bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 262: Low Self-Efficacy Correlates with Increased Cardiovascular Disease Risk
Authors: Bailey Karla , Kashani Mariam , Eliasson Arn , Vernalis Marina
Published: March 2022

Background:
Cardiovascular disease (CVD) is largely a preventable illness contingent upon the ability of patients to adhere to healthy lifestyle choices. Self-efficacy is a strong predictor of a patient’s ability to adopt healthy lifestyle change. We sought to examine correlations between self-efficacy and CVD risk.

Methods:
The Integrative Cardiac Health Project is an interdisciplinary CVD prevention program that seeks to improve modifiable CVD risk factors among military healthcare beneficiaries. Participants are provided comprehensive assessments and consultations within the disciplines of exercise, nutrition, stress and sleep to identify and modify CVD risk. Upon initiation of the program, participants complete a battery of assessments including anthropomorphic measurements, fasting laboratory studies and validated surveys for self-efficacy and sleep. Sleep surveys include the Berlin Questionnaire for sleep apnea, Pittsburgh Sleep Quality Index (PSQI) for global assessment of sleep quality, and the visual analog fatigue score. In this retrospective analysis, patients were sorted into low and high self-efficacy groups using the midpoint of the range of self-efficacy scores. Patients with low (10 to <16.25 points) and high (16.25 to 22.5 points) self-efficacy scores were compared utilizing t-tests.

Results:
Of 71 participants (mean age 52 yrs, 33 men (46%)), 25 (35.2%) had low self-efficacy scores. Subjects with low self-efficacy scores demonstrated numerous CVD risk factors (See table).

Conclusions:
Self-efficacy and CVD risk profiles appear to be inversely related. To lower CVD risk and improve adherence to healthy lifestyle change, strategies to improve patient self-efficacy must be a primary consideration.
Abstract 263: Predictors of Physical Activity Increase among People Enrolled in a Worksite Wellness Center
Authors: Diaz-Melean Carlos M , Rodriguez-Escudero Juan P , Oliveros Estefania , Clark Matthew M , Somers Virend , Egginton Jason S , Thomas Randal J , Lopez-Jimenez Francisco
Published: March 2022

Background:
Physical activity (PA) prevents cardiovascular (CV) disease and maintains health. It is unclear which factors predict the adoption or maintenance of PA at a worksite wellness center.

Methods:
To assess the predictors of increase in PA we conducted a retrospective study on 7237 adults attending a worksite wellness center between September 2008 and October 2011. Upon joining the wellness center, participants completed an electronic or paper survey that assessed for the presence of CV risk factors, height, weight, self-perceived health behaviors and psychosocial factors using eleven validated 0-10 point scale. We included 1927 participants who completed the standard survey at the time of enrollment and at 12 months (+/- 90 days). For logistic regression analysis PA increase at 12 months was defined as an increase of ≥2 points of self-reported PA, on a 0 to 10 point scale, or maintenance of a high level of PA at follow up (FU).

Results:
Mean (SD) age was 38 (11) yr., BMI was 26.93 (6.06) kg/m
2
and 32% were men. From the study sample, 717 (37%) participants increased their PA level or maintained a high level of PA at FU. When comparing people who increased or maintained a high level of PA with the group without improvement or a decline in PA, there were differences in age and BMI: age [39 (11) vs. 38 (11) yr.; p=0.04] and BMI [27.37 (5.92) vs. 26.68 (5.92) kg/m
2
; p=0.024]. The Table reports the results of the multivariate logistic regression model. While CV risk factors (tobacco use, hyperglycemia/diabetes mellitus, and high blood cholesterol), perceived stress level and self-perception of being overweight were not significant predictors of increase PA, low muscular strength and flexibility and interactions with close friends were significantly associated with PA.

Conclusion:
A significant proportion of people, over one-third, enrolled in a wellness center increase their PA level or maintain high levels of PA at 12 months after enrollment. Increasing age and BMI, and a measure of social support; interaction with close friends, and perceived muscular strength and flexibility, predict increase in PA. Presence of CV risk factors do not predict increase in PA. Tailoring programs to address these domains may help younger, less fit, and those with less social support improve their PA level.
Abstract 271: Lack Of Prognostic Value Of High Ankle Brachial Pressure Index (ABI) In Patients With Advanced Heart Failure
Authors: Nagarajan Vijaiganesh , Cauthen Clay A , Tang WH Wilson
Published: March 2022

Introduction:
Ankle brachial pressure index (ABI) is a noninvasive test to diagnose peripheral arterial disease (PAD). Abnormally high ABI has been associated with increased LV mass and mortality in patients free of cardiovascular disease, while low ABI is often indicative of PAD that portends poor prognosis. But the prognostic significance of high ABI in advanced heart failure patients has not been studied.

Methods:
We reviewed 342 consecutive patients with advanced heart failure who underwent transplant evaluation between 2007 and 2011. Patients with history of PAD or ABI < 0.9 on either side were excluded. ABI values on both sides were added to create total ABI. Based on this total ABI, patients were divided into tertiles. Survival (death or heart transplant) analysis was assessed by Kaplan-Meier curves in different tertiles.

Results:
Mean total ABI was 2.29 ± 0.39. Mortality/transplant rates were 52.4%, 43.2% and 50.4% in increasing ABI tertiles. Kaplan-Meier survival analysis did not show any statistically significant prognostic importance (log rank, p = 0.39, Figure.1). Similar results were obtained when patients with ischemic (p = 0.094) and non-ischemic cardiomyopathy (p =0.899) were analyzed separately. ABI was not an independent predictor of mortality in Cox regression analysis (HR 0.95, 95% CI 0.66, 1.36).

Conclusion:
Higher tertiles of ABI were not associated with poor prognosis in patients with stage D heart failure. This remained true for both ischemic and non-ischemic cardiomyopathy.
Abstract 272: The Role of Diabetes Mellitus in Cardiac Resynchronization Therapy Response in Patients with Optimal Anatomical and Electrical Left Ventricular Lead Location.
Authors: Bose Abhishek , Kandala Jagdesh , Singh Jagmeet P
Published: March 2022

Background:
While optimal left ventricular (LV) lead location is known to predict a favorable response to cardiac resynchronization therapy (CRT) therole of underlying Diabetes Mellitus (DM) in this patient population remains uncertain.

Methods:
We analyzed a prospective cohort of 180 CRT patients. Anatomical lead location was confirmed by coronary venograms and chest radiographs. LV lead electrical delay (LVLED) was measured from QRS onset on surface ECG to the first sensed signal of the LV lead, and standardized based on native QRS width. Echocardiographic response was evaluated at baseline and 6 months. Time to first heart failure hospitalization or death was assessed over 3 years.

Results:
100 patients (Age 68.2 ± 12.3 years; Baseline LVEF 23.2 ± 6.8 %, NYHA 3.0 ± 0.3) with optimal LV lead location defined as ‘long’ LVLED(LVLED>50%) with non-apical and anterolateral, lateral or posterolateral lead position were selected from the original cohort. They were further categorized by the presence (n=38) or absence (n=62) of DM. Baseline clinical and echocardiographic characteristics were similar between groups except for a higher incidence of hypertension in diabetics (94.7% vs. 58.1%, p <0.001) and longer LVLED in non-diabetics (81.7 ± 16.5 vs. 74.8 ± 14.8, p=0.03). DM was significantly associated with time to first heart failure hospitalizations (Fig 1A) and a composite of all-cause mortality and heart failure (Fig1B) by the Kaplan-Meir method. However on multivariate cox regression Diabetes was not an independent predictor of response. Echocardiographic response was similar across both groups.

Conclusion:
In CRT patients with optimal lead location and Diabetes, there is a trend towards worse outcomes. This could be the setting of Diabetes related cardiomyopathy and the higher incidence of ischemic heart disease in diabetics.
Abstract 277: Colesevelam Hcl Or Ezetimibe For Hypercholesterolemia: Differences In Patient Characteristics From A Healthcare Database
Authors: Ye Xin , Bays Harold , Swindle Jason
Published: March 2022

OBJECTIVES:
Colesevelam HCl is approved as both a cholesterol-lowering and anti-diabetes mellitus agent with pregnancy category B. Ezetimibe is approved as a cholesterol-lowering agent with pregnancy category C. This study examined demographic and clinical characteristics of hypercholesterolemic patients newly treated with colesevelam HCl vs. ezetimibe.

METHODS:
This retrospective observational study utilized claims data from a large national health plan, and identified either colesevelam HCl or ezetimibe pharmacy claims between 01/01/ 2006 and 03/31/2011 as the index drug and the first fill date as the index date. Inclusion criteria included patients 18 years or older, diagnosis for hypercholesterolemia, and at least 6 months (baseline) and 12 months (follow-up) continuous enrollment before and after the index date, respectively. Patient demographic and clinical characteristics were identified from enrollment, medical and pharmacy claims data. Chi-square and t-tests were used to examine patient characteristic differences between two treatment cohorts.

RESULTS:
A total of 3,357 colesevelam HCl and 17,026 ezetimibe patients met inclusion criteria, and were included in this study. Mean age was 55 and 57 years for colesevelam HCl and ezetimibe patients, respectively. Compared to the ezetimibe cohort, colesevelam HCl patients had higher prevalence of type 2 diabetes mellitus diagnosis (25% vs. 20%, p<0.001), and a larger proportion were female (56% vs. 45%, p<0.001). Baseline statin use was more common among ezetimibe patients than colesevelam patients (55% vs. 37%, p<0.001).

CONCLUSIONS:
Compared to ezetimibe, colesevelam HCl was administered to a greater percent of patients with type 2 diabetes mellitus and women, which may be related to colesevelam HCl’s approved use as an anti-diabetes mellitus drug, and its pregnancy category B status. The baseline statin use was less common among colesevelam HCI patients than ezetimibe patients. These differences should be taken into account when evaluating real-world effectiveness of the two therapies.
Abstract 28: Implementation of a Nationwide Health IT System for Cardiac Cath Labs in the VA Hospital System: the CART Program
Authors: Box Tamara L , Maddox Thomas M , Tsai Thomas T , Gethoffer Hans , Grunwald Gary K , Jesse Robert L , Fihn Stephan D , Rumsfeld John S
Published: March 2022

Background.
Despite growing availability of electronic health records (EHR) and interest in using health IT (HIT) applications within EHR’s to support clinical care, little is know about the factors associated with successful implementation of HIT applications. We evaluated the national implementation of the VA Clinical Assessment, Reporting and Tracking (CART) HIT system.

Methods.
The VA CART system is a clinical application embedded in the VA’s EHR that supports point of care procedure reports based on American College of Cardiology data standards, device surveillance, and real-time national quality of care oversight. CART was successfully implemented at the 75 VA cardiac catheterization hospitals, and remains in full clinical use for all sites. We evaluated the overall time for implementation and the four consecutive stages in the process (Initiation, Installation, Training, Clinical Use). We used Cox Proportional Hazards regression to evaluate the associations between full implementation time and urban location, academic affiliation, geographic region, size, and whether implementation was initiated before or after a memo of senior leadership support was issued.

Results.
CART was implemented at the 75 VA hospitals over 6.25 years, with a pattern of diffusion typical for successful HIT implementation based on prior studies (Figure 1). Median time per site for implementation was 14 ± 17 months (IQR 7, 33). Initiation, Installation, and Training stages exhibited relatively little variability in duration per site (Md = 2 ± 9, 4 ± 7, 2 ± 6 mos), while there was higher variability in the time required for full Clinical Use (5 ± 11; IQR 2, 14). In multivariable analysis, sites that initiated implementation after the senior leadership statement had significantly faster implementation (HR 0.49, 95% CI 0.29-0.83, P=0.008).

Conclusions.
The CART system was successfully implemented nationwide, achieving full use in the 75 VA cardiac cath labs. The final stage, full Clinical Use, took the longest and was most variable by site. These results reinforce that successful HIT implementation does not end with technical installation and training, and must support clinical use as part of routine care delivery. Our results also reinforce the importance of senior leadership support for HIT implementation to support clinical care. [[Unable to Display Character:  ]]
Abstract 287: Association of Primary Payer Status and In-Hospital Mortality After Heart Transplant: A Nationwide Inpatient Sample Study
Authors: Mujib Marjan , Kolte Dhaval , Khera Sahil , Palaniswamy Chandrasekar , Harikrishnan Prakash , Balasubramaniyam Nivas , Nabors Christopher , Sule Sachin , Peterson Stephen J , Gass Alan L , Lanier Gregg M , Frishman William H , Aronow Wilbert S
Published: March 2022

Background:
Medicaid enrollment and expenditures are projected to increase sharply with the Affordable Care Act’s eligibility expansions. However, the impact of these changes on outcomes after heart transplant procedure has not been studied before. The aim of this study was to analyze the relationship between payment source and outcomes following heart transplant in a national database.

Methods:
We used the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to evaluate patients who obtained a heart transplant (ICD 9 procedure codes 37.51). Discharge weights were used to obtain nationwide estimates. A total of 2,329 heart transplant procedures were identified in the NIS database, corresponding to an estimated 11,536 nationwide heart transplant procedures between 2005 and 2010. Patients were stratified on the basis of payer status: Medicare (30%), Medicaid (17%), private insurance (52%), and uninsured (1.5%). Multivariable logistic regression models were used to assess the effect of primary payer status on in-hospital mortality.

Results:
Patients had a mean age of 47 (±19) years, 26% were women and 55% were whites. Among insured patients, compared with private insurance, a higher unadjusted in-hospital mortality rate was found among patients with Medicare (4.3% vs. 6.4%; OR, 1.57; 95% CI, 1.31-1.89; P <0.001), and Medicaid (5.3%; OR, 1.30; 95% CI, 1.03-1.63; P=0.028). After controlling for patient demographics, comorbidities, income, hospital features and hospital region, Medicaid (OR, 1.41; 95% CI, 1.09-1.83; P=0.009) and Medicare (OR, 1.60; 95% CI, 1.31-1.96; P<0.0001) payer status were independently associated with higher in-hospital mortality. Length of stay was longest for Medicaid patients (48 ± 52 days) and shortest for Medicare patients (33 ± 38 days, P <0.001). Medicaid patients also accrued the highest unadjusted hospital charges (USD 518,233 ± 314,717, P <0.001).

Conclusion:
In this national study of hospitalized patients undergoing heart transplant, uninsured payer status was rare. Medicaid or Medicare payer status was associated with increased risk adjusted in-hospital mortality, while Medicaid payer status was also associated with increased length of stay and increased hospital charges. Further prospective studies are needed to elucidate factors that are responsible for such disparities in outcomes by payer status.
Abstract 29: Innovative iPhone App Enhances Reliable and Economical Transmission of High-quality ECG Images on Standard Cell Phone Networks
Authors: Burt David R , Zhang Richard , Fowler Steven , Seal Jonni , Patek Stephen
Published: March 2022

Introduction:
Transmission of pre-hospital ECG images to STEMI treatment centers aids in optimizing STEMI reperfusion times by promoting activation of the STEMI treatment process prior to patient arrival. Several proprietary systems have been designed for this purpose but they are expensive and incur substantial ongoing system costs. ECG photo images may also be sent by personal cell phone but require large file sizes to maintain diagnostic clarity, which results in lower reliability and speed and greater process variability.

Hypothesis:
A low-cost iPhone app that optimizes speed and reliability of the ECG pre-hospital transmission process could be developed to address many of these issues and provide an acceptable alternative to commercially available systems.

Methods:
A faculty/student team designed an iPhone app that takes a photo of the ECG, centers the image and reduces image size to < 30 kb with minimal loss of detail. The image is then sent over cell phone networks to a secure server. Successful transmission is noted with visual and audio cues to the user. The app terminates the send cycle after 120 seconds if not successful. Average time to obtain and initiate ECG transmission is 8-11 seconds.

Testing:
App image transmission was compared to four different photo sizes utilizing three cell phone networks. Fifty standardized physical waypoints were utilized and multiple test cycles were completed at each waypoint, totaling over 1500 separate transmission attempts. Acceptable success was defined as transmission within 120 seconds.

Results:
Image transmission via the app consistently outperformed standard photo transmission of all size photos with the difference becoming more marked as photo file size increased. This effect was seen within all cell phone networks. The app was significantly faster, exhibited substantially less standard deviation and had less than a 0.5% failure rate at 120 seconds, compared to failure rates of 3%, 71.2% and 15.5% for full-sized photos on the three networks tested. Average transmission times were also documented. (See figure I).

Conclusion:
The iPhone app outperformed the standard photo-to-email process -even in high signal-intensity suburban environments. Phase II testing is now underway in rural areas and other signal-limited environments.
Abstract 297: Trends in 1-year hospitalizations and costs from 2004 to 2010 among Medicare Fee-For-Service beneficiaries with LVADs
Authors: Lampropulos Julianna F , Kim Nancy , Wang Yun , Krumholz Harlan M
Published: March 2022

Background:
Short-term mortality among elderly Left Ventricular Assist Devices (LVADs) recipients has improved over time, yet LVADS are expensive and usually reserved for patients with severe heart failure with few other treatment options. Little is known about the long-term illness burden of these patients and how it has changed over time with improvements in LVAD technology. The aim of this study is to characterize the duration and cost of re-hospitalizations among elderly Medicare beneficiaries surviving one year post-LVAD implant from 2004-2010.

Methods:
We used inpatient National Claims History files from the Centers for Medicare and Medicaid Services (CMS) to identify 100% of fee-for-service (FFS) patients aged ≥65 years that received LVAD from 2004 to 2011 and were alive 1 year after discharge. The 2011 data was used for tracking the 1-year outcomes of 2010 patients. We censored patients that died within 1-year follow-up. We ascertained hospitalizations and in-hospital days through corresponding vital status files. Costs were defined as total health care facility payments made by Medicare per patient.

Results:
One year post-LVAD implantation, the proportion of living patients increased from 42% (n=45/107) in 2004 to 80% (n=348/433) in 2010. The proportion of patients readmitted decreased from 71% (n= 32/45) in 2004 to 61% (n=281/348) in 2010. The mean number of in-hospital days per patient hospitalized decreased from 30.2 days in 2004 to 20.8 days in 2010. Total CMS payments for all hospitalizations per patient increased from $50,111 in 2004 to $53,632 in 2010.

Conclusions:
From 2004 to 2010, more patients survived to 1 year after LVAD implant. Elderly patients spent a decreasing number of days in the hospital per patient with a slight increase in costs to Medicare. This reduction in hospital days suggests a decrease in LVAD morbidity over time that is complementary to the decline in mortality among this vulnerable group of LVAD recipients.
Abstract 301: Chronic Kidney Disease and Outcomes in Heart Failure with Preserved vs. Reduced Ejection Fraction
Authors: Smith David H , Thorp Micah L , Gurwitz Jerry H , McManus David D , Goldberg Robert J , Allen Larry A , Hsu Grace , Sung Sue Hee , Magid David J , Go Alan S
Published: March 2022

Background:
Patients with chronic kidney disease (CKD) often have heart failure with reduced left ventricular ejection fraction (HF-REF), and previous work has shown that the co-occurrence of those conditions confers a higher rate of poor outcomes than either condition alone. But few studies have examined whether CKD confers a clinically meaningful difference in outcomes among heart failure patients with preserved left ventricular ejection fraction (HF-PEF). Compared to previous work, our study uses more granular renal function estimates and a large, contemporary cohort.

Methods:
Using data from the NHLBI-sponsored Cardiovascular Research Network (CVRN), we identified a community-based cohort of patients with HF. Electronic medical record data, including manual review where necessary, were used to classify heart failure type (HF-PEF and HF-REF), based on quantitative and qualitative estimates. Renal function was assessed by estimated glomerular filtration rate (eGFR) and by dipstick proteinuria. We followed patients between 2005 and 2008 for a median of 22.1 months for outcomes of death and hospitalization (HF-specific and all cause). We used Cox regression with time-updated covariates to estimate relative-risk of outcomes by level of CKD, separately for HF-PEF and HF-REF.

Results:
We identified 14,579 patients with HF-PEF and 9,762 with HF-REF. Compared to patients with eGFR between 60-89 ml/min/1.73m2, lower eGFR was associated with an independent graded increased risk of death and hospitalization; this relation did not meaningfully differ by type of heart failure. For example, among patients with HF-PEF, compared to patients with eGFR 60-89 ml/min/1.73m2, the relative risk of death was 1.57 (95% CI 1.41, 1.76) for eGFR 15-29 ml/min/1.73m2; for those with HF-REF the same relative risk was 2.15 (95% CI 1.87, 2.48). Results were similar with renal function estimates using dipstick proteinuria.

Conclusions:
Renal dysfunction is common among patients with heart failure, and is an important independent predictor of death and hospitalization across the spectrum of left ventricular systolic function. Whether patients with heart failure respond differentially to treatments by level of renal function is not clear; Our study highlights the need to develop new and effective interventions for the growing number of patients with heart failure complicated by CKD.
Abstract 303: Adoption of the Novel Oral Anticoagulant Dabigatran in Patients with Atrial Fibrillation Receiving Warfarin in Community Practice: Findings from ORBIT AF
Authors: Holmes DaJuanicia N , Steinberg Benjamin A , Piccini Jonathan P , Ansell Jack , Chang Paul , Fonarow Gregg C , Gersh Bernard , Mahaffey Kenneth , Kowey Peter , Thomas Laine , Peterson Eric D , Hylek Elaine
Published: March 2022

Background:
Dabigatran is a novel oral anticoagulant approved in October 2010 for thromboprophylaxis in atrial fibrillation (AF), yet patterns of adoption of this novel agent in clinical practice are unknown.

Methods:
Using the ORBIT-AF Registry, a national outpatient prospective AF registry involving 170 sites, we examined patterns of those switching to dabigatran from warfarin from 2010 to 2012.

Results:
Of 7,066 patients with AF receiving warfarin at baseline, 511 (7%) were switched to dabigatran during follow-up. Patients switched to dabigatran were younger (median age 73 vs. 76, p<0.0001), more likely to be White (94% vs. 89%, p=0.001), and had better kidney function (median creatinine clearance (CrCl) 77 mL/min vs. 69 mL/min, p<0.0001), but less likely to have a history of anemia, (14% vs. 18%, p=0.009) or history of any cerebrovascular disease (14% vs. 17%, p=0.04) or CAD (22% vs. 34%, p<0.0001) or be followed in an anticoagulation clinic (36% vs. 45%, p<0.0001). Patients switched to dabigatran were more likely to have been recently diagnosed with AF (5.3% vs. 3.0%, p=0.03), and their CHADS
2
scores were significantly lower (p<0.0001).

Conclusions:
Patients receiving warfarin who were switched to dabigatran were younger, with lower CHADS
2
scores, better kidney function, and less concomitant cardiovascular disease than those not switched. This conservative transition pattern suggests greater physician emphasis on bleeding avoidance than on stroke risk reduction.
Abstract 305: Cost of Hospitalization for High Risk Percutaneous Coronary Intervention in the US: A 5-Year Contemporary Perspective
Authors: Patel Nileshkumar J , Mehta Kathan , Shah Neeraj , Chothani Ankit , Grover Peeyush , Deshmukh Abhishek , Rathod Ankit , Singh Vikas , Badheka Apurva , O’Neill William W , De Marchena Eduardo , Cohen Mauricio G
Published: March 2022

Background:
Utilization of intra-aortic balloon pump (IABP) and left ventricular assist device (LVAD) during percutaneous coronary intervention (PCI) has increased in recent years. We analyzed the trends and predictors of hospitalization cost associated with high risk PCI in US over a 5 year period (2005-2010).

Methods:
We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) between 2005 and 2010 using the ICD9 procedure code of 36.07 and 36.06 for PCI. The NIS represents 20% of all hospitals in the US and is the largest all payer hospital discharge database. We defined high risk PCI as PCI plus LVAD (ICD-9 code 37.68, 37.62) or IABP placement (ICD-9 code 37.61) during the same hospital admission. We examined the selective contribution of patient demographics, insurance type, and hospital characteristics, Deyo modification of Charlson comorbidity index (CCI) and hospital PCI volume (split into quartiles with first quartile as referent) to hospitalization cost. For each year, cost was adjusted for inflation according to the 2010 cost. The independent predictors of hospitalization cost were calculated by mixed effects linear regression modeling incorporating hospital ID as random effects.

Results:
26,300 (weighted n = 130,151) number of patients were identified. Overall hospitalization cost associated with high risk PCI increased from $137,354 in 2005 to $160,736 in 2010 (P<0.001), with $131,239 in 2005 to $158,937 in 2010 for IABP (P<0.001) and $185,774 in 2005 to $243,657 in 2010 for LVAD (P<0.001). The independent predictors of increased hospitalization cost associated with high risk PCI on a multivariable analysis included teaching hospital (+$10,212, p = 0.005), CCI = 2 (+$17,824, p= 0.001), CCI 3 or more (+$36,354, p= 0.001), presence of myocardial infarction (MI) or shock (+$9,094, p<0.001) and occurrence of any of periprocedural complication (+$68,704, p<0.001). The independent predictors of decreased hospitalization cost for high risk PCI included use of IABP vs. LVAD (-$51,783, p<0.001), female sex (-$3,567, p =0.01) and private insurance (-$6,840, p=0.001) or self-pay, no insurance (-$10,541, p<0.001) compared to Medicare/Medicaid as referent.

Conclusion:
In this observational study we demonstrated that increased hospitalization cost for high risk PCI is associated with teaching hospital, CCI, presence of MI or shock and occurrence of periprocedural complications. We also found use of IABP, female sex, having private, self-pay or no insurance to be associated with a decreased hospitalization cost related to high risk PCI in the US over a 5 year period from 2005-2010.
Abstract 314: Systematic Inquiry of Family History Improves Cardiovascular Disease Risk Assessment
Authors: Kashani Mariam , Eliasson Arn , Vernalis Marina , Bailey Karla , Terhaar Mary
Published: March 2022

Background:
Numerous research publications substantiate the value of family history of premature cardiovascular disease (CVD) as an independently predictive risk factor for CVD. However, many traditional CVD risk assessment tools do not incorporate family history and therefore underestimate true risk. Risk assessment is the cornerstone of determining therapeutic goals and preventive intervention.

Objective:
We sought to implement and validate a clinical decision support tool that incorporates family history as a high-risk factor to guide risk stratification in a population identified as low and intermediate risk by Framingham Risk Score (FRS).

Methods:
In a retrospective analysis of patients entering our CVD prevention program, the clinical decision support tool was applied. The clinical decision support tool defines family history of premature CVD as having a parent and/or sibling with a CVD event before the age of 65. Patients entering our CVD prevention program have a comprehensive risk assessment including measurement of blood pressure, lipids, glucose metabolism and Carotid Intima Media Thickness (CIMT).

Results:
Of 394 patients entering our program, 239 (61%) were scored as low or intermediate risk by FRS. These patients had a mean age of 49 years (range 20-76), 60% women, 52% Caucasian, 37% Black, 5% Hispanic and 6% other. The decision support tool identified 114 (48%) of these patients as high-risk for CVD as a result of the inclusion of family history of premature CVD. In these patients, 72% had dyslipidemia, 35% hypertension, 20% prediabetes and 61% had early atherosclerotic disease by CIMT.

Conclusions:
In our population, almost half of the patients previously determined as low or intermediate risk were reclassified as high-risk for CVD. This reclassification is underscored and validated in view of both the high frequency of metabolic abnormalities revealed and the atherosclerotic plaque burden seen by CIMT. These findings are highly relevant particularly in middle-aged women who are frequently more vulnerable to overt heart disease and require improved risk assessment for aggressive treatment goals to enhance prevention.
Abstract 321: Sodium Bicarbonate Use During In-hospital Pediatric Cardiopulmonary Resuscitation - A Report From the American Heart Association Get With The Guidelines-Resuscitation®
Authors: Raymond Tia T , Stromberg Daniel , Stigall William , Burton Grant , Zaritsky Arno
Published: March 2022

OBJECTIVES:
The 2005 and 2010 Pediatric Advanced Life Support (PALS) Guidelines do not recommend using sodium bicarbonate (SB) during cardiopulmonary resuscitation (CPR) except for select resuscitation situations. We hypothesize that SB is used frequently during in-hospital pediatric CPR and its use is associated with worse survival to hospital discharge when given outside of these recommended resuscitation situations.

PATIENTS AND METHODS:
We analyzed data from 8602 consecutive pediatric CPR events (patients < 18 yrs) submitted to the American Heart Association Get With The Guidelines-Resuscitation from January 2000 through September 2010. The primary outcome was survival to hospital discharge. Secondary outcomes included event survival, 24 hr survival, and neurologic outcome. Multivariable logistic regression was performed to analyze the association between SB use and outcomes.

RESULTS:
SB was used in 3923 (46%) of 8602 events. The incidence of SB use between 2000-2005 vs. 2006-2010 was 54% vs. 41% (p <0.001; Fig. 1). After adjustment for confounding factors (e.g. event location, illness category, arrest rhythm, concurrent advanced cardiac life support medications, and duration of CPR > 15 mins), the use of SB during CPR was associated with decreased survival to discharge (OR: 0.62; 95% CI: 0.54, 0.71), but not unfavorable neurologic outcome (OR 0.73; 95% CI 0.50, 1.05). In the settings of metabolic/electrolyte abnormalities, toxicologic abnormalities/overdose /poisoning, and high potassium, SB use during CPR was not associated with worse survival to discharge (OR: 0.78; 95% CI: 0.56; 1.09) or unfavorable neurologic outcome (OR 1.05; 95% CI: 0.37, 2.97). After excluding patients in the settings of metabolic/electrolyte abnormalities, toxicologic abnormalities, and hyperkalemia, SB use during CPR (n = 5270) continued to be associated with worse survival to discharge (OR: 0.61; 95% CI: 0.53, 0.71) and unfavorable neurologic outcome (OR: 0.64; 95% CI: 0.43, 0.95).

CONCLUSIONS:
Sodium bicarbonate continues to be used frequently during in-hospital pediatric CPR, yet there is a significant trend towards less routine use over the last decade. Sodium bicarbonate use is associated with decreased survival to hospital discharge and unfavorable neurologic outcome when given outside PALS recommendations.
Abstract 326: Low Rates Of Utilization Of Aldosterone Antagonists In Eligible Patients Post Myocardial Infarction: Insights From The Triumph And Premier Registries
Authors: Shore Supriya , Jones Philip G , Lanfear David E , Maddox Thomas M , Ho P. M
Published: March 2022

Background:
Current guidelines recommend initiation of an aldosterone antagonist post myocardial infarction (MI) for those with an ejection fraction (EF) <40% with heart failure (HF) or diabetes mellitus (DM) prior to hospital discharge in the absence of contraindications. We assessed rates of guideline concordant and discordant use of aldosterone antagonists at discharge and 1 month post-MI.

Method:
Data was analyzed from combined PREMIER and TRIUMPH registries: a prospective, 31-center U.S. study of AMI outcomes from 2003 to 2008. We assessed rates of guideline concordant and discordant utilization of aldosterone antagonists among 6,329 therapy-naïve patients surviving their hospitalization with data available on EF, creatinine and potassium at discharge. Medication utilization at 1 month post discharge was assessed through interviews.

Results:
In the entire cohort, 678 patients were eligible for aldosterone antagonists; however, only 15.2% (n=103) received it. Among eligible patients (n=55) discharged on an aldosterone antagonist who completed 1month interviews, 27% (n=15) had discontinued it. Furthermore, among those who were eligible but were not discharged on an aldosterone antagonist (n=322), only 7.5% (n=24) were initiated on them post discharge at 1 month. Guideline discordant use of aldosterone antagonists was observed in only 2.0% (n= 113 of 5,651) patients: ~1% had EF ≥40%, others either did not have HF and DM or had potassium ≥5 mEq/L at discharge.

Conclusion:
We found that less than 1 in 6 eligible patients were prescribed aldosterone antagonists at discharge and of those prescribed them, 1 in 4 stopped within 1 month. These results extend our knowledge on under utilization of aldosterone antagonist therapy at discharge as well as on follow up. Future work is needed to assess reasons for this underutilization in eligible patients despite a proven benefit in randomized trials and a class I recommendation in guidelines.
Abstract 338: High Quality Medical Care: A Key Component in Access to Vascular Care for Patients with Lower Extremity PAD
Authors: Goodney Philip P , Brooke Benjamin S , DeMartino Randall R , Goodman David C , Fisher Elliott S
Published: March 2022

Objectives:
Prior work has demonstrated that patients at risk for amputation often have limited access to vascular care. We hypothesized that patients at risk for amputation may also have poor access to medical care related to their peripheral arterial disease (PAD). Therefore, we studied the intensity of medical care provided to patients at risk for amputation, and its relationship to access to vascular care.

Methods:
We identified a cohort of 52,505 Medicare patients at risk for amputation (pre-existing diabetes, PAD, and foot ulceration) who required hospital admission for leg or foot cellulitis. Using the 307 hospital referral regions defined in the Dartmouth Atlas, we determined the proportion of patients that received appropriate, high quality medical care within 1 year (before or after) hospital admission. High-quality medical care was defined as evidence of (1) hemoglobin A1C testing (2) podiatric care, and (3) non-invasive vascular testing. Then, using regression analysis at the regional level, we assessed relationships between the use of high quality of medical care and access to diagnostic or therapeutic lower extremity vascular procedures.

Results:
Across the United States, only 36% of diabetic patients with PAD and tissue loss received all three components of high quality medical care; 76% received 2 of 3 components. A non-invasive vascular study was absent in 41%. Provision of high-quality medical care varied across regions, from 4% of patients in Mason City, Iowa to 58% of patients in Sun City, Arizona. Regions that provided high quality medical care were significantly more likely to provide vascular care (R=0.30, p<0.001). Across quintiles of medical care quality, those regions most likely to provide high quality medical care were 24% more likely to provide invasive vascular care and revascularization (p<0.001, Figure).

Conclusions:
Fewer than 4 out of 10 Medicare diabetics with PAD and tissue loss receive high-quality, appropriate medical care. Quality improvement efforts at limiting amputation need to incorporate multidisciplinary strategies and involve primary care providers, as high quality medical care is an important determinant of access to vascular care and limb preservation.
Abstract 35: Long-term Outcomes after Percutaneous Coronary Intervention in Australian Private Hospitals; Results from a National Registry
Authors: Eccleston David , Horrigan Mark , Rafter Tony , Sage Peter , Latchem Donald
Published: March 2022

Background:
Several large registries have evaluated outcomes after percutaneous coronary intervention (PCI) in the USA, however little national data exist regarding long-term outcomes of patients in Australian hospitals. The aim of this study was to report the long-term results of PCI from the Heart Care Group Registry.

Methods:
We prospectively enrolled consecutive patients (n=2158) undergoing PCI to 2950 lesions at 9 Australian private hospitals from November 2008 to December 2012. Baseline patient/procedural data and in-hospital, 30 day and 1 year outcomes were recorded in a secure electronic database and stored in the Department of Epidemiology at Monash University.

Results:
The mean age was 67 ± 12 years. Females comprised 25.1 %, diabetics 24.5%, 32% were obese (BMI>30) and 37.2% had acute coronary syndromes. At least one DES was used in 64.9% of PCI. Procedural success rates were 97%. In patients not taking Warfarin, 99.0% were taking aspirin and 97.7% clopidogrel at discharge. Obese patients were more likely to be readmitted by 12 months (p=0.002)

Conclusion:
Australian practice and long-term outcomes after PCI are consistent with those reported in international registries. Compliance with guideline therapy is high.
Abstract 41: Broken Heart Syndrome-“Not so rare anymore”
Authors: Rajamanickam Anitha , Kansara Pranav , Fanari Zaher , Rao Abhishek D , Hopkins James , Rahman Ehsanur , Kostal Michael , Stillabower Michael , William Weintraub
Published: March 2022

Background:
Takotsubo or stress induced cardiomyopathy (TCM), once considered rare is now an increasingly considered differential diagnosis in patients presenting as an acute myocardial infarction (MI). TCM is a rapidly reversible form of acute heart failure associated with a distinctive left ventricular contraction pattern and non-obstructive(<50% stenosis) coronary artery diseases(CAD) on cardiac catheterization(CC) Literature regarding this disease is relatively sparse with reports of incidence around 1%.

Methods:
Medical records were reviewed for patients, from 2006 onwards, with either a discharge diagnosis of TCM or a clinical presentation of ST elevation MI (STEMI) or a Non-STEMI (NSTEMI) and with ventriculogram on cardiac catheterizations (CC) but without any coronary interventions. We retrieved 972 patients and 99 met the criteria for TCM after a detailed review of their records.

Findings:
Our data showed that the diagnosis of TCM increased yearly from 2006 to 2011 presumably due to an increasing awareness of this entity. In 2011, 25 of 937 patients presumed to be a STEMI/NSTEMI were TCM (incidence of 2.7%). TCM patients were more likely to be older female patients (See figure for Demographics). A stressful trigger could be identified in 45 patients, the most common causes being death in the family, diagnosis of cancer or recent illness/surgery. Comorbidities included hypertension (57%), hyperlipidemia (55%), depression/anxiety(34%) , diabetes(22%), active smoking(16%) and chronic pain (24%).Follow up ECHO were available only in 69% and of theses completely recovery was seen in 73% ,partial recovery in 23% and minimal or no recovery in 4% of patients. All patients who showed no recovery had TCM in the postoperative period. Mortality was 5% during index hospitalization and all these patients were ICU patients (either postoperative or septic shock patients)

Conclusions:
TCM is becoming an increasing finding in the cardiac catheterization lab in patients presenting as an acute MI .Increasing awareness of this condition and performing a ventriculogram in these patients is necessary for diagnosis. Our study suggests that in ICU patients, a diagnosis of TCM portends a poor prognosis and TCM in the postoperative period may result in permanent cardiomyopathy.
Abstract 42: Use of the Kansas City Cardiomyopathy Questionnaire to assess acute heart failure patients
Authors: Sauser Kori , Spertus John A , Pierchala Linda , Pang Peter S
Published: March 2022

Background:
Patient reported health status outcomes are becoming increasingly important. While disease-specific measures exist for chronic heart failure (HF), there is not a well-validated instrument for acute HF. We sought to assess the feasibility of using the KCCQ during hospitalization and to examine whether acute changes were associated with early emergency department (ED) revisits or readmission for HF.

Methods:
A prospective cohort pilot study of a convenience sample of chronic HF patients presenting to the ED with worsening HF were enrolled who met the following inclusion criteria: >18 years old, BNP>400, primary admission for HF (dyspnea at rest or on minimal exertion, and at least 2 of following: CXR consistent with HF, JVD, peripheral edema, rales), and treated with IV loop diuretics in pre-hospital or ED. Exclusion criteria were ongoing ACS, current or recent pregnancy, non-English speaking, unable to consent, terminal illness with life expectancy <6 months. Consenting patients were enrolled within 12 hours of presentation and administered the KCCQ by interview on presentation, at discharge (or hospital day 7, whichever came first), and 30 days post-discharge by phone. Primary analysis was a description of mean differences in the KCCQ Overall Summary score over time, and hospital-based changes stratified by early ED revisit or readmission were compared. Changes in summary scores between assessments were evaluated using paired t-test. Associations between summary scores, changes in scores, and ED revisits and readmissions were evaluated using t-tests for bivariate comparison and logistic regression to control for baseline scores.

Results:
Among the 53 enrolled patients (mean age 64±15, 56.6% male; 46.3% white, 29.6% black, 7.4% Hispanic, 16.7% other) assessments 2 and 3 were each completed by 92% (49). Within each domain and summary score, mean scores were lowest on admission, improved on assessment 2, and highest on assessment 3. The mean change in the KCCQ Summary score between admission and discharge was +11.5±26.5 (p=0.007) and between discharge and 30 days was +19.1±17.7 (p<0.001). Within the 30-day follow-up period, 8 patients re-visited the ED for HF, and 10 were readmitted for HF (6 through the ED). Patients with ED revisits versus those without had no difference in scores on discharge, but had significantly less improvement in summary scores during hospitalization (mean KCCQ score change -6.5 points vs. +17.6 points, p=0.03). There were no significant differences between patients with HF readmissions versus those without when comparing summary scores or changes in summary scores from presentation to discharge.

Conclusion:
The KCCQ is feasible to use during acute hospitalization for HF, and changes in summary score during hospitalization may predict ED revisits, but not readmissions for HF. Further validation of the instrument in the acute setting will be required.
Abstract 52: Association of Heparin Lead-in Therapy and Recurrence in the Treatment of Venous Thromboembolism
Authors: Preblick Ronald , Cai Jennifer , Kwong Winghan Jacqueline
Published: March 2022

Background:
Venous thromboembolism (VTE) encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE). Anticoagulant treatment significantly decreases the risk of recurrent VTE events and is typically initiated with the administration of a heparin therapy along with warfarin followed by warfarin treatment alone. The objective of this study was to assess the association between heparin lead-in therapy and VTE recurrence in patients receiving warfarin.

Methods:
Data from adult patients who had a VTE diagnosis in a large claims database (period 2005 - 2011), a warfarin claim within 30 days and continuous eligibility for at least 12 months pre/post first (index) diagnosis, were analyzed. Patients with atrial fibrillation, VTE, or treatment with warfarin therapy prior to the index date were excluded.

Patients were classified into 4 cohorts: 1) Outpatient DVT; 2) Outpatient PE; 3) Inpatient DVT; 4) Inpatient PE. Inpatient cohort patients had an index inpatient VTE claim or had an inpatient VTE claim within 7 days of an index outpatient VTE claim. Outpatient cohort patients were required to have another outpatient VTE claim within 7 days of their index claim. Patients with both DVT and PE claims were included in the PE cohorts. Recurrent VTE was defined as the presence of an inpatient VTE claim within 365 days from the index date. Heparin use was identified by a UFH/LMWH pharmacy claim within 7 days of the outpatient index date or discharge from an inpatient VTE index event. Cox proportional hazard models adjusting for age, gender, health insurance type and baseline Elixhauser comorbidities were used.

Results:
A total of 39,424 patients met study criteria. Mean (SD) age was 59.8 (15.6) years and 50.6% (19,946/39,424) were female. Most patients (72.0%; 28,388/39,424) had an index inpatient event with a mean (SD) LOS=5.4 (4.1) days. Outpatient DVT/PE patients who used heparin had significantly lower rates of VTE recurrence vs. those who did not (
P
<0.05). Post-discharge heparin use was not associated with VTE recurrence rates within inpatient cohorts.

Conclusion:
The use of heparin lead-in therapy can significantly reduce VTE recurrence in the Outpatient VTE cohorts. Due to the lack of inpatient drug use data to identify heparin use in this claims database, additional studies are needed to confirm our Inpatient cohort results.