bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 259: Success of Educational Interventions in Antiplatelet Therapy in Acute Coronary Syndrome
Authors: Larkin Amy , LaCouture Michael , Padbury Caroline , Bhatt Deepak
Published: March 2022

Introduction:
The purpose of this educational curriculum was to test the impact of continuing medical education (CME) participation on knowledge and performance of physicians related to evidence-based decision making in the area of ACS.
Methods:
Cardiologists (n = 153) and primary care physicians (PCPs) (n = 150) who manage patients with ACS participated in at least 1 of 3 online, multimedia, ACS-related CME activities within a curriculum. Responses to a case-based survey after activity completion were compared with responses from demographically similar control groups. Educational effect size was calculated using Cohen’s
d
formula.

Results:
Activity 1: Incorporating New Data into Practice Cardiologists (n=51) Effect size = 0.67 (Moderate Effect) PCPs (n=48) Effect size = 0.66 (Moderate Effect) Activity 2: Guideline-Based Care Cardiologists (n=52) Effect size = 1.0 (Strong Effect) PCPs (n=52) Effect size = 0.83 (Strong Effect) Activity 3: Selecting Antiplatelet Therapy Cardiologists (n=50) Effect size = 0.66 (Moderate Effect) PCPs (n=50) Effect size = 0.98 (Strong Effect)

Domain 1: Recognizing Characteristics of Antiplatelet Therapies
PCP participants performed significantly better than nonparticipants in identifying pharmacologic properties of new P2Y12 inhibitors. Both PCP and cardiologist participants demonstrated a significantly greater ability than nonparticipants to identify investigational P2Y12 inhibitors properties.

Domain 2: Implementing Antiplatelet Strategies

Both PCP and cardiologists participants performed significantly better than nonparticipants in appropriate use of new P2Y12 inhibitors prior to invasive cardiac procedures. PCP participants demonstrated significantly better performance than nonparticipants regarding pharmacologic use in patients undergoing CABG and in making recommendations about dual antiplatelet therapy.

Conclusion:
This study demonstrated that an educational curriculum, designed for the right clinicians and with appropriate content, can be successful at improving knowledge and performance in ACS management.
Abstract 265: Survival Analysis of Extracorporeal Life Support Under Different Indications - A Nation-wide Cohort Study in Taiwan
Authors: Lin Jou Wei , Chang Chia-Hsuin , Chen Hsi-Chieh , Lai Mei-Shu
Published: March 2022

Background:
Extracorporeal membrane oxygenation (ECMO), or extracorporeal life support (ECLS), has been gradually incorporated into cardiopulmonary resuscitation procedures, post-operational life support, and a variety of scenarios. Despite of the wide use of ECMO in Taiwan, the efficacy of ECLS in these cardiac and non-cardiac conditions was largely unknown. Therefore, the objective of this study was to compare the survival outcomes in the patients who received ECMO under different indications.

Methods:
The patients aged 20 years and above who received ECMO from September 1, 2009 to December 31, 2012 were identified from Taiwan’s National Health Insurance Database. The indications were classified into 1) life support after cardiac surgery (LSCS), 2) myocardial infarction and cardiogenic shock (post-MI), 3) injury, 4) infection, adult respiratory distress syndrome, and septic shock, and 5) others. Rare conditions such as donor support and obstetric labor complications were excluded. Cox-regression model was used to compare the 30-day and one-year mortality, using the LSCS as the reference group.

Results:
A total of 3,346 patients were included in the analysis (1,428, 944, 216, 691, and 67 for groups 1 to 5, respectively). The mean age was 53.2 years, and 71.2% was male. The 30-day mortality was 51.6%, 66.6%, 55.6%, 49.2%, and 49.3%, and the one-year mortality rate was 67.4%, 77.8%, 66.2%, 74.0%, and 68.7%, for the five groups, respectively. In the first 30 days, the post-MI group had a higher mortality hazard (HR: 1.62, 95% CI: 1.46~1.81) and the infection group had a lower one (HR: 0.87, 95% CI: 0.76~0.99) than the LSCS group. The one-year mortality was still the highest among the post-MI group (HR: 1.52, 95% CI: 1.38~1.67), and the survival among the other groups did not statistically differ from that of the LSCS group.

Conclusion:
The overall survival was worst in the patients who required ECLS due to myocardial infarction and cardiogenic shock. Patients with infection, adult respiratory distress syndrome, and septic shock had a higher possibility of surviving through the first month, but the overall mortality was not necessarily better. Further analysis regarding the cost and benefit of ECLS is warranted.
Abstract 287: Trajectories of Post-acute Care in the Initial 365 Days Following Hospital Discharge After Left Ventricular Assist Device Implantation
Authors: Lander Bradley S , Patel Krishna , Blackstone Eugene H , Nordseth Trond , Starling Randall C , Gorodeski Eiran Z
Published: March 2022

Background:
Frequency and types of care transitions (CTs) experienced by patients within 365-days following discharge from index hospitalization for LVAD implantation are unknown.

Methods:
We conducted a retrospective study of consecutive adults who were discharged after LVAD implantation at our institution. We recorded numbers and types of CTs following discharge.

Results:
Between 1/2008 and 12/2012, 227 patients were discharged. Of these, 162 (71%) were discharged home, and 65 (29%) were discharged to facility. These included long term acute care hospitals (n=50), inpatient rehabilitation (n=11), and skilled nursing facilities (n=4). In the first 365-days post-discharge, those patients initially discharged home spent a mean 265 days at home, 0.5 days in facility, and 13 days in hospital as result of readmission. Those initially discharged to facility spent mean 37 days in facility, 241 days at home, and 19 days in hospital as result of readmission. Clinical state prevalence stratified by initial discharge destination is shown in the figure. In the first 90 days, patients discharged to facility had an increased burden of hospital days as compared to those discharged home (9.1 days versus 4 days).

Conclusion:
Patients discharged to facility following index hospitalization for LVAD implantation have an increased burden of CTs, especially within the initial 90 days, as compared to those initially discharged home. Specialized models of care are needed in facilities caring for patients with LVADs.
Abstract 315: Use of Echocardiography and Nuclear Scintigraphy for Patients with Heart Failure in the Veterans Administration and Medicare Systems
Authors: Rajaei Sheeva , Groeneveld Peter , Teerlink John , Whooley Mary , Turakhia Mintu , Richman Ilana , Sahay Anju , Kini Vinay , Heidenreich Paul
Published: March 2022

Background:
The high use of cardiac imaging in the United States is increasingly scrutinized. We sought to determine differences in cardiac imaging between the Veterans Healthcare Administration (VA) and Medicare for veterans with heart failure (HF).

Methods:
We analyzed VA and Medicare data from 2002 to 2009 to identify 2,536,556 unique veterans age 65 and older with a known diagnosis of HF for at least one year (those with care in both systems are excluded). The fraction of patients with an echocardiogram (ECHO) or nuclear scintigraphy (NUC) test was determined. Logistic regression was used to adjust for patient characteristics.

Results:
More veterans received care in Medicare (82%) than in the VA (18%) The mean age was 79 years, 93% were male and comorbidities were common: diabetes mellitus (44%), ischemic heart disease (67%), and chronic kidney disease (25%). Imaging per year was higher in Medicare compared to the VA for ECHO (51% vs. 21%) and NUC (18% vs. 8%, both p<0.0001). Use plateaued or decreased for all procedures after 2006 except for VA ECHO (Figure). After adjustment for patient characteristics the use odds ratio in Medicare (compared to VA) was 3.61 for ECHO (95% CI 3.58-3.64) and 2.82 for NUC (2.79-2.86). Adjusted 1 year mortality was lower in the VA, OR 0.80 (0.81-0.79).

Conclusion:
There is much greater use of imaging procedures among veterans in Medicare than in the VA not explained by patient characteristics and not associated with improved survival.
Abstract 321: Comparison of Two Models of an Outpatient Anticoagulation Management Service at a Pediatric Medical Center
Authors: Faircloth Jenna M , Taylor BreAnn N , Nelson Nicole L , Ciambarella Julie A , Brown James M , Simon Katie , Jefferies John L
Published: March 2022

Introduction:
Studies and national patient safety organizations recognize benefits of a dedicated warfarin anticoagulation service in maximizing efficacy and minimizing adverse events, hospitalizations and cost. The impact of a pharmacist-led anticoagulation service on adult patient outcomes and health care expenditures has been established, however, similar data is lacking in a pediatric setting. In 2013, the outpatient anticoagulation program within the Heart Institute at Cincinnati Children’s Hospital Medical Center (CCHMC) transitioned from a nurse-managed service model to a pharmacist-managed collaborative service model. This study will describe the differences between a nurse-managed (NM) service model and a pharmacist-managed (PM) service model for outpatient anticoagulation management of cardiology patients followed at a pediatric medical center.

Methods:
A retrospective study was conducted to evaluate warfarin anticoagulation management of a NM service and PM service at CCHMC. Each service model was reviewed for thirteen months between November 1, 2011 and November 30, 2014. The primary outcomes are percent of time within therapeutic INR range and median time to patient follow-up for INR monitoring (days).

Results:
Fifty-eight cardiology patients managed by both outpatient anticoagulation services were evaluated during each study group time frame. Median age was 19.1 years (IQR 14.2, 25.7) and 65.5% were male (38 of 58). Of the 58 patients evaluated, 51.7% (30 of 58) were managed within an INR goal range of 2- 3. Most common indications for anticoagulation were cardiac valve replacement (50%; 29 of 58) and Fontan procedure (37.9%; 22 of 58). Percent of time within therapeutic range was 65.7% (12,897 of 19,636 days) for the NM service model and 80.6% (18,650 of 23,131 days) for the PM service model. Percent of time below therapeutic INR range was reduced with the PM model compared to NM model, respectively (12.3% v. 24%). Median time between INR lab draws was 35.1 days (IQR 23.8-73.6) for NM model and 22.3 days (IQR 17.9-26.5) for the PM model.

Conclusions:
A pharmacist-managed collaborative outpatient anticoagulation service model improved the time within therapeutic range and frequency with INR lab monitoring at a pediatric medical center compared to nurse-managed model.
Abstract 323: Standardized Triggers for Catheterization Laboratory Morbidity and Mortality Case Review
Authors: Doll Jacob A , Patel Manesh R , Sketch Michael H , Harrison J K , Tcheng James E
Published: March 2022

Background:
Guidelines recommend cardiac catheterization laboratories operate a quality improvement program that includes peer review and assesses physician performance. Traditionally this has been accomplished by a morbidity and mortality (M&M) process, but no prior studies have described M&M case selection methods. The use of objective, pre-defined triggers for case selection could avoid under-reporting by physicians and identify complex cases of educational value.

Methods:
The Duke University Hospital Cardiac Catheterization Laboratory is a high-volume academic practice that involves trainees in the performance of all coronary angiograms and interventions. At a monthly M&M conference, challenging cases are reviewed to identify opportunities for performance improvement. Cases are selected for review based on the occurrence of pre-defined clinical triggers or by any staff member or physician request. A consensus assessment of physician, staff, and hospital systems performance is reported as a standardized score. We retrospectively reviewed M&M documentation for the purpose of assessing our approach to case selection and performance evaluation.

Results:
Of 37,250 coronary catheterizations performed between January 1, 2004 and December 31, 2013, 239 (0.6%) were selected for M&M review based on at least one triggering event. The most common triggering events were defibrillation, unplanned use of mechanical circulatory support, and unplanned intubation (Table). Multiple triggers were present in 118 cases (49.4%). An additional 125 (0.3%) cases were triggered for review by physician or staff request. These included cases resulting in access site hematoma (33 events), peripheral arterial dissection (14), stroke (12), and acute coronary thrombosis (11). “Very controversial” or “unacceptable” performance was identified for physicians in 21 (5.8%) cases, for hospital systems in 3 (1.1%) cases, and in no cases for cath lab staff.

Conclusions:
We present a 10-year experience with the use of objective triggers to identify cases for M&M review. This method identifies challenging cases of educational value and could be immediately implemented to strengthen national catheterization laboratory quality improvement programs.
Abstract 327: An Emerging Public Health and Primary Care Strategy for Hypertension Management
Authors: Goldstein Allison , Wall Hilary
Published: March 2022

Control and Prevention (CDC) and Centers for Medicare & Medicaid Services, with the goal of preventing one million heart attacks and strokes by 2017. To help achieve this goal, Million Hearts
®
aims to increase by 10 million the number of persons in the United States whose blood pressure is under control. Self-measured blood pressure monitoring (SMBP) is one strategy for managing hypertension, a condition that now affects one in three American adults. This is a critical time for public health and primary care to promote tools that strengthen a system of care for treatment of chronic disease. In July 2012, the Agency for Healthcare Research and Quality (AHRQ) released a comparative effectiveness review that found strong evidence that SMBP plus additional clinical support is more effective than usual care in lowering blood pressure among patients with hypertension. Based on AHRQ’s review, CDC staff collaborated with partners and stakeholders to develop a series of guides on SMBP,
Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners
and
Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians (SMBP Action Steps)
.
SMBP
Action Steps
provide information, guidance, and resources for public health practitioners and clinicians to promote and implement SMBP plus additional clinical support to increase access to care and improve the quality of care for patients with hypertension. This presentation will provide an overview of
SMBP
Action Steps
and highlight strategies and examples that public health practitioners and clinicians can use to work with care teams, patients, payers, and the public to promote more widespread implementation of and coverage for SMBP plus additional clinical support interventions.
Abstract 333: How Much Information Do Patients Prefer When Discussing Cholesterol Lowering Medications? Results From an Internet Based Nationally Representative Survey
Authors: Ye Siqin , Haynes Norrisa , Spertus John A , Alcantara Carmela , Shaffer Jonathan A , Moise Nathalie , Kronish Ian , Davidson Karina W
Published: March 2022

Background:
Patients are often unsatisfied with the information they receive about statins, which could lead to decreased adherence. Using a national survey of patients with myocardial infarctions (MI), we examined the prevalence and predictors of patients receiving too little or too much information when discussing cholesterol-lowing medications (CLM).

Methods:
A nationally representative sample of patients with MI were surveyed via the internet from May to July, 2013. Participants were asked to report whether they received insufficient, excessive, or appropriate amounts of information for benefits and risks of CLM. Using multinomial logistic regression, we assessed the relationship between receiving insufficient or excessive information and demographic, clinical and psychosocial predictors as well as self-reported degree of shared decision-making during the discussion for CLM.

Results:
412 (36%) of 1154 participants were female, and 440 (38%) were ≤65 years old. For benefits of CLM, 252 (22%) reported receiving insufficient information, and 113 (10%) reported receiving excessive information; for risks, 413 (36%) reported receiving insufficient information, and 67 (6%) reported receiving excessive information. In multivariable analyses, women were more likely to receive insufficient information about benefits (relative risk ratio [RRR] 1.52, 95% CI 1.12-2.06) and risks (RRR 1.45, 95% CI 1.11-1.89), while patients ≤65 years of age were more likely receive excessive information about benefits (RRR 1.75, 95% CI 1.14-2.68), with a trend for the same for risks (RRR 1.71, 95% CI 0.99-2.96). Patients with hyperlipidemia were less likely to receive insufficient information for benefits and were more likely to receive excessive information for risks. For both benefits and risks, depressive symptoms tended to increase the likelihood of receiving insufficient as well as excessive information, while shared decision-making decreased the likelihood of receiving insufficient information (Table).

Discussion:
Patients with MI have diverse information preferences when discussing CLM, while shared decision-making may improve patient satisfaction with the information received. These results suggest the importance of tailoring the amount of information delivered to patient preference.
Abstract 344: Optimal Serum Potassium, Calcium and Magnesium in the Coronary Care Unit
Authors: Krittanawong Chayakrit , Thongprayoon Charat , Park Jae Y , Sharma Sunita , Gaba Prakriti , Rosenbaum Andrew , Hu Tiffany , Bell Malcolm R , Brady Peter A , Herasevich Vitaly , Kapa Suraj , Asirvatham Samuel J , Naksuk Niyada
Published: March 2022

Background:
It is known that hypokalemia, hypocalcemia and hypomagnesemia cause a prolonged QTc interval and are associated with an increased risk of ventricular arrhythmias. However, there are limited data on optimal serum electrolytes for patients admitted to the coronary care unit (CCU).

Objective:
Here, we aimed to evaluate the relationship between serum potassium, ionized calcium and magnesium levels and in-hospital mortality in the CCU setting.

Methods:
This retrospective cohort study included 8,498 consecutive patients admitted to the CCU at an academic tertiary medical center from 2004 through 2013. The mean of serum electrolytes was categorized as <3.5, 3.5-<4.0, 4.0-<4.5 (reference), 4.5-<5.0, and ≥5.0 mEq/L for potassium; <4.4, 4.4-<4.6, 4.6-<4.8, 4.8-<5.0 (reference), and ≥5.0 mg/dL for ionized calcium; and <1.8, 1.8-<2.0, 2.0-<2.2 (reference), 2.2-<2.4, and ≥2.4 mg/dL for magnesium. Multivariate logistic regression analysis was used to determine the association between the mean of serum electrolytes and in-hospital mortality.

Results:
Of the 8,498 patients, 599 (7%) died during hospitalization. Relationship between mean serum potassium (U-shaped), ionized calcium (inverted J-shape) and magnesium (J-shaped) and in-hospital mortality was present in Figure. Serum potassium levels <3.5, 4.5-<5.0 and ≥5.0 mEq/L were independently associated with an increased risk of in-hospital mortality (adjusted OR 1.7 95% CI 1.1-2.5, OR 1.7 95% CI 1.3-2.2, and OR 3.4 95% CI 2.4-4.8, respectively), compared to the reference group. As for serum ionized calcium, the levels of <4.4, 4.4-<4.6, and 4.6-<4.8 mg/dL independently increased risk of mortality (adjusted OR 3.0 95% CI 2.3-4.0, OR 2.0 95% CI 1.5-2.6, and OR 1.4 95% CI, 1.1-1.8, respectively). As for serum magnesium, an only level above 2.4 mg/dL was associated with an increased mortality risk (OR 1.6 95% CI, 1.1-2.2).

Conclusions:
In the CCU setting, serum potassium 3.5-<4.5 mEq/L, ionized calcium ≥5.0 mg/dL and magnesium <2.4 mg/dL are associated with the lowest in-hospital mortality. These findings do not support supratherapeutic repletion of potassium and magnesium.
Abstract 352: Does Imaging The Culprit or Non-culprit Coronary Artery First in Acute ST-Elevation Myocardial Infarction Change Outcomes?
Authors: Ballard James R , Brown Brian J , Gepner Adam D , Li Zanhai , Gimelli Georgio
Published: March 2022

Background:
Practice variation exists regarding diagnostic coronary angiography for acute ST elevation myocardial infarction (STEMI). Operators can initially image either the presumed culprit vessel (CV) or the non-culprit vessel (NCV) based on the electrocardiogram (ECG) injury pattern. It is not clear if this leads to clinically meaningful differences in the time to intervention or outcomes.

Methods:
All patients presenting to the University of Wisconsin for STEMI (2009 to 2013) and registered with the National Cardiovascular Data Registry (NCDR) were included. Baseline ECGs were reviewed to identify the probable culprit vessel. Coronary angiograms were reviewed and subjects were divided into CV or NCV groups based on the artery imaged first. Differences between groups were compared with student’s t-tests of unequal variance. CV and NCV effect on death was analyzed with logistical regression models adjusted for age, sex, cardiovascular disease risk factors, access site, peak troponin, and time to intervention time.

Results:
The 702 STEMI patients identified were mean (standard deviation) 62.7 (13.2) years old and 28% (195 of 702) female. The left coronary artery was the presumed culprit vessel in 46% of cases; the right coronary artery was the presumed culprit in 54% of cases. The CV was imaged first in 28.5% (200 of 702) of cases and the NCV was imaged first in 71.7% (502 of 702) of the cases. Of these, 610 (87%) underwent primary percutaneous coronary intervention (PCI); 40 (5.6%) subjects did not survive until hospital discharge. Cath lab arrival to intervention time was not different in the two groups (CV (26 [13] minutes; NCV 26 [11] minutes; p=0.94). After adjustment, imaging the CV first had no effect on in-hospital death (p=0.95).

Conclusion:
Imaging the CV first had no effect on time to intervention or mortality. This argues that non-procedural aspects of catheterization (ie prep, drape, access, etc) may be a better target intervention to improve time to PCI.
Abstract 4: Different Impacts of Time From Collapse to First Cardiopulmonary Resuscitation on Outcomes After Out-of-Hospital Cardiac Arrest in Adults by First Documented Rhythm
Authors: Hara Masahiko , Kitamura Tetsuhisa , Hayashi Kenichi , Hikoso Shungo , Sakata Yasushi
Published: March 2022

Background:
It is well-known that cardiopulmonary resuscitation (CPR) should be attempted as early as possible after out-of-hospital cardiac arrest (OHCA). However, it has not been sufficiently investigated about the impact of time to CPR on OHCA outcome by first documented rhythm (pVT, pulseless ventricular tachycardia/VF, ventricular fibrillation; PEA, pulseless electrical activity; and asystole) in a same cohort.

Methods:
We enrolled 257354 adult (≥ 18 years old) witnessed OHCA patients (median age 77 years old and 60.2% were male sex) between 2007 and 2012 from a prospective nationwide population-based cohort database in Japan. We evaluated relationships between time from collapse to first CPR by bystanders or emergency-medical-service personnel and neurologically favorable 1-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 both in whole population and patients who achieved return of spontaneous circulation (ROSC) by first documented rhythm. We employed logistic models for the estimation of prognoses.

Results:
During the study period, the number of OHCA patients with pVT/VF, PEA, and asystole were 38661 (15.0%), 96906 (37.7%), and 121787 (47.3%), respectively. Of them, 12551 (32.5%) patients with pVT/VF, 13137 (13.6%) PEA, and 7310 (6.0%) asystole achieved ROSC. Estimated curves with their 95% confidence intervals (bands) of neurologically favorable outcome after OHCA in adults calculated from measured values (dots) were shown in the Figure by time to first CPR and first documented rhythms. Prognoses became worse as first CPR delayed irrespective of type of first documented rhythm, but were totally different by the rhythm both in total population and in patients who achieved ROSC.

Conclusions:
We revealed that the OHCA outcome exceedingly differed by time to first CPR and first documented rhythm in the prospective nationwide population-based cohort database. Shortening of time to first CPR is crucial for improving the OHCA outcome.
Abstract 107: A Field Synopsis of Sex in Clinical Prediction Models for Cardiovascular Disease
Authors: Paulus Jessica , Wessler Benjamin S , Lai Lana L , Lundquist Christine , Raman Gowri , Lutz Jennifer S , Kent David M
Published: March 2022

Introduction:
Incorporating sex in Clinical Prediction Models (CPMs) may support sex-specific clinical decision making. Risk scores commonly used in CVD prevention, such as the Pooled Cohort Equation and the Framingham risk score for 10 year CVD risk, present sex-specific algorithms, yet to date, there has been no systematic summary of the role of sex across CPMs. To better understand the potential influence these models might have on sex-specific care, we conducted a field synopsis of the role of sex in CPMs for CVD.

Methods:
We identified CPMs in the Tufts PACE CPM Database, a systematic review of CVD CPMs published from 1/1990-5/2012. We report the proportion of models including the effect of sex on CVD incidence or prognosis, summarize the directionality of sex effects (harm or protection associated with female sex), and explore factors influencing the inclusion of sex.

Results:
Out of 592 CPMs with CVD as either an index condition or outcome, 173 (34%) contained a coefficient for sex and 27 (5%) presented sex-stratified models. Sex was over 2.5 times more likely to be included in models predicting CVD incidence in a general population sample versus models predicting prognostic outcomes among patients with known CVD (79% (54/68) vs. 29% (146/498), p<0.0001). Among the 366 CVD-related models that did not include sex as a covariate or stratification variable, 71% reported that sex had been considered as a candidate for inclusion based on clinical or statistical criteria. Being a woman was associated with lower risk of death in 8 of 8 models predicting mortality among patients with heart failure that included sex as a covariate (see figure), yet a higher risk of death among women undergoing revascularization procedures in 10 of 12 CPMs. In multivariable analysis, the number of outcome events (OR=2.6, 95% CI 1.6-4.4, p=0.0002) and a cohort defined as a population sample at risk for developing CVD (OR=6.2, 95% CI 2.7-14.1, p<0.0001) were significantly associated with inclusion of sex in CPMs.

Conclusions:
Sex is included in about one third of published CPMs, but more frequently in models predicting incidence of CVD. The importance of sex-specific care may be especially well established for primary prevention. The rapidly growing literature on CPMs may yield important insights to guide sex-specific CVD prevention and treatment.
Abstract 113: Adherence to Antihypertensive Medication in the Jackson Heart Study (JHS)
Authors: Butler Mark , Tanner Rikki M , Muntner Paul , Shimbo Daichi , Bress Adam , Shallcross Amanda , Ogedegbe Gbenga , Spruill Tanya M
Published: March 2022

Objectives:
Adherence to antihypertensive medications is associated with increased blood pressure (BP) control and reduced cardiovascular disease and mortality. The Jackson Heart Study (JHS) is a longitudinal study of 5,301 adults recruited from the general population of the Jackson, Mississippi area designed to evaluate cardiovascular disease in African Americans. The goal of the current analysis was to develop a measure of adherence to antihypertensive medication from available JHS data to facilitate future research in this sample.

Methods:
JHS participants were asked to bring in all medications taken in the prior two weeks to the baseline interview and were asked if they had taken each medication in the past 24 hours. Non-adherence was defined as not taking all antihypertensive medications in the past 24 hours. The mean of two clinic BP measurements taken one minute apart with a Hawksley random zero sphygmomanometer was used for this analysis. The associations between non-adherence and systolic/diastolic BP and uncontrolled BP (systolic/diastolic BP ≥ 140/90 mm Hg) were examined using linear and Poisson regression. Analyses were adjusted for age, sex, smoking, years of education, income, cohabitation, diabetes, depressive symptoms, and weekly stress symptoms.

Results:
Of the 5,301 JHS participants, 2,415 who reported current use of antihypertensive medication and had valid clinic BP and 24-hour adherence data were included. The mean age was 54.9 (SD 12.9) years and 68.7% (n=1,660) were female. Overall, 25.3% of participants (n=612) were non-adherent to their antihypertensive medication. For adherent and non-adherent participants, the mean systolic BP was 130.0 (SD 17.2) and 135.2 (SD 19.8) mm Hg, respectively (
P
<0.001), and the mean diastolic BP was 78.7 (SD 10.6) and 79.4 (SD 10.9) mm Hg, respectively (
P
=0.15). After multivariable adjustment and compared to their adherent counterparts, non-adherent participants had 4.6 (SD 0.8) mm Hg higher systolic BP (
P
<.001) and 1.1 (SD 0.4) mm Hg higher diastolic BP (
P
=.01). The prevalence of uncontrolled BP was 31.3% among adherent participants and 41.7% among non-adherent participants. After multivariable adjustment, non-adherent participants were 1.28 times more likely to have uncontrolled BP (95% CI:1.14-1.43;
P
<.001).

Conclusions:
These findings suggest that 24-hour adherence to antihypertensive medications is a viable measure of medication adherence in the JHS.

Implications:
Evaluatingmedication adherence in patients with hypertension is important butchallenging. Valid and reliable self-report measures are needed when objectivemeasures are unavailable. If validated in future research, 24-hour adherence to antihypertensive medications may provide a parsimonious way of assessing medication adherence in epidemiological studies.
Abstract 124: Bridging Clinical Trial and Community-Based Cardiovascular Outcomes With Antiplatelet Therapy: An Analysis of Cardiovascular Outcomes in a Phase 3 Long-Term Safety Study of PA32540 Compared to a Matched Community-Based Sample
Authors: Hatoum Hind T , Fort John G
Published: March 2022

Background:
Improvements in antiplatelet strategies could have a significant impact on cardiovascular (CV) events. PA32540 is a novel single-dose tablet of 325 mg enteric-coated aspirin and 40 mg immediate-release omeprazole developed to significantly reduce upper gastrointestinal (UGI) toxicity and discontinuation due to aspirin-associated UGI symptoms. In order to bridge the potential clinical benefits of PA32540 to a broader community setting, we compared CV and gastrointestinal (GI) outcomes from a long-term, open-label PA32540 Phase 3 clinical trial to CV and GI outcomes in a community setting (CS).

Objective:
To assess 2 clinically and demographically matched patient populations receiving treatment for secondary CV prevention: one group treated with PA32540, and the other group treated with standard antiplatelet therapy.

Methods:
All patients were receiving secondary CV preventive therapy and were at risk for GI events. Patients (n=379) from a 12-month Phase 3 open-label clinical trial of PA32540 were matched to CS patients (n=379) prescribed antiplatelet therapy following an index CV event from a retrospective (2001-2010) claims analysis database. Patients were matched on clinical and demographic variables that included gender, age (±2 years), history of proton pump inhibitor use, and nonsteroidal anti-inflammatory drug use. The relationship between CV outcomes and multiple demographic variables (eg, age, race, comorbidities) were examined.

Results:
Within 12 months of initiating preventive secondary CV therapy, 18% (68/379) of CS patients and 13% (49/379) of PA32540 patients experienced a secondary CV event. This corresponds to a 28% reduction of reported CV events compared with similar CS patients (Figure). Similarly, the proportion of patients experiencing a serious GI event was 3.7% (14/379) in the CS group and 0.8% (3/379) in the PA32540 group; a 78.6% reduction.

Conclusions:
Fewer CV and GI events occurred among the open-label Phase 3 clinical trial patients treated with PA32540 than among the matched population of CS patients receiving antiplatelet therapy. These data suggest that a further reduction in secondary CV outcomes may be achieved by reducing aspirin-associated UGI symptoms that may lead to discontinuation of antiplatelet therapy.
Abstract 158: Geographic and Temporal Variation in Implanted Cardiac Devices to Treat Heart Failure
Authors: Hatfield Laura A , Kramer Daniel B , Reynolds Matthew R , Normand Sharon-Lise T
Published: March 2022

Background:
Patients with heart failure frequently receive cardiac implantable electrical devices including ICDs and CRT devices with (CRT-D) and without (CRT-P) ICD capability. This study describes the clinical, temporal, and regional characteristics of ICD vs CRT-D vs CRT-P use in the United States.

Methods:
Patients receiving a first ICD, CRT-D, or CRT-P device between 2008 and 2013 in a national database of commercial and Medicare Advantage claims were eligible for analysis. Included patients had at least 6 months of continuous enrollment prior to implant and no codes indicating device revision/upgrade. Prior claims provided information on relevant comorbidities and heart disease characteristics, demographics, and medications, specifically beta blocker and ACE-I/ARB use in 2 of 3 months prior to implant.

Results:
Among 55,433 patients (median age 63, 28% women), CRT-P implants comprised a small but increasing proportion over time (from 3% to 7% of devices over the study period) compared with CRT-Ds (25-27%) and ICDs (72-66%) (see Figure). We observed minimal regional variation in device proportions. Compared with CRT-D recipients, CRT-P recipients were older (median age 76 versus 67), more likely to be female (40% vs 30%), more likely to have AF/AFL (37% vs 20%), and LESS likely to have CHF (65% vs 92%). Receipt of optimal medical therapy in the months preceding implant was low in both CRT-D (35%) and CRT-P (29%) patients.

Conclusion:
This study provides nationwide proportions and trends in device use. CRT-D use dwarfs CRT-P in the US, though the latter proportion has doubled over 6 years. In contrast to many other cardiac interventions, there was little apparent geographic variation in device selection. Optimal medical therapy appears suboptimal in real-world practice.
Abstract 159: Glycemic Status and Sleep Duration Among Individuals With Diabetes in Hispanic Community Health Study/ Study of Latinos
Authors: Espinoza-Giacinto Rebeca , Buelna Christina , Allison Matthew , Castaneda Sheila , Martinez Elena , Perez Ramona , Loredo Jose , Talavera Gregory A
Published: March 2022

Background:
Healthy sleep has gained growing recognition in its relationship to cardiometabolic health to include type 2 diabetes. The association between sleep and glycemic management among individuals with diabetes is understudied. Therefore, we examined the relationship between sleep duration and glycemic control among a diverse group of US Hispanic/Latino adults with diabetes in the Hispanic Community Health Study/Study of Latinos.

Methods:
This cross-sectional study included 3,180 adults with diabetes who reported quantity of sleep. Individuals with glycosylated hemoglobin (HbA1c) < 7% were considered to have adequate glycemic control while those with HbA1C
>
7% were considered to have suboptimal or uncontrolled glycaemia. Using multivariable regression, we assessed associations between glycemic control and three categories of sleep duration (<6hrs; ≥6- 9hrs; > 9hrs) adjusting for covariates. Covariates included age, sex, language of interview, US residency duration, household income, education level, insurance status, Hispanic/Latino background, field center site, body mass index, insomnia, sleep apnea, diet quality, physical activity, and depression and anxiety symptomology among others.

Results:
Almost half of individuals (47%) had suboptimal diabetes control assessed by HbA1c levels. Most individuals (83%) reported sleeping 7-9 hours per night. Few individuals (8%) slept less 6 hours per night while 27% slept more than 9 hours. Findings indicate that sleep duration was significantly associated with glycemic control after adjusting for covariates. Specifically, individuals with long sleep duration (>9 hours) were less likely to have controlled glycemic status compared to those who reported average sleep duration of 6-9 hours (OR=0.76; 95% CI; 0.57-1.00; P=0.038). In addition, covariates such as age, heritage group and participants recruitment site were also found to be significant in glycemic control status.

Key words:
sleep, diabetes, glycemic regulation, Latinos
Abstract 208: Impact of Symptoms and Degree of Valvular Regurgitation on Patient-perceived Health Status in Patients With Aortic Regurgitation
Authors: Tower-Rader Albree , Griffin Brian , Rodriguez Leonardo , Stewart William , Grimm Richard , Hachamovitch Rory
Published: March 2022

Background:
Patients (pts) with severe aortic regurgitation (AI) often present with symptoms of shortness of breath (SOB) or heart failure (HF); however, the effect of these symptoms and severity of aortic regurgitation on patient-perceived health status is unknown.

Methods:
Kansas City Cardiomyopathy Questionnaire (KCCQ) data were collected using tablet computers from pts presenting for routine outpatient cardiovascular assessment between 6/1/2011 and 8/31/2012 who also underwent echocardiography within 90 days. Pts with other valvular lesions (including aortic stenosis) moderate or greater in severity, congenital heart disease, hypertrophic cardiomyopathy, pericarditis or constriction, cardiac amyloid, sarcoid, restrictive cardiomyopathy, or pulmonary hypertension were excluded. Demographic, clinical, historical, and echocardiographic data was collected as per routine. Multiple linear regression was used to assess the association of this information and valve lesion severity with KCCQ summary score (SS).

Results:
590 pts [age 61.9±13.8 years, 363 (61.5%) men, 132 (22%) with prior aortic valve surgery] were identified; 452 with mild, 86 with moderate and 52 with severe AI. Mean KCCQ SS was 74.5±23.7; 74.3±23.0 with mild AI, 73.8±26.2 with moderate AI, and 76.7±19.4 with severe AI (p=NS). SOB was present in 290 pts (49%, KCCQ SS 65.3±23.7), HF in 43 (7.3%, KCCQ SS 50.1±22.3) and both in 36 pts (KCCQ SS 47.0±21.7). After adjusting for multiple factors, linear regression (r2=0.28, p<0.001) revealed that the presence of SOB (β: -13.841, p<0.001) and heart failure (β:-19.484, p<0.001) were associated with lower SS; however, the degree of AI and history of aortic valve surgery were not associated with KCCQ SS. Male sex (β: 7.279, p=0.001), heart rate (β: -0.223, p=0.005), prior CAD (β: -4.364, p=0.038) and BMI (β:-0.357, p=0.035) were also significant in this model. Pt age, presence of atrial fibrillation, angina, hypertension, diabetes, prior CAD, renal disease, cancer, cerebrovascular disease, peripheral vascular disease, left ventricular diastolic dimension and ejection fraction were not significant predictors.

Conclusions:
In stable outpatients with AI, KCCQ scores correlate with the presence of shortness of breath and heart failure symptoms, but are not affected by the degree of AI or history of aortic valve surgery. Symptoms rather than diagnosis drives patient perceived health status.
Abstract 211: Influence of Parental Education on Nutritional and Lifestyle Choices of Project Healthy Schools Students
Authors: Rogers Ryan , Jiang Qingmei , Costin Nathaniel , de Visser Rosa S , Sylvester Rachel , DuRussel-Weston Jean , Kline-Rogers Eva , Eagle Kim A , Jackson Elizabeth A
Published: March 2022

Background:
Prior research has shown that dietary beliefs and activity levels of parents significantly mediate dietary and physical behaviors of their children. However, there is limited research regarding the influence of parental education on children’s health. This study analyzes the differences in dietary and lifestyle behaviors of 6th grade students with more educated parents compared to those with less educated parents.

Methods:
Data were taken from 6048 students in 41 schools involved in Project Healthy Schools (PHS), a middle school-based intervention program in Michigan. Students were divided into two groups based on their parents’ education levels, as selected in a health behavior survey given to the students. Students were included in the “More Educated” group if they had at least one parent with a college or Master’s/Professional degree. Students with neither parent having completed a college degree were classified as the “Less Educated” group. Students’ baseline survey responses to nutritional and lifestyle questions were compared using a Wilcoxon rank-sum test.

Results:
Students with more educated parents reported eating more fruits and vegetables per day, exercising more frequently, and spending less time in front of a screen. The more educated group were more likely to eat breakfast (0.70 vs. 0.53 on a 0-3 scale p<.0001), less likely to eat school lunch (1.11 vs 1.39 on a 0-2 scale; p<.0001), and less likely to have a TV in their bedroom (0.53 vs. 0.70 on a 0-1 scale; p<.0001).

Conclusions:
It was observed that students with more educated parents made healthier dietary choices, exercised more often, spent less time in front of screens, and participated more often in other healthy lifestyle choices. These observations may be partially attributed to higher income levels in more educated parents, which may increase students’ access to healthier resources; however, this study certainly highlights the importance of parental influence on a child’s health. Future efforts will encourage more parental involvement in Project Healthy Schools.
Abstract 212: Integration of Multiple Cardiac Biomarkers into a Disease-Specific Score: Relationship to Clinical Status and Therapeutic Intensity
Authors: Munkres Alyssa G , Vasudevan Anupama , Shin Hyun J , Sarmast Syed A , McCullough Peter A
Published: March 2022

Introduction:
The 2013 American College of Cardiology/American Heart Association postulated four blood biomarkers as key parameters in the risk-stratification and management of heart failure (HF). These four markers, troponin I or T, B-type natriuretic peptide or N-terminal BNP, galectin-3, and ST2, each reflect different aspects of myocardial pathophysiology in HF. We propose a novel method of integration of biomarkers which are summarized into a Modified Myocardial Injury Summary Score (MMISS) to serve as an individualized biomarker-based index of HF severity.

Methods:
For each patient, biomarkers were used to calculate the MMISS (Σ log10 [Biomarker(i)measured / Biomarker(i)ULN]/n, i=1). Pharmacologic regimen recorded at the time of biomarker draw was assimilated into a Therapeutic Intensity Index (TTI) based upon dosing of pertinent HF drug classes. A univariate analysis was performed to determine the relationship between MMISS and TII among patients included in this cross sectional study.

Results:
Of the 39 patients included in the study, 61.9% were male with a mean age of 60.5 ± 10.5. A total of 13(33.3%), 22(56.4%), and 4(10.3%) patients were classified as NYHA FC 2, 3, and 4, respectively. The etiology of HF was ischemic cardiomyopathy in 51% of patients. In creating the MMISS, 24(61.5%), 2(5.1%), and 13(33.3%) patients had two, three, and four biomarkers available, respectively. Through our analysis, we found the MMISS (range -0.76 to +1.08) to have no association with TII (R= -0.23, p=0.15).

Conclusions:
There is no significant correlation between the intensity of medical management and myocardial disease severity as reflected by cardiac biomarkers measured at a single time in cross-section. Our findings suggest there may be an opportunity to tailor therapy to the severity of disease as indicated by blood biomarkers. We plan to use our observation as basis for a randomized trial that leverages measured changes in MMISS to guide personalization of medical therapy.
Abstract 229: Patients’ Undergoing Cardiac Catheterization May Not Have Adequate Knowledge to Make Informed Decisions About Treatment
Authors: Lin Grace , Aguilar Thomas , Ponce Anita , Dean Mitzi , Dudley R. Adams
Published: March 2022

Objective:
To be able to fully participate in a shared decision-making process, patients should be sufficiently knowledgeable about the risks and benefits of all available options, such that they can state informed preferences for care. Our objective was to assess knowledge about treatment options for coronary artery disease (CAD) and factors that are associated with a greater knowledge level about treatment.

Methods:
Cross-sectional survey of patients from four hospitals who were referred for cardiac catheterization for evaluation for CAD. The survey included 9 questions asking basic knowledge about the treatment options, 15 questions assessing decision-making processes (discussion of risks and benefits of treatment, preferred method of decision-making, and treatment preferences), demographics, and medical history. Knowledge was measured as the number of correct responses to the 9 questions about CAD treatment. Factors associated with a greater amount of knowledge were determined using multivariate linear regression.

Results:
One hundred forty-seven patients were surveyed around the time of cardiac catheterization with or without PCI. The sample had a mean age of 62 ±11 years, was 64% (94 of 147) male, 70% white (103 of 147), and 64% (94 of 147) had education beyond high school. Twenty-nine percent (43 of 147) of patients had prior myocardial infarction, 44% (64 of 147) had prior PCI, and 18% (26 of 147) had prior bypass surgery. The majority of patients (81%, 119 of 147) stated a preference for shared decision-making; however, when asked about their preferred treatment option, 46% (67 of 147) of patients indicated either that they were not sure what treatment they would choose or wanted their doctor to decide.

The mean knowledge score was 5.0 ± 1.5 (range 1-8). In a multivariate linear regression model, white race (p=0.005), higher educational level (p<0.001), preference for shared decision-making (p=0.02), and a more robust discussion about treatment risks (p=0.047) were associated with a higher knowledge score. Age, sex, and prior cardiac history were not associated with knowledge level.

Conclusions:
Patients making decisions about CAD treatment may not have enough knowledge to make an informed decision, resulting in a substantial number of patients who were not sure which treatment they preferred. This may in part be due to incomplete discussions, particularly about treatment risks. Interventions to ensure more complete counseling, particularly for non-white and less educated patients, and encourage shared decision-making may improve patients’ ability to make informed decisions about treatment.