bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 155: Prevalence and Clinical Correlates of Left Ventricular Hypertrophy by Sokolow-Lyon and Cornell Electrocardiogram Voltage Criteria in Transcatheter Aortic Valve Replacement Patients
Authors: Xiao Emily , Delago Augustin , El-Hajjar Mohammad , Bulibek Batyrjan , Torosoff Mikhail
Published: June 2021

Background and Hypothesis:
The sensitivity of LVH analysis by ECG voltage criteria in patients with severe aortic valve stenosis undergoing trans-catheter aortic valve replacement (TAVR) has not yet been studied. LVH is expected in the TAVR population and would be reflected in voltage criteria by ECG.

Methods:
A retrospective chart review was conducted in 176 consecutive TAVR patients without ventricular-paced rhythm. ECG data was collected and analyzed by Sokolow-Lyon and Cornell Voltage criteria. Results were compared to transthoracic echocardiogram. Analyses of variation, correlation, chi-square, and logistic regression were used. The study was approved by the institutional IRB.

Results:
Sokolow-Lyon and Cornell Voltage criteria for LVH were present and concordant in 19% (33 of 176) of patients; in 49% (86 of 176) of patients, neither criteria was suggestive for LVH. Only 19% (34 of 176) of patients had LVH by Cornell Voltage and 13% (23 of 176) by Sokolow-Lyon criteria, indicative of poor concordance between these two commonly used ECG criteria for LVH (p<0.0001).

Ejection fraction, aortic valve gradient, aortic valve area, COPD, PVD, prior stroke, dyslipidemia, and hypertension did not affect the prevalence of LVH by either or both criteria.

Women (p<0.01) and patients with rhythm other than atrial fibrillation (p<0.0053) were more likely to have voltage criteria for LVH, while older adults were more likely to meet criteria for LVH. Concordant LVH criteria were noted in patients 84.6 +/- 7.2 years of age, while patients without LVH by ECG voltage criteria were significantly younger at 80.21 +/- 8.1 years of age (p<0.007).

Conclusion:
The presence of LVH by Sokolow-Lyon and Cornell ECG voltage criteria poorly correlates with the presence of LVH and critical aortic stenosis in TAVR patients. Women are more likely to have voltage criteria for LVH. Therefore, ECG may not be a suitable method of screening patients with severe aortic stenosis for LVH, especially in men.
Abstract 159: Evaluation of Clinical Outcomes among Nonvalvular Atrial Fibrillation Patients Treated With Warfarin or Rivaroxaban Stratified by Presence or Absence of CKD in a Claims Database
Authors: Weir Matthew R , Haskell Lloyd , Berger Jeffrey S , Ashton Veronica , Laliberté François , Crivera Concetta , Brown Kip , Lefebvre Patrick , Schein Jeffrey
Published: June 2021

Introduction:
Renal functional impairment is linked to an increased risk of thromboembolic and bleeding events in patients with nonvalvular atrial fibrillation (NVAF) treated with warfarin and rivaroxaban. Anticoagulants such as warfarin and rivaroxaban are often recommended to reduce the risk of stroke in NVAF patients. The purpose of this study was to evaluate and compare thromboembolic and bleeding event rates for warfarin and rivaroxaban patients stratified by presence of chronic kidney disease (CKD).

Methods:
Claims from the IMS Health Real-World Data Adjudicated Claims database from 05/2011-6/2015 were analyzed. Adult patients with NVAF who had ≥6 months of baseline data prior to the first dispensing of warfarin or rivaroxaban after 11/2011 were included. Patients were followed until the end of index therapy or end of data availability/insurance coverage. Outcomes were stratified by presence of CKD for ischemic stroke, major bleeding, and a composite measure of thromboembolic events (ischemic stroke, myocardial infarction (MI) or venous thromboembolism (VTE)) and analyzed using hazard ratios (HRs). Adjustments for confounding were made with inverse probability of treatment weights (IPTW).

Results:
The analysis included 39,872 rivaroxaban (9.0% [3,572 of 39,872] with CKD) and 48,637 warfarin patients (16.9% [8,230 of 48,637] with CKD). As expected, thromboembolic and bleeding events were more common in patients with CKD than those without CKD. Rivaroxaban patients had significantly lower risk of ischemic stroke, both in the overall population (HR = 0.79 [0.68-0.90], p=0.0008) and for those with CKD (HR = 0.55 [0.40-0.77], p=0.0004). A composite of thromboembolic events were lower with rivaroxaban irrespective of CKD. Major bleeding rates were comparable across all groups.
Table 1
reports incidence rates and HRs stratified by presence of CKD.

Conclusions:
This study suggests that, in an adult population with NVAF, rivaroxaban-treated patients had fewer ischemic strokes across all patients, including patients with renal impairment. Rivaroxaban-treated patients also had significantly better outcomes for the composite (VTE, MI, or stroke) measure across all groups. Bleeding rates were comparable across all groups.
Abstract 160: Impact of Medication Adherence on Risk of Stroke, Major Bleeding and Other Outcomes in Atrial Fibrillation Patients Using Novel Oral Anticoagulants (Dabigatran and Rivaroxaban)
Authors: Deshpande Chinmay G , Willey Temkin Cynthia , Laforge Robert , Kogut Stephen
Published: June 2021

Introduction:
Dabigatran and Rivaroxaban have shown better or similar efficacy to lower stroke risk compared to warfarin in clinical trials. Evidence suggests adherence to cardiac drugs tend to reduce outcomes and cost. Our study is the first to examine the impact of atleast 6 to 12 month adherence to NOACs on ischemic stroke, major bleeding, Deep Vein Thrombosis and Pulmonary Embolism (DVTPE) risk in a propensity score based matched sample.

Methods:
A retrospective cohort study utilized de-identified data from Optum® Clinformatics™ Data Mart database (OptumInsight, Eden Prairie, MN) (Jan 1, 2010 and Dec 31, 2012). Adult patients with ≥ 1 diagnosis of atrial fibrillation or flutter (ICD9 427.31/32), >1 prescription of NOACs, 6 months pre-index continuous enrollment and CHA2DS2VASC score >1 were included. Adherence was calculated using Proportion of Days Covered (PDC ≥80%) for atleast 6 and 12 months of NOAC use and cohorts (adherent vs. non adherent) were matched on propensity score using Inverse Probability Treatment Weighting (IPTW) controlling for demographic and clinical characteristics at baseline. The risk of ischemic stroke, major bleeding (primary outcomes) and DVTPE (exploratory outcome) was evaluated for the matched cohorts post adherence assessment using Cox regression.

Results:
Out of 25,150 NOAC patients, a total of 3,629 and 1,946 patients with atleast 6 and 12 months of NOAC use were included. Across 2 cohorts, the mean age of the sample was 65 years, 65% were males and >60% had a moderate-high risk of stroke (CHA2DS2VASC>2). Adherence (PDC ≥80%) was 77% and 76% for patients with 6 and 12 month drug use. Post 12 months of drug use, the overall incidence of bleeding, stroke, and DVTPE in the follow-up period was 4.42%, 1.80%, and 0.82% respectively. Each outcome was analyzed separately to avoid calculation of competing risks. Using Cox models with IPTW balanced cohorts, non-adherence was significantly (p ≤0.05) associated with an increase in stroke (≥ 1.5 fold) and DVTPE (≥ 2 fold) risk in both 6 and 12 month users. The risk of bleeding was not significantly different across adherent vs. non adherent users (Table).

Conclusion:
In our sample, adherence to NOACs was associated with a reduction in stroke and DVTPE risk but did not substantially increase bleeding risk. Further studies with newer NOACs are warranted.
Abstract 162: Evolution of Acute Coronary Syndrome Treatment During Last Years in Russian Hospitals (Based on Results of RECORDs Registries)
Authors: Erlikh Alexey D
Published: June 2021

Background and Purpose:
The prospective registries are the most powerful evaluation tool to characterize patients and features of acute coronary syndrome (ACS) treatment. There have been a lot of changes in ACS treatment in Russian hospitals in recent 5-7 years. The aim of our study was to evaluate changes in the ACS treatment occurred in Russia during the last few years.

Methods:
We conducted the series of independent registries of ACS which were organized by the initiative of their participants - RECORD registries. The first regi stry was held in 2007 (18 centers in 13 cities, n=796). The RECORD-2 registry was conducted in 2009-2011 (7 centers in 7 cities, n=1656). In this analysis pooled data of the RECORD and RECORD-2 (“old” registries; n=2452) were compared with data of the RECORD-3 (“new” registry), conducted in March-April 2015 (47 centers in 37 cities, n=2370).

Results:
In comparison with “old” registries significantly more patients from “new” registry were hospitalized in PCI-capability hospitals (72.5% vs 56.7%; p<0.0001). The rate of troponin detection was also higher in “new” registry (75.7% vs 41.5%; p<0.0001). The rate of primary PCI (pPCI) in ST-elevation myocardial infarction (STEMI ) was 39.0% in “new” and 36.3% in “old” registry (p=0.24). The rate of pPCI in PCI-capability centers wasn’t also significantly higher in “new” registry (47.2% vs 45.8%). The rate of fibrinolysis in STEMI was nearly similar (32.1% vs 32.2%; p=0.98), but the rate of prehospital fibrinolysis and the rate of PCI after fibrinolysis became more frequent in “new” registry (50.9% vs 23.5%; p<0.0001 and 52.4% vs 25.0%; p<0.0001 respectively). In patients with non-ST elevation ACS (NSTEACS) the rate of diagnostic coronarography (CAG) and the rate of PCI within 72 hours after admission weren’t significantly different in “new” and “old” registries (68.2% vs 71.8%; p=0.15 and 26.6% vs 23.6%; p=0.19 respectively). Among discharge medication from “old” to “new” registries decreasing of aspirin and beta-blockers prescription (89.7% and 91.3%; p=0.009 and 86.0% vs 90.2%; p<0.0001 respectively) and increasing of dual antiplatelet therapy and statin prescription (82.6% vs 43.7%; p<0.0001 and 90.9% vs 78.1%; p<0.0001 respectively) were obtained.The duration of in-hospital stay in “new” registry was shorter than in “old” registries (10,2 vs 13.4 days; p<0.0001), the proportion of patients transferred in non-PCI-capability centers to CAG was higher (16.3% vs 2.2%; p<0.0001) and the rate of in-hospital death was lower (5.1% vs 6.6%; p=0.041).

Conclusion:
A series of prospective independent registries RECORDs showed that in recent years some progress towards better adherence to the guidelines has been made in the treatment of ACS in Russian hospitals participating in those registries. However, there wasn’t a clear increase in the rate of pPCI and fibrinolysis in STEMI and the rate of invasive strategy in NSTEACS.
Abstract 172: Ticagrelor Use in Acute Coronary Syndrome: A Real-World Experience
Authors: Gabriel Paolo P , Sledge Tyler , Sorensen Teshia , Cornachione Kristen , Morshedzadeh Jack , Owan Theophilus , Shah Rashmee U
Published: June 2021

Background:
Ticagrelor improves survival in patients with acute coronary syndromes (ACS) compared to clopidogrel. Patients are often urgently loaded with P2Y12 inhibitors in the setting of ACS, with little time to consider barriers for continuation in the outpatient setting. We sought to evaluate the association between socioeconomic factors (type of insurance, medication co-payment) and patient choice to switch from ticagrelor to clopidogrel prior to hospital discharge.

Methods:
Our medical center implemented a standardized protocol to load ACS patients with ticagrelor in 2015. During the hospitalization, pharmacists specialized in cardiovascular treatment reviewed the out-of-pocket costs with the patient and assessed their willingness to continue ticagrelor in the outpatient setting. Based on patient choice, some patients were re-loaded with clopidogrel prior to discharge. Using the ACTION Registry-GWTG, we identified all ACS patients who were loaded with ticagrelor since the start of the protocol. We examined the association between switching and socioeconomic factors using chi-squared and rank sum tests.

Results:
We identified a total of 162 ACS patients who were loaded with ticagrelor prior to percutaneous coronary intervention (PCI). Of these patients, 84 (51.9%) were discharged on clopidogrel. Patients who switched to clopidogrel prior to discharge were more likely to have federal outpatient or no prescription insurance (p<0.01), and were more likely to be non-white race (p=0.05; Table). Co-payment data were available for 70.4% of the 162 ticagrelor-loaded patients. For patients who were discharged on ticagrelor, the median monthly co-payment for continuing the drug in the outpatient setting was $18.00 (interquartile range, 18 to 45). The median monthly co-payment for patients who were not discharged on ticagrelor was $253.77 (IQR, 45 to 350; p<0.01).

Conclusion:
Co-payment, race, and prescription insurance are associated with patient choice to switch from ticagrelor to clopidogrel in the ACS setting. This finding implies that socioeconomic factors, namely drug cost, are barriers to implementation of standardized ticagrelor use in ACS patients. While clinical trials suggest a mortality benefit with ticagrelor, real-world practice may not realize this benefit.
Abstract 188: Hospital and Regional Variation in Use of High-intensity Statins Following Myocardial Infarction Among Medicare Beneficiaries
Authors: Levitan Emily B , Muntner Paul , Dai Yu Ling , Woodward Mark , Mefford Matthew , Colantonio Lisandro D , Rosenson Robert S , Monda Keri L , Bittner Vera , Kilgore Meredith L
Published: June 2021

Background:
American College of Cardiology/American Heart Association guidelines published in 2013 recommend high-intensity statins (atorvastatin 40 or 80 mg or rosuvastatin 20 or 40 mg) for most adults ≤75 years of age with atherosclerotic cardiovascular disease (ASCVD). For adults >75 years of age with ASCVD, the guidelines recommend continuation of tolerated statins or initiation of moderate intensity statins for most patients.

Objective:
To examine whether guideline concordant use of high-intensity statins following myocardial infarction (MI) among Medicare beneficiaries differed by hospital size, medical school affiliation, and region of the US in 2014 (after publication of the guidelines).

Methods:
We identified 28,086 Medicare beneficiaries with fee-for-service and pharmacy coverage who filled a statin within 30 days following hospital discharge for MI in 2014. The analyses were restricted to 731 hospitals with at least 20 beneficiaries discharged for MI in 2014. Hospital size and medical school affiliation were determined from the American Hospital Association survey. In subgroups ≤75 and >75 years of age, we calculated the proportion of beneficiaries whose first statin fill after MI was a high-intensity statin by hospital, hospital size, medical school affiliation, and region.

Results:
Among statin users ≤75 years of age, 10,696 (55%) beneficiaries filled a prescription for a high-intensity statin following MI. The percentage filling high-intensity statins range from 0-100% (25
th
percentile 39%, 75
th
percentile 69%) across hospitals. High-intensity statin use was more common following hospitalization at larger hospitals, hospitals with medical school affiliations, and those in New England (
Figure
). A lower percentage of Medicare beneficiaries >75 years of age filled high-intensity statins (n = 8,441, 44%), but patterns were similar across hospital characteristics and region.

Conclusions:
Similar patterns of high-intensity statin use were present among individuals ≤75 years of age, in whom high-intensity statin use is guideline concordant, and individuals >75 years of age, in whom high-intensity statin use is not necessarily guideline concordant, suggesting that variation in high-intensity statin prescriptions may not be directly related to close adherence to guidelines.
Abstract 193: Observation on Repeatability of Grading by Casual Blood Pressure in Hypertensives & New Proposal
Authors: Liu Yong
Published: June 2021

Background:
In practice there is no definite clinical value of grading by casual blood pressure(CBP) and it is need to put forward new Suggestions.

Methods:
According to the method of three grades by CBP, blood pressure of 270 hypertensives without treatment were graded by three patterns: 4 times of CBP per day(pattern A), 2 times of CBP that not on the same day(pattern B) and 4 times from randomized daily ambulatory blood pressure(pattern C), and then repeatability were compared.

Results:
(1), In pattern A: BP gradings on the same level in total of 4 times of CBP were 18.50% (50/270 cases), BP gradings between two levels were 38.20% (103/270 cases), BP gradings between three levels were 43.30% (117/270 cases), total of BP gradings between two to three levels were 81.50% (220/270 cases); (2), In pattern B: BP gradings were respectively 25.19% (68/270 cases), 41.48% (112/270 cases), 33.33% (90/270 cases), 74.81% (202/270 cases); (3), In pattern C: BP gradings were respectively 23.70% (64/270 cases), 38.89% (105/270 cases), 37.41% (101/270 cases), 76.30% (206/270 cases).

Conclusion:
The repeatability of blood pressure gradings judgment are very poor all of above three patterns, and were no clinical value. New recommendations are: (1) It is necessary to classified into stages by target organ damage in hypertensives without ABPM, and not necessary to do grading of CBP; The stages include the phase of pure high blood pressure, the phase of high blood pressure with compensatory target organ damage, the phase of high blood pressure with decompensated target-organ damage; (2) It is necessary not only to classified into stages by target organ damage in hypertensives with ABPM but also necessary to do grading by average ambulatory blood pressure in daytime and nighttime respectively.

Key words:
hypertension; casual blood pressure; Ambulatory blood pressure; grading; Stage; proposals.
Abstract 209: Does a Level Playing Field Reduce Disparities in Quality of Care For Hispanics and Women With Acute Myocardial Infarction?
Authors: Romero Tomás , Greenwood Kristina , Glaser Dale
Published: June 2021

Background:
Acute Myocardial Infarction (AMI) care and outcomes disparities have been reported worldwide in women and racial-ethnic minorities. In the U.S., some have attributed disparities in Hispanics and other minorities to lower quality of services at hospitals where they seek care. Current information from hospitals with large Hispanic representation and equitable updated resources is needed.

Methods:
Retrospective observational study of 839 AMI patients discharged in 2013 from three Southern California Community Hospitals (A, B, C) with tertiary cardiac care level. Non-Hispanic Whites (NHW) and Hispanics (H) were the larger racial-ethnic groups (68.3%). Mortality, 30 day readmissions, medication/performance measures (PRx); Aspirin, Statins/anti-lipids, Beta-blockers, Angiotensin Converting Enzyme Inhibitors and Receptor Blockers for Left Ventricular Systolic dysfunction, <90 minute door-balloon time, and coronary percutaneous interventions and revascularization procedures were compared between Hospitals, NHW and H, and gender using Chi-squared tests (χ
2
), Odds Ratios (OR) with 95% confidence intervals (CI), and Z tests for proportions -independent groups.

Results:
No significant differences in hospital, 30 day mortality, or PRx were observed between hospitals, NHW and H. Hospital C had 47.3% Hispanics, Hospitals A+B 14.6% (η
2
=.430, p<0.001). AMI performance measures exceeded 2013 national rates across all facilities. NHW had more private insurance (52.5% vs. 25.4%, OR 3.24, 95% CI 2.19-4.80, p<.001) than Hispanics. Women had similar PRx, mortality, and readmissions, yet less CABG (6.7% vs. 14.1%, OR 0.38, 95% CI 0.21-0.67, p = .001) and Non-STEMI PCI procedures than men (39.1% vs. 51.2%, z = 2.65, p = 0.008) after full data adjustment.

Conclusions:
Equitable standards of care offset previously reported disparities in AMI management in Hispanics but not in women’s coronary revascularization procedures.
Abstract 216: Effectiveness of Telehealth on Hypertension Management Among Disparate Populations: a Systematic Review
Authors: Chowdhury Farah M , Ayala CDR Carma , Dalmat Deborah , Shantharam Sharada , Chang Tiffany , Russell Zachary , Zhang Xuanping
Published: June 2021

Introduction:
Telehealth (TH) uses telecommunication technology (e.g. internet, telephone, mobile or smart phone) as a cost-effective way to provide healthcare delivery for hypertension (HTN) control. However, effectiveness of TH on HTN control among disparate populations is unclear.

Methods:
We conducted a systematic review using the Cochrane methods to assess effectiveness of TH for HTN control in disparate people diagnosed with HTN. Participants were considered disparate based on Healthy People 2020 definitions. Outcomes included: 1) HTN control; 2) blood pressure change; 3) medication adherence; and 4) utilization of care. Multiple databases were searched for published articles from 2000-July 2016 without restrictions on study design, language, location, or outcomes. The search garnered 1766 titles. Following screening, 18 primary studies were included that noted at least one outcome from TH use in disparate people with HTN.

Results:
Thirteen randomized control trials, 4 pre-post, and 1 cross-sectional studies were included. Most studies (61%) were conducted in USA. Follow-up varied from 28-730 days and total sample included 14,136 adults. Studies reported disparate populations by social and community context (89%), education (28%), income (33%), health and healthcare (39%), neighborhood and built environment (6%). TH was utilized in primary care including federally qualified health centers, community clinics, rural and urban small practices, homes, or in mixed settings. Most TH interventions were multi-component, included disease monitoring (83.3%), and/or self-management education (55.5%) implemented by nurses, pharmacists, or community health educators. TH used internet (55.5%) and/or phone (61.1%) or text message (22.2%) to deliver healthcare securely. Physicians reviewed reports as needed. Compared to usual care (UC), 14 of 18 studies found improvement in HTN control or reduced blood pressure. Of these, 9 of the 14 reported on HTN control and 3 of the 9 found improved control (p< 0.05). Of the 12 studies reporting on change in blood pressure, 9 found a significant reduction in either SBP or DBP (p<0.05). Eight of the 18 studies reported on hypertension medication adherence and 2 of the 8 studies found a significant improvement in adherence (p<0.05). Frequency of HTN assessment was reported and significantly improved for TH in 2 of 18 studies (p<0.05).

Conclusion:
In conclusion, TH showed promise to improve blood pressure control, and other health outcomes in disparate people with HTN. These results may inform healthcare providers, health plans, and decision makers of the potential for TH to improve HTN control among disparate populations.
Abstract 217: Prediction Outcomes Using Other People’s Models
Authors: Kolm Paul , Chiam Tze , Esham Matthew , Godbole Sangita , Caplan Richard , Fawcett Mitchell , Weintraub Willaim
Published: June 2021

Introduction:
Predictive models of adverse outcomes are developed to identify combinations of variables that can be used to identify at-risk patients. Prediction accuracy of the model is assessed by discrimination - how well the model discriminates those experiencing the outcome vs. those who don’t, and calibration - how well the predicted probabilities of the model correspond to the observed probabilities of the outcome. The ultimate test of a model is applying it to a different cohort. Typically, models developed from the same cohort tend to be overfit, that is, they apply well to the cohort on which they were developed, but less well to a different cohort. We show that re-calibration can result in a valid and useful model.

Methods:
The Society of Thoracic Surgeons (STS) established the National Adult Cardiac Surgery Database (NCD) in response to inadequately risk-adjusted hospital mortality released by the former Health Care Financing Administration (now the Centers for Medicare and Medicaid Services). Subsequently, the STS published models of several adverse outcomes including in-hospital mortality for patients undergoing coronary artery bypass grafting surgery (CABG). We applied the regression coefficients of the risk factors from their model to a different cohort of CABG patients (patients who underwent CABG at Christiana Care Health System) and assessed discrimination and calibration with the c-index and correlation of observed probabilities to predicted probabilities of in-hospital death. As the model resulted in poor calibration, we then re-estimated the regression coefficients for our cohort by applying penalized logistic regression and calculated discrimination and calibration statistics for the re-calibrated model.

Results:
While discrimination was good (0.827), the STS model was not well-calibrated (Figure 1A) when applied to our cohort. When the model was re-calibrated, discrimination and calibration statistics indicated good discrimination (0.835) and calibration (Figure 1B).

Conclusion:
When predictive models of adverse outcomes developed on one cohort of patients are applied to a different cohort of patients, the model needs to be re-calibrated to obtain a useful model.
Abstract 223: Impact of Differences in Once- vs Twice-Daily Medications Adherence on the Risk of Bleed and Stroke in Non-Valvular Atrial Fibrillation: Analysis of Randomized Trials and Claims Data Sources
Authors: McHorney Colleen A , Peterson Eric D , Durkin Mike , Ashton Veronica , Laliberté François , Crivera Concetta , Sheikh Naveed , Germain Guillaume , Schein Jeffrey R , Xiao Yongling , Lefebvre Patrick
Published: June 2021

Background:
In non-valvular atrial fibrillation (NVAF) patients, those receiving once-daily (QD) versus twice-daily (BID) non vitamin-K antagonist oral anticoagulants (NOACs) may have better medication adherence. The impact on stroke and bleed risk is not known.

Objective:
To estimate the impact of adherence differences between QD vs BID therapies on bleed and stroke risks in NVAF patients.

Methods:
The relation between adherence (proportion of days covered [PDC]) for QD vs BID NOACs and one year bleed risk was modeled using claims data from Truven Health Analytics MarketScan databases (7/2012-10/2015). Next, the relation between adherence and bleeding was calibrated to match that seen in the placebo and NOAC arms of previous randomized controlled trials (RCTs). Finally, we used adherence rates for QD (PDC=0.849) and BID (PDC=0.738) cardiovascular medications from a meta-analysis (Coleman et al.). These rates were used in the calibrated model to estimate bleeds. An analogous method was applied to evaluate the impact of QD vs BID adherence on stroke risk.

Results:
The relation between PDC and risks of bleed and stroke was modeled using claims data (N=65,022) and calibrated using RCTs. In the calibrated model, compared with BID dosing, QD dosing was associated with 81 fewer strokes (34% reduction) and 14 more bleeds (6% more) per 10,000 patients/year (Figure).

Conclusion:
Among NVAF patients, better adherence to QD dosing was associated with a significantly lower stroke risk of QD but similar risk of bleed.
Abstract 234: Participation in a Virtual Community and Its Impact on Quality of Life and Perceived Support
Authors: Khan Yosef , Grady Kathleen , Braun Lynne , Groom Allison , Bahn Katie
Published: June 2021

Background:
Patients with cardiovascular disease (CVD) and stroke can experience poor outcomes, including poor quality of life (QOL). Support of CVD and stroke patients is often associated with improved QOL. Support is typically provided ‘face-to-face’ by loved ones who often function as caregivers and need support related to the burden of providing care. Receiving support through an online “virtual community” is novel with promising effects on endpoints, yet it is unclear if participants experience enhanced QOL and support. The American Heart Association/American Stroke Association has developed an online virtual Support Network (SN) dedicated to serving patients, loved ones and caregivers and enabling them to meet others, share their stories, and find and give support. The purpose of this study is to evaluate and determine if patients, loved ones, and caregivers who participate in the SN increase their QOL and perception of support.

Methods:
Using a longitudinal matched pre-test/post-test design study, we asked CVD and stroke patients, loved ones, and caregivers to complete an online QOL and support survey at time of the SN network registration and 6 months after. Inclusion criteria included being > 21 years and the ability to read and understand English. The baseline survey included self-reported demographic data, clinical data related to comorbidities, the PROMIS Perception of Support and Global Health Scale. The post test survey additionally examined satisfaction with the SN.

Results:
We report here results from the baseline QOL and support surveys along with the 6 months follow up support survey. At baseline the SN had a total of 10, 948 members. We surveyed a total of 1076 participates including 802 patients, 175 caregivers, and 99 loved ones. Most participants were white (73%), female (80%), with a median age range from 50-59, and married (59%). Participants’ QOL was overall found to be good or better (68%).

A statically significant increase of perception for emotional support in having someone to confide in and being listened to was found (p = .03 and .025), while 51% of patients were satisfied or extremely satisfied with the SN, compared to 78% caregivers and 85% loved ones. Most patients (75%), caregivers (85%), and loved ones (73%) were likely to continue participating in the SN, with 68% patients,75% caregivers and 81% loved ones likely to recommend the SN to others.

Conclusions:
Virtual networks are an evolving and a useful way to engage people. Understanding whether patients, loved ones, and caregivers perceive support, experience improved QOL after participation in, and are satisfied with a virtual community experience may provide evidence to inform ongoing development of the SN and confirm its value to these individuals. We found significant improvement in support and broad satisfaction with such an experience. More research is needed on the impact of virtual support networks.
Abstract 243: Organic Dissemination and Natural Implementation of Decision Aids for Left Ventricular Assist Device
Authors: Thompson Jocelyn S , Matlock Daniel D , McIlvennan Colleen K , Morris Megan , Allen Larry A
Published: June 2021

Objective:
We systematically created pamphlet and video decision aids (DAs) for destination therapy left ventricular assist device (DT LVAD) and hosted them online for free public use. Although DAs have been shown to improve patient knowledge and satisfaction, they are rarely used. Thus, we aimed to assess 1) if our DAs were being used in clinical practice and 2) evaluate the factors influencing uptake.

Methods:
We contacted people who previously requested information about our DAs. Through snowball sampling, we identified additional programs that may be using them. Participants completed a semi-structured interview. We analyzed the interviews using normalization process theory (NPT).

Results:
From May 2014 to November 2016, 30 people (surgeons, cardiologists, social workers, coordinators, nurses, industry managers) from 25 different organizations contacted our research team inquiring about use of the DAs. Nearly all were contacted for an interview (1 excluded for involvement in efficacy trial), with an additional 8 referred through snowballing. Of the 37 eligible, 28 people from 25 different organizations across the United States, Canada, and France participated. We found that 11 organizations currently use the DAs, 5 plan to use them but have not yet, and 9 do not currently use them nor have active plans to use them in the near future. All interviewees agreed that LVAD is a complex decision which requires as much knowledge transfer as possible. Using the 4 constructs of NPT—coherence, cognitive participation, collective action, reflexive monitoring—we found that the DAs were seen either as “good” educational resources, or as an important element of the education process that helped improve decision making (coherence). LVAD coordinators and social workers were typically the ones to use the DAs directly with patients; however, initial implementation at the program was done by a champion of the DAs, which was either the coordinator or social worker themselves or physicians who advocated for their use (cognitive participation). Use of the materials ranged from merely providing the pamphlet to utilizing both the pamphlet and the video as the cornerstone of teaching for all patients considering LVAD (collective action). Those using the DAs reported value and benefits to their use; some who did not use the DAs wished they could but were limited by systemic or programmatic issues, while those who did not plan to use them reported a lack of time, personnel, and resources as the reason for not implementing (reflexive monitoring).

Conclusion:
Members of many LVAD centers around the world independently inquired about freely available DT LVAD DAs, and over half of those centers are actively or in the process of implementing the DAs into routine care. Implementation was facilitated by unmet informational needs, invested clinical champions, a favorable environment, and successful experiences with the DAs.
Abstract 247: A Randomized Controlled Study of a Platform to Maximize Patient Knowledge of Health Goals After Acute Myocardial Infarction
Authors: Mathews Robin , Shrader Peter , Demyaneko Vladimir , Miller Vincent , Webb Laura , Washam Jeffrey W , Peterson Eric D , Wang Tracy Y
Published: June 2021

Objectives:
Patients vary in the degree to which they understand and engage in their health care. We hypothesized that a personalized patient health education tool will promote patient communication and align patient and provider treatment goals in follow-up visits in order to optimize guideline adherence, including evidence-based therapy use and cardiovascular risk factor control, after an acute myocardial infarction (AMI).

Methods:
We developed a personalized patient education tool that summarized each patient’s status at discharge of secondary prevention risk factors (blood pressure (BP), low density lipoprotein cholesterol (LDL-C) and glycemic control), medication use (aspirin, beta blocker, ACE inhibitor/ARB, statin, P2Y
12
inhibitor), and outpatient treatment goals. Patients were randomized 1:1 to usual care vs. receipt of the education tool within 2 weeks post-discharge (before the outpatient visit). We compared secondary prevention medication use, cardiovascular risk factor control, and awareness of treatment goals between randomized groups at 6 months post-discharge.

Results:
Among 192 enrolled AMI patients, the median age was 60 years, 42% female, and 35% African American; demographic and clinical characteristics were well balanced between randomized groups. We noted high rates of secondary prevention therapy use at 6 months (Table). By 6 months post-discharge, mean systolic BP decreased by 10 mmHg with 80% of patients <140/90 mmHg, and mean LDL-C decreased by 13 mg/dl with 64% of patients under 100mg/dl. Overall, 36% of patients participated in cardiac rehabilitation. We observed no significant differences between randomized groups in any of these outcomes. Only 9% of patients who received the education tool brought it to their outpatient visit for discussion.

Conclusion:
Though secondary prevention medication use remains reasonably high at 6 months, achievement of secondary prevention health goals remains suboptimal after a myocardial infarction. Few patients utilized the health tool in discussions with outpatient providers during their follow-up visit which likely explains the lack of outcomes differences between randomized groups. Further work is needed to find effective interventions to engage patients and promote sustained behavioral modification for secondary prevention.
Abstract 255: Echocardiographic Evidence of Systemic Atherosclerosis in Patients Referred for Atrial Fibrillation
Authors: Koutroumpakis Efstratios , Rau Elizabeth , Schwartz Benjamin , Espey John , Steckman David , Torosoff Mikhail
Published: June 2021

Objectives:
Atherosclerosis is an established risk factor for atrial fibrillation (AF). While evaluation for coronary artery disease (CAD) is routinely performed in patients with AF and left ventricular systolic dysfunction (LVSD), patients with preserved LV contractility are not routinely screened. Echocardiographic evidence of atherosclerosis (aortic valve sclerosis, papillary muscle fibrosis or calcification, mitral annular calcification, and ascending aorta thickening or calcification) has been shown to predict clinical CAD.

Methods:
We investigated prevalence of subclinical atherosclerosis by echocardiography in 77 consecutive patients (32% females, 63+/-9.7 years old, 5% active smokers, 18.2% with LV ejection fraction (EF) <50%, 66% with hypertension, 13% with diabetes, 2.6% with chronic kidney disease, and 1 patient with peripheral artery disease) referred for AF ablation.

Results:
Majority of patients referred for AF ablation manifested significant echocardiographic evidence of atherosclerosis: 62% increased aortic thickening or calcification, 55% aortic valve sclerosis, 42% papillary muscle fibrosis or calcification, and 39% mitral annular calcification. Despite high prevalence of atherosclerosis, only 19% of patients with preserved LVEF (>50%) underwent pre-ablation non-invasive assessment for ischemia. Abnormal stress tests were uncommon (5% of tested patients), but were significantly increased in patients with LVSD (20% vs. 7% in patients with EF >50%). In 10 patients with LVSD, who underwent cardiac catheterization, non-obstructive CAD was noted in 5 (50%) and additional 2 (20%) had obstructive CAD/underwent PCI. In 14 patients with preserved LVEF who underwent cardiac catheterization, non-obstructive CAD was noted in 2 (14.3%) while 4 (28.6%) had obstructive CAD (all 6 had echocardiographic evidence of atherosclerosis).

Conclusions:
Systemic and coronary atherosclerosis are common in patients referred for AF ablation, with significant proportion suffering from obstructive CAD. Our findings highlight importance of evaluation for ischemia in patients referred for AF ablation with LVSD or evidence of atherosclerosis on non-invasive imaging.
Abstract 256: Cardiac CT in Ablation of Atrial Fibrillation
Authors: Mohsen Ala , Worden Nicole , Bengaluru Jayanna Manju , Giudici Michael
Published: June 2021

Background:
This study aims to determine the impact of pre-procedural cardiac computerized tomography (CT) on procedural efficacy, clinical outcome and complications in patients who undergo radiofrequency or cryo-therapy catheter ablation to eliminate atrial fibrillation (AF).

Methods:
In this retrospective review, Radiofrequency or Cryoballoon ablation was done on 50 consecutive patients with atrial fibrillation with mean age of 63 (Min 47-Max 86) with paroxysmal (8
2
%) or persistent (18%) AF. Twenty-five patients underwent cryoablation and twenty-five patients underwent Radiofrequency ablation to isolate the pulmonary veins. Procedural and clinical outcomes were compared among patients who underwent catheter ablation with and without pre procedural Cardiac CT.

Results:
Out of 50 consecutive patients between 01/2014 and 08/2014 there were 26 patients who had a pre-procedural CT scan and 24 patients who did not undergo a pre-procedural CT scan. The mean duration of the procedure (303 ± 93 vs. 271 ± 43 min, P = 0.244) and fluoroscopy time (53 ± 25 vs. 43 ± 17 min, P = 0.086) was similar among patients who did and did not have pre-procedural cardiac CT. The occurrence of complications such as bleeding, pericardial tamponade, pneumothorax, infection and embolic events were also similar in both groups. Repeat ablation was performed in 4 (15%) and 7 (29%) of the patients who did and did not have cardiac CT, respectively (P = 0.249). At 3 months, 5 (19%) and 2(8%) of the patients who did and did not have pre-procedural cardiac CT had atrial fibrillation recurrence (P =0.323). At 12 months, 6 (23%) and 4 (17%) of the patients who did and did not have pre-procedural cardiac CT had atrial fibrillation recurrence (P = 0.467). There was statistically significant difference in Radiation exposure (1805 [IQR 998-2397] vs. 1195 [IQR 738-1363] P=0.0323) between patients who did and did not get pre-procedural cardiac CT, which did not include the radiation added by performing the CT itself.

Conclusions:
Pre-procedural structural anatomy obtained by cardiac CT scan before catheter ablation for atrial fibrillation in a center where operators used both Radiofrequency and Cryoablation does not appear to have a significant effect on AF recurrence at 3 months or 1 year. The procedural radiation exposure was significantly less in the group that did not have pre-procedure cardiac CT.
Abstract 257: Urban Teaching and Non-Teaching Hospitals Outcomes: Myocardial Infarction
Authors: Okunji Priscilla O , Daniel Johnnie
Published: June 2021

Background:
Patients with myocardial infarction reportedly have different outcomes on discharge according to hospital characteristics. In the present study, we evaluated the differences between urban teaching hospitals (UTH) and non-teaching hospitals (NTH), discharged in 2012. We also investigated on the outcomes.

Methods:
Sample of 117,808 subjects diagnosed with myocardial infarction were extracted from a nationwide inpatient stay dataset using the International Classification Data, ICD 9 code 41000 in the United States, according to hospital location, size, and teaching status.

Results:
The analysis of the data showed that more whites were admitted to both teaching and non teaching hospitals with more males (~24%) admitted than their female counterparts. However, blacks were admitted more (~15%) in urban teaching hospitals than medium urban non teaching hospitals. Age difference was noted as well, while age group (60-79 years) were admitted more in UTH, inversely urban non-teaching hospitals admitted more older (80 years or older) age group. A significant difference (~28%) was observed in both hospital categories with UTH admitting more patients of $1.00 - $38,999.00 income group than other income categories. In addition, it was observed that patients with MI stayed more (~5%) for 14 or more days, and charged more especially for income group of $80,000 or above in UTH than NTH. No significant difference was found in the mortality rate for both hospital categories.

Conclusion:
The overall outcomes showed that the mortality rate between urban teaching and non-teaching hospitals were non significant, though the inpatients MI stayed longer and were charged more in UTH than NTH. The authors call for the study to be replicated with a higher level of statistical measures to ascertain the impact of the variables on the outcomes for a more validated result.
Abstract 258: Prevalence and Clinical Correlates of LVH by Sokolow-lyon and Cornell ECG Voltage Criteria in TAVR Patients
Authors: Zhang Robert , Xiao Emily , Ibrahim Tarek , Delago Augustin , El-Hajjar Mohammad , Torosoff Mikhail
Published: June 2021

Background and Hypothesis:
LV hypertrophy (LVH) due to critical aortic stenosis is expected in the TAVR patients. In a patient with a murmur and suspected aortic stenosis, absence of LVH by ECG criteria may suggest less severe aortic valve disease. However, the sensitivity of LVH analysis by ECG voltage criteria in patients with severe aortic valve stenosis undergoing trans-catheter aortic valve replacement (TAVR) has not yet been studied.

Methods:
A retrospective chart review was conducted in 388 consecutive TAVR patients (57.7% females, transfemoral approach in 59.3%, 77.9% with Sapien valve) without ventricular-paced rhythm. ECG data was collected and analyzed by Sokolow-Lyon and Cornell Voltage criteria. Results were compared to transthoracic echocardiogram. Analyses of variation, correlation, chi-square, and logistic regression were used. The study was approved by the institutional IRB.

Results:
LVH by echocardiographic criteria was present in all patients. Sokolow-Lyon and Cornell Voltage criteria for LVH were present and concordant in 15% of patients; and in 53% of patients, neither criteria was suggestive for LVH. Only 37% of patients had LVH by Cornell Voltage and 25% by Sokolow-Lyon criteria, indicative of poor concordance between these two commonly used ECG criteria for LVH (p<0.0001).

Older age was strongly associated with presence of LVH voltage criteria by both Sokolow-Lyon (OR=1.052, 95%CI 1.019-1.085, p=0.001) and Cornell criteria (OR=1.030, 95%CI 1.002-1.059, p=0.035). However, female gender was only predictive of LVH voltage criteria by Sokolow-Lyon (OR=2.844, 95%CI 1.672-4.837, p=0.001) and not by Cornell criteria (OR=1.160, 95%CI 0.663-2.030, p=0.603).

Conclusion:
The presence of LVH by Sokolow-Lyon and Cornell ECG voltage criteria poorly correlates with the presence of LVH in critical aortic stenosis patients undergoing TAVR. Sokolow-Lyon may predict LVH better in female patients, Therefore, ECG does not appear to be a suitable method of screening patients with severe aortic stenosis for LVH and the lack of LVH by voltage criteria does not imply non-critical aortic valve stenosis.
Abstract 005: A Small-molecule Inhibitor of NLRP3 Inflammasome Activity, MCC950, Reduces Blood Pressure and Restores Renal Function in Hypertensive Mice
Authors: Ferens Dorota M , Krishnan Shalini M , Kett Michelle M , Ling Yeong H , Mirabito Katrina M , Robertson Avril A , Cooper Matthew A , Vinh Antony , Chan Christopher T , Mansell Ashley , Sobey Christopher G , Drummond Grant R
Published: June 2021

Inflammasomes are a family of interleukin-1 processing complexes and master regulators of inflammation. We recently showed that both one-kidney/deoxycorticosterone acetate/salt (1K/DOCA/salt)- and angiotensin II-dependent hypertension in mice are associated with elevated expression of the NLRP3 inflammasome in the kidneys. Moreover, genetic deficiency of a key subunit critical for NLRP3 inflammasome activity protected mice against renal inflammation and chronic pressor responses associated with these models. As a step towards translation of these findings into new therapies, here we investigated whether a highly specific small-molecule inhibitor of NLRP3 inflammasome activity, MCC950, similarly reduces the deleterious effects of 1K/DOCA/salt on blood pressure (BP) and renal function. Male C57BL6/J mice were implanted with telemetry probes for continuous recording of BP (mean arterial (MAP), systolic, diastolic) and heart rate (HR), or placed in metabolic cages for 24 h urine collections to assess renal function. Once baseline parameters were established, mice were uninephrectomized, received a DOCA pellet (2.4 mg/kg/d,
s.c.
) and were given 0.9% saline to drink. Following establishment of hypertension (10 d), mice were implanted with osmotic pumps containing either MCC950 (10 mg/kg/d,
s.c.
) or vehicle (saline) and followed for 28 d. MAP increased from 102 ± 2 to 133 ± 3 mmHg over the 10 d following 1K/DOCA/salt surgery. In vehicle-treated mice, MAP remained at this elevated level until the end of the treatment period. By contrast, MAP of mice treated with MCC950 gradually declined such that at day 38 it was 15 mmHg lower than that of vehicle-treated mice. Systolic and diastolic BP response was similar to MAP, whereas HR was unaffected by MCC950. Urine, Na
+
and albumin excretion, and osmolality were all markedly increased after 10 d of 1K/DOCA/salt treatment. Consistent with its effect on BP, MCC950 decreased each of these parameters by 30-40%, whereas vehicle had no effects. In conclusion, we have shown that an inhibitor of NLRP3 inflammasome activation reduces BP and restores renal function in mice with established hypertension, highlighting MCC950 as a promising candidate for future therapies.