bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4139443: Patient Decision Aids and Encounter Decision Aids Improve Shared Decision Making and Patient Knowledge About Stroke Prevention In Patients with Atrial Fibrillation
Authors: Fagerlin Angie , Barnes Geoffrey , Cameron Kenzie , Cavanaugh Kerri , Crossley George , Greene Tom , Kansal Preeti , Montori Victor , Noseworthy Peter , Passman Rod , Roden Dan , Steinberg Benjamin , Witt Daniel , Ozanne Elissa
Published: November 2024

Background:
Guidelines recommend shared decision-making (SDM) for patients with atrial fibrillation (AF) making decisions regarding anticoagulation for stroke prevention. Decision support tools (e.g., Decision Aids [DAs]) facilitate SDM. However, little research has compared the effectiveness of the two most common types of DAs: (1) encounter decision aid (EDA) and (2) pre-encounter patient decision aid (PDA). Our study assessed the comparative effectiveness of PDAs and EDAs on SDM during AF clinical encounters where stroke prevention strategies were discussed.

Research Question:
Do decision aids (PDA or EDA), alone or in combination, improve patients’ AF decision-making experience compared to usual care?

Methods:
A cluster randomized multi-center trial in patients with AF comparing usual care (no DA) vs. one DA (EDA or PDA) or both DAs. Clinicians and patients were randomized independently into 4 study arms. Clinicians were randomized to use or not use the EDA for all study visits, and patients were randomized to use or not use the PDA. Co-primary outcome domains were: (1) quality of SDM (2) patient knowledge, and (3) decisional conflict. Secondary outcomes included: (1) treatment choice, (2) treatment initiation, and (3) treatment persistence. Patient characteristics were assessed. We will present comparisons of the randomized DAs on the co-primary and secondary outcomes and subgroup analyses.

Results:
Between December 2020-July 2023, investigators in 6 U.S. healthcare systems enrolled 1117 patients (mean (M) age 69, 63% male, 89% White) and 107 clinicians. Compared to usual care (no DA, M=31.6), SDM was better in patients receiving PDA (M=35.4) and EDA (44.5) alone or together (M=43.7; p’s<0.001). Knowledge about AF was greatest for those receiving both DAs or the PDA alone (84% accurate responses for PDA and both vs 76% with no DA, p<0.001), followed closely by the EDA alone (82%, p=0.003). Finally, both DAs (M=19.5) and EDA alone (M=20.0) had better decisional conflict scores compared to usual care (M=25.8; p’s<0.001). We will present analyses that assess the impact of DAs on secondary outcomes and interactions with DA, patient, and clinical characteristics across each outcome.

Conclusions:
In one of the first randomized trials examining the comparative effectiveness of EDAs and PDAs on SDM in clinical medicine, both PDAs and EDAs improved shared decision-making, decisional conflict, and knowledge compared to patients receiving usual care.
Abstract 4139450: Prevalence of Cardiovascular-Kidney-Metabolic Conditions Across the Spectrum of Body Mass Index Among US Adults, 2017-March 2020
Authors: Ostrominski John , Hirsch Jamie , Miao Benjamin , Kuti Effie , Donato Bonnie MK , Crowell Marjorie , Parrinello Christina , Woolley Jonathan , O'Connell Thomas , Vaduganathan Muthiah
Published: November 2024

Background:
Obesity is a major risk factor for the onset and progression of cardiovascular-kidney-metabolic (CKM) conditions. However, there is substantial epidemiological and phenotypic heterogeneity across the spectrum of body mass index (BMI), and whether the contemporary prevalence of CKM conditions varies according to BMI in the US population has not been rigorously evaluated.

Methods:
In this serial cross-sectional analysis of nonpregnant US adults aged ≥20 years participating in the nationally representative pre-pandemic National Health and Nutrition Examination Survey (2017-March 2020), we evaluated the prevalence of CKM conditions (cardiovascular disease [atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF)], at least moderate-risk chronic kidney disease [CKD], and metabolic disease [type 2 diabetes (T2D) or metabolic dysfunction-associated steatotic liver disease (MASLD)] by BMI category (18.5-<25, 25-<30, 30-<35, 35-<40, and ≥40 kg/m
2
). Associations between each BMI category with prevalent CKM conditions were expressed as prevalence ratios (PR) with 95% CI, estimated using Poisson regression.

Results:
Among 6,337 US adults (mean age, 48 years; 51% women), 26% had BMI 18.5-<25, 32% had BMI 25-<30, and 42% had BMI ≥30 kg/m
2
. Nearly half (48%) of US adults with BMI ≥40 kg/m
2
were aged <45 years. CKM multimorbidity (≥2 CKM conditions) generally increased with increasing BMI category; 4.2% among those with BMI 18.5-<25 vs. 21.3% among those with BMI ≥30 kg/m
2
(
Figure, A
). Overall, increasing BMI was associated with a higher prevalence of all CKM conditions (
P
≤0.001 for all), with strongest associations observed for MASLD (BMI ≥40 vs. 18.5-<25 kg/m
2
; PR, 20.8, 95% CI 12.8-33.8;
P
<0.001), T2D (BMI ≥40 vs. 18.5-<25 kg/m
2
; PR, 5.8, 95% CI 4.3-7.8;
P
<0.001), and HF (BMI ≥40 vs. 18.5-<25 kg/m
2
; PR, 5.2, 95% CI 2.7-10.1;
P
<0.001) (
Figure, B
).

Conclusions:
This analysis highlights the robust association between higher BMI and the prevalence of CKM conditions among US adults, supporting weight management as a core component of comprehensive CKM-oriented care strategies. These findings also support efforts to enhance screening and management for the full spectrum of CKM conditions in overweight/obesity.
Abstract 4139461: Proteomic and Phosphoproteomic Profiling in an Experimental Model of Electrical Storm
Authors: Tsuji Yukiomi , Shimojo Masafumi , Yanagisawa Satoshi , Inden Yasuya , Dobrev Dobromir , Nattel Stanley , Murohara Toyoaki
Published: November 2024

Background:
Electrical storm (ES), characterized by clustered ventricular tachycardia/fibrillation (VT/VF) episodes, is a major problem with substantial mortality in patients with implantable cardioverter-defibrillators (ICDs) and ischemic/non-ischemic cardiomyopathy, but available therapeutic approach is suboptimal, likely due to incomplete understanding of the pathophysiology.

Objective:
To identify the cardiac-specific features of protein/phosphoprotein changes in experimental ES.

Methods:
The model was created by inducing chronic complete atrioventricular-block in ICD-implanted rabbits, causing hypertrophy, QT prolongation, and frequent VT/VF-episodes. Relative protein/phosphoprotein abundances in hearts from 4 rabbits with ES (defined as ≥3 VF-episodes/24-hr period) experiencing 97±27 VF-episodes and 4 controls (CTL) were assessed by iTRAQ LC-MS/MS and key regulatory pathways were examined by Ingenuity-Pathway-Analysis.

Results:
Proteomic analysis identified 1938 proteins, 106 of which were differentially expressed between ES and CTL (False Discovery Rate (FDR)<0.1). ES was profoundly associated with mitochondrial dysfunction, oxidative phosphorylation inactivation and ATP depletion along with decreased measurement of electron transport chain and ATP synthase proteins and inner membrane-localized transporters and enzymes. Reductions in mitochondrial matrix-enzymes inferred downregulation of fatty acid β-oxidation and TCA cycle. Phosphoproteome detected 641 phosphorylated proteins, 82 of which have changes in phosphorylation state in ES versus CTL (FDR<0.1). Hyperphosphorylation of Z-disc proteins/associated proteins of sarcomeres, especially N-terminals of titin, and actin and protein kinase A subunits predicted striated muscle contraction and integrin signaling activation, which in part explain cardiac dilation with enhanced contractility due to sustained bradycardia in this model. Nuclear integrators for mitochondrial biogenesis and function, including cyclic AMP-response element binding, peroxisome proliferative activated receptor gamma, coactivator 1 alpha and nuclear respiratory factor 1, were activated, the prediction opposite to proteomic data. The activation status of other pathways linked to heart failure was undeterminable.

Conclusion:
ES is associated with evidence of mitochondrial dysfunction, known to contribute to ventricular dysfunction and arrhythmogenesis. Mitochondria-targeted agents merit further investigations as therapeutic targets in ES.
Abstract 4139462: Admission and Discharge B-Natriuretic Peptide Profiles Are Predictive of 1-Year Mortality Above Intermountain Risk Score in Heart Failure Phenotypes
Authors: Sanchez Pablo , ODonnell Christian , bagherzadeh shadi , Celestin Bettia , Santana Everton , Bair Tami , Haddad Francois , Horne Benjamin
Published: November 2024

Introduction:
Pre-discharge and in-hospital trends of B-type natriuretic peptide (BNP) are predictive of mortality in patients recently discharged after acute decompensated heart failure (ADHF). The Intermountain risk score (IMRS) uses common serum laboratory data to predict outcomes in hospitalized patients. Considering that in-hospital BNP levels differ for HF with preserved (HFpEF) and HF with non-preserved EF (HFnpEF), the goal of this work was to assess whether BNP at admission and discharge provided prognostic information beyond the IMRS in either phenotype.

Methods:
In a hospitalized cohort with ADHF in Intermountain Health, adult patients were included if they had 1) a BNP value within 24 hours of admission, and 2) a separate BNP value within 3 days pre-discharge. HF phenotypes were determined using echocardiography within 1 year prior to admission (HFpEF >= 50%, HFnpEF < 50%). IMRS calculated on admission from CBC and CMP components. Within each HF phenotype, time-dependent ROC analyses were used to derive admission and discharge BNP thresholds for 1-year mortality (highest product of sensitivity and specificity). Patients were categorized as above or below their HF-specific admission and discharge thresholds (low-low, low-high, high-low, high-high). Nested multivariable Cox proportional hazard models for 1-year mortality evaluated admission BNP, discharge BNP, relative change in BNP, and admission-discharge BNP profile, in addition to IMRS and comorbidities.

Results:
A total of 2,933 patients were included, where 43.9% (1,287) had HFpEF and 56.1% (1,646) HFnpEF. Median BNP was lower in HFpEF compared to HFnpEF (admit: 703 vs 1300 pg/mL; discharge: 406 vs 796 pg/mL, both p<0.001). In HFpEF, admission and discharge BNP thresholds were 763 pg/mL and 474 pg/mL, respectively, while in HFnpEF, the thresholds were 1520 pg/mL, and 1043 pg/mL. The best model above the baseline model used admission-discharge BNP profile (Table 1). In both HF phenotypes, the low-low profile had the lowest 1-year mortality, and the high-high profile had the highest mortality (Figure 1). After multivariable adjustment, each admission-discharge BNP profile was associated with higher 1-year mortality vs. low-low, meeting significance in high-high profile in HFpEF and high-high and low-high profiles in the HFnpEF (Table 2).

Conclusions:
The inclusion of admission-discharge BNP profiles was complementary and added significant and incremental value to the IMRS to predict mortality.
Abstract 4139465: Integrin α5β1 represents a novel therapeutic target to improve vascular remodeling in pulmonary arterial hypertension
Authors: Lemay Sarah-Eve , Montesinos Monica , Grobs Yann , Yokokawa Tetsuro , Shimauchi Tsukasa , Romanet Charlotte , Sauvaget Melanie , Breuils Bonnet Sandra , Bourgeois Alice , Theberge Charlie , Martineau Sandra , Lippa Blaise , Goodwin Bryan , Lin Albert , Wang Hua , Dowling James , Lu Min , Qiao Qi , McTeague T. Andrew , Moy Terence I. , Potus Francois , Provencher Steeve , Boucherat Olivier , Bonnet Sebastien
Published: November 2024

Introduction:
Pulmonary arterial hypertension (PAH) is characterized by progressive obstruction and decreased compliance of pulmonary arteries (PA), leading to right ventricular failure and premature death. Sustained proliferation and resistance to apoptosis of PAs smooth muscle and endothelial cells (PASMCs, PAECs) and accumulation of extracellular matrix (ECM) elements are key features contributing to vascular remodeling. Integrins, members of the cell adhesion receptor superfamily, are known to promote cell proliferation and survival through ECM binding. Despite the recognition of the role of ECM elements in vascular remodeling in PAH, the contribution of integrins remains poorly studied. We hypothesized that integrin signaling could promote PAH-PASMCs and PAH-PAECs proliferation and resistance to apoptosis contributing to vascular remodeling.

Methods&Results:
Using Western blot (WB) and Meso Scale Discovery, we found that α5β1 was upregulated in distal PAs, PA smooth muscle cells (PASMC) and PA endothelial cells (PAEC) from PAH patients compared to controls. Small molecule, antibody (M200), or siRNA-mediated inhibition of α5β1 decreased PAH-PASMC and PAH-PAEC proliferation (WB, MCM2 and Ki67 labeling), resistance to apoptosis (WB, Survivin and Annexin V labeling) and migration (scratch test assay). RNA sequencing analysis revealed that inhibition of α5β1 regulates a FOXM1-dependant gene network through the activation of focal adhesion kinase, resulting in mitotic defects (Immunofluorescence: α-tubulin and pericentrin labeling).
In vivo
, in both monocrotaline and Sugen/hypoxia rats with established PAH, inhibition of α5β1 using a small molecule inhibitor or a neutralizing antibody alone or in combination with macitentan and tadalafil improved hemodynamics (RHC and echocardiography: mean pulmonary arterial pressure, cardiac output, pulmonary artery acceleration time) and vascular remodeling (Elastica Van Gieson staining).
Ex vivo
, inhibition of α5β1 decreased vascular remodeling in human precision-cut lung slices (PCLS) from PAH patients and attenuated growth factors-induced vascular remodeling in control PCLS.

Conclusion:
Integrin α5β1 plays a key role in vascular remodeling in PAH and represents a novel therapeutic target.
Abstract 4139474: Safety of Sodium-Glucose Cotransporter-2 Inhibitors Peri-Percutaneous Coronary Intervention: A National Experience
Authors: Rahhal Alaa , Mohammad Hashim , AlKodmani Sham , Hamsho Firas , Hamam Wael , Al-Tikrety Nawras , Moustafa Noor , Chawa Yamane , Aladwan Barakat , Dulli Mohamad Wajeh , Alomari Dana , Shehadeh Mohanad , Mahfouz Ahmed , Alyafei Sumaya , Arabi Abdulrahman , Mohamed Khaled
Published: November 2024

Background:
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have cardio-renal protection benefits regardless of diabetes status. However, the outcomes of uninterrupted SGLT2i use peri-percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) remain uncertain. Therefore, this study aimed to evaluate the safety of SGLT2i use peri-PCI.

Methods:
We conducted a retrospective observational cohort study that included all patients admitted with ACS who underwent revascularization with PCI at Qatar's main tertiary cardiology center between 1/01/2018 and 31/12/2020. The use of SGLT2i peri-PCI was defined as the established use of SGLT2i before the index admission or early initiation of SGLT2i during the index admission within 24 hours of contrast exposure. The study population was divided into two groups; (1) SGLT2i users; (2) SGLT2i non-users. The primary outcome was the risk of contrast-induced nephropathy (CIN) with SGLLT2i use, defined as an increase in serum creatinine by more than 0.3mg/dL or more than 50% of the baseline value within 48 hours of contrast exposure. A propensity score–matched model (1:1) was used to adjust for baseline characteristics between the study groups. Logistic regression analysis was used with a P-value <0.05, indicating statistical significance.

Results:
We included 3421 ACS patients who met the eligibility criteria (88% male, mean age 54±10 years, and 59% Asian), with 95 patients classified as SGLT2i users and 3326 as SGLT2i non-users. Using 1:1 propensity score matching, 95 patients were included per arm with an absolute standardized difference <0.1 for all baseline characteristics. The use SGLT2i peri-PCI was not associated with an increased risk of CIN [
before propensity score matching:
4 (4.2%) versus 146 (4.4%), aOR= 1.31 (0.45-3.78), P-value 0.622;
after propensity score matching:
4 (4.2%) versus 5 (5.3%), OR= 0.79 (0.21-3.04), P-value 0.733].

Conclusion:
Our findings suggest that the uninterrupted use of SGLT2i among patients with ACS undergoing PCI is safe without increasing the risk of CIN, warranting continuation of SGLT2i use or early initiation during ACS.
Abstract 4139481: Relationship between Iron Deficiency and Cardiovascular Health in Pediatric Patients with Fontan Circulation
Authors: Agrawal Arushi , Weisert Molly , Detterich Jon , Wood John , Cheng Andrew
Published: November 2024

Background:
The physiology of the Fontan circulation is consistent with chronic heart failure, characterized by elevated central venous pressure and reduced cardiac output. In adults with conventional heart failure, iron deficiency is common and is associated with increased morbidity and mortality. However, data is lacking on the prevalence of iron deficiency and its relationship with cardiovascular outcomes in pediatric patients with Fontan circulation.

Aim:
To characterize the relationship between iron profiles and measures of cardiovascular health in pediatric patients with Fontan circulation.

Hypothesis:
Iron deficiency is associated with worse measures of cardiovascular health.

Methods:
Cross-sectional study comprising patients with Fontan circulation who had iron labs measured from 2010 - 2024 at a single urban center. Exclusion criteria were hematologic disease other than iron deficiency, acute bleeding, and acute illness other than heart failure. Cardiovascular health was evaluated with NYHA or Ross class, echocardiogram, and cardiac MRI. Kruskal-Wallis tests and linear regression were used to analyze associations between iron labs and measures of cardiovascular health. Indexed oxygen delivery (iDO2) was calculated from cardiac index measured by cardiac MRI, pulse oximetry, and hemoglobin.

Results:
100 patients (mean 12.5±4.7 years, 46% female) were included. Iron deficiency was present in 45% or 51% based on conventional criteria of transferrin saturation (TSAT) <20% or ferritin <30 ng/mL, and 94% based on suggested criteria for heart failure (ferritin <100 ng/mL or ferritin 100-299 ng/mL and TSAT <20%). TSAT was significantly lower in patients with NYHA or Ross class III/IV vs. I/II symptoms (median 14% [IQR 10-19%] vs. 20% [15-25.5%], p=0.014) and in those with history of ≥ moderate vs. < moderate atrioventricular valve regurgitation (median 12.5% [10-21.8%] vs. 20.5% [15-24.5%], p=0.049). Ferritin trended toward being significantly lower in those with ≥ moderate vs. < moderate ventricular dysfunction (median 19.5 [11-34] vs. 30.5 [18-56], p=0.095). Among patients with hemoglobin <15 g/dL, TSAT strongly correlated with iDO2 (R
2
=0.495, p=0.034).

Conclusion:
Iron deficiency is common and is associated with both worse heart failure symptoms and objective measures of cardiovascular health in pediatric patients with Fontan circulation. Interventions to improve iron stores offer promising avenues for mitigating heart failure risk and improving outcomes.
Abstract 4139507: Impact of Hemodynamic Management on Early Mortality in Patients Undergoing Radiofrequency Catheter Ablation for Ventricular Tachycardia: A Single Center Experience
Authors: El Rafei Abdelghani , Sandhu Amneet , Cerbin Lukasz , Aleong Ryan , Zipse Matthew , Tumolo Alexis , Sabzwari Syed Rafay Ali , Garg Lohit , Barrett Christopher , Varosy Paul , von Johannes , Ashur Carmel , Adewumi Joseph , Padalia Kishan , Grubb Alex , Varela Daniel , Rosenberg Michael , Tzou Wendy
Published: November 2024

Background:
Catheter ablation (CA) is an established treatment for ventricular arrhythmias (VAs). Vasoactive drugs are used to manage intraprocedural acute hemodynamic decompensation (AHD). To date, there is limited data on the association between intra-procedural vasoactive drug choice and outcomes in patients undergoing VA CA.

Objective:
Evaluate if the use of certain vasoactive agents interprocedurally is associated with worse outcomes in patients undergoing VA CA.

Methods:
This was a single center retrospective analysis of patients undergoing VA CA 2018-2023. Patients were risk-stratified using the PAAINESD score (calculated by: presence of lung disease, age >60, anesthesia use, New York Heart Association classification III/IV, left ventricular ejection fraction (LVEF) <25%, electrical storm, and diabetes mellitus) and divided into low- (<10), medium- (10-16), and high-risk (>16) tertiles. Use of vasoactive drugs between tertiles was compared, as were outcomes when pure afterload agents (-INO), versus agents with positive inotropy (+INO) were used.

Results:
Two hundred and three patients undergoing 233 procedures were included. Mean (±SD) age was 62±13years, LVEF was 37±15%; 1/3 had LVEF<25%, and 99 (39%) were NYHA III/IV. Median (range) PAAINESD was 17 (5-36). Use of -INO (ephedrine, phenylephrine, or vasopressin) occurred in 179 patients (77%); 63(27%) received 2 -INO, and 10 (4%) received 3 -INO agents. Twelve (5%) died within 90 days, all with PAAINESD >16, and all with 1 -INO used interprocedurally (Fig., A). After adjustment for LVEF and +INO, increasing number of -INO was significantly associated with 90-day mortality (OR 2.67, 95%CI 1.24 – 5.76, P=0.012; Fig., B), as was the cumulative dose of -INO (OR 1.43, 95%CI 1.03 – 1.98, P=0.031, Fig., C).

Discussion:
Among patients with depressed LV function undergoing VAs ablation, the use of pure afterload agents is associated with increased 90-day mortality, especially among patients with high baseline risk of AHD.
Abstract 4139527: Prognostic Characteristics of Patients with Electrocardiograms Masquerading as ST Elevation Myocardial Infarction
Authors: Fathieh Sina , Tran Tu Hao , Faour Amir , Dang Viet , Aljazaery Asala , Gibbs Oliver , Assad Joseph , Faddy Steven , Long Mitchell , Pahn Reece , Rajaratnam Rohan , Lo Sidney , Juergens Craig , Tam Gladys , French John
Published: November 2024

Background:
Prehospital identification of STEMI reduces time to reperfusion by timely primary PCI or fibrinolytic therapy. We previously reported that 40-50% of prehospital ECG transmissions meeting Glasgow algorithm (GA) criteria for STEMI did not meet STEMI criteria on adjudication using the 4th Universal Definition of MI (4UDMI). These cases, herewith called ‘masquerading STEMI’, had high rates of late clinical complications. Here, we determined clinical factors predictive of late clinical outcomes among patients with masquerading STEMI.

Methods:
From June 2010 to October 2021, 2,992 patients with prehospital ECG transmissions to Liverpool Hospital, Sydney, Australia, who met GA criteria for STEMI were identified. These were adjudicated according to the 4UDMI as confirmed STEMI or masquerading STEMI. Using multivariate logistic regression, we identified baseline patient characteristics that were associated with the outcome of cardiovascular death, MI and stroke at 2 years, among the masquerading STEMI cohort.

Results:
1553 (51%) patients were true-positive STEMI, while 1439 (49%) were masquerading STEMI. In the masquerading STEMI cohort, age, current smoking, and CKD (eGFR<60) were significant predictors of the 2-year cardiovascular death, MI stroke with OR of 1.05, 2.07, and 3.58, respectively (p<0.05 for all). Diabetes predicted MI re-presentation within 2 years (OR 3.76, p<0.05), and CKD predicted heart failure hospitalisation (OR 2.55, p<0.05).

Conclusions:
Among patients with masquerading STEMI, current smoking and CKD were associated with the 2-year cardiovascular death, MI stroke. Diabetes predicted a higher risk of re-presenting with MI within 2 years, and CKD predicted a higher risk of hospitalisation with heart failure. Therefore, in this cohort of patients with masquerading STEMI, despite not having a true STEMI, smoking cessation and opportunistic management of diabetes and CKD may modify prognosis.
Abstract 4139542: Left or Bilateral Cardiac Sympathetic Denervation: Comparison of Antiarrhythmic Efficacy and Complications
Authors: Girvin Zachary , Wright Adam , Shoemaker BEN , Bichell David , Shah Ashish , Kannankeril Prince
Published: November 2024

Background:
Cardiac sympathetic denervation (CSD) is a well-established procedure to prevent ventricular arrhythmias in genetic and acquired arrhythmia syndromes. It is unknown whether initial bilateral (B) CSD or left (L) CSD, followed by right (R) CSD for breakthrough events is the better strategy.

Aims: We compared the antiarrhythmic efficacy and complications of primary B vs L CSD at a single center where both are performed routinely.

Methods:
Patients who underwent CSD were retrospectively identified. At our center L CSD is performed in children while B CSD is performed in adults by operator preference. Demographic data, procedural indications, complications, and arrhythmia events (arrhythmic syncope, sudden cardiac arrest, appropriate shock) were collected. Arrhythmia events (AE) were compared before and after CSD in those with arrhythmia indications. Complications were compared in all subjects and in the subset with arrhythmia indications.

Results:
Between 2011 and 2023, 65 patients underwent 68 CSD procedures (39 B, 26 L, 3 R after initial L). As expected, BCSD patients were older [median 32 (IQR 21-48) years vs. 16 (6-38) years; P=0.002]. Overall complication rates were similar [BCSD 17/39 (44%) vs 12/29 (41%), P=0.85]; most were transient/minor. Complications that required intervention were rare (n=5) and only observed after BCSD. Forty CSD were for an arrythmia indication (18 B, 21 L, 1 R). AEs were reduced from a median of 3 (1-4) before CSD to 0 (0-1) after CSD (p<0.001). The reduction was similar for BCSD [3.5 (2-5) before vs 0 (0-0.25) after (p<0.001)] and L/R CSD [2 (1-4) before vs 0 (0-1) after (p=0.002)]. Only 1 LCSD had subsequent RCSD for an arrhythmia indication 4 years later due to breakthrough AEs: a severe long QT syndrome patient who ultimately required heart transplant. Complications that required intervention after CSD for an arrhythmia indication were seen in 4/18 BCSD and 0/22 L/R CSD (P=0.03).

Conclusions:
BCSD and LCSD are both highly effective in reducing arrhythmia events. Complication rates may be less frequent in unilateral CSD, although the observed difference may be due age differences in the two groups.
Abstract 4139547: Price and Affordability of Guideline-Directed Medical Therapy for Heart Failure in Venezuela
Authors: Gebran Karim , De Oliveira Gomes Diana , Bacci Maria , Lombardo Pascareli Gabriela
Published: November 2024

Introduction:
Heart failure (HF) is a global health burden, with disproportionately higher mortality rates in low and low-middle income countries (LIC/LMIC). Despite advances in guideline-directed medical therapy (GDMT), its accessibility and affordability remain major challenges, particularly in developing countries such as Venezuela.

Methods:
This study aimed to assess the price and affordability of GDMT for HF in Venezuela. Prices of GDMT medications were obtained from leading pharmacies across the nation, and salary data retrieved from Observatorio Venezolano de Finanzas (OVF). Prices were adjusted to represent a standardized 30-day supply at GDMT target dosages. Affordability was assessed by comparing medication costs to monthly salaries across different employment categories.

Results:
The study revealed substantial barriers to accessing GDMT in Venezuela, with prices of certain medications representing a significant percentage of monthly salaries. The cost of Angiotensin Receptor-Neprilysin Inhibitors (ARNI) alone consumes nearly 80% of the income for individuals in managing positions, rendering it almost inaccessible. Moreover, those earning minimum wages would struggle to afford any type of GDMT combination. (Table 1)

Discussion:
These findings underscore the economic disparities in accessing GDMT for HF in Venezuela, reflecting broader challenges in LIC/LMICs. Comparison with similar studies in other countries highlights the global issue of medication affordability and availability. Addressing these barriers is crucial to improving HF outcomes and reducing disparities in healthcare access. Furthermore, there is a pressing need for comprehensive epidemiological data and national registries to inform policy decisions and optimize HF management strategies in Venezuela.

Conclusion:
The study highlights the critical need for interventions to address the cost-related barriers to GDMT access for HF patients in Venezuela. Efforts to improve affordability and availability of essential medications are essential to ensure equitable access to life-saving therapies and reduce the burden of HF in developing countries.
Abstract 4139550: Americans’ Views on Healthcare Coverage, Access, and Equity in the US: Implications for Cardiovascular Health
Authors: Perera Sudheesha , Wadhera Rishi , Khullar Dhruv
Published: November 2024

Background:
Increased healthcare coverage and access leads to better cardiovascular outcomes. Policymakers are currently assessing strategies to expand coverage and access through government programs, but Americans’ views on health care remain poorly characterized.

Methods:
We used the 2022 General Social Survey (GSS) to assess perceptions of US healthcare coverage, access, and equity. We examined responses to 3 questions for all respondents, and stratified by age, income, and political affiliation: (1) whether the rich have easier access to health care, (2) whether it is unfair that those with higher incomes can afford better health care, and (3) whether respondents would be willing to pay higher taxes to improve the level of health care for all. GSS survey weights were used to generate nationally representative estimates.

Results:
Our analyses included 3544 survey respondents (weighted mean [SD] age, 47.1 [17.9] years). The majority of US adults agreed that the rich have easier access to health care (79.5%, [95% CI 75.7%, 83.3%]). Overall, more than half of Americans believe that differential access based on income is unfair (56.5% [52.0%, 60.9%]), with significant variation based on political party affiliation (Democrats 70.8% [62.4%, 79.2%]) vs Republicans 34.0% [25.9%, 42.1%], p < 0.001). In terms of expanding coverage, 10.7% [8.1%, 13.3%] of Americans were willing to pay higher taxes to improve the level of health care for all, with stronger support among Democrats than Republicans (20.3% [14.4%, 26.2%] vs 2.6% [0.6%, 4.5%], p < 0.001). We found no statistically significant variation in responses based on respondent age and income.

Conclusions:
In this national study, we find that Americans’ views on healthcare coverage, access, and equity are divided along partisan lines. Despite broad agreement that access is inequitable, only 1 in 10 Americans are willing to pay higher taxes to increase health care coverage nationwide. These results may inform policy priorities around expanding care coverage – including preventative screening, guideline-directed therapies, and in-hospital care for cardiometabolic conditions – with the goal of improving cardiovascular health in the US.
Abstract 4139560: Lipoprotein(a) [Lp(a)]-Enriched Plasma Undergoes More Rapid Oxidation than Small Dense LDL-Enriched Plasma that is Inhibited by Eicosapentaenoic Acid (EPA)
Authors: Sherratt Samuel , Libby Peter , Bhatt Deepak , Mason Preston
Published: November 2024

Background:
Elevated Lp(a) levels are associated with increased cardiovascular (CV) risk, along with small dense LDL (sdLDL). Lp(a) contains oxidized phospholipid that may “seed” lipid oxidation reactions compared to other lipoproteins. The omega-3 fatty acid EPA delivered as icosapent ethyl (4 g/d) reduced CV events in high-risk patients, including those with elevated Lp(a) (REDUCE-IT). EPA has conjugated double bonds that trap lipid free radicals. We compared rates of oxidation for Lp(a)-enriched and sdLDL-enriched LDL with potential inhibition by EPA at a pharmacologic concentration.

Methods:
Lp(a) and sdLDL were enriched to 66% of total ApoB-containing particles from patients with elevated levels following isopycnic centrifugation. Lp(a), sdLDL and LDL were matched for total protein (50 µg/mL) and incubated at 37°C for 30 min with EPA (50 µM). Samples then underwent copper sulfate-induced oxidation (20 µM) monitored by formation of malondialdehyde (MDA) for 3 h. We normalized rates of oxidation to total available lipid in the samples.

Results:
After 0.5 h, Lp(a)-enriched plasma underwent the most rapid oxidation – 60% of total lipid oxidation (
p
<0.001 vs other fractions) – followed by sdLDL-enriched plasma (30% of total oxidation) then pure LDL (17% of total oxidation). All samples underwent complete oxidation by 2 h. Initially (t = 0 h), Lp(a) enriched plasma contained more oxidized lipid than all other fractions (
p
<0.05). The relative antioxidant activity of EPA was greatest in the Lp(a) enriched samples; EPA inhibited oxidation of Lp(a)-enriched, sdLDL-enriched, and pure LDL by 50%, 46% and 47% (
p
<0.001), respectively, at 2 h. The antioxidant activity of EPA in samples persisted at all time points.

Conclusions:
Lp(a)-enriched plasma underwent rapid oxidation attributed to oxidized phospholipid content and followed by sdLDL and LDL. Oxidation was disproportionately inhibited by EPA in Lp(a) enriched plasma due to free radical scavenging mechanism associated with its multiple conjugated double bonds. The high lipid oxidation rates for Lp(a) inhibited by EPA may contribute to the benefit observed in REDUCE-IT, including in subjects with elevated Lp(a) levels.
Abstract 4139561: Exploring The Risks And Benefits of Upstream Loading of P2Y12 inhibitors In Acute Coronary Syndrome Patients
Authors: Lim William , Htwe Khaing Khaing , Ahmad Muhammad , Khan Ali Akram , Changezi Hameem
Published: November 2024

Background:
Acute coronary syndrome (ACS) is the leading cause of heart disease, resulting in over 300,000 deaths annually. The 2014 ACC/AHA guideline recommends a loading dose of a P2Y12 receptor inhibitor prior to PCI with stenting (Class IA).

Objective:
This study aims to evaluate the risks and benefits of upstream loading of P2Y12 inhibitors in ACS patients.

Methodology:
We retrospectively analyzed the charts of all ACS patients over 18 years old admitted to our community hospital in Michigan from August 2022 to July 2023. Exclusion criteria included patients with type II NSTEMI, hypersensitivity to P2Y12 inhibitors, active bleeding, hemoglobin levels less than 7 g/dl, those already on P2Y12 inhibitors, and pregnant patients.

Results:
Out of 518 patients reviewed, 399 were included in the study. Among 285 NSTEMI patients, 89.5% were not loaded with P2Y12 inhibitors in the ED, while 10.5% were. In the loaded group, 3% underwent CABG, 90% required PCI, and 6% received medical treatment. In the non-loaded group, 12.5% underwent CABG, one patient had an aortic dissection, and 53.8% and 33.7% required PCI and medical treatment, respectively. Among 114 STEMI patients, 74.5% were not loaded with P2Y12 inhibitors in the ED, while 25.5% were. In the loaded group, 100% required PCI. In the non-loaded group, 8.2% underwent CABG, and 92% required PCI.

Conclusion:
Our real-world data from a community hospital indicate that most ACS patients benefit from P2Y12 loading, with only a minority experiencing adverse effects. To address this, we plan to collaborate with our information technology department to implement reminders for ED physicians to consult with cardiologists about P2Y12 inhibitor loading in ACS patients.
Abstract 4139570: A Hard Start: Early, Intensive Healthcare Utilization for Children with Critical Congenital Heart Disease
Authors: Ellis Danielle , Hall Matthew , Blume Elizabeth , Wolfe Joanne , Snaman Jennifer , Berry Jay
Published: November 2024

Introduction/Background:
Critical congenital heart disease (CCHD), requiring surgical intervention in the neonatal period, confers significant morbidity including high healthcare utilization, symptom burden, and psychosocial difficulties. Families also face the challenge of numerous decisions surrounding early, high-risk operative and procedural interventions. Pediatric palliative care (PPC) can facilitate goals of care/decision-making conversations and as such has great potential to improve the experiences of and outcomes for children with CCHD and their families.

Goals/Aims:
We examined the healthcare utilization of children with CCHD and how this differed by sociodemographic and clinical factors, as well as PPC consultation.

Methods:
We performed a retrospective review of infants with one of five CCHD (anomalous pulmonary venous return [APVC], single ventricle disease [SVD], tetralogy of Fallot [TOF], transposition of the great arteries [TGA], and truncus arteriosus [TA]) enrolled from birth to 2 years old between 2016 and 2020 in Medicaid in 12 U.S states participating in the Merative Marketscan Medicaid. Healthcare utilization included inpatient stays, outpatient and emergency visits, pharmacy encounters, and surgical interventions (SI), and were summed to determine total healthcare days (HD). PPC consultation was also assessed. Multivariable log-normal models assessed patient factors [including complex chronic conditions (CCC)] associated with total HD.

Results:
The cohort included 615 children (28% non-White, 46% female, and 67% with at least two other CCC) who underwent a median of 8 SI and had 69 HD during the two-year follow up period. SVD patients had the highest utilization and intervention burden (median 117.5 HD, 11.5 SI), followed by TOF (82 HD, 10 SI), TGA (58 HD, 8 SI), APVC (51 HD, 7 SI), and TA (47.5 HD, 3.5 SI) (p<0.001). Having three or more CCC was associated with greater HD for all conditions (p<.001). PPC consultation was uncommon (4.5%), but greatest in SVD (13%) (p<0.001).

Conclusions:
Children with CCHD, especially those with SVD and greater medical complexity, had significant healthcare utilization including numerous SI. PPC consultation occurs for few patients. Given the clinical and psychosocial implications of frequent decision making and medicalization for children with CCHD, greater PPC engagement should be investigated.
Abstract 4139576: Trends in Incidence, Therapies Utilized and Clinical Outcomes after Cardiac Medication Exposures in the Pediatric Population
Authors: Borkey Nicholas , Yin Shan , Worley Sarah , Aziz Peter , El Assaad Iqbal , Patel Akash
Published: November 2024

Background:
Approximately 2 million exposures are reported to US poison centers annually with 56% <20yrs of age in 2022. Adverse events due to cardiac medication ingestions are well-known, but limited data exists on national trends and outcomes in pediatrics.

Aims:
This study describes the trends in incidence, therapies used, and outcomes after cardiac med exposure over the last decade in the pediatric population.

Methods:
A retrospective cohort study was conducted from the National Poison Data System from 2012-2022 for patients ≤ 19 yrs exposed to cardiac meds: anti-arrhythmics, β-blockers, calcium channel antagonists, and cardiac glycosides. Analyses were stratified by med class and age group for trends in incidence, therapies, and outcomes.

Results:
A total of 100223 cases of cardiac med exposures were reviewed: 74% (0-5 yr), 8% (6-12 yr), and 18% (13-19 yr). From 2012-2022, the annual incidence of exposures decreased by 6%; however, it increased by 82% in the 13-19 yr group. In 6-19 yr olds, there was an increase in exposures for all med classes except cardiac glycosides. There was a difference in the therapies used across med classes, and 2.2% of all cases required selected cardiorespiratory therapies (p<.001, Table 1). The outcomes also varied by med class (p<.001, Table 1). 11819 (11.8%) cases resulted in ICU admission, of which 64% were in the 13-19 yr group, and 1355 (1.4%) cases resulted in a major/fatal outcome. For all age groups, exposure to >1 med type had a higher proportion resulting in ICU admission (p<.001). Of those with a major/fatal outcome, 82% were in the age 13-19 yr group. For this age group, exposure to >1 med type had a higher proportion resulting in major/fatal outcome compared to any single med class except for anti-arrhythmics (p<.001). Chronic exposure was more likely to result in major/fatal outcome compared to acute exposures in followed cases (4.7% vs 1.6%, p<.001).

Conclusions:
Teenagers showed the largest increase in cardiac med exposures from 2012-2022 and the highest rates of ICU admissions and major/fatal outcomes. These findings underscore the need for heightened awareness when prescribing cardiac mediations and the importance of mental health screening in older children.
Abstract 4139585: Differences in Health Care Utilization Prior to Cardiac Arrest Among Patients with Shockable versus Non-Shockable Rhythms
Authors: Burden Elizabeth , Deyell Marc , Hawkins Nathaniel , Guan Meijiao , Helmer Jennie , Grunau Brian , Fordyce Christopher
Published: November 2024

Background:
Health care utilization has been shown to be high prior to out-of-hospital cardiac arrest (OHCA). However, differences in patterns of health care utilization between OHCA presenting with shockable and non-shockable rhythms have not been explored.

Hypothesis:
Health care interactions prior to cardiac arrest are more common among those presenting with non-shockable rhythms, a large proportion of which may be a manifestation of chronic disease progression.

Aim:
To examine health care utilization prior to OHCA and the differences between patients presenting with shockable and non-shockable rhythms, in comparison to population controls.

Methods:
This was a matched case-control study. Cardiac arrests from 2009-2019 were identified in the British Columbia Cardiac Arrest Registry. Age, sex and geographic population controls were identified. We examined health care utilization in the 3 years prior to cardiac arrest.

Results:
A total of 3,461 shockable and 11,470 non-shockable OHCA patients were identified and matched 4:1 to 45,871 controls. The rate of hospitalization in the 3 years prior was 57% in the shockable group (39.5% in controls, OR 1.66, 95% CI 1.53-1.79) and 61.5% in the non-shockable group (39.5% in controls, OR 2.67, 95% CI 2.55-2.79). Overall hospitalizations were more common in both OHCA compared to controls, while non-cardiovascular (CV) admissions were greater for the non-shockable versus shockable groups (
Figure
). When examining bi-weekly rates of hospital and ER visits leading up to OHCA, both groups had increased CV encounters arising at 10 weeks prior to arrest, whereas the non-shockable group had greater non-CV encounters as compared to the shockable group.

Conclusion:
Shockable and non-shockable OHCA show high rates of health care utilization leading up to cardiac arrest, which may provide opportunities for intervention. Differences between the shockable and non-shockable groups may reflect underlying pathophysiology, which has implications for prevention of OHCA.
Abstract 4139594: Temporal Evolution and Incidence of Device Related Thrombus in Left Atrial Appendage Closure
Authors: Alabre Alisha , Savona Salvatore , Hummel John , Rizwan Afzal Muhammad
Published: November 2024

Background:
Studies related to the Watchman device generally report data at the 45-day, 6-month, 1-year, and 2-year intervals, with outcomes supportive of Watchman closure. The imaging of the device at 45 days is believed to coincide with substantial completion of device endothelization and the end of the high risk period for device related thrombus (DRT). Thus, prophylactic systemic anticoagulation (SA) is often discontinued at this time.

Objective:
To report the incidence of delayed DRT in patients following the 45 day post-implant imaging and the cessation of SA.

Methods:
In this single center retrospective study, we assessed patients undergoing Watchman device placement between April 16, 2016, and June 30, 2022. Patient data was retrieved from our institutional Cardiovascular Data Registry database. Following Watchman device implantation, all patients underwent a 45-day surveillance TEE or CT. Our primary interest was assessing the incidence and timing of delayed DRT and determining the anti-platelet and/or SA regimen at the time of DRT.

Results:
A total of 861 patients who underwent Watchman device placement were included in the study. The 45-day surveillance imaging revealed that 2.2% (19/861) of patients exhibited a DRT during the initial follow up imaging while on SA and aspirin (ASA). These patients continued on SA/ASA until the 6-month imaging, at which point 84% (16/19) patients showed DRT resolution. Among the 2 with persistent thrombus, one was on ASA/warfarin, while the other was on DAPT. The 3rd patient did not complete subsequent imaging after 45 days.

The patients without DRT at 45-day imaging had a 0.83% (7/842) incidence of DRT with 42.9% (3/7) revealed at 6 month, 42.9% (3/7) revealed at 12 months and the remaining 14.3% (1/7) at 24 month imaging. SAPT/SA protection was in place in 57.1% (4/7) of these cases, while the remainder were on SAPT 28.5% (2/7), or nothing at all 14.3% (1/7). Alarmingly, 2/7 of these cases resulted in an ischemic stroke in the absence of SA. In 85% of cases, DRT was associated with peridevice leak.

Conclusion:
These findings underscore the importance of ongoing surveillance in patients with Watchman devices and do not suggest a clear association between continued anticoagulation therapy and reduced risk of delayed DRT formation. Further investigations are warranted to determine whether there are predictive patient or implant characteristics and elucidate optimal management strategies for this patient population.
Abstract 4139607: Endothelial Dysfunction is Associated with Major Adverse Cardiovascular Events in Prediabetes
Authors: Kozlova Dariya , Gimblet Colin , Wendt Linder , Ten Eyck Patrick , Akbari Sadaf , Taiwo Adeyinka , Jalal Diana
Published: November 2024

Background:
Prediabetes is an intermediate stage of hyperglycemia associated with an elevated risk of major adverse cardiovascular events (MACE). Vascular dysfunction is a non-traditional risk factor that worsens with hyperglycemia and elevates the risk of MACE in high-risk populations. It is currently unknown whether vascular dysfunction contributes to MACE in prediabetes. We hypothesized that vascular dysfunction would associate with an elevated risk of MACE in individuals with prediabetes independent of traditional risk factors.

Methods:
We conducted an observational study (n=4557) in the Framingham Offspring and Generation III cohorts. Prediabetes status was defined by ADA criteria as fasting plasma glucose between 100-125 mg/dL or HbA1c between 5.7-6.4%. Endothelial function was determined via brachial artery flow-mediated dilation (BA-FMD), aortic stiffness via carotid-femoral pulse wave velocity (cfPWV), and coronary artery calcium (CAC) score via computed tomography. Cross-sectional general linear models were utilized with appropriate transformation of the outcome variable to evaluate if BA-FMD, cfPWV, and CAC score differed by prediabetes status. Cox regression was used to assess the association of BA-FMD, cfPWV, and CAC score with time to MACE in prediabetes. MACE was defined as coronary artery disease, stroke, and all-cause mortality. Models were adjusted for age, sex, smoking status, cardiovascular disease, and blood pressure.

Results:
Median age of the prediabetes group was 55 (48,62) years and 42% were female, whereas median age of the normoglycemic control group was 45 (39,51) years and 61% were female. In unadjusted models, individuals with prediabetes had lower BA-FMD and higher cfPWV and CAC score (p<0.001). After adjustment, prediabetes remained associated with lower BA-FMD [Beta -2.1 (95% CI, -2.3,1.8; p <0.001)] and higher cfPWV [exp(Beta) 1.30 (95% CI, 1.28-1.32; p <0.001)], however the association with CAC score was abolished [OR 0.83 (95% CI, 0.67-1.01; p=0.06)]. In unadjusted analyses, BA-FMD, cfPWV, and CAC score > 100 were associated with MACE in the prediabetes group (p<0.001). After adjustment, BA-FMD [HR 0.94 (95% CI, 0.88-1.00; p=0.035)] and CAC score > 100 [HR 2.67 (95% CI, 1.26-5.64; p=0.010)] remained associated with MACE.

Conclusions:
Individuals with prediabetes exhibit impaired vascular function compared with controls. Moreover, peripheral endothelial function and CAC score > 100 associate with MACE in prediabetes.