bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17: Association Between Age And Health Status In Chronic Coronary Disease With An Initial Invasive Or Conservative Strategy: Insights From The ISCHEMIA Trial
Authors: Nguyen Dan D , Spertus John A , Jones Philip G , Alexander Karen P , Reynolds Harmony R , Newman Jonathan D , Stevens Suzanna , Reynolds Harmony , Bangalore Sripal , Mark Daniel B , Stone Gregg W , Boden William E , O'Brien Sean M , Arnold Suzanne V , Chan Paul S , Maron David J , Hochman Judith S
Published: May 2022

Background:
Patients with chronic coronary disease (CCD) and at least moderate ischemia who were randomized in the ISCHEMIA trial to an invasive strategy (INV) had greater benefit in angina-related health status during follow-up than with a conservative strategy (CON). Whether this benefit varies by age is unknown.

Methods:
Angina-related health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ; score range 0-100; higher score=less angina). Linear regression models assessed the association of treatment strategy (INV vs CON) with 1-year health status, including a treatment-by-age interaction using splines, adjusted for sex, ejection fraction, eGFR, diabetes, and baseline health status.

Results:
Among 4617 ISCHEMIA patients with complete health status data, mean age was 64±10 years; 2239 (48.5%) were <65, 1713 (37.1%) were 65-74, and 665 (14.4%) were ≥75. Baseline SAQ Summary scores were higher in patients aged 65-74 and ≥75 compared with those <65 (76.2 vs 75.4 vs 71.8 points). At 1 year, an INV strategy resulted in higher mean SAQ Summary Scores for all age groups but with greater benefit in younger patients (<65 vs 65-74 vs ≥75: +5.1 vs +2.5 vs +1.5 points). In adjusted analyses, the largest health status benefits of INV treatment were observed with younger age, with significant interactions between age and treatment strategy for SAQ Summary (p=0.007) and Quality of Life (QOL) scores (p=0.02) (

Figure

). At age 80, the benefits of an INV over CON strategy diminished for SAQ Summary Score, Physical Limitations, and QOL, despite increases in SAQ Angina Frequency scores. Similar trends were observed when patients without angina were excluded.

Conclusion:
CCD patients of all ages had better health status with an INV vs CON strategy, but these benefits were greater in younger patients and diminished with increasing age. These data suggest an initial CON strategy may be preferred in older patients with CCD, based on goals of care.
Abstract 177: Predictors Of All-cause Mortality In Young Onset Stroke: An Artificial Neural Network Analysis Using A Nationwide Cohort
Authors: Desai Rupak , Aiya Utsav , Rashid Rakin , Deb Avijit , Patel Neel , Alli-Ramsaroop Bibi , Brereton Brian , Jain Akhil , Rupareliya Chintan
Published: May 2022

Background:
It is crucial for providers to screen high risk patients with limited data being available on young onset stroke (YOS). We aimed to determine predictors of all-cause mortality in this population using the Artificial Neural Network (ANN) model in a national cohort.

Methods:
We identified young adult (18-44 yrs) YOS hospitalizations from the National Inpatient Sample (2018). ANN’s predictive factors were selected for all-cause mortality. YOS admissions were randomly split between training (70%) & testing datasets (30%). Training data was used to calibrate ANN while testing data was used to evaluate accuracy of the algorithm. We compared the frequency of incorrect prediction between training and testing data and measured area under the Receiver Operating Curve (AUC) to determine ANN’s efficacy in predicting in-hospital mortality in YOS.

Results:
The 2018 YOS cohort consisted of 39,040 admissions with a mean age of 36 ± 6 years (50.1% male, 51.1% white, 26.2% black, 15.5% Hispanic, 3.2% Asian or Pacific islanders) patients). The all-cause-in-hospital mortality was 5.3%. Training data showed an improved lower predictions in testing model vs testing (5.0% vs 5.2% error rate) , thereby depicting better accuracy. Normalized predictors are displayed in Figure 1a. The AUC was 0.82 (Fig 1b) which shows an excellent ANN model for inpatient mortality in YOS patients.

Conclusion:
The ANN model successfully revealed the order of prevalent predictors for all-cause mortality that can eventually be utilized to improve survival in high-risk patients.
Abstract 179: Impact Of Age On Catheter Ablation For Atrial Fibrillation In Octogenarians
Authors: Abumoawad Abdelrhman , Mirza Jacqueline , Mark Justin , Lopez-Candales Angel
Published: May 2022

Introduction:
Patients undergoing catheter ablation for atrial fibrillation (CA-AF) often have significant co-morbidities. Although multiple comorbidities increase with age, outcomes of CA-AF), particularly, in older patients has been conflicting.

Methods:
The International Classification of Diseases Code, 10
th
Revision Clinical Modification (ICD-10) was used to identify patients hospitalized for CA-AF between 2016-2019 from the National Readmission database (NRD). Patients were classified into two groups, those younger than 80 years and older than 80 years. Ninety-day readmission rates and causes of readmission were compared. Adjusted multivariate regression analysis was used to identify factors associated with readmissions.

Results:
We identified 40,174 patients who underwent CA-AF from this cohort, 5875 (14.6%) patients were above the age of 80 years and these patients were more likely to have congestive heart failure (72.8% vs 42.6 %), valvular disease (39.3% vs 20.4), pulmonary vascular disorders (18.5% vs 7.4%), chronic pulmonary disease (29.9% vs 23%) and renal failure (35.7% vs 16.6%). In addition, patients >80 years had longer hospital length of stay, higher rates of major adverse cardiovascular events (6.4% vs 3.5%; p<0.0001), acute heart failure and sepsis during their index admission when compared with patients < 80 years. A total of 1201 (20.4%) patients above age for 80 years were readmitted within 90 days as compared to 4295 (12.5%) below the age of 80 years ( p<0.001). Acute heart failure, AF and acute kidney injury were the most common causes for readmission. The following factors were associated with higher risk of readmission in multivariate regression analysis: length of stay > 4 days (OR 1.36 95% CI 1.17-1.91, P<0.0001), chronic pulmonary disease (OR 1.35 95%1.17-1.55, P<0.0001) and renal failure (OR 1.25 95% CI 1.006-1.55, p=0.04).

Conclusion:
Age > 80 years is associated with increased risk of complications and higher readmission post CA-AF in patients with OSA . Shared medical decision making for octogenarians with AF should consider these data and alternative treatment strategies when appropriate.
Abstract 193: Major Adverse Cardiovascular Events And Conduction Abnormalities In Patients With ANCA-Associated Vasculitis: Retrospective Analysis From A Tertiary Referral Center
Authors: Ehtesham Moiz , Shabbir Muhammad Asim , Peredo-Wende Ruben
Published: May 2022

Objective:
Our aim was to determine the association of major adverse cardiovascular events (MACE) and cardiac conduction abnormalities in patients with history of ANCA-associated vasculitis.

Methods:
We retrospectively reviewed patients with ANCA vasculitis (n=125) from 2017-2020. Charts were reviewed to assess cardiovascular (CV) risk factors which included history of smoking, hypertension, hyperlipidemia, diabetes mellitus and chronic kidney disease. Incidence of MACE such as myocardial infarction (MI), stroke, heart failure (HF) was calculated retrospectively after the diagnosis of ANCA vasculitis. Similarly, the incidence of cardiac conduction abnormalities [atrial fibrillation (AF), first degree atrioventricular block (1AVB), and advanced heart block (ADVB)] was analyzed. Chi square and modified Poisson regression were used to calculate the incidence rate ratio (IRR) for MACE and conduction abnormalities.

Results:
Of 125 total patients, 77 (61.6%) had granulomatosis with polyangiitis (GPA), 37 (29.6%) had eosinophilic granulomatosis with polyangiitis (EGPA), and 11 (8.8%) had microscopic polyangiitis (MPA). Females were 68%. Mean age of the cohort was 58 +/- 15 with a mean BMI of 29.4 +/- 6.4 kg/m
2
. The unadjusted and adjusted (for age, gender, and CV risk factors) IRR for stroke was significantly lower in patients with EGPA and MPA vs. GPA (p<0.05), while IRR for HF was higher in EGPA vs. GPA (p<0.05) [Table 1]. IRR for AF was higher in patients with EGPA vs. GPA (p<0.02), while for ADVB it was lower (p<0.04) [Table 2]. The adjusted IRRs for MI and HF were higher in patients with EGPA and MPA but were not statistically significant [Table 1].

Conclusion:
Incidence of stroke is higher in GPA patients compared with EGPA and MPA, while EGPA is more likely to lead to heart failure compared to GPA. Atrial fibrillation is more commonly seen in patients with EGPA, and advanced heart block is less common in EGPA compared with GPA.
Abstract 21: Characteristics Of Patients With Transthyretin Amyloid Cardiomyopathy Receiving Tafamidis Therapy: Experience At An Advanced Heart Failure Program
Authors: Egolum Ugochukwu , Sykalo Christine , Ahmad Moaz , Cates Drew , Ling Hua
Published: May 2022

Background:
While the safety and efficacy of tafamidis are described in clinical trials, data on its real-world application are lacking. This study summarized the characteristics of patients initiating first-time treatment with tafamidis at the Cardiac Amyloidosis Clinic at Georgia Heart Institute.

Methods:
A retrospective analysis of the clinical characteristics and treatment progress of patients diagnosed with transthyretin amyloid (ATTR) cardiomyopathy receiving tafamidis therapy from May 6, 2019, to Oct 1, 2021.

Results:
In total, 18 patients were identified who had received tafamidis. Two patients were excluded from the analysis as they did not receive care from our clinic. Of the remaining 16 patients, 2 African American and 1 Caucasian patients with a mean age of 59.5 years old, carried V122I mutation. The other 13 patients, Caucasian with a mean age of 81.4 years old, possessed wild-type ATTR amyloidosis. No patients with V30M mutation were identified. Of the patients included, 14 male and 2 female, the 2 female patients had wild-type ATTR amyloidosis. At the time of tafamidis initiation, 10 patients were at the UK National Amyloidosis Centre (NAC) stage 1 amyloid cardiomyopathy, 5 patients at NAC stage 2, and 1 patient at NAC stage 3. The median (IQR) levels of NT-proBNP were 2240 (1098 - 4148) pg/mL at baseline, and 1446 (800 - 2795) pg/mL at 12 months after initiation of therapy. The mean eGFR of patients with wild-type ATTR and V122I mutation were 58 and 72 mL/min/1.73 m2, respectively. Four patients received additional therapy with 1) doxycycline, 2) doxycycline and tauroursodeoxycholic acid, 3) diflunisal, 4) patisiran. There were 13.33% patients on beta-blockers, 53.33% received ACEI/ARBs, and 86.67% took aldosterone antagonists. No adverse events were reported nor therapy discontinuation.

Conclusion:
Our findings are consistent with published data with wild-type ATTR more frequently seen in males and V122I mutation predominantly seen in individuals of African descent. Overall, in a real-world setting, tafamidis was associated with a decline in NT-proBNP and well-tolerated in our patients.
Abstract 218: Aerobic And Strength Training Improves Functional Capacity In Diabetic Patients Undergoing Cardiac Rehabilitation
Authors: Liu Nina , Gonzalez Tinoco Jose , Cortez-Toledo Elizabeth , Andrade Humberto J , Khong Anthony , Junker Margaret , Lopez Javier E
Published: May 2022

Background:
Traditional cardiac rehabilitation (CR) focuses on aerobic training to improve functional capacity and recovery after cardiovascular events. The use of combined aerobic and strength training is not yet standard of care despite its potential for improving functional capacity. The aim of this study was to characterize the effectiveness of a combined aerobic and strength training CR program for patients living with diabetes in comparison to patients without diabetes.

Methods:
We retrospectively reviewed initial and final functional assessments for 167 patients participating in CR between 12/2019 - 9/2021. Functional capacity was assessed by the metabolic equivalent of task (METs) in a 6-minute walk test (6-MWT), arm curl reps, chair-to-stand reps, and timed up and go test. P-values were determined by the Mann Whitney U test and Wilcoxon signed rank test.

Results:
Cohort characteristics and outcomes are listed in Table 1. Diabetic and non-diabetic patients improved in all measures of functional capacity, with arm curls and chair-to-stand exhibiting the greatest change. There was no statistical difference in outcomes between groups.

Conclusions:
Diabetic patients had equivalent improvements in both aerobic and strength measures as their non-diabetic counterparts. This is an early dataset that highlights the effectiveness of combined aerobic and strength training to improve the quality of CR care for diabetic patients.
Abstract 22: Racial And Ethnic Differences In Bystander Cardiopulmonary Resuscitation For Witnessed Out-of-Hospital Cardiac Arrest
Authors: Garcia Raul A , Spertus John A , Girotra Saket , McNally Bryan F , Breathett Khadijah , Del Rios Marina , Kennedy Kevin F , Nallamothu Brahmajee K , Sasson Comilla , Chan Paul S ,   CARES Surveillance Group
Published: May 2022

Background:
Racial disparities in bystander cardiopulmonary resuscitation (CPR) treatment contributes to inequities in survival for out-of-hospital cardiac arrest (OHCA). Whether bystander CPR rates differ by race/ethnicity for witnessed OHCAs in public settings is unclear but critical to understand for informing public health interventions.

Methods:
Within the Cardiac Arrest Registry to Enhance Survival, we identified 110,054 witnessed OHCAs during 2013-2019. Using hierarchical logistic regression, we compared rates of bystander CPR in Blacks/Hispanics vs. Whites for OHCAs at home vs. in public locations, overall and by neighborhood race and income groups.

Results:
Overall, 35,469 (32.2%) witnessed OHCAs occurred in Black/Hispanic individuals and 25,758 (23.4%) OHCAs occurred in public locations. Blacks/Hispanics were less likely to receive bystander CPR at home (38.5% vs. 47.4% for Whites; adjusted OR [aOR]=0.74 [95% CI: 0.71-0.76]) and in public (45.6% vs. 60.0%; aOR=0.59 [0.56-0.63]), and the magnitude of this disparity was greater for OHCAs occurring in public (
P
for interaction <0.001). Lower bystander CPR rates for Blacks/Hispanics at home and in public were found in majority Black/Hispanic, Integrated, and predominantly White neighborhoods (

Table

), and the magnitude of this difference was greater for public OHCAs in each neighborhood race/ethnicity stratum (all
P-
values for interaction
<
0.02). A similar pattern was found in high, middle, and low-income neighborhoods, with lower bystander CPR rates for Blacks/Hispanics at home and in public and a larger treatment disparity for OHCAs in public vs. at home in each income strata (all
P-
values for interaction
<
0.001).

Conclusions:
Black and Hispanic victims of witnessed OHCA are less likely to receive potentially life-saving bystander CPR, as compared with White patients, and the magnitude of this disparity was greater for OHCAs witnessed in public than at home.
Abstract 226: The Appropriate Use Of Stress Tests In Low Pretest Probability Of CAD
Authors: Naqvi Abeeha , Mohmand Billal , Durland Justin , Charlamb Mark
Published: May 2022

Chest pain is the second most common complaint seen in ED and remains a leading diagnostic challenge. Multiple assessment tools are validated to predict the probability of coronary obstruction causing chest pain for appropriate diagnostic care. Although clear guidelines are available for intermediate and high-risk individuals, analysis by AHA for low-risk patients and the indication for cardiac imaging is ongoing. An observational retrospective analysis was performed of patients above 18 years admitted for ACS rule out chest pain from January 2019 to 2020 at Upstate University Hospital. Electronic records were reviewed for patient demographics, pre-test probability of CAD based on Diamond and Forrester (DF) model, troponins, ECG, stress test modality, if cardiac catheterization was required and 30-day readmission rate for MI. Exclusion criteria ensured using only low-risk patients, with heart scores of 1 or 2 depending on age. The study selected 173 patients, 107 (61.8%) females and 66 (38.1%) males. Stress tests were performed on 22 (20.6%) female patients and 14 (21.2%) male patients. No stress test yielded abnormal results or required cardiac catheterization. None had 30-day readmission for MI. The most common stress test modality was exercise ECHO (50%). All patients had a low pretest probability (<10%) but 21% underwent inappropriate stress testing, without a change in outcomes. The 2021 AHA guidelines for chest pain support no additional cardiac testing in the low-risk population within 30 days of presentation to ED. Prior to this update, guidelines broadly recommended stress testing for this cohort. Our study supplements new guidelines and is a quality metric evaluation. As guidelines are readily investigated and updated by field experts, evaluating their clinical use by referring providers is imperative. Our study highlights the challenges to diagnose CAD and the overestimation by current and unrevised DF and HEART scores. The overestimation coupled with financial reimbursement policies allow for unnecessary testing. Guidelines have outlined when not to order cardiac imaging, and future directives need to focus on comparing risk models to define probability of CAD, with the shift of demographics to older, female and with noncardiac symptoms.
Abstract 232: Determinants Of Discharge Disposition In High-risk Myocardial Infarction And Heart Failure
Authors: Naik Mitha , Mealy Shane , Doyle Mark , Poornima Indu G
Published: May 2022

Background:
Discharge to home is a quality metric tracked by several health systems, payers, and certifying bodies. We examined the factors determining discharge to home versus post-acute care facilities (Nonhome) in a Medicare Fee-for-service (MFFS) population with acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF).

Methods:
All MFFS patients who had a DRG of 280, AMI with major comorbidities (MCC), and DRG 292, ADHF with shock, complication, or comorbidity (CC), in Allegheny Health Network hospitals between 2018-2020 were included in the study. Clinical characteristics, discharge location, 30-day readmission, and 1-year mortality rates were obtained retrospectively.

Results:
There were 144 patients in the AMI group (56% male) and 67 patients in the ADHF group (42% male). Our MFFS numbers were lower than other metropolitan areas due to our area's high use of Medicare Advantage plans. Discharge to nonhome locations occurred in 35% of AMI and 34% of ADHF patients. Lower mean age (73 vs. 77), higher functional status prior to admission, admission from home, and normal diet consumption were more likely in-home discharges in both AMI and ADHF(p<0.05). Comorbidities including hypertension, diabetes, CKD, COPD, and clinical characteristics including LVEF, NYHA class, BMI, anemia were similar between home and nonhome groups. Prior hospitalization for a cardiac cause occurred more often in home discharges only in AMI groups (53% vs. 27% p=0.004) but not in ADHF. Independent predictors of nonhome discharge in AMI and ADHF are shown in the table. No differences in 1-year mortality and 30-day readmission rates were noted between home and nonhome discharges.

Conclusions:
In a high-risk population of AMI with comorbidities and ADHF with shock, nonhome discharge was best predicted by functional status prior to admission. Heightened focus on physical therapy and rehab in-hospital can promote discharge to home regardless of clinical characteristics.
Abstract 236: Evaluation Of The Radiation Safety And Protection Practices At The Cardiac Catheterization Unit Of The Cairo University Hospital.
Authors: Ghallab Muhammad , Nassar Mahmoud , Mostafa Karim S , Salama Dina H. , Abdelmoteleb Salma , Hashad Assem
Published: May 2022

Introduction:
Cardiac Catheterization laboratories are one of the most hazardous places to work in. The aim of this study is to evaluate the radiation safety in the cardiac catheterization unit at the Cairo University Hospital in Egypt.

Hypothesis:
We hypothesize that the employees of the Cath labs are overexposed to radiation.

Methods:
We conducted a cross-sectional observational descriptive study at two Cath labs at the Cairo University Hospital in 2019. The participants were nine cardiologists, six nurses, three technicians, and seven hundred patients. The study was conducted over seven months in three phases. Phase I (Thre months), we measured the real-life radiation exposure for the participants in the Cath lab of our department. Phase II (Four weeks), educational lectures about radioprotection and the hazards of radiation exposure were given. Phase III (Three months) The operators were motivated to use maximally the radiation protection shields that are fixed to the table and the ceiling, and radiation doses were re-meausred.

Results:
The total cumulative radiation doses in Phase I ranged from 2.7mSv to 6.5mSv (mean=4.29±1.26), 0.5mSv to 5.5mSv (mean=2.7±1.7), and 0.7 mSv to 4 mSv (mean=2.9±1.9), while in Phase III ranged from 2.1mSv to 5.5 mSv (mean=3.48±1.26), 0.6 mSv to 4.8 mSv (mean=2.4±1.5), and 0.8 mSv to 5.8 mSv (mean=4±2.8); for the cardiologists, the nurses and the technicians respectively. There was a statistically significant difference between the two phases in the mean total cumulative radiation doses received by the cardiologists (P value=0.013), and the mean total dose area product for the patients (P value= <0.001).

Conclusion:
The staff compliance with radiation protection standards during cardiac catheterization was insufficient. However, the exposure to radiation to the operators and the patients was significantly lowered after we educated the staff and applied out the methods of radiation protection. To the best of our knowledge, it is the first study to clarify the role of radiation protection on reducing the received radiation doses by the working personnel and patients in the region of Africa. The challenges we faced were huge to introduce then implement the basics of radiation safety and protection practices in our hospital.
Abstract 244: The Potential Population Health Impact Of Treating US Adults With Icosapent Ethyl.
Authors: Derington Catherine G , Bress Adam P , Herrick Jennifer S , FAN WENJUN , Wong Nathan D , Andrade Katherine E , Johnson Jonathan , Philip Sephy , Abrahamson David , Jiao Lixia , Bhatt Deepak L , Weintraub William S
Published: May 2022

Background:
To estimate the population health impact of treating all US adults eligible for the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) with icosapent ethyl (IPE), we estimated (1) the number of ASCVD events and healthcare costs that could be prevented; and (2) medication costs.

Methods:
We derived REDUCE-IT eligible cohorts in (1) the National Health and Nutrition Examination Surveys (NHANES) 2009-2014 and (2) the Optum Research Database (ORD). Population sizes were obtained from NHANES and observed first event rates at five years (composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, unstable angina requiring hospitalization, or coronary revascularization) were estimated from ORD. Hazard ratios from REDUCE-IT USA estimated events prevented with IPE. Total (i.e., first and recurrent) event rates were estimated from the REDUCE-IT USA subgroup, applying the treatment effect on total events observed in the entire REDUCE-IT trial. The National Inpatient Sample estimated facility and professional event costs and daily IPE treatment cost was approximated at $4.16.

Results:
We estimate 3.6 million US adults to be REDUCE-IT eligible, and an observed first event rate of 19.0% could be lowered to 13.1% with five years of IPE treatment, preventing 212,000 events (Table). We projected the annual IPE treatment cost for all eligible persons to be $5.5 billion, but saving $1.7 billion annually due to first events prevented (net annual cost $3.8 billion). The total five-year event rate (first and recurrent) could be reduced from 42.5% to 28.9% with five years of IPE therapy, preventing 490,000 events (net annual cost $2.3 billion).

Conclusions:
Treating all REDUCE-IT eligible US adults has substantial medication costs but could prevent a substantial number of ASCVD events and associated direct costs. Indirect cost savings by preventing events could outweigh much of the incurred direct costs.
Abstract 247: Reducing Repeat Echocardiography Testing In Hospitalized Patients
Authors: Tran Matthew , Kalwani Neil , Haddad Francois , Loh Eileen , Leung Benjamin , Shieh Lisa , Heidenreich Paul
Published: May 2022

Background/Problem:
Medicare spends more than $900 million annually on cardiac echocardiography. Despite the development of appropriate use criteria for echocardiography to limit inappropriate testing, at least 5% to 20% of studies may remain inappropriate. For simple indications or repeat serial exams, a brief, limited transthoracic echocardiogram (TTE) with minimal views and measurements may answer the diagnostic question. In the current state, there are no guidelines of when to order a comprehensive TTE vs limited TTE or a reminder in our electronic health record system (EPIC) that a TTE has already been done. Few physicians are aware of the possibility of even ordering a limited TTE.

Intervention:
Patient encounters with repeat comprehensive TTE orders were randomized (in real-time) to the intervention, an electronic reminder or best practice alert (BPA), or control, no reminder. The reminder interrupted the ordering process and notified the ordering provider that a comprehensive TTE result was available within the prior 3 months. The reminder provided a link to the result and offered a limited study order as an alternative. The primary outcome was the number of full versus limited TTEs.

Results:
Over one year in a tertiary care medical center, 3314 patient encounters were randomized to the intervention (N=1661) with a BPA or control group (N=1653) without a reminder. In the control group, there were 1803 full TTE and 222 limited TTE. In the intervention group, there were 1647 full TTE and 379 limited TTE. Analysis with chi-square testing resulted in a p<0.0001.

Conclusion:
In this randomized trial, a BPA or interruptive reminder in an EHR reduced repeat comprehensive echo testing. The reduced repeat testing can decrease the cost of care, increase access by decreasing wait times for other patients, and potentially improve the patient experience by avoiding any discomfort associated with testing.
Abstract 269: Coronary Artery Calcium As A Predictor For Stenting Outcomes: A Meta-analytic Comparison
Authors: Alam Mustafa , Savinova Olga , Jhamnani Sunny
Published: May 2022

Abstract:
Coronary Artery Calcium (CAC) measurement and its usefulness to stratify patients by CAD risk remains an area of controversy. Current AHA/ACC guidelines recommend using CAC to guide management on patients with risk factors for CAD but not on optimal medical treatment. The purpose of this study is to investigate the impact of CAC on stenting outcomes.

Methods:
A systematic review of MEDLINE using PRISMA guidelines was conducted using the search terms CAC, Calcium, Coronary, and Stent. Studies were included if they had an appropriate control group and subdivided high coronary calcium and low coronary calcium measured using an approved imaging modality. Clinical characteristics of patients and outcomes were aggregated according to the Cochrane Manual. A random effects model was used to retrieve odds ratio values. Revman 5.3 was used to aggregate outcomes.

Results:
A total of 11 studies with 56,725 patients were included. The high CAC cohort included 14,390 patients and Low/No CAC included 42,335 patients. TLR was significantly higher in the high CAC cohort: Odds Ratio: 1.82 [1.37, 2.43], Test for overall effect: Z = 4.08 (P < 0.0001). Heterogeneity was significant amongst the studies for TLR but not amongst TVR or Stent Thrombosis outcomes (Heterogeneity: Tau
2
= 0.14; Chi
2
= 84.08, df = 10 (P < 0.00001); I
2
= 88%). TVR and Stent Thrombosis was significantly higher in the high CAC cohort: Odds Ratio 1.20 [1.14, 1.26] and Odds Ratio 1.42 [1.24, 1.62] Test for overall effect: Z = 5.01 (P < 0.00001) respectively.

Conclusion:
TLR, TVR, and Stent Thrombosis were all significantly higher in the high CAC cohort as compared to control. Elevated CAC not only provides a description of coronary plaque morphology but also can be used to predict adverse interventional outcomes. Further prospective studies with standard imaging techniques are needed to eliminate any inter-imaging modality differences in CAC characterization.
Abstract 32: Temporal Trends And Drivers Of Growth In Heart Transplantation Volumes In A Globally Representative Sample
Authors: Manla Yosef , Bader Feras , Kanwar Oshin , Al Badarin Firas
Published: May 2022

Background:
The need to handle a growing number of advanced heart failure (HF) patients has fueled growth in heart transplantation (HT) activities and development of effective strategies to increase the availability of donors in the last two decades. The impact of these changes on global HT volumes has not been previously described.

Methods:
Using data from the Global Observatory of Donation and Transplantation (GODT) for the years (2000-2019), we obtained the annual number of HT performed in each country per million population (PMP), number of brain-dead donors, and number of officially registered HT centers. We also identified WHO countries with sustained HT activities (HT data in ≥ 5 years). Data on health expenditures and on the prevalence of severe HF were collected from the World Health Expenditure and Global Burden of Disease (GBD) databases, respectively. Average annual percentage change (AAPC) in number of HT PMP was calculated using JoinPoint software. The contribution of the above-mentioned variables on change in HT volumes over time was determined using a linear mixed-effects regression model.

Results:
In a sample of 55/194 countries with sustained HT activities, the absolute number of HT increased by 92% (from 4504 in 2000 to 8646 in 2019), or 0.05 to 0.09 HT PMP with an AAPC of 3.6% (95% CI [2.7, 4.5]) in HT/PMP. Temporal trends in HT volumes varied considerably among countries, such that as significant growth in HT was seen in 41 (74.5%) countries (AAPC 5.6%; 95% CI [5, 6.2]), while the remaining 14 countries experienced a decline (AAPC -0.7%; 95% CI [-1.1, -0.2]) (
Figure A
). In an adjusted model, donor availability, HF prevalence, and health expenditure, but not the number of HT centers, significantly predicted an increase in HT over time (
Figure B
).

Conclusion:
Despite near doubling of HT worldwide in the last two decades, there remain unmet needs to face the growing burden of HF, specifically maximizing organ utilization in brain-dead donors.
Abstract 33: Interventional Cardiologist Beliefs And Practices Before And After Implementation Of An Electronic Health Records-based Safe Contrast Limit Tool For Percutaneous Coronary Interventions
Authors: Zhang Justin C , Khaki Rakan , Leong Derek , Bhoopalam Chandru , Tabak Steven , Elad Yaron , Ebinger Joseph , YUAN NEAL
Published: May 2022

Background:
Best Practice Advisories (BPAs) within electronic health record (EHR) systems can inform clinician decision-making and improve patient care. Their success depends on BPA content, clinical context, and staff buy-in. We recently implemented a safe contrast limit tool to reduce contrast-associated AKI (CA-AKI) after percutaneous coronary intervention (PCI). We evaluated the impact of this Contrast Limit BPA on interventional cardiologist attitudes and practices, and examined possible factors that influenced the BPA’s success.

Methods:
Using a published model, we implemented a BPA in our Epic EHR that displayed calculated individualized safe contrast limits prior to PCI. Cardiologists were surveyed prior to and 9 months after BPA implementation. Pre-implementation questions covered beliefs about CA-AKI, practice patterns, knowledge of CA-AKI risk factors, and asked for safe contrast estimates for example patients. Post-implementation questions assessed practice patterns and the BPA’s perceived accuracy, efficacy, and utility. Survey data was compared to clinician PCI contrast use using logistic regression.

Results:
We surveyed 8 clinicians pre-implementation and 10 post-implementation. Pre-implementation, 25% (2/8) reported using a contrast limit to make decisions about PCI and 12.5% (1/8) believed that they could improve their CA-AKI rates. In both their assessment of CA-AKI risk factors and contrast limit estimations, respondents often overestimated the contribution of age and diabetes while underestimating the influence of anemia and cardiogenic shock. Post-implementation, 30% (3/10) stated they were often surprised by the contrast limit and 80% (8/10) reported using the Contrast Limit when making PCI decisions. Clinicians who found the BPA to be clear and understandable or had catheterization lab staff discuss the limit prior to PCI had significantly lower odds of exceeding the safe contrast limit (OR=4.63, 95% CI [1.17, 18.35]; OR=6.76, 95% CI [1.81, 25.27]).

Conclusion:
Clinicians often misestimated safe contrast limits and believed that there was little room for improvement in their CA-AKI rates. Despite initial skepticism, an EHR-based safe contrast limit BPA was frequently used and influenced contrast use.
Abstract 42: Understanding Treatment Preferences For Patients With Tricuspid Regurgitation
Authors: Mancilla Melissa , Iyer Vijay S , Faza Nadeen N. , Pfieffer Michael , Wyler von Ballmoos Moritz , Kozak Mark , Peterson Brandon , Mollenkopf Sarah , Latibeaudiere Diandra , Reardon Michael J
Published: May 2022

Background:
A quantitative patient preference study aims to understand tricuspid regurgitation (TR) patients’ priorities for symptom relief and treatment risk-benefit tradeoffs.

Methods:
150 clinically confirmed moderate or greater TR patients completed a discrete choice experiment survey online to elicit their preferences. Attributes (levels) tested were treatment (procedure, medical management), re-intervention risk (0%, 1%, 5%, 10%), medications in 2 yrs (none, reduce, same, more), shortness of breath (none/mild, moderate, severe) and swelling (never, 3x a week, daily). A mixed logit regression (MXL) model estimated preferences. MXL choice model calculated predicted probabilities.

Results:
Shortness of breath contributed 66% to patients’ treatment decision making over other attributes. Patients’ predicted probability of preferring a procedure-like profile over a medical management-like profile was 99.7% and it was 78.9% for a medical management shortness of breath level change (Table 1). Subgroup analysis showed that patients over 64 yrs old preferred to more strongly avoid severe shortness of breath compared to under 65 (p<0.02), as did severe or worse TR patients over moderate. NYHA Class I/II patients more strongly preferred to avoid procedural re-intervention risk of 10% over Class III/IV (p<0.03).

Conclusion:
TR patients prioritize improving shortness of breath and are willing to accept higher procedural re-intervention risk if it is alleviated, even to a small degree.
Abstract 49: Variation In Cardiac Rehabilitation Enrollment During Aortic Valve Replacement Episodes Of Care
Authors: Guduguntla Vinay , Yaser Jessica , Keteyian Steven J , Pagani Francis D , Likosky Donald S , Sukul Devraj , Thompson Mike P
Published: May 2022

Intro:
Despite providing benefit in the setting of aortic valve replacement (AVR), cardiac rehabilitation (CR) utilization remains low, with few studies evaluating hospital and patient-level variation in CR enrollment. We explored determinants of CR variability during AVR episodes of care: transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).

Methods/Results:
A cohort of 10,124 AVR episodes of care (TAVR n=5,121 from 24 hospitals; SAVR n=5,003 from 32 hospitals) were identified from the Michigan Value Collaborative statewide multipayer registry (2015 to 2019). CR enrollment was defined as the presence of a professional or facility claim (93797, 93798, G0422, G0423) within 90 days of discharge. Annual trends in CR were evaluated for TAVR, SAVR, and all AVR. CR use in SAVR was significantly higher than TAVR and increased over time for all modalities (p<0.001, Figure 1). Multilevel logistic regression analysis identified significant differences in CR enrollment across age groups, comorbidities, and payer status. At the hospital-level, CR enrollment rates for all AVR varied 10-fold (4.8% to 68.7%) and moderately correlated between SAVR and TAVR (Pearson r=0.56, p<0.01, Figure 2).

Conclusions:
Substantial variation exists in CR enrollment during AVR episodes of care across hospitals. However, within-hospital CR enrollment rates were significantly correlated across treatment strategies. These findings suggest that CR enrollment is the product of hospital-specific practice patterns. Identifying hospital practices associated with higher CR enrollment can help assist future quality improvement efforts to increase CR use after AVR.
Abstract 53: Body Mass Index Is A Predictor Of Mortality And Adverse Cardiorespiratory Outcomes In Patients Hospitalized For SARS-COV-2 Infection
Authors: Ehtesham Moiz , Oweis Jozef , Al-Tarbsheh Ali , Chopra Amit , Torosoff Mikhail
Published: May 2022

Objectives:
We aimed to evaluate the association of body mass index (BMI) with in-hospital mortality and cardiorespiratory outcomes in patients admitted with COVID-19 infection.

Methods:
This data was collected from an academic tertiary referral center in upstate New York. Retrospective cohort analysis was conducted on patients admitted with COVID-19 infection (n=194). BMI was calculated and patients were stratified into two categories: ‘healthy’ (BMI=18.5-24.5) and ‘overweight’ (BMI>25). Cardiorespiratory outcomes were classified as in-hospital mortality, need for vasopressors, mechanical ventilation, and hemodialysis. Transthoracic echocardiography was performed to evaluate for left ventricular (LV) ejection fraction, right ventricular (RV) systolic function and RV dilation. Cardiovascular (CV) risk factors such as history of COPD, Diabetes, HTN, CAD and cigarette smoking were analyzed. LDH, troponin, CRP and ferritin levels were also noted.

Results:
Out of 194 patients, 68% were overweight with a mean BMI of 29.8 +/- 9.5 kg/m2 and a mean age of 66 +/- 16, 75% of females and 63% of males were overweight. Mortality rate was 31% in overweight patients compared to 17% in healthy subset (p<0.04). The rate of need for mechanical ventilation was higher in overweight group as well (34% vs. 17%, p<0.02). There was no significant difference between the cohorts in terms of vasopressor and hemodialysis requirement (p=0.09 and 0.2 respectively). RV systolic function was depressed in 21% of overweight cohort vs. 8% of healthy patients (p<0.02) while RV dilatation was seen in 15% of overweight patients compared with 5% of healthy patients (p<0.03). There was no significant difference in LV ejection fraction between the groups. LDH was more frequently elevated in overweight cohort with a mean level of 346 +/- 185 IU/L (p<0.01). No significant difference in rest of the laboratory analysis or CV risk factors were found.

Conclusion:
Elevated BMI (>25) is associated with a statistically significant increase in in-hospital mortality, need for mechanical ventilation, right ventricular abnormalities, and LDH levels in patients hospitalized with COVID-19 infection.
Abstract 62: Burden And Disparities Of Major Adverse Cardiac And Cerebrovascular Events In Nationwide Adult Hospitalizations With Cannabis Use Disorder
Authors: Desai Rupak , Taj Shiza Saher , Shawl Saima , Yarrarapu Siva Naga , Raina Jilmil , Itare Vikram , Ijaz Hasnan , Rida Taherunnisa , Alukal Thomas , Singh Sandeep , Jain Akhil
Published: May 2022

Background:
Following the legalization/decriminalization of recreational cannabis use in the United States, an associated increase in the cardiac-deaths has been reported. Therefore, we aimed to study the burden and healthcare disparities in major adverse cardiac and cerebrovascular events (MACCE) in cannabis use disorder (CUD)-related hospitalizations using a nationwide cohort.

Methods:
We queried the National Inpatient Sample (2018) to identify CUD-related adult (≥18 years old) hospitalizations and associated MACCE (all-cause mortality, acute myocardial infarction-AMI, cardiac arrest and stroke) using ICD10 diagnostic codes. We also evaluated disparities in MACCE based on sex, race, household income, and geography.

Results:
Of 436,440 CUD-related admissions (34±14 years, 63.4% males, 53.4% white, 30% black, and 11.2% Hispanic), 4% (n=17335) patients experience in-hospital MACCE. All MACCE events including all-cause mortality were highest among geriatric patients followed by 45-64 years and 18-44 years age group with CUD
[Table 1]
. There was a sex disparity with males (4.6%) having higher MACCE than females (2.9%). Blacks (4.5%) compared to whites (3.9%) demonstrated a higher overall MACCE. Asian or Pacific Islanders with CUD had overall higher rates of all-cause mortality (1%) and cardiac arrest (1%) vs. others. Lowest income quartile CUD hospitalized patients had higher MACCE than higher-income quartile (4.3 vs 3.3%). MACCE were highest in Southern hospitals (5%) with CUD-related admissions.

Conclusion:
Among CUD-related admissions, elderly vs. younger patients, males vs. females, black and Asians compared to whites, and lowest income quartile patients and Southern region are prone to have increased MACCE. A multitude of factors including age, sex, race, socioeconomic status, and access to health care seems to play role in MACCE incidence and its outcomes in cannabis users which warrants attention by policymakers and physicians.
Abstract 64: Cardiac Rehabilitation: A Missed Opportunity For Heart Failure Medication Optimization?
Authors: Sifuentes Aaron A , Hummel Scott L , Dorsch Michael P
Published: May 2022

Background:
Guideline-directed medical therapy (GDMT) reduces hospitalization and death in heart failure with reduced ejection fraction (HFrEF), but GDMT is often not fully optimized. Cardiac rehabilitation, with frequent in-person assessment, may provide an unrealized opportunity to optimize GDMT.

Methods:
We analyzed the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) study, which showed cardiac rehabilitation in stable HFrEF was safe and improved functional status. We applied a previously validated GDMT optimization algorithm to the baseline HF-ACTION data. It uses medications/doses, vitals, and labs to calculate a medication optimization score (MOS: range 0-100%; 100% is fully optimized for clinical status). We hypothesized the MOS would identify GDMT titration opportunities and predict clinical outcomes.

Results:
Of 2130 patients, 27% (n=578) had MOS 100%; GDMT barriers (e.g. low blood pressure, renal dysfunction) were more common in this group. Among 1552 non-optimized patients (age 58±13, 28% female, 39% non-White, ejection fraction 25±7%) the median MOS was 50% (IQR 38-60%) (Figure 1). After adjustment using the HF-ACTION risk model, higher MOS was associated with a decrease in death or all-cause hospitalization (HR 0.66, 95% CI 0.48-0.90, p=0.009); for each 10% MOS increase (example: metoprolol increase from 100 to 200 mg daily) the composite endpoint decreased 4.1%. Figure 2 shows survival curves for an MOS of 25%, 50% and 75%.

Conclusion:
Among patients with HFrEF undergoing cardiac rehabilitation, the MOS outlines ample opportunity for GDMT titration and predicts clinical outcomes in non-optimized patients
Abstract 65: Composite Biomarkers Could Assess Frailty Status In Stable Older Adults With Cardiovascular Disease
Authors: Hirashiki Akihiro , Nomoto Kenichiro , Kokubo Manabu , Shimizu Atsuya
Published: May 2022

Background:
The relationship between frailty status and laboratory measurements in cardiovascular disease (CVD) remains unclear. We investigated which laboratory measurements indicated frailty in stable older CVD patients.

Methods:
One-hundred thirty-eight stable older CVD patients were evaluated by laboratory measurements and frailty as assessed by the Kihon Checklist (KCL). We compared laboratory measurements between frail and non-frail groups.

Results:
Mean age was 81.7 years, mean left ventricular ejection fraction was 57.8%, and mean plasma brain natriuretic peptide content was 182 pg/mL. Patients were allocated to non-frail (
n
= 43) and frail (
n
= 95) groups on the basis of KCL score. Serum iron was significantly lower in the frail group (frail, 61.2 ± 30.3 μg/dL; non-frail, 89.5 ± 26.1 μg/dL;
P
< 0.001). Blood urea nitrogen (BUN) and C-reactive protein (CRP) were significantly higher in the frail group (frail, 27.3 ± 16.5 mg/dL, non-frail, 19.7 ± 8.2 mg/dL;
P
= 0.013; frail, 1.05 ± 1.99 mg/dL, non-frail, 0.15 ± 0.21 mg/dL;
P
= 0.004, respectively). Multivariate analysis revealed that serum iron, CRP and BUN were significant independent frailty predictors (β = –0.069, 0.917, and 0.086, respectively).

Conclusions:
Frailty status was significantly associated with iron, CRP, and BUN in stable older CVD patients. Composite biomarkers (inflammation, iron deficiency, and renal perfusion) may be useful for assessing frailty in these patients.
Abstract 68: Impact Of Health Related Social Needs On Sex-based Differences In Hospital Readmissions For Atrial Fibrillation
Authors: Tran Amy , Latif Azka , Niu Fang , Walters Ryan , Kim Michael H
Published: May 2022

Background:
Readmissions have a significant economic impact on the healthcare burden of atrial fibrillation (AF). Health Related Social Needs (HRSN) contribute to poor outcomes including readmissions. Differences in readmission rates related to sex are unclear.

Methods:
Data were abstracted from the 2016 to 2018 National Readmission Database (NRD). The primary outcome was all-cause 30-day readmission following discharge for index AF. We identified HRSN (employment, family, housing, psychosocial, and socioeconomic status [SES]) using ICD-10 codes. Using multivariable logistic regression models, we evaluated whether the association between HRSN and readmission differed between males and females.

Results:
We identified 614,520 AF hospitalizations, which included 51% female and 49% male. The overall readmissions rate was 14.5% (95% CI: 14.4%, 14.6%). The adjusted odds of readmissions in the presence of housing, family, or psychosocial HRSN were statistically higher for males compared to females (all interaction p < .05), whereas the association between readmission and employment and SES were statistically similar. Overall, the strongest association with readmission was observed for housing (Table 1).

Conclusion:
Males with housing, family, and psychosocial HRSN have a higher risk of readmissions for AF
.
Further study is needed to address why these sex-based disparities exist and what interventions that impact HRSN may result in improved outcomes.