bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4143621: Efficacy and Safety of Rivaroxaban and Lower Molecular Weight Heparin in Preventing Venous Thromboembolism in Cancer Patients; A Systematic Review and Meta-analysis.
Authors: Shrestha Abhigan , Adhikari Ashok , Devkota Anirudra , Shrestha Aayush , Akhtar Syed Muhammad Muneeb , Goyal Aman , Shrestha Sajina , Jaiswal Vikash
Published: November 2024

Introduction:
As per current guidelines, low molecular weight heparin (LMWH) has been commonly used as prophylaxis for venous thromboembolism in cancer patients. Directly acting anticoagulants (DOACs) having ease of administration, oral availability despite renal dysfunction, and possibly higher adherence, are also being used as an alternative to prevent venous thromboembolism Events (VTE) recently. In addition, rivaroxaban is among the first DOACs used in the prophylaxis for VTE.

Hypothesis:
This study intends to compare the efficacy and safety of rivaroxaban and LMWH (enoxaparin, dalteparin, and nadroparin) in preventing VTE in cancer patients.

Methods:
A comprehensive literature search was performed on PubMed, Embase, Scopus, and Cochrane libraries from inception until March 2024, with suitable Mesh terms. The random effects model was used to calculate the pooled Odds Ratio (OR) with their corresponding 95% confidence intervals (CI). A p-value of <0.005 was considered statistically significant.

Results:
Four studies including two cohort studies and two Randomized Controlled trials (RCTs) with 1515 patients (rivaroxaban: 753 and LMWH: 762) with mean ages of 58.15 and 58.6 years respectively were included in the analysis. Up to 30 days after follow-up, the rates of VTE (OR, 0.38, 95% CI: 0.10 – 1.40, p=0.42), DVT (OR, 0.74, 95% CI: 0.48 – 1.16, p= 0.76) and major bleed (OR, 0.88, 95% CI: 0.36 – 2.14, p=0.26) were lower with rivaroxaban compared to LMWH. But, the minor bleeds (OR, 3.82, 95% CI: 1.76 – 8.29, p=0.38), clinically relevant non-major bleeding (CRNMB) (OR, 1.09, 95% CI: 0.11 – 10.79, p=0.16), bleeding (major + CRNMB) (OR, 1.47, 95% CI: 0.82 – 2.61, p=0.27), all-cause mortality (OR, 1.17, 95% CI: 0.70 – 1.96, p=0.54) were higher with rivaroxaban compared to LMWH.

Conclusion:
In cancer patients for the prevention of venous thromboembolism, rivaroxaban shows non-inferior efficacy and questionable safety profile as compared to LMWH. Further research needs to be done to confirm the above findings.
Abstract 4143665: Study of Prognostic Importance of Hyponatremia in the Acute Phase of ST Elevation Myocardial Infarction
Authors: Rathod Vaishnavi , Raval Darshankumar , Patel Kristina , Elkhatib Wiaam , Ramnani Juhi , Bhattacharya Dr Amalkumar
Published: November 2024

Introduction:
Hyponatremia is a common electrolyte abnormality that has been associated with poor outcomes in several conditions including acute myocardial infarction (AMI). However, those studies were performed in the era before percutaneous coronary intervention (PCI), focused mostly on ST-elevation myocardial infarction (STEMI), and sodium levels up to 72 h of admission.

Aim:
The purpose of this study was to identify the prognostic importance of hyponatremia in patients with acute myocardial infarction.

Methods:
We performed a cross sectional and retrospective analysis of 100 patients with a diagnosis of non-ST-elevation myocardial infarction (NSTEMI) and STEMI presenting at PSH, Vadodara, Gujarat, India from January 2022 to May 2024. Our independent variables were sodium levels on the day of admission. Dependent variables were in-hospital mortality, 30-day mortality, length of hospital stay, intensive care admission, new heart failure diagnosis, and ejection fraction. Infarct size was determined by echocardiographic examination that was performed on admission, day 2 or 3 of hospitalization

Results:
Hyponatremia, defined as a plasma sodium level <135 mmol/L (<135 mEq/L). 32% of patients had hyponatremia up to 7 days of admission. Intensive care admission was higher in patients with hyponatremia up to7 days (70% vs 383%), they had worse 30-day mortality (15% vs to 3%), in hospital mortality (12% vs 2%), and new heart failure diagnosis (32% vs 16%). Hyponatremia on admission was associated with in-hospital mortality (15% vs 4%), 30-day mortality (19% vs 6 %).

Conclusions:
This study suggests that hyponatremia on admission and at any point during the first seven days of hospitalization are associated with in-hospital and 30-day mortality and prognosis worsens with the severity of hyponatremia. Further studies are required to determine if plasma sodium levels may serve as a simple marker to identify patients at high risk.
Abstract 4143691: Prediction of extent of reverse remodeling and outcome after cardiac resynchronization therapy using a strain-based classification of dyssynchrony
Authors: Duchenne Jurgen , Calle Simon , Aalen John , Galli Elena , Larsen Camilla , Mirea Oana , Puvrez Alexis , de Buyzere Marc , Kongsgard Erik , Voros Gabor , Penicka Martin , Donal Erwan , Smiseth Otto , Timmermans Frank , Voigt Jens-Uwe
Published: November 2024

Introduction:
Echocardiography-derived septal strain patterns can serve as indicators of the progressive left ventricular (LV) remodeling caused by left bundle branch block (LBBB)-induced dyssynchrony.

Research question:
What is the prognostic value of these strain patterns in predicting volumetric response and clinical outcome in patients undergoing cardiac resynchronization therapy (CRT)?

Methods:
In this prospective multicenter study, CRT candidates from 5 centres received pre-implantation echocardiographic assessments with speckle-tracking strain analysis. Dyssynchrony was quantified through the analysis of septal strain curves, categorizing patients into 5 distinct strain patterns, denoted as Stage-0 through Stage-4 (Fig. 1). Extent of reverse remodeling was determined at 1 year. The pre-defined endpoint was death from any cause.

Results:
A total of 267 patients were included (66±11 years, 69% males, 90% LBBB, LV ejection fraction [EF] 30±7%). CRT yielded a progressive reverse remodeling: minimal in Stage-0 patients (ΔLV end-systolic volume (ESV) -9±21ml; ΔLVEF +4±8%) and substantial in Stage-4 patients (ΔLV ESV -85±54ml; ΔLVEF +20±9%) (ANOVA p<0.001 for both) (Fig. 2). Median follow-up was 49 months. Stage-0 patients showed the least favorable outcome (log rank p=0.002), while subsequent stages exhibited progressively more favorable outcome (log rank p=0.045) (Fig. 3). The occurrence of death decreased incrementally according to the strain stages, with corresponding hazard ratios of Stage-1 through -4: 0.61 (95% CI 0.25-1.50), 0.26 (95% CI 0.10-0.68), 0.29 (95% CI 0.11-0.77), and 0.13 (95% CI 0.04-0.51) compared to Stage-0 (all p<0.001). After adjusting for baseline LVEF, ischemic heart disease, and the presence of an ICD, strain staging maintained a significant association with a reduced risk of adverse outcomes (hazard ratio 0.69 (95% CI 0.51-0.92), p<0.001).

Conclusions:
Septal strain patterns show a clear association with the extent of reverse remodeling and outcome in CRT-treated patients. The proposed strain staging classification offers valuable insights into the pathophysiology of LBBB-induced LV remodelling and may assist in the identification of candidates who stand to gain the most from CRT implantation.
Abstract 4143725: Down-regulation Of Cardiomyocyte Isocitrate Dehydrogenase 2 Mediates Metabolic Reprogramming, Contributing To Heart Failure By Remodeling The Lactate Microenvironment.
Authors: Li Juncong , Duan Xiaolin , Hu Dongtu , Liu Pei , Lin Ying-wen , Zhong Guoheng , Wen Liming , Li Shunyi , Zhang hao , Lin Xiangjie , Zeng Qingchun
Published: November 2024

Backgroud:
Metabolic and ventricular remodeling are early events of pressure overload that lead to heart failure. Metabolic remodeling is characterized by an imbalance between the tricarboxylic acid cycle and glycolysis.This imbalance increases glucose uptake by the heart, promotes glycolysis, and leads to its dissociation from oxidative phosphorylation, resulting in increased lactate production.

Research Aim:
To investigate whether there are genes that regulate the switching of energy metabolism patterns during pressure overload and act through lactate.

Results:
We used untargeted metabolomics to detect changes in metabolite content in transverse aortic constriction (TAC) mice and analyzed bulk RNA sequencing and single-cell sequencing data from public databases. Combined with a systematic literature review, we found that isocitrate dehydrogenase 2 (IDH2) plays an important role in switching energy metabolism modes, suggesting that IDH2 may be a potential therapeutic target.Silencing IDH2 in TAC mice using AAV resulted in an aggravated cardiac hypertrophy phenotype, accompanied by more extensive cardiac fibrosis compared to wild-type (WT) mice. On the contrary, overexpression of IDH2 by AAV attenuated cardiac hypertrophy in TAC mice. Mechanistically, IDH2 deficiency aggravates cardiomyocyte acidification, prompting cardiomyocytes to release lactate to maintain intracellular acid-base balance. Lactate, acting as a "signal molecule," is taken up by macrophages to promote H3K18 lactylation, which further enhances the expression of pro-inflammatory cytokines. In contrast, cardiac overexpression of IDH2 via AAV and administration of a lactate inhibitor alleviated cardiac hypertrophy and fibrosis.These findings suggest that lactate plays an important role in heart failure. Cardiomyocyte IDH2 can regulate the metabolic mode of cardiomyocytes and affect the lactate microenvironment, thereby altering the inflammatory state of macrophages and impacting pathological cardiac hypertrophy.

Conclusion:
IDH2 may be involved in the regulation of cardiac metabolism during pressure overload, leading to myocardial acidification, promoting the release of lactate and affecting the inflammatory state. This suggests the possibility of IDH2 as a potential therapeutic target and the nonmetabolic function of lactate as an intercellular signaling molecule. These findings will help to further explore the role of energy metabolic turnover in the occurrence and development of heart failure.
Abstract 4143727: AI Integration Decreased Rural Documentation Burden by 40% in Medicare's Chronic Care Management Setting
Authors: Miller Jered , Jimmerson Garrett , Miller Callie , Dey Ashley , Wheeler Caroline , Miller Samuel , Al Tibi Ghaith , Chronos Nicolas
Published: November 2024

Efforts to ameliorate rural healthcare burnout stemming from overwork have taken many approaches, including the increased usage of Artificial Intelligence (AI) to aid in generating electronic medical records (EMR). This new application of AI technology demands characterization of the possible benefits and efficacy of its new use. Using a commercially available AI software (Freed AI) designed for EMR production, we conducted a study to determine the quality of EMR generated by AI.

Methods:
This trial analyzed 248 patient-provider interactions within a rural setting of Medicare’s Chronic Care Management (CCM program), recorded by Freed AI and a human scribe. Three blinded readers with a clinical background were given 2 notes from the same patient-encounter. One note was written by a provider and one was generated by Freed AI. Each reader performed a binary, independent assessment of each note compared with the note generated by the human control. Readers were trained on definitions of the categories clarity, accuracy, completeness, and relevance. The time required per encounter was also recorded and analyzed.

Discussion:
As seen in Table 1, AI performed better than a human-generated EMR in the fields of clarity and relevance, suggesting effective formatting and a well calibrated understanding of what information is medically relevant. No significant difference in completeness was observed, suggesting AI was able to record as much valuable information as traditional charting. AI performed below the human standard in the category of accuracy. For example, AI sometimes misspelled names or misunderstood complex situations being discussed because it was not able to infer certain information which a human, using outside knowledge and past experiences, could. The reduction in time spent while utalizing AI demonstrates a highly significant decrease in workload and allows providers freedom to allocate more time interacting with each patient and hopefully reducing physician burnout.
Abstract 4143742: A Tale of Two Surgeries: Single Stage Versus Two Staged Approach to Creating an Ovine Model of Fontan Palliation
Authors: Kievert Jennifer , Spiess Joshua , DeShetler Cameron , Yuhara Satoshi , Watanabe Tatsuya , Jimenez Michael , Naguib Aymen , McKee Christopher , Yates Andrew , Morrison Adrienne , Nelson Kirsten , Heuer Eric , Shinoka Toshiharu , breuer christopher , Carrillo Sergio Alejandro , Kelly John
Published: November 2024

Introduction:
Children born with single ventricle heart disease must undergo Fontan palliation. The lack of chronic preclinical animal models has limited the study of the significant end-organ complications that reduce the quality and duration of life. Here, we explore surgical strategies to improve animal survival in a chronic model of Fontan palliation.

Methods:
Sheep were divided based on the surgical approach: single stage Fontan (SS) versus staged Fontan. Controls were age/sex matched to the surgical cohort. The SS surgery consists of the Glenn, direct anastomosis of the SVC to the main pulmonary artery (MPA), and the Fontan, IVC connection to the MPA using a Gore-Tex conduit. Stage palliation consists of two stages. During stage 1 (S1), the IVC is connected to the MPA. A year later, stage 2 (S2) Glenn surgery is completed. Early post-op hemodynamics were monitored for 2 weeks through daily blood gases, an implanted telemetry device, and chest tube output.

Results:
SS had 5/6 sheep survive. S1 had 8/9 sheep survive (7/9 sheep continued to S2). S2 had 3/7 sheep survive. The trend in heart rate was not significantly different across the groups. However, we note a trend of an increase in heart rate in all groups on post-operation day (POD) 3 (144.90±20.72 BPM), which normalized POD10 (118.63±23.84 BPM) (p=0.006). Similarly, lactate peaked on POD0 (3.37±2.53mmol/L) and normalized POD2 (0.59±0.20 mmol/L) (p=0.0003) with no significant difference across groups. Creatine increased (SS) 1.7-fold (p=0.016) and (S2) 1.4-fold (p=0.032) from PO to POD1 and normalized by POD14. There was no significant elevation in creatine in S1. The chest tube output was not significantly (p=0.270) different across SS (4827.83±435.71 mL (11.6 days)), S1 (3305.33±1086.18 mL (10.5 days)), and S2 (4056±1890.26 mL (7 days)).

Conclusions:
We have demonstrated a similar clinical course for both surgical approaches of our ovine model with animals alive 1 to 3-year(s) post-operation. Future studies will follow the single stage approach given the improved animal survival and reduced surgical complexity. The ovine surgical model will allow the study of Fontan associated end-organ complications and be a testbed for potential curative solutions.
Abstract 4143757: Adverse Outcomes with Cardiac Contractility Modulation: Insights From the MAUDE Registry
Authors: Katapadi Aashish , Chelikam Nikhila , Katapadi Aashika , Darden Douglas , Gopinathannair Rakesh , Kabra Rajesh , Atkins Donita , Lakkireddy Dhanunjaya , Pothineni Naga Venkata
Published: November 2024

Background:
Cardiac contractility modulation (CCM) is a device-based heart failure therapy that augments cardiac contractility. One CCM device – the Optimizer Smart Mini System [Impulse Dynamics, Marlton, NJ] – is approved by the Food and Drug Administration (FDA) for clinical use.

Research Question:
What are real-world and long-term outcomes of the Optimizer Smart Mini CCM system?

Objective:
We reviewed the United States FDA Manufacturer and User Facility Device Experience (MAUDE) database for adverse events and outcomes associated with the Optimizer Smart Mini System CCM.

Methods:
On June 3rd, 2024, we performed a MAUDE database search for all reports of CCM devices from January 2019 - when the first pre-market implantation was noted - to the present. Duplicates were removed, and outcomes were noted.

Results:
A total of 34 total reports were found. The majority of events were reported since 2023. 58.8% (n=20) of events were classified as device malfunctions. This occurred most often due to a computer software problem (35.3%, n=12), failure to charge (14.7%, n=5), and an adverse event without an identified problem (14.7%, n=5). Commonly, error code A09 - a charging error due to incorrect interpretation of a high current during a routine safety self-check - occurred in 38.2% (n=13) of all cases, even in patients without a reported software problem, and was solved by resetting the device in 47.1% (n=16) of cases. This is a known problem. Injury occurred in 35.3% (n=12) of cases due to implant failure (52.9%, n=18) as the most common patient problem. There was a 5.9% (n=2) rate of mortality.

Conclusions:
Real-world CCM implantation appears to have low device-related adverse risks but suffers from computer software issues that may be solved by resetting the device. Continued monitoring and accurate adverse event reporting are needed with increased use to assess long-term risks.
Abstract 4143784: Long-Term Effectiveness of a Community Health Worker-Led Blood Pressure Intervention on Cardiovascular Disease and Mortality
Authors: Allouch Farah , Ouyang Nanxiang , Sun Guozhe , Qiao Lixia , Wang Chang , Liu Songyue , Chen Chung-shiuan , Mills Katherine , He Hua , Chen Jing , Geng Danxi , Xie Ziyi , Yu Yao , Li Zhi , He Jiang , Sun Yingxian
Published: November 2024

Background:
Hypertension is the leading preventable risk factor for cardiovascular disease (CVD) and all-cause mortality worldwide. Community health worker (CHW)-led intervention has been effective in lowering blood pressure (BP) and CVD risk. However, the long-term effectiveness of CHW-led intervention is unknown.

Aim:
We assessed the long-term effectiveness of a CHW-led intensive BP intervention on CVD incidence and all-cause mortality.

Methods:
The China Rural Hypertension Control Project (CRHCP) involved 33,995 hypertensive individuals aged ≥40 years from 326 villages in rural China. A total of 163 villages were randomly assigned to a CHW-led intervention, while the other 163 villages were assigned to usual care. CHWs were trained village doctors who initiated and titrated antihypertensive medications using a simple stepped-care protocol according to ACC/AHA clinical guidelines. They also conducted health coaching and delivered free or discounted antihypertensive medications to participants. The primary effectiveness outcome was a composite of myocardial infarction, stroke, heart failure, or CVD death during the 48-month follow-up period. Secondary outcomes included CVD death and all-cause death. Safety outcomes were also assessed at 48 months.

Results:
During a median follow-up of 48 months, 1,744 CVD events (2.6% per year) were documented in the intervention group, compared to 2,191 CVD events (3.5% per year) in the usual care group. The CHW-led intervention resulted in a 27% reduction in CVD (hazard ratio [HR] 0.73; 95% CI 0.69 to 0.78). Furthermore, CVD deaths were reduced by 24% (HR 0.76; 95% CI 0.68 to 0.84), and all-cause deaths were reduced by 14% (HR 0.86; 95% CI 0.80 to 0.94) in the intervention group compared to the usual care group. Participants in the intervention group had a significantly lower rate of serious adverse events compared to usual care participants (risk ratio 0.94; 95% CI: 0.91 to 0.98). However, there was no statistically significant difference in injurious falls, symptomatic hypotension, or syncope between the two groups.

Conclusion:
This randomized cluster trial showed that a CHW-led intervention significantly reduced CVD risk and all-cause mortality over 48 months among rural residents in China. This feasible and effective BP intervention strategy should be scaled up in China and other low- and middle-income countries to reduce the burden of CVD worldwide.
Abstract 4143794: Drug-Coated Balloon Strategy Following Rotational Atherectomy for Calcified Coronary Artery Compared with Drug-Eluting Stent
Authors: Yui Hisanori , Kuramitsu Shoichi , Sugie Takuro , Tadano Yutaka , Kaneko Umihiko , Kanno Daitaro , Kashima Yoshifumi , Fujita Tsutomu
Published: November 2024

Background:
Drug-coated balloons (DCB) have emerged as an effective treatment for in-stent restenosis and small vessel disease. DCB angioplasty might improve outcomes in heavily calcified lesions, a challenge in the current era of drug-eluting stents (DES). Calcified nodules (CN) also remain problematic due to high incidences of target lesion revascularization (TLR). However, there is limited evidence comparing the efficacy of DCB and DES angioplasty in heavily calcified lesions requiring rotational atherectomy (RA), including those with CN.

Methods:
From January 2020 to July 2022, 471 patients underwent percutaneous coronary intervention (PCI) for calcified de novo coronary lesions using either DCB or DES (≤ 3 mm) following RA. Among these, 102 cases (21.7%) received DCB angioplasty, while 369 cases (78.3%) received DES angioplasty. The primary endpoint was the cumulative incidence of major adverse cardiac events (MACE), defined as a composite of cardiac death, clinically driven target lesion revascularization (CDTLR), and target vessel-related myocardial infarction (TVMI). We also compared the cumulative one-year incidence of TLR between the DCB and DES groups based on the presence of CN. CN was defined by intravascular ultrasound or optical coherence tomography as a convex shape of the luminal side of calcium.

Results:
The cumulative one-year incidence of MACE was higher in the ROTA+DCB group compared to the ROTA+DES group (12.7% vs. 6.2%, Log-rank P=0.039). ROTA+DCB angioplasty was associated with an increased risk of MACE (inverse probability weighted hazard ratio [IPWHR], 3.02 [95% confidence interval {CI}, 1.063-8.583]; p=0.038) and CDTLR (IPWHR, 6.423 [95% CI, 1.825-22.60]; p=0.004) compared to ROTA+DES angioplasty.

In the CN subgroup (n=185), the one-year incidence of TLR was comparable between the DCB and DES groups (10.6% vs. 5.8%, IPWHR, 1.909 [95% CI, 0.414-8.804]; p=0.41). Conversely, in non-CN lesions (n=248), the one-year TLR rate was higher in the DCB group (7.8% vs. 1.0%, IPWHR, 12.42 [95% CI, 1.780-86.59]; p=0.011).

Conclusion:
In patients with calcified coronary artery disease, the DCB strategy following RA was associated with a higher rate of MACE at one year compared to the DES strategy following RA. However, for calcified nodules in heavily calcified coronary arteries, the DCB strategy alone was comparable to DES following RA. In contrast, non-CN calcified lesions had a higher TLR rate with DCB compared to DES.
Abstract 4143800: Behavioral Components of Cardiovascular Health and Their Determinants Among Medical Students at the University of Danang, Vietnam
Authors: Giang Hoang Thi Nam , Le Tho Minh Hieu , Nguyet Truong Thi Anh , Hung Nguyen Nguyen , Vu Thanh-Huyen
Published: November 2024

Background:
Although cardiovascular health (CVH), especially health behaviors among youth and young adults, has been well-studied in the United States, similar research is limited in Vietnam. This study assesses the prevalence of various CVH behaviors—including ideal sleep health (ISH), ideal body mass index (IBMI), ideal physical activity (IPA), and non-smoking status—and identifies factors associated with these behaviors among medical students at the University of Danang, Vietnam (UD).

Methods:
We used cross-sectional data from a health survey conducted in March-April 2024, targeting all medical students at UD (Years 1-6) with a 98% response rate. Definitions of CVH behaviors were detailed in the Table's footnotes. Multivariable logistic regression was employed for analysis. Demographic information, depression and anxiety levels, other lifestyle factors, and living environment conditions were included in the models. Differences in determinants by sex were also examined.

Results:
Among 510 students (mean age 21.9 years; 51.4% female), 27.1% reported ISH, 19.8% achieved IPA, 61.2% had IBMI, 17.3% were underweight, and 96.3% were non-smokers. Multivariable regression indicated that age, anxiety levels, noise at night, and uncomfortable sleep space were associated with lower odds of ISH; odds ratios (95% confidence intervals) were 0.78 (0.68, 0.88), 0.99 (0.87, 0.99), 0.55 (0.35, 0.89), and 0.26 (0.11, 0.64), respectively. For other ideal behaviors, compared to males, females were significantly less likely to achieve IPA but more likely to have IBMI and be non-smokers (see Table). In gender-stratified analyses, working for pay was positively associated with IPA for females but negatively for males. Among females, better academic achievement was linked to a lower likelihood of IPA. Male students with less gaming time were more likely to be non-smokers.

Conclusion:
Ideal sleep health, BMI, and physical activity levels are low, while non-smoking rate is high among medical students in Danang, Vietnam. Key determinants of sleep health include age, mental health, and living environments. Factors such as working for pay, academic achievement, and time spent gaming link to other CVH behaviors differently for males and females. More comprehensive studies on cardiovascular health in Vietnamese college students are needed to identify effective interventions for improving cardiovascular health in the young adult population of this developing country.
Abstract 4143804: Factors Associated With Increased Inpatient Mortality Risk In End Stage Heart Failure Patients That May Help Providers To Identify triggers For Palliative Care Consultation
Authors: Cedeno Juan , Ogg Galen , Chandra Akhil , Atienza Matthew , Pandya Vidish , Ippolito Paul , Chavez Patricia , Eti Serife
Published: November 2024

Introduction:
Palliative care interventions for patients with heart failure have been shown to significantly improve quality of life, reduce symptom burden, and enhance functional status. Timing of referral becomes challenging as disease progresses and readmission rates increase. We studied factors associated with inpatient mortality in patients with end stage heart failure, ineligible for additional advanced therapies.

Methods:
Individuals with acute decompensated heart failure admitted between 2021-2023, who were ineligible for further advanced cardiac therapies and referred to palliative care, were included to this retrospective study. Data on demographic variables, clinical parameters (NYHA classification, Karnofsky Performance Scale (KPS) scores, comorbidities, type of heart disease, BNP, albumin, creatinine levels), and palliative care interventions (symptom burden assessments, family meetings, and advanced care planning (ACP) discussions) were collected. We conducted bivariate and multivariate analyses using Kruskal-Wallis and chi-square tests, and adjusted regression models to compare characteristics between individuals who died while admitted and survivors.

Results:
A total of 97 individuals were included in the study, with a mean age of 68 ± 17.7 years, 33.0%(n=32) of whom were female. Patients who died during admission had significantly higher rate of established ACP following palliative care consult (p< 0.01) and had a shorter time from consultation to discharge and were more likely to be declared DNR/DNI during admission. Hospital length of stay was shorter for patients who died in the hospital Lower KPS scores, with KPS scores <40 associated with increased hospital mortality (OR = 3.6 [CI 1.16–10.57], p < 0.01). Albumin levels were lower in this group, and levels <2.5 g/dL were associated with increased mortality (OR = 3.2 [CI 1.4–9.3], p < 0.01).

Conclusions:
individuals with end-stage heart failure who have lower KPS scores, and reduced albumin levels may face a higher risk of in-hospital mortality and rapid disease progression. Identifying triggers such as severe symptom burden, complex decision-making needs, and functional decline can ensure timely and appropriate palliative care referrals.
Abstract 4143807: Risk of all-cause mortality after aortic valve replacement in 66,931 individuals across the VA Healthcare System
Authors: Small Aeron , Saavedra Armando , Houghton Serena , Cho Kelly , Tarko Laura , WILSON PETER , Cui Xiangqin , LINEFSKY JASON
Published: November 2024

Introduction:
Aortic stenosis is the most common valvular heart disease and is managed by aortic valve replacement (AVR) procedures. Comorbid conditions may impact survival after AVR.

Methods:
We evaluated risk factors for all-cause mortality after AVR in the Veterans Affairs (VA) healthcare system for individuals with an AVR between January 1
st
2007 and December 31
st
2017, with National Death Index mortality data through December 31
st
, 2020. Clinical diagnoses and procedures were established by
International Classifications of Disease
(ICD) and
Current Procedural Terminology
(CPT) codes both in the VA and the Center for Medicare and Medicaid Services. Hazard rates for the primary outcome of all-cause mortality were calculated using a cox proportional hazards model adjusted for age at AVR, sex, and prevalent clinical risk factors (heart failure [HF], obesity, type 2 diabetes [T2D], and myocardial infarction [MI]).

Results:
There were 7,984,029 individuals seen regularly at the VA between 2007 and 2017. Within this group, there were 783,772 (9.8%) individuals with an established diagnosis of AS without prior valve replacement with a median (interquartile [IQR]) age of 73.5 [67.4-80.3] years, and 98% male. Between 2007-2017, 66,931 individuals had an AVR with median [IQR] age 72.8 [66.6-79.3] years, 98% male. Of the individuals with an AVR, 24,253 (36.2%) died prior to the end of follow up, with a median [IQR] time to death of 3.3 [2.8-5.3] years. At the time of valve replacement, there were 16,301 (24%) diagnoses of CKD, 11,916 (18%) diagnoses of HF, 21,575 (32%) diagnoses of T2D, and 4,211 (6%) diagnoses of prior MI. In a multivariable model, with adjustment for age, sex, and all clinical risk factors, a prevalent HF diagnosis portended the highest risk of all-cause mortality after AVR (HR 1.57 [1.52-1.62], p < 0.001), followed by T2D (HR 1.13 [1.09-1.16], p < 0.001), CKD (HR 1.11 [1.08-1.15], p < 0.001), and MI (1.05 [0.99-1.11], p = 0.06).

Conclusions:
Common clinical comorbidities including HF, CKD, and T2D, but not MI independently increase the risk of all-cause mortality after AVR.
Abstract 4143813: Secular Trends and Mortality Rates in Percutaneous Coronary Intervention in Non-ST Elevation Acute Coronary Syndrome: 15-Year Nationwide Survey
Authors: Abood Zaid , Allaqaband Suhail , Sokhal Balamrit , Tunink Kirsten , Hommeida Mohamed , Bajwa Tanvir , Jan M. Fuad
Published: November 2024

Background:
Non-ST elevation acute coronary syndrome (NSTE-ACS) is a leading cause of cardiovascular morbidity, with variable mortality across age groups. Older patients exhibit higher in-hospital mortality and often experience delayed percutaneous coronary intervention (PCI) owing to comorbidities. Large-scale data on PCI and inpatient mortality trends are limited.

Aim:
To evaluate inpatient mortality rates of NSTE-ACS treated with PCI over a 15-year period, comparing trends based on age groups.

Methods:
We used the National Inpatient Sample from 2005 to 2019 to identify the study population using the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification. The primary outcome was the PCI trend of NSTE-ACS among age groups. The secondary outcome was in-hospital mortality. Multivariate logistic regression and adjustment for sex, race, and Charlson comorbidity index score were used.

Results:
We evaluated 6,645,610 patients hospitalized in the United States for NSTE-ACS. Of these, 2,291,282 (34.4%) underwent PCI; mean age was 64.8 years, and 34.3% were female. PCI rates increased in all age groups during the study period; however, they remained significantly lower in patients above 80 years of age. The rate of PCI increased from 38% to 44.7% in the 18-64 years age group, from 29.1% to 43.1% in the 65-79 years age group, and from 15.6% to 31.7% in those 80 years and older during the study period (P<.001) (Figure 1). Furthermore, inpatient mortality rates decreased significantly across all age groups. From 2005-2007 to 2017-2019, mortality rates declined from 1.1% to 0.8% in the 18-64 years age group (P<.001), from 2.5% to 1.6% in the 65-79 years age group (P<.001), and from 4.8% to 2.9% in those aged 80 years and older (P<.001).

Conclusion:
From 2005 to 2019 (15 years), an increasing number of patients with NSTE-ACS underwent invasive treatment with PCI each year, most notably in those aged 80 years and older. This was associated with a decline in inpatient mortality across all age groups, greatest in those 80 years of age and older. These results are reassuring as people are living longer and NSTE-ACS is increasingly identified in an older population group.
Abstract 4143815: Structural, Hospital, and Clinical Factors Do Not Completely Explain Major Lower Limb Amputation Disparities among Patients Hospitalized with Peripheral Artery Disease
Authors: McGinigle Katharine , Kalbaugh Corey , Minc Samantha , Strassle Paula
Published: November 2024

Background:
Racial and ethnic disparities in major lower limb amputation (MLLA) in patients with peripheral artery disease (PAD) are well documented. Rural/urban differences have also been observed. Disparities in the prevalence of PAD, progression to chronic limb-threatening ischemia, and access to vascular centers and revascularization may explain observed differences.

Research Question/Hypothesis:
Are MLLA disparities still present after accounting for clinical presentation, hospital characteristics, and social drivers of health? We hypothesized that race, ethnicity and rurality differences in MLLA rates would disappear after accounting for these factors.

Methods:
We conducted a retrospective cohort study of 2017-19 PAD-related hospitalizations in adults ≥40 years old living in Florida, Georgia, Maryland, Mississippi, and New York using HCUP State Inpatient Databases, which include all community hospital admissions in each state, regardless of insurance status. Patients were excluded if they were not a resident or if they were admitted for lower limb trauma, malignancy, or non-vascular wounds. We used machine learning (LASSO) to predict the probability of revascularization and MLLA for each hospitalization, using clinical presentation, chronic conditions, hospitalizations and surgery within past year, hospital characteristics, and social drivers of health. We calculated observed-to-expected (O/E) ratios across race, ethnicity, and rurality. Bootstrapping (n=1000) was used to estimate confidence intervals.

Results:
1,577,061 hospitalizations (990,152 patients) were included; there were 100,549 revascularizations (6.4%) and 21,233 MLLA (1.4%). No meaningful disparities were seen for revascularization. More than expected MLLA were performed in Black patients, both rural (O/E:1.26, 95% CI:0.98-1.54) and non-rural (O/E:1.12, 95% CI:1.09-1.15), and rural Hispanic patients (O/E:1.50, 95% CI:0.89-2.12),
Fig
.

Conclusions:
Even after accounting for clinical, hospital, and structural factors, MLLA disparities were observed among Black and rural Hispanic patients. These results suggest other factors, such as implicit bias in healthcare, play a role in the elevated limb amputation rates in minority and rural patients.
Abstract 4143835: Cardiac Magnetic Resonance Imaging in Pediatric Heart Transplant Recipients: Correlation With Cardiopulmonary Exercise Testing
Authors: Tucker Sarah , Griffith Garett , Desai Lajja , Wang Alan , Gambetta Katheryn , Ward Kendra , Husain Nazia
Published: November 2024

Background:
Cardiac magnetic resonance (CMR) is increasingly used for rejection surveillance in pediatric heart transplant recipients (PHTR). It is unclear if CMR-derived tissue characterization and myocardial perfusion correlate with functional status, i.e. VO
2peak
as derived by cardiopulmonary exercise testing (CPET). Lower VO
2peak
has been associated with poor cardiometabolic health and development of coronary artery vasculopathy in PHTR.

Aim:
Our aim was to evaluate the correlation between CMR derived variables and CPET outcomes.

Methods:
PHTR who underwent CMR within 1 year of CPET were retrospectively reviewed. Those with submaximal effort on CPET (RER<1.1) or clinical events (rejection, new or worsening CAV, or cardiac hospitalizations) between CMR and CPET were excluded. CMR variables were biventricular volumes, ejection fraction, myocardial T2, T1/extracellular volume fraction (ECV) which are biomarkers for edema and fibrosis respectively, and myocardial perfusion reserve index (MPRI). CPET variables were VO
2peak
, O
2
pulse, age-predicted maximum heart rate (APMHR), HR reserve and exercise duration. Relationships between variables were studied using Pearson’s correlations and regression.

Results:
Fifty PHTR met inclusion criteria (age 16.5 ± 2.9 yrs, female=25). Time from transplant and time between CPET and CMR were 5.9 ± 0.5 yrs and 0.5 ± 0.3 yrs, respectively. CPET mean baseline HR was 89 ± 11 bpm and peak HR was 167 ± 21 bpm; 8 patients were on beta blockers. Mean LVEF was 60 ± 4.5%. Higher T2 correlated with reduced VO
2peak
(
R
= -0.346,
p
=0.029) and higher global MPRI correlated to increased exercise duration (
R
=0.323,
p
=0.048). Associations were also noted between CMR variables and HR-dependent CPET variables including O
2
pulse, HR reserve and %APMHR (table 1). However, given known abnormal HR response to exercise related to denervation and variable timing of reinnervation in PHTR, the significance of these associations is unclear.

Conclusion:
In PHTR with normal LV function, CMR cardiac structure and tissue characteristics have correlations with exercise capacity and duration. Larger studies are needed to understand the role of multiparametric CMR in the functional surveillance of PHTR.
Abstract 4143837: Demographics and Regional Trends in Mortality associated with Atherosclerotic Cardiovascular Diseases in the Nicotine-Dependent Population: A Retrospective Study in the United States from 1999 to 2020
Authors: Raza Ahmed , Cheema Ameer Haider , Bin Gulzar Abu Huraira , Arshad Mirza Ammar , Tanveer Rahman , Sohail Haroon , Hamza Ali , Khan Ubaid
Published: November 2024

Background:
Atherosclerotic Cardiovascular Diseases (ASCVD) are a leading cause of morbidity and mortality, causing four out of every five cardiovascular (CV) deaths. Nicotine is a significant risk factor for ASCVDs. While there is comprehensive data available on mortality trends for cardiovascular diseases (CVDs) in general, the mortality data for ASCVDs in the nicotine-dependent population is still lacking.

Objective:
We aim to explore the mortality trends and patterns related to ASCVDs in the nicotine-dependent population of the US, stratified by different demographic and regional variables.

Methods:
We retrieved the data from the CDC Wonder database and determined the crude death rates (CRs) and age-adjusted mortality rates (AAMRs) per 100,000 individuals. We targeted the middle-aged and older adult nicotine-dependent population. Our study examined the changes in AAMR through annual percentage change (APC) and average annual percentage change (AAPC) using Joinpoint regression program.

Results:
From 1999 to 2020, a total of 912,565 deaths were reported due to ASCVDs in the nicotine-dependent population of the US, demonstrating an increasing trend (AAPC = 13.06). Males (56.63) had a higher AAMR than females (19.05). Non-Hispanic (NH) American Indians or Alaska Natives had the highest AAMR (47.16), while the NH Asians or Pacific Islanders had the lowest (7.52). The AAMRs also varied by regions, with Midwest having the highest AAMR (44.88) followed by Northeast (35.72), South (33.9), and West (25.97). The states with the highest percentage change in AAMR were New Jersey and Tennessee, while those with the lowest percentage change were California and North Dakota. Non-metropolitan areas had the highest AAMR (47.29), followed by medium/small metropolitan (39.24) and large metropolitan (28.36). Most deaths occurred at the decedent’s home (39.46%) and the medical facility (39.37%).

Conclusion:
We reported increasing ASCVDs-related age-adjusted mortality trends in the nicotine-dependent population of the US, with the highest AAMRs in males, NH American Indians/Alaska Natives, the midwestern region, and the non-metropolitan areas. Targeted health policy measures must be taken to address these alarming trends.
Abstract 4143844: Multidisciplinary management of a pregnant patient with advanced systolic heart failure
Authors: Mitchell Jameson , Hoffman Karlee , Singh Katherine
Published: November 2024

A 35-year-old gravida 1, para 0 with biventricular heart failure (LVEF 25%), nonischemic cardiomyopathy, history stroke, history of left ventricular thrombus, class III obesity, and chronic kidney disease who had been followed by Cardio-Obstetrics throughout her pregnancy presented at 34 weeks gestation for planned induction of labor. Upon presentation, she underwent assessment with a pulmonary artery catheter (PAC) and was noted to be in cardiogenic shock with elevated biventricular filling pressures and low cardiac index necessitating hemodynamic stabilization followed by primary cesarean section.

The patient was admitted to the cardiac ICU for medical optimization prior to delivery. Home medications including isosorbide dinitrate, metoprolol, and hydralazine were continued. The patient was briefly placed on inotropic support with dobutamine, which was discontinued due to ectopy. After PAC-guided IV diuresis, anticoagulation transition from enoxaparin to heparin, and twice daily fetal monitoring via non-stress test, a multidisciplinary team, including cardiology, maternal fetal medicine, cardiac anesthesia, and cardiothoracic surgery assembled for the C-section. Following pre-delivery cannulation for potential ECMO support, the patient underwent C-section and elective salpingectomy under epidural anesthesia with delivery of a healthy neonate.

Post-delivery, the patient was monitored in the ICU, focusing on fluid management, anticoagulation transition to warfarin, and titration of heart failure medications, as the patient did not plan to breastfeed. After discharge, she was scheduled for a 2-week postpartum visit including echocardiogram, EKG, and NT-proBNP.

Discussion:
Given the patient's acute decompensation and fluid overload, medical optimization was essential prior to delivery. However, stabilization was expected to be temporary due to ongoing physiologic changes of pregnancy. Her limited mobility and concern for multiorgan compromise, such as new oxygen dependency and rising creatinine, made a prolonged induction of labor unfeasible. Due to concern for maternal intolerance of labor, unstable fetal lie, fetal distress due to decreased perfusion, and an increased likelihood of emergency C-section, a primary C-section was recommended as a safer option. The successful delivery of a healthy neonate and post-operative maternal stabilization highlights the importance of a multidisciplinary approach in managing complex cardio-obstetric cases.
Abstract 4143849: The Impact of Community Health Workers in a Pre-existing Postpartum Hypertension Program
Authors: Azzi Marly , Bisson Courtney , Everett Arin , Potchileev Sanela , Mueller Ariel , Duncan Colleen , Rana Sarosh
Published: November 2024

Background:
Maternal mortality in the United States continues to rise, with hypertensive disorders of pregnancy (HDP) playing a significant role in adverse outcomes. Patients of color have worse outcomes compared to their White counterparts. Data in non-pregnant patients suggests community health workers (CHWs) can help mitigate disparities and improve HDP outcomes. Does exposure to a CHW improve patient education about HDP and satisfaction and are these findings different between Black and non-Black patients?

Methods:
This was a prospective survey study that enrolled patients delivering at the University of Chicago (UCM). Patients with HDP are automatically enrolled in a standardized postpartum hypertension education program (STAMPP-HTN) where they receive education and a blue tooth compatible blood pressure monitor. Patients who did not record their blood pressures were contacted by a CHW and surveyed about their experience. Results were compared between Black and Non-Black patients using a Wilcoxon Rank Sum, X
2
or Fisher’s Exact test, as appropriate.

Results:
There were 32 survey responses from 22 respondents and 15 patients with complete baseline data, 6 of whom were Black and 9 of whom were non-Black. There were no differences in age, insurance status, or pregnancy outcomes between groups. Additionally, of the 32 survey responses, there were no significant differences in experiences with a CHW between Black and non-Black patients. Table 1 outlines the impact of CHW on patient’s education and attitude towards HDP. Most patients found that CHW involvement increased the amount of time they checked their blood pressure (76%) with no difference between races (p=0.23). Overall, 84% patients (strongly agreed or agreed) that their CHW knows the important issues about their healthcare.

Conclusion:
The incorporation of a CHW program into a pre-existing postpartum hypertension program was overall well-received by patients with no racial disparity. The program increased the patient’s understanding of HDP and lead to a better follow up of their blood pressures values. Further work is needed to determine how this program impacts long-term patient’s outcomes.
Abstract 4143893: Combining Noncoding and Coding Genetic Variation Improves Arrhythmia Risk Prediction
Authors: Monroe Tanner , pesce Lorenzo , Kearns Samuel , Page Patrick , Dellefave-Castillo Lisa , Webster Gregory , Puckelwartz Megan , McNally Elizabeth
Published: November 2024

Background:
Ventricular arrythmias are highly heritable disorders and can cause sudden cardiac death (SCD). However, clinical genetic testing identifies pathogenic variants in less than 20% of nonischemic SCD cases. Additionally, there is considerable overlap in cardiomyopathy and arrhythmia (CMAR) genetics. Identifying genetic risk is important for predicting who might benefit from clinical intervention. We hypothesized that combining common, regulatory, and coding genetic variation could improve genetic risk prediction.

Methods:
We established a cohort of 1042 individuals with nonischemic arrhythmia risk (n=505, mean age 37) or controls, lacking cardiac or arrhythmia related diagnostic codes (n=537, mean age 58). Genome sequencing was analyzed for rare variants in CMAR and epilepsy genes, and extended to include noncoding variants in the regulatory regions of these genes. We also included common variants derived from polygenic scores for 18 cardiac rhythm and myopathic disorders. We then created a risk stratification algorithm that incorporated all 3 analyses.

Results:
When comparing the top quintile to the lowest quintile of scores, the 18 polygenic scores had an odds ratio of 5.0 [95%CI 3.8-6.7], indicating significant contribution from common variation. Coding region analysis demonstrated an enrichment of ultrarare and pathogenic CMAR and epilepsy gene variants in the arrhythmia cases compared to controls. The high risk arrhythmia cases also had a >1.5-fold enrichment of ultrarare regulatory variants mapping to CMAR/epilepsy genes. As a predictor, the combination of common, coding, and regulatory variant analysis performed best, with the top 20% of the cumulative risk score carrying an odds ratio of 18.4 [95%CI 12.7-26.9], outperforming any subset of variant classes. A replication cohort confirmed these results. Importantly, this risk analysis performed well in individuals without monogenic arrhythmia risk (genotype negative cases).

Conclusions:
A comprehensive genetic risk score that includes noncoding and polygenic analyses can improve arrhythmia risk stratification.