bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 373: Unexpected Differences In Traditional Etiologies of Readmission and Mortality Post Left Ventricular Assist Device After Adjusting For Socioeconomic Status
Authors: Breathett Khadijah , Thomas Jordan , Foraker Randi , Smith Sakima
Published: March 2022

Background:
Readmission rates after placement of left ventricular assist device (LVAD) remain high and are generally attributed to arrhythmia, bleeding, heart failure (HF), infection, and thrombosis. Readmission and mortality risks have not been clearly assessed after adjusting for socioeconomic status (SES). We hypothesized that etiologies unrelated to medication adherence and nutrition would contribute to worse outcomes.

Methods:
We retrospectively evaluated 101 patients who underwent HeartMate II LVAD between January 2006- December 2010 at our facility. All patients were followed until December 2011 for readmission and death. Multivariable analysis with adjustment for median household income, insurance status, age, gender, and race was performed.

Results:
The main causes of initial readmission and death respectively were arrhythmia (n=5, 5.4%; n=1, 3%), bleeding (n=13, 14.0%; n=9, 30%), device issue (n=20, 21.5%; n=6, 20%), HF (n=8, 8.6%; n=2, 7%), and infection (n=6, 6.5%; n=0, 0%). After adjusting for SES, bleeding alone remained a significant independent predictor for readmission [Hazard Ratio (HR) 2.57, p=0.003] and mortality (HR 4.73, p<0.0001). Standard HF therapy upon discharge or place of discharge (home versus facility) after LVAD provided no significant reduction in risk of readmission or mortality.

Conclusions:
Bleeding was associated with significant increased risk of readmission and mortality after LVAD even after adjusting for SES. This suggests that income levels and perhaps education do not provide protection from readmission and mortality after LVAD.
Abstract 379: Trends in Coronary Revascularization Procedures among Medicare Beneficiaries between Fiscal Years 2010 and 2013
Authors: Kugelmass Aaron , Reynolds Matthew R , Cohen David J , Brown Phillip P , Simon April W , Culler Steven D
Published: March 2022

Background:
This study reports trends among Medicare beneficiaries (MB) in the volume and outcomes of coronary revascularization procedures (CRP) performed between fiscal year 2010 and 2013.

Methods:
This study examined both the Medicare Provider Analysis and Review Files and the Medicare Outpatient File to identify all MB undergoing a CRP; either coronary bypass graft (CABG) surgery or any percutaneous coronary intervention (PCI). The study population consists of 2,148,877 MBs. ICD-9 procedure codes were used to identify procedures. Diagnosis and present-on-admission codes were used to identify MBs presenting with acute myocardial infarction (STEMI or NSTEMI). Discharge status was used to calculated mortality rates.

Findings:
Over the study period, the number of CRP among MBs decreased annually from 568,744 to 510,277 (3.35% per year): any CABG surgery declined by 3.36% per year and PCI only admissions declined by 5.16% per year. Non-admission PCI episodes varied between 104,566 and 109,064 per year. Mortality rates declined for all major CRP groups, except for PCI only admissions (increased from 2.16% to 2.75%). The proportion of MBs presenting with STEMI or NSTEMI increased from 11.9% to 15.2% and from 17.2% to 23.7% of all CRP, respectively. Mortality rates were highest and increasing for MBs presenting with STEMI across all procedures.

Conclusions:
The overall volume of CRPs among MBs is declining and more MBs are presenting with an AMI, and overall mortality rates are increasing year over year.
Abstract 5: Heart Failure Patients Hospitalized with Bacterial Infections: A Nationwide Analysis of Concomitant Clostridium Difficile Infection Rates and In-Hospital Mortality
Authors: Mamic Petra , Heidenreich Paul A , Tennakoon Lakshika , Staudenmayer Kristan
Published: March 2022

Heart failure (HF) patients have altered gut microbiota, as do patients who receive antibiotics for bacterial infections. Altered gut microbiota is associated with increased susceptibility to C. difficile infection (CDI). It is not known if HF patients hospitalized with bacterial infections experience CDI more frequently and whether CDI impacts their mortality.

We utilized Healthcare Cost and Utilization Project National Inpatient Sample data from 2010 to 2012 to determine the rate of CDI and associated in-hospital mortality for HF patients hospitalized with urinary tract infection (UTI), pneumonia (PNA) or sepsis. Univariate and multivariate analyses were performed. Unweighted data are presented.

We identified 868,401 HF patients hospitalized with UTI, PNA, or sepsis. There were 2,825,390 patients without HF hospitalized with the same infections. HF patients were on average older (75.4 vs 65.1 years, p<0.001) compared to patients without HF. In unadjusted analysis, HF patients hospitalized with UTI, PNA or sepsis had higher rates of CDI compared to patients without HF hospitalized with the same infections (UTI 3.9% vs 2.7%, PNA 2.9% vs 2.3%, sepsis 6.8% vs 5.3%; p<0.001 for all). Heart failure remained significantly associated with CDI (OR 1.2, 95% CI 1.18-1.23, p<0.001), even after controlling for patient demographics, insurance status, hospital characteristics, and presence of ischemic heart disease.

Heart failure patients hospitalized with UTI, PNA or sepsis and diagnosed with CDI had higher in-hospital mortality rates compared to HF patients hospitalized with UTI, PNA or sepsis who did not develop CDI (figure). CDI remained significantly associated with in-hospital mortality for HF patients hospitalized with bacterial infections (OR 2.0, 95% CI 1.9-2.1, p<0.001), even after controlling for the above variables.

Heart failure is associated with higher rates of CDI among patients hospitalized with common bacterial infections, even when adjusting for other known risks for CDI. Furthermore, within the HF population, CDI is associated with markedly higher in-hospital mortality. These findings suggest an opportunity to improve outcomes for HF patients through improved C. difficile screening and prophylaxis protocols.
Abstract 1: Effect of Under-recognition on Angina Treatment in Stable Ischemic Heart Disease in Cardiology Outpatients: Seeing Eye to Eye is Key
Authors: Qintar Mohammed , Spertus John A , Gosch Kensey L , Kureshi Faraz , Shafiq Ali , Arnold Suzanne V
Published: March 2022

Background:
Clinical inertia in treating stable ischemic heart disease (SIHD), the phenomenon of not intensifying treatment, may occur more often when clinicians fail to accurately estimate patients’ symptoms. We hypothesized that under-recognition of angina would be associated with less treatment escalation in SIHD patients.

Methods:
Cardiology outpatients with SIHD were recruited from a 25-site US registry and each completed the Seattle Angina Questionnaire (SAQ). Physicians independently quantified patients’ angina at end of visit, blinded to patients’ SAQ scores. Among patients who reported angina, under-recognition was defined as the physician reporting a lower frequency of angina than the patient. Based on providers’ management plan at end of visit, patients were divided into treatment escalation and no treatment escalation groups. Treatment escalation was defined as up-titration or addition of anti-anginal medication (beta-blockers, calcium channel blockers, nitrates, ranolazine), diagnostic/invasive testing or treatment (CT angiogram, stress test, cardiac catheterization, PCI, CABG), or hospital admission. Multivariable logistic regression model was used to examine the association of under-recognition with treatment escalation, independent of patient demographic and clinical characteristics, including the severity of angina.

Results:
Of 1257 outpatients with SIHD, 411 reported angina of whom 178 (43.3%) were under-recognized by providers. Treatment escalation occurred in 106 (25.8%) patients with angina, of whom 28 (26.4%) were managed with medication up-titration, 67 (63.2%) with diagnostic/invasive testing and 11 (10.4%) with both. Patients with under-recognized angina were less likely to get treatment escalation (8.4% vs 34.1%, p=***), regardless if patients reported daily, weekly or monthly angina (Figure). In the multivariable model, under-recognition of angina remained strongly associated with a lack of treatment escalation (adjusted OR 0.13, 95% CI 0.07-0.24, p<0.001).

Conclusion:
Under-recognition of patient’s angina in the outpatient setting is common and leads to markedly less frequent treatment escalation. Using validated tools to support clinicians’ recognition of patients’ angina should be considered to improve care and outcomes.
Abstract 102: Effects of Proprioceptive Neuromuscular Facilitation Exercises on Upper Extremity Function in the Patients With Acute Stroke
Authors: Chaturvedi Poonam , Singh Ajai K , Kulshreshtha Dinkar , Maurya Pradeep K , Thacker Anup K
Published: March 2022

Background:
Stroke leads to impairment in upper extremity function and hence impairment in performance of activities of daily living. The studies that emphasize the effects of PNF (Proprioceptive Neuromuscular Facilitation) in acute stroke are still lacking.

Aim:
In this study we aim to investigate the effects of PNF exercises on upper extremity function in acute stroke.

Methods:
Total 35 patients were recruited from the OPD of Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow. Written informed consent was obtained from their legal relatives. Patients were given PNF exercises for scapula from the first day of their admission to the hospital and then arm pattern (D1 and D2 flexion , extension) by using rhythmic initiation technique until discharge from the hospital (Mean 15.2+ 3.9days). PNF was given twice daily for 30 minutes for 5 days a week. Arm recovery was assessed by Fugl- Meyer scale and arm function was assessed by Arm Motor Ability Test (AMAT). Patients were followed up in neurology OPD on monthly basis up to 6 months.

Results:
Out of 35, 26 were of ischemic stroke and 9 were of haemorrhagic stroke. 17 were left sided and 18 were right sided hemiplegics. 15 were females and 20 were males. Mean age of the patient was 56.45 + 12.14. Glasgow coma scale at the time of admission was 14.6+ .338. Mean NIH stroke severity was 7.48 + 3.95, shows all the patients were of mild to moderate stroke. The mean Fugl- Meyer score before the intervention was 151.60+ 41.72 with SE= 7.05 and after intervention was 209.9. Paired t - test was run to determine if PNF is effective in improving upper extremity function in acute stroke t (34)= - 9.920, p= .001. There was significant improvement in upper extremity functions. The mean AMAT score before intervention was 63.53+ 28.32 and after intervention was 120.22+ 12.12 and t(34)= 5.92 p= .026 which shows significant improvement in upper extremity function.

Conclusion:
Proprioceptive neuromuscular facilitation exercises are very effective in generating voluntary control and improving functional activities of daily living if given from the first day of stroke. For improvement in arm function the intervention should be started first from scapula. Due to the irradiation effect, there is generation and improvement of tone and power in upper extremity.

Acknowledgements:
This study was supported by the department of Science and Technology, New Delhi, India.
Abstract 111: A Patient-centered Approach to Reduce Contrast Volume During Percutaneous Coronary Intervention to Prevent Acute Kidney Injury
Authors: Amin Amit P , P Calderon , Crimmins-Reda Patricia , Spertus John
Published: March 2022

Introduction:
Acute Kidney Injury (AKI) is common, morbid and costly. Reducing contrast volume is one of the most effective strategies to reduce AKI, but physicians are not necessarily aware of the AKI risk nor limits of contrast use. Therefore, the volume of contrast used during PCI varies tremendously. No study has examined practical strategies to identify a safely tolerated limit of contrast.

Methods:
We developed a novel, patient-centric strategy to identify a safely tolerated limit of contrast during PCI. We identify AKI risk using the ACC NCDR CathPCI Aki risk model. We then use the contrast volume/eGFR ratio among deciles of AKI risk strata. Multiplying these ratios by eGFR results in the safely tolerated limit of contrast. We implemented this at Barnes Jewish Hospital (N=2,268 PCIs, 2013 -2015), we identified the impact of implementing this method on reducing costs and improving AKI outcomes.

Results:
For a high risk patient undergoing PCI, the decision aid for identifying safely tolerated risk of AKI is shown (Fig1). Since implementation, contrast volumes have reduced from 240 ml to 135 ml. AKI rates have reduced from7.75% to 3.6%. This has translated into reduced cost, estimated at $ 780,000.

Conclusions:
We have identified a novel patient centered method to reduce contrast volume during PCI. This has resulted in a greater than 50% reduction in reducing contrast volume and AKI rates. Furthermore, this has resulted in cost-savings of $700,000. Our study underscores an important opportunity of patient
Abstract 112: Adherence and Persistence with Statins in Patients with ASCVD
Authors: Burke James P , Paoli Carly J , McPheeters Jeffrey , Gandra Shravanthi R , Simpson Ross J
Published: March 2022

Introduction:
The benefits of lipid lowering therapy (LLT) include reductions in fatal CV disease, CHD and all-cause mortality. Adherence to LLT is critical for patient benefit. Several studies studies have shown high rates of LLT discontinuation and poor persistence but little is known about adherence and persistence with LLT in patients with artherosclerotic cardiovascular disease (ASCVD).

Hypothesis:
This study examined adherence and persistence to LLT in patients with ASCVD initiating statin therapy.

Methods:
This retrospective claims-based study used medical, pharmacy, laboratory and enrollment data from a large US health plan. Patients had commercial or Medicare Advantage Part D (MAPD) coverage and were identified from 1/1/07 to 12/31/12 and were followed for three years, disenrollment or 12/31/13 whichever occurred first. The index date was the date of first statin and/or ezetimibe use. Treatment modifications included switching, dose escalation or reduction, augmentation, and discontinuation. ASCVD patients were identified as having a myocardial infarction, stroke, revascularization (coronary artery bypass graft or percutaneous coronary intervention), unstable angina, or peripheral artery disease in the 12 months prior to the index statin. The time to first treatment modification and the proportion of patients who discontinued therapy were examined. Adherence was examined using a medication possession ratio (MPR) and persistence via % discontinuing medication.

Results:
The sample included 91,740 patients with ASCVD (mean age 64.9 years, 57.4% male, 37.7% MAPD). The mean time to first treatment modification, including discontinuation, was 351.7 days (SD=334.4; median=216.0). Over the course of treatment, 23.7% remained on index therapy, 34.3% had a treatment modification and 42.0% of patients discontinued therapy. However, 29.6% restarted therapy sometime in the study follow-up period. The mean MPR while on therapy was 0.89 (SD=0.13, median =0.95) in the overall sample and 0.92 (SD=0.12, median =0.97) in patients with ASCVD. The proportion of patients with a MPR ≥0.80 was 79.0% in the overall cohort and 84.6% in patients with ASCVD.

Conclusions:
While patients remained on their first statin (or ezetimibe) therapy for a substantial period of time, a large proportion of patients eventually discontinue therapy. Overall, adherence was high, indicating that ASCVD patients are compliant with their LLT. Interventions and new treatments to improve lipid lowering therapy seem necessary in patients with ASCVD.
Abstract 132: Comparing Time in Therapeutic Range between Point of Care and Tele-Management Patients
Authors: Kocis Paul T , Casey Edward W
Published: March 2022

Introduction:
A strong relationship exists between the Time in Therapeutic Range (TTR), bleeding and thromboembolic events. The TTR percentage can be calculated by the following three methods. The Rosendaal method assumes a linear relationship between two INR values, the Cross Section method uses INR values that are within a specified range and at a specific point in time, and the Fraction of INR Results method measures the number of INRs in a specified range over the total number of INRs.

Objectives:
Compare the TTR between Point of Care (POC) and Tele-Management (TELE) Non-Valvular Atrial Fibrillation (NVAF) patients calculated by the Rosendaal, Cross Section, and Fraction of INR Results methods.

Methods:
Data was collected retrospectively during the 2014 calendar year for 100 randomly selected patients ≥ 18 years, received warfarin without interruption, and were monitored by the Penn State Hershey Medical Center Anticoagulation Clinic. INR lab values were obtained 14 days after initiating warfarin therapy and the interval between 2 consecutive INR lab values was ≤ 56 days. All patients in this study had a target INR range of (2.0-3.0). There was a total number of 1,889 INR lab values collected for the POC (n=826) and TELE (n=1,063) cohort groups respectively. The mean TTR value was calculated for each patient. When comparing TTR between the POC and TELE cohorts, the two-sample t-test was used for both the Rosendaal and Fraction of INR Results methods and the Chi-Square test was used for the Cross Section method.

Results:
Illustrated in Table 1, the mean TTR for the entire study sample (n=100) was (72.4%, 70.0%, and 67.6%) for the Rosendaal, Cross Section, and Fraction of INR Results methods respectively. When comparing between the POC and TELE cohorts, the TTR was 72.8% for the POC cohort and 72.0% for the TELE cohort by the Rosendaal method (p=0.81); the TTR was 64.0% for the POC cohort and 76.0% for the TELE cohort by the Cross Section method (p=0.19); and the TTR was 68.3% for the POC cohort and 67.0% for the TELE cohort by the Fraction of INR Results method (p=0.69).

Conclusion:
The mean TTR percentage did not provide a consistent pattern among the different TTR calculation methods or between the POC and TELE cohort groups. The differences observed between the POC and TELE cohort groups were not statistically significant (all p > 0.05).
Abstract 136: Complexity and Collaboration in Discharge Planning for Inpatient Cardiology
Authors: Soulakis Nicholas D , Carson Matthew B , Frailey Conor , Kricke Gayke S , Scholtens Denise M , Anderson Allen S , Benacka Corrine , Kansal Preeti , Mutharasan R K , Gurvich Itai , Van Mieghem Jan A , Yancy Clyde W
Published: March 2022

Background:
Multidisciplinary, collaborative care improves outcomes and reduces costs but may unintentionally increase the operational overhead to manage the complexity of increasingly sophisticated teamwork.

Objective:
To quantify complexity of a standardized discharge planning process by closely examining team continuity, composition, and experience for both explicitly defined, deliberately organized teams and implicitly defined, organically assembled teams.

Methods:
We examined discharge planning team membership for inpatient cardiology encounters with a length of stay (LOS) greater than 48 hours for a three-year period from 2012-2014 in a large academic medical center. By constructing a co-affiliation graph from transactional EHR data, we determined the frequency of team occurrence and size. We then calculated the shared experience of teammates using a pairwise similarity metric and identified modularity, groups of healthcare personnel with dense connections, within the graph by applying a community detection algorithm.

Results:
We identified 52,254 transactions for 3,213 encounters with an average LOS of 8.7 days for the time period. The standard discharge planning team accounted for 41,101 (79%) transactions, consisted of 7 team member types, and comprised 709 individual providers performing 36 activities. We identified 569 additional discharge planning team members, consisting of 22 additional provider types. When constrained to only explicitly defined teams, 404 unique teams with an average size of 5.9 members occurred with a mean of 8 (min=1, max=118) shared encounters. When unconstrained, organically assembled teams with no explicit definition occurred 3,209 times (mean=1; min=1, max=3) with an average size of 7.3 members. Single-encounters accounted for 21,107 (62%) of all provider pairs. However, over 50% of all discharges had at least 1 pair sharing over 99 encounters (median=4 pairs). Community detection found 9 modules (range: 12-275 members) among pairs with more than 5 shared encounters.

Conclusions:
We have shown by deconstructing digital interactions via the EHR, a core group of providers, defined by role and activity, anchor most discharge planning teams. However, the EHR can also identify identify the 20% of teams with constantly recombining membership due to situational care; this can impose overhead when targeting team-wide process improvements, communication strategies, or educational initiatives.
Abstract 142: Design and Implementation of an Electronic Process for Provider-ordered Post-hospitalization Follow-up Appointment Scheduling for Inpatients in an Academic Cardiology Department
Authors: Perez Antonio L , Sobol Timothy , Barzilai Benico , Starling Randall , Khot Umesh N
Published: March 2022

Introduction:
Post-hospitalization outpatient follow-up visits are important components of high quality care for patients with cardiovascular diseases. However, challenges in scheduling appointments prevent many patients from obtaining timely post-discharge care.

Hypothesis:
We hypothesized that a streamlined process for follow-up appointment scheduling utilizing the electronic order entry system would be an effective means of scheduling post-discharge visits for many inpatient admissions.

Methods:
In effort to increase patient access to post-discharge care, we designed a process for electronic provider-ordered follow-up appointment scheduling that was implemented on cardiology inpatient services in a large academic medical center in January 2014. During a patient hospitalization, providers were given the capability to order a follow-up appointment via the electronic order entry system. The order allows providers to designate the time-frame for follow-up, desired outpatient providers, and patient scheduling preferences. These orders are electronically transmitted to appointment schedulers, who schedule visits within two hours of order entry six days per week. Appointment information is reviewed with patients prior to discharge.

Results:
During the first 12 months after implementation (January to December 2014), 3406 follow-up appointment orders were placed for 2749 patients, or 1.24 visits ordered per patient. At least one visit ordered for 49.8% of the total 5534 cardiology admissions. The percentage of admitted patients for whom an outpatient visit was ordered from the first through fourth three-month interval in 2014 significantly increased: 28.2%; 48.0%, 53.4%, and 63%, respectively (Figure, p<0.0001).

Conclusion:
A post-hospitalization outpatient appointment scheduling process using the electronic order entry system can be an effective method for scheduling follow-up visits for many inpatients prior to discharge.
Abstract 15: Quantifying Teamwork at Hospital Discharge for Readmissions Reduction: A Network Analytics Approach
Authors: Carson Matthew B , Scholtens Denise M , Frailey Conor N , Kricke Gayle S , Benacka Corrine , Ahmad Faraz , Mutharasan R. Kannan , Kansal Preeti , Anderson Allen S , Yancy Clyde W , Soulakis Nicholas D
Published: March 2022

Background:
The vulnerable period for hospital readmission begins upon hospital discharge, a complex, interdisciplinary process that necessitates close teamwork for accurate execution of the discharge plan. Thus, better understanding of the quality of teamwork throughout the discharge process may inform strategies to reduce hospital readmissions rates. Novel methods using a network analytics approach to quantify teamwork may better characterize this critical clinical process, facilitate quality improvement (QI), and become an important tool in learning healthcare systems.

Methods:
We extracted three years of patient, provider, and activity data related to discharge planning for an inpatient cardiology unit from Northwestern Medicine’s Enterprise Data Warehouse. We then created a provider-patient network to identify providers who shared patients and calculated readmissions rates for provider pairs. Using these data, we calculated a novel parameter, the
Shared Positive Outcome Ratio
(SPOR), an objective composite measure that quantifies the concentration of positive outcomes over a set of shared patients. To identify significant low-readmission and high-readmission collaborative relationships, we compared the observed network to 1000 sample networks containing randomized readmission values.

Results:
We identified 133,927 actions distributed among 38 discharge activity types performed during 13,720 patient encounters. The collaborative network was composed of 1,542 providers including 503 nurses, 432 residents, 207 physicians, 111 physical and occupational therapists, 59 medical students, 32 dieticians, and other medical and administrative staff. The average encounter involved 4 providers performing 10 discharge-related actions. After pruning the network to include only provider pairs with 6 or more shared patients, we found that 6% of collaborative interactions had a significantly low SPOR, indicating lower than expected readmission rates. Conversely, 12% of collaborative interactions had a significantly high SPOR, indicating higher than expected readmission rates. We identified 21 providers who had a low SPOR for a significant percentage of their collaborations, indicating potential top performers in the teamwork domain.

Conclusions:
Readmission rates appear to vary across different teams of providers. Team collaboration can be quantified using a composite measure of collaboration across provider pairs. Tracking provider pair outcomes over a sufficient set of shared encounters may inform various QI strategies, such as optimizing team staffing, identifying high-performing teams who can share their best practices, and redesigning discharge care processes. Ongoing work on this model is focused on accurately risk-adjusting outcomes, which will increase the robustness of this method.
Abstract 16: Preferences for Shared Decision Making in International Patients With Peripheral Arterial Disease: Insights From the PORTRAIT Study
Authors: Smolderen Kim , Hirsch Alan , Decker Carole , Sepucha Karen , Jones Phil , Stone Nancy , Scott Kate , Spertus John
Published: March 2022

Background:
There is no ‘gold-standard’ treatment for Rutherford Grade I (mild-severe claudication) peripheral arterial disease (PAD), with different treatments associated with different benefits and risks. The choice of treatment should therefore be sensitive to patients’ preferences and supported by shared-decision making. It is, however, unknown to what degree patients seeking treatment for claudication symptoms want to be involved in the medical decision process for their PAD treatment.

Method:
The international PORTRAIT study enrolled 1142 patients with new or an exacerbation of claudication symptoms between June 2, 2011 and September 25, 2015 from 17 PAD specialty clinics. Upon PAD evaluation, patients were interviewed to assess preferences for shared decision making using the Preferences for Shared Decision Making Scale. Information on demographic, socio-economic, and clinical factors were obtained from medical records and interviews. A multivariable log-binomial regression model examined patient- and site-level characteristics associated with an autonomous or shared vs. a passive decision-making role when selecting PAD treatment.

Results:
Among 1142 patients, 56% (n=638) preferred shared or autonomous decision-making, whereas 44% (n=504) preferred that the doctor alone (passive role) made the decision for their PAD treatment. Whether or not patients preferred a shared/autonomous decision-making role varied greatly across countries (The Netherlands 33%; Australia, 43%; US, 70%; P<0.0001). Other independent predictors of shared/autonomous decision making were having completed high school education or more (P=0.001) (Figure 1).

Conclusion:
While the majority of patients prefer an active role in the medical decision process for their PAD treatment, preferences differed markedly by geographic region and education level. US Patients and more educated patients preferred a shared/autonomous decision-making role. Given the observed variability, it is important that providers elicit patients’ wishes regarding their desired involvement in PAD treatment decision-making and tailor their processes to meet patients’ preferences. Future work should also focus on developing care innovations that can increase patient engagement in care.
Abstract 162: Heart Failure Phenotyping: A Set Theory Based Approach to Identify Patients With Heart Failure
Authors: Gold Alex , Sontag David , Rosenman Marc , Katz Stuart , Kuperman Gilad , Blecker Saul
Published: March 2022

Background:
Electronic Health Records (EHRs) and other databases are increasingly used to identify patients with clinical conditions such as heart failure (HF). This process, called phenotyping, has a number of uses including in quality improvement measurement, observational studies, and targeted disease management interventions. To date, patients with HF have largely been identified through diagnosis codes; however, this approach has limitations in sensitivity and positive predictive value (PPV). We hypothesized that we could improve phenotyping of hospitalized patients with HF through use of three readily accessible EHR variables.

Methods:
We conducted a cohort study of all hospitalizations at NYU Medical Center for patients age≥18 in 2012-2014. Hospitalizations were categorized into eight mutually exclusive groups based on the presence or absence of three characteristics: discharge diagnosis of HF, an echocardiogram performed, and loop diuretic administered. To maintain simplicity, we did not use echocardiogram results which are in free text. We randomly sampled a minimum number of charts from each group and performed physician chart review for diagnosis of HF based on the Atherosclerosis Risk in Communities (ARIC) Study criteria. We used a set theory approach to calculate performance characteristics for pre-specified combinations of groups. We calculated variances using the delta method and compared algorithms using Z tests.

Results:
We included 41,349 hospitalizations in the study. Of 315 that were sampled for chart review, 47% (148 of 315) were adjudicated as having acute or chronic HF. Using this gold standard, we found that a discharge diagnosis of HF had a sensitivity of 71.4% and PPV of 92.2% (Table). The presence of at least one of the three characteristics was associated with a sensitivity of 95.9% but PPV of 37.4% (p<0.001 for both when compared to discharge diagnosis only).

Conclusions:
We found a discharge diagnosis code for HF was associated with moderate sensitivity and high PPV. Related algorithms improved sensitivity but had lower PPV. These findings suggest that more complex algorithms are needed to improve EHR-based HF phenotyping.
Abstract 169: Impact of Dosing Frequency on Non-adherence to Oral Anticoagulant Therapy Among Patients With Non-valvular Atrial Fibrillation
Authors: Fu An-Chen , Stephenson Judith J , Kwong Winghan J , Tan Hiangkiat , Weintraub William S
Published: March 2022

Background:
Treatment complexity is an important risk factor for medication non-adherence. Previous studies have shown higher rates of non-adherence among patients taking medications requiring more frequent dosing than those requiring less frequent dosing. However, few studies have investigated the relationship between dosing frequency and adherence to oral anticoagulants (OACs). This study evaluated the impact of dosing frequency of OAC on adherence among patients with non-valvular atrial fibrillation (NVAF).

Methods:
Survey-eligible NVAF patients on commercial or Medicare Advantage health plans, receiving warfarin (W), dabigatran (D), rivaroxaban (R) or apixaban (A) from October 2011 to June 2014, were identified using administrative claims data from the HealthCore Integrated Research Database. Consenting patients completed an initial patient survey and three follow-up surveys at 4, 8 and 12 months either over the telephone or via the internet. Study surveys included questions on the dosing schedule of their OAC medications, medication side effects, the Morisky Medication Adherence Scale 8-item (MMAS-8) and other topics. An overall MMAS-8 score that ranged from 0 to 8 was calculated, with higher scores indicating greater adherence. Patients with MMAS-8 scores <6 were considered non-adherent. Generalized estimating equation (GEE) logistic regression model was used to estimate the impact of the dosing schedule on patient-reported non-adherence over time while controlling for patient characteristics, health plan types, region, marital status, and number of side effects at each time-point.

Results:
Of the 798 patients who completed the initial study survey (323 W, 320 D, 141 R and 14 A users), 398 (50%) completed the 4-month, 327 (41%) the 8-month and 256 (32%) the 12-month surveys, respectively. The proportion of patients who reported taking their OAC once daily (QD) was stable over the 12-month study period. At baseline, 60% of patients reported OAC QD use (317 W, 23 D, 141 R, 1 A users), and 67% patients reported OAC QD use (107 W, 6 D, 45 R, 1 A) at 12 months. The proportion of non-adherent patients taking OAC twice daily (BID) was consistently higher than those taking OAC QD (BID vs. QD: 13% vs.7% [initial survey]; 16% vs.9% [4-month]; 21% vs.10% [8-month]; 23% vs.15% [12-month]). After controlling for potential confounders, BID users were 92% more likely to be non-adherent compared to QD users (odds ratio [95% CI] =1.92 [1.29 to 2.87], p=0.001). Younger patients were more likely to be non-adherent compared to patients ≥65 years old (p≤0.01).

Conclusions:
This study showed that younger age and a more frequent dosing schedule was associated with an increased level of self-reported non-adherence with OAC therapy. Future studies are needed to explore how this association may impact economic and clinical outcomes.
Abstract 170: Weight Changes 1 Year beyond Completion of a 12 month Workplace-Based Intensive Lifestyle Modification Program: The My Unlimited Potential
Authors: Aneni Ehimen C , Osondu Chukwuemeka U , Rouseff Maribeth , Guzman Henry , Das Sankalp , Brown Doris , Santiago-Charles Joann , Ochoa Teresa , Mora Joseph , Gilliam Cynthia , Lehn Virginia , Sherriff Shoshana , Post Janisse , Veledar Emir , Feldman Theodore , Agatston Arthur S , Nasir Khurram
Published: March 2022

Introduction:
To date, there is paucity of evidence describing the long-term effects of health promotion programs in the workplace. In the current study, we present weight changes over 2 years of follow-up after participation in a 12-month lifestyle improvement program (My Unlimited Potential, [MyUP]) among high metabolic risk employees of Baptist Heath South Florida.

Methods:
The MyUP program is a 1 year lifestyle improvement program with an initial intensive phase of 12 weeks, and subsequent monthly checks up to 12 months from commencement of the program. To assess weight changes beyond one year, data from participants who began the program in 2011 and 2012 and subsequently participated in a voluntary health risk assessment (HRA) in 2013 and 2014 was analyzed. We excluded follow-up data less than 18 months or more than 3 years, as well as participants who did not complete the 12-week intensive phase. Baseline weight was measured at the beginning of the MyUP in each participant and follow-up weight was obtained via the HRA.

Results:
There were 138 participants with follow-up data, with a median follow-up of 25 months (range 22-27months). At baseline, the mean weight was 212.4 ± 45.1 lbs. At follow-up, mean weight change (in lbs) from baseline was -1.9 (95%CI: -4.1, 0.4). By contrast, there was a mean weight reduction from baseline to 1 yr prior to the end of follow-up was 9.8 lbs, with an average weight increase of 8 lbs in the 12 month period prior to the end of follow-up. At the end of follow-up, 18% achieved ≥ 5% weight loss from baseline, compared to 46% a year preceding the follow-up date. Completing the 12 month period of program was not associated with achieving ≥5% weight loss at 2 years.

Conclusion:
An intensive workplace lifestyle program remains effective at maintaining significant weight loss in a nearly 20% individuals even after 2 years. More studies are needed to understand factors that determine how to achieve and maintain long term gains achieved in lifestyle intervention wellness programs.
Abstract 206: Impact of Inpatient Evaluation of Health Literacy on Outcomes in Post-MI Patients
Authors: Rymer Jennifer , McCoy Lisa , Anstrom Kevin , Fonarow Gregg , Peterson Eric , Wang Tracy
Published: March 2022

Background:
Low health literacy is common in the US and may impact outcomes after myocardial infarction (MI). Whether hospitals routinely screen for low health literacy is unknown.

Methods:
We surveyed 122 hospitals, who enrolled 8412 acute MI patients in the TRANSLATE-ACS registry, whether they routinely screened patients for low health literacy prior to discharge. Hospitals were divided into those that screened routinely (in >75% of MI patients), sometimes (1-75%) or never (0%). 1-year MACE (composite of death, recurrent MI, stroke, or unplanned revascularization) and all-cause readmission were compared between hospital groups before and after adjustment for clinical, socioeconomic and hospital characteristics.

Results:
There was no difference in the proportion of patients who graduated high school among hospitals that routinely, sometimes, or never screened health literacy (88% vs. 86% vs. 88%, p=0.07). Hospitals that never or sometimes screened health literacy were more likely to have uninsured patients than hospitals that routinely screened, respectively (17% vs. 16% vs. 11%, p<0.001). Age, gender, and ACTION mortality risk score were not significantly different between groups. Figure shows unadjusted cumulative incidence of 1-year MACE and all-cause readmission by hospital group. Compared with hospitals that never screen health literacy, neither hospitals that routinely screened (unadjusted 13.4% vs. 14.3%, adjusted HR 0.921, 95% CI 0.745-1.139, p=0.447) nor those that sometimes screened (unadjusted 14.7 vs. 14.3%, adjusted HR 1.009, 95% CI 0.843-1.207, p=0.925) had a significant difference in 1-year MACE. Unadjusted risk of 1-year all-cause readmission was lowest among hospitals that routinely screened health literacy (34.4%). After adjustment, only hospitals that sometimes screened health literacy were significantly associated with a lower risk of all-cause 1-year readmission (unadjusted 37.0% vs. 38.3%, adjusted HR 0.886, 95% CI 0.789-0.995, p=0.041).

Conclusion:
Routine hospital health literacy screening did not improve risk of MACE. Selective health literacy screening was associated with lower 1-year readmission risk compared with hospitals that never screened. Studies are needed to elicit how inpatient health literacy screening can improve patient transition of care.
Abstract 207: Impact of Statins’ Therapy on the Fasting Blood Glucose Level of Cardiac Patients
Authors: AbdulRazzaq Al-Ani Hadeer Akram , Talib Al-Ani Iman Nazar , Abdulameer Al-Hashimi Aseel Hadi , Syed Sulaiman Syed Azhar , Hussein Hanan , Mansoor Sarab M
Published: March 2022

Background:
recent studies have shown the crucial role of statins in diabetic patients. Cardiac patients need statins to reduce the abnormal levels of lipoproteins and as prophylaxis against other cardiovascular risks.

Objectives:
this study aims to determine the impact of types and dose of statin on the glucose level of cardiac patients.

Methods:
a prospective study was conducted among 217 cardiac outpatients at the cardiac clinic of a governmental hospital in Malaysia. These patients were categorized into three groups based on statins used; 54 patients with atorvastatin, 84 patients with simvastatin and 79 patients with lovastatin. Required information relating to statin therapy and fasting blood sugar (FBS) for five visits (3 months per visit) was collected from patients’ progress file. Repeated measured ANOVA with multiple factors and post-hoc tests were used to determine the differences in FBG among statins.

Results:
simvastatin raised the FBG level more than lovastatin and atorvastatin, respectively. Atorvastatin was significantly the only statin type that reduced the FBG based on the number of visits. Atorvastatin reduced FBG in fifth visit to the minimum level compared to the first visit (5.72 mmol/L vs 6.52 mmol/L), while in simvastatin and lovastatin groups, FBG increased to the maximum level compared to the first visit (12.91 mmol/L vs 6.98 mmol/L, and 8.05 mmol/L vs 6.52 mmol/L), respectively. As to the statin dose, 40 mg induced significantly abnormal increase in FBG compared to 20 mg and 10 mg, especially simvastatin and lovastatin, respectively. Chinese patients were more susceptible to abnormality in FBG compared with Malay and Asian Indian patients. Cardiovascular diabetic patients significantly got more abnormality in FBG than cardiac non-diabetic patients. The predictors interactions of statin types with the number of visits, dose, race and diabetes mellitus were significantly affected the abnormal increase in FBG.

Conclusions:
atorvastatin is the appropriate lipid lowering agent recommended to be used by cardiac patients. Dose and duration of statin therapy must be adjusted to avoid the abnormal increase of FBG especially among cardiac diabetic patients.
Abstract 217: Long-Term Follow-Up of an Electronic System for Referral to Cardiac Rehabilitation Shows Increase in Referrals and Utilization
Authors: Pirruccello James , Traynor Kathleen C , Natarajan Pradeep , Hidrue Michael , Leavitt Marcia , Brown Carol , Rosenfield Kenneth A , Kathiresan Sekar , Wasfy Jason H
Published: March 2022

Introduction:
Cardiac rehabilitation attendance is associated with improved outcomes for patients with acute myocardial infarction (AMI) but it remains underutilized. Provider organizations accountable for population health may be incentivized to improve outcomes for patients with coronary disease through increased utilization of cardiac rehabilitation.

Hypothesis:
We sought to determine if replacing traditional referrals for cardiac rehabilitation for patients with AMI with an electronic referral system would increase utilization.

Methods:
As part of care redesign for AMI, we implemented the change from traditional to electronic referrals on December 10, 2013, and used negative binomial regression to assess the impact of this care innovation, controlling for other secular effects. Previously, we reported an analysis of the impact of this intervention on referral to cardiac rehabilitation over a period of months. To determine the effects of our intervention on patient access to care, we have now created a combined endpoint of confirmed cardiac rehabilitation attendance at our hospital or patient-initiated referral to another cardiac rehabilitation facility, and we have expanded the analysis to a 30-month period.

Results:
We analyzed 1,940 referral records over a 30-month period. After the intervention, the combined endpoint of intake attendance at our hospital or referral to another hospital’s cardiac rehabilitation program increased by a factor of 1.5 (p = 0.004). Total referrals to our cardiac rehabilitation program increased by a factor of 1.8, primarily attributable to a 17-fold increase in inpatient referrals (p < 0.0001 for both).

Conclusions:
Even controlling for secular trends, switching to an electronic referral system increases both referral volume and attendance at cardiac rehabilitation for patients with AMI. These types of electronic care innovations may improve provider organizations’ ability to provide guideline-oriented care for patients with coronary artery disease.
Abstract 225: Patient Activation is Low and Associated With Early Post-discharge Outcomes in Patients Hospitalized With Acute Decompensated Heart Failure
Authors: Dunlay Shannon M , Redfield Margaret M , Griffin Joan M , Roger Veronique L
Published: March 2022

Background:
Recent studies have suggested that patient activation, or having the knowledge, skills and confidence to manage one’s own health, has a substantial impact on patient behaviors and health outcomes. However, the role of activation in patients with heart failure is unknown.

Methods:
We prospectively recruited Southeastern Minnesota residents hospitalized with acute decompensated heart failure (ADHF) from January 2014 through July 2015. Activation was measured by face-to-face questionnaire using the Patient Activation Measure (PAM) and patients were categorized into four activation levels (lowest to highest activation) per PAM guidelines. Logistic regression was used to examine the association between activation level and discharge location and early post-discharge outcomes.

Results:
Among the 302 patients enrolled, the mean age was 77.3 years, 57.3% were men, and 46.8% had preserved ejection fraction. Median (25th-75th percentile) length of stay was 4 (3-7) days and 7 (2.3%) patients died prior to discharge. Among survivors, 73.3% discharged to home, while the remainder went to skilled nursing facilities (23.0%), assisted living facilities (2.0%) or other arrangements (1.4%). The 30-day mortality rate was 7.0% and the 30-day readmission rate was 21.2%. The number (%) of patients in each activation category from highest to lowest was 9 (3.0%), 121 (40.1%), 122 (40.4%), and 50 (16.6%). Patients with lower activation were older, less educated, had worse overall and financial satisfaction, and worse health literacy. They more often discharged to skilled nursing facilities and had higher 30-day mortality, though 30-day readmission did not differ by activation (Figure). Adjusting for age, patients in the lowest activation level were at 3.1-fold increased odds of discharging to a skilled nursing facility and 6.0-fold increased odds of dying within 30 days of hospital discharge compared with patients in the highest two activation levels.

Conclusions:
Patients hospitalized with ADHF with lower activation are less satisfied, have worse health literacy, more often require skilled care and are at increased risk for early post-discharge mortality. Activation is easy to measure, identifies a high-risk subgroup, and is potentially modifiable.