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April 11, 2023; 100 (15) Research Article

Changing Trends in Demographics, Risk Factors, and Clinical Features of Patients With Infective Endocarditis–Related Stroke, 2005–2015

Mohamed Ridha, Mathew L. Flaherty, View ORCID ProfileYasmin Aziz, Laura Ades, Kathleen Alwell, Jane C. Khoury, Daniel Woo, Simona Ferioli, Opeolu Adeoye, Pooja Khatri, View ORCID ProfileFelipe De Los Rios La Rosa, Eva A. Mistry, Stacie L. Demel, Jason Mackey, Sharyl Martini, Elisheva Coleman, View ORCID ProfileAdam Jasne, Sabreena Slavin, Kyle Walsh, Michael Star, Mary Haverbusch, Tracy E. Madsen, View ORCID ProfileJoseph P. Broderick, View ORCID ProfileBrett Kissela, Dawn O. Kleindorfer
First published February 6, 2023, DOI: https://doi.org/10.1212/WNL.0000000000206865
Mohamed Ridha
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Mathew L. Flaherty
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Yasmin Aziz
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Laura Ades
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Kathleen Alwell
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Jane C. Khoury
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Daniel Woo
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Simona Ferioli
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Opeolu Adeoye
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Pooja Khatri
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Felipe De Los Rios La Rosa
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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  • ORCID record for Felipe De Los Rios La Rosa
Eva A. Mistry
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Stacie L. Demel
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Jason Mackey
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Sharyl Martini
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Elisheva Coleman
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Adam Jasne
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Sabreena Slavin
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Kyle Walsh
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Michael Star
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Mary Haverbusch
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Tracy E. Madsen
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Joseph P. Broderick
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Brett Kissela
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Dawn O. Kleindorfer
From the Columbia University Medical Center (M.R.), New York; University of Cincinnati Medical Center (M.R., M.L.F., Y.A., L.A., K.A., D.W., S.F., P.K., E.A.M., S.L.D., K.W., M.H., J.P.B., B.K., D.O.K.), OH; NYU Langone Hospital at Brooklyn (L.A.); Cincinnati Children's Hospital Medical Center (J.C.K.), OH; Washington University School of Medicine (O.A.), St. Louis, MO; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Indiana University (J.M.), Indianapolis; VA National Telestroke Program (S.M.), Houston, TX; Northwestern University (E.C.), Chicago, IL; Yale University (A.J.), New Haven, CT; University of Kansas Medical Center (S.S.); Soroka Medical Center (M.S.), Beersheva, Israel; Brown University (T.E.M.), Providence, RI; and University of Michigan (D.O.K.).
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Changing Trends in Demographics, Risk Factors, and Clinical Features of Patients With Infective Endocarditis–Related Stroke, 2005–2015
Mohamed Ridha, Mathew L. Flaherty, Yasmin Aziz, Laura Ades, Kathleen Alwell, Jane C. Khoury, Daniel Woo, Simona Ferioli, Opeolu Adeoye, Pooja Khatri, Felipe De Los Rios La Rosa, Eva A. Mistry, Stacie L. Demel, Jason Mackey, Sharyl Martini, Elisheva Coleman, Adam Jasne, Sabreena Slavin, Kyle Walsh, Michael Star, Mary Haverbusch, Tracy E. Madsen, Joseph P. Broderick, Brett Kissela, Dawn O. Kleindorfer
Neurology Apr 2023, 100 (15) e1555-e1564; DOI: 10.1212/WNL.0000000000206865

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Abstract

Background and Objectives There is a rising incidence of infective endocarditis–related stroke (IERS) in the United States attributed to the opioid epidemic. A contemporary epidemiologic description is necessary to understand the impact of the opioid epidemic on clinical characteristics of IERS. We describe and analyze trends in the demographics, risk factors, and clinical features of IERS.

Methods This is a retrospective cohort study within a biracial population of 1.3 million in the Greater Cincinnati/Northern Kentucky region. All hospitalized patients with hemorrhagic or ischemic stroke were identified and physician verified from the 2005, 2010, and 2015 calendar years using ICD-9 and ICD-10 codes. IERS was defined as an acute stroke attributed to infective endocarditis meeting modified Duke Criteria for possible or definite endocarditis. Unadjusted comparison of demographics, risk factors, outcome, and clinical characteristics was performed between each study period for IERS and non-IERS. An adjusted model to compare trends used the Cochran-Armitage test for categorical variables and a general linear model or Kruskal-Wallis test for numerical variables. Examination for interaction of endocarditis status in trends was performed using a general linear or logistic model.

Results A total of 54 patients with IERS and 8,204 without IERS were identified during the study periods. Between 2005 and 2015, there was a decline in rates of hypertension (91.7% vs 36.0%; p = 0.0005) and increased intravenous drug users (8.3% vs 44.0%; p = 0.02) in the IERS cohort. The remainder of the stroke population demonstrated a significant rise in hypertension, diabetes, atrial fibrillation, and perioperative stroke. Infective endocarditis status significantly interacted with the trend in hypertension prevalence (p = 0.001).

Discussion From 2005 to 2015, IERS was increasingly associated with intravenous drug use and fewer risk factors, specifically hypertension. These trends likely reflect the demographics of the opioid epidemic, which has affected younger patients with fewer comorbidities.

Glossary

ICD-9=
International Classification of Diseases–9;
IERS9=
infective endocarditis–related stroke;
IQR=
interquartile range;
IVDU9=
intravenous drug users;
GCNKSS9=
Greater Cincinnati Northern Kentucky Stroke Study;
LKW=
last known well;
tPA9=
tissue plasminogen activator

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was Editor-in-Chief José Merino, MD, MPhil, FAAN.

  • All authors contributed equally to this manuscript.

  • Received July 18, 2022.
  • Accepted in final form December 12, 2022.
  • Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.
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  • All Cerebrovascular disease/Stroke
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  • Basal ganglia
  • Metabolic disease (inherited)
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