The optimal target blood pressure (BP) during and after mechanical thrombectomy (MT) for acute ischemic stroke remains uncertain. While BP drops during MT are associated with worse outcomes, evidence on postprocedural BP instability is limited. We aimed to assess the impact of BP drops within the first 24 hours after MT on functional outcome.

Retrospective observational study analyzing data from 2 tertiary stroke centers, gathered between October 2020 and September 2022 within the German Stroke Registry Endovascular Treatment, a national prospective registry of patients receiving MT for ischemic stroke. High-resolution BP data of patients who reached successful recanalization at the end of MT (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b) were obtained using stroke unit monitoring. BP drops were defined as systolic BP decreases of ≥40 mm Hg occurring within 1 hour during the first 24 hours after groin puncture. Primary outcome was level of disability at 3 months, assessed on the modified Rankin Scale (mRS shift analysis). Secondary outcomes included early neurologic deterioration (defined as an increase of 4 or more points on the National Institutes of Health Stroke Scale (NIHSS) between admission and 24-hour assessment) and death at 3 months. Associations between BP drops and functional outcomes were evaluated using multivariable ordinal and binary logistic regression.

Among 300 patients analyzed (median age 77 years [interquartile range (IQR) 65-83], 46.0% female, median admission NIHSS 13 points [IQR 7-17]), 123 patients (41.0%) had at least 1 drop, including 77 patients (62.6%) with 1 drop and 46 patients (37.4%) with 2 or more drops. BP drops were independently associated with worse functional outcome, both in binary (drops vs no drops; adjusted common odds ratio [OR] 1.66 [95% CI 1.02-2.70]) and count-based analysis (adjusted common OR per +1 drop; 1.33 [95% CI 1.05-1.69]). Patients with drops more often had early neurologic deterioration (22.2% vs 13.4%; adjusted OR 2.22 [95% CI 1.03-4.78]). BP drops were not associated with death at 3 months (adjusted OR 1.25, 95% CI 0.66-2.40).

BP drops within 24 hours after successful MT are associated with worse functional outcome. Targeted measures to prevent or mitigate BP drops should be explored in future studies.

Clinical guidelines recommend the early initiation of secondary prevention strategies prior to hospital discharge for patients with myocardial infarction (MI) to reduce morbidity and mortality, but implementation is resource-intensive. Multilingual videos can deliver information in diverse preferred languages and literacy levels, but their impact on MI knowledge among hospitalized patients remains unclear.

This study aims to assess whether the delivery of a multilingual educational video to hospitalized patients with MI can improve patient MI knowledge before hospital discharge.

We conducted a single-arm pre-post study with embedded formative implementation evaluation from December 2023 to October 2024 in a tertiary hospital. The intervention was a video on post-MI management, available in English, Arabic, Hindi, and Mandarin (with Simplified Chinese subtitles). The intervention was delivered via a tablet provided by the research assistant. The primary outcome was the change in patient knowledge of MI, measured by comparing the mean number of correct responses before and after the intervention using a 2-tailed paired t test. We assessed early-stage implementation using 2 prespecified elements from the Proctor implementation outcomes framework: acceptability and fidelity of the video delivery. We performed content analysis on the notes taken from participants' feedback to improve the video.

We recruited 129 participants (mean age of 59.4, SD 12.6 years) for this study. English was the preferred language (n=96, 74.4%) and Hindi was the predominant non-English language (n=17, 13.2%). Of the 129 participants enrolled, 128 completed follow-up immediately postintervention (1 lost interest). The average number of correct responses out of 10 was 5.4 (SD 2.7) at baseline and 7.2 (SD 2.5) postintervention (mean difference=1.9, 95% CI 1.6-2.2; P<.001; Cohen drm for paired change=0.72). The educational video was well-accepted, with 83.6% (107/128) of participants finding it easy to understand, 74.2% (95/128) engaging, and 87.5% (112/128) useful. Participants' feedback for improvement highlighted content complexity and a preference for conversational language and dialects. Fidelity of the intervention was subjectively assessed as reasonably achieved, given that the core components of the intervention (ie, animations and educational content conveyed through the audio and subtitles) were delivered as intended. Fidelity of the implementation strategy was similarly assessed as reasonably achieved because there were no technology issues preventing delivery of the intervention as intended, through video display from a weblink embedded in REDCap, using a tablet with internet connection.

A short educational video may improve patient knowledge of MI before discharge. Further scaled research is needed to evaluate the effectiveness and implementation of this intervention in additional languages and diverse populations. This study highlights the need for culturally and linguistically tailored resources in clinical settings, informing future research and policy on inclusive patient education.

High-density lipoprotein cholesterol (HDL-C)-related inflammatory markers are increasingly being recognised as indicators of inflammation and metabolism associated with cardiovascular events. Here, we examined their associations with all-cause and cardiovascular disease (CVD) mortality in the ageing population.

We retrieved data on patients aged ≥60 years from the National Health and Nutrition Examination Survey (2001-2018). We ascertained exposures (neutrophil/HDL ratio (NHR), lymphocyte/HDL ratio (LHR), monocyte/HDL ratio (MHR), platelet/HDL ratio (PHR)) and covariates at baseline and cross-linked them to mortality outcomes via the National Death Index. We tested for associations using survey-weighted Cox proportional hazards models, with restricted cubic splines assessing nonlinearity and C-statistics evaluating discrimination.

We included 5700 patients in our sample. A total of 1817 deaths occurred over a mean follow-up of 7.51 years, including 618 CVD deaths. After multivariable adjustment, higher NHR showed a consistent linear association with increased all-cause and CVD mortality. Each standard deviation increase in NHR corresponded to 11% higher all-cause mortality (hazard ratio (HR) = 1.11) and 12% higher CVD mortality (HR = 1.12). Compared to the lowest tertile, the highest NHR tertile was associated with 29% higher all-cause mortality (HR = 1.29) and 70% higher CVD mortality (HR = 1.70). Higher LHR showed a non-linear relationship with 21% lower all-cause mortality (HR = 0.79) and 31% lower CVD mortality (HR = 0.69) in the highest tertile. MHR and PHR showed no significant associations with mortality.

Higher NHR was consistently associated with increased all-cause and CVD mortality among older adults, while higher LHR showed an inverse association. NHR may serve as a useful inflammatory-lipid marker for mortality risk assessment in ageing populations.

Early supported discharge (ESD) facilitates the transition from specialized stroke units to home-based rehabilitation in familiar environments. While ESD has shown positive outcomes for people with stroke, little is known about how their family caregivers experience this transition and the support available once ESD ends. This qualitative study explores the needs, challenges, and expectations of family caregivers during the period following very early supported discharge (VESD) in Sweden.

In-depth, individual, semi-structured interviews were conducted with twelve family caregivers of persons who had received VESD after stroke. Data were analysed using thematic analysis with an inductive approach. This design was chosen to capture the caregivers' rich experiences and to allow themes to emerge directly from the data.

The findings showed that while the VESD intervention provided important initial support, its limited duration left family caregivers feeling unprepared, anxious, and overwhelmed by their new responsibilities. The overarching themes indicated that caregivers faced emotional strain alongside new and unclear demands. Many struggled to balance caregiving with work and family life, while also coping with relationship changes. The caregivers perceived their role as informal medical coordinators and advocates for the person with stroke within the healthcare system to be particularly challenging. The absence of structured follow-ups, professional guidance, and caregiver-focused support further intensified these challenges.

This study underscores the need for sustained and comprehensive long-term strategies that include education and mental health support for caregivers in the rehabilitation process after stroke. Moreover, the integration of caregivers into rehabilitation is essential to ensure their preparedness and well-being. Such measures are crucial not only for reducing caregiver burden, but also for promoting better long-term outcomes for both caregivers and the person with stroke.

Stroke is the third most common cause of disability and the second most common cause of death worldwide. Greater levels of medication adherence after stroke or transient ischemic attack are associated with improved survival. Very few medication adherence prediction models are available and have not been validated using external data. The current study aimed to evaluate the predictive performance of previously published beta regression models for statin and antiplatelet adherence at 1 year in patients' post-stroke or transient ischemic attack. The models use the first 90-day adherence data as a single predictor for 1-year adherence. Adherence was measured using the Proportion of Days Covered (PDC), which utilized prescription-filling data. Model performance was assessed using the following metrics: R² (proportion of variance explained), the difference between the mean observed and the mean predicted PDC, and the calibration slope, which ideally should be one. 2369 were included in the statin cohort, and 2147 patients were included in the antiplatelet cohort. R2 was 0.67 and 0.56 for statin and antiplatelet models, respectively. The difference between the mean observed and the mean predicted PDC was -3.7% and -2.5% for statin and antiplatelet models, respectively. The calibration slopes were 1.06 and 0.96 for the statin and antiplatelet models, respectively. The model performed well on a new patient population comprised of post-stroke patients and may be used for early identification of patients at high risk for low 1-year adherence within 90 days post-stroke, enabling timely, targeted adherence-support interventions.

Patients at high ischemic or bleeding risk after percutaneous coronary intervention (PCI) require protection against thrombotic events with dual antiplatelet therapy (DAPT) while avoiding bleeding. Although guidelines recommend 12-month DAPT after acute coronary syndrome (ACS), recent trials have tested the safety of early aspirin withdrawal with potent P2Y12-inhibitor monotherapy.

We performed a meta-analysis of randomized trials (from inception through August 2025) comparing early aspirin withdrawal (≤3 months) with transition to ticagrelor- or prasugrel-monotherapy versus continued DAPT. Co-primary outcomes were myocardial infarction (MI) and clinically relevant bleeding. Prespecified timing analyses stratified the comparison versus DAPT by aspirin timing: immediate (aspirin noninitiation or in-hospital cessation) and early (post-discharge discontinuation within 3 months). Bayesian models quantified risk-stratified probabilities of benefit and harm; trial sequential analysis (TSA) assessed conclusiveness of evidence. Seven trials (n = 27,743) were included. P2Y12-inhibitor monotherapy reduced bleeding (HR = 0.55, 95% CI [0.42, 0.71]; p < 0.001) without significantly increasing MI overall (HR = 1.11, 95% CI [0.91, 1.35]; p = 0.31), death, stroke, or stent thrombosis. Immediate aspirin noninitiation/cessation increased MI (HR = 1.41, 95% CI [1.01, 1.97]; p = 0.04), whereas early discontinuation did not (HR = 0.97, 95% CI [0.76, 1.24]; p = 0.82). TSA indicated conclusiveness for bleeding benefit and futility for an MI excess. Analyses restricted to ACS confirmed the overall results. Bayesian analyses corroborated these effects and identified risk-aligned timing: in high bleeding risk, ≤1-month aspirin discontinuation yielded a 100% posterior probability of bleeding benefit (NNT = 12) and 70% probability of MI-safety; in high ischemic risk, 3-month aspirin discontinuation yielded 100% probability of bleeding benefit (NNT = 57) and 86% probability of MI-safety. Limitations include aggregate data only and limited precision for the immediate aspirin withdrawal subgroup.

Among high-risk post-PCI patients on ticagrelor/prasugrel, discontinuing aspirin within 3 months reduces bleeding without an ischemic trade-off versus DAPT. Immediate aspirin noninitiation or cessation should be avoided; timing should be individualized to bleeding and ischemic risk. PROSPERO: CRD420251167706.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors such as dapagliflozin and empagliflozin are increasingly used in heart failure (HF) management due to their cardiovascular benefits. However, glycosuria induced by SGLT2 inhibition may increase the risk of urinary tract infections (UTIs). Limited data exist on UTI burden among HF patients on SGLT2 inhibitors in low-resource settings.

This study aimed to determine the prevalence of UTIs, associated factors, and antimicrobial susceptibility patterns of uropathogens in HF patients receiving SGLT2 inhibitors at the Jakaya Kikwete Cardiac Institute (JKCI) in Tanzania.

A hospital-based cross-sectional study was conducted from March to June 2024 among HF patients aged ≥18 years on SGLT2 inhibitors. Data was collected using structured questionnaires and medical records. Midstream clean-catch urine samples were collected in sterile containers and processed using semi-quantitative urine culture on CLED and blood agar and subjected to antimicrobial susceptibility testing using the Kirby-Bauer disk diffusion method per CLSI M100 (2024) guidelines. Descriptive statistics and modified Poisson regression were used for analysis.

Out of 138 urine samples processed, 22 (15.9%) showed significant growth. The most common uropathogen was Escherichia coli (50.0%), followed by Klebsiella pneumoniae (13.6%), Pseudomonas aeruginosa (9.1%), and Candida spp. (9.1%). Significant risk factors for UTI included age > 60 years (aPR 3.77; 95% CI: 1.42-10.01), female sex (aPR 2.92; 95% CI: 1.19-7.15), and SGLT2 inhibitor use ≥ 4 months (aPR 3.19; 95% CI: 1.70-5.96). High resistance was observed among bacterial isolates against ampicillin (100%), tetracycline (69.2%), and ceftazidime (53.8%), whereas high susceptibility was noted against nitrofurantoin (84.6%) and meropenem (100%).

UTIs are common among HF patients on SGLT2 inhibitors, with E. coli as the predominant pathogen and a concerning resistance to commonly used antibiotics. These findings underscore the need for routine urine culture and sensitivity testing to guide appropriate therapy and promote antimicrobial stewardship, particularly in resource-constrained settings.

This study aimed to examine the associations of individual and cumulative social determinants of health (SDoH) with cardiovascular disease (CVD) prevalence and sex-specific disparities among U.S. adults.

Employing a cross-sectional design, we analyzed data from the nationally representative National Health and Nutrition Examination Survey (NHANES, 2005-2018). Five core SDoH domains were operationalized through eight validated sub-indicators. Associations between individual and cumulative SDoH and CVD prevalence were assessed using survey-weighted multivariate logistic regression, with sex-stratified analyses.

In this cross-sectional sample of 35,781 participants, adverse individual SDoH and higher cumulative adverse SDoH were associated with higher odds of prevalent CVD. In the fully adjusted model (Model 2), unemployment showed a large association with prevalent CVD (AOR = 2.27, 95% CI: 2.01-2.57). In sex-stratified analyses, point estimates for some SDoH indicators were higher in women than in men, but 95% confidence intervals overlapped for many comparisons and sex-by-SDoH interaction tests were not statistically significant (all P for interaction > 0.05). Among individual SDoH indicators, unemployment and low income (PIR < 300%), as well as food insecurity, showed the strongest independent associations with prevalent CVD.

Both individual and cumulative SDoH were independently associated with prevalent CVD. Sex-stratified analyses suggested that some point estimates were larger in women than in men, but sex-by-SDoH interaction tests were not statistically significant.

The inflammatory burden index (IBI) is a comprehensive indicator of the inflammatory state of the body and is associated with a variety of chronic diseases. Sarcopenia is a disease characterized by a reduction in skeletal muscle mass, but the association between IBI and sarcopenia is currently unclear.

This study was based on data from the National Health and Nutrition Examination Survey (NHANES) 2015-2018 and included 4523 participants aged 20 years and older. IBI was calculated by the product of C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR). Sarcopenia was defined by the extremity skeletal muscle mass index (ASM/body mass index [BMI]). The association between IBI and sarcopenia was analyzed using multivariate logistic regression models with nonlinear and subgroup analyses.

The mean age of the participants was 39.9 years, and 52.5% were female. Higher IBI scores were associated with a higher risk of chronic disease. IBI was positively associated with sarcopenia, with the highest IBI group having a 1.94 times greater risk of sarcopenia than the lowest group (95% CI: 1.34-2.81). The natural log transformation of IBI resulted in a 42% increase in risk of sarcopenia for each unit increase (95% CI: 1.08-1.87). Nonlinear analyses showed an inflection point in the association between IBI and sarcopenia at 2.38, with a significant increase in risk before the inflection point and no longer significant after the inflection point. Subgroup analyses showed that this association was consistent across sex, age, diabetes, cardiovascular disease (CVD), and chronic kidney disease (CKD).

There is a positive association between IBI and sarcopenia with nonlinear characteristics. High IBI levels may increase the risk of sarcopenia, suggesting that inflammation may play an important role in sarcopenia, providing a potential target for future interventions.

To evaluate the 12-month cost-effectiveness of the implementation of a home blood pressure telemonitoring (HBPT) program in a large US integrated health care system.

Retrospective cohort study.

Data from patients enrolled in the Kaiser Permanente Southern California HBPT program (November 2019-June 2022) were analyzed. We estimated program implementation costs and hypertension-related health care utilization and costs (in 2020 US$) 12 months pre- and post HBPT program enrollment. We compared 12-month costs and blood pressure (BP) outcomes between patients who participated in the program and those who abandoned it prior to participation, using inverse probability of treatment weights to adjust for baseline characteristics. A difference-in-differences analysis estimated mean differences in outcomes associated with the HBPT program. Incremental cost-effectiveness ratios (cost per mm Hg reduction) were calculated with 95% bootstrapped CIs.

The study included 3067 patients (mean age, 56.7 years; 62.7% female; 62.1% non-Hispanic Black). HBPT program implementation costs averaged $113.35 per patient. The program reduced hypertension-related office visit costs (-$6.52; P = .016) and BP clinic visit costs (-$2.58; P = .002), despite an increase in hypertension-related virtual encounter costs ($11.80; P < .001). Mean BP reductions were 1.42 mm Hg (P = .071) for systolic BP (SBP) and 1.58 mm Hg (P = .001) for diastolic BP (DBP). Incremental cost-effectiveness ratios were $81.67 per mm Hg SBP reduction and $73.22 per mm Hg DBP reduction.

The HBPT program in a real-world clinical setting achieved modest BP reductions, although overall costs increased primarily due to enrollment expenses.