bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P19: Stroke Self-Management: Outcomes of a Randomized Controlled Pilot
Authors: Damush Teresa M , Ofner Susan , Yu Zhangsheng , Nicholas Gloria , Plue Laurie , Williams Linda S
Published: March 2022

Background:
Secondary stroke prevention is championed as guideline care; yet there are no systematic programs offered in the Veterans Health Administration (VHA). Moreover, from our preliminary work, stroke survivors are often left alone to cope with the psychosocial aftermath of recovery. We developed a stroke self-management program to address these gaps.

Objectives:
The purpose of this study was to pilot test a stroke self-management program on stroke specific, quality of life, depression, self-efficacy and risk factor management.

Methods:
We conducted a randomized controlled trial at two VA sites where we recruited patients with an acute stroke to receive either the stroke self-management program or an attention-control protocol over a 12-week period following hospital discharge. Participants received 6 sessions targeting primary outcomes of stroke self management including post stroke depression, fears of injury, secondary stroke risk factor management, and secondary outcomes of self-efficacy, and communication with providers using social learning theory as a framework. We surveyed outcomes at baseline and at 3 months. We conducted an intention to treat analysis comparing the intervention to the control group on outcomes using t-tests.

Results:
We recruited 62 participants (33 control and 29 intervention) who were hospitalized with a primary diagnosis of ischemic stroke. The sample was 21.3% African-American and 69.8% White and all but 1 (1.6%) were men. We found trends in differences between groups on self-efficacy to exercise regularly (p<.07) and communicate with physicians (p<.04); minutes spent stretching (p<.09) and aerobic activity (p<.10) and on dimensions of stroke-specific quality of life (changes in family roles (p<.05), social roles (p<.03), work roles (p<.02) and thinking (p<.03)) and changes in social support (p<.05) and overall stroke quality of life (p<.07).

Conclusion:
This pilot study demonstrated the feasibility of delivering a stroke self-management program to recent stroke survivors. As a next step, we plan to test in a larger scale randomized controlled trial after incorporating lessons learned from this pilot study.
Abstract P199: Prevalence of Appropriate Patients for Cardiac Radionuclide Imaging (RNI) Who Are Not Referred for the Procedure
Authors: Khalid Adnan , Al-Amoodi Mohammad , Patil Harshal , Bhatti Salman K , Spertus John A , William Daniiel
Published: March 2022

Background:
Concern regarding the growth of RNI led to the creation of Appropriate Use Criteria (AUC) as a foundation for evaluating potential overuse. No data exist surrounding the proportion of patients who would be considered appropriate for RNI, but who are not referred for the procedure.

Methods:
We reviewed charts of 997 randomly selected patients, regardless of their medical history, seen in the outpatient setting of a single-specialty cardiology group from January to July 2008. Records were reviewed by physicians who were trained to abstract all relevant information to assign an AUC Class; including prior revascularization, recent MI, risk factors, functional capacity, chest pain, anginal control, symptoms and Framingham Risk score. The 2009 Update to the SPECT AUC were used to systematically assign each patient an indication for SPECT of Inappropriate (I), Uncertain (U) or Appropriate (A). Descriptive statistics were calculated to describe the prevalence of AUC ratings.

Results:
Of the 997 subjects included, 268 were referred for cardiac RNI and 729 (73%) patients were not. Baseline characteristics of those who were not referred for RNI are reviewed in the
table
. Among those not referred, 28% (206/729) would have been A, 13% (93/729) U, 42% (308/729) I and 17% (124/729) had insufficient information to classify.

Conclusions:
While there are important concerns of RNI overuse, more than 1 in 4 patients not referred for RNI would have meet the AUC criteria for being an appropriate indication. Whether avoiding testing in this group represents judicious use of expensive resources, or these patients outcomes are worse than comparable patients referred for RNI requires follow up and additional research.

Baseline demographics of subjects not undergoing RNI (n= 729)

Age; years (mean±SD)

64 ±16

Male

419(57%)

Prior Revascularization

253 (35%)

CABG>5 yrs

59 (8%)

CABG<5 yrs

28 (4%)

PCI>2 yrs

112 (15%)

PCI<2 yrs

54 (7%)

DM

104 (14%)

Framingham Risk Score (FRS)

Moderate risk

97 (13%)

Low risk

229 (31%)

Data not available

386 (39%)

CHD High Risk (DM or high FRS)

119 (16%)

Chest Pain

23 (3%)

Anginal equivalent

Present

160 (22%)

Absent

409 (56%)

Data not available

160 (22%)

Symptoms

Absent

371 (51%)

Present

196 (27%)

Data not available

162 (22%)

Functional capacity

Good

457 (63%)

Poor

113 (15%)

Data not available

161 (22%)
Abstract P211: Cumulative Exposure to Depressive Symptoms and Inflammation in Patients With Coronary Heart Disease: Findings From the Heart and Soul Study
Authors: Duivis Hester E , de Jonge Peter , Penninx Brenda W , Na Beeya , Whooley Mary A
Published: March 2022

Background:
Depression has been associated with inflammation in patients with coronary heart disease (CHD). However, it is unknown whether greater cumulative exposure to depressive symptoms predicts even higher levels of inflammation.

Methods:
We evaluated 667 outpatients with CHD who were followed for 5 years. Depressive symptoms were assessed annually using the 9-item Patient Health Questionnaire, and we used the standard cutpoint of >=10 to define depressive symptoms. After 5 years of follow-up, blood samples were collected to measure inflammatory biomarkers (fibrinogen, interleukin 6, high sensitivity C-reactive protein, and white blood cell count).

Results:
Of the 667 participants, 138 (21%) had depressive symptoms at 2 or more annual interviews, 86 (13%) had depressive symptoms at 1 interview, and 443 (66%) had no depressive symptoms at any interview. Participants with depressive symptoms at 2 or more assessments had higher mean levels of inflammatory markers than those with depressive symptoms at 1 assessment or no assessment (
Table
). These associations were similar after adjustment for age, gender, education, race, history of diabetes, MI, CHF and aspirin use. However, they were largely eliminated after adjustment for physical inactivity, smoking and body mass index.

Conclusion:
Greater cumulative exposure to depressive symptoms predicts higher levels of inflammation in patients with CHD. This association is mostly explained by lifestyle factors.

Table.

Mean ± SE levels of inflammatory markers by exposure to depressive symptoms.

Inflammatory marker
No depressive symptoms at any interview N=443
Depressive symptoms at one interview N=86
Depressive symptoms at 2 or more interviews N=138

p
value

Log interleukin 6

1.19±0.66
1.19±0.71
1.38±0.71
0.01

Log hsCRP

0.34±1.14
0.58±1.30
0.70±1.30
0.006

Fibrinogen

371.3±78.7
370.3±86.6
390.7±102.0
0.06

White blood count

6.49±1.91
6.54±2.04
7.32±2.49
0.0002
Abstract P218: Changing National Trends in the Use of Drug-Eluting Stents in Australian Private Hospitals: Balance at last?
Authors: Eccleston David , Rafter Tony , Worthley Stephen , Sage Peter , Holt Geoff , Horrigan Mark ,   for the Heart Care Group Investigators
Published: March 2022

Background:
Drug-eluting stent (DES) use in Australian private hospitals enjoyed initial enthusiasm due to their effectiveness in reducing restenosis, followed by a reduction in use following reports of late DES thrombosis (LST) in 2006. We aimed to assess the current utilisation of DES in private hospitals across the nation to assess whether further data clarifying a low rate of DES thrombosis as well as intense scrutiny of the literature regarding the benefits of DES have altered DES usage.

Methods:
We compared quarterly DES use as a percentage of the total number of stents deployed between June to September 2006 (n=1179), October 2007 to January 2008 (n=1179) and November 2009 to February 2010 (n=951) across six Australian private hospitals. Fisher's exact test (2 tailed) and Chi-square were used to assess the data for significant change.

Results:

Interval
P value

June-Sep 06
Oct 07-Jan 08
Nov 08-Feb 10

% DES use

81.1
*

69.8

64.8
*

<0.0001
*

69.8
64.8
0.20

*

p for 2006 vs. 2008-10

Conclusion:
The initial enthusiasm for DES was tempered by concerns regarding possible late stent thrombosis. DES use has not increased again despite further data demonstrating low rates of LST, and the emergence of newer DES platforms. DES usage may have plateaued due to clearer recognition of the most appropriate balance between risk and benefit.
Abstract P22: Neighborhood Disadvantage and Stroke
Authors: Brown Arleen F , Liang Li-Jung , Vassar Stefanie , Merkin Sharon S , Longstreth W. T , Ovbiagele Bruce , Yan Tingjian , Escarce Jose
Published: March 2022

Background:
The spatial and social separation of poorer persons and racial/ethnic minorities into disadvantaged communities may contribute to stroke disparities, but the mechanisms are not well understood.

Methods:
We used data from the Cardiovascular Health Study, a multicenter, population-based, longitudinal study of adults ≥65 years. The dependent variable was incident ischemic stroke. Residential neighborhood disadvantage was measured using a composite of six census tract variables representing income, education, employment, and wealth. Race-stratified multilevel Cox proportional hazard models were constructed, adjusted for sociodemographic characteristics (age, gender, education, and income), behavioral risk factors (smoking, physical activity, and alcohol use), and biologic risk factors (EKG abnormalities, subclinical cardiovascular disease, or a diagnosis of hypertension, diabetes, and hyperlipidemia).

Results:
Among the 4619 participants with no prior stroke, 650 had an ischemic stroke over a mean 11.5 years of follow up. In models adjust for sociodemographic characteristics, stroke hazard among whites was significantly higher among residents of neighborhoods in the lowest SES quartile relative to those in the highest quartile (Hazard Ratio=1.32; 95% CI 1.01-1.72), but not after adjustment for behavioral risk factors (HR=1.30; 0.99-1.70) or biologic risk factors (HR=1.16; 0.88-1.52). Among African Americans, there was no association between neighborhood disadvantage and stroke.

Conclusions:
We found shorter time to first ischemic stroke in the most disadvantaged neighborhoods among whites, but not among African Americans. Neighborhood disadvantage appears to influence stroke hazard through higher levels of biologic risk in low income neighborhoods.

Incident Ischemic Stroke Hazard Ratios (P), Cardiovascular Health Study

Unadjusted HR
(P)

Model 1 (Adj. for age, sex, income, education)
Model 2 (Model 1 + Behavioral Risk Factors)
Model 3 (Model 2 + Biologic Risk Factors)

Whites (N=3834)

Quartile 1
1.00
1.00
1.00
1.00

Quartile 2
1.34 (0.02)
1.27 (0.07)
1.27 (0.07)
1.21 (0.14)

Quartile 3
1.43 (0.005)
1.27 (0.07)
1.26 (0.08)
1.16 (0.26)

Quartile 4 (Most disadvantaged neighborhood)
1.56 (<0.001)
1.32 (0.04)
1.30 (0.06)
1.15 (0.32)
Abstract P235: The Impact of Coronary Computed Tomography Angiography on Near-Term Resource Utilization in Patients With Prior Stress Tests
Authors: Al-Mallah Mouaz H , Swadia Tanmay , Khawaja Owais , Abdul-Nour Khaled , Pantelic Milan
Published: March 2022

Objectives:
Coronary Computed Tomography Angiography (CCTA) has emerged as a new tool for non-invasive detection of coronary artery disease (CAD). However, its impact on near term downstream resource utilization is not known. The aim of this study is to determine the impact of CCTA on near term post resource utilization in patients with recent prior stress tests (<one year).

Methods:
The study population consisted of 454 consecutive patients at a single tertiary care center who underwent CCTA between 1/2006 and 6/2009. Patients were followed up for six months to determine the rate of hospitalization, emergency room visit, coronary angiography, revascularization and additional stress testing.

Results:
Of the 454 patients included, 33%, 58% and 10% had normal, abnormal and equivocal stress test respectively. There was no difference in the prevalence of obstructive CAD among patients with normal or abnormal stress tests (figure). Normal CCTA were associated with low resource utilization. To establish the diagnosis of CAD, a CCTA-based approach to abnormal or equivocal stress test was associated with a cost saving of $579 per patient compared to a coronary angiography based approach.

Conclusions:
Our data suggest that a normal CCTA after stress testing is associated with very low rate of subsequent resource utilization.

Six Months Resource Utilization in Patients with Prior Stress Test

No Coronary Artery Disease N=183
Non Obstructive Coronary Artery Disease N=186
Obstructive Coronary Artery Disease N=85
P value

Emergency visits
15 (8.2%)
14 (7.5%)
10 (11.8%)
0.50

Cardiac Hospitalizations
2 (1.1%)
3 (1.6%)
15 (17.7%)
<0.0001

Stress tests
8 (4.4%)
6 (3.2%)
11 (12.9%)
0.0034

Cardiac Catheterization
2 (1.1%)
9 (4.8%)
41 (48%)
<0.0001

Revascularization
0
0
19 (4%)
<0.0001

Any Resource Utilization
24 (13%)
28 (15.1%)
50 (58.8%)
<0.001
Abstract P24: Ethnic Disparities in Acute Stroke Care in New York State
Authors: Gropen Toby I , Magdon-Ismail Zainab , Colello Anna
Published: March 2022

Background:
There is a greater burden of disease, mortality, and severity of strokes for Blacks and other ethnic minorities. Evidence for disparities in acute stroke care is less conclusive. Our goal was to assess whether significant ethnic disparities in acute stroke care exist in New York State (NYS).

Methods:
NYS Statewide Planning and Research Cooperative System (SPARCS) data was used to identify all patients from NYS with a principal diagnosis of acute ischemic stroke (AIS, ICD-9 Diagnosis code of 433.01, 433.11, 433.21, 433.31, 433.91, 434.01, 434.11, or 434.91) from 1-1-2007 through 12-31-2008. Data were analyzed by chi square with respect to race/ethnicity (White, Black, or Hispanic), discharge from a NYS designated Primary Stroke Center (PSC), and use of intravenous t-PA.
Get With The Guidelines
preliminary data was used to examine the relationship between ethnicity and percent of AIS patients arriving < 2 hours, and percent arriving < 2 hours who were eligible for t-PA for whom t-PA was initiated < 3 hours.

Results:
There were 47,037 patients with AIS, including 28,628 Whites, 4,166 Hispanics, and 9,001 Blacks. Whites were treated at PSCs 75% (21,489 of 28,628) of the time, compared to 91% (3,786 of 4,166) of Hispanics (p < 0.0001) and 85% (7,620 of 9,001) of Blacks (p < 0.0001). Overall, 4.7% (1,737 of 37,162) of AIS patients at PSCs were treated with t-PA compared to 1.4% (143 of 9,875) of patients treated elsewhere (p < 0.0001). Whites at PSCs received t-PA 5.2% (1,119 of 21,489) of the time, compared to 4.2% (160 of 3,786) of Hispanics (p = 0.01 vs. Whites), and 3.5% (267 of 7,620) of Blacks (p < 0.0001 vs. Whites). Whites arrived within 2 hours 48% (5,762 of 12,016) of the time, compared to 45% (815 of 1,792) of Hispanics (p < 0.001) and 44% (1,096 of 2,479) of Blacks (p <0.001). Eligible White patients were treated with t-PA 71% (864 of 1,216) of the time, compared to 70% (133 of 191) of Hispanics (p = NS) and 62% (164 of 265) of Blacks (p = 0.03).

Conclusions:
Access to care does not guarantee utilization, particularly for Blacks. Black and Hispanic AIS patients were more often treated at PSCs compared to Whites. Yet, a lower percent of Blacks and Hispanics were treated with t-PA, reflecting both lower rates of timely hospital arrival and less frequent treatment of eligible patients.
Abstract P262: Evaluating the Nationwide Implementation of the VA Cardiovascular Assessment, Reporting, and Tracking System for Cath Labs (CART)
Authors: Box Tamara L , McDonell Mary , Gethoffer Hans , Helfrich Christian D , Fihn Stephan D , Jesse Robert L , Rumsfeld John S
Published: March 2022

BACKGROUND
CART is a clinical software application that is integrated in the VA's electronic health record (EHR) and supports a national data repository and quality improvement program. From 2004-2009, CART was developed and implemented in the 77 VA cath labs. The goal of this project was to measure variations in implementation of CART across VA cath labs, and identify facilitators and barriers to successful implementation.

METHODS
The rate and degree of implementation of CART, from first contact with a site through technical installation and then clinical adoption, was assessed via the CART tracking database and by comparing procedure entries in CART with site case logs at three time points. Clinical adoption by site was described at each time as full (>90% concordance), partial (1-90%), or none (0%). To assess facilitators and barriers, we surveyed clinical champions at each of the sites using a structured, web-based survey.

RESULTS
Between June, 2004-May, 2007, 59 sites (77%) had either fully or partially adopted CART; by April, 2009, 74 sites (96%) had fully (71%; 52) or partially adopted (29%; 21) CART. Technical installation took a median of 3 ± 4.2 months, while the time to clinical adoption, defined as the time from installation completion to active use, took a median of 1 ± 7.6 months.

Survey responses were obtained from 64 sites (83% of sites). Sites felt integration of CART within the VA EHR was extremely important (74%; 47). The majority agreed that CART would improve current processes (80%; 51). The majority also believed CART was strategically important to VA quality improvement (76%; 49). Among the top facilitators noted were CART's integration within the VA EHR, future research potential using CART, and the desire to improve quality. Respondents cited contentment with current processes, concern regarding staff resources, and lack of interfacing with proprietary hemodynamic systems as top barriers.

CONCLUSIONS
CART represents a successful nationwide health IT implementation. Throughout the process, however, success was dependent on a balance of clinical and technical priorities. The variation in implementation and the strategies learned through this process may be applicable to other health IT implementation projects.
Abstract P294: Transport Time Out for Cardiovascular Intensive Care Unit Patients Traveling off of the Unit
Authors: Boord Jeffrey B , Symlar Rochelle , Cunningham Brittany L , McPherson John , Burns Kathleen , Byrd Jeannie
Published: March 2022

Background:
Transportation of critically ill patients to other areas for diagnostic testing or procedures can present risks to patient safety. It is necessary to ensure that the same level of care and support be provided for critically ill patients when they are removed from the ICU environment. There were no established processes available in the literature to address this safety issue.

Aim:
To establish a “transport time out” checklist process for transport of critically ill patients outside of the ICU environment. This process ensures that patient care and monitoring continues at the level deemed necessary by patient condition without interruption.

Methods:
A multidisciplinary team of nurses, physicians, and respiratory therapists created an algorithm to ensure that crucial care elements were considered prior to leaving the ICU environment with a critically ill patient. Elements were categorized in the “Airway, Breathing, Circulation, Drugs (ABCD)” format. Tools developed included a flowchart and transport time out check list (Figure).

Results:
The checklist outlines essential equipment and supplies for respiratory care, intravenous infusions, and clinical monitoring. The process has been in use for over 9 months encompassing approximately 330 patient transports. The process was rapidly and widely accepted by nursing staff. No adverse events during transport have occurred since implementation of the transport time out process.

Conclusion:
Use of a “transport time out” checklist process potentially can decrease the likelihood of adverse events during transport of a critically ill patient from the ICU. The process was simple and easy to implement.
Abstract P301: Are Variations in Delivery of Guideline Recommended Therapies by Cardiology Practices Reduced After Implementation of a Performance Improvement Initiative? Findings From IMPROVE HF
Authors: Fonarow Gregg C , Albert Nancy M , Curtis Anne B , Gheorghiade Mihai , Heywood J. Thomas , McBride Mark L , Johnson Inge Patches , Mehra Mandeep R , O'Connor Christopher M , Reynolds Dwight , Walsh Mary N , Yancy Clyde W
Published: March 2022

Background:
Variations between outpatient cardiology practices in adherence to guideline-recommended therapies for heart failure (HF) have previously been described. The effect of performance improvement initiatives on reducing these variations has not been evaluated.

Methods:
IMPROVE HF is a prospective evaluation of a practice-based, performance improvement intervention implemented at cardiology practices to increase use of evidence-based, guideline-recommended care for eligible outpatients with systolic HF or post-myocardial infarction LVSD. Variations in use of 7 individual and 2 summary care measures were assessed by comparing the 10
th
and 90
th
percentiles, the inter-decile differences, and variance for each measure at baseline (pre-intervention) and 24 months post-intervention.

Results:
A total of 15,177 patients followed in 155 of 167 practices were available for analysis. Substantial variations for all care measures were evident at baseline with inter-decile differences ranging from 23.6% for β-blockers to 81.3% for CRT-P/CRT-D. The 24-month evaluation revealed significant improvements in adherence to 6 of 7 specific measures, the composite, and all-or-none care measures. However, large care variations persisted among practices with interdecile differences at 24 months ranging from 16.2% to 75.0%. No measure demonstrated significantly reduced variation at 24 months compared to baseline.

Conclusions:
Implementation of a practice-based performance improvement initiative resulted in substantial improvement in adherence to guideline-recommended therapies for HF. However, wide variations in provision of evidence-based care persisted among cardiology practices. Additional targeted interventions may be necessary to reduce variations in use of guideline-recommended HF therapies in outpatient cardiology practices.
Abstract P302: Improvement of Quality of Life and Socioeconomic Parameters After Ablation is Equal in Patients With Paroxysmal and Persistent Atrial Fibrillation
Authors: Bulkova Veronika , Fiala Martin , Wichterle Dan , Chovancik Jan , Simek Jan , Havranek Stepan , Brada Jiri , Tolaszova Hana , Pindor Jakub
Published: March 2022

Background:
Because patients with persistent atrial fibrillation (AF) are perceived to have more ‘stable’ symptoms, it is unclear if their long-term resource use and health status improves after treatment with radiofrequency catheter ablation (RFA).

Methods:
In a large, multicentre-study, prospective cohort of 472 consecutive patients undergoing RFA, we examined the success rate, resource use, and quality of life (QoL) of patients with paroxysmal and persistent AF at baseline and 18 months after RFA. QoL was assessed using the EQ-5D questionnaire.

Results:
The mean age of the study cohort was 57+9 years, of which 126 (27%) were female. Of 472 patients, 314 patients (66.5%; mean age 57+10 years) had paroxysmal AF and 158 (33.5%; mean age 58+9 years) had persistent AF. Patients with paroxsymal AF reported more frequent acute symptoms (palpitations [82 vs. 43%; P<0.001], chest discomfort [16 vs. 8%, P<0.001], syncope [8 vs. 2% P<0.001] and presyncope [14 vs. 5%; P=<0.001], while patients with persistent AF reported more frequent chronic symptoms (incapacity [44% vs. 78%; p<0.001], dyspnea [52% vs. 81%; P<0.001] and fatigue [53 vs. 62%; P=0.6]). Compared to their baseline, patients with paroxysmal AF at the 18-month follow-up reported fewer days in the hospital per year (2.6 vs. 0.7; P<0.001), days off from work per year (9.6 vs. 1.5; P<0.001), and need for repeat cardioversions per patient (0.4 vs. 0.2; P=0.01), as well as improved subjective QoL (67% vs. 76%; P<0.001) and objective QoL (71% vs. 79%; P<0.001). Similarly, compared to their baseline, patients with persistent AF at the 18-month follow-up reported fewer days in the hospital per year (1.9 vs. 1.0 P=0.01), days off from work per year (19.9 vs. 5.3; P<0.001), and need for repeat cardioversions per patient (0.7 vs. 0.3; P=0.01), as well as improved subjective QoL (63% vs. 76%; P<0.001) and objective QoL (69% vs. 77%; P<0.001). There was no difference in AF recurrences between patients with paroxsymal (28%) and persistent (32%; P=0.55) AF at follow-up.

Conclusion:
Pts with persistent AF experienced had lower resource use and improved QoL after RFA. Our findings suggest that the benefits of RFA persist beyond 1 year in patients with both paroxysmal and persistent AF. The work was supported by grant IGA MZ NS10261-3/2009
Abstract P339: Benefits of Achieving Optimal Risk Factor Levels for the Primary Prevention of Cardiovascular Disease in Elderly Men
Authors: Robinson Jennifer G , Rahilly-Tierney Catherine , Lawler Elizabeth , Gaziano J M
Published: March 2022

Context:
Most cardiovascular disease (CVD) occurs after age 65. The additive benefits of aggressive risk factor management with advancing age are not well established.

Objective:
Evaluate the relationship between the intensity of control of 4 modifiable risk factors [smoking, non-high density lipoprotein cholesterol (non-HDL-C), blood pressure, and aspirin use] and the risk of CVD in a primary prevention population of men ≥65 years.

Methods:
The study population was comprised of 4203 U.S. male physicians from the Physicians' Health Study who in 1997 were aged ≥65 years, free of CVD and diabetes, and had lipids available. The primary endpoint was first of any CVD event, defined as cardiovascular death, non-fatal myocardial infarction, angina, coronary revascularization, non-fatal stroke, transient ischemic attack, carotid artery surgery, and other peripheral vascular disease surgery. Age and risk factor adjusted Cox proportional hazard models were adjusted for competing causes of death.

Results:
Mean age was 73 years and 96% were nonsmokers; 28% experienced a CVD event during the mean 9 year follow-up. Few had optimal levels of all 4 modifiable risk factors (6%): 18% had an untreated non-HDL-C<130 mg/dl; 54% had an untreated blood pressure <140/90 mm Hg; and 51% used aspirin; <1% had none of the 4 risk factors controlled. Compared to when all 4 risk factors were controlled (6%), CVD risk increased by 55% when 3 of 4 risk factors (36%) were controlled (event rate 25%; HR 1.55, 95% CI 1.08-2.22), 75% when 2 of 4 risk factors (44%) were controlled (event rate 28%; HR 1.74, 95% CI 1.22-2.49), and more than doubled when 1 of 4 risk factors (14%) were controlled (event rate 35%; HR 2.29, 95% CI 1.57-3.34); p for trend p=0.0002. The number-needed to control to prevent one CVD event over 9 years ranged from 4 to 11 depending on the number of risk factors controlled.

Conclusion:
In elderly men, not smoking, control of non-HDL-C and blood pressure, and aspirin use conferred substantial protection against incident CVD events. Nonetheless, the CVD event remained high even in those with well-controlled risk factors ≥65, emphasizing the need for optimal risk factor control throughout adulthood.
Abstract P64: The Safety and Efficacy of Anticoagulation for Atrial Fibrillation in Patients With Severe Sepsis in the Medical Intensive Care Unit
Authors: Darwish Omar S , Strube Sarah , Phan Andrew , Tanios Maged
Published: March 2022

Introduction:
Atrial fibrillation is a common comorbid condition in patients with severe sepsis admitted to the medical intensive care unit (ICU). While anticoagulation is indicated for moderate to high-risk patients with non-valvular atrial fibrillation (AF) to reduce risk of thromboembolic complications, its benefit in critically ill patients has not been determined. We conducted a study to assess the safety and efficacy of anticoagulation in AF patients with severe sepsis.

Methods:
A retrospective chart review of 115 patients with AF admitted from February 2004 to February 2009 with a primary diagnosis of sepsis to a teaching community-based hospital was conducted. Medical records were reviewed to confirm AF, determine stroke risk factors (CHAD2) and documented contraindications for anticoagulation. The primary endpoints included stroke and anticoagulation-related bleeding complications before hospital discharge.

Results:
Amongst 115 patients (mean age 81yrs ± 9.5 and CHAD2 3.17 ± 1.20), the majority of patients 71.3% (82/115) did not receive anticoagulation with a supratherapeutic admission INR>3 being the most common reason for withholding anticoagulation. None of the patients in the non-anticoagulated group developed any embolic events. There was no difference between the anticoagulated and the non-anticoagulated groups in the ICU and hospital length of stay 8.6 days ± 9.1 and 13.6 ± 11.3 vs 7.0 ± 6.7 and 15.6 ± 10.6. Anticoagulation-related complications occurred more often in the anticoagulation group (9.1% [3/33] vs 0%, p = 0.006): these included a nonfatal gastrointestinal bleed (1/33), fatal CNS hemorrhage (1/33), and heparin-induced thrombocytopenia (1/33). In addition, a majority of the patients who received anticoagulation had a therapeutic range achieved in less than 50% of their ICU stay. The two groups had similar hospital survival (64.6% [53/82] for the non-anticoagulated group vs 78.8% [26/33] in the anticoagulated group, p= 0.14).

Conclusion:
The risk of thromboembolic complications from AF in patients with severe sepsis is exceedingly low and prophylaxis anticoagulation is not warranted. Moreover, a safe anticoagulation range in septic patients is difficult to achieve and is associated with increased risk of bleeding.
Abstract P66: Factors Associated With Treatment With Antihyperlipidemic Agents in Patients With Cardiovascular Disease: Evidence From the National Health and Nutrition Examination Survey (NHANES)
Authors: Sarsour Khaled , Nelson David R , Ward Sarah , Mc Collam Patrick , Johnston Jospeh A
Published: March 2022

Background
Despite widespread acceptance of NCEP guidelines, the extent of treatment of hyperlipidemia in patients with cardiovascular disease (CVD) remains poor. This analysis investigated factors associated with treatment with antihyperlipidemic agents in a US representative cohort of patients with evidence of CVD.

Methods
We used the 2005-2006 NHANES to explore the research question of interest. Self reports of physician diagnosis indicating the presence of coronary heart disease, myocardial infarction, angina, congestive heart failure, or stroke served as evidence of established CVD. We used multivariate logistic regression to examine factors independently associated with current antihyperlipidemic treatment, maintaining factors in the final model if p<0.15.

Results
Nearly 50% of the 561 subjects with established CVD were not taking any antihyperlipidemic agents. Compared with those not receiving treatment, greater percentage of those treated were male (58.8% vs. 42.2%), non-Hispanic whites (84.8% vs. 71.7%), aged 55-74 (56.3% vs. 30.4%), holders of private insurance (57.3% vs. 52.2%), Medicare insured (65.8% vs. 50.5%), and obese (47.4% vs. 39.4%). Greater percentage of untreated patients was African American (15.1% vs. 10.4%), had a break in their health insurance coverage in past 12 months (21.9% vs. 7.0%) & was current smoker (29.4% vs. 15.2%). In multivariate results, the following factors remained significantly associated (OR [95%CI]) with treatment: male gender (1.89 [1.06 -3.39]), White race (2.45 [1.53 - 3.95]), older age (P < 0.0001), high school education compared with less than 9
th
grade education (2.53 [1.35 - 4.71]), and anti-diabetic treatment (3.31 [2.20 - 4.99]).

Conclusion
Treatment with antihyperlipidemic agents in patients with CVD are related to individual (behavioral) and contextual (institutional, structural) factors. Further investigation is required to understand unmeasured factors associated with treatment initiation and to develop and test appropriate behavioral and contextual interventions to remove barriers to treatment initiation. Younger age groups, women, individuals with education < 9
th
grade and racial/ethnic minorities who have CVD should especially be the target of such intervention.
Abstract 7: Appropriateness of Percutaneous Coronary Interventions in Washington State
Authors: Bradley Steven M , Maynard Charles , Bryson Chris L
Published: March 2022

Background.
The use of percutaneous coronary intervention (PCI) has increased dramatically in the past decade despite uncertainty regarding the appropriateness of these procedures. Methods. Within the Clinical Outcomes Assessment Program (COAP), a quality-improvement initiative that captures all revascularization procedures performed in Washington State, we assessed the appropriateness of PCI performed between June 2009 and September 2010 in accordance with published Appropriate Use Criteria. We report the appropriateness of PCI stratified by acute (acute myocardial infarction or unstable angina with high-risk features) or non-acute (stable angina) coronary presentation.

Results.
Of 12,528 PCI performed during the study period, we successfully mapped the PCI indication to the Appropriate Use Criteria in 9,025 (72%) of cases. Of the 3,521 PCI not classified, common failures to map to the criteria included acute PCI of multiple lesions without evidence of shock (n=517, 14.7%), unstable angina without high-risk features (n=918, 26.1%), or non-acute PCI without preprocedural non-invasive stress results (n=2,049, 58.2%). Of mapped PCI, 7,031 (77.9%) were for acute indications with 6,921 (98.4%) rated as “appropriate”, 40 (0.6%) as “uncertain”, and 70 (1.0%) as “inappropriate”. Of 1,987 non-acute coronary presentations, 788 (39.7%) were rated as appropriate, 812 (40.9%) as uncertain, and 387 (19.5%) as inappropriate (Table). Assuming non-acute PCI with missing data on non-invasive stress test were performed in the setting of high-risk non-invasive stress testing, 387 (9.8%) PCI were inappropriate.

Conclusion.
In a complete cohort of PCI performed in Washington State, 1.0% of PCI for acute indications and 9.8% of PCI for non-acute indications were classified as inappropriate after assumptions to maximize appropriateness. These findings suggest an opportunity to improve the selection of patients undergoing PCI to maximize anticipated benefit.

TABLE 1

Appropriateness of PCI in Washington State

PCI Indication
Total Cases
Appropriateness Rating by Indication, n (%)

Appropriate
Uncertain
Inappropriate

All PCI
9018
7708 (85.4)
853 (9.5)
464 (4.7)

Acute presentation
7031
6921 (98.4)
40 (0.6)
70 (1.0)

Non-acute presentation
1987
788 (39.7)
812 (40.9)
387 (19.5)

Acute presentation includes STEMI, NSTEMI, and unstable angina with high risk features. Non-acute presentation is limited to stable angina.
Abstract P125: Correlation of Inflammatory Marker Burden with Progressive Increase in Short-Term Risk of Cardiovascular Disease
Authors: Panaich Sidakpal S , Rathod Ankit , Badheka Apurva , Sudhakar Rajeev , Jacob Sony , Afonso Luis
Published: March 2022

Background:
Newer inflammatory markers of atherosclerosis have been shown to correlate well with cardiac risk profiling.

Methods:
Multi-Ethnic study of Atherosclerosis (MESA) is a population based study (n=6814) of varying ethnicities, aged 44-84 years, free from clinical cardiovascular disease (CVD). We did a post-hoc analysis of the NHLBI Limited Access Dataset of MESA subjects between 44-50 years(n=1076), and stratified them into 3 risk groups- low 10-year (<10%)/low lifetime (<39%) risk, low 10-year (<10%)/high lifetime risk (>39%), and high 10-year risk (>10%) or diagnosed diabetes mellitus. C - reactive protein (CRP), fibrinogen, Interleukin 6 (Il-6) and plasmin-antiplasmin complex (PAC) levels were analyzed across the 3 groups. Further each quartile of a marker was assigned 1 point and a Mean inflammatory score was computed by adding total points for each patient in the risk groups. Age, sex and race adjusted regression co-efficients were estimated.

Results:
Mean age of the study group was 47±1.7 yrs, CRP-3.3±4.9 mg/L, IL-6-1.4±1.1 pg/ml, fibrinogen-324±69. Mean levels of CRP, fibrinogen, Il-6, PAC and mean inflammatory score increased progressively across the 3 risk groups. Adjusted regression co-efficients also demonstrated linear relationship with increasing risk hierarchy (Table 1).

Conclusions:
Burden of inflammatory markers increases progressively across risk groups- being the highest in those with high short term risk of cardiovascular disease.
Abstract P130: Cardiogenic Shock Complicating Acute Coronary Syndromes: The Global Registry of Acute Coronary Events
Authors: Awad Hamza H , FitzGerald Gordon , Anderson Frederick A , Gore Joel , Goldberg Robert J
Published: March 2022

Introduction:
Cardiogenic shock (CS) is the leading cause of death for patients with an acute coronary syndrome (ACS). Despite impressive advances in the management of ACS, the frequency of CS among patients hospitalized with an ACS has remained relatively constant over the past several decades, and mortality remains unduly high in these high risk patients.

Objectives:
To describe the characteristics, clinical management, and hospital outcomes of patients with an ACS complicated by CS. Our secondary objective was to describe decade long trends in the incidence and hospital case-fatality rates (CFRs) of CS, and predictors of increased hospital mortality in these patients.

Methods:
The study sample consisted of all patients enrolled in the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 with a confirmed ACS.

Results:
Of all patients with ACS enrolled in GRACE, 2,992 (4.6%) developed CS. Compared to patients who did not develop CS, patients with CS were more likely to be older (mean age 71 vs. 65 years), female, have a history of diabetes or heart failure, and present with an ST-segment elevation. Cardiac catheterization was performed in 1,706(57%) patients and in-hospital revascularization in 1,408(47%) patients with CS. Patients with CS were less likely to receive effective cardiac medications as ACE inhibitors, aspirin and β-blockers compared to patients who did not develop CS. The in-hospital CFR of patients with CS was 59.4% compared to 2.3% in those who did not develop CS. Hospital CFR was lower for patients who underwent revascularization compared with those in whom a conservative medical approach was adopted (45% vs. 72%). Factors associated with an increased risk of in-hospital death in CS patients included advanced age, history of diabetes mellitus, heart failure and renal insufficiency. Adjusted incidence rates of CS showed slight significant annual decline over the study period (OR= 0.97, CI= 0.95 - 0.98) as well as in hospital CFRs (OR= 0.94, CI= 0.90 - 0.99), while in-hospital revascularization rates increased annually (OR= 1.09, CI= 1.06 - 1.12).

Conclusion:
Despite the increasing use of evidence-based therapies, the overall hospital CFR of CS remains high (59%) and incidence showed only slight declines between 1999 and 2007.
Abstract P165: Is Knowledge Given, Knowledge Gained? American Heart Association Heart Failure Protocols and Educational Content within the Intel® Health Guide System
Authors: Albert Nancy M , Pĩna Ileana L , Fonarow Gregg C , Catha Gloria , Wayte Patrick , Plank Tracy , Bruckman David , Kikano George
Published: March 2022

Background:
The value of telemonitoring on improved knowledge about what heart failure (HF) means and HF self-care, and the association of this knowledge with rehospitalization is unknown.

Methods:
In a small pilot sample, change in HF knowledge and accuracy of beliefs about HF were examined before/after a 60-day monitoring period with the Intel Health Guide System (HGS), a remote patient (pt) monitoring system deployed with AHA HF protocols and pt education. Pts were self-selected and met home care services criteria. After HGS training, pts could assess educational content in scheduled sessions or independently. HF knowledge was assessed using a 20-item true/false HF knowledge test (score range =0-100%) and accuracy of HF beliefs was assessed using a 14-item survey; mean score ≥ 3.0 reflects accurate HF beliefs based on contemporary medical knowledge. Rehospitalization data were collected post monitoring.

Results:
Of 26 home-bound pts with HF, 62% NYHA Class II/ 29% Class III, mean age 75.2 ±10.1 years, 61.5% women and 39% African Americans. Baseline (n=25) and follow-up (n=22) HF knowledge scores were 74% ± 13% and 76% ± 11%; mean HF knowledge change was 0.032 (95% CI, -0.034, 0.097),
P
=0.32. Of knowledge survey items, 8 of 20 trended toward improved scores after HGS services; most notably, knowledge on thirst and drinking fluids score increased from 40.9% to 63.6% correct (
P
=0.095). Baseline and follow-up mean HF illness beliefs scores were 2.75 ± 0.33 and 2.95 ± 0.35, respectively; mean HF beliefs change, 0.208 (95% CI, 0.044, 0.372);
P
=0.015 (non-paired). Belief about HF being chronic vs. episodic trended up in score: 2.48 to 2.83 (
P
=0.056). In pts with HF beliefs above the group mean, there was a trend toward less rehospitalization for HF (0 vs. 4 HF rehospitalization,
P
=0.105). There were no differences in HF rehospitalization based on HF knowledge scores above and below the mean,
P
=1.00.

Conclusions:
In a small sample of home-bound pts recently hospitalized for HF, HF knowledge was moderately strong at baseline but HF beliefs were inaccurate. After using the HGS system, mean HF beliefs scores increased in accuracy. Further study in a larger sample is needed to learn the utility of HGS services on pt knowledge, beliefs, and their association with rehospitalization.

Funding(This research has received full or partial funding support from the American Heart Association, National Center)
Abstract P227: Prevalence of Microvascular-Related Complications Among Individuals with Diabetes Projected from National Health and Nutrition Examination Survey (NHANES), 2007-2008
Authors: Nair Radhika , Thakker Kamlesh M , Kelly Maureen T , Zachry Woodie M
Published: March 2022

Objectives:
To estimate prevalence of microvascular complications and microvascular-related clinical data points among individuals with diabetes using NHANES, 2007-2008

Methods:
This study was conducted using the 2007-2008 NHANES, a cross-sectional, multi-stage probability sample survey. The data is appropriately weighted to represent the US population. Individuals ≥18years of age who reported a history of diabetes during the interview, with BMI≤45 kg/m² and/or serum creatinine≤0.5mg/dL were selected. Descriptive analyses were used to estimate the prevalence of microvascular complications and average values of relevant microvascular-related clinical data points (e.g. eGFR, serum creatinine, fasting glucose, lipid values). Sub-analyses were conducted among individuals with a history of cardiovascular disease (CVD) or with ≥2 CVD risk factors (hypertension, dyslipidemia, smoking, obesity) to estimate prevalence of microvascular complications in this subgroup.

Results:
The prevalence of diabetes in the US in 2007-2008 was estimated to be 17.8MM (projected) of which 15.3MM adults (projected) met inclusion criteria of the study (Average age 58years +/−0.8, 53.9% Men, 66.0% White). A total of 16.8% reported retinopathy and 4.1% reported having weak/failing kidneys. Microalbuminaria and macroalbuminaria were detected in 35.2% and 10.1% of the individuals, respectively. Prevalence of microalbuminaria was higher while prevalence of macroalbuminaria and average eGFR were lower among those treated with a lipid-modifying therapy for >180days (N=6.6MM, 39.6%, 8.9%, 81.5ml/min/1.73 m
2
+/−2.3) compared to the untreated group (N=7.2MM, 29.2%, 13.1%, 94.4ml/min/1.73 m
2
+/−3.0). In the subgroup of patients with a history of CVD or with ≥2 CVD risk factors (13.5MM projected), 44.2% were not treated with lipid-modifying therapy. The differences between the treated and untreated groups in this sub-population were similar to the differences between the groups in the overall analyses.

Conclusions:
The prevalence of microvascular complications among individuals with diabetes was different when comparing those treated with lipid-modifying therapy vs. untreated. This may have implications for the assessment of cardiovascular risk.
Abstract P290: Role of Social Support in Heart Failure Readmissions
Authors: Djilan Yao , Neugaard Britta , Pierce Rebecca , Zoble Robert
Published: March 2022

Background:
Heart failure (HF) is a rising public health concern in the United States (US). Currently nearly 5 million people in the US have HF and nearly 1 in 5 patients with HF die within one year of diagnosis. Understanding patient characteristics and processes which influence HF readmissions will help to identify interventions to target patients at increased risk for re-admissions. Studies have shown that social support has improved patients’ adherence to medical treatment and their overall health outcomes. The purpose of this study was to evaluate the impact of social support on re-hospitalization after a prior HF hospitalization.

Methods:
This was a retrospective study conducted at a VA Medical Center on patients identified for HF with ICD-9 codes for HF (428.x) in 2008. Readmission during the year post-discharge was the outcome variable and the social support variables were: care giver status (non-relative, relative, and spouse) and living situation (alone, nursing home, other relative, and spouse). A logistic regression model was used to examine the association of social support on hospital readmission while adjusting for other co-morbidities and demographic factors at a significance level of 0.05.

Results:
The study sample contained 269 HF patients with a mean age of 72 (SD: 11.8), where 258 (96%) were male. After adjusting for age and smoking status, patients who had a relative or spouse as a care giver were less likely to be readmitted with respective OR of 0.29 (0.07 - 1.21) and 0.22 (0.05 - 0.99) compared to having a non-relative as care giver. In addition, the patients living in a nursing home were also less likely to be readmitted with an OR of 0.46 (0.11 - 1.88) compared to living alone.

Conclusion:
The associations between social supports and readmission in this study were all protective. Having a spouse as care giver was the only statistically significant social support factor in this study; further research is needed with a larger sample size to improve the detection of significant effects. The importance of this study in male Veterans is that it has shown that social support improves the health of HF patients, and results in reduced rates of re-hospitalization.