bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 209: Sex Differences in Characteristics, Symptoms, and Management of Geriatric Patients with Atrial Fibrillation: Insights from the SAGE-AF Study
Authors: Awad Hamza H , Lessard Darleen , Parish David , Dhillon Navdeep , Waring Molly E , Goldberg Robert J , Sogade Felix O , Saczynski Jane , McManus David D
Published: April 2019

Background:
Data from previous studies that examined sex differences in the characteristics, clinical presentation, and management of patients with atrial fibrillation (AF) have been inconsistent.

Objective:
To use data from a large contemporary cohort of older patients with AF to examine sex specific differences in baseline characteristics, symptoms, and management practices.

Methods:
We used data from baseline interviews and the review of medical records of participants in the Systematic Assessment of Geriatric Elements in AF (SAGE-AF) study. Participants were ≥ 65 years old with AF and a CHA2DS2-VASc≥ 2.

Results:
Of the 1244 participants, 49% were female. Women on average were slightly older (76.3 (7.4) vs. 74.8 (6.7) years, p<0.01), and less often had a history of coronary heart disease, diabetes, renal disease, dyslipidemia, smoking, or alcohol abuse, in comparison with men. Women reported higher rates of anxiety, depression, and frailty (27% vs. 20%, 34% vs. 23%, and 18% vs. 10%, respectively, p<0.01) when compared with men. Women had higher average CHA2DS2-VASc (4.9 (1.6) vs. 4.0 (1.5), p<0.01) but lower HAS-BLED (2.7 (1.0) vs. 3.0 (1.0), p<0.01) scores compared with men. Women more frequently reported AF-related symptoms of palpitations, irregular heartbeat, pause in heart activity, and dizziness (29% vs. 16%, 22% vs. 15%, 11% vs. 6%, and 25% vs. 19%, respectively, p<0.05) than men. Women were more likely to have paroxysmal AF (54% vs. 65%, p<0.01) than persistent AF (30% vs. 20%, p<0.01) than men. Approximately 85% of study participants received oral anticoagulants (OACs). There were no significant differences in either the rates of prescription of OACs or their classes between men and women. There were no sex differences in the choice of rate or rhythm control treatments by sex. Multivariable adjusted models showed that women were less frequently treated with cardioversion (OR=0.69, 95% CI: 0.54-0.90), pacemaker (OR= 0.73, 95% CI: 0.56-0.96), or an implanted defibrillator (OR= 0.32, 95% CI: 0.21-0.50) compared with men.

Conclusion:
Women with AF were older, had more psychosocial but less comorbidities, and were more symptomatic than men. While no differences in the receipt of OACs were detected, women continue to be treated more conservatively with lower rates of receipt of interventions than men.
Abstract 214: Stroke Epidemiology in the State of Maine 2010-2014
Authors: Gordon Perue Gillian , Padooru Keerthi , Fathima Samreen , Sorondo Barbara , Cournoyer Nicole
Published: April 2019

Purpose:
Maine’s stroke prevalence/mortality is highest of New England states, yet US mortality rates are in decline overall. We hypothesized that the epidemiology of stroke in Maine has unique characteristics to explain the disparity; that a high mortality rate is due to geography, aging and non-traditional factors such as polysubstance abuse or cancer.

Objective:
This study aims to identify local determinants for in hospital mortality stroke in Maine, comparing demographics, clinical factors and access to certified stroke centers.

Design/ Methods:
As a descriptive study using all Maine inpatient stroke related discharge data: demographics, diagnosis, procedure codes and disposition from Maine Health Data Organization (MHDO), stroke was classified as ischemic, hemorrhagic, and Transient Cerebral Ischemia. Traditional risk factors include: age, sex, hypertension, diabetes mellitus, tobacco use, atrial fibrillation, left ventricular hypertrophy and dyslipidemia. Clinical nontraditional risk factors: sleep apnea, neoplasm, mental disorders and polysubstance and alcohol abuse. Zip codes were used to determine driving distance of one hour or more from certified stroke centers; Maine has only three.

Statistical Analysis:
Cases with complete data were included. Excluded were diagnostic codes for pregnancy, childbirth, puerperium, preeclampsia, eclampsia or traumatic brain injury; cases of ICD-9-CM codes for epidural and subdural hematoma; and ill-defined cerebrovascular disease or late effects of cerebrovascular disease. Descriptive statistics identified stroke characteristic. Multiple linear regression analyses identified associations between in hospital mortality due to stroke and age, gender, clinical factors, and driving distances to identify the independent predictors. Analyses were done using SPSS software version 21.

Results:
From 2010-2014, 13,857 hospital stroke diagnoses represented 2% of all Maine discharges. Mean age for all stroke events was 73 (± 14 years), and 52% were female. Overall, ischemic strokes accounted for 66% of all stroke discharges followed by TIA (19%) and hemorrhagic (15%). There were no statistically significant changes in mortality rate during the five year period. A Multiple logistic regression model showed associations with older age, atrial fibrillation, neoplasm, and more than one hour to a certified stroke center; and a negative trend for traditional factors. Maine had lower prevalence of Hypertension, Diabetes mellitus and tobacco use when compared with national rates (50% vs. 74%; 24.6% vs. 30%; 13.6% vs. 17% respectively).

Conclusion:
Maine local determinants for in hospital stroke mortality include: limited access to a certified stroke center and an older population. Other concomitants conditions for risk include atrial fibrillation and neoplasm.
Abstract 217: PCSK9 Inhibitor Use and Health Characteristics Among High-Risk Patients with Atherosclerotic Cardiovascular Disease
Authors: Dayoub Elias J , Nathan Ashwin S , Adusumalli Srinath , Groeneveld Peter W
Published: April 2019

Introduction:
Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are a promising class of lipid lowering therapy. The number of high-risk atherosclerotic cardiovascular disease (ASCVD) patients who may benefit from PCSK9i therapy, and the number of these patients actually initiated on PCSK9i therapy, has not been well characterized.

Methods:
We used administrative claims from a large, national commercial payer (n=15 million annual covered lives) during years 2015-2016, including inpatient and outpatient facility and provider claims, pharmacy claims, and laboratory results to determine the total number of ASCVD patients ages 18 to 64 years who were adherent to high-intensity statins with persistently high low-density lipoprotein cholesterol (LDL-C), and the fraction of these patients who were subsequently started on a PCSK9i. Secondary objectives were to compare differences in cardiovascular comorbidities, use and adherence to lipid lowering therapies, and baseline LDL-C measurements between patients who were treated and were not treated with PCSK9i.

Results:
We identified 5,355 ASCVD patients adherent to high-intensity statins of whom 38 (0.7%) were initiated on a PCSK9i. Of the 5,317 patients not receiving PCSK9i, 2,882 (54%) of these patients had LDL-C greater than 70 mg/dL. Among the 264 ASCVD patients started on a PCSK9i, 38 (14%) had persistent statin use in the previous year. Compared to the ASCVD patients not started on a PCSK9i, those initiated on PCSK9i therapy had higher rates of ezetimibe use (34% vs. 9%;
p
< .001) and bile acid sequestrant use (10% vs. 2%;
p
< .001) in the previous year. Of ASCVD patients started on a PCSK9 inhibitor, 54 (20%) had LDL-C less than 70 mg/dL prior to initiating therapy.

Conclusions:
We observed a small number of patients starting PCSK9 inhibitors in years 2015 and 2016, relative to the number of eligible ASCVD patients adherent to high dose statins with suboptimal LDL-C levels. Among ASCVD patients started on a PCSK9 inhibitor, we found low rates of statin use and 1 out of 5 had LDL-C less than 70 prior to initiation. Our findings suggest that differences in clinician practice and prescribing may be contributing to suboptimal patient selection for these therapies.
Abstract 223: Adherence to Warfarin and Oral Anticoagulants: Outcomes of 12 Months Follow-up in Patients With Non-valvular Atrial Fibrillation
Authors: Giedrimiene Dalia , Tarsilo Marc , Giedrimas Deivydas
Published: April 2019

Adherence to direct oral anticoagulants (DOACs) or vitamin K antagonists (warfarin) is an essential element of anticoagulation effectiveness and can be related to the outcomes of long-term therapy. Multiple studies have proved that patients with atrial fibrillation (AF) can be effectively treated with oral anticoagulants, achieving reduced morbidity and mortality which is mostly associated with stroke due to thromboembolism. However, despite these DOACs offering some potential advantages over vitamin K antagonists, their usage in the US has been slow to increase, and information on adherence and clinical outcomes based on real-world data is still limited. The goal of this retrospective study was to identify any distinct characteristics of patients with atrial fibrillation who received initial anticoagulation therapy with warfarin versus those who received DOACs. In addition, follow-up for at least the first 12 months of anticoagulation therapy was assessed for adherence to the prescribed anticoagulant or the reasons for change.

Methods:
This IRB approved study was conducted at Hartford Hospital using data from the Cardiology/Cardiac Arrhythmia clinic database to identify patients with non-valvular atrial fibrillation. Out of more than 4,000 encounters during 2014-2016, 100 patients on anticoagulation therapy with full records of follow-up for at least 12 months were randomly identified (35 on warfarin and 65 on DOACs). Patients’

CHA
2
DS
2
-VASc

scores and clinical baseline clinical characteristics were recorded at the onset of anticoagulation treatment. Patients were followed for at least 12 months in order to assess the outcomes and reasons for changes in anticoagulation therapy.

Results:
The patients initially started on warfarin had a higher mean

CHA
2
DS
2
-VASc

score (4.54 vs. 3.69) and higher mean age (76.63 vs 72.73 years) than the composite DOACs group. At the time of initial prescription, the warfarin group tended to have a higher percentage of co-morbidities than patients on DOACs, such as previous MI - 17.14% vs 7.69%, previous CVA - 22.85% vs 15.38%, diabetes - 40.0% vs 26.15 %, CAD - 42.85% vs 29.23%, previous CABG - 22.85% vs 9.23%, and CHF - 22.85% vs 16.93 %. The 12 month follow-up showed that 22.9% of the patients on warfarin were switched to a DOAC versus only 6.2% of patients on DOACs being switched to warfarin. The most common reasons for patients on warfarin being switched to DOACs were individual patient preference or difficulties with INR monitoring. DOACs were most commonly changed to warfarin due to cost.

Conclusions:
Patients placed on warfarin may initially have more severe co-morbidities and higher

CHA
2
DS
2
-VASc

scores. The change in anticoagulation treatment from warfarin to DOACs may suggest greater patient or provider satisfaction with this new class of anticoagulants, but patient preference and cost are also important factors.
Abstract 226: Predicting Major Adverse Cardiac Events Using HEART Score in the Elderly
Authors: Gu Kevin , Kaneria Amar , Sharedalal Parija , Chang David , Patel Neel , D’Mello Kevin , Kohut Andrew
Published: April 2019

Background:
The HEART score was developed to predict major adverse cardiac events (MACE) within 6 weeks in patients evaluated for chest pain. In the established score, age is scored as <45 years old (y/o) = 0 points, 45-64 y/o = 1 point, and >65 y/o = 2 points. The average age of patients in the original study by Backus et al was 61.2 y/o. Our aim is to evaluate the prognostic value of the HEART score in patients >65 y/o. We hypothesized that elderly patients are at increased risk of MACE unaccounted for by the established age scoring system.

Methods:
We retrospectively reviewed 668 emergency room visits for chest pain (excluding STEMI) between 2016 to 2018 at a single tertiary, urban medical center. HEART scores were calculated based on presenting data. The primary outcome was MACE (MI, PCI, CABG, or death) within 6 weeks. Patients >65 y/o were stratified to 65-74 y/o, 75-84 y/o, and >85 y/o. Primary outcomes were compared between these age groups. Differences in HEART scores between age groups were controlled by comparing patients within the same HEART score brackets (4-6, 7-8, 9-10). Chi squared analysis was used to determine statistically significant differences in MACE (p<0.01).

Results:
The average age was 60.2 y/o and average HEART score 5.56. There was statistically significant increase in MACE between <45 y/o (18.5%), 45-64 y/o (36.6%), and >65 y/o (47.4%), as outlined by the established HEART score (p<0.01). However, when comparing 65-74 y/o (45.7%), 75-84 y/o (48.8%) and >85 y/o (48.8%), increasing age did not correlate with increasing rate of MACE (p=0.90). When controlled for differences in HEART scores, there was again no statistically significant increase rates of MACE between 65-74 y/o, 75-84y/o, and >85 y/o across all HEART score brackets (4-6, 7-8, 9-10).

Conclusion:
In patients >65 y/o, increasing age did not correlate with increasing rate of MACE refuting our hypothesis. This represents that the other components of the HEART score have greater impact on prognosis than age in this elderly patient population. Our findings support the current age stratification of the established HEART score and show that even in the very elderly, the HEART score adequately accounts for age as a contributor to MACE.
Abstract 227: Maximum IV-tPA Dose is Associated with Greater Likelihood of Hemorrhagic Conversion, and Worse Functional Outcome at Discharge
Authors: Guillen Roboan , Starosciak Amy K , De Los Rios La Rosa Felipe
Published: April 2019

Introduction:
IV-tPA is the mainstay of treatment for acute ischemic stroke (AIS) at a weight-based dose of 0.9 mg/kg with a maximum limit of 90 mg. The prevalence of adult obesity in the United States has progressively increased; hence, the percentage of patients receiving the maximum dose is expected to rise as well. We examined differences between AIS patients treated with the weight-based dose (WBD) vs. the maximum dose (MD) of IV-tPA.

Methods:
We performed a historical cohort study using the Baptist Hospital Get With The Guidelines Stroke database between October 2013 and February 2017. Selection criteria included hospital admission, age > 18 years, received IV-tPA as treatment for their AIS and have a recorded measured or estimated weight. Patients were dichotomized into WBD group (<90 mg, 0.9mg/kg), weighing <100 kg, and MD group (90mg), weighing ≥ 100 kg. Categorical variables were summarized using count and percentages then analyzed using Chi square tests. Continuous variables were summarized using mean, range and standard deviation then analyzed using independent samples t-tests.

Results:
In total, 328 patients were included in the study, 38 (11.6%) in the MD group. The proportions of younger, male, non-Hispanic, taking antidiabetic and anticholesterol drugs were higher in the MD group. There were no statistically significant differences for initial NIHSS and 90-day modified Rankin Scale (mRS) between groups. The proportion of patients with mRS (3 to 6) at discharge was higher in the MD group (82% vs. 77%; P<0.001). The frequency of symptomatic ICH was three times higher in the MD group (9.5 vs. 3.1%; P=0.045).

Conclusion:
Patients who received MD IV t-PA for AIS were more likely to have ICH and a worse discharge functional outcome compared to the WBD group. This was not seen on the 90-day mRS, possibly explained by a 28% lost to follow-up rate.
Abstract 228: Comparison of the Effect of Local and Long-Distance Delivery Models for a School-Based Wellness Intervention on Health Behaviors of Middle School Students
Authors: Guo Emily , Krallman Rachel , Bernardo Sabrina , Montgomery Daniel , DuRussel-Weston Jean , Kline-Rogers Eva , Eagle Kim A , Jackson Elizabeth A
Published: April 2019

Background:
Michigan’s upper peninsula (UP) is a remote area with only 3% of the state’s population, making it difficult to reach with health interventions. Nearly half of the UP counties have higher adult obesity rates than the state average. The Project Healthy Schools (PHS) middle school-based wellness program uses local and long-distance delivery models in Michigan’s lower peninsula (LP) and UP, respectively. Schools utilizing the local model (LP schools) have routine staff visits to assist in program implementation; conversely, long-distance model schools (UP) rely on telecommunication with PHS staff to implement the program. This study sought to determine if differences exist in health behaviors of LP and UP students at baseline, as well as post-PHS intervention to determine the effectiveness of the local and long-distance PHS delivery models.

Methods:
Data from 6
th
grade students enrolled in PHS between 2014-2017 were analyzed. Students were divided into two groups, UP and LP students. Demographics and health behaviors at baseline and post-intervention were compared between groups.

Results:
Of 21,459 students, 695 (3.2%) were from the UP. Compared to LP students, UP students were more likely to be White and from lower and middle socioeconomic status communities. Pre-PHS intervention, UP students ate more fruits, vegetables, and chocolate candy, engaged in more moderate exercise, and spent less time on TV, computers, video games, and mobile devices than LP students. No significant differences in post-intervention impact on health behaviors were seen between UP and LP students.

Conclusions:
At baseline, UP students reported better health behaviors than LP students. However, the lack of differences in post-intervention impact suggest the local and long-distance delivery models were equally effective in influencing health behaviors. Future investigation of the effect of school-based interventions in remote communities, like the UP, are warranted.
Abstract 235: Landscape of Cardiovascular Device Registries in the US
Authors: Rajan Prashant V , Holtzman Jessica N , Kesselheim Aaron S , Yeh Robert W , Kramer Daniel B
Published: April 2019

Background:
The FDA increasingly relies on medical device registries to help promote effective safety surveillance of high-risk medical devices in the US. However, there are limited uniform standards for how device registries should be organized or the data collected. Therefore, there may be substantial variability in registry implementation, which can reduce their utility to regulators.

Objective:
To survey the current landscape of US cardiovascular device registries and chart the extent of inconsistency in research goals, administration, enrollment procedures, and approach to data access.

Methods:
A systematic review using PRISMA guidelines was conducted to identify studies (1995-2017) referencing cardiovascular device registries with a US-based institution. Registries referenced in these studies were evaluated by reviewing associated manuscripts and websites. Data extracted for each registry included device type, primary scientific aim(s), funding, stewardship (e.g., administration of registry procedures), enrollment procedures, informed consent process, and mechanisms to access data for research.

Results:
The 138 cardiovascular device registries in the cohort (
TABLE
) covered devices addressing interventional cardiology (65.9%, 91/138), arrhythmias (15.2%, 21/138), heart failure (10.1%, 14/138), and valvular disease (10.1%, 14/138). While the majority (55.8%, 77/138) were industry-funded, stewardship was predominantly overseen by academic centers (74.0%, 102/138). Most registry participation was voluntary (77.5%, 107/138), but a substantial minority (20.3%, 28/138) were required as a condition of device implantation. Informed consent requirements varied widely, with written consent required in only 55.1% of registries. Registry data were primary accessible only to stewards (84.1%, 116/138), with 13.8% (19/138) providing pathways for external applications.

Conclusion:
The majority of cardiovascular device registries over the past two decades were funded privately under the auspices of academic institutions, which set the rules for data access. The substantial variation between cardiovascular device registries indicates a role for regulators to strengthen guidelines to improve quality, consistency, and ethical standards.
Abstract 243: ICD-10, DRG and ACTION: Poor Agreement Between Diagnoses of Acute Myocardial Infarction Results in Significant Differences in Process and Outcome Measures
Authors: Levy Andrew , Ream Karen , Hammes Andrew , Anoff Debra L , Raines Joshua D , Beck Natalie , Rudofker Eric , Marshall Kimberly J , Nensel Jessica D , Messenger John C , Masoudi Frederick A , Allen Larry A , Ho P. M
Published: April 2019

Background:
In the Unites States, there are three major approaches to identify patients diagnosed with Acute Myocardial Infarction (AMI). The Center for Medicare and Medicaid Services uses ICD-10 codes (1) for the Value-Based Payments program whereas it uses DRG codes (2) for the Inpatient Prospective Payment System. Hospital administrators, meanwhile, often use the NCDR® ACTION Registry® (3) to examine process and outcome measures for their AMI patients. Understanding which patients are captured by these different classification systems, and whether there is agreement between them, has important implications for hospitals’ efforts to optimize performance measures and payments for AMI.

Methods:
In a retrospective cohort analysis, we examined 730 hospitalizations at the University of Colorado Hospital between January 1, 2017 and October 6, 2018 that were captured by one of the three methods for identifying AMI patients: 1) ICD-10, 2) DRG, or 3) ACTION. Categories were not mutually exclusive. Agreement between DRG, ICD-10 and ACTION diagnoses of AMI was assessed by percentage agreement with the total AMI cohort and dual-comparison kappa statistics. AMI cohorts defined by ICD-10 vs. DRG vs. ACTION were then compared according to the primary outcome of 100-day mortality, as well as secondary outcomes of 30-day readmission, length of stay (LOS), P2Y12 inhibition and rates of inpatient echocardiography.

Results:
Among 730 hospitalizations with at least one diagnosis of AMI, 617 (84.5%) were assigned a primary ICD-10 code for AMI, 227 (31.1%) were assigned a DRG code for AMI, and 479 (65.6%) carried a diagnosis of AMI in ACTION. Only 112 (15.3%) were captured by all 3 diagnosis groups (ICD-10, DRG and ACTION). 159 (21.7%) hospitalizations were captured by both ICD-10 and DRG diagnoses (Kappa -0.143); 425 (58.2%) were included in ICD-10 and ACTION groups (Kappa 0.141); 121 (16.6%) were included in DRG and ACTION groups (Kappa -0.137). Outcomes and process measures as a function of diagnosis category are presented in Figure 1.

Conclusion:
Only about 15% of patients with a diagnosis of AMI were included in all three diagnosis groups (ICD-10, DRG and ACTION). There may be significant between-group differences in outcomes and process measures. These data emphasize the need to harmonize administrative definitions for AMI.
Abstract 259: Impact of Valvular Heart Disease on 1-Year Mortality in Veterans
Authors: Parikh Puja , Romeiser Jamie , Jannello Pam , Shroyer A. Laurie
Published: April 2019

Background:
The impact of valvular heart disease (VHD) on outcomes in the Veteran population has not been well studied, especially in the contemporary era.

Methods:
The study population included 244 Veterans who were seen in Cardiology Clinic in January 2015 - of which 190 had a recent echocardiogram at the time of visit. Veterans with evidence of VHD (defined as any evidence of aortic stenosis (AS),
>
2+ moderate mitral regurgitation (MR), and/or
>
2+ tricuspid regurgitation(TR)) were identified and characteristics of Veterans with and without VHD were evaluated. Differences in one-year rates of major adverse cardiac events (MACE) (a composite of all-cause mortality or cardiovascular hospitalization) were compared for Veterans with VHD versus those without.

Results:
Of these 190 Veterans, 39 (20.5%) had evidence of valvular heart disease - 19 (10.0%) has any grade of AS, 15 (7.4%) has
>
2+ MR, and 18 (9.5%) has
>
2+ TR. Veterans with VHD were older (77 vs 68 years, p<0.001), had higher rates of prior coronary artery bypass graft surgery (41.0% vs 21.9%, p=0.015), had higher serum creatinine (1.8 vs 1.2 mg/dl, p=0.002) and lower hemoglobin (12.5 mg/dl vs 13.4mg/dl, p=0.003), higher right ventricular systolic pressure (47 vs 32mmHg, p<0.001) and higher left atrial volume (107 vs 79ml, p<0.001). Rates of MACE and all-cause mortality at 1 year were significantly higher for Veterans with VHD than those without (See Figure). VHD was associated with 1-year mortality [odds ratio (OR) 8.04, 95% confidence interval (CI) 2.22-29.11.35) in Veterans.

Conclusions:
In Veterans with cardiovascular disease, presence of VHD is associated with higher rates of MACE and all-cause mortality at 1 year. Further research on VHD specifically in the Veteran population is warranted.
Abstract 262: Factors Influencing the Adoption of Get With The Guidelines® Quality Improvement Registries: Findings from a Regional Survey
Authors: Poe Gregory L , Thomas Kathie , Kiser Robin , Saathoff Kayli , Serdynski Lynn , Mathew Cristin
Published: April 2019

Background and Objectives:
Healthcare systems are under increasing pressure to deliver a high quality care. To assist with this delivery, hospitals often participate in data registries. The American Heart Association’s Get With The Guidelines® modules are an in-hospital suite of programs designed to improve quality of care, adhere more closely to evidence-based guidelines, and improve patient outcomes. The objective of this study was to determine factors that influence the adoption of GWTG or other quality improvement registries in Midwest (IA, IL, IN, KS, MI, MN, MO, ND, NE, SD, WI) hospitals.

Methods:
Data was collected via an online survey tool. The tool consisted of 8 questions, consisting of 6 rank order or fill in the blank and 2 demographic questions. Communication about the survey and a link to it was distributed via email to 1100 participants at 726 facilities across the Midwest. The survey was available to hospitals for 1 month.

Results:
The survey was completed by 260 individuals, giving a response rate of 23.6%. Quantities of returned surveys were proportional to the population in each surveyed state. Job titles of respondents were predominantly Administrative Service Line Directors, Nurses, C-Suite Personnel, Quality Improvement Personnel and Physicians. Questions focused on the following: elements considered during the purchase of a registry, reasons for the retention and continued use of a data registry, Full Time Equivalent (FTE) and other operational costs tied to Return on Investment (ROI), and the identification of which department is responsible for the final approval and acquisition of a data registry. Calculations clearly demonstrated three primary factors influenced the selection and continued use of a data registry - (1) Cost of acquiring and operating the tool, (2) Ease of use and tool functionalities, and (3) Registry purchasing decisions are typically made at the C-Suite level.

Conclusions:
This survey was designed to examine hospital motivations, barriers and deterrents when considering data registry implementation. Ease of use, data mapping capabilities and reporting functions were consistently ranked highest in importance from most respondents. It is evident as well that the cost of acquiring and operating a registry are primary concerns of hospitals and the final decision to engage in a registry rests with C-Suite personnel. This correlates closely to the desire to lower operating costs and larger ROI through efficient and effective tool usage. Resultingly, building strategies to address financial returns on investment is imperative to engage hospitals. Specific strategies towards addressing the needs and concerns of C-Suite personnel are critical if quality improvement data registry implementation is to occur.
Abstract 270: Patients With Acute Ischemic Stroke and Associated Diagnosis of Obstructive Sleep Apnea Have Lower In-hospital Mortality
Authors: Rzechorzek Wojciech , Bhatia Kirtipal , Narasimhan Bharat , Skaf Michel , Herzog Eyal
Published: April 2019

Background:
Obstructive sleep apnea (OSA) is present in almost 60% of patients with cerebrovascular disease and it is an independent predictor of ischemic stroke. Yet, the impact of OSA on outcomes of ischemic stroke is unclear. Some, small cohort studies indicate increased short-term mortality, whereas larger studies, with more complex logistic regression models, show decreased in-hospital mortality. Lower mortality could be attributed to chronic intermittent episodes of hypoxia affecting the remodeling of cerebral collateral circulation. We thought to investigate outcomes in a large unselected population of patients presenting with acute ischemic stroke.

Methods:
In a retrospective cohort study, using the 2014 Nationwide Inpatient Sample (NIS), we analyzed adult patients with acute ischemic stroke and OSA. We performed univariate analysis of age, sex, race, hospital location, hospital teaching status, insurance type, hospital bed size, Charlson Comorbidity Index and other relevant comorbidities and we included variables with p<0.2 in the multivariate logistic regression model.

Results:
A total of 95282 patients with acute ischemic stroke were identified. Patients with the associated diagnosis of OSA (5%) had a mean age of 66+/_0.2, vs 71+/_0.1, p<0.001 and a higher percentage of them were male (63% vs 48%, p<0.001). Patients with OSA were more likely to have hypertension (88% vs 83%, p<0.001), heart failure (24% vs 14%, p<0.001), chronic kidney disease (20% vs 14%, p<0.001) ESRD (3% vs 2%, p<0.001) and diabetes mellites (40% vs 30%, p<0.001). Patients with associated diagnosis of OSA had higher incidence of ventricular fibrillation and ventricular tachycardia (OR=1.27, 95%CI=1.02-1.58, p=0.27) with no difference in incidence of cardiac arrest (OR=1.14, 95%CI=0.78-1.66, p=0.50) and lower in-hospital mortality (OR=0.68, 95%CI =0.57-0.82, p<0.001). They were less likely to have hemiplegia (OR= 0.83, 95% CI=0.74-0.95, p=0.004) and less likely to receive a blood product transfusion (OR =0.71, 95%CI =0.54-0.93, p<0.014). There was no difference in utilization of percutaneous endoscopic gastrostomy (OR=0.90, 95%CI=75-1.07, p=0.23), incidence of shock (OR=1.13, 95% CI =0.66-1.90, p=0.66) and utilization of mechanical ventilation (OR=0.96, 95%CI =0.82-1.11, p=0.55) as well as in length of stay (Coef. =-0.039, 95% CI=-0.23—0.16, p=0.70) and total costs of hospitalization (Coef. =180.73, 95% CI= -1925-2287, p=0.87).

Conclusion:
Patients with OSA and ischemic stroke have a higher number of cardiovascular comorbidities. After adjustment with a complex multivariate regression model in a large population of patients, they have lower in-hospital mortality and lower incidence of hemiplegia. We also uncovered underdiagnosing of obstructive sleep apnea in National Inpatient Sample registry, which is a limitation of the study.
Abstract 275: The Association of Gout with an Increased Risk of Hypertension and Diabetes Mellitus Among Stroke Survivors in New Zealand: An Observational Study Using Routinely-collected Electronic Health Data
Authors: San Gabriel Dina Eufemia , Slark Julia
Published: April 2019

Background:
There is a paucity of data relating to the association of gout with the occurrence of hypertension and diabetes mellitus in patients with stroke. This study aimed to determine the association of gout with the risk of hypertension and diabetes mellitus in a cohort of stroke patients from Auckland, New Zealand.

Methods:
A cross-sectional study was conducted among stroke survivors in South and East Auckland, New Zealand from the years 2010 to 2014. Electronic health record data were collected and analysed using SPSS version 23. Multivariate logistic regression modelling adjusted for age, gender, and ethnicity was conducted to determine the association of gout with the risk of hypertension and diabetes mellitus in patients discharged with a diagnosis of stroke.

Results:
The age-, gender-, and ethnicity-adjusted odds ratio (OR) for having hypertension and diabetes mellitus among stroke survivors with gout history were: 3.25 [95% confidence interval (CI) 1.32-8.03] and 1.94 (95% CI 1.12-3.36), respectively. Måori stroke survivors with gout history had the highest risk of having diabetes mellitus with age- and gender-adjusted OR of 5.10 (95% CI 1.90-18.93).

Conclusion:
The findings from this study suggest gout may be independently associated with an increasedrisk of hypertension and diabetes mellitus in patients with stroke. Måori who are the indigenous population of New Zealand show a greater risk of diabetes mellitus associated with a gout history compared to other populations. This finding highlights the importance of the need for further research on the association of gout with hypertension and diabetes mellitus.
Abstract 283: Healthcare Resource Utilization and Costs Associated with Oral Anticoagulant Reversal Therapy
Authors: Spyropoulos Alex C , Ó Hartaigh Briain , Cao Zhun , Caberwal Harjeet , Lipkin Craig B , Franchino-Elder Jessica , Wang Cheng , Robinson Scott B
Published: April 2019

Introduction:
Oral anticoagulants (OAC) are essential for stroke prevention in atrial fibrillation (AF). Occasionally, reversal of anticoagulation is critical for treating life-threatening or uncontrolled bleeding episodes, as well as emergency surgery/urgent procedures. Prothrombin complex concentrates (PCC) or specific anticoagulant reversal agents such as idarucizumab (IDA) are initiated in patients who present with a significant bleed or who require urgent surgery. Currently, there is a scarcity of published data regarding healthcare resource utilization (HCRU) or costs incurred by these anticoagulant reversal agents in patients with AF or venous thromboembolism (VTE). Hence, we sought to describe the HCRU and total costs sustained among patients with AF or VTE receiving IDA or PCC in US-based healthcare systems.

Methods:
A retrospective observational study using the Premier Healthcare Database was undertaken. The study included adult patients aged ≥18 years treated with IDA or 3 or 4-factor PCC (Kcentra, Feiba, Profilnine, or unspecified) to reverse the effects of dabigatran or warfarin, respectively, between October 2015 and February 2018. Patients who received PCC were excluded if they had no evidence of warfarin use, or were administered a direct OAC within the 12-month period prior to first hospitalization admission with a record of IDA/PCC use (index hospitalization). Clinical characteristics, HCRU, and total costs during index hospitalization for patients treated with IDA or PCC were examined by use of unadjusted descriptive analysis.

Results:
The median ages for IDA (n=1,232) and PCC (n=4,939) patients were 78 [IQR: 70-85] and 74 [IQR: 65-83] years, respectively. Both treatment groups had a slightly higher representation of males (55.0% for IDA, 55.2% for PCC), and were predominantly of Caucasian race (86.6% in IDA, 79.7% in PCC). Among IDA patients, 59.3% had life-threatening bleeds and 30.4% underwent emergency/urgent surgery, with 56.7% and 30.8% for PCC patients, respectively. The median length of stay for the index hospitalization was 6 [IQR: 3-9] and 7 [IQR: 4-14] days for patients who received IDA or PCC, respectively. Intensive Care Unit admission rates were 61.3% for IDA patients and 68.7% for PCC patients. Median total costs per hospitalization were $19,357 for IDA patients and $26,920 for PCC patients, with the median cost of IDA and PCC therapy per hospitalization being $3,277 and $4,424, respectively.

Conclusions:
This observational, descriptive analysis revealed numerically lower HCRU and total hospital costs in patients administered IDA compared with PCC for reversal of OAC, though there were differences in population characteristics. Further studies are needed to determine the factors that potentially drive the disparate HCRU and associated costs between patients receiving IDA or PCC.
Abstract 292: Depression is Associated With Decrease in Cardiac Catheterization Rate and Delay in Cardiac Catheterization in Patient With Non-ST-Segment Elevation Myocardial Infarction: Insight From National Inpatient Sample Database
Authors: Wu Lingling , Haddadin Faris , Herzog Eyal
Published: April 2019

Background:
Depression poses a major health challenge to patients with cardiovascular disease. But little is known about its impact on Non-ST-elevation myocardial infarction (NSTEMI).

Methods:
Using the data from the 2016 National Inpatient Sample database, we identified hospitalization with a principal diagnosis of NSTEMI with or without medical history of depression. Prevalence and baseline characteristic of NSTEMI patient with or without depression was delineated. Mortality, catheterization rate, length of stay, time to catheterization were compared using multivariate linear regression with adjustment for age, sex, race, region, hospital size, Charlson Comorbidity Index, tobacco, heart failure, diabetes, and stable coronary heart disease.

Results:
Depression was found in 42,914 (9.11%) of total NSTEMI admission of 470,933. A higher percentage of female and a higher prevalence of hypertension, hyperlipidemia, diabetes, and smoking (table 1) was observed in the depression group. No significant association between depression and in-hospital mortality in NSTEMI patient can be found after adjustment for confounders (odds ratio 0.88, p=0.08). However, having depression was associated with lower catheterization rate (odds ratio 0.91, p<0.001), prolonged time to catheterization (1.4 vs 1.2 days, p=0.029) as well as prolonged length of hospital stay (4.9 vs 4.0 days, p<0.001) in admissions because of NSTEMI.

Conclusion:
Depression is associated with decreased catheterization rate, increased length of stay and delayed catheterization in NSTEMI patient. Further investigation of the impact of depression on NSTEMI patient is warranted.
Abstract 32: Implementation of Bedside CYP2C19 Genotype Testing and Personalization of Antiplatelet Therapy in Cardiac Catheterization Lab
Authors: Gurbel Paul A. , Sherwood Matthew , Bliden Kevin P , Jindal Manila , Vyas Ankit , Truesdale Alexander , Taheri Hamid , Yazdani Shahram , Akbari Marjaneh , Tehrani Behnam , Epps Kelly , Russell Heather , Iyer Ramaswamy , Tantry Udaya S
Published: April 2019

Background:
CYP2C19
polymorphisms affect clopidogrel metabolism and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). Although FDA recommended pharmacogenetic testing and alternative antiplatelet agents in
CYP2C19 loss-of-function (LoF)
allele carriers, implementation in practice has been minimal. Our goal is to personalize antiplatelet therapy using point-of-care (POC) assay to genotype patients immediately prior to PCI in a hospital cardiac catheterization lab.

Methods:
Appropriate P2Y
12
receptor antagonist therapy following non-emergent PCI based on bedside genetic testing (SpartanRx system) was initiated at Inova Heart and Vascular institute catheterization laboratory in February 2017. Patients were genotyped using buccal swab technique before proceeding to the catheterization laboratory. A best practice advisory (BPA) was implemented into the EPIC EMR prescription medication ordering system based on genotype. Poor (*2/*2, and *2/*3) and intermediate metabolizers (*1/*2, *1/*3, and *2/*17) were recommended more potent P2Y12 inhibitor therapy using BPA. Demographics, BPA compliance and 1 year outcomes including major adverse cardiac events (Cardiovascular death, MI, Ischemic stroke) and NACE (MACE + major bleeding) were collected.

Results:
Between 2/2017 to 12/2017, 1050 patients underwent POC genetic testing. The frequency of poor, intermediate, extensive, and ultra-rapid metabolizer status was 2.9%, 26.8%, 42.5%, and 27.9%, respectively. The highest percentage of poor metabolizers were observed in Middle-Eastern (12.1%) and Asian (8.9%) populations as compared to African Americans (n=3.4%) and Caucasians (1.1%). In patients treated with PCI (n=429), 28.9% were intermediate (n=112) or poor (n=12) clopidogrel metabolizers, with 87.1% of these patients receiving ticagrelor (n=84) or prasugrel (n=24) based on the BPA from genotype consortium. MACE (0.7%) and NACE (0.9%) rates were minimal as compared to historical controls (5-10%).

Conclusions:
CYP2C19
genotyping at the bedside facilitated early personalization of antiplatelet therapy according to BPA and is associated with low one year MACE and NACE rates.
Long‐Term Outcomes Following Heart Team Revascularization Recommendations in Complex Coronary Artery Disease
Authors: Patterson Tiffany , McConkey Hannah Z.R. , Ahmed‐Jushuf Fiyyaz , Moschonas Konstantinos , Nguyen Hanna , Karamasis Grigoris V. , Perera Divaka , Clapp Brian R. , Roxburgh James , Blauth Christopher , Young Christopher P. , Redwood Simon R. , Pavlidis Antonis N.
Published: April 2019

Background

The Heart Team (
HT
) comprises integrated interdisciplinary decision making. Current guidelines assign a Class Ic recommendation for an
HT
approach to complex coronary artery disease (
CAD
). However, there remains a paucity of data in regard to hard clinical end points. The aim was to determine characteristics and outcomes in patients with complex
CAD
following
HT
discussion.

Methods and Results

This observational study was conducted at St Thomas’ Hospital (London, UK). Case mixture included unprotected left main, 2‐vessel (including proximal left anterior descending artery)
CAD
, 3‐vessel
CAD
, or anatomical and/or clinical equipoise.
HT
strategy was defined as optimal medical therapy (
OMT
) alone,
OMT
+percutaneous coronary intervention (
PCI
), or
OMT
+coronary artery bypass grafting. From April 2012 to 2013, 51
HT
meetings were held and 398 cases were discussed. Patients tended to have multivessel
CAD
(74.1%), high SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) scores (median, 30; interquartile range, 23–39), and average age 69±11 years. Multinomial logistic regression analysis performed to determine variables associated with
HT
strategy demonstrated decreased likelihood of undergoing
PCI
compared with
OMT
in older patients with chronic kidney disease and peripheral vascular disease. The odds of undergoing coronary artery bypass grafting compared with
OMT
decreased in the presence of cardiogenic shock and left ventricular dysfunction and increased in younger patients with 3‐vessel
CAD
. Three‐year survival was 60.8% (84 of 137) in the
OMT
cohort, 84.3% (107 of 127) in the
OMT
+
PCI
cohort, and 90.2% in the
OMT
+coronary artery bypass grafting cohort (92 of 102).

Conclusions

In our experience, the
HT
approach involved a careful selection process resulting in appropriate patient‐specific decision making and good long‐term outcomes in patients with complex
CAD
.
Is Electrocardiography‐Left Ventricular Hypertrophy an Obsolete Marker for Determining Heart Failure Risk With Hypertension?
Authors: Ferdinand Keith C. , Maraboto Carola
Published: April 2019

See Article
Johnson et al
Effect of Cumulative Case Volume on Procedural and Clinical Outcomes in Endovascular Thrombectomy
Authors: Kim Byung Moon , Baek Jang-Hyun , Heo Ji Hoe , Kim Dong Joon , Nam Hyo Suk , Kim Young Dae
Published: April 2019

Background and Purpose—

The effect of endovascular thrombectomy (EVT) cumulative case volume (EVT-CCV) on outcomes of acute stroke patients has not been studied. This study investigated whether EVT-CCV was associated with outcomes.

Methods—

We identified all patients who underwent EVT for anterior circulation large vessel occlusion. Patients who met enrollment criteria were grouped into 5 based on the number of previous cases at each hospital. The number of cases that were recruited from each hospital and then assigned to each group (n) was designed to increase by the function of 10×2
(n-1)
; group 1 consisted of cases 1 to 10 at each hospital, group 2 was cases 11 to 30, group 3 was cases 31 to 70, group 4 was cases 71 to 150, and group 5 was cases ≥151. We tested whether EVT-CCV group was associated with procedural and clinical outcomes.

Results—

Nine hundred fifty-five patients fulfilled the enrollment criteria. Recanalization and good outcome positively correlated with EVT-CCV group (
P
<0.001 [correlation coefficient,
r
=0.122] for recanalization;
P
=0.002 [
r
=0.099] for good outcome), whereas symptomatic intracranial hemorrhage and mortality negatively correlated (
P
=0.039 [
r
=–0.067] for symptomatic intracranial hemorrhage;
P
=0.016 [
r
=–0.078] for mortality). EVT-CCV group was independently associated with recanalization (odds ratio, 1.182; 95% CI, 1.029–1.358) and good outcome (odds ratio, 1.187; 95% CI, 1.053–1.337).

Conclusions—

With increased EVT-CCV, recanalization and good outcome increased, whereas symptomatic intracranial hemorrhage and mortality decreased. Increased EVT-CCV was independently associated with recanalization and good outcome.
New record of the rare genus Crinalium Crow (Oscillatoriales, Cyanobacteria) from sand dunes of the Baltic Sea, Germany: epitypification and emendation of Crinalium magnum Fritsch et John based on an integrative approach
Authors: MIKHAILYUK TATIANA , VINOGRADOVA OKSANA , HOLZINGER ANDREAS , GLASER KARIN , SAMOLOV ELENA , KARSTEN ULF
Published: April 2019

Representatives of the Gomontiellaceae (Oscillatoriales) are rare and hence unstudied cyanobacteria with unusual morphology, distributed in terrestrial and aquatic habitats all over the world. Investigation of the group based on an integrative approach is only beginning, and to understand the actual biodiversity and ecology, a greater number of cultivated strains is necessary. However, some ecological traits of these cyanobacteria (e.g. low population densities, the absence of conspicuous growth in nature) led to methodological difficulties during isolation in culture. One species in the family Gomontiellaceae, Crinalium magnum Fritsch et John, is characterized by prominent wide and flattened trichomes, and represented by the non-authentic strain SAG 34.87. Detailed previous investigation of this strain clearly showed its morphological discrepancy with the original description of C. magnum and the genus Crinalium in general. The new isolate from maritime sand dunes of the Baltic Sea coast (Germany), however, revealed morphological characters completely corresponding with the diagnosis of C. magnum. Phylogenetic analysis based on 16S rRNA sequences indicated a position of the new strain inside Gomontiellaceae. Both morphology and ultrastructure of the strain are congruous with characters of the family. Epitypification and emendation of C. magnum are proposed since the ecology and habitat of the original strain are congruent with the type locality of this rare species (sand, Irish Sea coast, North Wales, UK). We expanded the description of C. magnum by details of the filament development and specified dimensional ranges for trichomes and cells, as well as by new data about the transversely striated structure of mucilaginous sheath.
Drilorhinus, a new genus of the family Drilidae Lacordaire, 1857 (Coleoptera: Elateroidea) from Iran
Authors: KOVALEV ALEXEY V. , KIREJTSHUK ALEXANDER G. , SHAPOVALOV ANDREY M.
Published: April 2019

A new genus of the family Drilidae, Drilorhinus gen. nov. with one new species D. klimenkoi sp. nov. from the South-West Iran (Lorestan) is described, illustrated and compared with all known genera of this group. The new genus differs from all members of the family in the strong projection of the anterior part of the frons between antennal insertions. Some problems of taxonomic rank and classification of Drilidae are considered.