bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 216: Outcomes Of Percutaneous Coronary Interventions In Patients With Chronic Total Occlusion (CTO): A Single Center Study Evaluating A New Dedicated CTO Program In Egypt
Authors: Fathelbab Hany Tawfik , Abdelghany Mahmoud , Megaly Michael S , Shawky Mohamed Ashraf
Published: May 2022

Background:
Percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO) is underutilized. Initiation of a dedicated, cost-oriented, CTO PCI program is challenging.

Objectives:
We present our experience in establishing a limited resources dedicated multi-operator CTO PCI program in a major tertiary academic center in Egypt.

Methods:
We analyzed the clinical, angiographic, and procedural characteristics of patients who underwent CTO PCI during the first year of our program. Major outcome was successful recanalization. Other outcomes include in-hospital mortality, stroke, peri-procedural myocardial infarction (MI), coronary perforation, and urgent need of coronary artery bypass grafting (CABG).

Results:
Sixty-four patients underwent CTO PCI. The median J-CTO score was 2 (0-5). Successful recanalization was achieved in 47 patients (73%). The most common cause of failure was failure of re-entry (46.7%). The mean number of wires per patients was 2.69+/-1.32, and the most successful crossing strategy was antegrade wire escalation (56.3%). The mean procedural time was 123 +/- 48.8 min, mean contrast volume was 359.03 +/- 151.9 and mean radiation dose was 9.4 +/-4.2 Gy. There was no in-hospital mortality nor stroke. We had one case (1.6%) with peri-procedural MI, and one patient who needed an urgent CABG. The cost ranged from 6520 Egyptian Pounds (EP) ($415) to 63, 720 EP ($4058), with a mean of 26,213 EP ($1670) (Table 1).

Conclusion:
A dedicated limited resources CTO PCI program, in a low-income country as Egypt, can probably be established with a good success rate and a low complication rate. Proctored program allows rational equipment utilization and growth of the operators’ experiences and skills.
Abstract 222: Paradoxical Favorable Clinical In-hospital Outcomes In Geriatric HF(pEF) Patients With Depression
Authors: Desai Rupak , Chintalapalli Patta Harika Varma , Soni Sukriti , Ghumare Ishan , Khanolkar Vidhi , Yadav Tarun , Bansal Prerna , Asifali Roshna , Asifali Ryana , Asfeen Ummul Z , Alukal Thomas , Jain Akhil
Published: May 2022

Background:
Depression has been identified as a risk factor for acute cardiovascular events. Considering limited data on the subject, we studied the burden and impact of comorbid depression on heart failure with preserved affection fraction (HFpEF)-related hospitalizations and outcomes using a nationally representative sample.

Methods:
Elderly (≥65 years) patients’ hospitalizations with HFpEF (after excluding HFrEF) were extracted from the National Inpatient Sample 2018 (ICD-10) and divided into with or without comorbid depression. Demographics, clinical profile and major cardiovascular and cerebrovascular events (MACCE, all-cause mortality, AMI, cardiac arrest and stroke) were compared between cohorts. Multivariable regression analysis was performed controlling covariates to assess the risk of MACCE in geriatric HFPEF admissions with depression.

Results:
Of 1,599,220 HFpEF hospitalizations in elderly patients (median age 80 years, 61.1% females) 14.1% (n=224,970) had comorbid depression (median age 77 years, 70.6% females). Females had a higher depression prevalence than males (16.2 vs. 10.6%, p<0.001). The HFpEF-depression arm often had relatively younger (77 vs. 80 years), white (83.1 vs. 76.1%), female (70.6 vs. 59.6%) patients with a significantly higher burden of CVD risk factors including hypertension, DM, hyperlipidemia, obesity, smoking, prior MI/TIA/stroke, alcohol abuse, anxiety-related and bipolar disorder vs. non-depression arm. Interestingly, the depression arm had a significantly lower rate (10.9% vs. 13.6%) and lower odds of MACCE (aOR 0.85, 95CI 0.82-0.88) when adjusted for sociodemographic confounders and comorbid risk factors (p<0.001)
[Table 1]
.

Conclusion:
The elderly patients with HFpEF have a high burden (female>males, whites>non-whites) of comorbid depression, however, our analysis revealed the “depression paradox” effect for in-hospital MACCE in geriatric HFpEF admissions and needs further evaluation.
Abstract 242: Assessing Variation In Data Captured By Clinical Registries And The Electronic Health Record: Clinical Phenotypes Of Patients Undergoing Cardiac Catheterization
Authors: Sheppard John P , Huang Chenxi , Mortazavi Bobak J , Schulz Wade L , Krumholz Harlan M , Khera Rohan
Published: May 2022

Background:
Cardiovascular registries are built through expert abstraction of summary clinical information often represented as binary flags used to define diagnosis status. We considered underlying variation in clinical data obtained from the electronic health record (EHR) with respect to binary flags denoting presence or absence of cardiometabolic disease in a clinical data registry.

Methods:
We linked data abstracted for percutaneous coronary intervention (PCI) visits registered in NCDR CathPCI® with EHR data from Yale New Haven Hospital. We identified registry flags indicating diagnoses of hyperlipidemia (HLD), hypertension (HTN) and diabetes mellitus (DM) and evaluated EHR data with respect to registry diagnosis status.

Results:
Among 3,473 patients, mean age was 67 ± 12 years and 960 (28%) patients were female. HLD, HTN and DM registry diagnoses were present (+) in 2694 (78%), 2833 (82%) and 1358 (39%) patients, and absent (-) in 779 (22%), 640 (18%) and 2115 (61%) patients. EHR data revealed mean baseline total cholesterol of 168 ± 51 mg/dL (+HLD) vs 182 ± 44 mg/dL (-HLD), presenting systolic blood pressure of 130 ± 19 mmHg (+HTN) vs 120 ± 17 mmHg (-HTN), and A1c of 7.9% ± 1.8% (+DM) vs 5.8% ± 0.7% (-DM). Prescription histories of patients with HLD, HTN or DM diagnoses included 1 or more relevant drug class in 2409 (89%), 2620 (92%) and 1222 (90%) patients, and 2 or more drug classes in 450 (17%), 2020 (71%) and 820 (60%) patients. Patients without these diagnoses had been prescribed 1 or more drug class in 268 (34%), 223 (35%) and 55 (3%) patients, and 2 or more drug classes in 28 (4%), 71 (11%) and 9 (0.4%) patients (Figure 1).

Conclusions:
Binary diagnosis flags used in cardiovascular registries do not capture the full variation of clinical phenotypes underlying cardiometabolic disease processes. Harnessing comprehensive EHR data may provide a fuller picture of cardiometabolic disease, enhance quality and utility of national registries and improve outcomes research.
Abstract 245: Increased Prevalence Of Children With Congenital Heart Disease In Colorado From 2012 - 2019
Authors: Parker Devin M , Brown Jeremiah R , Stabler Meagan E , Everett Allen D , MacKenzie Todd A
Published: May 2022

Introduction:
Congenital heart defects (CHD) are the most common birth defects and are estimated to affect almost 1% of births per year in the US. Most CHD prevalence estimates are based on data from population-based birth defects surveillance systems and these estimates are inconsistent due to varied definitions. It is therefore important to derive high-quality, population-based estimates of the prevalence of CHD to help care for this vulnerable population.

Methods:
We analyzed all payer claims data (APCD) from Colorado from 2012-2019. Children with CHD were identified by applying CHD ICD-9 and ICD-10 diagnoses codes from the Society of Thoracic Surgeons (STS) International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD) harmonized cardiac codes. We included children with CHD < 18 years of age who resided in Colorado, had a documented zip code, and had at least one ambulatory healthcare claim. We analyzed the test for linear trends in the proportion of CHD diagnoses from 2012-2019 with the Cochran-Armitage (Z) test. Differences among patient characteristics and CHD diagnosis were tested using the Pearson Chi-square test and Wilcoxon rank sum tests as appropriate.

Results:
Overall the current study analyzed 1,565,438 children with 36,567 CHD diagnoses (i.e. 23.4 per 1,000 live births), comprising 2.3% of the pediatric population. Between 2012 and 2019 the statewide rate of children diagnosed with CHD significantly increased from 21.9 to 32.3 per 1,000 children per year (Z: 5.38; p<0.001). There were statistically significant differences in the magnitude of the trend in CHD prevalence rate by region (Z: -31.82), urban-rural residence (Z:-24.02), degree of chronic complex conditions (Z: -38.78), disease severity (Z: -44.11), age (Z: -72.89), insurance type (Z: 46.51) and median household income (Z: 12.87; all p<0.001).

Conclusion:
The current study is the first population-level analysis of pediatric CHD in the US and these findings suggest that the statewide CHD prevalence rate has increased significantly since 2012. Children with CHD are a priority population for quality improvement in pediatrics given their growing prevalence and corresponding risk of adverse outcomes.
Abstract 248: IMPLEMENT-HF: An Initiative To Improve Guideline Adherence Across The Continuum
Authors: Cherkur Sruthi , Kiser Robin Y , Serdynski Lynn , Saunders Rhoda , Sterzing Christina , Macheska Kelly L , Scharnott Michelle , Bolles Michele M , Fonarow Gregg C , Yancy Clyde W
Published: May 2022

Background & Objectives:
Nearly 1 in 4 heart failure (HF) patients are readmitted within 30 days of discharge and nearly half readmitted in 6 months. HF prevalence is projected to continue increasing resulting in over 8 million adults with HF by 2030. Rising prevalence and poor outcomes provide significant improvement opportunities. Health system participation in a quality improvement (QI) initiative promoting adherence to evidence-based scientific clinical practice guidelines informs high quality care and improves patient outcomes. IMPLEMENT-HF, an American Heart Association (AHA) multi-site QI collaborative across inpatient and outpatient settings, uses implementation science and data analysis to improve guideline adherence across the HF care continuum.

Methods:
The IMPLEMENT-HF program targets the transformation of HF care in seven national regions. Organizations across the care continuum collect baseline and 30-day follow-up HF data and contribute to learning collaboratives. Data sources include HF measures in the AHA Outpatient Pilot Registry and Get With The Guidelines®-Heart Failure (GWTG-HF) inpatient and post-acute data. In addition to quantitative data, qualitative data including needs assessments, model sharing queries, and evaluation surveys are assessed. After establishing benchmark data, performance is evaluated continuously to identify care gaps. Opportunities for HF QI from this analysis emanate from 1:1 site meetings, regional, and initiative-wide learning collaboratives. AHA staff monitor data to recommend improvements, provide consultation, and deliver targeted training and resources to address common guideline adherence barriers.

Intended Analyses:
Demonstrate improved guideline adherence across the currently participating 60 sites; benchmark clinical outcomes, esp., mortality, against prevailing community norms with a goal absolute reduction in cardiovascular mortality of 5%; and use multi-site collaboration to develop and promulgate implementation strategies.

Conclusions:
This three-year multi-region QI initiative connects sites to share challenges and strategies, develop resources, and analyze data to foster continuous guideline adherence improvement across the HF care continuum.
Abstract 255: Implementation Of An Electronic Health Record (ehr) Tool To Improve Care Delivery In The Management Of Heart Failure
Authors: Ibrahim Michel , Ruppert Linda , Hoosain Jamael , Rakita Val , Hamad Eman
Published: May 2022

Background:
The usage of guideline-directed medical therapy (GDMT) in the treatment of heart failure (HF) has shown to reduce mortality and hospitalization. However, majority of the HF patients do not receive GDMT or do not achieve the target dose despite the abondance of positive evidence. We conducted a quality improvement project at our hospital with the aim to evaluate the impact of utilization of an Epic-based EHR tool that allows adherence with evidence-based guidelines and improve efficiency in coordination of care.

Methods:
Our cohorts included adult patients admitted with Acute Decompensated Heart Failure. We implemented within our documentation using structured EHR notes to pre-populate clinical data on patient including their current GMDT, also justifying the reasons why they aren’t on certain medications (GDMT).

Results:
When comparing our pre (2020) and post (2021) intervention data, we observed an increase from 50% to 97% in compliance with beta-blockers, angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs) or Angiotensin receptor-neprilysin inhibitors (ARNIs) on discharge(Figure 1). 7-day follow up scheduled before discharge went from 58% pre-intervention to 91% post-intervention (Figure 1).

Conclusion:
This retrospective, single-center observation study found that an integrated EHR disease specific template can help improve adherence to GDMT in turn improving survival and reducing hospitalization. We observed a 100% compliance with BB, ACEi/ARBs or ARNIs. There was also an improvement in 7-day discharge follow up.
Abstract 256: Discharging Low-risk Pulmonary Embolism From An Emergency Room
Authors: Koujane Radwa , Drogowski Matthew , Abou-Alaiwi Ali , Newson Joshua , McNally Vicki , Chen Nai-Wei , Berger David A , Turner-Lawrence Danielle
Published: May 2022

Background and Objectives:
Patients with PE are traditionally admitted on parenteral agents, despite increasing literature that sPESI negative patients can be safely discharged from the ED. Our quality improvement initiative is focused on outpatient treatment for ED-diagnosed pulmonary emboli (OTPE) and our objective is to assess LOS, readmissions and to describe findings of our follow-up phone calls.

Methods:
This is an actively enrolling prospective study from 7/2020 at a single site with >500 PE cases per year with a PE Response Team (PERT). All ED PE patients are screened for OTPE. Exclusion criteria include sPESI ≥ 1, ESC high or intermediate, bleeding ≤ 30 days, hemoglobin < 8, platelet < 50,000, pregnancy, prior VTE, concomitant COVID-19, recent major surgery and social factors. Patients identified are discussed with PERT and ED physicians. If agreed upon, patients are discharged on DOAC with follow-up within one week. Patients receive calls on days 3, 7, and 30 from the OTPE team to assess AE relating to the DOAC or PE. LOS metrics are reported as mean with standard deviations, and readmissions are reported as percentages.

Results:
Ninety-eight low-risk patients were identified, of which 50 were OTPE-eligible with mean age 44.5 ± 16.9 years of age and 58% female. When comparing OTPE to low-risk admissions, there are no differences in age (p=0.35) and sex (p=0.72). For OTPE, the follow-up calls on day 3, 7, and 30 revealed no patient reported recurrent VTE, major bleeding or death. There was a similar ED provider to disposition LOS (p=0.74). Low-risk admissions had a higher rate of readmission than OTPE (p=0.19).

Conclusion:
Our OTPE process does not increase ED provider to disposition LOS, readmissions, or adverse outcomes. Future work will examine financial implications of OTPE and barriers to adoption of the process. As this is actively enrolling quality improvement initiative, we will continue to track post-implementation to optimize our process.
Abstract 260: Provider Perspectives On Peripheral Artery Disease: Uncovering Practice Patterns That May Contribute To Health Disparities
Authors: McNeal Demetria M , Hanratty Rebecca , Hogan Shea E , Morris Megan , Huebschmann Amy G , Lockhart Steven , Ritger Carly , Peterson Pamela
Published: May 2022

Background:
PAD is often undiagnosed and undertreated. Black American and Hispanic patients experience greater disease severity and worse outcomes compared to white patients. Applying the Kilbourne et al.’s comprehensive framework which identifies multilevel determinants of health disparities, we sought to understand why disparities exist by identifying provider factors that explain gaps in health and health care.

Methods:
Semi-structured in-depth interviews were conducted with 19 providers across diverse specialties from two clinical sites. Interviews occurred from November 2021 to February 2022. Domains of interest were provider factors that contribute to delays in diagnosis, treatment, and management of PAD, as well as how providers communicate with patients about PAD. Interviews were professionally transcribed and analyzed using a qualitative content analysis methodology.

Findings:
Specialists noted that the diagnosis of PAD may be delayed due to the lack of consistent early detection of risk factors and screening. PCPs felt that diagnosis of PAD is difficult due to patient under recognition of symptoms, symptoms mimicking other diseases, and asymptomatic patients. Both specialists and PCPs highlighted delayed PAD diagnosis due to a lack of clear guidelines for screening. Broader institutional constraints on screening for and diagnosing PAD related to time, resources, and logistics for both specialists and PCPs. There was general agreement that disease awareness and knowledge was lacking by both providers and patients, and may contribute to gaps in screening, treatment, and management of disease across the health care system. Some providers noted differences across populations in access to care and interventions, which may contribute to health disparities around PAD.
Implications for Cardiovascular and Health Disparities Research:
Overall, there is a clear sense among providers representing multiple disciplines that diagnosis of PAD is challenging. To address these challenges, more work needs to be to develop clinic team approaches to screen for PAD symptoms in at-risk patients. To close the gap in health disparities, patient perspectives should also be sought to better understand specific needs among different populations.
Abstract 263: Insights From Meta-analysis Of Studies Using Machine Learning To Predict Mortality Or Acute Kidney Injury After Coronary Artery Bypass Graft
Authors: Ahmed Md Ashfaq , Zhang Zhenwei , McGranaghan Peter , Rubens Muni , Ramamoorthy Venkataraghavan , Saxena Anshul , Chaparro Sandra , Jimenez Javier , Veledar Emir
Published: May 2022

Objective:
Machine learning (ML) may enhance prediction of outcomes such as mortality or acute kidney injury (AKI) among cardiac patients after coronary artery bypass graft (CABG). In this study, we used meta-analyses of reported ML models to assess what ML has been able to accomplish in this field, by evaluating the model performance in studies with CABG patients.

Methods:
We performed a literature search using Google Scholar and included studies that reported AUC and 95% CI for various models in our analysis. In addition, total participants, year of publication, type of analytical method (gradient boosting, random forest, etc.) and type of outcome (mortality or AKI) were extracted. We combined effect sizes using random effects model, and tested for heterogeneity, and publication bias.

Results:
5 models from 5 studies were included in the analysis (patients= 35,152; with outcome mortality =3,080, AKI=933). Combined mean AUC was 0.796 (95% CI: 0.776, 0.815). Test of heterogeneity showed high variation between studies (I
2
= 66.7%). Egger’s test intercept was -1.03 (95% CI: -7.22, 5.17,
p
> .25) indicating no small study bias. Meta regression showed newer publications had a positive association (
coef =
0.003) and number of variables in the study had a negative association with higher AUC values (
coef
= -0.0002). In subgroup analysis, the pooled AUC values for mortality and AKI groups were 0.795 and 0.805 respectively. The highest individual AUC was from ensemble model predicting AKI with AUC 0.84 and lowest was from gradient boosting model predicting mortality with AUC 0.77.

Conclusion:
Among the presented models for CABG ensemble methods performed well, but surprisingly methods with lesser number of variables tended to have higher predictive power. In near future, ML-based models may form the basis to build intelligent decision support systems for patient selection and risk stratification prior to CABG and could be applied to other cardiac surgeries.
Abstract 271: Bradyarrhythmia Associated With Remdesivir And Covid-19 Pneumonia: A Pharmacovigilance Analysis:
Authors: Pandya Krutarth K , Shah Parth R , Patel Harsh P , Thakkar Samarthkumar , Deshmukh Abhishek , Bhakta Shyam
Published: May 2022

Background:
Different arrhythmias have been reported in patients with COVID-19 due to the complication of the disease, and medications used in the management of COVID-19. Remdesivir was approved by FDA for the management of COVID-19 patients in October 2020. There are several case reports suggesting remdesivir causing bradyarrhythmia in COVID-19 patients.

Objective:
To increase the knowledge and awareness among healthcare professions (HCPs) about the risk of arrhythmias associated with the use of remdesivir.

Methods:
We used the FDA Adverse Events Reporting System (FAERS) database to find bradyarrhythmia as a reported adverse event (AE) due to remdesivir until October,2021. Total 6,504 events were reported, out of which 5,996 (92.2%) were reported by HCPs. These AEs were included and further analyzed.

Results:
Out of 5,996 AEs reported with remdesivir, total 537 (9.0%) events were bradyarrhythmia. There were 74 (1.27%) events reported for atrial fibrillation, and 24 (0.04%) for ventricular tachycardia attributed to the use of remdesivir. Reported events of bradyarrhythmia were further divided and analyzed into men vs women, and different age groups of years 18-64, 65-85, >85. Total events of bradyarrhythmia among men (238, 6.5%) vs women (141, 6.4%) were not significantly different. Among all the age groups, more events were reported in younger women in the age group of 18-64 (12.3%) vs 65-85 (7.9%) vs >85 (6.9%).

Conclusion:
Multiple studies have shown COVID-19 associated tachyarrhythmias, likely secondary to the myocardial damage due to hypoxia. Few studies have also suggested bradyarrhythmias in these patients. Our analysis of the FAERS database also showed many reported AEs of bradyarrhythmia attributed to the use of remdesivir. Postulated mechanisms include; medication side effects, damage to the SA node as a complication of the COVID-19 disease process, and electrolyte imbalance due to the renal failure. Close surveillance of these patients with early diagnosis can lead to prompt discontinuation of the medication, which can further decrease the mortality related to bradyarrhythmias. Further studies are required to identify the at-risk population and to better understand the risk of bradyarrhythmia associated with remdesivir.
Abstract 30: Trends Of Telehealth Utilization Among Cardiovascular Disease Patients Before And During The Covid-19 Pandemic And Cost Analysis
Authors: Lee Jun Soo , Lowe Kincaid , Schey Michael , Luo Feijun
Published: May 2022

Objectives:
To determine the costs and trends of telehealth utilization before and during the COVID-19 pandemic for patients with cardiovascular diseases (CVD).

Methods:
We calculated the proportions of patients with CVD who used telehealth before (January 2019-February 2020) and during (March 2020-April 2021) the pandemic using MarketScan Commercial Claims and Encounters. We compared the trends of telehealth utilization among CVD patients by sex, age, claim type, payment plan, and rural/urban status. We calculated mean, SD, median, and IQR of total and average telehealth costs.

Results:
The results show that telehealth utilization spiked in March 2020 and further rapidly increased and peaked in April 2020. Telehealth utilization increased from 0.021% in March 2019 to 6.7% in March 2020 and from 0.024% in April 2019 to 39.8% in April 2020. After peaking in April 2020, telehealth utilization rapidly fell in May-June 2020 and then gradually decreased before rebounding in October-December 2020. It resumed the decline through April 2021 remained much higher than the prepandemic level. Telehealth utilization was higher during the pandemic for females than males; for younger age groups (aged 18-44 or 45-64) than older age group (aged 65+); for commercial claims than Medicare supplemental insurance; for capitated insurance plans than non-capitated insurance plans; and for patients in urban areas than rural areas. From March 2020-February 2021, the mean (SD) telehealth cost per visit was $115.7 (66) (median [IQR], $104.8 [$75.8-$139.4]), with patient out-of-pocket cost $25.5 (42.8) (median [IQR], $10 [$0-$30]), insurance cost $90.4 (71.0) (median [IQR], $83 [$45.3-$121.3]), and the mean (SD) number of telehealth utilizations per patient was 1.67 (1.8) (median [IQR], 1 [1-2]).

Conclusions:
Policymakers, health care practitioners, and insurance companies should be aware of trends and costs of telehealth utilization among patients with CVD. Our results show that telehealth would facilitate better management of CVD. Our results may inform future policies and practices to meet the increased demand for telehealth.
Abstract 35: Age, Gender And Race Bias In Provider Adherence To The 2018 AHA/ACC Cholesterol Guidelines: A Single-Center Retrospective Cohort Analysis
Authors: Roman Aida , Mai William , Clark Christina , Ciarleglio Adam , Goyal Sharad , Choi Brian G
Published: May 2022

Background:
Cholesterol treatment is central to cardiovascular risk reduction, but disparities in management may exist. Our hypothesis is that demographic factors may predict guideline adherence.

Methods:
This retrospective cohort analysis included patients seen at an urban academic medical center between November 2018 to March 2021. Patient and provider demographics, cardiovascular comorbidities, and lab values were examined to determine if provider adherence to the 2018 AHA/ACC cholesterol guidelines demonstrated bias by age, gender, or race. Logistic models were estimated via generalized estimating equations to account for clustering by patient and provider and used to calculate odds ratios (OR), confidence intervals, and p-values.

Results:
24,733 lipid panels were obtained from patients with mean age 57.8 ± 15.6, BMI 29.4 ± 6.8, 56.9% female, 44.2% White, 42.1% Black, 6.8% Asian, 6.8% Other, 26.5% tobacco use, 12.7% ASCVD, 51.1% hypertension, 21.1% diabetes. Significant adjusted OR for appropriate treatment was 0.91 (p<0.001) for each 1-year increase in age, 2.2 (p<0.001) for female, 0.88 (p=0.02) for Black relative to White, 1.36 (p=0.003) for Asian relative to White, 0.73 (p<0.001) for BMI>40 relative to BMI<25. Providers had mean age 51.1 ± 12.2, 60.5%female, 73.2% White, 6.9% Black, 18.6% Asian, 1.3% Other. On univariate analysis, OR for appropriate statin prescription were 0.82 (p=0.016) for provider-patient race discordance; 0.90 (p=0.251) for gender discordance, 0.34 (p<0.001) if provider age 10+ years younger than the patient, and 4.72 (p<0.001) if provider age 10+ years older. On multivariate analysis adjusted for clinical risk factors, none of these OR for patient-provider discordance were significantly different from 1: race 1.06 (p=0.42), gender 0.96 (p=0.34), provider 10+ years younger 1.05 (p=0.61), provider 10+ years older 0.91 (p=0.32).

Conclusion:
In this analysis, Black, male, morbidly obese and older patients were less likely to receive appropriate statin therapy. However, there was no evidence that inappropriate treatment was associated with patient-provider age, gender, or race discordance. Further investigation is needed to guide targeted interventions aimed at addressing these inequities.
Abstract 43: A Case-based Survey Of Physician Practice Patterns Following Asymptomatic, Wearable Device-detected Irregular Rhythm
Authors: Demkowicz Patrick C , Dhruva Sanket S , Spatz Erica S , Beatty Alexis L , Ross Joseph S , Khera Rohan
Published: May 2022

Background:
While the US FDA has cleared wearable device software for the detection of irregular rhythms suggestive of atrial fibrillation, there is little evidence to guide decision-making in response to abnormal rhythm notifications. We evaluated physician practice patterns across specialties at 2 large academic centers.

Methods:
We conducted a case-based survey of attending and resident physicians in primary care, emergency medicine, and cardiology at Yale and UCSF from September to December 2021. Case scenarios were presented where patients reported receiving wearable device alerts for “signs of an irregular rhythm suggestive of atrial fibrillation” in the absence of symptoms. Physicians were asked to select from among prespecified diagnostic testing, referral and treatment options, including none. We used a Chi-square test of independence to compare decisions across specialties.

Results:
We emailed 636 physicians and 95 surveys (14.9%) were completed: 39 primary care, 25 emergency medicine, and 31 cardiology. In response to 192 case scenarios, 99.5% of physicians selected at least one diagnostic test: electrocardiography (96.4%), ambulatory rhythm monitoring (77.1%), transthoracic echocardiography (TTE) (32.8%), stress tests (9.9%), and brain natriuretic peptide (BNP) (8.9%) (Fig A). When asked about referral and treatment options, 18.8% of physicians selected referral to a different specialty and 25.0% selected new medication treatment, including aspirin (18.2%), antiarrhythmics (15.1%), and anticoagulation (9.4%) (Fig B). Emergency physicians were more likely than primary care physicians and cardiologists to refer patients (P=.048) and order a BNP (P=.003). Cardiologists were more likely to perform ambulatory rhythm monitoring (P<.001) and prescribe antiarrhythmics (P=.02).

Conclusion:
There was considerable variation across physician specialties in practice patterns for asymptomatic, device-detected irregular rhythms.
Abstract 55: Statin Type Does Matter: Decreasing Incorrect Statin Administration For Hospitalized Heart Transplant Patients
Authors: Daraz Yasmeen , Nnani Daryl , Small Katherine , Sims Daniel B
Published: May 2022

Background:
Statin therapy has been shown to prevent the development of transplant coronary artery disease (TCAD) in heart transplant (HT) patients. Pravastatin is used in HT patients as it does not depend on CYP3A4 metabolism. Other widely used statins, such as simvastatin, have significant drug-drug interactions with the calcineurin inhibitors, which are used as standard immunosuppression therapy for all HT patients.

Objective:
Our goal was to increase correct statin administration for HT patients from 41-43% to 80% by June 2021 through electronic medical record (EMR) modification and interprofessional communication with the pharmacy department.

Methods:
Previous to our intervention, the EMR would recommend ordering simvastatin when ordering pravastatin, due to simvastatin being the hospital formulary preferred statin. The EMR did not cross reference HT status, and that pravastatin should be ordered instead. Our intervention was to remove the EMR notification for HT patients recommending simvastatin, as well as working with the clinical heart transplant pharmacists to mediate communication with primary teams. Monthly data was obtained through retrospective chart review.

Results:
Following our intervention in March 2021, pravastatin was ordered for 67%, 78%, and 81% of heart transplant readmissions in April, May, and June 2021, respectively (Table 1).

Conclusion:
Our intervention of EMR modification as well as interprofessional communication has almost doubled the correct administration of pravastatin in HT admissions from 41% to 81% over the course of seven months. Prescribing the proper statin for HT patients prevents unwanted toxicities, as well as TCAD - a major limitation to longevity amongst HT patients. Further educational interventions will be implemented for providers to achieve 100% correct statin administration to patients with heart transplant.
Abstract 69: Predictors Of Cardiac Arrest-related Hospitalizations In Young (18-44 Years) Females - An Artificial Neural Network Analysis Using A Nationwide Cohort
Authors: Desai Rupak , Dhaduk Kartik , Verma Jyoti , Klair Harroop SIngh , Merugu Bhavyasri , Dhakal Roshan , Rizvi Bisharah , Jain Akhil
Published: May 2022

Background:
Considering the limited availability of data on Cardiac Arrest (CA) in young patients and especially females, we aimed to determine the predictors of CA in this population using Artificial Neural Network (ANN) Model in a national cohort from the United States.

Methods:
We identified CA-related hospitalizations among young females (18-44 years) using 2018’s National Inpatient Sample database. ANN’s predictive factors were selected for this cohort. Young females with CA (n=10810, 0.2% of all 2018 young female admissions) were randomly split into training data (n=7567, 70%) which were used to calibrate ANN and testing data (n=3243, 30%) which were used to evaluate the accuracy of the algorithm. We compared the frequency of incorrect prediction between training and testing data and measured the Area under Receiver Operator Curve (AUC) to determine ANN’s efficacy in predicting CA.

Results:
Young females with CA often consisted of older (median age 36 vs 30 years), blacks (25.3% vs 18%), and patients from lower-income quartile (0-25% income quartile:36.4% vs 29.9%) with higher rates of modifiable cardiovascular disease risk factors vs. females admitted without CA (p<0.001). Females with CA expectedly had significantly high (48.4%) in-hospital mortality. Normalized Predictors are displayed in Table 1. Our ANN model had AUC 0.902 (Fig 1) which correlates with an excellent prediction model. Our data showed 0.2% error in both testing and training models.

Conclusion:
Our ANN model achieved high performance to predict risk factors for CA admissions in young females. It will enable clinicians to screen high-risk young female hospitalized patients and improve survival in them.
Abstract 70: Females With Acute Myocardial Infarction Are Still Undertreated
Authors: Cordova Sanchez Andres , Chaudhuri Debanik
Published: May 2022

Objective:
To identify differences in management and outcomes in males versus females with acute myocardial infarction(AMI) presenting to our institution.

Methods:
Retrospective analysis of patients between the ages of 18 to 89 years old presenting to SUNY Upstate Medical University with a diagnosis of AMI defined as either STEMI or NSTEMI from March 2021 to September 2021. Patients with diagnosis of demand ischemia were excluded.

Results:
From a total of 236 patients, 44.1% (104 out of 236) were females. The age in both groups was similar with mean of 63.64 (SD 14.5) years old in males and 66.36(SD 14.2).

Only 53.8% (56 of 104) Females were admitted to intensive care level of service versus 72% (95 of 132) males (P 0.004 OR 0.264-0.781).

Cardiac catheterizations were done more frequently in males than females 78.8% (104 of 132) and 67.3% (71 of 104) respectively (P0.047). Between patients who underwent cardiac catheterization 45.7% (33 of 70) females and 66.3% (69 of 104) males received PCI. More males had depressed left ventricular ejection fraction 50.8% (64 of 132) versus 32% (31 of 104) females. Although not statistically significant, 30-day mortality was more frequent in women 10.6% (11 of 104) compared to males 6.8% (9 of 132).

Conclusions:
Females with AMI where less likely to be admitted to the ICU or undergo cardiac catheterization. They had either similar or worse 30-day mortality, despite having lower rates of coronary disease requiring intervention. These findings support the fact that despite the efforts taken in the last several years, women with AMI are still being undertreated.
Abstract 81: Appropriateness And Clinical Utility Of Echocardiograms For (Pre)Syncope And Palpitations In An Academic Primary Care Practice
Authors: Gupta Kush , Kalwani Neil M , Gaspar Cindie , Bobokalonova Zarrina , Paul Ria , Tsai Sandra , Levin Eleanor
Published: May 2022

Introduction:
Patients with (pre)syncope and palpitations are often assessed in primary care clinic. Guidelines recommend evaluation with history, physical exam, and an EKG followed by a transthoracic echocardiogram (TTE) only when structural heart disease is suspected.

Hypothesis:
We hypothesized that many TTEs ordered for (pre)syncope and palpitations from primary care clinic do not meet appropriateness criteria.

Methods:
We reviewed charts for TTE orders for (pre)syncope and palpitations from the primary care clinics of a large academic health system from 9/1/20 - 4/30/21. We extracted visit type, evaluation completed prior to the TTE order, and TTE findings. Appropriateness was assessed based on published clinical guidelines and practice recommendations.

Results:
During the study period, 6.0% of all TTEs ordered (31/520) were for (pre)syncope and 5.4% were for palpitations. Of these, 39% for (pre)syncope and 46% for palpitations met appropriateness criteria. At the time of the TTE order, 51% (30/59) of patients had a recent physical exam and 63% (37/59) had an EKG or cardiac monitor completed in the past 6 months. Of the visits completed, 42% (25/59) were virtual / telemedicine, and the rate of TTE appropriateness did not differ between virtual and in-person visits (40%, 10/25 vs 44%, 15/34, p=0.752). Of the TTEs completed, 7% (2/29) for (pre)syncope and 17% (4/23) for palpitations revealed clinically significant findings. The proportion of TTEs with clinically significant findings was low for both studies deemed appropriate and inappropriate (14.3%, 3/21 vs 9.7%, 3/31, p=0.610).

Conclusions:
At this primary care practice, a large proportion of TTEs ordered for (pre)syncope and palpitations did not meet appropriateness criteria. Few TTEs deemed inappropriate revealed clinically significant findings. Improved education and decision support for these clinical scenarios may increase appropriate use of cardiac imaging and decrease costs.
Abstract 87: Comparative Outcomes Of TAVR In African Americans Versus Non-African Americans
Authors: Nasrollahi Farrah S , Dohse Carlos , Ambalavanan Manoj , Patel Keshav , Twing Aamir , Dickens Helena , Tiu David , Ramsis Ramsis , Sreepathy Pranati , Cho Nicole , Ibrahim Khalil , Kansal Mayank M , Shroff Adhir R
Published: May 2022

Introduction:
African Americans (AA) experience more postoperative complications compared to non-African Americans (NAA) after certain procedures. Few studies compare clinical outcomes between AA and NAA post Transcatheter Aortic Valve Replacement (TAVR). Our aim is to further explore racial disparities among TAVR patients.

Methods:
Retrospective analysis of electronic medical records from March 2018-November 2020 of a major academic center and affiliated Veterans Affairs hospital in Chicago, IL identified all TAVR patients. Participants self-identified by race and were stratified into AA and NAA groups. The primary outcome was 3-point composite major adverse cardiac outcomes (MACE) (all cause death, myocardial infarction, cerebrovascular accident). Secondary outcomes included major differences in comorbidities, creatinine, baseline mean gradient, congestive heart failure (CHF) exacerbations, and hospital admissions. Outcomes were analyzed at 6- and 12-months post TAVR.

Results:
We included 151 patients in the analysis; 22% female, 65% were non-AA (44.7% white, 16.4% Hispanic, and 3.9% other) and 35% AA. They were 74 +/- 14 years old for the AA and 74 +/- 10 years old for non-AA. At 6 months (AA:15.1% v NAA:8.1%; p=.2) and at 12 months (AA:22.6% v NAA:16.2%; p=.3), there was no difference in MACE between the two populations. At 6 months post TAVR, AA were more likely to have a CHF exacerbation compared to NAA (AA:15.1% v NAA:3.1%; p=.007) despite a similar prevalence of heart failure at baseline, hypertension, hyperlipidemia, diabetes, coronary artery disease, atrial fibrillation and smoking. AA were found to have a higher baseline mean gradient when compared to NAA (AA: 36.2 v NAA:31.9 mmHg; p=.049). Creatinine at time of procedure was higher in AA when compared to NAA (Cr: 2.37 vs. 1.49 mg/dL; p=.015) and AA trended towards higher rates of end stage renal disease compared to NAA (AA:22.6% v NAA:11.1%; p=.059).

Conclusion:
We observed significant disparities between AA and their NAA counterparts. While both groups had similar rates of composite MACE events post TAVR at 6 and 12 months, AA tend to be a higher risk post-operative population. AA were more likely to have CHF exacerbations and were evaluated for TAVR at a later stage in their disease course.
Why Drones Have Not Revolutionized War: The Enduring Hider-Finder Competition in Air Warfare
Authors: Calcara Antonio , Gilli Andrea , Gilli Mauro , Marchetti Raffaele , Zaccagnini Ivan
Published: May 2022

According to the accepted wisdom in security studies, unmanned aerial vehicles, also known as drones, have revolutionizing effects on war and world politics. Drones allegedly tilt the military balance in favor of the offense, reduce existing asymmetries in military power between major and minor actors, and eliminate close combat from modern battlefields. A new theory about the hider-finder competition between air penetration and air defense shows that drones are vulnerable to air defenses and electronic warfare systems, and that they require support from other force structure assets to be effective. This competition imposes high costs on those who fail to master the set of tactics, techniques, procedures, technologies, and capabilities necessary to limit exposure to enemy fire and to detect enemy targets. Three conflicts that featured extensive employment of drones—the Western Libya military campaign of the second Libyan civil war (2019–2020), the Syrian civil war (2011–2021), and the Armenia-Azerbaijan conflict over Nagorno-Karabakh (2020)—probe the mechanisms of the theory. Drones do not by themselves produce the revolutionary effects that many have attributed to them.
Dynamic Incentives in Retirement Earnings-Replacement Benefits
Authors: Dean Andrés , Fleitas Sebastian , Zerpa Mariana
Published: May 2022

We analyze dynamic incentives in pension systems created by the use of a small set of final years of earnings to compute benefits. Using social security records and household surveys from Uruguay, we show that self-employed workers and some employees of small firms respond to these incentives by increasing reported earnings in the benefit calculation window. We find evidence that suggests that these responses are explained by changes in earnings reporting and not in total earnings or labor supply. Back-of-the-envelope calculations indicate that this behavior increases the cost of pensions by about 0.2% of the GDP.
Optimal Vaccine Subsidies for Epidemic Diseases
Authors: Goodkin-Gold Matthew , Kremer Michael , Snyder Christopher M. , Williams Heidi
Published: May 2022

We analyze optimal vaccine subsidies in a model integrating disease epidemiology into a market with rational economic agents. The focus is on an intensive vaccine campaign to quell an epidemic in the short run. Across a range of market structures, positive vaccine externalities and optimal subsidies peak for diseases that spread quickly, but not so quickly that everyone is driven to be vaccinated. We assess the practical relevance of this peak—as well as the existence of increasing social returns to vaccination and optimality of universal vaccination—in calibrations to the COVID-19 pandemic.
Nonrandom pattern of vigilance by preening black-headed gulls
Authors: Novčić Ivana , Vidović Zoran , Hauber Mark E.
Published: May 2022

Classic models of vigilance assume instantaneous and sequential randomness in the scanning process, implying negative exponential distribution of interscan durations and no interdependence among successive interscans. We examined whether vigilance pattern by preening black-headed gulls, Chroicocephalus ridibundus, meets these assumptions. Out of 54 behavioural sequences, 50 departed from the expected negative exponential distribution, whereas the focal interscan duration was significantly affected by the interaction of the preceding scan and the interscan interval. These results reveal departures from randomness in the scanning process by gulls, which may be a consequence of the hunting strategies of their predators or due to the trade-off between the needs for feather maintenance and antipredator vigilance.
Two-Dimensional Wavenumber Spectra on the Horizontal Submesoscale and Vertical Finescale
Authors: Vladoiu Anda , Lien Ren-Chieh , Kunze Eric
Published: May 2022

Horizontal and vertical wavenumbers (kx, kz) immediately below the Ozmidov wavenumber (N3/ε)1/2 are spectrally distinct from both isotropic turbulence (kx, kz > 1 cpm) and internal waves as described by the Garrett–Munk (GM) model spectrum (kz < 0.1 cpm). A towed CTD chain, augmented with concurrent Electromagnetic Autonomous Profiling Explorer (EM-APEX) profiling float microstructure measurements and shipboard ADCP surveys, are used to characterize 2D wavenumber (kx, kz) spectra of isopycnal slope, vertical strain, and isopycnal salinity gradient on horizontal wavelengths from 50 m to 250 km and vertical wavelengths of 2–48 m. For kz < 0.1 cpm, 2D spectra of isopycnal slope and vertical strain resemble GM. Integrated over the other wavenumber, the isopycnal slope 1D kx spectrum exhibits a roughly +1/3 slope for kx > 3 × 10−3 cpm, and the vertical strain 1D kz spectrum a −1 slope for kz > 0.1 cpm, consistent with previous 1D measurements, numerical simulations, and anisotropic stratified turbulence theory. Isopycnal salinity gradient 1D kx spectra have a +1 slope for kx > 2 × 10−3 cpm, consistent with nonlocal stirring. Turbulent diapycnal diffusivities inferred in the (i) internal wave subrange using a vertical strain-based finescale parameterization are consistent with those inferred from finescale horizonal wavenumber spectra of (ii) isopycnal slope and (iii) isopycnal salinity gradients using Batchelor model spectra. This suggests that horizontal submesoscale and vertical finescale subranges participate in bridging the forward cascade between weakly nonlinear internal waves and isotropic turbulence, as hypothesized by anisotropic turbulence theory.