Background and Purpose: Hospitals are increasingly utilizing 30-day readmission to define quality of care and reimbursement. We hypothesized that common infections occurring during the stroke stay are associated with 30-day readmission (30dRA). Methods: We conducted a weighted analysis of the federally managed 2013 National Readmission Database to assess the relationship between infection during a stroke hospitalization and 30dRA among ischemic stroke survivors. Ischemic stroke, common infections (defined as sepsis, pneumonia (PNA), and urinary tract infection (UTI)), and comorbidities were identified using ICD-9 diagnosis codes, and IV-tPA or intra-arterial therapy was identified using ICD-9 procedure codes. Survey design logistic regression models were fit to estimate crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between infections and 30dRA. Results: Among 319, 317 ischemic stroke patients, 12.1% were readmitted within 30 days, and 29% had an infection during their index hospitalization. Patients with infection during their stroke admission had a 21% higher odds of being readmitted than patients without any type of infection (adjusted OR 1.21, 95%CI 1.16–1.26). The association between infection and unplanned readmission was similar with an increased odds of unplanned readmission (adjusted OR 1.23, 95%CI 1.18–1.29). When assessing specific types of infections, only urinary tract infections were associated with 30-day readmission in adjusted models (OR 1.10, 95%CI 1.04–1.16). Conclusions: In a nationally representative cohort, patients who had a common infection during their stroke hospitalization were at increased odds of being readmitted. Patients with infection may benefit from earlier post-stroke follow-up or closer monitoring.

Background Influenza may be associated with increased stroke and myocardial infarction (MI) risk. We hypothesized that risk of stroke and MI after influenza-like illness (ILI) would be higher in patients in New York State. We additionally assessed whether this relationship differed across a series of sociodemographic factors. Methods A case-crossover analysis of the 2012–2014 New York Statewide Planning and Research Cooperative System (SPARCS) was used to estimate odds of ischemic stroke and MI after ILI. Each patient’s case window (the time period preceding event) was compared to their control windows (same dates from the previous 2 years) in conditional logistic regression models used to estimate odds ratios and 95% confidence intervals (OR, 95% CI). We varied the case windows from 15 to 365 days preceding event as compared to control windows constructed using the same dates from the previous 2 years. Analyses were stratified by sex, race, and urban-rural status based on residential zip code. Results A total of 33,742 patients were identified as having ischemic stroke and 53,094 had MI. ILI events in the 15 days prior were associated with a 39% increase in odds of ischemic stroke (95% CI 1.09–1.77), increasing to an almost 70% increase in odds when looking at ILI events over the last year (95% CI 1.56, 1.83). In contrast, the effect of ILI hospitalization on MI was strongest in the 15 days prior (OR = 1.24, 95% CI 1.06–1.44). The risk of ischemic stroke after ILI was higher among individuals living in rural areas in the 90 days prior to stroke and among men in the year prior to event. In contrast, the association between ILI and MI varied only across race with whites having significantly higher ILI associated MI. Conclusion This study highlights risk period differences for acute cardiovascular events after ILI, indicating possible differences in mechanism behind the risk of stroke after ILI compared to the risk of MI. High risk populations for stroke after ILI include men and people living in rural areas, while whites are at high risk for MI after ILI. Future studies are needed to identify ways to mitigate these risks.

Background and Purpose: Influenza may be associated with stroke risk. We hypothesized that risk of ischemic stroke is increased after influenza-like illness (ILI), and that these effects are even greater for those in an urban environment, of Black race, and male sex. Methods: A case-crossover analysis of the 2012-2014 inpatient and outpatient New York Statewide Planning and Research Cooperative System (SPARCS) was used to estimate the odds of hospitalization for ischemic stroke after hospitalization for ILI. Each patient’s case window (the time period preceding stroke) was compared to their control windows (constructed using the same dates from the previous two years) in conditional logistic regression models used to estimate odds ratios and 95% confidence intervals (OR, 95% CI). We varied the case windows from 15 to 365 days. Analyses were stratified by urban and rural status based on residential zip code, sex, and race. Results: A total of 30,912 patients were identified as having an ischemic stroke in 2014 and included in the study (49% male, 20% Black, 84% urban, mean age 71.9 [SD 14.7] years). ILI in the 15 days before a stroke was associated with an overall increase in odds of stroke (OR=1.39, 95% CI 1.09-1.77), and this association remained over time (Table). There was no significant interaction between ILI and urbanicity (p=0.29), sex (p=0.81), or race (p=0.85). Conclusion: ILI was associated with stroke risk, but there was no evidence of race, sex or location differences in the relationship between ILI and stroke.

Introduction Idiopathic hypersomnia (IH) is a rare neurologic disorder that can cause debilitating symptoms, including excessive daytime sleepiness, severe sleep inertia, prolonged nighttime sleep, long and unrefreshing naps, and cognitive dysfunction. Limited research has investigated the clinical burden associated with IH. This study compared the clinical profile of patients diagnosed with IH versus matched non-IH controls. Methods MarketScan® administrative claims were analyzed between December 2013 and February 2020. Eligible patients were aged ≥18 years upon cohort entry and had 365 days of continuous medical coverage (gaps ≤30 days allowed) before and after cohort entry. IH cases entered the cohort upon the first medical claim containing an IH diagnosis and without history of cataplexy. Non-IH controls were matched 5:1 to patients with IH on age, sex, region, payer type, and cohort entry date. Prevalence estimates of Clinical Classification System Multilevel (CCSM) categories and comorbid conditions during the 2-year study period were compared between cohorts using logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results The final cohorts included 11,428 and 57,138 patients with IH and non-IH controls, respectively. Approximately two-thirds of the sample was female (65.0%); median age was 45 years. Compared with non-IH controls, patients with IH experienced significantly higher prevalence of all CCSM categories. Prevalence estimates of conditions associated with sleep disorders, such as sleep apnea (OR: 26.1 [CI: 24.8, 27.6]), mood disorders (OR: 3.7 [CI: 3.6, 3.9]), and headache/migraine (OR: 2.9 [CI: 2.7, 3.0]), were higher among patients with IH. Similarly, cardiovascular conditions, including cardiovascular disease (OR: 2.2 [CI: 2.1, 2.4]), stroke (OR: 2.2 [CI: 2.0, 2.4]), major adverse cardiovascular events (OR: 2.2 [CI: 2.0, 2.4]), a composite of hypertension diagnosis or use of antihypertensive medications (OR: 2.0 [CI: 2.0, 2.1]), and heart failure (OR: 2.0 [CI: 1.8, 2.3]), were significantly more prevalent among patients with IH. Conclusion Patients with IH experience a significant burden of psychiatric and medical comorbidities, including acute and chronic cardiovascular illnesses. This is consistent with observations in other sleep disorders, namely, narcolepsy. Holistic treatment strategies for IH patients are needed, requiring careful consideration of patients’ overall clinical profile when selecting therapies. Support (if any) Jazz Pharmaceuticals.

Background: New hereditary angioedema (HAE) treatments have become available in recent years for the treatment of HAE due to C1-inhibitor (C1-INH) deficiency, including two subcutaneous (SC) options: a monoclonal antibody (lanadelumab) and a plasma-derived C1-INH concentrate (SC-C1-INH). Limited real-world data on these therapies have been reported.Objective: The objective was to describe new users of lanadelumab and SC-C1-INH, including demographics, healthcareresource utilization (HCRU), costs, and treatment patterns before and after beginning treatment.Methods: This was a retrospective cohort study that used an administrative claims data base. Two mutually exclusive cohorts of adult (ages 18 years) new users of lanadelumab or SC-C1-INH with 180 days of continuous use were identified. HCRU, costs, and treatment patterns were assessed in the 180-day period before the index date (new treatment use) and up to 365 days after the index date. HCRU and costs were calculated as annualized rates.Results: Forty-seven patients who used lanadelumab and 38 patients who used SC-C1-INH were identified. The most frequentlyused on-demand HAE treatments at baseline were the same for both cohorts: bradykinin B2 antagonists (48.9% of the patients on lanadelumab, 52.6% of the patients on SC-C1-INH) and C1-INHs (40.4% of the patients on lanadelumab, 57.9% of the patients on SC-C1-INH). More than 33% of the patients continued to fill on-demand medications after treatment initiation. Annualized angioedema-associated emergency department visits and hospitalizations decreased after initiation of treatment, from 1.8 to 0.6 for the patients on lanadelumab and from 1.3 to 0.5 for the patients on SC-C1-INH. Annualized total healthcare costs after treatment initiation in the database were $866,639 and $734,460 for the lanadelumab and SC-C1-INH cohorts, respectively. Pharmacy costs accounted for >95% of these total costs.Conclusion: Although HCRU decreased after the initiation of treatment, angioedema-associated emergency department visits and hospitalizations and on-demand treatment fills were not completely eliminated. This indicates ongoing disease andtreatment burden despite use of modern HAE medicines.