bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13479: Association of Plasma Branched Chain Amino Acid With Biomarkers of Inflammation and Lipid Metabolism in Women
Authors: Hamaya Rikuta , Mora Samia , Lawler Patrick R , Cook Nancy R , Ridker Paul M , Buring Julie E , Lee I-min M , Manson Joann E , Tobias Deirdre K
Published: May 2021

Introduction:
We previously observed that circulating branched-chain amino acids (BCAAs) were associated with a higher risk of cardiovascular disease (CVD). However, the relationships of BCAAs with other cardiometabolic pathways other than type 2 diabetes (T2D) are unclear, including inflammation, dyslipidemia, and impaired glucose metabolism.

Hypothesis:
We hypothesized plasma BCAAs are correlated with cardiometabolic dysfunction in women, independent of shared risk factors.

Methods:
We conducted a cross-sectional analysis of 19,472 participants (mean age=54.9 years, SD=7.2) in the Women’s Health Study without a history of T2D, CVD, or cancer at baseline blood collection. We used multivariable linear regression models comparing quartiles of BCAAs (sum of fasting isoleucine, leucine and valine concentrations via NMR spectroscopy) with biomarkers of inflammation, lipids, and glucose metabolism, adjusting for age, body mass index, smoking, diet, and other CVD risk factors.

Results:
Women in the highest vs. lowest quartiles of plasma BCAAs had higher inflammatory markers including high-sensitivity C-reactive protein (hsCRP; adjusted mean: 2.7 vs. 2.0 mg/L), fibrinogen (390 vs. 384 mg/dL), GlycA (420 vs. 384 μmol/L), and soluble intercellular cell adhesion molecule-1 (sICAM-1; 350 vs. 341 ng/mL) (p<0.001 for linear trends across quartiles). Similarly for lipids, women with higher BCAAs had lower HDL-c (48.8 vs. 54.7 mg/dL), and higher LDL-c (142 vs. 135 mg/dL) and triglycerides (142 vs. 114 mg/dL) (p<0.001). BCAAs were positively associated with insulin resistance (lipoprotein insulin resistance [LPIR] score [54.8 vs. 40.0]) and HbA1c (5.2 vs. 5.1%). BCAAs remained associated with GlycA and hsCRP, but not fibrinogen or sICAM-1, when we further adjusted for LPIR and HbA1c, and remained associated with lipids after additional adjustment for HbA1c.

Conclusions:
Circulating BCAAs are concurrently associated with biomarkers of inflammation, dyslipidemia and impaired glucose metabolism indicative of an overall poorer cardiometabolic health profile. BCAAs remained positively associated with some of these pathways when adjusted for impaired glucose metabolism, suggesting elevated BCAAs may be an independent CVD risk factor in women.
Abstract 13480: High Density Lipoprotein Promotes Angiogenesis by Suppressing Mir-24-3p Expression
Authors: OU Zhijun , Li Hua-Ming , Mo Zhi-Wei , Peng Yue-Ming , Li Yan , Dai Wei-Ping , Ou Jingsong
Published: May 2021

Introduction:
Previous studies showed that high density lipoprotein (HDL) can stimulate angiogenesis. However, the mechanisms by which HDL promotes angiogenesis remains unclear.

Hypothesize:
HDL may promote angiogenesis by regulating miRNAs expression.

Methods:
HDL was isolated from healthy subjects. Human umbilical vein endothelial cells (HUVECs) were cultured with vehicle or HDL (100 μg/ml), and the differential miRNAs expression were indentified by miRNA array and verified by qRT-PCR. HUVECs were treated with vehicle or HDL (100 μg/ml) with or without miRNAs mimic, endothelial cells proliferation, migration and tube formation were detected. The production of nitric oxide(NO) was measured. The expression and phosphorylation of endothelial nitric oxide synthase (eNOS) was determined.

Results:
The miRNAs profile of HDL-treated HUVECs is significantly different from control group. HDL significantly downregulated miR-24-3p expression. HDL significantly promoted HUVECs proliferation, migration and tube formation. HDL also significantly stimulated NO production and up-regulated the expression and phosphorylation of eNOS. However, HDL did not stimulated HUVECs proliferation, migration, tube formation and NO production as well as the expression and phosphorylation of eNOS after pretreated with miR-24-3p mimic.

Conclusions:
HDL can promote angiogenesis by suppressing miR-24-3p expression.
Abstract 13497: Prognostic Value of the Combination of the Echocardiographic Derived Pulmonary Artery Wedge Pressure and Body Mass Index in Patients With Heart Failure With Preserved Ejection Fraction: Insights From PURSUIT-HFpEF Registry
Authors: Ueda Kumpei , Hikoso Shungo , Nakatani Daisaku D , Tamaki Shunsuke , Yano Masamichi , Hayashi Takaharu , Nakagawa Akito , Nakagawa Yusuke , Yasumura Yoshio , Yamada Takahisa , Sakata Yasushi
Published: May 2021

Background:
An elevated pulmonary artery wedge pressure (PAWP), a surrogate of left ventricular filling pressure, is associated with poor outcomes in patients with heart failure (HF). In addition, obesity paradox is well recognized in HF patients and body mass index (BMI) also provides a prognostic information. However, there is little information available on the prognostic value of the combination of the echocardiographic derived PAWP and BMI in patients with HF with preserved ejection fraction (HFpEF).

Methods and Results:
Patients data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, which is a prospective multicenter observational registry for acute decompensated heart failure (ADHF) patients with HFpEF. We analyzed 548 patients after exclusion of patients undergoing hemodialysis, patients with in-hospital death, missing follow-up data, or missing data to calculate PAWP or BMI. Body weight measurement and echocardiography were performed just before discharge. PAWP was calculated using the Nagueh formula [PAWP = 1.24* (E/e’) + 1.9] with e’ = [(e’
septal
+ e’
lateral
) /2]. During a mean follow up period of 1.5±0.8 years, 86 patients had all-cause death (ACD). Multivariate Cox analysis showed that both PAWP (p=0.020) and BMI (p=0.0001) were significantly associated with ACD, independently of age and previous history of HF hospitalization, after the adjustment with gender, left ventricular ejection fraction, NT-proBNP and estimated glomerular filtration rate. Kaplan-Meier curve analysis revealed that there was a significant difference in the risk of ACD when patients were stratified into 3 groups based on the median values of PAWP (17.3) and BMI (21.4).

Conclusions:
The combination of the echocardiographic derived PAWP and BMI might be useful for stratifying ADHF patients with HFpEF at risk for the total mortality.
Abstract 13534: Reduced Hospitalizations, Emergency Room Vists and Death Among Patients Seen Once in a Heart Failure Bridge Clinic (HFBC) Program
Authors: Upton Addison , Sleater Laura , Bankieis Kaitlyn , Smith LaVone , Trichon Benjamin , Thohan Vinay
Published: May 2021

Introduction:
Multidisciplinary clinics established in the care of heart failure patients are particularly impactful after hospital discharge. Clinical pharmacist integration with HFBC allows focused attention to optimizing guideline directed medical therapies (GDMT). The clinical impact of pharmacist inclusive HFBC requires further evaluation.

Hypothesis:
Patients with a HFBC encounter within 30 days after index heart failure hospitalization have reduced recurrent hospitalization, emergency room visits and mortality.

Methods:
All patients with left ventricular ejection fraction (LVEF) less than 40% obtained within 90 days prior to hospital discharge from Mission Memorial Hospital between 8/2018 and 7/2019 were screened. Patients included in the HFBC arm had a clinic encounter within 30 days of hospital discharge and the remainder of patients comprised the control arm. Electronic and manual chart abstraction was used to assess and follow patients. Baseline characteristics were compared for differences using descriptive statistics. HFBC included clinical assessment, detailed heart failure education, medication reconciliation and adjustment with an emphasis on optimization of GDMT. Patients were followed for 90 day for the primary endpoints of hospitalization, emergency room visit and death

Results:
A total of 1,463 patients (HFBC 307, Control 1156) comprised our final cohort. After accounting for baseline variables associated with endpoints the cumulative rates of hospitalization, emergency room visit or death still favor HFBC compared with controls at 90 days (HFBC 26% vs Control 32%, p=0.03). The 30 and 90 day frequencies of individual endpoints are represented in figure 1.

Conclusions:
Clinical pharmacist integrated HFBC program allows for focused medication review and optimization is associated with 19% risk reduction in hospitalization, emergency room visit and death at 90 days.
Abstract 13537: Similar Long-term Survival in Patients Bridged With Biventricular Devices or Extracorporeal Membrane Oxygenation in the Contemporary Era of Heart Transplantation
Authors: Jaiswal Abhishek , Gadela Naga Vaishnavi , Azmeen Ayesha , Gluck Jason A , Radojevic Joseph , Arora Sabeena , Hammond Jonathan , Ali Ayyaz , Jennings Douglas , Baker William
Published: May 2021

Introduction:
A recent trend favoring donor allocation to sicker patients has led to a rise in the number of patients undergoing heart transplantation (HT) on ECMO or non-dischargeable biventricular mechanical circulatory devices (BiVAD). While suboptimal short-term outcomes of such patients have raised concerns, long-term outcomes are unknown. We examined long-term survival in patients bridged with BiVAD or ECMO in the contemporary era before the donor allocation policy changed.

Methods:
We identified the adult patients listed for HT and bridged with ECMO or BiVAD between 2000 and 2018 in the Scientific Registry of Transplant Recipients. We compared 3- and 5-year survival with the Kaplan-Meier method. Using overlap propensity score weighting, we constructed doubly-robust Cox proportional hazards regression models to determine the risk-adjusted influence of support type on survival.

Results:
Of the 1495 listings; 868 (58.1%) were bridged with BiVAD and 627 (41.9%) with ECMO. 730 underwent successful HT; 528 (72.3%) and 202 (27.7%) were bridged with BiVAD and ECMO, respectively. The ECMO group had higher prevalence of pre-transplant ventilator support (30.7% vs 6.3%, p<0.0001), dialysis (15.8% vs 8.0%, p-0.005), inotrope use (36.6% vs 22.4%, p<0.0001) and a higher IMPACT score (11.5 vs 5.5, p<0.0001). Unadjusted 3- and 5-year estimated survival were similar in BiVAD vs. ECMO patients (Figure). After risk-adjustment, BiVAD and ECMO patients had a similar 3-year (HR 1.32, 95% CI 0.80-2.00; p=0.1849) and 5-year survival (HR 1.31, 95% CI 0.88-1.95; p=0.1878).

Conclusions:
A minority of patients on BiVAD and ECMO underwent HT suggesting high complication and waitlist mortality rates. Besides, the transplantation rate was disproportionately lower in patients on ECMO compared to BiVAD support. Patients with heart failure bridged with BiVAD or ECMO experienced similar long-term outcomes despite worse clinical and hemodynamic profile of patients in the ECMO group.
Abstract 13538: Trends in Utilization and Outcomes of Mechanical Circulatory Support for Patients With Myocarditis
Authors: Edelson Jonathan B , Kamesh Alicia , Faerber Jen , Mondal Antara , Griffis Heather M , Burstein Danielle S , Wittlieb-Weber Carol A , Lin Kimberly Y , Mascio Christopher , Gaynor James W , Chen Jonthan , Fuller Stephanie M , O'Connor Matthew J , Birati Edo , Rossano Joseph W
Published: May 2021

Introduction:
Outcomes of mechanical circulatory support (MCS) to treat myocarditis are not well described.

Hypothesis:
We hypothesize that MCS is increasingly utilized for the treatment of myocarditis and is associated with high morbidity and mortality.

Methods:
This study utilized admissions from the National Inpatient Sample (NIS) from 2012-2016. Patient-encounters with myocarditis were identified using ICD-9/10 codes. Weighted population estimate outcomes comparing encounters with MCS or without MCS were calculated. Mode of MCS was examined and trends in MCS treatment, mortality and morbidity were assessed using logistic regression models.

Results:
Of the 48,965 encounters for myocarditis between 2012 and 2016, 1,910 patients died (3.9%) and 255 (0.5%) underwent transplant. MCS was used in 2,215 patients (4.5%): extra corporeal membrane oxygenation (ECMO) in 590, durable ventricular assist device (VAD) in 150, temporary VAD (tVAD) in 320, and intra-aortic balloon pump (BP) in 770. Over 5 years there was no change in the frequency of MCS and mortality in MCS patients remained stable (p for trends >0.3
).
However, the use of ECMO increased from 23.2% in 2012 to 38.5% in 2016 while BP use decreased from 60.9% to 26.4% (p trend for both <0.05). Mortality (25.5% vs 2.9%), infection (32.7% vs 11.7%), stroke (10.2% vs 2.2%), bleeding events (16.0% vs 2.2%) and arrhythmia (58.9% vs 29.0%), were higher in MCS (p for all <0.0001). Incidence of mortality, stroke, and bleeding differed by mode of MCS support {ECMO (31.2%, 15.3%, 23.7%), BP (18.2%, 4.6%, 7.8%), tVAD (26.6%, 4.7%, 7.8%) and VAD (6.7%, 6.7%, 16.7%) (p for all <0.05)} with ECMO having the highest number of complications.

Conclusion:
MCS is utilized in 5% of patients with myocarditis. ECMO has become the most common support modality, but its use is associated with significant morbidity and mortality. Further evaluation of how patient characteristics influence the MCS type utilized and their impact on outcomes is needed.
Abstract 13546: Chromogranin-A Levels Differentiate Takotsubo From Acute Coronary Syndrome and Congestive Heart Failure in Women: A Single-center Case-control Study
Authors: Tarantino Nicola , Santoro Francesco , Di Biase Luigi , Di Terlizzi Vito , Della Rocca Domenico G , Manheimer Eric D , TRIVEDI CHINTAN , Vitale Enrica , Faggioni Michela , De Leon De La Cruz Nicole S , Di Biase Matteo , Brunetti Natale D
Published: May 2021

Background:
Takotsubo syndrome (TTS) has been reported in up to 10% of women with a clinical presentation suggestive of acute coronary syndrome (ACS), making the differential diagnosis challenging. Chromogranin-A (CgA) is a pro-hormone co-released with catecholamines. Elevated levels of CgA are found in ACS and in exacerbations of congestive heart failure (CHF), indicating an imbalance of the neuroendocrine system.

Hypothesis:
CgA levels in women with TTS might differ from levels in other conditions featuring acute heart failure.

Methods:
We systematically screened CgA levels in 54 consecutive women admitted with TTS (n=29) or either CHF exacerbation or ACS (n=25) between November 2016 and September 2019. Clinical parameters including left ventricle ejection fraction, in-hospital events, troponin I (TnI), creatinine, and natriuretic peptide type B (NT-pro-BNP) values were recorded. Only samples obtained within 24 hours from symptom onset were analyzed. We excluded 18 subjects with TTS and 6 with ACS/CHF because of a history of cancer, chronic kidney disease >III stage, liver cirrhosis, or autoimmune disease.

Results:
Patients with TTS (Group 1, n=11) were compared with patients with ACS/CHF (Group 2, n=19). Subjects in Group 1 were significantly younger (mean age 67 vs 80, p<0.01) and presented with remarkably lower levels of CgA compared to Group 2 (1.57 nMol/l, IQR 0.56-4.6 vs 7.46, IQR 1.1-17.15, normal value <3 nMol/l, p<0.002), even adjusting for confounders such as the use of proton pump inhibitors, hypertension, and renal function. When controlling for age, there was a significant association between being in Group 2 and higher mean levels of CgA (p<0.03). At ROC curve analysis, CgA was the best predictor of TTS vs ACS/CHF when compared with TnI and NT-pro-BNP levels (AUC 0.85, 95% C.I. 0.72-0.98; 0.59, 95% C.I. 0.31-0.86; 0.5, 95% C.I. 0.28-0.72, respectively). CgA levels <5.32 could discriminate TTS from ACS/CHF with positive and negative predictive values of 22 and 100% respectively (accuracy 68%).

Conclusion:
In our population, systemic CgA levels collected within 24 hours from symptom onset were significantly lower in women with TTS compared to ACS/CHF, possibly indicating a different acute neuroendocrine pattern.
Abstract 13549: GP130 Signaling Promotes Right Ventricular Dysfunction in Pulmonary Arterial Hypertension via Microtubules
Authors: Prisco Sasha Z , Hartweck Lynn , Rose Lauren , Thenappan Thenappan , Prins Kurt W
Published: May 2021

Introduction:
Pulmonary arterial hypertension (PAH) is a lethal pulmonary arterial vasculopathy that results in right ventricle dysfunction (RVD). We showed that microtubule-mediated junctophilin-2 (MT-JPH2 pathway) downregulation promotes t-tubule disruption and RVD; however, the upstream regulators of this pathway are unknown. GP130 signaling via its downstream mediator, STAT3 promotes microtubule remodeling in neonatal cardiomyocytes. However, the relationship between GP130 signaling and the MT-JPH2 pathway in RVD are unknown.

Methods:
Immunoblots of RV extracts were probed for the GP130 and the MT-JPH2 pathways in MCT rats treated with a GP130 antagonist (2 weeks after MCT injection). Quantitative mass spectrometry analyzed the microtubule associated protein (MAP) fraction of RV extracts. Echocardiography and invasive closed-chest right heart catheterization quantified RV function and pulmonary vascular disease. Pulmonary vasculature remodeling was assessed by H&E histology. Finally, the relationship between the GP130 agonist, interleukin (IL)-6, and RVD in PAH patients was examined.

Results:
GP130 antagonist treatment blunted RV STAT3 activation, normalized the MT-JPH2 pathway, and restored t-tubule architecture. Hierarchical cluster analysis and principal component analysis of 2842 proteins identified using mass spectrometry revealed normalization of the MAP-fraction with GP130 antagonist treatment. These molecular changes manifested as improved RV function, improved RV-pulmonary artery coupling, blunted RV hypertrophy, and improved survival despite no differences in pulmonary vascular disease severity. In PAH patients, higher IL-6 levels were associated with higher N-terminal pro-brain natriuretic peptide and lower RV fractional area change despite no differences in pulmonary vascular disease burden.

Conclusions:
Small molecular inhibition of GP130 enhances RV function, and improves survival in MCT PAH via modulation of the MT-JPH2 pathway.
Abstract 13550: Understanding Associations of Hospital Admission or Observation With Patient Outcomes After Emergency Department Evaluation for Suspected Acute Coronary Syndrome
Authors: Sharp Adam L , Kawatkar Aniket A , Baecker Aileen S , Redberg Rita F , Lee Mingsum , Ferencik Maros , Wu Yi-Lin , Shen Ernest , zheng chengyi , Park Stacy J , Sun Benjamin C
Published: May 2021

Introduction:
Evaluation for suspected acute coronary syndrome (ACS) results in millions of emergency department (ED) visits annually, and accounts for billions in health care costs. Understanding the benefits of hospitalization among patients who ruled out for an acute myocardial infarction (AMI) will inform physician decision making and future health care policies.

Hypothesis:
Hospital admission does not improve 30-day patient outcomes (death/AMI) compared to those discharged after ED evaluation for suspected ACS.

Methods:
We compared the effectiveness of hospitalization vs outpatient follow-up for a cohort of patients with chest pain presenting to one of 13 EDs within the Kaiser Permanente Southern California region between January 1, 2015 and December 1, 2017. The primary outcome was AMI or all-cause mortality, and secondary outcomes included revascularization and a composite MACE outcome within 30-days of ED visit. Adjusting for patient age, gender, race, ACS risk factors and chronic co-morbidities an instrumental variable (IV) analysis was used to evaluate the effect of hospitalization on patient outcomes

Results:
Of 77,562 chest pain patient encounters not identified as an AMI during the ED encounter, 322 (0.4%) went on to have an AMI (n=193, 0.2%) or died (n=137, 0.2%) within 30-days of ED visit (1.5% admitted vs 0.2% discharged). This included 200 (0.3%) patients who underwent coronary revascularization (0.7% admitted vs 0.2% discharged). IV analysis found no adjusted differences in 30-day patient outcomes between the hospitalized cohort and those discharged (risk reduction 0.002, 95% CI -0.002 to 0.007). Similarly, there were no differences in coronary revascularization (risk reduction 0.003, 95% CI -0.002 to 0.007).

Conclusions:
Among ED patients with chest pain who are not identified with an AMI, there does not appear to be a benefit in 30-day outcomes for patients who are hospitalized compared to those discharged with outpatient follow-up.
Abstract 13572: The Effects of Baseline Thrombocytopenia on Post-procedural Bleeding and Thrombotic Outcomes of Left Atrial Appendage Closure With Watchman Device
Authors: Chao Chiehju , Chiang Chia-chun , Agasthi Pradyumna , Girardo Marlene , Arsanjani Reza , Holmes David R , Alkhouli Mohamad Adnan , Friedman Paul , Pollak Peter , Yang Eric
Published: May 2021

Background:
Left atrial appendage occlusion (LAAO) devices have successfully provided an alternative therapeutic option in patients with atrial fibrillation and high bleeding risk. However, patients with thrombocytopenia (TP) were underrepresented in the milestone trials, and the optimal strategy of postprocedural antithrombotic therapy in this group of patients remains unclear.

Methods:
Patients were identified from the National Cardiac Database Registry - LAAO database at all three Mayo Clinic sites in the period from 1/2016-10/2019. Patients were further divided into TP (platelet < 150 x 10^9/L) and control (platelet > 150 x 10^9 /L) groups for clinical outcome analysis. Outcome endpoints include composite of bleeding (GI bleeding, hemorrhagic stroke, and other non-intracranial hemorrhage) and composite thrombotic events (device thrombus, ischemic stroke, TIA and undetermined stroke).

Results:
A total of 249 consecutive patients were included in the final analysis. The mean age was 76.7 ± 7.2 years, and 169 (67.9%) were male; 242 (97.2%) were white. The mean CHA2DS2-VASc score was 5.3 ±1.5, and the HAS-BLED score was 3.0 ± 1.1. TP at baseline was present in 74 (29.7%) patients. The median follow-up time was 6.8 months. The use of post-procedural antithrombotic regimens was similar between the two groups (Table 1). When comparing the TP group to control, there was no significant difference in composite bleeding events (10.8% vs. 8.0%, P = 0.069) and thrombotic events (2.7% vs. 2.3%, P= 0.170).

Conclusions:
The presence of baseline TP does not significantly increase post-procedural bleeding risk in atrial fibrillation/atrial flutter patients who underwent an LAAO occlusion procedure with the Watchman device (Boston Scientific). This group of patients can be treated with the same antithrombotic regimen as patients with normal platelet levels. Future studies are still warranted to determine the optimal antithrombotic regimen.
Abstract 13770: Experiences of Ethnic Discrimination and COMT Val158Met Polymorphism Are Associated With Depressive Symptoms in Hispanic Adults at Risk for Cardiovascular Disease
Authors: Key Kaitlin V , Estus Steven , Lennie Terry A , Linares Ana Maria , Mudd-martin Gia
Published: May 2021

Introduction:
There is emerging evidence that ethnic discrimination, commonly experienced among U.S. Hispanics, is associated with depressive symptoms, increasing cardiovascular disease (CVD) risk. Genetic variants in dopaminergic pathways may moderate this association. The
catechol-O-methyltransferase
Val158Met polymorphism is a potential candidate because the Met allele is associated with increased risk for depressive symptoms. The purposes of this study were to examine associations among ethnic discrimination, Val158Met polymorphism, and depressive symptoms, and to explore if Val158Met moderates the association between discrimination and depressive symptoms in Hispanic adults.

Methods:
Participants were 124 Hispanic adults with 2+ CVD risk factors. Ethnic discrimination was measured with the Experiences of Discrimination instrument, which measures discrimination experiences across 9 settings (e.g. at work). Scores range from 0 to 45; higher scores indicate more experiences of discrimination. Depressive symptoms were measured using the Patient Health Questionnaire-8. Scores range from 0 to 21; higher scores indicate more depressive symptoms. DNA was isolated from saliva and analyzed for Val158Met genotype. A hierarchical linear regression was conducted adjusting for sex, age, income, education, acculturation, and years in the U.S. Discrimination was entered in Step 1 and Val158Met in Step 2 to examine the association with depressive symptoms. To assess moderation, a discrimination*Val158Met interaction term was entered in Step 3.

Results:
Participants were aged 40.2 ± 9.3 years and mostly female (74.2%). Discrimination was positively associated with depressive symptoms (p = 0.041). Participants with at least one Met allele at the Val158Met polymorphism had more depressive symptoms than those with a Val-Val genotype (p = 0.049). No moderation effect was found.

Conclusion:
Findings suggest that discrimination and Val158Met genotype independently influence depression in Hispanic adults, which may increase risk for depression and CVD in certain individuals. This highlights the need to explore mechanisms underpinning these associations, and to address the impact of discrimination on depression and CVD disparities.
Abstract 13773: Applied Behavior Change Techniques in Self-care Interventions for Patients With a Chronic Condition
Authors: Riegel Barbara , Westland Heleen , Iovino Paolo , Barelds Ingrid , Bruins Slot Joyce , Stawnychy Michael A , Osokpo Onome H , Tarbi Elise , Trappenburg Jaap , Vellone Ercole , Stromberg Anna , JAARSMA Tiny
Published: May 2021

Introduction:
Self-care requires behavior change in patients and healthcare providers play a pivotal role in supporting those changes. Examination of the behavior change techniques used by providers in self-care interventions can provide insights into how self-care behavior is enhanced in patients with a chronic condition.

Objective:
To quantify the behavior change techniques used to enhance healthy behavior in self-care interventions for patients with a chronic condition.

Methods:
Studies from a scoping review (n=233) were reviewed to identify behavior change techniques used in studies testing self-care interventions in adults with nine chronic conditions, most of which were CVDs. All studies were published between January 2008 and January 2019. Nine techniques from the Behavior Change Technique Taxonomy V1 (with 93 consensually agreed, distinct techniques) were selected for review because they are commonly used by a broad range of disciplines and have previously been shown to influence behavior change.

Results:
The 233 studies represent 59,950 patients, mean age 59.5 (±8.3) years, 44% female. Study sample sizes ranged from 24 to 2,445 patients. Most studies focused on DM2 (n=85; 36%), HTN (n=32; 14%) or HF (n=27; 12%). Most interventions targeted only patients (n=207; 89%). Goal setting (n=113; 48%) and problem solving (n=92; 40%) were the behavior change techniques used predominantly. Action planning, feedback and review of behavioral goals were used in 46-60 (20%-26%) studies and most commonly in patients with DM2 or CAD and rarely in patients with HTN or HF. Information about health consequences was used in 46 (20%) studies. Social support (n=17; 7%) and reminders (n=13; 6%) were rarely used.

Conclusions:
Few behavior change techniques were specified in the published self-care intervention trials. In future research, behavior change techniques and the associated mechanisms of actions need to be specified to support self-care intervention research.
Abstract 13776: The Impact of Race on In-hospital Quality of Care Among Young Adults With Acute Myocardial Infarction
Authors: Benea Diana , Raparelli Valeria , behlouli hassan , Pilote Louise , Dryer Rachel
Published: May 2021

Introduction:
The extent to which race influences in-hospital quality of care among young adults with acute myocardial infarction (AMI) is unknown. We examined racial differences in in-hospital quality of AMI care in young adults and described the patient and/or clinical characteristics associated with potential disparities in care.

Methods:
Data from the GENESIS-PRAXY (Canada) and the VIRGO (U.S.) prospective cohorts of young adults with AMI were analyzed. Among a total of 4,048 adults with AMI (≤55 years) (median=49 years [IQR 44-52], 22% non-white, 58% women), we calculated an in-hospital quality of care score (QCS) for AMI (quality indicators divided by total, with higher scores indicating better care) based on AHA quality of care standards, reporting data disaggregated by race. We categorized race as white versus non-white, which included Black, Asian and North American Indigenous populations.

Results:
This cohort was comprised of 906 non-white individuals and 3142 white individuals. Non-white adults exhibited a clustering of adverse cardiac risk factors, psychosocial risk factors and comorbidities versus whites; they had higher rates of hypertension, diabetes, alcohol abuse and prior AMI and lower rates of physical activity. They were more likely to have a low SES and receive low social support, and were less likely to be employed, a primary earner, or married/living with a partner. Non-white individuals were also more likely to experience a NSTEMI and less likely to receive cardiac rehabilitation, smoking cessation counseling as well as dual antiplatelet therapy at discharge. Furthermore, non-white individuals had a lower crude QCS than whites (QCS=69.99 vs 73.29, P-value<0.0001). In the multivariable model adjusted for clinical and psychosocial factors, non-white race (LS Mean Difference=-1.49 95%CI -2.87, -0.11, P-value=0.0344) was independently associated with a lower in-hospital QCS.

Conclusion:
Non-white individuals with AMI exhibited higher rates of adverse psychosocial and clinical characteristics than white individuals yet non-white race was independently associated with lower in-hospital quality of care. Interventions are needed to improve quality of AMI care in non-white young adults.
Abstract 13795: Race and Gender Differences in Mortality From Atrial Fibrillation in the United States: 1999 to 2018
Authors: Parvez Arshi , Salciccioli Justin , DeLago Augustin , Shalhoub Joseph , Hartley Adam , Marshall Dominic , Goodall Rick , Hammond-Haley Matthew , Essa Mohammed , Philips Binu
Published: May 2021

Objective:
To assess differences in mortality trends from atrial fibrillation (AF) among different races and genders in the United States (US).

Background:
AF is the most common sustained cardiac arrythmia in the US. No up to date analysis has assessed AF mortality trends by race and gender across the US.

Methods:
For this observational analysis US AF mortality data from 1999 to 2018 for individuals >45 years of age were extracted from the CDC WONDER database. International Classification of Diseases code I48 was used to define AF. Mortality data were age-standardized to the US 2000 standard population, and stratified by gender and race (Caucasian, Black, Asian). Joinpoint regression analysis was used to assess for significant changes in trends over the observation period, and provide estimated annual percentage changes (EAPC)s with 95% confidence intervals (CIs).

Results:
From 1999 to 2018, the mortality rate per 100,000 population, increased significantly from 3.7 to 8.3 (+124%, the greatest increase observed) amongst Asian men (AM), from 5.4 to 10.8 (+100%) amongst Black men (BM), and from 9.2 to 19.2 (+108%) amongst Caucasian men (CM). Mortality increases, per 100,000 population, were seen from 4.0 to 7.4 (+85%, the smallest increase observed) in Asian women (AW), 5.3 to 12.8 (+121%) in Black women (BW), and 8.9 to 19.7 (+121%) in Caucasian women (CW) over the same time period. Joinpoint analysis demonstrated significant increasing AF mortality trends for both genders and all races studied. AW had the highest EAPC of 8.6 (95% CI 6.0-11.3) between 1999-2008, which slowed to 2.2 (95% CI 0.1-4.3) between 2009-2018. AM followed a similar EAPC pattern: 7.7 (95% CI 5.7-9.8) between 1999-2008, decreasing to 0.5 (95% CI -1.1-2.2) between 2009-2018. Between 1999-2018, EAPCs increased for BW (3.8, 95% CI 3.2-4.4), CW (4.4, 95% CI 4.0-4.8), BM (4.0, 95% CI 3.4-4.6) and CM (4.8, 95% CI 4.4-5.2).

Conclusion:
Between 1999 and 2018, there are increasing AF mortality trends amongst both genders and all races, with Caucasians having the greatest overall increases during the observation period. EAPCs demonstrate that the rates of increases in AF mortality are greatest in Caucasians, followed by Asian then Black Americans.
Abstract 13820: Temporal Trends and Prognosis of Physical Exam Findings in Patients Hospitalized With Acute Decompensated Heart Failure With Preserved versus Reduced Ejection Fraction the Aric Study Community Surveillance
Authors: Kolupoti Abhigna , Pandey Ambarish , Kucharska-newton Anna , Hall Michael E , Vaduganathan Muthiah , Mentz Robert J , Caughey Melissa
Published: May 2021

Introduction:
Bedside evaluation of congestion remains important in both heart failure (HF) with reduced and preserved ejection fraction (HFrEF and HFpEF). Whether presence of physical exam findings have changed over time, or if prognosis of physical examination differs by HF type is uncertain.

Methods:
From 2005-2014, the Atherosclerosis Risk in Communities (ARIC) Study conducted hospital surveillance of acute decompensated heart failure (ADHF). Events were verified by physician review, and clinical data were abstracted from the medical record. We examined presence of 3 physical exam findings suggesting congestion: lower extremity edema, jugular venous distension, and pulmonary rales > 1/3 of the lung field. Analyses were weighted by sampling fractions.

Results:
Of 24,937 hospitalizations for ADHF (mean age 75 years, 53% women, 32% black), 47% were HFpEF. Presence of edema increased from 2005-2009 to 2010-2014, both for HFpEF (66% to 72%;
P
for annual trend = 0.002) and HFrEF (62% to 67%;
P
for annual trend = 0.009), while presence of rales and jugular distention remained stable. There were 2640 (11%) and 7766 (31%) deaths within 28 days and 1 year of hospitalization, respectively. Patients with HFpEF and all 3 physical exam signs had a greater risk of short- and long-term mortality (
Figure
). After adjustments for demographics and length of stay, there was a differential association between clinical signs and 28-day mortality by HF type (
P
for interaction = 0.02). Presence of all 3 vs. <3 signs was associated with increased mortality for HFpEF (HR = 2.22; 95% CI: 1.51 - 3.27) but not HFrEF (HR = 1.13; 95% CI: 0.79 - 1.61). A similar association was observed for 1-year mortality (HFpEF: HR = 1.49; 95% CI: 1.13 - 1.98) vs. (HFrEF: HR = 1.13; 95% CI: 0.91 - 1.40).

Conclusion:
The presence of edema on physical examination of patients with ADHF has increased in recent years, both for HFpEF and HFrEF. However, the prognostic utility of physical exam signs of congestion may differ by HF type.
Abstract 13829: Index Event, Clinical Outcomes and Response to Vericiguat in the Victoria Trial
Authors: Lam Carolyn , Sliwa Karen S , Giczewska Anna , Anstrom Kevin , Edelmann Frank , Refsgaard Jens , Bocchi Edimar A , Ezekowitz Justin , Hernandez Adrian F , O'Connor Christopher , ROESSIG Lothar , Patel Mahesh J , Pieske Burkert , Armstrong Paul W
Published: May 2021

Introduction:
The VICTORIA (Vericiguat Global Study in Subjects with HF with Reduced EF) trial included 5050 patients in 3 discrete subgroups reflecting their index worsening heart failure (HF) event: <3 months after HF hospitalization (HFH) (n=3366), 3-6 months after HFH (n=871), and those requiring IV diuretic therapy without HFH within the prior 3 months (n=813). We evaluated clinical characteristics, outcomes and treatment response to vericiguat across these index event subgroups in VICTORIA.

Methods:
We compared primary composite (CV death and HFH) and secondary (all-cause death and HFH) outcomes across index event subgroups, both before and after adjusting for clinical covariates (HF duration, NYHA class, medical history, heart rate, HF medications and laboratory values including baseline NT-proBNP), as well as their response to vericiguat.

Results:
Baseline characteristics were balanced between treatment arms within each subgroup. Over a median follow up of 10.8 months, the absolute primary event rates were high in all subgroups (20.5 - 42.5 per 100 patient-years, Figure). Compared to the IV diuretic group highest relative risk was in HFH <3 months (HR 1.69, 95% CI 1.46-1.95), followed by HFH 3-6 months (HR 1.26, 95% CI 1.06-1.50). After multivariable adjustment, this difference remained significant only in HFH <3 months (adjusted HR [vs IV diuretic] 1.47, 95% CI 1.26-1.72). Vericiguat was associated with reduced risk of the primary outcome overall (HR 0.90, 95% CI 0.82-0.98) and in all 3 subgroups, with no evidence of treatment heterogeneity. Similar results were evident for the secondary composite outcome.

Conclusions:
Among patients with worsening chronic HF, those within a 3 month window of HFH had almost a 1.5 times risk of CV death or HFH compared to those requiring IV diuretics
but not HFH
, irrespective of age or clinical risk factors. Vericiguat added to standard therapy was associated with similar benefit across the spectrum of risk in worsening HF.
Abstract 13835: Anti-inflammatory Effect of Rosuvastatin in Patients With HIV Infection: A Randomized Controlled FDG-PET Study
Authors: Boczar Kevin E , Faller Elliott , Wang Jerry , Zeng Wanzhen , Small Gary R , Corrales-Medina Vicente , deKemp Robert , Ward Natalie , Beanlands Rob S , MacPherson Paul , Dwivedi Girish
Published: May 2021

Introduction:
Cardiovascular disease (CVD) is a major source of morbidity and mortality in HIV+ patients, which is thought to be in part due to a state of persistent systemic inflammation that results in accelerated atherosclerosis.

Hypothesis:
We hypothesized that inflammation, as measured by 18F-fluorodeoxyglucose (18F-FDG) uptake measured by 18F-FDG positron emission tomography/computed tomography (18F-FDG-PET/CT) in the bone marrow, spleen and thoracic aorta would improve in HIV+ patients following therapy with rosuvastatin compared to HIV+ patients not receiving a statin.

Methods:
HIV+ patients with a moderate Framingham risk score were enrolled in the study and randomized to treatment with rosuvastatin or usual treatment for 6 months. Patients were matched for age, sex, smoking status, Framingham risk score, duration of anti-retroviral therapy (ART) and type of ART. Fasting blood was collected and 18F-FDG-PET/CT imaging of bone marrow, spleen, and thoracic aorta was performed at baseline and 6 months.

Results:
Thirty-five HIV+ patients were enrolled in the study; 17 were randomized to treatment with rosuvastatin and 18 were randomized to the control group. There was a significant drop in the 18F-FDG bone marrow, spleen and thoracic aortic uptake in the statin-treated group compared to the control group (bone marrow: -10.3±16.9% versus 5.0±18.9%, p=0.0262; spleen: -9.8±20.3% versus 11.3±28.8%, p=0.0497; thoracic aorta: -8.6±24.5% versus 12.6±29.5%, p=0.0343). 18F-FDG changes over the study period are shown in Figure 1.

Conclusions:
The present study observed a significant decrease in 18F-FDG-PET uptake in the bone marrow, spleen, and thoracic aorta following treatment with rosuvastatin for 6 months in HIV+ patients. These data suggest a wide-range anti-inflammatory effect of rosuvastatin in HIV+ individuals with well-controlled infection on ART, ultimately resulting in decreased inflammatory activity in the arterial walls of these patients.
Abstract 13843: Icd Therapy After the First Primary-Prevention Implantable Cardioverter-Defibrillator Battery Change-out
Authors: Buck Benjamin H , Kellett Eric , Elgazzar Rana , Ward Chad , Kahaly Omar , Osei Jemina , Singh Prabhpreet , Weiss Raul , Tyler Jaret , Afzal Muhammad , Augostini Ralph S , Kalbfleisch Steven J , Hummel John , Okabe Toshi , Daoud Emile G , Houmsse Mahmoud
Published: May 2021

Background:
Implantable cardioverter-defibrillator (ICD) therapy prevents sudden cardiac death in selected patients with heart failure. When a primary prevention ICD arrives at elective replacement interval (ERI), conventional management is to replace the device. However, the effectiveness of ICDs in patients with nonischemic and ischemic cardiomyopathy (NICM and ICM, respectively) whose left ventricular ejection fraction (LVEF) improved to ≥50% before replacement is unclear.

Hypothesis:
The therapeutic benefit of primary prevention ICD for NICM is attenuated by the recovery of LVEF at the time of ERI.

Methods:
Consecutive patients presenting for first time primary prevention ICD battery change-out at a single quaternary care center between 1/1/2008 and 6/27/2019 were included. The primary endpoint was the rate of ICD therapy (ICD discharge and anti-tachycardia pacing) according to LVEF recovery at ERI.

Results:
During the study period 6851 ICDs were placed, of which 310 underwent battery change-out, of whom 100 did not receive therapy from the first ICD, of whom 44 had NICM. The demographics of the NICM cohort are in the table. Following ERI, 0 (0%) with NICM and recovered LVEF had received ICD therapy, whereas 13 (30%) with persistently low LVEF had received therapy (p = 0.07). Furthermore, among patients without recovered LVEF, the NICM group had a lower rate of therapy (4, 12%) than the ICM group (12, 32%) (p=0.04).

Conclusion:
Rates of ICD therapy provided by primary prevention ICD after first battery change out trended towards a significantly lower rate in NICM patients with LVEF that recovered to ≥50% than those without LVEF recovery. No other patient demographic significantly predicted therapy-free survival but the analysis was limited by sample size. A prospective study with a larger cohort would be necessary to better estimate therapy-free survival.
Abstract 13852: Socioeconomic Status is Associated With Recurrent Cardiovascular Disease Events in People With Prevalent Cardiovascular Disease
Authors: Mathews Lena , Ding Ning , Mok Yejin , Loop Matthew S , Collison Amira , Crews Deidra , Rosamond Wayne D , Lakshminarayan Kamakshi , Koton Silvia , Kucharska-newton Anna , Chang Patricia , Coresh Josef , Matsushita Kunihiro , Ndumele Chiadi E
Published: May 2021

Introduction:
While low socioeconomic status (SES) is an established risk factor for incident cardiovascular disease (CVD), there is scarce data regarding the association between SES and recurrent CVD events.

Hypothesis:
SES measures are associated with recurrent CVD events and mortality among those with prevalent CVD.

Methods:
We examined 3,031 individuals in the ARIC Study who developed CVD (either myocardial infarction [MI], heart failure [HF] or stroke) from the baseline visit (1987-1989) through 2013 to allow 5 years follow-up for recurrent CVD. SES was defined using baseline measures of income, education and area deprivation index (ADI), modeled individually and combined in a cumulative SES score. We used adjusted Cox proportional hazard regression to evaluate the associations of SES with composite and individual outcomes of first recurrent CVD and mortality.

Results:
Median age was 69 years, 49% were female, 29% Black. Over a median follow up of 4.6 years, 2,033 participants (67%) had a recurrent CVD event, and 2,202 (73%) died. Relative to the highest income group, being in the lowest income group was associated with higher risk for recurrent CVD (HR 1.27; 95% CI: 1.07-1.51) and mortality (HR 1.32; 95% CI: 1.12-1.56) (
Table
). Similarly, less than high school education was associated with increased risk of recurrent CVD (HR 1.25; 95% CI: 1.04-1.51) and mortality (HR 1.21; 95% CI: 1.01-1.45). No significant outcome associations were seen for ADI. Low cumulative SES was associated with approximately 20% higher risk of recurrent CVD, total mortality and the composite of recurrent CVD and mortality. Similar patterns were seen for individual subtypes of CVD, with the strongest SES-mortality associations for MI and stroke.

Conclusions:
In the high-risk group of individuals with existing CVD, low SES was linked to greater likelihood of recurrent CVD events and death. SES should be a focus in the design of secondary prevention efforts to improve outcomes in CVD.
Abstract 13880: A Novel, Evidence-based, Standardized Discharge Checklist Reduces Thirty Day Heart Failure Readmissions in an Urban Safety Net Hospital
Authors: Marano Paul J , Steverson Alexandra B , Chen Caren , Ma Yifei , Stern Rachel J , Davis Jonathan , Hsue Priscilla , Zier Lucas S
Published: May 2021

Introduction:
Safety net hospitals are more likely to be penalized for heart failure (HF) readmissions. There is limited evidence as to whether readmission reduction strategies are effective in this setting. We hypothesized that a discharge checklist would reduce readmissions in an urban safety net hospital.

Methods:
We implemented a novel HF discharge checklist in an academic safety net hospital in San Francisco from October 2018 to April 2019. The checklist included 1) achievement of euvolemia based on physical exam, 2) prescription of guideline-directed medical therapy, and 3) establishment of scheduled follow-up within 7 days of discharge. All HF patients who were discharged with the checklist in the 6 month study period were retrospectively compared to all HF patients discharged in the 6 months prior to the implementation of the checklist. The primary outcome was the 30-day readmission rate and multivariate modeling was used to assess the significance of each checklist component.

Results:
Demographics were similar between the intervention (n=118) and control (n=265) groups. Of all 383 patients, mean age was 60±13 years, 102 (27%) patients were women, 170 (44%) were black, 88 (23%) were latinx, 127 (33%) were not housed, 208 (54%) used illicit substances, and 289 (76%) had ejection fraction ≤ 40%. Use of the checklist was associated with a 13.3% absolute reduction in the 30-day readmission rate (33.6% vs 20.3%, p=0.009). The intervention group was more likely to be discharged on guideline-directed medical therapy (54% vs 25%, p<0.0001) including beta blockers (89% vs 71%, p<0.0001), ACEI/ARBs (88% vs 66%, p<0.0001) and MRAs (50% vs 23%, p<0.0001). The intervention group was also more likely to have scheduled follow-up within 7 days (70 vs 58%, p=0.02). There was no difference between the groups in achievement of euvolemia. In all patients, multivariate analysis adjusted for demographics and insurance status demonstrated that the prescription of guideline-directed medical therapy was associated with lower risk of readmission (OR 0.31, 0.15-0.64).

Conclusions:
A novel, inexpensive discharge checklist increased the prescription of guideline-directed medical therapy and significantly reduced 30-day HF readmissions in a safety net hospital.