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.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.

OBJECTIVE\nLabetalol is often used in severe preeclampsia (PE). Hypotension, bradycardia and hypoglycemia are feared neonatal side effects, but may also occur in (preterm) infants regardless of labetalol exposure. We analyzed the possible association between intrauterine labetalol exposure and such side effects.\n\n\nSTUDY DESIGN\nFrom 1 January 2003 through 31 March 2008, all infants from mothers suffering severe PE admitted to one tertiary care center were included. Severe PE was defined according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Infants exposed to labetalol in utero (labetalol infants) were compared with infants, who were not exposed to labetalol (controls). Neonatal records were reviewed for hypotension (RR<mean gestational age in weeks), bradycardia (heartrate<100/min) and hypoglycaemia (glucose<2.7 mmol/L) in the first 48 postnatal hours.\n\n\nRESULTS\nOf 109 infants, 55 had been exposed to labetalol, whereas 54 were not (controls). Gestational age at delivery and birthweight were similar in both groups (31.8 vs. 32.8 weeks (p=0.06) and 1510 vs. 1639 grams (p=0.25), respectively for the labetalol vs. control group). Hypotension occurred significantly more in conjunction with labetalol exposure (16, (29.1%) vs. 4 (7.4%); p=0.003), irrespective of the route of administration. Patent ductus arteriosus (PDA) was present in 9 (56%) of hypotensive labetalol infants compared to 1 (24%) infant in the hypotensive control group (NS). In a multivariate regression model, labetalol exposure, the need for intubation and PDA appeared independently associated with hypotension (P<0.001). Hypoglycemia occurred in 26 (47.3%) of labetalol infants and in 23 (42.6%) of control infants (p=0.62). Bradycardia occurred in 4 (7.3%) of labetalol infants and in 1 (1.9%) of control infants (p=0.18). Hypoglycemia was more common in premature infants (n=45 (48,9%) vs. n=4 (23.5%), p=0.05) in both labetalol and control infants.\n\n\nCONCLUSION\nHypotension is more common after maternal labetalol exposure, regardless of the dosage and route of administration. The need for intubation and the presence of a PDA also play a role. Hypoglycemia is a very common finding in this population and is merely related to prematurity and independent of labetalol exposure as was the incidental occurrence of bradycardia. These findings on the neonatal side effects of maternal labetalol treatment in preeclampsia underline the importance of frequent blood glucose and blood pressure measurements in the first days of life, especially in intubated preterm infants with a PDA.

Neonatal side effects of maternal labetalol treatment in severe preeclampsia

https://link.springer.com/content/pdf/10.1007/s13311-023-01373-5.pdf

Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke

Perinatal stroke is related to possible differences in predisposing factors and outcomes between acutely and retrospectively diagnosed cases. In most cases, there are different risk factors and infections that could play an important role. Thus far, different clinical manifestations have been reported in children presenting with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ranging from asymptomatic status to severe disease sustained by an immune-mediated inflammatory response. SARS-CoV-2 has been associated with severe neurological diseases including seizures and encephalitis in both adults and children. However, there are still few reports regarding the possible relation between SARS-CoV-2 infection of mothers during pregnancy and the neurologic outcome of the newborns. We described the case of a newborn diagnosed with a perinatal stroke, born at 35 weeks of gestation from a mother presenting with SARS- CoV-2 infection during the last months of pregnancy. We also added a brief review of the literature with similar cases. Close monitoring and early intervention in young children born to infected mothers would be highly recommended for the potential neurodevelopmental risk.

/pdf/perinatal-cerebral-ischemic-lesion-and-sars-cov-2-infection-2x7sdsd6.pdf

Perinatal Cerebral Ischemic Lesion and SARS-CoV-2 Infection during Pregnancy: A Case Report and a Review of the Literature

Digital healthcare systems in a federated learning perspective

Objective To assess the incidence, risk factors, and clinical characteristics of perinatal stroke in Beijing. Methods This multicenter prospective study included all the live births from 17 representative maternal delivery hospitals in Beijing from March 1, 2019 to February 29, 2020. Neonates with a stroke were assigned to the study group. Clinical data, including general information, clinical manifestations, and risk factors, were collected. Up until 18 months after birth, neonates were routinely assessed according to the Ages and Stages Questionnaire (ASQ) and/or the Bayley scale. Statistical analysis was done using the chi-squared, t-tests, and logistic regression analysis using SPSS version 26.0. Outcomes In total, 27 cases were identified and the incidence of perinatal stroke in Beijing was 1/2,660 live births, including 1/5,985 for ischemic stroke and 1/4,788 for hemorrhagic stroke. Seventeen cases (62.96%) of acute symptomatic stroke and convulsions within 72 h (10 cases, 37.04%) were the most common presentations. Ten patients showed no neurological symptoms and were found to have had a stroke through routine cranial ultrasonography after being hospitalized for non-neurological diseases. The risk factors include primiparity, placental or uterine abruption/acute chorioamnionitis, intrauterine distress, asphyxia, and severe infection. In the study group, 11.1% (3/27) of patients had adverse neurodevelopmental outcomes. The patients in the study group had lower scores for the ASQ than those in the control group in the communication, gross, and fine motor dimensions. Conclusion The incidence of perinatal stroke in Beijing was consistent with that in other countries. Routine neuroimaging of infants with risk factors may enable identification of asymptomatic strokes in more patients. Patients who have suffered from a stroke may have neurological sequelae; therefore, early detection, treatment, and regular follow-ups are beneficial for improving their recovery outcomes.

/pdf/the-incidence-and-characteristics-of-perinatal-stroke-in-285cai4t.pdf

The Incidence and Characteristics of Perinatal Stroke in Beijing: A Multicenter Study

The adverse effects of long-term maternal exposure of labetalol on neonates have been recognized clinically. But there are few systematic studies on their clinical demonstrations and potential mech...

Distinct outcomes of labetalol exposed infants: case reports and systematic review.

ABSTRACT Vital signs have been widely used to assess the disease severity of patients, but there is still a lack of research on their circadian rhythms. The objective is to explore the circadian rhythms of vital signs in critically ill patients and establish an in-hospital mortality prediction model. Study patients from the recorded eICU Collaborative Research Database were included in the present analyses. The circadian rhythms of vital signs are analyzed in critically ill patients using the cosinor method. Logistic regression was used to screen independent predictors and establish a prediction model for in-hospital mortality by multivariate logistic regression analysis and to show in the nomogram. Internal validation is used to evaluate the prediction model by bootstrapping with 1000 resamples. A total of 29,448 patients were included in the current analyses. The Mesor, Amplitude, and Peak time of vital signs, such as heart rate (HR), temperature, respiration rate (RR), pulse oximetry-derived oxygen saturation (SpO2), and blood pressure (BP), were significant differences between survivors and non-survivors . Logistic regression analysis showed that Mesor, Amplitude, and Peak time of HR, RR, and SpO2 were independent predictors for in-hospital mortality in critically ill patients. The area under the curve (AUC) and c-index of the prediction model for the Medical intensive care unit (MICU) and Surgical intensive care unit (SICU) were 0.807 and 0.801, respectively. The Hosmer-Lemeshow test P-values were 0.076 and 0.085, respectively, demonstrating a good fit for the prediction model. The calibration curve and decision curve analysis (DCA) also demonstrated its accuracy and applicability. Internal validation assesses the consistency of the results. There were significant differences in the circadian rhythms of vital signs between survivors and non-survivors in critically ill patients. The prediction model established by the Mesor, Amplitude, and Peak time of HR, RR, and SpO2 combined with the Acute Physiology and Chronic Health Evaluation (APACHE) IV score has good predictive performance for in-hospital mortality and may eventually support clinical decision-making. Abbreviations: ICU: Intensive care unit; MICU: Medical intensive care unit; SICU: Surgical intensive care unit; HR: Heart rate; RR: Respiration rate; SpO2: Pulse oximetry-derived oxygen saturation; BP: Blood pressure; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; APACHE: Acute Physiology and Chronic Health Evaluation; bpm: beats per min; BMI: Body mass index; OR: Odd ratio; CI: Confidential interval; IQR: Interquartile range; SD: Standard deviation; ROC: Receiver operating characteristic; AUC: area under the curve; DCA: Decision curve analysis; IRB: Institutional review board.

/pdf/circadian-rhythms-of-vital-signs-are-associated-with-in-18pejxdx.pdf

Circadian rhythms of vital signs are associated with in-hospital mortality in critically ill patients: A retrospective observational study

Objective: To assess the clinical value of bedaquiline in five dimensions: effectiveness, safety, economics, appropriateness, and social benefits, to provide a reference for medical and health insurance-related decisions. Methods: A total of 792 patients with multidrug-resistant tuberculosis who were hospitalized at Wuhan Pulmonary Hospital, Ganzhou Fifth People's Hospital and Jiangxi Chest Hospital between January 2018 and December 2020 were included in the study. Based on a retrospective survey of case data, and each evaluation dimension of bedaquiline was statistically analyzed by causal analysis or chi-square test, using linezolid as the reference drug. Results: In terms of effectiveness, bedaquiline significantly increased treatment success by 23.9% (95%CI:4.8%-43.0%) and shortened treatment duration by 64 days(95%CI:18-109 days). In terms of safety, the incidence of adverse reactions to bedaquiline and the discontinuation rate of adverse reactions (5.11%,4.55%) were significantly lower than those for linezolid (22.49%,15.24%), with statistically significant differences (χ2=27.50,P<0.001;χ2=14.09,P<0.001). In terms of economics, patients treated with bedaquiline had a significantly higher anti-TB drug course cost of RMB 48 209.4 Yuan(95%CI: 28 336.0-68 082.8 Yuan). In terms of appropriateness, the proportion of bedaquiline in patients' initial treatment regimens was lower than that of linezolid (16.7% vs. 86.5%) in the 2020 observation sample, with a statistically significant difference (χ2=238.96,P<0.001). In terms of social benefits, the infection control rate was significantly increased by 27.8% (95%CI:8.2%-47.5%) in patients using bedaquiline. Conclusions: Bedaquiline performed well in terms of efficacy, safety, and social benefits. However, it was less economical and the actual use rate of bedaquiline in clinical practice was lower than that of its counterpart drug, linezolid. Price reductions might be needed to increase the clinical use and performance of bedaquiline in the future.

[Comprehensive clinical evaluation of bedaquiline in the treatment of multidrug-resistant tuberculosis].

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Papers

The Incidence and Characteristics of Perinatal Stroke in Beijing: A Multicenter Study

Distinct outcomes of labetalol exposed infants: case reports and systematic review.

Circadian rhythms of vital signs are associated with in-hospital mortality in critically ill patients: A retrospective observational study

[Comprehensive clinical evaluation of bedaquiline in the treatment of multidrug-resistant tuberculosis].