bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 349: Comparisons of Self-reported and Measured Body Mass Index in a large Employee Population: The Baptist Health South Florida Employee Study
Authors: Osondu Chukwuemeka U , Aneni Ehimen C , Das Sankalp , Rouseff Maribeth , Guzman Henry , Tran Thinh , Roberson Lara , Post Janisse , Feldman Theodore , Agatston Arthur S , Veledar Emir , Nasir Khurram
Published: March 2022

Background:
Self reporting of health information by participants in employer sponsored programs may result in under reporting of this data. Since policies are formulated on the basis of analysis of available data, underreported data may adversely inform healthcare policy decisions in workplace and other relevant settings. In this study, we examine the disparity in measured versus self reported body mass index (BMI) in a large, diverse working population participating in a work-based Health Risk Assessment (HRA).

Methods:
Baptist Health South Florida, a large not-for-profit health care organization, conducts a HRA annually for its employees. The HRA consists of an online health questionnaire and an in-person assessment of biometric measures. Participants report their height and weight in the online questionnaire, and height and weight is measured during collection of biometric information, from which BMI is calculated. BMI was categorized as: not obese (<25kg/m
2
), obese (30 - 34.9kg/m
2
) and morbidly obese (≥35kg/m
2
).

Results:
A total of 9536 persons self reported their BMI and subsequently had BMI measured. Mean age of the participants was 43.1 years (± 12.1). Mean BMI was 28.6 (± 6.2) and 27.8 (± 5.9) respectively for measured and self reported BMI respectively. Among all participants, 90% self reported accurately in their respective weight categories, while 9% underreported their weight. However, among obese participants (n=3168), 72% correctly self-reported their BMI. Approximately 29% of obese class I participants reported BMIs in the non-obese category, while about 22% of those with BMI ≥35 kg/m
2
reported as being in Obese class I (<35kg/m
2
). There was a high degree of agreement overall observed between measured and self reported BMI (κ = 0.84; Intra Class Coefficient = 0.89).

Conclusion:
Despite of a high degree of overall agreement between measured and self reported BMI, obese participants considerably underreport BMI. Thus, underreporting of self-reported data should be taken into account during program planning and formulation of healthcare policy decisions in the workplace.
Abstract 357: Consistency in Survival for In-hospital Cardiac Arrest: Do Hospitals Which Excel One Year Continue to Excel in the Next Year?
Authors: Chan Paul S , Iwashyna Theodore J , Ewing Lee A , Tang Fengming , Kennedy Mary M , Lehrich Jessica L , Nallamothu Brahmajee K
Published: March 2022

Background:
Recently, we developed and validated a model to calculate risk-standardized survival rates (RSSRs) for in-hospital cardiac arrest_a common condition occurring within hospitals. Although RSSRs can be used to determine high and low performing sites, it remains unclear if RSSRs for in-hospital cardiac arrest are stable, i.e., similar from year to year.

Methods:
Within the Get With The Guidelines-Resuscitation registry, we identified 21,947 patients from 240 hospitals admitted between 2012 and 2013 with an in-hospital cardiac arrest. Using hierarchical logistic regression, we separately calculated 2012 and 2013 risk-standardized RSSRs for hospitals with at least 10 cardiac arrest cases and evaluated the correlation between 2012 and 2013 RSSRs.

Results:
The mean hospital RSSR was 23%
+
4% (median, 23% [IQR: 21%-25%]) in 2012 and 25%
+
5% (median, 25% [IQR: 22%-27%]) in 2013. There was strong correlation between a hospital’s performance between the two years (r=0.50;
P
<0.0001;
Figure
). Most hospitals with RSSRs in the top quintile in 2012 (64.2% [34/53]) remained in the top 2 quintiles in 2013, and only 13.2% (7/53) had RSSRs below the median in 2013. Conversely, most hospitals with RSSRs in the lowest quintile in 2012 (60.4% [29/48]) remained in the lowest 2 quintiles in 2013, and only 22.9% (11/48) had RSSRs above the median in 2013.

Conclusion:
There was good correlation in RSSRs for in-hospital cardiac arrest for 2012 and 2013. Most top performing hospitals continued to excel and most low performing hospitals continued with below average survival, although some discordance was noted. These findings have implications for identifying top performing hospitals as those that
consistently excel
in survival outcomes each year.
Abstract 359: Duke Activity Status Index is Sensitive to Non-Fatal Adverse Cardiac Events when Evaluating Patient Outcome at Late Follow-up
Authors: Shaw Richard E , Kuschner Cyrus E , Johnson Christopher K , Ferrari Giovanni , Brizzio Mariano E , Zapolanski Alex , Grau Juan B
Published: March 2022

Objective:
The Duke Activity Status Index (DASI) questionnaire has become an established measure of cardiac functional capacity and quality of life. However, the relationship between a low DASI score and presence of major adverse cardiac events has not yet been assessed. This study evaluates differences in patient function and occurrence of late cardiac events in patients undergoing coronary artery bypass (CAB).

Methods:
Patients undergoing CAB between 1994 and 2014 at the Valley Hospital were assessed and propensity matched for surgical approach. The resulting population of 1856 patients was followed for a mean time of 11.2 years ranging from 1 to 20 year. Survival, occurrence of MI, stroke, repeat revascularization and patient function using the DASI questionnaire were assessed. At the latest follow-up, 1363 patients were still alive, of which 776 had completed the DASI questionnaire. Patients who completed the questionnaire (Responders) were compared to those who did not complete the DASI (Non-Responders) on baseline demographic and clinical characteristics. Kaplan-Meier and Cox Proportional Hazards Regression were used to compare late non-fatal events that occurred in patients with a low (<37, N=247), medium (37-52, N=209), or high (>52, N=310) DASI score.

Results:
Responders had a higher rate of prior MI, increased hypertension, and were significantly older at baseline procedure compared to Non-Responders. Both groups had comparable surgical risk and left ventricle ejection fraction at baseline revascularization. Kaplan-Meier analysis of the Responders showed that patients with a low scoring DASI had significantly greater occurrence of all late events. Cox Regression analysis controlling for all baseline factors showed that patients with a low DASI score had a two-fold increase in late non-fatal events compared to medium and high DASI scoring patients (adjusted hazard ratio: 2.076, 95% C.I. 1.309-3.293, p=0.002) (Figure 1).

Conclusions:
This study demonstrates that in cardiac surgical patients, a low score on DASI is independently associated with a higher occurrence of late non-fatal cardiac events. This provides further evidence supporting the use of the DASI questionnaire in evaluating patient functioning after cardiac surgery.
Abstract 362: Diagnostic Value of Non-invasive Computed Tomography Perfusion Imaging for Assessing Hemodynamically Significant Native Coronary Artery Lesion: A Meta-analysis
Authors: Sethi Pooja , Panchal Hemang , Raham Zia , Batheja Samit , Veeranki Sreenivas P , Paul Timir
Published: March 2022

Background:
Traditionally, hemodynamic significance of a native coronary artery lesion is determined by invasive coronary angiography and fractional flow reserve. Computed tomography perfusion imaging (CTP) is a novel non-invasive method for determining hemodynamic significance of a coronary artery lesion. The objective of our meta-analysis is to determine the diagnostic performance of CTP with and without computed tomography angiography (CTA) in assessment of hemodynamically significant coronary artery lesions in comparison to invasive angiography.

Methods:
PubMed was searched through December 2014. Nine original studies were found evaluating the diagnostic performance of CTP with and without CTA to invasive coronary angiography in evaluation of hemodynamic significance of coronary lesions (n=951). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive and negative likelihood ratios (LR+ and LR- respectively) were calculated using hierarchical summary receiver operating curves and compared with bivariate random-effects model to accommodate for heterogeneity due to study design, population and diagnostic tests.

Results:
Total of 951 coronary vessels were evaluated for hemodynamically significant lesions. The sensitivity, specificity, PPV, NPV, LR+ and LR- values for CTP with CTA to diagnose hemodynamically significant coronary artery lesions were 83%, 91.7%, 86.4%, 89.4%, 9.94, and 0.19 respectively. The sensitivity, specificity, PPV, NPV, LR+ and LR- values for CTP alone were 82.9%, 84%. 76.1%, 88.9%, 5.18, and 0.20 respectively. The sensitivity, specificity, PPV, NPV, LR+ and LR- values for CTA alone were 89%, 72%, 64.2%, 92.1%, 3.18, and 0.15 respectively (Figure).

Conclusion:
The results of our meta-analysis assessing diagnostic value of CTP with or without CTA suggest that adding CTA to CTP significantly improves diagnostic performance of hemodynamic significance of coronary artery lesions compared to CTP alone. CTA with CTP is closely comparable with invasive angiography in assessing hemodynamic significance of coronary artery lesions in patients with stable coronary artery disease.
Abstract 363: Trends in Body Mass Index Based on Socioeconomic Status: A Report from Project Healthy Schools
Authors: Coolidge Alexis M , Sylvester Rachel , Jiang Qingmei , Rogers Robert , Wei Wen-Ching , Pew Alexandra , Goldberg Caren S , DuRussel-Weston Jean , Kline-Rogers Eva , Eagle Kim A , Jackson Elizabeth A
Published: March 2022

Background:
Project Healthy Schools (PHS) is a school-based wellness program that aims to reduce childhood obesity and its associated long-term effects through educational and environmental initiatives. This study aims to explore BMI trends from 2004 to 2014 according to socioeconomic status (SES).

Methods:
From 2004-2014, sixth-grade BMI measurements from 23 schools were recorded at baseline (BL) and follow-up (FU) (n=2,651). Schools were divided by SES based on area median household income. Mean BMI at BL and mean change in BMI between BL and FU are shown with 95% confidence intervals for the three SES groups at each year.

Results:
The high SES group had lower mean BMIs at BL than other groups each year. The trends suggest there was no difference between the low and middle SES groups at BL, although it appears low SES BMI is increasing over time. There were no notable differences in mean BMI change between groups.

Conclusions:
These data support previous studies showing lower BMIs in students from higher income areas. This validates the need to focus health interventions and nutritional efforts on lower SES groups.
Abstract 376: Trajectories of Angina-related Physical Limitations Following Acute Coronary Syndrome in TRACE-CORE
Authors: Nobel Lisa , Tjia Jennifer , Saczynski Jane S , Waring Molly E , Anatchkova Milena D , Ash Arlene S , Kiefe Catarina I , Allison Jeroan J
Published: March 2022

Objective:
The American Heart Association (AHA), recognizing critical knowledge gaps, has called for more research into determinants of patient functional status. We sought to identify longitudinal patterns (trajectories) of functional status and their predictors during 6 months following an acute coronary syndrome (ACS) discharge.

Methods:
We used data from the Transitions, Risks, and Actions in Coronary Events - Center for Cardiovascular Outcomes and Education (TRACE-CORE) prospective cohort of patients hospitalized with ACS. We measured physical limitations using the Seattle Angina Questionnaire at the index hospitalization and at 1-, 3-, and 6-months post-discharge. The Seattle Angina Questionnaire physical limitation sub-score (SAPL) ranges 1-100; higher scores indicate fewer limitations. We identified subgroups of patients with distinctive SAPL trajectories and predictors of those trajectories.

Results:
Participants (N=470) had mean age 62.8 (SD 10.8) years; 26.6% were female and 86.2%, white. We identified 2 SAPL trajectories: MINOR and MODERATE impairment. The majority of participants (80.3%) had MINOR impairment at baseline (mean SAPL 88.2) and modestly improving scores over time. A minority (19.7%) had MODERATE impairment at baseline (mean SAPL score 61.2) and modestly improving scores over time (Figure 1). With MODERATE limitation as the referent, we found that older age predicted membership in the MINOR limitation group (Odds Ratio [OR] per 10-years 2.28), as did being white (OR 4.07) and male (OR 3.50). Patients with co-morbidities (chronic lung disease OR= 0.31, hypertension OR= 0.34, peripheral vascular disease OR= 0.27) were less likely to have MINOR limitations, while those with acute myocardial infarction were more likely than those with unstable angina (NSTEMI OR= 2.95 and STEMI OR=6.23) to have MINOR limitations. [All p < 0.05].

Conclusions:
Traditional analyses without trajectories did not reveal the MODERATE subgroup with enduring deficits in physical function. Identifying and intervening early may help to improve post-hospitalization quality of life for patients with poorer expected trajectories. Trajectories of Physical Function Over Time Following Discharge from an Acute Coronary Syndrome Hospitalization
Abstract 380: Comparison of 6-Year Outcomes of Bare-metal and Paclitaxel-eluting Stents: Results from New York Cardiac Registries
Authors: Qian Feng , Kheocha-on Tammie , Hannan Edward
Published: March 2022

Background:
Coronary stents are commonly used in percutaneous coronary interventions (PCI). Bare-metal stents (BMS) as the first generation stent and paclitaxel-eluting stents (PES) as a second generation stent are widely deployed in PCIs. However, the long-term comparative effectiveness of BMS vs PES in the real practice remains unclear. Our aim was to assess a comprehensive set of 6-year clinical outcomes of all patients undergoing PCI with either BMS or PES placement and to determine comparative effectiveness of BMS vs PES in “off-label” (ST Segment Elevation Myocardial , totally occluded lesions, left main disease, multiple vessels diseased, bypassed graft lesions, and ejection fraction75 years, and diabetes) patient subgroups.

Methods:
A 6-year longitudinal database was created by linking data from the New York State (NYS) PCI registry, the NYS Cardiac Surgery Reporting System (CSRS) registry, the Statewide Planning and Research Cooperative System (SPARCS), the National Death Index (NDI) file, and the U.S. Census data (2010) for patients undergoing PCI with BMS or PES placement from January 1, 2006 through December 31, 2007. Outcomes included all-cause mortality, acute myocardial infarction (AMI), subsequent coronary revascularizations (PCI or coronary artery bypass graft surgery) and target-vessel PCI (TVPCI). Propensity score-matched patients undergoing BMS or PES (n=13,879 pairs) were compared with respect to 6-year outcomes using Kaplan-Meier estimates and Cox proportional hazards regression models applied to propensity-matched patients.

Results:
There were no significant differences in demographics, comorbidities, clinical profile, vessel/lesion related risk factors, and hospital/physician level characteristics between BMS and PES after propensity score matching. Kaplan-Meier estimates indicated that there were significant differences between BMS and PES for 6-year all-cause mortality (BMS: 26.87%, PES: 22.0%, Log-rank P<0.001), AMI (BMS: 8.91%, PES: 8.89%, P=0.045), repeat revascularization (BMS: 34.14%, PES: 36.27%, P=0.004), and TVPCI (BMS: 15.43%, PES: 15.28%, P=0.01). After further adjustment with Cox models, PES use was associated with significantly lower occurrence of 6-year all-cause mortality (adjusted hazard ratio : 0.74, P<0.001), AMI (AHR: 0.91, P=0.04), and TVPCI (AHR: 0.92, P=0.02) but higher occurrence of 6-year repeat revascularization (AHR: 1.08, P=0.001). The reason why BMS had lower repeat revascularization rate was because of its lower rate of repeat PCI in non-target vessels. For “off-label” and “high-risk” subgroups, PES had superior or non-inferior outcomes relative to BMS.

Conclusion:
Overall, PES improved clinical outcomes compared to BMS at 6 years. For each “off-label” or “high-risk” subgroup, the comparative effectiveness of PES vs BMS varied by the outcome assessed.
Abstract 10: Pre-stroke Antithrombotic Therapy and Stroke Severity in Acute Ischemic Stroke Patients with Atrial Fibrillation
Authors: Xian Ying , O’Brien Emily C , Liang Li , Pencina Michael J , Schwamm Lee H , Fonarow Gregg C , Bhatt Deepak L , Smith Eric E , Maisch Lesley , Hannah Deidre , Lindholm Brianna , Lytle Barbara L , Hernandez Adrian F , Peterson Eric D
Published: March 2022

Background:
Antithrombotic therapies are known to prevent thromboembolic events and stroke for patients with atrial fibrillation (AF). Despite this, it is unclear in contemporary practice what percentage of AF patients presenting with acute ischemic stroke (AIS) receive antithrombotic therapy prior to stroke and how pre-stroke antithrombotic therapy affects stroke severity, particularly in the era of non-vitamin K antagonist oral anticoagulants (NOACs).

Methods:
We analyzed data from 1625 Get With The Guidelines-Stroke hospitals between October 2012 and March 2015. Multivariable logistic regression was performed to evaluate the association between antithrombotic therapy and stroke severity according to NIHSS.

Results:
Of 103,327AIS patients with pre-stroke AF, 28,583 (28%) were not on any home antithrombotics prior to their stroke, and another 30,149 (29%) were receiving aspirin alone; followed by warfarin alone (18,532, 18%) with only a quarter (4705/18,532) in the therapeutic range, aspirin and warfarin (7130, 7%), and NOACs alone (5803, 6%) (
Figure
). Even among patients with a CHA2DS2-VASc score≥2, only one third of them (34,145/99,807) were receiving some form of oral anticoagulant. Stroke severity was associated with home antithrombotic use (
Figure
). Compared with those receiving aspirin alone, warfarin with INR≥2 (adjusted odds ratio [aOR], 0.72, 95% CI 0.66-0.79), aspirin and warfarin (aOR 0.83, 95% CI 0.77-0.90), NOACs alone (aOR 0.83, 95% CI 0.77-0.91), NOACs with aspirin or clopidogrel (aOR 0.69, 95% 0.60-0.79), aspirin and clopidogrel (aOR 0.90, 95% CI 0.83-0.99), or triple antithrombotic therapy (aOR 0.64, 95% 0.49-0.84) were associated with a lower likelihood of severe stroke (NIHSS≥16). In contrast, patients subtherapeutic (INR<2 or INR missing) on warfarin (aOR 1.07, 95% 1.01-1.13) and those not receiving any antithrombotic treatment (aOR 1.10, 95% 1.05-1.15) were more likely to present with more severe stroke.

Conclusions:
A majority of AF patients presenting with AIS are not on guideline recommended anticoagulation or are not therapeutic on their anticoagulation. Even when strokes occurred on therapeutic warfarin or a NOAC, the strokes were less severe. These findings highlight the huge opportunities to further improve proper use of oral anticoagulants in eligible AF patients.
Abstract 104: Group Medical Visits versus Usual Care in Heart Failure: Clinical Trial Design & Rationale
Authors: Dev Sandesh , Taveira Tracey H , Allen Susan M , Cohen Lisa B , Urbine Terry F , Rumsfeld John S , Heidenreich Paul A , Grady Kathleen L , Wu Wen-Chih
Published: March 2022

Objective:
The literature has demonstrated that patient self-care behaviors in heart failure (HF) and health system factors play an important role in patients’ health status and hospitalization risk. Utilizing the Chronic Care Model, shared medical appointments (SMA) are a type of care delivery redesign that provides patient self-management and peer support in addition to clinician-led disease management. In this model, the SMA team consists of a nutritionist, cardiology nurse, health psychologist, and a non-physician prescribing provider. The session begins with an assessment of patient needs followed by pre-assigned theme-based education and individualized medication management.

Methods and Expected Results:
At two VA medical centers, we will randomize 375 patients within 6 weeks of discharge from a HF hospitalization to receive either SMA intervention (4 sessions over 8 weeks) versus usual care (individual provider appointments) for HF. Inclusion criteria are: not enrolled in other programs for HF care, <2 hospitalizations last 6 months, left ventricular ejection fraction <40%. We will use stratified block randomization with block sizes of 4 at each site to ensure balance of the stratified variables. At 180 days, we will determine whether HF patients who participate in HF-SMA, as compared to patients who receive usual care: 1) Experience better cardiac health status measured by Kansas City Cardiomyopathy Questionnaire (primary outcome), and overall health status (EQ5D, secondary outcome); 2) Have fewer hospitalization or death and 3) Experience improvement in intermediate outcomes: a) increase in HF Self-Care Index, and b) decrease in plasma BNP levels. For patients who underwent HF-SMA, we will also determine perceived benefits, areas in need of improvement, potential obstacles of implementation, and fidelity of the intervention across sites, by conducting (a) face-to-face interviews with patients and (b) telephone interviews with physicians and administrators. Using VA cost data, we will perform a cost-effectiveness analysis to inform future VA resource allocation.

Conclusions:
This trial will generate critical knowledge regarding the clinical and cost-effectiveness of SMA in HF patients to provide patient-centered care, improve health status, and reduce readmission for patients with HF. Further, the results of the formative evaluation will support future implementation of this novel intervention into routine clinical practice.
Abstract 109: A Multidisciplinary Checklist for Management of Acute Decompensated Heart Failure: A Quality Improvement Initiative
Authors: Punnanithinont Natdanai , Kairouz Victor , Diaz Del Carpio Roberto , Page Brian
Published: March 2022

Objectives:
To determine the effect of a comprehensive checklist on readmission rate and providers adherence to 2013 AHA/ACC guidelines in the management of heart failure (HF) at Buffalo General Medical Center (BGMC).

Background:
HF is among the most common admitting diagnoses at BGMC. From prior studies, HF readmission can be prevented substantially by effective education, discharge instructions and appropriate medications.

Intervention and Methods:
A multidisciplinary checklist was developed as a tool to guide house staff physicians in the care of patients with acute decompensated HF. It includes optimal pharmacological therapy as recommended by guidelines, relevant HF education and counseling by dedicated nurse practitioner, nutrition consultation, physical therapy evaluation and treatment and scheduled out-patient follow up. The laminated checklist cards and brief presentation of current HF guideline were provided to house staff physicians on teaching cardiology service weekly from April to June 2015. The control group was randomly selected from the patients who were admitted with acute decompensated HF prior to intervention period.

Results:
Thirty-day readmission decreased from 47% (16 of 34) to 24% (8 of 34) following the implementation (adjusted OR = 0.32 95% CI = 0.11-0.97). A higher percentage of patients were discharged on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers or had documentation of a reason for not prescribing the medication in the checklist group compared with the control group (31 of 34 vs 21 of 34, P<0.05). Similarly, a higher percentage of patients were discharged on β-blockers or had documentation of a reason for not prescribing the medication in the checklist group compared with the control group (34 of 34 vs 32 of 34, P 0.15).

Conclusion:
Our initiative, which consists of HF checklist use and reminders, was associated with decreased thirty-day readmission rate and increased providers adherence to current HF guidelines.
Abstract 125: Burden & Timing of Recurrent Angina in Patients With Incomplete Revascularization Following Percutaneous Coronary Intervention
Authors: Lansky Alexandra , Ng Vivian G , Cristea Ecaterina , Bouras Georgios , Pietras Cody , Pangilinan Drea , Polsonetti Bryan , Herriott Denise , Barr Peri , Oppelt Tom
Published: March 2022

Background:
Angiographic incomplete revascularization (IR) has been reported in 30-60% of cases following percutaneous coronary intervention (PCI). The extent to which IR contributes to the burden, timing & characteristics of angina & the role of angina in contributing to adverse outcomes has not been defined.

Methods:
A retrospective review of 200 patients with IR after PCI from 9 US cardiology practices was performed to determine the frequency of recurrent angina. All angiograms were reviewed for residual coronary artery disease by an independent core laboratory. IR was defined as residual diameter stenosis >50% by quantitative coronary angiography in any epicardial coronary or major side branch. Recurrent angina was defined as documented worsening of angina or initiation of either ranolazine or long-acting nitrates. Angina was assessed at 30 days, 3 months, 6 months, 9 months, 12 months, & greater than 12 months. We report an interim analysis.

Results:
In the overall population of 200 patients, patients were mostly male (62%) with a mean age of 63.7±13.3 years, & mean BMI of 30.2±6.4. There was a high prevalence of comorbidities including hypertension (93.4%), hyperlipidemia (88.5%), diabetes (52.5%), & prior MI (36.1%). Of the 200 patients, 61 (30%) patients developed recurrent angina at a mean follow-up time of 549 days. Among those with recurrent angina, 26% of patients developed recurrent angina within 30 days of the index PCI procedure. At 3-, 6-, 9, & 12-months, 46%, 62%, 67%, & 80% of patients, respectively, had recurrent angina. The remaining 20% of patients experienced post-PCI angina after 12 months. Baseline demographic factors associated with recurrent angina included hypertension, diabetes, history of angina, prior PCI, & African American ethnicity (See Table 1).

Conclusions:
Angiographically identified IR alone does not adequately identify patients at risk for the development of recurrent angina. Among a cohort of 200 patients with angiographically identified IR, only 30% of patients developed recurrent angina post-PCI. Almost half of patients with recurrent angina experienced it within 3 months of the index PCI procedure. Several common cardiovascular comorbidities including diabetes, hypertension & prior PCI were associated with recurrent angina post-PCI. Complete analysis will be presented.
Abstract 135: Complementary-Medicine Prevention of Alzheimer’s Disease by Blackcurrant Extract
Authors: Siegel Günter , Mockenhaupt Felicitas Helena M , Pircher Adolf , Ermilov Eugeny , Hammersen Stefanie
Published: March 2022

Background:
Every 3.2 s, an individual falls ill with dementia, the number of persons concerned will almost be trebled by 2050, scientists communicated in London at the World Alzheimer Report 2015. They called upon government and employers to invest more in prevention. At present, 46.8 million people live with a demential disease worldwide. From a public health point of view, this high prevalence should motivate to greater efforts regarding prevention and treatment of the vascular component of the disease, because this has the potential to markedly reduce the occurrence of dementia.

Methods:
Flow-dependent isometric tension was measured in segments of isolated human intracerebral arteries from consciousness areas (brain surgery). Flow variations of the Krebs solution were 3, 5, 20, 40 and 100 mL/min. Krebs without and with addition of either 0.01% membrane filtered blackcurrant extract (BCE, Code 70140015, BerryPharma®) or ethanol extracted BCE was used as superfusate. Biosensor ellipsometry and EIAs were applied. VLDLapoE4/E4 (10 mg/dL) from genotypized patients and human β-amyloid Aβ42 were used in ellipsometry.

Results:
In controls (n = 14), brain arteries relaxed from 1.416 g (T3) to 1.011 g (T100), i.e. by 28.6% of their initial tone. Under BCE 70140015 (n = 5), vascular tone decreased from 1.390 g to 0.803 g (against control p < 0.0354). This is a 42.2% reduction in tension, a 45.2% increase in flow relaxation, and a 50.7% rise in blood perfusion. Ethanol extracted BCE, however, showed against controls an even slightly impaired relaxation (contraction by 3.6%). - BCE is bound to membrane proteoheparan sulfate (HS-PG), the natural flow sensor and peripheral lipoprotein receptor. Addition of VLDLapoE4/E4, Aβ42, and Ca2+ ions to HS-PG adsorbed to a silica surface led to quaternary Alzheimer plaque formation. Preincubation of HS-PG with BCE reduced VLDL docking by 5.9%, ternary plaques with Aβ42 by 11.6%, and quaternary calcified Alzheimer nanoplaques by 17.3%.

Conclusion:
The flow experiments show that membrane filtered BCE clearly improved endothelial function by an additional NO release, while ethanol extracted did not. This vasodilatation together with the reduction of Alzheimer nanoplaques may have a beneficial effect on cognitive functions in dementiae of the Alzheimer type, in prevention of TIA and stroke.
Abstract 138: Contemporary Patterns of Use of Antiplatelet Agents in Patients With Acute Myocardial Infarction: Insight From the National Cardiovascular Data Registry (NCDR)
Authors: Basra Sukhdeep S , Wang Tracy Y , Simon DaJuanicia N , Chiswell Karen , Virani Salim S , Alam Mahboob , Nambi Vijay , Denktas Ali E , Deswal Anita , Ballantyne Christie M , Peterson Eric D , Jneid Hani M
Published: March 2022

Background:
Compared with clopidogrel, ticagrelor and prasugrel are more potent and faster-acting antiplatelet agents that have been associated with a greater reduction in thrombotic cardiovascular events in patients with acute myocardial infarction (AMI). We examined contemporary patterns of P2Y12 inhibitor selection both early (within 24 h of admission) and at discharge among AMI patients captured by a large national registry.

Methods:
Patients in the ACTION Registry® -GWTG™ who presented with AMI from October 2013 through December 2014 were included in the study (167,455 patients from 622 sites). Among these patients, we evaluated the temporal trends in early use (within 24 h of admission) and discharge prescription of antiplatelet agents and used logistic regression to identify factors associated with P2Y12 inhibitor selection at discharge.

Results:
Early ticagrelor use increased significantly over time from 11.8% to 16.4% (STEMI 19.6% to 27.6%; NSTEMI 6.8% to 9.5%; p<0.0001 for all). Similarly, ticagrelor prescription at discharge increased significantly from 12% to 16.7% (STEMI 17.5% to 24.6%; NSTEMI 8.7 to 11.9%; p<0.0001 for all). During the same time period, we observed a significant decrease in the early use of prasugrel and clopidogrel (13.3% to 11.9% and 43.4% to 39.5%, respectively, p<0.0001 for all) and their prescription at discharge (15.7% to 13.9% and 54.2% to 51.1%, respectively, p<0.0001 for all) (Figure 1). Independent factors associated with ticagrelor prescription at discharge over clopidogrel included younger age, white race, HMO/private insurance, home ticagrelor use, invasive management and in-hospital re-infarction and CVA (p<0.0001 for all), whereas prior CVA, atrial fibrillation and CABG favored clopidogrel prescription at discharge. Independent factors associated with ticagrelor prescription at discharge over prasugrel included older age, female gender, prior stroke, home ticagrelor use and in-hospital CVA (p<0.001 for all), whereas prior diabetes (p<0.001) and home prasugrel use (p<0.0001) were associated with prasugrel prescription at discharge.

Conclusions:
Our contemporary dataset shows a modest but significant increase in use of ticagrelor early and at discharge, with simultaneous decline in the use of clopidogrel and prasugrel in patients presenting with AMI.
Abstract 143: Development of a Novel Electronic Preventative Cardiology Decision Aid
Authors: Adusumalli Srinath , Ferd Polina , Murray Sarah , Venkat Rathnam , Jacoby Douglas , deGoma Emil
Published: March 2022

Objectives:
Few contemporary electronic decision aids have been designed and evaluated rigorously in the realm of preventative cardiology. Our aim was to develop and test a web-based decision aid that: 1) effectively conveys information on cardiovascular disease risk as well as therapies that modify that risk, 2) improves decisional quality, and 3) is able to be efficiently implemented.

Methods:
We utilized the Internal Patient Decision Aid Standards (IPDAS) collaboration development process as a framework for the creation of our patient decision aid (PtDA). We conducted a literature review and convened a focus group of experts to identify risk prediction models and interventions to be included in our PtDA. Based on this, we used the AHA/ACC Pooled Cohort Risk Assessment Equations to estimate risk and included the following interventions as risk modifiers: smoking cessation, dietary modification, weight loss, exercise (grouped as healthy living options), statin therapy, and aspirin therapy. Additionally, we included evidence-based estimates on the most common side effects of aspirin and statin therapies. We then designed a web-based decision aid (located at
http://demo.heartriskreport.com
, username and password “innovation”). We then completed several rounds of mixed-methods alpha testing of our PtDA with patients (n=36) consisting of quantitative surveys (incorporating elements of the Control Preferences Scale and the Decisional Conflict Scale) as well as semi-structured in-person interviews. Standardized patient scenarios were utilized. Finally, we surveyed 7 national experts in the field of preventative cardiology on the accuracy and usability of our PtDA.

Results:
The majority (92%, 33/36) of patients wished to incorporate elements of shared decision making processes when considering their care. Patients estimated risk 20 % points different from risk determined by validated calculators prior to using the PtDA. After using the PtDA, the patients’ estimation differed by less than one point from actual risk. The majority of patients knew which healthy living (94% of patients, 34/36) and medication (86% of patients, 31/36) options were available. Similarly, most patients knew the benefits of healthy living (89%, 32/36) and medication (86%, 31/36) options. The majority of patients understood the risks of medication options (89%, 32/36). In terms of feedback from our external experts (n=7), 100% of experts felt the PtDA was useful, accurate, and comprehensible to patients. All experts felt they would utilize the PtDA with their own patients. The majority of experts felt the PtDA would be best used in an exam room with a patient (67%, 4/7) and felt that the primary physician would be the best provider to review the PtDA with a patient (86%, 6/7).

Conclusions:
Our PtDA is highly usable and effective in conveying information regarding cardiovascular risk and common therapies to patients.
Abstract 146: Drivers of Healthcare Costs Among Adults With Obesity in United States: 2012 Medical Expenditure Panel Survey
Authors: Valero-Elizondo Javier , Salami Joseph A , Osondu Chukwuemeka U , Latif Muhammad A , Arrieta Alejandro , Spatz Erica S , Rana Jamal S , Virani Salim S , Blankstein Ron , Blaha Michael J , Veledar Emir , Nasir Khurram
Published: March 2022

Background:
It is well established that obesity is associated with increased morbidity, mortality and healthcare costs. However, additional factors contributing to higher healthcare expenses among those with obesity is not well characterized. In our study we specifically aimed to elucidate drivers of healthcare expenditures among adults with obesity in a national representative sample of U.S population.

Methods:
The 2012 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the non-institutionalized civilian population of the United States, was analyzed. Our study population consisted of adults ≥ 18 years of age. Obesity was defined as self-reported body mass index (BMI) values ≥ 30 kg/m2. Two-part models were utilized to study cost data; after taking into consideration the probability of having an expenditure (first model), a generalized linear model with gamma distribution and link log (second model) was used to assess the mean expenditure per capita among participants classified as obese. The survey’s complex design was taken into consideration.

Results:
27,288 MEPS participants met our inclusion criteria (mean age: 47 years, 53% female), which translates to 231 million people across the United States. Prevalence of obesity was 30% (69 million). The total expenditure for obese adults in 2012 was nearly $350 billion. Modifiable risk factors (hypertension, diabetes mellitus, hypercholesterolemia, smoking and physical activity), increasing age, and burden of comorbid conditions (defined by modified Charlson Comorbidity Index [CCI]), were the biggest drivers of cost among obese adults, while physical activity was associated with lower health-related expenditures. On adjusted analysis, the highest average incremental cost was noted with presence of 2 or more comorbid conditions ($10,462.66), followed by diabetes ($3,328.78) and hypertension ($1,617.23). Furthermore, with increasing obesity categories, differences among CCI categories became non-significant.

Conclusion:
Comorbid disease burden along with diabetes and hypertension are the most significant drivers of cost among obese adults. Future research should clarify role of chronic disease management in curtailing increasing healthcare expenditure among this high-risk population.
Abstract 149: Effects of Ethnicity and Prior Depression on Hospital Course and Outcomes in First-Time Stroke Patients
Authors: Starosciak Amy K , Payret Karelys , Ramirez Maygret , Viera Yolexis , Alegria Cris , Bedgio Rodney , Ruiz Felix
Published: March 2022

Background:
Stroke is the fifth leading cause of death in the US and can result in major disability. It is important to identify factors that increase risk of stroke so that they may be targeted for modification, if possible. Depression can increase risk of stroke, increase risk of death from stroke, and it is related to worse post-stroke outcomes. There is a dearth of research in the Hispanic population, who have a higher burden of disease than non-Hispanic whites and blacks. The goal of this research project was to determine how ethnicity and prior depression affect patient outcomes after first-time stroke.

Methods:
The study was an analysis of 500 cases from Baptist Hospital of Miami’s Get With The Guidelines-Stroke database (9/2014-5/2015). It was a 2 (Hispanic vs. non-Hispanic) x 2 (prior depression vs. no prior depression) factorial cross-sectional design. Descriptive statistics characterized subjects on baseline characteristics, hospital course, discharge functional status, and discharge disposition. Baseline characteristics included demographics, comorbidities, and NIHSS score. Hospital treatment included whether patients received IV t-PA or neuro-intervention and their turnaround times. Patient outcomes included length of stay (LOS), discharge modified Rankin Scale (mRS), and discharge disposition. Effects of Hispanic ethnicity and prior depression on patient outcomes were analyzed using a nonparametric median test for LOS and chi square analysis for mRS score and disposition.

Results:
Out of 500 cases that were analyzed, 199 were excluded because of: prior stroke, TIA, MI, or atrial fibrillation, or LOS ≥ 30 days. Of the remaining 301 cases, 195 patients were Hispanic (65%), and 30 were characterized as having depression (9/97 non-Hispanic, 9% and 21/195 Hispanic, 12%). A marginally significant interaction (p=0.061) between ethnicity and depression was found, such that non-Hispanic patients with depression had a shorter LOS than the other three groups (3.7 d vs. 6.3-6.9 d). Of the 301 patients, 171 (57%) were discharged home. Hispanic patients were less likely to be discharged home (54%) compared to 62% of non-Hispanic patients, regardless of depression. Out of 279 patients that had a discharge mRS score, 98 (35%) had a good clinical outcome (mRS 0-2). Only 1/4 of Hispanic patients with depression had a good clinical outcome, vs. 1/3 of patients in the other groups. However, neither ethnicity nor depression had a statistically significant effect on discharge disposition or discharge mRS.

Conclusions:
There was a combined effect of ethnicity and depression on LOS where non-Hispanic patients with depression had a shorter LOS than other groups. Although not statistically significant, the findings may be clinically important. It is critical to determine whether these patients had less severe strokes or fewer comorbidities, or if patients were discharged too quickly.
Abstract 166: Ideal Timeframe for Post-Discharge Follow-Up Appointment in ACS and CHF BRIDGE Patients
Authors: Geiger Matthew , Sylvester Rachel , Costin Nathaniel , Larin Katherine , Kim Maria , Kline-Rogers Eva , Eagle Kim A , Rubenfire Melvyn , Bumpus Sherry
Published: March 2022

Background:
Current research and guidelines vary greatly on the ideal time for initial post-discharge follow-up for acute coronary syndrome (ACS) and congestive heart failure (CHF). BRIDGE is a nurse practitioner-delivered cardiac transitional care program for patients lacking primary care or cardiology follow-up at discharge. BRIDGE referrals are seen within 14 days of discharge. This study aimed to determine the ideal timeframe for initial post-discharge follow-up.

Methods:
Retrospective data from the BRIDGE registry were abstracted for ACS and CHF patients referred to BRIDGE and readmitted within 30 days. Patients were divided into 4 cohorts based on the number of days to readmission: Time (T)1=0-3 days, T2=4-7 days, T3=8-14 days, and T4=15-30 days. Readmissions were further classified as the same cardiac reason as index admission, “Different Cardiac” or “Non-Cardiac.” ACS and CHF readmissions were compared by time to readmission and reason for readmission .

Results:
Of 2367 patients (mean age 64.9, 58% male and 85.3% white), 733 patients had an admission for ACS and 548 for CHF. Regardless of BRIDGE attendance, 16.8% (n=123) of ACS patients and 25.4% (n= 139) of CHF patients and were readmitted within 30 days. The majority of readmissions within 30 days (ACS 62.6%, CHF 53.2%) were on or before the 14th day post-discharge. Nearly half of T1 readmissions (ACS=47.6%, CHF=55.6%) were for Non-Cardiac reasons. For all other timeframes, ACS patients had more readmissions for Different Cardiac reasons, and CHF patients more often were readmitted for CHF. In contrast to 30 day readmission rates for the entire population (16.8% and 25.4%), the 30-day readmission rate for ACS and CHF patients who attended their BRIDGE appointment was 6.4% and 15.4% respectively .

Conclusions:
For both CHF and ACS patients, greater than 50% of readmissions occurred before 14 days, with the majority of cardiac-related reasons occurring after the 3rd day post-discharge. Based on BRIDGE readmission rates, follow-up at 14 days substantially reduces 30-day readmissions in both ACS and CHF patients. However, seeing patients earlier or additionally during the 4-7 day period may further reduce 30-day readmissions.
Abstract 203: Preventing Stroke in Patients With Atrial Fibrillation: A Review of Published Interventions to Aid Patient Decision Making
Authors: O’Neill Elizabeth S , Grande Stuart W , Elwyn Glyn , Coylewright Megan
Published: March 2022

Background:
Atrial fibrillation (AF) is a common irregular heart rhythm that increases patients’ risk of stroke; blood thinners can reduce this risk. The objective of this review is to examine published interventions to aid patient decision making around stroke prevention therapy in AF.

Data sources:
Six online databases were searched from inception to August 2015 with a biomedical librarian: Medline (1946-2015), CINAHL (1981-2015), PsycINFO (1806-2015), Web of Science (1900-2015), Cochrane CENTRAL (Issue 8 of 12, August 2015), and the Cochrane Database of Systematic Reviews (Issue 8 of 12, August 2015). Search terms included: atrial fibrillation, decision aid, decision tool, decision support, and shared decision making.

Methods:
Peer-reviewed articles in English of any study type examining the effects of interventions to aid patient decision making around stroke prevention in AF were included. Studies were excluded independently by two authors using a priori criteria. For each included study, two authors assessed for measurement of decisional conflict, patient knowledge, patient choice, and decision making preference. Quality of studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.

Results:
The initial search resulted in 609 articles for title and abstract review. Most were excluded for examining clinical questions other than stroke prevention in AF. Thirteen articles underwent full-text review, and seven studies were eventually included. Six interventions displayed different combinations of aspirin, warfarin, or no therapy to reduce stroke risk in AF; one study included a non-vitamin K oral anticoagulant (NOAC). Most of the interventions were delivered by research staff or were self-administered at home by the patients themselves. The intervention was physician-administered in one study. Overall, interventions were associated with lower decisional conflict, increased patient knowledge, or increased likelihood of making a treatment choice. In the three studies that assessed decision making preference, preferred roles varied. No studies formally assessed the presence of shared decision making using established observational methods. None of the included interventions are available for clinical use, free of charge or commercially.

Conclusion:
Interventions designed to aid patient decision making around stroke prevention in AF improved a selection of patient-centered outcomes. Given the availability of multiple NOACs and an implantable device for stroke prevention in AF, there is a need to develop and evaluate new patient decision support tools.