Bruce Ovbiagele

Medical University of South Carolina, Charleston, South Carolina, United States

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Publications (234)1108.04 Total impact

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    ABSTRACT: Several studies have assessed the link between cognitive impairment and risk of future stroke, but results have been inconsistent. We conducted a systematic review and meta-analysis of cohort studies to determine the association between cognitive impairment and risk of future stroke.
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    ABSTRACT: There is a paucity of information on clinical characteristics, care patterns, and clinical outcomes for hospitalized intracerebral hemorrhage (ICH) patients with chronic kidney disease (CKD). We assessed characteristics, care processes, and in-hospital outcome among ICH patients with CKD in the Get With the Guidelines-Stroke (GWTG-Stroke) program.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 08/2014;
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    ABSTRACT: RationaleStroke is the second-leading cause of death in low- and middle-income countries, but use of evidence-based therapies for stroke prevention in such countries, especially those in Africa, is extremely poor. This study is designed to enhance the implementation and sustainability of secondary stroke-preventive services following hospital discharge.Aim/HypothesisThe primary study aim is to test whether a Chronic Care Model-based initiative entitled the Tailored Hospital-based Risk reduction to Impede Vascular Events after Stroke (THRIVES) significantly improves blood pressure control after stroke.DesignThis prospective triple-blind randomized controlled trial will include a cohort of 400 patients with a recent stroke discharged from four medical care facilities in Nigeria. The culturally sensitive, system-appropriate intervention comprises patient report cards, phone text messaging, an educational video, and coordination of posthospitalization care.Study OutcomesThe primary outcome is improvement of blood pressure control. Secondary endpoints include control of other stroke risk factors, medication adherence, functional status, and quality of life. We will also perform a cost analysis of THRIVES from the viewpoint of government policy-makers.DiscussionWe anticipate that a successful intervention will serve as a scalable model of effective postdischarge chronic blood pressure management for stroke in sub-Saharan Africa and possibly for other symptomatic cardiovascular disease entities in the region.
    International Journal of Stroke 08/2014; · 2.75 Impact Factor
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    ABSTRACT: Objective. A better understanding of the manuscript peer-review process could improve the likelihood that research of the highest quality is funded and published. To this end, we aimed to assess consistency across reviewers’ recommendations; agreement between reviewers’ recommendations and editors’ final decisions; and reviewer- and editor-level factors influencing editorial decisions in STROKE Journal.Methods. We analyzed all initial original contributions submitted to STROKE from January 2004 through December 2011. All submissions were linked to the final editorial decision (accept vs. reject). We assessed the level of agreement between reviewers (intraclass correlation coefficient). We compared the initial editorial decision (accept, minor revision, major revision and reject) across reviewers’ recommendations. We performed a logistic regression analysis to identify reviewer- and editor-related factors related to acceptance as the final decision.Results. Of 12,902 original submissions to STROKE during the 8-year study period, the level of agreement between reviewers was between fair and moderate (intraclass correlation coefficient 0.55, 95%CI: 0.09-0.75). Likelihood of acceptance was less than 5% if at least one reviewer recommended a rejection. In the multivariable analysis, higher reviewer-assigned priority scores were related to greater odds of acceptance (OR 26.3, 95%CI: 23.2-29.8); while higher numbers of reviewers (OR 0.54 per additional reviewer, 95%CI: 0.50-0.59) and suggestions for reviewers by authors vs. no suggestions (OR 0.83, 95%CI: 0.73-0.94) had lesser odds of acceptance.Interpretation. This analysis of the peer-review process of STROKE identified several factors that might be targeted to improve the consistency and fairness of the overall process. ANN NEUROL 2014. © 2014 American Neurological Association
    Annals of Neurology 07/2014; · 11.19 Impact Factor
  • Andrea D Boan, Daniel T Lackland, Bruce Ovbiagele
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    ABSTRACT: A substantial literature exists regarding cost-of-care outcomes in adult stroke, however less is known about pediatric stroke. The objective of this review of the literature was to examine studies of costs associated with pediatric stroke care. Six studies reporting data from individuals who experienced a pediatric stroke were included in the review. Cost data (charges and payments) were generally limited to one year and ranged from approximately US$15,000-140,000 depending upon stroke type. Pediatric stroke is linked to substantial costs but studies primarily emphasize the direct cost of care during the first year post-stroke onset. However, since many pediatric stroke survivors experience normal lifespans, they can also accumulate a significantly greater long term cost of care than strokes that occur in adulthood. Future studies are needed to examine long term direct costs, short and long term indirect costs and other economic outcomes in this population.
    Expert Review of Pharmacoeconomics & Outcomes Research 06/2014; · 1.67 Impact Factor
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    ABSTRACT: Mounting evidence points to a decline in stroke incidence. However, little is known about recent patterns of stroke hospitalization within the buckle of the stroke belt. This study aims to investigate the age- and race-specific secular trends in stroke hospitalization rates, inpatient stroke mortality rates, and related hospitalization charges during the past decade in South Carolina.
  • 06/2014; 45(6):1862-8.
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    ABSTRACT: Cardiovascular diseases, principally ischaemic heart disease and stroke, are the leading causes of global mortality and morbidity. Together with other non-communicable diseases, they account for more than 60% of global deaths and pose major social, economic and developmental challenges worldwide. In Africa, there is now compelling evidence that the major cardiovascular disease (CVD) risk factors are on the rise, and so are the related fatal and non-fatal sequelae, which occur at significantly younger ages than seen in high-income countries. In order to tackle this rising burden of CVD, the H3Africa Cardiovascular Working Group will hold an inaugural workshop on 30 May 2014 in Cape Town, South Africa. The primary workshop objectives are to enhance our understanding of the genetic underpinnings of the common major CVDs in Africa and strengthen collaborations among the H3Africa teams and other researchers using novel genomic and epidemiological tools to contribute to reducing the burden of CVD on the continent.
    Cardiovascular journal of Africa. 05/2014; 25:1-4.
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    ABSTRACT: IMPORTANCE The Stroke Prognostication using Age and the NIH Stroke Scale index, created by combining age in years plus a National Institutes of Health (NIH) Stroke Scale score of 100 or higher (and hereafter referred to as the SPAN-100 index), is a simple risk score for estimating clinical outcomes for patients with acute ischemic stroke (AIS). The association between this index and response to intravenous thrombolysis for AIS has not been properly evaluated. OBJECTIVE To assess the relationship between SPAN-100 index status and outcome following treatment with intravenous thrombolysis for AIS. DESIGN, SETTING, AND PARTICIPANTS Using the Virtual International Stroke Trials Archive (VISTA) database, an international repository of clinical trials data, we assessed the SPAN-100 index among 7093 patients with AIS who participated in 4 clinical trials from 2000 to 2006. The SPAN-100 index is considered positive if the sum of the age and the NIH Stroke Scale (a 15-item neurological examination scale with scores ranging from 0 to 42, with higher scores indicating more severe strokes) score is greater than or equal to 100. Multivariable logistic regression analyses were used to determine the independent association between SPAN-100 index status and 90-day outcomes. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of severe disability or death measured 90 days after stroke, and the secondary outcomes were death alone and a composite of no disability/modest disability. RESULTS Of 7093 patients, 743 (10.5%) were SPAN-100 positive, and 2731 (38.5%) received intravenous thrombolysis. Compared with SPAN-100-negative patients, SPAN-100-positive patients were more likely to experience a catastrophic outcome (adjusted odds ratio [AOR], 9.03 [95% CI, 6.68-12.21]) or death alone (AOR, 5.03 [95% CI, 4.06-6.23]) and less likely to experience a favorable outcome (AOR, 0.08 [95% CI, 0.06-0.13]). However, there was an interaction between SPAN-100 index status and thrombolysis treatment (P < .001) revealing a reduction in the likelihood of severe disability/death with thrombolytic treatment for SPAN-100-positive (AOR, 0.46 [95% CI, 0.29-0.71]) but not SPAN-100-negative patients (AOR, 0.96 [95% CI, 0.85-1.07]). Similar interactions between SPAN-100 index status and thrombolysis treatment were observed for the 2 secondary outcomes. CONCLUSION AND RELEVANCE Compared with the SPAN-100-negative patients with AIS, the SPAN-100-positive patients with AIS seem to have poorer 3-month outcomes but may derive greater benefit when treated with intravenous thrombolysis. The SPAN-100-positive patients are often excluded from AIS clinical trials but should probably not be denied thrombolysis treatment on the basis of such a profile alone.
    JAMA neurology. 05/2014;
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    ABSTRACT: The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.
    Stroke 05/2014; · 6.16 Impact Factor
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    ABSTRACT: Background: Clinical trials have failed to show a benefit of B vitamin therapy in reducing composite outcomes of cardiovascular death, myocardial infarction, and stroke among stroke survivors with elevated total serum homocysteine (tHcy) levels. Recent post hoc analyses have shown that numerous factors including age, baseline tHcy levels, folic acid fortification of grains, B12 status, renal function, comorbidities, and medications may modify the effect of B vitamin therapy on vascular risk in individuals with high tHcy. It remains possible that tHcy-lowering therapy may reduce cardiovascular risk in certain subgroups of stroke survivors. Post hoc subgroup analysis of the Heart Outcomes Prevention Evaluation-2 randomized controlled trial, which randomized participants with known cardiovascular disease to tHcy-lowering therapy or placebo, revealed larger treatment benefit for patients aged younger than 69 years; however, that analysis did not control for other factors. The aim of this study was to determine the effect of age on the impact of tHcy-lowering therapy for reducing vascular risk after stroke while controlling for other factors known to modify the effect of tHcy and tHcy-lowering therapy on vascular risk. Methods: In this post hoc analysis of the Vitamin Intervention for Stroke Prevention (VISP) trial, a randomized controlled trial of tHcy lowering for secondary stroke prevention, we excluded individuals who had poor renal function (glomerular filtration rate <47; the 10th percentile) or were treated with vitamin B12 injections. We assessed the effects of high-dose vitamin replacement on primary (stroke, myocardial infarction, or death) and secondary (stroke) outcomes, after stratifying by age (< vs. ≥ median age, 67 years) and adjusting for demographic and clinical factors. Results: This subgroup consisted of 2,993 individuals. Among individuals older than 67 years, high-dose vitamin therapy was associated with reduced risk of stroke, myocardial infarction or death (adjusted HR 0.76, 95% CI 0.58-0.99) and a trend towards reduced likelihood of stroke (adjusted HR 0.86, 95% CI 0.59-1.25). High-dose vitamin therapy did not impact outcomes among individuals younger than 67 years. Conclusions: In this post hoc subgroup analysis of the VISP trial, age modified the association between B vitamin therapy and recurrent vascular risk among stroke survivors with elevated serum tHcy levels. Older individuals with stroke were more likely to benefit from B vitamin therapy than younger individuals. These findings can help inform the future design of clinical trials of tHcy-lowering therapy for cardiovascular risk reduction after stroke. © 2014 S. Karger AG, Basel.
    Cerebrovascular Diseases 04/2014; 37(4):263-267. · 2.81 Impact Factor
  • Amytis Towfighi, Daniela Markovic, Bruce Ovbiagele
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    ABSTRACT: Blood pressure (BP) reduction lowers vascular risk after stroke; however, little is known about the relationship between consistency of BP control and risk of subsequent vascular events. In this post hoc analysis of the Vitamin Intervention for Stroke Prevention trial (n=3680), individuals with recent (<120 days) stroke, followed up for 2 years, were divided according to proportion of visits in which BP was controlled (<140/90 mm Hg): <25%, 25% to 49%, 50% to 74%, and ≥75%. Multivariable models adjusting for demographic and clinical variables determined the association between consistency of BP control versus primary (stroke) and secondary (stroke, myocardial infarction, or vascular death) outcomes. Only 30% of participants had BP controlled ≥75% of the time. Consistency of BP control affected outcomes in individuals with baseline systolic BP >132 mm Hg. Among individuals with baseline systolic BP >75th percentile (>153 mm Hg), risks of primary and secondary outcomes were lower in those with BP controlled ≥75% versus <25% of visits (adjusted hazard ratio, 0.46; 95% confidence interval, 0.26-0.84 and adjusted hazard ratio, 0.51; 95% confidence interval, 0.32-0.82). Individuals with mean follow-up BP <140/90 mm Hg had lower risk of primary and secondary outcomes than those with BP ≥140/90 mm Hg (adjusted hazard ratio, 0.76; 95% confidence interval, 0.59-0.98 and adjusted hazard ratio, 0.76; 95% confidence interval, 0.62-0.92). In this rigorous clinical trial, fewer than one third of patients with stroke had BP controlled ≥75% of the time for 2 years. Furthermore, consistency of BP control among those with elevated baseline systolic BP was linked to reduction in risk of recurrent stroke and stroke, myocardial infarction, and vascular death.
    Stroke 03/2014; · 6.16 Impact Factor
  • Wuwei Wayne Feng, Bruce Ovbiagele
    Journal of the neurological sciences 03/2014; · 2.32 Impact Factor
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    ABSTRACT: There is an urgent need to develop effective strategies to improve stroke outcomes in Sub-Saharan Africa (SSA), where use of evidence-based therapies among patients receiving conventional care is poor. Designs of behavioral interventions to improve stroke care in SSA need to be sensitive to both individual and community factors (including local perceptions and public policies) contributing to the likelihood of compliance with recommended therapeutic goals. This article presents a community-based participatory research protocol that will evaluate systems and processes affecting the continuum of stroke-preventive care in an SSA country. Phase 1 of the Tailored Hospital-based Risk Reduction to Impede Vascular Events study will be implemented from 2013 to 2014 at 4 different types of hospital settings in Nigeria. Six adult stroke survivor focus group discussions and six caregiver focus group discussions, each lasting about 120 minutes will be conducted. Each group will comprise 6 to 8 participants. We will also conduct 22 semi-structured key informant interviews (informed by the Theoretical Domains Framework) with several types of providers and hospital administrators. Purposive and maximum variation sampling will be used to identify and recruit participants from participating hospitals. Transcript data will be analyzed by reviewers in an iterative process to identify recurrent and unifying themes using a constructivist variant of the grounded theory methodology, and will involve participatory co-analysis with key stakeholders to enhance authenticity and veracity of findings. On the basis of the results of Tailored Hospital-based Risk Reduction to Impede Vascular Events phase 1, we intend to develop a culturally sensitive, system-appropriate, multipronged intervention whose efficacy to boost adherence to evidence-based stroke-preventive care will be tested in a future randomized trial (phase 2).
    Critical pathways in cardiology 03/2014; 13(1):29-35.
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    Oh Young Bang, Bruce Ovbiagele, Jong S Kim
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    ABSTRACT: Despite efforts to arrive at a diagnosis, the cause of stroke remains undetermined in 25% to 40% of patients. Factors contributing to undetermined causes of stroke include inadequate information about the underlying vascular pathology, ill-timed diagnostic workup, and incomplete evaluation. Fortunately, mounting evidence suggest that advanced diagnostic techniques may have great use in reducing the proportions of strokes of undetermined cause. For instance, long-term monitoring to document paroxysmal atrial fibrillation, high-resolution MRI technique to visualize wall pathology (ie, plaque, dissection, or vasculitis), coronary computed tomographic angiography to better establish potential sources of aortocardiac embolism, and laboratory tests for cancer-related coagulopathy can all assist with prompt identification of underlying stroke mechanisms and guide early specific treatments to improve stroke outcomes. Still, conducting many of the aforementioned advanced diagnostic techniques can be time-consuming and expensive, and so careful selection and judicious use of the most appropriate diagnostic modalities, guided by patients' characteristics at the time of presentation, are crucial. This review article provides an overview of the promising role of various advanced diagnostic techniques in the approach to deciphering the so-called cryptogenic strokes. It details sophisticated tools that have the potential to better inform clinicians caring for patients with stroke about the causative mechanisms at play (and, therefore, distinctive treatments that may be required) and presents pragmatic strategies for using these procedures in routine practice although the effectiveness of such strategies need to be tested in future longitudinal studies.
    Stroke 02/2014; · 6.16 Impact Factor
  • Stroke 02/2014; · 6.16 Impact Factor
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    ABSTRACT: Background: Currently, intensive lipid lowering is recommended in patients with atherosclerotic ischemic stroke or transient ischemic attack. However, the role of statin in cardioembolic stroke is unclear. We investigated the association of statin with pretreatment collateral status in cardioembolic stroke. Methods: A collaborative study from two stroke centers in distinct geographic regions included consecutive patients with acute middle cerebral artery (MCA) infarction due to atrial fibrillation (AF) who underwent cerebral angiography. The relationship between pretreatment collateral grade and the use/dose of statin at stroke onset was assessed. The angiographic collateral grade was evaluated according to the ASITN/SIR Collateral Flow Grading System. Results: Ninety-eight patients (76 statin-naïve, 22 statin users) were included. Compared with statin-naïve patients, statin users were older and more frequently had hypertension, hyperlipidemia and coronary heart disease. Excellent collaterals (grade 3-4) were more frequently observed in statin users (11 patients, 50%) than in statin-naïve patients (21 patients, 27.6%; p = 0.049). The use of atorvastatin 10 mg equivalent or higher doses of statin was associated with excellent collaterals (p for trend = 0.025). In multiple regression analysis, prestroke statin use was independently associated with excellent collaterals (odds ratio, 7.841; 95% confidence interval, CI, 1.96-31.363; p = 0.004). Conclusions: Premorbid use of statin in AF patients is associated with excellent collateral flow. Although most statin trials excluded patients with cardioembolic stroke, our data suggests the possibility that statin may be beneficial in AF-related stroke. © 2014 S. Karger AG, Basel.
    Cerebrovascular Diseases 01/2014; 37(2):77-84. · 2.81 Impact Factor
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    ABSTRACT: Relatively little is known about the quality of care and outcomes for hospitalized ischemic stroke patients with chronic kidney disease (CKD). We examined quality of care and in-hospital prognoses among patients with CKD in the Get With The Guidelines-Stroke (GWTG-Stroke) program
    Journal of the American Heart Association. 01/2014; 3(3).
  • Mayowa O. Owolabi, Bruce Ovbiagele
    Journal of the Neurological Sciences. 01/2014;

Publication Stats

3k Citations
1,108.04 Total Impact Points


  • 2013–2014
    • Medical University of South Carolina
      Charleston, South Carolina, United States
    • Rancho Los Amigos Rehabilitation Center
      Downey, California, United States
  • 2011–2013
    • Chang Gung Memorial Hospital
      • Division of Neurology
      Taipei, Taipei, Taiwan
  • 2007–2013
    • University of Toronto
      • Division of Neurology
      Toronto, Ontario, Canada
    • Northwestern University
      • Feinberg School of Medicine
      Evanston, IL, United States
    • Temple University
      • Department of Medicine
      Philadelphia, PA, United States
  • 2012
    • Henan Provincial People’s Hospital
      Cheng, Henan Sheng, China
    • Loma Linda University
      • Division of General Internal Medicine and Geriatric Medicine
      Loma Linda, CA, United States
  • 2011–2012
    • University of California, San Diego
      • Department of Neurosciences
      San Diego, CA, United States
  • 2009–2012
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      Torrance, California, United States
    • Hospital Italiano de Buenos Aires
      • Department of Neurology
      Buenos Aires, Buenos Aires F.D., Argentina
    • Uniformed Services University of the Health Sciences
      • Department of Neurology
      Bethesda, MD, United States
  • 2007–2012
    • University of Southern California
      • Department of Neurology
      Los Angeles, CA, United States
  • 2008–2011
    • Sungkyunkwan University
      • Department of Neurology
      Seoul, Seoul, South Korea
    • Hallym University
      Sŏul, Seoul, South Korea
  • 2004–2011
    • Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2003–2011
    • University of California, Los Angeles
      • • Center for Neurobiology of Stress
      • • Department of Neurology
      Los Angeles, CA, United States
    • Beth Israel Deaconess Medical Center
      • Department of Neurology
      Boston, MA, United States
  • 2010
    • Ajou University
      • Department of Neurology
      Seoul, Seoul, South Korea
  • 2009–2010
    • Samsung Medical Center
      • Department of Neurology
      Seoul, Seoul, South Korea
  • 2008–2010
    • Charles R. Drew University of Medicine and Science
      • • Family Medicine
      • • Department of Medicine
      Los Angeles, California, United States
  • 2006–2009
    • Children's Hospital Los Angeles
      • Division of Hospital Medicine
      Los Angeles, California, United States