bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 225: Hispanics And Chest Pain: An Opportunity To Address Healthcare Disparities In A Residency Training Program
Authors: Pintor Jimenez Katiria , Burgess Kisha , Joung Yoo , Nyange Christabel , Charaf Christine , Chang Eric Y
Published: May 2022

Background:
Racial and ethnic healthcare disparities contribute to significant morbidity, mortality, and healthcare costs in cardiovascular disease. As one of the primary reasons for emergency department (ED) presentation, rapid assessment of patients with chest pain is necessary to guide further intervention and disposition. However, even with continued efforts to achieve health equity and eliminate disparities, Hispanics continue to face significant barriers to healthcare. Our goal was to assess the characteristics, and disposition, of Hispanic patients presenting to the ED with chest pain to identify potential targets for intervention to improve healthcare delivery.

Methods:
Data was obtained from the electronic medical record warehouse of a large, safety-net, academic hospital from January to December 2020. Patients who presented to the emergency department with a chief complaint of “chest pain” were identified and medical records were reviewed. Bivariate analyses were performed to identify the relationship between Hispanic ethnicity and ED disposition.

Results:
Hispanic patients who presented with chest pain represented only 4.78% (530 of 11095). Hispanics were of younger age (43.4 vs 48.5) and had lower BP (128.8/77.8 vs 134.5/81.5), but were 2.93 times more likely to be uninsured (2.44-3.51, 95% CI, p<0.05). Hispanic females were 1.58 more likely to present with chest pain (1.32-1.88, 95% CI, p<0.05). Although Hispanics were admitted more often (17.74 vs 16.79%), overall disposition from the ED (admit to inpatient, observation, discharge) was 1.39 times longer for this ethnic group (99.0 vs 71.0 min, p<0.05). Disposition for admitted Hispanics took 1.98 times longer, (86.0 vs 43.5 min, p<0.05).

Discussion:
Our study suggests that Hispanics with chest pain may experience delays in triage and disposition from the ED. Contributing factors may be due to higher prevalence of undocumented status, lack of insurance, language barriers, and a lack of Hispanic providers who promote healthcare equity. Our next steps are to begin a focused educational program for residents to demonstrate that physician driven interventions are an effective way to promote the elimination of racial and ethnic healthcare disparities.
Abstract 231: Patient, Operator, And Procedural Characteristics Of Guidewire Retention As A Complication Of Vascular Catheter Insertion
Authors: Kassis Nicholas , Alkukhun Laith , Kravitz Kathleen A , Miclea Carolyn , Gill Amanjit , Udeh Chiedozie , Mathur Piyush , Hamilton Aaron , Lyden Sean , Kapadia Samir R , Khot Umesh N
Published: May 2022

Introduction:
Guidewire retention after intravascular catheter insertion is considered a “never event.” Prior reports attribute this complication to various characteristics including uncooperative patients, operator inexperience, off-hour or emergent insertion, and underutilization of ultrasound guidance. In this descriptive analysis of consecutive events, we assessed the frequency of patient, operator, and procedural factors in guidewire retention.

Methods:
All consecutive incidents of guidewire retention across 10 hospitals within the Cleveland Clinic Health System in Ohio from August 2007 to October 2015 were prospectively identified and retrospectively analyzed. Data were manually obtained from the electronic medical records and reviewed for potential contributing factors for guidewire retention including patient, operator, and procedural characteristics.

Results:
A total of 24 guidewire retention events were identified. Overall, the median age was 74 years, 58% were males, and the median body mass index was 26.5 kg/m
2
. A total of 12 (50%) individuals were sedated during the procedure. Most incidents (10 [42%]) occurred in internal jugular venous access sites. The majority of cases (13 [54%]) were performed or supervised by an attending. Among all cases, 3 (12%) were performed by first-year trainees, 7 (29%) by residents, 3 (12%) by fellows, and 4 (17%) by certified nurse practitioners. Overall, 16 (67%) events occurred during regular working hours (8AM - 5PM). In total, 22 (92%) guidewires were inserted non-emergently, with 2 (8%) during a cardiac arrest. Ultrasound guidance was used in all but 1 case.

Conclusion:
Guidewire retention can occur even in the presence of optimal patient, operator, and procedural circumstances, highlighting the need for constant awareness of this risk. Efforts to eliminate this important complication will require attention to issues surrounding the technical performance of the procedure.
Abstract 251: Natural Language Processing Of Clinical Documentation To Assess Racial Differences In The Clinical Profile Of Patients Hospitalized With Heart Failure
Authors: Adejumo Philip , Rosand Benjamin , Khera Rohan
Published: May 2022

Background:
Self-reported racial classification is often used as a proxy for phenotypic differences among clinical populations. We demonstrate an approach to identify differences between Black and White individuals using clinical notes among patients hospitalized with heart failure (HF).

Methods:
We identified HF hospitalizations for patients at Yale and developed a word frequency embedding (TF-IDF)-based natural language processing (NLP) model on clinical notes to classify “tokens” or words from notes of Black and White individuals based on their frequency. We manually classified these tokens into clinical and non-clinical entities. We evaluated the frequency of clinical tokens successfully identified in ICD diagnosis codes and qualitatively assessed non-clinical tokens for stigmatizing language across Black and White patients.

Results:
There were 8798 patients (mean age 81±13y, 50% female) with a total of 14,655 unique patient encounters. Of these, 4293 were for Black patients. The NLP-based model determined Black vs White race of patients based only on notes with an AUROC of 0.92 after removing all explicit mentions of race. Of the top 80 tokens that identified Black vs White patients from notes, 53 (66%) were identified as clinical entities. The clinical tokens were underrepresented in structured ICD diagnosis for both Black and White, with a median 88% (IQR=27%, Q1=66%, Q3=94%) of Black-identifying tokens defining clinical conditions and 72% (IQR=45%, Q1=43%, Q3=89%) for White-identifying tokens. Among non-clinical tokens, there was a greater occurrence of stigmatizing words in the notes of Black patients (40% vs 32% in White).

Conclusion:
We demonstrate that an NLP-based approach can better define clinical differences between Black and White patients, and can be used to screen for stigmatizing language against Black and other minority groups.
Abstract 252: 12 Months Outcomes For Heart Failure Patients Attending Outpatient Clinics In Tanzania.
Authors: Wajanga Bahati M , Kim Christine , Mabula Deodatus , Kayange Neema M , Bartlett John , Knettel Brandon A , Msabah Msabah , Msangi Jamal , Muiruri Charles
Published: May 2022

Introduction:
The burden of cardiovascular disease is growing at an alarming pace in low- and middle-income countries, especially in Sub-Saharan Africa (SSA). Heart failure (HF) in SSA is associated with higher rates of rehospitalization, poor quality of life and high mortality. In SSA, it is estimated that 3-7% of all admissions to hospitals are due to HF. For inpatient HF patients in Tanzania, studies have found greater than 50% mortality rate at 12 months post discharge. In developed countries, outpatient HF clinics have been associated with reduction of 30-day readmission and mortality rates. However, there is limited published data on HF outcomes for HF patients seen at outpatient clinics in SSA. The purpose of this study was to determine frequency of hospitalization, occurrence of stroke, and mortality at two HF outpatient clinics in Mwanza city, Tanzania.

Methods:
From February 2017 to September 2018 HF patients at Bugando Medical Center and Sekou Toure Regional Hospital outpatient clinics were recruited and followed for 12 months. HF was confirmed by Framingham criteria and the severity was determined by New York Heart Association (NYHA) classification. Participant’s data were collected in four waves over the course of 12 months. Demographic data were collected at baseline and data on hospitalization, occurrence of stroke, and mortality were collected during the follow up period.

Results:
Four hundred and eighteen patients were enrolled and 369 were included in the final analysis. Most were female (n=264, 63%), small scale farmers (n=278, 66.5%) and from Mwanza City (n=299, 71.5%). More than two-thirds did not have health insurance (n=295, 70.6%) and the majority were in the NYHA I and II classification (n=267, 64.7%) during the study period. Twenty-one, 25, 11 and 13 HF patients were hospitalized at least once in the 1
st
, 2
nd
, 3
rd
, and 4
th
data collection periods respectively. Fifty patients died (14%) and 7 sustained stroke (2%) over the 12 months period.

Conclusion:
Moderate levels of hospitalization, mortality, occurrence of stroke was reported in this study compared published inpatient studies in Tanzania. Interventions are needed to improve the long-term health and survival of HF patients attending HF outpatient clinics in Mwanza City.
Abstract 258: Prehospital Transport Protocol For Comprehensive Stroke Center Triage Is Associated With Reduced Last KnownWell To Arrival Times For Intracranial Hemorrhage
Authors: Donnelly Sarah , Oneill Kathleen , Prabhakaran Shyam , Kass Hout Tareq , Thomas Kathie , Tataris Katie , Sednew Renee
Published: May 2022

Title:
Prehospital Transport Protocol for Comprehensive Stroke Center Triage is Associated with Reduced Last Known Well to Arrival Times for Intracranial Hemorrhage

Background:
In September 2018, we implemented a prehospital routing protocol for patients with suspected severe stroke and large vessel occlusion using the 3 Item Stroke Scale (3I-SS). Patients who have a 3I-SS score of ≥4 and have a known last normal time of ≤6 hours were transported to the closest Comprehensive Stroke Center (CSC). While the impact on endovascular treatment for ischemic stroke is more established, the effect of this transport policy on patients with intracerebral hemorrhage (ICH) is unknown.

Objective/Methods:
The objective of the study was to determine if implementation of a regional CSC transport protocol reduced last known well (LKW) to hospital arrival time for patients with ICH. Data was retrospectively reviewed all patients with a primary diagnosis of ICH from Get With The Guidelines®(GWTG) Stroke regional registry between January 2018 to May 2019 (8 month pre and 8 months post-implementation) and consisting of 16 Primary Stroke Centers (PSCs) and 8 CSCs. We analyzed LKW-arrival times to compare median times in the pre- vs. post-implementation periods.

Results:
There were 501 ICH cases in the pre-implementation period (mean age 66, 43.3% Black, and 52.3% male) and 548 in the post-implementation period (mean age 66, 41.0% Black, and 54.3% male). In the post-implementation period, median LKW to hospital arrival time was 255 minutes vs. 270.5minutes in the pre-implementation period (P value 0.029). LKW to hospital arrival times for those patients arriving from EMS decreased from a median 112.5 minutes to 81 minutes (P value 0.034).

Conclusions:
A prehospital direct-to-CSC transport protocol resulted in a substantial decrease in the median LKW to hospital arrival times for ICH patients, driven especially by EMS-arriving patients. Prehospital protocols could increase access to time sensitive life-saving therapies for ICH.
Abstract 265: Implementation Of Treat To Target Hypertension Strategy In A Metropolitan Primary Care Facility
Authors: Arshad Iqra , Faiz Mohammad , Ovalle Ramos Julio A , Shariff Masood A , Ding Matthew R , Mistry Rakeshkumar , Espejo Maria
Published: May 2022

Background:
We developed a hypertension (HTN) care initiative in a metropolitan based Primary Ambulatory Care to advocate and increase adherence to blood-pressure (BP) standards. The strategy involved, Treat to Target (T2T), linked health promotion by addition of BP clinic slots and training Nursing staff to optimize BP monitoring and care. Uncontrolled HTN leads to increased risk CVD complications with a socioeconomic cost attached. Thus, we evaluated the pre- and post-T2T period outcomes for systolic BP control.

Methods:
Patients that presented to ambulatory clinic prior to and during the T2T initiative were selected in a case control paired chart review (24 months pre & post initiative). Enrollment criteria included BP readings greater than 130 mmHg systolic or 80 mmHg diastolic in the T2T period or change in current BP medication were selected and enrolled into the BP initiative. The nursing staff reviewed BP diary, addressed medication concerns, established a patient center module to promote salt reduction/medication adherence/exercise/weight loss. Final BP outcomes were assessed, pre and post T2T initiative for systolic & diastolic control, number of visits, and meeting the set BP standards.

Results:
A total of 2729 patients were included in paired review. The mean age was 61.3±9.6 years, 57% were females, and 70% were Latinx & 25% were Blacks. At baseline, mean systolic BP was 143.2mm Hg in the T2T group and 144.1 mmHg in the control group. At last follow-up in the period of the study, mean systolic BP fell by 7.6 mmHg (to 135.5mmHg) in the T2T group and by 9.5 (to 134.6mmHg) in the control group. The average number of visits decreased from control to the T2T period by 31% (5.1±3.0 vs. 3.5±1.5, p<0.01) & the number of events of uncontrolled BP reading also decreased (3.4±2.1 vs. 2.4±1.3, p<0.01), respectively.

Conclusions:
The HTN initiate by increasing BP clinic spots run by Nursing to educate, monitor and titrate BP control which resulted in sustained BP reduction with fewer visits and decreased uncontrolled BP events and was a sustainable initiative. Broad-scale implementation is both justified and warranted in a metropolitan ambulatory care setting, which will entail cost initially, and in turn develop continual relationship to reduce HTN related compliance.
Abstract 267: Impact Of Sodium-Glucose Cotransporter-2 Inhibitors On Quality-of-life Outcomes Using The Kansas City Cardiomyopathy Questionnaire: A Meta-analytic Comparison
Authors: Alam Mustafa , Liang Qiangrong , Jhamnani Sunny , Courgi Robert
Published: May 2022

Abstract:
SGLT2i have recently demonstrated efficacy in reducing acute CHF exacerbations, hospitalizations, and major adverse cardiac outcomes. Their efficacy in reducing symptom burden remains unclear. The purpose of this study is to quantify heart failure symptom burden improvement as measured by the Kansas City Cardiomyopathy Questionnaire.

Methods:
A systematic review of MEDLINE and the Clinical Trials Database using PRISMA guidelines was conducted using the search terms SGLT2 inhibitor and heart failure. Studies were included if they measured change from baseline values of KCCQ Total Symptom Score in treatment and control groups. Clinical characteristics of patients and outcomes were aggregated according to the Cochrane Manual. A random effects model using mean differences was utilized. Revman 5.3 was used to aggregate outcomes and statistics.

Results:
A total of 14 studies with 18,117 patients were included. The studies comprised of 10,996 patients with HFrEF and 7,121 patients had HFpEF. The aggregate score improvement was significant with a mean difference of 1.87 [1.54, 2.20] Test for overall effect: Z = 11.05 (P < 0.00001). Study heterogeneity was also significant (Heterogeneity: Tau
2
= 0.07; Chi
2
= 634.86, df = 13 (P < 0.00001); I
2
= 98%). A subgroup analysis of HFpEF only patients showed a significant improvement: 2.46 [0.75, 4.18] Test for overall effect: Z = 2.82 (P = 0.005).

Conclusion:
SGLT2i reduce symptom burden with a modest improvement that is statistically significant regardless of ejection fraction. However, long term results are needed to quantify clinically significant symptom reduction.
Abstract 47: Tapering And Discontinuation Of Background Therapies During The Transition To Rilonacept Monotherapy In Rhapsody, A Phase 3 Clinical Trial Of Rilonacept In Patients With Recurrent Pericarditis
Authors: Brucato Antonio , Wheeler Alistair , Luis Sushil A , Abbate Antonio , Cremer Paul C , Fang Fang , Insalaco Antonella , Lewinter Martin M , Lewis Basil S , Lin David , Nicholls Stephen J , Chatfield Jay B , Klein Allan L , Imazio Massimo , Paolini John F
Published: May 2022

Background:
Post-episode tapering of Standard of Care (SoC) medication in patients with recurrent pericarditis (RP) varies considerably. Gradual tapering of corticosteroids (CS) is recommended in ESC guidelines (decreasing by 1-2.5 mg/day every 2-6 weeks over 1-2 years) to prevent recurrence. We describe successful faster tapering of SoC treatment onto rilonacept monotherapy during RHAPSODY, a Phase 3, placebo-controlled, randomized-withdrawal (RW) trial in RP.

Methods:
Patients with acute symptomatic RP despite stable doses of NSAIDs, colchicine, and/or CS in any combination enrolled in a 12-week run-in period in which weekly rilonacept was initiated. After 1-week of stabilization, tapering of CS began at a rate dependent on baseline dose, to be completed by Week 10 for randomization at Week 12 when clinical response was confirmed by reduced pain and normalized CRP levels. Colchicine tapering/discontinuation was initiated no earlier than Week 4. This analysis evaluates time to rilonacept monotherapy in subgroups receiving different combinations of background therapies.

Results:
79 of 86 patients were receiving pharmacotherapy at run-in baseline. Median (95% CI) time to monotherapy (n=79) was 7.9 (7.0-8.1) weeks. Of the patients receiving CS at baseline (41/86 [48%]), 39 (95%) tapered to rilonacept monotherapy, and median time to monotherapy was 7.9 (7.1-8.1) weeks. Of the patients receiving colchicine at baseline (65/86 [76%]), 61 (94%) patients achieved rilonacept monotherapy, and median time to monotherapy was 8.0 (7.1-8.3) weeks. Patients receiving only one SoC therapy achieved rilonacept monotherapy faster (6.1 [0.4-8.1] weeks) than those receiving 2 (8.0 [6.7-9.9] weeks) or 3 (7.7 [7.0-8.3] weeks) therapies. All patients who did not achieve monotherapy had withdrawn from the study for reasons unrelated to pericarditis.

Conclusion:
All patients randomized in the RHAPSODY trial discontinued SoC and transitioned to rilonacept monotherapy (median time 7.9 weeks) without a recurrent pericarditis episode during run-in. With rilonacept, time to successful discontinuation of SoC, including high dose CS, was substantially more rapid than current treatment practices. RHAPSODY data helped support FDA approval of the first therapy for RP.
Abstract 51: Too Little, Too Late: Diuresing Inefficiencies At A Veterans Affairs Hospital
Authors: Ardeshna Nelish , Grondin Christopher , Breeden Madison , Goyal Tanvi , Saleh Zachary , Lebold Erin
Published: May 2022

Background:
Between 2016 and 2021, the average length of stay for congestive heart failure (CHF) patients at our Veterans Affairs (VA) Hospital has ranged from 0.8 to 1.9 days longer than comparable VA hospitals. This extended length of stay (LOS) results in increased healthcare costs and is an institutional focus to increase quality of care. Current cardiology guidelines for patients admitted with an acute CHF exacerbation recommend aggressive diuresis, defined as high-dose loop diuretics at least twice a day. We sought to analyze our institution’s compliance with this guideline-directed care.

Methods:
We performed a retrospective chart review of Veterans admitted between July and September 2021 with a primary diagnosis of CHF exacerbation. We tabulated the average LOS, days IV diuretics were administered, time(s) of administration, and the number of IV diuretic doses per day.

Results:
44 patients were identified. The average LOS and number of days of IV diuretics a Veteran received was 7.5 (SD 3.5) and 4.5 (SD 1.4) days, respectively. The average number of IV diuretics given during days of IV diuresis was 1.4 (SD 0.5). We noted that 11.5% of IV diuretic doses were given before 8AM.

Conclusions:
Our results demonstrate that the diuresing patterns at our VA hospital fall short of the recommended guidelines. Receiving an average of 1.4 doses of IV diuretic, rather than at least 2, likely contributes to extended length of stay and cost. Additionally, we note that very few doses of diuretics are administered prior to 8AM, which may delay or prevent subsequent dosing. This project identifies clear targets for future quality improvement projects at our institution aimed at improving length of stay and Veteran care by increasing the number of IV diuretic doses per day.
Abstract 60: Mortality Following Heart Failure Hospitalization By QRS Duration In Patients With Preserved Ejection Fraction
Authors: Downey Michael , Gravely Amy , Westanmo Anders , Hubers Scott , Adabag Selcuk
Published: May 2022

Background:
Heart failure with preserved ejection fraction (HFpEF) comprises almost half of all heart failure (HF) diagnoses. Similar to HF with reduced ejection fraction (HFrEF), HFpEF carries up to a 75% 5-year mortality following HF hospitalization. However, unlike its corollary, HFpEF has exceedingly limited therapeutic options to alter its natural history. While QRS prolongation (QRS > 120 msec) carries prognostic significance in HFrEF, less is known about the implications of this conduction abnormality in HFpEF.

Objective:
To determine the association of QRS prolongation with survival among patients with HFpEF following HF hospitalization.

Methods:
A retrospective review of 1,454 patients with left ventricular EF ≥ 45% discharged from the Minneapolis VA Medical Center between 2015 and 2019 from a HF hospitalization. All patients’ electrocardiograms (ECG) were classified by QRS duration as either prolonged (QRS >120 msec) or narrow complex (QRS ≤120 msec). Those with prolonged QRS were further subtyped as: left bundle branch block (LBBB), right bundle branch block (RBBB), intraventricular conduction delay (IVCD), or ventricular paced (VP) rhythm.

Results:
Of the 1,454 patients (mean age 75.1 ± 10.8 years, 97.7% male, and mean EF 58.5% ± 10.2%), 545 (37.5%) had QRS prolongation. Specifically, 61 (4.2%) had LBBB, 266 (18.3%) had RBBB, 77 (5.3%) had IVCD and 141 (9.7%) had VP. Over 4.09 ± 1.00 years of follow up, 769 (52.9%) of the patients died (Table). Patients with a narrow QRS had a similar survival relative to those with a QRS >120 msec with an age and sex adjusted hazard ratio of 1.01 (95% CI: 0.87-1.17, p = 0.16) (Figure).

Conclusions:
The mortality rate is exceedingly high in patients with HFpEF discharged after a HF hospitalization. While the QRS interval was not significantly associated with near-term survival in this analysis, these data suggest that studies with greater statistical power and follow-up duration are warranted.
Abstract 61: Major Adverse Cardiovascular And Cerebrovascular Events Among Homeless Cancer Survivors: A Decade-apart Nationwide Hospitalizations Analysis
Authors: Jain Akhil , Dhaduk Kartik , Taj Shiza Saher , Shawl Saima , Raina Jilmil , Itare Vikram , Ijaz Hasnan , Alukal Thomas , Singh Sandeep , Desai Rupak
Published: May 2022

Background:
Homelessness being one of the independent risks for cardiovascular disease (CVD), we explored the burden of CVD risk factors and major adverse cardiac and cerebrovascular events (MACCE) and in-hospital outcomes among homeless cancer survivors in the USA two-decade apart.

Methods:
We compared the baseline demographic, comorbidities, and inpatient MACCE outcomes (all-cause mortality, cardiac arrest including arrhythmia, and stroke) between 2007 and 2017 using homeless cancer survivors' hospitalizations from National Inpatient Sample datasets.

Results:
A total of 14973 (median age 59 years, 53.4% male) admissions among homeless cancer survivors were studied (4778 in 2007 & 10195 in 2017, Table 1). Cohort 2017 had younger (median age 57 vs. 71 years), male (59.5% vs. 40.5%), Hispanic (8.0% vs. 5%), non-elective (93.8% vs. 87.4%) and low household income (24.7% vs. 20.8%) (p<0.001) admissions, and had a significantly higher burden of traditional cardiovascular risk factors like smoking, hypertension, hyperlipidemia, diabetes with chronic complications, congestive cardiac failure, alcohol abuse, drug abuse and depression compared to 2007 cohort. Univariate incidence of composite MACCE (16.2 vs 19.5%) and all-cause mortality (0.9 vs 1.3%) were significantly lower in 2017 compared to 2007. Multivariate analysis after socio-demographics, admitting hospital-related characteristics and comorbidities did not reveal worsening for MACCE-related hospitalizations (aOR 1.16, 95 CI 0.83-1.62, p=0.381).

Conclusion:
Homeless cancer survivors tend to be younger in 2017 than in 2007, with higher prevalence of cardiovascular risk factors and hospitalizations related to MACCE. However, they also tend to have improved in-hospital outcomes. Propagating aggressive screening in such survivors may further prevent MACCE-related hospitalizations.
Abstract 63: The Impact Of Percutaneous Coronary Intervention On Transcatheter Aortic Valve Replacement Outcomes
Authors: Zayyad Zaid A , Sreepathy Pranati , Dohse Carlos , Twing Aamir , Patel Keshav , Ambalavanan Manoj , Nasrollahi Farrah , Tiu David , Khalil Ibrahim , Kansal Mayank M , Shroff Adhir R
Published: May 2022

Background:
Many patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis also have significant coronary artery disease (CAD). Although the impact of planned percutaneous coronary intervention (PCI) before TAVR has been studied, a clear strategy for timing of PCI has yet to be determined. Additionally, the effects of emergent PCI for acute coronary syndrome (ACS) prior to TAVR have not been investigated. The purpose of this study is to evaluate the impact of both emergent and planned pre-TAVR PCI on outcomes, namely major adverse cardiovascular events (MACE).

Methods:
Retrospective analysis of electronic medical records from 2018-2020 at the University of Illinois at Chicago and affiliated Veterans Affairs identified all TAVR patients. Patients were placed into one of three groups: those who had TAVR within 6 months of urgent/emergent PCI for ACS, those who had TAVR within 6 months of planned PCI for stable ischemic heart disease (SIHD), and those who did not have PCI in that time period. Primary outcomes included composite MACE (all-cause mortality, MI, or CVA) at 6 and 12 months.

Results:
Of 152 patients, 78% (118) were male and 56% (85) were non-white. In the 6 months prior to TAVR, 5 patients underwent PCI for ACS, 49 underwent PCI for SIHD, and 98 did not have PCI. There were no differences in co-morbidities including DM, HTN, CHF, and CKD between the three groups. No significant difference in outcomes were identified at 6 months. At 12 months, 80% (4/5) of patients with PCI for ACS had MACE compared to 20.4% (10/49) in patients with PCI for SIHD, and 14.3% (14/98) in patients with no PCI (p=0.001). All-cause mortality at 12 months was 60% (3/5) for patients with PCI for ACS, 12.2% (6/49) for patients with PCI for SIHD, and 13.3% (13/98) for patients with no PCI (p=0.01).

Conclusion:
Our findings suggest that patients requiring PCI for ACS close to TAVR are at higher risk for poor outcomes compared to those with non-emergent PCI, or no PCI. Their 12 month mortality also exceeds expected mortality for patients who undergo PCI for ACS without TAVR. For this reason, these patients may require more careful follow up post-procedurally. It remains uncertain whether delay of TAVR for these patients improves outcomes.
Abstract 66: Predictors And Long-term Outcomes Of Skilled Nursing Facility Use After Cardiac Surgery: Insights From Michigan
Authors: Thompson Mike P , Hou Hechuan , Nathan Hari , Pagani Francis D , Hawkins Robert B , Theurer Patricia F , Likosky Donald S , Prager Richard L
Published: May 2022

Background:
Payment reform efforts have sought to minimize the use of skilled nursing facilities (SNF) after coronary artery bypass grafting (CABG). Little is known about the characteristics and long-term consequences of CABG patients that are discharged to SNF. The purpose of this study was to identify clinical predictors and long-term outcomes associated with SNF use after isolated CABG.

Methods and Results:
Clinical data from the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative were linked to Medicare fee-for-service claims for 8280 Michigan residents undergoing isolated CABG that had no prior SNF use and were discharged alive between 7/1/2012-12/31/2018. A total of 1876 patients (22.7%) had any SNF use identified in claims within one year of discharge with a mean of 27.1 SNF days (SD=30.2). Mean Society of Thoracic Surgeons calculated preoperative risk of mortality was higher for SNF users compared to non-users (3.6% vs 2.0%, p<0.001). Among the 2471 patients with a five-meter walk test, SNF users had a significantly longer five-meter walk time (7.4 vs 6.0 seconds, p<0.001). Multivariable logistic regression identified several factors associated with SNF use, including female sex, older age, non-white race, urgent admission, and the presence of comorbid conditions and major operative morbidity. Long-term survival was significantly worse for SNF users (log-rank test p<0.001) with Kaplan-Meier estimated 5-year survival at 66% versus 86% for non-SNF users (Figure). Even after risk adjustment, hazard ratio of mortality associated with SNF use was 2.04 (95% CI: 1.81-2.29, p<0.001).

Conclusions:
One in five isolated CABG patients in Michigan used SNF within a year of discharge and represented a demographically and clinically distinct population of patients with worse long-term survival. Efforts to reduce SNF use following CABG could result in serious unintended effects on outcomes in this at-risk population.
Abstract 73: Associations Of Social Determinants Of Health On Anticoagulation Treatment Among Patients With Atrial Fibrillation At Risk For Stroke At A Large Health System
Authors: Glowacki Nicole , Khatib Rasha , Colavecchia Anthony C , Mills J. Rebecca , Glosner Scott E , Cato Matthew , Brady Peter
Published: May 2022

Objectives:
The objective of this study was to evaluate anticoagulant prescribing disparities in atrial fibrillation (AF) by exploring associations between social determinants of health (SDOH) collected from electronic health records (EHR) and oral anticoagulant (OAC) prescription.

Methods:
This retrospective study included adult patients newly diagnosed with AF who had ≥ 2 encounters from a large, integrated healthcare system between May 2016 and May 2021. Patient-level demographics, prescribing provider specialties, comorbidities, medications, and SDOH were extracted from EHRs. Area deprivation index (ADI) was linked to patient records as a measure of socioeconomic status. Patients were followed for 1 year from diagnosis. Multivariable logistic regression models were used to assess associations between SDOH, clinical factors, and OAC prescribing and class (warfarin or direct-acting OAC[DOAC]) of OAC prescribed.

Results:
Of 19,191 AF patients, 12,718 patients (66.3%) were prescribed an OAC within the first year of diagnosis. Mean age was 71.1
+
12.9 years, 43.9% (8,430 of 19,191) were females, and 91.2% (17,705 of 19,191) were white. Patients were less likely to be prescribed an OAC (relative risk [95% CI]) if they were widowed (0.98 [0.96-0.99] vs single) or had history of alcoholism (0.86 [0.79-0.95] vs no history). Most patients (53.3%) received prescriptions from a primary care provider. A linear relationship was found between worsening ADI and increased warfarin prescriptions compared with DOACs.

Conclusion:
Though guideline-concordant anticoagulation use remained suboptimal, clinical characteristics were strong predictors if an OAC was prescribed for AF stroke prevention. Worsening ADI was associated with an increased likelihood for patients to be prescribed warfarin instead of a DOAC.
Abstract 82: Post Coronary Angioplasty; Why Did My Patient Die?
Authors: George Sareena , Goolsarran Nirvani , Wilbert Lisa , Sun Edward , Pyo Robert , Lawson William E
Published: May 2022

Introduction:
PCI interventions carry the risk of mortality. Minimizing by appropriate selection of patients, procedural technique, aftercare is critical. Despite advances, mortality risk has not significantly changed. Registries have been developed to assess and report outcomes/quality of care.

Methods:
Mortalities identified in the National Cardiovascular Disease Registry [NCDR] database from 2017-2020 @ Stony Brook University Hospital were identified and reviewed. The 2017 mortalities were compared with Vizient [Analytics providing cost/quality/value benchmarking & practice improvement feedback] predictors of mortality (case mix index [CMI]) and NYS PCI database which use different risk adjusters.

Results:
There were 79 mortalities over 4 years (average age 79, M:F ratio 2.07 [54/26], 76 died in-house). Cause of death [59 cardiac, 8 neurologic, 4 infection, 1 hemorrhage, 1 pulmonary, 3 unknown; 10 cases attributed to surgery]. Mortality rates remained constant over time. Vizient expected mortality rates show poor correlation with NCDR predictions, which may reflect in part patient selection and unadjusted comorbidity. NCDR correlation with the more restrictive risk adjusted NYS DOH mortality rates is better than for Vizient. NCDR mortality for 2017 was 1.4% [21/1503]; NYS DOH 30 day reported OMR1.76%, EMR 1.36%, RAMR of 1.46% for all [26/1,476] cases and RAMR of 0.95% for non-emergent [1,150] cases.

Conclusions:
The NCDR provides a useful tool to benchmark PCI mortality, but unadjusted comorbidity, as demonstrated by mismatches in predicted outcomes] adversely affects observed mortality. Increased attention to patient selection may provide improvements in outcomes, decrease mortality risks, and improve value. Value: Improving patient selection improves NCDR mortality and result in lower costs and better reported outcomes. Patients, Providers and Payers may benefit from the provision of appropriate services and improved outcomes..
Abstract 89: Temporary Pacing And Clinical Outcomes In The Tavr Patient
Authors: Sreepathy Pranati , Zayyad Zaid , Twing Aamir , Ambalavanan Manoj , Nasrollahi Farrah , Brett Rachel , Dohse Carlos , Bhayani Siddharth , Khalil Ryan , Patel Keshav , Dickens Helena , Tiu David , Kansal Mayank M , Ibrahim Khalil , Shroff Adhir R
Published: May 2022

Introduction:
Transvenous pacemaker (TVP) use during transcatheter aortic valve replacement (TAVR) is routinely utilized to rapid pace the ventricle to assist in valve deployment and treat conduction abnormalities. This study aimed to evaluate the outcomes of patients who had their TVP left in place post procedure as compared to those patients where the TVP was removed in the operating room.

Methods:
A retrospective analysis of medical records for TAVR patients from 2018-2020 at the University of Illinois Hospital was conducted. These patients were placed into two groups: Those with TVP left in place and those without TVP. Patients with a pacemaker prior to procedure were excluded (11). Primary outcomes included composite MACE (all-cause mortality, MI, or CVA) at 6 months and 12 months. Secondary aims included length of stay (LOS) and ICU length of stay (ILOS).

Results:
A total of 138 patients were included for analysis. Of this population, 78% (109) were male, 54% (71) non-white, and mean age of 75+/- 12 years old. TVP was left in post procedure for 41 patients (29%). When comparing patients with TVP in place post procedure and those without, there was no difference in 6-month composite MACE (4.9% vs 13.4%, p=0.14). This was redemonstrated at 12 months (9.8% vs 22.6% p=0.076). There was no significant difference in LOS (2.88 vs 2.82 p=0.92). ILOS was significantly longer for those with TVP in place vs. those without (0.63 vs 0.08 days, p=0.006).

Conclusion:
Our results indicate that a TVP left in place is not significantly associated with composite MACE. Though presence of a TVP is associated with longer ICU stay it is not associated with longer total LOS. We noted that those with TVP in place post procedure did have lower percentage of composite MACE however the reasons for this trend are unclear. The prognostic implication of TVP left in place post TAVR remains to be determined. Further evaluation into the relationship of TVP and clinical outcomes should be investigated to better understand the clinical significance of this practice.
Cardiorenal Syndrome: The Role of Neural Connections Between the Heart and the Kidneys
Authors: Patel Kaushik P. , Katsurada Kenichi , Zheng Hong
Published: May 2022

The maintenance of cardiovascular homeostasis is highly dependent on tightly controlled interactions between the heart and the kidneys. Therefore, it is not surprising that a dysfunction in one organ affects the other. This interlinking relationship is aptly demonstrated in the cardiorenal syndrome. The characteristics of the cardiorenal syndrome state include alterations in neurohumoral drive, autonomic reflexes, and fluid balance. The evidence suggests that several factors contribute to these alterations. These may include peripheral and central nervous system abnormalities. However, accumulating evidence from animals with experimental models of congestive heart failure and renal dysfunction as well as humans with the cardiorenal syndrome suggests that alterations in neural pathways, from and to the kidneys and the heart, including the central nervous system are involved in regulating sympathetic outflow and may be critically important in the alterations in neurohumoral drive, autonomic reflexes, and fluid balance commonly observed in the cardiorenal syndrome. This review focuses on studies implicating neural pathways, particularly the afferent and efferent signals from the heart and the kidneys integrating at the level of the paraventricular nucleus in the hypothalamus to alter neurohumoral drive, autonomic pathways, and fluid balance. Further, it explores the potential mechanisms of action for the known beneficial use of various medications or potential novel therapeutic manipulations for the treatment of the cardiorenal syndrome. A comprehensive understanding of these mechanisms will enhance our ability to treat cardiorenal conditions and their cardiovascular complications more efficaciously and thoroughly.
The Nuclear Balance Is What States Make of It
Authors: Logan David C.
Published: May 2022

Does nuclear superiority offer states political or military benefits? And do those benefits accrue beyond acquiring a secure second-strike capability? International relations theory has long held that nuclear superiority does not confer significant advantages, a conclusion supported by much of the qualitative literature on bargaining and crisis interactions between nuclear-armed states. New work by scholars using statistical methods to analyze data on nuclear crises, interstate disputes, and compellent threats has sought to answer these questions, producing conflicting results. Despite the contributions of these recent works, this line of research has assumed that warhead counts are an appropriate measure of nuclear capabilities and that states possess accurate information about the material balance. Instead, states use multiple quantitative and qualitative characteristics to evaluate the nuclear balance, and they often have inaccurate or incomplete information about the size, composition, and configuration of other states' nuclear forces. Using new data, replications of two prominent recent works show that results are sensitive to how the nuclear balance is operationalized. Drawing on archival and interview data from the United States and the Soviet Union during the Cold War, findings show how states and leaders often understand and respond to the nuclear balance in inconsistent, asymmetric, and subjective ways.
The identity of Eunotia paludosa Grunow 1862 (Eunotiaceae, Bacillariophyta), a revision, and the description of three new species of Eunotia Ehrenberg
Authors: VAN DE VIJVER BART , LANGE-BERTALOT HORST , GOEYERS CHARLOTTE , MERTENS ADRIENNE , SCHUSTER TANJA M. , ECTOR LUC
Published: May 2022

Eunotia paludosa is an abundant and frequent diatom species in ombrotrophic, Sphagnum-dominated bog ponds in Europe. Analysis of the type material from Mandling, Austria, revealed that our currently accepted concept of E. paludosa, based on morphology, was incorrect. The valves in the type population of E. paludosa possess distinct, relatively large, acute spines on the dorsal margin, which are not present in what is currently understood under E. paludosa. Based on the comparison with the E. paludosa type material, three new Eunotia species are described. Eunotia sphagnicola encompasses all European populations formerly and thus incorrectly identified as E. paludosa. The former E. paludosa populations in the sub-Antarctic region are described as E. insularum, a widespread species on almost all sub-Antarctic islands. Finally, E. zackenbergensis was described from Greenland. The three new species differ from each other in valve dimensions, valve outline and shape of the apices.
Chaenomeles japonica (Maleae, Amygdaloideae, Rosaceae): validation of six Alberts Tīcs’ cultivar names and two new synonyms for the species
Authors: STALAŽS ARTURS , SVIĶE SILGA , VECKALNE AIGA
Published: May 2022

Chaenomeles is a rosaceous genus of Asian origin with eight species, including four artificially created hybrids. Several species of this genus are used in many countries for ornamental plants and fruit production. As a result of many years of breeding work in Latvia, Alberts Tīcs selected six Chaenomeles japonica (Japanese quince) cultivars. Unfortunately, when publishing the descriptions of his cultivars, he does not comply with the requirements of the International Code of Nomenclature for cultivated plants because the names of newly introduced cultivars are not validly published. In his publications on the cultivation of Chaenomeles, Tīcs has introduced new scientific names, which have been published without complying with the requirements of the International Code of Nomenclature for algae, fungi, and plants. The validation of Tīcs’ cultivar names has been performed here, and the names—Chaenomeles maulei f. pomifera-inermis  nom. nud. and Chaenomeles ×pomoidea  nom. nud.—have been recognized as new synonyms of Chaenomeles japonica. Descriptions have been provided for all Alberts Tīcs’ cultivars.
Coupling length: a generalized gleno-acetabular distance measurement for interpreting the size and gait of quadrupedal trackmakers
Authors: Stevens Kent A. , Ernst Scott , Marty Daniel
Published: May 2022

The gleno-acetabular distance DGA, a conventional proxy for the size of a quadrupedal trackmaker, is often estimated as the distance GA between the midpoint between a left and right pair of pes tracks and the midpoint between a selected pair of left and right manus tracks. While frequently used to estimate trackmaker size from fossil trackways, the relationship between GA and DGA depends upon the gait (which is unknown for extinct trackmakers), and is subject to multiple additional sources of uncertainty including which specific pair of manus tracks to associate with a given pair of pes tracks. Here a generalization is introduced, termed coupling length, which does not require any presumption about trackmaker gait of the degree of overstepping. On the contrary, a systematic analysis of a trackway in terms of coupling length can permit estimation of both the size and the gait with which the trackmaker progressed. Coupling length can be computed at successive points along a trackway, allowing exploration of a range of hypothetical gaits and body sizes for the trackmaker responsible. A fitness function quantifying persistent variation in coupling length along a trackway is used to indicate whether a given trackway could have been created by a fairly consistent gait, and if so, a range of high-fitness solution gaits and their associated DGA. The method was applied to selected quasi-regular sauropod trackways and a solution found for a narrow range of gaits with limb phase of about 0.3 and DGA = 1.6 ± 0.2 m. This is the first estimation of sauropod trackmaker gait, and introduces a novel method by which irregularity along a trackway is used as a source of information to constrain inferences of trackmaker behavior. The computed DGA for this sauropod suggests significantly smaller trackmakers than conventional estimations based on track dimensions and hip height estimates. Size estimation by this approach offers greatly reduced uncertainty compared to conventional estimates.
Prediction of lung cancer using gene expression and deep learning with KL divergence gene selection
Authors: Liu Suli , Yao Wu
Published: May 2022

Background

Lung cancer is one of the cancers with the highest mortality rate in China. With the rapid development of high-throughput sequencing technology and the research and application of deep learning methods in recent years, deep neural networks based on gene expression have become a hot research direction in lung cancer diagnosis in recent years, which provide an effective way of early diagnosis for lung cancer. Thus, building a deep neural network model is of great significance for the early diagnosis of lung cancer. However, the main challenges in mining gene expression datasets are the curse of dimensionality and imbalanced data. The existing methods proposed by some researchers can’t address the problems of high-dimensionality and imbalanced data, because of the overwhelming number of variables measured (genes) versus the small number of samples, which result in poor performance in early diagnosis for lung cancer.

Method

Given the disadvantages of gene expression data sets with small datasets, high-dimensionality and imbalanced data, this paper proposes a gene selection method based on KL divergence, which selects some genes with higher KL divergence as model features. Then build a deep neural network model using Focal Loss as loss function, at the same time, we use k-fold cross validation method to verify and select the best model, we set the value of k is five in this paper.

Result

The deep learning model method based on KL divergence gene selection proposed in this paper has an AUC of 0.99 on the validation set. The generalization performance of model is high.

Conclusion

The deep neural network model based on KL divergence gene selection proposed in this paper is proved to be an accurate and effective method for lung cancer prediction.