Abstract 210: Association between Paroxysmal Supraventricular Tachycardia and Ischemic Stroke in Patients Without Atrial Fibrillation
Bibliographic record
Abstract
Introduction: Paroxysmal supraventricular tachycardia (PSVT) is viewed as a benign heart-rhythm disorder. However, recent studies suggest that atrial dysrhythmias other than atrial fibrillation/flutter (AF) may signify an increased stroke risk. Hypothesis: PSVT is associated with subsequent ischemic stroke in patients without documented AF. Methods: We obtained inpatient and outpatient claims data from 2010-2011 in a 5% sample of Medicare beneficiaries ≥66 years of age. We included only patients with a pacemaker or defibrillator, since such patients often undergo interrogation of heart rhythm. Patients with AF or stroke before or at the time of device implantation were excluded. Our predictor variable was PSVT. The primary outcome was ischemic stroke and the secondary outcome was embolic stroke. All diagnoses were ascertained from ICD-9-CM codes using previously validated algorithms. We used Kaplan-Meier survival analysis and the log-rank test to compare outcomes in patients with and without PSVT, which was modeled as a time-varying covariate. Patients were censored at the time of incident AF, stroke, death, or on December 31, 2011. Cox proportional hazards analysis was used to assess the relationship between PSVT and stroke while adjusting for demographic characteristics and vascular risk factors. Results: Among 42,152 eligible patients with a median 1.8 years of follow-up, 2,245 (5.3%) had PSVT and 1,007 (2.4%) developed a stroke. The incidence of stroke after a PSVT diagnosis (2.17% per year; 95% confidence interval [CI], 1.45-3.24%) was significantly higher than in patients without PSVT (0.95% per year; 95% CI, 0.87-1.03%; P < 0.001). After adjustment for demographic characteristics and vascular risk factors, PSVT was associated with a higher hazard of stroke (hazard ratio [HR], 2.0; 95% CI, 1.3-3.0). This association appeared stronger for embolic stroke (HR, 3.6; 95% CI, 1.1-11.8). Conclusions: In Medicare beneficiaries with implantable pacemakers or defibrillators, PSVT was associated with ischemic stroke, especially embolic stroke, in the absence of documented AF. These results build on recent findings that disturbances of atrial rhythm and function other than AF may be a previously unrecognized stroke risk factor.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".