BACKGROUND:The American Heart Association annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and cardiovascular-kidney-metabolic syndrome) that contribute to cardiovascular health. The 2026 Heart Disease and Stroke Statistics Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS:The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistics Update with review of published literature through the year before writing. The 2026 Statistics Update is the product of a full year's worth of effort in 2025 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes a new chapter on cardiovascular-kidney-metabolic syndrome, as well as an expanded chapter on tobacco and nicotine use and exposure. RESULTS:Each of the chapters in the Statistics Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS:The Statistics Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Atrial fibrillation (AF) is increasing in incidence, prevalence, and lifetime risk, and contributes to substantially greater health care costs and increased risks of stroke, heart failure, and mortality. Improving adherence to evidence-based recommendations equitably in AF is critical to advancing clinical care, patient outcomes, and public health. The writing committee developed a comprehensive set of 5 performance measures, which are appropriate for public reporting or pay-for-performance programs, and 16 quality measures, which are useful to clinicians and health care organizations for quality improvement. The writing committee selected the measures from the strongest recommendations (Class 1 or 3) in the “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation.” The purpose of the writing committee’s performance measures is meant to ensure that patients with newly diagnosed AF receive a basic clinical evaluation, with an emphasis on secondary prevention for patients at all stages of AF, documenting stroke risk, and, if indicated, providing appropriate anticoagulation. AF quality measures cover a variety of topics including measuring and addressing health inequities, optimizing antiarrhythmic or anticoagulant treatment, engaging in shared decision-making for rate- versus rhythm-control strategies, and, in appropriate patients, offering catheter ablation for those with heart failure with reduced ejection fraction. The performance and quality measures are intended to advance the quality and equity of AF care across all patient populations with AF.

Background: Previous reports have established a relationship between asymptomatic high-grade carotid artery stenosis (CAS) and impaired cognition. Different forms of cardiac disease have also been associated with cognitive impairment and dementia. The effect of concurrent high-grade CAS and cardiac disease on cognition is unknown. We hypothesize the presence of comorbid cardiac disease has a synergistic effect on cognitive impairment in patients with asymptomatic CAS. Methods: Patients with ≥80% internal carotid artery stenosis with no history of stroke were recruited from inpatient and outpatient practices at a single, large, comprehensive stroke center. Patients with vs without comorbid cardiac disease (coronary artery disease [CAD], CAD with history of coronary artery bypass graft [CABG] or percutaneous intervention [PCI], heart failure [HF], atrial fibrillation [AF], or valvular disease [aortic or mitral]) were identified. Cognitive assessments were performed using a battery of 14 standardized tests of attention, memory, processing speed, visual construction, language and executive function. Z-scores were generated based on age-specifc norms. Multivariable linear regression was used to compare test-specific Z-scores in patients with vs without cardiac disease controlling for age, sex, years of education and depression. Results: Thirty-three patients with asymptomatic CAS were identified (21 males, age 74+/-10 years, education=16+/-3 years). Twenty-six (79%) had cardiac disease. Patients with comorbid cardiac disease had significantly lower Z-scores across multiple tests of memory compared to patients without cardiac disease (Fig). After adjusting for age, sex, years of education and depression, significant differences persisted in tests of memory in patients with CAD [Hopkins Recognition Memory Test, β= -1.127 (95% CI: -2.234, -0.020), P=0.046], CABG [Hopkins Learning Trial Memory Test, β= -1.441 (95% CI: -2.532, -0.350), P=0.012], and valvular disease [Hopkins Learning Trials Memory Test, β= -1.121 (95% CI: -2.224, -0.018), P=0.047]. Conclusion: Cardiac disease is common among patients with asymptomatic high-grade carotid stenosis and may have a synergistic effect on impairments in memory in a manner not mediated by stroke. Further work is needed to confirm these relationships and their longterm implications on vascular brain health.

Background and Purpose The utilization and outcomes of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) in the presence of brain tumors has not been studied. Using the National Inpatient Sample (NIS), we performed a retrospective analysis of the rate of utilization of EVT in patients with AIS and brain tumors and their odds of in-hospital mortality and home discharge. Methods All adult (≥18 years) AIS patients with brain tumors of malignant, benign, or undetermined subtypes, and EVT use were identified in the NIS (2016-2019). Outcomes were odds of home discharge and in-hospital mortality, adjusted for age, sex, race, income, insurance, hospital size, intravenous tissue plasminogen activator (IV-tPA) use, and clinical severity of hospital admission. Results Of 533,351 AIS patients, 7070 (1.3%) had brain tumors. Sixty-two percent were malignant, 33% benign, and 5.2% undetermined. Patients with brain tumors less frequently received IV-tPA (3.4% vs 10.3%) and EVT (1.9% vs 3.6%) ( P < 0.001). Home discharge after EVT was similar in patients with vs without brain tumors, for all tumor subtypes (28.0% vs 28.4%, P = 0.933). In-hospital mortality was higher with brain tumors (22.6% vs 13.0%, P < 0.001), but largely driven by malignant subtype. In adjusted analysis, only patients with malignant tumors experienced greater in-hospital death after EVT (aOR: 2.78, 95% CI: 1.61-4.80). Conclusions Patients with malignant brain tumors may have higher in-hospital mortality after EVT but similar rate of home discharge. These results are limited by lack of information on confounders such as brain tumor characteristics and causes of mortality in the NIS.

Congenital heart disease is associated with an increased risk of cerebrovascular events. The authors investigated the incidence of stroke and transient ischemic attack (TIA) in adults with congenital heart disease (ACHD). A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all studies reporting the incidence of stroke and TIA in ACHD. Two independent reviewers screened studies, which were included if patients were of age 16 years or older with congenital heart disease and if the outcome was stroke or TIA. Random-effects meta-analysis was conducted to estimate the pooled incidence rate of stroke and TIA with 95% CIs. The Newcastle-Ottawa Scale for Risk of Bias was applied. This systematic review is registered (CRD42022322144). Of 11,028 identified abstracts, 27 studies met inclusion criteria. Twenty-one studies reported mean or median age, which was <60 years in 19 studies. Thirty-nine estimates of incidence rates from 24 studies were entered in the meta-analysis. The pooled incidence rate estimate of stroke and TIA was 0.58 per 100 person-years, with significant heterogeneity between studies (95% CI: 0.39-0.86; I2: 97.8%; P < 0.001). Secondary analyses were performed stratified by outcome subtype. The pooled incidence rate of ischemic stroke was estimated at 0.59 per 100 person-years (95% CI: 0.36-0.95; I2: 98%; P = 0.01). This meta-analysis describes the incidence rate of stroke and TIA in the ACHD population. High-quality studies are needed to identify which ACHD patients are at the highest risk and to develop effective strategies for primary stroke prevention in this population.

Background Congenital heart disease is associated with an increased risk of cerebrovascular events. Objectives The authors investigated the incidence of stroke and transient ischemic attack (TIA) in adults with congenital heart disease (ACHD). Methods A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all studies reporting the incidence of stroke and TIA in ACHD. Two independent reviewers screened studies, which were included if patients were of age 16 years or older with congenital heart disease and if the outcome was stroke or TIA. Random-effects meta-analysis was conducted to estimate the pooled incidence rate of stroke and TIA with 95% CIs. The Newcastle-Ottawa Scale for Risk of Bias was applied. This systematic review is registered (CRD42022322144). Results Of 11,028 identified abstracts, 27 studies met inclusion criteria. Twenty-one studies reported mean or median age, which was <60 years in 19 studies. Thirty-nine estimates of incidence rates from 24 studies were entered in the meta-analysis. The pooled incidence rate estimate of stroke and TIA was 0.58 per 100 person-years, with significant heterogeneity between studies (95% CI: 0.39-0.86; I2: 97.8%; P < 0.001). Secondary analyses were performed stratified by outcome subtype. The pooled incidence rate of ischemic stroke was estimated at 0.59 per 100 person-years (95% CI: 0.36-0.95; I2: 98%; P = 0.01). Conclusions This meta-analysis describes the incidence rate of stroke and TIA in the ACHD population. High-quality studies are needed to identify which ACHD patients are at the highest risk and to develop effective strategies for primary stroke prevention in this population.

Background and aims Calcific aortic valve disease is associated with increased thrombin formation, platelet activation, decreased fibrinolysis, and subclinical brain infarcts. We examined the long-term association of aortic valve calcification (AVC) with newly diagnosed dementia and incident stroke in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods AVC was measured using non-contrast cardiac CT at Visit 1. We examined AVC as a continuous (log-transformed) and categorical variable (0, 1-99, 100-299, >= 300). Newly diagnosed dementia was adjudicated using International Classification of Disease codes. Stroke was adjudicated from medical records. We calculated absolute event rates (per 1000 person-years) and multivariable adjusted Cox proportional hazards ratios (HR). Results Overall, 6812 participants had AVC quantified with a mean age of 62.1 years old, 52.9 % were women, and the median 10-year estimated atherosclerotic cardiovascular disease (ASCVD) risk was 13.5 %. Participants with AVC >0 were older and less likely to be women compared to those with AVC=0. Over a median 16-year follow-up, there were 535 cases of dementia and 376 cases of stroke. The absolute risk of newly diagnosed dementia increased in a stepwise pattern with higher AVC scores, and stroke increased in a logarithmic pattern. In multivariable analyses, AVC was significantly associated with newly diagnosed dementia as a log-transformed continuous variable (HR 1.09; 95 % CI 1.04-1.14) and persons with AVC >= 300 had nearly a two-fold higher risk (HR 1.77; 95 % CI 1.14-2.76) compared to those with AVC=0. AVC was associated with an increased risk of stroke after adjustment for age, sex, and race/ethnicity, but not after adjustment for ASCVD risk factors. Conclusions After multivariable adjustment, AVC >0 was significantly associated with an increased risk of newly diagnosed dementia, but not incident stroke. This suggests that AVC may be an important risk factor for the long-term risk of dementia beyond traditional ASCVD risk factors.

Introduction: Congenital cardiac lesions result in abnormal flow patterns that increase risk of cerebrovascular events. We investigated the incidence of stroke and transient ischemic attack (TIA) in adults with congenital heart disease (ACHD). Methods: A systematic review was performed per PRISMA guidelines to identify all studies reporting the incidence of stroke and TIA in ACHD. Two independent reviewers screened studies, which were included if patients were age 16 and older with congenital heart disease, and if the outcome was stroke or TIA. Random-effects meta-analysis was conducted to estimate the pooled incidence rate of stroke and TIA with 95% confidence intervals. The Newcastle-Ottawa Scale for risk of bias was applied. This systematic review is registered (CRD42022322144). Results: Of 11,028 identified abstracts, 27 studies met inclusion criteria. 22 studies reported mean or median age, which was less than 60 years in 18 studies. 39 estimates of incidence rates from 24 studies were entered in the meta-analysis. The pooled incidence rate estimate of stroke and TIA was 0.58 per 100 person years, with significant heterogeneity between studies (95% CI 0.39-0.86, I2 97.8%, p<0.001). Secondary analyses were performed stratified by CHD and outcome subtype. The pooled incidence rate of ischemic stroke was estimated at 0.59 per 100 person years (95% CI 0.36-0.95, I2 98%, p=0.01). Conclusions: This meta-analysis found that the incidence rate of stroke and TIA is higher in ACHD than age-adjusted global estimates, and similar to the American Heart Association reported global ischemic stroke incidence rate for individuals >60 years (0.52 per 100 person years).

Cognitive impairment is common among adults with heart failure (HF), as both diseases are strongly related to advancing age and multimorbidity (including both cardiovascular and noncardiovascular conditions). Moreover, HF itself can contribute to alterations in the brain. Cognition is critical for a myriad of self-care activities that are necessary to manage HF, and it also has a major impact on prognosis; consequently, cognitive impairment has important implications for self-care, medication management, function and independence, and life expectancy. Attuned clinicians caring for patients with HF can identify clinical clues present at medical encounters that suggest cognitive impairment. When present, screening tests such as the Mini-Cog, and consideration of referral for comprehensive neurocognitive testing may be indicated. Management of cognitive impairment should focus on treatment of underlying causes of and contributors to cognitive impairment, medication management/optimization, and accommodation of deficiencies in self-care. Given its implications on care, it is important to integrate cognitive impairment into clinical decision making. Although gaps in knowledge and challenges to implementation exist, this scientific statement is intended to guide clinicians in caring for and meeting the needs of an increasingly complex and growing subpopulation of patients with HF.

Introduction: Fontan surgery performed during childhood enhances the lifespan and quality of life of patients with critical congenital heart disease. Post-Fontan circulation may impact function in multiple organ systems, but its long term effects on the brain microvasculature are not well characterized. We investigated brain MRI markers of cerebral small vessel disease (SVD) after exposure to Fontan circulation. Methods: We reviewed medical records and MRI images of 34 adults followed in an academic medical center after Fontan surgery, who had brain MRI for any reason from 08/01/1995-03/01/2022. We characterized Fontan physiological stage (a standardized measure of disease severity) at time of MRI, and identified SVD markers, including deep silent brain infarcts, small perivascular spaces in the basal ganglia, microhemorrhages, and white matter hyperintensities. We calculated SVD scores using a standardized scale of 0-4, where scores of ≥2 indicate moderate to severe SVD. We created ordinal logistic regression models to test the association between physiological stage and SVD score. Results: Characteristics of the patients are summarized in the Table, and distribution of SVD scores in the Figure. Adjusting for age at MRI, there was no association between physiological stage of disease and higher SVD score. Conclusion: In our sample of 34 young adult patients with long term exposure to Fontan circulation, the majority had evidence of moderate to severe SVD, which was not predicted by physiological stage of disease at time of MRI. Exposure to Fontan circulation may be associated with early onset of cerebral SVD, suggesting increased long term risk of stroke and dementia.

The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation.

ObjectivesRace-ethnic disparities contribute to cardiovascular morbidity. Heart failure (HF) is highly prevalent in acute ischemic stroke (AIS) and associated with worse outcomes. We hypothesized race-ethnic differences exist in the prevalence of HF among patients with AIS, particularly in younger patients, and in a manner not fully explained by cardiovascular profiles.MethodsPatients with AIS in the National Inpatient Sample (2016-2019) were categorized as young (<50 years), middle (50-64) and older (≥65) age. Interaction between age and race-ethnicity on the presence of comorbid HF was examined, adjusting for vascular risk factors. Effect modification on in-hospital mortality and prolonged hospitalization across race-ethnic groups and age was also examined.ResultsOf 398,470 AIS patients, 16.2% had HF. HF patients were older (73.7 vs 69.5 years, P <0.001), had a lower proportion of White, Hispanic and Asian/PI individuals but a larger proportion of patients of Black race (21.0 vs 16.4%, P < 0.001). Race-ethnicity modified the relationship between HF and age (Pinteraction <0.001). Stroke patients of Black race had the greatest odds of having HF across all age groups, however differences between Black and White patients were most pronounced in young adults (OR: 2.08, 95% CI: 1.91-2.27) after adjusting for vascular risk factors. Among patients with HF, Black race was associated with reduced risk of in-hospital mortality but greater likelihood of prolonged hospitalization at middle and older age.ConclusionHF is highly prevalent in stroke patients of Black race, particularly in younger cohorts, and in a manner not fully explained by cardiovascular profiles.

Introduction: Adults with congenital heart disease (ACHD) are at risk for stroke, but risk factors within this population are not well characterized. Methods: We reviewed medical records of patients evaluated in an ACHD clinic from 8/1/1995- 3/1/2022 who underwent brain imaging for any reason. We categorized patients by anatomical complexity based on American Heart Association guidelines (simple, moderate or high complexity). The primary outcome was ischemic or hemorrhagic stroke. TIA and silent infarcts were excluded. We created logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (CI) for the association between anatomic complexity and stroke. Results: Out of 184 patients, 48 (26.1%) had any stroke (62% ischemic, 38% hemorrhagic). Median age at first stroke was 26.2 years (IQR 19.2-38.5) (Figure). Those with stroke had higher proportion of Black race, more major cardiac surgeries, and more use of antithrombotic medications prior to stroke (see Table). Adjusting for age, sex, race, number of cardiac surgeries, and use of antithrombotic medications, those with highly complex lesions had a trend towards higher odds of any stroke (adjusted OR 2.0, 95% CI 0.89 - 4.4). Effect size was higher for ischemic stroke (adjusted OR 2.6, 95% CI 0.99-6.7). Conclusion: In our sample of 184 ACHD patients who underwent brain imaging, stroke was common with half of strokes occurring before the age of 26 years. High complexity cardiac lesions were associated with more than double the odds of ischemic stroke. Larger studies are needed to develop effective stroke prevention strategies in this growing young adult population.

Background Peripartum cardiomyopathy (PPCM), a form of heart failure with reduced ejection fraction (HFrEF) that occurs during the final month of pregnancy through the first 5 months postpartum, is associated with heightened risk for maternal morbidity and mortality. Stroke is a common complication of HFrEF but there is limited data on the incidence of stroke in PPCM. Methods Using statewide, nonfederal administrative data from 2000 to 2015, we analyzed age-adjusted risk of stroke within 3 years after PPCM-associated pregnancies. Results PPCM was associated with a greater than 4-fold increased risk of pregnancy-related stroke (aHR 4.7, 95% CI: 3.0-7.5). This risk was highest at the time of PPCM diagnosis but remained elevated in the first postpartum year. Conclusion Our findings confirm the strong association between PPCM and stroke, with risk that persists throughout and after the peripartum period.

Neurological complications represent a major shortcoming of left ventricular assist device (LVAD) therapy, as they may confer significant long-term disability and increased mortality. This chapter reviews the pathophysiology, incidence, types, prevention, and management of neurological complications in patients on LVAD. Microemboli can lead to both ischemic and hemorrhagic events. LVAD patients with acute ischemic stroke or transient ischemic attack have a high prevalence of microembolic events on transcranial Doppler. Vascular imaging with computed tomography angiogram is generally recommended in the acute setting for LVAD patients with high clinical suspicion for stroke, regardless of stroke subtype. Hemorrhagic transformation, largely a radiographic diagnosis, results from bleeding within or around an area of infarcted brain parenchyma. Cerebral perfusion injury is manifested by watershed infarctions or generalized brain edema due to generalized hypoxic-ischemic injury. Neurologic events during LVAD support are associated with significant morbidity and mortality rates and can cause death by neurologic criteria.