Geisinger Wyoming Valley Medical Center

Background: Stroke and diabetes mellitus share causes, making co-mortality a key risk marker. After decades of gains, U.S. progress plateaued in the mid-2010s as risk-factor control faltered and stroke declines reversed, exposing disparities by ethnicity, region, rurality, race, and sex. Objective: To evaluate national trends in stroke–diabetes co-mortality in the U.S. from 1999–2020, with emphasis on geographic and demographic disparities. Methods: We analyzed U.S. death certificates from CDC WONDER (1999–2020), defining stroke as the underlying cause (ICD-10: I60–I64, I69.0–I69.4) and diabetes as the contributing cause (E10–E14). Age-adjusted mortality rates (AAMRs), per 100,000, were calculated and stratified by sex, race, ethnicity, Census region, and urbanization. Trends were assessed with Joinpoint regression, estimating annual percent changes (APCs). Results: From 1999–2020, 222,658 stroke–diabetes deaths were identified. Nationwide, AAMR declined from 4.3 in 1999 to 2.7 in 2020, with a steep fall until the mid-2010s followed by a reversal. Hispanics had a higher mean AAMR (3.8) than non-Hispanics (3.1). Regional variation was marked, with the South (3.5) and West (3.4) exceeding the Midwest (3.0) and Northeast (2.4); post-2014 increases were concentrated in the South/West. Non-metropolitan areas had higher mean AAMRs (3.6) than metropolitan areas (3.0), with the sharpest resurgence after 2015 in rural settings. By race, Black/African Americans had the highest mean AAMR (5.6), Whites the lowest (2.7), while American Indians/Alaska Natives declined steadily, and Asians/Pacific Islanders reversed upward post-2015. By sex, men consistently had higher mean AAMRs (3.3) than women (2.8). Conclusions: Stroke–diabetes co-mortality in the U.S. shows a mid-2010s reversal, with Hispanic/Latino, Southern/Western, and rural groups most affected. These trends reflect faltering control of blood pressure and diabetes, unequal access to stroke-ready care, and a 2020 pandemic spike. Priorities include tighter control of hemoglobin A1c, blood pressure, and LDL cholesterol: optimized statin use; screening for nonalcoholic fatty liver disease (NAFLD) in diabetes care; and expanded rural access to intravenous thrombolysis and endovascular thrombectomy.

Introduction:A patient presented with traumatic posterior shoulder dislocation and underwent a diagnostic arthroscopy, where an acute subscapularis anterior leading edge tear was identified. This tear patient is exceptionally uncommon, having only been cited in the literature 5 times as of 2013, and to our knowledge, has no known documented cases since. This report seeks to summarize challenges associated with such a rare diagnosis by presenting a case where this rare presentation was timely diagnosed and treated with an optimal outcome, and to highlight pertinent details of the case that are critical to not miss this diagnosis in the future.Case Report:This patient is a 45-year-old male who suffered a motor vehicle-pedestrian collision and was diagnosed with left posterior shoulder dislocation resulting in shoulder instability. Physical exam demonstrated signs of both shoulder instability as well as cervical radiculopathy. No other workup or history-taking yielded significant results, other than a distant past medical history of acute neurological distress from traumatic brain injury. The treatment plan consisted of diagnostic arthroscopy with the expectation of finding associated soft tissue and labral pathology and possible Bankart and other indicated soft tissue repair for instability. Upon arthroscopic investigation, not only was a posterior labral tear identified, but also an unexpected anterior edge subscapularis tear. The patient demonstrated rapid pain relief in the immediate post-operative period.Conclusion:Acute posterior shoulder dislocations of the shoulder are seldomly reported in the literature, with even fewer cases reporting on associated rotator cuff tears with this injury. Due to the challenges associated with diagnosing subscapularis tears following posterior shoulder dislocation, we encourage standardization of the variable terminology of subscapularis tear classifications and for surgeons to be aware of the potential of subscapularis pathology with frontal impact injuries. With the increase of motor vehicle accidents, we postulate that this rare scapularis tear patten may become more prevalent and requiring an expanding body of literature on the topic.

BackgroundAtrioventricular (AV) block is a potential complication of orthotropic heart transplantation (OHT). The optimal cardiac pacing method is largely unexplored in patients after OHT.Case SummaryWe present a patient with AV block after OHT in whom right ventricular pacing resulted in pacing-induced cardiomyopathy (PICM). Left ventricular function was restored with left bundle branch pacing.DiscussionAV block is an uncommon complication after OHT that requires ventricular pacing. Ventricular dyssynchrony induced by right ventricular pacing may be associated with increased risk for PICM in OHT recipients. Cardiac physiologic pacing should be considered as the primary pacing strategy in this population.Take-Home MessagesOHT recipients may be at increased risk for PICM. Left bundle branch pacing is an effective strategy for both prevention and treatment of PICM.

onduction system pacing (CSP) has emerged as an alternative to right ventricular (RV) pacing and has demonstrated clinical benefits for patients with bradycardia in both clinical studies 1 and real-world cohorts. 2 However, few studies have further disaggregated RV pacing into RV septal pacing (RVSP) versus RV apical pacing (RVAP) and have mostly focused on acute implant metrics such as QRS duration. 3Few have compared long-term benefits across these 3 pacing modalities.This analysis aimed to compare CSP versus RVSP versus RVAP in a large, population-based cohort of US Medicare beneficiaries.The objectives were to compare rates of incident heart failure hospitalization (iHFH) and a composite end point of iHFH+all-cause mortality (ACM) at 12 months.This study utilized data from the Micra CED study (Micra Coverage With Evidence Development), 4 a continuously enrolling, longitudinal cohort study that follows all Medicare patients implanted with either a leadless or transvenous pacemaker.Medicare administrative claims data were used to identify patients implanted with either a single-chamber or dual-chamber transvenous pacemaker from 2020 to 2022.Lead placement data from Medtronic's device registration system were used to identify patients treated with CSP using a 3830 catheter-delivered lead or RVSP and RVAP delivered via a 4076/5076 lead at the same centers using previously described methodology. 2Patient characteristics, comorbidities, and outcome measures were ascertained from the Medicare claims data using the relevant diagnostic and procedure codes.An iHFH

The relationship between left ventricular (LV) mechanical efficiency and various modalities of left bundle branch area pacing (LBBAP) is not well understood. The goal of this study was to evaluate the correlation between 2 different modalities of LBBAP, including left bundle branch pacing (LBBP) and LV septal pacing (LVSP) and myocardial work (MW), during spontaneous rhythm and LBBAP in patients with normal or moderately reduced LV ejection fraction. Patients were retrieved from the TREEBEARD (Evaluation of Contemporary Cardiac Stimulation in Clinical Practice: Left, Biventricular, Right, and Conduction System Pacing; NCT06324682) prospective study and categorized into 2 groups based on whether they received LBBP or LVSP. MW was assessed using metrics such as global work index, global constructive work, global wasted work, and global work efficiency. Overall, 155 patients were included in the study (mean age 73.3 ± 14.3 years; 74.8% male), with 102 in the LBBP group and 53 in the LVSP group. In the LBBP group, all MW indices displayed a strong correlation between values recorded during spontaneous rhythm and LBBP. Conversely, the LVSP group exhibited moderate correlations for global work index (r = 0.535; P = 0.004), global constructive work (r = 0.587; P = 0.009), and global work efficiency (r = 0.503; P = 0.01). Global wasted work did not show a statistically significant correlation (r = 0.641; P = 0.13). In patients with preserved or moderately reduced LV ejection fraction, LBBP exhibited LV mechanical efficiency comparable to that of spontaneous LV activation. Conversely, LVSP is a valuable option, but LV mechanics is impaired, showing a reduced GWE of the left ventricle. (Evaluation of Contemporary Cardiac Stimulation in Clinical Practice: Left, Biventricular, Right, and Conduction System Pacing [TREEBEARD]; NCT06324682).