Raed A. Joundi's research while affiliated with McMaster University and other places

Publications (44)

Article
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BACKGROUND: Health state utility values are commonly used to provide summary measures of health‐related quality of life in studies of stroke. Contemporaneous summaries are needed as a benchmark to contextualize future observational studies and inform the effectiveness of interventions aimed at improving post‐stroke quality of life. METHODS AND RES...
Article
Background: The Passive Surveillance Stroke Severity (PaSSV) Indicator was derived to estimate stroke severity from variables in administrative datasets but has not been externally validated. Methods: We used linked administrative datasets to identify patients with first hospitalization for acute stroke between 2007-2018 in Alberta, Canada. We u...
Article
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BACKGROUND In light of evidence from recent trials that endovascular thrombectomy (EVT) alone may potentially be noninferior to combined treatment, that is, with intravenous thrombolysis (IVT) with alteplase and EVT, we sought to understand physician and patient preferences around this issue. METHODS We conducted a 2‐stage mixed methods study that...
Article
Source citation: Wang Y, Meng X, Wang A, et al. Ticagrelor versus clopidogrel in CYP2C19 loss-of-function carriers with stroke or TIA. N Engl J Med. 2021;385:2520-30. 34708996.
Article
Treatment with endovascular therapy in the extended time window for acute ischaemic stroke with large vessel occlusion involves stringent selection criteria based on the two landmark studies DAWN and DEFUSE3. Current protocols typically include the requirement of advanced perfusion imaging which may exclude a substantial proportion of patients from...
Article
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Background: Faster treatment with endovascular thrombectomy (EVT) in patients with acute ischemic stroke is associated with better functional outcome at 90 days on the modified Rankin Scale. Whether speed of treatment is associated with improvements in patient-reported outcomes such as health-related quality of life is not well known. Methods: We u...
Article
Background: Basilar artery occlusion (BAO) is a devastating condition without definitive evidence to guide treatment. While the association between faster treatment times with endovascular therapy (EVT) and better outcomes in anterior circulation is well established, whether this relationship exists for those with BAO is not well delineated. Method...
Article
Background The incidence of stroke in developed countries is increasing selectively in young individuals, but whether this is secondary to traditional vascular risk factors is unknown. Methods We used the Canadian Community Health Survey from 2000 to 2016 to create a large population-representative cohort of individuals over the age of 30 and free...
Article
Background and Objectives New imaging techniques have advanced our ability to capture thrombus characteristics and burden in real time. An improved understanding of recanalization rates with thrombolysis and endovascular thrombectomy based on thrombus characteristics has spurred interest in new therapies for acute stroke. Methods and Results This...
Article
Background: Excess sleep is associated with higher risk of stroke, but whether the risk is modified by age and if it remains elevated after accounting for the competing risk of death is not well understood. Methods: We used nine years of the Canadian Community Health Survey between 2000 to 2016 to obtain self-reported sleep duration and created...
Article
Background Temporal trends in life‐sustaining care after acute stroke are not well characterized. We sought to determine contemporary trends by age and sex in the use of life‐sustaining care after acute ischemic stroke and intracerebral hemorrhage in a large, population‐based cohort. Methods and Results We used linked administrative data to identi...
Article
Background and Purpose The association between physical activity (PA) and lower risk of stroke is well established, but the relationship between leisure sedentary time and stroke is less well studied. Methods We used 9 years of the Canadian Community Health Survey between 2000 and 2012 to create a cohort of healthy individuals without prior stroke...
Article
Objective To determine the relationship between physical activity and mortality in community-dwelling stroke survivors. Methods The Canadian Community Health Survey was used to obtain self-reported physical activity (PA) across four survey cycles and was linked to administrative databases to obtain prior diagnosis of stroke and subsequent all-caus...
Article
Introduction Health utility instruments are increasingly being used to measure impairment in health-related quality of life (HRQoL) after stroke. Population-based studies of HRQoL after stroke and assessment of differences by age and functional domain are needed. Methods We used the Canadian Community Health Survey linked with administrative datab...
Conference Paper
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Objective: To characterize intra-individual variability of the utility-weighted modified Rankin Scale (UW-mRS) between day 30 and 90 post-stroke. Background: The UW-mRS links health-related quality of life (HRQoL) to the mRS score by assigning a health utility weighting. An individual’s perception of health utility for a given mRS could potentiall...
Article
Objective To determine contemporary trends in case fatality, discharge destination, and admission to long-term care after acute ischemic stroke and intracerebral hemorrhage (ICH) using a large, population-based cohort. Methods We used linked administrative data to identify all emergency department visits and hospital admissions for first-ever isch...
Article
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Background and Purpose Endovascular thrombectomy (EVT) reduces 90-day disability in patients following acute ischemic stroke due to large vessel occlusion. Patient-reported outcome measures after EVT, such as health-related quality of life and specific functional domains, are less well described. Methods We report outcomes on the EuroQol-5D (EQ-5D...
Article
Background: Endovascular thrombectomy (EVT) improves 90-day disability in patients following acute ischemic stroke due to large vessel occlusion. However, the effect of EVT on health-related quality of life and specific functional domains, and whether this effect differs by age or sex is less studied. Methods: We used data from the ESCAPE randomize...
Article
Background Contemporary data on temporal trends in acute stroke incidence, specific to stroke type and age, are lacking. We sought to evaluate temporal trends in incidence of ischemic stroke and intracerebral hemorrhage over 15 years in a large population. Methods We used linked administrative data to identify all emergency department visits and h...
Article
Introduction The advent of endovascular thrombectomy (EVT) has been a game changer for the management of acute ischemic stroke due to large vessel occlusion. However, the selection of suitable candidates for EVT remains a significant challenge. Areas covered This review focuses on the clinical, radiological and procedural considerations for EVT in...
Article
Background and Purpose— We aimed to create a novel prognostic risk score to estimate outcomes after direct enteral tube placement in acute stroke. Methods— We used the Ontario Stroke Registry and linked databases to obtain clinical information on all patients with direct enteral tube insertion after ischemic stroke or intracerebral hemorrhage from...
Article
Background: Direct enteral feeding tube (DET) placement for dysphagia after stroke is associated with poor outcomes. However, the relationship between timing of DET placement and poststroke mortality and disability is unknown. We sought to determine the risk of mortality and severe disability in patients who receive DET at different times after st...
Article
Objective To determine predictors of direct enteral tube (DET) placement after acute stroke. Methods We used the Ontario Stroke Registry to identify patients who received direct enteral tubes (gastrostomy or jejunostomy) during hospital stay after acute ischemic stroke or intracerebral hemorrhage from July 1, 2003 to March 31, 2013. We used multiv...
Article
Myotonic Discharges in Anti-MuSK Myasthenia - Raed A. Joundi, Gaspar Israelian, Amer Ghavanini, Charles D. Kassardjian
Article
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Background: Clinical Inertia is defined as "failure of health care providers to initiate or intensify therapy according to current guidelines". This phenomenon is gaining increasing attention as a major cause of clinicians' failure to adequately manage hypertension, thus leading to an increased incidence of cardiovascular events. We performed a sy...
Article
Background: The relationship between timing of direct enteral feeding tube (DET; gastrostomy/jejunostomy) placement and outcomes after stroke is unknown. Methods: We used the Ontario Stroke Registry and linked administrative databases to identify patients with acute stroke between 2003-2013 who received DET during hospital admission. We used multip...
Article
Objective: To compare complications, disability, and long-term mortality of patients who received direct enteral tube vs nasogastric tube feeding alone after acute stroke. Methods: We used the Ontario Stroke Registry to identify patients who received direct enteral tubes (DET; gastrostomy or jejunostomy) or temporary nasogastric tubes (NGT) alon...
Article
Long standing, evidence based approved therapies for acute ischemic stroke include intravenous thrombolysis therapy (IVT) with alteplase (recombinant tissue plasminogen activator, rtPA) given within 4.5 h; aspirin therapy within 48 h; management in an acute stroke unit and hemicraniectomy in cases of malignant infarction. Multiple recent positive r...
Article
Background Dysphagia screening is recommended after acute stroke to identify patients at risk of aspiration and implement appropriate care. However, little is known about the frequency and outcomes of patients undergoing dysphagia screening after intracerebral hemorrhage (ICH). Methods We used the Ontario Stroke Registry from 1 April 2010 to 31 Ma...
Article
The risk of recurrent stroke after transient ischemic attack (TIA) is high. In the past 10 years, TIA has increasingly been recognized as a medical emergency. Health systems have adapted toward rapid evaluation, investigation, and secondary prevention in patients with presumed TIA and minor stroke, and the significant benefits in reducing recurrent...
Article
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Background: Dysphagia is a common and devastating complication after acute stroke. Percutaneous endoscopic gastrostomy (PEG) tubes are often placed for persistent dysphagia. However, little is known regarding outcomes after PEG tube placement. Methods: We used a 10-year Ontario Stroke Registry to shed light on the clinical outcomes of patients with...
Article
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Background: In patients with acute stroke, nasogastric (NG) tubes are commonly inserted for feeding when dysphagia is identified, and percutaneous endoscopic gastrostomy (PEG) tubes are placed for severe or persistent dysphagia. However, little is known regarding predictors of PEG insertion. Methods: We used the Ontario stroke registry from 2003-20...
Article
Background and purpose: Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many and which patients are screened and how failing a swallowing screen affects patient outcomes. We sought to evaluate predictors of receiving dysphagia screening after acute ischemic stroke and outcome...
Article
Background: The management of stroke prevention among patients with atrial fibrillation (AF) has changed in the last few years. Despite the benefits of new oral anticoagulants (NOACs), decisions about the optimal agent remain a challenge. We provide a visual aid tool to guide clinicians and patients in the decision process of selecting oral antico...
Article
We thank Nielsen et al for their positive comments regarding our meta-analysis and for highlighting the hurdles in designing studies to estimate the risk of stroke in patients with atrial fibrillation and a CHA2DS2-VASc score of 1. Among people with nonvalvular atrial fibrillation, CHA2DS2-VASc score of 1 is estimated to comprise 12.4% of patients...
Article
Dysphagia is a devastating complication of stroke and can lead to malnutrition, immobility, aspiration pneumonia, and death. Guidelines advocate screening all patients with acute stroke for swallowing impairment. However, previous research suggests only 60% are screened, and it is unclear what factors contribute to receiving dysphagia screening. Me...
Article
Bedside dysphagia screening is recommended for all patients with acute ischemic stroke, in order to detect swallowing impairment early and prevent complications. However, limited data are available on outcomes associated with failing a dysphagia screen. Methods: We used the Ontario Stroke Registry to identify patients who were admitted to Regional...
Article
Background: Cardiac arrest is a devastating complication of acute ischemic stroke, but little is known about its incidence and characteristics. We studied a large ischemic stroke inpatient population and compared patients with and without cardiac arrest. Methods: We studied consecutive patients from the Ontario Stroke Registry who had an ischemi...
Article
Background and Purpose— The CHA2DS2-VASc score aims to improve risk stratification of ischemic stroke among patients with atrial fibrillation to identify those who can safely forego oral anticoagulation. Oral anticoagulation treatment guidelines remain uncertain for CHA2DS2-VASc score of 1. We conducted a systematic review and meta-analysis of the...
Article
Full-text available
Article InformationCorresponding Author: Jerome A. Leis, MD, MSc, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room H463, Toronto, ON M4N 3M5, Canada (jerome.leis@sunnybrook.ca). Published Online: February 9, 2015. doi:10.1001/jamainternmed.2014.8030. Conflict of Interest Disclosures: None reported.

Citations

... The trial used deferred consent procedures wherever approved by local research ethics boards. 16,17 Two centres, in the province of Quebec, Canada, used only prospective consent (written or verbal) from patients or their representatives. At the remaining centres where consent was deferred, patients or their legal representatives were asked to provide written or electronic informed consent as soon as possible after treatment, within 7 days of randomisation, or before discharge, whichever was earlier. ...
... A recent multicenter study utilizing the Get With The Guidelines-Stroke nationwide United States registry, which included 3,015 BAO patients, showed that onset-to-EVT time <6 hours was significantly associated with lower in-hospital mortality (aOR, 0.55; 95% CI, 0.45 to 0.68) and sICH (aOR, 0.52; 95% CI, 0.32 to 0.84) rates, and a higher rate of independence at discharge (aOR, 2.21; 95% CI, 1.66 to 2.95) than those with >6 hours. 78 The fastest decline of good outcomes per hour occurred within 6 hours of symptom onset. Regarding late-window treatment, imaging-based patient selection utilizing the core-penumbra mismatch concept is currently less established in PC-EVT. ...
... The direct imaging of thrombus is, therefore, of great importance. In clinics, CT and MRI are the major methods used [157,158]. Traditional CT and MRI (with or without a contrast agent) diagnoses of thrombosis are usually based on visualizations of the reduction of the blood flow within the vessel lumen, instead of the thrombus itself [159]. They thus cannot differentiate between a thrombus and atherosclerosis as both can obstruct blood flow [160]. ...
... We adjusted for age, gender, race, and comorbidities using multiple Poisson regression model. We used Kendall's tau-b (s b ) to determine strength and direction of trends in annual CDI prevalence, mortality, and severity [12]. ...
... As a result of poorer health education, women may not recognize the symptoms of stroke, and activation of emergency medical serves may be delayed. suggests that women experience less pain and discomfort compared with men after EVT, 58 which is only moderately associated with the mRS score 59 because the mRS is heavily weighted on motor function and does not capture discomfort and anxiety. Poststroke depression, on the other hand, is more commonly seen in women. ...
... With respect to HRQoL, patients in the therapy group had a significantly lower EQ VAS compared to the stroke patients without acute therapy, but after adjustment for confounding variables, patients having profited from recanalization therapies did not have a significantly different EQ VAS compared to the patients with stroke unit therapy only, neither in the subacute phase nor in the follow-up period. At first glance, this was rather surprising, as another study could detect a prominent treatment effect, especially for endovascular therapy (23). As functional deficits and HRQoL correlate in stroke patients (24), the strong functional improvement during hospitalization in our treated patients might explain the low treatment effect in the statistical analysis of the present cohort. ...
... Oral conversation was regained in six (20%) of the patients [7,20,25,27,28,32,42,43]. In two patients, CD was transient, one following a bilateral middle cerebral vasospasm secondary to an aneurysm rupture [30] and the other two after a unilateral ischemic stroke [38,40]. ...
... According to the Global Burden of Disease Study, a significant increase in stroke prevalence and incidence rates in terms of ischemic stroke (IS) was found in both men and women aged under 70 years between 1990 and 2019, with even faster increases observed from 2010 to 2019 [1]. A stable or increasing trend in stroke incidence among middle-aged people was recently observed in the USA, Canada, Australia, and European countries including France [3][4][5][6][7][8][9][10]. Several studies have predicted a substantial increase in the number of stroke cases in high-income countries by 2030 and 2050, associated with almost a doubling of healthcare costs related to stroke by then [1,[11][12][13], as supported by projections from the Dijon Stroke Registry for France [14]. ...
... 26,27 In contrast, there was a decrease in the use of feeding tubes for both ischemic stroke and ICH, consistent with a US study that showed decreased feeding tube usage from 2002 to 2012. 9 The dissociation in trends between ICU care and feeding tube use may be attributed to improvements in acute stroke care and subsequent disability, reducing the prevalence of severe dysphagia at 2 to 3 weeks, when feeding tubes are typically placed in Canada, 28 or an increase in the use of palliative care or care limitations. Importantly, we observed an approximate doubling in the absolute numbers of patients with first acute stroke requiring ICU care across the 15-year study period, from 1054 per year to 2017 per year, highlighting the increasing resource need for ICU and post-ICU care among patients with stroke. ...
... Several studies have investigated predictive factors for dysphagia recovery in stroke patients including age [7,12,[15][16][17], sex [18,19], body mass index (BMI) [12,20], the National Institute of Health Stroke Scale score [19,[21][22][23][24][25], stroke location [17,21,23,24], the Functional Independence Measure score [7,15,18,20], multiple comorbidities [17], and intubation [24]. However, most previous studies were conducted at a single institution with a limited number of patients, and numerous factors could not be analyzed simultaneously. ...