bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P348: Association of Social Determinants of Health and Hypertension and Diabetes Among Middle Eastern Immigrants in the United States: Evidence From the 2010-2018 National Health Interview Survey
Authors: Alharthi Abeer , Ogungbe Oluwabunmi , Elias Sabrina d , Metlock Faith , Hinneh Thomas , Kruahong Suratsawadee , Dennison Himmelfarb Cheryl R , Commodore-Mensah Yvonne
Published: March 2023

Introduction:
Recent literature has documented a high prevalence of cardiovascular disease (CVD) risk factors among Middle Eastern (ME) population. Yet, literature is sparse regarding the association of social determinants of health (SDoH) and CVD risk factors among ME immigrants. The objective of this study was to examine the associations between SDoH and hypertension and diabetes among ME immigrants in the U.S.

Methods:
A cross-sectional analysis was conducted using data from the 2010-2018 National Health Interview Survey (NHIS). SDoH were defined as income, education, employment, and health insurance. Hypertension and diabetes diagnoses were self-reported. Generalized linear models using Poisson distribution were fitted to examine the associations between the SDoH and hypertension and diabetes, separately.

Results:
We included 3,271 ME immigrants, 45% female, with mean age 46 years, 85.3% were insured, 44% had at least a college education, and 21% lived below poverty level. Almost 3% had diabetes and 8% had hypertension. Participants with higher income had lower odds (Adjusted Odds Ratio(aOR): 0.35, 95% CI): 0.18-0.69), while those who had health insurance had higher odds (aOR: 5.77, 95% CI: 1.37–24.32) of diabetes diagnosis. There were no significant associations between SDoH and hypertension diagnosis.

Conclusion:
Our analysis yielded significant associations of SDoH and diabetes among ME immigrants. Future investigations should focus on addressing health inequities to establish SDoH-informed care targeting CVD risk factors.
Abstract P349: Predictive Value of Long-Term Systolic Blood Pressure Variability for the Development of Type 2 Diabetes Mellitus
Authors: Yatsuya Hiroshi , Song Zean , Hong Young-Jae , Mamun Razib , Yoshida Yuko , Akter Tahmina , Nuamah Gabriel , Tajima Rina , Lin Jingyi , Al-shoaibi Abubakr , Chiang Chifa , Nakano Yoshihisa , Li Yuanying , Matsunaga Masaaki , Ota Atsuhiko , Tamakoshi Koji
Published: March 2023

Background:
Better identification of high-risk individuals of type 2 diabetes mellitus (T2DM) for focused delivery of preventive measures requires risk prediction models using novel predictors. We evaluated the predictive value of long-term variability of systolic blood pressure (SBPV), which was recently reported to be associated with T2DM incidence, if added to a model with conventional T2DM predictors in a Japanese cohort study.

Methods:
A cohort of 3017 Japanese individuals (2446 male, 571 female) ages 36-65 years were followed from 2007 to 2019. Root-mean-square error (RMSE) and slope of systolic blood pressure (SBP) change regressed on year were calculated per individual using SBP values obtained consecutively from 2003 to 2007 to represent SBPV. An initial Cox model included age, sex, smoking status, regular exercise, family history of diabetes, body mass index (BMI), baseline SBP, blood levels of triglycerides (TG), high-density lipoprotein cholesterol (HDLC) and fasting blood glucose (FBG), and backward elimination was used for variable selection. The c-statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to compare the performance of prediction models without (Model 1) and with SBPV (Model 2).

Results:
During 9.8-year (median) follow-up, 135 developed T2DM. We confirmed that RMSE was significantly associated with T2DM incidence independent of other variables used in a conventional model. Backwards elimination procedure selected BMI, TG, HDLC, FBG, SBP RMSE, and SBP slope for the final model (Table 1). Although the c-indices were not statistically different between Model 1 (0.77) and Model 2 (0.78) as well as the NRI (7.1%), the IDI was statistically significant (0.8%, p<0.05).

Conclusions:
The present study revealed that long-term variability of SBP slightly improved the predictive value of T2DM if added to a conventional prediction model.
Abstract P351: Prevalence of Diabetes in a Sub-Saharan African Community
Authors: Niassy Daouda , Diop Ibrahima Bara , Geoffroy Audrey , Ba Awa , Diaw Mor , Sene Mame Awa , Tajeu Gabriel S , SAMB Abdoulaye , Seck Sidy Mohamed , Jouven Xavier , Gaye Bamba
Published: March 2023

Background:
Diabetes is a major cardiovascular disease (CVD) risk factor. There has been a epidemiological shift and chronic CVD is increasing in Sub-Saharan Africa, however, the extent is unknown.

Methods:
Data were collected between March and April 2013 from 3 regions of the Northern Senegal (i.e., Saint-Louis, Matam etand Louga) using a cluster sampling method and the survey base of the national statistical and demographical agency, we included subjects aged between 18 and 80 years old. Participants underwent a face-to-face questionnaire to collect demographics and data on cardiovascular history/risk factors. Blood pressure and anthropometric measurements were measured in addition to blood tests including fasting plasma glucose. Diabetes was defined as fasting plasma glucose >= 1.26 g/L. Continuous data were reported as mean ± standard deviation (SD). Comparisons used the chi-squared test for categorical variables and Student’s
t
test for continuous variables. Multivariable adjusted logistic regression was used to identify factors associated with diabetes. Covariates with significant association (P<0.05) in univariate analysis were included in the model.

Results:
Among the 2440 subjects in this study (mean age: 44 years old, SD: 15.99), 692 (28%) were male. Nearly half of the sample never attended school (48%, 95%CI: 46-50%). Body mass index (BMI) higher than 25 was present in 43% of the sample (95%CI: 29-35%), with a significant increase in women (51% vs 22%, p<0,001).. The prevalence of diabetes was 5.9% (95%CI: 5-6,9%). Among them, 93% had at least two cardiovascular diseases (95% CI: 87-96%), 71% had dyslipidemia (95%CI: 63-78%) and 67% had a BMI over 25 (95%CI: 58-74%).

Conclusion:
This community-based study revealed a low prevalence of diabetes. However, the prevalence of additional CVD risk factors in this population was high. Preventive measures should be implemented to avoid increasing rates of diabetes in Sub-Saharan Africa.
Abstract P353: Association of United States Nativity With Cardiovascular Health Among Race and Ethnic Groups
Authors: Hammond Michael M , Mensah Cheryl , Turkson-Ocran Ruth-Alma N , Khan Sadiya S , Shah Nilay S
Published: March 2023

Introduction:
Lived experiences based on self-identified race and ethnicity or place of birth are important determinants of cardiovascular health (CVH). However, the association of US nativity with CVH among different race and ethnic subgroups is not well studied.

Hypothesis:
We hypothesized that CVH will be higher among adults born outside the US compared with adults born in the US.

Methods:
We included participants aged ≥18 years from the National Health Interview Survey from 2011 through 2018. CVH was calculated based on 5 available metrics: hypertension, diabetes, cholesterol, smoking, and body mass index calculated from self-reported height and weight. Scores ranged from 0 (low CVH) to 10 (high CVH). Nativity was classified as born in or outside the US. Survey-weighted linear regression models examined the association between CVH and US nativity, adjusting for age and sex and stratified by race and ethnic subgroups.

Results:
Of 117,894 participants (representing 120,295,032 US adults), 51% were female and the mean (SE) age was 45 (0.1) years. Overall, among all combined race and ethnic subgroups, participants born outside the US had significantly higher CVH compared with participants born in the US (beta +0.42; 95% CI: +0.38, +0.46). Hispanic adults (beta +40; 95% CI: +0.32, +0.49), Non-Hispanic Black adults (beta +0.89; 95% CI: +0.77, +1.01), Non-Hispanic Asian adults (beta +0.39; 95% CI: +0.24, +0.54), and Non-Hispanic White adults (beta +0.36; 95% CI: +0.28, +0.45) all had significantly higher CVH compared with adults who were born in the US. The age-and sex-adjusted CVH scores by U.S. nativity for overall race and ethnic groups, Hispanic American subgroups, and Asian American subgroups are shown in the Figure.

Conclusion:
Overall CVH is significantly higher among people born outside the US compared with those born in the US. Among race and ethnic subgroups, people born outside the US had higher CVH compared with those born within the US, except for Asian Indian adults.

Figure. Age-and-sex adjusted CVH scores by US nativity.
Abstract P355: Examining Sexual Identity Differences in Self-Measured Blood Pressure Monitoring Among Adults in the Behavioral Risk Factor Surveillance System
Authors: Doan Danny , Bhargava Anisha , Sharma Yashika , Caceres Billy A
Published: March 2023

Background:
Hypertension is a leading risk factor for cardiovascular disease. Self-measured blood pressure (SMBP) monitoring has been identified as an effective strategy to achieve BP control among adults with hypertension. Although there is growing evidence that sexual minority (e.g., gay/lesbian, bisexual) adults are at higher risk of hypertension than heterosexual adults, there is no data on hypertension self-management among sexual minority people with hypertension.

Methods:
We used data from the 2019 Behavioral Risk Factor Surveillance System to examine differences in SMBP monitoring between sexual minority and heterosexual participants with hypertension. Participants were asked questions regarding SMBP monitoring at home, including whether they were advised by a healthcare professional to check their BP at home, regularly checked their BP at home, and if they shared their home BP readings with a healthcare professional. We ran sex-stratified logistic regression models, adjusted for demographic factors and healthcare utilization, to estimate differences in SMBP monitoring between sexual minority and heterosexual participants.

Results:
The sample included 25,461 participants with a mean age of 54.1 (
±
16.8) of which 95.1% were heterosexual, 1.7% were gay/lesbian, and 2.2% were bisexual. Although there were no differences in the odds of being advised by a healthcare professional to check their BP at home, lesbian women were more likely than heterosexual women to report taking their BP at home (AOR 1.23, 95% CI = 1.03-4.85) and sharing their home BP readings with a healthcare professional (AOR 2.31, 95% CI = 1.04-5.17). In contrast, bisexual women were less likely than heterosexual women to report taking their BP at home (AOR 0.59, 95% CI = 0.43-0.81) and sharing their home BP readings with a healthcare professional (AOR 0.56, 95% CI = 0.40-0.78). No differences in SMBP monitoring were found between sexual minority and heterosexual men.

Conclusions:
As the first examination of sexual identity differences in SMBP monitoring among adults with hypertension, this study addresses important knowledge gaps within cardiovascular and sexual minority health research. Lesbian women with hypertension exhibited more favorable self-management behaviors compared to heterosexual women. However, bisexual women with hypertension were less likely than heterosexual women to engage in SMBP monitoring. Findings suggest there is a need for clinical interventions to improve hypertension self-management among bisexual women.
Abstract P358: Racial Differences in Determinants and Timing of Dropout From an Exercise Intervention: The STRRIDE Trials
Authors: Collins Katherine A , Huffman Kim M , Wolever Ruth Q , Smith Patrick J , Siegler Ilene C , Ross Leanna M , Jakicic John M , Costa Paul T , Kraus William E
Published: March 2023

Introduction:
Most adults recognize the positive health benefits of being physically active and maintaining a healthy weight, yet inactivity and obesity rates continue to rise. This disconnect is even more pronounced among racial and ethnic minorities across the United States, with Black/African American women being the highest risk group for inactivity an obesity. To begin to close this growing racial disparity gap, racial differences in exercise intervention dropout must be assessed.

Hypothesis:
We hypothesized that compared to their White counterpart, Black participants would dropout earlier and more often due to environmental factors.

Methods:
A total of 947 adults with dyslipidemia (STRRIDE I, STRRIDE AT/RT) or prediabetes (STRRIDE-PD) were randomized to either inactive control or to 1 of 10 exercise interventions, ranging from doses of 8 to 23 kcal/kg/wk, intensities of 50% to 75%VO
2
peak, and durations of 6 to 8 months. Two groups included resistance training, and one included dietary intervention (7% weight loss goal). Dropout was defined as an individual who withdrew from the study. Timing of intervention dropout was defined as the last session attended and categorized into phases. Chi-square or
t
-tests assessed differences in baseline characteristics by race.

Results:
Black versus White participants were on average younger (50.7 ± 7.7 vs. 56.0 ± 8.9 years; p<0.01), however they had similar fitness levels (24.5 ± 6.0 vs. 24.7 ± 5.5 ml/kg/min; p=0.83) and body mass indexes (31.6 ± 3.1 vs. 30.8 ± 3.1 kg/m
2
; p=0.07). Black participants were particularly more likely to dropout during the ramp period (43.1% vs. 35.4%) of the exercise intervention compared to their White counterparts. Black participants were more likely to dropout because they lacked time (43.2% vs. 38.7%), work responsibilities (26.3 % vs. 14.3%), were lost to follow-up (23.9% vs. 14.6%), had transportation issues (4.6% vs 0.0%), changed their mind (10.2% vs. 8.5%), or lack of motivation (10.5% vs. 1.3%).

Conclusions:
Understanding racial differences among determinants and timing of exercise intervention dropout provides key insights for future interventions aiming to optimize exercise adoption and adherence. These insights will in turn improve cardiometabolic risk among this understudied minority group.
Abstract P361: Cardiovascular Health in South Asian American Adults in the MASALA Study: Updated Metrics Using the Life’s Essential 8 Definitions
Authors: Shah Nilay S , Hussain Bridget M , Talegawkar Sameera , Jin Yichen , Kandula Namratha , Kanaya Alka M
Published: March 2023

Introduction:
The AHA Life’s Simple 7 (LS7) score was recently updated to the Life’s Essential 8 (LE8) score which revised cardiovascular health (CVH) scoring, including accounting for Asian-specific body mass index, secondhand smoke exposure, and sleep. We evaluated CVH in South Asian American participants of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.

Methods:
At the MASALA baseline exam, median LE8 CVH score was calculated across levels of the LS7 score. Age- and sex-adjusted mean LE8 CVH score was compared by income, education, and country of birth using linear regression. Logistic regression evaluated the age- and sex-adjusted association of LE8 CVH with prevalent coronary artery calcium (CAC) score greater than 0. Sleep duration was not available, so the LE8 score was calculated with the 7 original CVH factors.

Results:
Among 1,093 South Asian American adults in the MASALA Study (48.5% female, mean age 56.7 [SD 9.4] years), mean LE8 CVH score was 68.7 (SD 11.6). The LE8 and LS7 CVH scores were significantly correlated (r=0.78, p<0.01). Median (interquartile range) LE8 score across levels of LS7 score is shown in the Figure. Mean adjusted LE8 score was significantly higher (p<0.01) among those with annual income ≥$75,000 vs. <$75,000 (70.0 [11.6] vs. 65.7 [10.9]) and those with more vs. less than college education (69.5 [11.3] vs. 67.7 [11.8]). Mean LE8 scores significantly varied by place of birth (Bangladesh 69.3 [14.8]; India 69.2 [11.3]; Pakistan 61.0 [11.7]; Sri Lanka 63.9 [11.7]; United States 68.2 [13.7]; p<0.01). A 10-point higher LE8 score was associated with lower odds of prevalent CAC (OR 0.67 [95% CI 0.58-0.76]). Odds of any CAC was higher for participants with low (score 0-49) or moderate (score 50-80) vs. high (score 80-100) CVH (low: OR 5.43 [2.51-11.77]; moderate: OR 3.23 [2.07-5.06]).

Conclusions:
The LE8 CVH score is highly correlated with the LS7 CVH score among South Asian American adults, varies across sociodemographic factors, and is associated with odds of prevalent CAC.
Abstract P362: Racial Disparities in Cardiovascular Disease Mortality: Mediation by Socioeconomic Factors and Statin Use (The ELSA-Brasil Study)
Authors: Pedroso-Camargos Aline , Brant Luisa C , Ribeiro Antonio L , Giatti Luana , Camelo Lidyane V , Diniz Maria de Fatima H , Barreto Sandhi M , Figueiredo Roberta C
Published: March 2023

Background:
Statins are an effective strategy to reduce CVD risk, however, treatment goals are not achieved especially among Blacks and “Pardos” in Brazil.

Hypothesis:
Socioeconomic differences and lack of statin treatment for primary CVD prevention can explain part of the elevated mortality risk of Blacks and “Pardos”.

Methods:
Data from the ELSA-Brasil cohort (15,105 civil servants, from 6 state capital cities), excluding Asians, Indigenous, those with prevalent CVD and missing information about race or statin use. Race was self-reported as Black, “Pardo” or White. Brazilian guidelines at baseline (2008) were used to define those eligible for statin treatment. Cox survival analysis determined the risk of CVD mortality for Black and “Pardo” compared to White (adjusted by age, sex, hypertension, diabetes, LDL-c, BMI and smoking). We used inverse odds ratio weighting technique to calculate mediation for socioeconomic factors (SEF) (education, income, and having health insurance) and statin use when indicated to determine the natural direct and indirect effects of race on CVD mortality. We estimated the percent mediation as the percent change between β coefficients with and without weights applied.

Results:
Among the 13,396 individuals, the mean age was 52±9 years, 55.2% were women, 54.2% were White, and 10.2% were taking statins. Adjusted Black and “Pardo”/White CVD mortality HR was 1.91 (CI
95%
= 1.30-2.81, p<0,001). The direct effect of race on CVD mortality when considering the weight of SEF was 1.37 (CI
95%
= 0.86-2.19) and considering the weight of statin use was 2.01 (CI
95%
=1.36-2.98). SEF explained 51.5% (CI
95%
= 17.0-60.2) and not using statins when indicated explained 7.8% (CI
95%
= 4.2-23.3) of the racial inequality observed in CVD mortality risk (Table 1).

Conclusions:
The higher Black and “Pardo”/White CVD mortality risk is primarily explained by racial differences in SEF. Not using statins when there is indication for treatment increases in about 8% the CVD mortality risk for Blacks and “Pardos” compared to Whites.
Abstract P367: Automated Outreach to Improve Statin Initiation and Follow-Up of Lipid Panels Among Patients With High LDL-C
Authors: Mefford Matthew T , Zhou Hui , Zhou Mengnan , Derakhshan Hananeh , Harrison Teresa N , Rojas Mara , Kanter Michael H , Scott Ronald D , Imley Tracy , Sanders Mark , Timmins Royann , Reynolds Kristi
Published: March 2023

Background:
Despite their effectiveness in reducing low-density lipoprotein-cholesterol (LDL-C) and cardiovascular disease (CVD) risk, high-intensity statins are underutilized among patients with LDL-C ≥ 190 mg/dL. We aimed to determine if a patient outreach program (KP Sure Net) automating high-intensity statin orders and lipid panels improved statin initiation and lab completions.

Methods:
Kaiser Permanente Southern California adults 20-60 years of age with LDL-C ≥ 190 mg/dL and no recent statin use were compared pre- (January 2016-September 2018, n=3,534) and post- (April 2019-July 2021, n=3,555) program implementation to examine statin prescriptions and fills, lab completions, and improved LDL-C (<190 mg/dL) at 6 months. Using Poisson regression with robust variance, we calculated relative risks (RR) and 95% confidence intervals (CI) for the association of program implementation with statin prescriptions, fills, lab completions, and improved LDL-C, separately, adjusting for sociodemographics, insurance, comorbidity burden, and non-statin medication use.

Results:
Among adults identified during pre- and post-implementation, 759 (21.5%) and 976 (27.5%), respectively, received a statin prescription. Adults with a prescription post- versus pre-implementation were more likely to be younger, identify as Black or Asian ethnicity, be English-speaking and have higher income, but were similar by sex, education, insurance, and comorbidity burden. (Table) After multivariable adjustment, adults post- versus pre-implementation had a higher likelihood of receiving a statin prescription (RR 1.36, 95% CI 1.25, 1.48), filling their statin (RR 1.32, 95% CI 1.26, 1.38), completing their lipid panel (RR 1.60, 95% CI 1.44, 1.78), and improving LDL-C (RR 1.36, 95% CI 1.20, 1.53).

Conclusion:
Automating statin orders and lipid panels for high-risk adults improved prescription rates, fills and LDL-C. Understanding facilitators and barriers to adherence is an important next step in improving patients’ health.
Abstract P369: Using Machine Learning to Predict Unplanned Readmission Due to Cardiovascular Disease Among Hospitalized Patients With Cancer
Authors: Park Chanhyun , Han Sola , Ng Boon Peng
Published: March 2023

Background:
Cardiovascular disease (CVD) morbidity and mortality rates have risen in cancer patients. We aimed to demonstrate the feasibility of a using machine learning technique in predicting the risk of unplanned readmission due to CVD among hospitalized cancer patients.

Methods:
We included hospitalized patients with a primary diagnosis code for any cancer for the index hospitalization using the 2017-2018 Nationwide Readmissions Database. The outcome was unplanned hospital readmission due to any CVD within 180 days after discharge. CVD included atrial fibrillation, coronary artery disease, heart failure, stroke, peripheral artery disease, cardiomegaly, and cardiomyopathy. The original data was separated into training (80%) and testing (20%) data. Decision tree (DT) and three ensemble algorithms, including random forest (RF), extreme gradient boost (XGBoost), and AdaBoost, were implemented. Accuracy, precision, recall, F2 score, and receiver operating characteristic curve (AUC) were used to assess the model’s performance. Each algorithm's feature importance was obtained.

Results:
Among 358,629 hospitalized patients with cancer, 5.86% (n=21,021) experienced unplanned readmission due to any CVD. The XGBoost indicated the highest AUC at 0.76, followed by the AdaBoost (AUC=0.75) and RF (AUC=0.75), while the DT had the lowest score at 0.72. Similarly, the XGBoost had the highest F2 score of 0.36, followed by the AdaBoost (F2=0.35) and RF (F2=0.35), whereas the DT had the lowest score at 0.33. The AdaBoost demonstrated the highest accuracy and precision while having the lowest recall (Figure). The feature importance plot of the XGBoost identified Medicare enrollment, mortality risk, private insurance, and cancer surgery as top importance features for unplanned readmission due to CVD.

Conclusions:
Machine learning models can predict the risk of unplanned readmission due to CVD among hospitalized cancer patients. The three ensemble algorithms outperformed the DT, with the XGBoost displaying the best performance.
Abstract P371: Estimating Cost-Effectiveness of Exercise Based Cardiac Rehabilitation for Older Patients With Atrial Fibrillation
Authors: Parikh Romil , Shah Viraj , Patel Prachi , Pillai Ashwin , Salunke Rajeev , Shetty Nishka , Parikh Radhika , Mehta Tapan
Published: March 2023

Introduction:
Observational evidence from real world data suggests that providing cardiac rehabilitation (CR) to older patients with incident atrial fibrillation (AF) is associated with lower risk of all-cause mortality and re-hospitalization. We leveraged these data to estimate cost-effectiveness of extending Medicare coverage for exercise based CR to older AF patients.

Hypotheses:
Exercise based CR for older patients with incident AF is cost-effective at a conventional willingness to pay threshold of $50,000 per quality adjusted life year (QALY).

Methods:
A cost-utility analysis was conducted using a decision tree to compare initiation of exercise-based CR with standard care versus standard care alone for older patients with incident AF. Outcomes considered were re-hospitalization and all-cause mortality. A systematic review was conducted to obtain inputs for model parameters. Paucity of research did not allow meta-analyses. Estimated risks & related uncertainty intervals for re-hospitalization and death were obtained from a published propensity score matched analysis of electronic health records data pooled from 41 health care organizations in the United States of America and the United Kingdom. In this study, CR + standard care versus standard care alone was associated with lower odds of all-cause mortality (odds ratio, 0.32, 95% uncertainty interval 0.29, 0.35) and re-hospitalization (odds ratio, 0.56, 95% uncertainty interval, 0.53, 0.59) over 18 months of follow-up. Estimations for costs and QALY were obtained from USA based, peer-reviewed, published studies. Probabilistic sensitivity analysis was conducted to account for uncertainty in estimates. Data analysis was performed from healthcare perspective using Microsoft Excel software.

Results:
In a hypothetical cohort of 10,000 older patients with incident AF (mean age, 68 years, 71% male, 84% White), estimated costs per QALY gained for CR + standard care was about $2659 and standard care alone was about $2455. Providing CR was associated with an estimated incremental cost of $10,374 per incremental QALY gained. Probabilistic sensitivity analysis showed that CR had a >75% chance of being cost-effective at a willingness to pay threshold of $50,000 per QALY.

Conclusions:
Findings from our simulation study based on real world evidence suggest that extending Medicare coverage for exercise based CR to older patients with incident AF may be potentially cost-effective. Implementing such a policy change requires evidence from a large randomized controlled trial that overcomes design-related limitations identified in previous observational and small, randomized interventional research studies.
Abstract P373: Health Care Access and Usage Patterns Among Native Americans: The Strong Heart Study
Authors: Jernigan Valarie , Lee Elisa T , Yeh Jeunliang , Fabsitz Richard R , Howard Barbara V , Zhang Ying
Published: March 2023

Introduction:
Previous research has shown that health care access and usage patterns among Native Americans are often difficult to measure.

Hypothesis:
We hypothesize that sociodemographic factors such as age, gender, education, and employment influence health care access and usage patterns in Native communities in the Strong Heart Study (SHS).

Methods:
The SHS is a prospective population-based epidemiological study of cardiovascular disease and its associated risk factors in American Indians (AI). Between 1997 and 1999, surviving participants (N=2,382) of the original cohort were invited to a third exam, in which health care access and usage information were collected, along with other clinical and sociodemographic measurements. Multivariate logistic regression was used to find influencing factors of health care choices.

Results:
The majority of study participants (79%, 1,877/2,382) reported Indian Health Services (IHS) as their primary source of care, and close to one-third (29%, 689/2,358) reported having no additional coverage. Figure 1 showed travel time, waiting time after arriving at the clinics, and waiting time of a walk-in visit in IHS, tribal health service, and private practice. As participants aging or obtaining more years of education, they were less likely to use public (IHS or tribal) health service vs. private practice with odds ratio (95% confidence interval) 0.97 (0.95-0.99, p<0.01) and 0.89 (0.84-0.93, p<0.01) respectively, adjusting for gender and employment status.

Conclusions:
SHS participants primarily utilize IHS compared to other health services. Average waiting time is longer for IHS facilities (vs. private practice or tribal health facilities) with 35% (622/1,760) participants waiting for > 60 minutes to be seen in regular appointments, and with 53% (814/1,540) participants waiting for > 60 minutes in a walk-in visit. Age and education influence access to and selection of health care services for AI. This report provides baseline information for future health care access study in SHS.
Abstract P375: Envisioning an “Ideal State” for Hypertrophic Cardiomyopathy — Patients and Health Care Professionals Discuss Steps to Improve Guideline-Directed Diagnosis and Treatment
Authors: Gonzalez Nicole , Picou Kylie
Published: March 2023

Introduction:
Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease, affecting an estimated 1 in 500 adults in the U.S. Despite its prevalence, the condition is underdiagnosed because HCM symptoms are not widely recognized among patients and health care professionals. Previously, the American Heart Association (AHA) hosted two Roundtable Discussions on HCM. These discussions identified diagnosis challenges and education resource gaps, and highlighted updates to HCM scientific guidelines.

Objective:
Build on previous Roundtables to identify steps needed to achieve an “ideal state” for patients with HCM through a guided discussion with patients and multi-disciplinary health care professionals.

Methods:
The virtual Roundtable was facilitated using a semi-structured interview guide with HCM patients (n=3) and multi-disciplinary health care professionals (n=8). The discussion recording was transcribed, and inductive and deductive thematic analyses identified key themes.

Results:
Patients described an “ideal state” that included increased awareness and management of HCM among patients and health care professionals, a greater sense of empowerment and trust in health care systems, and improved connections with allied health, mental health, and peer support services. Health care professionals described an “ideal state” as increased awareness of and training in HCM and genetics at all levels of medical education, equitable and timely access to care and diagnosis, improved models of care, and scientific advancements to improve treatment and diagnosis. Health care professionals cited financial barriers to achieving this state, particularly the need to improve health care financing to facilitate HCM care coordination across departments and health systems. The role of technology and digital tools was also identified as key to achieving the “ideal state,” with health care professionals noting both promise and limitations in their ability to improve HCM diagnosis and treatment.

Conclusions:
Reaching an “ideal state” for diagnosing and treating HCM patients requires systematic changes at the patient, health care professional, and health care system levels. Addressing the steps outlined during this discussion could vastly improve treatment, outcomes, and quality of life for patients with HCM as well as support health care professionals as they provide timely, guideline-directed diagnosis and treatment.
Abstract P376: Home Blood Pressure Telemonitoring Linked With Community Health Workers to Improve Blood Pressure: The LINKED-BP Program
Authors: Commodore-Mensah Yvonne , Liu Xiaoyue , Ogungbe Oluwabunmi , Ibe Chidinma A , Moyo-Songonuga Sharon , Amihere Johnitta , Mensa Margaret , Lane Tye , Martin Seth S , Crews Deidra , Cooper Lisa A , Dennison Himmelfarb Cheryl R
Published: March 2023

Background:
Hypertension disparities persist in underserved populations in the United States. Presently, few implementation trials have focused on adults with elevated blood pressure (BP) or untreated stage 1 hypertension. To address this scientific gap, we have developed a pragmatic cluster-randomized controlled trial, the “LINKED-BP Program,” a patient-centered, multi-level intervention linking home blood pressure monitoring (HBPM) via a telemonitoring platform (the Sphygmo BP application) that integrates Bluetooth-enabled validated BP devices, support from community health workers, and BP measurement training at primary care practices to improve BP. The LINKED-BP Program is one of the five studies in the RESTORE (Add
RE
ssing
S
ocial Determinants
TO
p
R
event hyp
E
rtension) Network, an American Heart Association-funded initiative focused on the prevention of hypertension. The study aims to examine the effect of the LINKED-BP Program on BP reduction, as well as to evaluate the reach, adoption, sustainability, and cost-effectiveness of the intervention.

Methods:
We are recruiting 600 adults with elevated BP or untreated stage 1 hypertension from 20 primary care practices that provide care to underserved populations in Maryland and Pennsylvania. The practices are randomly assigned to the intervention or the enhanced usual care arm. Patients in the LINKED-BP Program receive training on HBPM with a validated home BP monitor, BP telemonitoring through the Sphygmo app, and community health worker visits for education and counseling on lifestyle modification over 12 months. Data are collected at baseline, 6, 12, and 24 months. The primary clinical outcome is a change from baseline in systolic BP at 6 and 12 months.

Discussion:
The LINKED-BP Program tests a sustainable, scalable approach to prevent hypertension and advance health equity. The study findings will inform implementation strategies that address social determinants of health and barriers to hypertension prevention in underserved populations.
Abstract P378: Design of the Equity in Prevention and Progression of Hypertension by Addressing Barriers to Nutrition and Physical Activity (EPIPHANY) Study: A Cluster Randomized Trial
Authors: Hardy Shakia T , Hall Lanisha , Hannon Lonnie , Cherrington Andrea
Published: March 2023

Introduction:
High rates of hypertension and poverty in the rural South contribute to health disparities with Black adults experiencing higher rates of cardiovascular disease than White adults. Clinical trials have shown that lifestyle interventions like the Dietary Approaches to Stop Hypertension diet and increasing physical activity reduce the risk for hypertension. However, suboptimal implementation indicates a need to identify mechanisms of prevention in rural populations impacted by negative social determinants of health that can make achieving healthy lifestyle behaviors more challenging.

Methods and Results:
The EPIPHANY (Equity in Prevention and Progression of Hypertension by Addressing barriers to Nutrition and Physical activitY) Study is a cluster randomized controlled trial testing a multilevel intervention designed to reduce community and individual barriers to a healthy lifestyle to lower blood pressure (BP) among rural, Black adults. EPIPHANY is enrolling and randomizing 20 churches in the Black Belt region of Alabama. Health education fairs offered to all churches are being used to screen and enroll Black adults with elevated BP or stage 1 hypertension (120-139 mm Hg and diastolic BP <90 mm Hg) who are not recommended for antihypertensive medication, according to the 2017 American College of Cardiology/ American Heart Association BP guideline. Participants (n=240) in churches randomized to the control condition are offered access to online resources including cooking demonstrations and exercise classes. Participants (n=240) in churches randomized to the intervention are receiving access to online resources; telephone-based peer support for lifestyle modification, goal setting and problem solving; funding for churches to develop programs to address food access and/or barriers to physical activity; and training of church members to serve as peer health advocates to deliver training for church members on lifestyle modification. We will employ a Type 1 Hybrid Implementation-effectiveness design to assess the effectiveness and implementation of this multi-level intervention, using the RE-AIM framework. BP, social determinants of health, psychosocial factors, physical activity and diet are being assessed. The EPIPHANY trial began recruitment in August 2022 and has enrolled 18 and 25 Black adults in the first two churches randomized to the control and intervention conditions, respectively, and recruited four churches for the next wave of screenings.

Conclusion:
The EPIPHANY study is designed to prevent hypertension among rural, Black adults by addressing structural and individual barriers to lifestyle modification through peer support. The study could provide evidence for a feasible, scalable and sustainable approach to preventing hypertension in rural, underserved communities.
Abstract P382: Blood Pressure Outcomes After 12 Months in Primary Care: A Prospective Cohort Study in Electronic Health Records Using Propensity Score Matching for Remote Patient Monitoring for Hypertension
Authors: Petito Lucia , Lee Ji Young , Peprah Yaw , Anthony Lauren , Li Jim , Sato Hironori , Persell Stephen D
Published: March 2023

Introduction:
In primary care (PC) settings, more hands-on hypertension management may be enabled by remote patient monitoring (RPM) for blood pressure (BP), leading to greater BP control over time

Hypothesis:
Individuals prescribed RPM will have better BP control (BP <140/90 mmHg) and lower office SBP after 12 months, compared with temporally-matched controls.

Methods:
We conducted a pragmatic matched cohort study in Medicare-enrolled patients with Hypertension at six PC practices, 288 of whom participated in pilot studies of a Omron VitalSight
TM
RPM system that enabled automatic transmission of BP and pulse into the electronic health record (EHR). We used 1:4 propensity score matching to identify 1152 contemporary matches for these patients from the same PC practices, based on age, sex, systolic BP (SBP), marital status, and several other clinical and healthcare visit characteristics. Outcomes after 12 months included controlling high blood pressure (most recent BP <140/90 mm Hg), and most recent systolic BP and diastolic BP, assessed 1) using PC office measurements only and 2) incorporating RPM measurements.

Results:
The matched cohort of 1152 patients was, on average, 74 (SD 8) years old, 71% female, and 71% non-Hispanic white. Average baseline systolic BP (SD) was similar between groups: 142.7 (19.5) and 141.2 (18.7) mm Hg in RPM-prescribed patients and controls, respectively (Table). Compared with matched controls, after 12 months the RPM-prescribed cohort had greater BP control (72.6% versus 65.6%) and lower systolic BP (132.3 versus 136.6 mm Hg) when including RPM measurements. However, these metrics were similar when using PC office measurements only.

Conclusions:
Greater BP control and lower SBP were observed after 12 months in RPM-prescribed patients when considering RPM measurements. Further studies will assess the contributions of adherence to RPM use to observed declines in BP. The EHR can be used to prospectively construct and conduct cohort studies.
Abstract P384: Gender Disparities in the Co-Existence of Hypertension and Diabetes in South Africa: Results From the Nationwide Demographic and Health Household Survey Data
Authors: Kandala Ngianga-Bakwin , Stranges Saverio
Published: March 2023

Introduction:
The rapidly growing public health burden of cardiovascular disease and diabetes in low- and middle-income countries threatens the progress expected by many countries’ effort to combat endemic infectious diseases and achieve good health and wellbeing (SDG3). Specifically, in South Africa the burden of hypertension and diabetes is a preventable but still neglected public health issue, causing a large number of premature deaths among men and women. There are very few population-based studies examining the distribution of risk factors and the combined burden of hypertension and diabetes prevalence in South Africa to inform an effective public health response.

Objectives:
This study investigates potential gender disparities in the co-existence of hypertension and diabetes prevalence and provincial variation in South Africa in 2016, adjusting for individual level demographic, behavioural and socio-economic variables, while allowing for spatial autocorrelation and adjusting simultaneously for the hierarchical data structure and risk factors.

Methods:
The study sample was based on participants aged ≥15 years from the 2016 South Africa DHS. Hypertension was defined as blood pressure ≥ 140/90 mmHg or self-reported health professional diagnosis or on antihypertensive medication and diabetes was defined as self-reported health professional diagnosis or on diabetic medication. Bayesian geo-additive regression modelling investigated the association of various socio-economic factors on the prevalence of both hypertension and diabetes across SA’s nine provinces while controlling for the latent effects of geographical location.

Results:
The prevalence of hypertension, diabetes, and combined hypertension and diabetes were 48.2% (4212 of 8679), 4.5% (458 of 10255) and 3.8% (314 of 8195) successively in the DHS in 2016. The prevalence of hypertension increased with age and was significantly higher in male, in people of coloured ethnic group, in overweight and obese, in people with high blood cholesterol and varied with geographical location. Diabetes prevalence increased with age and was significantly higher in male, in overweight and obese and in people with high blood cholesterol. The co-existence of the prevalence of both combined hypertension and diabetes was significantly higher in male, in overweight and obese and in people with high blood cholesterol, in people with heart attack/angina and increased with age.

Conclusions:
The findings can inform public health policy and decision making regarding the allocation of public resources to tackle the growing burden of hypertension and diabetes in South Africa, particularly in the most affected areas and subgroups of the population. Public health education aiming at the prevention of CVDs should target both ailments at the same time as cost-effective measure to achieve SDG3.
Abstract P387: Effects of Reduced Dietary Sodium and the Dash Diet on Glomerular Filtration Rate: Results From the Dash-Sodium Trial
Authors: Morales-Alvarez M. Catalina , Nissaisorakarn Voravech , Appel Lawrence J , Miller Edgar R , Christenson Robert H , Rebuck Heather , Rosas Sylvia E , William Jeffrey H , Juraschek Stephen P
Published: March 2023

Background:
While prior studies demonstrated that a low-sodium, DASH diet reduced blood pressure, the effects of sodium reduction, alone or in combination with the DASH diet, on kidney function are still unknown.

Objective:
We measured cystatin C in stored specimens of the DASH-Na trial, to determine the effects of sodium reduction and the DASH diet, alone or combined, on kidney function assessed by eGFR.

Methods:
DASH-Sodium was a controlled, feeding study in adults with pre- or stage 1 hypertension, who were randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4-weeks following a 2-week run-in period where all consumed a high sodium-control diet. The three sodium levels were low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). Outcomes included eGFR by cystatin C (CKD-EPI 2021 equation) at baseline and at the end of each feeding period.

Results:
Cystatin C was measured in 409 of the original 412 participants, 207 were assigned the DASH diet, and 202 were assigned the control diet. The mean age was 48 years; 56% were women, and 56% were Black. The mean baseline BP was 135/86 mm Hg and BMI was 29.2 kg/m
2
. Compared with control, the DASH diet did not affect eGFR (β=-0.96 mL/min per 1.73 m
2
; 95% CI: -2.74, 0.83) (
Figure
). In contrast, low versus high sodium intake decreased eGFR (β=-2.36 mL/min per 1.73 m
2
; 95% CI: -3.64, -1.07). Together, compared to the high sodium-control diet, the low sodium-DASH diet decreased eGFR by 3.10 mL/min per 1.73 m
2
(95% CI: -5.46, -0.73).

Conclusions:
A combined low sodium-DASH diet reduced eGFR over a 4-week feeding period. Whether these effects are reno-protective long-term represent an important clinical inquiry for subsequent research.
Abstract P390: Trends in Contraceptive Prescribing in Women With Hypertension From 2017-2022
Authors: Sadaniantz Katherine , Wilkie Gianna , Kovell Lara
Published: March 2023

Introduction:
Estrogen based contraception is not recommended by the U.S. Medical Eligibility Criteria (MEC) in women with hypertension (HTN), regardless of control. While the CDC reports 65.3% of women of child-bearing age use contraception, little is known about rates of contraceptive prescriptions in women with HTN.

Purpose:
To examine contraceptive prescription patterns among women with and without HTN.

Methods:
Retrospective review of electronic health record (EHR) data through EPIC from a large health system was performed using a data extraction tool called EPIC SlicerDicer. All women aged 18-55 with HTN who presented to the health system from 2017-2022 were included. HTN, defined by ICD codes, included essential HTN, benign HTN, HTN in CKD due to T2DM, HTN in CKD III due to T2DM, HTN concurrent and due to end stage renal disease, HTN secondary to endocrine disorder, renovascular HTN, HTN with albuminuria, and secondary HTN. Contraceptive prescriptions were abstracted from the EHR including estrogen based contraception (combination oral contraceptive pills, patch, and ring), long acting reversible contraception (intrauterine device or implant), progestin only pills, and depo-provera.

Results:
Over 5 years, 33.5% (613 of 1,831) of women with HTN were prescribed contraceptives vs. 12.2% of women without HTN (77,742 of 637,820, p < 0.001,
Table
). Women with HTN prescribed contraceptives were mean age 43 (SD 9) years, 76.2% White, 9.3% Black, and 16.2% Hispanic/Latina. Women with HTN not prescribed a contraceptive were mean age 48 (7) years (p < 0.001) with similar racial/ethnic background (p = 0.47). Among prescriptions for women with HTN, 37.7% were estrogen based.

Conclusions:
Women with HTN are prescribed effective contraception at a higher rate compared to the general population. Despite US MEC recommendations, over 1/3 of women with HTN are prescribed estrogen based contraception. Further efforts are warranted to encourage effective contraception counseling and prescription in this high-risk population.