title: Failure to impact prevalence of arterial ischemic stroke in pediatric cardiac patients over three decades.
abstract: BACKGROUND
  Over the past three decades, significant advances in treatment have improved the mortality of children with cardiac disease. The effect of these advances on the prevalence of arterial ischemic stroke (AIS) is unknown. We describe AIS in children with cardiac disease in the modern era.
  
  
  METHODS
  The prospectively enrolled Intermountain Pediatric Stroke Database (including Utah, Wyoming, Idaho, and Nevada) was queried for all patients less than 18 years old with new-onset AIS between January 1, 2003 and August 31, 2009. Medical records of patients with AIS and cardiac disease were reviewed for cardiac diagnosis, age at AIS, anticoagulant therapy, diuretics, hematocrit, bolus fluids, and ongoing morbidity. Data were analyzed using chi-square test and a mixed-effects Poisson regression growth curve model.
  
  
  RESULTS
  AIS incidence in our catchment area was 0.01% (10.7/100,000; N = 97). The incidence of AIS in patients with cardiac disease was higher compared with AIS in the total population (incidence 0.13% [132/100,000], odds ratio [OR] 16.1, 95% confidence interval [CI; 9.7--25.9], P < 0.001). Of the 97 patients with AIS, 24 had cardiac disease (25%). The most common cardiac diagnosis was single ventricle (SV; 8/24, 33%). The incidence of AIS in patients with SV cardiac disease was higher compared with those with other cardiac diagnoses (incidence 1.38% [1380/100,000], OR 15.3, 95% CI [5.7--38.2], P < 0.001). Modeling the prevalence estimates reported since 1978, the prevalence of cardiac disease in AIS patients has remained unchanged across time (prevalence increase per each additional year, 0.5%, 95% CI [--2.1%, 3.1%], P = 0.71).
  
  
  CONCLUSIONS
  Children with cardiac disease (particularly those with SV) have increased risk for AIS. The prevalence is unchanged from reports over previous decades. AIS occurred in SV patients despite compliance with current anticoagulation recommendations. Future efforts should focus on best practices to prevent AIS in cardiac patients.
authors: Department of Pediatrics, Divisions of Pediatric Cardiology, University of Utah, Salt Lake City, Utah 84113, USA. james.hoffman@imail.org
authors: James L
authors: JL
authors: Hoffman
authors: Gordon K
authors: GK
authors: Mack
authors: L LuAnn
authors: LL
authors: Minich
authors: Susan L
authors: SL
authors: Benedict
authors: Mason
authors: M
authors: Heywood
authors: Gregory J
authors: GJ
authors: Stoddard
authors: Elizabeth V
authors: EV
authors: Saarel
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D002539:Cerebral Arterial Diseases / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D016009:Chi-Square Distribution; D002675:Child, Preschool; D019992:Databases as Topic; D006331:Heart Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants