Sparrow Hospital

Background: Atrial fibrillation (AF) and atrial flutter (AFL) are the most prevalent sustained cardiac arrhythmias globally, contributing to significant morbidity and mortality. Metabolic risk factors such as high systolic blood pressure (SBP) and elevated body mass index (BMI) are established contributors to the development of AF/AFL via structural and electrical remodeling of the atria. Methods: Data were extracted from the Global Burden of Disease (GBD) Results curated by the Institute for Health Metrics and Evaluation. DALY rates attributed to AF/AFL due to risk factors such as high BMI and high SBP were obtained for adults aged > 20 years. Temporal trends were analyzed using the Joinpoint Regression tool and changes in trends through logarithmic regression modeling. Annual percent changes (APC) and average APC were computed. Analyses were done stratified by risk factors and genders. Results: From 1990 to 2021, DALYs attributable to AF/AFL due to high BMI, high SBP, and both increased significantly. Among the total population, the AAPC for high BMI was 3.46% (95% CI: 3.44–3.48), for high SBP was 1.04% (95% CI: 1.02–1.05), and for metabolic risks was 1.54% (95% CI: 1.53–1.55), all with p-values <0.001. In females, the AAPC for high BMI was 2.89% (95% CI: 2.87–2.91), for SBP was 1.17% (95% CI: 1.15–1.20), and for metabolic risks was 1.51% (95% CI: 1.49–1.53). Females showed early periods of steep increases, particularly in BMIMI (5.23%, 1990–1994), followed by gradual growth. SBP trends in females showed a notable decline between 2003 and 2006 (–2.51%) followed by renewed increases. For both risks, females showed strong positive trends after 2009. In males, the AAPC for high BMI was the highest across all groups at 4.09% (95% CI: 4.07–4.12), with a rapid rise between 1996 and 2000 (6.69%). The AAPC for SBP in males was lower at 0.93% (95% CI: 0.92–0.95), while for both risks, it showed a steady increase with an AAPC of 1.58% (95% CI: 1.56–1.59). Multiple inflection points with consistent upward trends resumed after 2009 for all three risk categories. Conclusion: The burden of AF/AFL attributable to high BMI, high SBP, and both risks has risen substantially in U.S. adults over the past three decades. This upward trend was consistent across both genders. These findings highlight the growing public health impact of modifiable cardiometabolic risk factors and highlight the urgent need for demographic-specific strategies focused on risk reduction and prevention.

Osteogenesis Imperfecta (OI) Type II is the most severe and often lethal form of OI, characterized by profound skeletal fragility and perinatal complications, most notably respiratory failure secondary to thoracic deformities and pulmonary hypoplasia. Effective NICU management requires a holistic, family-centered approach combined with comprehensive medical care, and can be particularly challenging in centers with limited experience managing similar conditions. This is further complicated by ethical dilemmas, including decisions regarding the extent of interventions requiring nuanced judgment and continual reassessment of goals of care. We describe a term infant prenatally diagnosed with OI Type II, born to an 18-year-old mother. After prenatal counseling from maternal fetal medicine (MFM) and neonatologist about the poor prognosis, the mother opted to continue the pregnancy. At birth, the baby presented with multiple fractures, severe growth restriction and required noninvasive positive pressure ventilation. Management required balancing medical interventions with family goals, the infant's quality of life, and ethical dilemmas due to the life-limiting prognosis. A holistic approach involved early multidisciplinary collaboration, weekly communication of family goals, and consistent medical updates along with supporting the teen mother and her family through complex decisions. This led to a safe discharge to concurrent hospice care with supplemental oxygen via nasal cannula and a feeding tube, alongside comprehensive specialty follow-up. This case helps expand the scope of what is possible for families facing life-limiting diagnosis. It informs best practices for navigating prognostic uncertainty, guiding ethical decision-making, and promoting holistic support beyond survival metrics. Cases like this advocate for a shift in focus from solely survival to quality of life and help establish thoughtful standards for managing severe skeletal dysplasias within perinatal and neonatal care frameworks.