bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P181: Myocardial Infarction Treatment: Gender Disparity
Authors: Morrone Doralisa , Xu Xin , Murphy Dan , Bowen James R , Weintraub William S , Jurkovitz Claudine T
Published: March 2022

Purpose:
Rapid time of reperfusion of the infarct-related artery is a key element in the treatment of acute myocardial infarction (MI). Prompt recognition of MI can be challenging in women because of the frequency of atypical symptoms. Our purpose is to determine whether the time to coronary catheterization (cath) differs between men and women.

Methods:
We conducted a retrospective study of all patients admitted at an academic medical center for whom troponin (cTn) levels were measured between 2004 and 2010. ICD9 codes were used to identify patients with MI. Chi-square and Wilcoxon-rank sum test were used to compare demographic and clinical characteristics between genders. Multiple linear regression (MLR) was used to predict time to cath according to gender after adjusting for kidney function, age, race, diabetes, hypertension, cTn levels and type of MI: ST-segment elevation (STEMI) or non-ST elevation (NSTEMI). We examined the interaction between type of MI and gender.

Results:
Our study population included 2354 patients with MI who had a cath. Among them 31.4% were women, 38.4% were older than 65 years, 11.7% black. Women were older than men (mean age 65.2 versus 59.6, p<0.0001), less likely to have diabetes (67.9% versus 72.7%, p=0.0178) but more likely to have hypertension (75.1% versus 69.4% p=0.0047) more likely to have chronic kidney disease defined as GFR<60 mL/min/1.73m
2
(30.9% versus 16.0%, p<0.001). Less women than men had STEMI (48.3% versus 56.4%, p=0.0003). In STEMI as well as in NSTEMI, median time to cath was longer in women (STEMI: 70 versus 65 minutes, p=0.0364; NSTEMI: 26.5 hours versus 22.5 hours, p<0.0001). Results from the MLR showed that the interaction between gender and type of MI was significant (p=0.0010). In NSTEMI patients, adjusted means in time to cath were 4.6 hours longer (p<0.0001) in women than men (25.9 hours versus 30.5 hours ).There was no difference in STEMI patients (p=0.874).

Conclusion:
Appropriate treatment seems to be delayed in women with NSTEMI. Reason for this treatment disparity should be elucidated.
Abstract P189: Evaluating the Effects of Free the Children on Students' Self-Efficacy, Eating Habits, and Activity Levels
Authors: Rao Ravi , Aaronson Susan , Gurm Roopa , Corriveau Nicole , Goldberg Caren S , Du-Russel Weston Jean , Eagle Taylor , Flynn Shannon , Palma-Davis LaVaughn , Fitzgerald Catherine , Mitchell Lindsey R , Rogers Bruce , Jackson Elizabeth A , Eagle Kim A
Published: March 2022

Background:
The National Center for Chronic Disease Prevention and Health Promotion reported in 2008, obesity was 19.6% in children ages 6-11 and 18.1% in children ages 12-19. Free The Children (FTC) was created by a 12 year-old student to promote healthy eating habits, physical activity, and community service in his peers. The program has grown in popularity and this study aims to evaluate its effect on middle school students who are directly and indirectly involved with FTC.

Methods:
Middle school students from Project Healthy Schools, a school based intervention in southeast Michigan, completed surveys detailing their self-efficacy, eating habits, and activity levels. To determine the direct effect of FTC, only students in FTC schools were surveyed and comparisons were made between participating and non-participating students. To measure indirect effects of FTC, all students were surveyed, regardless of their involvement in FTC, and comparison made between students who attended FTC schools and those who did not. Statistical analysis was conducted using non-parametric, independent t-testing and chi-square analysis.

Results:
In the second comparison, students at FTC schools ate better, exercised more, and also had higher self efficacy.

Conclusions:
Students who attended schools offering FTC had better eating/activity habits and significantly higher self-efficacy ratings. Students that directly participated in the FTC program showed even better results for diet, activity and self-efficacy. These results suggest that the FTC program may have both a direct and indirect positive impact on health behaviors and emotional status in middle school students.
Abstract P209: Cardiovascular Medication Use Following Percutaneous Coronary Intervention: Results from the Melbourne Interventional Group Registry
Authors: Brennan Angela , Yan Bryan P , Duffy Stephen J , Loane Philippa , Ajani Andrew E , Reid Chris , Clark David J , Andrianopoulos Nick
Published: March 2022

Background:
Aspirin, clopidogrel, angiotensin-converting-enzyme inhibitors (ACEi), angiotensin-receptor blockers (ARB), beta-blockers (BB) and statins are of proven benefit in most coronary artery disease subgroups and are guideline indicated. We aim to describe the use of these medications following PCI from 2005 to 2009. Melbourne Interventional Group (MIG) is a multi-center PCI registry in Melbourne, Australia.

Methods:
Patients undergoing PCI were prospectively enrolled between 1
st
January 2005 and 31
st
December 2009, representing 12582 PCI procedures. Follow-up at 30 days and 12 months was completed for 99.5% & 91% of procedures respectively. We report the frequency of use of these medications at these time points.

Results:
Overall use of all 5 medications was high at both 30 days and 12 months. There was a steady increase in utilization of medication from 2005 to 2009 amongst all 5 medications, although the use of clopidogrel and BB increased the most. Utilization of all 5 medications from 30 days to 12 months was very good (see Table 1). Similar results were observed in the frequencies of total number of medications being taken, with very few patients reporting taking 0-3 medications at 30 days. At 12 months, 75.7% of patients were either taking 4 (37.6%) or 5 (38.1%) guideline-indicated medications.

Table 1:

Year
Aspirin (%)
Clopidogrel (%)
BB (%)
ACEi/ARB (%)
Statin (%)

30 day
12 month
30 day
12 month
30 day
12 month
30 day
12 month
30 day
12 month

2005

95.6
91
89.9
57.6
65.5
59.8
75.6
74.4
91.5
91

2006

96.7
91.5
94.6
63.6
69.3
62.7
77.4
76.9
93.3
91.23

2007

97.1
92.8
96.3
64.1
73.8
68.6
79.3
78.2
94.1
92.5

2008

98.2
94.5
96.3
64.4
77.5
71.7
79.3
80.2
94.8
94

2009

98.8
95.9
96
71.1
78.9
72.7
79.1
77.2
95.7
93.9

Total

97.2
92.8
94.5
63.5
72.6
66.3
78.1
77.3
93.8
92.3

Conclusion:
Overall use of these medications from 30 days through to 12 months was very good following PCI. The frequency of medication use across the years at follow-up post PCI is increasing
Abstract P211: Effect of Quality Improvement Discharge Tool in Heart Failure
Authors: Basoor Abhijeet , Saleh Tarek , Cotant John F , Patel Kirit , Diaczok Benjamin , Todorov Mina , Halabi Abdul R , Doshi Nitin , DeGregorio Michele
Published: March 2022

Background:
Approximately 33% to 40% of older adults with heart failure are re-hospitalized within three months of discharge. The 6 month readmission rate is as high as 50%. Studies have shown that upward titration of ACE I, ARB and beta-blockers after discharge resulted in reduced hospital re-admission rates, improved functional capacity and quality of life. In our quality improvement project two groups of patients admitted with primary diagnoses of CHF were studied. A discharge checklist was developed for the second group and its effect on dose titration and readmissions was studied.

Methods:
For the first group, all patients readmitted within 3 months for CHF from April 1, 2007 to December 31, 2007 were identified. The primary end point was the difference in dosage of ACE I/ARB and B- blockers between discharge and readmission. For the second group a CHF discharge checklist was used randomly in patients admitted with primary diagnoses of CHF from August 2008 to October 2009. Checklist included documentation regarding dose titration, relevant counselling, education and follow up instructions.

Results:
The first group had 127 readmissions for CHF within 3 months of discharge. The second had 48 patients in which CHF discharge checklist was used. The characteristics of two populations is shown in the Table. Second group readmissions for CHF were decreased after using the checklist from 68% (15/22) to 36% (8/22, p = 0.3). Compared to prior to using the checklist, the total number of readmissions within 6 months of discharge were reduced significantly from 25 to 9 (p = 0.04). Up titration of diuretics in the hospital was associated with decreased readmissions (p=0.07, 4/14 vs 0/8).

Conclusion:
The use of CHF discharge checklist significantly improves dose titration of heart failure medications and decreases the total number of readmissions due to CHF. Furthermore among drug dose titration, up titration of diuretics tend to decrease CHF readmissions.

Baseline characteristics of the two study groups and effect of discharge checklist on dose titration

Baseline characteristic
Study group 1
Study group 2 (discharge checklist)
p - value

Age (mean +/− SD) in years
75.94 +/− 13.1
75.97 +/− 13.1

CHF readmissions
180 of 318
25 of 48
0.8

Women
70 of 127
21 of 48
0.47

Dose titration of beta blocker
16 of 127
17 of 48
0.008

Dose titration of ACE I/ARB
7 of 127
7 of 48
0.07

Dose titration of diuretic
16 of 127
11 of 48
0.17

Dose titration in beta blocker + ACE I/ARB
19 of 127
21 of 48
0.004

Dose titration in beta blocker + ACE I/ARB + diuretic
31 of 127
27 of 48
0.009
Abstract P214: Utilizing Geospatial Technologies to Compare Existing Healthcare Resources with Noted Cardiovascular Risks Among Children in a Rural Setting
Authors: Cottrell Lesley A , Ice Christa , Fedorko Evan
Published: March 2022

With 1/3 of children classified as overweight or obese in the US, effective programming is important. Child obesity programs are conceptualized to reach various settings (e.g., school, home) and (e.g., parents, teachers). In this submission, we describe general geospatial methodologies useful for understanding the environmental resources of a community prior to implementing a child obesity program. Our rationale is that having a better understanding of the community will contribute to the fit between the community and a program. A better fit would, in turn, contribute to the program's success and sustainability.

For this study, we explored the associations between the mean BMI% by zip code and the distance to the nearest school-based health center (SBHC). Child BMI percentile (BMI%) of 10,806 2nd graders and 5,596 5th graders were collected by the CARDIAC Project in 2009-2010 and used in this study. Zip codes with more than 5 data points were retained for these analyses.

On average, 8% of the zip codes had a mean BMI% representing an overweight-obese population. SBHCs were found in 10.2% areas and adjacent to an additional 37.5%. The average distance to a SBHC was 28.9 kilometers. No significant association was found in mean BMI% based on the distance to a SBHC. SBHCs and other child-focused services within the community might be applicable locations for new obesity prevention programs. Future work will focus on characteristics of the SBHCs including types of programs offered and involvement within the community in hopes of better understanding the dynamic between these programs and West Virginia's adolescent obesity issues.
Abstract P226: Anticoagulation Therapy for Patients with Nonvalvular Atrial Fibrillation: Comparison of Decision Analytic Model Recommendation and Real-World Warfarin Prescription Use
Authors: Casciano Julian P , Singer Daniel E , Kwong W Jacqueline , Fox Eben S , Martin Bradley C
Published: March 2022

Background
The use of anticoagulation (AC) in AF is challenging because stroke risk reduction and increased bleeding risk must be considered simultaneously. We developed a decision model (DA) integrating stroke and bleeding risks to guide optimal use of AC and compared actual warfarin utilization in a real-world database with model recommendations.

Methods
A Markov model simulated health state transitions for newly diagnosed AF patients (N=64,946; mean age=71, 45% females) from the Thomson Reuters Marketscan database. The model evaluated occurrence and disability associated with stroke, intracranial and extracranial hemorrhage, and mortality with warfarin or aspirin treatment. Probabilistic transitions were based on patient demographics, stroke and bleeding risk assessed by CHADS
2
(Gage 2001), and ATRIA index scores (Fang 2010), respectively, and AC treatment effects from published clinical trials and other sources. The model recommended warfarin if estimated quality adjusted life expectancy was higher than for aspirin. Model recommendations were contrasted with warfarin prescription claims in the Marketscan AF cohort.

Results
Overall, 74.8% (n=48,548) of the cohort had CHADS
2
≥1, of which 85.7%, 4.6%, and 9.7% had low (0-3), moderate (4), and high (≥5) ATRIA bleeding risk, respectively. Almost all (91.9% of 48,548) patients with CHADS
2
≥1 were recommended to receive warfarin. The AC decision was less certain in patients with moderate stroke and moderate/high bleeding risks. Concordance of warfarin recommendation (Rec. W) and utilization (Rx W) was low and decreased with higher bleeding risk.

Stroke risk
N
Rec. W
Rx W
N
Rec. W
Rx W
N
Rec. W
Rx W

CHADS
2
≥4 (high risk)

2,558

100% (n=2,558)
58.7% (n=1,501)

339

100% (n=339)
51.9% (n=176)

900

97.1% (n=874)
50.8% (n=444)

CHADS
2
= 2 or 3 (moderate risk)

18,093

99.7% (n=18,043)
64.1% (n=11,574)

1,437

76.7% (n=1,102)
59.0% (n=650)

2,873

46.3% (n=1,330)
48.1% (n=640)

CHADS
2
= 1 (low risk)

20,930

97.3% (n=20,365)
65.3% (n=13,304)

468

0%
0%

950

0%
0%

ATRIA = 0 to 3 (low risk)

ATRIA = 4 (moderate risk)

ATRIA ≥5 (high risk)

Bleeding risk

Conclusions
This analysis is distinctive in its use of explicit bleed risk (by ATRIA index) and comparison of DA with clinical care. High discordance between actual warfarin use and model recommendation suggests the AC decision is often not based on systematic evaluation of stroke and bleeding risks. Model-based clinical decision aids may improve oral AC decisions.
Abstract P231: A National Initiative to Improve Utilization of Cardiac Imaging: The FOCUS Learning Community and Performance Improvement Module
Authors: Allen Joseph
Published: March 2022

Background:
The growth of medical imaging has placed burdens on healthcare finance and raised questions about quality of care. Resource sensitive and quality-centered imaging begins with the selection of the appropriate patient and test. Appropriate use criteria have been developed to aid clinicians but are often not in an easily accessible format.

Objective:
FOCUS, a web-based community, quality improvement, and education product, was developed to reduce inappropriate imaging by 15% in one year and by 50% within three years.

Methods:
Voluntary data collection occurred from April 2010 to January 2011 through the FOCUS Radionuclide Imaging Performance Improvement Module (PIM). The PIM consisted of three stages. In the first stage, participants entered patient cases (prospective or retrospective) to establish a baseline. Appropriate use was measured based on the 2009 RNI Appropriate Use Criteria using a computer based algorithm. Stage 2 featured the development of an action plan and incorporated quality improvement activities to support appropriate use of imaging. Patient cases were entered both at the end of stage 2, to check the participants progress, and in stage 3 (which is currently in progress), to evaluate the intervention period. Appropriate, inappropriate, and uncertain levels were compared between phases of the PIM.

Results:
For the 23 participating sites that had completed the two stages the proportion of inappropriate cases decreased from 10 %( 75/765) to 5 %( 33/609), for an overall decrease of 50% (p < .01)
(See Table)
.

Conclusions:
The data suggests that through the use of a self-directed, quality improvement software and interactive community, such as the FOCUS PIM, physicians can significantly decrease the proportion of tests not meeting appropriate use.

This table displays the changes seen in appropriateness between stage 1 and stage 2

Patient Cases
Stage 1
Stage 2
% Stage 1
% Stage 2
% Relative Change

Appropriate
633
535
83%
88%
+6%

Innappropriate
75
33
10%
5%
-50%

Uncertain
57
41
7%
7%
No Change

TOTAL
765
609
100%
100%
Abstract P233: Selecting Antiplatelet Therapy After Percutaneous Intervention for an Acute Coronary Syndrome: Weighing the Risks and Benefits of Prasugrel Versus Clopidogrel
Authors: Salisbury Adam C , Wang Kaijun , Cohen David J , Li Yan , Spertus John A
Published: March 2022

Introduction:
Clinical trials report the mean benefits and risks of a treatment for a population, which can mask the heterogeneity of risks and benefits for individual patients. Recognizing and communicating individual patients’ risks may support translation of trial results into practice.

Methods:
Using data from 12,907 ACS patients undergoing percutaneous coronary intervention (PCI) in TRITON-TIMI 38, we fit separate multivariable logistic regression models to predict major ischemia (cardiac death, MI & stroke) and bleeding (TIMI major/minor) risk with both prasugrel and clopidogrel. We built full models using variables selected
a priori
, then created a more parsimonious model by sequentially removing variables explaining the least variance until the reduced model R
2
in prediction of the full model fell below 0.95. Potential interactions were tested between treatment and all covariates.

Results:
Models are presented in the Figure; the ischemia risk model included interactions of treatment with age, heparin, diabetes and Killip class. Predicted risk of ischemia varied substantially across the population and was lower with prasugrel (mean 8.9%±4.2%, range 1%-50.6%) vs. clopidogrel (mean 11.3%±5.2%, range 1.5%-61.7%), while bleeding risk was greater with prasugrel (mean 5.0%±3.1%, range 0.5%-26.8%) vs. clopidogrel (mean 3.7%±2.4%, range 0.4%-20.8%).

Conclusions:
We found substantial variability in patients’ predicted benefit and risk. Risk models that leverage data clinical trial data to estimate each patient's risk and benefit with prasugrel vs. clopidogrel at the time of decision making should be tested to see if they support safer, more cost-effective care.
Abstract P241: Treatment Persistence Among Atrial Fibrillation/Flutter Patients on Combination Warfarin and Antiarrhythmic Drug Therapy in the Real-World Setting
Authors: Alpert Joseph S , Guerin Annie , Lin Jay , Jhaveri Mehul , Wu Eric Q
Published: March 2022

Background:
Antiarrhythmic drugs and warfarin (W) are often co-administered for atrial fibrillation/flutter (AF/AFL). Amiodarone (A) potentiates the anticoagulant effect of W, necessitating frequent INR monitoring and dose adjustment. We compared real-world treatment persistence in AF/AFL patients (pts) receiving W + A or W + another Class I/III antiarrhythmic drug (Other AAD).

Methods:
This retrospective cohort study identified AF/AFL pts ≥18 yrs with concurrent pharmacy claims (≥ 60 days' supply over first 90 days) for W and A or Other AAD from the Ingenix IMPACT database (1997-2009). Eligible pts had ≥1 claims with an AF/AFL diagnosis ≤6 months before starting concomitant W + A or W + Other AAD (‘index date’) and continuous pre- (≥6 months) and post-index (≥12 months) enrollment. Drug discontinuation (≥ 60-day gap between consecutive prescriptions) was recorded over 1 year from the index date. Pts were censored at first discontinuation of either drug (last day with supply before 60-day gap) or after 1 year. Times to drug discontinuation (either drug and W and AAD separately) were compared using Cox proportional hazards models.

Results:
4,238 pts (mean age 66.5 yrs; 70% male; mean Charlson Comorbidity Index [CCI] 1.76) received W + A and 6,332 pts (mean age 61.9 yrs; 65% male; mean CCI 0.89) received W + Other AAD. Over 1-year post-index, the W + A cohort had higher rates of discontinuation of warfarin (51.7%
vs
43.4%), AAD (53.1%
vs
32.9%) or either drug (72.7%
vs
58.3%) than the W + Other AAD cohort (all
P
<0.0001) (Table). After adjusting for demographic/clinical differences, the W + A cohort was at higher risk of discontinuing warfarin (hazard ratio [HR] 1.33, 95% CI 1.25−1.42), AAD (HR 1.92, 95% CI 1.80−2.06) or either drug (HR 1.54, 95% CI 1.46−1.62) than the W + Other AAD cohort (all
P
<0.0001).

Treatment discontinuation rate - either drug

90 days
180 days
360 days

Warfarin + Amiodarone
19.1%
48.5%
72.7%

Warfarin + Other AAD
14.0%
36.6%
58.3%

Conclusion:
In real-world practice, AF/AFL pts are less persistent with W + A than with W + Other AAD combination therapy. The reasons for this difference remain to be established.
Abstract P25: Factors Associated with Patients' Adoption and Adherence to a Heart Failure Telemonitoring System
Authors: Mattera Jennifer A , Chaudhry Sarwat , Lin Zhenqiu , Curry Leslie , Hodshon Beth , Herrin Jeph , Merry Brian , Krumholz Harlan M
Published: March 2022

Background:
Despite numerous studies of telemonitoring (TM), the use of technology to monitor patients remotely, information about patients' adoption and adherence to using such technologies is scarce. The objective of this study was to determine the patient characteristics associated with: 1) initiating use of TM and 2) adherence to using daily TM over 6 months.

Methods:
We evaluated all 826 patients enrolled in the TM arm of the Tele-HF multicenter RCT. TM consisted of a telephone-based interactive voice response system whereby patients reported symptoms and weight daily for 6 months. The adherence rate was calculated as the # of weeks the patient used the TM system at least 3 days/week over 6-month study period. Multivariable hierarchical regression was used to identify factors independently associated with initiation of and adherence to TM.

Results:
The mean ± SD age of patients was 61.1 ± 15.3 years (range 19-90), 44% were women, and 50% were of minority race. Overall, 14% (119/ 826) never initiated use of TM. In the multivariable analysis, younger patients (age < 65) and patients with higher satisfaction with care were more likely to initiate TM (p-values ≤ .03) (Figure). Among the 707 patients who initiated TM, adherence averaged 90% in week 1 and 55% in week 26. Younger patients and those with lower health literacy had lower rates of adherence to using TM over 6 months (p-values ≤ .004).

Conclusion:
Age, satisfaction with care and health literacy were associated with utilization of a TM system for the management of HF. Understanding more about how patient nonclinical factors impact use of new technologies such as TM, may improve the design and effectiveness of TM strategies.
Abstract P253: Lipid Control in Minority and Nonminority Veterans Following Percutaneous Intervention
Authors: Healy Chris , McGraw Sloane A , Mohamedali Burhan , Shivaraju Anupama , Scholfield Michael , Shroff Adhir
Published: March 2022

Background:
Control of lipids is vital in patients with Coronary Artery Disease (CAD). According to the American College of Cardiology (ACC) guidelines, all patients with CAD should have low density lipoprotein (LDL) goals of less than 100 mg/dl. It is unclear whether race plays a role in lipid control.

Methods:
We conducted a retrospective cohort study focusing on lipid management and statin use in 857 veterans, 41% minority (M) & 59% non-minority (NM), undergoing percutaneous coronary intervention (PCI) between September 2004 and December 2009 at the Jesse Brown Veterans Hospital in Chicago, IL. Values were collected both pre-intervention and at six month follow up.

Results:
The mean total cholesterol and LDL decreased from prior to intervention to six month follow up in both groups. The mean total cholesterol pre-PCI and at six month follow up was 166 mg/dl & 150 mg/dl, respectively, in the minority group and 165 mg/dl & 150 mg/dl, respectively, in the non-minority group. The mean LDL pre-PCI and at six month follow up was 100 mg/dl & 88 mg/dl, respectively, in the minority group and 94 mg/dl & 82 mg/dl, respectively in the non-minority group. The percent of patients at LDL goals of 100 mg/dl pre-PCI and at six month follow up were 55% and 73% in the minority group and 64% and 77% in the non-minority group. The percent of patients on a statin pre-PCI and at six month follow up were 70% and 91% in the minority group and 75% and 88% in the non-minority group.

Conclusions:
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 ACC recommended goal of LDL cholesterol less than 100 mg/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 P259: Novel Risk Factors and Management Strategies for Transient Ischemic Attack and Stroke: The Inova Fairfax Stroke Database
Authors: Cochran John W , Callahan Christa , Krzywicki Karen , O'Mara Susan , Whitson Maurie , Munoz Rosalyn , Mancini Barbara , Kitsantas Panagiota , Cheema Jehanzeb
Published: March 2022

INTRODUCTION
Several studies suggest that obstructive sleep apnea (OSA) is a novel risk factor for cerebrovascular and cardiovascular disease. The Berlin Questionnaire (BQ) which is an inexpensive screen for OSA was used in the current study to examine potential associations between OSA (as measured by BQ), stroke and transient ischemic attack (TIA).

METHODS
During the 2008 calendar year 1,434 stroke and/or TIA patients were evaluated by the stroke response nurses at Inova Fairfax Hospital. Although the original sample size provided by the Inova staff was 1,433, not all of the patients responded to the BQ. Of the 1,433 cases, 113 were eliminated because they had non-unique responses. Of the remaining cases, 60 cases were left that provided complete responses to the BQ and had no missing values.

STATISTICAL ANALYSIS
We focused only on two outcomes, ischemic stroke and TIA. Demographic variables: Gender, race (white and non-white), and age. Descriptive statistics were performed for all variables. Univariate analyses were performed and associations between the dependent variables and the predictors were analyzed using exact tests. Logistic regression models were built to identify any potential risk factors for TIA and ischemic stroke.

RESULTS
In this sample, approximately 28.3% were females and 71.6% were male. The sample was composed of 65% white and 35% non-white patients. The average age of the entire sample was 65.6 years (SD= 13.2 years). Further, 23.3% were identified as having TIA, 55.5% had suffered ischemic stroke while 21.6% had other type of stroke or no diagnosis.

Exact tests of significance failed to detect any significant associations between stroke type and OSA as measured by BQ. Furthermore, we did not find any significant associations or differences between age, race, gender, OSA and the outcome variables. Findings from the binary logistic regression models did not identify any significant predictors of TIA and ischemic stroke.

CONCLUSIONS
Although in this study we did not find a significant association between OSA, TIA and ischemic stroke, we recommend that this study be replicated with larger samples. An analysis of the cause of such low number of complete responses will follow as well.
Abstract P261: The Effectiveness of the “InSTROKEtional” Module in Increasing the Level of Knowledge of Primary Caregivers of Postcerebrovascular Accident Patients for Home Care Management
Authors: Magalona Marxanndra A , Magdangal Kennrick Glenn G , Lusabia Julie Anne D , Lustresano Mary Ann S , Macrohon Carizza Candra Rei L , Madrazo Angela G , Magnaye Rei Nikolai T
Published: March 2022

Cerebrovascular Accident (CVA) is a major cause of disability which afflicts a great number of Filipinos yearly. Disability often leads to inability to perform activities of daily living resulting to the need for caregivers for assistance. However, not all caregivers are knowledgeable enough about CVA. As nurses, providing care includes educating the client and caregiver about CVA and its management. Therefore, in order to facilitate effective home care management, informational materials must be provided to ensure quality care. This led to the development of the “InSTROKEtional” module to increase the level of knowledge of caregivers on CVA and its management.

The study utilized a quasi-experimental quantitative research that followed pretest-posttest design. The design was used to evaluate the effectiveness of the “InSTROKEtional” module in increasing the level of knowledge of primary caregivers of post-CVA patients. A non-probability, convenience sampling design was used to gather participants consisting of fifteen (15) caregivers of post-CVA patients from hospitals in the Philippines. The caregivers were subjected to a pretest to measure their level of knowledge prior to the implementation of the “InSTROKEtional” module. After a five day interval, the participants were given a posttest to determine the change in their level of knowledge about CVA.

The mean scores of the pretest taken by the caregivers was 11.87 while the mean score for the posttest was 16.73. The results showed that the module was effective in providing the caregivers additional information about CVA. Therefore, the “InSTROKEtional” module is an effective intervention in increasing the level of knowledge of primary caregivers of post-CVA clients as seen by the significant difference between the pretest and posttest scores.
Abstract P263: Dynamic Changes and Lifetime Scores of Quality of Life Measured by WHOQOL-BREF for Patients with Different Types of Ischemic Stroke
Authors: Hung Mei-Chuan , Lee Hsin-Yi , Jeng Jiann-Shing , Wang Jung-Der
Published: March 2022

Background and Purpose:
Few studies have estimated the dynamic changes and lifetime scores of quality of life (QOL) among different subtypes of ischemic stroke. The aim of this study is to quantify these changes as an understanding to the demand of long term care for these patients.

Methods:
The hospital-based cohort, which consisted of 10,102 patients with first-ever ischemic stroke during 1995-2007, were classified into large artery atherosclerosis, lacunar, cardioembolism and other determined or underdetermined subtypes. After linking with the National Mortality Registry 2008, survival function were determined and extrapolated over a 600 months period based on the survival ratio between the patient's survival and age- and sex- matched reference group's as estimated by a semi-parametric method through Monte Carlo simulation and hazard functions taken from the vital statistics of Taiwan. The survival functions were then multiplied with the scores of QOL assessed under the WHOQOL-BREF questionnaire based on a cross-sectional random sample of 748 patients with different subtypes of ischemic stroke to estimate the dynamic changes and lifetime scores of QOL.

Results:
Patients with large artery atherosclerosis showed the lowest average scores in each domains and facets along with time, and the lifetime scores of QOL were 39.45 (1.73), 41.17 (3.04), 41.06 (2.82), 47.01 score-months (2.59) in physical, psychological, social and environmental domains, respectively. The lucunar stroke appeared the second lowest with lifetime scores of 64.05(3.22), 63.13(2.64), 67.39(2.44), and 112.04(3.57) score-months, accordingly. They were followed by cardioembolism and other subtypes.

Conclusion:
The dynamic changes of QOL scores and lifetime scores were worst in patients with large artery atherosclerosis followed by lacunar stroke, indicating a greater demand for long term care for these types of ischemic stroke.
Abstract P264: Medication Coaching for Secondary Prevention Adherence in Stroke Patients: A Pilot Study
Authors: Bushnell Cheryl , Sides Elizabeth , Zimmer Louise , Olson DaiWai , Pan Wenqin , Peterson Eric
Published: March 2022

Objective:
Education about stroke prevention medications after discharge is suboptimal. Our aim was to assess feasibility of a telephone intervention designed to provide education and coaching about medications and/or stroke recovery following hospital discharge.

Methods:
We performed a two-arm pilot study of patients admitted with ischemic or hemorrhagic stroke or TIA who had at least 2 medications changed between admission and discharge. The intervention was a telephone contact from a medication coach (study coordinator) about 2 weeks after discharge and included reviewing each medication on the participant's discharge list, assessing his/her understanding about the medication's purpose, how to take it, refill it, and its side effects. Patients were then asked if they had any specific questions about their medications or stroke recovery. The coach triaged medication-related questions to a pharmacist and stroke-related questions to a stroke nurse, compiled responses, and called the patient back with the information.

Results:
Thirty patients were enrolled, (intervention n=20, 12 women; and control n=10, 4 women) and we report results for 29 patients. Age, gender, stroke severity, socioeconomic status, and number of discharge medications were similar in both groups. In the intervention group, 7 of 19 patients stated the correct reason for all prescribed prevention medications and 9 could state the reason for 50% or more. None could identify side effects for all prescribed medications and 5 were unable to list any medication side effects. Eleven of the 19 patients (58%) in the intervention group had questions for the pharmacist or nurse (range1 to 5 questions per patient). More women (7 of 11) requested information than men (4 of 11; p=0.017). The median number of calls required to complete the intervention was 2 (range 1 to 9). The median lengths of the coaching and follow-up calls with requested answers to questions were 27 minutes and 12 minutes, respectively.

Conclusion:
This medication coaching pilot study performed early after discharge demonstrated feasibility of coaching and educating stroke patients using pharmacy and nurse consultation, via a coach. Larger studies are needed to determine the impact of this intervention on medication adherence.
Abstract P3: Socioeconomic Status a Better Predictor of Heart Failure Outcomes than Performance Measures
Authors: Schopfer David W , Gans Christopher P , Stamos Thomas D
Published: March 2022

BACKGROUND
ACC/AHA published performance measures for patients admitted to hospitals with heart failure (HF) in 2005 with the goal to provide a standard of care. Hospitals have made significant changes to be compliant with these recommendations, however, there are limited data evaluating if these measures are responsible for decreasing morbidity and mortality.

METHODS
The US Department of Health and Human Services Hospital Compare database was used to identify patients admitted with a diagnosis of HF in 2008. Hospitals were excluded if they treated fewer than 25 HF patients or there was incomplete data collected. Inpatient performance measures for HF were defined as: evaluation of left ventricular (LV) systolic function, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin-receptor blockers (ARB) for LV systolic dysfunction, smoking cessation counseling, and discharge instructions. Risk-adjusted 30-day mortality and readmission rates were also collected. Using hospital zip codes, catchment demographic data was correlated using US Census Bureau data from 2000. Statistical analysis was performed using ANOVA and multiple regression.

RESULTS
Analyses included 3,659 hospitals treating 1,059,640 patients. Hospitals reporting greater compliance with performance measures had significantly lower 30-day mortality and readmission rates. However, after controlling for individual measures and demographics, socioeconomic status consistently had a significant association with mortality and readmission rates. Only ACE-I/ARB use was associated with a lower readmission rate (p<0.001) for performance measures.

CONCLUSION
This study found that multiple socioeconomic factors but only 1 of 4 HF performance measures are significant predictors of improved HF outcomes. Further research to determine appropriate metrics of quality care for HF is necessary.

Multivariable Analysis of Factors on Mortality and Readmission Rates

Effect on Mortality
Effect on Readmission

Variable

t
ratio

p
value

t
ratio

p
value

EF evaluation
0.5512
0.5816
1.715
0.0865

ACE/ARB
0.1014
0.9192
2.750
0.0060

Smoking cessation
0.9793
0.3275
0.1936
0.8465

Discharge instructions
0.7698
0.4415
1.014
0.3105

Age
0.2831
0.7771
0.8412
0.4003

Household income
8.928
<0.0001
5.968
<0.0001

% HS graduates
4.997
<0.0001
9.211
<0.0001

% White
5.479
<0.0001
0.6069
0.5440

% Black
0.6494
0.5161
3.184
0.0015

HF admissions
11.875
<0.0001
0.5310
0.5954
Abstract P30: Gender-Specific Profiles of Lifestyle Behaviors Among US Adults Treated for Hypertension
Authors: Lee Christopher S , Abraham Ivo , Skrepnek Grant H
Published: March 2022

Background:
The 7th Joint National Committee (JNC7) recommends lifestyle behavior modification as an essential strategy in the management of hypertension.

Purpose:
To identify gender-specific profiles among multiple JNC7-recommended lifestyle behaviors in a nationally-representative sample of adults on antihypertensive medications.

Methods:
We used data from the 2009 CDC Behavioral Risk Factors Surveillance Study on adults (age ≥18years) taking antihypertensive medications. Latent class mixture modeling (with sampling weights) was applied to identify common profiles among ordered categories of physical activity, fruit/vegetable consumption, alcohol consumption, body mass index, and smoking in models stratified by gender. Lo-Mendell-Rubin tests were used to compare model solutions (k vs. k-1 profiles). Within-profile gender differences were quantified using χ2 tests. Results are reported in weighted means or proportions ± standard errors.

Results:
Mean age (population estimate=45,703,441) was 61.1±0.1 years; 51% of the sample was female. Lifestyle behaviors fit best into three profiles for both women and men (both P<0.05). Hallmarks of profile 1 (35.9% of women, 37.3% of men) were high prevalence of physical activity, low prevalence of obesity, and frequent fruit/vegetable consumption. Hallmarks of profile 2 (52.2% of women, 52.5% of men) were very high prevalence of insufficient physical activity, very high prevalence of obesity, and moderate-to-low fruit/vegetable consumption. Hallmark of profile 3 (11.9% of women, 11.1% of men) were current smoking, high prevalence of insufficient/no physical activity, high prevalence of obesity, poor fruit/vegetable consumption, and the highest prevalence of alcohol consumption. Within each profile, there were significant differences in each lifestyle behavior comparing women with men (all P<1x10-7).

Conclusions:
We observed three distinct profiles that characterize a gradient of cardiovascular risk based on multiple modifiable lifestyle behaviors in hypertension that are different in women and men. Personalized and gender-specific interventions that focus on multiple lifestyle behaviors are needed to reduce cardiovascular risk in the treated hypertensive U.S. population.
Abstract P41: How to Implement International Recommendations in Daily Practice in a Large EMS Center
Authors: Goddet Nathalie S , Descatha Alexis , Loeb Thomas , Baer Geraldine M , Pochet Veronique , Lagron Patrick , Baer Michel ,   Professional Practice Assessment Working Group
Published: March 2022

Introduction:
Continuous professional development and education associated with Evaluation of health Professional Practices (EPP) has been legally implemented and is mandatory in France since 2004. EPP applies to all aspects of the health care system, including pre-hospital EMS and their call centers. EPP must comply with one of the restricted proposals issued by Health Authorities. The aim of this presentation is to lay out the methodology selected to achieve this legal requirement in an EMS serving 1.5 million population.

Methods:
The proposed methods were: clinical audit compared with standards, identification of existing procedures, identification of clinical decision trees, identification of patient's pathway to optimised final care. Among these methods, identification of patient's clinical pathway was selected as the best method for a call center study, since it allows to monitor the overall handling of an emergency call, from the early phone call to the final point of care. Among the various pathologies, cardiac arrest was selected because: 1 - The release of new AHA recommendations in 2010, 2 - Similar “cardiac arrest” EPP developments in the hospital where the EMS is based, 3 - The need for quality control of all cardiac arrest calls.

Expected results:
EPP in the EMS is divided in 3 steps: Step 1: results from studying the running procedures, regarding call handling of cardiac arrests including triage performed by operators and medical dispatchers (physicians). Retrospective study of files that were triaged as cardiac arrests by operators. Duration: 6 months. Step 2: elaboration of an action plan: Sharing of the results with operators and medical dispatchers. Setting up of a global team training program for both operators and physicians, in agreement with new AHA guidelines. Duration: 6 months. Step 3: new retrospective study based on the same methodology than step 1, done after 6 months. The comparison of results of both studies will lead to the selection of pertinent indicators allowing continuous quality control.

Conclusion:
This EPP aims at evaluating and improving the management of emergency calls. It is expected to bring other benefits, such as easing the implementation of new guidelines, or defining new indicators for a continuous quality control.
Abstract P51: Trends in Utilization of Invasive Cardiac Procedures in North Carolina
Authors: Jones W S , Patel Manesh R , Holleran Sara A , O'Connor Christopher M , Harrison J K , Phillips Harry R
Published: March 2022

Background:
Concerns around utilization of coronary revascularization remain in the US. We aimed to understand the temporal trends and variation in invasive diagnostic cardiac catheterization (Cath), percutaneous intervention (PCI) and coronary artery bypass surgery (CABG) in North Carolina from 2003-2009.

Methods:
All Cath, PCI, and CABG procedures performed in North Carolina from 2003-2009 were identified using hospital-reported data submitted in a License Renewal Application by all catheterization labs for the North Carolina State Medical Facilities Plan. Rates of procedure use, ratios of PCI to Cath, CABG to Cath, and CABG to PCI were compared over time and between hospitals. Hospitals that performed at least 25 Cath, 25 PCI, and 25 CABG were included in the variation analysis.

Results:
From 2003-2009, there was an observed decline in the annual rate of all procedures, 16% for Cath, 9% for PCI, 27% for CABG. However, the ratio of PCI to diagnostic Cath over the time period increased by 10%, rising to 51% in 2009, while the ratio of CABG to Cath decreased by 10% (see Figure). Of the 119 hospitals in North Carolina, 21 hospitals reported performing more than 25 Cath, 25 PCI and 25 CABG each year from 2003-2009. Hospital level analysis also showed evidence of significant variation in the ratio of both PCI to Cath (10% to 90%, p<0.05) and CABG to Cath (5-35%, p<0.05).

Conclusions:
Although the use of all cardiac procedures declined, the ratio of PCI to Cath increased over the study period. There was significant variation in the mode of revascularization (CABG and PCI) across hospital systems in North Carolina. Further investigation into revascularization decisions is warranted.

Figure.Trends in Volume and Rates of Diagnostic Cath, PCI, and CABG in North Carolina from 2003-2009.
Abstract P56: Early and Mid-Term Outcome of LAD Endarterectomy and Left Internal Mammary Artery Bypass in Patients with Severe Coronary Artery Disease with Poor Targets
Authors: Chaturvedi Rakesh K , Binsalamah Ziad , Alam Ahsan , Belly Genevieve , Dominique Shum-Tim
Published: March 2022

Background:
With the advancement of percutaneous trans-coronary angioplasty and stenting, patients referred for bypass grafting (CABG) are usually higher-risk and have advanced coronary artery diseases (CAD). The distal targets are frequently diffusely calcified and not amenable for stenting or even CABG. The objective of this study is to review the outcome of endarterectomy in the LAD, in addition to conventional left internal mammary artery (LIMA).

Methods:
Between September 2005 to June 2010, 52 consecutive patients operated on for severe multi-vessel CAD affecting the LAD were managed with endarterectomy, with or without patch (vein or LIMA) reconstruction, in addition to LIMA grafting of the LAD (Group E). Their medical records were reviewed retrospectively and patients followed prospectively. Another 52 matched-control patients operated on with conventional CABG (Group C) over the same period were used to compare their clinical outcome. CT angiography was performed in 24 Group E patients between 3-23 months post-operatively. Continuous variables were expressed as mean±SD and categorical variables were expressed as absolute numbers. All variables were analyzed with univariate and multi-variate analysis to determine whether any single factor influenced outcome. P<0.05 is considered significant.

Results:
The demographic characteristics, operative data between groups were recorded. All patients remain free of angina or symptoms of congestive heart failure with zero 30-days mortality. Compared with control, post-operative inotropic/pressor requirements were significantly lower (p= 0.001), despite longer surgery time (p<0.0001) in group E. CT-angio showed LIMA graft patency in all studied Group E patients. Although the median ICU stay was significantly longer in endarterectomy patients (p<0.0001), the overall hospital stay was similar between groups (p=0.76).

Conclusions:
In patients with diffused LAD disease, the use of extensive endarterectomy with or without patch reconstruction followed by LIMA graft offers a safe alternative for complete revascularization. Alternative techniques with excellent early results can be considered in poor coronary distal beds before rendering the patients non-operable.