Mortality After Pediatric Arterial Ischemic Stroke

Total Page:16

File Type:pdf, Size:1020Kb

Mortality After Pediatric Arterial Ischemic Stroke Lauren A. Beslow, MD, MSCE, a Michael M. Dowling, MD, PhD, b Sahar M.A. Hassanein, MBBS, PhD,c John K. Lynch, DO, d MortalityDimitrios Zafeiriou, MD, PhD, e LisaAfter R. Sun, MD, f Ilona Pediatric Kopyta, PhD, g Luigi Titomanlio, MD, h Anneli Kolk, MD, i Anthony Chan, MBBS, j Jose Biller, MD, k Eric F. Grabowski, MD, ScD, l Abdalla A. Abdalla, MD, m Mark T. Mackay, ArterialMBBS, PhD, n Gabrielle deVeber, Ischemic MD, MSc, o on behalf of theStroke International Pediatric Stroke Study Investigators OBJECTIVES: abstract Cerebrovascular disease is among the top 10 causes of death in US children, but risk factors for mortality are poorly understood. Within an international registry, we METHODS: identify predictors of– in-hospital mortality after pediatric– arterial ischemic stroke (AIS). Neonates (0 28 days) and children (29 days <19 years) with AIS were enrolled from January 2003 to July 2014 in a multinational stroke registry. Death during hospitalization and cause of death were ascertained from medical records. Logistic RESULTS: regression was used to analyze associations between risk factors and in-hospital mortality. Fourteen of 915 neonates (1.5%) and 70 of 2273 children (3.1%) died during hospitalization. Of 48 cases with reported causes of death, 31 (64.6%) were stroke- – related, with remaining deaths attributed to medical disease. In multivariable analysis, P – P congenital heart disease (odds ratio [OR]: 3.88; 95% confidence interval [CI]: 1.23 12.29; – P = .021), posterior plus anterior circulation stroke (OR: 5.36; 95% CI: 1.70 16.85; = .004), and stroke presentation without seizures (OR: 3.95; 95% CI: 1.26 12.37; = .019) were – P – P associated with in-hospital mortality for neonates. Hispanic ethnicity (OR: 3.12; 95% CI: – P 1.56 6.24; = .001), congenital heart disease (OR: 3.14; 95% CI: 1.75 5.61; < .001), and posterior plus anterior circulation stroke (OR: 2.71; 95% CI: 1.40 5.25; = .003) were CONCLUSIONS: associated with in-hospital mortality for children. In-hospital mortality occurred in 2.6% of pediatric AIS cases. Most deaths were attributable to stroke. Risk factors for in-hospital mortality included congenital heart disease and posterior plus anterior circulation stroke. Presentation without seizures and Hispanic ethnicity were also associated with mortality for neonates and children, respectively. Awareness and study of risk factors for mortality represent opportunities to increase survival. WHAT’S KNOWN ON THIS SUBJECT: Stroke is among the top 10 causes of death among children according a Division of Neurology, Children’s Hospital of Philadelphia, and Departments of Neurology and Pediatrics, to administrative data in the United States, with Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; bDepartments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas, Texas; cDepartment of differences in mortality possibly associated with Pediatrics, Ain Shams University, Cairo, Egypt; dSection on Stroke Diagnostics and Therapeutics, National geographic location, sex, and race. Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; eDivision of Child Neurology and Developmental Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece; fDepartment WHAT THIS STUDY ADDS: In this study, we add to our of Neurology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland; gDepartment of understanding of mortality rates among neonates Pediatric Neurology, School of Medicine, Medical University of Silesia, Katowice, Poland; hPediatric Emergency and children with arterial ischemic stroke and i Département, Hôpital Robert Debré, Paris, France; Department of Neuropsychology, University of Tartu, Tartu, identify both demographic and stroke-related risk Estonia; jDepartment of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, Canada; kDepartment of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois; lDepartment factors for in-hospital mortality. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; mDepartment of Neurosciences, Al Jalila Children’s Hospital, Dubai, United Arab Emirates; nDepartment of Neurology, The Royal Children’s Hospital, Melbourne, Australia; and oDivision of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada To cite: Beslow LA, Dowling MM, Hassanein SMA, et al. Mortality After Pediatric Arterial Ischemic Stroke. Pediatrics. 2018;141(5):e20174146 Downloaded from www.aappublications.org/news by guest on September 25, 2021 PEDIATRICS Volume 141, number 5, May 2018:e20174146 ARTICLE ∼ 8 Childhood arterial ischemic mortality. We explored potential oxygenation, or other). Information stroke (AIS) affects 1.2– to 2.4 risk factors for mortality in a large regarding withdrawal of care per 100000 children1 per3 year in multinational cohort of children and included whether withdrawal was developed countries. In one study, neonates with AIS. entirely or in part due to stroke researchers used death certificates METHODS deficit severity or to an underlying from children in the United medical illness. Cause of death was States between 1979 and 1998 to Subjects and Study Design then classified as due to stroke, demonstrate a decline in mortality due to a combination of underlying due to all stroke subtypes4 during that medical disease and stroke, or due to period, including in AIS. This finding The International Pediatric Stroke underlying medical disease. Statistical Analysis was supported by the Global Burden Study (IPSS) is a multinational cohort of Disease Study, which revealed study of children aged 0 to <19 years a global trend toward a decrease with AIS or cerebral sinovenous in mortality among children with thrombosis. IPSS participation was Descriptive statistics included approved by the institutional review ischemic5 stroke between 1990 and counts and percentages for 2013. However, in 2015, childhood board of each contributing center. categorical variables, means cerebrovascular disease remained Informed consent and assent, when with SD for normally distributed among the top 10 causes of death appropriate, was obtained for each – continuous variables, and medians enrolled subject. This study is a among children6 in the United States with interquartile range (IQR) for (1 19 years), demonstrating retrospective analysis of the IPSS nonnormally distributed continuous that despite overall decreases registry and includes children >28 variables. A nonparametric test in mortality, stroke remains an days to <19 years and neonates 0 to of trend was used to determine important cause of pediatric deaths. 28 days of life diagnosed with AIS whether mortality changed during between January 1, 2003, and July the study period. Logistic regression Given differing stroke definitions 31, 2014. Subjects with concomitant was used to analyze associations and case ascertainment methods cerebral sinovenous thrombosis were between possible risk factors and among studies, risk factors for Dataexcluded. Abstraction odds of in-hospital mortality. The mortality remain poorly understood. following factors were hypothesized In the United States, Black race and “ ” to be associated with mortality: age living in certain geographic regions Enrolling institutions recorded at stroke, congenital heart disease, (southeastern stroke belt states) medical, laboratory, and imaging clinical stroke severity (Pediatric have been reported as mortality 4,7 data on a standardized IPSS data National Institutes of Health Stroke risk factors after childhood AIS. 9 collection form that included Scale [PedNIHSS] score), Black race, Geographic region was also demographics, clinical presentation, Hispanic ethnicity, and birth in a low- important in the Global Burden of stroke risk factors, imaging results, or middle- income (LAMI) country. Disease Study; an estimated 4043 laboratory data, treatment, and Only variables with <15% missing children aged 0 to 19 years died of outcome at discharge (normal, data were evaluated, with the ischemic stroke in 2013 globally (0.2 – death, neurologic deficit). Race and exception of the PedNIHSS because per 100000), with 3948 deaths in ethnicity were based on National it has previously been validated as developing countries (30 60-fold 10 Institutes of Health definitions a predictor of functional outcome. higher mortality than in developed 5 and assigned by the enrolling LAMI countries were defined by countries). 11 investigator. For those who died the World Bank. Subjects from 3 The Global Burden of Disease Study during hospitalization, centers were countries (Chile, Estonia, and Poland) also showed a trend toward higher recontacted to obtain date of death whose LAMI status changed to high mortality among male children5 with and cause of death. Causes of death income during the study period were ischemic stroke globally, a finding included those directly related to assigned LAMI status on the basis of not present in a previous4 report stroke (brain death, herniation, whether the birth country was LAMI from the United States. The authors hemorrhagic transformation, at the date of stroke ictus. Sites from “ ” of most reports on mortality after intracerebral hemorrhage, or other) the United States were categorized pediatric AIS have not examined or those related to an underlying as stroke belt states if located in specific stroke risk factors or stroke medical
Recommended publications
  • Serum Mercury Concentration and the Risk of Ischemic Stroke: the Reasons for Geographic and Racial Differences in Stroke Trace Element Study
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Environ Manuscript Author Int. Author manuscript; Manuscript Author available in PMC 2019 August 01. Published in final edited form as: Environ Int. 2018 August ; 117: 125–131. doi:10.1016/j.envint.2018.05.001. Serum Mercury Concentration and the Risk of Ischemic Stroke: the REasons for Geographic and Racial Differences in Stroke Trace Element Study Cheng Chena, Pengcheng Xuna, Leslie A. McClureb, John Brockmanc, Leslie MacDonaldd, Mary Cushmane, Jianwen Caif, Lisa Kamendulisg, Jason Mackeyh, and Ka Hea,* aDepartment of Epidemiology and Biostatistics, School of Public Health -- Bloomington, Indiana University, Bloomington, IN 47405, USA bDepartment of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA cColumbia Research Reactor, University of Missouri, Columbia, MO 65211, USA dNational Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA eDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT 05401, USA fDepartment of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA gDepartment of Environmental Health, School of Public Health -- Bloomington, Indiana University, Bloomington, IN 47405, USA hDepartment of Neurology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA Abstract Background—Although biologically plausible, epidemiological evidence linking exposure to methylmercury with increased risk of ischemic stroke is limited. The effects of methylmercury may be modified by selenium, which is an anti-oxidant that often co-exists with mercury in fish. *Corresponding author: Dr. Ka He, Department of Epidemiology and Biostatistics, School of Public Health -- Bloomington, Indiana University, 1025 E.
    [Show full text]
  • Diabetes & Its Complications
    Review Article ISSN 2639-9326 Diabetes & its Complications The Diet and Diabetes: A Focus on the Challenges and Opportunities within the Stroke Belt Dietary Pattern Melissa Johnson* *Correspondence: Melissa Johnson, Tuskegee University, Department of Food and Tuskegee University, Department of Food and Nutritional Nutritional Sciences, 207 Morrison-Mayberry Hall, Tuskegee, AL, Sciences, 207 Morrison-Mayberry Hall, Tuskegee, AL, 36088, 36088, USA, E-mail: [email protected]. USA. Received: 12 August 2017; Accepted: 01 September 2017 Citation: Melissa Johnson. The Diet and Diabetes: A Focus on the Challenges and Opportunities within the Stroke Belt Dietary Pattern. Diabetes Complications. 2017; 1(3); 1-6. ABSTRACT Diabetes mellitus, the most common type of endocrine disorder, globally affects over 400 million individuals and is steadily rising. Cultural and environmental norms that embrace or facilitate the lack of consistency in diet, lifestyle and behavioral patterns that promote health have inadvertently promoted and sustained a diabetogenic environment. Dietary patterns plentiful in processed foods, refined grains, sugar, sodium, fat and calories, coupled with modern conveniences that commission sedentary lifestyles have noticeably contributed to the diabetes epidemic as well. Like other chronic diet-related diseases, modifications of dietary intake and consumption patterns are necessary for diabetes prevention. Unfortunately, many modifiable and non-modifiable factors may hinder an individual’s ability to obtain an optimal diet for disease prevention and health promotion. This includes, but is not limited to, lack of access to affordable, nutrient-dense foods, geographical location, built environment and demographic characteristics. A prime example of this can be seen in the southeastern region of the United States known as the Stroke Belt, which exhibits exceptionally higher than national average prevalence rates of cardiovascular disease, stroke, diabetes and accompanying disparities in health.
    [Show full text]
  • In Dialysis: Contribution of Patient Characteristics to Ischemic Stroke Rate and Its Geographic Variation
    CLINICAL EPIDEMIOLOGY www.jasn.org Stroke and the “Stroke Belt” in Dialysis: Contribution of Patient Characteristics to Ischemic Stroke Rate and Its Geographic Variation † ‡ James B. Wetmore,* Edward F. Ellerbeck, Jonathan D. Mahnken,§ Milind A. Phadnis,§ | Sally K. Rigler, ¶ John A. Spertus,** Xinhua Zhou,§ Purna Mukhopadhyay,§ and †‡ Theresa I. Shireman *Department of Medicine, Division of Nephrology and Hypertension, † The Kidney Institute, ‡Department of Preventive Medicine and Public Health, §Department of Biostatistics, |Department of Medicine, and ¶The Landon Center on Aging, University of Kansas School of Medicine, Kansas City, Kansas, and **St. Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri ABSTRACT Geographic variation in stroke rates is well established in the general population, with higher rates in the South than in other areas of the United States. ESRD is a potent risk factor for stroke, but whether regional variations in stroke risk exist among dialysis patients is unknown. Medicare claims from 2000 to 2005 were used to ascertain ischemic stroke events in a large cohort of 265,685 incident dialysis patients. A Poisson generalized linear mixed model was generated to determine factors associated with stroke and to ascertain state-by-state geographic variability in stroke rates by generating observed-to-expected (O/E) adjusted rate ratios for stroke. Older age, female sex, African American race and Hispanic ethnicity, unemployed status, diabetes, hypertension, history of stroke, and permanent atrial fibrillation were positively associated with ischemic stroke, whereas body mass index .30 kg/m2 was inversely associated with stroke (P,0.001 for each). After full multivariable adjustment, the three states with O/E rate ratios .1.0 were all in the South: North Carolina, Mississippi, and Oklahoma.
    [Show full text]
  • FY 2007 Mississippi State Health Plan
    FY 2007 Mississippi State Health Plan Mississippi Department of Health FY 2007 Mississippi State Health Plan Mississippi Department of Health Governor State of Mississippi The Honorable Haley Barbour Mississippi State Board of Health Mary Kim Smith, RN, Chairman Alfred E. McNair, Jr., MD, Vice-Chairman Larry Calvert, RPh H. Allen Gersh, MD Ruth Greer, RN Debra L. Griffin J. Edward Hill, MD Lucius M. Lampton, MD Cass Pennington, Ed.D. Norman Marshall Price Kelly S. Segars, MD Sampat Shivangi, MD Ellen Williams State Health Officer Brian W. Amy, MD, MHA, MPH Acknowledgments The Mississippi Department of Health, Division of Health Planning and Resource Development, prepared the FY 2007 Mississippi State Health Plan(also State Health Plan, or Plan) in accordance with Sections 41-7-173(s) and 41-7-185(g) Mississippi Code 1972 Annotated, as amended. The FY 2007 State Health Plan results from the comments and information supplied by various divisions of the Department of Health, other agencies of state government, health care provider associations, and interested members of the public. The Plan also reflects the direction and guidance of the Mississippi State Board of Health. The Division of Health Planning and Resource Development expresses appreciation to the many individuals who provided invaluable help in publishing a timely and accurate State Health Plan and recognizes the following agencies for particular contributions: Mississippi Department of Health Office of the Governor Communications Mississippi Department of Human Services Health
    [Show full text]
  • Wayne Giles CV
    1 CURRICULUM VITAE WAYNE HOWARD ALEXANDER GILES, M.D., M.S. Dean, School of Public Health University of Illinois at Chicago 1603 W Taylor Street Chicago, IL 60612 (312) 996-5939 Education: Graduate M.S. (Epidemiology, 1992) University of Maryland Baltimore, MD M.D. (1987) Washington University St. Louis, MO Undergraduate A.B. (Biology, 1983) Washington University St. Louis, MO Professional Training 7/91-7/92 Chief Resident - Preventive Medicine and Epidemiology University of Maryland, Baltimore, MD 7/90-7/91 Resident - Preventive Medicine University of Maryland, Baltimore, MD 7/88-7/90 Resident - Internal Medicine University of Alabama at Birmingham Birmingham, AL 7/87-7/88 Intern - Internal Medicine University of Alabama at Birmingham Birmingham, AL Certification and Licensure Certification Federation of State Medical Boards June, 1988 2 Work Experience Current Position Dean University of Illinois at Chicago School of Public Health Chicago, IL (September 2017-Present) Responsible of oversight of the only accredited school of public health in the state of Illinois. The school offers three masters degrees, 2 doctoral degrees, an undergraduate degree and 7 certificate programs. The school comprises four divisions: Community Health Sciences, Epidemiology and Biostatistics, Environmental and Occupational Health Sciences and Health Policy and Administration. The School includes over 800 students and 100 faculty. Previous Positions Division Director Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention And Health Promotion Centers for Disease Control and Prevention Atlanta, Georgia (January 2017-September 2017) Responsible for the oversight of the Division’s research and programmatic activities related to the treatment prevention and control of heart disease and stroke.
    [Show full text]
  • Are You Suprised ?
    MINDI SPENCER CURRICULUM VITAE Version Date: February 2, 2021 PERSONAL Work address: Department of Health Promotion, Education, and Behavior Arnold School of Public Health 915 Greene Street, Room 550 University of South Carolina Columbia, SC 29208 Telephone: 803-777-4371 (work) 412-651-4329 (cell) Fax: 803-777-6290 Email: [email protected] EDUCATION 2004-2006 West Virginia University, PhD (Life-span Developmental Psychology, Gerontology Graduate Certificate, Women’s Studies Graduate Certificate) 2001-2004 West Virginia University, MA, (Life-span Developmental Psychology) 1996-2001 West Virginia University, BA, BS, (Regents with Gerontology Certificate, Biology with Honors) PROFESSIONAL EXPERIENCE 2016- Associate Director of Research, Office for the Study of Aging, University of South Carolina, Columbia, SC 2014- Associate Professor, Department of Health Promotion, Education, and Behavior & the Institute for Southern Studies, University of South Carolina, Columbia, SC 2008-2014 Assistant Professor, Department of Health Promotion, Education, and Behavior & the Institute for Southern Studies, University of South Carolina, Columbia, SC 2006-2008 Kellogg Health Scholar, Multidisciplinary Disparities Track, Center for Minority Health and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 2003-2005 Research Assistant, Center on Aging, West Virginia University, Morgantown, WV 2002-2003 Teaching Assistant, Department of Psychology, West Virginia University, Morgantown, WV 2001-2002 Research Assistant, Department of Psychology,
    [Show full text]
  • 2019 Legislature Stroke Report
    Report on Stroke in Georgia 2019, as Required by the Coverdell-Murphy Act, Georgia SB549, Amended by Georgia HB853 Compiled by the Georgia Coverdell Acute Stroke Registry Georgia Department of Public Health December 2019 Background Why should we care about stroke in Georgia? • Georgia’s age-standardized stroke death rate in 2018 was 14.5 percent higher than the national average.1 • In 2018, Georgia had the seventh highest stroke death rate in the U.S.1 • Stroke is the fourth leading cause of death in Georgia (4,553 stroke deaths in 2018).1 • In 2018, about 17 percent of Georgia stroke deaths were premature (i.e., among persons under the age of 65 years).1 • In 2018, the age-adjusted stroke death rate for Blacks in Georgia was 53.7 per 100,000 population, which was 33 percent higher than the rates for Whites.1 • Stroke is a leading cause of disability.2 Treatment of eligible stroke patients with the drug Alteplase (a tissue plasminogen activator) can reduce disability by 30 percent, but the drug needs to be administered in the first three hours after symptom onset.3 • In 2018, Georgians had more than 22,000 stroke hospitalizations o The median charge per hospitalization was around $37,570. o The total stroke-related hospitalization charges were over $1.5 billion in Georgia. • Georgia is in the “Stroke Belt,” an area in the southeastern U.S. with stroke death rates that are approximately 30 percent higher than the rest of the U.S. The coastal plains of Georgia are in the “buckle” of the Stroke Belt, an area with stroke death rates about 40 percent higher than the rest of the nation.4 o The higher death rates seen in the Stroke Belt can be collectively explained, in large part, by demographic and socioeconomic factors and the prevalence of stroke risk factors and chronic diseases like diabetes and hypertension.5 Page 2 of 7 • In 2018, only 63 percent of adult Georgians knew all three signs of stroke – facial droop, arm weakness, and slurred speech – and the importance of calling 911 immediately.
    [Show full text]
  • Incident Cognitive Impairment Is Elevated in the Stroke Belt: the REGARDS Study
    ORIGINAL ARTICLE Incident Cognitive Impairment is Elevated in the Stroke Belt: The REGARDS Study Virginia G. Wadley, PhD,1 Frederick W. Unverzagt, PhD,2 Lisa C. McGuire, PhD,3 Claudia S. Moy, PhD,4 Rodney Go, PhD,5 Brett Kissela, MD,6 Leslie A. McClure, PhD,7 Michael Crowe, PhD,8 Virginia J. Howard, PhD,5 and George Howard, DrPH7 Objective: To determine whether incidence of impaired cognitive screening status is higher in the southern Stroke Belt region of the United States than in the remaining United States. Methods: A national cohort of adults age 45 years was recruited by the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from 2003 to 2007. Participants’ global cognitive status was assessed annually by telephone with the Six-Item Screener (SIS) and every 2 years with fluency and recall tasks. Participants who reported no stroke history and who were cognitively intact at enrollment (SIS >4 of 6) were included (N ¼ 23,913, including 56% women; 38% African Americans and 62% European Americans; 56% Stroke Belt residents and 44% from the remaining contiguous United States and the District of Columbia). Regional differences in incident cognitive impairment (SIS score 4) were adjusted for age, sex, race, education, and time between first and last assessments. Results: A total of 1,937 participants (8.1%) declined to an SIS score 4 at their most recent assessment, over a mean of 4.1 (61.6) years. Residents of the Stroke Belt had greater adjusted odds of incident cognitive impairment than non-Belt residents (odds ratio, 1.18; 95% confidence interval, 1.07–1.30).
    [Show full text]
  • The Burden of Heart Disease and Stroke in South Carolina
    The Burden of Heart Disease and Stroke in South Carolina South Carolina Department of Health and Environmental Control Heart Disease and Stroke Prevention Division 2010 Edition Acknowledgements We gratefully acknowledge the assistance of those who contributed to this report: Bureau of Community Health and Chronic Disease Prevention, Heart Disease and Stroke Prevention Division Division Director ....................................................................Joy Brooks, MHA Public Information Coordinator .............................................Betsy Crick Bureau of Community Health and Chronic Disease Prevention, Office of Chronic Disease Epidemiology and Evaluation Division Director ....................................................................Khosrow Heidari, MA, MS, MS Senior Epidemiologist ............................................................Betsy Barton, MSPH Senior Epidemiologist ............................................................Patsy Myers, DrPH BRFSS Coordinator ...............................................................Ryan Lewis, MPH Funding for the Heart Disease and Stroke Prevention program is provided by the Centers for Disease Control and Prevention (CDC) and South Carolina Department of Health and Environmental Control (DHEC). Please direct requests for additional information to: Heart Disease and Stroke Prevention Division Bureau of Community Health and Chronic Disease Prevention South Carolina Department of Health and Environmental Control 1800 St. Julian Place Columbia, SC 29204 (803)
    [Show full text]
  • The Surgeon General's Call to Action to Control Hypertension
    The Surgeon General’s Call to Action to Control Hypertension U.S. Department of Health and Human Services U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES U.S. Public Health Service Office of the Surgeon General Suggested Citation U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Control Hypertension. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2020. This publication is available at www.surgeongeneral.gov. Website addresses of nonfederal organizations are provided solely as a service to our readers. Provision of an address does not constitute an endorsement by the U.S. Department of Health and Human Services (HHS) or the federal government, and none should be inferred. The Surgeon General’s Call to Action to Control Hypertension Message from the Secretary, U.S. Department of Health and Human Services As a nation, our ability to improve hypertension control requires focus. We must focus on better using the interventions that we already know work, and we must focus on conducting science that supports the creation of new, innovative interventions. As Secretary, I have a unique perspective across multiple sectors that influence hypertension control, including the roles that social services, health insurers, patient care, research, public health, and the pharmaceutical industry can play. While we normally look to the health care sector to combat chronic diseases, the high burden of hypertension requires us to expand our partnerships across settings to maximize our collective influence. I am excited about The Surgeon General’s Call to Action to Control Hypertension, because it includes specific hypertension control goals for our nation and provides proven strategies and relevant resources that multiple sectors can use immediately.
    [Show full text]
  • Factors Influencing the Decline in Stroke Mortality: a Statement from the American Heart Association/American Stroke Association
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Stroke. Manuscript Author manuscript; Manuscript Author available in PMC 2018 June 11. Published in final edited form as: Stroke. 2014 January ; 45(1): 315–353. doi:10.1161/01.str.0000437068.30550.cf. Factors Influencing the Decline in Stroke Mortality: A Statement from the American Heart Association/American Stroke Association Daniel T. Lackland, DrPH, FAHA, Chair, Edward J. Roccella, PhD, MPH, Co-Chair, Anne Deutsch, RN, PhD, CRRN, Myriam Fornage, PhD, FAHA, Mary G. George, MD, MSPH, FACS, FAHA, George Howard, DrPH, FAHA, Brett Kissela, MD, MS, Steven J. Kittner, MD, MPH, FAHA, Judith H. Lichtman, PhD, MPH, Lynda Lisabeth, PhD, MPH, FAHA, Lee H. Schwamm, MD, FAHA, Eric E. Smith, MD, and Amytis Towfighi, MD on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Quality of Care and Outcomes and Research, and Council on Functional Genomics and Translational Biology Abstract Background and Purpose—Stroke mortality has been declining since the early twentieth century. The reasons for this are not completely understood, although the decline is welcome. As a result of recent striking and more accelerated decreases in stroke mortality, stroke has fallen from the third to the fourth leading cause of death in the United States. This has prompted a detailed assessment of the factors associated with this decline. This review considers the evidence of various contributors to the decline in stroke risk and mortality and can be used in the design of future interventions regarding this major public health burden. Methods—Writing group members were nominated by the committee chair and co-chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee.
    [Show full text]
  • Summer 2015 Board Profile 3 Letter from the CEO 18 Dreams Really Do Come True Sandra Carr-Johnson, M.D
    cape fear valley health and wellness magazine summer 2015 board profile 3 Letter from the CEO 18 Dreams Really Do Come True Sandra Carr-Johnson, M.D. wellness 4 Lost Pounds Often Return foundation news 4 Is lasting weightloss attainable? 20 Forever Grateful Sometimes a simple thank you 8 Accidents Happen just isn’t enough Preventing falls in the home letter from the ceo 22 Let’s Talk About It new programs & services Support group helps heart patients 10 A Better Picture talk about their experiences 10 How Advanced Endoscopy is providing a better look into patients infographic 24 Where There’s Smoke, There’s Cancer Hospitals across the state are transforming healthcare to we’ve brought “shift reports” to the bedside. Shift reports Getting Under the Skin 12 reduce costs and increase wellness in their communities. are patient updates given by the nurse leaving the shift to Diagnosing Ear, Nose & Throat problems Cape Fear Valley Health has been at the forefront of this the oncoming nurse. Bringing shift report to the bedside often requires looking a little deeper movement for several years now. allows the patient and family members to become part of the 26 New Physicians conversation. 14 health 27 Physician Briefs As a health system, we’re currently focusing on improving 14 The Golden Hour 27 News Briefs not only individual patient care, but also communitywide The second component (improving population health) is a Treating trauma patients often requires 32 Community Classes care. As a result, we’ve taken on the Institute for Healthcare loftier goal simply due to sheer numbers.
    [Show full text]