bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P362: Prognostic Value of Troponin in Myocardial Infarction in the Community
Authors: Roger Veronique L , Bell Malcolm R , Weston Susan A , Jaffe Allan S
Published: March 2022

Troponin is the biomarker of choice for the diagnosis of myocardial infarction (MI) in clinical practice. Data on its value to predict death, while documented in clinical trials, are lacking from community studies. There is little information from population studies of MI on short and long term predictive value of Troponin on death and nonfatal endpoints such as recurrent ischemic events and heart failure.

Methods:
We evaluated the prognostic value of Troponin T (TnT) among consecutive persons with incident MI in Olmsted County, MN.

Results:
1220 persons (mean age 69±15 years, 45% women) experienced an incident MI (20% ST elevation MI) in Olmsted County, MN between 2002 and 2008. Peak TnT value measured at a median of 1 day post-MI was 1.88±4.19 ng/mL (median 0.52 (25%: 0.16, 75%: 1.75)). After 1.27 years of follow-up, 294 deaths occurred, 360 recurrent ischemic events (recurrent MI or hospitalized unstable angina) and 345 episodes of heart failure. Associations between clinical events and TnT tertiles are shown in the
table
.

Conclusions:
In the community, the magnitude of TnT elevation is predictive of recurrent ischemic events, heart failure and early death. It is not associated with long-term mortality.

Hazard ratio compared to lowest TnT tertile, 95%CI and p value Adjusted for age, sex and comorbidity

Outcome

All events
Events within 30 days
Events among 30 day survivors

Death
TnT tertile 2 TnT tertile 3 p-value
1.02 (0.78-1.33) 1.15 (0.85-1.57) 0.64
0.64 (0.38-1.06) 1.59 (0.98-2.57) 0.004
1.24 (0.90-1.69) 0.93 (0.62-1.38) 0.26

Recurrent ischemic events
TnT tertile 2 TnT tertile 3 p-value
1.45 (1.12-1.88) 1.70 (1.29-2.24) <0.001
1.45 (0.96-2.19) 2.07 (1.37-3.12) 0.002
1.46 (1.05-2.04) 1.45 (1.00-2.10) 0.049

Heart failure
TnT tertile 2 TnT tertile 3 p-value
1.03 (0.78-1.36) 2.10 (1.58-2.78) <0.001
0.94 (0.68-1.29) 2.10 1.54-2.87) <0.001
1.38 (0.79-2.41) 2.19 (1.14-4.21) 0.067
Abstract P364: Gender Differences in Long-Term Survival Following Isolated Coronary Artery Bypass Graft Surgery
Authors: Filardo Giovanni , Hamilton Cody , Hamman Baron , Hebeler Robert F , Adams John P , Grayburn Paul
Published: March 2022

Background:
The current aging of the United States population and of the Western World is expected to increase the number of women undergoing isolated coronary artery bypass grafting (CABG). The literature consistently reports higher in-hospital mortality and morbidity in women undergoing isolated CABG. However, little has been done to determine the effect of gender on post-CABG long-term survival.

Methods and Results:
Survival was assessed in a cohort of 8,071 consecutive patients (28% were women) who underwent isolated CABG at Baylor University Medical Center, Dallas, TX between 1/1/1997-12/31/2008. Ten-year unadjusted survival was 55.6% [52.8%, 58.4%] in women and 64.3% [62.6%, 65.9%] in men. The unadjusted Hazard Ratio (HR) was 1.33 (95% Confidence Intervals [95%CI]: 1.22, 1.46) indicating a significantly higher risk of death in women. A propensity-adjusted model controlling for pre-operative risk factors identified by the Society of Thoracic Surgeons and other pre-operative clinical/non-clinical details was used to investigate the adjusted association between gender and post-CABG long-term mortality. After adjustment, the risk of death was not significantly higher in women than men (HR = 1.09; 95%CI: 0.97, 1.23) (see Figure).

Conclusions:
This study provides evidence that after controlling for pre-operative severity of disease and other possible confounders, risk of long-term mortality in women is not significantly higher than in men. Accordingly, women undergoing isolated CABG seem to be more likely to have important pre-operative comorbid conditions compared to men.
Abstract P365: Long-Term Survival in Women Undergoing Aortic Valve Surgery Surgery
Authors: Filardo Giovanni , Hamilton Cody , Hamman Baron , Hebeler Robert F , Adams John P , Grayburn Paul
Published: March 2022

Background:
Western society is, on average, aging, which translates into a growing number of patients, in particular women, undergoing aortic valve replacement (AVR) in coming years. Data regarding long-term survival in women undergoing AVR with or without concomitant coronary artery bypass grafting (CABG) is sparse and conflicting.

Methods and Results:
The effect of gender on survival was investigated in 1,532 consecutive patients (36% were women) who underwent AVR or AVR+CABG at Baylor University Medical Center, Dallas, TX between 1/1/1997-12/31/2008. Ten-year unadjusted survival in women was significantly lower in women (44.9%; 95%CI: 38.2%, 51.4%) than in men (54.6%; 95%CI: 49.5%, 59.5%). The unadjusted Hazard Ratio (HR) was 1.42 (95%CI: 1.19, 1.70). To account for pre-operative disease severity, a propensity-adjusted model that included pre-operative risk factors identified by the Society of Thoracic Surgeons (STS) in addition to pre-operative clinical/non-clinical data, was employed to assess the association between gender and post-AVR long-term mortality. The adjusted risk of death was significantly higher in women than men (HR = 1.40; 95%CI: 1.09, 1.73).

Conclusions:
This study supports the hypothesis that women undergoing AVR experience poorer long-term survival than men, independent of their pre-operative severity of disease. Our multivariable model accounted for established STS mortality risk factors as well as for other possible confounders, yet risk of death in women was 40% higher than in men. Tailoring post-discharge management to improve survival in women should be investigated.
Abstract P46: Correlation Between Inpatient and Outpatient Measures of Stroke Care Quality Within Veterans Health Administration Hospitals
Authors: Ross Joseph S , Arling Greg , Ofner Susan , Roumie Christianne L , Keyhani Salomeh , Ordin Diana L , Williams Linda S , Bravata Dawn M
Published: March 2022

Objective
To examine the correlation between hospitals' performance on delivering processes of high-quality care to ischemic stroke patients at discharge and ambulatory care post-discharge outcomes among Veterans Health Administration (VHA) hospitals.

Methods
Using 2007 chart abstracted data from nearly all veterans hospitalized for ischemic stroke at all VHA hospitals, we determined risk-standardized hospital performance for 1) four process measures of discharge care: prescription of anti-thrombotic and anti-lipidemic therapy, anti-coagulation therapy for patients with atrial fibrillation, and tobacco cessation counseling, and created a composite measure of defect free care; 2) 30-day mortality; 3) 30-day readmission; and 4) five outcome measures of post-discharge care within 6 months: blood pressure and low-density lipoprotein, international normalized ratio (INR) for patients on warfarin, glycosylated hemoglobin for patients with diabetes, and depression management, and created a composite measure of achieved outcomes. We used weighted Pearson correlation efficients to examine associations between the composite of defect free care processes at discharge and 30-day mortality, 30-day readmission, and composite achievement of outcomes within 6 months post-discharge.

Results
Among 3536 veterans hospitalized for ischemic stroke at 108 VHA hospitals, median risk-standardized rate of defect free composite of care at discharge was 79% (25th/75th percentile: 74%, 83%), 30-day mortality was 1% (1%, 1%), 30-day readmission was 9% (9%, 10%), and composite outcomes achieved post-discharge was 44% (41%, 47%). There was no correlation between defect-free delivery of processes at discharge and either 30-day mortality or readmission (p values > 0.70), although correlation with outcomes achieved post-discharge approached statistical significance (p=0.07), suggesting that performance on care at discharge may account for 4.8% of the hospital-level variation in performance on outcomes during the post-discharge period.

Conclusions
Performance on care delivered upon discharge from the inpatient setting did not predict performance on care delivered in the ambulatory care setting, even within an integrated health care system like VHA.
Abstract P48: The Inclusion of Stroke in Risk Stratification for Primary Prevention of Vascular Events: the Northern Manhattan Study
Authors: Dhamoon Mandip S , Moon Yeseon P , Paik Myunghee C , Sacco Ralph L , Elkind Mitchell S
Published: March 2022

Background:
The Framingham coronary heart disease risk score (FRS) estimates 10-year risk of myocardial infarction (MI) and coronary heart disease (CHD) death and is used to risk stratify individuals for vascular disease primary prevention. Since the preventive approaches to CHD and stroke are similar, a composite outcome may be more appropriate, and estimating risk of cardiac events alone may underestimate risk. We compared 10-year risk of MI or CHD death to risk of stroke, MI, or CHD death among individuals free of vascular disease, focusing on those with intermediate calculated FRS risk (10-20% over 10 years). We also used the Framingham general cardiovascular disease score (FGS), which calculates risk of a composite vascular outcome, but for which guidelines do not exist.

Methods:
The Northern Manhattan Study contains a prospective, population-based study of stroke- and CHD-free individuals ≥40 years of age, followed for a median of 10 years for MI, CHD death, and stroke. The FRS was used to calculate estimated 10-year risk of MI or CHD death. For those with intermediate estimated risk, Kaplan-Meier actual 10-year risks were calculated for 1) MI or CHD death and 2) stroke, MI, or CHD death. The cumulative risk of MI or CHD death was subtracted from risk of stroke, MI, or CHD death, and bootstrap methods produced 95% confidence intervals (CI) for the difference. This analysis was repeated using the FGS to stratify risk.

Results:
Among 2613 participants (53% Hispanic, 25% non Hispanic Black and 20% non Hispanic White), 867 had 10-20% estimated 10-year FRS risk. The actual 10-year risk of MI or CHD death was 14.2%. When stroke was added to the outcome, actual risk was 21.98% (absolute risk difference 7.78, 95% CI 5.86-9.75). For those with intermediate FGS risk, actual 10-year risk of MI or CHD death was 6.5. When stroke was added, actual risk was 10.55 (absolute difference 4.05, 95% CI 2.63-5.85).

Discussion:
In this multi-ethnic urban population, adding stroke to the risk stratification outcome cluster resulted in a 55% increase in risk and crossing of the threshold (>20% over 10 years) considered for preventive treatments such as statins. Research is needed to clarify the optimal use of primary risk stratification schemes, particularly among minority populations.
Abstract P53: Influence of Low Serum Triglyceride on Mortality After Cardioembolic versus Non-Cardioembolic Stroke: A Prospective Follow-Up Study
Authors: Lee Seung-Hoon , Kim Nami , Yoon Byung-Woo
Published: March 2022

Background:
Low serum triglyceride (TG) has been suggested as a predictor of mortality after cardiovascular disease. However, the relationship between the level of TGs and the outcome after stroke remains to be elucidated. We hypothesized that the influence of TG levels on post-stroke mortality varies according to stroke mechanism: cardioembolic (CE) vs. non-CE causes.

Methods and Results:
We prospectively enrolled a consecutive series of patients with first-ever acute ischemic stroke for five years (n=1,067), and followed them until the end of 2007 to obtain information on mortality and cause of death. We divided the level of TG into the quartiles, and classified the patients into CE (n=226) and non-CE stroke groups (n=841). The influence of TG level on mortality (all-cause death and vascular death) was examined by univariate and multivariate analyses using Cox regression. All-cause death and vascular death rates showed inverse relationships to the quartiles of TG levels in all patients (p<0.001, both) and also in non-CE stroke group (p<0.001, both), but not in CE stroke group (p=0.17 and p=0.37, respectively). In the Cox-regression analysis, compared with the highest quartile, the adjusted hazard ratio (HR) of the lowest quartile for all-cause death was 2.58 [95% confidence interval (CI), 1.38-4.82] and that for vascular death was 3.50 (95% CI, 1.39-8.82) in non-CE stroke group. These same associations however, were not significant in CE stroke group.

Conclusions:
Our results indicate that low serum TG is an independent predictor of mortality after ischemic stroke brought on by non-CE causes.
Abstract P54: Predicting Functional Outcome of Stroke Inpatient Rehabilitation
Authors: van Ginneken Berbke T , van Bragt Peter J , Heijenbrok Majanka H , Ribbers Gerard M
Published: March 2022

Stroke is a major cause of disability in western societies. Besides insight in the effectiveness of stroke inpatient rehabilitation, there is a need for studies evaluating the efficiency of rehabilitation after stroke. We aimed to study the effectiveness of inpatient stroke rehabilitation and evaluated the relative importance of demographic and clinical characteristics to predict (un)successful functional outcome of stroke inpatient rehabilitation. A total of 293 stroke patients were enrolled in this study. We assessed functional ability and quality of life (QoL) before and after inpatient stroke rehabilitation. Functional ability was assessed using the Barthel Index (BI) and the Academic Medical Center Linear Disability Score (ALDS). QoL was measured using the COOPWONCA and the Nottingham Health Profile (NHP). We used multivariable linear regression analysis to develop a model predicting functional outcome as assessed by the ALDS at discharge. We used ROC curve analysis to study the discriminatory power of the regression model for a (un)successful functional outcome. A successful outcome was defined as an ALDS discharge score of 1 or higher, i.e. able to perform difficult functional activities. An unsuccessful outcome was defined as an ALDS discharge score of -1 or lower, i.e. only able to perform simple functional activities. Results show significant improvements on both the functional ability measures (both BI score and ALDS score improved with 52% (p<.001)) and the quality of life measures (COOPWONCA improved with 9-31% (p<.05) and NHP improved with 25-56% (p<.001)). A better ALDS admission score, younger age, less severe stroke, a better BI admission score, less pain and less negative emotional reactions as measured with the NHP on admission turned out as independent predictors of a better ALDS discharge score, explaining 39.2% of its variance. ROC curve analysis showed a discriminatory power of the regression model for a successful or unsuccessful functional outcome of 80% and 93%, respectively. These prognostic factors need to be taken into account to optimize efficiency of stroke inpatient rehabilitation, like focusing on pain and negative emotional reactions, and can provide realistic therapeutic goals for stroke patients.
Abstract P55: Comparison of Real World Adherence, Healthcare Resource Utilization, and Cost for Valsartan/Amlodipine Single Pill Combination versus Angiotensin-Receptor Blocker/Calcium-Channel Blocker Free Combination Therapy
Authors: Baser Onur , Andrews Laquesha , Wang Li
Published: March 2022

Objective:
To evaluate adherence, healthcare resource utilization and cost outcomes of valsartan/amlodipine single pill combination (SPC) versus angiotensin-receptor blocker (ARB)/calcium-channel blocker (CCB) free combination (FC) therapy in hypertensive patients.

Methods:
A retrospective database study was conducted using a large US commercial insurance claims database for the period 01/01/2007-04/30/2008. Two cohorts of patients receiving valsartan/amlodipine SPC or ARB/CCB FC were identified. All patients were ≥18 years old with at least 1 medical claim for hypertension (ICD 9 401.x-404.x) with ≥6 months pre- and ≥12 months post-index follow up and ≥2 filled prescriptions with days supply ≥90 days for the index therapy over follow up. Primary outcomes were proportion of days covered, days to discontinuation (defined as a gap in therapy of 30 days), and all-cause healthcare cost and utilization. Multivariate regression analysis was conducted to control for baseline characteristics, including age, gender, region, comorbidities, pill burden, and resource utilization and cost.

Results:
A total of 3259 (13.1%) of patients were included in the valsartan/amlodipine SPC cohort and 21,597 (86.9%) in the ARB/CCB FC cohort. At baseline, patients taking SPC were more likely to be male, older, and reside in the Southern US. After adjusting for baseline differences through risk-adjusted logistic regression, adherence rates for patients taking SPC therapy were significantly higher compared to patients taking FC therapy (OR 1.38, 95% CI 1.27-1.51). Patients taking SPC therapy were also significantly less likely to discontinue their index therapy (HR 0.87, p<0.001). Total all-cause health care costs were 11% greater for patients in the FC cohort compared to patients taking SPC therapy (p<0.001). In addition, patients in the SPC cohort were less likely to have ER visits and hospitalizations during the follow up period.

Conclusion:
Use of valsartan/amlodipine single pill combination therapy in hypertensive patients was associated with significantly better adherence and lower cost and healthcare resource utilization compared to ARB/CCB free combination therapy.
Abstract P61: Degree of Beta-Blockade and Outcomes in Patients With Acute Coronary Syndrome
Authors: Amruthlal jain Sachin Kumar , Alexander Patrick , Madany Abraham , Shaw Michael , David Shukri
Published: March 2022

Objective:
We sought to determine whether the survival benefits of beta-blockade in the ACS population are associated with the magnitude of heart rate reduction.

Background:
Atherosclerotic coronary artery disease is the leading cause of morbidity and mortality in the United States with nearly 1.6 million hospitalizations for acute coronary syndrome (ACS) alone in 2004. Beta-blocker therapy along with anti-platelet medications, nitrates, and statins has been the corner stone of medical therapy. ACC guidelines recommend a resting heart rate (HR) goal of 50 to 60 beats per minute (bpm) in patients with ACS. However, these recommendations are not based on randomized clinical trials rather expert opinion. To date, there fails to be evidence-based clinical trials demonstrating the ideal target heart rate after initiation of beta-blockers in ACS patients.

Methods:
A retrospective analysis was performed from January 2007 to December 2008 in all ACS patients who underwent coronary angiography with or without PCI at Providence Hospital's Heart Institute. Patient charts, medication list and diagnostic reports were reviewed. Patients presenting with cardiogenic shock or contraindications to beta-blocker therapy were excluded.

Results:
A total of 430 patients were included in the analysis. (210 STEMI and 220 NSTEMI patients) HR was classified as upper (above 80 bpm), middle (67 to 80 bpm), and lower (below 67 bpm) quartiles. Each quartile was classified according to percent change in HR, the absolute change in HR between admission and discharge, and admission HR and discharge HR. Each quartile was correlated to major adverse cardiac events (MACE) and cardiac death at 30 days. There was a statistically significant difference in the composite endpoints between the upper and lower quartile on discharge HR (9% vs. 4%. p value < 0.05) in both STEMI and NSTEMI patients.

Conclusion:
In those with ACS, primarily STEMI and NSTEMI, lower discharge HR conferred a decrease in composite endpoints at 30 days. It's unclear whether the reduction in MACE will persist beyond the initial follow-up or if there is a long-term mortality benefit with this degree of HR reduction at discharge. Further studies are needed to investigate the clinical benefits of HR reduction in the ACS population.
Abstract P75: Discretionary Use of Dual Lead Implantable Cardioverter-Defibrillators (ICDs) by Hospital
Authors: Matlock Dan , Peterson Pamela N , Wang Yongfei , Curtis Jeptha P , Reynolds Matthew R , Varosy Paul D , Masoudi Frederick A
Published: March 2022

Introduction:
Current evidence does not support the use of dual lead ICDs over single lead ICDs for the primary prevention of sudden cardiac death in patients without a permanent pacing indication. The objective of this analysis was to explore hospital-level variation in the use of “discretionary” dual lead ICDs in a population without a clear indication for a permanent pacemaker.

Methods:
Using data from the National Cardiovascular Data Registry, we determined the total number of primary prevention ICDs implanted in each hospital where the choice between single and dual lead would be discretionary by excluding patients with a guideline-based indication for a permanent pacemaker (QRS > 120 msec, sinus node dysfunction, or 2
nd
or 3
rd
degree heart block). Using hierarchical logistic regression adjusted for clustering within hospitals, we then determined patient, physician, and hospital level correlates of receiving a dual lead ICD.

Results:
Marked hospital level variation exists in the use of “discretionary” dual lead devices, ranging from 0% to 100% (figure). Patients were more likely to receive a dual lead ICD if they had atrial fib/flutter (OR 1.41) or if their ICD was implanted by a surgeon (OR 2.22). Black patients (OR 0.90), patients on dialysis (OR 0.86), and patients at academic medical centers (OR 0.61) were less likely to receive a dual lead ICD.

Conclusions:
Use of dual lead ICDs among patients without indications for permanent pacing varies markedly at the hospital level. Given the paucity of data supporting dual lead ICDs in this population, research is needed to understand why this variation exists as well as on the comparative effectiveness of single and dual lead ICDs.
Abstract P95: Fibrinolysis and Mortality of ST-Elevation Myocardial Infarction Patients at Hospitals Without Percutaneous Coronary Intervention Capability
Authors: Pathak Elizabeth B , Strom Joel A
Published: March 2022

Objective:
Despite efforts to regionalize care for ST-elevation myocardial infarction (STEMI), some patients continue to be treated at hospitals without percutaneous coronary intervention (PCI) capability. In this study, we examined in-hospital mortality rates at these STEMI referral hospitals in Florida during 2001-2007.

Methods:
We classified hospitals based on their total PCI volumes (regardless of diagnosis) on a quarterly basis. Our study population included STEMI patients admitted to hospitals with total PCI volume = 0 for the quarter of their admission. In-hospital mortality and fibrinolysis treatment rates were calculated for all patients, and for the subset of patients who were not transferred to another acute-care general hospital. We analyzed hospital discharge data with 100% coverage (no sampling) for the state of Florida.

Results:
There were 32,371 STEMI patients admitted to 165 hospitals with PCI volume = 0 during 2001-2007. The majority of patients were white (77.3%) and male (57.7%), with sizeable numbers of Hispanics (14.7%, n=4,776) and Blacks (8.0%, n=2,602). Most patients were 65-84 years old (49.0%), with 31.5% 85 years old. Throughout the study period, approximately 50% of these patients were transferred out to another hospital. However days-to-transfer was > 2 days for the majority of patients in 2001, although time-to-transfer did improve in more recent years. In-hospital mortality rates were high - 13.9% for all patients and 28.0% for non-transferred patients - and did not decline over the study period. Use of fibrinolytics was low (<20% of patients in early 2001) and declined steadily to 4.4% in late 2007. Non-transferred patients who did not receive fibrinolysis were 36% more likely to die (28.4% vs. 20.8%), with the benefit of fibrinolysis strongest among patients aged < 65 years old (mortality 7.5% vs. 19.0%).

Conclusions:
Use of fibrinolysis was low and in-hospital mortality was relatively high among STEMI patients treated at non-PCI capable hospitals in Florida, adding support to the importance of implementing routine diversion/rapid transfer protocols in accordance with AHA Mission: Lifeline goals.
Abstract P104: β-Blocker Exposure and Systolic Heart Failure Outcomes by Race
Authors: Hrobowski Tara N , Peterson Edward L , Wells Karen , Spertus John A , Williams L K , Lanfear David E
Published: March 2022

Background:
Beta adrenergic blocking agents (BB) are a mainstay of heart failure (HF) treatment yet there is inconclusive data regarding their efficacy in African Americans due to low racial diversity in the clinical trials of approved agents.

Methods:
This was a retrospective study of patients who received care from a large health system and had a primary hospital discharge diagnosis of heart failure between 1/2000 and 6/2008. Ejection fraction (EF) was abstracted from the medical record and only patients with EF<50% were included. BB exposure (BBexp) was estimated over a six month rolling window using pharmacy claims; patients had to survive 6 months post-discharge to be included. Proportional hazards regression was used to test the association of this time-dependent BB exposure estimate with time to all-cause hospitalization or death, with adjustment for baseline covariates, as well as angiotensin converting enzyme/angiotensin receptor antagonist exposure. We performed analyses both stratified by race, and all-inclusive with an interaction term (BBexp*Race).

Results:
A total of 1094 patients met inclusion criteria; 476 whites and 618 African Americans. Median follow up was 2.1 years. In adjusted models, BBexp was independently associated with lower death or hospitalization in both groups, but appeared more protective in Whites (HR 0.41, 95%CI 0.27-0.61, p<0.001) than African Americans (HR 0.67, 95%CI 0.48-0.94, p=0.024). The formal test for interaction also indicated a significant difference in the BBexp associated outcomes by race (p=0.04). This difference was driven mostly by hospitalizations (HR 0.40 vs. 0.67 in Whites vs. African Americans, respectively), while the association of BBexp with death appeared similar between groups (HR 0.30 vs. 0.24, respectively).

Conclusion:
In this observational data set, beta adrenergic blocker exposure appears less efficacious in preventing death or re-hospitalization among African Americans with heart failure compared to Whites. Further study is needed to better understand the risks and benefits of beta blockade in African Americans with heart failure.
Abstract P110: Medicare/Medicaid Patients are at Increased Risk for Death after Prophylactic Implantable Cardioverter-Defibrillator Implantation
Authors: Subzposh Faiz , Desai Ankuri , Almasry Ibrahim , Barbera Saverio , Fan Roger , Iwai Sei , Rashba Eric
Published: March 2022

Background:
If reliable predictors of mortality after prophylactic implantable cardioverter-defibrillator (ICD) implantation were identified, this information could be used to target this therapy to patients (pts) who are most likely to benefit.

Methods:
The study population consisted of 584 pts who received an ICD for primary prevention from 3/06 to 12/09 at a single center. Clinical and demographic variables were obtained from the ACC-NCDR ICD Registry data. Vital status was obtained from clinic records and the Social Security Death Index. Univariate and multivariable Cox analysis were used to identify significant predictors of mortality.

Results:
The pts were 76% male with mean age 69±13 yrs. There were 89 deaths after 590±400 days of follow-up. Insurance type was a significant predictor of mortality (p=0.015, figure). Pts with Medicare/Medicaid (M) had more high risk features such as older age, worse renal function, more advanced heart failure, prior stroke, prior bypass surgery, and were more likely to receive biventricular ICDs. After adjustment for these factors, M was independently associated with decreased survival as compared to Commercial (adjusted HR 0.26, p=0.005) but not Health Maintenance Organization (HMO, adjusted HR 0.69, p=0.24).

Conclusions:
M insurance is independently associated with increased mortality after prophylactic ICD implantation. Additional research is needed to determine if this finding is attributable to quality of care or decreased access to medical services.
Abstract P113: Accuracy and Prognostic Value of AHA-Recommended Depression Screening in Patients with Coronary Heart Disease from the Heart and Soul Study
Authors: Elderon Larkin , Smolderen Kim G , Na Beeya , Whooley Mary A
Published: March 2022

Accuracy and prognostic value of AHA-recommended depression screening in patients with coronary heart disease from the Heart & Soul Study

Background-
In 2008, the American Heart Association (AHA) recommended a two-step screening method, consisting of the two-item Patient Health Questionnaire (PHQ-2) followed by the nine-item Patient Health Questionnaire (PHQ-9), for identifying depression in cardiovascular patients. The accuracy and prognostic value of this screening method have not been evaluated.

Methods and Results-
We administered the two-step AHA-recommended screening algorithm to 1024 patients with stable CHD and calculated sensitivity and specificity against a gold standard interview for major depressive disorder (MDD). Subsequent cardiovascular events (myocardial infarction, stroke, transient ischemic attack, heart failure or death) were determined during a mean of 6.27 ± 2.11 years follow-up. The AHA-recommended screening method had high specificity (0.91, 95% CI 0.46-0.59), but low sensitivity (0.52, 95% CI 0.89-0.93) for a diagnosis of MDD. Participants who screened positive on the AHA depression protocol had a 55% greater risk of events than those who screened negative (age-adjusted HR 1.55, 95% CI 1.21-1.97; p=0.0005). After adjustment for sex, body mass index, history of myocardial infarction, hypertension, diabetes, heart failure and HDL levels, screening positive remained associated with a 41% greater rate of cardiovascular events (HR 1.41, 95% CI, 1.10-1.81; p=0.008).

Conclusions-
Among outpatients with stable CHD, the AHA-recommended depression screening protocol is highly specific for depression and identifies patients at risk for adverse cardiovascular outcomes.
Abstract P115: First Door-to-Balloon Time: Improving Door-to-Balloon Times in Patients Transferred for Primary Percutaneous Intervention
Authors: Amruthlal Jain Sachin Kumar , Ismail Yousif , Alexander Patrick , Shaw Michael , David Shukri
Published: March 2022

Objective:
We sought to identify the cause of delay in the first door-to-balloon times (1stD2B) in patients presenting with an acute ST-segment myocardial infarction (STEMI) requiring transfer to a PCI capable hospital with post hoc implementation of novel yet simple and reliable initiative “Register and Roll” to improve the overall D2B. Background: National guidelines established by the ACC/AHA call for door-to-balloon (D2B) times of ≤ 90 minutes for patients presenting with STEMI undergoing PCI to facilitate timely reperfusion and salvage of the ischemic myocardium. In patients presenting to non-PCI capable hospitals the timely reperfusion (D2B ≤ 90 min) is met in only 8.6% of patients.

Methods:
A retrospective analysis was performed from April 2006 to May 2009 in all STEMI patients transferred for primary PCI (PPCI) to Providence Hospital's Heart Institute from non-PCI capable hospitals. Patient charts and available electronic records were reviewed. Patients under 18 years of age and those with indeterminate initial electrocardiogram were excluded. The” Register and Roll Initiative” designed to facilitate transfer to our PCI center was implemented in all transfer patients starting in June 2009 to December 2010.

Results:
A total of 148 patients were transferred for PPCI with 47 patients included post “Register and Roll”. Three local hospitals were involved in transferring of patients. The time to ECG, time to EMS activation, door-in-door-out, EMS transport time, and the first-door-to-balloon time were compared pre and post implementation. The door in-door out time played a major role in prolonging the time to reperfusion and after implantation; the patients were transferred sooner for PPCI resulting in improved 1stD2B. (140 min vs. 100 min, P < 0.05)

Conclusion:
Our novel initiative, “Register and Roll”, to facilitate prompt transfer of STEMI patients for primary PCI involves simple guideline, a CATH KIT and EMS notification, which improved delays in door-in-door-out time. This initiative is simple and reliable to follow in a community hospital setting, where resources are limited. AHA's “Lifeline Mission” recommends every health system to implement their own methods to facilitate the transfer and achieve the goal.
Abstract P138: Bare-Metal and Drug-Eluting Coronary and Peripheral Vascular Stent Procedures: Utilization in the United States
Authors: Ong Kevin L , Watson Heather , Patel Jasmine , Kuehn Carrie , Ochoa Jorge
Published: March 2022

Purpose:
To evaluate the use of bare-metal (BM) and drug-eluting (DE) stents (coronary and peripheral) in the U.S.

Methods:
The Nationwide Inpatient Sample (NIS) was used to identify BM or DE stent (coronary and peripheral) procedures between 1998 and 2007. Prevalence of these procedures was calculated by age, gender, race, and primary payer. Average lengths of stay and hospitalization charges were also assessed. National reintervention burden (RB), defined as the ratio of stenting for reintervention to total number of primary and reintervention procedures, was evaluated for BM and DE stents.

Results:
3.91 million BM and 2.74 million DE coronary stent procedures were identified between 1998-2007 and 2002-2007, respectively. During corresponding periods, 679,100 BM and 11,200 DE peripheral stenting procedures were performed. Use of bare-metal stents accounted for 100% of all coronary stents in 2002, but declined to 10.4% in 2005. After 2005, the use of bare-metal stents increased steadily, accounting for 32.8% of coronary stenting in 2007 due to increased safety concerns with the DES. In 2007, the RB for BM and DE coronary stents was 4.3% and 5.6%. 5.9% of reintervention procedures using BM stents followed infection of the previous device, in contrast to 2.3% for DE stents. Average length of stay in 2007 was 3.4 and 2.6 days for primary BM and DE coronary stent procedures, respectively.

Conclusion:
After FDA-approval of DE coronary stents in 2003, there was a steep increase in their use due to their reduced rates of restenosis, despite concerns about late stent thrombosis. Widespread publicity of these concerns led to an FDA meeting in 2006 and sharp decline in utilization. More research is needed to assess whether utilization will change over time as longer-term data and second generation DE stents become available. In the future, longitudinal administrative databases may provide a way to evaluate the comparative effectiveness of these procedures.
Abstract P142: Hospital Management Practices and Associations with MI Processes and Outcomes
Authors: Maddox Thomas M , Lindrooth Richard C , Wholey Doug , Jacuzzi Natalie , Bloom Nick , McConnell K John
Published: March 2022

Background:
Improving hospital management practices may improve the quality of cardiac care, but this relationship is poorly understood. One barrier to understanding is limitations of prior surveys of management practices. These surveys are often biased by respondents answering directed questions favorably. We employed a novel survey methodology to minimize this bias, and measured the association between management practices and myocardial infarction (MI) processes and outcomes of care.

Methods:
We used an innovative telephone survey using open-ended questions to assess 18 management practices in U.S. cardiac units, covering “Lean” management, target setting, and incentives for employees. Each practice was scored from 1 (worst) to 5 (best) and aggregated into a single summary score. We collected MI processes of care and 30-day mortality from the Hospital Compare website for each hospital. Due to ceiling effects, hospitals in the lowest quartile were compared to all other hospitals combined. Regression modeling was used to assess the association between management, process measures, and mortality.

Results:
In 2010, 665 cardiac units in 50 states, representing approximately half of units in the U.S., were surveyed on management practices. Higher management scores were significantly associated with higher rates of aspirin, ACEI, and beta-blocker use at discharge, receipt of PCI within 90 minutes of arrival for STEMI patients, and lower rates of 30-day mortality (Table). Higher scores demonstrated a trend toward higher rates of smoking cessation counseling. No statistically significant association existed between management scores and aspirin upon arrival.

Conclusions:
Higher management scores, as assessed by a novel, in-depth survey, are associated with several MI process of care measures and lower 30-day mortality. Further investigation into these management practices may identify methods for improving MI quality of care.

Process and Outcome of MI Care and Management Practices

MI Process and Outcome Measure
No. of Hospitals
Mean Management Score
Management Score of Hospitals with Process of Care Performance <25th Percentile
Management Score in Hospitals with Process of Care Performance >25th Percentile
P-value

ASA at arrival
619
3.13
3.08
3.19
0.12

ASA at discharge
614
3.12
3.04
3.21
<0.001

ACEI at discharge
249
3.2
3.09
3.3
0.003

Smoking Cessation Counseling
448
3.16
3.12
3.18
0.07

BB at discharge
616
3.13
3.04
3.18
0.001

PCI <90 minutes in STEMI patients
169
3.17
3.11
3.3
0.009

30-day mortality above the U.S. national average
49
3.35

0.001

30-day mortality at the U.S. national average
602
3.11

30-day mortality below the U.S. national average
8
2.88
Abstract P15: Psychometric Properties of the Kansas City Cardiomyopathy Questionnaire
Authors: Masterson Creber Ruth M , Polomano Rosemary C , Riegel Barbara
Published: March 2022

Background:
To explore the structure of the Kansas City Cardiomyothy Questionnaire (KCCQ) and compare it to the published version. The KCCQ is a well-established 5 domain, 23-item instrument evaluating the health status of heart failure patients. This analysis seeks to find the best factor fit for the items and subscale structure, thereby building evidence of the reliability and validity of the tool.

Methods and Results:
A sample of 280 adults with Stage C heart failure was enrolled from three sites in the northeast US. A principal component factor analysis was performed using Promax rotation, allowing for correlation between the subscales. Cronbach’s α scores were computed on the resulting item clusters. All data was analyzed using SPSS version 17.0. The analysis confirmed a five-factor solution; however, some of the items loaded on different factors from those published. The first five factors with Eigen values >1 explained 67.13% of the variance. The internal consistency/reliability was 0.92 overall and as follows in each domain: social interference (7 items, 0.90), physical limitation (4 items, 0.84), symptoms (8 items, 0.86), independent care (2 items, 0.80) and self-efficacy (2 items, 0.63). Two items related to independent care failed to correspond to a previously identified factor so a new domain was added and the items intending to measure quality of life loaded in the social interference domain.

Conclusions:
This analysis verifies the reliability and supports the validity of the KCCQ. To strengthen the KCCQ we recommend eliminating the quality of life domain and including those items in the social interference domain, renaming the self-efficacy domain because these items are not consistent with the theoretical definition of the concept, and re-evaluating the two items which address limitations in dressing and bathing. Key Words: heart failure, factor analysis, quality of life, Kansas cardiomyopathy questionnaire (KCCQ).
Abstract P161: Prevalence of Unaddressed Low HDL-C and Elevated Triglycerides by Age Using the 2007-2008 National Health and Nutrition Examination Survey (NHANES)
Authors: Nair Radhika , Thakker Kamlesh M , Padley Robert J , Zachry Woodie M
Published: March 2022

Objectives:
To estimate the prevalence of low HDL-C and/or elevated TG by age, gender, treatment with lipid-modifying therapy and LDL-C goal attainment.

Methods:
This study was conducted using the 2007-2008 NHANES, a cross-sectional, multi-stage probability sample survey. The data was weighted to represent the US population aged ≥18 years. Optimal/threshold levels used were: HDL-C ≥40mg/dL for men and ≥50mg/dL for women; TG<200mg/dL for general population and <150mg/dL for diabetics; LDL-C <100mg/dL for CHD/CHD risk equivalent subjects, <130mg/dL for ≥2 risk factors and <160mg/dL for 0-1 risk factors. Descriptive analyses were used to estimate and compare prevalence of low HDL-C and/or elevated TG by age, treatment with lipid-modifying therapy, and LDL-C goal attainment between men and women. Men were classified as: 18-44years, 45-64years and ≥65years of age. Women were classified as: 18-44years, 45-54years, 55-64years, ≥65years of age.

Results:
Regardless of LDL-C, 43MM, 14MM, and 16.9MM individuals in the US were projected to have low HDL-C only, elevated TG only and both low HDL-C and elevated TG, respectively. A majority of both the young and older age groups of men and women with low HDL-C had LDL-C at goal (18-44years: Men 82.0%, Women 93.6%; ≥65years: Men 85.1%, Women 73.5%). Among those ≥65years with elevated TG, twice as many men (53.1%) vs. women (21.3%) were treated and at LDL-C goal, while nearly twice as many women (48.9%) vs. men (24.9%) were untreated and not at LDL-C goal. The majority of the population aged 18-44years with low HDL-C and elevated TG were not treated but LDL-C was at goal (Men 68.6%, Women 69.3%). Among older (≥65years) subjects with both low HDL-C and elevated TG, majority of the men (38.1%) were untreated with LDL-C not at goal while the majority of the women (46.1%) were treated with LDL-C at goal.

Conclusions:
In the older population, fewer women than men are treated and have LDL-C at goal when only TG abnormalities are present. The converse is true when both TG and HDL-C abnormalities are present. Regardless of age and treatment, a large proportion of individuals with LDL-C at goal have low HDL-C and/or elevated TG indicating that there remain additional opportunities to optimize lipid management and reduce cardiovascular risk.
Abstract P179: Identifying Patterns and Trends in Indicators of Cardiology Practice Quality
Authors: Heidenreich Paul A , Russo Andrea , Biga Cathleen , Cacchione Joseph , Drozda Joseph , Duffy Peter L , Gillam Linda , Hagan Eileen , Jenkins Kathy , Kennett Jerry , Loth Ann , Mirro Michael , Newhall Chelsea , Smith Sidney , Weiner Bonnie , Windle John , Wright Janet
Published: March 2022

Objective:
The Cardiology Practice Improvement Pathway was created by the American College of Cardiology (ACC) to monitor and report patterns and trends in indicators of cardiovascular practice quality in the outpatient setting with the goals of providing a tool for practice quality improvement and a framework for practice recognition programs.

Methods:
Eleven practices (107 cardiologists), representing a variety of practice settings and sizes, completed the pilot using four clinical outcome measures (Table). Clinical measure performance was obtained from chart review for patients aged 18 years of age or older with hypertension, coronary artery disease, heart failure, and at least two office visits during the measurement period of 1/1/09-12/31/09.

Findings:
Data from a total of 2560 patient records were submitted (range 36-518 per facility). Variations in performance on clinical outcome measures are displayed in the table below. Overall quality of reported care was high with half of the practices reporting over 75% of hypertensive patients with blood pressure < 140/90, 66% with LDL cholesterol < 100 mg/dl in patients with coronary disease, and over 80% of heart failure patients having the left ventricular ejection fraction assessed. However, there was wide variation in performance across the 11 practices. There as a significant (p<0.05) correlation (r=0.76) between the HTN measures but not between any other pairwise comparisons.

Conclusions:
This pilot suggests there is significant variation in care among outpatient cardiology practices. The feedback of these data on indicators of CV practice quality has the potential to improve performance.
Abstract P180: Waist Circumference: A More Sensitive Marker than BMI for Predicting Cardiovascular Disease
Authors: Marcoyannopoulou Fojas Helen , Barrios Erniel B
Published: March 2022

PURPOSE:
To show by Pulse Wave Velocity (PWV) determination that Waist Circumference (WC) is a more sensitive marker than BMI for predicting cardiovascular disease (CVD).

METHOD:
PWV was determined with the BPULS apparatus using the left external carotid and left dorsalis pedis arteries as “central” and “peripheral” points respectively. Pulses were picked up by infrared sensors and recorded simultaneously with a single lead ECG. The time delay between the two pulses is measured. A shorter time delay or faster PWV indicates decreased arterial wall elasticity.

MATERIALS:
A total of 957 asymptomatic Filipino subjects were studied. Males - 447; Females - 510. Age Range: 17 - 84 years. Hypertensives - 327. They were classified into subgroups according to BMI and WC. The average PWV times in seconds (adjusted for height of subjects) for each group were noted. The relationship of increased BMI and WC to variations in PWV time was determined.

RESULTS:
Elevated BMI does not significantly influence PWV time in: 1) All subjects (p<0.1397); 2) Females - (p<0.2372); 3) Normotensives - (p<0.0866); and, 4) Hypertensives - (p<0.1548). However, for every cm. increase in WC, there is a corresponding decline of PWV time by: 1) 0.000743 sec. (p<0.0001) in All subjects; 2) 0.00063 sec. (p<0.0001) in Females; 3) 0.000759 sec. (p<0.0001) in Normotensives; and,4) 0.00035 sec. (p<0.0001) in Hypertensives.

DISCUSSION:
Abnormal PWV is a high risk factor for the development of CVD. In the four groups above, elevated BMI does not significantly influence PWV time. However, in the very same groups increasing WC significantly affect PWV time. This indicates that if we rely solely on BMI to predict CVD we will miss cases which are high risks as shown by abnormal WC.

CONCLUSION:
Waist Circumference is a more sensitive marker than BMI for predicting cardiovascular disease.