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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Johnson KH, Gardener H, Gutierrez C, Marulanda E, Campo-Bustillo I, Gordon Perue G, Hlaing W, Sacco R, Romano JG, Rundek T. Disparities in transitions of acute stroke care: The transitions of care stroke disparities study methodological report. J Stroke Cerebrovasc Dis 2023; 32:107251. [PMID: 37441890 PMCID: PMC10529930 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE The Transitions of Stroke Care Disparities Study (TCSD-S) is an observational study designed to determine race-ethnic and sex disparities in post-hospital discharge transitions of stroke care and stroke outcomes and to develop hospital-level initiatives to reduce these disparities to improve stroke outcomes. MATERIALS AND METHODS Here, we present the study rationale, describe the methodology, report preliminary outcomes, and discuss a critical need for the development, implementation, and dissemination of interventions for successful post-hospital transition of stroke care. The preliminary outcomes describe the demographic, stroke risk factor, socioeconomic, and acute care characteristics of eligible participants by race-ethnicity and sex. We also report on all-cause and vascular-related death, readmissions, and hospital/emergency room representations at 30- and 90-days after hospital discharge. RESULTS The preliminary sample included data from 1048 ischemic stroke and intracerebral hemorrhage discharged from 10 comprehensive stroke centers across the state of Florida. The overall sample was 45% female, 22% Non-Hispanic Black and 21% Hispanic participants, with an average age of 64 ± 14 years. All cause death, readmissions, or hospital/emergency room representations are 10% and 19% at 30 and 90 days, respectively. One in 5 outcomes was vascular-related. CONCLUSIONS This study highlights the transition from stroke hospitalization as an area in need for considerable improvement in systems of care for stroke patients discharged from hospital. Results from our preliminary analysis highlight the importance of investigating race-ethnic and sex differences in post-stroke outcomes.
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Affiliation(s)
- Karlon H Johnson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA.
| | - Hannah Gardener
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Carolina Gutierrez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Erika Marulanda
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Iszet Campo-Bustillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Gillian Gordon Perue
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - WayWay Hlaing
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Ralph Sacco
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Jose G Romano
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Tatjana Rundek
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
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Anadani M, Turan TN, Yaghi S, Spiotta AM, Gory B, Sharma R, Kevin N, de Havenon A. Change in Smoking Behavior and Outcome After Ischemic Stroke: Post-Hoc Analysis of the SPS3 Trial. Stroke 2023; 54:921-927. [PMID: 36876480 PMCID: PMC10050138 DOI: 10.1161/strokeaha.121.038202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 11/10/2022] [Indexed: 03/07/2023]
Abstract
BACKGROUND Cigarette smoking is a known risk factor for cardiovascular disease, including ischemic stroke. The literature regarding the rate of persistent smoking after acute ischemic stroke and its effect on subsequent cardiovascular events is scarce. With this study, we aimed to report the rate of persistent smoking after ischemic stroke and the association between smoking status and major cardiovascular outcomes. METHODS This is a post-hoc analysis of the SPS3 trial (Secondary Prevention of Small Subcortical Strokes). Patients were divided into 4 groups based on smoking status at trial enrollment: (1) never smokers, (2) former smokers, (3) smokers who quit at 3 months, and (4) persistent smokers. The primary outcome is a major adverse cardiovascular events composite of stroke (ischemic and hemorrhagic), myocardial infarction, and mortality. Outcomes were adjudicated after month 3 of enrollment until an outcome event or the end of study follow-up. RESULTS A total of 2874 patients were included in the study. Of the total cohort, 570 patients (20%) were smokers at enrollment, of whom 408 (71.5%) patients continued to smoke and 162 (28.4%) quit smoking by 3 months. The major adverse cardiovascular events outcome occurred in 18.4%, 12.4%, 16.2%, and 14.4%, respectively, in persistent smokers, smokers who quit, prior smokers, and never smokers. In a model adjusted for age, sex, race, ethnicity, education, employment status, history of hypertension, diabetes, hyperlipidemia, myocardial infarction, and intensive blood pressure randomization arm, the risk of major adverse cardiovascular events, and death were higher in the persistent smokers compared with never smokers (HR for major adverse cardiovascular events: 1.56 [95% CI, 1.16-2.09]; HR for death: 2.0 [95% CI, 2.18-3.12]). The risk of stroke, and MI did not differ according to smoking status Conclusions: Compared with never smoking, persistent smoking after acute ischemic stroke was associated with an increased risk of cardiovascular events and death. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT00059306.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurosurgery, Medical University of South Carolina
| | - Tanya N Turan
- Department of Neurology, Medical University of South Carolina
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School of Brown University
| | | | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, CHRU-Nancy, Nancy, France
| | - Richa Sharma
- Department of Neurology, Yale University School of Medicine
| | - N. Kevin
- Department of Neurology, Yale University School of Medicine
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Amin HP, Madsen TE, Bravata DM, Wira CR, Johnston SC, Ashcraft S, Burrus TM, Panagos PD, Wintermark M, Esenwa C. Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association. Stroke 2023; 54:e109-e121. [PMID: 36655570 DOI: 10.1161/str.0000000000000418] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
At least 240 000 individuals experience a transient ischemic attack each year in the United States. Transient ischemic attack is a strong predictor of subsequent stroke. The 90-day stroke risk after transient ischemic attack can be as high as 17.8%, with almost half occurring within 2 days of the index event. Diagnosing transient ischemic attack can also be challenging given the transitory nature of symptoms, often reassuring neurological examination at the time of evaluation, and lack of confirmatory testing. Limited resources, such as imaging availability and access to specialists, can further exacerbate this challenge. This scientific statement focuses on the correct clinical diagnosis, risk assessment, and management decisions of patients with suspected transient ischemic attack. Identification of high-risk patients can be achieved through use of comprehensive protocols incorporating acute phase imaging of both the brain and cerebral vasculature, thoughtful use of risk stratification scales, and ancillary testing with the ultimate goal of determining who can be safely discharged home from the emergency department versus admitted to the hospital. We discuss various methods for rapid yet comprehensive evaluations, keeping resource-limited sites in mind. In addition, we discuss strategies for secondary prevention of future cerebrovascular events using maximal medical therapy and patient education.
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1181] [Impact Index Per Article: 1181.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Parikh NS, Restifo D, Ganesh A, Kamel H. Practice Current: Variability in Smoking Cessation Intervention Practice Patterns After Ischemic Stroke and Transient Ischemic Attack. Neurol Clin Pract 2023; 13:e200115. [PMID: 36865635 PMCID: PMC9973318 DOI: 10.1212/cpj.0000000000200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/12/2022] [Indexed: 01/19/2023]
Abstract
People who continue to smoke after ischemic stroke and transient ischemic attack (TIA) are at increased risk for subsequent stroke and cardiovascular events. Although effective smoking cessation strategies exist, smoking rates after stroke remain high. Through case-based discussions with 3 international vascular neurology panelists, this article seeks to explore practice patterns and barriers to smoking cessation for patients with stroke/TIA. We sought to answer these questions: What are the barriers to using smoking cessation interventions for patients with stroke/TIA? Which interventions are most used for hospitalized patients with stroke/TIA? Which interventions are most used for patients who continue smoking during follow-up? Our synthesis of panelists' commentaries is complemented by the preliminary results of an online survey posed to global readership. Together, the interviews and survey results identify practice variability and barriers to smoking cessation after stroke/TIA, suggesting that there is substantial need for research and standardization.
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Affiliation(s)
- Neal S Parikh
- Clinical and Translational Neuroscience Unit (NSP, DR, HK), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York City; and Department of Clinical Neurosciences (AG), University of Calgary, Alberta, Canada
| | - Daniel Restifo
- Clinical and Translational Neuroscience Unit (NSP, DR, HK), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York City; and Department of Clinical Neurosciences (AG), University of Calgary, Alberta, Canada
| | - Aravind Ganesh
- Clinical and Translational Neuroscience Unit (NSP, DR, HK), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York City; and Department of Clinical Neurosciences (AG), University of Calgary, Alberta, Canada
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit (NSP, DR, HK), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York City; and Department of Clinical Neurosciences (AG), University of Calgary, Alberta, Canada
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2397] [Impact Index Per Article: 1198.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Allagbé I, Le Faou AL, Thomas D, Airagnes G, Limosin F, Chagué F, Zeller M. Tobacco-related cardiovascular risk in women: New issues and therapeutic perspectives. Arch Cardiovasc Dis 2021; 114:694-706. [PMID: 34593343 DOI: 10.1016/j.acvd.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Smoking is the main modifiable risk factor for stroke and myocardial infarction, particularly in women; its prevalence in France is evolving, and new patterns of nicotine consumption have emerged. AIMS To present contemporary data on smoking prevalence and the use of electronic cigarettes, and to describe current knowledge of the cardiovascular risk specificities and the effectiveness of withdrawal methods in women. METHOD We identified studies by searching the MEDLINE bibliographic database between 1995 and 2020, and the Weekly Epidemiological Bulletin (Bulletin Épidémiologique Hebdomadaire) published by the French health authorities. RESULT In recent years, smoking prevalence among French women has decreased overall, except in the oldest age group (aged>55 years). At the same time, the incidence of hospitalization for cardiovascular events has increased worryingly among women smokers aged<65 years. Active smoking in women is associated with an increased risk of premature myocardial infarction, and a risk of stroke that increases with the number of cigarettes consumed per day; it is also responsible for increased cardiovascular events in women taking oestrogen-progestin contraception. Quitting smoking reverses these effects in the long term, and women are just as likely to quit smoking as men. CONCLUSIONS Stopping smoking must be a priority objective for women smokers, for primary and secondary prevention, and they should systematically be offered a validated method of cessation or even electronic cigarettes.
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Affiliation(s)
- Ingrid Allagbé
- Team Physiopathlogy and Epidemiology Cerebro-Cardiovascular (PEC2), EA 7460, University of Burgundy Franche-Comté, Faculté des Sciences de Santé, 7, boulevard Jeanne d'Arc, 21000 Dijon, France; Outpatient Addiction Centre, Georges Pompidou European Hospital, AP-HP, University of Paris, 75015 Paris, France
| | - Anne-Laurence Le Faou
- Outpatient Addiction Centre, Georges Pompidou European Hospital, AP-HP, University of Paris, 75015 Paris, France; Fédération Hospitalo-Universitaire Network of Research in Substance Use Disorder, Ile-de-France, Paris, France
| | - Daniel Thomas
- Institut de Cardiologie, hôpital Pitié-Salpêtrière, AP-HP, Université Paris-VI-Sorbonne, 75013 Paris, France
| | - Guillaume Airagnes
- Outpatient Addiction Centre, Georges Pompidou European Hospital, AP-HP, University of Paris, 75015 Paris, France; Population-based Epidemiologic Cohorts, UMS 011, Inserm, 94807 Villejuif, France
| | - Frédéric Limosin
- DMU Psychiatry and Addictology, Corentin Celton Hospital, AP-HP, University of Paris, 92130 Issy-les-Moulineaux, France; Psychiatry and Neurosciences Centre, U894, Inserm, 75014 Paris, France
| | - Frédéric Chagué
- Cardiology Department, Dijon University Hospital, 21000 Dijon, France
| | - Marianne Zeller
- Team Physiopathlogy and Epidemiology Cerebro-Cardiovascular (PEC2), EA 7460, University of Burgundy Franche-Comté, Faculté des Sciences de Santé, 7, boulevard Jeanne d'Arc, 21000 Dijon, France.
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