RT Journal Article
SR Electronic
T1 Changing Trends in Demographics, Risk Factors, and Clinical Features of Patients With Infective Endocarditis–Related Stroke, 2005–2015
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 10.1212/WNL.0000000000206865
DO 10.1212/WNL.0000000000206865
A1 Mohamed Ridha
A1 Mathew L. Flaherty
A1 Yasmin Aziz
A1 Laura Ades
A1 Kathleen Alwell
A1 Jane C Khoury
A1 Daniel Woo
A1 Simona Ferioli
A1 Opeolu Adeoye
A1 Pooja Khatri
A1 Felipe De Los Rios La Rosa
A1 Eva A. Mistry
A1 Stacie L. Demel
A1 Jason Mackey
A1 Sharyl Martini
A1 Elisheva Coleman
A1 Adam Jasne
A1 Sabreena Slavin
A1 Kyle Walsh
A1 Michael Star
A1 Mary Haverbusch
A1 Tracy E. Madsen
A1 Joseph P Broderick
A1 Brett Kissela
A1 Dawn O Kleindorfer
YR 2023
UL http://n.neurology.org/content/early/2023/02/06/WNL.0000000000206865.abstract
AB Background: 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 -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 Cochran-Armitage test for categorical variables and a general linear model or a 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 8204 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 (IVDU) (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 peri-operative stroke. Infective endocarditis status significantly interacted with the trend in hypertension prevalence (p=0.001).Conclusion: From 2005 to 2015, infective endocarditis-related stroke 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.Non-standard Abbreviations and AcronymsIERS: infective endocarditis-related stroke; IVDU: intravenous drug users; GCNKSS: Greater Cincinnati Northern Kentucky Stroke Study; NIHSS: National Institute of Health Stroke Scale; tPA: tissue plasminogen activator