Abstract 9937: Three Times Higher Risk of Stroke in Adult Congenital Heart Disease on a Median Follow-Up of Over a Decade: A Global Meta-Analysis
Bibliographic record
Abstract
Background: With the advent of medicine, there is an increasing number of congenital heart disease survivors, which mandates assessment of the long-term risk of stroke and outcomes. We aimed to systematically review the pooled global prevalence of stroke in adults with congenital heart disease (ACHD). Methods: PubMed/Medline, SCOPUS and EMBASE were reviewed until May 2021 to ascertain articles describing stroke rates in ACHD compared to non-ACHD patients over a long follow-up (at least ≥3 years). Random effects models were used to estimate the pooled prevalence of stroke in ACHD and risk of stroke in ACHD vs non ACHD. Heterogeneity was assessed using the I 2 statistics with >75% value suggesting substantial heterogeneity, for which subgroup analysis was performed. Results: We included 14 studies comprising 96,626 participants with ACHD and 751,460 without ACHD. The overall pooled prevalence of stroke in ACHD was 3.7% (95CI 2.5%-5.0%, I 2 = 99%) over a median follow-up period of 11.5 years ( Fig. 1a ). The ACHD patients showed nearly 3 times higher risk of stroke [OR 3.11 (95% CI 2.09-4.63), I 2 =97.99%, p<0.01] on 11.5 years median follow-up ( Fig. 1b ). On subgroup analysis, studies with older ACHD patients showed nearly two times higher rate of stroke compared to studies with younger patients (mean age>40 years: 4.8% vs. mean age ≤40 years, 2.6%). Furthermore, the prevalence of stroke was higher among the ACHD cohorts with shorter median follow-up (<10 years) vs. studies with a median follow-up of >10 years [5.0% vs 3.0%]. Studies published from Denmark (4.5%) and Canada/USA (3.2%) revealed greater rates of stroke in ACHD than the studies from Sweden (2.8%). Conclusion: This meta-analysis found nearly three times higher risk of stroke in ACHD patients over a decade follow-up compared to controls. The demographic, chronological and regional variation of the stroke prevalence in ACHD indicates that the risk could be multifactorial and warrants further risk stratification measures
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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 | 0.015 | 0.021 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.080 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".