bluuebunny/crossref_metadata_2025 huggingface dataset:
172 CLINICAL AND PROGNOSTIC IMPLICATIONS OF RV UPTAKE WITH RADIONUCLIDE SCINTIGRAPHY IN TRANSTHYRETIN CARDIAC AMYLOIDOSIS
Authors: Porcari Aldostefano , Fontana Marianna , Canepa Marco , Biagini Elena , Cappelli Francesco , Gagliardi Christian , Longhi Simone , Pagura Linda , Tini Giacomo , Dore Franca , Bonfiglioli Rachele , Bauckneht Matteo , Miceli Alberto , Girardi Francesca , Martini Anna Lisa , Barbati Giulia , Costanzo Egidio Natalino , Caponetti Angelo Giuseppe , Paccagnella Andrea , Sguazzotti Maurizio , La Malfa Giovanni , Zampieri Mattia , Sciagrà Roberto , Perfetto Federico , Hutt David , Rapezzi1 Claudio , Merlo Marco , Sinagra Gianfranco , Gillmore Julian D
Published: December 2022

Aims

The prognostic role of bone tracer uptake in transthyretin cardiac amyloidosis (ATTR-CA) is controversial. The study investigated the potential prognostic significance of biventricular (BiV) uptake in ATTR-CA.

Methods

Consecutive ATTR-CA patients who had cardiac scintigraphy with acquisition of planar and single-photon emission computed tomography (SPECT) images from the National Amyloidosis Centre (NAC) and four Italian centres were included. Planar BiV uptake was defined in presence of right ventricle (RV) uptake and graded in combination with SPECT imaging. The primary outcome was all-cause mortality.

Results

Among 1422 patients with ATTR-CA, BiV uptake was found in 85% of cases on planar scintigraphy and in 100% of cases on SPECT images. During a median follow-up of 39 months, BiV uptake at planar scintigraphy was associated with a higher all-cause mortality compared to isolated LV uptake (40.5% vs 10.7%, p<0.001), whereas the Perugini scale was not (p=0.27 in grade 2 vs 3). At multivariable analysis, RV uptake at planar scintigraphy leading to BiV uptake (HR 2.80, p=0.001), together with higher age at diagnosis (HR 1.03, p=0.001), V122I TTR variant (HR 1.60, p=0.001), NAC ATTR Stage (HR 1.29, p=0.003), E/e’ (HR 1.02, p=0.044), right atrium area index (HR 1.04, p=0.018) and GLS (HR 1.05, p=0.003) were independently associated with all-cause death. At time-dependent ROC curve analysis, the addition of planar BiV uptake to the NAC stage resulted in improved accuracy of the model for prediction of all-cause death (from AUC 0.74 to 0.79; p<0.001).

Conclusions

Planar RV uptake leading to BiV uptake identified ATTR-CA patients with worse outcome, potentially serving as a novel prognostic marker.
189 PREVALENCE, DISEASE CHARACTERISTICS AND OUTCOMES OF HEREDITARY TRANSTHYRETIN AMYLOID CARDIOMYOPATHY AMONG ELDERLY INDIVIDUALS
Authors: Porcari Aldostefano , Razvi Yousuf , Masi Ambra , Patel Rishi , Ioannou Adam , Rauf Muhammad Umaid , Hutt David F , Rowczenio Dorota , Gilbertson Janet , Martinez-naharro Ana , Venneri Lucia , Whelan Carol , Lachmann Helen , Wechalekar Ashutosh , Quarta Candida Cristina , Merlo Marco , Sinagra Gianfranco , Hawkins Philip N , Fontana Marianna , Gillmore Julian D
Published: December 2022

Aims

Transthyretin amyloid cardiomyopathy (ATTR-CM) is often assumed to be associated with wild-type TTR genotype (ATTRwt) in elderly patients (aged ≥70), some of whom are not offered genetic testing. We sought to estimate the prevalence, clinical characteristics and prognostic implications of variant ATTR-CM (ATTRv-CM) among elderly patients.

Methods

Data from consecutive patients over 70 years of age diagnosed with ATTR-CM at the UK National Amyloidosis Centre between January 2012 and June 2022 were retrospectively evaluated. All patients underwent clinical evaluation, biochemical tests, echocardiography and TTR genotyping. The study outcome was all-cause mortality.

Results

The study population consisted of 2164 patients with ATTR-CM (median age 79 years at diagnosis, 13.2% females, 80.4% Caucasian). ATTRv-CM was diagnosed in 20% (n=431) of the study population of whom 329 (76.3%) carried V122I, 49 (11.4%) T60A, 18 (4.2%) V30M and 35 (8.1%) other pathogenic TTR variants. During a median (range) follow up of 29 (12-48) months, ATTRv-CM was associated with increased all-cause mortality compared to ATTRwt-CM, with the poorest survival observed in V122I-associated ATTRv-CM (p<0.001). Univariable and multivariable binary logistic regression analyses in those with ATTR-CM showed younger age at diagnosis (odds ratio [OR] 0.86 per year, p<0.001), female sex (OR 3.0, p<0.001), Afro-Caribbean ethnicity (OR 59.1, p<0.001), atrial fibrillation (OR 0.65, p=0.015), ischemic heart disease (OR 0.54, p=0.007), peripheral polyneuropathy (OR 3.72, p<0.001) and orthostatic hypotension (OR 3.75, p=0.001) to be independently associated with ATTRv-CM.

Conclusions

Up to 20% of elderly patients with ATTR-CM have a pathogenic TTR variant. These findings support routine sequencing of the TTR gene in all patients with ATTR-CM regardless of age.
438 INCIDENT HYPOCHLOREMIA AMONG PATIENTS WITH TAKOTSUBO SYNDROME: SHORT- AND LONG-TERM OUTCOME. RESULTS FROM A MULTICENTER PROSPECTIVE REGISTRY.
Authors: Cetera Rosa , Santoro Francesco , Vitale Enrica , Ragnatela Ilaria , Mallardi Adriana , Leopizzi Alessandra , Matera Annalisa , Correale Michele , Iacoviello Massimo , Brunetti Natale Daniele
Published: December 2022

Background

Takotsubo syndrome (TTS) is an acute heart failure syndrome featured by a reversible left ventricular systolic dysfunction with significant rate of in- and out-of-hospital mayor cardiac adverse events (MACE).

Aim of the study

To evaluate the possible role of hypochloremia as prognostic marker at short- and long-term follow-up in subjects with TTS.

Methods

305 consecutive patients were enrolled in a multicenter international registry. Clinical, laboratory and echocardiographic evaluations were performed at admission and during hospitalization. Incident hypochloremia (serum chloride level below 97 mEq/l) during hospitalization was recorded. In-hospital MACE, short- and long-term mortality was recorded.

Results

Mean admission serum chloride levels were 102±5 mEq/l. 97 out of 305 (37%) patients experienced incident hypochloremia. Patients with incident hypochloremia were older (78±10 vs 73±12 years, p=0.01), had lower admission LVEF (34±8% vs 37±8%, p=0.009), and longer hospital stay (9±4 vs 7±4 days, p=0.0003).

During hospitalization patients with incident hypochloremia had higher rates of complication (45% vs 32%, p=0.01), lower levels of natremia and azotemia at admission and discharge.

At long term follow-up incident hypochloremia was associated with increased risk of MACE (49% vs 32%, p=0.005) and death (42% vs 24%, p=0.002, log rank p<0.01).

Conclusion

Incident hypochloremia is a common finding among hospitalized patients with TTS, associated with higher risk of in-hospital events and long-term MACE and death.
864 ISOLATED CARDIAC METASTASIS FROM CARCINOMA OF THE CERVIX: RARE CASE OF ACS-NSTE. CASE REPORT
Authors: Ventura Ettore , Scalzi Giuseppe , Riverso Vincenzo , Serraino Filiberto , Petulla´ Maria , Mascaro Giuseppina , Indolfi Ciro , Aquila Iolanda
Published: December 2022

Introduction

The heart is a rare site of tumor metastasis. Although rarely, cardiac metastases may be secondary to a primary intra-abdominal tumor.

Aim

we report the case of a 60-years-old woman, ante-mortem finding of an isolated cardiac metastasis from cervical carcinoma presented as ACS-NSTE, who was evaluated in our Division of Cardiology.

Materials and methods

electrocardiogram, transthoracic echocardiography, angioTC, cardiac surgery and histopathologic analysis were performed.

Results

electrocardiogram showed incomplete right branch block with diffuse negative T waves. On the echocardiogram evidence of a voluminous hypo-isoechoic formation almost completely occupying the cavity of the right ventricule (RV) which appeared dilated and dysfunctional; D-shape aspect of the left ventricule as from the overload of the right sections and with moderate pericardial effusion, mildly reduced ejection fraction (EF50%Q). An urgent Angio-CT was performed and revealed a voluminous solid neoformation with inhomogeneous content and progressive contrast enhancement in the right ventricule. Following admission, the patient's haemodynamic status gradually worsened. Therefore, urgent cardiac surgery was performed. After drainage of abundant serum/haematic effusion, probably neoplastic infiltration of RV was seen. Therefore, given the extension it was decided to perform only multiple biopsies. Histopathological examination revealed moderately differentiated squamous cell carcinoma, as from metastasis from K. cervix.

Conclusions

there is no standardized therapy for the treatment of cardiac metastases, it is necessary to evaluate on a case-by-case basis. The most important prognostic factors are the obstructive effect of the intracardiac mass and the extent of any pericardial effusion. In fact, they can adversely affect hemodynamic stability.
425 THE IMPACT OF NURSING EDUCATION ON THE QUALITY OF LIFE IN PATIENTS WITH HEART FAILURE DURING CARDIAC REHABILITATION: A SYSTEMATIC REVIEW
Authors: Li Vigni Myriam Letizia , Artiola Gaetano , Cappelli Sara , Meucci Beatrice , Lulli Maria Sole
Published: December 2022

Introduction

Heart failure (HF) occurs in 26 million people worldwide and is one of the most common causes of hospitalization, hospital readmission and death. To overcome this, ESC guidelines recommend the cardiologic rehabilitation pathway, which places the patient with HF at the center of his or her care pathway with the aim of improving quality of life through the implementation of a personalized multidisciplinary program. In the cardiology rehabilitation pathway, the nurse plays a key role of education and support, encouraging the patient to change. The aim of the review is to explore the quality of life of the elderly patient with HF and the educational role of nursing in the cardiac rehabilitation setting.

Materials and Methods

A systematic search was conducted using PUBMED, CINAHL until June 2022, according to REA methodology.

The quality of the study was assessed by three reviewers using the DIXONWOOD checklist.

Results

and discussion: Analysis of the results suggests that multiple aspects need to be considered to improve the management and quality of life of patients with HF. Among these, the literature cites the implementation of a network of nurse case managers, standardization of operative protocols, mental and physical pain management, and cardiac rehabilitation units after hospital discharge. It also shows how physical activity, according to the ERIC-HF program, can improve the ability to perform ADL activities (Kang Y. et all, 2020). An additional study found that home cardiac rehabilitation intervention results in clinically significant improvement in disease-related quality of life in patients with HF.

Cost-utility analyses support that home cardiac rehabilitation programs are cost-effective treatments for patients with HF and that nurses play a key role in educating and managing their condition (Rod s. et all, 2019). They should encourage patients with heart failure to practice cardiac rehabilitation for a longer period to improve their quality of life. One study shows that rehabilitation intervention for caregivers of patients with HF is helpful in supporting their role and improving their confidence (Wingham J. et all, 2019).

Conclusions

Cardiac rehabilitation in which nurses are present proves to be crucial in both psychological (Suzanne H et al, 2018) and exercise-enhancing projects to improve long-term health conditions, as shown by Kentaro, K., this approach produces benefits on patients with HF and their caregivers. It induces in the patient greater autonomy in daily activities, medication adherence and self-care of the disease, delaying its progression. At the same time, for caregivers there is a reduction in caregiver burden resulting in economic, emotional and social improvement. For the National Health Service, there is a reduction in length of stay in intensive care and emergency departments and consequently, a decrease in costs.
10 RADIOLOGICAL ANATOMY OF THE HEART AND MEDIASTINUM IN ELECTROSTIMULATION: A GUIDE FOR TSRM, NURSES AND TFCPC
Authors: Santucci Stefano , Santucci Matteo
Published: December 2022

For the implantation of the PM, iodized contrast medium is rarely used and to recognize the anatomical structures within which one is operating, one must resort to the interpretation of only the radiological images obtained with the use of ionizing radiation. To verify the correct positioning of the leads, it is necessary to have multiple points of view (projections). Confirmation is usually sought with at least two projections that are almost orthogonal to each other. The fluoroscopic visualization shows a two-dimensional antomy typical of radiological imaging and we speak of a cardiac shadow formed by the overlapping of all vascular structures

Typical views to visualize correct lead placement require multiple views, usually two. The projections RAO 20-25 ° and LAO 25-30 ° are almost orthogonal. With the first, the cardiac silhouette shows the right ventricle in its maximum longitudinal extension. With the LAO, the left ventricle and the right ventricle are represented paired with a view comparable to the 4-chamber ultrasound imaging

Knowledge of radiological anatomy is very important in determining the correct positioning of the leads.
12 NUERSING MANAGEMENT RADIAL ACCESS WITH COMPRESSION BADAGE APPLICATION
Authors: Franchetti Domenico , Negossi Davide , Santucci Stefano
Published: December 2022

Radial access is now a diagnostic approach increasingly used in hemodynamics rooms, from the election procedure to primary emergency angioplasty Such access certainly guarantees minor bleeding complications, above all but ensures the patient a better comfort and well-being.

Nursing management of post-procedure radial vascular access is extremely important and early The radial approach according to Seldinger, requires, at the end of the procedure, except in special cases, the removal of the vascular valve introducer, usually of 5 or 6 French caliber, and to carry it out, the compression dressing must be taut.

This dressing can be done with mechanical compression means, see the air cushion bracelet, both with the classic and traditional elastic compression bandage.

The work will show how, in our laboratory, using the traditional dressing consistently, we used two types of dressing.

The classic one made with tensoplast, and the other using self-adhesive gauze bandages.

In both the packaging is custom, with the difference that the first is performed by two nurses while the second is performed only by one nurse
689 IMPACT OF RENIN-ANGIOTENSIN SYSTEM INHIBITORS ON CLINICAL OUTCOME IN HYPERTENSIVE PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION: INSIGHT FROM THE EFFECTAVI REGISTRY
Authors: Basile Christian , Mancusi Costantino , Franzone Anna , Avvedimento Marisa , Angellotti Domenico , Castiello Domenico Simone , Mariani Andrea , Manzo Rachele , Cirillo Plinio , De Simone Giovanni , Esposito Giovanni
Published: December 2022

Aims

Left ventricular pressure overload is connected with cardiac renin–angiotensin system activation, which may lead to myocardial fibrosis and poorer clinical outcomes. Hypertensive patients with symptomatic, severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) in the EffecTAVI registry were evaluated for the association between baseline treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and clinical outcomes.

Methods and results

The research comprised 373 patients with moderate, high, or prohibitive risk who had TAVI in the EffecTAVI registry (NCT05235555). Using Kaplan–Meier event rates and study-stratified multivariable Cox proportional hazards regression models, we evaluated clinical outcomes at 2 years according to ACEi/ARB therapy status at baseline. Among the 327 patients with hypertension included in the present study, 222 (67.9%) were treated with ACEI/ARB at baseline, whereas 105 (32.1%) were not. Treatment with ACEI/ARB was related with decreased all-cause mortality (HR=0.46, 95% CI 0.25-0.90, p=0.011), although this association was not statistically significant after multivariable adjustment for important covariates. Analyzing pre-procedural ACEi and ARBs separately, ARBs administration was related with a 58% decrease in all-cause mortality (HR=0.42, 95% CI 0.18-0.98, p=0.04), which was confirmed in multivariate analysis.

Conclusion

In a small cohort of hypertensive patients with severe symptomatic AS from the EffecTAVI registry, ARBs treatment at baseline was independently associated with a lower risk of 2-year all-cause mortality.
224 RIGHT VENTRICULAR MECHANICS AND THE CLINICAL IMPLICATION OF 2D SPECKLE TRACKING ASSESSMENT IN SEVERE AORTIC STENOSIS
Authors: Springhetti Paolo , Ciceri Luca , Urbani Giulia , Dotto Alberto , Maffeis Caterina , Tafciu Elvin , Bergamini Corinna , Rossi Andrea , Ribichini Flavio , Benfari Giovanni
Published: December 2022

Introduction

The prognostic role of RV function assessment in severe AS has been demonstrated in previous studies. However, the role of 2D speckle tracking RV evaluation in the context of severe AS has not been completely clarified.

Methods

We retrospectively evaluated consecutive patients with severe AS referred to TAVI at our institution. Exclusion criteria were severe aortic regurgitation, severe mitral stenosis and poor acoustic window for a correct 2D speckle tracking right chamber evaluation.

The echocardiographic exams were analyzed off-line with a semi-automatic software (Tomtec Arena, Autostrain ®) to assess RVFW strain and LV GLS. Additionally, a conventional echocardiographic evaluation was made in both right and left chambers (LVEF, FAC, LVEF).

Prevalence of conventional RV disfunction was defined as a TAPSE<17 mm or FAC<35%. RVFW impairment cuf-off was defined below 20%.

Multivariate regression models were elaborate to assess the major determinants of RV function.

Moreover, logistic regression analysis has been made to analyze if RV function could predict high-risk clinical features in the context of severe AS.

Results

Our cohort was composed of 110 consecutive patients. Mean RVFW was 21±7%, TAPSE 21±4 mm, FAC 44±11% and mean RV area 10±4 cmq/mq. The prevalence of RV disfunction defined by standard echocardiography was 26% (29 patients), instead, RVFW was impaired (below 20%) in 53 patients (40%). At multivariate regression analysis, the main RVFW determinants were MR, AS severity, LVMI, GLS and E/e’ (R2 0.68, p<0.001 including AVA; R2 0.53, p<0.001 including mean gradient).

At logistic regression analysis RVFW strain was associated with previous HF hospitalization admission independently from TAPSE (CI 95% 1.03–1.22, p=0.008). Furthermore in a second model, RVFW strain was a significant predictor of advanced NYHA class independently from FAC (CI 95%, 1.01–1.18, p=0.0036).

Conclusion

The major determinants of RV function in patients with severe AS were MR and LV function. A pressure overload driven by the MR-LV dysfunction combination on right sided heart could impact profoundly negatively on RV function. RVFW strain in this study resulted a more sensitive parameter that conventional RV assessment in highlighting more symptomatic severe-AS patients.
564 AN UNUSUAL PRESENTATION OF ICA DISSECTION. A CASE OF TRANSIENT GLOBAL AMNESIA IN A PATIENT WITH PAINLESS SPONTANEOUS INTERNAL CAROTID ARTERY DISSECTION
Authors: Natale Francesco , Loffredo Francesco , Molinari Riccardo , Covino Simona , Alfieri Roberta , Altobelli Ippolita , Cimmino Giovanni
Published: December 2022

Image focus

A 42-year-old woman was carried to emergency room lamenting sudden memory loss. Her husband witnessed the onset of the episode. No recent head trauma was reported, blood pressure was under control.

Anterograde and retrograde memory loss was present and confirmed by a neurologist. No other neurological signs were elicitable. Blood exams and toxicological analysis were negative. ECG, chest radiography, and cerebral TC showed no abnormalities. At physical examination a carotid bruit could be appreciated.

We performed an eco-color-Doppler of carotid artery that showed a left common and internal carotid artery dissection (figure 1). The diagnosis of ICA dissection was confirmed with a contrast CT. The coexistence of an aortic dissection was excluded with the same imaging technique.

The anterograde amnesia resolved 15 h after the admission. A neurologist confirmed that the patient experimented an episode of transient global amnesia (TGA).

After a vascular surgery consultation, a conservative treatment was deemed appropriate. After a 6 month follow up the patient didn't complain of any other neurological symptom or sign.

Transient global amnesia (TGA) is characterized by reversible anterograde and retrograde amnesia of sudden onset. This amnesic syndrome resolves spontaneously within 24 h. Annual incidence rate for all ages of spontaneous ICA dissection is approximately of 2.6 per 100 000 inhabitants, however data are extremely variable among different studies. TGA has never been associated with a spontaneous ICA dissection. In order to not miss a spontaneous ICA dissection as a rare ethology of TGA, we suggest performing an eco-color-Doppler of the epi-aortic vessels in patient affected by such amnesic syndrome.
Fact-checking as a deterrent? A conceptual replication of the influence of fact-checking on the sharing of misinformation by political elites
Authors: Ma Siyuan , Bergan Daniel , Ahn Suhwoo , Carnahan Dustin , Gimby Nate , McGraw Johnny , Virtue Isabel
Published: December 2022

In a field experiment conducted during the 2012 general elections in the U.S., Nyhan and Reifler found that the threat of fact-checking deterred state legislators from making false or misleading statements. The current study presents a conceptual replication and extension of this influential study by utilizing a similar treatment that leverages a recent partnership between local media outlets and fact-checking organizations, assessing the effects of the treatment on the accuracy of legislators’ statements on Twitter around the first impeachment trial of Donald Trump. Results provide limited evidence of the effects of our treatment on the accuracy of legislators’ posts, even among legislators within media markets directly affected by this partnership. We conclude with a discussion of the theoretical and practical relevance of these results and avenues for future research.
Deconstructing age(s): an analysis of the different conceptions of age as a legal criterion for access to assisted reproductive technologies
Authors: Martani Andrea , De Clercq Eva , De Geyter Christian , Pennings Guido , Wangmo Tenzin , Elger Bernice Simone
Published: December 2022

Whether there should be restrictions for access to Assisted Reproductive Technologies (ART) is a matter of continuous medical, societal, and ethico-legal debate. One of the most controversial topics in this context is the use of parental age as a criterion to limit access to ART. Views are divided on whether there should be an upper age limit for one or both parents and on where such limits should be. Although this debate is centered around the issue of ‘age’ and although age-related limits are present in many legislations, the intrinsic ambiguity of the term `age' is largely overlooked.

In this article, we build on gerontological, medical, and sociological literature on the concepts of ‘age’ and ‘aging’ to distinguish three conceptions of age that are relevant for ART regulation: the chronological, the biological, and the social-cultural one. Beyond mapping out these conceptions of age, we describe how they relate to ART and reproduction, and illustrate the advantages and disadvantages of relying on each of them as a basis for limiting ART access. Finally, we propose a template for defining legal age limits for ART access in the law, based on the refined understanding of the different conceptions of age that we outline and we discuss two potential objections to our proposal.
Intraneuronal tau aggregation induces the integrated stress response in astrocytes
Authors: Batenburg Kevin L , Kasri Nael N , Heine Vivi M , Scheper Wiep
Published: December 2022

Progressive aggregation of tau protein in neurons is associated with neurodegeneration in tauopathies. Cell non-autonomous disease mechanisms in astrocytes may be important drivers of the disease process but remain largely elusive. Here, we studied cell type-specific responses to intraneuronal tau aggregation prior to neurodegeneration. To this end, we developed a fully human co-culture model of seed-independent intraneuronal tau pathology, which shows no neuron and synapse loss. Using high-content microscopy, we show that intraneuronal tau aggregation induces oxidative stress accompanied by activation of the integrated stress response specifically in astrocytes. This requires the direct co-culture with neurons and is not related to neurodegeneration or extracellular tau levels. Tau-directed antisense therapy reduced intraneuronal tau levels and aggregation and prevented the cell non-autonomous responses in astrocytes. These data identify the astrocytic integrated stress response as a novel disease mechanism activated by intraneuronal tau aggregation. In addition, our data provide the first evidence for the efficacy of tau-directed antisense therapy to target cell autonomous and cell non-autonomous disease pathways in a fully human model of tau pathology.
Changes in Elective and Urgent Surgery Among TRICARE Beneficiaries During the COVID-19 Pandemic
Authors: Crawford Alexander M , Lightsey IV Harry M , Xiong Grace X , Ye Jamie , Call Catherine M , Pomer Alysa , Cooper Zara , Simpson Andrew K , Koehlmoos Tracey P , Weissman Joel S , Schoenfeld Andrew J
Published: December 2022

Background

COVID-19 is known to have altered the capacity to perform surgical procedures in numerous health care settings. The impact of this change within the direct and private-sector settings of the Military Health System has not been effectively explored, particularly as it pertains to disparities in surgical access and shifting of services between sectors. We sought to characterize how the COVID-19 pandemic influenced access to care for surgical procedures within the direct and private-sector settings of the Military Health System.

Methods

We retrospectively evaluated claims for patients receiving urgent and elective surgical procedures in March–September 2017, 2019, and 2020. The pre-COVID period consisted of 2017 and 2019 and was compared to 2020. We adjusted for sociodemographic characteristics, medical comorbidities, and region of care using multivariable Poisson regression. Subanalyses considered the impact of race and sponsor rank as a proxy for socioeconomic status.

Results

During the period of the COVID-19 pandemic, there was no significant difference in the adjusted rate of urgent surgical procedures in direct (risk ratio, 1.00; 95% CI, 0.97–1.03) or private-sector (risk ratio, 0.99; 95% CI, 0.97–1.02) care. This was also true for elective surgeries in both settings. No significant disparities were identified in any of the racial subgroups or proxies for socioeconomic status we considered in direct or private-sector care.

Conclusions

We found a similar performance of elective and urgent surgeries in both the private sector and direct care during the first 6 months of the COVID-19 pandemic. Importantly, no racial disparities were identified in either care setting.
Effectiveness of Bupropion and Varenicline for Smokers With Baseline Depressive Symptoms
Authors: Zhang Helena , Gilbert Emily , Hussain Sarwar , Veldhuizen Scott , Le Foll Bernard , Selby Peter , Zawertailo Laurie
Published: December 2022

Introduction

Smokers with concurrent depression are less likely to achieve abstinence, even with pharmacotherapy. The purpose of this secondary data analysis was to evaluate if the presence of any depressive symptoms at baseline alters the effectiveness of bupropion and varenicline for smoking cessation.

Aims and Methods

Eligible participants were enrolled via the internet and randomized 1:1 to receive a 12-week supply of either bupropion (n = 465) or varenicline (n = 499). Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-2). Follow-up surveys were conducted at weeks 4, 8, 12, 26, and 52 to assess self-reported quit. The primary outcome was 7-day point prevalence abstinence at 12 weeks follow-up (end-of-treatment).

Results

Participants who endorsed any depressive symptoms (PHQ-2 > 0; n = 280) were less likely to be quit at end-of-treatment compared to participants who did not endorse any symptoms (PHQ-2 = 0; n = 684) (OR = 0.56, 95% CI: 0.38 to 0.8, p = .003). Within the varenicline group, quit outcomes did not differ between those with and without depressive symptoms (21.3% vs. 26.9%, respectively). Within the bupropion group, however, those with symptoms had a significantly reduced quit rate compared to those without symptoms (7.0% vs. 17.3%, respectively).

Conclusions

The presence of even one symptom of depression at the start of a quit attempt may adversely affect quit outcomes. Patients should be assessed for depressive symptoms when planning to quit smoking as it may inform the approach to treatment. However, future studies are needed to confirm these findings.

Implications

Findings from the current study illustrate the importance of evaluating baseline sub-clinical depressive symptoms before a quit attempt using first-line pharmacotherapies. This secondary analysis of a large-scale randomized trial suggests that bupropion may be less effective for those with baseline depressive symptoms while varenicline may be equally effective for those with and without depressive symptoms
Umbrella review of time-restricted eating on weight loss, fasting blood glucose, and lipid profile
Authors: Chew Han Shi Jocelyn , Ang Wei How Darryl , Tan Zhen Yang Abel , Ang Wen Wei , Chan Kin Sun , Lau Ying
Published: December 2022

Context

A growing number of systematic reviews with meta-analyses have examined the effectiveness of time-restricted eating (TRE) in reducing weight and improving fasting blood glucose and lipid profiles. However, mixed results have been found, and its effectiveness remains uncertain.

Objective

This umbrella review aimed to summarize systematic reviews that (1) examine the effects of TRE on weight loss, fasting blood glucose, total cholesterol, triglycerides, high-density-lipoprotein cholesterol (HDL-C) and low-density-lipoprotein cholesterol (LDL-C) in individuals with overweight and obesity; and (2) compare the effect sizes on these outcomes between conventional TRE and Ramadan fasting.

Data Sources

A total of 11 databases were searched from inception until March 11, 2022.

Data Extraction

Two independent reviewers performed article selection, data extraction, and quality assessment.

Data Analysis

Seven systematic reviews with 30 unique meta-analyses involving 7231 participants from 184 primary studies were included. The quality of each review was evaluated as moderate (14.3%) or critically low (85.7%) according to the Assessment of Multiple Systematic Reviews 2. The degree of overlap was rated as slight for all outcomes (corrected cover area = 1.04%–4.27%). Meta-analyses at the meta-data level suggest that TRE is beneficial for reducing weight (P = .006) and fasting blood glucose (P < .01). Meta-analyses at the primary study level suggest that the effect on LGL-C was significant (P = .03). Subgroup analyses revealed greater effects in lowering fasting blood glucose, total cholesterol, and LDL-C from Ramadan fasting than from conventional TRE. The credibility of evidence was rated as suggestive (3.3%), weak (36.7%) or nonsignificant (60%) using a classification method.

Conclusion

TRE may complement usual care and reduce body weight and fasting blood glucose. Rigorous randomized controlled trials with long-term assessments in a wide range of populations are warranted.

Systematic Review Registration

PROSPERO registration no. CRD42022325657.
79. Long-term Health Outcomes of Individuals who are Infected with SARS-CoV-2 and Develop COVID-19
Authors: Tene Lilac , Bergroth Tobias , Eisenberg Anna , Chodick Gabriel
Published: December 2022

Background

Persistence of symptoms after the acute phase of COVID-19, often referred to as long COVID, is common and debilitating. Data on the burden and direct medical costs of long COVID is still limited.

Methods

A retrospective cohort study using data from a 2.6-million-member state-mandated health provider in Israel.

All adult patients with a positive SARS-CoV-2 RT-PCR test between March 2020 and March 2021 were included. Among them, patients with long COVID diagnoses or post-COVID symptoms persisting or newly diagnosed more than 4 weeks from the first positive RT-PCR test were defined as long COVID patients. Study endpoints included all COVID-related visits, hospitalizations, therapies, imaging, and lab tests. Costs of utilized healthcare service were evaluated for pre-infection, acute phase, and long COVID period.

Results

Included in the study were 180,759 incident COVID-19 patients (32.9±19.0 years; 89,665 [49.6%] females). 14,088 (7.8%) individuals developed long COVID (40.0±19.0 years; 52.4% females). In addition to older age (adjusted odds ratio (AOR)=1.06, 95% CI 1.05–1.06), long COVID was associated with female sex (AOR=1.14, 95% CI 1.10–1.18), ever smoking (AOR=1.53, 95% CI 1.36–1.73), symptomatic acute phase (AOR=1.17; 95% CI 1.13–1.22); and hypertension (AOR=8.21, 95% CI 6.80–9.90), particularly among younger adults. Hospitalization in Long COVID patients was associated with respiratory/ear-nose-throat (adjusted hazard ratio (AHR)=2.55; 95% CI 2.27–2.86), neurological (AHR=2.88; 95% CI 2.33–3.56), psychiatric (AHR=2.32; 95% CI 1.93–2.79), and cardio-metabolic long-term complications (AHR=1.61; 95% CI 1.41–1. 83). While long COVID patients had a lower use of services compared to non-long COVID patients during the acute phase (AOR=0.87; 95% CI 0.83–0.90), their mean cost per user was 52% higher. Direct medical costs of long COVID patients were substantially greater than non-long COVID patients post vs. pre infection (AOR=1.74; 95% CI 1.56–1.93).

Conclusion

This study demonstrated the association of long COVID with many complications requiring extended medical care and higher healthcare costs. These factors should be considered in priority setting around COVID-19 prevention and management.

Disclosures

Tobias Bergroth, PhD, Gilead Sciences: Stocks/Bonds|MSD, Sweden: Employee|MSD, Sweden: Stocks/Bonds Anna Eisenberg, PhD, MSD, Israel: Employee|MSD, Israel: Stocks/Bonds.
739. The High Burden of Bloodstream Infection in Adults: A Nation-Wide Population- Based Study
Authors: Schechner Vered , Wullfhart Liat , Temkin Elizabeth , Feldman Sarah F , Nutman Amir , Shitrit Pnina , Schwaber Mitchell J , Carmeli Yehuda
Published: December 2022

Background

Limited data exist on the long-term consequences of bloodstream infections (BSI). We examined incidence, 1-year mortality, and years of potential life lost (YPLL) following BSI by eight sentinel bacteria in adults. We also estimated the relative contribution of hospital-onset BSI (HO-BSI) and of antibiotic-resistant BSI to the burden of BSI.

Methods

We used data from Israel's national BSI surveillance system (covering E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, S. pneumoniae, S. aureus, E. faecalis and E. faecium, comprising 70% of all BSI) and the national death registry. Adults with BSI between 1/1/2018 and 31/12/2019 were included. The outcomes were all-cause 30-day and 1-year mortality. We constructed Kaplan-Meier curves and used the log-rank test to compare survival between age groups. We calculated the age-standardized mortality rate and YPLL using the Global Burden of Disease reference population and life expectancy tables.

Results

A total of 25,376 BSI occurred over 2 years in the adult Israeli population (mean adult population: 6,068,580). Drug-resistant BSI comprised 32% of all events (41.1% of HO-BSI). The annual BSI incidence was 209 per 100,000 population. The case fatality rate (CFR) was 25.6% at 30 days and 46.4% at 1 year. The 1-year CFR was higher among males than females (RR=1.17, 95% CI 1.14–1.20) and it increased with age (OR=1.37 per decade, 95% CI 1.36–1.39). In all age groups survival continued to decline up to 1 year (Figure). For the outcome of 1-year mortality, the annual age-standardized mortality rate and YPLL per 100,000 population following BSI were 48.6 and 1002.2, respectively. For comparison, the global mortality rate and YPLL from ischemic stroke are 36.6 and 521.8 per 100,000, respectively. HO-BSI represented 27.4% of BSI but contributed to 33.9% of deaths and 39.9% of YPLL. HO-BSI by drug-resistant bacteria represented 11.3% of BSI, 14.8% of deaths, and 17.4% of YPLL.

Conclusion

BSI have grave long-term consequences: nearly 50% of affected adult patients died within 1 year. The burden of BSI is higher than that of ischemic stroke. HO-BSI and drug-resistant BSI contribute disproportionately to BSI mortality and YPLL. Attention and resources should be directed to prevention of BSI, as well as to advances in early diagnosis and better treatment.

Disclosures

Yehuda Carmeli, MD, Allecra Therapeutics: Advisor/Consultant|MSD: Advisor/Consultant|Nabriva: Advisor/Consultant|Pfizer: Advisor/Consultant|Qpex Pharmaceuticals: Advisor/Consultant|Roche: Advisor/Consultant|Shinogi: Advisor/Consultant|Spero Therapeutics: Advisor/Consultant.
744. Infectious Diseases Providers Perspectives Around the Use of Outpatient Parenteral Antibiotic Therapy (OPAT) for Persons Who Inject Drugs (PWID), US, 2022
Authors: Solomon Daniel A , Beieler Alison M , Levy Sera , Eaton Ellen , Sikka Monica K , Thornton Alice C , Dhanireddy Shireesha
Published: December 2022

Background

Injection drug use-related infections are life threatening and may require prolonged courses of antibiotic therapy. There is no consensus on best practices for serious infections when patients are stable for discharge. Outpatient parenteral antimicrobial therapy (OPAT) has been shown to be feasible for people who inject drugs (PWID) especially when paired with medication for opioid use disorder. We set out to determine the current practice patterns and attitudes of infectious diseases (ID) clinicians in the United States regarding the use of OPAT for PWID.

Methods

We surveyed ID clinicians between January 2022 and March 2022. Topics focused on PWID including OPAT access, barriers to inclusion in OPAT, and factors clinicians considered for OPAT success. Responses from those who perceived PWID were eligible for OPAT (PWID-E) were compared to those who believed PWID were ineligible (PWID-I) using the Pearson chi-squared test.

Results

Of 239 clinician respondents, 80% were MD, 6% DO, 5% NP, 2% PA, and 7% Pharmacists. 187 (78.2%) work at an academic practice and 179 (75%) work in an urban setting. 182 (76%) respondents have access to inpatient addiction medicine services and 206 (86%) reported availability of outpatient addiction treatment, but only 86 (36%) described patient access to outpatient services as “good” or “excellent.”

Respondents were categorized as PWID-E (n=171, 72%) and PWID-I (n=68, 28%). Of the PWID-E group, only 48 (28%) have an institutional policy for determining eligibility. There was no significant difference in practice setting or access to addiction services between PWID-E and PWID-I. Access to inpatient and outpatient social work/case management was significantly higher for PWID-E. (Table 1).

Clinicians reporting PWID-I were more likely to cite risk of tampering with PICC (76.5% vs 62.6%, p = 0.04) and medical-legal risk (47.1% vs 19.3%, p < 0.001) as barriers to OPAT. (Table 2).

Conclusion

A high proportion of respondents to this national survey offer OPAT for PWID, but only a minority have an institutional policy for eligibility. Guidelines that outline a framework for discharge decision making, education regarding medical and legal risk, and development of best practices may help to standardize care across settings.

Disclosures

Ellen Eaton, MD, MPH, Gilead HIV Research Scholar: Grant/Research Support|Gilead HIV research scholar: Grant/Research Support Monica K. Sikka, MD, F2G: Site research investigator.
781. COVID-19 Outcomes in the Immunocompromised Population of the COVID-19 Community Research Partnership
Authors: Williamson John C , Strylewicz Gregory B , DeWitt Michael E , Uschner Diane , Soni Ashvi , Mongraw-Chaffin Morgana , Dantuluri Keerti L , Hinkelman Amy , Gibbs Michael A , Lagarde William H , Weintraub William , Bott Matthew , Ostasiewski Brian , Miller Kristen , McCurdy Lewis , Sanders John W , Herrington David M
Published: December 2022

Background

The COVID-19 Community Research Partnership (CCRP) is a large multicenter healthcare system-based study of the COVID-19 pandemic, including factors impacting risk of infection and hospitalization. The CCRP includes a subset of immunocompromised (IC) participants with varying vaccination status over time.

Methods

We conducted an observational cohort study of 2,515 IC and 41,941 non-IC CCRP participants who contributed electronic health record data and daily electronic surveys to self-report COVID-19 symptoms, test results, and vaccinations from April 2020 to March 2022. The IC population included those with stem cell transplant, HIV, cancer, autoimmune disease, or solid organ transplant. The latter 3 must have also had an active systemic therapy to meet the IC condition (e.g. chemotherapy, immune modulator, steroid). Logistic regression was used to investigate risk of COVID-19 and hospitalization among IC participants and according to vaccine status within viral variant time periods (pre-delta, delta, omicron).

Results

IC conditions included cancer (51%), autoimmune (41%), solid organ/stem cell transplant (9%), and HIV (7%). The IC group was older and had more comorbidities. 95% of vaccine recipients received an mRNA vaccine. More vaccine breakthrough infections occurred in the IC group than non-IC group (36.1% vs 29.5%, p< 0.001). IC participants were less likely to remain COVID-19 free over time if vaccinated but not boosted (Fig 1A). However, after receiving a booster there was no difference in COVID-19 cases between the groups (Fig 1B). IC participants were more likely to be hospitalized with COVID-19 (OR 2.85; 95% CI 1.69–4.76), but vaccination reduced risk for hospitalization (OR 0.26; 95% CI 0.08–0.8). Receipt of a booster dose reduced risk of COVID-19 among IC participants during the delta wave (IRR 0.52; 95% CI 0.28–0.94) but not during omicron. However, during omicron risk of hospitalization in the IC group was reduced by a booster dose (OR 0.13; 95% CI 0.02–0.72).

Conclusion

IC individuals were at increased risk for COVID-19 hospitalizations and breakthrough infections. After receiving a booster, IC participants were conferred the same level of protection from infection as their non-IC counterparts, highlighting the importance of boosters for these individuals.

Disclosures

All Authors: No reported disclosures.
785. Bacterial Co-infection and Empirical Antibiotic Therapy in Patients with COVID-19
Authors: Lee Jiyoung , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Kim Sung-Han , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Bae SeongMan
Published: December 2022

Background

Understanding the rate and composition of bacterial co-infection is important to determine antibiotic therapy in SARS-CoV-2 infection, but those vary according to healthcare settings and regional differences. We evaluated the rate of bacterial co-infection in hospitalized patients with COVID-19 in a single tertiary hospital in South Korea.

Methods

In this retrospective study, all the adult patients with COVID-19 hospitalized between Feb 2020 and Dec 2021 were included. Bacterial co-infection rate was assessed by results of sputum cultures, blood cultures, pneumococcal urinary antigen, Legionella urinary antigen, sputum Legionella pneumophilia PCR, and sputum multiplex PCR for Mycoplasma pneumoniae and Chlamydia pneumoniae. Characteristics and outcomes of patients were evaluated according to antibiotics exposure prior to hospitalization.

Results

Of 367 adult patients, 300 (81.7%) patients having sputum culture results were included in the analysis. Of these, 127 (42.3%) had a history of antibiotic exposure within 1 month before hospitalization. The coinfection rate within 48 hours of hospitalization was confirmed in 8.3% (25/300): 6.4% (11/163) of patients without prior antibiotic exposure and 11% (14/127) of patients with prior antibiotic exposure. In the group without prior antibiotic exposure, pathogens responsible for community-onset infections were isolated, whereas nosocomial pathogens were predominantly isolated in the antibiotic-exposed group. Empirical antibiotics were used in 144 (66%) of 275 patients without positive results for microbiological tests. Empirical antibiotic use in patients without positive results for microbiological tests was not significantly associated with 30-day mortality or in-hospital mortality after adjusting covariates including age, sex, comorbidity, anti-inflammatory treatment, and COVID-19 severity.

Conclusion

In this study with a high rate of microbiological testing, bacterial co-infection was not frequent, and the results varied depended on previous exposure to antibiotics. Given the rarity of bacterial co-infection and the lack of potential benefits of empirical antibiotic therapy, the antibiotic use in patients with COVID-19 should be restricted as an important target of antibiotic stewardship.

Disclosures

All Authors: No reported disclosures.
791. ICU Provider Overestimation of Ventilator-Associated Pneumonia Diagnostic Probability: An Opportunity for Diagnostic Stewardship
Authors: Soper Nathaniel , Albin Owen
Published: December 2022

Background

Overdiagnosis of ventilator-associated pneumonia (VAP) is common in intensive care units (ICUs). Because VAP is a clinical diagnosis without an easily accessible confirmatory diagnostic test, understanding how ICU physicians practice diagnostic reasoning in suspected VAP is vital to informing diagnostic stewardship efforts. We aimed to assess the accuracy of ICU practitioner estimates of VAP diagnostic probability.

Methods

We conducted a survey of physicians at Michigan Medicine ICUs. Providers were presented with clinical vignettes (Figure 1) in which mechanically ventilated patients developed clinical signs suggestive of VAP and then had radiographic/microbiologic tests performed. Providers were asked to estimate the probability of VAP before and after each presented clinical sign or test result, which were then used to impute provider-estimated likelihood ratios (pLRs) for each clinical sign and diagnostic test. Provider-estimated probabilities and LRs were compared to evidence-based VAP probabilities and LRs (eLRs) derived from systematic reviews and meta-analyses.

Survey Case Example.

Results

Of 102 survey respondents, 54% felt moderately to extremely confident in their ability to accurately diagnose VAP. Providers significantly overestimated the pre and post-test probability of VAP in all clinical scenarios (provider-estimated VAP diagnostic probabilities are visualized using density plots relative to evidence-based diagnostic probability in Figure 2). Median pLRs for nearly all VAP clinical signs and diagnostic tests were also significantly higher than eLRs (Figure 3), most notably for isolated purulent endotracheal secretions (pLR 1.54 vs eLR 0.76, p< 0.01), positive chest radiograph (pLR 6.0 vs eLR 3.55, p< 0.01), and positive bronchoalveolar lavage culture (pLR 5.7 vs eLR 1.37, p< 0.01).

Density Plots of Provider-Estimated vs Evidence-Based Diagnostic Probability of Ventilator-Associated Pneumonia.

Provider-Estimated vs Evidence-Based Diagnostic Likelihood Ratios for Clinical Signs and Test Results Related to Ventilator-Associated Pneumonia.

Conclusion

Physicians routinely overestimated the diagnostic probability of VAP and the positive LRs of possible VAP clinical signs, as well as VAP diagnostic radiographic and microbiologic tests. Educational initiatives addressing and calibrating ICU providers’ perceptions of VAP diagnostic probability warrant investigation as an antimicrobial stewardship tool.

Disclosures

Owen Albin, MD, Charles River Laboratory: Advisor/Consultant|Cipla Pharmaceuticals: Advisor/Consultant|Shionogi Inc: Advisor/Consultant.