bluuebunny/crossref_metadata_2025 huggingface dataset:
O amor pela locução e o movimento das rádios livres sorocabanas pela perspectiva de Silvana Lima
Authors: Parra Felipe , Maluly Luciano Victor Barros , Pasqualino Beatriz Buschel
Published: May 2022

As rádios livres consistem em meios de comunicação que estimulam a participação ativa do sujeito. Dessa forma, as pessoas podem reverberar suas ideias pelo espaço eletromagnético sem sofrer censuras. Essa forma diferente de fazer rádio adquiriu popularidade na cidade de Sorocaba (SP). Entre as décadas de 1970 e 1980, o município ficou conhecido pelo grande número de emissoras caseiras. A importância dessa ação é descrita em alguns livros e artigos científicos; todavia, nota-se que há poucas informações sobre essas mídias na academia. Nesta entrevista, Silvana Lima fala sobre sua participação nesse movimento. O intuito da atividade é coletar dados, na tentativa de elaborar um panorama sobre essas mídias. A entrevista foi realizada em Sorocaba, em 27 de abril de 2019, e utilizou alguns conceitos de história oral temática e entrevistas semiestruturadas como metodologias de investigação.
Influência e atualidade de Paulo Freire nos estudos em comunicação e no jornalismo: o retorno ao pensamento freiriano frente aos desafios contemporâneos
Authors: Oliveira Hebe Maria Gonçalves de
Published: May 2022

Este artigo reúne abordagens que situam as influências e atualidade do pensamento de Paulo Freire nos estudos em comunicação e jornalismo e destacam o educador entre os pesquisadores expoentes nessa área de conhecimento na América Latina do final dos anos 1960 aos anos 1980, e com uma ascendente presença nas pesquisas a partir dos primeiros anos do século XXI. Assim, demonstramos que as ideias de Paulo Freire não foram superadas, muito menos a sociedade excludente e injusta contra a qual o pensador construiu toda sua práxis teórica. Nesse sentido, também observamos, nos estudos contemporâneos em comunicação e no jornalismo nesta segunda década do século XXI e nas inúmeras celebrações de seu centenário, a força do retorno a Paulo Freire.
Educação crítica para os meios na cidadania comunicativa: apropriações para a crítica e o diálogo
Authors: Costa Filho Ismar Capistrano
Published: May 2022

A pedagogia libertadora e o conceito de comunicação do educador Paulo Freire subsidiam uma reflexão sobre a práxis da educação para os meios, que busca a multiplicidade dos saberes, a horizontalidade das relações e a comunicação dialógica. O método de Freire colabora, assim, para a construção da cidadania comunicativa em sintonia com as exigências de democratização das relações que fundamentam o direito à comunicação. A educação libertadora para os meios pode se realizar tanto na educação formal, por meio da construção de ecossistemas midiáticos e da abordagem do direito à comunicação nos temas transversais dos currículos, como pode acontecer nos movimentos sociais, através da educação informal. Um exemplo desse esforço, apresentado neste artigo, é o projeto de extensão de Apoio à Comunicação Alternativa, Cidadã e Comunitária da Universidade Federal do Ceará.
Cinema, educação e Paulo Freire: o estado do conhecimento das teses e dissertações de 2016 a 2021
Authors: Nunes Ana Luiza Ruschel , Suarez Adriana Rodrigues , Ferreira Daniele Rosa , Colman Danielli Taques
Published: May 2022

O objetivo deste artigo é compreender o cinema e a educação como práticas sociais, na perspectiva crítica e contemporânea, a partir do inventário descritivo analítico de teses e dissertações sobre cinema que utilizem como aporte o referencial de Paulo Freire, coletadas no acervo da Biblioteca Digital Brasileira de Teses e Dissertações, entre janeiro de 2016 e outubro de 2021. O referencial teórico desta pesquisa apoia-se em Freire e na tessitura do cinema e educação, a partir de abordagens de Duarte, Almeida, Prudente, Bergala e outros. Como resultados, entende-se que o cinema, enquanto revolução na contemporaneidade, pode favorecer questões emergentes da sociedade, como as delineadas pelo Cinema Novo. Portanto, compreende-se que o cinema é uma mídia revolucionária e transformadora que apresenta lacunas passíveis de estudos.
O pensamento de Paulo Freire e sua intersecção com cultura e comunicação
Authors: Oliveira Dennis de , Matos Luís
Published: May 2022

Editorial para a edição Paulo Freire
Abstract 15: The Design Of The Dashboard Activated Services And Telehealth For Heart Failure (DASH-HF) Study: A Pragmatic Quality Improvement Randomized Implementation Trial For Patients With Heart Failure With Reduced Ejection Fraction
Authors: Verma Aradhana , Fonarow Gregg C , Hsu Jeffrey J , Jackevicius Cynthia , Mody Freny , Amidi Omid , Goldberg Sarah , Upparapalli Deepti , Theodoropoulos Kleanthis , Chang Donald , Bostrom Kristina I , Althouse Andrew D , Ziaeian Boback
Published: May 2022

Heart failure is a leading diagnosis for hospitalization with a high risk of readmission. Despite robust data and recommendations by professional societies, there is a well-documented gap in delivering guideline-directed medical therapy (GDMT) known to reduce hospitalizations and improve mortality for patients with heart failure with reduced ejection fraction (HFrEF). The Dashboard Activated Services and Telehealth for HF (DASH-HF) is a quality improvement initiative to evaluate the effectiveness of proactive population management clinics to optimize use and dosing of GDMT for patients with HFrEF relative to usual care. The study utilizes the existing Veterans Affairs Academic Detailing HF Dashboard to target actionable patients (n=300) with a low optimization potential score (OPS) (Table 1). The intervention clinics utilize multidisciplinary providers (e.g., physicians, pharmacists) to perform chart review and telemedicine visits to address opportunities to optimize GDMT. The primary outcome of the study is the OPS 6 months after the end of the intervention, defined by active prescriptions and prescribed doses for each class of GDMT. Secondary outcomes include differences in hospitalizations and mortality and measures of health service efficiency such as patients contacted per clinic. The intervention duration was September to December 2021, and analysis is planned for June 2022. This is a unique study to systematically identify HFrEF patients with the largest gaps in GDMT and proactively engage with this group. We describe the study design for identifying target patients, logistics of the intervention, patient characteristics, and an overview of barriers faced during the intervention. The Coronavirus disease 2019 pandemic has led to a marked increase in telehealth services. If successful, this study may serve as a key pilot trial for more robust telehealth delivery, targeting patients at highest risk for HF-related hospitalizations and mortality.
Abstract 162: Burden And Impact Of Chronic Kidney Disease On Admissions Of Cancer Survivors And Assessing The Odds Of Major Adverse Cardiac And Cerebrovascular Events
Authors: Aiya Utsav , Rashid Rakin , Patel Neel , Deb Avijit , Brereton Brian , Alli-Ramsaroop Bibi , Desai Rupak
Published: May 2022

Background:
Cancer-specific adverse events are not well defined despite chronic kidney disease (CKD) being associated with high mortality rates in cancer patients. This study explores the prevalence of major adverse cardiac and cerebrovascular events (MACCE) in cancer survivors with CKD from a national cohort.

Methods:
We identified cancer survivors with and without concomitant CKD along with their age, sex, race and other comorbidities who were admitted to hospitals in a National Inpatient Sample database (2018). We then identified odds of MACCE including all-cause mortality, AMI, cardiac arrest (including ventricular fibrillation) and stroke while subsequently analyzing healthcare resource utilization in patients with versus without CKD. Multivariable regression analyses were adjusted for patient and hospital level covariates and pre-existing comorbidities. A p-value <0.05 was considered statistically significant.

Results:
CKD prevalence was higher among patients with a prior history of cancer versus those without it (21.5% vs 14.6%, p<0.001) in the cohort. Higher rates of traditional cardiovascular disease risk factors, prior history of MI, stroke/TIA, VTE, CHF, coagulopathy and MACCE (11.5% vs 8.1%, OR 1.22 [CI 1.20 -1.25]) were observed in patients with versus without CKD
[Table 1]
in hospitalized cancer survivors. Said survivors with CKD were specifically noted to have higher rates of all-cause mortality (3.4% vs 2.2%, OR 1.33 [CI 1.29 -1.37]) and AMI (6.0% vs 3.3%, OR 1.54 [CI 1.50 - 1.58]) (all p<0.001). The CKD cohort had fewer routine discharges, more frequent transfers to other facilities, higher length of stay and hospital costs versus the non-CKD cohort (p<0.001).

Conclusion:
This large retrospective analysis shows elevated burden of CKD (21.5%) amongst hospitalized cancer survivors, which is associated with not only increased rates of MACCE, all-cause mortality, AMI, cardiac arrest but also greater overall healthcare costs.
Abstract 164: Impact Of Chronic Kidney Disease On The Risk And Outcomes Of Type-2 Myocardial Infarction In Geriatric Patients With Prior Bypass Grafting
Authors: Yarrarapu Siva Naga S , Raina Jilmil , Itare Vikram , Vyas Ankit , Jain Akhil , Desai Rupak
Published: May 2022

Background:
Coronary artery disease associates with increasing age and correlates with CABG being more common in elderly. However, prognostic data of ischemic events post-CABG is limited especially in geriatric patients who are underrepresented in clinical-trials. Furthermore, CKD accelerates coronary atherosclerosis and although treatment practices improved, incidence of ischemic events remain high due to oxygen supple-demand mismatch. Thus, we aim to evaluate impact of CKD on risk of Type-2 Myocardial Infarction (T2MI) in geriatric patients post-bypass grafting.

Methods:
Data from National Inpatient Sample (2018) was used to identify T2MI-related hospitalizations in geriatric patients with prior history of CABG and CKD. Logistic regression was used to assess the odds of T2MI with CKD. In-hospital outcomes and co-morbidities were compared between CKD & non-CKD cohorts.

Results:
T2MI-associated hospitalizations among studied population has higher odds when controlled for confounders (OR 1.48, 95%CI: 1.33-1.64, p<0.001). The two cohorts, CKD(n=399485) vs non-CKD(n=676550), had comparable sociodemographics (Table 1b); age at admission (78 vs 77); males (70.6% vs 70%); race- white (77.9% vs 83.5%), black (8.7% vs 5.4%), Hispanic (7.8% vs 6.5%). The odds of adverse cardiac events (cardiac arrest, cardiogenic shock, and dysrhythmia), all-cause mortality, and hospital length-of-stay was higher in CKD cohort with an exception for stroke (Table 1c). Statistical significance was observed (p<0.001) for all co-morbidities (except age) and outcomes.

Conclusion:
CKD confers an increased risk of T2MI-related hospitalizations and adverse in-hospital outcomes in geriatric patients post-bypass grafting. It finds significance in the need to mitigate risk factors of T2MI and adopt appropriate treatment practices in this population subset.
Abstract 168: Population-based Epidemiology Of Heart Failure In A Low-income Country: The Haiti Cardiovascular Disease Study
Authors: Kingery Justin , Roberts Nicholas , Lookens Pierre Jean , Sufra Rodney , Dade Eliezer , Rouzier Vanessa , Goyal Parag , Pirmohamed Altaf , Yan Lily D , Lee Myung Hee , Nash Dennis , Metz Miranda , Safford Monika M , Fitzgerald Daniel , Deschamps Marie , Pape Jean , Mcnairy Margaret
Published: May 2022

Aims:
Modeling estimates indicate that heart failure (HF) prevalence may be lowest in low-income (LICs). Conversely, HF has been shown to be the leading cause of hospital admission in hospitals in many LICs. This disconnect between estimates and hospital-based observations may be explained by the underlying data. Modeling studies may have selection bias reporting data on individuals presenting with symptomatic disease and may introduce ascertainment bias based on accessibility of care and other structural factors in these communities. Population-based studies are needed to identify the true clinical epidemiology of HF in order to improve HF-related health outcomes in these under-resourced settings where four billion persons live. Haiti is the poorest, most under-resourced country in the Western Hemisphere. We describe HF prevalence, survival, subtypes, risk factors, and one-year mortality in the population-based Haiti Cardiovascular Disease Study.

Methods and Results:
Multistage cluster-area random sampling identified 2,981 adults, who completed standardized history and exam, laboratory measures, and cardiac imaging. Kaplan-Meier and Cox proportional hazard regression assessed survival; logistic regression identified associated factors. Median follow-up was 15.4 months (IQR 9-22). Age-standardized HF prevalence was 3.2% (93/2,981 [CI:2.6-3.9]). One-year HF mortality was 6.6% versus 0.8% (HR: 7.7 [CI 2.9-20.6], p<0.0001). The average age of participants with HF was 57 years (IQR 45-65). The first significant increase in HF prevalence occurred between 30-39 and 40-49-years (1.1% vs 3.7%, p=0.003). Age, hypertension, body-mass-index, poverty and renal dysfunction were associated with HF. 44.1% (41/93) of participants with HF were aware of their diagnosis. HFpEF was the most common HF subtype (71.0%).

Conclusion:
The age-standardized prevalence of HF in this low-income setting was alarmingly high at 3.2%--50% higher than rates in high-income countries and 5-fold higher than modeling estimates for LMICs. Adults with HF were two decades younger as compared to high-income settings and 7.7 times more likely to die at one year. These data serve as a warning sign and may have implications for policy makers and future HF interventions in LMICs.
Abstract 170: Cost-effectiveness Of Icosapent Ethyl In Reduce-it USA: Results From Patients Randomized In The United States
Authors: Zhang Zugui , Kolm Paul , Bhatt Deepak , Dolman Sarahfaye , Bress Adam P , King Jordan B , Bellows Pharmd Brandon K , Derington Catherine , Jiao Lisa , Philip Sephy , Weintraub William S
Published: May 2022

Background:
The Reduction of Cardiovascular Events with Icosapent Ethyl (IE)-Intervention Trial (REDUCE-IT) demonstrated the efficacy of IE among patients with elevated triglyceride levels despite the use of statins. This study aimed to examine the cost-effectiveness (CE) of IE among US adults using both in-trial and lifetime time horizons.

Methods:
US patients in REDUCE-IT were included in the in-trial analysis. We included all cardiovascular and serious adverse events from the REDUCE-IT database where rates differed between the study arms; we used patient-level data from REDUCE-IT USA based on 2019 US costs and $4.16/day for IE. The lifetime analysis used a microsimulation Markov model. Both analyses considered value from a US health sector perspective. The primary result is the incremental CE ratio (ICER), measured as incremental costs divided by incremental quality-adjusted life-years (QALY) of IE compared with placebo. We performed univariate and probabilistic sensitivity analyses (PSA) to capture the uncertainties involved in the estimation of costs and QALYs.

Results:
Based on 3146 REDUCE-IT USA participants, there was an incremental gain in QALYs with IE compared with placebo using in-trial (3.28 vs. 3.13) and lifetime (10.36 vs. 9.83) time horizons. Total healthcare costs were lower with IE compared with placebo for both in-trial ($20,221 vs. $20,357) and lifetime ($201,842 vs. $204,701). IE was a dominant strategy compared to placebo using a lifetime time horizon with a 74.8% probability of being more effective and costing less and had a 99.6% probability of costing below $50,000 per QALY. The lifetime PSA showed that IE was a dominant strategy in 65.6% of simulations and cost-effective in 98.8%, 99.6%, and 99.9% of simulations at the $50,000, $100,000, and $150,000 per QALY gained thresholds, respectively.

Conclusions:
The REDUCE-IT USA cost-effectiveness analysis has shown that IE provides better outcomes with lower costs, dominant both in-trial and lifetime as well in the majority of sensitivity analyses and subgroups, both in primary and secondary prevention. These results, with the clinical evidence of efficacy, suggest that at $4.16 per day, IE therapy should be strongly considered in patients similar to those enrolled in REDUCE-IT USA.
Abstract 172: Disparities In Pcsk9 Inhibitor Initiation Among Patients With Peripheral Arterial Disease Or Cerebrovascular Disease: A Cohort Study Of 500,000 Patients With Atherosclerotic Vascular Disease.
Authors: Deo Salil , McAllister David , Laforest Sherry K , Bal Simer , Altarabsheh Salah , Elgudin Yakov , Sattar Naveed , Pell Jill
Published: May 2022

Background:
Effective lipid lowering therapy reduces deaths due to atherosclerotic vascular disease (ASCVD). Proprotein convertase subtilsin/kexin type 9 inhibitor (PCSK9i) drugs have emerged as effective add-on therapy to lower low-density lipoprotein (LDL) levels. Although the use of PCSK9i is limited by cost, PCSK9i use in a low-cost healthcare system [Veteran Health Affairs (VHA)] is unknown.

Methods:
We queried a cohort of US Veterans with coronary artery disease (CAD), PAD or CeVD receiving outpatient care (January 2016 – December 2019) at 124 VHA medical centers to evaluate the initiation of PCSK9i. We fit a mixed effects logistic regression model [with results presented as odds ratio (OR)] to evaluate the association of social deprivation (assessed by median household income and community deprivation index), the patient’s primary diagnosis and VHA medical center enrollment with PCSK9i initiation.

Findings:
From 519,566 patients (median age 74 years), 337,766 (65%), 79,926 (15%) and 101,874 (20%) had CAD, PAD and CeVD. Among 2,115/519,566 (0.4%) initiated with PCSK9i therapy, 84.3% had CAD, while only 7.2% and 8.5% had PAD and CeVD respectively. PCSK9i initiation was lower in those earning $40,000 - $80,000 [OR 1.13 (1.01 – 1.27)] or > $80,000 [OR 1.41 (1.14 – 1.75)]. Even moderate community deprivation [OR 0.87 (0.77 – 0.97)] was associated with lower PCSK9i therapy. Compared to CAD patients, PAD [OR 0.50 (0.35 – 0.70)] and CeVD [OR 0.23 (0.15 – 0.37)] were less likely to receive PCSK9i.

Interpretation:
Despite low co-pay, PCSK9i initiation rates among US veterans, nationwide, is very low. PAD and CeVD patients are much less likely to receive PCSK9i therapy. Household income and community deprivation influence PCSK9i use.
Abstract 176: Optimizing Blood Product Utilization In The Cardiac Catheterization Laboratory
Authors: Trivedi Mira K , Sheth Shreya , Cooper Felicia R , Elhoff Justin , Rodrigues Miranda , Stapleton Gary
Published: May 2022

Background:
Packed red blood cells (PRBC) are often ordered for pediatric cardiac catheterizations (PCC) with no current appropriate use guidelines, resulting in increased utilization. A quality improvement (QI) project was created to focus on optimizing ordering of PRBC for PCC. The primary aim was to increase adherence to new guidelines to > 97%, with a global aim to decrease patient cost.

Methods:
Retrospective chart review was performed to collect baseline data. For PDSA cycle 1, we updated our own PRBC ordering guidelines by risk stratifying procedures. The PCC report was updated to include documentation of PRBC ordering or transfusion. PDSA cycle 2 included further refinement of the guidelines, and improved awareness amongst those placing the pre-PCC orders. Process measures included ensuring the need for PRBC stated during every pre-PCC time-out, and consistent documentation in the PCC report. Balancing measures included monitoring the rate of PRBC transfusion within 24 hours post-PCC, and incidence of emergency release of PRBCs.

Results:
For 3 months of baseline data, 112/403 of CCPs (27.8%) had PRBC ordered, 87.5% (98/112) of which followed the prior protocol, with 13/403 (3.2%) receiving PRBC transfusion during CCP. With our revised guidelines, there could be > 20% reduction in PRBC ordering, with estimated > $20,000 cost savings based on 1 crossmatch ($173) and 1 unit PRBC ($730) prepared. For PDSA cycle 1, 27/81 (33%) of PCC had PRBC ordered, with 92% adherence to the updated guidelines, and 100% documentation compliance. For PDSA cycle 2, 13/47 (27.6%) had PRBC ordered with 100% adherence to ordering guidelines. During both cycles, 3 patients had PRBC transfusions within 24 hours of their procedure for other medical reasons not related to bleeding. No cases required emergency release of PRBC. There was a statistically significant process change from a median of 86% to 100% adherence (p=0.01) since implementation of the updated guidelines.

Conclusion:
With revised guidelines and improved adherence, hospital resources and charges were decreased in low-risk cardiac catheterization procedures without an increase in adverse events. This model can be utilized in other systems to similarly reduce resource utilization and costs.
Abstract 178: Improving Cardiac Rehab Attendance By Providing Transportation Services And Removing Cost
Authors: Price Andrea , Kovacs Richard , Frick Kyle
Published: May 2022

For more than a decade, Cardiac Rehabilitation (CR) has been a Class IA indication for cardiovascular patient populations. While the benefits of CR are well published, enrollment and attendance barriers persist. The overall objective of the PACE Project is to increase enrollment and completion of a CR program in an urban academic health center. It addresses two known barriers to patient CR participation: transportation and affordability. Our hypothesis is that Phase II CR enrollment and attendance can be increased by providing free transportation and removing patient out-of-pocket expenses. The study recruitment period was October 2019 to March 2021, with a pause in services and recruitment during the initial COVID-19 pandemic lockdown. Patient were offer PACE participation during their hospitalization. Once consents were obtained, the standard processes to schedule and enroll in Phase II cardiac rehab and exercise prescription were adhered. Patients were responsible for calling and scheduling transportation services for their CR sessions. Upon completion of the study, 73% (41/56) patients attended at least one Phase II session, with an average of 15 session per attendee. This compared to previously published national participation of 8.2% or 32.6%, of at least one session, depending upon in-patient CR referral. The study had a Phase II graduation rate of 32% (13/41). Transportation was utilized in 10.7% (6/56) of participants, with billed mileage ranging from 1-5 miles. Those utilizing transportation services were all female, with 83% (5/6) being women of color. Out-of-pocket co-payments were observed for 41.4% (17/41) of attendees. For those with co-payments, an average of $40, with a range $2-$60, per session was observed. CR is a proven guideline directed intervention to reduce secondary cardiac events. Our study suggest the removal of frequently cited barriers to participation, cost and transportation, is associated with improved CR participation.
Abstract 180: South Asian Nativity And Cardiometabolic Risk Factors In Pregnant Women In The United States
Authors: Vardhan Sumana , Rana Mariam N , Al-Kindi Sadeer
Published: May 2022

Introduction:
Women of South Asian (SA) descent have high cardiometabolic risk which may impact obstetric and long-term morbidity and mortality. Data regarding contemporary epidemiology of cardiometabolic risk factors in pregnant women are scarce. Therefore, we sought to investigate contemporary epidemiology of cardiometabolic risk factors in pregnant women in the US with a focus on SA-born women in comparison with United States (US)-born and women born in the rest of the world (ROW).

Methods:
We used the natality database 2016-2020 to investigate the incidence/prevalence of cardiometabolic risk factors (pre-pregnancy diabetes [pre-DM], gestational diabetes [GDM], pre-pregnancy hypertension [pre-HTN], gestational hypertension [GHTN], smoking, and obesity) in the US, by country of nativity. SA women were defined as women born in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. US women were those born in the US (including US Virgin Islands) and ROW refers to women born in other countries.

Results:
A total of 18,916,536 pregnancies were studied (370,619 SA; 14,745,134 US; and 3,800,783 ROW). SA women had higher risk of pre-DM compared with US and ROW (1.2% vs 0.9% vs 1.0%), GDM (15.7% vs 5.9% vs 8.8%), but lower rates of pre-HTN (0.9% vs 2.3% vs 1.3%), GHTN (4.2% vs 7.8% vs 4.9%), obesity (11.2% vs 29.6% vs 20.2%), and smoking (0.1% vs 8.1% vs 0.6%). Between 2016 and 2020, there was a significant increase in cardiometabolic risk factors in SA women: pre-DM (1.2% to 1.5%), GDM (14% to 17.7%), pre-HTN (0.8% to 1.0%), GHTN (3.7% to 5.0%), obesity (10% to 12.4%).

Conclusions:
In this contemporary analysis of pregnant women in the US, SA women had higher risk of pre-DM and GDM compared with US and ROW women. Between 2016 and 2020, there was a significant increase in the rates of all cardiometabolic risk factors in SA women. Intensive preventive strategies should be implemented in high-risk SA pregnant women in the US.
Abstract 185: Income Status And Receipt Of Sacubitril/valsartan For The Treatment Of Heart Failure
Authors: Johnson Amber E , Swabe Gretchen M , Addison Daniel , Essien Utibe R , Breathett Khadijah , Brewer LaPrincess , Magnani Jared , Mazimba Sula , Mohammed Selma F
Published: May 2022

Background:
Outcomes in heart failure with reduced ejection fraction (HFrEF), are influenced by access and adherence to guideline directed medical therapy.

Objective:
To study the association between median annual household income and: (1) odds of receiving sacubitril/valsartan, a novel angiotensin receptor/neprilysin inhibitor (ARNI) therapy among insured patients with heart failure with reduced ejection fraction (HFrEF) and (2) medication adherence (measured as the proportion of days covered (PDC)).

Hypothesis:
lower income is associated with lower odds of receiving and adhering to ARNI among patients with HFrEF.

Methods:
Using Optum’s deidentified Clinformatics® Data Mart, patients with ≥ 2 diagnoses of HFrEF and ≥ 6 months of enrollment for follow up (2016-2020) were included. Covariates included age, race, ethnicity, sex, educational attainment, household net worth, geographical region and Elixhauser comorbidity index. Prescription for ARNI was defined by presence of a claim within 180 days. Adherence was defined as PDC ≥80%. We fit multivariable-adjusted logistic regression models and hierarchical logistic regression accounting for covariates. We also assessed for race-income interaction.

Results:
Among 322007 individuals with HFrEF diagnosis, 136,613 had ≥6 months of complete data. Of the patients eligible for ARNI, only 5.4% (7409/136613) received a claim within 180 days of HFrEF diagnosis. After adjusting for social and clinical factors, the odds were elevated for ARNI claim within 180 days of HFrEF diagnosis (OR=1.38, 95% CI: 1.27, 1.49) for the highest income category (>$100K) compared with the lowest (<$40K). After adjustment, income <$40k) was associated with a 47% higher odds of PDC<80% compared with income >$100K.

Conclusions:
Higher patient income is associated with increased likelihood of an ARNI claim within 180 days of HFrEF diagnosis, even after adjusting for socioeconomic and clinical factors. Future analyses are needed to determine other social factors associated with delay in ARNI initiation and long-term adherence.
Abstract 189: Implementing Systematic Screening Driven By Quality Improvement Education (QIE) For Atrial Fibrillation During The Covid-19 Pandemic: Insight From Primary Care Setting In The United States
Authors: Russo Andrea M , Jacobs Ginny , Hall Laura Lee , Smith Anne Marie , McFadden Pam , Schowengerdt Bethany , Bruns Michelle , Fisher Claire , Tan Jian Liang , Lazure Patrice
Published: May 2022

Background:
Asymptomatic patients with atrial fibrillation (AF) pose challenges to diagnosis. Early diagnosis can reduce morbidity and mortality. Systematic screening in primary care may result in early intervention.

Objectives:
We sought to examine the implementation outcomes of a systematic, team-based quality improvement education (QIE) intervention for AF screening in primary care during the COVID-19 pandemic.

Methods:
QIE intervention was implemented in academic-based (n=4) and community-based (n=2) practices to address COVID-19 challenges. Surveys administered by site identified existing approaches and provider teams developed screening protocol based on targeted education, deploying a mobile ECG device (Kardiamobile™). Patient charts were reviewed (Dec 2020 - May 2021) to determine eligibility, i.e., patients aged 65–74 (with prior stroke/TIA or two other risk factors) or aged ≥75 (with one other risk factor) without prior AF. Patient EHR data were examined for demographic/clinical data and screening outcome. Provider interviews (n=12) and validation from representative patients (n=2) accounted for sustainability of outcomes.

Results:
A total of 1,221 patients were evaluated for AF risk, with 408 eligible for screening. Of these, 277 (68%) were female and CHA
2
DS
2
-VASc varied -score=3 (45%); score=4 (24%); score=5+ (31%). Patients (n=7; 2%) who screened positive for AF were referred or started on anticoagulation, like other primary care studies. Figure 1 shows how systematic screening was re-imagined and implemented Satisfaction and engagement increased among providers and patients - attributed, in part, to benefits of team-based planning and targeted education.

Conclusion:
An AF screening program was adapted to improve patient care despite COVID-19 related challenges. A QIE toolkit was launched to assist primary care practices with implementing streamlined, sustainable, and patient-engaging strategies to reduce stroke.
Abstract 197: Racial Disparity In Major Adverse Cardiovascular Events In Patients With History Of Inflammatory Bowel Disease: Analysis From The National Inpatient Sample
Authors: Ehtesham Moiz , Ali Hassam
Published: May 2022

Objective:
We aimed to uncover gender and racial differences in major adverse cardiovascular events (MACE) in patients with inflammatory bowel disease (IBD).

Methods:
The National Inpatient Sample was retrospectively studied (1/1/19-12/31/19) for IBD hospitalizations of ages >17 years. The primary outcome was a composite 5 point-MACE: cerebrovascular accident (CVA), myocardial infarction (STEMI and NSTEMI), congestive heart failure (CHF), Hypertension (HTN), and peripheral arterial disease (PAD). Type of coronary revascularization was assessed: percutaneous intervention (PCI) or coronary artery bypass graft (CABG). Data were analyzed in STATA 16.0, and adjusted odds ratios (AOR) were calculated using hierarchal multivariate regression analysis reported with 95% confidence interval (CI) and P-values.

Results:
The study included 169,355 patients (females=78705). Caucasians were the predominant race ([78%] reference) followed by African Americans (AA) (11%), Hispanics (H) (7%), and others (4%). Analyses revealed decreased association of STEMI (AOR 0.56, [0.35-0.90], P < 0.001), NSTEMI (AOR 0.53, [0.31-0.92], P < 0.001), CABG (AOR 0.12, [0.01-0.90], P < 0.001) and PAD (AOR 0.76, [0.65-0.89], P < 0.001) in AA vs Caucasians. Concurrently, there was an increased association of CHF (AOR 1.63, [1.43 -1.86], P < 0.001) and HTN (AOR 2.1, [1.88-2.24], P < 0.001) in the AA cohort. No significant difference existed between Hispanics and Caucasians for risk of MACE. Subgroup analysis for ulcerative colitis revealed a decreased occurrence of CABG (P < 0.001) and an increased association of HTN, PAD, and CHF in AA cohort (P < 0.001). Subgroup analysis for Crohn's disease revealed an increased association between HTN and CHF in AA vs Caucasians (P < 0.001). Subgroup analysis for females revealed a decreased association of STEMI and NSTEMI in AA cohort (P< 0.001) and an increased association of HTN, PAD, and CHF (P < 0.001) compared to Caucasians.

Conclusion:
African American patients with IBD are more likely to develop HTN, PAD, and CHF compared to their Caucasian counterparts while the occurrence of STEMI, NSTEMI, and CABG is reduced. There was no statistically significant change noted in outcomes in the Hispanic population.
Abstract 198: Cardiovascular Outcomes, Behavioral Risk Factors, And Health Insurance In Transgender Population In The United States Of America: Analysis From The 2020 Behavioral Risk Factor Surveillance Survey
Authors: Ehtesham Moiz , Amjad Waseem , Shabbir Muhammad Asim
Published: May 2022

Background:
There is paucity of clinical data regarding the health and cardiovascular (CV) outcomes of transgender (TG) population. Our aim was to determine the association of CV outcomes (and behavioral risk factors) with being TG in the USA.

Methods:
We utilized Centers for Disease Control's Behavioral Risk Factor Surveillance Survey (BRFSS) 2020 to determine responders who identified as TG. Non-TG (Cis gender) were also identified and used as controls. Behavioral risk factors such as history of smoking, lack of exercise, and heavy alcohol consumption (adult men having >14 drinks/week and adult women having >7 drinks/week) were measured. CV outcomes such as stroke, myocardial infarction (MI) and stable angina (SA) were noted. Lack of health insurance and college education were also analyzed. Data was studied in STATA 15 and multivariate logistic regression was used to estimate adjusted odds ratios (AOR) reported with p-value (significance=<0.05).

Results:
There were 401,958 individuals in this survey. 1017 (0.25%) and 235887 (58.7%) were TG and cis genders respectively. There was a significant association of being TG and reporting stroke (AOR 1.87, [1.71-1.92], p=0.002) and MI (AOR 1.45, [1.39-1.55], p=0.003) compared to Cis genders. Association of TG population with reporting SA was statistically insignificant (p=0.66). TG group was also more likely to not have exercised in the past 30 days (AOR 2.71, [2.51-2.89], p=0.009). Heavy alcohol consumption in past 30 days was significantly higher in TG group (AOR 1.36, [1.21-1.44], P=0.002) compared to Cis genders. There was no significant association of smoking noted (p=0.5). TG population had higher odds of reporting depression (AOR 1.53, [1.50-1.61], p<0.001) compared to Cis genders. They were also more likely to not have health insurance (AOR 0.44, [0.36-0.71], p<0.002), and lack college education (AOR 0.53, [0.50-0.81], p<0.003).

Conclusion:
Transgender population reports higher rates of cardiovascular diseases (stroke and MI), depressive disorder and heavy alcohol consumption. They are also more likely to not exercise, lack basic health insurance and college education contributing to worse clinical outcomes.
Abstract 199: Use Of Hybrid Veno-venous-pulmonary Artery ECMO In A Patient With Respiratory Failure Secondary To COVID-19
Authors: Ehtesham Moiz , Mahmood Fatima , Shabbir Muhammad Asim
Published: May 2022

Background:
Extracorporeal membrane oxygenation (ECMO) is a form of cardio-pulmonary life support used for patients with respiratory and/or cardiac failure. Hybrid ECMO is a sophisticated circuit to match the exact hemodynamic demands in patients who are refractory to traditional ECMO settings.

Case:
A 43-year-old male presented with dyspnea for four days. On physical examination, he exhibited increased work of breathing and decreased breath sounds bilaterally. Pulse oximetry was 70% on room air, minimally improved to 75% on maximum high flow nasal cannula. He was found to be COVID-19 positive and demonstrated diffuse bilateral lung consolidation on CT chest consistent with severe acute respiratory distress syndrome. Patient was intubated but continued to show poor oxygenation with P/F ratio of 71 (Normal: >400). Veno-Venous (VV) ECMO was started with cannulations into the right femoral vein (RFV) and right internal jugular vein (RIJV); this resulted in an initial improvement of partial pressure of oxygen (pO2) in arterial blood gas. However, within a few days, pO2 started to decrease with visual evidence of recirculation of oxygenated blood into the venous drainage line. A transthoracic echocardiography revealed severe pulmonary artery (PA) hypertension secondary to respiratory failure with PA pressure of 116mmHg (Normal: 18-25mmHg). This prompted a revision of the ECMO circuit to offload the right ventricle. Revised circuit included a cannula in the RFV for venous drainage and oxygenated venous return through two pathways: cannula in the RIJV (approximately 1 liter return), and a third cannula inserted through the left subclavian vein terminating into the main PA (approximately 4 liters return). Hereon, patient was able to maintain adequate pO2 for the remainder of his hospital stay until he was transferred to a lung transplant center.

Conclusion:
Our case illustrates the clinical sophistication of hybrid VV-PA ECMO - especially in patients with PA hypertension and impending right-sided heart failure. As respiratory failure secondary to COVID-19 becomes more prevalent, hybrid ECMO may provide a practical solution to protect the right heart in the journey to lung transplant.
Abstract 20: Recruitment Strategies To Increase Diversity And Enrollment In Behavioral Clinical Trials
Authors: Lewey Jennifer , Riis Valerie , Stupp Sarah , Levine Lisa , Elovitz Michal , Allison Kelly
Published: May 2022

Background:
Increasing rates of obesity are a major contributor to CV disease among women of reproductive age, especially Black women. Enrollment of racially diverse populations in behavioral weight loss trials is suboptimal and may be impacted by recruitment approaches. Our objectives are to evaluate the effectiveness of recruitment strategies informed by principles of behavioral economics on the enrollment of women into a weight loss trial and to understand the impact of race and insurance.

Methods:
We tested 4 strategies to enroll postpartum women with CV risk factors into a behavioral weight loss trial. 1,047 individuals who met inclusion criteria in the electronic health record were randomized to receive one of two personalized emails. Email 1 stated that “we reserved a spot” in the study for the patient. Email 2 asked the patient to “commit to health.” Patients who did not respond or have an email address were then randomized to receive a mailer or mailer plus baby bib (gift). All groups were asked to sign up for a virtual information session. We compared response rates between the 2 email and 2 mail strategies. We identified participant characteristics associated with signing up using multivariate logistic regression.

Results:
Mean age was 31.3 years, 65% were Black and 52% had Medicaid. 1000 patients were randomized to email 1 (n=497) and email 2 (n=503). Response rates were similar in the email groups (17.7% vs. 20.3%, p=0.299). 849 patients were randomized to the mailer (n=424) or mailer plus gift (n=425). Response rates were low but did not differ by strategy (2.6% vs. 3.8%, p=0.331), and largely did not vary by race or insurance (Table). In multivariable analysis, Medicaid insurance was associated with lower odds of signing up for an info session, but race was not.

Conclusion:
A tailored email is a low-cost and time effective strategy to recruit racially diverse women in a behavioral weight loss trial, though women with Medicaid insurance may require additional outreach.
Abstract 207: Quality Improvement Project: Urgent Heart Failure Clinic Reduces Admissions And Emergency Department Visits In Heart Failure Patients.
Authors: Maitz Theresa , Guthier Desire , Rivera Orlando , Grigg Michelle , sundlof deborah w , Feiner Ellina C
Published: May 2022

Currently, 6 million Americans suffer from congestive heart failure (CHF). The economic burden of the disease continues to rise with an estimated cost of $70 billion by 2030. Providing high value care to CHF patients continues to be a challenge and a priority nationwide. We aim to evaluate the efficacy of the multicenter telemedicine Urgent Heart Failure Clinic (UHFC) in the reduction of hospital admission and emergency room visit rates and health care costs. UHFC care team consists of a primary cardiologist to review the patient’s overall care plan, care coordination by cardiology CHF nurse navigator, CHF nurse practitioners, community-based resources, and intensive medication management and monitoring. Enrolled patients are offered complex care coordination and frequent nursing follow up to reinforce compliance, provide education, and identify additional resources for patients. A retrospective chart review of patients deemed high-risk for heart failure readmission and enrolled into UHFC was conducted. Primary endpoint was the evaluation of admission and emergency room utilization 90-day prior and post enrollment in UHFC. Of the 132 patients enrolled: 80% (106 of 132) hypertensive, 71% (94 of 132) had hyperlipidemia, 55% (73 of 132) diabetic, 61% (81 of 132) had chronic renal disease, 54% (71 of 132) had coronary artery disease, 31% (41 of 132) had valvular disease, 22% (29 of 132) had pulmonary hypertension, and 60.6% (80 of 132) had arrhythmias. 44% (58 of 132) ejection fraction (EF) < 50% and 56% (74 of 132) EF ≥ 50%. There was a 47.2% (103 vs 195) reduction in hospitalizations and a 24% (19 vs 25) reduction in emergency room visits post enrollment. Prior to enrollment 79% (105 of 132) of patients had hospitalizations compared to the 54.5% (72 of 132) of patients that had hospitalizations post enrollment. An individual decrease in the number of admissions was seen in 56.8% (75 of 132) of patients post enrollment. Overall, 92 admissions were saved equating to a cost savings of $1,487,124.50. In conclusion, utilization of UHFC had a significant reduction in admission rates within 90-day post enrollment. Implementation successfully led to a decrease in hospital utilization and thus a substantial reduction in cost of care.
Abstract 220: Higher Odds Of Medication Non-compliance In Hospitalized Young Adults With Cannabis Use Disorder: A Nationwide Population-Based Study
Authors: Desai Rupak , Soni Sukriti , Ghumare Ishan , Khanolkar Vidhi , Chintalapalli Patta Harika Varma , Yadav Tarun , Asifali Ryana , Asifali Roshna , Asfeen Ummul Z , Alukal Thomas , Jain Akhil
Published: May 2022

Background:
Medication non-compliance (MNC) is both a health and an economic burden. Considering a paucity of large-scale contemporary data, we aim to compare the rate of MNC in young adults hospitalized with vs without dependent cannabis use (cannabis use disorder) and study the risk factors of MNC.

Methods:
Young (18-44 years) patients with MNC were extracted from the National Inpatient Sample 2018 (ICD10 codes), divided into having and not having cannabis use disorder (CUD+ and CUD-). Rates of MNC were compared between 2 cohorts, CUD+ vs CUD-. Multivariate analysis was performed for predictors of MNC with CUD+.

Results:
Young hospitalized adults with CUD+ had an overall higher rate of MNC (7.2 vs 2.2%) vs CUD- cohort (p<0.001)
[Table 1]
. On subgroup analyses, significantly higher rates of MNC in CUD+ were seen in males (8 vs 4.2%), females (6 vs 1.4%), white (6.2 vs 1.4%), black (9.6 vs 3.8%), Hispanic (6.6 vs 1.7%), Asian/Pacific Islanders (6.7 vs 1%), Medicare enrollees (11.7 vs 5.8%), Medicaid enrollees (7.7 vs 2.8%), private insurees (4.9 vs 0.9%), in patients with concomitant depression (6.4 vs 3.7%), psychosis (8.3 vs 5.6%), alcohol abuse (7.3 vs 4.8%), tobacco use disorder (8.0 vs 4.5%) and overall drug abuse (7.6 vs 6.9%). When adjusted for confounders, young adults with CUD+ had higher odds of hospitalization with MNC vs. patients without CUD (aOR 1.19, 95CI 1.14-1.24, p<0.001). Statistically significant predictors for MNC in young adults with CUD were males (vs females, aOR 1.41, 95CI 1.31-1.52), blacks (vs whites, aOR 1.42, 95CI 1.28-1.57), psychosis (aOR 1.25, 95CI 1.12-1.40), tobacco use (aOR 1.36, 95CI 1.24-1.50) and drug abuse (aOR 1.92, 95CI 1.61-2.29).

Conclusion:
Medication non-compliance was significantly higher in all subgroups of young adults with CUD, with concomitant depression, psychosis, tobacco and alcohol use compared to non-cannabis users. Males, blacks, patients with psychosis, tobacco and drug users were likely to have MNC.
Abstract 223: Assessment Of The Impact Of Social And Racial Determinants On Patients Admitted With Heart Failure To A Safety Net Hospital
Authors: Minkus Hannah , Wenn Peter , Munshi Rezwan , Hai Ofek , Makaryus Amgad , Zeltser Roman
Published: May 2022

Background:
Heart failure (HF) plays a role in more than 10% of deaths annually in America. Due to high economic burden, hospital readmissions are used as a measure of outcome in HF patients. Readmission rates are influenced by many factors including coronary artery disease (CAD), chronic kidney disease (CKD), diabetes, race, and socioeconomic factors, as such as insurance and neighborhood median income. This study analyzes demographic characteristics and readmission rates at a teaching safety net hospital with a comprehensive HF program.

Methods:
A retrospective chart review of 200 consecutive HF patients admitted to our hospital from 2011 to 2020 was performed. Zip codes were correlated to social deprivation index (SDI) using data from the 2011-15 American Community Service, a project of the US Census Bureau. All 90-day readmissions due to cardiac related conditions were included. Descriptive studies are reported. χ
2
and Independent Samples T test were used to identify demographic features correlated with cardiac readmissions.

Results:
There was a total of 44 readmitted patients (22%). Mean age was 74.6 vs 71 .57 in not readmitted (NRA) vs readmitted (RA) (p=0.492), sex was 50% male in both groups (p=1.00). Mean EF was 41.1 % vs 47.81% (NRA vs RA, p=0.332). There was no difference in incidence of CAD (p=0.348), HTN (p=0.15), Afib (p=0.303), CKD (p=0.374), DM (p=0.361) in NRA vs RA groups. Patients with pre-existing HF and a primary language other than English trended towards more readmissions (85.6% vs 95.5% p=0.059 and 19.2% vs 31.8% p=0.061). There was no statistical difference in non-white race (46.8% vs 56.8% p=0.158), extreme social deprivation as measured by SDI >76 (22.4% vs 22.7% p=0.557), or insurance presence (64.1% vs 63.6% p=0.544) in NRA vs RA groups.

Conclusion:
Treatment of hospitalized HF patients at our safety net hospital is equitable among hospitalized patients regardless of patient comorbidities, demographics, and socioeconomic status. Further studies should focus on attributes of a comprehensive heart failure program that contribute to this high quality of care, so they can possibly be replicated at other hospitals to improve outcomes across all patient populations.