Older Subjects Admitted to Hospital With Stroke From Long-Term Care: A National Cohort and Case Control Study.

Objectives: Internationally about 3% of people ≥65 years live in long-term care (LTC) settings. Older people living in nursing homes are more likely to be admitted to hospital. We examined the characteristics and outcomes of stroke patients admitted from LTC nationally and how this changed over the COVID-19 pandemic.

Should octogenarians and people aged 90 years and over be treated separately in studies of stroke? An evaluation of national audit data.

Introduction: Population studies frequently use ≥80 years for defining 'very old' but as mean life expectancy frequently exceeds 80 years internationally, this may no longer be appropriate. Those ≥90 years now represent a significant proportion of stroke patients. We examined national data to examine the differences between those 80-89 years and those 90+ years.

Anticoagulation usage and thrombolytic therapy in subjects with atrial fibrillation-associated ischemic stroke.

Background: Atrial fibrillation (AF) causes up to 20% of ischemic strokes and 30% in some populations such as those more than 80 years. Previous research showed that widespread adoption of Direct Oral Anticoagulant (DOAC) prophylaxis had not been associated with a reduction in AF-associated stroke prevalence but there was a considerable rate of breakthrough stroke in patients receiving anticoagulation and anticoagulation rate may be affected by increasing use of DOACs.

Aims: We undertook a more detailed study using the Irish National Audit of Stroke (INAS) to determine the characteristics of anticoagulation practice in AF-associated stroke, particularly breakthrough stroke, adherence to prescribing guidelines and effect on thrombolysis rate.

Hospital overcrowding and care of stroke patients: Irish national audit of stroke.

Introduction: Hospital overcrowding where patient admissions exceed capacity is associated with worse outcomes in Emergency Department. Developments in emergency stroke care have been associated with improvements in stroke outcome but are dependent on effective, organised care. We examined if overcrowding in the hospital system was associated with negative changes in stroke outcome.

The impact of hospital presentation time on stroke outcomes: A nationally representative Irish cohort study.

Objectives: There is conflicting evidence regarding the outcomes of acute stroke patients who present to hospital within normal working hours ('in-hours') compared with the 'out-of-hours' period. This study aimed to assess the effect of time of stroke presentation on outcomes within the Irish context, to inform national stroke service delivery.

Materials And Methods: A secondary analysis of data from the Irish National Audit of Stroke (INAS) from Jan 2016 to Dec 2019 was carried out.

Changes in anticoagulation practice in subjects admitted with stroke associated with atrial fibrillation, following introduction of direct oral anticoagulants over 2013-2021.

Background: The adoption of direct oral anticoagulants (DOACs) has changed practice in prevention of stroke in atrial fibrillation (AF). We used Irish data national data on stroke and anticoagulation therapy over 9 years to investigate changes in anticoagulation practice and potential consequences on stroke prevalence and thrombolysis.

Methods: AF, anticoagulation, thrombolysis, and stroke data from the Irish National Audit of Stroke (INAS) 2013-2021 were reviewed.

Hospital size, remoteness and stroke outcome.

Introduction: Previous studies have shown an association between number of stroke admissions and outcomes. Small hospitals often support more remote areas and we studied national data to determine if an association exists between hospital remoteness and stroke care.

Methods: Data from the Irish National Audit of Stroke (INAS) on average stroke admissions, adjusted mortality for ischaemic stroke, thrombolysis rate and proportion with door to needle (DTN) ≤45 min were analysed.

The association between increasing oral anticoagulant prescribing and atrial fibrillation related stroke in Ireland.

Aims: Recent increases in the number of patients with atrial fibrillation (AF) prescribed oral anticoagulants (OAC) are evident in Ireland and internationally, largely due to the availability of direct oral anticoagulants (DOACs). This study aimed to determine the rate of stroke in the context of increasing anticoagulation utilisation, with a focus on AF-related ischaemic stroke (IS).

Methods: Dispensing data for OACs were identified for the period 2010-2018 as well as hospital discharges for IS (2005-2018).

Development of a national stroke audit in Ireland: scoping review protocol.

Introduction Recent advances in stroke management and care have resulted in improved survival and outcomes. However, providing equitable access to acute care, rehabilitation and longer-term stroke care is challenging. Recent Irish evidence indicates variation in stroke outcomes across hospitals, and a need for continuous audit of stroke care to support quality improvement.

Drip and ship versus direct to endovascular thrombectomy: The impact of treatment times on transport decision-making.

Introduction: In ischaemic stroke care, fast reperfusion is essential for disability free survival. It is unknown if bypassing thrombolysis centres in favour of endovascular thrombectomy (mothership) outweighs transport to the nearest thrombolysis centre for alteplase and then transfer for endovascular thrombectomy (drip-and-ship). We use conditional probability modelling to determine the impact of treatment times on transport decision-making for acute ischaemic stroke.

A comparison of service organisation and guideline compliance between two adjacent European health services.

Introduction: Outcomes in stroke patients are improved by a co-ordinated organisation of stroke services and provision of evidence-based care. We studied the organisation of care and application of guidelines in two neighbouring health care systems with similar characteristics.

Methods: Organisational elements of the 2015 National Stroke Audit (NSA) from the Republic of Ireland (ROI) were compared with the Sentinel Stroke National Audit Programme (SSNAP) in Northern Ireland (NI) and the United Kingdom (UK).