bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15848: Hardly a Windfall: Prescribing Practices in Pediatric Heart Failure Before and After Food and Drug Administration Approval
Authors: Ludomirsky Avital B , Edelson Jonathan B , Berger Justin , Lin Kimberly Y , O'Connor Matthew , Wittlieb-Weber Carol , Griffis Heather , Zhang Bingqing , Ampah Steve , Rossano Joseph
Published: December 2023

Background:
Prior to the 2019 Food and Drug Administration (FDA) approval of ivabradine and sacubitril/valsartan, there were no medications approved for the treatment of pediatric heart failure (PHF). There are minimal data regarding the use of on- or off-label medications in PHF.

Aims:
We aim to describe medication use in PHF, factors associated with PHF medication use, and test the hypothesis that FDA approval is associated with changes in prescriber practice.

Methods:
Utilizing the Truven Health Marketscan Claims Encounter Database (2013-2021), we determined the prevalence of medication [diuretics, angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs), beta-blockers, pulmonary vasodilators, ivabradine, and sacubitril/valsartan] use in children ≤19yo with PHF and cardiomyopathy (CM), with a focus on use before and after FDA approval.

Results:
Of 2,218 children with PHF and CM, 76% were prescribed ≥ 1 HF medication. Diuretics (57%) and ACEi/ARBs (57%) were used most frequently (
Fig 1A)
. Only 0.4% of patients were prescribed ivabradine and 3% sacubitril/valsartan. Patients enrolled in Medicaid were more likely to be prescribed HF medications than those with commercial insurance (OR 1.83, 95% CI 1.50-2.22). After FDA approval in 2019, sacubitril/valsartan prescription rose significantly from 0.4% in 2013-2018, to 3.9% in 2020-2021 (p <0.001), and ivabradine use increased from 0.1% in 2018 to 0.5% (p = 0.043) in 2020-2021, but both remained rare
(Fig 1B)
.

Conclusion:
Diuretics and ACEi/ARBs are the most commonly used PHF medications, despite not being approved for this indication. The two FDA approved medications are used in ≤5% of patients. While FDA approval is important, it did not substantially influence physician prescribing behavior for PHF. Further study is needed to understand the value of FDA approval and the potential socioeconomic implications of the association between insurance type and medication use.
Abstract 15856: Genetics, Pathologic Characteristics, and Burden of Lethal Hypertrophic Cardiomyopathy Among Countywide Sudden Deaths
Authors: Haghighat Leila , Eik David , Yee Matthew , Kinkead Brielle , Wojciak Julianne , Connolly Andrew , Delling Francesca N , Abraham Theodore P , Moffatt Ellen , Tseng Zian H
Published: December 2023

Background:
Annual incidence of sudden cardiac death (SCD) is reported at 1% in cohorts with known hypertrophic cardiomyopathy (HCM), but these estimates presume arrhythmic cause and miss occult cases dying before diagnosis.

Hypothesis:
Prospective surveillance and postmortem investigation of community sudden deaths will uncover the true burden of presumed SCD (pSCD) and arrhythmic death (SAD) attributable to HCM.

Objectives:
Determine characteristics and precise contribution of HCM to population pSCD and SAD.

Methods:
POST SCD (POstmortem SysTematic Investigation of Sudden Cardiac Death) is a prospective cohort study using autopsy, clinical records, and toxicology to adjudicate arrhythmic (potentially rescuable with implantable defibrillator) or non-arrhythmic (e.g., tamponade, overdose) causes among pSCDs 0-90 years in San Francisco County. We included all incident cases from 2/1/11-3/1/14 (n=525) and approximately every 3rd day from 3/1/14-9/1/22 (n=497). We identified HCM victims via 3 parallel approaches: 1) pathology criteria; 2) echocardiogram (TTE) review; 3) genetic analysis.

Results:
Of 1022 pSCDs in the 11-year study period, we identified 13 cases with HCM, yielding a 2% contribution to arrhythmic death burden: 10 met pathology criteria; 2 via review of 203 TTEs (missed on initial report); 1 with pathogenic
ALPK3
mutation. Only 2 of 13 (15%) pSCDs with HCM had premortem diagnosis. A greater proportion of pSCDs with HCM had autopsy-confirmed arrhythmic cause than pSCDs without HCM (11/13 [85%] vs. 547/1009 [54%], p=0.03). HCM contribution to pSCD burden decreased with age (p=0.003), highest among victims <35 years, accounting for 7.1% (6/84) of pSCDs and 9.4% (3/32) of SADs. Genetic testing of 317 consented pSCDs (5/12 meeting pathologic or TTE HCM criteria) yielded pathogenic mutations in 40% (2/5), and identified 1 additional case without clinical phenotype.

Conclusions:
In this 11-year countywide postmortem study, HCM meeting pathologic, clinical, or genetic criteria was associated with autopsy-confirmed arrhythmic cause of sudden death, accounting for 2% of SADs, highest in cases <35 years. As 85% of cases were undiagnosed before pSCD, the true burden of HCM-related sudden death may be substantially underestimated.
Abstract 15893: A Quality Improvement Project of Increasing Utilization of SGLT2i in Patients With Heart Failure Within a Veterans Affairs Health System Through an Interdisciplinary Approach in the Primary Care Setting
Authors: Baviriseaty Niharika , Parza Kevin , Gross Cassandra , NEHAUL ROGER
Published: December 2023

Introduction:
Given the astounding beneficial effects of SGLT2i in patients with heart failure, they continue to be underutilized especially in the outpatient setting. Our project looked at increasing empagliflozin usage in patients with heart failure, preserved and reduced ejection fraction, at James A Haley VA Hospital (JAHVA).

Methods:
Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team was created to identify ways to increase utilization of empagliflozin in patients with heart failure. We created an actionable database using ICD codes for heart failure to identify eligible heart failure patients who were not on SGLT2i categorized by local primary care clinics at the JAHVA. We split up the responsibilities between clinic pharmacists and primary care physicians to safely start patients on SGLT2i from February to April 2023. Primary care physicians focused on patients scheduled for clinic during this period while pharmacists were responsible for patients not scheduled for clinic.

Results:
Our initial data showed only 19% of the 3,352 patients were on SGLT2i at JAHVA. From February to April 2023, we started 224 patients on empagliflozin with heart failure (preserved and reduced ejection fraction). We increased utilization by 13% in three months from 19% to 32% at JAHVA. Primary care physicians accounted for 46% of drug initiation while pharmacists accounted for 20% of new prescriptions. Cardiology providers prescribed 27% of all SGLT2i with 7% started by endocrinology or nephrology. Some of the characteristics of our sample included patients with an average age of 70 years old, 35% without diabetes, 50% with preserved heart failure.

Conclusion:
Our multi-disciplinary team approach involving pharmacists increased the utilization of SGLT2i in patients with heart failure through an actionable dashboard. Next steps for this project include improving the database to include other GDMT to further optimize medications.
Abstract 15944: Aspirin Use for Primary Prevention in High-Risk Patients: Insights From a Large Healthcare Network
Authors: Muluk Pallavi , Zhu Jianhui , Michos Erin D , Thoma Floyd W , MARROQUIN Oscar C , Hay Eli , Mehta Anurag , Mulukutla Suresh R , Saeed Anum
Published: December 2023

Background:
Recently, the value of routine use of aspirin in primary prevention for atherosclerotic cardiovascular disease (ASCVD) has come into question. We investigated patients with a high 10-year ASCVD risk profile to evaluate the magnitude of protection afforded by aspirin with and without statin in prevention of ASCVD events.

Methods:
Primary prevention patients were stratified based on 10-year ASCVD risk (High [20%]). Aspirin use was categorized over the 6-year follow-up period as “None”, “seldom” (<30% of follow up time), “sometimes” (>30 to =<70%), and often used (≥70% of the time). Cox regression models were used to assess HRs of MI, ischemic stroke and mortality with aspirin or statin use alone compared to a combination of aspirin and statin.

Results:
69,955 patients qualified as “high” 10-year ASCVD risk. In fully adjusted models, aspirin use ≥ 30% was associated with significantly lower risk of MI [HR ASA use ≥ 70% 0.76 (0.72-0.80), p <0.001], ischemic stroke [HR ASA use ≥ 70% 0.83 (0.77-0.90), p <0.007], and mortality [HR ASA use ≥ 70% 0.78 (0.74-0.82), p <0.001] in high-risk patients compared to no aspirin use (
Table
). Compared to patients on both a statin and aspirin, patients on statin alone had increased risk of MI [HR 1.30 (1.06-1.60), p = 0.013]. Patients on aspirin alone had increased risk of MI [HR 1.74 (1.34-2.26), p <0.001] and mortality [HR 1.70 (1.27-2.28), p < 0.0004] versus those on aspirin and statin. Patients not on any aspirin or statin were at significantly increased risk for MI [HR 2.28 (2.08-2.49), p<0.001], ischemic stroke [HR 1.77 (1.56-2.00), p<0.001), and mortality [HR 2.16 (1.60-2.90), p<0.001] compared to those taking both aspirin and statin.

Conclusions:
Low dose aspirin may still have a role in primary prevention of ASCVD events amongst high-risk patients when added to statin therapy. Risk-benefit profile of each high-risk primary prevention patient should be assessed for initiating or discontinuing low dose aspirin therapy
Abstract 15947: Cracking the Code of Cardiovascular Risk: Cardiac Troponin I vs. T in Community Dwelling Adults. Is Specificity at Stake?
Authors: Parashar Yashika , Awwad Aya , Bagchi Soahum , Siddiqui Saman Asad , Ajari Ogheneochuko , deFilippi Christopher
Published: December 2023

Introduction.
High sensitive cardiac troponin I and T (hs-cTnI and T) are detectable in most adults. Several studies have identified that hs-cTnI and T perform differently for long-term prediction of incident myocardial infarction (MI). Furthermore, in adults with myopathies, hs-cTnT can lose cardiovascular (CV) specificity which may be more relevant to MI prediction vs heart failure (HF) and CV death (CVD). We hypothesized that a meta-analysis of ambulatory adult studies would demonstrate hs-cTnI is a superior predictor of incident MI, but similar for HF and CVD.

Methods.
Research articles on hs-cTnI or T for longitudinal outcomes in ambulatory adults were screened from PubMed, EMBASE, and Web of Science inclusive of incident MI, HF or CVD and reporting hazard ratios (HR) and 95% confidence intervals (CI) for hs-cTn on a continuous log scale. Two reviewers evaluated the studies for inclusion, removing overlapping populations and extracting the most adjusted model HR. Pooled effect sizes were calculated with a random-effects model, and heterogeneity was assessed using the I
2
statistic. Subgroup analyses based on hs-cTn type were conducted.

Results.
A total of 3092 studies were screened and 44 met inclusion criteria. There were 109,553, 80,597, and 141,389 participants for HF, MI, and CVD with hs-cTnI measured, and 90,012, 81,259, and 73,977 participants for HF, MI, and CVD with hs-cTnT measured with a mean age of 61 ± 10 years and a median follow-up of 2.1 – 20 years. The pooled effect size estimate (HR) for HF, MI and CVD was 1.57(1.47, 1.66), 1.27(1.18, 1.37) and 1.41(1.32, 1.50) respectively. Subgroup analyses showed similar HR values for HF (I: 1.49 (1.37, 1.62) and T: 1.64 (1.51, 1.78)), MI (Figure) and CVD (I: 1.32 (1.21, 1.44) and T: 1.49 (1.36, 1.63)).

Conclusion.
hs-cTnI and T are prognostically similar for incident MI, as well as HF and CVD in ambulatory adults, suggesting similar cardiac specificity, though substantial heterogeneity exists between individual studies.
Abstract 15963: A Novel SGK1 Inhibitor (SGK1-I), Prevents Obesity-Related Atrial Fibrillation
Authors: Bapat Aneesh , Pradhananga Sabindra , Srinivasan Dinesh , Sager Philip , Ellinor Patrick T
Published: December 2023

Introduction:
Obesity is an important risk factor for atrial fibrillation. We have previously demonstrated the protective effect of genetic SGK1 inhibition in a mouse model of obesity-related atrial fibrillation (AF). SGK1-I is a novel and potent SGK1 inhibitor that has been shown to reduce late sodium current and has currently entered clinical trials as a potential treatment of long QT syndrome.

Hypothesis:
We sought to assess the efficacy of pharmacologic SGK1 inhibition in a mouse model of obesity-related AF.

Methods:
Wild type C57/Bl6 mice were fed a high fat diet containing 60% cholesterol (by calories) compounded with (HFD-SGK1i) or without (HFD) SGK1-I for 10 weeks. After feeding, the mice were assayed with invasive electrophysiology studies (EPS), optical mapping, and biochemical assays.

Results:
There were no significant differences in rate of weight gain, final body weight, fasting glucose, glucose tolerance, or tail-cuff blood pressure between the two groups of mice throughout the study. During EPS, there were no differences in nodal (sinus and atrio-ventricular) function or tissue (atrial/ventricular) refractory periods. However, HFD-SGK1i mice were significantly protected from obesity-related inducible AF during EPS, with a lower rate of AF inducibility (5.7% versus 1.5%, p<0.0001) and a lower total AF burden (35±54 versus 5.5±10.7 s, p=0.04). Optical mapping revealed abbreviated right (RA), but not left (LA), atrial action potential duration (APD) and attenuated inter-atrial APD differences in HFD-SGK1i mice as compared to HFD mice. In this context, Western blotting data demonstrated greater RA (versus LA) SGK1 activity/expression resulting from HFD, suggesting that SGK1 signaling may contribute to inter-atrial heterogeneity caused by HFD. Finally, protein expression of NLRP3 inflammasome components, Caspase-1 and ASC, as well as TGF-β expression were decreased in the SGK1-1 group; consistent with anti-inflammatory and anti-fibrotic signaling resulting from SGK1-I treatment.

Conclusion:
SGK1-I protects mice from obesity-related AF. These data further highlight SGK1 and its inhibition as a compelling target in cardiac arrhythmogenesis.
Abstract 15975: Cardiogenic Shock Teams Are Associated With Lower Mortality, Bleeding and Vascular Complications: A Systematic Review and Meta-Analysis
Authors: Alviar Carlos L , Maqsood Muhammad H , Tehrani Behnam N , Sinha Shashank , Van Diepen Sean , Katz Jason N , Bernard Samuel , Padilla-Lopez Mireia , Keller Norma , Bangalore Sripal
Published: December 2023

Introduction:
Short-term mortality and morbidity associated with cardiogenic shock (CS) remains high. However, observational studies suggest that CS teams improve outcomes. Our aim is to systematically evaluate the outcomes associated with CS team use by performing a meta-analysis of the published literature.

Methods:
A comprehensive literature search of the PubMed/EMBASE, Cochrane databases and published abstracts was performed from inception to 06/01/2023 including studies comparing CS outcomes before and after the implementation of CS teams (excluding case reports and pediatric studies). Outcomes included in-hospital mortality, bleeding, vascular complications, use of temporary mechanical circulatory support (tMCS), and renal replacement therapy (RRT). Odds ratios (OR) with 95% confidence intervals (CI) were calculated using DerSimonian-Laird method. The Eggers test was used to assess publication bias; significant heterogeneity was considered if I
2
> 75%.

Results:
Of 524 studies screened, 5 met inclusion criteria. This included 2,331 subjects (1091 managed with a CS team and 1270 without, mean age 62.5 years, 72.1% male, 41% non-white). The implementation of CS teams was associated with lower risk of in-hospital mortality ([OR] = 0.63 [95% CI 0.49 - 0.81]; I
2
=19%; p < 0.001)
(Fig),
major bleeding (OR = 0.69 [95% CI 0.48 - 0.99]; I
2
=0%; p = 0.042), and vascular complications (OR = 0.61 [95% CI 0.40 - 0.93]; I
2
=0%; p = 0.021) compared to management without CS teams. There were no differences in tMCS (OR = 0.81 [95% CI 0.56 - 1.17]; I
2
=52%; p = 0.26) or RRT use (OR = 0.74 [95% CI 0.44 - 1.25]; I
2
=78%; p = 0.26). There was no evidence of publication bias (p > 0.05).

Conclusions:
In this meta-analysis, CS team implementation was associated with lower in-hospital mortality, major bleeding, and vascular complications, but no difference in the use of tMCS or RRT. These findings support further prospective studies to assess the impact of CS teams in improving outcomes.
Abstract 15976: Age and Sex Differences in the Association of Habitual Physical Activity With Cardiovascular Structure and Function in Community-Dwelling Adults
Authors: Meagher Sean P , Dong Zhiyong J , Spartano Nicole L , Mitchell Gary F , Benjamin Emelia J , Cheng Susan , Vasan Ramachandran S , Tsao Connie W
Published: December 2023

Introduction:
The association of habitual physical activity (PA) with subclinical cardiovascular remodeling and their modifications by age and sex are not well understood in community-dwelling adults.

Methods:
We studied 5685 (mean age 49±15 y, 53% F) participants of the Framingham Heart Study 2
nd
generation Exam 8 (2005-2008) and 3
rd
generation Exam 1 (2002-2005) without cardiovascular disease (CVD) and with PA, echocardiography [left ventricular mass, volume (LVM, LVEDV)], and applanation tonometry (aortic stiffness, carotid-femoral pulse wave velocity [CFPWV]. PA was assessed using a validated activity questionnaire. We assessed the relationship of PA to echocardiographic and vascular stiffness measures using linear regression adjusting for CVD risk factors and evaluated age and sex interactions on these relations.

Results:
Higher PA was overall associated with greater LVM (p<0.0001) and LVEDV (p<0.0001), which appeared driven by those aged <48 years of age (p<0.0001) and men (p≤0.0002 for both LVM and LVEDV) [
TABLE
]. In women, PA was associated with higher LVM (p=0.02) but not LVEDV (p=0.09). There was a borderline inverse association of PA with PWV (p=0.05). In contrast to the association of PA with LV structure, the associations of PA with PWV were significant among age ≥48 years (p=0.005) and women (p=0.008).

Conclusions:
In a large sample of adults in the community, we observed divergent associations of habitual PA with ventricular and vascular remodeling between age and sex groups. The mechanisms of these differential associations and impact on outcomes deserve further study.
Abstract 15977: Utilizing Admission Bloodwork to Risk Stratify for Acute Kidney Injury in Hospitalized Patients With NSTEMI or Unstable Angina Undergoing Invasive Coronary Angiography± PCI
Authors: Leaphart Davis , Shah Rohan , Ellis Stephen G , Reed Grant W
Published: December 2023

Introduction:
AKI after invasive coronary angiography (CAG) or PCI is common with an estimated incidence of 7-9%. This complication incurs approximately a $9,500 higher cost of stay, with proportional length of stay increases with absolute elevations in serum creatinine (sCr). While the majority of adverse events occur within 30 days of procedure, there is evidence of increased mortality, stroke, and MACE at 1 year and 5 years following index AKI. This study aimed to identify risk factors for AKI in hospitalized NSTEMI and unstable angina undergoing CAG ± PCI.

Methods:
Patients who were admitted for NSTEMI or UA who underwent CAG from 2011-2022 in Northeast Ohio Cleveland Clinic hospitals were identified from the EMR. Admission and serial blood work results in addition to demographics, past medical history, and hospital course were compiled and analyzed via multivariable logistic regression using R statistical software. KIDAGO definitions of AKI were utilized to define presence of AKI. All patients declared ESRD prior to admission were excluded from analysis.

Results:
4,174 cases were included in the analysis with mean age 66.5 years, 63% male, and 81% Caucasian. 7% developed AKI and there was no difference in the proportion of race, gender, or prevalence of ischemic heart disease between those who developed AKI and those who did not. Patients who developed AKI were older (70.9 vs. 66.1 years, p<0.001), and were more likely to have a history of CHF (22.2 vs 10.1%, p<0.0001), CKD (26.3 vs. 9.5%, p<0.001), CVA (22.5 vs 15.3%, p=0.001), and hypertension (66.6 vs 59.4%, p=0.016). Multivariable logistic regression was performed on admission blood work in the presence of known risk factors for AKI, Table 1.

Conclusions:
In patients admitted with NSTEMI or UA who undergo CAG ± PCI, admission blood work helps identify patients at risk for AKI even in the presence of traditional risk factors such as IABP, age, and history of CKD.
Abstract 15983: Association of Cardiovascular Health With Nonalcoholic Fatty Liver Disease in American Adults
Authors: Alebna Pamela L , Grandhi Gowtham , Shetty Naman , Minhas Abdul Mannan Khan M , Chew Nicholas , Dixon Dave L , Blaha Michael J , Arora Pankaj , Siddiqui Mohammad , Sanyal Arun , Mehta Anurag
Published: December 2023

Introduction:
Nonalcoholic fatty liver disease (NAFLD) affects 1 in 3 Americans and is associated with an increased cardiovascular disease (CVD) risk, however the association of cardiovascular health (CVH), quantified by the AHA Life’s Essential 8 (LE8) score, and NAFLD is unclear.

Hypothesis:
CVH has an inverse association with NAFLD quantified using vibration-controlled transient elastography in a nationally representative sample from the NHANES 2017-2020 cycle.

Methods:
Individuals aged <20 years, with pregnancy, viral, autoimmune, or alcoholic liver disease were excluded. The mean value of the 8 components (each scored from 0 to 100) was calculated to estimate the LE8 score. Ideal, intermediate, and poor CVH were categorized based on LE8 score of ≥80, 50-79, and <50, respectively. A median controlled attenuation parameter of >288 decibels per meter and median liver stiffness of >8.6 kilopascals were used to define hepatic steatosis and fibrosis, respectively. A survey weighted logistic regression model was used to assess the association of CVH with liver steatosis and fibrosis.

Results:
The final study population included 8,974 participants, corresponding to a weighted sample of 230,700,687 with a mean age of 47.7 years, SE 0.76 and 51.3% women. The mean LE8 score was 68.4, SE 0.46. 35.6% (95% CI 33.4-37.8) participants had hepatic steatosis and 8.4% (95% CI 6.8-10.0) had hepatic fibrosis. Among those with poor CVH, the proportion of individuals with hepatic fibrosis (22.4% vs. 2.0%) and steatosis (67.4% vs. 11.9%) was higher as compared to those with ideal CVH (Figure). Participants with ideal CVH had 94% lower odds of hepatic steatosis and 86% lower odds of hepatic fibrosis as compared to those with poor CVH.

Conclusions:
CVH is independently associated with prevalent NAFLD among American adults. LE8 score may be considered an index of metabolic liver health and not just cardiovascular health.
Abstract 15986: Very Rare Case of a Interatrial Thrombus Following Watchman Device Placement
Authors: Prasai Astha , Babayale Omofolarin , Mohamed Mohamed Salah M , Latifi Ahmad , Sarji Rawa
Published: December 2023

Introduction:
Device related thrombus (DRT) is a known complication of left atrial appendage closure (LAAC). We present a case of a thrombus at the interatrial septum following LAAC detected eight months after the procedure.

Case:
Eighty-six years old woman with a history of coronary artery disease s/p percutaneous coronary intervention with drug eluting stent to right coronary artery in 2016, heart failure with preserved ejection fraction, atrial fibrillation (AF) s/p 27mm Watchman device placement (on aspirin only) due to recurrent episodes of hematuria, hypertension, hyperlipidemia, chronic kidney disease presented to the hospital with complaints of right flank pain. Initial labs were unremarkable except for anemia, hemoglobin of 10g/dl. Computed tomography (CT) abdomen and pelvis showed an incidental finding of new mass like filling defect within the left atrium. Transthoracic echocardiogram (TTE) showed mobile mass 1.7 x 1.6 cm attached to the interatrial septum on the left atrial side.(Figure 1.A) Low dose apixaban was started. Follow up transesophageal echocardiogram (TEE) in four months interval showed the thrombus attached to the interatrial septum had slightly reduced in size to 1.5 x 0.9 cm, but an additional large thrombus measuring 2.5 x 1.3 cm was seen on top of the Watchman device (Figure 1.B) and Apixaban was increased to full dose.

Discussion:
Incidence of DRT after LAAC is 3.74% with most cases occurring in the first year after LAAC. Exposed and incompletely endothelialized device are foci for DRT. Iatrogenic pericardial effusion, hypercoagulable state, deep implant, renal insufficiency, non-paroxysmal AF are some of the factors increasing the risk of device related thrombus. Most cases of DRT described are attached to the device. In our case, a large interatrial thrombus was identified incidentally which likely formed at the site of septal puncture during device insertion which highlights the importance of follow up echocardiogram at intervals.
Abstract 160: Atrial Fibrillation After Cardiac Arrest is Associated With Increased Risk of Mortality and Stroke
Authors: Curtis Kristen , Dombrowski Aleksander , Wisniewski Steven , Irish Laken , Almahameed Soufian , Ziv Ohad , Piktel Joseph S , Laurita Kenneth R , Wilson Lance D
Published: December 2023

Introduction:
The presence of atrial fibrillation (AF) in the first 2 days after resuscitation from cardiac arrest has been associated with increased mortality. However, whether new onset AF diagnosed in the first days to weeks after ROSC is associated with mortality or stroke is unknown. Our aim was to determine the incidence of new AF diagnoses after cardiac arrest and its impact on mortality and ischemic stroke.

Methods:
Retrospective observation cohort study using COSMOS, an Epic-based EHR database with >190 million deidentified patients from 5/18/2020 to 4/1/2023. Patients with an ICD-10 diagnosis of cardiac arrest (ICD-10 I46.*) without prior history of AF were included. Two groups were examined: 1) AF diagnosis (ICD 10 I48*) made within 48 hours and 2) within 14 days after index cardiac arrest. We examined mortality and incidence of ischemic stroke at 1, 3, 6, and 12 months. Statistical comparisons were made using Chi-squared analysis.

Results:
Among 410,850 cardiac arrest patients without prior history of AF, 16,498 received a new AF diagnosis within 14 days (4%). The mean age was 68 yrs. with 64% male, 72% white. Mortality at one year in patients who developed AF by post-arrest day 14 was 54.5% vs. 39.5% in patients with no AF diagnosis (p<.00001). The one-year incidence of stroke in patients with AF at 48 hours was 7.9%, similar to patients who had AF at 14 days (7.3%, p=NS). Moreover, stroke was diagnosed within 14 days of cardiac arrest in 5.4% of AF patients. Importantly, in these patients with stroke, 7% received anticoagulation with warfarin or direct oral anticoagulation, while the remaining 93% were not anticoagulated (p<.00001), suggesting that consideration of early anticoagulation is imperative.

Conclusion:
AF diagnosed after cardiac arrest is associated with increased mortality. Patients who develop AF after cardiac arrest have significant short and long-term ischemic stroke risk, which is markedly decreased by anticoagulation. These data suggest that vigilance is required for patients who develop persistent AF after cardiac arrest, particularly stroke risk and prevention, as well as the consideration of an early rhythm control strategy.
Abstract 16014: Health-Related Quality of Life in Patients With Heart Failure is Worse Than in Patients With Cancer: Analysis of the Medicare Health Outcomes Survey 2016-2020
Authors: Shah Kriti P , Khan Sadiya S , Baldridge Abigail , Grady Kathleen L , Cella David , Goyal Parag , Allen Larry A , Smith Justin , Lagu Tara , Ahmad Faraz S
Published: December 2023

Background:
People with heart failure (HF) experience impaired physical and mental health. However, health-related quality of life (HRQOL) in people with HF to those with cancer, another condition that impacts HRQOL, have not been directly compared in a contemporary population.

Research Question:
How does HRQOL compare in people with HF to those with lung, colon, breast, or prostate cancer?

Methods:
We performed a pooled analysis of Medicare Health Outcomes Survey data between 2016-2020 in participants ≥65 years with a self-reported history of HF or active treatment for lung, colon, breast, or prostate cancer using two HRQOL measures. The Veterans RAND-12 generates the physical component score (PCS) and mental component score (MCS), which range from 0-100 with a mean score of 50 (based on general US population), a standard deviation of 10, and a lower score representing worse health. We used pairwise t-tests to evaluate for differences in PCS and MCS by group. We used chi-squared to compare the distribution of days with poor physical or mental health in the past 30 days as measured by CDC Healthy Days core questions.

Results:
Compared to participants with lung, colon, breast, or prostate cancer, participants with HF (n=71,025; 54% female, 16% Black) had lower mean PCS and MCS (
Figure
; P<0.001 for HF vs each cancer). The distribution of unhealthy days differed across disease groups (all P<0.001). Over half (52%) of participants with HF reported ≥10 physically unhealthy days, which is higher than those with lung (51%), colon (41%), breast (31%), or prostate cancer (28%). Nearly one-third (32%) of participants with HF reported ≥10 mentally unhealthy days, which is higher than those with lung (28%), colon (25%), breast (21%), or prostate cancer (20%).

Conclusions:
People with HF on average experience worse HRQOL than those with cancer. The pervasiveness of low HRQOL in HF underscores the need to implement evidence-based interventions to improve physical and mental health.
Abstract 16040: Atrial Fibrillation Status and Physical Rehabilitation in Older Patients With Acute Decompensated Heart Failure: An Analysis From the Rehab-HF Trial
Authors: Dikdan Sean , Upadhyay Naman , Corsi Douglas R , Chen Haiying , Kitzman Dalane W , Mentz Robert J , Whellan David J , Frisch Daniel
Published: December 2023

Background:
The REHAB-HF randomized, controlled trial demonstrated that a transitional, tailored, progressive rehabilitation intervention improved physical function, 6-minute walk distance, frailty, quality-of-life, and depression in older patients hospitalized for acute decompensated heart failure (ADHF). Atrial fibrillation (AF) is common in patients with HF and associated with poor exercise tolerance. However, exercise has proven safe and effective in improving quality of life in AF patients. It is unknown if AF impacts the benefit gained by rehabilitation intervention.
Question:
We hypothesized that patients with AF and ADHF would significantly improve physical function outcomes, and these improvements would not differ significantly from those gained by patients without AF.

Methods:
REHAB-HF enrolled 349 patients hospitalized for ADHF. Mean age was 72.7 ± 8.1 years. Participants were randomly assigned to the 12-week progressive rehabilitation intervention or attention control. The trial’s primary outcome was change in short physical performance battery (SPPB) score between baseline and 3 months. Secondary outcomes were clinical endpoints (rehospitalization or death).

Results:
AF was prevalent in 176 patients (50.4%). Participants with AF were significantly older than those without (74.4 ± 8.3 vs. 70.8 ± 7.5, p<0.001) and had higher prevalence of HFpEF (58.5% vs 47.4%, p=0.037). Patients with and without AF had similar improvement in SPPB score (mean between-group difference, 1.5; 95% CI 0.4-2.5; p=0.001). There was no significant difference in mean SPPB between the two groups (p=0.98). KCCQ score and 6-minute walk distance significantly improved in patients with AF (p<.05). The interaction P-values for 3-month outcomes by AF status were not significant (P >0.1). There were no significant differences in deaths, all-cause rehospitalizations, or HF hospitalizations at 6 months.

Conclusions:
In older, hospitalized patients with ADHF, the presence of AF did not significantly affect the benefit of the transitional, tailored, progressive rehabilitation intervention. These findings suggest the intervention is safe to use to improve physical function and quality of life in patients hospitalized for ADHF regardless of AF status.
Abstract 16042: Sex/Gender Specific Differences in the Outcomes of Ventricular Arrhythmias Complicating Acute Myocardial Infarction
Authors: Markson Favour , Antia Akanimo , Allihien Saint-Martin , Ibrahim Sammudeen , Akuna Emmanuel , Ong Kenneth , Alviar Carlos L , Kwaku Kevin F
Published: December 2023

Introduction:
Ventricular Arrythmias (VA) is a common clinical problem in myocardial ischemia and the most common cause of sudden death in patients with Acute Myocardial Infarction (AMI). Studies have shown sex differences in the incidence, presentation, and outcomes of AMI. However, evidence on the sex differences in VA in patients with AMI is limited. In this study we evaluated the sex differences in the incidence and in- hospital outcomes of VA in patients who were admitted with AMI.

Methods:
Using the NIS 2016 - 2020, we retrospectively analyzed the data of patients admitted for AMI using the ICD 10 code (I21). Our primary population included patients who underwent reperfusion (PCI or CABG), 18 years and above, and had a secondary diagnosis of either Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT). We excluded patients who had infiltrative cardiac diseases (Sarcoidosis, Lyme disease, amyloidosis) or long QT syndrome. We further divided our sample population into 2 groups based on their reported gender (Male or Female). Using a multivariate analysis, we compared the odds of VA and in-hospital outcomes between both subgroups of patients.

Results:
We identified 174,565 patients with VA in the setting of AMI. Of these 75.8% were males. VF was observed in 15,500 (36.4%) of female patients and 45,010 (34%) of male patients. The odds of VA after AMI were higher in Men (AOR): 1.72, CI: 1.67 - 1.78, p<0.001). Male patients were more likely to have a history of myocardial infarction, smoking and Cocaine use while female patients were more likely to have DM, PVD and heart failure. Female patients had significantly higher odds of in-hospital mortality (AOR: 1.32, CI: 1.21 - 1.42, p<0.001), cardiogenic shock (AOR: 1.08, CI: 1.01 - 1.15, p<0.022) and Cardiac arrest (AOR:1.11, CI: 1.03 - 1.18, p<0.002). However, they had significantly lower odds of defibrillator insertion (AOR: 0.57, CI: 0.47 - 0.68, p<0.001) or catheter ablation (AOR: 0.51, CI: 0.27 - 0.98, p<0.001) during the index admission.

Conclusion:
There are sex differences in the incidence and outcomes of VA in AMI, with women having lower odds of VA but worse hospital outcomes. Incorporation of women in more VA studies and may help us understand why these differences in outcomes exists
Abstract 16043: Impact of Left Ventricular Global Longitudinal Strain on the Outcomes of Patients With Moderate Aortic Stenosis and Moderate Aortic Insufficiency
Authors: Raval Maharshi , Jain Akhil , Majmundar Vidit , Desai Rupak , Siddiq Sajid
Published: December 2023

Background:
Reduced left ventricular global longitudinal strain (GLS) is associated with worse outcomes in patients with severe aortic stenosis (AS). Its role in predicting outcomes in moderate AS is now being reported. We aim to investigate the prognostic value of GLS in patients with moderate AS and moderate aortic insufficiency (AI).

Methods:
We conducted a retrospective review of 1576 patients with a diagnosis of AS and AI at a community cardiology practice. We reviewed the echocardiographic data and included 254 patients with moderate AS and moderate AI. They were retrospectively followed for 1 year from the time they initially had the echocardiography findings to note the occurrence of shortness of breath (SOB), heart failure (HF) hospitalization, or mortality during the 1 year period.

Results:
Out of the 254 patients that were studied, 121 patients (47.64%) had GLS ≤16%. Demographics and comorbidities such as age, sex, hypertension, diabetes mellitus (DM), obesity, and atrial fibrillation were balanced in both arms. Patients with GLS ≤16% had significantly higher SOB (50.41% vs. 32.33%, p=0.003) and HF hospitalization (17.36% vs. 9.02%, p=0.049) during 1-year follow-up. 1-year mortality was higher in GLS ≤16% arm but not statistically significant (5.79% vs. 1.5%, p=0.065). After adjusting for patient characteristics using logistic regression, GLS ≤16% was independently associated with higher odds of SOB (aOR 2.139, 95CI 1.28-3.59, p=0.004) but not for HF hospitalization (aOR 2.022, 95CI 0.94-4.35, p=0.072) and 1-year mortality (aOR 4.165, 95CI 0.78-22.12, p=0.094).

Conclusions:
GLS ≤16% is associated with an increased likelihood of SOB in patients with moderate AS and moderate AI. HF hospitalization and 1-year mortality were not statistically significant, but there is a clear trend towards worse outcomes in patients with GLS ≤16%. If future studies reproduce similar results and outcomes, it may be time to rethink the timing of aortic valve intervention.
Abstract 16062: Acute Myocarditis and Pericarditis in Post-Acute Sequelae of COVID-19: Initial Insights From the IMPACT-COVID-19 Study
Authors: Calderone Alexander , Benharrats Mohammed Adam , Coderre Roxanne , Friedrich Matthias , Piche Alain , Falcone Emilia Liana , Chetrit Michael , Fitzcharles Mary Ann , boudreault caroline , Nguyen Michel T , Ni Jiayi , Huynh Thao
Published: December 2023

Introduction:
Myocarditis and/or pericarditis were reported in patients with Post-Acute Sequelae of COVID-19 (PASC).

Goals:
We aim to determine the prevalences, risk factors, and discriminative values of inflammatory biomarkers for acute myocarditis/pericarditis in patients with PASC.

Methods:
IMPACT-COVID-19 is an ongoing prospective longitudinal cohort enrolling adults with PASC and at least one symptom suggestive of potential cardiac disorder (dyspnea, palpitation, chest pain and dizziness) in Quebec, Canada (years 2021-ongoing). We obtained baseline inflammatory, cardiac biomarkers, electrocardiograms, echocardiograms, and cardiac magnetic resonance imaging (CMR). We defined myocarditis/pericarditis as either 1) positive Lake Louise criteria on CMR, 2) pericardial effusion or 3) chest pain with elevated cardiac biomarkers or inflammatory biomarkers.

Results:
The following results were based on the initial 256 patients enrolled (with a median of 279 days after their initial COVID-19 infection). Most were female (73%), and White (86%) with a mean age of 45 years. Seventy-six patients (30%) had acute myocarditis and/or pericarditis. One hundred and three patients (40%) had an emergency room (ER) visit for the index COVID infection and this was associated with an increased risk of myocarditis/ pericarditis: (odds ratio: 2.39 (95% confidence intervals: 1.21, 4.72). The ESR was elevated in patients with myocarditis/pericarditis compared to patients without myocarditis/pericarditis (18 mm/h vs 12 mm/h; p:0.02). There was no observed difference in CRP (1.85 mg/L for patients with myocarditis/pericarditis versus 1.54 mg/L for patients without myocarditis/pericarditis, p:0.51). ROC c-statistics were 0.61 for ESR and 0.49 for CRP. An ESR of ≥14 mm/h has the best predictive value for myo/pericarditis.

Conclusions:
Our findings suggest that clinicians should be aware that patients with PASC, especially those who required an ER visit for their COVID-19 infection, are at increased risk for acute myocarditis/pericarditis. ESR should also be considered in the diagnostic tests for PASC-related myocarditis/pericarditis.
Abstract 16105: Sex-Based Differences in Potential Risk Factors for Sudden Death in Patients With Mitral Valve Prolapse
Authors: Shaul Nathan C , Cesmat Andrew P , Chaudry Abdul M , Gupta Suhani , Weickert Thelsa T , Simpson Ross J , Syed Faisal F
Published: December 2023

Background:
The majority of individuals experiencing sudden arrhythmic death attributable to mitral valve prolapse (MVP) are women. However, factors leading to this increased risk in women are unknown.

Aims:
To describe sex differences in factors associated with MVP.

Methods:
We studied 637 patients aged 18-90 with MVP diagnosed by echocardiography at our center between 2016 and 2019. Clinical, echocardiographic and ECG parameters were compared between men and women using Fisher’s exact and Wilcoxon rank-sum tests, including features associated with arrhythmic MVP (bileaflet prolapse, mitral annular disjunction [MAD], ECG T-wave inversion (TWI), and complex or frequent ventricular ectopy (cfVE) including nonsustained ventricular tachycardia [NSVT]). All statistical tests are univariate, reported as OR [95% CI], and p-values are two-sided.

Results:
Among patients with MVP, 335 (52.6%) were women, 103 (16.2%) were African American and median (IQR) age was 67 (55-76.5) years. Women were more likely than men to have MAD (60/335 [17.9%] vs 35/302 [11.6%] respectively, 1.66 [1.06-2.61], p=0.026) and less likely to have moderate or severe mitral regurgitation (85/335 [25.4%] vs 99/302 [32.8%] respectively, 0.70 [0.49-0.98], p=0.044). There was no difference between women and men in presence of other features associated with arrhythmic MVP. Men were more likely than women to have cardiometabolic risk factors for sudden death including hypertension, diabetes, dyslipidemia, coronary artery disease, and heart failure.

Conclusions:
In patients with mitral valve prolapse, potential risk factors for sudden death vary by sex. Women are more likely than men to have mitral annular disjunction, while men are more likely to have cardiometabolic risk factors. Further studies are needed to determine whether mitral annular disjunction-associated ventricular arrhythmias can explain the increased incidence of sudden arrhythmic death in women with mitral valve prolapse.
Abstract 16114: Heart Failure Hospitalizations and In-Hospital Outcomes Among Patients With Schizophrenia - Nationwide Study
Authors: Costa Filho Francisco Flavio , Sharma Aditya , Zahid Ibrahim , Kaur Jaspreet , Mishra Tushar
Published: December 2023

Introduction:
There is limited data regarding hospital outcomes in patients admitted with heart failure (HF) exacerbation and schizophrenia.

Hypothesis:
We sought to determine the characteristics and in-hospital outcomes of patients with schizophrenia admitted due to HF exacerbation in the United States.

Methods:
We performed a retrospective cohort study using the National Inpatient Sample database from January to December 2019. Patients with HF exacerbation (defined by ICD-10 codes) were categorized into two groups: patients with versus without schizophrenia and associated psychoses (defined by ICD-10 codes). Baseline variables and in-hospital outcome trends were compared between the 2 groups. Using logistic regression, we assessed the odds of use of invasive ventricular support device, and of in-hospital mortality.

Results:
In total, 9,780 hospitalizations for HF in patients with schizophrenia were identified, equivalent to 0.76% of all HF hospitalizations (n = 1,295,395). Patients with schizophrenia were younger (mean age 60 vs 71 years, p<0.05), more likely to be men (57% vs 52%, p<0.05), and more likely to have chronic pulmonary disease, obesity or be currently smoking. Comparing to overall HF patients, those with schizophrenia were more likely to be African American and live in zip codes at the lowest quartile of national income. After adjusting for patient-level, hospital-level demographics, and coexisting clinical conditions in a multivariable logistic regression there was no significant difference in the odds of in-hospital mortality between the two groups (OR 0.99, 95% CI, 0.63-1.60; P=0.99). No discrepancies in access to invasive ventricular support device were found (OR 0.42, 95% CI, 0.15 - 1.06, P=0.07).

Conclusions:
Patients with HF exacerbation and schizophrenia are more than one decade younger than overall HF population. Our study did not find difference in the odds of in-hospital mortality in patients admitted with HF exacerbation and schizophrenia in the United States.
Abstract 16138: Hepatic Steatosis, Cardiorespiratory Fitness, and Metabolic Mediators in the Community
Authors: Florea Victor V , Tang Jingxian , Gajjar Priya , Shah Ravi V , Davenport Megan , Mi Michael , Haff Madeleine , Zhang Xiaoyu , Huang Shi , Liu Ching-Ti , Lewis Gregory , Long Michelle T , Nayor Matthew
Published: December 2023

Background:
Cardiorespiratory fitness (CRF) is a powerful predictor of cardiovascular (CV) outcomes and multi-organ reserve capacity.

Hypothesis:
We hypothesize that hepatic steatosis, an emerging CV risk factor, is associated with lower CRF and that certain metabolites mediate this association.

Objective:
To determine if hepatic steatosis contributes to impaired CRF in community-dwelling individuals.

Methods:
Framingham Heart Study participants (n=2722) underwent vibration-controlled transient elastography for assessment of controlled attenuation parameter (CAP; a measure of hepatic steatosis) and maximal cardiopulmonary exercise testing (CPET). In individuals with available metabolomic data (n=1346), we evaluated whether blood metabolites mediate the association of CAP and peak CRF (peak oxygen uptake [VO
2
]).

Results:
The study sample (mean age 54±9 years, 53% women) had a peak VO
2
of 95±20% of the predicted value, and 722 participants (26.5%) had hepatic steatosis (defined as CAP≥290 dB/m). In multivariable regression models adjusted for age, sex, alcohol use, smoking, systolic blood pressure, hypertensive medication use, diabetes, and prevalent CV disease, both CAP (continuous) and hepatic steatosis were associated with lower peak VO
2
(in ml/kg/min) and VO
2
at the anaerobic threshold, and unfavorable heart rate and blood pressure responses to exercise (at Bonferroni-adjusted P<0.008 for all; Figure 1). Eighteen out of 201 measured circulating metabolites were associated with both peak VO
2
and CAP in separate multivariable models also adjusted for BMI (at FDR 5%). Of these metabolites, 16 significantly mediated the association between CAP and peak VO
2
, with dimethylguanidino valeric acid and lysophosphatidylcholine 20:1 demonstrating the highest proportion mediated.

Conclusions:
Hepatic steatosis is associated with impaired CRF in the community and this association is partially mediated by known and novel circulating metabolites.