bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P334: Primary Prevention Aspirin Use in an African American Population: The Impact of Health Beliefs and Social Norms
Authors: Van’t Hof Jeremy R , Misialek Jeffrey , Oldenburg Niki , Duval Sue , Hirsch Alan T , Luepker Russell V
Published: July 2021

Background:
Cardiovascular disease (CVD) is a leading cause of death that disproportionately impacts African Americans. Aspirin (ASA) is a simple, low-cost medication that lowers the risk of a first heart attack or stroke by 12-22%. This study investigates the prevalence of primary prevention ASA use among a metropolitan, predominantly African American population. It examines the association between primary prevention ASA use and measures of health beliefs, social norms, and perceptions of CVD risk hypothesized to influence ASA use.

Methods:
Between April and August 2015, trained community health workers administered 10 minute, in-person surveys to a convenience sample of adults ages 45-79 years within the Minneapolis-St. Paul metro area. The survey defined demographics, CVD history, atherosclerosis risk factors and ASA use. CVD risk perceptions and ASA-related health beliefs and social norms were evaluated using a 4 point Likert scale. Logistic regression with adjustment for age and number of risk factors was used to examine the association of demographics and health beliefs with ASA use.

Results:
Of the 797 survey participants, 590 had no CVD history. Of these, 460 (78%) were between the ages of 50-69, the range recently defined in the 2016 United States Preventive Services Task Force (USPSTF) recommendation. Overall primary prevention ASA use was 38% and increased as the number of CVD risk factors (RF) increased, from 21% (0 RF) to 62% (≥ 3 RF). After adjusting for age and risk factors, ASA use was associated with diabetes (OR 2.6, 95% CI: 1.6-4.2) and current smoking (OR 0.4, 95% CI: 0.2-0.6). If a participant discussed ASA use with a doctor, they were much more likely to use ASA (OR 5.5, 95% CI: 3.7-8.1). Participants who believed ASA could prevent a heart attack or stroke were also more likely to use it (OR 4.6, 95% CI: 1.9-11.4). ASA use was higher among participants who perceived that their peers were using ASA (OR 3.7, 95% CI: 2.0-6.6), and among participants who believed those close to them thought they should use ASA (OR 6.6, 95% CI: 4.1-10.5). Perceived safety and ease of use were also positively associated with ASA use, (OR 9.8, 95% CI: 5.0-19.3 and OR 23.2, 95% CI: 8.2-65.5 respectively).

Conclusion:
Increased primary prevention aspirin use was associated with positive beliefs regarding the expectations and behaviors of participants’ social network, and about perceived effectiveness, safety and convenience of the medication. Novel interventions to increase primary prevention ASA use could focus on promoting conversations with physicians about appropriate ASA use, and normalizing ASA for at-risk individuals within communities.
Abstract P339: Volunteering and Favorable Cardiovascular Health in Hispanic/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study
Authors: Estrella Mayra L , Durazo Ramon A , Kelley Michele A , Gallo Linda C , Giachello Aida L , Perreira Krista M , Isasi Carmen R , Chambers Earle C , Zeng Donglin , Carrion Violeta , Lash James P , Daviglus Martha L
Published: July 2021

Introduction:
Volunteering - a social capital indicator - has been associated with a lower burden of
CVD
risk factors in middle-aged and older adults
.
The prevalence of volunteering and its association with favorable cardiovascular health (i.e., low CV risk,
LR
) has not been examined among diverse Hispanic/Latino adults.

Hypothesis:
Volunteering is positively associated with LR independent of sociodemographic and lifestyle factors; this association is modified by acculturation.

Methods:
Our analysis included 4,385 participants, ages 18-74 years, from the
HCHS/SOL
Sociocultural Ancillary Study (2010-2011), a population-based cohort of US Hispanics/Latinos. Multivariate logistic regression (survey weighted) was used to examine cross-sectional associations of self-reported current regular volunteering (yes vs. no) with LR (definition in Table). We tested whether these associations varied by acculturation (assessed as language preference [English vs. Spanish] and length of residence in the US [<10 vs.≥10 years]).

Results:
The prevalence of regular volunteering was 15.4%. Volunteers were more likely to be English speakers, have lived in the US ≥10 years, and had higher income and education than non-volunteers.Association of volunteering with LR varied by length of residence in the US but not with language preference (P for interactions=0.06 and 0.77, respectively). Among persons with ≥10 years of residence in the US, volunteering was associated with more than 2 times higher odds of being at LR vs. non-volunteering in the fully adjusted model (Table). No association of volunteering with LR was observed among those living in the US <10 years.

Conclusions:
Volunteering was associated with LR among Hispanic/Latino adults who have lived in the US for ≥10 years independent of sociodemographic and lifestyle factors. Future research should examine the mechanisms underlying this association, as well as the longitudinal associations of volunteering with incidence of CVD risk factors to assess reverse causality.
Abstract P342: Disparities in Awareness of Stroke Symptoms Among Different Socioeconomic, Ethnic/Race, and At-risk-of-stroke Groups
Authors: Tran Phoebe
Published: July 2021

Findings from a few small studies suggested that disparities in awareness of stroke symptoms lead to disparities in delays of receiving treatment and outcomes of patients with stroke. Hence it is important to conduct a study with a large sample size to understand the associations between awareness of symptoms of stroke with various socioeconomic factors as well as with modifiable stroke risk factors. We assessed the hypotheses that there are disparities in awareness of different stroke symptoms among different groups with respect to various SES factors (e.g., self-reported race, ethnicity, education, age, and income) in the presence/absence of modifiable stroke risk factors (e.g., smoking status, exercise, body mass index, and blood pressure). We combined four Behavioral Risk Factor Surveillance Surveys (BRFSS) from 2003, 2005, 2007, and 2009 to create a sample of 1,051,834 participants. We ran six logistic regression models, one for each of the measures of awareness of six common stroke symptoms (e.g., sudden confusion, numbness on one side of the body, sudden vision loss, sudden chest pain, sudden dizziness, and severe unexplained headache). The unweighted sample size in each of the six models was greater than 120,000. In addition, we calculated marginal probabilities which give the probability of an outcome (e.g., being aware of a specific stroke symptom) with respect to a specific factor (e.g., in the presence/absence of a stroke risk factor) in the context of averaging over all other factors/covariates. While there was low awareness of stroke symptoms among the US population except for recognition of chest pain or discomfort, we did find an association between the awareness of stroke symptoms with gender, educational levels, and income levels. Additionally, among all the ethnic groups, Native Americans had the lowest awareness of five out of six stroke symptoms. On the other hand, White only-non Hispanic, while being relatively better aware of several stroke symptoms, had the lowest awareness of the most common stroke symptom of sudden chest pain compared with other race/ethnicity groups. In conclusion, the findings from this study can serve as a useful guide to facilitating targeted educational efforts aimed at improving awareness of stroke symptoms that may ultimately reduce disparities in the outcomes of patients at risk for stroke.
Abstract P358: Sleepiness and Subclinical Measures of Atherosclerosis in a Bi-racial Cohort: The Bogalusa Heart Study
Authors: Stuchlik Patrick , Pollock Benjamin , Chen Wei , Harville Emily , Bertisch Suzanne , Redline Susan , Bazzano Lydia
Published: July 2021

Introduction:
That adverse health outcomes, including atherosclerosis, are associated with sleep disturbance is well-documented; however, evidence from diverse populations on the magnitude of this association, or investigating sleepiness as an outcome, is scarce.

Methods:
We examined data from theBogalusa Heart Study, a long-term community-based observational study of a biracial cohort, with first measurements in childhood in 1973. Men and women (n=546) who underwent a measure of carotid intima-media thickness (IMT), calculated as the composite IMT (cIMT), mean of six segments (common and internal carotid, and carotid bifurcation, each left and right), and completed the Epworth Sleepiness Scale (ESS), were included. Multivariable logistic regression was employed to model the association between ordinal self-rated sleepiness and cIMT per standard deviation, adjusted for age, sex, smoking status (at time of IMT measurement), hours of sleep, symptoms of sleep disturbance, and previous heart attack. Based on previous race-specific findings, data were analyzed separately by race.

Results:
Of whites (n=356), 59.6% were female and 22.5% were current smokers. Mean (SD) age was 43.1 (4.4) years, and cIMT was 0.6 (0.1) mm. Of African-Americans (n=190), 66.8% were female, 34.7% were current smokers. Mean (SD) age was 42.8 (4.6) years, and cIMT was 0.7 (0.2) mm. Multivariate modeling found a significant race-cIMT interaction term (p=0.04). In stratified analyses, the adjusted odds of abnormal sleepiness (vs. normal sleepiness) were 1.40 times greater (95% CI: 1.04-1.90) per 1-SD increase in cIMT in whites, while among black participants, the odds ratio (95% CI) was 1.01 (0.68-1.50).

Conclusions:
There was a significant association between unfavorable subclinical measures of atherosclerosis and excessive daytime sleepiness among white participants.
Abstract P367: Association of Risk Factor Exposure Patterns Through Young Adulthood With Left Ventricular Structure/Function in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Lloyd-Jones Donald M , Colangelo Laura , Lewis Beth , Schreiner Pamela , Sidney Stephen , Gidding Samuel S , Perak Amanda M , Gross Myron , Goff David C , Reis Jared , Liu Kiang , Lima Joao
Published: July 2021

Background:
Data are sparse regarding associations of risk factors (RF) across young adulthood with development of adverse left ventricular (LV) structure and function by middle age, and it is unclear whether baseline, cumulative, or longitudinal RF exposure patterns best represent that risk.

Methods:
We included up to 2335 CARDIA participants (ppts) who had echocardiographic data from exam year (Y)5, Y25, and Y30, and RF data from at least 3 exams including Y0 and Y25. Echo outcomes included Y30 indexed LV end-systolic (ESD/ht) and -diastolic (EDD/ht) dimensions, and LV mass (M/ht
2.7
), septal and posterior wall thickness, ejection fraction (EF), and incident adverse geometry (defined as LV concentric remodeling [CR], concentric hypertrophy [cLVH], or eccentric hypertrophy [eLVH]). We used multivariable linear, logistic or polytomous regression (as appropriate to endpoint) to examine associations of RF exposures measured as: 1) baseline (Y0); 2) change from Y0 to Y25; 3) cumulative exposure from Y0 to Y25 (e.g., pack-yrs, mmHg-yrs); or 4) latent class trajectories (using PROC TRAJ) from Y0 to Y25, with adjustment for demographics and relevant Y5 echo measures.

Results:
At Y30, ppts were 55±4 yrs, 56% women and 44% black; 12% smoked, mean BMI was 30.4±7, 37% had hypertension, and 17% diabetes; 20.5% had incident LVH; 4.5% EF<50%; and 37.2% adverse LV geometry. Models representing cumulative RF exposures tended to have the highest adjusted R
2
and lowest AIC for continuous and categorical Y30 LV outcomes. The table shows associations of cumulative RFs from Y0 to Y25 with incident LVH, EF<50%, and adverse LV geometry at Y30. Few RFs were consistently associated with Y25-Y30 change in echo measures, but they included education and SBP.

Conclusions:
Among initially healthy young adults, cumulative risk factor exposures (often within clinically normative ranges) over 25 years are significantly associated with continuous LV echo measures and adverse LV outcomes by middle age, suggesting the importance of primordial prevention.
Abstract P373: Higher Plaque Volume but Not Density of Coronary Artery Calcium is Associated With Left Ventricular Mass
Authors: Forbang Nketi I , Michos Erin , Allison Matthew , Thomas Isac , McClelland Robyn , Sandfort Veit , Criqui Michael
Published: July 2021

Coronary artery calcium (CAC) predicts future cardiovascular disease (CVD) events, including heart failure (HF), improves risk stratification beyond traditional CVD risk factors, and is associated with a higher left ventricular mass (LVM), a HF risk factor. Recent findings from the MESA have shown that for a given CAC volume, higher CAC density was inversely associated with incident CVD. It remains uncertain whether CAC volume and density associate differently with LVM. In a multi-ethnic cohort of community dwelling individuals free from clinical CVD at recruitment, we determined the independent cross-sectional associations of baseline CAC volume and density, measured by non-contrast cardiac CT, with LVM, measured by MRI.

In 2432 participants with prevalent CAC (density can only be assessed in those with CAC > 0), the mean age was 66 ± 10 years, 59% were men, 50% were European-, 22% were African-, 20% were Hispanic-, and 13% were Chinese-Americans. Median (25-75
th
) CAC volume was 78 (23-259) mm
3
, mean CAC density was 2.7 ± 0.7, and mean LVM was 151 ± 41 grams. CAC density and natural log (
ln
) CAC volume were correlated (correlation coefficient=0.60, P-value < 0.01). Multivariable linear regression models investigated associations of
ln
(CAC volume) and CAC density with LVM. Model 1 adjusted for demographics (age, sex, and ethnicity) and body surface area. Model 2 included Model 1 plus CVD risk factors (smoking status, fasting glucose, total and HDL cholesterol, systolic blood pressure, and use of medications for hypertension, diabetes, and abnormal lipids). In fully adjusted models one log unit increase in CAC volume as associated with 1.7 gram increase in LVM (Beta = 1.7, 95% CI: 0.7 to 2.6, P < 0.01). In contrast, a unit increase in CAC density was associated with 1.9 gram decrease in LVM (Beta = -1.9, 95% CI: -3.9 to 0.1, P = 0.07).

Higher CAC volume, but not CAC density, was cross-sectionally associated with higher LVM; a risk factor for HF. Higher calcium density of coronary artery plaques may not be a hazard for ischemic heart disease mediated increase in LVM. Future studies should determine independent associations of CAC volume and density with incident HF.
Pathogenic Variants Associated With Dilated Cardiomyopathy Predict Outcome in Pediatric Myocarditis
Authors: Seidel Franziska , Holtgrewe Manuel , Al-Wakeel-Marquard Nadya , Opgen-Rhein Bernd , Dartsch Josephine , Herbst Christopher , Beule Dieter , Pickardt Thomas , Klingel Karin , Messroghli Daniel , Berger Felix , Schubert Stephan , Kühnisch Jirko , Klaassen Sabine
Published: July 2021

Background:

Myocarditis is one of the most common causes leading to heart failure in children and a possible genetic background has been postulated. We sought to characterize the clinical and genetic characteristics in patients with myocarditis ≤18 years of age to predict outcome.

Methods:

A cohort of 42 patients (Genetics in Pediatric Myocarditis) with biopsy-proven myocarditis underwent genetic testing with targeted panel sequencing of cardiomyopathy-associated genes. Genetics in Pediatric Myocarditis patients were divided into subgroups according to the phenotype of dilated cardiomyopathy (DCM) at presentation, resulting in 22 patients without DCM (myocarditis without phenotype of DCM) and 20 patients with DCM (myocarditis with phenotype of DCM).

Results:

Myocarditis with phenotype of DCM patients (median age 1.4 years) were younger than myocarditis without phenotype of DCM patients (median age 16.1 years;
P
<0.001) and were corresponding to heart failure–like and coronary syndrome–like phenotypes, respectively. At least one likely pathogenic/pathogenic variant was identified in 9 out of 42 patients (22%), 8 of them were heterozygous, and 7 out of 9 were in myocarditis with phenotype of DCM. Likely pathogenic/pathogenic variants were found in genes validated for primary DCM (
BAG3, DSP, LMNA, MYH7, TNNI3, TNNT2
, and
TTN
). Rare variant enrichment analysis revealed significant accumulation of high-impact disease variants in myocarditis with phenotype of DCM versus healthy individuals (
P
=0.0003). Event-free survival was lower (
P
=0.008) in myocarditis with phenotype of DCM patients compared with myocarditis without phenotype of DCM and primary DCM.

Conclusions:

We report heterozygous likely pathogenic/pathogenic variants in biopsy-proven pediatric myocarditis. Myocarditis patients with DCM phenotype were characterized by early-onset heart failure, significant enrichment of likely pathogenic/pathogenic variants, and poor outcome. These phenotype-specific and age group–specific findings will be useful for personalized management of these patients. Genetic evaluation in children newly diagnosed with myocarditis and DCM phenotype is warranted.
Ex Vivo Assessment of Different Oral Anticoagulant Regimens on Pump Thrombosis in a HeartWare Ventricular Assist Device
Authors: Rao Sriram D. , Connor David E. , Shehab Sajad , Kerr Nicholas P. , Joseph Joanne , Muthiah Kavitha , Jain Pankaj , Robson Desiree , Jansz Paul , Hayward Christopher S.
Published: July 2021

Background:

In light of decreased intracranial hemorrhage with direct oral anticoagulants and concerns about their safety in continuous flow left ventricular assist devices, we conducted an ex vivo study of thrombus formation using multiple anticoagulation agents.

Methods:

A continuous flow left ventricular assist device (HeartWare ventricular assist device) hemocompatibility loop was run using human blood under 7 conditions: control (no anticoagulation or antiplatelet); in vitro addition of aspirin; in vitro addition of apixaban at low dose (equivalent 2.5 mg twice daily); addition of apixaban at high dose (equivalent 5 mg twice daily); patients on warfarin; patients on apixaban (5 mg twice daily); and patients on dabigatran (150 mg twice daily). The primary outcome was time to formation of intrapump thrombosis. Secondary outcomes were reduction in clotting times over 1 hour, hemolysis, reduced platelet aggregation, and von Willebrand activity.

Results:

Twenty-one runs were completed. Times to thrombosis in median (interquartile range) were control, 131 (127–134.5); in vitro aspirin, 124 (114.5–137); and patients on dabigatran, 131 (130.5–135.5) minutes, respectively. Times in patients on warfarin were, 137 (136.5–143.5); in vitro low-dose apixaban, 141 (138.5–142); and patients on apixaban, 140 (138–142.5) minutes, respectively. No thrombus formed in the in vitro high-dose apixaban group. There were no significant differences between the individual groups. When all apixaban groups were compared with nonapixaban groups, the time to thrombosis formation was significantly longer, 143 (137–150) versus 133.5 (128.5–140) minutes,
P
=0.02. There were similar changes in lactate dehydrogenase levels and other secondary end points.

Conclusions:

In an in vitro study of anticoagulation using human blood in a mock loop with a HeartWare HVAD, we demonstrated similar thrombosis times for apixaban and warfarin. Time to clotting was longer in the combined apixaban groups compared with combined other groups, but thrombosis times between individual groups were not significantly different.
Abstract 10: Cigarette Smoking and the Risk of Adverse Events in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Sandesara Pratik , O’Neal Wesley , Venkatesh Sanjay , Sperling Laurence
Published: July 2021

Background:
Cigarette smoking predisposes individuals to the development of cardiovascular disease by promoting inflammation, vascular dysfunction, and accelerated atherosclerosis. However, the association between smoking and outcomes in HFpEF remains unclear.

Objectives:
To examine the relationship between smoking and outcomes in patients with HFpEF.

Methods:
This analysis included 1,717 (mean age=71±10 years; 50% male; 78% white) patients with HFpEF enrolled in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) Trial from the Americas. Smoking was ascertained by self-reported history and was categorized as never, former, or current. Multivariable cox regression was used to examine the risk of hospitalization, hospitalization for heart failure, death, and cardiovascular death across smoking categories.

Results:
There were 116 (7%), 871 (51%), and 729 (42%) patients whose smoking status was classified as current, former, or never. Current smoking was associated with an increased risk for hospitalization (never: HR=1.0; former: HR=1.14, 95%CI=0.99, 1.31; current: HR=1.38, 95%CI=1.05, 1.80), hospitalization for heart failure (never: HR=1.0; former: HR=1.25, 95%CI=0.99, 1.57; current: HR=1.68, 95%CI=1.08, 2.61), death (never: HR=1.0; former: HR=1.02, 95%CI=0.81, 1.29; current: HR=1.82, 95%CI=1.19, 2.78), and cardiovascular death (never: HR=1.0; former: HR=1.00, 95%CI=0.74, 1.35; current: HR=1.85, 95%CI=1.09, 3.24) compared with former or never smokers in a multivariable model adjusted for cardiovascular risk factors. The cumulative incidence estimates for hospitalization for heart failure across smoking categories are shown in Figure 1 (log-rank p=0.0029). Similar effect estimates were observed for smoking categories and the outcomes examined when further adjusted for quantity of cigarette use.

Conclusion:
Current smoking is associated an increased risk for adverse outcomes in HFpEF, including hospitalization for heart failure. Smoking cessation possibly has role to reduce the risk for hospital admission and death in these high-risk patients.
Abstract 103: Women in Leadership Positions in Academic Cardiology: A Study of Program Directors and Division Chiefs
Authors: Khan Muhammad Shahzeb , Fatima Kaneez , Ayub Muhammad Talha , Usman Muhammad Shariq , Siddiqi Tariq Jamal , Tsao Connie W , Manning Warren J , Khosa Faisal , Figueredo Vincent M
Published: July 2021

Background:
Cross-sectional studies demonstrate that women are often under-represented in key-leadership roles. We sought to examine the proportion of women in cardiology leadership positions and to compare the findings with the disparity prevalent in the overall cardiology faculty. Furthermore, we aspired to compare the proportion of women in leadership positions to the proportion in which they entered the cardiology field.

Methods:
Cardiology fellowship training programs of all teaching hospitals of the United States were identified from Fellowship and Residency Electronic Interactive Database (AMA FREIDA). Program directors and division chiefs were identified from the institutions’ websites, and their research statistics and years of graduation were extracted from Scopus and Doximity.

Results:
Data of all (n=512) cardiology fellowship program directors, as well as 69% (n=140) of cardiology division chiefs were collected. A lower percentage of women held the role of division chief (5% vs. 95%) or program director (14% vs. 86%). However, when compared to the proportion of women in the 1992 fellowship cohort, women were significantly overrepresented in the role of program directors, with no significant difference in representation at the level of division chief. When compared to the overall cardiology faculty, program directors had significantly more publications and were more likely to have an academic rank of full professor (40% vs. 28%) or associate professor (37% vs. 23%). Male program directors had a significantly higher number of research publications, H-index and academic rank than their female counterparts; however, such difference was not seen at the level of division chief.

Conclusion:
Gender disparity is present in both cardiology program director and division chief roles. However, when compared to the historical cohort, significant overrepresentation of women was seen in the program director position, while proportionate representation was seen in the division chief role.
Abstract 107: Differential Ischemic Stroke Risk Among Women Veterans Across Age Strata
Authors: Comer Amber R , Sico Jason , Haggstrom David
Published: July 2021

Background:
Ischemic stroke disproportionately affects women. Women have a higher lifetime risk of stroke, experience worse functional recovery post-stroke, and are more likely to be institutionalized after stroke than men. Despite the pronounced differences in which stroke may affect women compared to men, stroke research specifically focusing on women has not been published until recently. For instance, stroke specific guidelines for women were not published until 2014. This study sought to determine whether differences in stroke risk exist between women and men across age strata using the Framingham Stroke Risk (FRS) score in a large cohort of Veterans.

Methods:
Study participants were Veterans receiving care within Veterans Health Administration facilities between April 2011 and May 2012 (N=57,072). In this secondary analysis, patients were excluded (n=39,978) based on age less than 55 years and prior history of stroke. FRS was calculated for each patient based on race- and sex-specific pooled cohort equations that accounted for age, atrial fibrillation, systolic blood pressure, diabetes mellitus, cigarette smoking, prior cardiovascular disease, and antihypertensive medication use. FRS scores ≥15% were classified as high risk for stroke. SAS Version 9.1 statistical software was used to calculate FRS, perform chi-square analysis, and perform logistic regression analysis.

Results:
Among 39,978 eligible patients, the mean age (standard deviation [SD]) was 71.6 ± 10.1 years with 1,842 (4.6%) patients within the cohort being women. The mean FRS score for women was 11.29 (± 4.29 SD) and was 14.52 (± 4.37 SD) for men. Risk factors for stroke including age, atrial fibrillation, systolic blood pressure, diabetes mellitus, and antihypertensive use were significant predictors of women’s high 10-year risk of stroke in unadjusted OR unadjusted analyses? (
P
=<.0001). When stratified into groups of high 10-year risk of stroke, this study found that nearly half (47.9%) of all Veterans were high-risk for stroke. Women 55-73 years old had a lower risk of future stroke than men of the same age; however, women Veterans 71 years and older had a higher risk of future stroke than similarly aged men (
P
<0.001).

Conclusions:
Nearly half of all women Veterans were found to be at high risk of ischemic stroke within the next 10-years. Furthermore, sex differences were noted across age strata, with women having a lower risk of stroke then men at younger ages and a higher risk at older ages. Given that women tend to have more severe strokes, higher mortality, and delayed diagnosis compared to men, further work is required to understand reasons for the differential stroke risk across sexes. Based on these study findings, implementing primary prevention programs for women Veterans would help to mitigate future ischemic stroke risk.
Abstract 126: Effect of Immunosuppressive Therapy, Clinical, and Demographic Parameters on Kidney Function After Cadaveric Renal Transplant
Authors: Muste Justin , Pashkovetsky Eugene , Wang Stephani , Misak Monika , Chandolias Nikolaos , Lopez-Soler Reynold , Conti David , Torosoff Mikhail
Published: July 2021

Background:
We compared effects of immunosuppression and co-morbidities on kidney function following renal transplant.

Methods:
We perfomed retrospective chart review in 211 consecutive renal transplant recipients, treated at a single medical center between 2004 to 2014, who also underwent a post-transplant echocardiogram. Patients were stratified into ESRD/CKD-4 group and CKD1-3 according to standard GFR criteria. The study was approved by IRB.

Results:
Average age was 52.4 +/- 11.8 years old, 41% were females, 95% with history HTN, 81% with dislipidemia, 20% with CAD, 42% with diabetes mellitus, 26% past smokers, 16% on thyroid replacement therapy, 8% with history of congestive heart failure. The average hemoglobin was 11.9 +/- 2.2 mg/dL. Sixty percent of patients were on triple immunosuppressive therapy. In our study cohort, with an average time post-kidney transplant of 41.7+/-34.8 months, 26.5% patients had ESRD/CKD-4. Female gender (OR 2.26, 95% CI 1.21-4.20; p=0.01), diabetes mellitus (OR 0.502, 95% CI 0.26-0.96; p=0.03), triple immunosuppressive therapy (OR 0.279, CI 0.15-0.23; p<0.0001), and hemoglobin (OR 0.632, 95% CI 0.53-0.76; p<0.0001) were significant independent predictors of post-kidney transplant GFR. In multivariable regression analysis, post-transplant hemoglobin (OR 0.641, 95% CI 0.53-0.77; p<0.0001) and triple immunosuppressive therapy (OR 0.282, CI 0.15-0.53; p=0.0004) were significant predictors of preserved GFR and lower CKD category.

Conclusions:
Higher Hgb levels and triple immune-suppressive therapy are associated with improved kidney function post-renal transplant. Additional studies are needed to identify causes of decreased hemoglobin in this patient population and to develop treatment strategies aimed at preserving GFR.
Abstract 128: A Precision Medicine Test Accurately Rules Out Obstructive Coronary Artery Disease Among Non-Diabetic Patients Presenting to Emergency Department With Acute Chest Pain
Authors: Nasir Khurram , Ali Shozab S , Saxena Anshul , Grandhi Gowtham , Siddiqui Usman , Kuo Jane Z , Wingrove James A , Johnson Andrea , Monane Mark , Arias Lara , Veledar Emir
Published: July 2021

Background:
An age, sex, and blood gene expression score (ASGES) has been previously validated to detect obstructive coronary artery disease (CAD) in non-diabetic patients presenting with stable chest pain in the outpatient setting. However, the diagnostic performance of this test in ruling out obstructive CAD in patients presenting with acute chest pain (ACP) to the emergency department (ED) is unknown.

Methods:
In an ongoing study, 371 low-intermediate risk patients with ACP and no prior history of CAD (TIMI risk score ≤ 2, negative troponins and normal/non-diagnostic ECG) underwent coronary CT angiography (CCTA) using institutional protocols. Patients were classified based on severity of stenosis (obstructive CAD, >50%; high grade stenosis, >70%) and ASGES. The ASGES blood test sample was drawn before ED discharge and analyzed in a commercial reference laboratory (Redwood City, CA). We excluded 23 (6%) patients with unreportable ASGES and 47 (13%) diabetics from this primary analysis.

Results:
301 (53±10 years, 45% males, 78% Hispanics) non-diabetic ACP patients undergoing CCTA in an ED setting were included in this analysis. No plaque was detected in 183 (60%) patients, and 22 (7%) patients had obstructive CAD. In this population, 51% of patients had scores below the previously defined threshold of ASGES≤ 15. This threshold yielded sensitivity, specificity, NPV, and PPV of 71% (52-86%), 53% (47-59%), 97% (93-98%), and 12% (9-14%) for obstructive CAD. Furthermore, ASGES≤15 yielded a 100% sensitivity and NPV for patients with high grade stenosis (n=7, 2%). In a multivariable analysis including patient demographics and clinical covariates, ASGES ≤15 was significantly associated with obstructive CAD (OR: 0.15, 95% CI: 0.04-0.62). As a continuous variable, increasing ASGES was positively correlated with the presence of obstructive CAD and CCTA-defined plaque burden (p<0.0001).

Conclusions:
This is the first study validating the use of this blood-based precision medicine test to rule out obstructive CAD among low-intermediate risk non-diabetic patients presenting with ACP in ED setting. 30-day follow-up is underway to evaluate the prognostic implications of these findings.
Abstract 133: Using Administrative Data Registries and Clinical Data Registries to Identify Discrepancies and Improve Data Quality
Authors: Hoegh Holly , Springborn Robert , Wang Limin , Krawczyk Christopher
Published: July 2021

Background:
The California (CA) Office of Statewide Health Planning and Development (OSHPD) collects three types of patient-level administrative data: patient discharge (PDD), ambulatory surgery (AS), and emergency room (ER). CA hospitals are mandated to submit clinical data to OSHPD for all adult coronary artery bypass graft (CABG) surgeries. This submission is usually a subset of hospital’s Society of Thoracic Surgeons Adult Cardiac Surgery Database submissions. In addition, OSHPD receives clinical data from the National Cardiac Data Registry CathPCI for CA hospitals certified to perform elective PCIs without onsite surgery available. OSHPD implements various data quality efforts to ensure accuracy in each data source, including using data from administrative registries to confirm clinical data and using data from clinical registries to confirm administrative data.

Methods:
The clinical CABG data submitted to OSHPD is linked to the PDD. The resulting discrepancy reports are shared with hospitals to assist them when revising their data. The reports show discrepancies in over- and under-reporting of CABG cases, isolated and non-isolated CABGs, and post-op complications. For PCI reporting, clinical data from the CathPCI registry is compared to the PDD, AS, and ER to look for discrepancies.

Results:
For the 2016 CABG data, discrepancy reports issued to 126 hospitals submitting clinical CABG data to OSHPD showed potential under-reporting of 417 CABGs that appeared in the PDD but were not submitted in the clinical data. The report showed an additional 437 CABGs that were submitted in the clinical data, but did not appear in the PDD. Hospital review and response to these reports resulted in an overall increase of 296 CABGs to the clinical database. Discrepancy reports also alerted hospitals to 66 cases where a post-operative stroke occurred but was not reported in the clinical database. Hospital review resulted in 22 post-operative strokes added to the clinical registry. The 2016 CathPCI data for CA certified elective PCI hospitals showed potential under reporting of PCIs in PDD, AS, and ER. Possible missing PCIs ranged from 0.4% to 21.6% per hospital. OSHPD worked with staff at the clinical data and administrative data units at these hospitals to understand the discrepancies. The main issue identified was that AS data submitted by some hospitals used alternate coding (Healthcare Common Procedure Coding System) and failed to convert these codes to Current Procedural Terminology codes as required. The findings plan to be used in an outreach effort to all CA hospital submitting administrative PCI data to OSHPD to ensure accurate reporting.

Conclusion:
Comparing administrative and clinical data registries data is an effective quality tool to identify discrepancies in each source of data. Sharing discrepancies with hospitals results in improved understanding of data standards and data quality.
Abstract 146: Efficacy of a Nurse-Led Risk Factor Modification Program in Achieving Weight Loss in Obese Atrial Fibrillation Patients
Authors: Yaeger Amaryah , Cash Nancy R , Parham Tara , Amaro Anastassia , Deo Rajat , Frankel David S , Epstein Andrew E , Santangeli Pasquale , Riley Michael , Nazarian Saman , Lin David , Garcia Fermin C , Schaller Robert , Arkles Jeffrey , Supple Gregory , Kumareswaran Ramanan , Callans David J , Marchlinski Francis E , Dixit Sanjay
Published: July 2021

Objective:
Weight loss (WL) can improve arrhythmia outcomes in obese patients (pts) with atrial fibrillation (AF). Although WL in this population has been achieved by strict dietary and lifestyle modification in physician-led research protocols, these resource intensive strategies have limited real-life applicability. We report the efficacy of a pragmatic outpatient based nurse-led risk factor modification (RFM) program that utilizes a high-touch, single point of care approach for achieving WL in AF pts at a tertiary care arrhythmia program.

Methods:
All new AF pts with obesity (defined as body mass index (BMI) ≥30kg/m
2
) were offered enrollment. The pragmatic approach to WL focused on patient engagement and education, motivational interviewing, development of individualized lifestyle modification goals to improve dietary and exercise habits, and longitudinal telephonic care management to reinforce these changes. WL and compliance with established goals were assessed during ongoing biweekly (initial 2 months) then monthly follow-up support calls for up to 12 months. Continuing participation in RFM program was on a voluntary basis. Pts unable to achieve ≥3% WL by 3 months were referred for escalated care to a WL physician specialist. Pts who declined participation served as controls. Student t-test and chi-square tests were used to compare continuous and dichotomous variables.

Results:
Between 11/1/16 to 10/31/17, 189 pts (BMI 36.3±6) enrolled in RFM program, and 115 pts (BMI 35.5±5.4; P=NS) declined participation. The majority of enrolled pts (72%, n=136 of 189) had failed ≥1 previous WL attempts. Follow-up WL data (5.5±4.1 months for enrolled; 5.2±2.9 months for declined; P=NS) was available and compared in 162 enrolled (86%, n=162 of 189) and 59 declined (51%, n=59 of 115) pts. Pts enrolled in RFM program achieved significantly greater WL than declined pts (2.7±3.8% vs. 0.3±3.5%, respectively; p<0.05). See table for details.

Conclusions:
A pragmatic nurse-led risk factor modification strategy focusing on lifestyle changes reinforced by frequent patient follow-up can be effective in achieving weight loss in obese atrial fibrillation patients. This single point of care approach is a potentially sustainable model for maintaining weight loss in this population.
Abstract 167: Factors Influencing the Decision to Accept or Decline to Participate in Clinical Research: A Qualitative Study
Authors: Ecarnot Fiona , Chopard Romain , Schiele Francois , Meneveau Nicolas
Published: July 2021

Introduction:
Guidelines rely on evidence-based data, and clinical research is key to providing this evidence-base. Yet the factors that influence a patient’s decision to participate (or not) in research remain poorly documented. We aimed to investigate the factors that determine the decision to accept or decline clinical trial participation, using a qualitative approach.

Methods:
Single-centre, qualitative study using semi-directive interviews with patients (pts) who had been invited to participate in a randomized clinical trial and who had given their decision. Both pts who refused and pts who accepted were included. There were no inclusion criteria; all pts who met the inclusion criteria of the selected trial and had been approached for consent were eligible. Pts also completed a questionnaire rating 16 statements examining reasons for accepting or declining trial entry. Verbatim from the interviews were analysed using a grounded theory (GT) approach.

Results:
To date, 14 patients have been interviewed; average age 75±7 years. Two pts did not know if they were currently participating in a trial or not; 1 said he was not participating although he had provided consent. From a GT perspective, the main concern of patients does not appear to be the question of research participation, but rather the fact of being sick, and their overriding preoccupation is how to return to their previous state of wellbeing and overcome the current acute episode. Regarding the decision to participate in research, the main themes that arose were: (1) the positive value of the trial for the patient (benefitting from the intervention; interest in receiving closer and/or more regular follow-up due to trial participation), although some pts clearly do not understand the concept of randomization; (2) the level of engagement in the process of care (some pts do not bother to read the information given to them, but just accept what is proposed without question, while others decline immediately without reading trial information). Two dimensions emerge, namely physical and emotional health, with a spectrum ranging from fragile to robust. Where the patient is situated on this spectrum appears to influence their attitude towards research participation.

Conclusions:
The decision to participate (or not) in clinical research appears to be more related to the patient’s general behaviour and attitude when sick, rather than any specific trial-related constraints or advantages. The level of comprehension of pts who have been through the consent process casts a doubt on the “informed” character of the consent.
Abstract 177: Heterogeneity in Blood Pressure Management in Patients With Peripheral Artery Disease; Insights From the PORTRAIT Registry
Authors: Peri-Okonny Poghni A , Patel Krishna , Wang Jingyan , Stone Nancy , Smolderen Kim
Published: July 2021

Introduction:
Patients with peripheral artery disease (PAD) are known to have the highest cardiovascular risk across the spectrum of patients with atherothrombotic disease. Hypertension (HTN) management is currently not a key performance measure for PAD despite being a common risk factor in patients with PAD. As there is lack of data on the management of blood pressure (BP) in PAD, we prospectively studied BP management among patients with new or worsening symptomatic PAD.

Methods:
In PORTRAIT, patients were evaluated for new or worsening PAD symptoms in 16 PAD clinics across the US, Netherlands and Australia. BP was measured in clinic and at time of enrollment. HTN was defined as prior history of HTN, use of antihypertensives or [SBP ≥140 or DBP ≥90 mmHg per old guidelines; or SBP≥130 or DBP≥80 per new ACC/AHA guidelines]. Untreated HTN was defined as patients with HTN who were not on antihypertensive therapy. HTN with BP <140/90 (old) or <130/80 (new guidelines) was defined as controlled HTN. We estimated country differences in BP and untreated HTN rates. Median odds ratio (MOR) and 95% confidence intervals was derived from hierarchical logistic regression modelling to estimate variability in achieving controlled HTN.

Results:
Among 1006 participants with documented BP, the prevalence of HTN increased from 96% to 98% based on old and new definitions respectively. BP control decreased from 51% (old) to 31% (new definition). Beta blockers (66.1%) were the most commonly used antihypertensive drug class (Table 1). Overall, 6.5% and 8.3% of HTN patients were untreated based on the old and new definitions respectively. Mean BP was lowest in the US compared to Netherlands and Australia (135/73 ± 21/11 mmHg, 146/76 ± 22/12, 151/80 ± 19/10, p <0.001) respectively. The MOR across sites was 1.7 (1.3 -2.5) for BP <140/90 (p <0.001), and 1.4 (1.0 -2.1) for BP<130/80 (p = 0.045) after adjusting for country.

Conclusion:
The prevalence of HTN among PAD patients with new or worsening symptoms was high independent of BP cut off. Based on new HTN definition, only 1 in 3 HTN patients in this cohort have controlled BP. There was significant heterogeneity in BP control and rates of untreated hypertension differed by country independent of HTN definition. This suggests an opportunity to improve BP control in PAD patients.
Abstract 184: Self-reported Hypertension Treatment Practices Among Primary Care Physicians and Cardiologists
Authors: Egan Brent , Flack John , Lombera Sofia , Patel Mehul
Published: July 2021

Objectives:
This study was conducted to examine perceptions, knowledge, and rationale for prescribing β-blockers among physicians who treat patients with hypertension.

Methods:
In August/September 2016, 103 primary care physicians (PCPs) and 59 cardiologists participated in a 20-minute quantitative, online survey regarding their use and perceptions of β-blockers. Significant between-group differences were examined via t-tests and z-tests.

Results:
Significantly more cardiologists chose β-blockers as first-line therapy than PCPs (30% vs 17%,
P
<0.01). Metoprolol and carvedilol were the most commonly prescribed β-blockers. When choosing a β-blocker, cardiologists rated “impact on fatigue and energy” and “arterial vasodilation” as more important treatment features than PCPs (
P
<0.05 and
P
<0.01, respectively). Physicians’ awareness of vasodilation was greater for carvedilol (52% [84/162]) than nebivolol (31%[51/162]). A large proportion of cardiologists and PCPs were unaware that any β-blockers cause weight gain (cardiologists, 34%[20/59]; PCPs, 39%[40/103]) or increased glucose (42% each, cardiologists [25/59], PCPs [43/103]). Overall, physicians associated atenolol and metoprolol with weight gain and clinically relevant changes in glucose, while nebivolol was least associated with either outcome. Only 10% of cardiologists (6/59) and 2% of PCPs (2/103) associated carvedilol with weight gain (
P
<0.05). Among β-blocker features, nebivolol was closely associated with: β
1
-selectivity; efficacy in patients aged >60 years; efficacy in African-American patients; and arterial vasodilation. Metoprolol was closely associated with heart rate reduction, and atenolol was associated with heart rate reduction, fatigue, erectile dysfunction, and impact on mood. Physicians had a positive response to using drugs other than metoprolol or atenolol that could lower the risk of new onset diabetes for pre-diabetic or obese patients. Clinical practice guidelines influenced prescribing behaviors more than formulary or performance metrics; continuing medical education and publications were commonly accessed materials for hypertension education.

Conclusions:
This survey highlights several educational gaps, including differences between PCPs and cardiologists, on the perceptions of β-blockers for hypertension treatment. Future efforts should include physician education on relevant evidence-based differences between β-blockers, given their heterogeneity.