Amelia Adcock (United States of America)

WVU Neurology
Rural health is a longstanding passion of mine. The impact of implementing real-world solutions to improve outcomes in these settings was first demonstrated to me as a Peace Corps Volunteer and ultimately led to my pursuit of medicine. I completed neurology/vascular neurology subspecialty training at Mayo Clinic Scottsdale where I remain as supplemental faculty. I am an Associate Professor at West Virginia University, a predominantly rural state. Effective systems of care are critical to resilient rural health models. Therefore, I conduct research, mentor trainees, and serve on multiple boards that emphasize care optimization and innovative approaches to reach our patients.

Author Of 1 Presentation

 Conference Calendar

UTILIZATION AND OUTCOMES OF ENDOVASCULAR THROMBECTOMY IN PATIENTS 80 YEARS AND OLDER

Session Name
0870 - Acute Stroke Therapy 2 (ID 77)
Session Type
Free Communication Session
Date
29.10.2021, Friday
Session Time
15:15 - 16:45
Room
FREE COMMUNICATIONS A
Presenter
Lecture Time
15:25 - 15:35

Abstract

Background and Aims

Patients aged 80 and over were often excluded or under-represented in pivotal endovascular thrombectomy (EVT) trials. Accordingly, trends in frequency, outcomes, and disparities of EVT use merit close analysis.

Methods

From a pool of 2.4 million AIS cases in the Get With The Guidelines-Stroke US nationwide registry from April 2012 to June 2019, we identified patients potentially eligible for EVT treatment (i.e., arrived≤6h, NIHSS≥6). We compared EVT use and outcomes between those ages ≥80y vs <80y.

Results

Among 42,422 patients arriving ≤6h and receiving EVT at 614 sites, 12,768 (30.1%) were age ≥80. EVT rates in these potentially EVT-eligible very old patients increased substantially during the study period, from 3.3% in early 2012 to 20.8% in early 2019. This increase paralleled that in younger patients so that, by study period end, the relative rate of EVT in ≥80y vs <80y had risen to 0.76. Older patients had poorer outcomes at discharge compared with younger patients, including discharge to home: 12.5% versus 31.1%, aOR 0.43 (95%CI 0.40-0.46), functional independence (mRS 0-2): 10.9% vs 26.6%, aOR 0.45 (0.41-0.49), and inpatient death/hospice, 34.5% vs 16.1%, aOR 2.22 (2.09-2.36). However, symptomatic intracranial hemorrhage rates did not differ, 6.9% vs 6.5%, aOR 1.04 (0.94-1.14).

Conclusions

Use of EVT among the very old has increased dramatically, though rates remain lower than in younger patients. Although favorable functional outcomes at discharge are lower and combined mortality/discharge to hospice higher in the oldest old, the risk of symptomatic intracranial hemorrhage is not increased.

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Presenter of 1 Presentation

 Conference Calendar

UTILIZATION AND OUTCOMES OF ENDOVASCULAR THROMBECTOMY IN PATIENTS 80 YEARS AND OLDER

Session Name
0870 - Acute Stroke Therapy 2 (ID 77)
Session Type
Free Communication Session
Date
29.10.2021, Friday
Session Time
15:15 - 16:45
Room
FREE COMMUNICATIONS A
Presenter
Lecture Time
15:25 - 15:35

Abstract

Background and Aims

Patients aged 80 and over were often excluded or under-represented in pivotal endovascular thrombectomy (EVT) trials. Accordingly, trends in frequency, outcomes, and disparities of EVT use merit close analysis.

Methods

From a pool of 2.4 million AIS cases in the Get With The Guidelines-Stroke US nationwide registry from April 2012 to June 2019, we identified patients potentially eligible for EVT treatment (i.e., arrived≤6h, NIHSS≥6). We compared EVT use and outcomes between those ages ≥80y vs <80y.

Results

Among 42,422 patients arriving ≤6h and receiving EVT at 614 sites, 12,768 (30.1%) were age ≥80. EVT rates in these potentially EVT-eligible very old patients increased substantially during the study period, from 3.3% in early 2012 to 20.8% in early 2019. This increase paralleled that in younger patients so that, by study period end, the relative rate of EVT in ≥80y vs <80y had risen to 0.76. Older patients had poorer outcomes at discharge compared with younger patients, including discharge to home: 12.5% versus 31.1%, aOR 0.43 (95%CI 0.40-0.46), functional independence (mRS 0-2): 10.9% vs 26.6%, aOR 0.45 (0.41-0.49), and inpatient death/hospice, 34.5% vs 16.1%, aOR 2.22 (2.09-2.36). However, symptomatic intracranial hemorrhage rates did not differ, 6.9% vs 6.5%, aOR 1.04 (0.94-1.14).

Conclusions

Use of EVT among the very old has increased dramatically, though rates remain lower than in younger patients. Although favorable functional outcomes at discharge are lower and combined mortality/discharge to hospice higher in the oldest old, the risk of symptomatic intracranial hemorrhage is not increased.

Hide