Hemorrhagic transformation in patients with acute ischemic stroke and atrial fibrillation

Time to initiation of oral anticoagulant therapy and outcomes

Maurizio Paciaroni, Fabio Bandini, Giancarlo Agnelli, Georgios Tsivgoulis, Shadi Yaghi, Karen L. Furie, Prasanna Tadi, Cecilia Becattini, Marialuisa Zedde, Azmil H. Abdul-Rahim, Kennedy R. Lees, Andrea Alberti, Michele Venti, Monica Acciarresi, Cataldo D’Amore, Maria Giulia Mosconi, Ludovica Anna Cimini, Riccardo Altavilla, Giacomo Volpi, Paolo Bovi & 82 others Monica Carletti, Alberto Rigatelli, Manuel Cappellari, Jukka Putaala, Liisa Tomppo, Turgut Tatlisumak, Simona Marcheselli, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Luca Masotti, Vieri Vannucchi, Sung Il Sohn, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, George Ntaios, George Athanasakis, Konstantinos Makaritsis, Efstathia Karagkiozi, Konstantinos Vadikolias, Chrissoula Liantinioti, Maria Chondrogianni, Nicola Mumoli, Domenico Consoli, Franco Galati, Simona Sacco, Antonio Carolei, Cindy Tiseo, Francesco Corea, Walter Ageno, Marta Bellesini, Giovanna Colombo, Giorgio Silvestrelli, Alfonso Ciccone, Alessia Lanari, Umberto Scoditti, Licia Denti, Michelangelo Mancuso, Miriam Maccarrone, Leonardo Ulivi, Giovanni Orlandi, Nicola Giannini, Gino Gialdini, Tiziana Tassinari, Maria Luisa De Lodovici, Giorgio Bono, Christina Rueckert, Antonio Baldi, Sebastiano D'Anna, Danilo Toni, Federica Letteri, Martina Giuntini, Enrico Maria Lotti, Yuriy Flomin, Alessio Pieroni, Odysseas Kargiotis, Theodore Karapanayiotides, Serena Monaco, Mario Maimone Baronello, Laszló Csiba, Lilla Szabó, Alberto Chiti, Elisa Giorli, Massimo Del Sette, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Patrik Michel, Peter Vanacker, Kristian Barlinn, Lars Peder Pallesen, Jessica Barlinn, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Vanessa Gourbali, Valeria Caso

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background—In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation (HT). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT, (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results—HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset. The incidence of ischemic recurrences as well as mortality or disability (modified Rankin Scale scores >2) were evaluated at 90 days. Ischemic recurrences were the composite of ischemic stroke, transient ischemic attack, or systemic embolism. Among the 2183 patients included in the study, 241 (11.0%) had HT. Patients with and without HT initiated anticoagulant therapy after a mean 23.3 and 11.6 days, respectively, from index stroke. At 90 days, 4.6% (95% confidence interval, 2.3-8.0) of the patients with HT had ischemic recurrences compared with 4.9% (95% confidence interval, 4.0-6.0) of those without HT; 53.1% of patients with HT were deceased or disabled compared with 35.8% of those without HT. On multivariable analysis, HT was associated with mortality or disability (odds ratio, 1.71; 95% confidence interval, 1.24-2.35). Conclusions—In patients with HT, anticoagulation was initiated about 12 days later than patients without HT. This delay was not associated with increased detection of ischemic recurrence. HT was associated with increased mortality or disability.

Original languageEnglish (US)
Article numbere010133
JournalJournal of the American Heart Association
Volume7
Issue number22
DOIs
StatePublished - Nov 1 2018

Fingerprint

Anticoagulants
Atrial Fibrillation
Stroke
Recurrence
Therapeutics
Confidence Intervals
Mortality
Transient Ischemic Attack
Incidence
Embolism
Odds Ratio
Brain

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Hemorrhagic transformation in patients with acute ischemic stroke and atrial fibrillation : Time to initiation of oral anticoagulant therapy and outcomes. / Paciaroni, Maurizio; Bandini, Fabio; Agnelli, Giancarlo; Tsivgoulis, Georgios; Yaghi, Shadi; Furie, Karen L.; Tadi, Prasanna; Becattini, Cecilia; Zedde, Marialuisa; Abdul-Rahim, Azmil H.; Lees, Kennedy R.; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D’Amore, Cataldo; Mosconi, Maria Giulia; Cimini, Ludovica Anna; Altavilla, Riccardo; Volpi, Giacomo; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Cappellari, Manuel; Putaala, Jukka; Tomppo, Liisa; Tatlisumak, Turgut; Marcheselli, Simona; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Masotti, Luca; Vannucchi, Vieri; Sohn, Sung Il; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Acampa, Maurizio; Martini, Giuseppe; Ntaios, George; Athanasakis, George; Makaritsis, Konstantinos; Karagkiozi, Efstathia; Vadikolias, Konstantinos; Liantinioti, Chrissoula; Chondrogianni, Maria; Mumoli, Nicola; Consoli, Domenico; Galati, Franco; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Corea, Francesco; Ageno, Walter; Bellesini, Marta; Colombo, Giovanna; Silvestrelli, Giorgio; Ciccone, Alfonso; Lanari, Alessia; Scoditti, Umberto; Denti, Licia; Mancuso, Michelangelo; Maccarrone, Miriam; Ulivi, Leonardo; Orlandi, Giovanni; Giannini, Nicola; Gialdini, Gino; Tassinari, Tiziana; De Lodovici, Maria Luisa; Bono, Giorgio; Rueckert, Christina; Baldi, Antonio; D'Anna, Sebastiano; Toni, Danilo; Letteri, Federica; Giuntini, Martina; Lotti, Enrico Maria; Flomin, Yuriy; Pieroni, Alessio; Kargiotis, Odysseas; Karapanayiotides, Theodore; Monaco, Serena; Baronello, Mario Maimone; Csiba, Laszló; Szabó, Lilla; Chiti, Alberto; Giorli, Elisa; Del Sette, Massimo; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Michel, Patrik; Vanacker, Peter; Barlinn, Kristian; Pallesen, Lars Peder; Barlinn, Jessica; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Gourbali, Vanessa; Caso, Valeria.

In: Journal of the American Heart Association, Vol. 7, No. 22, e010133, 01.11.2018.

Research output: Contribution to journalArticle

Paciaroni, M, Bandini, F, Agnelli, G, Tsivgoulis, G, Yaghi, S, Furie, KL, Tadi, P, Becattini, C, Zedde, M, Abdul-Rahim, AH, Lees, KR, Alberti, A, Venti, M, Acciarresi, M, D’Amore, C, Mosconi, MG, Cimini, LA, Altavilla, R, Volpi, G, Bovi, P, Carletti, M, Rigatelli, A, Cappellari, M, Putaala, J, Tomppo, L, Tatlisumak, T, Marcheselli, S, Pezzini, A, Poli, L, Padovani, A, Masotti, L, Vannucchi, V, Sohn, SI, Lorenzini, G, Tassi, R, Guideri, F, Acampa, M, Martini, G, Ntaios, G, Athanasakis, G, Makaritsis, K, Karagkiozi, E, Vadikolias, K, Liantinioti, C, Chondrogianni, M, Mumoli, N, Consoli, D, Galati, F, Sacco, S, Carolei, A, Tiseo, C, Corea, F, Ageno, W, Bellesini, M, Colombo, G, Silvestrelli, G, Ciccone, A, Lanari, A, Scoditti, U, Denti, L, Mancuso, M, Maccarrone, M, Ulivi, L, Orlandi, G, Giannini, N, Gialdini, G, Tassinari, T, De Lodovici, ML, Bono, G, Rueckert, C, Baldi, A, D'Anna, S, Toni, D, Letteri, F, Giuntini, M, Lotti, EM, Flomin, Y, Pieroni, A, Kargiotis, O, Karapanayiotides, T, Monaco, S, Baronello, MM, Csiba, L, Szabó, L, Chiti, A, Giorli, E, Del Sette, M, Imberti, D, Zabzuni, D, Doronin, B, Volodina, V, Michel, P, Vanacker, P, Barlinn, K, Pallesen, LP, Barlinn, J, Deleu, D, Melikyan, G, Ibrahim, F, Akhtar, N, Gourbali, V & Caso, V 2018, 'Hemorrhagic transformation in patients with acute ischemic stroke and atrial fibrillation: Time to initiation of oral anticoagulant therapy and outcomes', Journal of the American Heart Association, vol. 7, no. 22, e010133. https://doi.org/10.1161/JAHA.118.010133
Paciaroni, Maurizio ; Bandini, Fabio ; Agnelli, Giancarlo ; Tsivgoulis, Georgios ; Yaghi, Shadi ; Furie, Karen L. ; Tadi, Prasanna ; Becattini, Cecilia ; Zedde, Marialuisa ; Abdul-Rahim, Azmil H. ; Lees, Kennedy R. ; Alberti, Andrea ; Venti, Michele ; Acciarresi, Monica ; D’Amore, Cataldo ; Mosconi, Maria Giulia ; Cimini, Ludovica Anna ; Altavilla, Riccardo ; Volpi, Giacomo ; Bovi, Paolo ; Carletti, Monica ; Rigatelli, Alberto ; Cappellari, Manuel ; Putaala, Jukka ; Tomppo, Liisa ; Tatlisumak, Turgut ; Marcheselli, Simona ; Pezzini, Alessandro ; Poli, Loris ; Padovani, Alessandro ; Masotti, Luca ; Vannucchi, Vieri ; Sohn, Sung Il ; Lorenzini, Gianni ; Tassi, Rossana ; Guideri, Francesca ; Acampa, Maurizio ; Martini, Giuseppe ; Ntaios, George ; Athanasakis, George ; Makaritsis, Konstantinos ; Karagkiozi, Efstathia ; Vadikolias, Konstantinos ; Liantinioti, Chrissoula ; Chondrogianni, Maria ; Mumoli, Nicola ; Consoli, Domenico ; Galati, Franco ; Sacco, Simona ; Carolei, Antonio ; Tiseo, Cindy ; Corea, Francesco ; Ageno, Walter ; Bellesini, Marta ; Colombo, Giovanna ; Silvestrelli, Giorgio ; Ciccone, Alfonso ; Lanari, Alessia ; Scoditti, Umberto ; Denti, Licia ; Mancuso, Michelangelo ; Maccarrone, Miriam ; Ulivi, Leonardo ; Orlandi, Giovanni ; Giannini, Nicola ; Gialdini, Gino ; Tassinari, Tiziana ; De Lodovici, Maria Luisa ; Bono, Giorgio ; Rueckert, Christina ; Baldi, Antonio ; D'Anna, Sebastiano ; Toni, Danilo ; Letteri, Federica ; Giuntini, Martina ; Lotti, Enrico Maria ; Flomin, Yuriy ; Pieroni, Alessio ; Kargiotis, Odysseas ; Karapanayiotides, Theodore ; Monaco, Serena ; Baronello, Mario Maimone ; Csiba, Laszló ; Szabó, Lilla ; Chiti, Alberto ; Giorli, Elisa ; Del Sette, Massimo ; Imberti, Davide ; Zabzuni, Dorjan ; Doronin, Boris ; Volodina, Vera ; Michel, Patrik ; Vanacker, Peter ; Barlinn, Kristian ; Pallesen, Lars Peder ; Barlinn, Jessica ; Deleu, Dirk ; Melikyan, Gayane ; Ibrahim, Faisal ; Akhtar, Naveed ; Gourbali, Vanessa ; Caso, Valeria. / Hemorrhagic transformation in patients with acute ischemic stroke and atrial fibrillation : Time to initiation of oral anticoagulant therapy and outcomes. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 22.
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title = "Hemorrhagic transformation in patients with acute ischemic stroke and atrial fibrillation: Time to initiation of oral anticoagulant therapy and outcomes",
abstract = "Background—In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation (HT). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT, (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results—HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset. The incidence of ischemic recurrences as well as mortality or disability (modified Rankin Scale scores >2) were evaluated at 90 days. Ischemic recurrences were the composite of ischemic stroke, transient ischemic attack, or systemic embolism. Among the 2183 patients included in the study, 241 (11.0{\%}) had HT. Patients with and without HT initiated anticoagulant therapy after a mean 23.3 and 11.6 days, respectively, from index stroke. At 90 days, 4.6{\%} (95{\%} confidence interval, 2.3-8.0) of the patients with HT had ischemic recurrences compared with 4.9{\%} (95{\%} confidence interval, 4.0-6.0) of those without HT; 53.1{\%} of patients with HT were deceased or disabled compared with 35.8{\%} of those without HT. On multivariable analysis, HT was associated with mortality or disability (odds ratio, 1.71; 95{\%} confidence interval, 1.24-2.35). Conclusions—In patients with HT, anticoagulation was initiated about 12 days later than patients without HT. This delay was not associated with increased detection of ischemic recurrence. HT was associated with increased mortality or disability.",
author = "Maurizio Paciaroni and Fabio Bandini and Giancarlo Agnelli and Georgios Tsivgoulis and Shadi Yaghi and Furie, {Karen L.} and Prasanna Tadi and Cecilia Becattini and Marialuisa Zedde and Abdul-Rahim, {Azmil H.} and Lees, {Kennedy R.} and Andrea Alberti and Michele Venti and Monica Acciarresi and Cataldo D’Amore and Mosconi, {Maria Giulia} and Cimini, {Ludovica Anna} and Riccardo Altavilla and Giacomo Volpi and Paolo Bovi and Monica Carletti and Alberto Rigatelli and Manuel Cappellari and Jukka Putaala and Liisa Tomppo and Turgut Tatlisumak and Simona Marcheselli and Alessandro Pezzini and Loris Poli and Alessandro Padovani and Luca Masotti and Vieri Vannucchi and Sohn, {Sung Il} and Gianni Lorenzini and Rossana Tassi and Francesca Guideri and Maurizio Acampa and Giuseppe Martini and George Ntaios and George Athanasakis and Konstantinos Makaritsis and Efstathia Karagkiozi and Konstantinos Vadikolias and Chrissoula Liantinioti and Maria Chondrogianni and Nicola Mumoli and Domenico Consoli and Franco Galati and Simona Sacco and Antonio Carolei and Cindy Tiseo and Francesco Corea and Walter Ageno and Marta Bellesini and Giovanna Colombo and Giorgio Silvestrelli and Alfonso Ciccone and Alessia Lanari and Umberto Scoditti and Licia Denti and Michelangelo Mancuso and Miriam Maccarrone and Leonardo Ulivi and Giovanni Orlandi and Nicola Giannini and Gino Gialdini and Tiziana Tassinari and {De Lodovici}, {Maria Luisa} and Giorgio Bono and Christina Rueckert and Antonio Baldi and Sebastiano D'Anna and Danilo Toni and Federica Letteri and Martina Giuntini and Lotti, {Enrico Maria} and Yuriy Flomin and Alessio Pieroni and Odysseas Kargiotis and Theodore Karapanayiotides and Serena Monaco and Baronello, {Mario Maimone} and Laszl{\'o} Csiba and Lilla Szab{\'o} and Alberto Chiti and Elisa Giorli and {Del Sette}, Massimo and Davide Imberti and Dorjan Zabzuni and Boris Doronin and Vera Volodina and Patrik Michel and Peter Vanacker and Kristian Barlinn and Pallesen, {Lars Peder} and Jessica Barlinn and Dirk Deleu and Gayane Melikyan and Faisal Ibrahim and Naveed Akhtar and Vanessa Gourbali and Valeria Caso",
year = "2018",
month = "11",
day = "1",
doi = "10.1161/JAHA.118.010133",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "22",

}

TY - JOUR

T1 - Hemorrhagic transformation in patients with acute ischemic stroke and atrial fibrillation

T2 - Time to initiation of oral anticoagulant therapy and outcomes

AU - Paciaroni, Maurizio

AU - Bandini, Fabio

AU - Agnelli, Giancarlo

AU - Tsivgoulis, Georgios

AU - Yaghi, Shadi

AU - Furie, Karen L.

AU - Tadi, Prasanna

AU - Becattini, Cecilia

AU - Zedde, Marialuisa

AU - Abdul-Rahim, Azmil H.

AU - Lees, Kennedy R.

AU - Alberti, Andrea

AU - Venti, Michele

AU - Acciarresi, Monica

AU - D’Amore, Cataldo

AU - Mosconi, Maria Giulia

AU - Cimini, Ludovica Anna

AU - Altavilla, Riccardo

AU - Volpi, Giacomo

AU - Bovi, Paolo

AU - Carletti, Monica

AU - Rigatelli, Alberto

AU - Cappellari, Manuel

AU - Putaala, Jukka

AU - Tomppo, Liisa

AU - Tatlisumak, Turgut

AU - Marcheselli, Simona

AU - Pezzini, Alessandro

AU - Poli, Loris

AU - Padovani, Alessandro

AU - Masotti, Luca

AU - Vannucchi, Vieri

AU - Sohn, Sung Il

AU - Lorenzini, Gianni

AU - Tassi, Rossana

AU - Guideri, Francesca

AU - Acampa, Maurizio

AU - Martini, Giuseppe

AU - Ntaios, George

AU - Athanasakis, George

AU - Makaritsis, Konstantinos

AU - Karagkiozi, Efstathia

AU - Vadikolias, Konstantinos

AU - Liantinioti, Chrissoula

AU - Chondrogianni, Maria

AU - Mumoli, Nicola

AU - Consoli, Domenico

AU - Galati, Franco

AU - Sacco, Simona

AU - Carolei, Antonio

AU - Tiseo, Cindy

AU - Corea, Francesco

AU - Ageno, Walter

AU - Bellesini, Marta

AU - Colombo, Giovanna

AU - Silvestrelli, Giorgio

AU - Ciccone, Alfonso

AU - Lanari, Alessia

AU - Scoditti, Umberto

AU - Denti, Licia

AU - Mancuso, Michelangelo

AU - Maccarrone, Miriam

AU - Ulivi, Leonardo

AU - Orlandi, Giovanni

AU - Giannini, Nicola

AU - Gialdini, Gino

AU - Tassinari, Tiziana

AU - De Lodovici, Maria Luisa

AU - Bono, Giorgio

AU - Rueckert, Christina

AU - Baldi, Antonio

AU - D'Anna, Sebastiano

AU - Toni, Danilo

AU - Letteri, Federica

AU - Giuntini, Martina

AU - Lotti, Enrico Maria

AU - Flomin, Yuriy

AU - Pieroni, Alessio

AU - Kargiotis, Odysseas

AU - Karapanayiotides, Theodore

AU - Monaco, Serena

AU - Baronello, Mario Maimone

AU - Csiba, Laszló

AU - Szabó, Lilla

AU - Chiti, Alberto

AU - Giorli, Elisa

AU - Del Sette, Massimo

AU - Imberti, Davide

AU - Zabzuni, Dorjan

AU - Doronin, Boris

AU - Volodina, Vera

AU - Michel, Patrik

AU - Vanacker, Peter

AU - Barlinn, Kristian

AU - Pallesen, Lars Peder

AU - Barlinn, Jessica

AU - Deleu, Dirk

AU - Melikyan, Gayane

AU - Ibrahim, Faisal

AU - Akhtar, Naveed

AU - Gourbali, Vanessa

AU - Caso, Valeria

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background—In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation (HT). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT, (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results—HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset. The incidence of ischemic recurrences as well as mortality or disability (modified Rankin Scale scores >2) were evaluated at 90 days. Ischemic recurrences were the composite of ischemic stroke, transient ischemic attack, or systemic embolism. Among the 2183 patients included in the study, 241 (11.0%) had HT. Patients with and without HT initiated anticoagulant therapy after a mean 23.3 and 11.6 days, respectively, from index stroke. At 90 days, 4.6% (95% confidence interval, 2.3-8.0) of the patients with HT had ischemic recurrences compared with 4.9% (95% confidence interval, 4.0-6.0) of those without HT; 53.1% of patients with HT were deceased or disabled compared with 35.8% of those without HT. On multivariable analysis, HT was associated with mortality or disability (odds ratio, 1.71; 95% confidence interval, 1.24-2.35). Conclusions—In patients with HT, anticoagulation was initiated about 12 days later than patients without HT. This delay was not associated with increased detection of ischemic recurrence. HT was associated with increased mortality or disability.

AB - Background—In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation (HT). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT, (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results—HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset. The incidence of ischemic recurrences as well as mortality or disability (modified Rankin Scale scores >2) were evaluated at 90 days. Ischemic recurrences were the composite of ischemic stroke, transient ischemic attack, or systemic embolism. Among the 2183 patients included in the study, 241 (11.0%) had HT. Patients with and without HT initiated anticoagulant therapy after a mean 23.3 and 11.6 days, respectively, from index stroke. At 90 days, 4.6% (95% confidence interval, 2.3-8.0) of the patients with HT had ischemic recurrences compared with 4.9% (95% confidence interval, 4.0-6.0) of those without HT; 53.1% of patients with HT were deceased or disabled compared with 35.8% of those without HT. On multivariable analysis, HT was associated with mortality or disability (odds ratio, 1.71; 95% confidence interval, 1.24-2.35). Conclusions—In patients with HT, anticoagulation was initiated about 12 days later than patients without HT. This delay was not associated with increased detection of ischemic recurrence. HT was associated with increased mortality or disability.

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UR - http://www.scopus.com/inward/citedby.url?scp=85057096663&partnerID=8YFLogxK

U2 - 10.1161/JAHA.118.010133

DO - 10.1161/JAHA.118.010133

M3 - Article

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 22

M1 - e010133

ER -