bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 27: Long Term Outcomes with Optimal Medical Therapy in Patients Seeking a Second Opinion Regarding Invasive Coronary Angiography
Authors: Saini Vikas , Carolan Padraig , Aggarwal Deepa , Blatt Charles , Mamuya Wilfred , Bilchik Brian , Ravid Shmuel
Published: March 2022

Whether invasive coronary angiography (ICA) data is required to properly select patients (pts) for optimal medical therapy (OMT) is still a matter of debate. As part of a larger prospective cohort study of OMT, we examined rates of myocardial infarction (MI) and revascularization rates (revasc) in 63 pts with stable coronary artery disease (CAD) who had sought a second opinion (SO) regarding ICA in the period from 1992 to 1998. Management decisions were based primarily on history, physical examinations, and non-invasive data. During the follow-up period, decisions to pursue an invasive evaluation or revasc were based on stability of symptoms, LV function, and exercise duration. Revasc was defined as any percutaneous intervention or coronary artery bypass graft (CABG). MI was defined as meeting two of the three WHO criteria or a typical pattern of MI on a myocardial perfusion study or 2-D Echocardiography. Revasc and MI were ascertained up to June 2005. Survival status was ascertained as of December 2008.

Results:
We agreed with the first opinion for ICA in only 7 pts (11%), but in 56 pts (89%) we recommended deferring ICA, and this was accepted by 54 pts. These pts were then managed with OMT. Compared to the larger cohort of CAD pts, SO pts were younger (mean age 62.5 yrs), less likely to have a prior MI, and more likely to be on beta-blockers and lipid lowering agents at entry. 30.2% of SO pts had no angina, 31.7% had CCS class 1 angina, and 38.1% had CCS class 2 angina pectoris. No pts had CCS class 3 or 4 angina. The mean LVEF was 62.3%. Mean exercise treadmill duration was 7.4 minutes.

In the entire group of 63 pts, the annualized mortality rate was 1.7% over an average follow up period of 12.98 years. A total of 31 revasc events and 10 non-fatal MIs occurred over a follow up period of 7.12 years. The overall incidence of revasc was 6.9% annually, and of non-fatal MI 2.2%. In the subgroup of pts who did not have ICA the incidence rate of non-fatal MI was 2.6% and the incidence rate of revasc was 6.1%. Of the 9 pts who proceeded to ICA, 8 were revascularized, half within 6 weeks. There were no MIs post revasc in the follow up period in this group.

Conclusions:
Long-term revasc and MI rates were low in pts with stable CAD who were advised to pursue ICA but deferred the procedure after a SO, and were comparable to rates in recent randomized clinical trials such as COURAGE and BARI2D; annualized mortality rates were similarly low. Second opinion recommendations for ICA were well-accepted in pts who sought them, and reduced the number of revasc procedures that would otherwise have occurred. Our results suggest that ICA is not a pre-requisite in pursuing OMT in pts with acceptable non-invasive profiles.
Abstract 270: Self-Efficacy and Cardiovascular Health in 6
th
Graders: An Insight from Project Healthy Schools
Authors: Betzig Emma , Gurm Roopa , Corriveau Nicole , Smith Cydni , Follis Rose , Rao Ravi , DuRussel-Weston Jean , Kline-Rogers Eva , Goldberg Caren , Eagle Kim A , Jackson Elizabeth A
Published: March 2022

Background:
Behaviors such as regular physical activity are associated with improved self-esteem among children and adolescents. However, associations between wellness behaviors (including diet) and both self-esteem and leadership among middle-school children have not been well studied.

Methods:
Data were collected from middle-school children enrolled in Project Healthy Schools, a school-based wellness program. Baseline data included self-reported information on diet, physical activity, and questions on self-efficacy for empathy and leadership. Physiologic data included body mass index (BMI), blood pressure (BP), heart rates (resting and one minute post exercise protocol), non-fasting lipids, glucose. Respondents were grouped into tertiles based on survey items related to empathy.

Results:
Data from 1,079 6
th
graders (mean age 11.6 years) were included. Students in the low tertile for empathy had higher BMIs than students in the middle/higher tertiles (p=0.03) with no difference between tertiles for lipids (including total cholesterol, HDL-cholesterol, triglycerides, and LDL-cholesterol). A trend towards higher glucose levels was observed among children in the lower tertile compared to the other tertiles (101.2, 99.4, and 99.5 for tertile 1, 2, and 3 respectively, p = 0.58). A similar trend was observed for systolic BP (p = 0.52) but not diastolic BP, resting HR or HR post exercise. No difference was observed between self-efficacy for leadership and any of the physiologic parameters. Those in the highest tertile for leadership self-efficacy were more likely to be physically active, averaging 4.71 (± 2.11) days of vigorous activity; a similar trend was noted for empathy. Moderate exercise (≥ 30 minutes per day) and team sports positively correlated with empathy and leadership.

Conclusions:
Among middle-school students, measures of empathy and leadership were associated with higher levels of physical activity and participation in team sports; but not with physiologic parameters. Given that higher levels of empathy and leadership were associated with lower BMI, it is possible that programs which improve leadership skills and promote empathy can improve healthy lifestyle habits.
Abstract 272: Severity and Determinants of Underreporting of Obesity in a Diverse Population of Hospitalized Patients in an Academic Medical Center and its Impact on Mortality
Authors: Raiszadeh Farbod , Batisti Jennifer , Dekhtyar Jessica , Lee William , Garcia Mario J
Published: March 2022

Obesity has become a national epidemic with significant implications in the development of multiple diseases. Prior studies have shown that physicians often fail to diagnose obesity in the outpatient settings, and consequently fail to formulate treatment plans and medical interventions. With the introduction of electronic medical records, making the diagnosis of obesity in an inpatient setting is a straightforward process. Our objective was to determine the presence and extent of underreporting of obesity in hospitalized patients in an urban academic medical center and to identify determinants and consequences of underreporting. We used a proprietary electronic medical record aggregator platform (Clinical Looking Glass) to collect data on all adult admissions during 2007-2010 to Montefiore Medical Center, a tertiary medical center. Presence or absence of diagnosis of obesity in patients’ problem list was identified by examining inpatient problem list in the electronic record. Our study population included 22,857 obese adults (BMI of ≥ 30 kg/m
2
) of whom 66 % were female, 37% Black, 18.45% White, and 37.9% Hispanic. Overall, only 18.4% of the study population carried the diagnosis of obesity. There was significant variation in rates of correct diagnosis among different subgroups: 20.4% in women vs. 14.4% in men; and 22.4% in Blacks vs. 13.6% in Whites. There was a linear correlation between severity of obesity and correct diagnosis (53.38% of patients with BMI >45 kg/m
2
vs. 7.89% with BMI 30-35 kg/m
2
) (Fig. 1). In Kaplan-Meier survival analysis, patients with correctly reported obesity demonstrated decreased mortality rates after an average follow up of two years (6.4%, CI 5.6-7.3 vs. 11.4% CI 10.9-12). In conclusion, the correct diagnosis of obesity is severely underreported in hospitalized adult patients, with race, ethnicity, gender and degree of obesity being important determinants of this observation. Correct diagnosis of obesity is associated with decreased mortality over a two-year follow-up.
Abstract 275: Effect of Customized Cardiovascular Education on Patient Beliefs and Behaviors Around Cardiovascular Medications
Authors: Gordon Linda , Ansani Nicole
Published: March 2022

Objective:
The objective of this project was to describe the effect of tailored cardiovascular (CV) patient education on beliefs and knowledge about medication in a nurse managed CV risk reduction clinic.

Methods:
This prospective project was conducted on patients 18 years of age or older referred to usual care at a risk reduction clinic. The primary analysis was change in scores on the Beliefs about Medications Questionnaire (BMQ) pre and post customized CV education. Education included a background/risk assessment, personalized general information, disease management education, and therapeutic lifestyle intervention. The BMQ evaluates 2 domains: necessity and concerns about medications; and general overuse and harm of medications. Secondary analysis included pre/post scores on a patient knowledge assessment (2 questions: I have received education on the importance of continuing (1) cholesterol medications and (2) antiplatelet medications) and the relationship between specific demographics and BMQ scores pre/post. A power calculation determined 45 patients were needed. Data were analyzed using paired t-tests.

Results
Forty-five patients were enrolled and 40 completed the project. Average age was 64 years, 55% were male, and average number of medications was 4.5. Results of the BMQ demonstrated significant improvements in response to the following (scale 1 [strongly disagree] - 5 [strongly agree]): “my medications are a mystery to me” (average score pre=2.7 vs. post=2.2, p<0.05) and medications do more harm than good (average score pre = 2.1 vs. post = 2.0; p<0.05). Scores on all other questions were not significantly different pre/post. A higher number of patients responded “yes” that they were instructed on the importance of continuing cholesterol medications and antiplatelet medications pre/post (p<0.05 for both). Age, gender, and education level did not correlate with BMQ scores pre/post. Patients receiving primary prevention therapies showed significant improvements in score in 4 components of the specific necessity and concerns (p<0.05 for all). In 2 areas of general overuse and harm, there were both increases and decreases in scores, respectively (p<0.05 for all). Patients receiving secondary prevention therapies showed significant changes in scores in 12 components. With regard to specific necessity and concern, scores improved in 4 components (p<0.05 for all). A decrease in perception was seen in 1 component (p<0.05). General overuse and harm scores showed improvements in 5 components (p<0.05 for all). A decrease in perception was seen in 2 components (p<0.05 for all).

Conclusions:
Customized CV education results in improvements in patients’ beliefs and knowledge about medications. These data have provided a basis to further evaluate education methods in this CV practice. Future implications are to investigate changes in BMQ scores with clinical markers such as LDL and blood pressure goal attainment.
Abstract 280: Mayo Clinic Percutaneous Coronary Intervention Risk Score in Octogenerians Undergoing Acute Coronary Intervention
Authors: Mazimba Sula , Parikh Analkumar , Pena Esteban , Anaya Mauricio , Schwartz Brian , Hahn Harvey
Published: March 2022

Introduction:
Octogenarians comprise an increasing proportion of patients undergoing coronary angiography and percutaneous coronary interventional (PCI). Most interventional studies have focused on patients aged 50-65 years and as such there is paucity of scientific evidence regarding interventions in octogenarians. The Mayo clinic percutaneous coronary intervention risk score (MCRS) has been used to calculate the risk of patients undergoing PCI. We sought to determine the utility of MCRS in predicting clinical events in octogenarians in a busy community health care system.

Methods:
We tested the integer based mayo clinic risk score (MCRS) to predict clinical outcomes of 1173 consecutive octogenarians requiring urgent coronary interventions. Urgent coronary intervention was defined as PCI within 24 hours of the admission symptom onset. The MCRS was categorized into 3 score categories (Low:0-1%), (Moderate 2-8 %) and (High risk ≥ 11% ) Patients were then followed longitudinally for cardiovascular clinical outcomes. Clinical outcomes measured include readmission, all cause and cardiovascular mortality, revascularization and emergent coronary artery bypass at 30 days and 1 year of the index event.

Results:
There were 1173 patients that met the inclusion criteria. The mean age was 84 +/− 4 yrs. Fifty-two percent (610) were female. Ninety Four percent (1103) presented with chest pain on admission. Eighty seven percent (1020) had hypertension while 77% (903) had hyperlipidemia. Mean body mass index was 26+/− 4(kg/m2). The expected MCRS for the low, moderate and high risk category patients were 1%, 6% and 11% respectively, while the observed event rate in the corresponding categories for the 30 day adverse event rate was 1% (p=0.001), 8% (p=0.04) and 16% (p=NS). At one year the observed event rate for each corresponding category was 3%, (p=NS), 10% (p=NS) and 19%(P=NS).

Conclusion:
The Mayo clinic percutaneous coronary intervention risk score correlated well with expected and observed 30-day clinical outcomes in octogenarians with low to moderate risk categorization. In the high-risk patients the 30 day and 1 year outcomes had poor correlation between expected and observed events.
Abstract 283: Temporal Trends in Treatment of ST-Elevation Myocardial Infarction Among Men and Women in Switzerland from 1997 through 2010
Authors: Radovanovic Dragana , Nallamothu Brahmajee , Bertel Osmund , Eberli Franz , Urban Philip , Pedrazzini Giovanni , Rickli Hans , Stauffer Jean-Christophe , Windecker Stephan , Erne Paul , AMIS Plus Investigators
Published: March 2022

Introduction:
Few data describe temporal trends in presentation, treatment and outcome in men and women with acute ST-segment elevation myocardial infarction (STEMI).

Methods:
Swiss STEMI patients enrolled in the AMIS Plus registry from1997-2010 were analyzed using multivariate logistic regression.

Results:
From 20,363 STEMI patients, 5458 were women and 14,905 men. Women were 8.6 years older, had more co-morbidities (Charlson Index ≥2 16.9% vs 12.8%; P<0.001), diabetes mellitus (22.6% vs 17.3%; P<0.001) and hypertension (64.9% vs 50.6%; P2 (10.6% vs 7.2%; P<0.001) and atrial fibrillation (5.6% vs 3.9%; P<0.001). Men had more often dyslipidemia (54.1% vs 50.3%; P<0.001), resuscitation prior admission (6.3% vs 5.2%; P=0.003) and were more often current smokers (46.3% vs 29.9%; P<0.001). Women were less likely to undergo primary reperfusion (61.6% vs 75.4%; OR 0.52; 95%CI 0.49-0.58; P<0.001) even after adjusting for baseline characteristics and admission year (OR 0.80; 95%CI 0.71-0.89; P<0.001), or to receive early and discharge drugs such as thienopyridines, ACE inhibitors, AT antagonists or statins. In 1997, thrombolysis was performed in 51% of male and 39% of female patients. Now, thrombolysis is negligible. Use of primary PCI increased from below 10% in both genders in 1997 to over 70% in females and over 80% in males. Early thienopyridine therapy steadily increased to 90% of all patients in 2010. Statin use rapidly increased until 2002, peaking at 72% in women and 82% in men in 2005/6. Early statin use since decreased but thienopyridine and statin therapies at discharge increased and were prescribed to over 90% of patients in 2010. From 1997-2010, annual in-hospital mortality decreased by 5% in men (OR 0.95; 95%CI 0.94-0.97; <0.001) and 6% in women (OR 0.94; 95%CI 0.92-0.96; P<0.001). Despite higher crude in-hospital mortality, female gender was not an independent predictor of in-hospital mortality (OR 1.10; 95%CI 0.90-1.35; P=0.37).

Conclusion:
Therapy of STEMI patients has changed greatly during the past 14 years in Switzerland, largely in accordance with guideline recommendations.
Abstract 285: An Assessment of Factors Associated With Caregiver Burden in Atrial Fibrillation
Authors: Coleman Craig I , Coleman Stacey M , Vanderpoel Julie , Nelson Winnie , Colby Jennifer , Scholle Jennifer , Kluger Jeffrey
Published: March 2022

Background:
Nearly one-third of the unpaid adult caregivers in the United States aid in managing heart or cerebrovascular disease. Atrial fibrillation (AF) is the most common cardiac arrhythmia, increasing patients' stroke risk. To date, the burden on caregivers supporting AF patients has not been evaluated. We sought to examine the interrelationship between caregiver, patient and anti-clot treatment characteristics and perceived caregiver burden in AF.

Methods:
We conducted a cross-sectional survey study of AF patient-caregiver dyads recruited from the cardiology clinics of a large, urban teaching hospital. Eligible patients had AF, were receiving antithrombotic agents for stroke prevention, lived in the community and had an unpaid, English-speaking, adult caregiver. Hierarchical multivariate linear regression was used to evaluate the association between caregiver, patient and anti-clot treatment characteristics and caregiver burden as measured by the validated Caregiver Reaction Assessment (CRA).

Results:
Eighty AF patient-caregiver dyads completed the survey. The mean (±SD) scores for the 5 CRA domains were: Disrupted schedule (2.4±1.0), Financial problems (2.1±0.8), Lack of family support (1.9±0.7), Health problems (1.9±0.7) and Self-esteem (0.9±0.5). Significantly greater caregiver burden due to Disrupted schedule was seen in those spending >4 hours/week providing care and when caring for frail, sick or disabled patients, with higher CHADS2 scores and requiring help with their medications (p<0.05). Financial problems burden scores were significantly associated with caring for frail patients and those requiring more frequent office follow-up (p<0.05). Lack of family support scores increased as patients' CHADS2 score increased and were inversely associated with having another individual to assist with care. Worse Health problem burden scores were associated with female gender and the need to spend >4 hours/week providing care.

Conclusion:
Our results suggest that caregivers of AF patients incur the greatest burden due to disruption in schedule. Health care professionals should be cognizant of this, and the other sources of caregiver burden, when managing AF patients.
Abstract 290: Statin Adherence in Males and Females, and the Impact of Knowledge of a Genetic Test: Results from the AKROBATS Trial
Authors: Charland Scott L , Agatep Barnabie C , Schrader Bruce J , Frueh Felix W , Herrera Vivian , Ryvkin Miriam , Shabbeer Junaid , Devlin James J , Superko Robert H , Stanek Eric J
Published: March 2022

Background
A recent meta-analysis demonstrated that cardiovascular (CV) events and all-cause mortality are reduced in both sexes with statin therapy. Additionally, the Institute of Medicine and the American College of Cardiology advocate reporting of sex-specific CV treatment data. However, females are underrepresented in most CV clinical trials. We investigated the relationship between sex and other patient characteristics with regard to statin therapy adherence and persistence.

Methods
AKROBATS (
NCT01068834
) was a prospective, nonrandomized intervention trial of the effect on statin adherence and persistence of providing patients with information about
KIF6
carrier status and their
KIF6
test results. Eligible patients were ≥18 years old, new to statin therapy (none 6 months prior), and members of the same benefit plans. Controls and tested patients were matched for age, sex, prescription distribution channel, and number of chronic medications. The primary endpoint was statin adherence (proportion of days covered; PDC) at 6 months.

Results
The study included 1294 patients (582 males & 712 females) (Figure). There was no significant difference in beta blocker (22.3% vs 18.7%), calcium channel blocker (13.7% vs 16.0%), angiotensin-converting enzyme inhibitor, (22.9% vs 19.4%), or angiotensin receptor blocker (13.7% vs 14.2%) use in males compared with females. More females received diuretics (30.6% vs 19.6%) and aspirin/non-steroidal anti-inflammatory agents (16.3% vs 13.2%) than males, p <0.05. More males received nitrates (3.8% vs 1.8%), anticoagulants (5.2% vs 2.4%), and antiplatelet agents (6.5% vs 3.1%) than females. Males were also more likely to have a history of acute coronary syndrome (15.1% vs 8.0%), stable coronary artery disease (13.2% vs 6.9%) and peripheral arterial disease (4.1% vs 2.01%), p<0.05. Despite these and other baseline differences, 6-month unadjusted statin PDC was similar between males and females [0.63 (95% CI 0.59-0.67) vs 0.60 (0.56-0.63), p=0.18], as was adjusted PDC [females 0.72 (0.66-0.78) vs males 0.74 (0.68-0.80), p=0.20)]. Predictors of statin PDC ranked by model weight were
KIF6
testing, distribution channel, number of chronic medications, statin out-of-pocket spend, and income. Independent of sex, more
KIF6
-tested patients were adherent (PDC >0.80; OR 1.95, 95% CI 1.54 - 2.47, p<0.0001).

Conclusions
In this trial with a majority of females (55%), 6-month adherence and persistence to statin therapy did not vary by sex, and was significantly increased by individual knowledge of
KIF6
test results in both males and females.
Abstract 295: Potential Effectiveness for Anticoagulation Among Elderly Heart Failure Patients without Atrial Fibrillation? An Analysis of the ADHERE Registry Linked to Medicare Claims
Authors: Hernandez Adrian F , Hammill Bradley , Kociol Robb , Eapen Zubin , Mills Roger , Fonarow Gregg C , Curtis Lesley H
Published: March 2022

Background:
Prior studies suggest heart failure (HF) patients are at higher risk for thromboembolic events even in the absence of atrial fibrillation (AF), but the effect of anticoagulation on HF outcomes is uncertain.

Methods:
Using data from 2001 to 2006 from the ADHERE registry linked to Medicare claims we estimated 1-year cumulative incidence rates of a) mortality, b) thromboembolic events, and c) major adverse cardiovascular events (MACE) and d) readmission for HF. Eligibility criteria included: ejection fraction ≤ 35%, no concomitant AF, alive at discharge, and naïve to anticoagulation at admission. The adjusted associations between anticoagulation and 1-year outcomes were estimated using the inverse probability of treatment weighting method.

Results:
Of 13,217 patients in 276 hospitals, 1,140 (8.6%) received anticoagulation at discharge. Compared to patients without anticoagulation, patients with anticoagulation were slightly younger (77.0 vs. 78.2 years, P<0.001), more often male (60.5% vs. 53.6%, P<0.001), had lesser disease severity and comorbidity (e.g. coronary artery disease, diabetes mellitus, and hypertension) and were less likely to be discharged on anti-platelet therapy (aspirin: 46.2% vs. 64.4%, clopidogrel: 9.9% vs. 19.9%; P < 0.001 for each). The occurrence of all-cause mortality, thromboembolic events, MACE, and HF rehospitalization between non-anticoagulated and anticoagulated groups was 32.3% vs. 27.2% (P<.001); 3.9% vs. 4.7%, (p=0.212); 7.6% vs. 6.2%, (p =0.093); and 35.4% vs. 29.4% (P<.001), respectively. Figure shows the cumultative incidence of rehospitalization after discharge by anticoagulation status. After adjustment, the decrease in rehospitalization for HF associated with anticoagulation was the only outcome that retained statistical significance

Conclusion:
Anticoagulation with warfarin at discharge among older HF patients with systolic dysfunction without atrial fibrillation not previously treated is infrequent. There were no statistically significant propensity weighted associations between anticoagulation and 1-year outcomes except for moderately lower risk for HF rehospitalization
Abstract 298: Incidence, Treatment and Outcomes of Cardiogenic Shock in STEMI and NSTEMI: Results from the NCDR®
Authors: Anderson Monique L , Peterson Eric D , Ohman E. M , Peng S. A , Roe Matthew T
Published: March 2022

Objectives:
Cardiogenic shock (CS) is a deadly complication of an acute myocardial infarction (MI). We sought to characterize the contemporary incidence, treatment, and outcomes of CS in ST and non-ST elevation (STEMI and NSTEMI) classification.

Methods:
We examined 235,541 patients treated at 392 ACTION Registry
®
-GWTG
™
hospitals from 2007- 2011. CS was defined as sustained systolic blood pressure (SBP) <90 mmHg or cardiac index (CI) <2.2 L/min/m2 secondary to cardiac dysfunction or use of vasopressor or inotropic agents or mechanical support that occurred on admission or that developed during the hospital stay.

Results:
CS occurred in 12.2% (11,406 patients; 47.4% at presentation, 52.6% in-hospital) of STEMI vs 4.3% (6,130; 34.3% at presentation, 65.7% in-hospital) of NSTEMI patients. STEMI patients with CS were more likely to undergo PCI vs NSTEMI patients with CS (84.2% vs 35.4%, p<0.0001). CABG was uncommon among STEMI or NSTEMI CS patients (11.6% vs 21.2%, p<0.0001)). STEMI patients with CS had significantly lower mortality than NSTEMI patients with CS (33.1% vs. 40.8%, p<0.0001). In both STEMI and NSTEMI groups, the subsequent development of CS was associated with significantly higher mortality than CS on admission (35.1% vs 30.9%, p <0.0001 and 42.9% vs 36.8% p <0.0001, respectively).

Conclusion:
In the contemporary era, after ACCF/AHA Class IA guidelines endorsing early revascularization for STEMI related CS, most STEMI patients with CS undergo revascularization, and death is significantly lower in comparison to earlier pre-guideline data. However, compared to STEMI CS, a majority of NSTEMI CS patients do not undergo revascularization, and death rates are significantly higher. In-hospital development of CS carries a higher mortality rate in both MI subtypes compared to CS on admission.
Abstract 30: Real-Time Review of AF Ablation Quality Metrics Improves Patient Outcomes and Resource Utilization
Authors: McGuiness Matthew E , Suter Donna M , McManus David D
Published: March 2022

Background:
Atrial fibrillation is an extremely prevalent condition with a high level of associated morbidity, mortality and healthcare resource utilization. Catheter-based ablation is an effective tool for the management of symptomatic AF patients, however the procedure is technically and logistically complex. Data describing process improvement within the context of an AF ablation program are limited.

Methods:
We developed an AF Treatment Registry to track patients undergoing AF ablation. Our primary purpose was to conduct real-time review of pre-specified quality and resource utilization outcomes, thereby facilitating process improvement. Patient characteristics and procedural details were collected at the time of ablation and at regular intervals thereafter. Members of a multidisciplinary AF treatment team reviewed registry data on a weekly basis. Operational deficiencies were identified and changes implemented. In this study, we evaluated the impact of our intervention on AF ablation case start time, case duration and procedural adverse outcomes.

Results:
In the six months prior to our intervention, mean AF ablation case start time was 8:31 AM (n=12), mean case duration was 203 minutes (n=24), mean procedural transseptal time was 228 minutes (n=24) and the rate of adverse outcomes was 16.7% (n=24). Over a 20-month period post-intervention, concurrent with process improvement efforts, 104 patients presented for AF ablation. During the last six months of the study period, the rate of adverse outcomes decreased to 0% (n=35, p=0.13), average case start time improved by 52 minutes (n=21, p<0.01), mean case duration decreased by 34 minutes (n=35, p<0.01) and mean procedural transseptal time decreased by 46 minutes (n=35, p=0.05).

Conclusion:
Use of a registry to facilitate real-time review of AF ablation outcomes and quality metrics was associated with a decrease in adverse events and an increase in the efficiency of hospital resource utilization. Although the non-randomized nature of this study precludes an assumption of causality, we hypothesize that real-time review and feedback was the primary driver of performance improvement.
Abstract 306: Pacemaker Implantation in Nonagenarians is Safe
Authors: Mandawat Anant , Curtis Jeptha P , Njike Valentine Y , Lampert Rachel
Published: March 2022

Introduction

: The number and proportion of nonagenarians in the US is increasing dramatically. Data are scarce on outcomes of pacemaker implantation in the very elderly, limiting the ability of physicians and patients to make informed decisions.

Hypothesis

: We hypothesized that increasing age is associated with worse in-hospital outcomes (mortality and complications) in the elderly.

Methods

: Patients ≥ 70 years with a new pacemaker implant were identified in the 2004-2008 HCUP-Nationwide Inpatient Sample, the largest all-payor inpatient database in the US. Patient demographic and clinical variables, including an age-independent Charlson comorbidity index, as well as hospital characteristics were analyzed. Clinical outcomes were in-hospital mortality and complications (identified through ICD-9 codes) including pneumothorax, tamponade, device infection, hematoma, and acute renal failure/new hemodialysis. Unadjusted outcomes were compared using χ² and Mantel-Haenszel tests. Multivariate hierarchical logistic models were created to adjust for case-mix variation and clustering of cases within hospitals.

Results

: Among 115,683 patients (mean age 81.47 years; SEM 0.02), patients ≥ 90 years were less likely to be male, to have mild comorbidity, and to have elective procedures (Table). Unadjusted mortality and complication rates were higher with increasing age although absolute differences were small (Table). Multivariable analysis revealed severe comorbidity (OR 5.00; 95% CI 4.05-6.17) and nonelective admission (OR 3.09; CI 2.46-3.88) were greater predictors of mortality than increasing age (OR 2.81; CI 2.35-3.35), all p<0.0001. For complications, severe comorbidity (OR 1.35; CI 1.20-1.51) and female gender (OR 1.35; CI 1.28-1.42) were larger predictors than increasing age (OR 1.07; CI 1.01-1.13), all p<0.02.

Conclusions

: This is the largest study to date examining outcomes of pacemaker implantation among nonagenarians. Although increasing age is a predictor of worsening outcomes in the elderly, the absolute rates are modest, even in nonagenarians, and other factors are more important predictors than age.
Abstract 313: Growth-Differentiation Factor-15 and Heart Failure in Patients with Stable Ischemic Heart Disease (The Heart and Soul Study)
Authors: Schopfer David W , Regan Mathilda , Whooley Mary A
Published: March 2022

Background:
Ischemic heart disease is the strongest risk factor for development of heart failure (HF). Growth-differentiation factor-15 (GDF-15) has been associated with future cardiovascular events in patients with heart failure but its association with incident heart failure in patients with stable ischemic heart disease is unknown.

Methods:
We measured serum GDF-15 and cardiac disease severity in 981 patients with stable ischemic heart disease who were recruited for the Heart and Soul Study between September 2000 and December 2002. Subsequent heart failure hospitalization was determined by chart review.

Results:
There were 164 HF hospitalizations over an average of 7.1 years of follow-up. HF hospitalization occurred in 31.4% (102/325) of participants with GDF-15 levels in the highest tertile vs. 3.7% (12/324) in those in the lowest tertile. Participants with GDF-15 levels in the highest tertile had a 3.4-fold higher rate of HF (HR, 3.41; 95% CI, 1.31-8.88; p=0.012) after adjustment for covariates. Each doubling in GDF-15 was associated with an increased risk of HF hospitalization (HR, 2.32; 95% CI, 1.82-3.00; p<0.001). This association persisted after extensive adjustment for covariates including comorbidities, cardiac disease severity, and left ventricular function, inflammatory markers, and adipokines (HR, 1.58; 95% CI, 1.02-2.45; p=0.04).

Conclusions:
Higher levels of GDF-15 predict HF hospitalizations in patients with stable ischemic heart disease. GDF-15 is an emerging biomarker which identifies patients at highest risk of developing heart failure.
Abstract 315: Myocardial Repolarization Abnormalities During Therapeutic Hypothermia Do Not Affect Mortality and AICD Therapy in Cardiac Arrest Survivors
Authors: Waters Theresa , Khurana Vikash , Ji Yong , Saour Basil , Liakos Matthew , Torosoff Mikhail
Published: March 2022

Background:
We investigated changes in myocardial repolarization and associated outcomes in patients undergoing therapeutic hypothermia after cardiac arrest.

Methods:
Demographic, clinical, and ECG data on 19 consecutive cardiac arrest survivors (6 females, 59+/-15 years old, 3 with diabetes, 3 with cancer, 3 with CKD, 5 with pulmonary disease and 5 with cardiovascular disease) undergoing therapeutic hypothermia were collected. Absolute QT dispersion was calculated. ANOVA, chi-square, Kaplan-Meier and logistic regression analyses were used. The study was approved by the IRB.

Results:
Hypothermia resulted in significant prolongation of both minimum (baseline 277+/-74 vs. cooled 408+/-129 vs. re=warmed 313+/-82 msec, p<0.001) and maximum QT intervals (392+/-60 vs. 549+/-147 vs. 453+/-90 msec, respectfully, p<0.001, Figure) but no significant changes in QT dispersion. Age, gender, history of cancer, kidney, pulmonary, or cardiovascular disease, use of thiazide or loop diuretics, ACE inhibitors/ARBs, or potassium supplements had no effect on QT dispersion or hospital mortality . Similarly, Na, K, Mg, Cr, Ca, pH, or hematocrit on admission, during cooling or rewarming had no effect on QT dispersion or hospital mortality. In 7 survivors to hospital discharge QT changes at baseline, during hypothermia, or rewarming were not predictive of mortality or AICD discharges during long-term follow-up (27+/-8 months).

Conclusion:
Therapeutic hypothermia is associated with significantly prolonged QT intervals. However, these QT abnormalities do not translate into increased mortality and/or AICD therapy during short or long-term follow-up.
Abstract 32: Adverse Outcomes among Patients with End Stage Liver Disease who undergo Cardiac Catheterization
Authors: Dickens Carolyn , Lulla Sanya , Katta Sindura , Kerbow David , Berkes Jamie , Shroff Adhir
Published: March 2022

Introduction
End stage liver disease (ESLD) is a highly morbid condition. While awaiting liver transplantation, many patients experience adverse events including cardiovascular events. Performing invasive cardiac procedures is a precarious undertaking given abnormal bleeding profiles that are common in this patient population. Revascularization options are challenging due to a need a potentially life changing operation, inability to tolerate dual antiplatelet therapy, and other comorbidities.

Objective
To examine the characteristics and outcomes of patients who are awaiting a liver transplant with ESLD who undergo cardiac catheterization at a University Medical Center.

Methods
We reviewed the medical records of all patients awaiting liver transplantation that were referred for cardiac catheterization between March 2006 and December 2010. We recorded demographic data, cardiac risk factors, relevant laboratories, results of their catheterization procedure and adverse events for the following year. Death from any cause within one year of the procedure, myocardial infarction, stroke, repeat revascularization, cardiac re-hospitalization and periprocedural bleeding were recorded as adverse events. Only patients with complete follow-up records were included. The MELD score, a common measurement of liver disease severity, was calculated at the time of initial referral

Results
Of the 440 charts reviewed, 18% (78) patients had a left heart catheterization. The demographics of the patients who had a left heart catheterization were women 35% (n=28), 50% (39) Caucasian, 21% (16) Black, 23% (18) Hispanic and 6% other. The average MELD score at the time of the procedure was 17, with the average platelet count 101. Cardiac risk factors were diabetes 59% (46), hyperlipidemia 13% (10) and hypertension. 30% (23) had radial access, while 70% (55) had femoral. 14% (n=11) underwent revascularization (7 PCI and 4 CABG). Complications for all patients undergoing cardiac catheterization included bleeding 26% (20) and death within one year 28% (22).

Conclusion
Patient with ESLD undergoing a cardiac catheterization have a higher rate of bleeding complications and death than patients who don’t have ESLD (26% versus <1%). Opportunities to decrease complications and mortality need to be further investigated in this patient population.
Abstract 322: Echocardiographic Predictors of Long-Term Outcomes in Patients with CVA and Type 2 Myocardial Infarction
Authors: Murthy Avinash , Nourkeyhani Houman , Shah Amar , Khawaja Hussain , Torosoff Mikhail
Published: March 2022

Title:
Echocardiographic Predictors of Long-Term Outcomes in Patients with CVA and Type 2 Myocardial Infarction.

Authors:
Avinash Murthy, Houman Nourkeyhani, Amar Shah, Hussian Khawaja, Mikhail Torosoff

Institution:
Albany Medical College, Albany, NY

Background:
We investigated effects of echocardiographic signs of atherosclerosis on long-term outcomes in patients with non-hemorrhagic stroke and Type 2 myocardial infarction (MI), as manifested by elevated troponin.

Material and Methods:
Long-term outcomes (51+/-24 months) were ascertained in 380 consecutive stroke patients (173 females, 67+/-16 years old, 103 with history of diabetes, 88 with CAD, 276 with history of hypertension, 18 on hemodialysis) with abnormal troponin level during index CVA admission. Echocardiographic indicators of atherosclerosis were collected: mitral annular calcification (MAC), aortic valve and aortic root sclerosis. ANOVA, chi-square, Kaplan-Meier, and logistic regression tests were employed. Study was approved by the institutional IRB.

Results:
There was no effect of echocardiographic indicators of atherosclerosis on inpatient mortality by lifetable or logistic regression analyses. However, when long-term mortality was considered, patients with CVA and elevated troponin had worse outcomes if MAC (p=0.0009) or AV sclerosis (P<0.0001) or aortic root sclerosis were present (p<0.0001; Figure panels A, B, and C, respectively). When multivariate logistic regression analysis was performed, MAC (p=0.438) was not a significant mortality predictor, while aortic valve sclerosis (HR 1.9 95%CI 1.1-3.2, p=0.0298) and aortic root sclerosis (HR 2.5 95%CI 1.4-4.5, p=0.0024) retained predictive power.

Conclusions:
In CVA survivors with elevated troponin during index admission echocardiographic evidence of cardiovascular atherosclerosis confers increased risk of long-term mortality but does not affect hospital outcomes. When atherosclerotic burden is limited to mitral annular calcification this risk appears to be the lowest, while aortic valve and aortic root involvement are associated with progressively worse long-term survival.
Abstract 329: Effect of Psychological Distress on Cardiovascular Event Rates One Year Following Cardiac Rehabilitation
Authors: Darden Douglas , Krishnan Sangeetha , Kaiser Kristine , Gracik theresa , Jackson Elizabeth , Rubenfire Melvyn
Published: March 2022

Rationale:
Psychological (psych) distress is a putative risk factor for coronary artery disease (CAD) and may affect compliance with lifestyle & treatment. We sought to determine the impact of psych distress in cardiac rehab (CR) patients (pts) on cardiovascular event rates (CVE) including PCI/CABG, coronary angiogram, acute coronary syndrome (ACS).

Methods:
Psych profile of 440 CAD pts was assessed on entry to CR using Symptom Check List-90 (SCL-90). Questionnaire screened for depression (dep), anxiety (anx), hostility, and a global severity index (GSI). Mean SCL-90 T-score for each parameter in the adult population is 50 with a standard deviation of 10. SCL-90 score ≥60 = 84th percentile, SCL≥63 = 90th percentile, SCL score ≥70 is the 98th percentile. Complete data on repeat admissions and subsequent non-elective and elective CV procedures performed in the one-year following enrollment to CR was available on 410 pts.

Results:
Of the 440 pts 28.4% were female, 75.7% married and 89% Caucasian; 25.5% were hypertensive, 20.5% diabetic and 47% had a BMI>30. Mean age was 61.5+10.7. Clinical indication for CR: 56.4% PCI/CABG, 8.4% stable angina (SA) and 35.2% ACS. There was a high prevalence of dep, anx, and overall psych distress as measured by the GSI (Table1.) SA pts had significantly higher prevalence of anx (p=0.018) and hostility (p=0.009) compared to PCI/CABG and ACS. There was no difference in SCL-90 scores by gender, age, education, body mass index (BMI) or diabetes. 89 CVE required hospital admission; 62 (15.1%) pts once and 27(6.5%) two or more times. Reasons for the 89 readmissions included myocardial infarction (7.9%), SA (11.2%), unstable angina (50.6%) and other non-cardiac (30.3%). 62 procedures were performed, which included 6(10%) CABG, 21(34%) PCI, 20(32%) heart catheterizations, and 15(24%) other procedures. Forty percent of procedures performed were elective. Odds of readmission at one year was 3.14 greater in pts with dep score ≥70 (p=0.003) and 2.95 times greater in pts with Anx score ≥70 (p=0.037). Pts with dep score ≥70 were 3.4 times more likely to get a non-elective procedure (p<0.001), while the likelihood of a non-elective procedure in a patient with anx score ≥70 was not statistically significant (p=0.59) (Table 2.) 32 (7.8%) of pts had both dep and anx scores ≥ 63 and these pts were significantly more likely to be re-admitted OR 3.14, (p=0.003) and more likely to have multiple admissions OR 3.9 (p=0.007).

Conclusions:
Psych distress in CR pts has a significant impact on outcomes. Consideration should be given to routine psych profiling at entry to CR and appropriate treatment for these pts.
Abstract 34: National Trends in Therapeutic Hypothermia, Mortality and Resource Utilization After Cardiac Arrest
Authors: Moradiya Yogesh , Modi Sneha , Paulson Jessica , Isache Carmen , Gropen Toby
Published: March 2022

Background:
In 2002, the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation recommended the use of hypothermia in unconscious adult patients with out-of-hospital cardiac arrest. Since then, various retrospective and prospective studies have shown to improve outcomes with therapeutic hypothermia in select cases of cardiac arrest. Despite the evidence of benefit, it is a widely underutilized in US hospitals. We aimed to study 5-year trend in the use of therapeutic hypothermia in the US hospitals. We also studied trends in the outcome and resource utilization in cardiac arrest over the study period.

Methods:
We analyzed data for years 2005-2009 from the United States Nationwide Inpatient Sample which is a 20% stratified clustered sample of all non-federal hospital discharges. Using International Classification of Diseases-9 (ICD-9) codes, we identified cases with cardiac arrest (427.5) who underwent therapeutic hypothermia (99.81). Population estimates were obtained by complex sample analysis used for NIS design. Comparisons were made by using χ2 and student-t tests. Trend analysis was performed by univariate regression using the year as a predictor variable.

Results:
We included a total of 687211 cases of cardiac arrest, of which 3420 (0.498%) underwent therapeutic hypothermia. Patients with therapeutic hypothermia were less likely of female gender (36.7% vs. 45.6%, p<0.001) and were more likely to be younger (mean age: 59.9 vs. 65.8 years, p<0.001). Compared to White (0.59%), African-American (0.34%) and Hispanic (0.25%) patients had lower use of hypothermia (p<0.001). Patient who underwent hypothermia incurred higher inflation adjusted hospital charges (117119 vs. 90511 USD, p<0.001). The discharge survival rate was also higher in patients with hypothermia treatment (41.8% vs. 37.2%, p=0.015). There was a significant upward trend in utilization of therapeutic hypothermia and downward trend in inpatient mortality during the 5-year study period (figure).

Conclusions:
With accumulating evidence of benefits of therapeutic hypothermia after cardiac arrest, its utilization rate in US has gradually improved over last few years. Though this finding is encouraging, a substantial proportion of eligible patients do not receive this treatment. Downward trend of post-arrest mortality found in this study may be an indicator of improvements in advanced life support protocols over the years.
Abstract 38: Bleeding Incidence And Severity Among Patients With Nonvalvular Atrial Fibrillation In A Large Managed Care Population
Authors: Deitelzweig Steven B , Pinsky Brett , Buysman Erin , Lacey Michael , Makenbaeva Dinara , Wiederkehr Daniel , Graham John
Published: March 2022

Introduction
Risk of bleeding is an important consideration among patients with nonvalvular atrial fibrillation (NVAF).

Hypothesis
We hypothesized that in a real-world managed care setting, bleeding incidence among NVAF patients is high and increases with higher bleeding risk HAS-BLED score.

Methods
Adults with healthcare claims related to AF between Jan 2005 and Jun 2009 but no evidence of valvular disease were included in this retrospective study. Follow-up lasted until the earliest of death, disenrollment from the health plan, or 30 Jun 2010. A claims-based approximation of HAS-BLED score was used to measure bleeding risk. Bleeding events were categorized as major, serious non-major, or minor. A bleeding event was considered major if it was associated with any of the following: inpatient care, blood transfusion, decreased hemoglobin or hematocrit, death, physician guided medical or surgical treatment, or intracranial bleed. Serious non-major events were those that involved vascular injury or critical site bleeding and were associated with outpatient hospital care or an emergency department visit. Minor events were those associated with noncritical anatomical sites and an emergency department, outpatient hospital, or office visit.

Results
Mean (SD) age of the study sample (N=48,260) was 67±13 years and 62% of the patients were male. Mean follow-up was 802±540 days (median 673 days). Approximately 34% of NVAF patients had an incident bleeding event; 43% of these had at least one subsequent event. Of all bleeding events, 35% were major, 14% serious non-major, and 51% minor. Death was associated with 270 (2%) major events (n=7908). Event rates for each bleeding category increased with greater scores (Table).

Conclusions
Patients with NVAF in a real-world managed care setting had a high incidence of bleed episodes, and approximately one-third of these events were major. High HAS-BLED scores were associated with a greater incidence of bleeding events.