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Environmental Factors Impact Clinical Outcomes in Atrial Fibrillation
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the world with a lifetime risk of 26% for men and 23% for women. The global prevalence was estimated at 20.9 million males and 12.6 million females in 2010, with as many as 4.7 million total new cases per year.1 AF carries significant comorbidities such as stroke, leading to over 467,000 hospitalizations and over 99,000 deaths per year in the US.2 AF has repeatedly been shown to be associated with poorer quality of life.3 The underlying mechanisms of AF are extremely complex with an integral part involving a systemic inflammatory syndrome.
Source: Mayo Clinic Proceedings - November 1, 2020 Category: Internal Medicine Authors: Robert C. Ward, Christopher V. DeSimone Tags: Editorial Source Type: research

In reply —Risk Framing in Cardiovascular Medicine I and II
We thank the authors for their insightful comments on our perspective published in the journal.1 We agree with Dr Modarressi1 that sodium-glucose cotransporter-2 inhibitors indeed represent an important new treatment for patients with heart failure. Although we used the trial definition of major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or stroke) in the text and in the table ’s footnote, we acknowledge that this was a secondary and not a primary end point.
Source: Mayo Clinic Proceedings - November 1, 2020 Category: Internal Medicine Authors: Mohamad Alkhouli, Charanjit S. Rihal Tags: Letter to the editor Source Type: research

Predicting Who Will Experience Cerebral Hemorrhage When Anticoagulated
The most feared hemorrhagic complication of anticoagulating patients with atrial fibrillation is intracerebral hemorrhage (ICH). However, not anticoagulating high-risk patients with atrial fibrillation can lead to cardioembolic stroke, another disastrous outcome. Physicians may tend to avoid blame by inaction, which can result in underprescribing. Such clinical inertia is not unique to anticoagulating patients with atrial fibrillation. Clinical inertia has been noted in the treatment of several common chronic conditions, such as treating blood pressure in patients with hypertension and treating hyperglycemia in patients wi...
Source: Mayo Clinic Proceedings - September 30, 2020 Category: Internal Medicine Authors: James F. Meschia Tags: Editorial Source Type: research

Remaining Challenges With Transcatheter Left Atrial Appendage Closure
Left atrial appendage closure has emerged as a feasible stroke prevention strategy in selected patients with nonvalvular atrial fibrillation. Since its commercial approval in the United States in 2015, the use of percutaneous left atrial appendage closure has witnessed a substantial growth. However, certain issues remain unresolved with the technology. Knowledge of these issues, their significance, and the current and future efforts to resolve them is key for proper informed decision making by physicians and patients.
Source: Mayo Clinic Proceedings - September 30, 2020 Category: Internal Medicine Authors: Mohamad Alkhouli, David R. Holmes Tags: Concise review for clinicians Source Type: research

Utility of HAS-BLED and CHA2DS2-VASc Scores Among Patients With Atrial Fibrillation and Imaging Evidence of Cerebral Amyloid Angiopathy
To determine the utility of the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol concomitantly) and CHA2DS2-VASc (Congestive heart failure, Hypertension, Age, Diabetes, previous Stroke/transient ischemic attack –VAScular disease) scores among patients on anticoagulation (AC) therapy for atrial fibrillation (AF) who have evidence of cerebral amyloid angiopathy (CAA).
Source: Mayo Clinic Proceedings - August 19, 2020 Category: Internal Medicine Authors: Robert Ward, Shiva Ponamgi, Christopher V. DeSimone, Stephen English, David O. Hodge, Joshua P. Slusser, Jonathan Graff-Radford, Alejandro A. Rabinstein, Samuel J. Asirvatham, David Holmes Tags: Original article Source Type: research

Introduction to Thematic Reviews on Neurovascular Diseases
This is an unprecedented era in the evolution of endovascular and surgical management options for the spectrum of neurovascular diseases seen in clinical practice. While stroke remains the fourth-leading cause of death, and the leading cause of disability in the United States, interventional techniques are now available that can lead to a favorable outcome in some situations in which death or disability would have undoubtedly occurred just a few years ago.1 In this issue of Mayo Clinic Proceedings, the first of several articles will appear as part of a Thematic Review Series on Neurovascular Diseases.
Source: Mayo Clinic Proceedings - June 30, 2020 Category: Internal Medicine Authors: Robert D. Brown, Giuseppe Lanzino, David F. Kallmes Tags: Editorial Source Type: research

Contemporary Management of Acute Ischemic Stroke Across the Continuum
In this comprehensive contemporary review of acute ischemic stroke management, what is new and different will be highlighted beginning with prehospital stroke systems of care, emergency medical systems, and mobile stroke units, followed by hospital stroke teams, emergency evaluation, telemedicine, and brain and vascular imaging, and finishing with emergency treatments including thrombolysis and mechanical thrombectomy.
Source: Mayo Clinic Proceedings - June 30, 2020 Category: Internal Medicine Authors: Bart M. Demaerschalk, Eugene L. Scharf, Harry Cloft, Kevin M. Barrett, Kara A. Sands, David A. Miller, James F. Meschia Tags: Thematic review on neurovascular diseases Source Type: research

Cardiorespiratory Fitness and Incident Stroke Types
To study the association between cardiorespiratory fitness (CRF) and incident stroke types.
Source: Mayo Clinic Proceedings - June 30, 2020 Category: Internal Medicine Authors: Mahmoud Al Rifai, Michael J. Blaha, Amjad Ahmed, Fatimah Almasoudi, Michelle C. Johansen, Waqas Qureshi, Sherif Sakr, Salim S. Virani, Clinton A. Brawner, Jonathan K. Ehrman, Steven J. Keteyian, Mouaz H. Al-Mallah Tags: Original article Source Type: research

Telestroke in the Time of COVID-19: The Mayo Clinic Experience
On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic, and in the weeks following, public health organizations, medical associations, and governing bodies throughout the world recommended limiting contact with others to “flatten the curve” of COVID-19. Although both ischemic and hemorrhagic strokes have been reported with COVID-19, there has been anecdotal suggestion of an overall decrease in stroke admissions. To date, the effects of any pandemic on telestroke service lines have not been described.
Source: Mayo Clinic Proceedings - June 12, 2020 Category: Internal Medicine Authors: Josephine F. Huang, Melanie R.F. Greenway, Deena M. Nasr, Felix E. Chukwudelunzu, Bart M. Demaerschalk, Cumara B. O ’Carroll, Charisse A. Nord, Emily A. Pahl, Kevin M. Barrett, Lindsy N. Williams Tags: Brief Report Source Type: research

Telestroke in the Time of COVID-19: The  Mayo Clinic Experience
On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic, and in the weeks following, public health organizations, medical associations, and governing bodies throughout the world recommended limiting contact with others to “flatten the curve” of COVID-19. Although both ischemic and hemorrhagic strokes have been reported with COVID-19, there has been anecdotal suggestion of an overall decrease in stroke admissions. To date, the effects of any pandemic on telestroke service lines have not been described.
Source: Mayo Clinic Proceedings - June 12, 2020 Category: Internal Medicine Authors: Josephine F. Huang, Melanie R.F. Greenway, Deena M. Nasr, Felix E. Chukwudelunzu, Bart M. Demaerschalk, Cumara B. O ’Carroll, Charisse A. Nord, Emily A. Pahl, Kevin M. Barrett, Lindsy N. Williams Tags: Brief report Source Type: research

End-Stage Renal Disease, Nonvalvular Atrial Fibrillation, and the Warfarin Dilemma
There are more than 660,000 Americans with kidney failure and nearly 470,000 on dialysis.1 Of these, estimates of nonvalvular atrial fibrillation (NVAF) approach 20%.2 Atrial fibrillation nearly doubles the anticipated mortality and increases the stroke risk by approximately six-fold in these patients. The intersection between end-stage renal disease (ESRD) and NVAF is complicated and not easily parsed. Atrial fibrillation likely increases the rate of progression to ESRD in patients with underlying chronic kidney disease (CKD).
Source: Mayo Clinic Proceedings - May 31, 2020 Category: Internal Medicine Authors: Robert D. McBane Tags: Editorial Source Type: research

Brain Volume: An Important Determinant of Functional Outcome After Acute Ischemic Stroke
To determine whether brain volume is associated with functional outcome after acute ischemic stroke (AIS).
Source: Mayo Clinic Proceedings - April 30, 2020 Category: Internal Medicine Authors: Markus D. Schirmer, Kathleen L. Donahue, Marco J. Nardin, Adrian V. Dalca, Anne-Katrin Giese, Mark R. Etherton, Steven J.T. Mocking, Elissa C. McIntosh, John W. Cole, Lukas Holmegaard, Katarina Jood, Jordi Jimenez-Conde, Steven J. Kittner, Robin Lemmens, Tags: Original article Source Type: research

A Review of Hypertension Management in Black Male Patients
Hypertension affects approximately 85 million Americans, or almost 1 in 3 adults. Black men have disproportionately higher rates of hypertension and are more likely to experience complications of hypertension, including stroke, myocardial infarction, and death. In addition, hypertensive black men are less likely to achieve optimal blood pressure (BP) than women and persons of other races. In light of this, we performed a literature search for articles published from January 1, 1966, to December 31, 2018, using terms including hypertension, blood pressure, black male, and African American male.
Source: Mayo Clinic Proceedings - April 6, 2020 Category: Internal Medicine Authors: Elisabeth M. Sulaica, Joshua T. Wollen, John Kotter, Tracy E. Macaulay Tags: Review Source Type: research

Legacy of Nutritionist Ancel Keys
A diet high in saturated fat increases risk for heart disease and stroke. We know this, but few can recall who first uncovered the connection. It was Ancel Keys — a name to note and remember. Some 60 years ago, he was a luminary in medical science with a reputation that reached ordinary Americans. In 1961, his image graced the cover of TIME magazine. He was the first to promote the health benefits of the Mediterranean diet. An esteemed professor at the Un iversity of Minnesota, Ancel Keys was brilliant, bold, and worldly.
Source: Mayo Clinic Proceedings - February 29, 2020 Category: Internal Medicine Authors: Phillip B. Sparling Tags: Letter to the editor Source Type: research

91-Year-Old Man With Upper Extremity Ecchymoses
A 91-year-old man with a medical history significant for previous ischemic stroke, tuberculosis status post lung resection, and type 2 diabetes mellitus presented to his primary care physician with extensive non-traumatic bruising of the bilateral upper extremities.
Source: Mayo Clinic Proceedings - February 29, 2020 Category: Internal Medicine Authors: Ryan B. Khodadadi, John R. Ogden, Ariela L. Marshall Tags: Residents ’ clinic Source Type: research

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