Stroke Mortality Research Articles

The effect of institutional case volume on post-operative outcomes after endarterectomy and stenting for symptomatic carotid stenosis

ObjectiveTo investigate the effects of yearly institutional case volume for carotid endarterectomy (CEA) and stenting (CAS) among symptomatic carotid stenosis patients on the rates of postoperative stroke and inpatient mortality. Materials and MethodsPatients with prior stroke (“symptomatic”) undergoing CEA or CAS during an inpatient stay were identified from the National Inpatient Sample for years 2012-2015. The primary variable was volume of CEA or CAS performed annually by each institution. The primary outcome was a composite variable for in-hospital death or postoperative stroke. ResultsA total of 5,628 patients with symptomatic carotid stenosis underwent CEA, while 245 underwent CAS. In the symptomatic CEA population, 519 (9.2 %) patients experienced postoperative stroke or mortality, and were more likely to be treated at centers with a lower yearly institutional volume (median 10 [IQR 5-15] versus 10 [7-20] cases, p < 0.001). In the symptomatic CAS population, 32 (13.1 %) patients experienced stroke or mortality, and these patients were also more likely to undergo treatment at hospitals with a lower yearly institutional volume (median 5 [IQR 5-7] versus 5 [5-10] cases, p = 0.044). Thresholds for yearly institutional volume found differences in adverse outcome between 0-9, 10-29, and ≥30 cases/year (11.7 % vs 8.4 % vs 6.0 %, p < 0.001) for CEA, and differences in postoperative stroke between 0-9 and ≥10 cases/year for CAS (11.0 % vs 1.4 %, p = 0.028). ConclusionsHospitals performing higher volumes of CEA or CAS have fewer postoperative strokes. The threshold reported herein is ≥30 CEA procedures or ≥10 CAS procedures annually for appreciably improved outcomes.

Correlation of Silent Brain Infarction with the Metabolic Abnormality of CKD Stage 3-5 (non-dialytic) Patients

Background: Silent brain infarction (SBI) poses a significant yet often undetected risk in chronic kidney disease (CKD) patients, predisposing them to symptomatic stroke, dementia, and neurological mortality. Despite its implications, the association between SBI and CKD remains elusive, necessitating further exploration to elucidate potential predictive factors. Objective: This cross-sectional study investigated the relationship between SBI and metabolic abnormalities prevalent in CKD stages 3-5 (non-dialytic) patients. Methods: Conducted at the Department of Nephrology, Dhaka Medical College Hospital, Dhaka, from September 2018 to March 2020, the study enrolled 115 participants. Group I comprised 85 CKD stage 3-5 (non-dialytic) patients without neurological symptoms, while Group II comprised 30 healthy controls. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Diseases equation. Magnetic resonance imaging (MRI) was performed on all subjects. Statistical analysis utilized SPSS-26. Results: The rate of Silent Brain Infarction is 52.9% in CKD patients. SBI was found in 45(52.9%) patients in group I and 4(13.3%) in group II. The differences were statistically significant (p&lt;0.05). Glomerulonephritis (45.9%) was the leading cause of CKD among the study patients. Most of the patients with Hypertensive Nephrosclerosis (76.9%) had SBI, which indirectly showed its strong association. As the CKD stages progressed, the SBI rate also increased (stage-3:8.9%; stage-4:35.6%; stage-5ND:55.6%). In a multivariate logistic regression analysis, CKD had an independent relationship with SBI along with serum phosphate level and serum parathyroid hormone level (CKD had Odds ratio (OR)=1.847 (95.0% CI 0.064 to 53.319), serum PO4 had OR=0.958 (95.0% CI 0.885 to 1.038) and serum PTH had OR=0.996 (95.0% CI 0.993 to 1.000). Spearman rank correlation coefficient test showed a positive correlation between the occurrence of SBI and serum PO4 level (r=0.416; p=0.001) and serum PTH level (r= 0.405; p=0.001) separately. Conclusions: The high prevalence of SBI in CKD stage 3-5 (non-dialytic) patients underscores its clinical significance. Serum phosphate and parathyroid hormone levels positively correlate with SBI occurrence, highlighting their potential as predictive markers. Understanding these associations can inform risk stratification and guide targeted interventions in CKD management.

The Role of 24-Hour Holter Electrocardiogram in the Early Detection of Atrial Fibrillation in Newly Diagnosed Acute Ischemic Stroke Patients.

Introduction Stroke is a leading cause of death and disability globally, with atrial fibrillation (AF) recognized as a significant risk factor due to its association with increased stroke recurrence and mortality. Timely detection of AF is crucial to prevent recurrent strokes and improve outcomes. This study primarily aimed to evaluate the utility of 24-hour Holter monitoring for AF detection in acute ischemic stroke patients. Methods This retrospective observational study examined data from 207 patients admitted with acute ischemic stroke to a tertiary-care hospital over a two-year period. Patients with pre-existing AF, transient ischemic attacks, unconfirmed diagnoses, and missing Holter reports were excluded. A total of 140 patients were included in the analysis. The study investigated AF detection rates, the relationship between AF and stroke risk factors, other Holter findings, and the time delay in attaching Holter monitors. Results Of the 140 patients evaluated, AF was detected in nine (6.4%), exclusively in those aged ≥65 years. The most prevalent risk factors among the study participants were hypertension (74.3%) and diabetes (61.4%). No significant correlations were observed between AF and the analyzed stroke risk factors. The median delay for Holter device attachment was 3,503 minutes (approximately two days and 10 hours), with longer delays noted in males (4,084 mins (approximately two days and 20 hours) vs. 2,565 mins (approximately one day and 18 hours), p=0.005). Premature atrial complexes(PACs) were notably associated with the absence of AF, suggesting their potential role as markers for undiagnosed AF. Conclusion The study highlights the limited utility of 24-hour Holter monitoring in detecting AF in acute ischemic stroke patients, advocating for extended monitoring durations, especially in older patients. To improve AF detection, potential strategies include using longer monitoring periods and optimizing hospital workflows to reduce delays in attaching Holter devices. These approaches can minimize the risk of underdiagnosing paroxysmal AF, thereby preventing recurrent strokes and improving patient outcomes. Further investigation into PACs as potential predictive markers for AF is warranted.

Stroke Prevention and Management in Rural Georgia: Evaluating the Effectiveness of a Community Paramedicine Program.

Stroke remains a major public health concern in the state of Georgia with high mortality, disproportionately affecting rural and socioeconomically disadvantaged communities. Georgia's age-standardized stroke death rate is 10.8% higher than the national average, and related comorbidities remain elevated in adult Georgians, contributing to higher stroke prevalence. The Georgia Department of Public Health piloted a Community Paramedicine (CP) program in 2 rural counties to improve stroke management, readmissions, and mortality. Various supportive interventions to address barriers to chronic disease management were provided by a local emergency medical service agency for 90days. This study aims to evaluate the effectiveness of the CP care delivery model in improving stroke outcomes among high-risk individuals. CP leverages emergency medical service infrastructure to provide community health services such as home visits, telemedicine, care coordination, education, and access to social support services. The Georgia Hospital Discharge data and Georgia death records were used to measure stroke rehospitalization and deaths at 30, 60, and 90 days post-discharge for stroke. We compared the health outcomes of high-risk individuals who participated in the CP program to those who did not. Multivariable analysis suggested a reduction in stroke mortality rates among the intervention groups in both counties. The CP program demonstrated effectiveness in assisting patients with managing risk factors through medication adherence for conditions such as hypertension, hypercholesterolemia, and diabetes.

Prognostic model of in-hospital ischemic stroke mortality based on an electronic health record cohort in Indonesia.

Stroke patients rarely have satisfactory survival, which worsens further if comorbidities develop in such patients. Limited data availability from Southeast Asian countries, especially Indonesia, has impeded the disentanglement of post-stroke mortality determinants. This study aimed to investigate predictors of in-hospital mortality in patients with ischemic stroke (IS). This retrospective observational study used IS medical records from the National Brain Centre Hospital, Jakarta, Indonesia. A theoretically driven Cox's regression and Fine-Gray models were established by controlling for age and sex to calculate the hazard ratio of each plausible risk factor for predicting in-hospital stroke mortality and addressing competing risks if they existed. This study finally included 3,278 patients with IS, 917 (28%) of whom had cardiovascular disease and 376 (11.5%) suffered renal disease. Bivariate exploratory analysis revealed lower blood levels of triglycerides, low density lipoprotein, and total cholesterol associated with in-hospital-stroke mortality. The average age of patients with post-stroke mortality was 64.06 ± 11.32 years, with a mean body mass index (BMI) of 23.77 kg/m2 and a median Glasgow Coma Scale (GCS) score of 12 and an IQR of 5. Cardiovascular disease was significantly associated with IS mortality risk. NIHSS score at admission (hazard ratio [HR] = 1.04; 95% confidence interval [CI]: 1.00-1.07), male sex (HR = 1.51[1.01-2.26] and uric acid level (HR = 1.02 [1.00-1.03]) predicted survivability. Comorbidities, such as cardiovascular disease (HR = 2.16 [1.37-3.40], pneumonia (HR = 2.43 [1.42-4.15] and sepsis (HR = 2.07 [1.09-3.94, had higher hazards for post-stroke mortality. Contrarily, the factors contributing to a lower hazard of mortality were BMI (HR = 0.94 [0.89-0.99]) and GCS (HReye = 0.66 [0.48-0.89]. In summary, our study reported that male sex, NIHSS, uric acid level, cardiovascular diseases, pneumonia, sepsis. BMI, and GCS on admission were strong determinants of in-hospital mortality in patients with IS.

Effect modification by statin use status on the association between fine particulate matter (PM2.5) and cardiovascular mortality.

Numerous studies have linked fine particulate matter (PM2.5) to increased cardiovascular mortality. Less is known how the PM2.5-cardiovascular mortality association varies by use of cardiovascular medications. This study sought to quantify effect modification by statin use status on the associations between long-term exposure to PM2.5 and mortality from any cardiovascular cause, coronary heart disease (CHD), and stroke. In this nested case-control study, we followed 1.2 million community-dwelling adults aged ≥66 years who lived in Ontario, Canada from 2000 through 2018. Cases were patients who died from the three causes. Each case was individually matched to up to 30 randomly selected controls using incidence density sampling. Conditional logistic regression models were used to estimate odds ratios (ORs) for the associations between PM2.5 and mortality. We evaluated the presence of effect modification considering both multiplicative (ratio of ORs) and additive scales (the relative excess risk due to interaction, RERI). Exposure to PM2.5 increased the risks for cardiovascular, CHD, and stroke mortality. For all three causes of death, compared with statin users, stronger PM2.5-mortality associations were observed among non-users [e.g. for cardiovascular mortality corresponding to each interquartile range increase in PM2.5, OR = 1.042 (95% CI, 1.032-1.053) vs OR = 1.009 (95% CI, 0.996-1.022) in users, ratio of ORs = 1.033 (95% CI, 1.019-1.047), RERI = 0.039 (95% CI, 0.025-0.050)]. Among users, partially adherent users exhibited a higher risk of PM2.5-associated mortality than fully adherent users. The associations of chronic exposure to PM2.5 with cardiovascular and CHD mortality were stronger among statin non-users compared to users.

The impact of sex and gender on advanced stroke interventions and end-of-life outcomes after stroke

ObjectivesIn this review, we examine the impact of sex and gender on advanced stroke interventions and end-of-life outcomes after stroke and discuss the current theories, available evidence, and gaps in the literature. MethodsA scoping review of the literature was conducted to determine gender differences on advanced stroke interventions and end-of-life outcomes after stroke. The study team utilized PubMed to conduct a review of the literature and included research studies related to sex, gender, advanced stroke interventions, and end-of-life outcomes after stroke. The PRISMA process for conducting a scoping review was followed. ResultsThis review found that although evidence regarding gender differences in advanced stroke interventions and end-of-life care after stroke is disparate, some gender differences do indeed exist. Women are less likely to receive thrombectomy or alteplase, women are more likely to receive palliative care intervention, hospice, and women experience stroke mortality at higher rates. ConclusionsGender differences in end-of-life care after stroke are apparent with women experiencing lower rates of life sustaining interventions, and higher rates of mortality, palliative and hospice care. More research is needed to identify variables associated with or responsible for gender differences during advance interventions and end-of-life care after stroke.

Stroke in Qatar: a decade of insights from a national registry

ABSTRACT Background Stroke is a major cause of death and disability worldwide and presents a significant burden on healthcare systems. This retrospective study aims to analyze the characteristics and outcomes of stroke patients admitted to Hamad General Hospital (HGH) stroke service in Qatar from January 2014 to July 2022. Methods The medical records of 15,859 patients admitted during the study period were analyzed. The data collected included patient demographics, stroke types, admission location, procedures performed, mortality rates, and other clinical characteristics. Results Of the total cohort, 70.9% were diagnosed with a stroke, and 29.1% were diagnosed with stroke mimics. Of the stroke patients, 85.3% had an ischemic stroke, and 14.7% had a hemorrhagic stroke. Male patients below 65 years old (80.2%) and of South Asian ethnicity (44.6%) were the most affected. The mortality rate was 4.6%, significantly higher for hemorrhagic stroke than ischemic stroke (12.6% vs. 3.2%). Female patients had a higher stroke-related mortality rate than male patients (6.8% vs. 4%). The thrombolysis rate was 9.5%, and the thrombectomy rate was 3.4% of the ischemic stroke cohort. The mean door-to-needle time for thrombolysis was 61.2 minutes, and the mean door-to-groin time for thrombectomy was 170 minutes. Stroke outcomes were good, with 59.3% of patients having favorable outcomes upon discharge (mRS ≤2), which improved to 68.2% 90 days after discharge. Conclusion This study provides valuable insights into stroke characteristics and outcomes in Qatar. The findings suggest that stroke mortality rates are low, and favorable long-term disability outcomes are achievable. However, the study identified a higher stroke-related mortality rate among female patients and areas for improvement in thrombolysis and thrombectomy time.

Air Quality Perceptions, Awareness, and Associated Behaviors Among U.S. Adults With and Without Heart Disease

IntroductionExposure to ambient air pollution can worsen cardiovascular disease and increase the risk of stroke, myocardial infarction, and cardiovascular disease mortality. Strategies to reduce air pollution exposure can therefore help prevent cardiovascular morbidity and mortality. This study was conducted to assess awareness among U.S. adults of the effect of air pollution on cardiovascular health and actions individuals can take to reduce their air pollution exposure. MethodsIn May–July 2022, 4,156 adults responded to the summer wave of the 2022 ConsumerStyles survey and self-reported their heart disease status and perceptions, awareness, and behaviors about ambient air pollution and health. In 2023, the data were analyzed to generate weighted population estimates representative of noninstitutionalized U.S. adults. Associations between heart disease and responses about perceptions, awareness, and behaviors were estimated using binomial and multinomial regression methods for weighted data. ResultsOverall, 90% of the weighted population estimate of U.S. adults reported that air pollution can impact a person's health and 44% reported that air pollution can cause or worsen heart disease. Percentages of adults reporting that air pollution can impact a person's health (prevalence ratio=1.09, 95% CI=1.06, 1.12) and that air pollution can cause or worsen heart disease (prevalence ratio=1.28, 95% CI=1.08, 1.51) were higher among adults with than without heart disease. ConclusionsLess than half of U.S. adults are aware that air pollution affects heart disease. Improvements in awareness of the effect of air pollution on cardiovascular health and strategies to reduce exposure could help protect individuals with heart disease.

Automated titanium fastener for surgical aortic valve replacement-preventive role for infective endocarditis?

Evidence on long-term clinical outcomes considering suture-securing techniques used for surgical aortic valve replacement is still uncertain. A total of 1405 patients who underwent surgical aortic valve replacement between January 2016 and December 2022 were included and grouped according to the suture-securing technique used (automated titanium fastener versus hand-tied knots). The occurrence of infective endocarditis during follow-up was set as the primary study end-point. As secondary study end-points, stroke, all-cause mortality, and a composite outcome of either infective endocarditis, stroke, or all-cause mortality were assessed. The automated titanium fastener was used in 829 (59%) patients, whereas the hand-knot tying technique was used in 576 (41%) patients. The multivariable proportional competing risk regression analysis showed a significantly lower risk of infective endocarditis during follow-up in the automated titanium fastener group (adjusted sub-hazard ratio 0.44, 95% confidence interval 0.20-0.94, p = 0.035). The automated titanium fastener group was not associated with an increased risk of mortality or attaining the composite outcome, respectively (adjusted hazard ratio 0.81, 95% confidence interval 0.60-1.09, p = 0.169), (adjusted hazard ratio 0.82, 95% confidence interval 0.63-1.07, p = 0.152). This group was not associated with an increased risk of stroke (adjusted sub-hazard ratio 0.82, 95% confidence interval 0.47-1.45, p = 0.504). Also, a significantly lower rate of early-onset infective endocarditis was observed in the automated titanium fastener group, (0.4% vs 1.4%, p = 0.032). Suture-securing with an automated titanium fastener device appears to be superior compared to the hand-knot tying technique in terms of lower risk of infective endocarditis.

Impact of alcohol control policy on hemorrhagic and ischemic stroke mortality rates in Lithuania: An interrupted time series analysis.

Given the causal impact of alcohol use on stroke, alcohol control policies should presumably reduce stroke mortality rates. This study aimed to test the impact of three major Lithuanian alcohol control policies implemented in 2008, 2017 and 2018 on sex- and stroke subtype-specific mortality rates, among individuals 15+ years-old. Joinpoint regression analyses were performed for each sex- and stroke subtype-specific group to identify timepoints corresponding with significant changes in mortality rate trends. To estimate the impact of each policy, interrupted time series analyses using a generalized additive mixed model were performed on monthly sex- and stroke subtype-specific age-standardized mortality rates from January 2001-December 2018. Significant average annual percent decreases were found for all sex- and stroke subtype-specific mortality rate trends. The alcohol control policies were most impactful on ischemic stroke mortality rates among women. The 2008 policy was followed by a positive level change of 4,498 ischemic stroke deaths per 100,000 women and a negative monthly slope change of -0.048 ischemic stroke deaths per 100,000 women. Both the 2017 and 2018 policy enactment timepoints coincided with a significant negative level change for ischemic stroke mortality rates among women, at -0.901 deaths and -1.431 deaths per 100,000 population, respectively. Hemorrhagic stroke mortality among men was not affected by any of the policies, and hemorrhagic stroke mortality among women and ischemic stroke mortality among men were only associated with the 2008 policy. Our study findings suggest that the impact of alcohol control policies on stroke mortality may vary by sex and subtype.

Predictions for functional outcome and mortality in acute ischaemic stroke following successful endovascular thrombectomy

BackgroundAccurate outcome predictions for patients who had ischaemic stroke with successful reperfusion after endovascular thrombectomy (EVT) may improve patient treatment and care. Our study developed prediction models for key clinical...

Is essential thrombocytosis associated with worse outcomes in patients with stroke? Results from 2016-2020 National Inpatient Sample study.

e23060 Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm. Thrombosis is a major cause of morbidity and mortality in ET. It is unknown whether the morbidity and mortality of ischemic stroke in ET is different from that in non-ET patients. Similarly, the quantitative data regarding the use of platelet pheresis in this population is also unknown. This National Inpatient Sample (NIS) database study aims to answer these questions. Methods: A retrospective analysis of the NIS database from 2016 to 2020 was conducted using ICD-10 codes to identify hospitalizations with ischemic stroke. STATA version SE18.0 was used for statistical analysis. We used multivariate regression analysis to calculate the effects of ET on mortality and length of stay along with various other variables including age, gender, primary payer, household income, Charlson Comorbidity index, hospital bed size, hospital region, diabetes mellitus, heart failure, hypertension, coronary artery disease, smoking, hyperlipidemia, carotid artery stenosis, and atrial fibrillation. Results: There were 2,635,595 hospitalizations with primary diagnosis of ischemic stroke. Among these, 9604 patients had secondary diagnosis of ET. The mean age of ET patients with stroke was 67 years. 60.5% of patients were females. 40 (0.41%), 335 (3.48%) and 720 (7.49%) patients underwent plateletpheresis, thrombectomy, and thrombolysis respectively. Multivariate logistic regression showed that ET was not associated with increased mortality, but was associated with significantly increased length of stay with odds ratio (OR) of 0.95 [95% confidence interval (CI) = 0.73 to 1.23, p-value = 0.7) and 2.58 (95% CI = 2.12 to 3.04, p-value = 0.00) respectively. The effect of other pertinent variables are summarized in Table 1. Conclusions: Our analysis shows that stoke in ET was not associated with increased mortality. ET was associated with increased length of stay in patients with stroke. 0.41% of ET patients with stroke received platelet pheresis. Limitations of this study include failure of the multivariate model to account for all the variables, coding errors, and increased risk of bias due to retrospective nature of the data. [Table: see text]

Life's Essential 8 and risks of cardiovascular morbidity and mortality among individuals with type 2 diabetes: A cohort study

BackgroundThe association of cardiovascular health levels, as measured by the Life's Essential 8 score, with cardiovascular disease (CVD) incidence and mortality among individuals with type 2 diabetes (T2D) has not been fully elucidated. MethodsThis cohort study included 15,118 participants with T2D from the UK Biobank who were free of CVD and cancer at baseline. The cardiovascular health of participants was evaluated using the Life's Essential 8 score, categorizing their health levels into low, moderate, and high based on this assessment. ResultsDuring a median follow-up period of 13.0 years, we observed a total of 4421 cases of CVD, comprising 3467 cases of coronary heart disease (CHD), 811 cases of stroke, 1465 cases of heart failure (HF), and 523 cases of CVD mortality. Compared to participants with low cardiovascular health, those with high cardiovascular health had a 52 %, 50 %, 47 %, 67 %, and 51 % lower risk of CVD, CHD, stroke, HF, and CVD mortality, respectively. Among the components of the Life's Essential 8 score, body mass index showed the highest population attributable risk of 12.1 %. Similar findings were observed in joint analyses of cardiovascular health and diabetes severity status. ConclusionsThis study emphasizes the importance of maintaining good cardiovascular health among individuals with T2D to reduce their risk of CVD incidence and mortality.

Trends of stroke-related mortality among patients with cancer in the United States, 1999-2020.

e24021 Background: Patients with cancer are at an increased risk of stroke and stroke-related mortality via various mechanisms such as hypercoagulability, direct tumor effects, and largely as side effects of treatments. Enhancement of thrombin release from chemotherapy induced release of extracellular vesicles and cell-free DNA, and the use of angiogenesis inhibitors are some of the proposed mechanisms for stroke development in patients with cancer. Despite this, current guidelines lack clarity in identifying patients with cancer as having moderate to high risk of mortality from stroke. Recognizing this complex relationship is pivotal for crafting comprehensive care plans that address the dual challenges of cancer and stroke risks. Hence, our CDC analysis focuses on unraveling mortality trends among patients grappling with both conditions from “1999 to 2020”. Methods: We analyzed national mortality data from the multiple causes of death files in the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 people were calculated for the total population, stratified by gender, race, urban/rural metro status, and census region. Annual percent change (APC) was calculated using the Joinpoint regression software. Results: A total of 36,648 stroke-related deaths among patients with cancer occurred between 1999 and 2020. The APC trends are as follows: a major decrease of -6.8 (95% CI: -11.8 to -1.5) from 2002 to 2009, a slight decline of -1.23 (95% CI: -13.8 to 13.2) from 2009 to 2014, a significant decrease of -6.71 (95% CI: -46.2 to 61.7) from 2014 to 2017, and an increase of 2.07 (95% CI: -26.1 to 41.1) from 2017 to 2020. Men consistently showed higher mortality rates compared to women in 1999 (AAMR Men: 1.0 vs Women: 0.63) and 2020 (AAMR Men: 0.94 vs Women: 0.69). Moreover, when stratified by race non-hispanic (NH) Black showed the highest mortality rate, followed by NH Whites, and Hispanics throughout the study period between 1999 (AAMR NH Black: 0.96 vs NH White: 0.75 vs Hispanic: 0.32) and 2020 (AAMR NH Black: 0.85 vs NH White: 0.81 vs Hispanic: 0.53). Rural areas compared to urban areas showed consistently higher mortality rates over the study period. Conclusions: Despite more than a decade-long decline, stroke-related mortality among cancer patients has significantly increased since 2015. Targeted therapy and investigations into the role of social determinants of health may improve care for these patients. Further investigation is warranted to elucidate the mechanisms for the increase in stroke-related mortality among people with cancer, particularly those with the following demographics: Men, Black or African American, and residents of rural areas and Midwestern regions.

The impact of glucagon-like peptide-1 receptor agonists on proteasome inhibitor-associated cardiotoxicity in patients with multiple myeloma.

e24008 Background: Patients with multiple myeloma undergoing proteasome inhibitor therapies face an elevated risk of cardiotoxicity. Existing evidence in the non-cancer population indicates that glucagon-like peptide-1 receptor agonists (GLP1a) can mitigate the risk of cardiovascular events. We hypothesize that GLP1a may reduce the risk of cardiotoxicity in patients with multiple myeloma undergoing proteasome inhibitor therapies. Methods: We conducted a retrospective, propensity score-matched cohort study by utilizing the TriNetX Analytics Network database, which contains de-identified data spanning over 250 million patients. We included adult patients with multiple myeloma and type 2 diabetes mellitus who received proteasome inhibitor therapy. We matched patients treated with GLP1a and those treated with Dipeptidyl Peptidase 4 (DPP4i) in a 1:1 ratio based on predetermined clinical variables. The primary outcome included major adverse cardiovascular events, defined as a composite of heart failure and heart failure hospitalization, myocardial infarction, and ischemic stroke. Other outcomes included individual cardiovascular events, atrial fibrillation/flutter, and all-cause mortality within 3 years of proteasome inhibitor therapy. Results: We matched 183 patients on GLP1a to patients on DPP4i. The prevalence of hypertension, ischemic heart disease, and use of proteasome inhibitors was similar between cohorts. In a Cox proportional hazard analysis, patients who received GLP1a had an approximately 50% lower risk of major adverse cardiovascular events (HR, 0.53 [95% CI: 0.29-0.96]) compared to those who received DPP4i. Furthermore, GLP1a was associated with a reduction in heart failure and heart failure hospitalization, ischemic stroke, and all-cause mortality. The risks of myocardial infarction and atrial fibrillation/flutter were comparable between the two cohorts. Conclusions: GLP1a were associated with a reduction in major adverse cardiovascular events and mortality among patients with multiple myeloma and diabetes mellitus receiving proteasome inhibitors. [Table: see text]

Impact of semaglutide and tirzepatide administration on weight in women with stage I-III breast cancer.

e24140 Background: Weight gain and obesity are significant problems for women receiving adjuvant therapy for breast cancer and obesity is associated with adverse breast cancer outcomes. In addition, obesity is associated with negative impact on overall physical and mental health. The GLP-1 agonists, semaglutide (S) and tirzepatide (T), are effective in achieving weight loss and have been associated with decreased incidence of diabetes, stroke and overall mortality in the non-diabetic as well as diabetic populations. There are limited data on the efficacy and safety of GLP1 agonists in women with breast cancer. Methods: We performed a retrospective analysis of the association of S and T use with weight loss in patients with stage I-III breast cancer diagnosed and treated at the Yale Cancer Center/Yale New Haven Health Network between 2017 and 2022. After institutional review board approval, a database including 7149 patients including 92,989 office visits was constructed. Maximal weight loss after S/T prescription as well as mean weight loss were calculated. S and T treated patient’s stage distribution and rates of recurrence were compared to untreated patients. For patients without metastatic disease, repeated measures regression analysis was utilized to evaluate changes in weight and BMI. Results: Of the 5430 evaluable patients with non-metastatic disease, 70 (1.3%) were prescribed S or T. Mean age was 58 (41-78). 74% received endocrine therapy. Mean pretreatment weight was 95.8 kg and BMI was 35.9 kg/m2. Mean weight loss for S/T treated patients was 3.03 kg (3.9-2.13, p &lt; .0001) corresponding to reduction in BMI of 1.1 kg/m2 (0.7-1.5 p &lt; .0001). We also calculated maximal weight loss after S/T prescription. Mean maximal weight loss was 8.89 kg (6.71-10.98 P &lt; .0001) corresponding to a mean maximal reduction in BMI of 3.2 kg/m2 (2.3-4.2 P &lt; .0001). Rates of local, locoregional, and distant breast cancer recurrence were 1.5%, 0%, 1.5% in the S/T treated patients and 1.3%, 4.7% and 3.3% in the untreated patients. None of these differences were statistically significant. Conclusions: In this retrospective analysis, GLP-1 agonist are associated with clinically meaningful weight loss in overweight and obese women with early breast cancer. Recurrence risk did not appear to be preliminarily impacted by treatment. Additional research is needed on long term safety as well as weight loss maintenance with these drugs in breast cancer survivors.

Investigation of the weekend effect on perioperative complications and mortality after carotid revascularization

ObjectiveOutcomes for weekend surgical interventions are associated with higher rates of mortality and complications than weekday interventions. Although prior investigations have reported the “weekend effect” for carotid endarterectomy (CEA), this association remains unclear for transcarotid artery revascularization (TCAR) and transfemoral carotid artery stenting (TFCAS). We investigated the weekend effect for all three carotid revascularization methods. MethodsWe queried the Vascular Quality Initiative for patients who underwent CEA, TCAR, and TFCAS between 2016 and 2022. χ2 and logistic regression modeling analyzed outcomes including in-hospital stroke, death, myocardial infarction, and 30-day mortality by weekend vs weekday intervention. Backward stepwise regression was used to identify significant confounding variables and was ultimately included in each final logistic regression model. Logistic regression of outcomes was substratified by symptomatic status. Secondary multivariable analysis compared outcomes between the three revascularization methods by weekend vs weekday interventions. ResultsA total of 155,962 procedures were analyzed including 103,790 CEA, 31,666 TCAR, and 20,506 TFCAS. Of these, 1988 CEA, 246 TCAR, and 820 TFCAS received weekend interventions. Logistic regression demonstrated no significant differences for TCAR and increased odds of in-hospital stroke/death/myocardial infarction for CEA (odds ratio [OR]: 1.31, 95% confidence interval [CI]: 1.04-1.65) and TFCAS (OR: 1.46, 95% CI: 1.09-1.96) weekend procedures. Asymptomatic TCAR patients had nearly triple the odds of 30-day mortality (OR: 2.85, 95% CI: 1.06-7.68, P = .038). Similarly, odds of in-hospital death were nearly tripled for asymptomatic CEA (OR: 2.89, 95% CI: 1.30-6.43, P = .009) and asymptomatic TFCAS (OR: 2.78, 95% CI: 1.34-5.76, P = .006) patients. Secondary analysis demonstrated that CEA and TCAR had no significant differences for all outcomes. TFCAS was associated with increased odds of stroke and death compared with CEA and TCAR. ConclusionsIn this observational cohort study, we found that weekend carotid revascularization is associated with increased odds of complications and mortality. Furthermore, asymptomatic weekend patients perform worse in the CEA and TFCAS procedural groups. Among the three revascularization methods, TFCAS is associated with the highest odds of perioperative stroke and mortality. As such, our findings suggest that TFCAS procedures should be avoided over the weekend in favor of CEA or TCAR. In patients who are poor candidates for CEA, TCAR offers the lowest morbidity and mortality for weekend procedures.

Exploring the Interplay between Asthma and Hemoglobinopathies: A Comprehensive Review.

Asthma, a prevalent chronic respiratory condition characterized by inflammation of the airways and bronchoconstriction, has demonstrated a potential association with hemoglobinopathies such as thalassemia and sickle cell disease (SCD). Numerous studies have highlighted a higher prevalence of asthma among thalassemia patients compared to the general population, with rates ranging around 30%. Similarly, asthma frequently coexists with SCD, affecting approximately 20-48% of patients. Children with SCD often experience heightened lower airway obstruction and airway hyper-reactivity. Notably, the presence of asthma in SCD exacerbates respiratory symptoms and increases the risk of severe complications like acute chest syndrome, stroke, vaso-occlusive episodes, and early mortality. Several studies have noted a decrease in various cytokines such as IFN-γ and IL-10, along with higher levels of both IL-6 and IL-8, suggesting an overactivation of pro-inflammatory mechanisms in patients with hemoglobinopathies, which could trigger inflammatory conditions such as asthma. The exact mechanisms driving this association are better elucidated but may involve factors such as chronic inflammation, oxidative stress, and immune dysregulation associated with thalassemia-related complications like chronic hemolytic anemia and iron overload. This review aims to comprehensively analyze the relationship between asthma and hemoglobinopathies, with a focus on thalassemia and SCD. It emphasizes the importance of interdisciplinary collaboration among pulmonologists, hematologists, and other healthcare professionals to effectively manage this complex interplay. Understanding this link is crucial for improving care and outcomes in affected individuals.

Stroke care in sub-Saharan Africa: Evaluating the present landscape and proposing strategies for improving outcomes

The burden of stroke is alarmingly high in sub-Saharan Africa (SSA), characterized by increasing trends in stroke incidence, prevalence, and mortality. This review details the landscape of stroke care in SSA, encompassing epidemiology, risk factors, care availability, and challenges in advancing stroke care, along with a proposed strategic framework for improvement. Epidemiological studies in SSA indicate a rising trend in stroke incidence and prevalence, with significant variability attributable to differences in study methodologies. Crude incidence rates have risen from an average of 53 (range: 26 &amp;ndash; 101) cases/100,000 population between 1973 and 1991 to 88 (range: 25 &amp;ndash; 149) cases/100,000 population between 2003 and 2011. Similarly, prevalence rates have shown an upward trend. Stroke mortality in SSA remains high, with variability across studies. Key predictors of mortality include hemorrhagic stroke, gender, National Institute of Stroke Scale score at presentation, and comorbidities such as anemia and human immunodeficiency virus infection. However, the interpretation of mortality rates warrants caution due to methodological limitations. Both modifiable and non-modifiable risk factors significantly contribute to stroke risk in SSA. Notably, stroke occurs at a younger age in SSA compared to Western countries. Hypertension, diabetes, dyslipidemia, and lifestyle factors are among the major modifiable risk factors. The availability of organized stroke care varies significantly across SSA, with more advanced care typically found in higher-level health-care centers. However, efforts to improve access and quality of care are ongoing. The challenges in advancing stroke care in SSA include cultural beliefs, limited access to care, and prohibitive costs. A &amp;ldquo;5 Ps&amp;rdquo; framework involving collaboration among policymakers, payers, partners in health care, providers, and patients is proposed to improve stroke care. This review underscores the urgent need for enhanced public health strategies, medical interventions, and collaborative efforts to address the escalating stroke burden in SSA.