Journal of the American Heart Association最新文献

{"title":"Sex Differences in Psychosocial Factors and Angina in Patients With Chronic Coronary Disease.","authors":"Anaïs Hausvater, Rebecca Anthopolos, Alexa Seltzer, Tanya M Spruill, John A Spertus, Jesus Peteiro, Jose Luis Lopez-Sendon, Jelena Čelutkienė, Elena A Demchenko, Sasko Kedev, Branko D Beleslin, Mandeep S Sidhu, Anna Grodzinsky, Jerome L Fleg, David J Maron, Judith S Hochman, Harmony R Reynolds","doi":"10.1161/JAHA.124.037909","DOIUrl":"https://doi.org/10.1161/JAHA.124.037909","url":null,"abstract":"<p><strong>Background: </strong>Women with chronic coronary disease have more frequent angina and worse health status than men, despite having less coronary artery disease (CAD). We examined whether perceived stress and depressive symptoms mediate sex differences in angina, and whether this relationship differs in the setting of obstructive CAD or ischemia with no obstructive coronary artery disease (INOCA).</p><p><strong>Methods: </strong>We analyzed the association between sex, stress (Perceived Stress Scale-4) and depressive symptoms (Patient Health Questionnaire-8) on angina-related health status (Seattle Angina Questionnaire [SAQ]) at enrollment in the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial and CIAO-ISCHEMIA (Changes in Ischemia and Angina Over 1 Year Among ISCHEMIA Trial Screen Failures With No Obstructive CAD on Coronary CT [Computed Tomography] Angiography) ancillary study.</p><p><strong>Results: </strong>Scores for the SAQ, Perceived Stress Scale-4, and Patient Health Questionnaire-8 were available in 1626 participants (N=1439 CAD and N=187 INOCA). Women had lower (worse) SAQ-7 summary scores than men in both CAD and INOCA cohorts (CAD: median 76 [25th, 75th percentiles 60, 90] versus 83 [70, 96], <i>P</i><0.001; INOCA: 80 [64,89] versus 85 [75, 93], <i>P</i>=0.012). Higher stress and depressive symptoms were associated with worse angina in both cohorts. Female sex, Perceived Stress Scale-4 score, and Patient Health Questionnaire-8 score were each independently associated with lower SAQ summary score, but CAD versus INOCA cohort was not. There was no interaction between sex and stress (-0.39 [95% CI, -1.01 to 0.23]) or sex and depression (-0.00 [95% CI, -0.53 to 0.53]) on SAQ summary score.</p><p><strong>Conclusions: </strong>High stress and depressive symptoms were independently associated with worse angina and poorer health status, without interaction with sex with or without obstructive CAD. Factors other than stress or depression contribute to worse health status in women with obstructive CAD or INOCA.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02347215, NCT01471522.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037909"},"PeriodicalIF":5.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Related Differences in the Prognostic Role of Acetylcholine Provocation Testing.","authors":"Riccardo Rinaldi, Michele Russo, Giovanni Occhipinti, Claudio Laudani, Ilaria Torre, Michele Colucci, Filippo Luca Gurgoglione, Francesco Maria Animati, Jacopo Lenkowicz, Andrada Mihaela Tudor, Giovanna Liuzzo, Tommaso Sanna, Antonio Maria Leone, Giampaolo Niccoli, Gaetano A Lanza, Carlo Trani, Francesco Burzotta, Filippo Crea, Rocco A Montone","doi":"10.1161/JAHA.124.037942","DOIUrl":"https://doi.org/10.1161/JAHA.124.037942","url":null,"abstract":"<p><strong>Background: </strong>Intracoronary provocation testing with acetylcholine (ACh) is helpful to diagnose and risk-stratify patients with ischemia with nonobstructed coronary arteries (NOCA) and myocardial infarction with NOCA. This study explored potential sex-related disparities on the prognostic significance of ACh provocative testing.</p><p><strong>Methods: </strong>Consecutive patients with ischemia with NOCA and those with myocardial infarction with NOCA who underwent ACh provocation testing were enrolled. The primary end point was the incidence of major adverse cardiovascular and cerebrovascular events at follow-up. Co-primary end points were angina recurrence and quality of life assessed by 12-month Seattle Angina Questionnaire (SAQ) summary score.</p><p><strong>Results: </strong>A total of 519 patients (mean age, 61.4±12.1 years; 275 [53.0%] women and 244 [47%] men) were enrolled: 346 (66.7%) with ischemia with NOCA and 173 (33.3%) with myocardial infarction with NOCA. A positive ACh test was observed in 274 (52.8%) patients, with a lower prevalence of epicardial spasm (82 [56.2%] versus 106 [82.8%]) and a higher prevalence of microvascular spasm (64 [43.8%] versus 22 [17.2%]) in women compared with men (<i>P</i>>0.001). After a median 22-month follow-up, major adverse cardiovascular and cerebrovascular events occurred in 53 (10.2%) patients, without significant sex differences (<i>P</i>>0.05). Men with a positive ACh test had a significantly higher rate of major adverse cardiovascular and cerebrovascular events (22 [17.2%] versus 5 [4.3%], <i>P</i>=0.002) compared with those with a negative test; no difference was observed in women (<i>P</i>>0.05) (<i>P</i> for interaction=0.003). Women with a positive test experienced a higher rate of angina recurrence (61 [41.8%] versus 32 [24.8%], <i>P</i>=0.005) and a lower SAQ summary score (82 [interquartile range, 72-90] versus 86 [interquartile range, 78-100], <i>P</i><0.001) compared with those with a negative result; no difference was observed in men (<i>P</i>>0.05).</p><p><strong>Conclusions: </strong>This study revealed the importance of recognizing sex-specific differences in the prognostic value of ACh testing for proper management of coronary vasomotor disorders.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037942"},"PeriodicalIF":5.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in the Participation in Secondary Prevention Stroke Studies.","authors":"Kurt Moelgg, Anel Karisik, Lucie Buergi, Cheryl Carcel, Hanne Christensen, Gisele Sampaio Silva, Benjamin Dejakum, Silvia Komarek, Lena Domig, Heinrich Rinner, Julian Granna, Karin Willeit, Johann Willeit, Raimund Pechlaner, Christian Boehme, Lukas Mayer-Suess, Thomas Toell, Stefan Kiechl, Michael Knoflach","doi":"10.1161/JAHA.124.038917","DOIUrl":"https://doi.org/10.1161/JAHA.124.038917","url":null,"abstract":"<p><strong>Background: </strong>Women show higher age-standardized mortality rates for ischemic stroke. Nevertheless, women are underrepresented in secondary stroke prevention trials. Our analysis investigated contributors to reduced study participation among women in a comprehensive stroke center in Austria.</p><p><strong>Methods: </strong>The population-based Tyrolean Stroke Pathway database was used to describe sex distribution in patients with ischemic stroke in the region and at the study site. Screening logs from 3 secondary stroke prevention studies at the Medical University of Innsbruck were analyzed containing information on age, self-reported sex, and causes for nonparticipation. Binary and multinomial logistic regression were performed to calculate odds ratios (ORs) and 95% CIs.</p><p><strong>Results: </strong>Women constituted 45.6% of all patients with ischemic stroke in the federal region and 43.1% at the study site. Of 4511 patients screened, 68.1% were included in at least 1 stroke trial, 39.5% of whom were female. Screened women were older than screened men, median age (interquartile range) of 76 (66-83) versus 72 (61-80) years. Women showed higher odds than men of receiving comfort terminal care (OR, 1.53 [95% CI, 1.14-2.05]), being unable to provide informed consent (OR, 1.95 [95% CI, 1.54-2.47]) due to aphasia (OR, 2.79 [95% CI, 1.91-4.06]) or cognitive impairment (OR, 1.96 [95% CI, 1.30-2.95]), and being ineligible for study participation based on inclusion and exclusion criteria (OR, 1.28 [95% CI, 1.04-1.58]). When adjusting for age, women were not more likely than men to refuse study participation (OR, 1.09 [95% CI, 0.84-1.43]).</p><p><strong>Conclusions: </strong>Female sex was associated with higher odds of exclusion from studies due to comorbidities and more severe neurological deficits. However, in our analysis women were not more likely to refuse study participation.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038917"},"PeriodicalIF":5.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Smoking Intensity During Pregnancy and Early Adolescent Cardiovascular Health.","authors":"Mengjiao Liu, Elna Yihui Soon, Katherine Lange, Markus Juonala, Jessica A Kerr, Richard Liu, Terence Dwyer, Melissa Wake, David Burgner, Ling-Jun Li","doi":"10.1161/JAHA.124.037806","DOIUrl":"https://doi.org/10.1161/JAHA.124.037806","url":null,"abstract":"<p><strong>Background: </strong>The adverse cardiovascular effects of smoking are well established. We aimed to investigate the less well-understood effects of pregnancy smoke exposure on offspring cardiovascular health in early adolescence.</p><p><strong>Methods and results: </strong>Data were drawn from the nationally representative Longitudinal Study of Australian Children's Child Health CheckPoint. Mothers reported mean daily cigarettes smoked in each trimester (≤10 versus >10/day), and smoking cessation during pregnancy. Blood pressure, pulse wave velocity, carotid intima-media thickness, and retinal microvascular parameters were measured in early adolescence (mean 11.5 years). Hypertension was defined as systolic blood pressure ≥120 or diastolic blood pressure ≥80 mm Hg. 187 (11.8%) of 1582 women (mean age 30.7±0.2 years), smoked during pregnancy, of whom 143 (76.5%) smoked throughout pregnancy, and 58 (31.0%) smoked >10 cigarettes/day. Compared with those born to nonsmoking mothers, the odds of hypertension in early adolescence were 1.44 (95% CI, 1.01-2.06) if mothers ever smoked, 1.99 (1.22-3.24) if mothers smoked >10 cigarettes/day, and 1.64 (1.11-2.42) if mothers smoked throughout pregnancy There was limited evidence of associations between smoking throughout pregnancy and other cardiovascular measures. Offspring of mothers who stopped smoking during pregnancy and nonsmokers had similar cardiovascular measures, apart from hypertension.</p><p><strong>Conclusions: </strong>Offspring of mothers who smoked in pregnancy have increased risks of hypertension in adolescence, with increased risk with greater exposure intensity and duration. Mothers who stopped smoking during pregnancy had offspring with similar cardiovascular health to those born to nonsmokers. Our findings underscore the importance of specific strategies to stop maternal smoking before conception and during pregnancy.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037806"},"PeriodicalIF":5.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>JAHA</i> Go Red for Women Spotlight 2025.","authors":"Pamela N Peterson","doi":"10.1161/JAHA.125.041914","DOIUrl":"https://doi.org/10.1161/JAHA.125.041914","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041914"},"PeriodicalIF":5.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Use and Expenditures Associated With Cardiac Rehabilitation Among Eligible Medicare Fee-for-Service Beneficiaries.","authors":"Lisa M Pollack, Anping Chang, Jun Soo Lee, Thomas Shaffer, Hilary K Wall, Clinton A Brawner, Michael P Thompson, Steven J Keteyian, Devraj Sukul, Feijun Luo, Sandra L Jackson","doi":"10.1161/JAHA.124.037811","DOIUrl":"10.1161/JAHA.124.037811","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) can improve cardiovascular health. We identified whether CR participation was associated with fewer subsequent inpatient hospitalizations and emergency department visits and less Medicare and out-of-pocket expenditures, and whether outcomes varied by amount of participation.</p><p><strong>Methods: </strong>This retrospective study used Medicare fee-for-service claims data, including beneficiaries with a CR-qualifying event in 2016. Participants attended ≥2 sessions of CR within 365 days of the event. Propensity score matching was used to identify CR-eligible nonparticipants. Difference-in-differences analyses were used to compare differences in outcomes before (2014-2015) and after (2018-2019; 2-year CR period=2016-2017) the CR period between participants and nonparticipants.</p><p><strong>Results: </strong>We identified 57 668 CR-eligible beneficiaries after matching, with equal numbers of participants and nonparticipants. Nearly 65% of beneficiaries had a percutaneous coronary intervention, 33.5% had an acute myocardial infarction, 17.5% had a coronary artery bypass graft, and 16.8% had a heart valve repair/replacement. Compared with nonparticipants, participants had 47.6 fewer subsequent annual inpatient hospitalizations per 1000 beneficiaries (95% CI, -58.8 to -36.3) and $1005 lower subsequent annual Medicare expenditures per beneficiary (95% CI, -$1352 to -$659). Compared with no participation, medium participation (12-23 sessions), high participation (24-35 sessions), and CR completion (≥36 sessions) were associated with fewer inpatient hospitalizations and lower Medicare expenditures per year.</p><p><strong>Conclusions: </strong>CR was associated with fewer subsequent annual inpatient hospitalizations and lower subsequent annual Medicare expenditures. A higher amount of participation was associated with a further reduction in hospitalizations and expenditures. These findings can inform programs and policies that encourage CR participation.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037811"},"PeriodicalIF":5.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence ECG Diastolic Dysfunction and Survival in Cardiac Intensive Care Unit Patients.","authors":"Jacob C Jentzer, Eunjung Lee, Zachi Attia, Dustin Hillerson, Garvan C Kane, Francisco Lopez-Jimenez, Peter A Noseworthy, Paul A Friedman, Jae K Oh","doi":"10.1161/JAHA.124.037839","DOIUrl":"https://doi.org/10.1161/JAHA.124.037839","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular diastolic dysfunction (LVDD) predicts mortality in patients in cardiac intensive care units. An artificial intelligence enhanced ECG (AIECG) algorithm can predict LVDD and mortality in general populations but has not been examined in cardiac intensive care units.</p><p><strong>Methods: </strong>This historical cohort study included consecutive adults admitted to Mayo Clinic cardiac intensive care unit from 2007 to 2018 with an admission AIECG. The AIECG assigned the LVDD grade (0-3). Medial mitral E/e' ratio >15 on transthoracic echocardiogram (TTE) defined elevated filling pressures. In-hospital and 1-year mortality was evaluated, before and after multivariable adjustment.</p><p><strong>Results: </strong>We included 11 868 patients (median age 69.5 years, 37.7% female); 48% had heart failure and 44% had acute coronary syndromes. AIECG LVDD grade was 0 (normal), 33%; 1, 7%; 2, 39%; and 3, 21%. In-hospital and 1-year mortality increased in each higher AIECG LVDD grade. After adjustment, each higher AIECG LVDD grade was associated with higher in-hospital (adjusted odds ratio [OR], 1.22 [95% CI, 1.13-1.32]) and 1-year mortality (adjusted hazard ratio [HR], 1.23 [95% CI, 1.19-1.29]); this persisted after adjustment for TTE measurements. Patients with grade 2 or 3 LVDD by AIECG and medial mitral E/e' ratio >15 by TTE had the highest in-hospital (adjusted OR, 2.54 [95% CI, 1.69-3.88]) and 1-year (adjusted HR, 2.03 [95% CI, 1.65-2.48]) mortality, whereas patients meeting either of these criteria had similar, elevated mortality.</p><p><strong>Conclusions: </strong>The AIECG LVDD grade was strongly associated with in-hospital and 1-year mortality in patients in cardiac intensive care units, even after adjusting for clinical variables and TTE measurements. Patients with concordant AIECG and TTE for elevated filling pressures were at highest risk.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037839"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Elevated Total Homocysteine and Heart Failure Risk in the Multi-Ethnic Study of Atherosclerosis Cohort.","authors":"Amy B Karger, Sarah O Nomura, Weihua Guan, Parveen K Garg, Geoffrey H Tison, Moyses Szklo, Matthew J Budoff, Michael Y Tsai","doi":"10.1161/JAHA.124.038168","DOIUrl":"https://doi.org/10.1161/JAHA.124.038168","url":null,"abstract":"<p><strong>Background: </strong>Limited studies show an association between elevated total homocysteine (tHcy) and heart failure (HF) risk, but no studies have assessed whether this association differs by HF subtype. This study examines the relationship between tHcy, HF overall, and HF subtype (HF with preserved ejection fraction [HFpEF] and HF with reduced ejection fraction) in the Multi-Ethnic Study of Atherosclerosis cohort.</p><p><strong>Methods: </strong>Multi-Ethnic Study of Atherosclerosis participants with baseline tHcy and HF data were included (N=6765). Cox proportional hazards regression was used to calculate hazard ratios and 95% CI for tHcy and risk of HF. Models were stratified by impaired fasting glucose/type 2 diabetes status, and the combined impact of elevated tHcy and impaired fasting glucose/type 2 diabetes on HF incidence was examined.</p><p><strong>Results: </strong>Elevated tHcy (>12 μmol/L) was statistically significantly associated with HF overall and HFpEF, and conferred a higher risk for HF overall among individuals with dysglycemia impaired fasting glucose/type 2 diabetes compared with those with normoglycemia. Additionally, there was a statistically significant increased risk of HF overall and HF with reduced ejection fraction and a trend towards increased risk of HFpEF in individuals with both elevated tHcy and dysglycemia. tHcy appears to be a more significant contributor to HFpEF risk than dysglycemia, whereas dysglycemia seems to be more important in driving HF with reduced ejection fraction risk.</p><p><strong>Conclusions: </strong>Our study confirms an association between hyperhomocysteinemia and HF risk in a large, multi-ethnic cohort. This is the first study to demonstrate that the impact of tHcy differs by HF subtype and appears to contribute more to HFpEF risk than HF with reduced ejection fraction risk.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038168"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating Multiple Mediators to Mitigate Socioeconomic Differences in Patient-Reported Outcomes After Stroke: A Nationwide Register-Based Study.","authors":"Anita Lindmark, David Darehed","doi":"10.1161/JAHA.124.039466","DOIUrl":"https://doi.org/10.1161/JAHA.124.039466","url":null,"abstract":"<p><strong>Background: </strong>Substantial socioeconomic differences in patient-reported outcome measures (PROMs) 3 months after stroke have recently been shown. We aimed to understand the underlying mechanisms and investigate potential interventional targets to equalize differences.</p><p><strong>Methods: </strong>All patients aged 18 to 64 years, independent in activities of daily living, registered with a first-time stroke in Riksstroke (the Swedish Stroke Register) from 2015 to 2017 were included. PROMs 3 months after stroke included activities of daily living status, mood, fatigue, pain, and general health. Socioeconomic status (SES) was measured on the basis of income and education. Using causal mediation analysis, we simulated the effect of interventions on the distributions of smoking, metabolic health (diabetes, antihypertensive treatment, statin treatment), atrial fibrillation, and stroke characteristics (stroke type, severity) on the absolute SES-related risk difference in PROMs.</p><p><strong>Results: </strong>Of 6910 patients, 8% had become dependent in activities of daily living, 13% reported low mood, 42% fatigue, 23% pain, and 17% poor general health 3 months after stroke. Adjusted for sex and age, low SES was associated with increased absolute risks of poor PROMs with between 6% and 18% compared with higher SES with the largest increase for general health (18.2% [95% CI, 13.5%-22.9%]). Intervening to shift the distribution of all mediators among patients with low SES to those of patients with higher SES potentially reduces SES disparities by a proportion of 14% to 45%. For most PROMs the most important intervention was reducing smoking and improving metabolic health.</p><p><strong>Conclusions: </strong>Working-age patients with low SES report more severe outcomes 3 months after stroke than patients with higher SES. Targeted interventions reducing the prevalence of smoking, diabetes, hypertension, and high cholesterol in patients with low SES could mitigate these disparities.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"eJAHA2024039466T"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends in Stroke Management and Outcomes Between 2011 and 2020 in South Korea: Results From a Nationwide Multicenter Registry.","authors":"Tai Hwan Park, Keun-Sik Hong, Yong-Jin Cho, Wi-Sun Ryu, Dong-Eog Kim, Man-Seok Park, Kang-Ho Choi, Joon-Tae Kim, Jihoon Kang, Beom-Joon Kim, Moon-Ku Han, Jun Lee, Jae-Kwan Cha, Dae-Hyun Kim, Jae Guk Kim, Soo Joo Lee, Jee-Hyun Kwon, Wook-Joo Kim, Dong-Ick Shin, Kyu Sun Yum, Sung Il Sohn, Jeong-Ho Hong, Jay Chol Choi, Byung-Chul Lee, Kyung-Ho Yu, Mi-Sun Oh, Jong-Moo Park, Kyusik Kang, Kyungbok Lee, Sang-Hwa Lee, Hae-Bong Jeong, Kwang-Yeol Park, Ji Sung Lee, Juneyoung Lee, Philip B Gorelick, Hee-Joon Bae","doi":"10.1161/JAHA.124.035218","DOIUrl":"https://doi.org/10.1161/JAHA.124.035218","url":null,"abstract":"<p><strong>Background: </strong>This study aims to evaluate temporal trends of advanced treatments and related clinical outcomes of ischemic stroke through a decade-long trend analysis, using data from a comprehensive, national, multicenter registry. We also seek to identify areas in need of improvement.</p><p><strong>Methods and results: </strong>This analysis involved patients with ischemic stroke or transient ischemic attack registered prospectively in the CRCS-K-NIH (Clinical Research Center for Stroke in Korea-National Institute of Health) registry between 2011 and 2020. We examined temporal trends in risk factors, pathogenetic subtypes, acute management strategies, and outcomes for up to 1 year following a stroke. Generalized linear mixed models were used to account for center clustering. The average age of 77 662 patients increased 2.2 years in men and 2.4 years in women over the 10-year follow-up. Notably, in-hospital neurological deterioration, 3-month and 1-year mortality rate, and cumulative incidence of recurrent stroke within 1-year decreased over time after adjustments for age, sex, and initial stroke severity (<i>P</i><0.01). However, functional outcomes at 3 months and 1 year remained unchanged. Endovascular thrombectomy increased from 5.4% in 2011 to 10.6% in 2020. Use of anticoagulants for atrial fibrillation, dual antiplatelet therapy, statins, and stroke unit care also increased. Contrarily, the rate of intravenous thrombolysis showed a slight decline.</p><p><strong>Conclusions: </strong>This study points to a reduction in death and risk of recurrent stroke over the past decade, paralleling enhancement in acute and preventive stroke management. Nevertheless, the decline in the use of intravenous thrombolysis and the lack of improvement in functional outcomes following stroke are concerning trends that warrant thorough investigation.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e035218"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}