{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T20:04:30Z","timestamp":1789589070648,"version":"build-2803163510"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Thromb Thrombolysis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The prognostic significance of dementia onset in patients with stroke\u2013heart syndrome (SHS) remains uncertain. We compared clinical outcomes between patients with pre-existing and new-onset dementia after ischemic stroke complicated by SHS. This retrospective cohort study used the TriNetX Global Collaborative Network, comprising de-identified electronic health records from more than 130 healthcare organizations between 2000 and 2024. Adults with ischemic stroke and subsequent SHS, defined as acute cardiac complications within 30 days after stroke, were identified and categorized as having pre-existing or new-onset dementia. Propensity score matching was used to balance demographics, comorbidities, and baseline treatments. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals. We identified 7,667 patients with pre-existing dementia and 22,375 with new-onset dementia. After matching, 7,667 pairs were analyzed. Compared with pre-existing dementia, new-onset dementia was associated with a higher 1-year risk of major adverse cardiovascular events (MACE; HR 1.13, 95% confidence interval 1.07\u20131.19). This excess risk was mainly reflected by recurrent stroke (HR 1.50, 95% CI 1.31\u20131.72) and heart failure (HR 1.34, 95% CI 1.23\u20131.47) among MACE components, while atrial fibrillation was also increased as a secondary outcome (HR 1.36, 95% CI 1.25\u20131.48). Findings were consistent at 2- and 3-year follow-up, among patients with first-ever stroke, and after further adjustment for NIHSS, thrombolysis, and post-stroke rehabilitation. Among patients with SHS, new-onset dementia was associated with higher cardiovascular risk than pre-existing dementia, supporting closer brain\u2013heart\u2013cognition monitoring after stroke.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical abstract<\/jats:bold>\n                  <\/jats:p>\n                  <jats:p>Dementia timing and 1-year cardiovascular outcomes after stroke\u2013heart syndrome. This retrospective TriNetX cohort study included 30,042 adults with ischemic stroke and stroke\u2013heart syndrome (SHS), classified as having new-onset or pre-existing dementia. After 1:1 propensity score matching (PSM), 7,667 pairs were followed from day 30 after stroke. Compared with pre-existing dementia, new-onset dementia was associated with higher 1-year risks of major adverse cardiovascular events (MACE), recurrent stroke, heart failure, and atrial fibrillation, highlighting a higher-risk brain\u2013heart\u2013cognition phenotype after SHS.<\/jats:p>","DOI":"10.1007\/s11239-026-03389-y","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:20:25Z","timestamp":1789586425000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stroke\u2013heart syndrome outcomes in pre-existing vs. new-onset dementia: a report from a global federated research network"],"prefix":"10.1007","author":[{"given":"Tianshu","family":"Gu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akash","family":"Mavilakandy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven H. M.","family":"Lam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Askarinejad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Proietti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang-Yin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"3389_CR1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","volume":"20","author":"VL Feigin","year":"2021","unstructured":"Feigin VL, Stark BA, Johnson CO et al (2021) Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 20:795\u2013820. https:\/\/doi.org\/10.1016\/S1474-4422(21)00252-0","journal-title":"Lancet Neurol"},{"key":"3389_CR2","doi-asserted-by":"publisher","unstructured":"Tsao CW, Aday AW, Almarzooq ZI et al (2023) Heart Disease and Stroke Statistics\u20142023 Update: A Report From the American Heart Association. Circulation 147. https:\/\/doi.org\/10.1161\/CIR.0000000000001123","DOI":"10.1161\/CIR.0000000000001123"},{"key":"3389_CR3","doi-asserted-by":"publisher","first-page":"61","DOI":"10.4103\/bc.bc_70_22","volume":"9","author":"N Yang","year":"2023","unstructured":"Yang N, Lee H, Wu C (2023) Intravenous thrombolysis for acute ischemic stroke: From alteplase to tenecteplase. Brain Circulation 9:61\u201363. https:\/\/doi.org\/10.4103\/bc.bc_70_22","journal-title":"Brain Circulation"},{"key":"3389_CR4","doi-asserted-by":"publisher","first-page":"1759","DOI":"10.1161\/STROKEAHA.121.037316","volume":"53","author":"BJR Buckley","year":"2022","unstructured":"Buckley BJR, Harrison SL, Hill A et al (2022) Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke. Stroke 53:1759\u20131763. https:\/\/doi.org\/10.1161\/STROKEAHA.121.037316","journal-title":"Stroke"},{"key":"3389_CR5","doi-asserted-by":"publisher","unstructured":"Scheitz JF, Sposato LA, Schulz-Menger J et al (2022) Stroke\u2013Heart Syndrome: Recent Advances and Challenges. https:\/\/doi.org\/10.1161\/JAHA.122.026528. JAHA 11:","DOI":"10.1161\/JAHA.122.026528"},{"key":"3389_CR6","doi-asserted-by":"publisher","first-page":"2768","DOI":"10.1016\/j.jacc.2020.10.009","volume":"76","author":"LA Sposato","year":"2020","unstructured":"Sposato LA, Hilz MJ, Aspberg S et al (2020) Post-Stroke Cardiovascular Complications and Neurogenic Cardiac Injury. J Am Coll Cardiol 76:2768\u20132785. https:\/\/doi.org\/10.1016\/j.jacc.2020.10.009","journal-title":"J Am Coll Cardiol"},{"key":"3389_CR7","doi-asserted-by":"publisher","first-page":"e23","DOI":"10.1093\/eurjpc\/zwad211","volume":"31","author":"BJR Buckley","year":"2024","unstructured":"Buckley BJR, Harrison SL, Lane DA et al (2024) Stroke\u2013heart syndrome: mechanisms, risk factors, and adverse cardiovascular events. Eur J Prev Cardiol 31:e23\u2013e26. https:\/\/doi.org\/10.1093\/eurjpc\/zwad211","journal-title":"Eur J Prev Cardiol"},{"key":"3389_CR8","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.1161\/STROKEAHA.111.680728","volume":"44","author":"PM Rist","year":"2013","unstructured":"Rist PM, Chalmers J, Arima H et al (2013) Baseline Cognitive Function, Recurrent Stroke, and Risk of Dementia in Patients With Stroke. Stroke 44:1790\u20131795. https:\/\/doi.org\/10.1161\/STROKEAHA.111.680728","journal-title":"Stroke"},{"key":"3389_CR9","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1177\/23969873241293573","volume":"10","author":"T Bucci","year":"2025","unstructured":"Bucci T, Choi SE, Tsang CT et al (2025) Incident dementia in ischaemic stroke patients with early cardiac complications: A propensity-score matched cohort study. Eur Stroke J 10:541\u2013551. https:\/\/doi.org\/10.1177\/23969873241293573","journal-title":"Eur Stroke J"},{"key":"3389_CR10","doi-asserted-by":"publisher","first-page":"e105","DOI":"10.1016\/S2468-2667(21)00249-8","volume":"7","author":"E Nichols","year":"2022","unstructured":"Nichols E, Steinmetz JD, Vollset SE et al (2022) Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health 7:e105\u2013e125. https:\/\/doi.org\/10.1016\/S2468-2667(21)00249-8","journal-title":"Lancet Public Health"},{"key":"3389_CR11","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.1161\/STROKEAHA.119.028845","volume":"51","author":"Y B\u00e9jot","year":"2020","unstructured":"B\u00e9jot Y, Duloquin G, Crespy V et al (2020) Influence of Preexisting Cognitive Impairment on Clinical Severity of Ischemic Stroke. Stroke 51:1667\u20131673. https:\/\/doi.org\/10.1161\/STROKEAHA.119.028845","journal-title":"Stroke"},{"key":"3389_CR12","doi-asserted-by":"publisher","unstructured":"El Husseini N, Katzan IL, Rost NS et al (2023) Cognitive Impairment After Ischemic and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association\/American Stroke Association. Stroke 54. https:\/\/doi.org\/10.1161\/STR.0000000000000430","DOI":"10.1161\/STR.0000000000000430"},{"key":"3389_CR13","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.ijge.2017.07.004","volume":"11","author":"G-C Hu","year":"2017","unstructured":"Hu G-C, Chen Y-M (2017) Post-stroke Dementia: Epidemiology, Mechanisms and Management. Int J Gerontol 11:210\u2013214. https:\/\/doi.org\/10.1016\/j.ijge.2017.07.004","journal-title":"Int J Gerontol"},{"key":"3389_CR14","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1161\/CIRCRESAHA.122.319951","volume":"130","author":"NS Rost","year":"2022","unstructured":"Rost NS, Brodtmann A, Pase MP et al (2022) Post-Stroke Cognitive Impairment and Dementia. Circ Res 130:1252\u20131271. https:\/\/doi.org\/10.1161\/CIRCRESAHA.122.319951","journal-title":"Circ Res"},{"key":"3389_CR15","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1136\/jnnp.2008.166603","volume":"80","author":"S Melkas","year":"2009","unstructured":"Melkas S, Oksala NKJ, Jokinen H et al (2009) Poststroke dementia predicts poor survival in long-term follow-up: influence of prestroke cognitive decline and previous stroke. J Neurol Neurosurg Psychiatry 80:865\u2013870. https:\/\/doi.org\/10.1136\/jnnp.2008.166603","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"3389_CR16","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1016\/S1474-4422(09)70236-4","volume":"8","author":"ST Pendlebury","year":"2009","unstructured":"Pendlebury ST, Rothwell PM, Pendlebury ST, Rothwell PM (2009) Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol 8:1006\u20131018. https:\/\/doi.org\/10.1016\/S1474-4422(09)70236-4","journal-title":"Lancet Neurol"},{"key":"3389_CR17","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1007\/s10072-023-07129-5","volume":"45","author":"J Dro\u015b","year":"2024","unstructured":"Dro\u015b J, Segiet N, Pocz\u0105tek G et al (2024) Five-year stroke prognosis. Influence of post-stroke delirium and post-stroke dementia on mortality and disability (Research Study \u2013 Part of the PROPOLIS Study). Neurol Sci 45:1109\u20131119. https:\/\/doi.org\/10.1007\/s10072-023-07129-5","journal-title":"Neurol Sci"},{"key":"3389_CR18","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1159\/000497614","volume":"54","author":"M Graber","year":"2020","unstructured":"Graber M, Garnier L, Mohr S et al (2020) Influence of Pre-Existing Mild Cognitive Impairment and Dementia on Post-Stroke Mortality. Dijon Stroke Registry Neuroepidemiology 54:490\u2013497. https:\/\/doi.org\/10.1159\/000497614","journal-title":"Dijon Stroke Registry Neuroepidemiology"},{"key":"3389_CR19","doi-asserted-by":"publisher","unstructured":"Tsang CTW, Choi SE, Bucci T et al (2025) Stroke\u2013heart syndrome and risk of incident dementia among patients with first-ever ischemic stroke: A territory\u2010wide population\u2010based cohort study. Alzheimers Dement 21. https:\/\/doi.org\/10.1002\/alz.70716","DOI":"10.1002\/alz.70716"},{"key":"3389_CR20","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1016\/j.jstrokecerebrovasdis.2011.11.005","volume":"22","author":"KM Busl","year":"2013","unstructured":"Busl KM, Nogueira RG, Yoo AJ et al (2013) Prestroke Dementia is Associated With Poor Outcomes After Reperfusion Therapy Among Elderly Stroke Patients. J Stroke Cerebrovasc Dis 22:718\u2013724. https:\/\/doi.org\/10.1016\/j.jstrokecerebrovasdis.2011.11.005","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"3389_CR21","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1007\/s00415-004-0385-4","volume":"251","author":"WK Tang","year":"2004","unstructured":"Tang WK, Chan SSM, Chiu HFK et al (2004) Frequency and determinants of prestroke dementia in a Chinese cohort. J Neurol 251:604\u2013608. https:\/\/doi.org\/10.1007\/s00415-004-0385-4","journal-title":"J Neurol"},{"key":"3389_CR22","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1136\/jnnp-2020-325796","volume":"93","author":"L Craig","year":"2022","unstructured":"Craig L, Hoo ZL, Yan TZ et al (2022) Prevalence of dementia in ischaemic or mixed stroke populations: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 93:180\u2013187. https:\/\/doi.org\/10.1136\/jnnp-2020-325796","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"3389_CR23","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1177\/23969873241264115","volume":"10","author":"KL Hoad","year":"2025","unstructured":"Hoad KL, Jones H, Miller G et al (2025) Stroke-heart syndrome: Incidence and clinical outcomes of cardiac complications following intracerebral haemorrhage. Eur Stroke J 10:100\u2013107. https:\/\/doi.org\/10.1177\/23969873241264115","journal-title":"Eur Stroke J"},{"key":"3389_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/4356386","volume":"2020","author":"K Song","year":"2020","unstructured":"Song K, Li Y, Zhang H et al (2020) Oxidative Stress-Mediated Blood-Brain Barrier (BBB) Disruption in Neurological Diseases. Oxid Med Cell Longev 2020:1\u201327. https:\/\/doi.org\/10.1155\/2020\/4356386","journal-title":"Oxid Med Cell Longev"},{"key":"3389_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12987-024-00563-3","volume":"21","author":"J Che","year":"2024","unstructured":"Che J, Sun Y, Deng Y, Zhang J (2024) Blood-brain barrier disruption: a culprit of cognitive decline? Fluids Barriers CNS 21:1\u201337. https:\/\/doi.org\/10.1186\/s12987-024-00563-3","journal-title":"Fluids Barriers CNS"},{"key":"3389_CR26","doi-asserted-by":"publisher","first-page":"1462","DOI":"10.3390\/antiox13121462","volume":"13","author":"S Kim","year":"2024","unstructured":"Kim S, Jung UJ, Kim SR (2024) Role of Oxidative Stress in Blood\u2013Brain Barrier Disruption and Neurodegenerative Diseases. Antioxidants 13:1462. https:\/\/doi.org\/10.3390\/antiox13121462","journal-title":"Antioxidants"},{"key":"3389_CR27","doi-asserted-by":"publisher","first-page":"101428","DOI":"10.1016\/j.lanepe.2025.101428","volume":"56","author":"J Filler","year":"2025","unstructured":"Filler J, Georgakis MK, Janowitz D et al (2025) Risk factors for dementia and cognitive impairment within 5 years after stroke: a prospective multicentre cohort study. Lancet Reg Health - Europe 56:101428. https:\/\/doi.org\/10.1016\/j.lanepe.2025.101428","journal-title":"Lancet Reg Health - Europe"},{"key":"3389_CR28","doi-asserted-by":"publisher","first-page":"4813","DOI":"10.1007\/s00415-024-12480-4","volume":"271","author":"L Wang","year":"2024","unstructured":"Wang L, Ma L, Ren C et al (2024) Stroke\u2013heart syndrome: current progress and future outlook. J Neurol 271:4813\u20134825. https:\/\/doi.org\/10.1007\/s00415-024-12480-4","journal-title":"J Neurol"},{"key":"3389_CR29","doi-asserted-by":"publisher","unstructured":"Ding L, Mane R, Wu Z et al (2022) Advances in brain-heart syndrome: Attention to cardiac complications after ischemic stroke. Front Mol Neurosci 15. https:\/\/doi.org\/10.3389\/fnmol.2022.1053478","DOI":"10.3389\/fnmol.2022.1053478"},{"key":"3389_CR30","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1016\/j.cardfail.2017.04.007","volume":"23","author":"JA Cannon","year":"2017","unstructured":"Cannon JA, Moffitt P, Perez-Moreno AC et al (2017) Cognitive Impairment and Heart Failure: Systematic Review and Meta-Analysis. J Card Fail 23:464\u2013475. https:\/\/doi.org\/10.1016\/j.cardfail.2017.04.007","journal-title":"J Card Fail"},{"key":"3389_CR31","doi-asserted-by":"publisher","first-page":"1913","DOI":"10.1161\/CIRCULATIONAHA.124.070553","volume":"150","author":"L Shen","year":"2024","unstructured":"Shen L, Dewan P, Ferreira JP et al (2024) Clinical Correlates and Prognostic Impact of Cognitive Dysfunction in Patients With Heart Failure and Preserved Ejection Fraction: Insights From PARAGON-HF. Circulation 150:1913\u20131927. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.124.070553","journal-title":"Circulation"},{"key":"3389_CR32","doi-asserted-by":"publisher","first-page":"3883","DOI":"10.1111\/ene.15068","volume":"28","author":"TJ Quinn","year":"2021","unstructured":"Quinn TJ, Richard E, Teuschl Y et al (2021) European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment. Eur J Neurol 28:3883\u20133920. https:\/\/doi.org\/10.1111\/ene.15068","journal-title":"Eur J Neurol"},{"key":"3389_CR33","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1159\/000289344","volume":"29","author":"A Jaillard","year":"2010","unstructured":"Jaillard A, Grand S, Le Bas JF, Hommel M (2010) Predicting Cognitive Dysfunctioning in Nondemented Patients Early after Stroke. Cerebrovasc Dis 29:415\u2013423. https:\/\/doi.org\/10.1159\/000289344","journal-title":"Cerebrovasc Dis"},{"key":"3389_CR34","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1001\/jama.2015.6968","volume":"314","author":"DA Levine","year":"2015","unstructured":"Levine DA, Galecki AT, Langa KM et al (2015) Trajectory of Cognitive Decline After Incident Stroke. JAMA 314:41. https:\/\/doi.org\/10.1001\/jama.2015.6968","journal-title":"JAMA"},{"key":"3389_CR35","doi-asserted-by":"publisher","unstructured":"Regan EW, Handlery R, Stewart JC et al (2021) Integrating Survivors of Stroke Into Exercise-Based Cardiac Rehabilitation Improves Endurance and Functional Strength. . JAHA 10 https:\/\/doi.org\/10.1161\/JAHA.120.017907","DOI":"10.1161\/JAHA.120.017907"}],"container-title":["Journal of Thrombosis and Thrombolysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11239-026-03389-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11239-026-03389-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11239-026-03389-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:20:26Z","timestamp":1789586426000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11239-026-03389-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":35,"alternative-id":["3389"],"URL":"https:\/\/doi.org\/10.1007\/s11239-026-03389-y","relation":{},"ISSN":["1573-742X"],"issn-type":[{"value":"1573-742X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"assertion":[{"value":"27 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"GYHL reports institutional consultancy and\/or speaker roles for BMS\/Pfizer, Boehringer Ingelheim, Anthos, Huawei (No fees are received personally). He is co-PI of the AFFIRMO project on multimorbidity in AF (grant agreement No 899871), TARGET project on digital twins for personalised management of atrial fibrillation and stroke (grant agreement No 101136244) and ARISTOTELES project on artificial intelligence for management of chronic long term conditions (grant agreement No 101080189), which are all funded by the EU\u2019s Horizon Europe Research & Innovation programme. Others: None declared.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This retrospective analysis used only de-identified data from the TriNetX Collaborative Network. Because no identifiable private information was accessed, this work did not constitute human subjects research and institutional review board approval and informed consent were not required.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}]}}