American heart journal plus : cardiology research and practice最新文献

{"title":"Can utilization of the venous-to-arterial carbon dioxide difference improve patient outcomes in cardiogenic shock? A narrative review","authors":"Oskar Kjærgaard Hørsdal","doi":"10.1016/j.ahjo.2025.100504","DOIUrl":"10.1016/j.ahjo.2025.100504","url":null,"abstract":"<div><div>Cardiogenic shock (CS) is a critical condition with high mortality, characterized by reduced cardiac output (CO) and tissue hypoperfusion, despite advancements in treatment. Traditional hemodynamic markers like CO measurements, monitoring of mixed venous oxygen saturation (SvO₂) and lactate levels have limitations, particularly in detecting microcirculatory dysfunction. The venous-to-arterial carbon dioxide tension difference (V-A PCO₂ gap, also known as P(V-A)CO₂ and delta PCO₂ or ∆PCO₂) has been established as a sensitive marker of tissue perfusion and CO adequacy in septic shock but lacks extensive exploration in CS.</div><div>This narrative review evaluates the possible uses of V-A PCO₂ gap in contemporary management of CS. Based on the available literature, it elucidates how the V-A PCO₂ gap may offer valuable insight into tissue perfusion and CO adequacy in patients with CS. Elevated V-A PCO₂ gaps may reflect impaired clearance of CO₂ due to reduced CO and tissue hypoxia, serving as a reliable early indicator of circulatory failure. Integrating V-A PCO₂ gap monitoring into contemporary hemodynamic assessments holds potential to improve clinical decision-making, enabling more timely interventions and better stratification of patients at risk of deterioration.</div><div>The sparse evidence suggests an association between elevated V-A PCO₂ gaps and poor outcomes in cardiac patients, including increased mortality and prolonged ventilation needs. Further research is needed to validate the use of this marker in CS and explore its potential to enhance treatment protocols by providing a more nuanced understanding of tissue-level perfusion, especially when macrocirculatory function appears normalized.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"50 ","pages":"Article 100504"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' lives don't pause for blanking periods","authors":"Mohammed Ruzieh ,&nbsp;John M Mandrola ,&nbsp;Andrew J Foy","doi":"10.1016/j.ahjo.2024.100497","DOIUrl":"10.1016/j.ahjo.2024.100497","url":null,"abstract":"","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"50 ","pages":"Article 100497"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143223675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underlying and contributing causes of mortality from CDC WONDER—Insights for researchers","authors":"Abdul Mannan Khan Minhas ,&nbsp;Laurence S. Sperling ,&nbsp;Sadeer Al-Kindi ,&nbsp;Dmitry Abramov","doi":"10.1016/j.ahjo.2025.100499","DOIUrl":"10.1016/j.ahjo.2025.100499","url":null,"abstract":"<div><h3>Background</h3><div>The multiple cause of death files available through the Center for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) present underlying and contributing causes of mortality. We sought to evaluate potential differences in mortality reporting that may occur based on utilization of only underlying versus utilization of both underlying and contributing cause of mortality.</div></div><div><h3>Methods</h3><div>All-cause and top 5 underlying causes of deaths in individuals ≥25 years of age from 2011 to 2019 occurring within United States were extracted from CDC WONDER. Deaths for the top 5 underlying causes of death as underlying and as underlying or contributing causes were extracted. For each cause, we calculated the percentage of the deaths that would be reported if only the underlying versus the underlying or contributing mortality was reported.</div></div><div><h3>Results</h3><div>Between 2011 and 2019, the top 5 underlying causes of mortality were heart disease, malignant neoplasm, chronic lower respiratory disease, cerebrovascular disease, and accidents. For these causes, the percentages of deaths presented by reporting (underlying)/(underlying or contributing) causes were 53 %, 91 %, 50 %, 59 %, and 79 % respectively.</div></div><div><h3>Discussion/conclusion</h3><div>Data within the commonly utilized multiple cause of death files from CDC WONDER demonstrate that reliance solely on the underlying cause of mortality may underestimate important contributions of common contributing causes. These findings could aid in the understanding of published research and may shape the framework for future studies utilizing multiple cause of death data through CDC WONDER.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"50 ","pages":"Article 100499"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypothesis on the role of cholesterol crystals in spontaneously ruptured aortic plaques: Potential triggers for inflammation and systemic effects","authors":"Chikao Yutani ,&nbsp;Hirotaka Noda ,&nbsp;Nobuzo Iwa ,&nbsp;Sei Komatsu ,&nbsp;Satoru Takahashi ,&nbsp;Yoshiharu Higuchi ,&nbsp;Kazuhisa Kodama","doi":"10.1016/j.ahjo.2025.100507","DOIUrl":"10.1016/j.ahjo.2025.100507","url":null,"abstract":"<div><div>Cholesterol crystals (CCs) are a key component of atherosclerotic plaques and play a pivotal role in plaque progression, rupture, and the resulting inflammatory responses. CCs emboli trigger proinflammatory cytokines which can potentially lead to organ damage. Spontaneously ruptured aortic plaques (SRAPs) are frequently observed via non-obstructive general angioscopy (NOGA) in patients with or suspected coronary artery disease. The release of CCs from SRAPs can activate the innate immune system and induce neutrophil extracellular trap (NET) formation, further exacerbating inflammation. Inflammation levels in SRAPs vary, and the interleukin (IL)-6 ratio may reflect the degree of inflammation. Systemic inflammation induced by CCs may contribute to conditions that may lead to cerebral infarction, and chronic kidney disease. The effects of anti-inflammatory drugs, including IL-6 inhibitors, IL-1β inhibitors, and colchicine, may be evaluated by measuring the IL-6 ratio in SRAPs. This review examined innate immunity mechanisms associated with CCs in SRAPs sampled via NOGA and discussed their systemic impact and potential therapeutic strategies.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"51 ","pages":"Article 100507"},"PeriodicalIF":1.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"QUIET WARRIOR – Rationale and design: An ancillary study to the Women's IschemiA TRial to Reduce Events in Nonobstructive CAD (WARRIOR)","authors":"Osama Dasa ,&nbsp;Eileen Handberg ,&nbsp;Damini Dey ,&nbsp;Pinaki Sarder ,&nbsp;Margaret C. Lo ,&nbsp;Balaji K. Tamarappoo ,&nbsp;Steven M. Smith ,&nbsp;Leslee J. Shaw ,&nbsp;C. Noel Bairey Merz ,&nbsp;Carl J. Pepine","doi":"10.1016/j.ahjo.2025.100508","DOIUrl":"10.1016/j.ahjo.2025.100508","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease is the leading cause of death among women in the US, predominantly due to ischemic heart disease (IHD). There is a notable deficiency in therapies tailored for IHD in women, who often present with variable symptoms that delay diagnosis and treatment. In many cases, coronary angiography does not reveal obstructive coronary artery disease (CAD) despite increased risk for major adverse cardiac events (MACE) compared with sex and age-matched asymptomatic cohorts.</div></div><div><h3>Objectives</h3><div>The Women's IschemiA TRial to Reduce Events in Nonobstructive CAD (WARRIOR) evaluates intensive medical treatment for women with Ischemia with No Obstructive Coronary Arteries (INOCA). The QUIET WARRIOR sub-study aims to improve predictive tools for adverse outcomes by detailed analysis of Coronary Computed Tomography Angiography (CCTA) data and biorepository samples. These data will also uncover pathophysiological mechanisms associated with angina and MACE, improving predictive tools for symptomatic women with INOCA.</div></div><div><h3>Methods</h3><div>This ancillary study will analyze CCTA images from 600 WARRIOR subjects. It will assess clinical, social, and coronary artery variables, including plaque characteristics and markers of inflammation. Advanced imaging techniques and machine-learning models will be employed to quantify plaque features and predict clinical outcomes.</div></div><div><h3>Expected results</h3><div>The study aims to elucidate associations between CCTA-derived plaque characteristics, ischemic symptoms, and MACE. Anticipated findings include correlations of specific plaque attributes with angina severity and novel insights into inflammatory markers. Socioeconomic variables will also be examined for their impact on cardiovascular risk.</div></div><div><h3>Conclusion</h3><div>The QUIET WARRIOR sub-study will advance the understanding of INOCA in women, integrating clinical, imaging, and socioeconomic data to enhance risk prediction and guide personalized therapeutic strategies. This research will address critical gaps in managing nonobstructive CAD, promoting more equitable cardiovascular care.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"51 ","pages":"Article 100508"},"PeriodicalIF":1.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143358788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implantable loop recorder migration: Case-based review and implications for clinical practice","authors":"Allam Harfoush","doi":"10.1016/j.ahjo.2025.100505","DOIUrl":"10.1016/j.ahjo.2025.100505","url":null,"abstract":"<div><h3>Introduction</h3><div>Implantable loop recorders (ILRs) are vital for continuous rhythm monitoring; however, post-implantation migration can impair device function. ILR migration may range from minor positional shifts causing discomfort to severe displacement, potentially resulting in device malfunction or requiring surgical intervention. This review examines migration patterns to identify factors associated with ILR migration.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted in PubMed, Cochrane Library, CINAHL, and EMBASE for case reports on ILR migration from inception to October 2024. Data on patient demographics, comorbidities, device models, implantation sites, detection times, and interventions were qualitatively synthesised to identify factors linked to migration.</div></div><div><h3>Results</h3><div>Older age, female gender, and specific comorbidities emerged as migration risk factors. Device implantation angulation and depth were common contributors. Migration typically followed a posterior or inferior direction and was detected within 5–35 days, often presenting as loss of connection or continuous chest pain. Migration was also observed following patient manipulation of the device. Although migration is rare, cases requiring video-assisted thoracoscopic surgery (VATS) highlight the significant morbidity associated with this complication.</div></div><div><h3>Conclusion</h3><div>Optimising implantation techniques and employing effective follow-up strategies can reduce the risk of migration and improve migration detection. Further studies with standardised reporting are needed to better understand this complication.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"51 ","pages":"Article 100505"},"PeriodicalIF":1.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced retinal microvascular density in women with coronary microvascular dysfunction: A pilot study","authors":"Sakshi Shiromani ,&nbsp;Ahmed AlBadri ,&nbsp;Aaron Lindeke-Myers ,&nbsp;Arielle Schwartz ,&nbsp;Nishant Vatsa ,&nbsp;Esha Dave ,&nbsp;Fauzia Rashid ,&nbsp;Nieraj Jain ,&nbsp;Puja K. Mehta","doi":"10.1016/j.ahjo.2025.100502","DOIUrl":"10.1016/j.ahjo.2025.100502","url":null,"abstract":"<div><h3>Objective</h3><div>To compare retinal microvascular density among women with ischemia with no obstructive coronary artery disease (INOCA) with and without coronary microvascular dysfunction (CMD).</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting</h3><div>Patients with myocardial INOCA often have CMD, possibly indicating systemic vascular dysfunction. While retinal microvasculature relates to many cardiovascular risk factors, its link with CMD remains unknown.</div></div><div><h3>Participants</h3><div>Women with INOCA (N = 18) and coronary function testing were enrolled and classified into CMD and non-CMD groups, with CMD defined as coronary flow reserve (CFR) &lt;2.5 in response to adenosine.</div></div><div><h3>Interventions</h3><div>Participants underwent retinal optical coherence tomography angiography for noninvasive imaging of the retinal microvasculature.</div></div><div><h3>Main outcome measures</h3><div>Vessel density, perfusion density, and area, perimeter, and circularity of the foveal avascular zone (FAZ). Non-parametric statistics were used for comparisons.</div></div><div><h3>Results</h3><div>Mean age was 54.7 (SD 12.5) years. The CMD (N = 11) and non-CMD (N = 7) groups were balanced with respect to age, BMI, systemic diseases including diabetes, hypertension, and hyperlipidemia, and medications. Those with CMD had a lower retinal vessel density [20.9 (0.7) vs 21.6(0.8), p = 0.006] and lower inner perfusion density [38.5 (1.6) vs 41.2 (0.8), p = 0.006] as compared to those without CMD. There were no differences in the FAZ area, perimeter, or circularity.</div></div><div><h3>Conclusions</h3><div>In this study of women with INOCA, those with CMD showed lower retinal microvascular and perfusion densities than those without CMD. Direct, non-invasive retinal imaging is feasible, affordable, and may reflect coronary microvascular function in INOCA patients. A larger study, including men, is needed to confirm these findings.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"51 ","pages":"Article 100502"},"PeriodicalIF":1.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex and race disparities in emergency department patients with chest pain and a detectable or mildly elevated troponin","authors":"Lucas M. Boyer ,&nbsp;Anna C. Snavely ,&nbsp;Jason P. Stopyra ,&nbsp;Subha V. Raman ,&nbsp;Jeffrey M. Caterino ,&nbsp;Carol L. Clark ,&nbsp;Alan E. Jones ,&nbsp;Michael E. Hall ,&nbsp;Carolyn J. Park ,&nbsp;Brian C. Hiestand ,&nbsp;Sujethra Vasu ,&nbsp;Michael A. Kutcher ,&nbsp;W. Gregory Hundley ,&nbsp;Simon A. Mahler ,&nbsp;Chadwick D. Miller","doi":"10.1016/j.ahjo.2024.100495","DOIUrl":"10.1016/j.ahjo.2024.100495","url":null,"abstract":"<div><h3>Background</h3><div>Identifying and eliminating health disparities is a public health priority. The goal of this analysis is to determine whether cardiac testing or outcome disparities exist by race or sex in patients with detectable to mildly elevated serum troponin.</div></div><div><h3>Methods</h3><div>We conducted a secondary analysis of the CMR-IMPACT trial that randomized patients with symptoms suggestive of acute coronary syndrome and a detectable or mildly elevated troponin measure from 4 US hospitals to an early invasive angiography or cardiac MRI strategy. The primary endpoint was the composite of all-cause mortality, myocardial infarction, cardiac hospital readmission, and repeat cardiac ED. Secondary outcomes were components of the composite and revascularization.</div></div><div><h3>Results</h3><div>Participants (<em>n</em> = 312, mean age 61 ± 11 years) were 36.2 % non-white and 40.1 % female. The composite outcome occurred in 63.7 % of non-white vs. 49.8 % of white patients (aHR 1.50, 95 % CI 1.08–2.09) and 53.6 % of female vs. 55.6 % of male patients (aHR 0.93, 95 % CI 0.68–1.28). Non-white (aHR 0.57, 95 % CI 0.35–0.92) patients had lower rates of revascularization also less median stenosis (<em>p</em> &lt; 0.001) and stenosis &gt;70 % (p &lt; 0.001) during index cardiac testing. Despite these findings, ACS after discharge was higher among non-white patients (aHR 1.84, 95 % CI 1.11–3.05). Females had lower rates of revascularization (aHR 0.52, 95 % CI 0.33–0.82), but no increase in ACS after discharge (aHR 0.90, 95 % CI 0.55–1.49).</div></div><div><h3>Conclusion</h3><div>Non-white patients had higher rates of ACS following discharge despite lower rates of obstructive CAD following standardization of index cardiac testing. Future disparity works should explore care following the index encounter.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"49 ","pages":"Article 100495"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accurate diagnosis of ischemic heart disease without exposure to radiation using non-stress unshielded magnetocardiography","authors":"Kirsten Tolstrup ,&nbsp;Massoud Akhtari ,&nbsp;Donatella Brisinda ,&nbsp;Anna M. Meloni ,&nbsp;Robert J. Siegel ,&nbsp;Riccardo Fenici","doi":"10.1016/j.ahjo.2024.100483","DOIUrl":"10.1016/j.ahjo.2024.100483","url":null,"abstract":"<div><h3>Study objectives</h3><div>To evaluate the capability and accuracy of magnetocardiography (MCG) to identify patients with ischemic chest pain from those with non-ischemic pain and to verify normalcy in the MCG in healthy subjects.</div></div><div><h3>Design</h3><div>We studied 133 patients (mean age 59 ± 14 years, 69 % male) with chronic or acute chest pain syndrome and 63 healthy subjects (mean age 41.7 ± 12.2 years, 51 % male) using unshielded cryogenically cooled MCG systems (Cardiomag Imaging Inc., 9 and 36 channels) in a general clinical setting. Scan time was 90 s to 6 min. Interventions: The MCG data were processed with the same automated analysis software and results were immediately available. All patients were chest pain free at the time of scanning.</div></div><div><h3>Results</h3><div>A diagnosis of ischemic chest pain was established in 41 % after non-invasive and invasive testing. Rest MCG was normal in all healthy subjects. An abnormal rest MCG was strongly associated with ischemic chest pain, <em>p</em> &lt; 0.0001 (sensitivity of 86 %, specificity of 80 %, positive (PPV) and negative predictive value (NPV) of 75 % and 89 %, respectively). In comparison, the sensitivity, specificity, PPV and NPV of stress SPECT was 93 %, 72 %, 77 % and 91 %, respectively.</div></div><div><h3>Conclusion</h3><div>Resting MCG is a rapid risk-free method for the detection of ischemic chest pain without the use of radiation or contrast with results comparable with stress SPECT.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"49 ","pages":"Article 100483"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in stroke-related mortality in atrial fibrillation patients in the United States: Insights from the CDC WONDER database","authors":"Muhammad Abdullah Naveed ,&nbsp;Sivaram Neppala ,&nbsp;Himaja Dutt Chigurupati ,&nbsp;Muhammad Omer Rehan ,&nbsp;Ahila Ali ,&nbsp;Hamza Naveed ,&nbsp;Bazil Azeem ,&nbsp;Rabia Iqbal ,&nbsp;Manahil Mubeen ,&nbsp;Mashood Ahmed ,&nbsp;Ayman R. Fath ,&nbsp;Timir Paul ,&nbsp;Muhammad Bilal Munir","doi":"10.1016/j.ahjo.2024.100491","DOIUrl":"10.1016/j.ahjo.2024.100491","url":null,"abstract":"<div><h3>Background</h3><div>Stroke associated with atrial fibrillation (AF) is a significant cause of mortality. This study analyzed demographic trends and disparities in mortality rates due to stroke in AF patients aged ≥25 years.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted to acquire death data using the Centers for Disease Control and Prevention database from 1999 to 2020. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons, and trends were assessed using Average Annual Percentage Change (AAPC) and annual percent change (APC). Data were stratified by year, sex, race/ethnicity, and geographical regions.</div></div><div><h3>Results</h3><div>Between 1999 and 2020, AF-associated stroke contributed to 331,106 deaths among adults in this study population. Deaths occurred predominantly in medical facilities (43.2 %). The overall AAMR for AF-associated stroke decreased from 7.4 in 1999 to 6.4 in 2020, with an APC of −1.02 (<em>p</em>-value = 0.004). Additionally, AAMR showed a significant decline from 2015 to 2018 with an APC of −7.22 (p-value &lt;0.000001), followed by a striking rise from 2018 to 2020 (APC: 4.98) (p-value = 0.0008). Women had slightly higher AAMR than men (men: 6.6; women: 7.1) (<em>p</em> value = 0.02). AAMRs varied among racial/ethnic groups, with Whites having the highest AAMR (7.4), followed by Blacks (5.4), American Indian or Alaska Natives (4.6), Asian or Pacific Islanders (4.5), and Hispanics (4.1). AAMRs decreased for all races except Blacks. Geographically, AAMRs ranged from 4.3 in Nevada to 11.9 in Vermont, with the Western region showing the highest mortality (AAMR: 7.9). Nonmetropolitan areas had slightly higher AAMRs than metropolitan areas, with both experiencing a decrease over the study period.</div></div><div><h3>Conclusion</h3><div>This analysis depicts significant demographic and geographic disparities in mortality rates attributed to stroke associated with AF. Targeted interventions and equitable healthcare access are crucial to mitigate these disparities and improve outcomes for this population.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"49 ","pages":"Article 100491"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11696626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}