bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 98: Personal and Community Barriers to a Heart-healthy Lifestyle in Women
Authors: Parashar Sonya , Hui SK Azor , Vacek James L , Simmons Ashley
Published: July 2021

Background:
Though heart disease is the leading killer of women in the United States, many of them are unaware of their individual risks. Studies have shown that awareness of cardiovascular disease risk correlates with positive behavior changes, including increased physical activity and weight loss, leading to a heart-healthy lifestyle. The purpose of this study was to assess women’s awareness of their heart disease risk and barriers to starting heart healthy behaviors, such as improved diet and exercise.

Methods:
The Change of Heart (COH) Program at the University of Kansas Hospital conducted a self-reported assessment on women’s perceived barriers to leading heart-healthy lifestyle. Participants (N = 157) of this study were recruited from Mid-America Cardiology and their age ranged from 29 to 78 years (M = 53 years). Additionally, participants had an average education level of college and above and the median income was greater than $60,000. The assessment included questions regarding family and other care giving responsibilities, personal perception of heart disease risk, availability of indoor exercise facilities, and community access to fresh fruit and vegetables.

Results:
The three most common personal barriers amongst this population were family and other care giving obligations (87%), not perceiving oneself to be at risk for heart disease (63%), and feeling too stressed to accomplish one’s tasks (51%). Additionally, the three most common community barriers were a lack of nutritional information posted on restaurant menus (32%), not having access to indoor exercising facilities (17%), and not having access to support groups, such as weight management, smoking cessation (13%). When participants were asked what their intentions to make lifestyle changes to lower heart disease risk, 66% answered either an 8 or 9 on a scale of 0 (no intention) to 10 (most intention); however, 21% of women did not or occasionally did not believe they had control over their health conditions. The majority of participants had access to fresh fruits and vegetables (66%), to smoke free restaurants and public facilities (75%), and to safe, outside, public exercises areas (61%).

Conclusion:
In this well-educated cohort of women, the most common barrier to leading a heart-healthy lifestyle was lack of time due to family obligations. Most women were aware that women in general needed to make healthy changes in their lives, but they did not personalize their risk. This study suggests that women, even with available resources, need to be assessed, reminded, and encouraged to develop behavioral skills and strategies (e.g. time management) to incorporate heart healthy behaviors into their lifestyle.
Abstract 10: Predictors of Poor Outcome in Acute Ischemic Stroke Patients after Successful Recanalization
Authors: Starosciak Amy K , Linfante Italo , Walker Gail , Zaidat Osama O , Castonguay Alicia C , Lin Eugene , Dabus Guilherme ,   NASA Investigators
Published: July 2021

Background:
Recanalization of the occluded artery is a powerful predictor of good outcome in acute ischemic stroke secondary to large artery occlusions. Mechanical thrombectomy with stent-trievers results in higher recanalization rates and better outcomes compared to previous devices. However, despite successful recanalization rates (Treatment in Cerebral Infarction, TICI, score ≥ 2b) between 70 and 90%, good clinical outcomes assessed by modified Rankin Scale (mRS) ≤ 2 is present in 40-50% of patients . We aimed to evaluate predictors of poor outcomes (mRS > 2) despite successful recanalization (TICI ≥ 2b) in the acute stroke patients treated with the Solitaire device of the North American Solitaire Stent Retriever Acute Stroke (NASA) registry.

Methods:
The NASA registry is a multicenter, non-sponsored, physician-conducted, post-marketing registry on the use of SOLITAIRE FR device in 354 acute, large vessel, ischemic stroke patients. Logistic regression was used to evaluate patient characteristics and treatment parameters for association with 90-day mRS score of 0-2 (good outcome) versus 3-6 (poor outcome) within patients who were recanalized successfully (Thrombolysis in Cerebral Infarction or TICI score 2b-3). Univariate tests were followed by development of a multivariable model based on stepwise selection with entry and retention criteria of p < 0.05 from the set of factors with at least marginal significance (p ≤ 0.10) on univariate analysis. The c-statistic was calculated as a measure of predictive power.

Results:
Out of 354 patients, 256 (72.3%) were successfully recanalized (TICI ≥ 2b). Based on 90-day mRS score for 234 of these patients, there were 116 (49.6%) with mRS > 2. Univariate analysis identified increased risk of mRS > 2 for each of the following: age ≥ 80 years (upper quartile of data), occlusion site other than M1/M2, NIH Stroke Scale (NIHSS) score ≥ 18 (median), history of diabetes mellitus (DM), TICI = 2b, use of rescue therapy, not using a balloon-guided catheter (BGC) or intravenous tissue plasminogen activator (IV t-PA), and time to recanalization > 30 minutes (all p ≤ 0.05). Three or more passes was marginally significant (p=0.097). In multivariable analysis, age ≥ 80 years, site other than M1/M2, initial NIHSS ≥18, DM, absence of IV t-PA, use of rescue therapy and three or more passes were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index = 0.80).

Conclusions:
Age, occlusion site, high NIHSS, diabetes, not receiving IV t-PA, use of rescue therapy and three or more passes, were associated with poor 90-day outcome despite successful recanalization.
Abstract 132: The POWR Survey: Patient and Physician Perspectives on Outcomes Weighting in Revascularization.
Authors: Pandit Jay A , Gupta Vipul , Boyer Nathan , Ports Thomas A , Yeghiazarians Yerem , Boyle Andrew J
Published: July 2021

Objective:
To better understand and compare how patients and physicians weight adverse outcomes of coronary revascularization.

Background:
One in every twenty American adults is living with coronary heart disease. Given the high prevalence, approximately one million percutaneous coronary interventions (PCI) and half a million coronary artery bypass grafting (CABG) procedures are performed each year. The decision between PCI and CABG is based on studies that have looked at differences in major adverse cardiac events (MACE) in various populations. While the outcomes included in the MACE category are impactful, they are selected by physicians and do not include all possible adverse outcomes of coronary revascularization that affect patients. With so many Americans facing the clinical impact of coronary revascularization we wished to see if patients and physicians align in the weighting of twenty outcomes of coronary revascularization that have been identified.

Methods:
1500 physicians (500 internists, 500 cardiologists and 500 cardiac surgeons) and 54 patients were invited to fill out a survey over a 12 month period. Patients were approached upstream of diagnostic catheterization. Physicians were invited through an AMA database licensee. All responders were asked to use a rating scale to weight twenty outcomes of coronary revascularization.

Results:
54 patient and 57 physician (20 internists, 19 cardiologists and 18 cardiac surgeons) responses were received. Patients weighted stroke the highest (8.83/10), while physicians weighted death the highest (8.63/10). Patients and physicians differed (p<0.01) on myocardial infarction (physicians 6.59, patients 8.13), atrial fibrillation (physicians 4.28, patients 6.67), acute respiratory distress syndrome (ARDS) (physicians 5.94, patients 7.44), pseudoaneurysm (physicians 4.45, patients 6.23), post-operative chronic pain (physicians 5.20, patients 6.38) and procedural cost (physicians 4.22, patients 3.18). Notably patients weighted ARDS, renal failure, major bleeding, atrial fibrillation, mediastinits, post-operative chronic pain, post-procedural angina, pseudoaneurysm, long term plavix and pneumonia heavier than repeat PCI, another commonly used outcome for MACE.

Conclusions:
Patients and physicians agree on which outcomes are most (death and stroke)and least impactful (incision scar), but there is a lot of variability in between supporting the reporting of more adverse outcomes and not just those included in MACE.
Abstract 134: Influence of Predictive Modeling in Implementing Optimal Heart Failure Therapy in Inpatient setting
Authors: Prasad Hari , Choudhary Gujan , Fahad Ali , Stapleton Dwight
Published: July 2021

Background:
A gap remains between evidence-based guidelines in the treatment of heart failure and current pharmacologic and device therapy. The Seattle Heart Failure Model is an accurate predictive tool that allows the clinician to quantitatively assess the influence of pharmacologic and device therapy on heart failure that has been validated in outpatient setting. We attempt to use the Seattle Heart Failure Model in optimizing the heart failure therapy.

Methods:
We examined 405 patients’ charts who were admitted with a diagnosis of acute systolic heart failure or acute on chronic systolic heart failure with left ventricular ejection fraction ≤ 40%. Twenty-one data elements were entered into the Seattle Heart Failure Model to create a survival estimate before and after implementation of interventions known to be beneficial, both pharmacologic (addition of ACE/ARB, statin, β-blocker, aldosterone blocker) and device-based (consideration for AICD, BiV pacer, BiV ICD).

Results:
The mean age of the population examined was 77 ± 9 years. The cohort was comprised of 72 % males, mean weight 89 ± 22.5kg, with NYHA class 2.4 ± 0.6 symptoms. Ischemic etiology was identified in 86% with a mean left ventricular EF of 29.8 ± 9 %. Laboratory data included mean Hgb 10.1 ±1.5g/dL with 15 ± 8% lymphocytes, mean total cholesterol of 176 ± 42mg/dL and mean sodium of 133 ± 3.5mmol/L. The one year all-cause mortality rates were 19.5 % reflecting advanced heart failure population. In the 405 patients examined, we were able to alter therapy (medical or device) in 86%. This included advancement of medical therapy in 56%, consideration for device referral in 11%, or both (medical therapy and device referral) in 19 %. This augmentation of therapy resulted in an increase in estimated mean life expectancy from 6.6 years to 9.6 years (p < 0.001).

Conclusion:
Use of the Seattle Heart Failure Model significantly helps in intensification of heart failure therapy when applied at time of discharge or in first follow up visit post discharge.
Abstract 135: Change in Cognition, Depression, and Anxiety Following Catheter Ablation
Authors: Saczynski Jane S , Richardson Heather M , Hajduk Alexandra , Kiefe Catarina I , Goldberg Robert J , Floyd Kevin C , Rosenthal Lawrence S , Browning Clifford , McManus David D
Published: July 2021

Background:
Patients with atrial fibrillation (AF) commonly experience symptoms such as palpitations, shortness of breath and chest discomfort. The severity of AF-related symptoms is associated with psychosocial factors such as anxiety and depression. Limited data suggests that catheter ablation, a treatment option in symptomatic patients with AF, reduces depression and anxiety but its effect on cognitive function remains unclear.

Methods:
Participants were 38 AF patients (mean age = 63 years ±8; 68% male, 66% paroxysmal AF) undergoing an index catheter ablation for AF at the University of Massachusetts Medical Center and interviewed pre-ablation and post ablation (1-week, 1 month and 3 months) as part of an ongoing study of AF treatment and psychosocial factors. A total of 150 ablation patients will be included in the final sample. Cognitive function was assessed using the Montreal Cognitive Assessment Battery (impairment = score <27 on the 30 point scale), depression by the Patient Health Questionnaire (PHQ) and anxiety by the Generalized Anxiety Score (GAD). Trajectories of depressive symptoms, anxiety and cognitive function were modeled before and after catheter ablation using linear mixed models adjusting for age, sex, AF type (paroxysmal vs other), and history of coronary artery disease or diabetes.

Results:
Patients reported high levels of depressive symptoms and anxiety and many (>50%) were cognitively impaired prior to ablation. Cognitive function increased following ablation, with improvements observed as early as one week after catheter ablation and continued to improve at 3-months post procedure (Table). Symptoms of depression and anxiety declined immediately following ablation and continued to decline through 3-months post procedure but changes were not statistically significant and may have been limited by power.

Conclusions:
Catheter-based ablation was associated with improved symptoms of depression and anxiety as well as cognitive function among patients with symptomatic AF. Knowledge of the patient-centered, as well as clinical, benefits of the various treatments for AF will guide patients, their families and their physicians make informed treatment choices.
Abstract 138: Characterizing Depressed Symptoms in Younger Women and Men Who Experienced an Acute Myocardial Infarction: Insights from the VIRGO Study
Authors: Smolderen Kim , Strait Kelly , Rachel Dreyer , D’Onofrio Gail , Zhou Shengfan , Lichtman Judith H , Safdar Basmah , Krumholz Harlan M , Spertus John A
Published: July 2021

Background:
This study aimed to determine the prevalence of the depressive symptom burden among younger men and women, and to better characterize those experiencing depressive symptoms in the weeks leading up to their AMI.

Method:
The VIRGO study enrolled 3,572 AMI patients (2:1 ratio for women: men; 67.1% women) between 2008 and 2012 (103 US hospitals, 24 in Spain and 3 in Australia) at their index AMI admission. The PHQ-9 (clinically relevant depressive symptoms = PHQ-9 scores ≥10) was administered to assess patients’ depressive symptoms. Demographic, socio-economic, cardiovascular risk, AMI risk factor, perceived stress (PSS-14), and health status information (Seattle Angina Questionnaire [SAQ], EQ-5D) was obtained through patient interviews during the index hospitalization and medical chart abstraction. Information about history of depression was also documented through interviews.

Results:
A total of 886 (39%) women experienced clinically relevant depressive symptoms vs. 245 (22%) men (P<0.0001). Overall, about half (n=1141, 48%) of women reported a prior history of depression vs. 1 in 4 in men (n=280, 24%) (P<0.0001). Women had higher rates of somatic depressive symptoms (10% vs. 6% in men), as well as a combination of cognitive and somatic symptoms of depression (23% vs. 11% in men) (P<0.0001). High levels of stress (mean score 32±8 vs. 21±8 for men; 34±8 vs. 23±8 for women on PSS-14) and low quality of life scores (mean SAQ Quality of Life score 50±22 vs. 63±21 for men; 45±25 vs. 61±22 for women) were noted among depressed patients, regardless of their gender (all P-values <0.0001 for depressed vs. non-depressed). In both women and men, depression was more prevalent among patients with a lower socio-economic profile (e.g. lower education, uninsured), among those with cardiovascular risk factors (e.g. diabetes, smoking). As compared with men, women had a 2.28-increased odds of experiencing depressive symptoms. This relationship persisted after adjusting for demographic, socio-economic, cardiovascular and AMI risk factors, and health status (OR=1.64; 95%CI 1.36, 1.98).

Conclusions:
A high depressive symptom burden and prior history of depression was observed among younger women admitted with AMI. Regardless of gender, depression affected those with a lower socio-economic status and cardiovascular risk factors; it was also accompanied with high levels of stress and worse health status. Targeted interventions and preventive strategies should consider addressing this high burden of depressive symptoms among younger depressed AMI patients.
Abstract 146: Demographic and Clinical Characteristics Associated with Patient Perceptions of Being Cured Following Hospitalization for Acute Coronary Syndromes: Preliminary Results from TRACE-CORE and TRACE-CARE
Authors: Waring Molly E , Lemon Stephenie C , Anatchkova Milena D , Gore Joel M , McManus David D , McManus Richard H , Ash Arlene S , Goldberg Robert J , Kiefe Catarina I , Saczynski Jane S
Published: July 2021

Background:
Recent decades have seen improvements in treatment for acute coronary syndromes (ACS), reduced mortality, and shortened hospital stays. Limited evidence suggests that some patients may leave the hospital with the perception that they are cured.

Objective:
To describe demographic and clinical characteristics associated with patient perceptions that their heart condition is cured at one week following hospitalization for ACS.

Methods:
We analyzed data from 397 patients interviewed during hospitalization for ACS in 2011-2013 as part of the Transitions, Risks, and Actions in Coronary Events: Centers for Outcomes Research and Education (TRACE-CORE), and again at one week post-discharge as part of an ancillary study, TRACE-CARE. At one week, patients were asked “How true or false is this statement for you: My heart condition is cured. Would you say that this is definitely true, mostly true, neutral, mostly false, or definitely false?” We considered patients who responded “definitely true” or “mostly true” to perceive that their heart condition was cured. We calculated 6-month GRACE risk scores using clinical data from medical records. We used multivariable logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with cure perceptions.

Results:
Participants were 26% (n=105) female and 89% (n=350) non-Hispanic white with mean age 60.7±11.0 years. Sixteen percent (n=63) were hospitalized with unstable angina, 69% (n=266) with NSTEMI, and 14% (n=55) with STEMI; 31% (n=124) had a history of CHD; and the average GRACE risk score was 93.6 (SD: 26.6). Seventy-three percent (n=289) received PCI during hospitalization and 11% (n=43) CABG. Discharge occurred the same or next day for 19% (n=76) and within 2-3 days for 54% (n=214). One week post-discharge, 30% (n=120) perceived their heart condition was cured. In a multivariable model, male sex, unstable angina, no history of CHD, and receipt of CABG were associated with greater odds of perceiving oneself cured (Table).

Conclusions:
One week post-discharge for ACS, 3 in 10 patients perceived their heart condition was cured. Future research should examine additional patient factors related to cure perceptions, and whether these perceptions influence engagement in recommended secondary prevention strategies.
Abstract 177: Credentials of Staff Performing Echocardiography in the United States: Insights from the Intersocietal Accreditation Commission
Authors: Parker Matthew W , Sobieraj Diana , Farrell Mary Beth , Coleman Craig I
Published: July 2021

Background:
Little has been published on the practice of echocardiography (echo) in the United States. We used the Intersocietal Accreditation Commission-Echocardiography (IAC-Echo) applications database to describe the personnel in echo laboratories seeking accreditation.

Methods:
We used de-identified data provided on IAC-Echo applications to characterize facilities by hospital association, census region, annual volume, number of sites, previous accreditation, and numbers of physicians and sonographers as well as National Board of Echocardiography (NBE) testamur status of physicians and registered credential status of sonographers. We categorized Medical Directors by board certification in cardiovascular diseases, internal medicine, other specialty, or none. Medical Director echo training could be formal Level 2 or 3 or experiential by ≥3 years of practice. Frequencies, means, and medians were compared between groups using the chi-square test, t-test, or Mann Whitney test, respectively.

Results:
From 2011 to 2013, 1926 echo labs representing 10618 physicians and 6870 sonographers applied for IAC-Echo accreditation or re-accreditation. The majority of medical directors were board certified in cardiovascular diseases and 34.1% of medical directors and 27.2% of staff physicians held NBE testamur status; 79.5% of sonographers held registered credentials. Most echo labs were in the Northeast or South census regions, have an average of 1.75 sites, and are based outside of hospitals (Table). Compared to nonhospital echo labs, medical directors of hospital-based echo labs were more likely to be Level 3 trained (19.8% versus 30.8%, p<0.01) and be NBE testamurs (28.9% versus 45.6%, p<0.01). Markers of echo lab size, region, previous accreditation, and credentialed sonographers were associated with accreditation versus delay decisions; there was a trend toward accreditation among facilities with NBE medical directors.

Conclusion:
Among facilities seeking IAC-Echo accreditation, the minority of echo physicians hold NBE testamur status. Hospital and nonhospital facilities are different in the credentials of their personnel.
Abstract 18: Aco Payment Models And The Use Of Discretionary And Non-discretionary Cardiovascular Care
Authors: Goodney Philip P , Lewis Valerie A , Gottlieb Daniel J , Nallamothu Brahmajee K , Colla Carrie H
Published: July 2021

Background:
Accountable care organizations (ACOs) seek to limit discretionary health care spending while ensuring high-quality care. We studied spending patterns in cardiovascular care, one of the largest cost centers for Medicare patients, in hospitals enrolled in an ACO pilot program, the Medicare Physician Group Practice Demonstration (PGPD).

Methods:
To estimate spending on discretionary and non-discretionary cardiovascular care in for beneficiaries in PGPD and non-PGPD care systems, we performed a quasi-experimental analyses comparing pre-intervention (2001-2004) and post-intervention (2005-2009) rates of use of diagnostic and therapeutic cardiovascular procedures. We studied ten physician groups across the United States. The intervention group was composed of fee-for-service Medicare patients (n=990,177) receiving care from the groups participating in the practices in the PGPD. Controls were Medicare patents (n=7,514,453) from the same regions who received care from non-PGPD physicians. Our main outcome measure was the difference in the rate of discretionary imaging and procedures in PGPD practices compared to control practices, before and after implementation of ACO payment models (difference-in-difference). We studied this for carotid and coronary imaging, in both discretionary and non-discretionary clinical settings.

Results:
As expected, before and after PGPD implementation, at both PGPD sites and their controls, the rates of carotid and coronary imaging and procedures were higher in non-discretionary situations when compared to discretionary clinical situations (55% versus 22%, p<0.001). For discretionary carotid and coronary imaging, the differences in the rate of change in imaging use before and after the ACO implementation period was minimal (carotid imaging difference between PGPD and controls, 0.25% (95% CI -0.44%-0.95%, discretionary coronary imaging difference between PGPD and controls, 0.06% (95% CI -0.45%-0.58%). Similarly, the differences in the rate of change in discretionary revascularization procedure use before and after ACO implementation was minimal between PGPD sites and controls (carotid revascularization 0.003% 95% CI -0.008%- 0.002%, coronary revascularization -0.13%, 95% CI -0.30% - 0.029%). Similar results were seen for non-discretionary cardiovascular imaging and procedures.

Conclusion:
Little evidence exists to suggest that ACO payment models will save money by limiting discretionary cardiovascular imaging or procedures.
Abstract 189: Surveillance and Management of Lymphoma Patients Receiving Anthracycline Based Chemotherapy
Authors: Brown Jennifer R , Flowers Christopher R , Dai Tian , Parashar Susmita
Published: July 2021

Background:
Cardiotoxicity is one of the most common and devastating complications of anthracyline-based chemotherapy (AC). The AHA recommends routine surveillance, early diagnosis and treatment of AC induced cardiomyopathy (CMP). We assessed the pattern of surveillance of left ventricular ejection fraction (LVEF) and management of AC-CMP.

Methods:
We performed a retrospective analysis of a cohort of Non-Hodgkin lymphoma (NHL) patients evaluated by the Emory Lymphoma program who received AC between 1992 and 2013. We assessed cardiac function by echocardiogram or equilibrium radionuclide imaging. We also examined the prevalence of AC-CMP (defined as an absolute decrease in LVEF > 10% with a decline <50%, or an LVEF reduction of at least 15% with absolute LVEF > 50%) and quality of care of AC-CMP based on AHA heart failure guidelines including treatment with beta-blockers and ACE-inhibitors. Finally, we reviewed echocardiograms to assess echocardiographic measures of diastolic function.

Results:
Of 218 patients who received AC (median dose 300 mg/m2), 41% (89 of 218) had imaging surveillance before and after AC (Table 1). LVEF was evaluated by limited echo in 52% (46 of 89), comprehensive echo in 32% (29 of 89) and MUGA in 16% (14 of 89) of patients. Diastolic function was evaluated in only 20% (15 of 75) of patients. Twenty seven percent of patients (24 of 89) had AC-CMP, out of which 17% (15 of 89) had moderate-severe decrease in LVEF < 45%. Of patients with LVEF < 45%, only 47% (7 of 15) received ACE Inhibitors, 40% (6 of 15) received beta-blockers and 40% (6 of 15) had repeat assessment of LVEF. Notably, 46% (11 of 24) of patients with AC-CMP were asymptomatic and 42% (10 of 24) were symptomatic.

Conclusions:
Less than half of NHL patients treated with AC receive surveillance and treatment according to AHA guidelines. There is substantial opportunity for collaboration between oncologists and cardiologists to improve the care of oncology patients receiving AC
.
Abstract 222: Students’ Assessment of the Educational Component of Project Healthy Schools: A Middle-School Wellness Program
Authors: Pew Alexandra , Aaronson Susan , Rogers Robert , Mitchell Lindsey , Lee Alexander , Foti Alisa , Wei Wen-Ching , Vuong Belinda , Corriveau Nicole , Kline-Rogers Eva , Goldberg Caren , DuRussel-Weston Jean , Jackson Elizabeth A , Eagle Kim A
Published: July 2021

BACKGROUND/INTRODUCTION:
Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years, potentially leading to dangerous problems in heart health in later years. Project Healthy Schools (PHS) aims to improve the wellness of students during adolescence by promoting healthy lifestyle changes. PHS incorporates 10 educational lessons into 6th grade students’ curricula. Each of these lessons emphasizes the PHS goals of healthy eating, regular exercise, and less sedentary behavior and are designed to be interactive, hands on, and fun. This report describes the students’ assessment of the educational model used in PHS.

METHODS:
Upon completion of the education module, participating students received a process survey. The purpose of this survey was to gather feedback from the students on the educational component of PHS. Results from the process survey were compiled from 4 separate school districts over the years 2008-2013. Five questions regarding the educational activities and resultant behavior changes are reported.

RESULTS:
1793 students completed the survey. After completing the 10 lessons, 71% of students reported learning that was consistent with the PHS goals and25% reported liking all 10 PHS activities. Students enjoyed the activities for the following reasons: 45% because they were fun; 16% enjoyed moving around and/or playing games; and 36% enjoyed learning about being healthy. Furthermore, students reported the following lifestyle changes after the program was completed: 43% eating more fruits/vegetables, 38% increasing minutes of physical activity, 27% decreasing screen time, 30% choosing healthier drinks, 38% eating less fast food, with 29% making no changes. Lastly, when being tested on specific material from the course, 46% of students selected the correct answer.

DISCUSSION/CONCLUSIONS/FUTURE DIRECTIONS:
The majority of students successfully learned the content of the lessons and made at least one positive healthy lifestyle change. The process survey has allowed PHS leaders to assess real-time feedback from participating students, make content changes accordingly and will continue to guide future revisions of the program.
Abstract 228: Variation in Results of Coronary Angiography Among Referring Providers
Authors: Wasfy Jason H , Yeh Robert W , Litvak Andrea , Pomerantsev Eugene V , Dec G William , Armstrong Katrina , Fifer Michael A , Ferris Timothy G
Published: July 2021

Background:
Nationally, the diagnostic yield of coronary angiography is low. Little is understood about how referring providers vary in propensity to refer for coronary angiography. Understanding these sources of variation and improving the yield of coronary angiography has the potential to reduce costs and enhance value.

Methods:
We identified all cases of diagnostic coronary angiography performed at the Massachusetts General Hospital from January 1, 2012 until June 30, 2013 (Analysis A). We then identified all positive angiograms, as defined as at least one epicardial coronary stenosis greater or equal than 50%. We excluded angiograms for STEMI, NSTEMI and excluded angiograms in patients with cardiomyopathy, LVEF < 50%, valve disease, history of cardiac transplantation, prior PCI, or prior CABG (Analysis B). For both Analysis A and Analysis B, we calculated proportions of positive angiograms for each referring provider and calculated variance, medians, and standard deviations of those proportions among providers. Referring providers with fewer than 10 included angiograms (Analysis B) over the 18 month period were excluded for both analyses. We compared the variances of the two analyses with an F-test. Logistic regression models were developed using both characteristics of referring physician and characteristics of patients.

Results:
5186 total coronary angiograms were performed, of which 1334 met inclusion criteria. 117 physicians ordered at least one angiogram, and 34 physicians ordered at least 10 angiograms. The positivity rate for Analysis A was greater than the positivity rate for Analysis B (64.3% versus 50.9%, p < 0.0001). The variance of the positivity rates for Analysis A was 0.0099, and the variance of the positivity rates for Analysis B was 0.0201 (F-test = 0.045). Preliminary results suggest that more variance is due to patient factors (R-squared = 0.46) than physician factors (R-squared = 0.04). The distribution of positivity rates by referring physician for Analysis B is shown in Figure 1.

Conclusions:
Variation among referring providers increases after cases with clearer guidelines are excluded. Preliminary results suggest this variance is related to different patient characteristics (case mix) rather than referring physician characteristics.
Abstract 283: Health Status Outcomes in Acute Myocardial Infarction Patients Following Rehospitalization for Unplanned Revascularization or Unstable Angina
Authors: Shore Supriya , Li Yan , Smolderen Kim , Jones Philip G , Arnold Suzanne V , Cohen David , Zhenxiang Jenny , Wang Tracy Y , Ho P. Michael , Spertus John
Published: July 2021

Background:
Rehospitalizations for unplanned coronary revascularization and unstable angina (UA) among patients after myocardial infarction (MI) are common. The association of these events with health status is unknown.

Methods:
Patients with MI were enrolled between 2005 and 2008 in the TRIUMPH registry-a prospective, 24 center U.S. study. Follow-up was attempted on all survivors at 1, 6 and 12 months after index MI admission. Data on all reported re-hospitalizations were adjudicated. Staged revascularizations and elective coronary artery bypass grafts performed within the first month after the index MI were excluded. Health status was assessed using the Seattle Angina Questionnaire (SAQ) and Euroqol-5D Visual Analog Scale (EQ-5D VAS). One-year health status was compared between those who did and did not experience a rehospitalization due to a coronary revascularization or UA using hierarchical, repeated measures analyses in 2 propensity-matched cohorts created for each of these events.

Results:
A total of 3,283 MI patients were analyzed; mean age was 59 years, 33% were female and 70% were Caucasian. In the year following the MI there were 144 (4.4%) re-hospitalizations for unplanned coronary revascularization and 140 (4.3%) for UA. Baseline health status was comparable between patients with and without re-hospitalizations. In contrast, SAQ summary scores at 1 year post-MI were lower in patients with re-hospitalizations for unplanned revascularization (-10.1; 95% CI -12.4, -7.9) and UA readmissions (mean difference -6.9; 95% CI -9.1, -4.7) vs. those without. Similarly, EQ-5D VAS scores were lower among patients with readmissions for unplanned revascularization and UA readmissions (Table). Individual domains of the SAQ score indicated higher angina frequency, worse quality of life, and more physical limitations over the year following the index MI among patients re-hospitalized for UA and revascularization.

Conclusions:
Rehospitalizations within the first year following a MI for unplanned coronary revascularization and UA are associated with more angina and worse health status. Whether more aggressive treatment of patients’ health status can prevent these events, or if preventing these events can improve patients’ health status, requires further study.
Abstract 319: Transthoracic Bioimpedance Monitoring Predicts Heart Failure Decompensation and Early Readmission after Heart Failure Hospitalization: Preliminary Data from SENTINEL-HF
Authors: McManus David D , Riistema Jarno , Saczynski Jane S , Sert Kuniyoshi Fatima , Rock Joseph , Meyer Theo E , G.P. den Teuling Niek , Goldberg Robert J , Darling Chad
Published: July 2021

Background:
Patients, providers, and health systems are focused on reducing readmissions for patients with acute decompensated heart failure (ADHF). Readmission after hospitalization is common and often secondary to HF decompensation, but it remains challenging to identify patients at-risk. Bioimpedance is a validated marker of thoracic fluid accumulation. We examined whether transthoracic bioimpedance, measured using a Fluid Accumulation Vest (FAV), predicted HF decompensation in advance of a clinical event in patients discharged after ADHF.

Methods:
Participants included 42 patients hospitalized for ADHF. Participants were trained on the use of a FAV-smartphone dyad to obtain and transmit a 5-minute bioimpedance measurement once daily for 45-days after discharge. Readmission and diuretic dosing adjustments were identified using participant report and causes adjudicated using medical records. Daily bioimpedance was analyzed using the HF detection strategy shown in Figure. Receiver operating characteristic (ROC) curves and C-statistics were calculated to describe the characteristics of a bioimpedance based algorithm as a predictor of HF decompensation 3 or 7-days in advance of the clinical event.

Results:
Participants (mean age 69 ± 12 years, 43% female, 88% white, 11% cognitively impaired, 12% depressed) had a mean ejection fraction of 50 ± 18%. HF-related rehospitalization occurred in 10% (n=4) and 10% (n=4) reported diuretic up-titration during the 45-day follow-up. An algorithm analyzing bioimpedance up to 3 or 7 days prior to an event was related to HF readmission (C statistics for 3 and 7 days = 0.83, 0.94, respectively) and the combined outcome of HF hospitalization or diuretic up-titration (C statistics for 3 and 7 days = 0.76, 0.80, respectively).

Conclusions:
Early readmission after hospitalization for ADHF was common and predicted up to 7 days in advance by an algorithm analyzing transthoracic bioimpedance. Despite their advanced age and high burden of comorbid diseases, study participants with ADHF were able to make daily bioimpedance measurements using a FAV and transmit them using a smartphone. Transthoracic bioimpedance monitoring may offer possibilities for reducing HF readmissions by enabling identification and treatment of outpatients with early HF decompensation.
Abstract 339: Insights into Readmission Rates of Atrial Fibrillation Patients
Authors: Vasko Thomas , Sylvester Rachel , Froehlich William , Subramanian Meghana , Wiles Alison , Froehlich Benjamin , Mahmood Redah , Kline-Rogers Eva , Vaishnava Prashant , Rubenfire Melvyn , Bumpus Sherry
Published: July 2021

Purpose and Background:
Bridging the Discharge Gap Effectively (BRIDGE) is an NP-driven transitional care program for cardiovascular patients. It has demonstrated lower rates of readmission for patients with acute coronary syndrome who participated, but a similar benefit was not seen for atrial fibrillation (AF) patients. We sought to assess differences between AF patients who participated in the BRIDGE program and those who did not.

Methods:
Retrospective review of all patients referred to BRIDGE with a primary discharge diagnosis of AF was conducted (n=148). An equal number of BRIDGE attendees was randomly matched to non-attendees (n=36). Univariate techniques were used to compare groups.

Results:
Of 148 AF patients referred to BRIDGE, 84 (56.8%) attended BRIDGE, 36 (24.3%) saw cardiologists or PCPs for their first post-discharge follow-up, and 28 (18.9%) saw other providers or had unknown follow up. There was no significant difference in median time to follow up (12.5 days for attendees vs 9.0 days for non-attendees, p=0.503). Of the 72 patients reviewed, 17 (23.6%) were readmitted within 30 days (Table 1). Non-attendees were more likely (85.7% vs 40% p=0.134) to be readmitted with AF/related diagnoses as compared to attendees. More than half of 30-day readmissions for BRIDGE attendees were unrelated to AF (n=6, 60.0%). There was a trend toward greater incidence of comorbid CAD, HTN, CHF, or vascular disease among BRIDGE attendees, compared to non-attendees.

Conclusion:
Readmission patterns vary in AF patients; comorbid conditions play a role in early 30-day readmissions for AF patients despite adequate transitional care. NP-driven transitional care models, compared to traditional follow-up with a physician provider, may help identify additional issues related to comorbidities, leading to readmission. A larger sample is needed to better understand this dichotomy and to determine what measures can be taken to enhance the BRIDGE program for AF patients.
Abstract 363: Chest Pain Observation Unit: Does Post-Discharge Stress Testing Influence Physician Management Decisions?
Authors: Khalil Yasser , Matsumura Martin E , Abdul-Latif Maida , Pandey Prasant , Schwartz Melvin
Published: July 2021

Background:
Chest pain (CP) accounts for approximately 6 million emergency visits per year in the United States. There is growing interest in strategies to effectively risk stratify pts for coronary artery disease (CAD) related events in a cost-effective manner. The use of chest pain observation units followed by early stress testing is frequently employed in these pts. However the utility of stress testing in this population is not well defined, and the effect of stress test results on subsequent management decisions is a topic of controversy. In the present study we examined the relationship of stress myocardial perfusion imaging (MPI) results to physician decisions regarding ccath in a single community teaching hospital.

Methods:
Retrospective study of 426 pts undergoing a chest pain observation strategy over a 24 month period. Pt eligible for the program had CP deemed possibly related to CAD but no diagnostic ECG changes and negative TnI measurements x2. All pts underwent outpt. stress MPI within 72 hours of discharge. Pts saw a cardiologist the day of stress MPI who reviewed the CP history, MPI results, and made decisions regarding further risk stratification. Demographic and medical history was collected from the pts chest pain observation unit record. Multivariate regression analysis was used to determine significant independent variables related to physician decisions regarding further risk stratification.

Results:
Of 426 pts who underwent outpt stress MPI, 71(16.7%) were positive for ischemia, and 16 (22.5% of +MPI) underwent cath with reperfusion performed in 8 (5PCI, 3 CABG, 11.3% of +MPI). Of the 355 pts with negative stress MPI, 5(1.4% of -MPI) underwent cath with reperfusion performed in 2 (2PCI, 0 CABG, 0.5% of -MPI).

A MLR model suggested only stress MPI results were independently predictive of the use of ccath for risk stratification.

Conclusion:
Stress MPI was an important factor in physician decision-making regarding the need for ccath in pts managed in a chest pain observation unit. The rate of +MPI and subsequent use of ccath in our institution supports MPI as an appropriate step in risk stratification of low to moderate risk CP pts triaged through a CP observation unit.
Abstract 367: Comparison of the Healthcare Systems of the United States and Portugal: Epidemiology and Management of Coronary Heart Disease
Authors: Lobo Mariana F , Azzone Vanessa , Melica Bruno , Freitas Alberto , Gonçalves Francisco R , Soares António J , Normand Sharon-Lise , Teixeira-Pinto Armando , Pereira-Miguel José , Costa-Pereira Altamiro
Published: July 2021

Objectives:
Adoption of health technologies may yield significant individual and societal benefits. Because different healthcare systems vary in their adoption speeds, an understanding of the underlying healthcare system is critical. We compared the United States (US) and Portugal (PT) healthcare systems focusing on coronary heart disease (CHD). CHD remains one of the main causes of death in high-income countries with significant economic costs.

Methods:
We conducted a comprehensive literature review based on publications from national governmental bodies, international institutional organizations, professional associations, and scientific journals. We abstracted information regarding risk factors, incidence, access to health technologies, and hospital mortality rates in CHD observed between 2000 and 2011.

Findings:
The prevalence of obesity and high cholesterol levels is higher in the US while higher rates of hypertension and tobacco consumption prevail in PT. The 2009 incidence of cardiovascular disease per 100000 population in the US is 1944.5 versus 1320.4 in PT. The percentage of total health expenditure financed through public funds is 48.2% in the US versus 65.8% in PT. Public hospitals represent 26% (1526 of 5754) of US hospitals and 55% (129 of 231) of hospitals in PT. Between 2000 and 2011, the average high-risk device approval time was 43 months quicker in the European Union (EU) compared to the US. Drug-eluting stents were approved in 2002 in the EU and in PT versus 2003 in the US. Speeds of approval for pharmaceuticals vary – prasugrel, and ticagrelor were approved 5 and 8 months faster in PT compared to the US but PT approval of glycoprotein IIb/IIIa inhibitors was slower (18 months slower on average). However, US CHD standardized mortality is more than twice that of PT (126.5 vs 59.4 per 100000).

Conclusions:
Procedure and new technology use differ dramatically between the two healthcare systems for CHD care. Portugal offers an interesting contrast to the US for studies focusing on health technologies adoption, diffusion, cost-effectiveness and determinants of outcomes in the realm of CHD. How these factors directly impact patient outcomes remains unknown and deserves further investigation.
Abstract 377: Characteristics, Care, and Outcomes of Asian American Heart Failure Patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program
Authors: Qian Feng , Fonarow Gregg C , Krim Selim R , Vivo Rey P , Cox Margueritte , Hannan Edward L , Shaw Benjamin A , Hernandez Adrian F , Eapen Zubin J , Yancy Clyde W , Bhatt Deepak L
Published: July 2021

Background:
Because little is known about Asian American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program.

Methods:
We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3,774 Asian Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program between January 1, 2005 and December 31, 2012. Baseline characteristics, achievement measures, composite “all-or-none” care (proportion receiving all eligible achievement measures), quality measures, in-hospital mortality, discharge to home, and length of stay were examined.

Results:
Relative to white patients, Asian American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency. At admission, they had higher heart rate, systolic blood pressure, B-type natriuretic peptide, serum creatinine, and blood urea nitrogen. Overall, Asian American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk , 0.88; 95% confidence interval , 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Asian American patients had lower unadjusted rate than white patients in terms of implantable cardioverter defibrillators (ICD) counseling (32.7% versus 48.1%) and ICD placed/prescribed at discharge (33.8% versus 50.6%). However, these differences were not statistically significant after risk adjustment for patient and hospital characteristics. Compared with white patients, Asian American patients had comparable in-hospital mortality, length of stay, and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11) (Table).

Conclusion:
Despite some differences in clinical profiles, Asian American HF patients receive very similar quality of care and have comparable or even better health outcomes than white patients. This study suggests that focusing on 2 specific quality measures might further improve HF care for Asian Americans.
Abstract 100: Influence of Race on Presentation, Treatment, and Outcome Among Patients With Atrial Fibrillation-related Ischemic Stroke
Authors: Limdi Nita A , Thigpen Jonathan , Ko Darae , Sisson Emily K , Tripodis Georgios , Henault Lori E , Berger Peter B , Hylek Elaine
Published: July 2021

Background:
Blacks have been underrepresented (<2% of 71,683) in recent atrial fibrillation (AF) trials of novel anticoagulants vs. warfarin. Blacks with AF have also been underrepresented in stroke cohort studies from which the stroke risk prediction rules are derived.

Objective:
We examined whether there exist racial differences in presentation, treatment, and outcome among patients with AF-related ischemic stroke (IS).

Methods:
Consecutive IS were identified from 2006-2010 at 3 U.S. sites. All events were evaluated by CT or MRI, and assigned a discharge modified Rankin score (mRS). AF was confirmed by ECG. Baseline medications and clinical characteristics were abstracted from the medical record. Race was determined by self-report.

Findings:
We identified 1,030 AF-related IS; 96% (n=985) had race reported as White (n=764, 74%) or Black (n=221, 21%). Compared to Whites, Blacks were younger, had a higher burden of risk factors, had higher prevalence of paroxysmal or new onset AF, and more often presented outside the t-PA window. Among patients with known AF, 40% Whites and 39% Blacks were taking warfarin on admission. INR on admission was not different by race (mean 1.4, SD =0.7; p=0.64). These strokes resulted in severe neurological deficit (mRS >3) in a majority of Blacks and Whites (70% vs. 64%; p=0.09).

Conclusion:
Blacks with AF who suffer IS are younger, have a higher burden of risk factors, and more often present with paroxysmal or new onset AF. IS in the setting of AF was associated with significant mortality and morbidity in both Blacks and Whites.