bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 229: Burden And Predictors Of Sepsis-associated Cardiac Arrest: A National Inpatient Sample Analysis, 2018
Authors: Desai Rupak , Patel Viralkumar , Vasavada Advait , Haque Fariah Asha , Jain Manisha , Shawl Saima , Desai Rohan , Sadum Navya , Sanikommu Sailaja , Edusa Samuel , Alukal Thomas , Jain Akhil
Published: May 2022

Background:
Sepsis-induced myocardial dysfunction with the resultant cardiomyopathy carries a high risk of mortality. We aimed to study the risk factors of cardiac arrest (CA) in Sepsis-related hospitalizations (SRH).

Methods:
We identified SRHs using the National Inpatient Sample (2018) and ICD10 codes to categorized them into with vs without CA. We then compared baseline characteristics and performed multivariate analysis adjusting for confounders to identify predictors of sepsis-associated CA.

Results:
Of SRH (1,345,595) in 2018, 0.8% (11,365) had a CA
(Table1)
. SRH with CA often had elderly (median age 70 vs 66 years), males (55.3% vs 48.8%), blacks (19.6% vs 13.3%), Hispanics (12.3 vs 11.7%), Medicare enrollees (69.9 vs 59.1%), and had patients from lower-income households (LIH, 36.9% vs 30.7%) than non-CA cohort. Statistically significant predictors for CA in SRH were age (5% increased risk every 5 years), male sex (aOR 1.28, 95CI 1.16-1.4), black (aOR 1.49, 95CI 1.3-1.7) & Hispanic (aOR 1.26, 95CI 1.09-1.45) race, LIH (aOR 1.31, 95CI 1.13-1.52), CHF (aOR 2.4, 95CI 2.16-2.68), pulmonary circulation disorder (aOR 2.14, 95CI 1.72-2.66), prior cardiac arrest (aOR 1.95, 95CI 1.16-3.27), coagulopathy (aOR 1.69, 95CI 1.5-1.9), alcohol abuse (aOR 1.42 95CI 1.17-1.74), PVD (aOR 1.36, 95CI 1.17-1.58), CKD (aOR 1.26, 95CI 1.14-1.39), cancer without metastasis (aOR 1.49, 95CI 1.24-1.8) and with metastasis (aOR 1.24, 95CI 1.01-1.52). Urban non-teaching vs rural (aOR 1.32, 95CI 1.1-1.57) and Southern vs Northeast hospitals (aOR 1.26, 95CI 1.09-1.46) showed higher odds of CA.

Conclusion:
SRH associated CA had high mortality with prevalent demographic and regional disparities, evident from black and Hispanic, males, patients from LHI and Southern hospitals revealing a higher risk of sepsis-associated CA. Congestive heart failure, pulmonary disease, prior cardiac arrest, coagulopathy, alcohol abuse, PVD, CKD, and cancers were the strongest predictors of CA in SRH.
Abstract 230: Prediabetes In Young Adults And Its Association With Type 1 Myocardial Infarction-related Admissions And Outcomes: A Population-based Analysis In The United States
Authors: Desai Rupak , Haque Fariah Asha , Vasavada Advait , Jain Manisha , Desai Rohan , Patel Viralkumar , Shawl Saima , Sanikommu Sailaja , Edusa Samuel , Sadum Navya , Alukal Thomas , Jain Akhil
Published: May 2022

Background:
Prediabetes (pDM) has recently drawn attention for being associated with poor outcomes after acute myocardial infarction (MI). We aimed to analyze the incidence and odds of type 1 MI admissions, and outcomes using a nationally representative sample.

Methods:
We queried the National Inpatient Sample (2018) to identify T1MI-related hospitalizations (T1RH) in young (18-44 years) adults with vs without pDM using ICD-10 codes. T1RHs with DM were excluded. Demographics, comorbidities and outcomes including major cardiovascular and cerebrovascular adverse events (MACCE) were compared between two cohorts.

Results:
Overall prevalence of pDM in young adults hospitalized in 2018 was 0.4% (31460/7851019). T1RH was found to be significantly higher in the pDM vs. non-pDM cohort (2.15%, 675/31460 vs. 0.3%, 21655/7820953) among all non-diabetic admissions in young adults. T1RH with pDM often had males (78.5 vs 72.8%), blacks (26.7 vs 21%), Hispanics (18.3 vs 11.5%), Asian/Pacific Islanders (6.9 vs 3.1%), patients from higher-income quartile (19.1 vs 15.8%), urban-teaching (81.5 vs 72.2%), Midwest (23.7 vs 21.9%) and West (23 vs 16.4%) region hospitals, and patients with higher rates of hyperlipidemia (68.1 vs 47.3%), obesity (48.9 vs 25.7%), fluid-electrolyte imbalance (18.5 vs 15.3%). The univariate (OR 7.9, 95CI 6.54-9.53) and adjusted multivariate analysis (OR 1.71, 95CI 1.38-2.12) revealed significantly higher odds of T1MI in the pDM vs non-pDM cohort (p<0.001)
[Table 1]
. However, T1RH’s outcome for MACCE (adjusted) did not differ between two cohorts (P=0.074). Furthermore, T1RH with pDM had higher transfers to short-term facilities (6.7 vs 5.3%, p<0.001).

Conclusion:
Young patients with prediabetes had significantly higher T1MI hospitalizations without any impact on subsequent MACCEs. This highlights the need for aggressive management of CVD risk factors in the young by primary care physicians to curtail acute cardiac events and healthcare costs.
Abstract 234: Implementation Of A Structured Nurse-led, Patient-centered, Multimedia Education Program To Promote Self-care In Heart Failure Management
Authors: Ly Vy , Fisher Brian , Pham Michael , Ray Ranjan
Published: May 2022

Objectives:
In patients with chronic heart failure (HF), self-care improves the quality of life and prevents hospitalizations. The health confidence 0-10 scoring system is a simple and effective tool to promote patient engagement and adherence to care plans. Our quality improvement initiative incorporates these essential elements into building an effective HF education program.

Methods:
Patients admitted to the cardiac unit for HF exacerbation at the California Pacific Medical Center were identified using a novel EMR-based algorithm. Each patient was offered 1-on-1 teaching with a nurse educator, video education, printed materials (e.g., interactive self-care workbook), and weight-management supplies (e.g., graduated fluid container, scale). Key teaching topics included HF disease, daily weight, diet, medications, and symptom monitoring. Nurse training videos and checklists were created to ensure standardization and quality of teaching. Patient health confidence score was recorded before and after each in-person and video teaching session.

Findings:
From October 2020 to February 2022, the average health confidence scores before and after in-person teaching were 4.3 and 7.1, respectively (n=700). HF disease overview and symptom monitoring had the lowest pre-teaching confidence scores among all topics but had the most improvement post-teaching. In some cases, teaching was deferred due to patient refusal (13%) and confusion (5%). Video education was associated with an average improvement of confidence score from 5 to 7.7 (n=65).

Conclusions:
We have developed a comprehensive HF education pathway that utilizes a novel EMR-based algorithm for early identification of HF patients, standardized training and competency evaluation to assure consistent, high-quality education delivery by the nurses, and multimedia HF education materials to promote HF self-care. Further investigation on the effects of our interventions on HF readmission is underway.
Abstract 238: Early Or Delayed Percutaneous Coronary Intervention For Non-st-elevation Myocardial Infarction In Pneumonia: Analysis From California State Inpatient Database (2006-2011)
Authors: Mahmood Riaz , Shah Chail , Kumar Gagan
Published: May 2022

Objective:
Evaluate the safety of performing PCI for NSTEMI within 2 days compared to 2-7 days in patients admitted with pneumonia.

Background:
The gold standard for detecting coronary atherosclerotic plaque in NSTEMI continues to be PCI. The need for providing lifesaving procedures such as stent placement for NSTEMI in patients admitted with pneumonia early, within 2 days, has not been evaluated.

Methods:
We performed a retrospective analysis using California State Inpatient Database from years 2006-2011 to identify patients with a diagnosis of pneumonia present on admission (ICD-9-CM code 480-487) and a secondary diagnosis of NSTEMI (ICD-9-CM code 410.7) using the International Classification of Diseases, 9th edition codes. We compared the primary outcome of in-hospital mortality for patients that received PCI within 2 days of admission (early group) to those who received it between 2-7 days of admission (late group). We used a multivariable logistic regression model and adjusted for demographical characteristics, co-morbidities and severity of disease as identified by different organ failures. We also added propensity score to identify the probability that a patient would receive early PCI to the above model to increase its robustness.

Results:
Between 2006-2011, we identified 4980 patients in the database who were admitted with pneumonia and developed NSTEMI who underwent PCI within 7 days. A total of 1809 patients underwent PCI in early group and 3171 underwent PCI in late group. In-hospital mortality was significantly higher in early PCI group (6.5% vs 4.1%, p < 0.001) when compared to late PCI. Of those who underwent PCI, 1142 (36%) received stents in early group while only 518 (28.6%) received stent in late group (p < 0.001). Propensity adjusted multiple logistic regression analysis showed higher odds of death in early group when compared to late group (OR 1.70, 95%CI 1.26-2.29, p < 0.001).

Conclusions:
Patients admitted with pneumonia undergoing PCI within 48 hours for NSTEMI had higher mortality in comparison to those patients that underwent PCI within 2-7 days. Timing for PCI should be delayed beyond the first 48 hours in order to reduce the risk for complications and mortality in this patient population.
Abstract 240: Leveraging Health Equity Data To Drive Public Health And Health Care Practice, 2010-2020
Authors: Roberson Shamarial L , Forrest Jamie R , Sanders Jontae L
Published: May 2022

Objectives:
Increasing the understanding of the variety of data sources around health equity that are available and how to use these data to drive public health and health care practice is critical to address inequities and improve health outcomes. The social determinants of health (SDOH), factors related to where people live, work, play, and age, are strongly tied to health outcomes. Primary and secondary SDOH can be used to understand the context of the issues faced at the individual and community levels and can help inform appropriate interventions and support the connection to available resources.

Methods:
The Heath Equity Profile, available from the public facing Florida Community Health Assessment Resource Toolset (FLHealthCHARTS) website, contains over 150 indicators at the county-level related to demographics, income and employment, housing, education, risk behaviors, access to care, access to food, and various health outcomes, including prevalence, incidence, morbidity, and mortality. The indicators contained in the Health Equity Profile were used to identify counties with the largest SDOH disparities and largest burden of poor health outcomes for several initiatives focused on increasing community-clinical linkages and leveraging cross-sector partnerships to address health outcomes.

Findings:
Public health initiatives focused on hypertension, diabetes, and heart disease have leveraged the data contained in the Health Equity Profile to select geographic areas for implementation. Using these data, interventions were able to be deployed in areas with the greatest need and opportunity to benefit. Understanding the conditions under which individuals live is critical to the successful implementation of both public health and health care improvement efforts. Various data sources are widely available that can provide additional context and guidance for the development of tailored interventions to improve individual and population health.
Abstract 250: Psychosocial Assessment And Services Provided By Licensed Cardiac Rehabilitation Programs
Authors: Bush Montika , Evenson Kelly R , Aylward Aileen , Cyr Julianne , Kucharska-Newton Anna
Published: May 2022

Background:
Professional health organizations recommend that outpatient cardiac rehabilitation (CR) programs include activities to optimize the physical, mental, and social well-being of patients. How these guidelines are being put into practice is not well known so there is a critical need to describe the real-world implementation of psychosocial guidelines in CR programs. To meet this need, the study objectives were to describe 1) mental health assessments performed and 2) psychosocial services offered among CR programs.

Methods:
A cross-sectional survey of North Carolina licensed outpatient CR programs was conducted. The online survey was designed to obtain descriptive information on CR personnel, assessments completed, services offered, and the patient population that is served by each program in 2018. Descriptive statistics were used to summarize mental health assessments and other closed-question responses. Standardized differences were computed to detect an imbalance in characteristics between CR programs that did and did not provide psychosocial services. Thematic analysis of free text responses to psychosocial services offered was performed by 2 team members until consensus was reached.

Results:
Sixty-eight programs (89%) responded to the survey. Forty-eight programs (70%) indicated offering psychosocial services. At program enrollment, mental health was assessed in 94% of programs of which 92% repeated the assessment at discharge. Depression was assessed with the 9-item Patient Health Questionnaire by a majority (75%) of programs. Health-related quality of life (QoL) instruments were used by 60 (88%) programs. Health-related QoL was assessed at program enrollment and conclusion by 95% of programs that completed this type of assessment. Psychosocial services included individual counseling (59%), counseling referrals (49%), and educational classes (29%).

Conclusions:
Cardiac rehabilitation programs routinely screen for psychosocial distress, a known risk factor for heart disease. CR programs can identify patients at risk for mental health problems following an MI and be a resource for connection to appropriate services.
Abstract 257: Appraisal Of The Modified Lace Score In Heart Failure Admissions
Authors: Heaton Joseph , Singh Sohrab , Reddy Sarath
Published: May 2022

Background:
Medicare’s Hospital Readmissions Reduction Program has focused on reducing the readmission rate in patients admitted for heart failure exacerbations. The LACE score has shown moderate to high predictive value in 30-day readmission and has been validated in heart failure cohorts. We sought to assess the utility of the LACE score in patients admitted for acute myocardial infarctions (AMI).

Methods:
The National Readmission Database was queried for 2016 and 2019 for adults admitted for acute myocardial infarctions. Patients were stratified by their modified LACE (mLACE) score index, substituting emergency department visits for prior admissions. Trends in 30-day readmission and healthcare utilization were analyzed.

Results:
Between 2016 and 2019, 2,018,837 patients were admitted for AMI. Stratified by mLACE score, 5.87% (n=118,634) were low-risk, 61.53 were moderate-risk (n=1,242,207), and 32.60% (n=657,997) were high-risk. Readmissions within 30 days occurred in 5.33%, 7.15%, and 14.99% for low, moderate, and high risk, respectively. The Kaplan Meier readmission curve is presented in Figure 1. Multivariate logistic regression showed moderate-risk had 16.60% higher odds of readmission, while high-risk had 77.16% higher odds of readmission. Length of stay (LOS) was 0.81 days for low risk, 2.92 days for moderate risk, and 8.40 days for high risk. Regression analysis showed LOS risk increased 63% for moderate-risk and was 6.16 times higher in high-risk admissions. Total cost was higher by $17,947 and $73,826 in moderate and high risk, respectively.

Conclusion:
The modified LACE index provides a feasible and cost-effective measurement of risk for readmission, mortality, and healthcare utilization. Patients with a high modified LACE index should be assessed for increased requirements upon discharge and readmission mitigation techniques
Abstract 264: Tachyarrhythmias Associated With Sacubitril-valsartan - A Pharmacovigilance Analysis:
Authors: Pandya Krutarth K , Moussa Zahir , Shah Parth R , Patel Harsh P , Thakkar Samarthkumar , Bhakta Shyam , Deshmukh Abhishek
Published: May 2022

Background:
Sacubitril-valsartan is a combination of a neprilysin inhibitor and an angiotensin II receptor blocker respectively. Sacubitril-valsartan has become a standard of care in the treatment of patients with Congestive Heart Failure (CHF) with reduced EF. During its clinical trials and upon review of U.S. Food and Drug Administration (FDA) approval, sacubitril-valsartan exhibited a side effect profile including hyperkalemia, hypotension, renal dysfunction, and angioedema. Recently, sacubitril-valsartan was also approved for the treatment of CHF patients with preserved EF.

Objective:
In view of new indications and increased usage, it is important to establish the updated safety profile of sacubitril-valsartan in the general population since the PARADIGM-HF trial.

Methods:
We explored reported Adverse Events (AEs) of sacubitril-valsartan using the FDA Adverse Event Reporting System. A total of 57,958 AEs were reported until August 2021. Total of 16,658 (28.7%) AEs were reported by HCPs, which were further analyzed. AEs were analyzed in men (56.7%) vs women (25.3%), and also in 3 age groups of 18-64, 65-85, >85.

Results:
Out of 16,658 AEs, the most frequently reported AE was hypotension (17.2%). Other commonly reported AEs were renal dysfunction (14.3%), allergic reactions including angioedema (10.8%), GI distress (8.8%), tachyarrhythmias (5.8%), hyperkalemia (4.5%), and cough (3.0%). Out of 16,658 AEs, 11,631 (69%) were deemed serious and 4,422 (26.5%) resulted in hospitalization. Deaths were attributed to 3,909 serious AEs (23.5%). In the age group of 18-64, events of atrial fibrillation were less among women compared to men (1% vs 3%), while total events of ventricular tachycardia were noted more among men compared to women (2% vs 0.5%).

Conclusion:
Most of the reported AEs were consistent with the observed AEs from PARADIGM-HF except for tachyarrhythmia. There are few reports documenting arrhythmias followed by the use of sacubitril-valsartan, however, the clear mechanism is unknown. Despite the wide use of sacubitril-valsartan, there is currently limited data on the safety profile. In future with the increasing use, further randomized controlled trials (RCTs) are needed to better understand the safety profile of the medication.
Abstract 270: Disparities In Cardiovascular Mortality Associated With Diabetes Prevalence In United States: County Level Analysis From 2011 To 2019
Authors: Sayed Ahmed , Aldosoky Wesam , Diab Mohamed , Abbasi Taimur , Dar Tawseef , Mir Tanveer , Abohashem Shady
Published: May 2022

Introduction:
A significant rise in the rates of Diabetes Mellitus (DM) amongst U.S. adults has been observed in recent decades. Although associations between DM and cardiovascular mortality (CVM) are well-known, disparities in related CVM are unclear.

Hypothesis:
We sought to study the independent impact of DM on CVM among age, sex, and race/ethnic subgroups.

Methods:
County-level age adjusted CVM rates (ACVM) were obtained from the CDC WONDER database. DM prevalence, demographics, socioeconomic, environmental, and other cardiovascular risk factors obtained from the County Health Rankings project database. Multivariate generalized linear mixed models were used to investigate the independent association between ACVM and DM amongst different subgroups using incidence rate ratios (IRRs) to evaluate the relative impact and additional yearly deaths (AYD) to evaluate the absolute impact of DM.

Results:
Among 309,886,995 residents (50% women, 11.7% non-Hispanic blacks, 23.8% [45-64 age group]) lived at 2900 US counties in 2011, total 7,381,448 (2.4%) CV deaths occurred between 2011-2019. In fully adjusted model*, DM significantly associated with ACVM (IRR: 1.013; 95% CI: 1.006 to 1.020; AYD: 3). This association remained robust amongst those aged 45 to 64 (IRR: 1.023; 95% CI: 1.013 to 1.033; AYD: 3.4), those aged ≥65 (IRR: 1.010; 95% CI: 1.003 to 1.017; AYD: 14.5), males (IRR: 1.023; 95% CI: 1.014 to 1.031; AYD: 6.2), females (IRR: 1.010; 95% CI: 1.001 to 1.018; AYD: 1.8), non-Hispanic Whites (IRR: 1.011; 95% CI: 1.003 to 1.018; AYD: 2.5); and 45-64 age group of non-Hispanic blacks (IRR: 1.033; 95% CI: 1.001 to 1.066; AYD: 9.2);
Figure.

Conclusion:
Increased DM prevalence is independently associated with high ACVM among different age, sex, and race/ethnic groups, and this impact is most pronounced in the middle-aged group of males, non-Hispanic whites, and non-Hispanic blacks. Population-level interventions are imperative to effectively combat this ongoing epidemic.
Abstract 272: Infective Endocarditis Of Unicuspid-unicommisural Aortic Valve
Authors: Osman Abdul Fatawu , Barham Waseem , Abela george
Published: May 2022

Approximately, 75% of patients with infective endocarditis have underlying structural heart disease at the time of diagnosis. Aortic valve disease is associated with up to a quarter of patients, with aortic regurgitation being the most common abnormality. A unicuspid aortic valve (UAV) is an extremely rare congenital anomaly with a prevalence of 0.02%. We present a unique case of UAV with a devastating association.

Case Summary:
A 32-year-old male intravenous drug abuser presented with weakness after 18-hours of symptom onset. He was afebrile but tachycardic, with left-sided hemiparesis and sensory loss. Brain CT-scan revealed a hypodensity within the right cerebral hemisphere, a CTA of head-neck revealed an acute right MCA infarct with malignant cerebral edema. Due to deteriorating clinical condition, he was intubated for airway protection and underwent emergent hemi-craniectomy. Blood cultures grew enterococcus faecalis. Transthoracic echocardiogram showed abnormal aortic valve with severe regurgitation. Transesophageal echocardiography (TEE) demonstrated unicuspid unicommissural aortic valve with a small mobile echodensity attached to the left ventricular outflow tract aspect.

Decision Making:
He received a 6-weeks course of ceftriaxone and vancomycin with negative repeat blood cultures. Given poor clinical state, he was deemed poor candidate for valve replacement and was discharged to long-term rehabilitation facility. Four-months later, he was re-admitted with fevers. Repeat TEE demonstrated multiple aortic valve vegetations. He subsequently underwent successful minimally invasive aortic valve replacement.

Conclusion:
Unicuspid unicommisural aortic valve is an extremely rare condition that can be complicated by aortic stenosis more often than regurgitation. Infective endocarditis has been reported in 11% among UAV patients and can lead to valvular destruction with severe regurgitation which can be catastrophic in some patients
Abstract 273: Prescription Rate For Antihyperglycemic Medication With Proven Cvd Benefit At Discharge In Stroke Patients Not Equal Among Payer Sources
Authors: Abelt Susan , Bluma Dot , Ebert Lisa
Published: May 2022

Mortality doubles in stroke patient with diabetes mellitus (DM). Target: Type 2 DiabetesSM (TT2DM) is an American Heart Association (AHA) initiative focused on providing evidence-based guideline (EBG) resources to mitigate risk in hospitalized stroke patients with DM. Get With The Guidelines® (GWTG)- Stroke hospitals track EBG data to improve patient outcomes. TT2DM initiative is comprised of 10 EBG data elements related to stroke and DM subpopulation. The measure Antihyperglycemic Medication with Proven CVD Benefit at Discharge in Stroke Patients with DM has low compliance.

Methods:
GWTG®-Stroke DM reports reviewed from January 1, 2020-June 30, 2021, from 50 Wisconsin Coverdell Stroke Program hospitals. Analysis of 2554 patients with primary diagnosis of stroke with history of or newly identified DM during hospitalization were in the denominator. Numerator met when patients were prescribed GLP-1 Receptor Agonist or SGLT-2 Inhibitor at discharge. Measure compliance was further delineated according to payment source documented. Patient payer source was identified as: Self-Pay, Medicaid, Medicare, and Private. Findings: In specified timeframe, 7.9% of patients received Antihyperglycemic Medication with Proven CVD Benefit at Discharge. Compliance variation exists across payer source. Differences in compliance rates were 2.2% Self-Pay, 6.4% for Medicare, 7.7% Medicaid, and 12.1% for Private.

Conclusions:
Discharge prescription rate for antihyperglycemic medication with proven CVD benefit at discharge in stroke patients has low compliance, further variation exists among payor sources. Items for consideration are higher cost of medication and thus payor status are driving factors in prescribing rates. Additional barriers may exist as discharge clinicians may not feel DM management is their responsibility, there may be a medication knowledge gap. Providing EBC requires shared decision making among patients and clinicians to ensure proper follow up. Engaging a multidisciplinary approach at discharge to verify insurance coverage, alternate cost options, and follow up needs may enhance compliance. Future considerations are to assess race “within” payor source to gauge if there is disparate care.
Abstract 275: The Association Between Elevated Lipoprotein(a) And In-hospital Outcomes
Authors: Weze Kelechi O , Echols Melvin
Published: May 2022

Purpose:
Elevated lipoprotein(a), Lpa, has quickly emerged as an independent cardiovascular disease risk factor with increased risk for adverse atherosclerotic Using the National Inpatient Sample (NIS) database, we sought to assess the association of elevated Lp(a) to in-hospital cardiovascular outcomes.

Methods:
We identified patients with elevated Lpa using ICD-10 code in the NIS data from the year 2019. We compared in-hospital outcomes between elevated and non-elevated Lpa groups before and after propensity score matching. We then performed a regression analysis on the matched cohort. Our predictors of interest were acute myocardial infarction (AMI), cerebrovascular disease (CEVD), peripheral vascular disease (PVD), and a composite outcome (cardiorisk) including, AMI, CEVD, and PVD.

Results:
In the unmatched cohort, the elevated Lpa group had higher incidences of AMI, CEVD, PVD, and the composite outcome (all p<0.05). However, length of stay and cost of hospitalization did not differ considerably. After propensity score matching, the elevated Lpa group had higher rates of AMI (7.1% vs 1.2%, p<0.001), CEVD (11.2% vs 2.8%, p<0.001), PVD (1.8% vs 0.2%, p=0.021), and composite outcome (20% vs 6%, p<0.01). Elevated Lpa group had longer length of stay 5±5 vs 4±3, p=0.002), and higher cost of hospitalization (69,060 ± 76,028 vs 20,992±15,065, p<0.001). Multivariable regression analysis controlling for common predictors of atheroembolic risk showed higher odds of AMI (2.33, p<0.001), CEVD (1.62, p= 0.002), PVD (2.22, p=0.094), and cardiorisk (1.68, p<0.001) among the elevated Lpa group.

Conclusion:
Elevated Lpa is associated with a higher incidence of atheroembolic disease in this nationally representative sample and associated with a higher length of stay and healthcare costs. Further research is needed to fully understand its mechanism and possible treatment to reduce adverse cardiovascular outcomes.
Abstract 29: Evaluating The Feasibility Of A Statewide Collaboration To Improve Cardiac Rehabilitation Participation: The Michigan Cardiac Rehabilitation Consortium
Authors: Thompson Mike P , Yaser Jessica , Forrest Annemarie , Keteyian Steven J , Sukul Devraj
Published: May 2022

Background:
Regional quality improvement collaboratives may provide one solution to improving cardiac rehabilitation (CR) participation through performance benchmarking and provider engagement. The objective of this descriptive study was to evaluate the feasibility of the Michigan Cardiac Rehab Consortium to improve CR participation

Methods and Results:
Multipayer claims data from the Michigan Value Collaborative were used to identify hospitals and CR facilities. Univariate analyses described participating hospital characteristics and hospital-level rates of CR enrollment within 1-year. A total of 95 hospitals and 85 CR facilities with 48 hospitals (51%) providing interventional cardiology services and 33 (35%) provided cardiac surgical services. The overall consortium-wide enrollment rate into CR across all conditions was 19.8% (26,398 of 133,641 eligible admissions), which was highest for CABG (58.4%), followed by SAVR (54.8%), PCI (34.6%), TAVR (33.1%), AMI (12.7%), and CHF (3.4%). There was wide variation in CR participation across participating eligible admissions and hospitals (Figure). A 17-member multidisciplinary stakeholder group was assembled representing 12 institutions and diverse roles, including exercise physiologists, cardiologist, program directors, and patients. Three diverse CR facilities participated in virtual site visits, which revealed individual successes in improving CR participation, but a variety of barriers to participation related to referrals, capacity and staffing constraints, and geographic and financial barriers.

Conclusions:
This study demonstrated the feasibility of a statewide collaboration centered around the goal of equitably improving CR enrollment for all eligible patients that is supported by a multidisciplinary stakeholder group and performance benchmarking. Future work will seek to continuously improve and evaluate the impact of this consortium on CR participation in Michigan.
Abstract 39: Association Between Copay Amount And Medication Adherence For Angiotensin Receptor Neprilysin Inhibitors In Patients With Heart Failure
Authors: Mukhopadhyay Amrita , Adhikari Samrachana , Li Xiyue , Dodson John A , Kronish Ian M , Ramatowski Maggie , Chunara Rumi , Blecker Saul
Published: May 2022

Background:
Angiotensin receptor neprilysin inhibitors (ARNI) can significantly reduce mortality and hospitalization for patients with heart failure (HF). However, relatively high copayment costs for ARNI may contribute to shortfalls in adherence.

Methods:
We conducted a retrospective cohort study of patients within a large, diverse, multi-site health system. We included patients with: an active diagnosis of HF or ejection fraction (EF) ≤ 40% on echocardiogram; a prescription for ARNI between 11/20/2020-3/31/2021; and available pharmacy or pharmacy benefit manager copayment data. Our primary exposure variable was copay amount, categorized as: $0, $0.01-$10, $10.01-$100, >$100. Our primary outcome was adherence to ARNI, defined as the proportion of days covered (PDC) ≥ 80% over 6 months. We assessed the association between copay amount and PDC using multivariable logistic regression, adjusting for the following: age, sex, race, ethnicity, insurance type, socioeconomic status (based on AHRQ SES index), EF, prior hospitalizations, and prior emergency visits.

Results:
A total of 567 patients met inclusion criteria. Low copay amounts ($0.01-$10), as opposed to no copay or higher copay amounts ($10.01-$100, >$100), were more common for patients who were younger, of Black race, Hispanic/Latinx ethnicity, with Medicaid insurance, lower SES index, and lower EF (all p<0.01). Unadjusted rates of ARNI adherence varied significantly by copay amount (Figure 1A: p<0.01), and adjusted odds of ARNI adherence was significantly lower for patients with copay over $100 as compared to no copay (Figure 1B: OR 0.33, 95% CI 0.14-0.71, p<0.01). There was a graded association between copay amount and ARNI non-adherence.

Conclusions:
We found lower rates of ARNI adherence for patients with higher copay amount, which persisted after multivariable adjustment. Our findings support policy-level interventions to reduce copay amounts for ARNI.
Abstract 40: Comparative Effectiveness Of Sglt2 And Glp1ra On Major Adverse Cardiac Events: A National Retrospective Cohort Of Patients With Diabetes
Authors: Richardson Tadarro , Halvorson Alese , Hackstadt Amber , Hung Adriana M , Greevy Robert , Grijalva Carlos , elasy tom , Roumie Christianne
Published: May 2022

Background:
To test the hypothesis that patients treated with sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 receptor agonists (GLP1RA) was associated with lower risk of cardiovascular endpoints vs dipeptidyl peptidase 4 inhibitors (DPP4).

Methods:
A retrospective cohort combined Veterans Administration, Medicare, and National Death Index databases. Patients using metformin, sulfonylurea or insulin alone or in combination were followed until a new fill of one of the following classes: SGLT2; GLP1RA; or DPP4. The index date and start of follow-up was the new prescription fill date. The composite outcome was major adverse cardiovascular event (MACE) or heart failure (HF) hospitalization: acute myocardial infarction (AMI), stroke, acute HF or cardiovascular (CV) death. Cox Proportional Hazards models compared MACE and HF for the comparison groups of interest, separately, in propensity score (PS) weighted cohorts adjusted for clinical covariates, laboratory data, ejection fraction (EF), smoking, and selected medications.

Results:
After PS weighting the cohorts included 46018 GLP1RA vs 45814 DPP4 and 36646 SGLT2 vs 36261 DPP4 participants. Median age was 69 years and diabetes duration of 9.0 (5.2, 13.4) years for GLP1RA vs DPP4 and 9.3 (5.7, 13.8) years for SGLT2 vs DPP4 users. Most new agents were added as third drug to either metformin + sulfonylurea or metformin + insulin regimen. GLP1RA was associated with lower hazard of MACE/HF vs DPP4 (0.73 [0.68, 0.78]) (panel A) yielding an adjusted risk difference (aRD) of 10.5 events [8.5, 12.4]); results were consistent for all outcome components. SGLT2 was associated with a lower hazard of MACE and HF (0.76 [0.69, 0.85]) (panel B) (aRD 8.1 [5.2, 10.7]); primarily due to reduction in CV death (0.71 [0.56, 0.90]) and HF hospitalization with reduced EF (0.40 [0.26, 0.62]).

Conclusions:
Use of GLP1RA or SGLT2 for diabetes treatment was associated with reduced risk of MACE and HF hospitalization vs DPP4.
Abstract 44: Impact Of Social Isolation During Covid-19 Pandemic On Individual Subjective Assessment Of Cardiac Disease Symptoms
Authors: Tawfellos George , Torosoff Mikhail
Published: May 2022

Background:
Impact of social isolation associated with the COVID-19 pandemic on the severity and frequency of cardiac symptoms has not been well investigated.

Material and methods:
This was a single tertiary center cohort study of inpatients admitted with a primary diagnosis of either CHF or acute myocardial infarction. Each patient rated the extent of isolation related to the pandemic and severity and frequency of symptoms during an in-person interview.

Results:
The study cohort included 54 patients, 48.1% females (26 of 54), 70.2+/-13.5 years old, who reported moderate or severe isolation in 57% (31 of 54). Symptom severity worsening was reported in 48% (26 of 54) of patients and was more common in socially isolated patients (74 vs. 29%, p=0.001; 17 of 23 vs. 9 of 31). Symptom frequency increase was reported in 43% (24 of 54) and was also more common in socially isolated patients (61 vs. 33%, p=0.036; 14 of 23 vs. 10 of 31). There was no difference in mortality between the two groups (p=0.6971). There was a trend of increased hospitalizations, on average, among patients who reported drastic isolation than patients who maintained social contacts (0.826+/-1.614 vs. 0.484+/-0.996 admissions, p=0.349). These findings were not affected by the diagnosis (CHF vs. MI), age, gender, race, and co-morbidities including HTN, DM, atril fibrillation, COPD or asthma, and/or chronic renal insufficiency. Likewise, there was no association between symptom worsening and GDT utilization including beta-blockers, RAAS inhibitors, MRA, anticoagulants, ICD or PPM placement.

Conclusions:
Our findings suggest that independent of age, gender, race, LVEF, recorded comorbidities, and recorded active therapeutics, the COVID-19 pandemic resulted in a significant cardiac symptom increase in patients who reported social isolation. Interventions aimed at reducing social isolation require investigation and implementation.
Abstract 45: Trends In Ductal Arteriosus Stent Versus Blalock-Thomas-Taussig Shunt Utilization In Neonates With Ductal-dependent Pulmonary Blood Flow
Authors: Lemley Bethan A , Wu Lezhou , Roberts Amy L , Shinohara Russell T , Smith Christopher L , Dori Yoav , Rome Jonathan J , Gillespie Matthew J , Glatz Andrew C , O'Byrne Michael L
Published: May 2022

Background:
Neonates with cyanotic congenital heart disease (CHD) and ductal-dependent pulmonary blood flow require a life-saving intervention soon after birth. The modified Blalock-Thomas-Taussig shunt (BTTS) is a well-established palliative intervention for securing pulmonary blood flow. More recently, development of the ductus arteriosus stent (DAS) has presented an alternative option. There is no consensus regarding the optimal strategy. Observational studies have not demonstrated clear differences in mortality or unplanned reintervention for cyanosis between DAS and BTTS, with DAS associated with shorter length of stay but greater likelihood of other reinterventions.

Objective:
To examine trends in DAS versus BTTS utilization in a cohort of US neonates with cyanotic CHD.

Methods:
An observational study of neonates undergoing DAS or BTTS within 30 days of birth discharged 1/2017-12/2020 was performed using the Pediatric Health Information Systems database. Mixed-effects multivariate regression was used to adjust for patient characteristics and center-level covariance.

Results:
A total of 2143 subjects from 39 centers were studied (29% DAS). The proportion of DAS increased over the study period (PANEL A). Prematurity (OR 2.0, p<0.001), genetic anomalies (OR 1.2, p=0.02), and pulmonary atresia (OR 2.1, p<0.001) were associated with increased odds of performing DAS over of BTTS. Adjusting for measurable confounders, the odds of DAS increased significantly over time (OR 1.3 per year, p<0.001, PANEL B). However, there was significant intra-hospital practice variation not explained by differences in case-mix (MOR 3.48, 95% CI 2.58-5.15).

Conclusion:
Utilization of DAS is increasing overall. However, there remains significant variability in practice across US pediatric hospitals. Studies guiding optimal patient selection for DAS and BTTS are warranted.
Abstract 52: Application Of Machine Learning In Predicting Clinical Adverse Events After Transcatheter Aortic Valve Replacement Procedure: Insights From A Systematic Review And Meta-analysis Of Studies
Authors: McGranaghan Peter , Meyer Alexander , Rubens Muni , Ahmed Ashfaq , Zhang Zhenwei , Saxena Anshul , Veledar Emir
Published: May 2022

Objective:
Identifying patients at high risk of AE after TAVR is essential to prolong their survival. Current prediction models for AE after TAVR suffer from a lack of accuracy and external validation. Modern ML approaches can account for higher-dimensional relationships among variables, potentially improving the prediction of outcomes. We performed a systematic review and meta-analysis to estimate the discriminative ability of recently developed ML-based models, which predict various AE after TAVR.

Methods:
We searched Pubmed, Google Scholar, and Web of Science for studies (Jan 2019 to Jan 2022) that used ML approaches to predict AE after TAVR. Inputs in the meta-analysis were study-reported c-index values and 95% CI. Subgroup analyses separated models by outcome (mortality or clinical AE). Combined effect sizes using a random-effects model, test for heterogeneity, and Egger’s test to assess publication bias were considered.

Results:
Eight studies were included in the systematic review (patients = 26,023; outcomes = 1,014), of which five models had sufficient data for the meta-analysis. The number of features included in each model ranged from 6 to 107. The two most common models were random forest (n=2) and logistic regression (n=2). The most common outcome was mortality (n=5). The meta-analysis showed that models predicting mortality performed better (0.90; 95% CI: 0.81, 1.01) than models predicting clinical AE (0.80; 95% CI: 0.79, 0.95). The combined mean c-index was 0.87 (95% CI: 0.79-0.95). Test of heterogeneity showed high variation among studies (
I
2
=98.5%). Egger’s test did not indicate publication bias (
β
= 1.48; 95% CI: –18.14, 21.09,
p
= 0.848).

Conclusion:
Although relatively few studies have applied ML for predicting AE after TAVR, the results are very promising. The time of complex sophisticated models has arrived with improved predictive accuracy through advanced ML methods able to help identify patients who are at risk for clinical AE early in their care.
Abstract 56: Differences Between Chronic Thromboembolic Disease And Chronic Thromboembolic Pulmonary Hypertension Patients At Time Of Presentation
Authors: Hakim Husain , Meyyappan Lakshmi , Liu Emily , Kline-Rogers Eva M , McDevitt Susanne , Moles Victor , McLaughlin Vallerie V
Published: May 2022

Background:
Approximately 1/3 of acute pulmonary embolism (PE) patients develop chronic thromboembolic disease (CTED), a condition in which a patient’s PE does not resolve after standard anticoagulation therapy. Chronic thromboembolic pulmonary hypertension (CTEPH) can occur in about 3-4% of acute PE patients. Though CTED and CTEPH share an underlying cause, few studies have compared symptom severity, patient history, and other clinical indicators for the two diseases. Moreover, CTED is sometimes considered to be an asymptomatic condition. The symptomatology in CTEPH is thought to be primarily determined by pulmonary hypertension, a characteristic that CTED patients do not share.

Methods:
Data were collected at baseline diagnosis from 24 CTED and 65 CTEPH patients in the University of Michigan Pulmonary Hypertension Registry between 2016-2020. Demographic, 6-minute walk (6MW), echocardiography, past medical history, and brain natriuretic peptide (BNP) data were compared between groups.

Results:
CTED patients were: 1) less symptomatic (better WHO functional class [FC], better predicted 6MW), 2) had more preserved oxygenation during 6MW, 3) had less RV dilation/dysfunction and RA dilation on echo, and 4) lower BNP, than CTEPH patients. Despite this, 54% of CTED patients demonstrated significantly impaired FC (III/IV) without evidence of significant RV dysfunction, exercise hypoxia or volume overload.

Conclusion:
More than half of CTED patients in our study had significantly impaired FC. Further investigation into CTED symptomatology is warranted. CTEPH patients are more symptomatic and present with worse clinical metrics than CTED patients, which may be attributed to more advanced RV dysfunction and higher BNP level. These results may help distinguish CTED v. CTEPH diagnoses earlier, leading to earlier targeted treatment and better outcomes.
Abstract 58: Implementation Of An Electronic Health Records-based Safe Contrast Limit For Preventing Contrast-associated Acute Kidney Injury After Percutaneous Coronary Intervention
Authors: Zhang Justin , Khaki Rakan , Leong Derek , Bhoopalam Chandrashekhar , Tabak Steven , Elad Yaron , Ebinger Joseph , Yuan Neal
Published: May 2022

Background:
Contrast-associated acute kidney injury (CA-AKI) after percutaneous coronary intervention (PCI) is associated with cardiovascular complications and mortality. We previously published a multivariable model for calculating safe contrast volume limits derived from National Cardiovascular Data Registry (NCDR) data. We assessed the performance of this safe contrast limit when implemented in an electronic health records (EHR) system.

Methods:
We created an advisory alert in our Epic EHR system, which displayed the safe contrast limit to catheterization lab staff and operators prior to PCI along with CA-AKI risk reduction strategies. The alert required no clinician data entry and used risk factors automatically pulled from the EHR: age, sex, body mass index, creatinine clearance, hemoglobin, and use of intra-aortic balloon pump pre-procedure. We included procedures from 11/1/2020 to 10/1/2021 that had pre- and post-procedure creatinine data; the intervention went live 2/10/2021. We used NCDR-defined CA-AKI events to assess the performance of the safe contrast limit in predicting CA-AKI. We used interrupted time series analysis to determine if the intervention reduced contrast use and CA-AKI.

Results:
There were 201 PCIs; 10.4% (21 out of 201) had CA-AKI. The contrast limit predicted CA-AKI well using real-time EHR data (sensitivity 76.2%, specificity 50.0%, negative predictive value 94.7%). Among 178 patients with modifiable CA-AKI risk (defined as safe contrast limit ≤ 500mL), the intervention was associated with an immediate significant decrease in contrast use (-44.34mL (95% CI -81.71, -6.97)) and a decrease with time (-0.77mL/day (-1.31, -0.22)). For 23 patients at low CA-AKI risk (contrast limit > 500mL), there was a non-significant increase in contrast use (28.55 (-92.79, 149.88) and with time (1.15 (-0.73, 3.03)). There was no significant decrease in CA-AKI (OR 0.21 (0.03, 1.37)).

Conclusion:
An EHR-based safe contrast limit using automatically derived patient data performed well in predicting CA-AKI. The intervention significantly decreased contrast use for patients with modifiable CA-AKI risk and non-significantly increased contrast in patients with low risk. Longer follow-up will help clarify effects on CA-AKI rates.
Abstract 59: Increasing Participation In Improvement Work Through Heart Center Performance Rounds
Authors: Sheth Shreya S , Moore Judson , Cooper Felicia , Wells Jenna , Wrenn Tiffany , Stapleton Gary , Goldman Jordana R
Published: May 2022

Excellence in congenital cardiac care requires team resilience, complex decision-making, analysis of errors to adjust practice, and continuous targeted improvement. Medicine has learned from other high reliability organizations, but effective team communication and awareness of improvement opportunities remain challenging. We describe how our Heart Center Performance Rounds (HCPR) meeting addresses these gaps, and provides attention to quality improvement (QI) work, which in turn leads to increased participation and improved clinical outcomes. Our HCPR is a weekly review of one week’s worth of surgical and catheterization cases. Each patient’s course is reviewed against both internal and external benchmarks, such as length of stay (LOS) and markers of clinical progression. Eligibility for multidisciplinary improvement projects is reviewed for each patient. A committee tracks trends in discussion, assessing areas for improvement work and team learning. This committee then organizes methods for follow up and arranges presentation back to the Heart Center (HC) audience. Over the course of 12 months, we tracked LOS data and participation for two multidisciplinary QI projects to assess project participation and outcomes. Projects featured in HCPR included reduction of chest tube duration and awareness of median clinical targets. Patients undergoing specific operations were eligible, but could be excluded at the request of the clinical team. We noted a decrease in exclusion over 12 months, as teams became more aware of eligibility criteria and early results. As participation in these projects improved, both variability and overall length of stay decreased for 2 of 4 studied operations. Updates on outcomes were periodically presented to HC audience. Survey responses and interviews demonstrated increased awareness of projects and their potential for improved care metrics. Our HCPR has promoted knowledge of benchmarks and increased participation in quality improvement projects, leading to improved clinical outcomes. Transparency in data and communication of ongoing work is essential for success. Challenges include dedicated time and resources for spreading and sustaining improvement.