bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 176: Is Measuring Blood Pressure All That Simple? An Investigation of Medical Staff’s Proficiency in Blood Pressure Measurement
Authors: Mehlman Andrew , Batra Nakul , Moreland Spencer
Published: March 2022

Hypertension is a very common medical condition, affecting millions of adults worldwide. Consequently, blood pressure measurement is a universally performed clinical procedure. However, studies have shown that errors in measurement may occur as often as 63% of the time. This study sought to determine whether improper blood pressure measurement techniques occur in our clinic, and to assess our medical staff’s knowledge of the procedure.

A single-blinded observational study was conducted at an academic tertiary referral center’s cardiology clinic. Criteria for proficiency in blood pressure measurement were assessed with a 15-point checklist based on American Heart Association guidelines. All observers received hands-on training in BP measurement prior to evaluating medical staff. After the observational period, medical staff were asked to complete a multiple-choice questionnaire regarding BP measurement technique.

In total, 72 different BP measurements were observed, and 25 members of the medical staff completed the post-observation questionnaire. A mean of 69% (10.35 of 15, SD of 13%) of AHA guidelines were followed when obtaining BP measurements. In no encounter were all 15 measured guidelines completed. The most commonly overlooked criteria included inquiry about recent exercise or tobacco/alcohol consumption (completed in 5.6% [4 of 72] of encounters), instruction not to speak (27.8% [20 of 72]), and absence of communication during testing (51.4% [37 of 52]). While cuff size was selected appropriately 87.5% (63 of 72) of the time, in ~24% (17 of 72) of encounters, the cuff was not properly placed on the patient’s arm. The post-observational questionnaire demonstrated less significant deviation from guideline recommended techniques compared to the observed clinical practice. For example, greater than 92% (23 of 25) of medical staff answered that they should ask patients about recent exercise, tobacco, or alcohol use. The most commonly incorrect answers regarded cuff selection, communication with patient, and patient positioning.

The data demonstrates that nearly a third of AHA guidelines for proper BP measurement are not followed. Differences between our observational and questionnaire results suggest that guidelines are either largely ignored, or more easily remembered when given in multiple-choice format. As most of these improper techniques lead to falsely elevated BP recordings, further research is needed to evaluate for possible overdiagnosis of hypertension and unnecessarily aggressive treatment.
Abstract 183: Factors Associated With Hospital Readmissions Following Myocardial Infarction in Southern Appalachia
Authors: Treece Jennifer , Brooks Billy , Moore Christine , Shipley Lindsey C , Zhang Michael , Onweni Chidinma , Jbara Manar , Bhattad Venugopal B , Rahman Zia U , Sivagnanam Kamesh , Ramu Vijay , Paul Timir K
Published: March 2022

Objective:
Identify factors associated with readmissions following myocardial infarction.

Background:
The Hospital Readmission Reduction Program, implemented in 2012 under the Affordable Care Act, penalizes hospitals with higher rates of readmission, defined as admission within 30 days from prior hospital discharge, than the national average for targeted diagnoses. One of the more common causes of readmission is myocardial infarction (MI). Southern Appalachian hospitals have readmission rates for MI that exceed the national average, resulting in financial penalties for these hospitals.

Methods:
Retrospective chart review study evaluating readmissions within 30 days of hospital discharge following MI in medical facilities in Southern Appalachia from 2014 to 2017.

Results:
There were 3,913 patients admitted to hospitals in Southern Appalachia between 2014 to 2017 with an MI; of these, 439 patients were readmitted within 30 days from previous hospital discharge. Patients with length of stay (LOS) less than 2 days were 50.3% (OR 0.497
Abstract 203: Health Status Variations Across Practices in Outpatients With Heart Failure: Health Status Variations Across Practices in Outpatients With Heart Failure: Insights From the CHAMP-HF Registry
Authors: Khariton Yevgeniy , Nassif Michael , Thomas Laine , Fonarow Gregg , Mi Xiaojuan , DeVore Adam , Duffy Carol , Sharma Puza , Albert Nancy , Patterson J. , Butler Javed , Hernandez Adrian , Williams Fredonia , McCague Kevin , Spertus John
Published: March 2022

Background:
Heart failure with reduced ejection fraction (HFrEF) has a significant impact on patients’ health status. A primary goal of treatment is to minimize patients’ symptoms, while maximizing their functional status and quality of life. The variability across outpatient practices, and the characteristics of those practices, in optimizing patients’ health status is unknown.

Methods:
In the multicenter CHAMP-HF registry, the association between practice characteristics and Kansas City Cardiomyopathy Questionnaire Overall Summary Scores (KCCQ-os) in 3,494 patients across 140 US centers was assessed with hierarchical logistic regression adjusting for 23 patient characteristics to predict excellent health status (KCCQ-os ≥75). A median odds ratio (MOR) was estimated to quantify the average relative difference a patient would exhibit excellent health status when being treated at one random practice versus another.

Results:
The mean (±standard deviation) KCCQ-os was 64.2±24, and 39% (n=1,380) had a KCCQ-os ≥75. In a fully-adjusted model, patients were more likely to have excellent health status if the practice was in a suburban (vs. urban) location (OR=1.47, p = 0.02), while those enrolled at a primary care (vs. cardiology) setting were less likely to have a KCCQ≥75 (OR=0.52, p = 0.02). The MOR across practices was 1.69 (95% CI=1.46, 1.90; p < 0.0001) indicating a median 69% higher odds of a statistically identical patient having excellent health status when treated at one random practice versus another.

Conclusion:
In this first large, contemporary assessment of health status in outpatients with HFrEF, we found marked variation by site in patients having excellent health status. Proposed efforts to use patient-reported outcomes as a quality measure may support improved attention to patients’ health status in clinical care.
Abstract 21: Post-Coronary Revascularization Mortality in Diabetes Patients With and Without End-Stage Renal Disease: Do Outcome Disparities Exist?
Authors: Sergeev Alexander V
Published: March 2022

Background:
Previously conducted studies have demonstrated that diabetes mellitus (DM) and end-stage renal disease (ESRD) can worsen survival prognosis in coronary artery disease (CAD) patients. It remains unclear whether racial and socio-economic disparities can affect the outcomes of coronary revascularization procedures in CAD patients with DM (CAD-DM), in particular in relation to the presence of ESRD.

Study Objective:
To investigate racial and socio-economic disparities in the in-hospital mortality outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in CAD-DM patients with and without ESRD.

Methods:
We conducted a retrospective cohort study of in-hospital mortality in 353,711 CAD-DM patients [mean±SD age: 66.1±11.1 years; 65.2% (230,617 of 353,711) males] after CABG and PCI during 2007-2011. Median household income state quartile was used as a measure of patients’ socio-economic status (SES). Race was defined as white, black, Asian, or Native American. In-hospital patient death was a dichotomous outcome of interest. Adjusted odds ratios were obtained from multivariable logistic regression, adjusted for the type of coronary revascularization procedure and known clinical, demographic, and socio-economic covariates.

Results:
In the covariate-adjusted multivariable logistic regression analysis, post-procedure mortality in CAD-DM patients with ESRD was significantly higher than in their counterparts without ESRD (adjusted OR = 1.70, 95% CI: 1.56-1.87, p<0.001). Post-procedure mortality was independently associated not only with the type of procedure (PCI vs CABG, adjusted OR = 0.69, 95% CI: 0.65-0.73, p<0.001), age (3.7% increase for each year, 95% CI: 3.4-3.9%, p<0.001) and comorbidities status (12.5% increase for each point increase of the modified Elixhauser-Walraven score, 95% CI: 12.1-12.9%, p<0.001), but with race and SES too. Patients of the lowest household income quartile were more likely to die than the ones of the highest income quartile (adjusted OR = 1.14, 95% CI: 1.06-1.24, p=0.003). Blacks were more likely to undergo an emergency admission (44.9%) than Asians (38.3%), whites (37.0%) or Native Americans (34.0%; p<0.01 with multiple comparisons correction), and emergency admission was an independent predictor of post-procedure mortality (adjusted OR = 2.02, 95% CI: 1.90-2.13, p<0.001). C-statistic for the multivariable logistic regression model was 0.788.

Conclusions:
Results suggest existence of SES and racial disparities in in-hospital post-coronary revascularization mortality in CAD-DM patients independently of the type of procedure, presence of ESRD, comorbidities and demographic covariates. Further studies investigating the responsible mechanisms for these outcome disparities – possibly, disparities in the realized access to primary care – are warranted.
Abstract 211: Long-Term Participant Engagement in Weight Management Programs
Authors: Graham Laura A , Malone Emily B , Richman Joshua S , Knight Sara J , Affuso Olivia , Carson April P , Levitan Emily B
Published: March 2022

Lifestyle interventions must be effective at engaging participants beyond the initial intervention period in order to be successful in reducing long-term cardiovascular risks. Unfortunately, there is a lack of evidence for improvement in long-term cardiovascular outcomes following participation in lifestyle interventions. Participant engagement has been shown to wane after the first 12 months of participation. This gradual reduction in engagement may be responsible for the limited evidence for an effect on long-term cardiovascular risk. The objective of this study is to assess patient, program and community characteristics associated with better participant engagement after 2 years in a weight management program. This is an observational study of 330,522 participants enrolled in MOVE! programs within the Veterans Healthcare Administration (VHA) from 2008 to 2013. The MOVE! program is a nationwide weight management intervention integrated into primary care within the VHA and provided free to Veterans. Participant engagement is defined as the number of MOVE! program visits per year for each participant. Engagement is assessed at 6 months, 12 months, and 24 months following the first program visit. Bivariate statistics and multivariate generalized linear models were used to assess factors associated with patient engagement at each time point. At the first MOVE! visit, the average participant age was 56.3 years old (SD=12.0) with a body mass index of 36.9 [Standard Deviation (SD)=5.4). Most participants were male (87.9 and lived in an urban area (69.7%) an average of 38.6 miles from the MOVE! program (SD=48.5). Eight percent (7.5%) of participants had a Charlson Comorbidity Index of 4 or more at the time of their first visit. Engagement decreased as time from the first visit increased. Patients had a median of 4.0 visits per year at 6 months [Interquartile Range (IQR)=2.0-8.0], 2.0 visits per year at 12 months (IQR=1.0-5.0), and 1.0 visit per year at 24 months (IQR=0.5-3.0). In adjusted models of 24-month engagement, older age (beta=0.03, p<0.01), greater body mass index (beta=0.06, p<0.01), and female gender (beta=0.46, p<0.01) were associated with better engagement. Factors predicting better engagement at each time period were similar with the exception of comorbidities. More comorbidities at the time of first visit was the only factor associated with a small improvement in 24-month engagement (beta=0.01, p=0.04) but no difference in 6-month (p=0.35) or 12-month (p=0.10) engagement. In conclusion, in this large observational study, female gender, greater BMI, older age, and more comorbidities are associated with better 24-month engagement in a weight management program. Few factors stood out as predictors of better 24-month engagement as compared to 6- and 12-month engagement.
Abstract 214: Strict versus Lenient versus Poor Rate Control Among Patients With Atrial Fibrillation and Heart Failure: Findings From the Get With the Guidelines - Heart Failure Program
Authors: Hess Paul , Sheng Shubin , Matsouaka Roland , Devore Adam , Heidenreich Paul , Yancy Clyde , Bhatt Deepak , Allen Larry , Peterson Pamela , Ho Michael , Lewis William , Hernandez Adrian , Fonarow Gregg , Piccini Jonathan
Published: March 2022

Background:
Randomized data suggest that lenient rate control (resting heart rate <110 bpm) is noninferior to strict rate control (resting heart rate <80 bpm) in patients with atrial fibrillation (AF). However, the optimal rate control strategy in patients with AF and heart failure (HF) remains unknown.

Methods:
Using data from the Get With The Guidelines-HF Program linked with Medicare data from July 1, 2011 to September 30, 2014, we identified patients with HF and AF and evaluated the association of heart rate at discharge with subsequent outcomes and the differential association by ejection fraction.

Results:
Of 13 981 patients with AF, 9 100 (65.0%) had strict rate control, 4 617 (33.0%) had lenient rate control, and 264 (1.9%) had poor rate control by resting heart rate on the day of discharge. After multivariable adjustment inclusive of medical therapy, compared with strict rate control, lenient rate control was associated with higher adjusted risks of all-cause death (HR 1.21, 95% CI 1.11-1.33, p<0.001), all-cause readmission (HR 1.09, 95% CI 1.03-1.15, p<0.002), all-cause death or all-cause readmission (HR 1.11, 95% CI 1.05-1.18, p<0.001), but not cardiovascular readmission (HR1.08, 95% CI 1.00-1.16, p=0.051) at 90 days. Associations were largely comparable among patients with poor rate control and with heart rate modeled as a continuous variable (Table). The presence or absence of reduced ejection fraction did not impact the magnitude of most observed associations.

Conclusions:
Among patients with HF and AF, 2 out of 3 patients had a heart rate that met strict-control heart rate goals at discharge. Heart rates above 80 bpm at discharge were associated with adverse outcomes irrespective of left ventricular ejection fraction.
Abstract 223: Rapid Response Teams at Top-performing Hospitals for In-hospital Cardiac Arrest: A Qualitative Study
Authors: Girotra Saket , Dukes Kimberly , Bunch Jacinda , Guetterman Timothy , Harrod Molly , Krein Sarah , Kellenberg Joan , Lehrich Jessica , Reisinger Heather , Kronick Steven L , Chan Paul S , Nallamothu Brahmajee K
Published: March 2022

Background:
Prior studies have shown that hospitals with exceptional survival for in-hospital cardiac arrest (IHCA) also excel at preventing IHCA—a key function of rapid response team (RRT). However, little is known about how RRTs differ across sites. We used qualitative methods to evaluate organizational and contextual factors of RRTs that may be linked to hospital performance on IHCA survival.

Methods:
We selected 9 academically and geographically diverse hospitals in the AHA Get With The Guidelines Resuscitation registry based on risk standardized IHCA survival during 2012-2014 (top quartile: 5 hospitals; middle quartiles: 1 hospital; bottom quartile: 3 hospitals). During site visits, we conducted semi-structured interviews with key stakeholders regarding resuscitation care at their site. We conducted a directed content analysis focused on RRT roles and activities related to preventing IHCA.

Results:
A total of 158 interviews were conducted that included physicians (17.1%), nurses (45.6%), other clinical (17.1%), and administrative staff (20.3%). Differences in RRTs at top and bottom performing sites were noted in the following domains: team design and composition, engagement of RRT in surveillance of at-risk patients, empowerment of bedside nurses to activate RRT, and collaboration of RRT members with bedside nurses during and after a rapid response. Differences within each domain and representative quotes are included in the Table. Top performing hospitals tended to have RRTs staffed with members without other clinical responsibilities, often served as a resource for bedside nurses in preventing patient decline, and collaborated with them during and after a rapid response. Bedside nurses were empowered to activate RRTs based on their judgement and experience. In contrast, RRTs at bottom performing hospitals were staffed with members with competing clinical responsibilities, and were generally less engaged with bedside nurses. Moreover, nurses were concerned about potential consequences (e.g. fear of reprisal from physicians) in calling a rapid response.

Conclusions:
The design and implementation of RRTs differ markedly between top and bottom performing hospitals with regard to IHCA survival. Our findings provide unique insights into RRTs at hospitals with better IHCA outcomes.
Abstract 224: Why Do Patients Decline to Participate in Heart Failure Trials?
Authors: Shore Supriya , Speight Candace , Kelkar Anita , Dickert Neal
Published: March 2022

Background:
Randomized controlled trials (RCTs) remain the gold standard in establishing clinical efficacy. However, low patient enrollment escalates costs of conducting trials and selective enrollment leads to under-representation of the real-world population. Limited data exists on why patients decline participation in RCTs and what factors may lead to increased participation rates.

Methods:
In-person and telephone interviews were conducted with 20 patients with congestive heart failure who declined participation in a RCT using a semi-structured interview guide. Questions assessed comprehension of the trial they were approached for, perceived risks and benefits, perception about the recruiter, rationale behind declining participation, and suggestions to improve participation. Qualitative descriptive analysis was conducted of transcribed responses.

Results:
Participants’ median age was 63 years (IQR 51.5-69), 50% were female, and 60% were African-American. Only 6 participants could accurately describe the intervention and understood design of the trial in which they were asked to participate. Majority of the participants (n=15) had a positive view of the recruiter who approached them. Most participants made the decision to not participate quickly while only 2 participants took extended time to deliberate. The most common reasons for not participating was due to concern for adverse events from the intervention being studied (n=15) and because participation was thought to be too burdensome (n=10). Other reasons for not participating included mistrust of research staff (n=3), concern for receiving inadequate treatment (n=3) and lack of involvement or consultation with the patient’s physician (n=3). The most common suggestion provided to increase participant recruitment was involving primary care physicians or cardiologists known to the patients. Overall, 5 decliners reported previously participating in research studies stating prior participation was less burdensome (n=2), they were previously approached by physicians known to them (n=2) or their health was better and participation seemed less risky (n=1).

Conclusion:
Slow participant enrollment in clinical trials threatens our ability to produce timely data necessary to guide clinical practice, while increasing cost of conducting them. The most common suggestion to improve participation made by patients who declined enrollment in a clinical trial was engaging physicians known to the patient in the process of recruitment while making participation less burdensome. Accordingly, educating potential participants regarding clinical trials, clarifying study risks and benefits with incorporation of design features that reduce burden such as frequency of invasive testing and follow-up visits can help increase participation rates.
Abstract 225: LVEF Over Time: Trends and Analysis of a National VA Database
Authors: Patel Jay M , Heidenreich Paul A
Published: March 2022

Background:
Patients who are diagnosed with heart failure (HF) are almost universally characterized by left ventricular ejection fraction (LVEF) at the time of diagnosis, where the most common dichotomy is preserved LVEF (HFpEF, LVEF > 50%) or reduced LVEF (HFrEF, LVEF < 40%). The concept of recovered LVEF (< 40% to > =50%) is considered by some to indicate a separate category of HF. We sought to study the natural history of a patient’s LVEF using natural language processing among a large cohort of patients.

Methods:
We identified 457,457 patients in the VA Health Care System between 2005 and 2016 with a first outpatient diagnosis of heart failure with an LVEF between 6 months before or one year after the heart failure diagnosis and a second LVEF after the diagnosis. We used all LVEF data from 2005-2016 obtained from previously validated natural language processing of echo reports. LVEF at baseline was grouped into deciles (1-29, 30-39, 40-49, 50-59, 60-69 and >=70%).

Results:
The 457,457 patients had 8,857,436 echos over a mean 4 +/- 3 years of follow-up (median 11 echos per patient). At the time of diagnosis the mean age was 69 +/- 11 years, 97.6% male, 19% were African-American, 45% had a diagnosis of diabetes, and 61% had a diagnosis of ischemic heart disease. During follow-up among those with an initial LVEF < 40%, between 21% and 31% recovered their LVEF to over 50% at some point during follow-up (Table). A similar frequency was noted for those dropping to an LVEF < 40% if the initial LVEF was high. When the last LVEF was used to define change, then a recovered LVEF (>50%) was less common (9% if initial LVEF was < 20%, 8% if the initial LVEF was 20-29%, 13% if the initial LVEF was 30-39%). The final LVEF was < 40% in 30% of patients with an initial LVEF of 40-49%, 15% if the initial LVEF was 50-59%, 9% if the initial LVEF was 60-69%, and 6% if the initial LVEF was >=70%.

Conclusion:
In this multiyear study of a national cohort, LVEF varied substantially over time, with a recovered LVEF (<40% to >=50%) noted at some point in 20-30% depending on initial LVEF. However, when the last LVEF is used, recovery occurred in only 8-13%. Thus, approximately half of patients with a recovered LVEF at some point will revert to depressed LVEF.
Abstract 234: Informal (Family) Caregiver Outcomes From a Symptom and Psychosocial Collaborative Care Intervention in Patients With Heart Failure: A Randomized Clinical Trial
Authors: Flint Kelsey , Johnson Rachel A , Bekelman David
Published: March 2022

Question:
Does a symptom and psychosocial collaborative care intervention for patients with symptomatic heart failure (HF) and their informal (family) caregivers improve caregiver depression, burden, or ability to find caregiving benefits (benefit finding)?

Methods:
The Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) trial randomized 317 patients with HF and 101 of their caregivers to either usual care or the CASA intervention. The CASA intervention consisted of symptom and psychosocial collaborative care for patients provided by a nurse and social worker, respectively, who worked with patients’ primary care providers and were supervised by a study primary care provider, cardiologist, and palliative care physician. The social worker offered caregivers in the CASA intervention psychosocial assessment and treatment. Caregiver outcomes (depression, burden and benefit finding) were measured at baseline and 12 months.

Results:
Caregivers were mostly female (N=77/101) with mean age 57.3 ± 15.7 years. Most caregivers were the patient’s spouse (N=58/101) or child (N=25/101) (Table 1). Of caregivers in the intervention arm, N=38/56 had at least one social worker visit, with variability in the number and duration of visits (Table 1). Caregivers faced diverse issues, such as need for self-care, difficulty adjusting to loved one’s illness, and bereavement. There were no significant changes in depression, burden or benefit finding between CASA intervention and control (Table 2).

Conclusion:
The CASA intervention did not improve caregiver outcomes. Besides addressing challenges to caregiver recruitment and participation, future studies should consider the diverse issues faced by caregivers of patients with HF.
Abstract 24: Association of Opioids and Cardiovascular Comorbidities
Authors: Chui Philip W , Bastian Lori
Published: March 2022

Background:
The rising opioid epidemic in the United States has been linked to higher cardiovascular disease (CVD) mortality although the mechanism for this association remains unclear. We investigated whether prescription opioid usage is associated with the prevalence of CVD and risk factors in a young Veteran population that have few comorbidities at baseline and at risk for prescription opioid usage.

Methods:
We utilized a Veterans Affairs administrative and clinical database of Veterans who were deployed to or served in support of the wars in Iraq or Afghanistan. We extracted information on patient demographics, self-reported race, and clinical comorbidities using ICD-9 codes. Veterans were classified as using opioids for an intermediate duration if they were on prescription opioids for more than 30 and less than 90 days and chronic duration if more than 90 days between 2014 and 2015. We then utilized logistic regression to determine the association of intermediate duration and chronic duration of prescription opioid usage on CVD and risk factors (dyslipidemia, hypertension, diabetes, coronary artery disease, and atrial fibrillation) controlling for patient demographics, psychiatric, and other medial comorbidities.

Results:
Of the 1,1085,016 Veterans who met inclusion for our study, the mean age was 38 and 12% were female. Within our study period, 3.3% of Veterans were on prescription opioids for an intermediate duration and 4.0% were on prescription opioids for a chronic duration. After adjustment, Veterans on prescription opioids for an intermediate and chronic duration were at higher odds of having dyslipidemia, hypertension, diabetes, coronary artery disease, and atrial fibrillation [Table].

Conclusion:
A significant minority of Veterans serving or returning from recent deployment is on extended duration of opioids and has a higher likelihood of having cardiovascular risk factors and disease. Our results suggest that the association of CVD mortality with opioid usage may be explained by patients on opioids with increased odds of having CVD risk factors. Future prospective studies are warranted to determine if declines in prescription opioid usage in a relatively young population may reduce risk of developing CVD in later decades.
Abstract 241: Health Resource Utilization and Healthcare Expenditure Among Myocardial Infarction Patients With Depression
Authors: Okunrintemi Victor , Tibuakuu Martin , Valero-Elizondo Javier , Salami Joseph , Nasir Khurram , Michos Erin D
Published: March 2022

Background:
Depression and myocardial infarction (MI) often coexist and has been associated with worse health outcomes. Evidence suggest that hospital visits and prescription medications account for majority of the healthcare expenditure, even among MI patients and this is expected to increase over the next decade. However, little is known of the excessive burden of depression on health resource utilization and healthcare expenditure among patients with MI. Using a nationally representative sample of the US adult population, we compare healthcare expenditure(total and out-of-pocket) and health resource utilization(emergency room visits and hospitalizations) among MI patients without the diagnosis of depression with depressed MI patients.

Methods:
We used data from the 2006-2015 Medical Expenditure Panel Survey (MEPS) for this study. We included adults ≥18 years with a diagnosis of MI (ICD9 code 410 and/or self-reported) and stratified these individuals based on the presence of the diagnosis of Depression, identified by ICD9 code 311. We used the two-part econometric model to study cost data and regression models adjusted for sociodemographic characteristics and cardiovascular disease risk factors to compare health resource utilization between depressed and non-depressed MI patients.

Results:
The study sample consisted of 6,702 individuals, representing 7.16m MI patients without the diagnosis of depression and 1,381 individuals representing 1.42m depressed MI patients (aged 65 ± 13 years, 63% male). Compared with non-depressed MI patients, MI patients with a diagnosis of depression had higher odds for hospitalizations [OR 1.54 (1.29, 1.83)] and emergency room visits [OR 1.43 (1.21, 1.69)], significantly greater mean annual expenditure as well as an estimated $4,381 ($2,553, $6,209) & $402 ($225, $579) higher annual overall and out-of-pocket healthcare expenditures respectively (Table).

Conclusion:
Depression among MI patients is associated with a significant increase in annual healthcare expenditure and health resource utilization. As a quality improvement measure to increase healthcare efficiency, routine depression screening at follow up visits may be appropriate especially among these high risk population.
Abstract 247: Is Oxygen Therapy Beneficial in Acute Myocardial Infarction? A Meta-Analysis
Authors: Khan Muhammad Shahzeb , Kolkailah Ahmed , Fugar Setri , Ayub Muhammad Talha , Al-Ogaili Ahmed , Ayoub Ali , Asmi Nisar , Sreenivasan Jayakumar , Khosa Faisal , Samady Habib
Published: March 2022

Background:
Supplemental oxygen (O2) is beneficial in patients with acute myocardial infarction (AMI) who have hypoxemia. However in patients who have suspected AMI without hypoxemia, the benefit of O2 remains uncertain. We conducted a meta-analysis, including the recent landmark trials, to establish the efficacy and safety of O2 in AMI.

Methods:
We searched Medline, Embase, and Ovid SP databases for randomized clinical trials that compared O2 with room air in suspected AMI without hypoxemia. Hypoxemia was defined as O2 saturation of <90%. The primary endpoint was all-cause mortality. Data were pooled by the random effects model and I2 was used to assess for the heterogeneity.

Results:
A total of 6 studies including 8193 participants were included in the final analysis. On pooled analysis, there was no significant difference between the two arms in 30-day all-cause mortality (OR=1.10 [0.67, 1.80]; p=0.70), cardiogenic shock (OR=0.75 [0.49, 1.16]; p=0.19), recurrent myocardial infarction (OR=1.24 [0.46, 3.34]; p=0.67) and left ventricular ejection fraction (SMD= -1.95 [-4.76, 0.85]; p=0.17).

Conclusion:
Contrary to the routine clinical practice, our analysis shows that O2 administration does not provide any benefit in AMI patients who have normal oxygen saturation. It is reasonable to reserve O2 only for patients with AMI and hypoxemia.
Abstract 254: The Benefits and Barriers to Remote Health Coaching in Patients at Risk for Cardiovascular Disease
Authors: Kelly Noreen , Licurse Adam , Sperry Keri
Published: March 2022

Background:
Partners’ Center for Population Health is reviewing the effectiveness of an app-based remote health coaching program, designed to complement the care of providers. The program allows patients to regularly communicate with a live health coach via text, phone, or video conferencing. The health coaches are provided by an outside vendor and are trained to provide guidance relevant to a number of chronic diseases, including obesity, hypertension and diabetes.

Objectives:
The aim for the health coaching cardiovascular program is to see an improvement in clinical outcomes including blood pressure, blood glucose, body mass index (BMI), and LDL cholesterol in patients at risk for cardiovascular disease. In addition, patient satisfaction and patient engagement are being evaluated.

Methods:
Patients must be 18 or older but less than 76 years old, and have a smartphone or tablet. Patients must also have one of the following medical conditions: (1) obesity with BMI> 30, (2) diabetes with HgbA1C >8.0%, (3) hypertension on two or more antihypertensive medications (ACEI, ARB, calcium channel blocker, beta blocker, hydrochlorothiazide, chlorthalidone, amlodipine, clonidine, or doxazosin) with a blood pressure greater than 140/90 mm Hg.

Findings:
Of 116 patients who have been sent a consent form to sign, 35 have completed the program and 17 are still active. All patients are from Brigham and Women’s Hospital, an academic medical center within the Partners HealthCare network. Among those who completed the program, patient engagement with the health coach varied significantly. Four patients had no consults and 13 patients had six or fewer consults with their health coach. Six patients had 20 or more consults, with the most being 41 consults.

The number of messages sent between the patient and their health coach varied as well. For example, 11 patients sent less than 50 messages to their coach while four patients had each sent and/or received more than 2,000 messages. Self-reported weight loss results related to health coaching have been encouraging. Of 27 patients who recorded their weight loss 4 months or more into the pilot, 52% had lost weight. Improvements in blood pressure, blood glucose, and LDL will be measured and provided as part of the presentation. In addition to the weight loss data, 90% of the 19 patients who responded to a post health coaching survey responded that they are very motivated to improve their overall health.

Challenges

One of the biggest challenges has been patient enrollment. The barriers to patient enrollment have included: limited or no access to a smartphone or tablet which is required to download and use the app; resource requirements to educate patients about the program and assist them in enrollment; and a multi-step process between enrollment and the initial health coach visit. The presentation will focus on those challenges and efforts being made to overcome them.
Abstract 256: Infections Among Patients With Left Ventricular Assist Devices at University of Kansas Medical Center - Statistics and Strategies
Authors: Rali Aniket S , Foster Rachel , Dalia Tarun , Kandah Danial , Sauer Andrew J , Haglund Nicholas
Published: March 2022

Background:
Owing to this improved technology and peri-implantation care around 90% of patients being considered for mechanical circulatory support receive an LVAD. Although LVAD support is associated with improved survival and quality of life, infectious complications remain a major limitation. The exact incidence of LVAD-related and non-VAD related infections among patients with VADs is unknown. Several potential factors make patients with VADs more prone to infectious complications, most obvious being the presence of an implanted device. Temporary alterations in the host immune system, including changes in T-cell function and quantity, have been observed after VAD implantation and may contribute to development of VAD-related infections. The optimal approach to empiric antibiotic therapy and duration of treatment has yet to be fully elucidated. Current treatment recommendations are based on observational studies and expert opinion, as no randomized controlled trials have evaluated empiric treatment of VAD infections. In the past several years we have expanded our understanding of driveline infections in VAD patients. However, information about non-drive line infections in VAD patients remains limited.

Study Objectives:
This is a quality-improvement (QI) project to look for preventable causes of driveline as well as non-driveline infections (i.e. VAD related and non-VAD related infections) among LVAD patients cared for at University of Kansas Medical Center.
Primary Objectives
a) Investigate the incidence and types of non-driveline infections among LVAD patients within the first six months of their VAD implantation. b) Investigate the incidence of driveline infections among LVAD patients within the first six months of their VAD implantation. c) Identify potentially preventable causes of driveline and non-driveline infections and propose interventions to reduce the future incidence of such infections.
Secondary Objective
a) Share our findings with our leadership with the ultimate goal of developing recommendations on empiric antibiotic treatments based on patient-specific risk factors
Study Methods:
We will perform retrospective chart review of LVAD patients to establish the incidence and types of infections among these patients within the first six months of LVAD implantation. Study will only include patients who received their LVAD implantations at University of Kansas Medical Center between October 2015 and October 2017. Data collection will include patient demographics, co-morbidities and risk factors for infections, as well as infection-focused information including site of acquisition and time to onset, causative organism, and microbiological data (e.g., cultures and sensitivities, viral panels, MIC, MRSA screen) and duration of therapy.
Abstract 258: Impact of Community Health Workers in Management of Heart Failure: A Pilot Study
Authors: Vohra Adam S , Chua Rhys , Alcain Charina F , Coplan Mitchell J , Spencer Kirk T , Liao James K , Tabit Corey E
Published: March 2022

Background:
Community health workers (CHW) are specially trained lay-people often used as liaisons between underserved communities and the health care system. Prior studies suggest that use of CHWs can improve patient outcomes and reduce costs in a variety of illnesses. The role of CHW in managing patients with heart failure however has not been studied. This pilot study assesses the effect of CHW on hospital readmissions and Emergency Department (ED) visits for heart failure patients in an urban setting.

Methods:
Patients admitted to the hospital with a primary diagnosis of acute decompensated heart failure between April 2016 and March 2017 were screened for a pilot program to receive weekly home visits by a CHW. Visits included standardized assessment of overall well-being, vital signs, weight management, symptom control, medication compliance, diet education, and healthcare appointment reminders. Abnormal findings were reported to a cardiology nurse practitioner who triaged complaints and made appropriate changes. For this pilot study, enrolled patients were matched using 31 variables with retrospective control patients admitted with heart failure who did not receive a CHW. Hospital admissions and ED visits were compared for the 6 months following the index admission vs. the 6 months prior.

Results:
Sixteen patients received weekly visits from a CHW for 6 months after hospital admission. These were matched with 16 control patients who did not receive a CHW. Patients who received a CHW experienced a 36% decrease in Emergency Department (ED) visits in the 6 months after enrollment compared with the 6 months before. Control patients, however, experienced a 40% increase in ED visits over the same period. Similarly, patients with a CHW experienced a 42% decrease in hospital readmissions while control patients experienced a 28% increase. There was no significant difference in mortality between the groups.

Conclusions:
This pilot study suggests that CHW may reduce healthcare utilization for patients with heart failure without negatively impacting mortality. Based on these findings, a larger study is warranted to assess the efficacy and cost-efficiency of CHWs in helping to manage patients with heart failure.
Abstract 259: Pre-Procedure Checklist and Morning Huddle as Part of Patient Evaluation for Cardiac Catheterisation
Authors: Samani Saira , Clegg Stacey , Sheldon Mark , Garcia Mark
Published: March 2022

Background:
World Health Organization (WHO) Surgical Safety Checklist had a significant impact on surgical outcomes(1). In 2009, The United Kingdom National Patient Safety Agency required the use of this checklist(2). A pre procedure checklist for central venous line placements was one of the first commonly used checklists, and since then, the concept has been expanded to include venous thromboembolism prophylaxis, patient discharge, and many more(3). In 2016, Society of Cardiovascular Angiography and Interventions (SCAI) published a best practices consensus statement Update, which included a pre-procedure checklist for cardiac catheterizations(4).

Objectives:
The goals of the project were two-fold. First, to formalize the pre-procedure evaluation of patients referred to the cardiac catheterization laboratory, and second, to introduce a ‘Morning Huddle’ for all team members. The huddle is directed by a physician and includes a brief patient history and procedural plan to ensure everyone has a clear understanding of the procedure indication, patient specific risks, and procedural equipment needed. It would also provide an opportunity for group questions or to raise concerns.

Methods:
Safety Attitudes Questionnaire (SAQ) was used with permission from University of Texas Health Science Center at Houston, to assess the attitudes towards safety of the staff working at the cardiac catheterization laboratory, as well as the general cardiology fellows. Cardiology fellows were provided with pre-catheterization checklist, adapted from the SCAI best practices consensus statement Update, as well as an outline for the format of the ‘Morning Huddle’.

Results:
The total number of responses obtained were 23. The survey revealed that the majority of the staff felt that the physicians and nurses worked in a well-coordinated team (95.7%, 22 of 23). Almost 26% (6 of 23) of the staff interviewed reported difficulty in speaking up when a problem was perceived. Communication breakdown was not noted to be a problem by the majority interviewed, although a small percentage did disagree (26%, 6 of 23).

Conclusions:
Although the survey was overwhelmingly positive at baseline, room for improvement was noted. It is anticipated that the intervention will allow the staff an opportunity to speak up when a problem is perceived, and improve communication, by empowering the team during the ‘Morning Huddle’. Our overarching goal is to improve the safety climate in the catheterization laboratory.
Abstract 265: Angiotensin-Converting-Enzyme Inhibition in Stable Coronary Artery Disease and Cardiomyopathy With Mid-range Ejection Fraction: Insights From the PEACE Trial
Authors: Alzahrani Talal , Tiu John , Solomon Allen , Panjrath Gurusher
Published: March 2022

Background:
There have been significant advances in the treatment of patients with cardiomyopathy with reduced ejection fraction (EF <40%). However, there is a dearth of information in the treatment of patients with cardiomyopathy and mid-range ejection fraction (EF 40 to 50%). Current guidelines state to treat these patients as patients with cardiomyopathy and preserved ejection fraction. The Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) trial was conducted on patients with stable coronary artery disease and normal or slightly reduced left ventricular function to evaluate the benefit of an ACE inhibitor, trandolapril, versus modern conventional therapy. This trial did not show any advantage from treating these subjects with an ACE inhibitor. Our goal is to elucidate further whether ACE inhibitors reduce death in patients with cardiomyopathy and mid-range ejection fraction.

Methods:
PEACE Trial data was used to evaluate the effect of ACE inhibitors in a subgroup of patients with cardiomyopathy and mid-range ejection fraction (40-50%). A chi-square test and a t-test were used to examine and compare the binary and continuous variables of demographic and health characteristics between experimental and comparison groups. A chi-square test was used to compare the difference in outcomes between the two groups. The statistical analyses were performed using SAS version 9.4. All tests were conducted using an α=0.05 as the probability of a Type I error.

Results:
We studied a subgroup of subjects from the PEACE trial with cardiomyopathy and mid-range ejection fraction (n=2512 of 8290 total subjects). Subjects were randomly assigned to the interventional group (n=1247) and the placebo group (n=1265). There were no significant differences in baseline demographic and health characteristics between the two groups. The risks of composite outcomes (death from cardiovascular causes, death from noncardiovascular causes, nonfatal myocardial infarction, and stroke) (RR 0.88, 95% CI 0.78-0.99; P=0.03) and death from any causes (RR 0.85, 95% CI 0.73-0.99; P=0.03) were lower in subjects treated with trandolapril.

Conclusion:
This study unveiled the benefit of ACE inhibitors among patients with cardiomyopathy and mid-range EF.
Abstract 269: Do Transferred-In Patients Have Longer Lengths of Stay at a Stroke Center?
Authors: Asaithambi Ganesh , Castle Amy L , Kukielka Denise , Ho Bridget M , Marino Emily H , Hanson Sandra K
Published: March 2022

Background:
Acute ischemic stroke (AIS) patients presenting to community hospitals may frequently be transferred to stroke centers if appropriate resources are not available at the referring facilities. Many patients may require discharge to acute rehabilitation (ARF) or skilled nursing (SNF) facilities prior to returning to home. We hypothesize that patients transferring to our comprehensive stroke center (CSC) who require discharge to either ARF or SNF may have longer lengths of stay (LOS) as compared to those who directly present to our CSC.

Methods:
From September 2015 to December 2016, LOS (days) of AIS patients admitted to our CSC who were discharged to either an ARF or SNF were examined. Patients were compared based on method of presentation (direct versus transfer).

Results:
During the study period, a total of 259 patients (75.1±14.1 years, 50.6% female) were examined (181 direct, 78 transfer). Mean distance of transferring facilities to our CSC was 112.3±87.3 miles. There were 154 patients (99 direct, 55 transfer) discharged to ARF, and 105 patients (82 direct, 23 transfer) were discharged to SNF. Transferred-in patients discharged to ARF had significantly longer LOS when compared to direct presentation patients discharged to ARF (6.1±3.5 vs 3.9±2.4, p<0.0001). However, no such significant difference was noted for discharges to SNF (5.3±2.8 transfer vs 7.9±15.9 direct, p=0.58).

Conclusion:
While LOS for patients discharged to SNF was not significantly different between those transferred as compared to those who directly present to our CSC, discharges to ARF were significantly longer among those who were transferred to our CSC. Future efforts should be made to examine potential reasons for prolonged LOS among this group of patients.