Abstract
Background and Aims. Atrial septal defects (ASD) are a well-recognised risk factor for acute ischaemic stroke (AIS). We aimed to delineate the relationship between ASD and in-hospital AIS outcomes (mortality, severe stroke (National Institutes of Health Stroke Scale (NIHSS) >15), prolonged hospitalisation >4 days and routine home discharge) in contemporary practice using data from the United States National Inpatient Sample.
Methods. NIS admissions with a primary diagnosis of AIS between 2016-2018 were extracted. The NIHSS variable had 75% missing data, which were imputed using multiple imputations by chained equations. The relationship between ASD and the main outcomes was modelled using multivariable logistic regressions, adjusting for age, sex, comorbidities, stroke severity and revascularisation therapies.
Results. 245,859 records representative of 1,229,295 AIS admissions were
included, 35,840 (2.91%) of whom had ASD. ASD patients were younger (median
15 age 63 years versus 72 years) and less likely to have traditional cardiovascular risk factors than their counterparts without ASD. ASD was independently associated with 58% lower odds of in-hospital mortality (hazard ratio (95% confidence interval) = 0.42 (0.33-0.54)), 18% lower odds of severe stroke (0.82 (0.71-0.94)), 20% higher odds of routine home discharge (1.20 (1.14-1.28)) and 28% higher odds of prolonged hospitalisation (1.28 (1.21-1.35)).
Conclusions. ASD was associated with better in-hospital outcomes, which were
likely driven by younger age, lower prevalence of traditional cardiovascular risk
factors, and lower stroke severity. Further research is warranted to clarify the ASD anatomical characteristics which are most strongly associated with these
associations.
Methods. NIS admissions with a primary diagnosis of AIS between 2016-2018 were extracted. The NIHSS variable had 75% missing data, which were imputed using multiple imputations by chained equations. The relationship between ASD and the main outcomes was modelled using multivariable logistic regressions, adjusting for age, sex, comorbidities, stroke severity and revascularisation therapies.
Results. 245,859 records representative of 1,229,295 AIS admissions were
included, 35,840 (2.91%) of whom had ASD. ASD patients were younger (median
15 age 63 years versus 72 years) and less likely to have traditional cardiovascular risk factors than their counterparts without ASD. ASD was independently associated with 58% lower odds of in-hospital mortality (hazard ratio (95% confidence interval) = 0.42 (0.33-0.54)), 18% lower odds of severe stroke (0.82 (0.71-0.94)), 20% higher odds of routine home discharge (1.20 (1.14-1.28)) and 28% higher odds of prolonged hospitalisation (1.28 (1.21-1.35)).
Conclusions. ASD was associated with better in-hospital outcomes, which were
likely driven by younger age, lower prevalence of traditional cardiovascular risk
factors, and lower stroke severity. Further research is warranted to clarify the ASD anatomical characteristics which are most strongly associated with these
associations.
| Original language | English |
|---|---|
| Pages (from-to) | 183-191 |
| Number of pages | 9 |
| Journal | American Journal of Cardiovascular Disease |
| Volume | 13 |
| Issue number | 3 |
| Early online date | 25 Jun 2023 |
| Publication status | Published - 30 Jun 2023 |
Bibliographical note
AcknowledgementsWe would like to acknowledge the HCUP Data Partners (https://www.hcup10 us.ahrq.gov/db/hcupdatapartners.jsp).
Sources of Funding FC received the Leslie Wilson Endowed Scholarship as a part of the Aberdeen Summer Research Scholarship Programme of the Aberdeen Clinical Academic Training (ACAT) Pathways. The Leslie Wilson Endowed Scholarship is funded by Department of Medicine for the Elderly, NHS Grampian.
Keywords
- Atrial septal defect
- Patent Foramen Ovale
- Acute Ischaemic Stroke
- Mortality
- Severe stroke