David Gladstone
Dr. Gladstone directs Sunnybrook’s Regional Stroke Prevention Clinic. His clinical research program focuses on improving stroke prevention with an emphasis on the intersection between heart and brain. His publications have had international impact (h-index 58; >16,000 citations).
His most significant contribution to date is EMBRACE (NEJM 2014), the first large randomized trial of prolonged noninvasive ECG monitoring after cryptogenic stroke. The trial found that undetected AF was common in patients with unexplained stroke and 30-day ECG was superior to the standard practice of 24-48 hour ECG for AF detection (16% vs. 3%), enabling more patients to be anticoagulated. The results changed practice protocols internationally and led to new guideline recommendations for more intensive ambulatory ECG monitoring poststroke. Building upon this work, as co-applicant of the CIHR-funded CSPIN Network (www.cspin.ca), he led SCREEN-AF (JAMA Cardiol 2021), a multicentre RCT in primary care (49 sites). He found a wearable ECG screening strategy highly effective for early detection of AF in asymptomatic adults aged 75+ and prompted OAC therapy. This work earned a UofT Division of Neurology award for paper of the year, and has important implications for primary stroke prevention and development of future AF screening programs. He co-led an analysis from the NAVIGATE ESUS trial that found anticoagulant therapy was more effective than standard therapy (aspirin) for secondary stroke prevention in patients with left atrial enlargement without AF (JAMA Neuro 2019). He presented this work at the World Stroke Congress (Late Breaking). To ensure anticoagulants are used as safely and effectively as possible, he created an Anticoagulant Safety Checklist practice tool for clinicians (Ann Int Med 2015) to promote standardized assessments, safety monitoring, adherence & counselling (endorsed by Thrombosis Canada & Canadian Cardiovascular Society).
As PI of SPOTLIGHT (JAMA Neuro 2019), he led an innovative image-guided national multicentre randomized trial of hemostatic therapy to stop brain bleeding in patients with acute ICH. He presented a pooled analysis with the NIH-sponsored STOP-IT trial at the International Stroke Conference (Late Breaking Trials) and this work is now stimulating new ICH treatment trials.
Dr. Gladstone served as the Canadian Secondary Stroke Prevention National Guidelines Committee Chair (CJNS 2021), Co-Chair (Int J Stroke 2017), co-author of Aspirin Primary Prevention Guideline (CMAJ 2020) & CCS AF Guideline (CJC 2021), senior author of The Code Stroke Handbook (Elsevier 2020), and he is a mentor for trainees, international fellows and junior stroke faculty. He received a Mid-Career Investigator Award from the Heart and Stroke Foundation (2017-2021) and a Clinician Scientist Award from the UofT Department of Medicine (2023). Dr. Gladstone’s next study set to launch in 2024 (STROKE75+) is a multicentre randomized trial that aims to improve secondary stroke prevention for the aging population.