Risultati per: Stroke

Circulation, Volume 150, Issue Suppl_1, Page A4145081-A4145081, November 12, 2024. Background:The incidence of stroke in young adults is on the rise in the United States. Drug abuse has been proposed as a known modifiable risk factor for stroke in this age group. The association between cannabis use and stroke in young adults is an area that needs further exploration.Research Hypothesis:Cannabis is an independent modifiable risk factor for stroke in young adults with Cannabis Use Disorder(CUD).Aim:To investigate the association between Cannabis Use Disorder(CUD) and Stroke in young adults.Methods:Using the National Inpatient Sample 2019, admissions for stroke in the age group of 18-45 were identified. The cohort was subdivided into admissions with documented CUD. Demographic data of the cohort was analyzed, including the prevalence of comorbid conditions. Using multivariate binomial logistic regression, the association between cannabis use and the occurrence of stroke was studied, after accounting for age, smoking, cocaine abuse, and uncontrolled hypertension(HTN). A two-tailed p-value

Circulation, Volume 150, Issue Suppl_1, Page A4134345-A4134345, November 12, 2024. Background:Diastolic dysfunction (DD) is associated with adverse cardiovascular outcomes including atrial fibrillation. Whether DD is independently associated with incident ischemic stroke/transient ischemic attack (TIA) and with bleeding events is not well established.Aims:To examine the association of presence and severity of DD with the risk of incident ischemic stroke/TIA and major bleeding.Methods:A total of 219,667 patients who underwent at least one echocardiogram between 2010 and 2022 at a large academic institution and were followed for at least 3 months were included. Patients with prior history of stroke or TIA (n=21,505, 10%) were excluded. Smart key-phrase search was applied to echocardiographic reports to classify patients into 4 groups, based on the most severe DD assessment: Normal (n=113,265), grade I (n=21,981), grade II (n=7,215), and grade III (n=1,627). Patients in whom the presence of DD could not be determined (n=54,074) were excluded. The final study cohort (n=144,088) was followed to the endpoint of hospital admission for ischemic stroke/TIA or for major bleeding.Results:Over a median follow-up of 3.4 years, 3482 (2.4%) patients were hospitalized for stroke/TIA and 6994 (4.9%) for major bleeding. After adjusting for several confounding variables (Table), DD remained a strong predictor of incident stroke/TIA (hazard ratio (HR)=1.34 per grade increase in DD, p

Circulation, Volume 150, Issue Suppl_1, Page A4124323-A4124323, November 12, 2024. Background:Atrial fibrillation (AF) is a leading cause of stroke. However, predictors of stroke after AF ablation have not been well clarified, therefore, evidences of anticoagulation therapy after the procedure have been limited. Although left atrial low-voltage areas (LVAs) reflects atrial cardiomyopathy, which is a potential cause of thromboembolism, there are few reports of an association between LVAs and stroke. The purpose of this study was to investigate the association between atrial cardiomyopathy assessed by LVAs and stroke in patients undergoing AF ablation.Methods:The study design was a single center, retrospective observational study. This study included 1,486 (age, 68 ± 10 years; female, 501 [34%]; persistent AF, 905 [61%]) consecutive patients who underwent initial AF ablation from December 2014 to March 2022. The definition of LVAs were areas with a bipolar voltage of

Circulation, Volume 150, Issue Suppl_1, Page A4139285-A4139285, November 12, 2024. Introduction:Stroke and Myocardial Infarction (MI) are the leading causes of death in the United States. Awareness of symptoms is vital for early recognition and prompt treatment, which can significantly improve health outcomes. This study examines MI and stroke symptom awareness among Asian American adults, a group with limited prevalence estimates on this critical health metric.Hypothesis:There is variability in MI and stroke symptom awareness among Asian American subgroups, influenced by sociodemographic factors such as age, nativity, education, and income.Methods:We conducted a secondary analysis using data from the 2014 and 2017 National Health Interview Survey. Our sample included 2,832 Asian adults, categorized into self-identified ethnic groups: Asian Indian, Chinese, Filipino, and “Other Asian” (an aggregate category including Japanese, Korean, Vietnamese, and others due to low sample sizes). We assessed awareness of MI and stroke symptoms and the prevalence of recognizing 9-1-1 as the appropriate subsequent action using the Rao-Scott chi-square test to account for the complex survey design.Results:The study sample consisted of 2,832 adults (46.7 % male, 53.3% female, mean age 44.6 years [SD: 16.5 years]). Ethnic distribution was 22.0% Asian Indian, 22.5% Chinese, 20.8% Filipino, and 34.7% Other Asians. Significant disparities in symptom awareness were found among subgroups. Filipino adults exhibited the highest awareness of all five stroke symptoms (68%, 95% CI: 63%-73%) compared to Chinese (62%, 95% CI: 57%-67%), Asian Indian (53%, 95% CI: 48%-58%), and Other Asian adults (59%, 95% CI: 57%-61%). Similarly, Filipino adults also had the highest awareness of MI symptoms (51%, 95% CI: 45%-56%), compared to Asian Indian (37%, 95% CI: 32%-42%), Chinese (30%, 95% CI: 25%-34%), and Other Asian adults (30%, 95% CI: 27%-34%) (Figure).Conclusion:There is significant heterogeneity in MI and stroke symptom awareness among Asian American adults. Filipino adults demonstrated the highest levels of knowledge regarding subsequent actions. The study underscores the need for targeted public health interventions to enhance MI and stroke symptom awareness, particularly focusing on subgroups with lower awareness.

Circulation, Volume 150, Issue Suppl_1, Page A4134364-A4134364, November 12, 2024. Introduction:Inclisiran, an siRNA, targeting PCSK9 mRNA, reduces LDL-c levels. In SIRIUS in silico trial (NCT05974345), inclisiran was predicted to lower cardiovascular (CV) events in virtual patients with atherosclerotic cardiovascular disease (ASCVD).Research question:This analysis predicted the potential efficacy of inclisiran on CV outcomes in virtual patients with or without prior ischemic stroke (IS).Methods:The SIRIUS trial was conducted using a calibrated and validated knowledge-based mechanistic computational model of ASCVD applied to a virtual population with LDL-C ≥ 70 mg/dL. Each virtual patient was its own control. SIRIUS compared the efficacy of inclisiran vs placebo on top of High Intensity (HI) statin with or without ezetimibe on 3-Point-MACE defined as a composite of time to first occurrence of CV death, nonfatal myocardial infarction (MI) or nonfatal IS over 5 years in patients with or without prior IS. Occurrence of fatal and non-fatal (IS) was also individually assessed in time-to-first-event analyses.Results:Among 204,691 virtual SIRIUS ASCVD patients, 39 371 (19%) had prior IS. At 5 years, the predicted mean percentage reduction in LDL-C with inclisiran as compared to placebo was –49.17% and –49.88% in patients with or without prior IS respectively. Patients with prior IS were at higher risk of 3P-MACE than patients without IS both with placebo and inclisiran (17.01% vs 14.41% with placebo and 13.44% vs 10.83% with inclisiran). However, the predicted rate of 3P-MACE in the inclisiran arm was consistently lower than in the placebo arm for both prior IS and no prior IS (HR 0.78 medium uncertainty and 0.74 low uncertainty respectively). Compared to placebo, inclisiran was also predicted to consistently reduce fatal and non-fatal IS in patients with or without prior IS (5.45% vs 7.22%; HR: 0.75 medium uncertainty and 1.87% vs 2.54%; HR: 0.73 medium uncertainty respectively).Conclusion:SIRIUS provides insights into the potential efficacy of inclisiran on CV events suggesting a substantial 3P-MACE and fatal and non-fatal IS reduction in ASCVD patients including those with prior IS, several years before the availability of results from ongoing outcomes trials (ORION-4, VICTORION-2P).

Circulation, Volume 150, Issue Suppl_1, Page A4119129-A4119129, November 12, 2024. Background:Thirty-day readmission following hospital discharge for stroke is an important quality measure for US hospitals. Current US prediction models for post stroke readmission based on electronic medical records from single healthcare systems or hospitals have modest discrimination (AUC range 0.64 – 0.74).Aim:To develop 30-day all-cause readmission prediction model using a machine learning (ML) based method trained on linked stroke registry and administrative claims data.Methods:Using probabilistic linking, we matched acute stroke (ICD-10 I61-I63) discharges from 31 hospitals participating in the Michigan Acute Stroke registry between 2016-2020 to multipayer administrative claims data provided by the Michigan Value Collaborative for Medicare and Blue Cross Blue Shield of Michigan commercial beneficiaries. Stroke registry data included patient demographics, clinical characteristics, past medical history, and treatments. Claims data was used to identify readmissions within 30 days of discharge. We used multivariable LASSO logistic regression- a simple ML technique to predict 30-day all-cause-readmission and evaluated the prediction accuracy using a hospital-split internal validation scheme to generate hospital-specific and pooled AUC estimates with 95% confidence intervals (Figure 1).Results:Of 19,382 linked stroke discharges, 2,724 (14.1%) were readmitted within 30-days. Readmitted patients were older, more likely to be male, black, and have higher stroke severity (NIHSS >5). Registry hospitals were either primary (64%) or comprehensive (26%) stroke centers. Hospital-specific 30-day readmission ranged between 9.9%-23.1% (P

Circulation, Volume 150, Issue Suppl_1, Page A4141534-A4141534, November 12, 2024. Background and purpose:Earlier European studies in young stroke patients have identified coronary artery disease (CAD) as a contributor to mortality. In the present Norwegian Stroke in the Young Study (NOR-SYS) sub-study we aim to investigate the true prevalence of CAD and the impact on mortality and event-free survival in young and middle-aged stroke survivors.Methods:Between September 2010 and December 2015, a total of 385 patients (15-60 years) with ischemic stroke were included. Clinical characteristics, echocardiographic and coronary imaging (angiography or cardiac CT) data, and arterial stiffness indices (pulse wave velocity, carotid intima media thickness and femoral plaque) were analysed. No CAD was defined as no history of CAD and no femoral artery plaque on vascular ultrasound (US) or negative coronary imaging. Coronary imaging was done if history of CAD or femoral plaque on US.Results:Mean (±SD) age was 49.6 (±9.7) year, 68.1% males. The overall prevalence of CAD was 25.2% (n=97) (non-obstructive 9.6% [n=37] and obstructive 15.6% [n=60]). In a subsample of patients (n=58) without a previous history of CAD or symptoms, who underwent cardiac CT as part of screening following femoral plaque on US, 46% (n=27) had non-obstructive CAD and 28% (n=16) had obstructive CAD. When further classified 17.2% had one-vessel disease, 3.4% two-vessel disease and 6.9% three-vessel disease. During a mean (±SD) follow-up of 9.8 (±2.5) years, 35 patients (9.1%) died (3.1% one-year mortality) and 83 (21.6%) reached a composite endpoint of new stroke, myocardial infarction or death, while 63 (16.4%) reached a composite endpoint of new stroke or death. In a Kaplan-Meier curve event-free survival was significantly lower in patients with CAD versus no-CAD (Figure). This was confirmed by multivariate cox regression models, in which CAD was an independent predictor of all-cause mortality (HR 2.25; 95% CI 1.07-4.47, p= 0.033) and composite endpoint of death or recurrent ischemic stroke (HR 3.26; 95% CI 1-47-7.23, p=0.004) adjusted for potential confounders.Conclusions:In the present study of young and middle-aged ischemic stroke survivors, a quarter of patients had CAD. In patients without previous history of CAD or symptoms who underwent cardiac CT on the basis of femoral plaque on US, nearly a half had non-obstructive and one-third obstructive CAD. CAD, and in particular obstructive CAD, was a major independent predictor of mortality and recurrent stroke.

Circulation, Volume 150, Issue Suppl_1, Page A4146431-A4146431, November 12, 2024. The growing adoption of advanced imaging modalities, such as transesophageal echocardiography (TEE), has led to more frequent detection of cardiac structural abnormalities. While intracardiac cardiac tumors and shunts are infrequent and typically asymptomatic, their existence can precipitate severe outcomes, including stroke, myocardial infarction and sudden death.Case Description:A 69-year-old female presented with left sided facial droop, slurred speech and left arm weakness. A computed tomography angiography revealed focal occlusion of the distal right middle cerebral artery. She was initiated on thrombolytic therapy and experienced resolution of symptoms. Transthoracic echocardiogram revealed right to left shunting consistent with a patent foramen ovale (PFO). Further workup with TEE confirmed the presence of a PFO but also detected a mobile echogenic mass on the aortic valve leaflet, indicative of papillary fibroelastoma (PFE). Cerebral infarction was attributed to an embolic event, with the PFO and PFE being likely culprits.Discussion:Current guidelines give a conditional recommendation, low certainty of evidence, for PFO closure in adults older than 60 years, although some observational studies have shown some risk reduction in older patients. The key trials showing clinical benefit of PFO closure were in adults younger than the age of 60. For left sided cardiac tumors, such as PFE, guidelines give a 2A recommendation for resection. Addressing the risk for recurrent stroke in this 69-year-old patient was an essential part of stroke care, as such, a multi-disciplinary team of experts including cardiology, neurology, and cardiothoracic surgery was conveyed. The decision was to proceed with surgical intervention in addition to antiplatelet therapy to achieve optimal risk reduction. The patient subsequently underwent successful surgical removal of the PFE with native valve preservation and PFO closure.Conclusion:Cardiac PFEs and PFOs can be associated with increased stroke risk. Employing appropriate imaging techniques and timely interventions are of utmost importance in stroke management.

Circulation, Volume 150, Issue Suppl_1, Page A4145764-A4145764, November 12, 2024. Background:Stroke is one of the leading causes of long-term disability and mortality worldwide. Of ischemic stroke etiologies, cardio-embolism both causes more severe strokes and is responsible for an increasing share of the ischemic stroke etiologies in the developed world. Mitral annular calcification (MAC), chronic degeneration of the fibrous base of the mitral valve, has been implicated by association with increased stroke risk. However, there has been conflicting evidence regarding the causative relationship between MAC and stroke risk. Although the 2008 CHEST guidelines recommended antithrombotic therapy with aspirin to mitigate stroke risk, the updated 2012 CHEST guidelines question the role of antithrombotic therapy since stroke may be due to embolized calcific spicules. 2020 American College of Cardiology / American Heart Association guidelines do not make recommendations regarding stroke prevention in MAC. Our study sought to assess the association of MAC and its severity with stroke outcomes.Hypothesis:We hypothesize an association between MAC and stroke which increases with increasing MAC severityMethods:We retrospectively studied patients undergoing transthoracic echocardiography in a single center cohort from 2005 through 2017. MAC severity was determined based on documented echo reports. Multivariable cox regression analysis was used to assess for correlation with stroke and was adjusted for diabetes, hypertension, hyperlipidemia, infection, endocarditis, lupus, prior MI, mitral disease, OSA, PAD, and prosthetic valves.Results:The cohort included 2,837 patients. Of the full cohort, 393 had no MAC, 1686 had mild MAC, 537 with had moderate MAC, and 221 had severe MAC. Mean age (57.2 to 68.6) and female gender rates (49.4% to 71%) significantly increased with increasing MAC severity. At median follow up of 73 months (IQR 6.1,103.7) there were a total of 92 stroke events. Cox regression analysis found aHR of 1.45 (0.74-2.84, p=0.28), 1.16 (0.52-2.59, p=0.72), and 1.23 (0.44-3.44, p=0.69), for mild, moderate, and severe MAC, respectively, when compared to patients without MAC.Conclusion:In a large single center cohort, there was no association found between MAC and stroke outcomes, regardless of severity.

Circulation, Volume 150, Issue Suppl_1, Page A4143300-A4143300, November 12, 2024. Background:Stroke contributes to significant morbidity and mortality in atrial fibrillation (AF). Clinical risk scores lack predictive accuracy and mechanistic links to thrombo-embolization.HypothesisAdding MRI-derived parameters to stroke risk calculators improves their predictive accuracy.AimsDemonstrate an association between left atrial emptying fraction (LAEF), long axis strain (LAS) and stroke in AF patients.Incorporating the above-mentioned LARF and LAS into the CHA2DVASc score improves its predictive accuracy.Methods:AF patients undergoing cardiac MRI were identified from the University of Washington Cardiac Arrhythmia Data Repository (CADRe). Pts with prior AF ablation were excluded from the study. LAEF and LAS were quantified using a semi-automated contouring of the LA wall was done through image processing software (CVI42®) (Panel A).Results:417 pts (average age 66±13years; 64% males) were included. The average CHA2DVASc (stroke component removed) score was 2.1±1.4. LAEF was 46.18%±11.64%, and LA LAS was 24.28%±13.45%. Univariate analysis revealed a significant association between stroke/TIA and LAEF (OR= 0.962, p= 0.024); but not with LAS (OR=0.962, p=0.091) or CHA2DVASc (OR=1.084; p=0.553). LAEF remained significantly associated with stroke in multivariate analysis, adjusting for age, gender, congestive heart failure, hypertension, coronary artery disease, and diabetes, (OR= 0.963, p= 0.042). Three other models including composite CHA2DVASc with and without LAEF with their respective ROC curves and AUC are shown in Panel B. Adding LAEF improved the AUC of CHA2DVASc (AUC 0.564 vs 0.653; p=0.048) or its components (AUC 0.539 vs 0.632; p=0.043). Using a cut-off LAEF of 46.53% (AUC: 0.71 CI: 0.61,0.81; Sensitivity: 68%; Specificity: 74%) resulted in the reclassification of 47(11.3%) pts to a higher risk category and none (0%) to lower risk (Panel C).Conclusion:Left atrial emptying fraction is independently associated with stroke or TIA, and improves the predictive accuracy of clinical risk scores in AF pts.

Stroke, Ahead of Print. BACKGROUND:Left ventricular diastolic dysfunction (DD) is associated with adverse cardiovascular outcomes including atrial fibrillation. Whether DD is independently associated with incident stroke and transient ischemic attack (TIA) and with bleeding events is not known. We performed this observational cohort analysis to examine the impact of DD on the risk of stroke/TIA and major bleeding.METHODS:Patients who underwent at least 1 cardiac echocardiogram and were followed for at least 3 months were included in this study. Patients with a prior history of stroke, TIA, or major bleeding, as determined byInternational Classifications of Diseasescodes, were excluded. Smart key-phrase search was applied to echocardiographic reports to classify patients into 4 groups based on the most severe DD assessment. Patients in whom the presence of DD could not be determined were excluded. The final study cohort was followed to the end point of hospital admission for stroke/TIA and major bleeding, and independent predictors of these events were evaluated using the multivariable Cox proportional hazards method.RESULTS:The final study cohort (age, 56±18 years; 56% women) had 96 702 patients with no DD and 18 164, 5881, and 1340 patients with DD grades I, II, and III, respectively. Over a median follow-up of 3.4 years, 2938 (2.4%) patients were hospitalized for stroke/TIA and 5567 (4.6%) for major bleeding. After adjusting for age, the CHA2DS2-VASc score, chronic kidney disease, use of antiplatelet agents, use of anticoagulation agents, the year of echocardiographic testing, household income, and history of atrial fibrillation, DD remained a strong predictor of incident stroke/TIA (hazard ratio, 1.22 per grade increase in DD [95% CI, 1.16–1.29];P

Circulation, Volume 150, Issue Suppl_1, Page A4139515-A4139515, November 12, 2024. Background:Recent clinical trials demonstrate the benefit of oral anticoagulation (OAC) for all device-recognized atrial fibrillation (AF) > 6 minutes. However, AF is not binary and those with greater AF burden generally have a higher risk of stroke. To date, there are limited data on a specific threshold of AF duration that is independently associated with the risk of ischemic stroke.Objective:To assess the association between baseline maximum daily AF duration (MDAFD) and ischemic stroke among patients with cardiac implantable electronic devices (CIEDs) capable of continuous AF detection.Methods:Using the Optum®de-identified electronic health record (EHR) (2007-2021) linked with the Medtronic CareLink®heart rhythm database, CIED patients with healthcare activity recorded in the EHR >12 months pre- and >6 months post-CIED implant were identified. Exclusion criteria included presence of a prescription for OAC. MDAFD was assessed during the first 30 days post-implant (baseline period). Associations between baseline MDAFD and ischemic stroke in follow-up were evaluated, adjusting for CHA2DS2-VASc and chronic kidney disease.Results:Of 26,400 patients (68±13 years; 60% male) analyzed, 2,544 (9.6%) had AF at baseline. The distribution of maximum daily AF duration during baseline was as follows: 6 min-5.5 hours of MDAFD was needed to increase the risk of ischemic stroke compared to those with no AF. These results suggest that there is a threshold of MDAFD, measured in hours, that may benefit from treatment with OAC.

Circulation, Volume 150, Issue Suppl_1, Page A4140884-A4140884, November 12, 2024. Background:Evidence on the use of digital health technologies by older adults is growing. However, the impact of these technologies in health promotion and disease prevention among older adults at risk for cardiovascular disease is not fully explored.Aims:This study aimed to compare the effect of two digital health technology-based interventions on engagement in healthy behaviors, weight loss, and psychological well-being over time (baseline [pre-intervention] to three months [post-intervention] to six months [long-term]) and explore outcome predictors.Methods:This randomized, longitudinal study examined the intermediate (three months) and long-term (six months) effects of two digital health technologies,Get FITvs.Get FIT+. Over 12 weeks,Get FITparticipants (n = 24) received one face-to-face counseling session on healthy food and exercise, an activity tracker (Fitbit Charge), and access to a nutrition app (MyFitnessPal app). TheGet FIt+group (n = 30) received all the same components asGet FIT, plus weekly personalized text messages to motivate and encourage them to meet their goals. General Linear Models were used for analysis.Results:Fifty-four older adults (mean age 65.6 ± 5.8 years, 60% women, 65.5% Hispanic) were randomly assigned into the two groups.Table 1shows the group comparisons betweenGet FITvs.Get FIT+in terms of healthy behaviors, weight loss, and psychological well-being outcomes at the three time-points. At six months, the group assignment was associated with greater weight loss, higher physical activity levels, reduced calorie intake, and lower depression scores. Being Hispanic was associated with higher weight, whereas being non-Hispanic and higher education with higher levels of depression.Conclusion:Digital health technologies increased the adoption of healthy behaviors, weight loss, and better psychological well-being over time, with greater improvements observed in theGet FIT+group. Likewise,Get FIT+participants sustained these improvements in the long term. A large randomized clinical trial is needed to evaluate the efficacy of both interventions in older adults at risk for cardiovascular disease.

Circulation, Volume 150, Issue Suppl_1, Page A4141154-A4141154, November 12, 2024. Background:Acute ischemic stroke (AIS) is one of the leading causes of death and disability in adults worldwide, and effective treatments are still lacking. Cold-inducible RNA-binding protein (CIRP) is up-regulated in response to various stress conditions. Previous studies have indicated that CIBP could potentially influence the development of various diseases.Research questions:Nevertheless, the specific role and molecular mechanism of CIBP after AIS remain unclear.Methods:The levels of serum CIRP and other brain injury markers such as NSE, S100β, GSDMD, and NLRP3 were measured by ELISA to explore the relationship between CIRP and AIS. Additionally, middle cerebral artery occlusion models (MCAO) in rats were established to investigate its localization in brain tissue using immunofluorescence staining. Additionally, the CIRP knockout MCAO rat model was established, and evaluate the effect of CIRP deficiency on the neurological function of rats. while the role of CIRP was investigated through RNA sequencing and Western Blot analysis. Additionally, the potential protective effect of the CIRP inhibitor C23 on neural injury following AIS was examined.Results:(1) Compared to the healthy control group, the serum levels of CIRP and other brain injury markers (NSE, S100β) in AIS patients and MCAO rats were significantly elevated, and the elevated levels were positively correlated. (2) In the MCAO rat model, the CIRP was mainly located in neurons and microglia. (3) Compared with wild-type MCAO rats, CIRP knockout MCAO rats improved neurological function scores. (4) RNA-seq analysis revealed that genes differentially expressed between wild-type MCAO rats and CIRP knockout MCAO rats were enriched in inflammation-related pathways. (5) The expression of pyroptosis-related proteins (NLRP3, Caspase-1, GSDMD, and ASC) and inflammatory factors (IL-1β, TNF-α, etc.) decreased in CIRP knockout MCAO rats. (6) The CIRP inhibitor C23 significantly alleviated brain injury and improved neurological function. C23 treatment significantly decreased the expression levels of pyroptosis-related proteins and inflammatory factors.Conclusions:This study shows that CIRP plays an important role in AIS development. The levels of CIRP in AIS patients and MCAO rats are significantly increased and are positively correlated with nerve damage markers. Thus, supporting CIRP as a potential target for the treatment of AIS. This discovery provides new strategies for the treatment of AIS.

Circulation, Volume 150, Issue Suppl_1, Page A4139504-A4139504, November 12, 2024. Background:Atrial fibrillation (AF) outcomes are strongly associated with continuous measures of AF burden.Objectives:To assess the association between changes in maximum daily AF duration (MDAFD) and the combined endpoint of ischemic stroke and mortality among patients with cardiac implantable electronic devices (CIEDs) capable of continuous AF detection.Methods:The Optum®de-identified electronic health record (EHR) (2007-2021) was linked with the Medtronic CareLink®heart rhythm database for this study. CIED patients with healthcare activity recorded in the EHR >12 months pre- and >6 months post-CIED implant were included, excluding those with oral anticoagulation (OAC) prescription. MDAFD was assessed during the first 30 days post-implant (baseline period) and the 30 days prior to censoring or an event. Associations between change in MDAFD and the combined endpoint were evaluated, adjusting for the individual components of CHA2DS2-VASc, baseline MDAFD category and chronic kidney disease (CKD).Results:Of 26,400 patients (68±13 years; 60% male; follow-up 2.6±1.6 years) analyzed, 2,544 (9.6%) had AF during baseline. In all patients, increased (vs. stable or decreased) MDAFD in follow-up was associated with a higher adjusted rate of stroke and mortality (HR 1.80 [1.61-2.01]). There was no association between decreased MDAFD in follow-up and the combined endpoint. Subgroup analysis by baseline MDAFD category demonstrated that increased MDAFD in follow up was associated with a greater risk of stroke or mortality among patients with no AF at baseline, and decreased MDAFD in follow-up was associated with a lower adjusted risk of stroke or mortality among patients with baseline MDAFD 1hour-

Circulation, Volume 150, Issue Suppl_1, Page A4147213-A4147213, November 12, 2024. Introduction:Stroke prevention with anticoagulation is an important aspect of atrial fibrillation (AF) management. Anticoagulation is often based on the premise that the risk of stroke increases with each additional CHA2DS2VASc risk factor. Diabetes is accepted as a risk factor for stroke in AF, but the threshold at which stroke risk increases is uncertain. Specifically, it is unknown if AF patients with recent-onset well-controlled diabetes (ROWCD) are at increased risk of stroke in AF compared to AF patients without diabetes.Hypothesis:We hypothesize that patients with AF and diabetes of 7%, or missing HbA1c data (to generate the ROWCD subset).Results/Data:The primary analysis included 233,692 patients with AF (mean age 78.8 years, 50.9% male), of whom 64,972 (27.8%) had diabetes. Diabetes was associated with an adjusted HR of 1.15 (1.08-1.22) for stroke in the full cohort (p< 0.001). After excluding people with diabetes of ≥5 years duration, HbA1c >7% or missing HbA1c, there were 7,415 patients with ROWCD. Mean diabetes duration was 3.0 years, mean HbA1c was 6.2%, with 38.5% metformin use, 10.6% dipeptidyl peptidase-4 inhibitor use, and 5.3% sulfonylurea use. There were 3,503 (2.1%) strokes in the non-diabetes group and 139 (1.9%) in the ROWCD group. ROWCD was not significantly associated with adjusted stroke hazard (HR 0.96, 95% CI 0.81-1.13, p=0.61).Conclusions:These findings suggest that people with AF who have ROWCD may not warrant a point on the CHA2DS2VASc score, as this subset of diabetes is not associated with increased hazard of stroke in AF.