Document Detail


Failure to impact prevalence of arterial ischemic stroke in pediatric cardiac patients over three decades.
MedLine Citation:
PMID:  21450034     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Over the past three decades, significant advances in treatment have improved the mortality of children with cardiac disease. The effect of these advances on the prevalence of arterial ischemic stroke (AIS) is unknown. We describe AIS in children with cardiac disease in the modern era.
DESIGN: The prospectively enrolled Intermountain Pediatric Stroke Database (including Utah, Wyoming, Idaho, and Nevada) was queried for all patients less than 18 years old with new-onset AIS between January 1, 2003 and August 31, 2009. Medical records of patients with AIS and cardiac disease were reviewed for cardiac diagnosis, age at AIS, anticoagulant therapy, diuretics, hematocrit, bolus fluids, and ongoing morbidity. Data were analyzed using chi-square test and a mixed-effects Poisson regression growth curve model.
RESULTS: AIS incidence in our catchment area was 0.01% (10.7/100,000; N = 97). The incidence of AIS in patients with cardiac disease was higher compared with AIS in the total population (incidence 0.13% [132/100,000], odds ratio [OR] 16.1, 95% confidence interval [CI; 9.7--25.9], P < 0.001). Of the 97 patients with AIS, 24 had cardiac disease (25%). The most common cardiac diagnosis was single ventricle (SV; 8/24, 33%). The incidence of AIS in patients with SV cardiac disease was higher compared with those with other cardiac diagnoses (incidence 1.38% [1380/100,000], OR 15.3, 95% CI [5.7--38.2], P < 0.001). Modeling the prevalence estimates reported since 1978, the prevalence of cardiac disease in AIS patients has remained unchanged across time (prevalence increase per each additional year, 0.5%, 95% CI [--2.1%, 3.1%], P = 0.71).
CONCLUSION: Children with cardiac disease (particularly those with SV) have increased risk for AIS. The prevalence is unchanged from reports over previous decades. AIS occurred in SV patients despite compliance with current anticoagulation recommendations. Future efforts should focus on best practices to prevent AIS in cardiac patients.
Authors:
James L Hoffman; Gordon K Mack; L LuAnn Minich; Susan L Benedict; Mason Heywood; Gregory J Stoddard; Elizabeth V Saarel
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Publication Detail:
Type:  Journal Article; Review     Date:  2011-03-31
Journal Detail:
Title:  Congenital heart disease     Volume:  6     ISSN:  1747-0803     ISO Abbreviation:  Congenit Heart Dis     Publication Date:    2011 May-Jun
Date Detail:
Created Date:  2011-05-23     Completed Date:  2011-09-16     Revised Date:  2012-01-09    
Medline Journal Info:
Nlm Unique ID:  101256510     Medline TA:  Congenit Heart Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  211-8     Citation Subset:  IM    
Copyright Information:
© 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.
Affiliation:
Department of Pediatrics, Divisions of Pediatric Cardiology, University of Utah, Salt Lake City, Utah 84113, USA. james.hoffman@imail.org
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use
Brain Ischemia / epidemiology*,  mortality,  prevention & control
Cerebral Arterial Diseases / epidemiology*,  mortality,  prevention & control
Chi-Square Distribution
Child, Preschool
Databases as Topic
Heart Diseases / diagnosis,  drug therapy,  epidemiology*,  mortality
Humans
Incidence
Infant
Odds Ratio
Prevalence
Prospective Studies
Regression Analysis
Risk Assessment
Risk Factors
Stroke / epidemiology*,  mortality,  prevention & control
Time Factors
United States / epidemiology
Chemical
Reg. No./Substance:
0/Anticoagulants

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