bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 281: First successful implementation of Crew Resource Management techniques adapted form the aviation industry to an Argentine Hospital
Authors: BOZOVICH GERARDO E , KLEIN FRANCISCO
Published: July 2021

Introduction:
Medical errors are a frequent cause of morbidity and mortality in hospitals worldwide. Poor teamwork and communication skills rather than lack of technical knowledge have been identified as a common factor in numerous studies.

Objective:
To promote a safer medical practice through the adoption of Crew Resource Management (CRM) procedures directly adapted from the aviation industry for the first time in Argentina.

Methods:
Starting in 2009 we organized a hybrid team of two physicians/amateur aviators and two expert airline pilots with a significant background on safety analysis and CRM training . The setting for the initial experience was a teaching hospital with high volume cardiovascular and organ transplantation departments. CRM training has been offered at least once a year in a non compulsory manner to the entire spectrum of healthcare personnel, including medical and nursing students. Courses are structured in two day sessions divided in several chapters and workshops: Introduction, statistics, leadership, communication skills, and avoidance of risky behaviors. Slides, full text articles and reports are available for permanent consultation by personnel along with discussion forums at the Moodle based site of the program.

Results:
Satisfaction levels among attendees has consistently averaged 92%. Following training, briefings and debriefings have been implemented as standard procedures along with checklists both at Intensive Care, Operating Rooms and General Ward. No wrong side or wrong patient interventions have been reported over 3 years, while in 1/9500 surgical procedures a misidentification of a patient occurred with successful detection at the second crossed check on admission to the OR. Overdosing was reported in 1 every 4960 admissions, none fatal or disabling.

Conclusions:
Choosing a hybrid team of physicians and airline pilots rather than physicians or nurses alone as facilitators was a key factor to spark interest in teamwork factors and to avoid fear of punishment following reports. Despite cultural differences, CRM can be as feasible and successful in a Latin American hospital environment as previously shown in several centers in the United States.
Abstract 288: Secondary Prevention Following Coronary Artery Bypass Surgery: The Need For a Continuum of Care
Authors: Barnes Brian K , Kramer Jeffrey B , Howard Patricia , Ababneh Bashar , Muehlebach Gregory , Daon Emmanuel , Zorn George L , Reed William , Vacek James L
Published: July 2021

Purpose:
Sustained positive outcomes after coronary artery bypass grafting (CABG) requires risk factor modification and secondary prevention medications. This study assessed the influence of a multidisciplinary educational program on disease understanding, motivation to reduce cardiovascular risk, and secondary prevention medication prescribing following CABG.

Methods:
Using a prospective, randomized, controlled design, adults undergoing CABG completed surveys at discharge, 3 months, and 12 months, assessing disease understanding and motivation to reduce cardiovascular risk. Four to six weeks after CABG, intervention subjects completed an educational program involving group discussions and individual counseling with pharmacists, dietitians, and a cardiac rehabilitation nurses. The primary endpoint was a composite score of reduced risk factors, medication use among those eligible, and awareness of prescribed medications. Secondary endpoints evaluated survey scores and medication use rates. Wilcoxon Rank Sum and Chi Square tests compared data between specific time points. Generalized estimating equations and linear contrasts of the parameter estimates compared data at the three time points.

Results:
The final analysis included 98 subjects (I=49, C=49). The composite score was not different between groups (I=12.8±4.5 points, C=12.7±4.9 points, p=0.9405). Improvements were noted in understanding and motivation in the entire cohort, but these changes could not be attributed to our intervention. Medication use declined at 3 and 12 months after CABG without significant differences between the groups.

Conclusions:
Disease understanding, motivation to reduce risk, and medication use is robust at hospital discharge but declines with time and was not improved by our intervention. These findings are concerning and warrant further study.
Abstract 303: Pre-operative Angiotensin Converting Enzyme Inhibitor use and outcomes in patients undergoing Isolated Coronary Artery Bypass Grafting
Authors: Bandeali Salman J , Kayani Waleed , Lee Vei-Vei , Pan Wei , Elayda MacArthur , Nambi Vijay , Jneid Hani , Alam Mahboob , Wilson James M , Birnbaum Yochai , Ballantyne Christie M , Virani Salim S
Published: July 2021

Background:
The association between pre-operative use of angiotensin converting enzyme inhibitors (ACEI) and outcomes after coronary artery bypass grafting (CABG) remains controversial. Our aim was to study in-hospital outcomes after isolated CABG in patients on preoperative ACEI.

Methods:
We performed a retrospective analysis of 8,889 patients who underwent isolated CABG from year 2000 to 2011. Primary outcome was the incidence of major adverse events (MAE) defined as a composite of in-hospital mortality, post-operative renal dysfunction, myocardial infarction, stroke, and atrial fibrillation during index hospitalization. Secondary outcomes studied were the incidence of individual components comprising MAE. Logistic regression analysis was performed.

Results (Table):
Of the 8,889 patients, 3,983 (45%) were on pre-operative ACEI (“ACEI group”) and 4906 (55%) were not (“no ACEI group”). The overall incidence of MAE was 38.1% (n=1518) in the “ACEI group” versus 33.6% (n=1649) in “no ACEI group”. Pre-operative ACEI use was independently associated with increased risk of MAE (OR; 1.12, 95% CI; 1.02-1.23), most of which was driven by a statistically significant increase in post-operative renal dysfunction and atrial fibrillation. Pre-operative ACEI therapy was not associated with in-hospital mortality, post-operative myocardial infarction, or stroke.

Conclusion:
Preoperative ACEI use was associated with an increased risk of MAE post CABG, in particular post-operative renal dysfunction and atrial fibrillation.
Abstract 309: Early Mortality Determinants in Cardiac Arrest Survivors Treated with Therapeutic Hypothermia
Authors: Ji Yong , Khurana Vikash , Waters Theresa , Liakos Matthew , Torosoff Mikhail
Published: July 2021

Purpose
: We hypothesized that advanced circulatory compromise, as manifested by acidosis and hyperkalemia should be associated with worsened clinical outcomes in cardiac arrest patients treated with therapeutic hypothermia.

Methods:
Results of initial admission laboratory studies, medical history, and echocardiogram in 41 consecutive cardiac arrest patients (13 females, 60+/- 32 years old, 6 with diabetes, 7 with chronic kidney disease, and 8 with history of cardiovascular disease) undergoing therapeutic hypothermia were reviewed. Mortality was ascertained through hospital records and Social Security Death Index. ANOVA, chi-square, Kaplan-Meier, and logistic regression analyses were used. The study was approved by the institutional IRB.

Results
: Age, gender, medication use, history of CAD, degree of systolic dysfunction by echocardiogram, serum pH, creatinine, sodium, glucose, magnesium, calcium, lactate, BUN, and osmolality were not predictive of mortality in our patient population. However, higher hemoglobin (0.336 per 1 mg/dL, 95% CI 0.138-0.818, p=0.016) and pre-resuscitation ventricular tachycardia or fibrillation (VT-VF vs. pulseless electrical activity or asystole, 0.02, 95% CI 0.002-0.312, p=0.004) were associated with decreased hospital mortality in both univariate and multivariate analyses. Median admission potassium level was 4.0 mEq/L. Unexpectedly, correlation between admission serum potassium and pH was poor (R^2= 0.06). Similarly, actual K requirements were poorly correlated with calculated K deficit (R^2=0.007). VT or VF were more prevalent in patients with K less than 4 (p=0.002). There was also a trend towards improved mortality in patients with lower K levels (72% survival in K≤4 vs. 47% in K>4 mEq/L, p=0.129).

Conclusions:
Hyperkalemia, pulseless electrical activity, and asystole are predictive of increased hospital mortality in survivors of cardiac arrest. In patients with admission hypokalemia, lack of correlation between admission potassium, pH, and potassium requirements are suggestive for acute event etiology in many cardiac arrests patients. An association between low or low-normal potassium, observed VT-VF, and better outcomes is unexpected and may be used for prognostic purposes. More prospective investigations of mortality predictors in these critically ill patients are needed.
Abstract 324: Cancer, Arterial Thrombosis and Major Bleeding Following Orthopedic Surgery
Authors: Oberweis Brandon S , Nukala Swetha , Rosenberg Andrew , Stuchin Steven , Radford Martha , Berger Jeffrey S
Published: July 2021

Background:
Although cancer is a well-recognized risk factor for venous thromboembolic events, the relationship between cancer and perioperative arterial thrombotic and bleeding complications is uncertain. We therefore sought to investigate the incidence of thrombotic and bleeding events in subjects with and without a history of cancer undergoing orthopedic surgery.

Methods:
We performed a retrospective cohort analysis of 3,082 subjects > 21 years of age undergoing orthopedic surgery of the hip, knee, or spine between November 1, 2008 and December 31, 2009 at a tertiary care medical center. The presence of cancer was determined by ICD-9 diagnostic coding. In-hospital outcomes included perioperative myocardial necrosis (troponin > 99
th
percentile), major bleeding (as per the International Society on Thrombosis and Haemostasis [ISTH] perioperative bleeding definition), and coded myocardial infarction (MI) and post-operative hemorrhage using the hospital administrative dataset using ICD-9 procedure codes.

Results:
Of the 3,082 subjects, 69 (2.2%) were identified as having a history of cancer. Subjects with cancer were older (65.5±14.7 vs 60.6±13.2, P=0.003) and less likely female (32/69 [46%] vs 1790/3013 [59%], P=0.03). Subjects with cancer had a greater incidence of myocardial necrosis (15/69 [21.7%] vs 164/3013 [5.4%], P<0.001), MI (3/69 [4.3%] vs 17/3013 [0.6%], P<0.001), perioperative major bleeding (21/69 [30.4%] vs 144/3013 [4.8%], P<0.001), and post-operative hemorrhage (6/69 [8.7%] vs 20/3013 [0.7%], P<0.001) than subjects without cancer. Following multivariable logistic regression, cancer was associated with myocardial necrosis (OR 2.64, 95% CI 1.30-5.35, P=0.007), MI (OR 2.65, 95% CI 0.63-11.09, P=0.18), major bleeding, (OR 6.45, 95% CI 3.42-12.17, P<0.001), and post-operative hemorrhage (OR 7.64, 95% CI 2.44-23.93, P<0.001).

Conclusions:
There is an increased risk of both thrombotic and bleeding complications in subjects with cancer in the setting of orthopedic surgery. This perioperative risk deserves careful attention in preoperative clearance and future studies aimed at attenuating this increased risk are warranted.
Abstract 45: Higher Reintervention Rate But Similar Amputation-free Survival With Endovascular Procedures For Peripheral Arterial Disease Compared To Bypass Surgery
Authors: Hedayati Nasim , Brunson Ann , Li Chin-Shang , Loja Melissa N , Carson John G , White Richard H , Romano Patrick S
Published: July 2021

Background:
Over the last decade, the number of endovascular procedures for peripheral arterial disease (PAD) has surpassed the number of open surgical bypass procedures. Yet, the effectiveness of endovascular procedures in comparison to open procedures is not fully understood. The aim of this study was to compare the outcomes of open and endovascular procedures for PAD in a population-based study.

Methods:
We used the Patient Discharge Data (PDD) from California’s Office of Statewide Health Planning and Development (OSHPD) to identify all patients >35 years of age who underwent a lower extremity arterial intervention from 2005 to 2009. OSHPD has been recording ambulatory surgery data since 2005. The PDD is linked to the death database. A look back period of five years was used to exclude patients with prior lower extremity endovascular or open procedures. Cox proportional hazards regression was used to compare amputation-free survival and logistic regression was used to compare 12-month reintervention rate between the endovascular and open groups adjusting for age, gender, race/ethnicity, insurance status, severity of illness, and comorbidities.

Results:
Between 2005 and 2009, 41,507 individuals underwent lower extremity arterial interventions. 25,635 (61.7%) underwent endovascular procedures and 15,872 underwent open procedures. There were 17,942 women (43.2%) and 23,565 men. 4,094 (25.8%) of the patients in the open group and 8,593 (33.5%) of patients in the endovascular group underwent reintervention for PAD. The 12-month reintervention rate was significantly associated with endovascular procedures (
p
<0.001). The odds ratio for 12-month reintervention was 1.38 in the endovascular group (95% CI 1.32-1.45) compared to the open group. However, there was no difference in the amputation-free survival following endovascular procedures compared to open procedures (
p
=0.154); the hazard ratio was 1.07 in the endovascular group (95%CI 0.97-1.15) compared to the open group.

Conclusions:
Nearly a third of all patients who undergo a lower extremity arterial revascularization procedure require reintervention within the first year. Our results demonstrate that although endovascular procedures are more likely than open procedures to require reintervention, the amputation-free survival is not improved with endovascular procedures. Cost analysis of multiple reinterventions can be beneficial in understanding the cost-effectiveness of endovascular procedures. Further research is also needed to understand patient characteristics that distinguish patients who benefit more from endovascular procedure for PAD.
Abstract 52: Short and Long Term Outcomes of Patients Admitted with Unexplained Syncope Using a Simple Novel SELF-Pathway
Authors: Aziz Emad F , Pamidimukala Chaithanya K , Bastawrose Joseph H , Park Terrence , Pratap Balai , Pokal Mythri , Siripuram Chandu , Tangwongchai Kultida , Alwood Darcie , Rittenhouse Chelsea , Herzog Eyal
Published: July 2021

Background:
According to the design of our SELF pathway, patients are stratified twice using the acronyms SELF-A (Short period, Early-rapid onset, Loss of consciousness, Full recovery) and SELF-B (Structural heart disease, abnormal Ecg, and arrhythmia Fib/FL). We assessed the short and Long-term outcome according to this approach.

Methods:
1468 patients were prospectively followed after presenting to our emergecy department for the evaluation of syncope. Patients were divided into Group I (SELF +/+) who met both SELF A and B criteria and group II (SELF -/-) who didnot meet these criteria.The primary endpoint was a composite of readmission for syncope, myocardial infarction (MI), stroke or death. Follow-up was 494 ± 120 days.

Results:
644 (44%) patients were included in group I and 824 (64%) patients in group II. Group I were older (73 ± 15 years vs. 58 ± 22 years), with more evidence of hypertension (74% vs. 41%), diabetes (24% vs. 15%), heart failure (15% vs. 5%), and coronary disease (26% vs. 10%); p<0.001. During hospital stay group I underwent more procedures. At the end of 7, 30 and 180 days follow up, group I patients had 9 (2%), 33 (5%), 96 (15%) vs. 7 (0.8%), 19 (2%), 55 (6%) events respectively; p <0.001 (Figure).

Conclusions:
Using the SELF-pathway for patients presenting with syncope effectively identifies high risk patients who merit hospitalization for further work-up. This has important implications for the evaluation of a common disease that poses a significant economic burden on healthcare systems.
Abstract 66: Current Attitudes and Practice Patterns of Using New and Emerging Therapies to Manage Patients with Atrial Fibrillation (AF): a National Assessment of Cardiologists and Primary Care Physicians
Authors: Salinas Gregory D , Robinson Caroline O , Roepke Nancy , Burton B. S , Susalka Debi , Cline Kristan
Published: July 2021

Introduction:
Stroke prevention is a cornerstone in the management of patients with AF at higher risk for ischemic events. This study assessed physician barriers to management of AF patients, including gaps in clinical knowledge and application of tools and guidelines for reducing stroke risk. Awareness, perception, and confidence in adopting newer anticoagulants were investigated, particularly related to balancing risk with treatment goals, and knowledge sources sought by physicians.

Methods:
The data for this study, conducted from March 2011 to May 2011, were collected through the use of a nationally-distributed case vignette survey to cardiologists and primary care physicians (PCPs), as well as patient chart audits nested within the physician sample. Each component of this study was reviewed and approved by the Western Institutional Review Board (WIRB).

Results:
Surveys from 142 cardiologists and 250 PCPs, and 632 patient chart audits, were analyzed. Nearly half of cardiologists and more than 75% of PCPs surveyed identified uncertainty regarding stroke risk assessment and lack of awareness of tools to guide risk assessment as barriers to determining appropriate antithrombotic therapy. Case vignette assessment found that 44% of PCPs familiar with the CHADS2 risk assessment tool were unable to appropriately assign a risk score, and they were less likely than cardiologists (53% vs 85%) to use this tool in clinical practice. Consistent with their greater familiarity, 65% of cardiologists are very confident in using emerging anticoagulants, while only 40% of PCPs have comparable confidence. The most frequently sought and valued resources for information about emerging anticoagulants were clinical practice guidelines, journal articles, CME activities, and communication with physician peers.

Conclusion:
Knowledge gaps and clinical barriers exist among physicians for stroke risk assessment, anticoagulation management, and use of emerging therapies in patients with AF. Physicians seek independent evidence-based information when deciding how to incorporate new anticoagulants into practice. The data suggest that physicians value education on safety and efficacy of therapies as well as practical guidance on applying clinical data to practice.
Abstract 70: Exercise Stress Testing Modality after Percutaneous Coronary Intervention - Choice of Modality and Implications for Resource Use: Retrospective Analysis using the NCDR®
Authors: Federspiel Jerome , Mudrick Daniel W , Shah Bimal R , Stearns Sally C , Masoudi Frederick A , Cowper Patricia A , Green Cynthia L , Douglas Pamela S
Published: July 2021

OBJECTIVES:
Exercise stress testing is frequently performed post PCI, but the choices amongst the modalities available (ECG-only, nuclear, or echocardiography) and consequences of such choices are not well characterized. We evaluated temporal trends and geographic variation in the choice of exercise testing modality post PCI, as well as associations between modality choice and procedure use after testing.

METHODS:
CathPCI Registry® data were linked with identifiable Medicare claims to capture stress testing use between 60 and 365 days after PCI and procedures within 90 days after testing. Testing rates and modality used were modeled based on patient, procedure, and PCI facility factors, calendar quarter, and Census Divisions using Poisson and logistic regression. Post stress test/procedure use was assessed using Gray's test.

RESULTS:
In 286,099 patients, the overall stress testing rate after PCI was 53.1 per 100 person-years. The rate declined from 59.5 in Q1 2006 to 47.2 in Q4 2008 (p<0.001), but the proportion of all stress tests performed with exercise and the proportion of all exercise tests performed with each modality changed little. After statistical adjustment, the proportion of exercise test recipients receiving ECG-only testing (vs. any stress imaging) varied from 8.7%-21.1% across divisions (p<0.001). Among exercise stress imaging recipients, the proportion receiving echocardiography (vs. nuclear) varied from 9.1%-31.2% across divisions (p<0.001). Rates of post-test procedure use varied among modalities; exercise ECG-only testing was associated with more subsequent stress testing (14.6% vs. 1.9%; p<0.001), but less catheterization (8.4% vs. 15.3%; p<0.001) than imaging-based tests.

CONCLUSIONS:
Modest reductions in stress testing after PCI occurring between 2006 and 2008 cannot be ascribed to trends in use of any single modality. Additional research should assess whether this trend represents better patient selection for testing or administrative policies (e.g., restricted access for patients with legitimate testing needs). Geographic variation in utilization of exercise stress modalities and differences in downstream procedure use among modalities suggest a need to identify optimal use of the different test modalities.
Abstract 84: Impact of Education on Dual Antiplatelet Therapy Adherence
Authors: Sergie Ziad , Baber Usman , Sartori Samantha , Cohen David J , Bharathi Pushpam , Alu Maria , Clark Avery , Gibson C. Michael , Chieffo Alaide , Krucoff Mitchell W , Moliterno David J. , Steg Philippe Gabriel , Weisz Giora , Witzenbichler Bernard , Colombo Antonio , Mehran Roxana
Published: July 2021

Background:
Lack of education is associated with adverse outcomes following percutaneous coronary intervention (PCI). Whether or not this is due to medication non-compliance, which is a risk factor for cardiac events, is unclear.

Methods:
PARIS (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) is a multi-center, multinational, prospective registry of patients that have undergone stent implantation. The primary outcome is non-adherence to dual antiplatelet therapy (DAPT) defined as discontinuation, interruption, or disruption. Independently adjudicated outcomes were measured at 30 days after procedure. Discontinuation was defined as stopping DAPT because therapy was no longer needed, in contrast to interruption (stopping DAPT on under physician guidance because of a procedure or surgery), and disruption (stopping DAPT due to bleeding or non-compliance).

Results:
Among 5033 patients, the average age was 64 years, 74.5% were male, 40.9% presented with ACS, and 82% received a drug-eluting stent. At 30 days, the overall incidence of non-adherence was 2.1%. For either aspirin or thienopyridine, disruption occurred because of bleeding in 31.4% and because of non-compliance in 62.7%. There was a significant association between education level and overall non-adherence (p=0.006) (see table). A higher proportion of non-adherent patients achieved less than secondary education (22.3% vs.11.9%, p=0.0013) or secondary education (50.9% vs. 38.8%, p=0.016), while there was no significant difference in patients with higher levels of education. After adjusting for age, those who achieved university compared with less than secondary education had a lower risk of non-adherence (odds ratio 0.53, 95% confidence interval: 0.30-0.92, p=0.03).

Conclusion:
In this study, lower education levels were associated with non-adherence to DAPT within 30 days after PCI. This underlines the importance of patient education tools, especially for those with lower education status to enhance compliance in the real world.
Abstract 121: Statin Use For Secondary Prevention Of Coronary Artery Disease In Patients Undergoing Repeat Percutaneous Coronary Intervention: Real World Data
Authors: Rajamanickam Anitha , Zhang YuanYuan , Rao Abhishek , Aguiar Ruth , Bradley Elizabeth , Weintraub William , Goldenberg Edward
Published: July 2021

Background:
Secondary prevention with statin therapy in Coronary artery disease (CAD) decreases future major cardiovascular events and mortality and improves outcomes. Current guidelines recommend a LDL goal of at least ≤ 100 and preferably ≤ 70 . Statins have also shown to have beneficial effects independent of LDL levels. We hypothesized that is the real world statin use and LDL goal in CAD patients who need a subsequent percutaneous coronary intervention (PCI) is inadequate in spite of strong recommendations and guidelines

Methods:
A query of electronic medical records (EMR) in our 1100 bed academic community hospital retrieved 8586 PCIs from 10/1/2006 to 2/14/2012. Of these 1641 patients had definite CAD (defined by either a prior PCI or CABG) and only 1315 had lipid levels drawn within three months prior to PCI and patient (pts) data was retrieved from our PCI database and EMR.

Results:
Only 573 (44%) patients were on statins on arrival for PCI .However, 1187(90%) patients were prescribed statins on discharge from the cardiac catheterization lab and this was independent of the experience of the interventional cardiologists. Only 26% (346) patients had LDL≤ 70 and only 55% (727 ) patients had LDL ≤ 100. Patients with LDL not at goal were less likely to be on statins or any lipid lowering medications. Patients with renal failure were less likely to be on stains. However there was no significant difference in comorbidities(except hypertension)like alcohol abuse, liver failure, arthritis, obesity or depression in patients whether on or not on therapy with statins.

Conclusions:
Real world data shows that we fail at adequate usage of statins or getting lipids to target goals. Interestingly around 90% of patients are prescribed statins on discharge from the cardiac catheterization lab. In practice statins are discontinued or higher doses to achieve target LDLs are avoided as they are generally less well tolerated due to side effects (muscle and liver toxicity). In this subset of patients, referral to lipid specialists and specialty centers and advent of newer lipid lowering drugs may prove to be beneficial.
Abstract 16: Early Use of Aspirin is Critical for Improving Outcomes Following Systemic to Pulmonary Artery Shunting
Authors: Norouzi Sayna , Heidari Bateni Giv , Hall Matthew , Eghtesady Pirooz
Published: July 2021

Objective:
Systemic to pulmonary artery shunting (BT) is a common palliative procedure used in children with congenital heart disease. Despite the relatively simple nature of the procedure, the BT shunt procedure is associated with significant morbidity and mortality that is believed to be related perhaps to thrombosis of the artificial graft. The optimal postoperative anticoagulation regimen for this procedure is unknown. We compared the effectiveness of various anticoagulation regimens in patients undergoing BT shunt procedure, evaluating in particular the time of aspirin (ASA) initiation on BT shunt outcomes.

Methods:
The Pediatric Health Information System database (PHIS) was retrospectively queried (2000-2011) to identify patients (<30 days old) who underwent isolated BT shunts procedures. Postoperative anticoagulation regimens were categorized into: Heparin only, ASA and Heparin and ASA only regimens. The primary end point was mortality; secondary endpoints included the need for shunt revision, catheter-based investigation or intervention post procedure. The effect of aspirin supplementation on heparin regimen on the day of surgery and the day after was evaluated using GEE logistic regression to account for hospital clustering. All confounding factors were adjusted between groups. Cox proportional hazard analysis was performed in order to compare anticoagulation regimens after BT shunt surgery.

Results:
A total of 1746 patients were identified. Survival analysis revealed that ASA plus heparin is the best anticoagulation regimen after BT shunt surgery (p =0.001). Patients who survived to discharged, started ASA earlier than those died during hospitalization (mean day of start of 3.7±0.2 vs. 14.6±6.3 with interquartile range of 3 vs. 11 respectively, p= 0.001). Based on GEE modeling, administration of aspirin even on day one significantly decreased mortality rate (adjusted OR=0.21, CI 95%=0.04-0.97, p =0.04 compared to heparin only group).

Conclusion:
Our results demonstrate a critical role for ASA in lowering rates of mortality and complications in the immediate perioperative period after BT shunt surgery. Administration of ASA as early as first postoperative day can reduce the mortality rate for this common congenital heart procedure.
Abstract 169: Targeting Patients with Multiple Readmissions in the Year after Non-ST-Elevation Myocardial Infarction Could Lower Hospital Readmission Rates
Authors: Bernacki Gwen , Alexander Karen , Roe Matthew , Li Shuang , Thomas Laine , Shah Bimal , Peterson Eric
Published: July 2021

Background:
Bundled payment policies have focused on 30-day readmission rates after AMI, yet these are likely to lengthen over time. Identifying patients with multiple readmissions in the year after AMI could help focus transitional care efforts on these high risk patients.

Methods:
Data from the CRUSADE registry linked to Medicare billing data was used to examine longitudinal outcomes of 32,776 NSTEMI patients ≥ 65 years between 2003 and 2006 with 12-month follow-up. Defining frequent readmissions as ≥3 hospitalizations in 12 months, we compared characteristics of patients frequently readmitted vs. not. The association between frequent readmissions and patient characteristics was examined using multivariable logistic regression.

Results:
Readmission within 12 months after NSTEMI occurred: once (N=8,830, 26.9%); twice (N=4334, 13.2%); 3 times (N=2,319, 7.1%); ≥4 times (N=2470, 7.5%). Those with multiple (≥3) readmissions (14.6%) were older with recent prior hospitalization and greater prevalence of comorbidities. In multivariable analysis, these factors increased discrimination of patients with frequent readmissions, (c-statistic=0.714).

Conclusions:
Comorbidities and recent prior hospitalization can predict patients with frequent readmissions. Better understanding of the influence of these clinical factors in this high-risk group presents an opportunity to lower hospital readmission rates.
Abstract 193: Primary Care Utilization Reduces Risk of Readmission among High-Risk Vascular Surgery Patients: Coordinating of Post-Discharge Care Matters
Authors: Brooke Benjamin S , Goodney Philip P
Published: July 2021

Objectives:
Readmissions are a common and costly occurrence following high-risk surgical procedures, but may be avoided if problems are identified early in the post-discharge period. We hypothesized that routine follow-up with a primary care provider (PCP) might reduce 30-day readmissions following a high-risk vascular surgery procedure, thoracic aortic aneurysm (TAA) repair.

Methods:
We conducted a retrospective cohort study of 42,935 Medicare beneficiaries who were discharged home from US hospitals following open TAA repair in 2003-2010. Primary care utilization was determined within 307 hospital referral regions described by the Dartmouth Atlas, as well as using a 20% sample of Medicare claims for outpatient primary care services within 30-days following TAA repair. We used hierarchical regression models, adjusted for patient and regional level differences, to examine the relationship between primary care utilization with 30-day readmission & mortality following TAA repair.

Results:
8,429 (20%) patients were readmitted within 30-days after open TAA repair, and more than 42% of readmissions occurred by 11 days post discharge. Among patients discharged following an uncomplicated hospital course, follow-up with a PCP within 30-days significantly reduced the risk of readmissions (Figure). Even after adjusting for differences in age, race, gender, and complications, PCP follow-up reduced the likelihood of 30-day readmission following TAA repair by over 30% (OR: 0.69; 95%CI: 0.49-0.97; P<0.05). As with most major surgical procedures, readmissions following TAA repair were more likely to occur among patients experiencing postoperative complications (21% vs. 19%, P<0.01). Finally, readmissions were less likely to occur in hospital referral regions with high primary care utilization as compared to regions with low rates of primary care utilization (19.4% high vs. 23.6% low; P<0.01).

Conclusions:
Medicare recipients discharged following open TAA repair were significantly less likely to be readmitted in regions with high primary care utilization and when primary care follow-up occurred after surgery. These results highlight the need for better coordination of care between surgeons and primary care providers, and suggest an opportunity to focus quality improvement efforts to limit readmission.
Abstract 223: National and Regional Trends in Hospitalizations for Hemorrhagic Stroke after Acute Myocardial Infarction in the United States: 1999-2010
Authors: Shi Ruizhi , Wang Yun , Lichtman Judith H , Dharmarajan Kumar , Masoudi Frederick A , Dodson John A , Chen Jersey , Chaudhry Sarwat I , Spertus John A , Nallamothu Brahmajee K , Krumholz Harlan M
Published: July 2021

Background:
Elderly survivors of acute myocardial infarction (AMI) are at elevated risk for hemorrhagic stroke, which has a mortality rate of approximately 50%. Increasing use of warfarin for arterial fibrillation and anti-platelet agents for AMI combined with an increasing aging population may have influenced the risk of post-AMI strokes. We sought to characterize temporal trends in the risk for and mortality from hemorrhagic stroke over 12 years among older AMI survivors of different age, sex, race, revascularization status, and region within the US.

Methods:
We used 100% of Medicare inpatient claims data to identify all fee-for-service (FFS) patients aged> 64 years who were hospitalized for AMI in 1999-2010. We excluded patients who died during the hospitalization or were transferred. Revascularization procedures were identified during the index admission. We used a Cox proportional-hazards regression model to estimate the risk-adjusted annual changes in one-year hemorrhagic stroke hospitalization after AMI, overall and by subgroups. Changes were adjusted by age, gender, race, medical history and comorbidities. We calculated the 30-day mortality among patients readmitted for hemorrhagic stroke. Stroke belt regions were defined as the states with high stroke hospitalization rates in the southeast United States.

Results:
Among 2,433,036 AMI hospitalizations and 4,852 hemorrhagic stroke readmissions, the risk-adjusted one-year post-AMI hemorrhagic stroke rate remained stable from 1999 to 2010 (range, 0.2% to 0.3%). No significant trends were found for post-AMI stroke rates across all age-sex-race groups and all treatment groups (Figure). Thirty-day mortality rates for stroke after AMI did not show significant changes (1999, 46.7%, 95% CI 39.9%-53.7%; 2010, 50.7%, 95% CI 45.3%-56.1%; range: 46.5% to 54.6%). No difference was found in post-AMI hemorrhagic stroke rates between the stroke belt and non-stroke belt regions.

Conclusions:
From 1999 to 2010, the overall hospitalization rates of hemorrhagic stroke after AMI were relatively stable without significant changes across all subgroups. Thirty-day mortality rates remained largely unchanged over time. Stroke risk in the stroke belt was not found significantly higher comparing with non-stroke belt states.
Abstract 257: Predictors of Long-Term Weight Loss among Overweight and Obese People Attending a Worksite Wellness Center
Authors: Rodriguez-Escudero Juan P , Clark Matthew M , Somers Virend K , Egginton Jason S , Diaz-Melean Carlos M , Hensrud Donald D , Lopez-Jimenez Francisco
Published: July 2021

Background:
Regular exercise is considered a key element to maintain weight loss, but its role to induce weight loss has been controversial.

Methods:
In this retrospective study of 7237 individuals attending a worksite wellness center from September 2008 to October 2011 to assess predictors of weight loss at 12 months after joining. Upon joining the wellness center, participants completed a survey that assessed for the presence of cardiovascular risk factors, height, weight, self-perceived health behaviors and psychosocial factors using validated 11-point scale items. We limited the sample to 1927 overweight (25 < BMI ≤ 30) and obese (BMI > 30) participants who completed the survey in full at baseline and at 12 months (+/- 90 days). The outcome variable was weight change at 12 months after enrollment. Weight loss was defined as a loss of > 1kg.

Results:
Of 1927 participants, 998 (52%) were either overweight (n=573; 57%) or obese (n=425; 43%), and 60% were women. Mean (SD) age was 41 (11.5) yr, BMI 30.7 (5.5) kg/m
2
and they visited the wellness center 49 (90) times/year. At 12 months, 416 (42%) of the participants had lost >1 kg and 19% had lost > 5kg. The predictors of weight loss were: baseline BMI, [Odds Ratio (OR)= 1.56 (1.15-2.13); p < .0044] and [OR= 1.75 (1.26-2.44); p < .0010] for BMI between 30-35 and BMI ≥35, vs BMI between 25-29, respectively. In addition, visits/year [OR= 1.60 (1.19-2.16); p < .0010] and [OR= 1.85 (1.37-2.61); p < .0001] for those attending 13-52 sessions and > 52 visits/year, vs ≤ 12 visits/year, respectively. The association persisted after controlling for all covariates (ie, cardiovascular risk factors, self-perceived health behavior and psychosocial factors). The Table shows the results of the multivariate analysis assessing predictors for >1kg weight loss. Neither age, gender, perceived stress, self-perception of being overweight, following a healthy diet, nor history of hypertension, high blood cholesterol or diabetes predicted weight loss.

Conclusions:
A significant percentage of overweight or obese individuals lose weight after enrolling in a worksite wellness center. Frequency of attendance, baseline BMI, and support for maintaining a healthy living are associated with weight loss. These results suggest interventions to promote usage of wellness centers maybe be beneficial for the obese adult.
Abstract 27: Impact of Telemonitoring on Health Status in Patients with Heart Failure
Authors: Jayaram Natalie , Krumholz Harlan M , Chaudhry Sarwat I , Mattera Jennifer , Tang Fengming , Spertus John A
Published: July 2021

Background:
Although telemonitoring in patients with heart failure is not effective in reducing mortality or hospitalizations, less is known regarding its effect on patients’ health status, their symptoms, functioning and quality of life.

Methods:
The TeleHF study randomized 1,653 patients with recent heart failure hospitalization to telephonic monitoring (n=826) or usual care (n=827). Patients in the telemonitoring arm phoned in daily and responded to a series of automated questions regarding their symptoms and daily weight. Health status information, using the Kansas City Cardiomyopathy Questionnaire (KCCQ), was collected at baseline, 3 months, and at 6 months. The primary endpoint was change in KCCQ score from baseline to 3 and 6 months.

Results:
The baseline characteristics of the two treatment arms were similar; 42% were female and 39% were black. At baseline, there were no significant differences in KCCQ scores between the telemedicine and the usual care group. Both groups reported significant quality of life limitations with median KCCQ score of 59.9, and median scores of 75.0, 87.5 and 56.3 on the physical limitation, self-efficacy and social limitation subscales respectively. At 3 and 6 month follow-up, there were no significant differences between the two treatment groups with respect to the primary endpoint, change in KCCQ overall summary score or subscale scores from baseline (see table).

Conclusion:
Telemonitoring in a large group of patients with heart failure did not improve health status when compared to usual care. Failure to improve readmission or mortality rates combined with lack of effect on quality of life suggests that alternative solutions for management of this complex population should be sought.
Abstract 273: Incidence and Predictors of Heart Failure Hospitalization in Veterans Undergoing Cardioverter-Defibrillator Implantation in the Outcomes among Veterans with Implantable Defibrillators (OVID) Registry
Authors: Schneider Preston M , Katz David F , Pelligrini Cara N , Heidenreich Paul A , Aleong Ryan G , Keung Edmund C , Massie Barry M , Varosy Paul D
Published: July 2021

Introduction:
Recent quality improvement initiatives and CMS policies have placed an additional focus on rates of hospital readmission. The rate of hospital readmission after defibrillator implantation is unknown. Our study examines 30 day, 90 day, and 1 year rates as well as risk factor associations with readmission following defibrillator implantation in the Veterans Affairs population.

Methods:
Among veterans enrolled in the Outcomes among Veterans with Implantable Defibrillators (OVID) registry between 2003 and 2009, 3,913 were identified as within 3 months of initial ICD implantation. Baseline clinical characteristics and hospitalizations were abstracted from the electronic medical record. Rates of thirty day, ninety day, and one year hospital readmission were calculated and predictors of subsequent heart failure hospitalization were determined using Cox proportional hazards models.

Results:
Among 3,913 patients we identified 65 hospital readmissions by 30 days, 93 by 90 days, and 308 by 1 year. This results in a thirty day, ninety day, and one year readmission rate of 1.7%, 4.0%, and 12.3%, respectively. Of the examined predictors, age, left ventricular ejection fraction < 25%, New York Heart Association (NYHA) class IV symptoms, prior heart failure hospitalization, heart failure diagnosis for longer than 9 months, chronic kidney disease, diabetes, and COPD were significant predictors of heart failure hospitalization. The strongest predictor was heart failure hospitalization within the 6 months prior to implantation (HR 2.42, 95% CI 1.94 - 3.00). Patients with NYHA Class IV symptoms had the highest hospitalization rates at 6.3%, 12.6%, and 27.8% at 30 days, 90 days, and 1 year after implantation respectively. Hospitalization rates for selected variables are shown in the Table.

Conclusions:
Hospital readmission rates after defibrillator implantation in this cohort are lower than previously published rates of heart failure readmission among patients with heart failure. Of the candidate predictors examined, heart failure hospitalization within 6 months prior to implantation was the strongest predictor of future hospitalization and patients with NYHA Class IV symptoms had the highest readmission rates.
Abstract 275: Concomitant Statin Use With Ezetimibe Or Colesevelam For Treatment Of Hypercholesterolemia
Authors: Ye Xin , Bays Harold , Schwab Philip
Published: July 2021

OBJECTIVES:
Ezetimibe or colesevelam are often used for treating hypercholesterolemia when statin therapy is insufficient or not well tolerated. Our study objective was to examine prevalence of concomitant statin use and associated factors among hypercholesterolemia patients newly treated with ezetimibe or colesevelam.

METHODS:
This analysis evaluated a large health plan’s Commercial and Medicare Advantage claims data from 1/1/08 to 7/31/12. The first ezetimibe (excluding fixed combination therapy of ezetimibe/simvastatin) or colesevelam prescription fill date during this period was identified as the index date. Patients were assigned to either ezetimibe or colesevelam cohort based on the index drug and were required to have ≥ 2 consecutive prescriptions for the index drug and have at least 6 months and 12 months continuous enrollment before and after the index date, respectively. Prevalence of concomitant statin use was identified based on pharmacy claims. Patient demographics and clinical characterisitics were explored to examine the factors associated with concomitant statin use using multivariate logistic regression.

RESULTS:
A total of 679 colesevelam and 1439 ezetimibe patients were included in this study. The concomitant use of statins was 24% among colesevelam and 50% among ezetimibe patients, respectively. After adjustment for patient demographics and comorbidities, ezetimibe patients were 3.2 times more likely than colesevelam patients to have concomitant statin use (OR= 3.168, 95% CI: 2.573, 3.900, P<0.001). Other significant factors associated with higher concomitant statin use include: male gender (OR= 1.296, 95%: 1.079, 1.558, P=0.006), presence of diabetes mellitus (OR=1.262, 95% CI: 1.035, 1.539, P=0.021) and higher Charlson comorbidity score (OR=1.114, 95% CI: 1.046, 1.187, P<0.001)

CONCLUSIONS:
In this claims data analysis, statins were administered along with ezetimibe more frequently than administered with colesevelam, which should be taken into account when evaluating effectiveness of ezetimibe vs. colesevelam in the real-world treatment of hypercholesterolemia.
Abstract 289: Hospital Volume of LVAD Procedures Determines Patient Outcome
Authors: Feldman Katherine , Doukky Rami , Johnson Tricia , Levine David , Hohmann Sam
Published: July 2021

Background:
Left ventricular assist devices (LVADs) provide mechanical circulatory support to patients with end-stage heart failure. The use of these devices in the United States has been increasing since the FDA approved the first device in 1994. There are no published studies that have evaluated the relationship between LVAD procedural volume and hospital mortality, despite large variation across hospitals in the volume of LVAD procedures performed. This study sought to explore whether a correlation exists between hospital and surgeon’s procedural volumes and patient outcomes, and also to identify a critical threshold.

Methods:
We conducted a retrospective cross-sectional analysis of all patient discharges from UHC member hospitals from January 2008 through June 2012 after an insertion of an LVAD during their hospitalization. Patients were identified from UHC’s Clinical Database/Resource Manager (CDB/RM) on the basis of the principal or secondary

International Classification of Diseases Ninth

Revision, Clinical Modification

(
ICD-9-CM) procedure code 37.66. The primary outcome was all cause mortality.

Results:
There were 87 hospitals that admitted at least 1 patient for an LVAD procedure during the study period (77.5 percent males, mean age 54.3). The mean length of stay was 42.1 days and a mean total cost of $299,067. We identified variation of in-hospital mortality by hospital LVAD procedure volume quartile. Quartile 1 included hospitals performing 1-9 procedures (38.8% mortality), quartile 2 performed 10-46 procedures (18.1% mortality), quartile 3 performed 55-97 procedures (12.8% mortality), and the fourth quartile performed 107-319 procedures (16.1% mortality) during the study period. Categorical variables were compared with the Chi-Square Test, and continuous variables were compared with t-tests. There was significant variation in the mortality for almost all study variables including age, gender, admission severity of illness, and admission risk of mortality, and the variation persisted by volume quartile.

Conclusion:
Initial results suggest that there is a correlation between hospital LVAD procedure volume and in-hospital mortality. LVADs are becoming an increasingly common treatment method for patients with end-stage heart failure and are either awaiting transplant or will receive the device as the final method of therapy. Identifying critical volume thresholds could improve outcomes and ultimately improve the efficiency and value of care.

Implications:
Identifying mortality associated with LVAD procedures at these hospitals will provide patients and physicians with more information when seeking treatment options for heart failure. This study may also have health policy implications for cardiac treatment by implementing guidelines that LVAD hospital and surgeon programs must adhere to.