bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 326: Adherence to Statins is Associated with Fewer Cardiovascular Related Hospitalizations and ED Visits in Patients 65 and Older
Authors: Pittman Donald G , Tao Zhuliang , Eisenberg Edward S , Pendergrass Merri
Published: July 2021

Objective
To examine the relationship between adherence to statins and subsequent cardiovascular related hospitalizations (CVH) and emergency department visits (CVED) in patients 65+ years of age.

Methods
A retrospective cohort study of patients 65+ years of age receiving statin therapy was performed. Patients had deidentified data on medical and pharmacy claims in the Medco Health Solutions, Inc. integrated warehouse, and were continuously enrolled in coverage from January 2009 through June 2011. Medication adherence was assessed by proportion of days covered (PDC) over 1 year, and risk of CVH and CVED over the subsequent year. Patients were segmented into three adherence cohorts based on PDC: 80 to 100% (adherent), PDC 60 to 79% and PDC <60%. Risk of CVH and CVED was determined by medical claims during the subsequent 12 months.

Results
Among the 225,802 total eligible adults, mean age was 74.4 +/-6.0 years; 53.7% were women, 73.1% (165,060) had hypertension, 31.5% (71,069) had coronary artery disease (CAD), 14.5% (32,713) had stroke, 8.3% (18,801) had heart failure (HF) and 33.3% (75,205) had diabetes. A subset that included only Medicare Part D (Med-D) plan participants (n=17,462, mean age 73.8 +/-5.6 years) had a greater percentage of women and comorbidities vs. the non-Med-D patients (n=208,340, mean age 74.4 +/-6.0 years). Comorbidity differences between the Med-D vs. non-Med-D groups were: Women 62.7% vs. 52.3%; hypertension 89.2% vs. 71.8%; CAD 38.1% vs.30.9%; stroke 16.8% vs. 14.3%; HF 14.2% vs. 7.8%; and diabetes 56.2% vs. 31.4%, p<0.0001 for all groups. Overall, mean PDC was 84% (+/-17%) and was lower in the Med-D group at 80% (+/-21%) vs. non-Med-D group at 85% (+/-17%). The majority, 167,356 (74.1%), were adherent with PDC ≥80%; 33,453 (14.8%) had PDC of 60-79% and 24,993 (11.1%) had PDC of <60%. After adjustment for age, sex, comorbidities, year 1 hospitalizations and ED visits, and total medications, the overall risk of CVH was significantly greater with PDC 60-79% (OR 1.14; CI 1.10-1.18) and PDC <60% (OR 1.28; CI 1.23-1.33), p<0.0001 compared to PDC ≥80%. The risk of CVED was increased with PDC 60-79% (1.15; CI 1.10-1.21) and PDC <60% (OR 1.43; CI 1.35-1.51), p<0.0001 compared to PDC ≥80%. The fully adjusted risk of CVH and CVED were similar between Med-D and non-Med-D plan patients.

Conclusions
For patients 65+ years of age, one in four was nonadherent to statin medications. Adherence to statins was associated with an inverse risk of CVH and CVED.The risk of increased CVH and CVED was similar in Med-D plan and non-Med-D participants with nonadherence.
Abstract 50: Elevated Serum Cobalamin associated Increased Mortality in Advanced Heart Failure
Authors: Cauthen Clay A , Nagarajan Vijaiganesh , Tang WH Wilson
Published: July 2021

Introduction:
Elevated serum cobalamin (B12) has been associated with liver dysfunction in decompensated heart failure. We hypothesize that elevated B12 is associated with worse outcomes in advanced heart failure.

Methods:
We examined 115 consecutive patients with advanced heart failure undergoing evaluation for advanced therapies. Patients receiving B12 injections were excluded. Our lab considers B12 >900pg/mL as elevated. Linear regression was performed to determine significant predictors. Survival was assessed by Kaplan Meier curves.

Results:
Mean and median serum B12: 843± 362pg/mL, 795 pg/mL (IQR 551-1046). Patients with elevated values were more likely to be have diabetes, dyslipidemia, COPD, CAD, and CKD. Less likely to be on spironolactone or be transplanted. Patients had higher total bilirubin and RDW; lower MVO2 and cardiac index. Hepatic, cholestatic, inflammatory and renal biomarkers were not found to be predictive of elevated B12, but MVO
2
(OR: 0.93, [95%CI 0.87,0.99]) was. At 2-yr, transplanted patients with increased B12 had higher mortality (logrank p=0.006).

Conclusions:
Serum B12 is elevated in patients with advanced heart failure. Decreased MVO2 and markers of chronic inflammation are predictive of higher B12 levels. Elevated B12 is a significant predictor of mortality. Mechanistic studies of B12 in heart failure could provide key insights into the complexity of heart failure pathophysiology.

Figure 1:
Survival Analysis of Elevated versus normal Serum B12 levels
Abstract 81: Lipid Profiles in Minority and Non-Minority Veterans following Percutaneous Coronary Intervention
Authors: Ladani Amit , Challa Karthik , McGraw Sloane , Shivaraju Anupama , Shroff Adhir
Published: July 2021

Background:
Lipid lowering therapy is an established core measure of secondary prevention in coronary artery disease (CAD) management. The National Cholesterol Education Program - Adult treatment panel III (NCEP ATPIII) guidelines recommend a goal low density lipoprotein (LDL) level less than 100 mg/dL for CAD management. Statins remain the preferred agent for LDL reduction. It is unclear whether race plays a role in lipid control.

Methods:
We conducted a retrospective, observational study on all patients undergoing PCI at an urban Veterans Hospital from September 2004 to January 2011. Statin use and lipid profiles at 6 months post-PCI were compared to pre-PCI values between minorities and non-minorities.

Results:
A total of 937 patients (59% minorities) were analyzed. The mean total cholesterol and mean LDL decreased at six-month follow-up in both groups. The mean total cholesterol decreased 18 mg/dL in both minority and non-minority groups. The mean LDL decreased by 11 mg/dL in the minority group and by 13 mg/dL in the non-minority group (p<0.001) (refer to table). The percent of patients at LDL goals of <100 mg/dL pre-PCI and at six month follow-up increased from 54% to 72% in the minority group and from 63% to 76% in the non-minority group. The percent of patients on a statin pre-PCI and at six month follow-up increased from 70% to 90% in the minority group and 73% to 87% in the non-minority group. There was no significant difference in lipid profiles and statin adherence between racial groups.

Conclusion:
There were improvements in both total cholesterol and LDL values at six months post-PCI in both the minority and non-minority groups. There were also improvements in the percentage of patients who met the ATP III recommended goal of LDL cholesterol less than 100mg/dL at six months in both groups. At six months, there was also an increase in usage of statin therapy in both groups. Race did not appear to play a significant role in lipid management.
Abstract 100: Effects of time to Physical Therapy Order on Length of Stay and Discharge NIH Stroke Scale Scores in an Acute Stroke Unit
Authors: John Emmanuel B , Gaskell Daniel J , Herbertson Robert K
Published: July 2021

Introduction:
Early physical therapy (PT) consults and subsequent rehabilitation services have been shown to improve functional and mobility outcomes post stroke. Shortage of PT staff may impact how soon patients can be seen after a physician’s order (PO) and rehabilitation outcomes. The current preliminary study purposed to assess the effects of time elapsed between PO for PT services and the first PT consult ≤ or >48 hours (time to PT order = TPO), on patient’s length of stay (LOS) and scores on the NIH Stroke Scale (NIHSS) at discharge, in a busy acute stroke unit of a regional health care facility. It was hypothesized that TPO of ≤48 hours after initial PO for PT services will show better LOS and NIHSS scores (at discharge) outcomes compared to TPO >48 hours.

Methods:
A total of 291 stroke patients who presented at an acute hospital were retrospectively placed in either a TPO ≤ 48 hours group, G1 (n=147), or a TPO >48 hours group, G2 (n=144) based on the time of their first PT consult after a PO. The LOS and NIHSS data were subjected to statistical analysis.

Results:
There were no significant differences in LOS (G1=5.5 ± 4.61
vs.
G2= 5.9 ± 5.62 days;
p=0.6542
) and discharge NIHSS scores (
p=0.6728
) of either groups. A
post hoc
regression analysis to examine impact of factors such as demographics (age, gender, weight, etc), number of PT visits (PTV) and discharge destination (DD) revealed that TPO (
p<0.0001
), PTV (p<0.0001) and DD (p<0.0001) were significant contributors to observations in group G1; while PTV (
p<0.0001
) and DD (
p<0.0001
) were the only significant contributors to observations in the G2 group, TPO was not significant (
p=0.0646
).

Conclusions:
Ideally, stroke patients should be evaluated for physical therapy services within 24 hours of a PO. Shortage of PT staff in a busy health care facility may impact how soon patients can be seen. Although the current pilot study did not reveal significant changes in LOS, and NIHSS scores of stroke patients at discharge irrespective of whether patients were seen by physical therapists ≤ or >48 hours after a PO, severity of the stroke, previous history of stroke or TIAs, and other co-morbidities that could have confounded the results were not examined. Future study design will take into account these potential confounding variables and other outcome measures.
Abstract 119: Prospective Assessment Of The Risk-Treatment Paradox In The Use Of Radial Access For Cardiac Catheterization
Authors: Gilchrist Ian C , Rao Sunil V , Robinson Caroline O , Pancholy Samir B , Nevins P. Holder , Kearns Charles K
Published: July 2021

Background:
Radial access (TRA) is associated with reduced access site bleeding, vascular complications, and in some settings, reduced mortality. The uptake of TRA in the US has been limited and prior studies have demonstrated a “risk-treatment” paradox wherein the patients at highest risk for bleeding are least likely to undergo TRA. The reasons for this risk-treatment paradox are unclear.

Methods:
Four case scenarios were developed that varied with respect to a patient’s risk of bleeding, complexity of coronary artery disease, and level of radial proficiency required to complete the procedure. The case vignettes were presented to 201 US interventional cardiologists with varying self-reported rates of TRA use who were surveyed as to their likelihood of using TRA for each case, which was measured on a 6-point Likert-type scale, with a range between 1 (“not at all likely”) to 6 (“very likely”). We then applied the theory of planned behavior (TPB), a framework utilizing behavioral constructs [attitudes (beliefs about TRA outcomes), normative beliefs (perceptions of how other physicians judge TRA use) and control beliefs (awareness of factors that facilitate or impede TRA use)], to determine predictors of TRA use. For each of the 4 patient case vignettes, multiple linear regression analysis was performed between the likelihood to use TRA and each of the TPB domains and additional factors..

Results:
The most significant predictor of TRA use across all vignettes was the attitude domain (beliefs about TRA outcomes) which showed to have the strongest interaction in all 4 linear regression models . In the three case scenarios representing increasing risk for bleeding and vascular complications, a reverse gradation of utilization of TRA could be seen in both the low (n=65) and high volume operators (n=136). Both groups showed a greater likelihood of using TRA in patients at lowest risk for bleeding (Table).

Conclusions:
This study demonstrates that one of the underlying reasons for the risk-treatment paradox in the use of TRA is related to the perception of its benefit. More education on the benefits of bleeding avoidance strategies like TRA may lead to wider application of TRA to patients most likely to benefit.
Abstract 129: Patients’ Perspectives of Participating in an Intervention to Improve Medication Adherence after ACS hospitalization A Qualitative Analysis
Authors: Lambert-Kerzner Anne , Havranek Edward , Plomondon Mary E , Albright Karen , Blatchford Patrick , Fagan Katherine , McCreight Marina , Ho Michael
Published: July 2021

Objective:
Few studies have documented the patient’s perspective on interventions designed to change health behavior. Patients choose to participate in studies and to execute prescribed behaviors.

Understanding patients’ choices and the reasoning behind their choices may help to explain variation in intervention effectiveness. Our objective was to understand patients’ perspectives of participating in a study designed to improve medication adherence after acute coronary syndrome (ACS) hospitalization comprised of automated medication refill reminders and educational messages, and pharmacist support.

Methods:
Sixty six in-depth interviews were conducted with patients in a study of an intervention to improve medication adherence after ACS hospitalization.

Transcripts of interviews were analyzed using a grounded theory approach and content analysis.

Results:
Some patients reported that having an ACS event redefined their identities based on real and perceived physical limitations. Bi-directional relationships between patients and providers were a key factor of medication adherence. Patients comfortable being honest with their providers are active participants in the shared decision making process that is inherent for adherence.

Patients expressed that providers need to be open to their divergent opinions. Some patients explained that clinicians don’t have the time to hear all the details the patient needed to share. Other patients felt their providers just did not listen to them. Positive attitudes towards medications and life in general strengthened adherence to recommended treatments. Some reported fear of having another event and of dying, and that this fear affected their behaviors, while others reported that fear hindered change. In addition, having the support of people to remind, organize and encourage patients helped adherence. Routines and pill boxes were identified as effective aids. Most patients did not remember receiving the automated messages.

Conclusions:
Among patients participating in a multifaceted study to improve medication adherence, bi-directional and open conversations with providers positively influenced adherence behavior. Fear of another ACS event, having social support and utilizing adherence aides were also influential factors. Future interventions designed to improve medication adherence should incorporate these patient-identified factors.
Abstract 149: Utilization and Costs of Hospitalization among Adolescents and Young Adults with Congenital Heart Disease in California
Authors: Lu Yang , Agrawal Garima , Williams Roberta G
Published: July 2021

Background:
Congenital heart disease (CHD) often requires intensive surgeries and care, especially in the early years of a CHD patient. However, it is not well understood how their health care utilization and costs vary as CHD patients transition into young adulthood.

Objective:
We aim to identify the utilization patterns of hospitalization by age among CHD patients 10-29 years old and to measure the associated costs as compared with the general population in California.

Methods:
We utilized the California State Inpatient Database (SID) and the Healthcare Cost and Utilization Project (HCUP) Cost-to-Charge Ratio Files 2005-2009. By merging the two datasets, we obtained data on about 97% of all hospital discharge records in California including principal and secondary diagnoses, principal and secondary procedures, admission and discharge status, basic patient demographics, total charges, imputed total costs, and length of stay (LOS). Hospital discharges of CHD patients were identified by one or more principal or secondary ICD-9 diagnosis codes of 745.xx, 746.xx, or 747.xx. Utilization and cost patterns were compared to the general population by 5-year age groups (10-14, 15-19, 20-24, and 25-29). We then conducted a multivariate linear regression with the CHD population to understand how age and other factors influence costs of hospitalization per stay.

Results:
The average hospitalization costs per stay among CHD patients remain 2-3 times as high as that of the general population across all age groups ($21-31k vs. $7k-12k). However, the total hospitalization costs of the CHD population monotonically decrease as patients with CHD age into adulthood: in 2005-2009, the total costs were $75m in the 10-14 group, $74m in the 15-19 group, $50m in the 20-24 group and $48m in the 25-29 group, which represented 3.8%, 1.7%, 0.8%, 0.7% of the total costs in the general population of the respective age group. The decline in total costs by age among the CHD population manifested in both decreasing numbers of hospitalizations and lower costs per stay. Other observed trends include increasing fraction of admissions from the emergency department (ED), decreasing fraction of surgery-related hospitalizations, and shorter LOS as CHD population age into adulthood. Regression results within the CHD population 10-29 years old (n=9680) suggest that costs per stay were positively associated with LOS (+$2674, p<.001) and were negatively associated with being 25-29 years old (-$3240, p<.001), being female (-$1935, p<.001), having no surgeries (-$16758, p<.001) or other procedures performed ($21396, p<.001), and being admitted from the ED (-$3638, p<.001).

Conclusion:
The CHD population incurs lower hospitalization costs as they age into young adulthood.
Abstract 150: Resource Utilization Patterns and Outcomes Among Acute Coronary Syndrome Patients: Findings From a Multi-Payer Analysis
Authors: Lang Kathleen , Bozkaya Duygu , Patel Aarti A , Macomson Brian , Crivera Concetta , Owens Gary , Mody Samir
Published: July 2021

Background:
Antiplatelet agents are a mainstay for the prevention of subsequent myocardial infarction (MI) or stroke among patients with acute coronary syndrome (ACS). This study analyzed recent pharmacy and medical claims from Medicare, Medicaid, and commercial insurance databases to assess health resource utilization patterns for ACS patients and identify potential gaps in care.

Methods:
Retrospective data analyses were performed using the Antithrombotic Quality Analyzer (AQuA), a software tool that analyzes health plan data to evaluate quality of care for various cardiovascular conditions. Five databases were analyzed: 1) IMS LifeLink (IMS), 7/2008-6/2010; 2) OptumInsight (Optum), 4/2010-3/2012; 3) MarketScan Commercial (MarketScanComm), 7/2009-6/2011; 4) MarketScan Medicare Supplemental (MarketScanMedicare), 7/2009-6/2011; and 5) Florida Medicaid (Medicaid)- 7/2008-6/2010. Given large sample sizes, a 10% random sample was selected from all databases except Medicaid for which the full sample was used. Included patients were ≥ 18 years old with a primary or secondary diagnosis of ACS during an inpatient and/or emergency room encounter. The first observed ACS diagnosis constituted the index date, with patient outcomes assessed over a maximum of two years. Study measures included guideline-recommended outpatient therapies, ACS complications, and re-hospitalization rates.

Results:
Total samples (mean age) included 8,791 (64) from IMS, 2,725 (58) from Optum, 8,917 (54) from MarketScanComm, 6,641 (77) from MarketScanMedicare, and 1,978 (57) from Medicaid. Among ACS patients, 41% (IMS), 48% (Optum), 39% (MarketScanComm), 35% (MarketScanMedicare), and 39% (Medicaid) received beta-blockers, while 35% (IMS), 45% (Optum), 36% (MarketScanComm), 30% (MarketScanMedicare), and 31% (Medicaid) received antiplatelets (not including aspirin). A total of 35% (IMS), 43% (Optum), 33% (MarketScanComm), 28% (MarketScanMedicare), and 43% (Medicaid) of ACS patients with diabetes, congestive heart failure, and/or hypertension received an ACE inhibitor. The majority of ACS patients with hyperlipidemia received a cholesterol lowering medication (67% IMS, 77% Optum, 69% MarketScanComm, 51% MarketScanMedicare, 64% Medicaid). Re-hospitalization rates within 30 days were 28% (IMS), 21% (Optum), 22% (MarketScanComm), 29% (MarketScanMedicare), and 25% (Medicaid), with 4%-6% of patients re-hospitalized for MI. Patients experiencing 1-2 re-hospitalizations and ≥ 3 re-hospitalizations during follow-up ranged from 28 - 35% and 8 - 24%, respectively.

Conclusion:
These findings suggest that many patients with ACS do not receive appropriate recommended antithrombotic prophylaxis, and opportunities exist to improve therapy. Increased use of software tools such as AQuA may support enhanced education efforts aimed at improving adherence to guidelines and quality of care.
Abstract 152: Daily Dietary Sodium Intake and Advice on Dietary Sodium among Heart Failure Patients in the Community
Authors: Roth Gregory A , Bolliger Ian W , Gillespie Catherine W , Mokdad Ali H
Published: July 2021

Objective:
Little is known about the sodium intake of heart failure (HF) patients in the community. We used data from the Measuring Disparities in Chronic Conditions Study to examine the receipt of advice on dietary sodium and its relationship with sodium intake among adults in a large urban county.

Method:
We recruited adults in King County, WA using a home-address based sample as well as sampling from health facilities using medical record billing codes for key cardiovascular conditions. Survey questions addressed past medical history as well as receipt of advice and behavior related to dietary sodium. Diet history was assessed using the National Cancer Institute Diet History Questionnaire II (DHQ) for intake in the past year. We also compared responses and estimated sodium intake for those who did and did not report a diagnosis of HF. As a sensitivity analysis, we repeated our analysis using the subset of individuals who had a medical record with an ICD9 code for HF in the previous two years.

Result:
Our results are based on 3357 respondents from the address-based sample and 3477 from the medical record-based sample. The DHQ was completed by 940 and 1291 of these respondents, respectively. HF was reported by 290 respondents (median age 66 years, 57% male, 6.6% black race, 85% from medical record sample, 43% with a DHQ). Among those reporting a diagnosis of HF, 61% (112 of 183) reported being advised to decrease dietary sodium and 37% (67 of 183) reported being told to buy food items labeled as low salt. These rates were 30% (755 of 2515) and 13% (337 of 2515) respectively among individuals without reported HF. Estimated daily dietary sodium intake over the prior year was lower among those with HF completing a DHQ if they reported receiving counseling (mean 2.5 vs 2.8 gm if advised to cut down on salt and 2.3 vs 2.8 gm if advised to buy low salt labeled products). However, these differences were not statistically significant. Only 65% of respondents with HF (183 of 282) said they buy low salt labeled foods and 26% (61 of 290) reported eating processed, fast, or canned food at least 5 times in the prior month. Overall mean estimated daily dietary sodium intake over the prior year was 2.7 gm for respondents both with and without HF. Results were similar for those with an ICD9 code for HF.

Conclusion:
Our findings revealed that a large percentage of HF patients report no receipt of medical advice to reduce dietary sodium or purchase foods labeled as low salt. Moreover, the dietary intake of salt was similar for HF patients and the general population. These results point to a need for dietary interventions in HF that are both widely adopted and can actually change behavior.
Abstract 155: Prevalence of Self-Reported Risk Factors for Myocardial Infarction Among Patients With Venous Thromboembolism
Authors: Vanderpoel Julie , Bookhart Brahim , Gross Hillary J , DiBonaventura Marco
Published: July 2021

Objective:
To identify the prevalence of risk factors that may be associated with a future myocardial infarction (MI) among patients with venous thromboembolism (VTE).

Methods:
This study was conducted using the 2010 wave of the National Health and Wellness Survey (NHWS). The NHWS is a self-administered, Internet-based questionnaire from a nationwide sample of adults (N=75,000). Only patients with a diagnosis of VTE, defined as a self-reported diagnosis of deep vein thrombosis (DVT), pulmonary embolism (PE), or both, were included in the analysis. Self-reported patient characteristics that may be potential risk factors for MI were collected, including sociodemographic characteristics, family medical history, and health behaviors (such as smoking status), as well as comorbidities. Included risk factors were based on a literature search. The risk factors were not weighted based on the strength of their potential association with a future MI. Thus, risk factors of varying significance were included and weighted equally.

Findings:
A total of 814 patients with VTE (519 with DVT, 196 with PE, and 99 with DVT and PE) were included in the analysis. Approximately 53% of the patients were female, and the mean age was 57 years. Among these patients, the mean number of reported risk factors that may be associated with a future MI was 5.6. Approximately 23% (n=189) of patients reported ≤3 risk factors, 55% (n=446) of patients had 4-7 risk factors, and 22% (n=179) of patients had ≥8 risk factors. Some of the more commonly reported risk factors included male gender (47%, n=381), obesity (53%, n=428), hypertension (53%, n=427), hyperlipidemia (49%, n=401), type 2 diabetes (21%, n=167), a family history of cardiovascular disease (81%, n=663), and currently smoking (22%, n=175).

Conclusions:
A high proportion of patients with VTE have risk factors for a future MI. Awareness of the prevalence of MI risk factors among patients with VTE may support optimal clinical decision-making for these patients. Providers should be cognizant of the potential risk for MI among patients with VTE when selecting treatment approaches. Additional research that considers the relative importance of each potential risk factor is needed to elucidate these findings.
Abstract 183: School-Centered CPR Education to Improve Survival from Out-of-Hospital Cardiac Arrest in High-Risk Neighborhoods
Authors: Califf Tom , Ramon René , Morrison Wendy , Nassel Ariann , Sasson Comilla
Published: July 2021

Background:
Low-income and Latino neighborhoods are at high risk for having low provision of bystander CPR for victims of out-of-hospital cardiac arrest (OHCA). Novel community-based intervention is needed in these neighborhoods to increase awareness of CPR techniques and, ultimately, to decrease mortality from OHCA.

Objective:
To determine the feasibility of a train-the-trainer hands-only CPR program as a required assignment in a middle school.

Methods:
Design:
Prospective survey-based interventional study.
Setting:
Public charter school in the Denver, CO metropolitan area.
Population:
Cohort of 118 subjects was recruited out of 134 eligible seventh grade students.
Observations:
Participants completed a 6-question test to assess baseline knowledge of CPR. Subjects then completed a group hands-only CPR training lasting 1 hour using the CPR Anytime kit, which included both an educational DVD and hands-on practical skills training with an inflatable mannequin. Participants were then asked to use these kits to train other community members over a 2-week period. At the end of the study, students were asked to complete the same 6-question survey to assess their retention of knowledge. Two-sample t-tests were conducted to assess for differences in hands-only CPR knowledge pre- and post-CPR training.

Results:
Demographics are given for the entire seventh grade class (
Table 1
). Students were mostly white (71.6%), and 11 (8.2%) participated in the Free & Reduced Lunch program. Of 134 seventh graders attending the school, 118 (88%) completed a pre-intervention survey and 74 (55%) completed a post-intervention survey. Between the surveys, the mean number of questions answered correctly increased (
Table 2
), as did performance on the question asking where to place AED pads on the chest (p < .001). Students performed poorest in both pre- and post-testing on identifying the appropriate situation for performing hands-only CPR.

Conclusion:
Implementation of a school-based train-the-trainee CPR education program is a feasible endeavor. Students demonstrated increased knowledge of CPR techniques two weeks after training compared to baseline. Future studies will need to be conducted to assess the people who are then trained by these students using the CPR Anytime Kits.
Abstract 185: Health Care Resource Utilization of Acute Coronary Syndrome (ACS) in a Geographically Distributed US Population 2006-2011
Authors: Cziraky Mark , Luthra Rakesh , Fisher Maxine D , Xu Yaping , Wilhelm Kenneth , Power Thomas P , Reddy Vanessa S
Published: July 2021

Background:
Cardiovascular (CV) disease is the leading cause of mortality in both men and women in the US, resulting in substantial health care utilization and costs. There are limited data quantifying long-term resource utilization following an ACS event.

Objectives:
Evaluate overall and CV-related health care utilization following an ACS event in patients with/without recurrent CV events (CVEs) post-discharge.

Methods:
Patients with ≥1 ICD-9 CM code for acute myocardial infarction MI) (410.xx) or unstable angina (411.1x) during ACS hospitalization were identified from the HealthCore Integrated Research Database 01/01/2006-09/30/2011. Index date was defined as the first ACS event. Patients with <12 months’ pre-/post-index plan eligibility or age <18 years were excluded. Recurrent CVEs were defined as any occurrence of MI, non-fatal stroke or coronary heart disease-related mortality after the index ACS event. Overall and CV-related health care resource utilization following the index ACS event were evaluated in patients with/without recurrent CVEs.

Results:
Of 140,903 patients, 22.0% had ≥1 subsequent CVE during follow-up. Patients with/without recurrent CVEs were older (mean 72.4 vs. 65.2 years) and had more comorbidities (mean baseline Deyo-Charlson Index scores 2.4 vs. 1.6). Mean (median) follow up was 2.0 (1.6) and 1.9 (1.5) years in patients with/without recurrent CVEs, respectively. Mean (median) number of 1-year post-index overall and CV-related hospitalizations in the recurrent CVE cohort was higher than the non-recurrent cohort (2.81 [1.98] and 2.40 [1.54] vs. 1.56 [1.23] and 1.30 [0.82], respectively). Mean number of 1-year post-index overall outpatient and office visits were higher in the recurrent versus non-recurrent cohort (31.82 [36.63] and 14.72 [11.15] vs. 21.65 [25.68] and 11.89 [9.67]). Mean annual 3-year utilization post-index showed the same trend (Table).

Conclusion:
Patients with recurrent CVEs had higher 1- and 3-year post-index overall and CV-related utilization as compared with patients without recurrent CVEs. More aggressive strategies to manage this increased long-term utilization is warranted. This study underscores the need to prevent subsequent adverse CVEs, ultimately to improve patient outcomes and help reduce overall health care utilization.
Abstract 195: Length of Stay in High Risk Percutaneous Coronary Intervention in US: A 5 year Contemporary Experience
Authors: Mehta Kathan , Shah Neeraj , Patel Nileshkumar J , Chothani Ankit , Grover Peeyush , Deshmukh Abhishek , Rathod Ankit , Singh Vikas , Badheka Apurva , O’Neill William W , De Marchena Eduardo , Cohen Mauricio G
Published: July 2021

Background:
High Risk Percutaneous Coronary Intervention (PCI) is increasingly being performed with the availability of hemodynamic support. The aim of this study was to determine the predictors of length of stay (LOS) for high risk PCI in US.

Methods:
We explored the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) using the ICD9 procedure code of 36.07 and 36.06 for PCI. NIS is largest all-payer dataset that represents 20% of all US hospitals. We included patients who had PCI from 2005 through 2010 who also underwent Percutaneous Circulatory Assist Device (PCAD) or Intra-aortic Balloon Pump (IABP) placement during the same hospital admission. Severity of comorbidities was defined by Deyo modification of Charlson’s Comorbidity Index (CCI). Hospitals were identified by a unique hospital identification number and hospital volume was determined by calculating the total number of PCI performed by an institution on year to year basis. Complications were based on Patient Safety Indicators (PSI) recognized by Agency for Health Care Research and Quality to monitor in hospital complications. We examined the predictors of LOS by a mixed effects linear regression model including patient demographics, admission characteristics, CCI quartiles with first quartile as a reference, hospital PCI volume quartiles, IABP or PCAD use and periprocedural complications. Hospital ID was incorporated as random effects in the model.

Results:
A total of 26,300 High Risk PCIs (weighted n = 130,151) were available for analysis. Factors associated with increased LOS were the use of IABP as compared to PCAD (+0.86 days, p=0.03), occurrence of any complication (+4.67 days, P < 0.001), high CCI (+2.5 days for CCI=2 and +4.1 days for CCI≥3, p<0.001 for both), teaching hospital (+0.96 days, p <0.001), presence of myocardial infarction (MI) or shock (+0.55 days, p = 0.002) and highest quartile of hospital PCI volume (+0.86 days, p<0.001). Factors associated with decreased LOS included private insurance (-0.9 days, p < 0.001) and self-pay or no insurance (-0.89 days, p<0.001).

Conclusion:
In our observational study based on a large database, use of IABP as compared to PCAD, occurrence of complications, CCI, teaching hospital, presence of MI or shock and high PCI volume were associated with increased LOS & having private insurance and self pay or no insurance was associated with decreased LOS.
Abstract 225: Healthcare Burden Associated with Dyspepsia Among Nonvalvular Atrial Fibrillation Patients
Authors: Kim Michael H , Bell Kelly F , Makenbaeva Dinara , Wiederkehr Daniel , Lin Jay , Graham John
Published: July 2021

Objective:
To evaluate the annual healthcare burden associated with dyspepsia among nonvalvular atrial fibrillation (NVAF) patients

Methods:
NVAF patients ≥18 years of age with continuous medical/prescription coverage were identified (1/1/2007-12/31/2009) from the
MarketScan
® Commercial and Medicare Research Databases. Patients with at least 1 inpatient or 2 outpatient dyspepsia diagnoses within 12 months following any NVAF diagnosis were grouped into the dyspeptic cohort, with patients without any dyspepsia diagnosis during the entire study period grouped into the non-dyspeptic cohort. The date of first dyspepsia diagnosis after NVAF diagnosis and a random date within 12 months after NVAF diagnosis were selected as the index dates for dyspeptic and non-dyspeptic patients, respectively. Baseline and follow-up periods were each 12 months. Of the overall dyspeptic and non-dyspeptic cohorts, patients were matched (1:1) by key patient characteristics. The dyspeptic cohort was further categorized as having a prior history of dyspepsia (chronic) or no dyspepsia (non-chronic) during the baseline period. Healthcare utilization and costs were evaluated and compared during the follow-up for matched cohorts.

Results:
Of 142,322 NVAF patients included in the overall study population (mean age: dyspeptic: 73.68, non-dyspeptic: 72.09 years, p<0.001), 10.2% were diagnosed with dyspepsia, with 67% of them having no history of prior dyspepsia during the baseline. Among the matched study population (N=28,172), patients had similar baseline characteristics: mean Charlson Comorbidity Index score of 2.3 in both cohorts and mean CHADS
2
scores of 1.9 and 1.8 for the non-dyspeptic and dyspeptic cohort, respectively. During the follow-up period, healthcare resource utilization and related costs were significantly greater for the dyspeptic cohort vs. the non-dyspeptic cohort (Table). Patients with chronic dyspepsia were the least likely to receive warfarin in the follow-up period (non-dyspeptic: 57.2%, non-chronic: 50.4%, chronic: 46.6%, p<0.001).

Conclusions:
NVAF patients with dyspepsia used healthcare resources to a greater extent and had greater healthcare costs than NVAF patients without dyspepsia. Warfarin usage appeared to be lower among NVAF patients with dyspepsia.
Abstract 229: Economic Burden of Deep Vein Thrombosis and Pulmonary Embolism for Employees and Employers
Authors: Page Robert L , Ghushchyan Vahram , Gifford Brian , Allen Richard R , Raut Monika , Bookhart Brahim K , Naim Ahmad B , Damaraju C V , Nair Kavita V
Published: July 2021

Introduction:
Though, deep vein thrombosis (DVT) and pulmonary embolism (PE) impose a major burden on US healthcare system, limited data exists on the economic impact of DVT and PE on younger working population. DVT, which occurs in approximately 1 in every 1,000 adults every year, is estimated to cost between $5-8 billion annually or on average $20,000 per treated patient per year. PE occurs in 0.6 million patients annually and results in 50,000 to 200,000 deaths every year. This study examined the total burden of illness, including the direct and indirect healthcare costs to employers and employees with DVT and PE.

Methods:
Retrospective analyses from 2007-2010 were performed using two datasets: (1) Integrated Benefits Institute’s Health and Productivity Benchmarking Database was used for short-term disability (STD) and long term disability (LTD) claims, and (2) IMS LifeLink data was used for medical and pharmacy claims. Indirect costs analyses included costs of lost work days from STD and LTD claims and wage replacement costs. Direct costs included annual pharmacy and medical claims for newly diagnosed DVT and/or PE individuals. Total healthcare cost estimates between the two datasets were linked by derived age and gender analytic weights.

Results:
5,445 (female=54%) and 6,199 (female=50%) disability claims were filed for DVT and PE, respectively. Employees with DVT lost on average 57 (SEM 4.6) STD and 440 (SEM 30.5) LTD days per disability incident. For employers, estimated lost productivity costs per DVT claim were STD=$7,414±625 and LTD= $58,181±4,332. Total annual DVT healthcare costs per employee including out of pocket costs were $2,449
+
106 with $2,160±102 for annual medical and $290 ±20 for total pharmacy costs. Employees with PE lost on average 56 (SEM 3.0) STD and 364 (SEM 26.1) LTD days per disability incident. For employers, the estimated lost productivity costs per PE claim for STD and LTD were $7,605±402 and $48,751±3,615, respectively. Total annual PE healthcare costs per employee including out of pocket costs were $5,040
+
460 with $4,851±457 for annual medical and $190 ±22 for total pharmacy costs. Hospitalizations accounted for 84% of total annual PE health costs.

Conclusion:
DVT and PE constitute a heavy economic and lost productivity burden for both employers and their employees. Direct and disability costs to employees are substantial. Productivity losses for employers are also significantly high. Appropriate management of DVT and PE may help improve lost days from work, reduce healthcare resource utilization, improve workforce productivity, and reduce total economic burden.
Abstract 235: Acute Care Measures of Rehabilitation Needs Associated with Discharge to Rehabilitation for Patients with Minor Stroke
Authors: Prvu Bettger Janet , Stein Joel , Magdon-Ismail Zainab , Hedeman Robin , Sicklick Alyse , Schwamm Lee H
Published: July 2021

Background:
The need for rehabilitation therapy after an acute hospitalization can be difficult to discern among patients with minor stroke. This study examined the guideline recommended components of a multidisciplinary assessment of rehabilitation needs and their association with discharge to inpatient rehabilitation among patients with a minor stroke.

Methods:
We analyzed data from a Northeast Cerebrovascular Consortium feasibility study of 22 Get With The Guidelines-Stroke participating hospitals that completed a standardized assessment of rehabilitation needs for 792 ischemic and hemorrhagic stroke patients. Patients with TIA or who died in hospital, left AMA, or were discharged to another hospital or hospice were excluded. Multivariable logistic regression was used to identify patient characteristics and acute hospital measures of impairment, complications and caregiver support associated with discharge to inpatient rehabilitation (IRF) or skilled nursing facilities (SNF) compared to discharge home among patients with a NIH Stroke Scale score<=4.

Results:
Among the 351 patients with minor stroke, 31% were discharged to inpatient rehabilitation (24% IRF, 7% SNF). In univariate analyses comparing patients discharged to rehabilitation vs. home there was no significant difference in gender, race, ethnicity, education, history of myocardial infarction or coronary artery disease, hypertension or dyslipidemia, hospital documented deep vein thrombosis, or caregiver availability after hospital discharge. In the multivariable model, only pre-stroke disability was associated with discharge to rehabilitation compared to discharge home.

Conclusions:
Rehabilitation needs were documented for patients with minor stroke and almost one third were discharged to receive inpatient rehabilitation in an IRF or SNF. Taking pre-stroke disability into consideration for transition planning from acute care could facilitate earlier communication and planning with the next point of care.
Abstract 274: Follow-Up of Young Acute Aortic Dissection Patients: How They Differ from Older Patients
Authors: Brinza Ellen K , Hagan Lindsay , Evangelista Arturo , Isselbacher Eric M , Ehrlich Marek P , Fattori Rossella , Trimarchi Santi , Hutchison Stuart , Harris Kevin M , Braverman Alan C , Woznicki Elise M , Montgomery Daniel G , Eagle Kim A , Nienaber Christoph A , Pape Linda
Published: July 2021

Background:
Young patients (pts) with acute aortic dissection (AAD) have distinct risk factors and presenting symptoms compared to older pts, but whether these differences extend past discharge is relatively unknown.

Methods:
Among pts presenting with AAD enrolled in the International Registry of Acute Aortic Dissection, pts <40 (N=280) were compared with pts ≥ 40 (N=3585). Chi-square analysis or Fischer’s Exact test were performed for categorical variables; age was compared using Student’s T-test. Kaplan-Meier curves were generated for freedom from adverse events rates 0-60 months following discharge. Mean follow-up was 28.6 months.

Results:
Significant differences in demographics and history were noted between pts <40 and the older cohort. Young pts more commonly had type A AAD (71.8%, 201/280, v. 64.6%, 2317/ 3585, p<0.016), while type B AAD was more typical in older pts (p<0.016). On imaging studies, pts <40 were less likely to present with IMH (7.3%, 246/3355, v. 2.3%, 6/266, p=0.002), but were more likely to have a patent false lumen (77.9%, 141/181, v. 62.1%, 1425/2295, p<0.001). Surgical management was more common in young pts, for both AAD types. In-hospital complications or mortality did not differ between groups. Kaplan-Meier analysis demonstrated better long-term survival in young pts compared to those ≥ 40 (p=0.029). Kaplan-Meier analyses of freedom from adverse events at 5 years illustrated no difference in aortic growth between groups, but significantly more late interventions in younger pts (p=0.006).

Conclusions:
Young pts show distinct differences in comparison to older pts, specifically regarding presentation, AAD type and management. Long-term survival and follow-up intervention rates are higher in young pts.
Abstract 3: Healthcare Resource Utilization and Expenditures Associated with Implantable Cardioverter Defibrillator Shocks
Authors: Turakhia Mintu P , Reynolds Matthew R , Gunnarson Candace L , Swain Andrea L , Mollenkopf Sarah A , Zweibel Steven L
Published: July 2021

Introduction:
Few studies have characterized the cost of health care associated with implantable cardioverter defibrillator (ICD) shocks. The objective of this study was to understand healthcare utilization patterns and expenditures following an ICD or cardiac resynchronization therapy defibrillator (CRT-D) shock.

Methods:
Using Medtronic’s Data Warehousing & Analytics Services (DWAS) database patients with an ICD or CRT-D implant date between 2008 and 2010 were identified. Implant records from DWAS were matched to patient level data in MarketScan® Commercial and Medicare claims databases (Truven Health Analytics, Inc) based on date and type of implant, gender, age, patient three digit zip code and location of care. A shock event was defined as a date where one or more spontaneous shocks (appropriate or inappropriate) were delivered. Shock events were recorded in DWAS and used to identify shock-related healthcare utilization in MarketScan. Shock-related healthcare utilization was defined as a visit with a diagnosis (primary diagnosis for inpatient) of dysrhythmia, syncope/dizziness, device malfunction, palpitations or tachycardia beginning within 7 days following a shock event. Shock events occurring during an ongoing inpatient stay were excluded. Expenditures for all shock-related utilization following a shock event were tallied and summarized.

Results:
Of 7705 patients matched between the 2 databases, 773 patients had 1409 shock events and 58 were excluded due to ongoing inpatient stay. Of the 1351 remaining shock days 798 (59%) were followed by any healthcare utilization and 575 (43%) were followed by shock-related healthcare utilization. The majority of patients (65%) seeking shock-related care did so on the same day as the shock. 157 shock events (11.6%) were followed by an inpatient stay and had a mean length of stay of 3.6±3.0 days. There was wide variation in shock-related expenditures (mean $5,124±$11,992; median $1,131) and expenditures were similar between ICD and CRT-D patients. Expenditures were higher when shock events were followed by inpatient care ($15,167±$19,229, median $8,812), as compared outpatient care only ($1,352±$2,716, median $376).

Conclusion:
Nearly 1 in 8 shock events were followed by hospitalization. Expenditures were higher when inpatient care followed a shock event as compared to when all care occurred in the outpatient setting. Strategies to reduce the incidence of ICD shocks may result in significant healthcare savings.