Risultati per: Stroke

Circulation, Volume 150, Issue Suppl_1, Page A4129945-A4129945, November 12, 2024. Objectives:The aim of this study was to assess the risk of stroke for temporary mechanical circulatory support (tMCS) device treated acute myocardial infarction (AMI).Background:Data are limited regarding risk of stroke for temporary mechanical circulatory support (tMCS) device treated acute myocardial infarction (AMI).Methods:The national inpatient sample database was analyzed to identify adults who were hospitalized for AMI between 2012 and 2021, hospitalizations were grouped based on the temporary mechanical circulatory support device.Study design:In the final cohort, there are 8,272,163 (96.0%) weighted hospitalizations treated without tMCS, 265,870 (3.1%) with Intra-Aortic Balloon Pump (IABP) alone, 59,240 (0.7%) with Impella alone, and 16,225 (0.2%) with Extracorporeal Membrane Oxygenation (ECMO) used during the hospitalization.Results:The overall stroke rates for patients who treated without tMCS, IABP alone, Impella alone, and ECMO group were 3.41%, 3.46%, 4.51%, and 13.34% respectively. Specifically, the rates of ischemic stroke for these groups were 2.95%, 3.12%, 3.96% and 10.11% respectively. The rates for hemorrhagic stroke were 0.68%, 0.55%, 0.81%, and 4.90% for the same groups. In the stepwise forward Cox regression analysis, the adjusted OR (aOR) of ECMO use for overall stroke was 3.04 (95%CI [2.66-3.48]), followed by Impella only use with an aOR of 1.79 (95%CI [1.61-2.00]), and atrial fibrillation (aOR 1.34, 95%CI [1.31-1.38]). The subgroup analysis revealed that hospitalization with age younger than 50 years old, those without hypertension, and those presented with ST-elevation myocardial infarction are at particularly high risk of stroke for ECMO treated AMI.Conclusion:This ten years AMI hospitalizations analysis revealed that ECMO and Impella treatment associated with increased risk of both ischemic and hemorrhagic stroke. Particularly for those younger than 50, those without hypertension, and those presented with ST-elevation myocardial infarction. However, treatment with IABP alone does not increase the risk of stroke.

Circulation, Volume 150, Issue Suppl_1, Page ASa308-ASa308, November 12, 2024. Background:Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), an impedance threshold device (ITD) and controlled, gradual, automated head and thorax elevation, collectively termed automated Head Up Position (AHUP) CPR, increases cerebral perfusion pressure (CerPP), brain blood flow, coronary perfusion pressure (CorPP), end tidal CO2 (ETCO2) and cerebral oximetry (rSO2) in animal models when compared with conventional (C) CPR. AHUP-CPR in patients is associated with increased neurologically favorable survival versus C-CPR. This study tested the hypothesis that AHUP CPR will increase cardiac stroke volume (SV) and other hemodynamics compared with C-CPR in a porcine model of cardiac arrest.Methods:Farm pigs (n=15) were sedated, anesthetized, and ventilated. Hemodynamics, including intracardiac conductance catheter based biventricular (BiV) pressure-volume (PV) loops, were continuously measured and recorded. After 10 minutes of untreated ventricular fibrillation, C-CPR was performed for 2 minutes in the supine position using an automated CPR device designed for pigs at a rate of 100 compressions/minute, depth of 21% of the chest antero-postero diameter, a 50% duty cycle, and no active decompression. ACD+ITD was then performed with 3 cm of active decompression for 2 minutes, followed by AHUP-CPR, where the head and thorax were initially raised to 10 cm and 8 cm for a 2-minute priming phase, followed by elevation over the next 2 minutes to 24 cm and 9 cm. A linear mixed-effects model with a random intercept for individual pigs was used for statistical analysis.Results:CerPP, CorPP, ETCO2, and rSO2, as well as BiV SV and cardiac output, increased progressively and significantly with implementation of AHUP-CPR (p

Circulation, Volume 150, Issue Suppl_1, Page A4139074-A4139074, November 12, 2024. Background:Early intervention with lipid lowering therapy (LLT) in patients with high cardiovascular (CV) risk before myocardial infarction or stroke may have substantial public health benefits, despite being perceived as less urgent. The effect of evolocumab in this population is being investigated in an ongoing clinical trial (NCT03872401: Effect of Evolocumab in Patients at High Cardiovascular Risk Without Prior Myocardial Infarction or Stroke [VESALIUS-CV]). The current ongoing observational study examines the global burden of a VESALIUS-CV-like population in the REAL-world (“VESALIUS-REAL”) in eight regions. We present data here on baseline characteristics and LLT of VESALIUS-CV like patients in the US.Methods:Using the eligibility criteria aligned with VESALIUS-CV (Figure), data were extracted from HealthVerity medical and pharmacy claims (2016-2023). A two-year observability period was required before index date; therefore, the first possible cohort entry was on January 1, 2018.Results:There were 518,852 VESALIUS-CV like patients with median age of 72 years (Q1-Q3: 64-79 years) and 56% were female (Table). Overall, 43% had coronary artery disease and 34% had high-risk diabetes mellitus (DM). Median low density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol and apolipoprotein B were 114 (Q1-Q3: 97-138) mg/dL, 141 (122-168) mg/dL and 92 (181-110) mg/dL, respectively. About 22% were on background LLT of whom 87% were on statins alone. Patients on LLT vs. no LLT were younger (median age 65 [Q1-Q3: 59-72] vs. 73 [66-80] years), had higher prevalence of tobacco users (29% vs. 17%) and high-risk DM (45% vs. 31%).Conclusions:In a large cohort of VESALIUS-CV like US patients, the majority had LDL-C sub-optimally managed with most not taking any LLT. This finding suggests an opportunity to reduce the treatment gap and improve lipid management in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4123899-A4123899, November 12, 2024. Aim:This study investigates the prevalence of isolated interventricular membranous septal (IVMS) aneurysms detected via echocardiography and assesses the associated stroke risk without other classical risk factors.Methods:We searched the echocardiography database at Mount Sinai Morningside from January 2017 to September 2023. Identified echocardiograms were reviewed to confirm IVMS aneurysms and exclude sinus of Valsalva aneurysms. Patients with concurrent structural heart anomalies were excluded. Medical records were examined for baseline characteristics, risk factors, and cortical brain infarcts.Results:From 51,732 subjects, 18 were identified with IVMS aneurysms, yielding a prevalence of 0.04%. Four patients with significant structural heart disease were excluded, resulting in a final sample size of 14. Of these, 9 (64%) were female with a mean age of 59.6, and 5 (36%) were male with a mean age of 55.4. The mean BMI was 27.9 kg/m2, with 4 classified as obese. All patients were nonsmokers; 2 had a family history of stroke. One patient had diabetes, 8 had hyperlipidemia, and 9 had hypertension. Only one patient had paroxysmal atrial fibrillation, with a CHA2DS2-VASc score of 0. Echocardiography revealed structurally normal hearts with a mean left ventricular ejection fraction of 61% and a mean left atrial volume index of 24.8 mL/m2. The mean neck diameter of the aneurysm was 8.7 mm, and the mean diameter was 11.9 mm. Two patients had inter-atrial septal aneurysms, and one had a patent foramen ovale.Out of the 14 patients, 5 had a history of ischemic stroke (4) or transient ischemic attacks (1), all of whom were 64 years or younger with a mean RoPE Score of 6 and a mean CHA2DS2-VASc score of 1.6 at the time of their first neurologic event. All patients were treated with aspirin and statin therapy. Two patients had recurrent strokes, one of whom had four recurrent strokes, all cortical infarcts. These patients were switched to clopidogrel after 3 months of dual antiplatelet therapy. No anticoagulation was used.Conclusion:This retrospective study highlights a notable association between isolated IVMS aneurysms and an increased risk of ischemic stroke (36%) and recurrent ischemic stroke (14%). Despite their rarity, these anomalies should be considered in unexplained strokes. Optimal management strategies remain ambiguous, but anticoagulation may be favored based on presumed stroke mechanisms. Large-scale multicenter studies are needed for validation.

Circulation, Volume 150, Issue Suppl_1, Page A4146473-A4146473, November 12, 2024. Background:Stroke presents a significant burden to the health care system of the United States. Previous research has shown a higher rate of stroke mortality in rural compared to urban areas. Rural communities are highly heterogeneous, and less is known about the variation in stroke across rural communities. Therefore, we sought to examine the association between rurality and hospitalization for acute ischemic stroke across rural vs urban zip codes among US census geographic regions.Methods:We included fee-for-service Medicare beneficiaries with prevalent hypertension and/or diabetes followed from 2017 to 2021. Participants were categorized at the residential zip code level into metropolitan, micropolitan, small towns, and rural areas using Rural Urban Commuting Area Codes. Census geographic regions were categorized at the state level into Northeast, South, Midwest, and West. First hospitalization for ischemic stroke or TIA were identified using algorithms from Medicare claims. The association between rurality and stroke hospitalization was estimated in age, race, and sex adjusted models. Additional models were stratified according to census region.Results:We included 25,915,862 participants (age 73; 45% male; 97.6% hypertension; 41.6% diabetes; 75.5% metropolitan). Hypertension prevalence was similar across RUCA codes (98%) but diabetes prevalence was slightly lower (42% vs. 39%, metropolitan vs. rural zip codes). After a mean follow-up of 3.8 years, we observed 832,567 first stroke hospitalizations. The south had a higher event rate compared to all other regions (8.79 vs. 8.17 per 1,000 person-years). In multivariable-adjusted models, compared to metropolitan zip codes, stroke risk was similar across micropolitan and small town areas but lower among rural areas. A different pattern of results was observed across geographic regions, with a higher risk for stroke across categories of rural areas in the south but not in other geographic regions (see Table).Conclusion:The impact of rurality on stroke risk varies by geographic region, with a higher risk for stroke among rural zip codes in the south but not in other geographic regions. Further research is needed to characterize the causes of the variability in stroke risk across rural communities.

Circulation, Volume 150, Issue Suppl_1, Page A4131630-A4131630, November 12, 2024. Introduction:Current guidelines recommend oral anticoagulation in atrial fibrillation (AF) patients with a CHA2DS2-VASc score ≥ 2 for stroke prevention. Left atrial appendage occlusion (LAAO) devices serve as alternatives to reduce stroke risk in select AF patients that are unable to tolerate long-term oral anticoagulation. However, Centers for Medicare&Medicaid Services reimburses left atrial appendage occlusion (LAAO) for patients with CHA2DS2-VASc score ≥ 3.Objective:To evaluate differences in outcomes and complications of LAAO therapy in AF patients with a CHA2DS2-VASc score of ≥ 3 versus < 3.Methods:National Inpatient Sample and International Classification of Diseases, 10th Revision codes were used to identify AF patients who underwent LAAO device implantation in the U.S. from 2016−2020. The study population was stratified by stroke risk into two groups, CHA2DS2-VASc ≥ 3 and < 3. Study endpoints assessed included procedural complications, inpatient outcomes and resource utilization. A multivariable logistic regression model was used to assess the independent association of CHA2DS2-VASc score with study outcomes.Results:A total of 73,795 and 15,500 LAAO devices were implanted in patients with CHA2DS2-VASc ≥ 3 and < 3, respectively. Compared to patients with CHA2DS2-VASc score of ≥ 3, patients with CHA2DS2-VASc < 3 had lower overall (6.9% vs 9.9%, P< 0.01) and major (4.5% vs 6.2%, P< 0.01) complications in the crude analysis. After multivariable adjustment for potential confounders, CHA2DS2-VASc < 3 was associated with lower overall complications (aOR 0.84, 95% CI 0.78 – 0.91), major complications (aOR 0.90, 95% CI 0.81-0.99) and cost of hospitalization (aOR 0.95, 95% CI 0.91-0.99).Conclusions:Patients with CHA2DS2-VASc < 3 had lower complications and hospitalization costs after LAAO device implantation than patients with CHA2DS2-VASc ≥ 3 . These data, if redemonstrated in a large randomized trial can have important clinical implications for stroke prevention in AF patients.

Circulation, Volume 150, Issue Suppl_1, Page A4147046-A4147046, November 12, 2024. Background:Stroke is one of the leading causes of death for older individuals with hypertension. This research investigates the variations in stroke mortality rates and trends among 65-year-old hypertension patients in the US from 2000 to 2020.Methods:The CDC WONDER database’s mortality data from 2000 to 2020 was used for a retrospective analysis. Average Annual Percentage Change (AAPC) and Annual Percent Change (APC) were used to evaluate trends and produce age-adjusted mortality rates (AAMRs) per 100,000 people. Data was stratified by year, sex, race/ethnicity, and geographical regions.Results:Between 2000 and 2020, 598,341 deaths among individuals 65 years of age or older in the United States were related to stroke due to hypertension. Most occurred in nursing homes/long-term care facilities (36.7%). The overall AAMR for stroke in hypertension-related deaths dropped from 86.6 in 2000 to 51.8 in 2020, with an AAPC of -2.86 (95% CI: -3.18 to -2.61, p < 0.000001). Between 2000 and 2012, the AAMR had a considerable reduction (APC: -2.30, p < 0.000001). Subsequently, from 2012 to 2018, there was a more dramatic decrease (APC: -6.85, p < 0.000001) than a notable rise (APC: 6.45, p = 0.024) from 2018 to 2020. Older women had higher AAMRs than older men (women: 66.5; men: 60.1). Both sexes experienced decreases, with the decline more prominent in women (women: AAPC: -3.20, p < 0.000001; men: AAPC: -2.22, p < 0.000001). There were notable racial differences: Black people had the highest AAMRs (31.0), followed by White people (21.8), American Indians and Alaska Natives (18.6), Asians and Pacific Islanders (12.9), and Hispanics (12.5). All racial groups experienced decreases in AAMRs, most pronounced in Asians (AAPC: -4.62, p < 0.000001). Geographically, Massachusetts had the lowest (36.3), and Mississippi had the highest (117.7) AAMRs. The Western region had the highest average AAMR (71.8), while nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (nonmetropolitan: 25.9; metropolitan: 20.7).Conclusion:The study uncovers significant variations in mortality rates among elderly individuals in the US due to stroke and hypertension. The recent uptick emphasizes the necessity for targeted efforts to tackle these disparities and improve the health outcomes of affected communities.

Circulation, Volume 150, Issue Suppl_1, Page A4144471-A4144471, November 12, 2024. Introduction:The CHADS2 and CHADS2VASc scoring systems are used to determine thromboprophylaxis indication in patients with atrial fibrillation (AF). While these scoring systems include multiple independent risk factors for the development of ischemic stroke, their overall predictive performance is poor when applied to cancer populations.Research Question:To identify whether cancer serves as an independent risk factor for ischemic stroke in AF.Methods:TriNetX, a global health research database, was utilized to identify AF patients with and without malignancy from 2015 to 2022, excluding patients with prior cerebrovascular disease. Propensity score matching was conducted to control for demographic variables, heart failure, type 2 diabetes, hypertension and anticoagulation. Propensity matching yielded two cohorts consisting of 45,339 patients each. Risk and survival analyses were then run at 3 months, 6 months, 1 year, and 5 years after the index event. The primary outcome was stroke and secondary outcomes were mortality and major bleeding events.Results:At 3 months, our study showed that the incidence of stroke was higher in patients with AF and malignancy when compared to AF alone, with an odds ratio (OR) of 2.773 (p < 0.001). A Kaplan-Meier curve analysis revealed a hazard ratio (HR) of 2.683 with a confidence interval of 2.564-2.807. These results were consistent at the 6-month, 1-year and 5-year intervals, with an OR of 2.737, 2.685 and 2.167, respectively (p-value

Circulation, Volume 150, Issue Suppl_1, Page A4143204-A4143204, November 12, 2024. IntroductionFamily caregivers of persons with advanced heart failure (HF) and stroke bear increased responsibilities as care recipients recover from acute hospitalization. Few formalized supports are available. We conducted a feasibility pilot of a caregiver-targeted support program: Heart Failure and Stroke Resilience Intervention for Caregivers (HEROIC) using a randomized waitlist-control design. Here we sought to understand similarities and differences in participation between HF and stroke enrolled caregiver participants.MethodsWe recruited caregivers of HF and stroke patients via review of the electronic health record and/or provider referral after the first follow-up visit. Baseline surveys were collected electronically. Enrolled participants were randomized to the intervention or waitlist group. HEROIC consists of 5 nurse-led, remote sessions over a 10-week period. Components incorporate resilience resources including emphasis on caregiver life purpose and values, goal-setting for self-care, social support, community and palliative care resources. Characteristics of participants were analyzed using descriptive statistics and t-test or chi-square as appropriate.ResultsWe identified 158 potential caregivers through electronic health records and provider referral. 65% (n=103) were reached by phone and 57/103 (55%) were eligible for participation. Fifty caregivers consented but only 31 completed baseline data collection and were randomized. Reasons for drop out included loss to follow-up, patient death and too many competing demands. Caregivers were on average 58.4 years old (SD: 11.4), 84% female and 45% Black. They supported patients with moderate to severe functional impairment and 5.5 ± 2.3 instrumental activities of daily living (IADL) on average. Over half of caregivers reported financial strain. Caregivers reported moderate caregiver strain using the Modified Caregiver Strain Index (Mean: 11.9, SD: 6.0). Most caregivers supported persons with HF (n=19). The only statistically significant difference noted between HF and stroke caregivers was gender; more caregivers of stroke patients were male.ConclusionsSimilarities in baseline characteristics of HF and stroke caregivers suggest similar caregiving experiences. HEROIC or other early post-hospital caregiver support interventions may appeal to caregivers to increase resilience to the stresses of transitions of care but recruitment strategies require additional consideration.

Circulation, Volume 150, Issue Suppl_1, Page A4124839-A4124839, November 12, 2024. Introduction:Thrombus in the left atrial appendage (LAA) is known to be one of the risk factors for ischemic stroke, and after the detection of LAA thrombus, anticoagulation therapy is usually administered. However, the role of anticoagulation therapy before the detection of LAA thrombus in the prognosis is still unclear.Hypothesis:We assessed the hypothesis that the anticoagulation status at the time of LAA thrombus detection with transesophageal echocardiography (TEE) affects the future incidence of ischemic stroke.Methods:Patients who underwent TEE and were found to have LAA thrombus were included. Patients were divided into two groups based on their anticoagulation status before TEE. To exclude strokes that might occur due to the detected LAA thrombus itself, landmark analysis was performed by excluding patients who had a stroke or died within 30 days after detection of the LAA thrombus. The difference in the 7-year cumulative incidence of ischemic stroke was assessed using the Gray-test. Fine-Gray proportional hazard regression was utilized to assess the impact of anticoagulation status on ischemic stroke.Results:Among 183 patients detected with LAA thrombus, 15 suffered ischemic stroke or death within 30 days of detection, and 168 patients were included in this study. Of these, 58 patients were treated with anticoagulation therapy before the index detection of LAA thrombus (PreAC group). Patients in the PreAC group were older (median 76 years [interquartile range 51-88 years] vs. 74 years [38-89 years], P = 0.032) than those in the non-PreAC group. The rates of CHA2DS2-VASc score ≥ 2 (93% vs. 89%, P = 0.582), male sex (64% vs. 70%, P = 0.488), and history of atrial fibrillation (98% vs. 95%, P = 0.667) were similar between the two groups. The cumulative ischemic stroke rate was higher in the PreAC group than in the non-PreAC group (P = 0.048, Figure). Even after adjusting for CHA2DS2-VASc score, anticoagulation therapy before detection of LAA thrombus was significantly associated with the cumulative incidence of ischemic stroke (P = 0.049).Conclusions:Anticoagulation status before the detection of LAA thrombus is a determinant of a higher incidence of ischemic stroke. The background mechanisms suggesting a tendency toward thrombus generation even when treated with anticoagulation are proposed.

Circulation, Volume 150, Issue Suppl_1, Page A4146347-A4146347, November 12, 2024. Background:Acute ischemic stroke (AIS) is a leading cause of mortality and disability globally, disproportionately affecting Black and Latinx populations who experience increased morbidity and mortality compared to their white counterparts. At one month, roughly 50% of AIS survivors experience mood disturbances (e.g., anger, irritability, and aggression) and exhibit a lower health-related quality of life (HRQOL) compared to pre-AIS levels. Downstream biomarkers of mitochondrial dysfunction such as oxidative stress may be important pathophysiological mechanisms underlying mood disturbance symptoms, stroke severity, and long-term functional recovery.Purpose:To examine associations among early and late peripheral plasma lipid levels, mood disturbance symptoms (e.g., anger, irritability), and HRQOL outcome over 3 months (baseline/study day 5, and months 1, 3) in persons following AIS.Methods:The pilot study is a non-probability, convenience sample of adult subjects ( > 18 years of age) with a diagnosis of AIS. Lipidomics analysis was performed using liquid chromatography-mass spectrometry (LC-MS) of untargeted lipids. The Agilent 6545 LC/Q-TOF platform was used to determine the absolute concentration of lipid species from peripheral plasma samples collected days 1, 3, 5 and months 1 and 3 post-AIS. General linear mixed models were used to test the predictive association of lipidomic biomarker mean value of peripheral plasma lipid levels and symptoms and outcomes over time (baseline and months 1 and 3).Results:We analyzed 82 subjects (age = 64 ± 12.1, 52% male, 78% Black, and 94% with hypertension). Elevated oxidative stress biomarkers (e.g., lipoxygenases, arachidonic acid, glycosylphosphatidylinositol) were associated with higher severity of anger and irritability symptoms, and a poorer HRQOL from baseline to 1- and 3-months post-AIS (p=0.04).Conclusion:An untargeted LC-MS lipidomics approach was used to identify lipids following AIS. Because oxidative stress plays a key regulatory role in complex downstream cellular function, these findings may be of great significance in understanding AIS pathophysiology that has the potential to inform personalized preventive strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4145771-A4145771, November 12, 2024. Background:Sleep quality has emerged as a potential contributor to ischemic stroke risk, and genetic associations have been increasingly investigated for this association. Our analysis aims to elucidate the current understanding of the genetic basis linking sleep quality parameters to ischemic stroke through four distinct exposure groups: short sleep duration, long sleep duration, total sleep duration, and the presence of insomnia.Method:The PubMed database was searched to find Mendelian randomization studies reporting the association between ischemic stroke and associated sleep durations and parameters using title abstract keywords and medical subject headings. The initial search yielded 76 results, of which 62 underwent title abstract screening, and nine studies were identified for full-text screening. Eight studies were included in the final analysis. The random effects model was used to pool binary outcomes as odds ratios (OR) with 95% confidence intervals (CI), and the results were presented on forest plots. P value < 0.05 was considered for statistical significance.Results:Our pooled analysis revealed a statistically significant association between insomnia and higher odds of ischemic stroke (1.11 [95% CI 1.01-1.22, p=0.03]). However, this finding was limited by high heterogeneity (I2 = 77%, p

Circulation, Volume 150, Issue Suppl_1, Page A4140589-A4140589, November 12, 2024. Introduction:Ischemic conditioning (IC), a procedure where the limb is exposed to recurrent bouts of blood flow occlusion followed by reperfusion, is clinically relevant for stroke rehabilitation as a neuromodulatory adjunct. Similar modalities (i.e., ischemic nerve block) revealed that peripheral blood flow restriction initiated neuroplastic changes in the motor cortex. Yet, this is unconfirmed with IC.Aims:To quantify changes in corticomotor excitability (CME) and transcallosal inhibition (TCI) of the paretic and nonparetic tibialis anterior (TA) muscle representations alongside changes in motor performance after one session of IC compared to sham ischemic conditioning (sham-IC), and aerobic exercise.Methods:Fifteen chronic stroke survivors will participate in three sessions: one involving IC, one involving sham-IC, and one involving aerobic exercise, with a one-week washout period between sessions. During the IC and sham-IC sessions, participants will undergo three 10-minute cycles, totaling 30 minutes. Each cycle will consist of 5 minutes of occlusion with cuff pressure set at either 225mmHg (IC) or 25mmHg (sham-IC), followed by 5 minutes of reperfusion with cuff pressure set at 0mmHg. The aerobic exercise session will involve 30 minutes of moderate-intensity recumbent stepper cycling. Before (pre), after (post) and 30 minutes after (post-30) each intervention, CME and TCI will be assessed using transcranial magnetic stimulation in addition to paretic ankle strength and reaction time (RT).Results:Pilot data from five males (mean ± SD: age = 62.4 ± 9.9 years; years since stroke = 8.4 ± 4.6) showed that after IC, CME increased by 31% (post) and 15% (post-30) and TCI increased by 12% (post) and 13% (post-30). After aerobic exercise, CME decreased by 8% (post) and increased by 5% (post-30) whereas TCI increased by 14% (post) and 16% (post-30). Sham-IC had negligible results. Strength improved by 19% (post) and 25% (post-30) following IC and by 16% (post) and 15% (post-30) following aerobic exercise. RT increased by 11% after IC but only by 2% after exercise and

Circulation, Volume 150, Issue Suppl_1, Page A4139443-A4139443, November 12, 2024. Background:Guidelines recommend shared decision-making (SDM) for patients with atrial fibrillation (AF) making decisions regarding anticoagulation for stroke prevention. Decision support tools (e.g., Decision Aids [DAs]) facilitate SDM. However, little research has compared the effectiveness of the two most common types of DAs: (1) encounter decision aid (EDA) and (2) pre-encounter patient decision aid (PDA). Our study assessed the comparative effectiveness of PDAs and EDAs on SDM during AF clinical encounters where stroke prevention strategies were discussed.Research Question:Do decision aids (PDA or EDA), alone or in combination, improve patients’ AF decision-making experience compared to usual care?Methods:A cluster randomized multi-center trial in patients with AF comparing usual care (no DA) vs. one DA (EDA or PDA) or both DAs. Clinicians and patients were randomized independently into 4 study arms. Clinicians were randomized to use or not use the EDA for all study visits, and patients were randomized to use or not use the PDA. Co-primary outcome domains were: (1) quality of SDM (2) patient knowledge, and (3) decisional conflict. Secondary outcomes included: (1) treatment choice, (2) treatment initiation, and (3) treatment persistence. Patient characteristics were assessed. We will present comparisons of the randomized DAs on the co-primary and secondary outcomes and subgroup analyses.Results:Between December 2020-July 2023, investigators in 6 U.S. healthcare systems enrolled 1117 patients (mean (M) age 69, 63% male, 89% White) and 107 clinicians. Compared to usual care (no DA, M=31.6), SDM was better in patients receiving PDA (M=35.4) and EDA (44.5) alone or together (M=43.7; p’s

Circulation, Volume 150, Issue Suppl_1, Page A4144617-A4144617, November 12, 2024. Introduction:Over the past two decades, treatment advances for atrial fibrillation (AF) and stroke have improved overall survival (OS). However, a significant proportion of the population still faces high mortality, suggesting an uneven distribution of improvements. This study analyzes mortality after stroke in older adults with AF in the United States (US), highlighting disparities and trends.Method:A retrospective analysis was conducted using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, extracting data through ICD-10 code I48, I63.1, I63.2, I63.4, I63.5, I63.8, I63.9, I64, I69.4, to find stroke-related deaths among people diagnosed with AF, aged ≥65 years old from 1999 to 2019. We examined demographic disparities in mortality rates by age, gender, race, geographic region, rural/urban classification, and place of death. Results were reported as age-adjusted mortality rates (AAMR) with 95% confidence intervals (CI). Joinpoint regression assessed trend changes and average annual percentage change (AAPC).Results:Between 1999 and 2019, 398,571 individuals aged 65 and older died from AF and stroke in the US, with an AAMR of 45.6 per 100,000 (95% CI: 45.5-45.8). The AAMR declined from 47.0 in 1999 to 45.7 in 2019. Mortality rates showed disparities: females had a higher AAMR than males (46.4 vs. 43.4), non-Hispanics higher than Hispanics (46.7 vs. 27.9), and Whites higher than Blacks (48.5 vs. 32.8). The West was the most affected region (53.9), while the Northeast was the least affected (42.1). State variations were most pronounced in Vermont and Oregon (84.9 and 78.6) and lowest in Louisiana and Nevada (28.3 and 27.0). Rural areas had higher AAMR than urban areas (51.1 vs. 44.4). Most deaths occurred in inpatient settings (39.3%), followed by nursing homes (32.6%). The age group 85 years and older accounted for the majority of deaths (56.5%).Conclusions:Overall mortality due to stroke and AF has decreased, yet disparities persist. Focused action is needed to mitigate these deaths. Expanding access to healthcare in rural areas and promoting stroke prevention programs are vital for improving survival rates.

Circulation, Volume 150, Issue Suppl_1, Page A4146740-A4146740, November 12, 2024. Background:Ischemic stroke incidence after catheter ablation is historically reported at 0.2-0.3%. With advancements in catheter design, mapping, ablation techniques, and reduced ablation times, it is pertinent to reevaluate stroke incidence. We aim to determine the rates of procedural stroke in a contemporary patient series and characterize the clinical profiles associated with procedure-related Ischemic stroke.Methods:All patients undergoing AF ablation from 2013 to 2021 at our center were enrolled in a prospective registry for outcomes and procedural complications and an automated platform for patient reported outcomes (AF symptom severity score, QoL, AF burden). Peri-procedural anticoagulation was continued peri-procedurally with therapeutic INRs or holding one dose of apixaban or dabigatran the morning of the procedure. Patients who experienced an ablation-related ischemic stroke or transient ischemic attack (TIA) were identified and compared to the general population of patients undergoing ablation.Results:Of 7020 patients undergoing ablation, only 8 had an ischemic cerebrovascular event (0.11%, 5 strokes, 3 TIAs). The average age was similar in stroke patients (66 years) and the general cohort (65 years). The average CHA2DS2Vasc score was higher in the stroke group (2.6) compared to the general cohort (2.3), with larger left atrial diameter (4.5 cm vs. 4.2 cm) and a more frequent history of TIA (11% vs. 3.2%). AF burden was higher in stroke patients at baseline with higher AF frequency scores (8.8 vs 6.8) and higher AF duration scores (10 vs. 7.0 in controls). Other characteristics of patients with ischemic cerebrovascular events are summarized in table. All but one patient recovered without residual neurological deficits.Conclusion:In this contemporary cohort of patients undergoing ablation, procedural related ischemic stroke incidence was 0.11% and associated with higher CHA2DS2Vasc score, larger atria, and baseline AF burden. This suggests that stroke rate is lower in modern practice versus historical cohorts.