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June 2017; 7 (3) Research

Early transition to comfort measures only in acute stroke patients

Analysis from the Get With The Guidelines–Stroke registry

Shyam Prabhakaran, Margueritte Cox, Barbara Lytle, Phillip J. Schulte, Ying Xian, Darin Zahuranec, Eric E. Smith, Mathew Reeves, Gregg C. Fonarow, Lee H. Schwamm
First published May 24, 2017, DOI: https://doi.org/10.1212/CPJ.0000000000000358
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Article Information

vol. 7 no. 3 194-204
DOI: 
https://doi.org/10.1212/CPJ.0000000000000358
Published By: 
Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology
Print ISSN: 
2163-0402
Online ISSN: 
2163-0933
History: 
  • Received December 2, 2016
  • Accepted February 10, 2017
  • First Published May 24, 2017.

Article Versions

Copyright & Usage: 
© 2017 American Academy of Neurology

Author Disclosures

    1. Shyam Prabhakaran, MD, MS,
    2. Margueritte Cox, MS, MGIST,
    3. Barbara Lytle, MS,
    4. Phillip J. Schulte, PhD,
    5. Ying Xian, MD, PhD,
    6. Darin Zahuranec, MD, MS,
    7. Eric E. Smith, MD, MPH,
    8. Mathew Reeves, PhD,
    9. Gregg C. Fonarow, MD and
    10. Lee H. Schwamm, MD
  1. Shyam Prabhakaran, MD, MS,
    2. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. Current Atherosclerosis Reports; Section editor; 2014-2016

    Patents:

    1. NONE

    Publishing Royalties:

    1. Cryptogenic stroke, Uptodate, 2006-current

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NINDS: NS084288-01A1 (3/2014-present; PI); 1U10NS086608- 01 (10/2013-present, PI) PCORI: AD-1310-07237 (10/2014-present, PI)

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  2. Margueritte Cox, MS, MGIST,
    3. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  3. Barbara Lytle, MS,
    4. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  4. Phillip J. Schulte, PhD,
    5. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. Mayo Clinic (Rochester, MN) is my current employer. The Research work related to this manuscript was performed while at the Duke Clinical Research Institute, as attributed in the manuscript.

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  5. Ying Xian, MD, PhD,
    6. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. American Heart Association

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  6. Darin Zahuranec, MD, MS,
    7. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. (1) NIH/NIA [#K23 AG038731] (PI) 2011-present (2) NIH/NINDS [#R01 NS09112] (PI) 2015-present

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  7. Eric E. Smith, MD, MPH,
    8. Scientific Advisory Boards:

    1. 1. Data safety monitoring board MR Witness trial, Massachusetts General Hospital (2011-2016).

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. 1. American Heart Association, travel expenses, 2015.

    Editorial Boards:

    1. 1. Stroke, Assistant Editor, 2010-present. 2. Journal of the American Heart Association, Editorial Board, 2011-present. 3. Neurology, Editorial Board, 2017-present.

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. 1. Canadian Institutes for Health Research (2), PI, 2009- 2014, 2013-2018, and 2015-2020. 2. Brain Canada, PI, 2016-2019. 2. Alberta Innovates Health Solutions, PI, 2010- 2017. 3. Canadian Partnership Against Cancer, Research Grant, co-PI, 2013-2017. 4. European Union Joint Program on Neurodegenerative Diseases, 2016-2017.

    Research Support, Academic Entities:

    1. 1. McMaster University, research services contracts, 2011- present.

    Research Support, Foundations and Societies:

    1. 1. Heart and Stroke Foundation of Canada, PI, 2012-2015.

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  8. Mathew Reeves, PhD,
    9. Scientific Advisory Boards:

    1. Non-profit. Advisory Board member ARAMIS Study, Duke University, no compensation.

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. Guest editor. Circulation- Cardiovascular Quality and Outcomes

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. Non-profit: Michigan Stroke Registry. Commercial: US Medical Management Inc (physician home-based practice service), Troy, Michigan.

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. PCORI funding, IHS-1310-07420-01, MISTT Study, PI, 2014- 2017. Veterans Health Administration, Functional Status Assessment after Hospitalization, Co-I, 1-year grant. 2016-2017.

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  9. Gregg C. Fonarow, MD and
    10. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. (1) Employee of the University of California, which holds a patent on retriever devices for stroke.

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. (1) Novartis (2) Pfizer

    Speakers' Bureaus:

    1. NONE

    Other activities:

    1. Serves as a member of the Get With the Guidelines (GWTG) steering committee

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. (1) National Institutes of Health (2) Patient-Centered Outcomes Research Institute

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  10. Lee H. Schwamm, MD
    11. Scientific Advisory Boards:

    1. Serve on the scientific advisory boards for (1) LifeImage (2) Medtronic clinical trial design for AF related stroke (3) NovoNordisk DeVote trial DSMB, (4) Toyama Pharma: stroke recovery trial consultant

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. Neurocritical Care, Editorial board (2007-) Stroke, editorial Board (2010-) Frontiers in TeleNeurology, Editorial board (2010-) Circulation Cardiovascular Quality and Outcomes

    Patents:

    1. Schwamm LH, Sorensen AG, inventors; The General Hospital Corporation assignee. Imaging system for obtaining quantitative perfusion indices. US Patent 6,542,769. 2003 Apr 1.

    Publishing Royalties:

    1. Acute Ischemic Stroke: Imaging and Intervention, 2nd Edition. Heidelberg, Germany: Springer-Verlag GmbH; 2011

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. Serve on the scientific advisory boards for (1) LifeImage (2) Medtronic clinical trial design for AF related stroke (3) NovoNordisk DeVote trial DSMB, (4) Toyama Pharma: stroke recovery trial consultant, (5) Flare Capital teleradiology, and (6) Mass Dept of Public Health on stroke systems of care

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. (1) Genentech; principal investigator of an investigator- initiated study of extended-window intravenous thrombolysis funded by the National Institutes of Neurological Disorders and Stroke (clinicaltrials.gov/show/NCT01282242) for which Genentech provides alteplase free of charge to Massachusetts General Hospital as well as supplemental per-patient payments to participating sites

    Research Support, Government Entities:

    1. (1) NINDS, P50NS051343, PI of sub-R01, 2010-2016 principal investigator of an investigator- initiated study of extended-window intravenous thrombolysis funded by the National Institutes of Neurological Disorders and Stroke (clinicaltrials.gov/show/NCT01282242) for which Genentech provides alteplase free of charge to Massachusetts General Hospital as well as supplemental per-patient payments to participating sites (2) NIH-NINDS 5U01NS077179-02 (Cudkowicz, PI) 09/30/2011- 08/31/2018 Clinical Coordinating Center for the Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT) The long-term objective of the Network of Excellence in Neuroscience Clinical Trials (NEXT) initiative is to rapidly and efficiently translate advances n neuroscience into treatments for people with neurological disorders. Role: Investigator NINDS U10 NS086729 (Schwamm)10/01/2013 ? 09/30/2018 New England Regional Coordinating Center for the NINDS Stroke Trials Network This is an integrated team of hospitals and EMS agencies in Boston and Western Massachusetts that will develop new translational science and successfully execute the NINDS Stroke Trials Network Phase 1,2 and 3 studies. Role: PD/PI PCORI CDRN-1306-04608 (PI: MANDL)11/01/2015 ? 09/30/2017 Scalable Collaborative Infrastructure for a Learning Healthcare System (SCILHS) The major goal of this project is to create a national- scale clinical data research network to support patient centered outcomes research PCORI IHS-1310-07420 (PI Reeves)10/01/2014 ? 09/30/2017 Improving care transitions for acute stroke patients through a patient centered home based case management The major goals of this grant are to assemble relevant stroke stakeholders (stroke survivors and caregivers, stroke nurses, therapists, social workers, discharge planners, physiatrists, neurologists) to identify needs and barriers to improving transitions of care after stroke hospitalization, and to test two different interventions against usual care among 480 acute stroke patients in a pragmatic randomized, open clinical trial. Role: Consultant

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. LifeImage, 2014

    Legal Proceedings:

    1. NONE

  1. Feinberg School of Medicine (SP), Northwestern University, Chicago, IL; Duke Clinical Research Institute (MC, BL, PJS, YX), Durham, NC; University of Michigan (DZ), Ann Arbor; Hotchkiss Brain Institute (EES), University of Calgary, Canada; Michigan State University (MR), East Lansing; Ahmanson Cardiomyopathy Center (GCF), UCLA, Los Angeles, CA; Stroke Service (LHS), Massachusetts General Hospital, Boston; and Duke University Medical Center (YX), Durham, NC.
  1. Correspondence to:
    sprabhak{at}nm.org
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