bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P48: Inflammatory Biomarkers as Mediators of the Relation Between Type D Personality and 12-Month Health Status in Outpatients with Heart Failure
Authors: Pelle Aline J , Mommersteeg Paula M , Ramakers Christian , Szabó Balázs M , Denollet Johan , Kupper Nina
Published: March 2022

Background:
The distressed (‘Type D’) personality has been associated with impaired health status and increased inflammatory activation in heart failure (HF). Increased pro-inflammatory activation has been suggested as a mediating pathway, explaining associations between Type D personality and impaired health outcomes. In this study, we examined whether inflammatory biomarkers mediated the association between Type D personality and 12-month health status.

Methods:
HF outpatients, recruited from one center in the Netherlands (
n
=228, 79.4% male, mean age 66.9±8.7 years), filled out the Type D questionnaire (DS14) at inclusion and the Short Form-12 (SF12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 12 months to assess generic and disease-specific health status, respectively. Blood samples at inclusion were analyzed for high sensitive C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor α (TNFα), and its soluble receptors (sTNFr1, sTNFr2). A multiple mediation model for Type D personality, 12-month generic and disease-specific health status, and mediating inflammatory biomarkers was tested using Structural Equation Modeling.

Results:
The prevalence of Type D personality was 20.6% (47/228). Type D personality was associated with lower generic and disease-specific health status (
p
<.001). IL-6 was inversely associated with health status (
p
<.01), and sTNFr1 was inversely associated with disease-specific health status (
p
=.03). No mediating effects were found for the five inflammatory biomarkers. Type D personality remained independently associated with lower health status in the final model comprising all inflammatory biomarkers.

Conclusions:
The association between Type D personality and impaired health status was not mediated by increased levels of inflammatory biomarkers. Future studies need to confirm these findings, and investigate whether the association between Type D personality and impaired health outcomes may be explained by other biological or behavioral factors.
Abstract P52: Epidemiology of Heart Valve Repair and Replacement Procedures in the United States: A 15-Year Perspective
Authors: Ong Kevin L , Lau Edmund , Patel Jasmine , Ochoa Jorge
Published: March 2022

Open heart valve repair/replacement is widely used to treat various valvular pathologies. The development of percutaneous valve replacement technology may pave the way for less invasive treatment options. This study characterized the epidemiology of valvular repair and replacement procedures in the U.S.

The Nationwide Inpatient Sample (NIS) was used to identify closed and open heart valvotomy, heart valve replacement, annuloplasty, and percutaneous valvotomy procedures between 1993 and 2007. NIS is an annual survey of ∼1,000 hospitals and contains 20% of the U.S. inpatient hospitalizations. The prevalence of these procedures was calculated as a function of age, gender, race, census region, and type of hospital.

3,342 closed heart valvotomy, 191,141 closed heart valvotomy, 1,078,388 heart valve replacement, 106,110 annuloplasty, and 35,071 percutaneous valvotomy procedures were identified. Heart valve replacements included 302,932, 89,249, 13,828, and 4,680 aortic, mitral, pulmonary, and tricuspid valve procedures with tissue graft, respectively, and 479,168, 253,804, 3,904, and 7,494 prosthetic aortic, mitral, pulmonary, and tricuspid valve procedures, respectively. In contrast to valvotomy procedures, the majority of heart valve replacements (64.0%) and annuloplasty (57.7%) were performed on elderly patients (>=65 years). Most repair/replacement procedures were performed on men, except for percutaneous valvotomy (41.9%). Regional variations were found; for example, closed valvotomy were disproportionately performed in South (44.2%). The vast majority of procedures were performed in urban, non-teaching and large hospitals.

Databases such as the NIS allow the characterization of the epidemiology for heart valve repair/replacement patients in a large, nationally representative patient sample. Our study demonstrates that these procedures vary considerably by patient demographics and geographic region. Additional research will help assess if the epidemiology will change over time, as the use of new technologies such as percutaneous heart valve devices grows. In the future, longitudinal administrative databases, such as Medicare, provide a mechanism to evaluate the comparative effectiveness of these procedures.
Abstract P54: Is Creatine Kinase-MB (CKMB) Really Necessary in the Diagnosis of Acute MI When Troponin Is Performed Simultaneously?
Authors: Rajamanickam Anitha , Zhang Yuan-Yuan , Jurkovitz Claudine , Kolm Paul , Aguiar Ruth , Bowen James , Xin Xu , Hess Dan , DiSabatino Angela , Ewen Edward , Weintraub William , Rahman Ehsanur
Published: March 2022

BACKGROUND
According to Joint ESC/ACC/AHA/WHF Task Force, troponin I (Tn) is the preferred biomarker for the diagnosis of acute MI. However, it is still common practice to order both serial CKMB and serial Tn to rule out acute MI.

OBJECTIVE
Our hypothesis is that most clinicians only use Tn and not the CKMB results in the diagnosis of acute MI when both test results are available. Subsequent investigation and management decisions are based on Tn and not on CKMB.

METHODS
Our large regional academic medical center has about 150,000 ED visits /yr. We queried the electronic medical records of 65,950 patients from Jan 1, 2005 to Dec 31, 2010 who had a Tn within 4 hours of arrival in the ED and at least 2 sets of Tn and CKMB within 24 hours. Out of that cohort we selected the records of 9605 consecutive patients with symptoms suggestive of ACS , admitted to our Clinical Decision Unit, with the express purpose of ruling out acute MI, and then going on to further management pathways based on their initial course. All these patients had both serial Tn and CKMB. These patients were then divided into

Group 1

( 9204 patients- normal serial Tn and CKMB) :mean age 57.33 years, males 45.22%, Caucasian 72.11%, African-American 22.38% and

Group 2

(401 patients- normal serial Tn and elevated CKMB ): mean age 58.33 years, males 72.82%, Caucasian 67.58%, African- American 27.43%.

RESULTS
(See Table) Chi square analysis was used to demonstrate that there was no statistically significant difference between the two groups in the percentage of patients who proceeded to stress test or were discharged without a stress test or a cath. Also, there was no statistically significant difference between the two groups in the percentage of patients who proceeded to cath.

CONCLUSIONS
In our patient population, elevated CKMB in the absence of elevated troponin did not influence further management decisions.

TABLE

.
TROPONIN NORMAL/CKMB NORMAL
TROPONIN NORMAL/ CKMB ELEVATED
P VALUE

Total patients(9605)
9204 (96.2%)
401 (3.8 %)

STRESS TEST
5899 (64.09%)
251 (62.59%)
0.5406

DISCHARGED WITHOUT STRESS TEST OR CATH
2315 (25.15%)
102 (25.44%)
0.8972

CATH WITHOUT STRESS TEST
990 (10.76%)
48 (11.97%)
0.4434
Abstract P57: The Baseline Characteristics Predictive of a Poor Procedural Response to Balloon Aortic Valvuloplasty Among a Cohort of High–Surgical Risk Patients with Aortic Stenosis
Authors: Cheung Michael , Tempelhof Michael , Tan Mark , Beohar Nirat
Published: March 2022

Background:
Balloon aortic valvuloplasty (BAV) for high-surgical risk patients with severe aortic stenosis (AS) has been used as a palliative therapy, a bridge to surgical aortic valve replacement (AVR) or to transcatheter aortic valve implantation (TAVI). Poor procedural response, including poor improvements in the aortic valve area (AVA) and the mean aortic valve pressure gradient (AVPG) immediately following BAV have been demonstrated to predict mortality following BAV. Whether any baseline characteristics can predict a poor procedural response to BAV has not been assessed.

Methods:
We retrospectively reviewed the medical records of 74 consecutive, AS patients who underwent BAV. Patient's baseline demographics, comorbid medical conditions, medications, laboratory results and echocardiographic findings were correlated with changes in the AVA and the mean AVPG immediately post-BAV.

Results:
The mean age was 80 ± 4 years, the mean Society of Thoracic Surgeons Surgical Risk Score (STS) was 7.73 ± 6.26 and the mean logistic EuroSCORE was 23.8 ± 15.4. There was 1 periprocedural death, 16 (21.6%) patients were bridged to AVR or to TAVI and 58 (78.3%) of the patients received palliative or definitive therapy. The mean AVA increased from 0.72 ± 0.24 cm
2
to 1.12 ± 0.42 cm
2
and the mean AVPG decreased from 42.09 ± 16.54 mmHg to 24.41 ± 10.86 mmHg. Overall, no baseline characteristics were statistically significant predictors of poor AVA improvements following BAV (Table 1). Patient's age < 80 years old was the only significant, independent predictor of poor AVPG reduction post-BAV compared to patient's > 80 years of age (Table 1).

Conclusion:
Prior to BAV, age < 80 years of age was the only characteristic predictive of a poor procedural response. All other baseline characteristics including patient demographics, pre-existing medical conditions, active medications and laboratory values were poor predictors of the procedural response to BAV therapy.
Abstract P59: Impact of Drug Therapy on Refractory Angina
Authors: Morrone Doralisa , Huqi Alda , Marzilli Mario
Published: March 2022

Background:
Revascularization is the ultimate therapeutic option for symptomatic angina patients on medical therapy. However, a continuously growing patient population presents with angiographic features not (any more) amenable to revascularization (refractory angina). The impact of medical therapy in refractory angina patients has not been evaluated. We sought to determine the symptom control in ‘spontaneous’ clinical practice and how this is affected by strict implementation of current guidelines for the management of chronic angina.

Methods:
Patients diagnosed with chronic stable angina who were not candidates for revascularization were included. Drug therapy over the last 4 weeks was recorded and patients were administered the Seattle Angina Questionnaire (SAQ). A 3 week period of drug insertion and/or titration was allowed. All patients were re-evaluated and repeated the SAQ at 6 months. Friedman's test with Bonferroni correction was used to compare difference in angina among the groups. A p value <0.05 was considered statistically significant.

Results:
A total of 118 patients were included (mean age 72 years; 71% males). Sixty-eight percent of patients were on beta-blockers (BB) (only 40% on maximally tolerated dose), 41% on calcium channel blockers (CCB), 81% on nitrates and 89% on aspirin. According to SAQ, 36% of patients suffered 3 or more angina episodes per week and 19% had heavy limitations in daily activities. At 6 months, 77% of patients were on maximally tolerated BB dose, 44% on CCB, 82% on nitrates and 93% on aspirin. SAQ score results improved significantly, with 20% of patients showing clinically important differences. Twenty-four percent of patients reported 3 or more angina episodes per week and 15% had heavy daily limitations.

Conclusions:
Refractory angina patients have a poor quality of life and often are not prescribed maximally tolerated drug therapy. Optimization of treatment regimen significantly improves quality of life but is clearly not sufficient for symptom control. Strategies for the treatment of this patient population are needed to be evaluate in clinical trials.
Abstract P62: Feasibility of Routine Quality of Life Assessment in Ambulatory Heart Failure Patients
Authors: Odutayo Kayode A , Badloe Sabrina , Pratibhu Parakash , Desai Akshay , Stevenson Lynne W , Young Michelle , Weintraub Joanne , Givertz Michael , Lewis Eldrin F
Published: March 2022

Background:
Assessment of quality of life (QOL) may be helpful in management of heart failure (HF) patients in ambulatory practice and is considered a performance measure. Little is known about the feasibility of routine assessment of QOL in clinical management of HF. The objectives of this study were to a) evaluate ability to serially measure QOL in clinical practice and b) determine patient characteristics that influence change in QOL scores.

Methods:
Patients presenting to the ambulatory HF clinic were routinely administered (prior to physician encounter) a 2-page questionnaire to assess QOL and concerns to be addressed during the visit. Visual analog scales (VAS) were used to assess a) overall QOL, b) dyspnea, and c) fatigue with scores ranging from 0 to 100 (higher scores representing better health status). Patients were asked if their QOL was affected more by their HF or another medical condition. Data was analyzed with ANOVA and Chi-square tests.

Results:
Of 1069 patients who completed baseline questionnaires, 557 (52%) had QOL assessed at subsequent visit (mean time between visits 225±142 days, 58% male, mean age 57
±
15, LVEF 40±16%). Health status was impaired at baseline (VAS QOL 63±29, dyspnea 68±32, and fatigue 65±25). Of patients with paired data, 411 (74%) answered (at baseline) questions on the contribution of HF to their QOL (Table). HF affected QOL most in 48% of these patients, 23% felt HF and other medical conditions affected them equally, and 29% felt other medical conditions were more important. Patients affected more by HF had greater improvements in VAS scores despite trend of more hospitalizations. Patients with other medical problems had better QOL at baseline, but noted declines in VAS scores.

Conclusions:
QOL can be routinely monitored in HF clinics. Strategies to improve QOL should be developed to meet the individual patient's needs as other co-morbidities often affect QOL equally or more. Future studies should evaluate more comprehensive QOL tools.

Patient characteristics that influence change in QOL scores
Abstract P63: Burden of Comorbidities Among Patients with Atrial Fibrillation
Authors: LaMori Joyce , Gross Hilary J , Patel Aarti A , Crain Melanie , DiBonaventura Marco D , Mody Samir H , Schein Jeff R
Published: March 2022

Objective:
Atrial fibrillation (AF) may manifest with comorbidities. We examined the prevalence of comorbidities and general medication use among AF patients in order to assess total disease burden.

Methods:
Data were obtained from the 2009 National Health and Wellness Survey (N=75,000), an annual cross-sectional Internet-based survey of adults in the United States. In addition to demographics and medication use, patients with AF also reported on their comorbid conditions. Using demographic and patient characteristics, a CHADS
2
score (an index of stroke risk) was calculated for each patient.

Results:
A total of 1297 patients reported a diagnosis of AF. The mean age was 64.9 years (SD 12.2), and 65% (n=844) were male. In addition to AF, these patients reported comorbidities in various organ systems, including 90% (n=1170) with a cardiovascular condition, 62% (n=802) with a urological condition, 42% (n=543) with a respiratory condition, and 527 (41%) with a gastrointestinal condition. Specific comorbid conditions reported in this AF patient population included hypertension in 72% (n=928) of patients, history of myocardial infarction in 21% (n=269) of patients, heartburn/gastroesophageal reflux disease (GERD) in 29% (n=372) of patients, and allergies/hay fever in 29% (n=377) of patients. The mean Charlson Comorbidity Index score was 1.53 for all patients. Of the 1297 patients, 46% (n=594) had a CHADS
2
score of ≥2. The percentage of patients reporting current medication use included: 71% (n=919) for AF, 64% (n=824) for hypertension, 50% (n=650) for hyperlipidemia, 29% (n=370) for arrhythmia, 310 24% (n=310) for diabetes and 26% (n=332) for heartburn/GERD medications. Overall, 43% (n=552) of patients with AF were using an anticoagulant medication.

Conclusions:
This self-reported national survey identified AF patients as having a high comorbidity burden, with conditions affecting a variety of organ systems. Medications used to treat a variety of conditions are also highly prevalent and should be taken into account in managing patients with AF.
Abstract P65: Risk Factor Reduction in the Progression of Coronary Artery Disease in an Outpatient Cardiology Practice
Authors: Lai Hoang M , Mercando Anthony D , Aronow Wilbert S , Kalen Phoenix , Desai Harit V , Gandhi Kaushang , Sharma Mala , Amin Harshad , Lai Trung M
Published: March 2022

Background
: Treating patients who received multiple cardiac catheterizations can be difficult because they are more likely to have multiple risk factors for coronary artery disease (CAD), complex coronary anatomy, and recurrent angina requiring repeated cardiac evaluation.

Purpose
: The aim of this study was to evaluate patients with at least two coronary angiograms and identify differences between the patients with progressive CAD (PCAD) and no progressive CAD (NPCAD) in an outpatient cardiology practice.

Methods
: Chart reviews were performed in patients receiving two or more cardiac catheterizations at least one year apart. The study population was divided into patients with PCAD and NPCAD. Progression of CAD was defined as 1: new non-obstructive or obstructive disease in a previously disease-free vessel; or 2: new obstruction in a previously non-obstructive vessel. Medication use, serum low-density lipoprotein cholesterol (LDL-C) and blood pressure were used for analysis.

Results
: The study included 183 patients, with 131 males and 52 females, mean age 71 ± 10 years. The average follow-up duration was 11 years. Of 183 patients, PCAD had 108 patients (59%), and NPCAD had 75 patients (41%). Statins were used in 80 patients (74%) with PCAD and in 55 patients (73%) with NPCAD (p not significant (NS)). Beta blockers were used in 85 patients (79%) with PCAD and in 61 patients (81%) with NPCAD (p NS). Angiotensin-converting enzyme inhibitors were used in 49 patients (45%) with PCAD and in 32 patients (43%) with NPCAD (p NS). Aspirin was used in 86 patients (80%) with PCAD and in 60 patients (80%) with NPCAD (p NS). Mean arterial pressure was higher in PCAD than in NPCAD (97 ± 13 mm Hg versus 92 ± 12 mm Hg) (p<0.05). Serum LDL-C level was insignificantly higher in PCAD (94 ± 41 mg/dL) than in NPCAD (81 ± 34 mg/dL) (p=0.09).

Conclusion
: There was no difference in medical therapy of patients with and without PCAD. However, patients with PCAD had a higher blood pressure and a trend toward higher serum LDL-C level. Our data suggest that in addition to using appropriate medical therapy, aggressive control of blood pressure and serum LDL-C level may reduce progression of CAD.
Abstract P69: Reduction of Contaminated Blood Culture Rates in a Cardiovascular Intensive Care Setting
Authors: Burns Kathleen M , Wagner Chad , McPherson John , Byrd Jeannie , Self Wesley , Martin Barbara , Talbot Thomas R
Published: March 2022

Background:
Blood cultures are an invaluable tool for diagnosing and guiding bacteremia therapy. The validity of culture results can be jeopardized when specimens are contaminated with bacteria from patient or collector's skin or catheter hubs. Because common skin bacteria can represent true bacteremia, their presence cannot automatically be dismissed. Contaminated blood cultures (CBCs) increase risk and cost of subsequent care. For patients in the cardiovascular intensive care unit (CVICU) with prosthetic valves, grafts and implanted devices and for those awaiting transplant, the implications of CBCs are exponential. The current Clinical and Laboratory Standards Institute (CLSI) recommendation is to maintain a contamination rate of less than 3%. Despite education on the implications of false positives, communication of target and actual rates, and encouragement to avoid central line sampling, the CVICU's average CBC rate from July - December of 2009 was 6.1% (monthly range: 2.7 - 9.6%).

Objectives:
Reduce the CVICU's CBC rate to less than 3%.

Methods:
Draw sites for cultures were reviewed during central line-associated blood stream infection (CLABSI) and CBC case-reviews and eventually through retrospective review of 1800 CVICU cultures. The CVICU Leadership then determined that all CVICU blood cultures were to be collected by venipuncture. A concurrent quality initiative was occurring in our Emergency Department. Following an observational review of 50 culture draws, they concluded that use of a clean procedure for culture collection resulted in frequent contamination risk opportunities. They designed a blood culture collection kit and a sterile collection procedure. The CVICU joined the pilot study for this kit and method.

Results:
The CVICU's average CBC rate from January 2010 - January 2011 was 2.7%. (monthly range: 0% - 6.9%) Reduction in CBC has also contributed to a decrease in the unit's CLABSI rates.

Conclusions:
Quality improvement initiatives often focus on education and results communication. The CVICU was unable to sustain improvement in blood culture contamination rates with these interventions alone. Process study and subsequent policy and procedure changes have netted sustained improvement in reduced CBC rates.
Abstract P7: The Impact of Cardiovascular Hospitalization on Mortality and Quality of Life Among 14,261 Atrial Fibrillation Patients in the ACTIVE Study
Authors: Nieuwlaat Robby , Ng Jennifer , Lewis Basil S , Budaj Andrzej , Connolly Stuart J
Published: March 2022

Background
Cardiovascular (CV) hospitalization has been used as primary outcome in atrial fibrillation (AF) research, but remains controversial. Our aim was to provide detailed information on characteristics and impact of CV hospitalization among 14,261 patients in the ACTIVE clinical trial.

Methods
Patient characteristics, mortality and time to first non-fatal CV hospitalization were measured in the ACTIVE controlled clinical trial setting. Multivariable proportional hazards regression analysis was used to determine factors associated with CV hospitalization, and to assess the independent association of CV hospitalization with all-cause mortality and quality of life using the EuroQoL scale.

Results
During a median follow-up of 3 years and 11 months, 10,584 CV hospitalizations were observed, of which 9,859 were non-fatal and 725 fatal. Non-fatal CV hospitalization had occurred in 50% of patients after 4 years follow-up and was more likely to occur in patients with at baseline heart failure (relative risk (RR) = 1.32; p<0.0001), coronary artery disease (RR = 1.43; p<0.0001), an antiarrhythmic drug (RR = 1.19; p<0.0001), sinus rhythm (RR = 1.42; p<0.0001) and with a history of fainting (RR = 1.23; p<0.0001), while less likely in working patients (RR = 0.84; p<0.0001). All-cause mortality in patients with at least 1 CV hospitalization was 6.60 per 100 patient years versus 4.97 per 100 patient years in patients without CV hospitalization. In time-dependent analysis, patients with CV hospitalization had an increased risk for mortality (RR = 3.13; p<0.0001), which remained significant when adjusting for baseline risk factors (RR = 3.00; p<0.0001). Heart failure hospitalization had the strongest association with mortality (RR = 5.92; p<0.0001), while hospitalization for AF was not associated (RR = 1.08; p=0.3058). The decrease in the EuroQoL quality of life score during the study was larger in surviving patients with CV hospitalization (−0.03 ± 22) compared with remaining survivors (−0.01 ± 21; p<0.0001).

Conclusions
Half of ACTIVE study patients had at least one CV hospitalization during 4 years, which was associated with increased mortality and a reduced quality of life in surviving patients. Hospitalization for AF alone was not associated with mortality.
Abstract P72: Medicolegal Characteristics of Cardiac Catheterization Litigation
Authors: Kim Candice , Vidovich Mladen I
Published: March 2022

BACKGROUND AND AIMS:
Cardiac catheterizations have become an integral part of medical care; however, there have been few assessments of the pattern of medicolegal cases that involve cardiac catheterizations. This study reviews the patterns of liability and medical outcomes in cases involving cardiac catheterization litigation.

METHODS:
Legal case opinions were obtained from LexisNexis Academic; case characteristics, litigation outcomes, and medical outcomes were identified. Additionally, data was collected from the Physician Insurers Association of America (PIAA), which is an Association that maintains a data registry of medical professional liability claims.

RESULTS:
Between 1985 and 2009, the PIAA registry documented 1361 closed coronary angiography claims. The medical specialty of Cardiovascular Disease was involved in 699 of these cases with other specialties such as internal medicine, CT surgery, general surgery being involved in the remaining cases. Of these claims, 36% (492 of 1361) were voluntarily dismissed, 25% (337 of 1361) were settled before litigation, 16% (215 of 1361) were not prosecuted, and 11% (154 of 1361) were involuntarily dismissed. The most common alleged error was for improper performance (482 of 1361) followed by no medical misadventure (316 of 1361). Of the 116 cases reviewed through LexisNexis, only 30% (35 of 116) were judged in the patients’ favor. Litigation against physicians occured in 90.5% (105 of 116) of cases with judgments in favor of the patients in 29.5% (31 of 105) of cases. Death as outcome was present in 42 cases. In these claims, the physicians were more likely to be sued (95%–40 of 42) and the judgment was more likely to be in the patients’ favor (40.5%–17 of 42).

CONCLUSION:
In litigation related to cardiac catheterizations, the majority of cases are due to medical malpractice and physicians are sued in a high percentage of those cases. It is important that cardiologists recognize these patterns of litigation as this may impact and improve the processes of care. However, physicians in other fields should be aware of these findings as specialties outside of cardiology were involved in almost half of all litigation cases.
Abstract P76: Minority Patients with Systolic Heart Failure Have a Lower Belief in the Necessity of Medication Score than Patients with a Kidney Transplant from the Same Population
Authors: Terebelo Sima , Markell Mariana
Published: March 2022

Nonadherence is a problem in pts with HF. Negative belief about the specific necessity of medications (SNmed) correlates with nonadherence in the general population. Studies have suggested that medication beliefs are culture specific. Many minority pts have negative med beliefs and distrust the healthcare system. This has been correlated with lower levels of adherence. High levels of SNmed have been demonstrated in asthmatics and correlate with adherence, which may be attributed to relationship of med use and symptom relief. 41 pts with HF whose symptom relief might also be related to med usage were compared with 79 kidney transplant recipients (KTR), whose transplant meds do not directly affect their symptoms, using the Beliefs in Medicine Questionnaire, which examines beliefs regarding necessity, overuse and general harm of prescribed meds using a 5 point Likert scale. The possible range for SNmed is 5-25, higher scores indicate more positive beliefs. There were 108/120 (90%) Black pts, 54/120 (45%) hospitalized in past year, 60/120 (50%) post-high school education, 84/120 (70%) unemployed, 77/120 (64%) income <20K, total meds 7.6±3. HF pts had a mean EF 34.8±14.4 and 71.5%(31/41) were NYHA Class 2 or 3. Non-adherence rate in the HF pts by provider estimate was 34%. The HF and KTR populations differed in age 61.4±11.7 vs 48.9±12.8, p<0.0001, gender 71%(29/41) male vs 48%(38/79), p<0.05 and marital status 42%(17/41) married vs 24%(19/79), p<0.05. Using a general linear model comparing HF vs KTR, controlling for age, gender, total meds, education and whether born in US, HF pts scored significantly lower on SNmed, adjusted mean 18.8±3.1 vs 21.8±2.5, p=<0.001. Models for general overuse or general harm were not significantly different. We conclude, in our population 1. HF pts have lower belief in the necessity of their medications when compared with KTRs from the same inner-City region. 2. Which medications are viewed as unnecessary and whether this finding is associated with medication non-adherence in HF remains to be studied. 3. As the populations draw from the same demographic, it would be interesting to examine the aspects of the transplant experience that reinforce beliefs in medication necessity, and those that contribute to lower SNmed beliefs in the HF group.
Abstract P78: Prior Noninvasive Testing and Diagnostic Yield of Elective Cardiac Catheterization in the VA: Insights from the VA Clinical Assessment, Reporting, and Tracking System for Cath Labs
Authors: Maddox Thomas M , Stanislawski Maggie A , O'Donnell Colin I , Grunwald Gary K , Rumsfeld John S
Published: March 2022

Background
Guidelines for cardiac catheterization recommend prior risk assessment and non-invasive testing. A recent contemporary study of U.S. patients found that 83.9% of patients undergoing elective catheterization had prior non-invasive testing. In addition, only 37.6% of patients had obstructive CAD, while 39.2% had no CAD. We sought to determine if similar trends existed in the VA, a national integrated health care system.

Methods
Using the VA Clinical Assessment, Reporting, and Tracking system for Cath Labs (CART-CL), a transactional, point-of-care software application installed at all 77 VA catheterization laboratories, we identified all patients without known CAD undergoing elective catheterization between 2005-2010. Patient demographics, risk factors, and non-invasive tests were correlated with the presence of obstructive CAD, defined as a stenosis of 50% or more of the left main coronary artery or 70% or more of a major epicardial artery.

Results
28,333 elective catheterizations were performed during the study period on patients without known CAD. Prior non-invasive testing occurred in 18,117 (63.9%). 12,659 of catheterizations identified obstructive CAD (44.7%) and 9,776 (34.5%) identified no CAD (no stenosis >20%). Patient factors significantly associated with obstructive CAD included older age (OR per 5-year increment 1.25, 95% CI 1.22, 1.28), hypertension (OR 1.11, 95% CI 1.02, 1.21), diabetes (OR 1.13, 95% CI 1.06, 1.21), dyslipidemia (OR 1.72, 95% CI 1.57, 1.87), tobacco use (OR 1.23, 95% CI 1.14, 1.33), peripheral vascular disease (OR 1.48, 95% CI 1.34, 1.63), cerebrovascular disease (OR 1.2, 95% CI 1.1, 1.31), and positive non-invasive stress testing (OR 1.25, 95% CI 1.11, 1.4).

Conclusions
In the VA health care system, there were lower rates of prior non-invasive testing and higher yields of CAD on elective cardiac catheterization in comparison to a prior study of a non-VA patient population. The lack of a fee-for-service payment structure and better integration of health care services in the VA may partly explain these differences. Direct comparison of different health care systems is needed to further explore these hypotheses.
Abstract P9: Comparing Hospital Ranking for Nonemergent PCI and CABG: How Many Hospitals Can Perform Both Procedures Above Average and Does It Matter?
Authors: Kugelmass Aaron , Brown Phillip P , Cohen David J , Reynolds Matthew R , Culler Steven D , Simon April W
Published: March 2022

Objective:
There has been significant focus ranking hospitals on outcomes for coronary revascularization (PCI and CABG). This analysis attempts to identify if performance in one modality is consistent in the other.

Methods:
Retrospective analysis using the Medicare Provider Analysis and Review (MedPar) Files for fiscal year (FY) 2009 for Medicare Beneficiaries (MB). The study includes 1120 hospitals performing at least 52 revascularization procedures (PCI or CABG). Non-emergent (NE) CABG and PCI procedures were defined as a PCI or CABG hospitalization without a primary STEMI, initial cardiogenic shock, cardiac arrest, or both CABG and PCI (229,952 PCI and 82,900 CABG) on MB's. The risk-adjusted mortality rates (RAMR) were calculated using logistic regression analysis. Hospitals were segmented into three groups- those that performed in: the top half for both PCI and CABG (RAMR); in the top half in PCI or CABG, but not both; or performed below average for both procedures.

Findings:
A total of 303 hospitals (24.8% of hospitals) performed in the top half for both NE procedures and 303 hospitals performed in the bottom half for both procedures. 514 hospitals were in the top half for one procedure but not the other. The table shows average hospital RAMR and procedural volume for hospitals in the three categories. Hospitals in the bottom half for both procedures had average RAMR that were approximately double the national average. Overall, there was an 8-10 fold increase in RAMR between those hospitals that perform PCI and CABG well, and those that under perform in both modalities.

Conclusion:
The degree of difference in the RAMR between top better and worse congruent performers of NE CABG and PCI is striking (8-10X). Increasing the proportion of hospitals with positive congruence in coronary revascularization could markedly reduce RAMR for these procedures. Alternatively, NE coronary revascularization patients could be directed to those hospitals that excel in both techniques.

Ranking
Number of Hospitals
RAM Elective CABG
Mean Volume Elective CABG
RAM Elective PCI
Mean Volume Elective PCI

Top Half Both Procedures
303
0.38%
80
0.25%
236

Top Half in PCI or CABG Procedure, but not both
514
1.93%
73
0.94%
200

Bottom Half for Both Procedures
303
3.63%
70
1.76%
183

All Hospitals
1120
1.97%
74
0.98%
205
Abstract 128: The Economics Of In-patient Stress Testing And Its Perceived Benefit To Low Risk Patients
Authors: Gopalakrishnan Mukesh , Pant Rojina , Urdininea-Kirkwood Carlos , Syed Toyiba , Villines Dana , Cook Jeffrey , Klein Lloyd
Published: March 2022

Background:
"Acute Coronary Syndrome Rule Out" accounts for 37% of telemetry admissions. Our aim was to determine the financial burden of such patients without known coronary artery disease (CAD), evaluate the effect of stress test on their hospital course, analyze the extent to which defensive medicine played a role and assess outpatient testing as a safe alternative for low risk patients.

Methods:
This is a retrospective observational study of 265 consecutive patients who underwent myocardial perfusion imaging. They were categorized into low, intermediate and high pretest probability with Diamond Forrester Risk Score (DFR) and Framingham Risk Score (FRS). Abnormal stress tests, change in management prior to discharge with modification of cardiovascular medications, consultations or interventions, and final diagnosis were analyzed. Cost analysis was done based on 24-hour telemetry hospital stay, services rendered and subsequent benefit to patients.

Results:
Inpatient management did not change for 93.7% (59 out of 63) in low-risk FRS group, (p<0.001) and 92.9% (65 out of 70) in low-risk DFR group, (p=0.002) based on stress tests. There were 82% (41 out of 50) with significant change in medical management prior to discharge that belonged to intermediate risk group. Analysis of cost to obtain one abnormal stress test demonstrated double the expense for inpatient versus outpatient setting ($63,306 and $30,625 respectively).The table describes the cost under each risk category for in-patient setting.

For every single low risk patient with meaningful benefit in terms of change in management, 2 and 5 patients in intermediate and high risk groups, respectively, would have benefited from utilization of equivalent resources. Amongst physicians surveyed, 45% (87 out of 193) felt defensive medicine played some role in the decision to order stress tests.

Conclusions:
It is ideal to restrict inpatient stress test to intermediate and high risk groups, while relegating low risk group to outpatient testing. Based on 2008 U.S. National Hospital Ambulatory Care Survey, this translates to billions of dollars, yet provide similar patient safety profile.
Abstract 129: Effect of Immigration to the US on Prevalence of Hypertension and Obesity in Asians
Authors: Finkelstein Joseph , Cha Eunme
Published: March 2022

Introduction:
In the United States, three fourths of the Asian population growth has been due to immigration. However, the effect of immigration on health of Asian immigrants has not been studied systematically. The goal of this project was to evaluate the effect of immigration on hypertension and obesity prevalence in Far East Asians.

Hypothesis
: The prevalence of hypertension and obesity is higher in Asians who immigrated to US as compared to Asians residing in the country of birth.

Methods:
We used the Korean National Health and Nutrition Examination Survey (KNHANES) and the US National Health Interview Survey (NHIS) to compare prevalence of hypertension and obesity in each population. The KNHANES is a national survey conducted by the Korea Institute of Health and Social Affairs with a multistage probability sampling design. The NHIS is an annual public health survey collected in US to monitor the overall health of US population. From NHIS, a subgroup of adults born in Korea and neighboring Far East countries who immigrated to US were compared to adults residing in Korea. In order to conduct a case-control study, Korean immigrants from NHIS were matched with Koreans from KNHANES by age, sex and income level in 1:1 ratio. The prevalence of hypertension and obesity (BMI≥25 kg/m
2
) was evaluated then in both cohorts. The case-control study was limited to the subjects of 40 years and older.

Results:
Overall, in the KNHANES adult population 27% reported to have high blood pressure and 34% had BMI≥25 whereas in the NHIS Korean population 30% had hypertension and 37% had obesity. The case-control study based on matching Korean adults from KNHANES and NHIS included 236 adults from each survey who were 40 years and older, 55% were females, 67% belonged to the high income group, and the mean age was 54.4±11.7. In the controls from Korean NHANES, 26% (N=60) reported to have hypertension and 32% (N=76) had a BMI>25 whereas in the matched cases from US NHIS 31% (N=73) had hypertension and 36% (N=86) had BMI>26. The differences in hypertension and obesity prevalence between two groups were statistically significant (P<0.05).

Conclusions:
The overall prevalence of hypertension and obesity was lower in Koreans residing in the country of birth than in Koreans who immigrated to the United States.
Abstract 139: Middle School-based Intervention Leads to Improved Behaviors: A Report from Project Healthy Schools
Authors: Smith Cydni A , Corriveau Nicole , Gurm Roopa , Goldberg Caren S , DuRussel-Weston Jean , Kline-Rogers Eva , Jackson Elizabeth A , Eagle Kim A
Published: March 2022

Background:
Project Healthy Schools (PHS) provides environmental changes and in-class lessons to sixth grade students to reduce future cardiovascular and diabetes risk. PHS has 5 main goals: (1) decrease mindless screen time, (2) exercise 150 minutes/week, (3) decrease unhealthy beverages, (4) increase fruits and vegetables and (5) decrease fried, fatty and sweet foods. Previous research demonstrated the program’s impact on total cholesterol, low density lipoprotein, and blood pressure.

Methods:
Baseline and follow up behavioral survey data was collected from 2130 sixth grade students, including: 24-hour food and 7-day physical activity recalls; compared using non-parametric Wilcoxon signed rank test. The behaviors were defined as follows: “screen time” as hours/week on computers, video games or TVs not for school; “exercise” as sessions/week of moderate for 30 minutes, vigorous for 20 minutes; servings of “unhealthy beverages” as soda, sports drinks or punch (not juice); “fruits and vegetables” as any fruits or vegetables (not fries, chips or juice) and “fried, fatty and sweet food” as any fried meat, hamburger, hot dogs, sausage, bacon, ribs, fries, chips, baked goods or candy.

Results:
Students improved on follow-up in 3 of 5 goals: decrease screen time (p≤.001), increase exercise (p=0.02) and decrease fried, fatty and sweet foods (p≤.001). Fruits, vegetables and beverages showed almost no net change.

Conclusions:
Improvements in 3 of 5 goals combined with previous physiologic findings suggest the program is effectively teaching healthy behaviors, but further research is required to improve all lessons, especially those including fruits, vegetables and beverages.
Abstract 178: African-Americans Have a Lower Incidence of Atrial Fibrillation but Higher Incidence of Stroke than Caucasians After Coronary Artery Bypass Surgery
Authors: Sun Xiumei , Lowery Robert , Hill Peter C , Lindsay Joseph , Boyce Steven W , Corso Paul J
Published: March 2022

Background
Some, but not all, population-based studies have shown a lower prevalence of atrial fibrillation (AF) in African-Americans compared with Caucasians. A comparison of the incidence new AF and stroke in these two ethnic groups after coronary bypass graft surgery (CABG) is unknown. We employed continuous electrocardiographic (ECG) monitoring to obtain information in this regard and to expand our understanding of the relation between ethnicity and AF.

Methods
We studied a consecutive series of 2,895 African-Americans and 6,166 Caucasians who underwent CABG surgery between January 2003 and December 2011 in an ethnically diverse hospital.

Results
Postoperatively, new-onset AF (POAF) developed in 649 of 2,895 African-American patients (22.4%) versus in 1,918 of 6,166 Caucasian patients (31.1%), P<0.0001. Stroke occurred in 79 of 2,895 African-American patients (2.7%) versus in 63 of 6,166 Caucasian patients (1%), P<0.0001.

Conclusions
POAF was significantly less common among African-American patients than in Caucasian patients after CABG, but the incidence of stroke was significantly higher in African-American patients than in Caucasian patients.
Abstract 181: Reducing Congestive Heart Failure Readmissions: A Successful Program Between an Acute Hospital and Skilled Nurse Facility.
Authors: Martinez-Vasquez Diego F , Lear Jan , Butler Marsha J , Proctor Suzanne
Published: March 2022

Background:
Congestive Heart Failure (CHF) is among the leading cause for hospital readmissions. Discharge to Skilled Nurse Facility (SNF) occurs in approximately 1 in 5 Medicare beneficiaries after hospitalization for CHF. Among these patients 23.5% are readmitted to acute hospitals within 30 days. CHF readmissions worsens patient outcomes are very costly and can be preventable in approximately 40% of the cases.

Purpose:
Develop a program to decrease CHF readmissions from patients discharged to a SNF.

Description:
The program started in February, 2011 and focused on CHF admissions that came to the hospital and were further discharged to a SNF. One specific SNF was chosen for this program. Upon admission to the hospital a readmission tool was administered to early detect the risk for a future readmission. A multidisciplinary team including the attending and nurse carrying for the patient, pharmacist, social worker, cardiologist and a SNF and VNA liaison performed medical rounds. After the acute hospitalization, patients who met criteria for SNF placement were sent to the specific SNF chosen for the program. This SNF has also developed a multidisciplinary team similar to the hospital one. After discharge from the SNF patients went home with or without VNA services.

Results:
The data analyzed is until November 30
th
2011.The readmission tool helped the multidisciplinary team focused on high yield reasons for potential readmission. During this period the hospital sent 68 patients with a Dx of CHF to the SNF vs. 20 same period previous year. Out of the patients sent by the hospital to the SNF, the hospital had 17 readmissions (25%) within 30 days in comparison with 13 readmission (65%) from previous year. Among the readmissions 10 (59%) came from the SNF and 7 (41%) from home. 8 readmissions (47%) had a diagnosis of CHF. Among the readmissions 15 (88%) did not have a VNA service set up when they went home from the SNF compared with only 2 (12%) who had a VNA service.

Conclusions:
The program decreased readmissions from patients sent to SNF by 40%. VNA services should be a part of a readmission program. Building programs of care between acute hospitals and SNF are fundamental to achieve reduction in CHF readmissions.
Abstract 184: Radiation Exposure, an Important Quality of Care Measure for Physicians and Patients
Authors: Lawson William E , Roodneshin Hamid , Gulino Kathie , Wilbert Lisa , Leonard Theresa , Greene William
Published: March 2022

Background:
The risks of ionizing radiation to patients and physicians from radiographic procedures are a significant concern. Radiation is essential for the performance of cardiac catheterization and angioplasty but exposure should be minimized. Because it cannot be sensed and the effects may be delayed, radiation exposure must be measured and critically reviewed.

Methods:
The procedure volume, personal radiation exposure of interventional cardiologists at Stony Brook University Hospital was reviewed for 10 months from 1-10/11. The sensitivity of 3 measures of patient exposure: total dose (Kerma area product = P
ka
), fluoroscopy time and skin dose were compared and the deep dose exposure of physicians was correlated with the number of incidents exceeding lab benchmarks for patient reportable excess radiation exposure.

Results:
During the monitored period a total of 1,978 cardiac catheterizations and 1,324 angioplasties [PCI] (>90% ad hoc) were performed by 14 interventional cardiologists. PCI volume averaged 94.6±54.6/ physician (range 28-180) and 40% of total lab volume (with ad hoc conversion rates from diagnostic catheterization ranging from 24% [72/303] -54% [180/332]). The average total deep dose/ physician was 787.5±710.6 mRem (high of 2,840). There were 187 incidents of total dose exceeding our benchmark of >20,000 microGray m
2
(14.1% [187/1,324] of PCI; 41 cases were > 30,000 and the highest procedural dose was 52,562). Excess fluoroscopy time (>60 minutes) was present in 5% (9/187) and excess skin dose (>5,000 milliGray) in 24% (12/51) of reportable cases of excessive total dose. Total and PCI volumes had Pearson correlation coefficients of 0.61 and 0.71 respectively with deep dose and 0.54 and 0.64 with patient total dose. Physician deep dose exposure had the best correlate (0.89) with reportable cases of patient exposure. Lifetime physician deep dose reflected case volume and years of practice, but exposure also varied markedly by physician, with average annual accumulations (mean 1,120.6 mRem/yr) ranging from 67 mRem/yr to 4,451.1 mRem/yr (the latter expected to limit the physician's cath lab career to an additional 6 years at the current rate of accumulation based on maximal allowable lifetime dose).

Conclusions:
The high variability in operator exposure suggests significant variations in technique which should be further explored. Of the routine measures of exposure, the total dose is the most sensitive indicator of patient exposure. Operator and patient exposures are highly correlated. The high number cases exceeding benchmarks provide an opportunity for further drill down and procedural changes to optimize the risk/benefit ratio for both patients and operators.