcome.

Stroke, Volume 56, Issue Suppl_1, Page ATP61-ATP61, February 1, 2025. Background:Intracerebral hemorrhage (ICH) constitutes 10% of all strokes and is the most fatal and debilitating subtype. Unlike ischemic stroke, treatment strategies for ICH have not advanced as rapidly, resulting in limited adoption of specialized care metrics. Translating current guidelines into actionable performance measures is central to enhancing care delivery and improving ICH patient outcomes.Objective:Establish a three-year national initiative focused on promoting ICH data collection and analysis with specific ICH education, model share events, and protocol contribution which is built on existing hospital quality improvement work.Methods:In February 2023, expanded data elements and sixteen measures for ICH care adopted from theClinical Performance Measures for Adults Hospitalized with Intracerebral Hemorrhagewere added to the American Heart Association’s Get With The Guidelines® (GWTG)-Stroke registries. This allowed hospitals to identify gaps and barriers in care with support from AHA staff through training, model sharing, and resource development.Findings:The initiative led to a significant increase in data collection entered into GWTG-Stroke registry during 2023. It also identified gaps in care, particularly inLast Known Well, Baseline Severity Scoredocumentationand Time to Anticoagulation Reversal.Conclusions:This national initiative allows for hospitals to analyze data, exchange challenges, develop strategies and resources, all aimed at fostering continuous quality improvement in ICH guideline adherence. Enhanced data collection established during the initiative timeframe will prove to strengthen insights into ICH care for years to come.

Stroke, Volume 56, Issue Suppl_1, Page AWP268-AWP268, February 1, 2025. Introduction:The overall composition of stroke subtype is typically stable within biogeographical groups. Whether the COVID-19 pandemic impacted stroke etiology is still being investigated, but most studies have been performed outside the United States. This study sought to determine the composition of acute ischemic strokes (AIS) before and during the pandemic.Methods:This retrospective cohort study was conducted at a comprehensive stroke center in Colorado (USA). Adults (≥18) with AIS were compared based on admission date: Pre-COVID period (1/1/2019 – 12/31/2019) vs. COVID period (3/1/2020 – 3/1/2021). Stroke subtype was examined using TOAST classification: 1) large artery atherosclerosis; 2) cardioembolic; 3) small vessel occlusion; 4) other known etiology (e.g., hematologic disorders or arterial dissection); 5) cryptogenic stroke. Comparisons were made with Pearson chi-square tests.Results:There were 2,130 patients with AIS during the study period: Pre-COVID (n=1,034) and COVID (n=1,096). There were significant differences in stroke subtype by time period (Table 1). Compared to the pre-COVID period, the COVID period had a lower proportion of strokes from large artery atherosclerosis (17.6% vs. 12.1%, p

Isa-Aii, con Stroke Action Plan for Italy obiettivo 90% nel 2030

Objective
Shared medical appointments (SMAs) are an innovative care delivery method that provides delivery of clinical care while also supporting self-management. Their usefulness for mental health conditions has only briefly been explored, though early evidence demonstrates their utility for supporting mental health management. Therefore, this study set out to better understand the views that adults with anxiety and depression have towards SMAs as a way of receiving care to support self-management in primary care.

Design and methods
A qualitative study using 1:1 semi-structured interviews which were analysed thematically following Braun and Clarke’s six-phase reiterative process. We employed a deductive, theory-informed approach to thematically analyse the data.

Participants
The final sample consisted of 17 predominantly White ethnic adults with a clinical diagnosis of anxiety and/or depression from five different regions in England. Participants represented a broad age group (22–74 years) and a range of socioeconomic backgrounds.

Results
Three main themes were established: (1) motivation to attend an SMA, (2) barriers and challenges to SMA engagement and (3) implementation preferences. The concept of SMAs was largely acceptable to participants, although participants reported several factors that would influence their decision to attend an SMA. Participants held some reservations but were on the whole receptive to the idea. The main benefits reported were peer support, support for self-management and quicker access to care. Drawbacks reported included risks to patient confidentiality, negative impact on emotional well-being and the unsuitability of the group setting for some patients. Some salient preferences identified included face-to-face/hybrid delivery formatting and mental health specialist involvement.

Conclusions
SMAs in primary care to support anxiety and depression self-management would be acceptable to patients, contingent on the mode of delivery of the SMAs. Future acceptability research should explore SMA appropriateness for diverse patient populations of different ethnic backgrounds, to inform their potential wider roll-out in English primary care.

Objectives
To explore the lived experiences of patients with advanced pancreatic cancer enrolled in a patient-reported outcomes (PROs) management programme and to preliminarily understand how PROs management influences various aspects of patient care and overall quality of life.

Design
A qualitative phenomenological study.

Setting
A national cancer care centre in Southwest China specialised in cancer care, with a comprehensive PROs management programme.

Participants
15 participants diagnosed with advanced pancreatic cancer.

Results
Five key themes emerged from our interviews, including enhanced communication with healthcare providers, attributed to the structured nature of PROs; increased perceived sense of care, with patients feeling more valued and heard; PROs management facilitated better treatment decision-making, with patients feeling more involved and empowered; improved communication with family members, aiding in better understanding and support; and varied perceptions of the impact on quality of life, with some noting improvements in specific aspects like symptom management, while others were uncertain about the overall benefit.

Conclusions
PROs management plays a significant role in improving communication between patients with advanced pancreatic cancer and their healthcare providers, enhancing patients’ involvement in treatment decisions, and potentially improving family dynamics. However, the impact of PROs management on the overall quality of life of patients remains complex and individualised. The findings suggest that further research with a more diverse patient population is needed to fully understand the implications of PROs management in advanced cancer care.

Introduction
Lung cancer is the leading cause of cancer-related mortality globally, with non-small cell lung cancer (NSCLC) comprising the majority of cases. For advanced NSCLC, immunotherapy offers substantial survival benefits but is often accompanied by severe immune-related adverse events symptoms, significantly affecting health-related quality of life (HRQoL). Routinely collection of patient-reported outcomes (PROs) followed by automated alerts has been shown to improve overall survival and HRQoL for cancers. However, there is limited evidence for PRO-based symptom monitoring on advanced NSCLC during immunotherapy. This study proposes an electronic PRO-based symptom tracking intervention, integrated with reactive alerts and nudges (PRO-NET) to improve HRQoL for advanced NSCLC patients receiving immunotherapy in China. Secondary objectives include assessing the effect of PRO-symptom monitoring on survival, physical function, symptom control, mental health, cost-effectiveness and implementation fidelity.

Methods and analysis
The PRO-NET study is a two-arm, parallel randomised controlled trial. The study will enrol at least 300 advanced NSCLC patients undergoing immunotherapy in China. Participants will be randomly assigned to either the intervention or control group in a ratio of 1:1 via PRO-NET programme. The intervention involves weekly electronic collection of immune-related PROs and reactive alerts sent directly to patients, combined with nudges over a 6-month period. Patients in the control group will follow usual care and will not trigger the alerts. Both the intervention and control groups will receive outcome assessments at baseline, 3 months and 6 months. Primary outcome focuses on HRQoL, while secondary outcomes include survival, physical function, symptom burden, mental health, cost-effectiveness and implementation fidelity. Differences in HRQoL between the groups will be compared using general linear mixed model, accounting for potential confounding.

Ethics and dissemination
The study was approved by the Institutional Review Board of the Peking University protocol on 21 July 2024 (No. IRB 00001052-24066). This protocol is based on V2.0, 6 July 2024 of the protocol. The results of this study will be disseminated through peer-reviewed publications and academic conferences.

Trials registration number
ChiCTR2400088408.

Objective
Delayed neurocognitive recovery, previously known as postoperative cognitive dysfunction, is a common complication affecting older adults after surgery. This study aims to address the knowledge gap in postoperative neurocognitive recovery by exploring the relationship between subjective experiences, performance-based measurements, and blood biomarkers.

Design
Mixed-methods study with a convergent parallel (QUAL+quan) design.

Setting and participants
The study reports results from 40 older adult patients (52.5% women; mean age 73, SD 6.7) scheduled for total hip arthroplasty at a hospital in Sweden.

Outcome measures
Neurocognitive performance was assessed using a standardised test battery, neuroinflammation through blood biomarker analysis and postoperative neurocognitive recovery via semistructured interviews and the Swedish Quality of Recovery questionnaire.

Results
Five patients were classified as having delayed neurocognitive recovery based on performance tests. Qualitative data revealed that most patients reported cognitive symptoms, particularly related to executive functions and fatigue. Psychological factors, including a sense of agency and low mood, significantly influenced cognitive recovery and daily functioning. Elevated inflammatory blood biomarkers were not detected pre- or postoperatively in patients with delayed neurocognitive recovery. The global postoperative recovery score was 40.9, indicating a low quality of recovery.

Conclusion
Many patients reported subjective cognitive decline that was not corroborated by delayed neurocognitive recovery in the performance-based tests. Psychological factors were influential for neurocognitive recovery and should be routinely assessed. Future research should incorporate longitudinal follow-ups with performance-based measurements, fatigue assessment, evaluations of instrumental activities of daily living and subjective reporting, supported by a multidisciplinary team approach.

Trial registration number
NCT05361460.

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