bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12889: Sex Differences in Exercise Capacity After Home-Based Cardiac Rehabilitation During the Covid-19 Pandemic
Authors: Hama Tomoaki , Chacin Suarez Audry , Bissen Thomas G , Olson Thomas P
Published: June 2023

Introduction:
Many center-based cardiac rehabilitation programs were forced to close during the pandemic resulting in a programmatic shift to delivering cardiac rehabilitation remotely in the home-based setting. This study examined sex differences in the change of exercise frequency and exercise capacity in patients participating in home-based cardiac rehabilitation (HBCR) during the COVID-19 pandemic.

Methods:
Retrospective cohort study of 567 HBCR patients between March 2020 and May 2021. Patients who completed the Duke Activity Status Index questionnaire before and after HBCR were included. We calculated the number of reported exercise days/ week, exercise min/day, and VO
2
peak estimated. Patients were divided into two groups according to sex (Male/Female). Continuous data are described as mean±SD and baseline data compared with a two-sample t-test. The delta change from pre-post between groups also are compared with a two-sample t-test.

Results:
Of 567 HBCR patients, 118 patients completed both pre and post HBCR questionnaires (Male, n=82, 66±12 yo vs Female, n=36, 65±12 yo, p=0.80). There were no differences between groups for baseline exercise days/week or exercise min/day pre HBCR (4.0±2.8 vs 4.1±3.0 days, p=0.87; 22±20 vs 18±20 min, p=0.33); however, VO
2
peak at baseline HBCR was higher in males than females (22.3±8.1 vs 18.9±5.9 ml/kg/min, p<0.05). Both groups improved exercise days/week (4.0±2.8 to 5.7±1.5 vs 4.1±3.0 to 5.7±1.4 days, p<0.05 for both), exercise min/day (22±20 to 40±15 vs 18±20 to 37±21 min, p<0.05 for both), and VO
2
peak (22.3±8.1 to 27.8±8.0 vs 18.9±5.9 to 22.7±6.5, ml/kg/min, p<0.05 for both). In addition, there was no significant difference for the delta change of the three outcomes between groups (1.7±2.7 vs 1.6±2.5 days; 18±19 vs 19±18 min; 5.5±6.5 vs 3.8±4.5 ml/min/kg, p>0.05 for all).

Conclusions:
Female patients entering HBCR during the COVID-19 pandemic demonstrated lower exercise capacity compared to males; however, both female and male patients increased exercise frequency (days/week and min/day) and exercise capacity (estimated VO
2
peak) similarly after attending HBCR during the COVID-19 pandemic.
Abstract 12891: Protocol Driven Therapeutic Efficacy of Intravenous Unfractionated Heparin in the Current Era
Authors: Torppey Kayla , kaur manpreet , Wasef Natale , Richardson Sandra , Cohen Marc
Published: June 2023

Introduction:
Despite years of refining algorithms, intravenous (IV) unfractionated heparin (UFH) is associated with many limitations in the inpatient setting. Low-molecular-weight heparin (LMWH) has shown to be equivalent to UFH in the treatment of acute venous thromboembolic disease (VTE), and demonstrated superiority in acute coronary syndrome (ACS). LMWH has less pharmacokinetic variability, a longer plasma half-life, and is associated with fewer complications. UFH also requires frequent activated partial thromboplastin time (aPTT) monitoring, affecting hospital resources. The objectives of this study were to assess the real-word therapeutic impact of routine IV UFH use in the setting of a hospital-based algorithm, evaluate the number of patients eligible for substitution with LMWH, and estimate the cost differential.

Hypothesis:
Methods:
Adult patients who received greater than 24 hours of IV UFH from 8/1/21 to 9/30/21 (n=174), were included in this retrospective evaluation. A random sample of 100 of these 174 patients was analyzed for aPTT results in hours 25-48. These 100 patients were also considered for theoretical substitution with LMWH. Ineligibility for substitution included intermittent and continuous renal replacement therapy (RRT), creatinine clearance less than 30 mL/min, and a planned invasive procedure within 24 hours. Fiscal analyses were also done.

Results:
Among 519 aPTTs drawn from these 100 patients, 348 (67%) were not within the hospital therapeutic range. The most common indications for anticoagulation were ACS and acute VTE. Eighty-one percent of patients on UFH were eligible for LMWH substitution. Ineligibility was most commonly secondary to renal dysfunction. Estimated drug acquisition costs were similar, but overall cost was lower with LMWH due to decreased laboratory testing, nurse/patient contact time, and infusion supplies.

Conclusions:
In spite of current hospital-based algorithms and electronic order sets to minimize variability, achieving a therapeutic aPTT during the day after UFH initiation, remained elusive. The majority of patients receiving IV UFH were eligible for substitution with LMWH. Patients who qualify, should be placed on the simpler and more reliable antithrombotic LMWH regimen.
Abstract 12898: Mobile Health Interventions and Remote Blood Pressure Monitoring in Underserved Populations: A Systematic Review and Meta-Analysis
Authors: Katz Miriam , Mszar Reed , Grimshaw Alyssa A , Spatz Erica S
Published: June 2023

Introduction:
Disparities in blood pressure (BP) control persist in underserved communities. Although mobile health (mHealth) technologies have increased access to routine care for HTN, few studies have analyzed the effectiveness of mHealth interventions in populations experiencing HTN disparities.

Methods:
We conducted a systematic review of studies in seven databases published up to November 2021. The search used controlled vocabulary and keywords for HTN, mHealth interventions, and social determinants of health. We included papers that focused on mHealth interventions to manage HTN in underserved populations based on racial, ethnic, and socioeconomic factors. The primary outcome was change in systolic BP (SBP) and diastolic BP (DBP), and we assessed variations in the primary outcome by each study’s relative sociodemographic representation.

Results:
Among 2,644 unique studies identified, 24 studies (evaluating 7,960 participants in total) met our inclusion criteria. Demographic characteristics were similar between intervention and control groups (intervention: mean age 57.7 [SD 6.2] years; 59.8% women; 40.4% Black; 22.2% Hispanic). Among 18 studies that reported 6-month BP changes, reductions in SBP and DBP values in the intervention group were -7.03 mmHg (control: -2.71 mmHg) and -3.65 mmHg (control: -1.63 mmHg), respectively. Subgroup analysis showed that studies with a higher representation of Hispanic, low-income, and low-education level participants had less pronounced BP improvements than studies with a lower representation of these subgroups.

Conclusion:
This review provides evidence for the effectiveness of mHealth interventions for HTN management. Future studies and community-based initiatives are needed to further increase individuals’ access to these interventions and to ensure their effectiveness across all populations disproportionately impacted by HTN.
Abstract 12908: Primary Partners Provide Key Social Support for the Management of Cardiometabolic Disorders in Sub-Saharan Africa
Authors: Ruark Allison , Bidwell Julie T , Butterfield Rita , Neilands Torsten , Weiser Sheri , Mulauzi Nancy , Mkandawire James , Huwa Jacqueline , Conroy Amy
Published: June 2023

Introduction:
Social support from primary partners has wide-ranging impacts on disease management and health outcomes, although scant research has explored this topic for couples living with cardiometabolic disorders (CMD) in low-resource settings in sub-Saharan Africa.

Objectives:
To explore patterns of partner support around CMD in Malawian couples

Methods:
We conducted a qualitative study with 25 married couples in Malawi who had at least one partner with HIV and CMD (either hypertension or diabetes). Index patients were recruited from three HIV care clinics and primary partners were subsequently enrolled. We conducted semi-structured interviews with both partners to understand how couples cope together with CMD and offer social support. Data were coded for patterns and themes within couples and between couples and data matrices were used to summarize the findings.

Results:
Couples described three patterns of partner support.
Instrumental support
was provided by partners who offered money for medication, transportation to medical appointments, and healthy foods. Partners also provided reminders to take medication and attend medical appointments, accompanied patients to medical appointments, and monitored medication use. While household chores are typically women’s work, in some cases male partners helped with these activities when their wives were too ill or were experiencing what they believed were symptoms of CMD.
Emotional support
was provided by partners through encouragement to practice a healthy lifestyle (such as increasing physical activity and reducing salt intake), rest, and reduce stress and avoid arguing.
Informational support
was provided by partners who gave advice for successful management of CMD and in making health-related decisions such as food purchases.

Conclusions:
Social support from primary partners around disease management may partially ameliorate inadequate health services for people with CMD in sub-Saharan Africa. While there remains a need to fortify health systems and address barriers to accessing treatment, couple relationships could be leveraged in care services to provide key forms of social support.
Abstract 12910: Exercise-Induced Specialized Proresolving Mediators Stimulate AMPK Phosphorylation to Promote Mitochondrial Respiration in Macrophages
Authors: Pena Calderin Ernesto H , Zheng Jing-Juan , Boyd Nolan , McNally Lindsey A , Lorkiewicz Pawel , Hill Bradford G , Hellmann Jason
Published: June 2023

Emerging epidemiological data suggests that exercise imparts its CVD risk-reducing effects in part through improvements in systemic inflammation. The mechanisms underpinning the salutary effects of physical activity, however, remain incompletely understood. We recently reported that exercise enhances the production of specialized proresolving mediators (SPMs), which act as agonist of inflammation resolution through actions on macrophages (Mϕ). In this study, we find that wheel running accelerated the metabolism of proinflammatory lipid mediators LTB
4
and PGD
2
into their respective metabolites 20-OH-LTB
4
(Sed 27.14±5.88 vs Exe 70.40±10.82 pg/mL; P<0.05;
n
=3-4) and PGJ
2
(Sed 92.63±16.08 vs Exe 227.90±30.23 pg/mL; P<0.05;
n
=3-4), resulting in an increase in the ratio of proresolving-to-proinflammatory lipid mediator levels (RvE1+RvD1:leukotrienes; Sed 0.19±0.02 vs Exe 0.32±0.90; P<0.05;
n
=3-4). These findings were associated with enhanced mitochondrial metabolism in Mϕ, as evidenced by increased basal (Sed 0.12±0.06 vs Exe 1.53±0.07; P<0.05;
n
=3-4), maximum (Sed 9.20±0.30 vs Exe 12.02±0.82; P<0.05;
n
=3-4), and ATP-linked oxygen consumption rate (Sed 1.25±0.06 vs Exe 1.47±0.09 pmol/min/μg protein; P<0.05;
n
=3-4). We also find that SPMs RvD1, RvD2, RvE1 or MaR1 stimulate basal (Ctrl 6.11±0.1 vs RvD1 7.76±0.6 vs RvD2 9.48±0.9 vs RvE1 7.20±0.5 vs MaR1 8.73±0.9 pmol/min/μg protein; P<0.05;
n
=3) and ATP-linked respiration (Ctrl 2.83±0.2 vs RvD1 4.50±0.3 vs RvD2 4.39±0.2 vs RvE1 4.71±0.3 vs MaR1 4.20±0.2 pmol/min/μg protein; P<0.05;
n
=3). We find that an increase in basal (Ctrl 1.80±0.13 vs RvD1 2.43±0.19 pmol/min/μg protein; P<0.05;
n
=3-5) and ATP-linked respiration (Ctrl 1.44±0.10 vs RvD1 1.70±0.15 pmol/min/μg protein; P<0.05;
n
=3-5) with RvD1 treatment occurs concomitantly with AMPK phosphorylation (Ctrl 1.00±0.07 vs RvD1 1.40±0.02 pAMPK/AMPK fold change; P<0.05;
n
=3) and inhibiting the kinase activity of AMPK with Compound C abrogates SPM-induced mitochondrial respiration. Taken together, these data suggest that exercise-enhanced SPM production stimulates mitochondrial metabolism in Mϕ via AMPK, which may contribute to exercise-induced amelioration of chronic inflammation.
Abstract 12920: Mir98 Regulates Myocardial Ischemia-Reperfusion Injury in Late Pregnancy by Targeting Stat3 and Pgc-1α
Authors: Aryan Laila , Medzikovic Lejla , Ruffenach Gregoire , Li Min , Rahman Shadie , Esdin Leana , Bastanhagh Ehsan , Sun Wasila , Eghbali Mansoureh
Published: June 2023

INTRODUCTION:
We have shown that the late-pregnant (LP) rodent is more vulnerable to myocardial ischemia-reperfusion injury (IRI) compared to non-pregnant (NP). The molecular mechanisms are unknown. Several microRNAs (miRs) are dysregulated in IRI, making them promising therapeutic targets. Our goal is to decipher the mechanisms underlying the higher susceptibility of LP to IRI.

Methods:
The left anterior descending coronary artery of female Sprague-Dawley rats (2-3 months old NP and LP, 20-21 days pregnant) was occluded for 45 minutes followed by 3 hours reperfusion. Myocardial necrosis was assessed using TTC staining. MicroRNA-microarray profiling was performed on hearts of NP and LP rats subjected to IRI (Ocean Ridge Biosciences). In vitro, female cardiomyocytes were transfected either miR98 mimic or inhibitor (40uM), followed by 3 hours hypoxia and 6 hours reoxygenation. Human blood samples were collected from NP, LP, and coronary heart disease (CHD) patients. Data were expressed as mean±SEM. P<0.05 was considered statistically significant.

Results:
MicroRNA-microarray profiling revealed miR-98-5p (miR-98) is upregulated in the hearts of LP IRI rats compared to NP IRI by 2.3 folds, which we confirmed with qPCR (1.89±0.15, n=5 animals/group). miR98 is significantly increased in the plasma of healthy LP compared to healthy NP women (2.32±0.44, LP n=9, NP n=7), and significantly increased in LP with CHD compared to healthy LP (4.41±0.73, CHD n=5). TargetScan revealed STAT3 and PGC-1α to be targets of miR98. We confirmed significantly decreased expression of STAT3 and PGC-1α in LP IRI rat myocardium compared to NP IRI (STAT3 0.48±0.12 n=5 and PGC-1α 0.39±0.17 n=5). MiR98 overexpression in female cardiomyocytes subjected to hypoxia/reoxygenation (H/R) significantly decreased STAT3 (0.75±0.11) and PGC-1α (0.52±0.16), and increased apoptosis (1.89±0.09), inflammation (2.12±0.18), and oxidative stress (2.3±0.22), while miR-98 knockdown resulted in the opposite effect (n=4).

Conclusions:
MiR98 is upregulated in LP rats subjected to IRI compared to NP IRI and in LP human plasma samples with CHD compared to healthy NP and LP. miR98 promotes oxidative stress, inflammation, and apoptosis in the setting of H/R
in vitro
by targeting STAT3 and PGC-1α.
Abstract 12936: Higher In-Hospital Mortality After TAVR and PCI on Same Hospitalization: A Systematic Review and Meta-Analysis
Authors: de Miranda Gauza Mateus , Abi-Kair Borges Calomeni Pedro , Felix Nicole , Machado Marina , Melo Pedro
Published: June 2023

Introduction:
Aortic stenosis (AS) patients admitted for elective transcatheter aortic valve replacement (TAVR) frequently present significant coronary artery disease (CAD). Despite the increasing number of TAVR procedures, it remains unclear if the strategy of performing percutaneous coronary intervention (PCI) and TAVR during the same hospitalization differs from isolated TAVR.

Methods:
We performed a systematic review and meta-analysis of observational studies in patients with AS and significant CAD (lesions ≥50%). The aim of the study was to compare TAVR and PCI on same hospitalization (with no regard for whether in the same procedure) to TAVR and deferred PCI. In-hospital mortality, acute kidney injury and major bleeding were our outcomes of interest.

Results:
We included 4 studies with 2917 patients, 665 treated with TAVR+PCI and 2252 treated with TAVR alone. TAVR+PCI was associated with higher in-hospital mortality (OR 1.66; 95% CI 1.21 - 2.27; p=0.002; Fig. 1). However, there was no difference in acute kidney injury (OR 0.59; 95% CI 0.26 - 1.32; p=0.20; Fig. 2A). Furthermore, TAVR+PCI seemed to lower the rate of major bleeding (OR 0.65; 95% CI 0.46 - 0.93; p=0.02 Fig. 2B).

Conclusions:
In this meta-analysis of retrospective studies, TAVR and PCI on same hospital admission was associated with higher in-hospital mortality when compared to isolated TAVR.
Abstract 12938: Intrathoracic Visceral Adiposity is Inversely Associated With Insulin Like Growth Factor Binding Protein 1: The Longenity Study
Authors: Kankaria Rohan A , Ye Kenny , Slipczuk Leandro , Dey Damini , Levsky Jeffrey M , Barzilai Nir , Milman Sofiya , Bortnick Anna E
Published: June 2023

Introduction:
Higher insulin-like growth factor binding protein 1 (IGFBP-1) level in serum has been variably associated with better insulin sensitivity and lower rates of obesity, diabetes mellitus, and atherosclerosis; suggesting that it may have a protective role in cardiometabolic aging. We hypothesized that epicardial, intrathoracic, or total thoracic adiposity (EAT, IAT, or TTA, respectively) measured on thoracic CT, were inversely associated with IGFBP-1, providing an assessment of cardiometabolic status by computed tomography (CT).

Methods:
Participants (n=104) were prospectively enrolled from the LonGenity study at Albert Einstein Institute of Aging. Participants were of Ashkenazi descent and ≥65 years, 53% were offspring of parents with exceptional longevity (OPEL) and 47% were offspring with usual survival (OPUS). Exclusion criteria were prior coronary artery bypass or stent, heart rate > 100 beats/minute or not in sinus rhythm. Participants underwent a non-contrast gated CT. Adiposity was quantified using QFAT software (Cedars Sinai, CA). IGFBP-1 measures closest to the CT were used, ranging from 58 months before to 16 months after, with the majority within 1 year of the scan. Associations between IGFBP-1 and the adiposity were evaluated with linear regression with square-root of adiposity measures as the outcome. Each subject was weighted by the inverse of the years between CT and closest IGFBP-1 measurement.

Results:
IGFBP-1 levels were inversely associated with EAT (p =0.007), IAT (p = 0.003) and TTA (p = 0.003) after adjustment for age, sex, body mass index, OPEL/OPUS, diabetic medication, statin use, and high- and low-density lipoprotein levels. BMI explained 27.2% of the variation of TTA (p < 0.001) and IGFBP-1 explained an additional 6% of the variation. There was no association of OPEL/OPUS status with adiposity measures.

Conclusion:
In conclusion, higher IGFBP-1 was associated with lower cross-sectional TTA, suggesting that IGFBP-1 may be indicative of a favorable cardiometabolic environment in aging. Future studies should evaluate the utility of IGFBP-1, epicardial and thoracic visceral adiposity as indicators of cardiometabolic disease.
Abstract 12942: Are Adult Cardiac Patient Education Materials Comprehensible for Patients?
Authors: Chen Lin , Orosa Dominic , Layoun Habib , Kakavand Mona , Salim Hammoud Miza , Mahboubi Rashed , Harb Serge C , Karamlou Tara
Published: June 2023

Introduction:
Patients are increasingly using the Internet to obtain healthcare information. Considering 21% of cardiac surgery patients are minorities, 27.9% are in the bottom quartile of household income, and 70% have Medicare/Medicaid or no insurance, online patient educational materials (PEMs) should be accessible and written at a level easily understood by majority of patients. We performed a comprehensive analysis of readability of websites containing patient-centered resources across all adult cardiac surgery areas.

Hypothesis:

Methods:
Online PEMs on cardiac surgical procedures (CSP) were collected from top 50 hospitals for cardiology and heart surgery ranked by US News and World Report as of December 1st, 2021. Text pertaining to CSPs was collected and divided into five procedural genres: mitral valve, coronary artery bypass, heart transplant, aortic valve, and aortic surgeries. Texts were analyzed using OleanderSoftware’s Readability Suite through the Raygor readability test.

Results:
N=282 articles met criteria for analysis. Online content for all 5 surgical genres were difficult to read, with mean (SD) grade level readability score for all content at 13.8 (3.1, panel a). The mean (SD) readability for mitral valve, coronary artery bypass, heart transplant, aortic valve, and aortic surgeries were 14.4 (3.0, panel b), 13.9 (3.3, panel c), 12.2 (2.7, panel d), 13.5 (3.1, panel e), and 14.3 (2.8, panel f) respectively. Online resources for content within the 5 genres required at least college reading level for comprehension.

Conclusions:
Online PEMs exceeded the sixth-grade level recommended by the American Medical Association and the second-grade level previous established at our institution in all included genres of adult cardiac surgery. Improving the readability of online PEMs in adult cardiac surgery will facilitate equitable access to high-quality care.
Abstract 12957: Identifying Reasons for Statin Nonuse in Individuals With Diabetes Using Deep Learning of Unstructured Electronic Health Records
Authors: Sarraju Ashish , Zammit Alban , Ngo Summer , Witting Celeste , Hernandez-Boussard Tina , Rodriguez Fatima
Published: June 2023

Introduction:
Statins are guideline-recommended and potentially life-saving for individuals with diabetes. Yet, statin use is concerningly low in this group. Identifying reasons for statin nonuse can inform targeted interventions. We hypothesize that clinical reasoning around reasons for statin nonuse may be buried in unstructured, narrative portions of the electronic health record (EHR). We aimed to identify reasons for statin nonuse in patients with diabetes from unstructured EHRs using deep learning.

Methods:
Adults diagnosed with diabetes from 2014 to 2020 with no statin prescriptions were identified from a multisite EHR health system in Northern California. We used a benchmark deep learning natural language processing (NLP) approach, Clinical Bidirectional Encoder Representations from Transformers (BERT), to identify statin nonuse and reasons for statin nonuse from unstructured EHRs. Clinical BERT was evaluated against expert clinician review in 20% test sets.

Results:
Of 33,461 patients with diabetes (mean age 59+15y, 49% women, 36% White, 24% Asian, 15% Hispanic), nearly half (47%) lacked statin prescriptions. By leveraging unstructured data containing any mention of statin-related terms, Clinical BERT accurately identified statin nonuse (area under the receiver operating characteristic curve (AUC 0.99 [0.98-1.0]) and identified key patient, clinician, and system reasons for statin nonuse, including statin-associated side effects, guideline-discordant clinician practice, and patient hesitancy (AUC 0.90 [0.86-0.93]; Figure).

Conclusions:
In a multiethnic diabetes cohort, we identified actionable reasons for statin nonuse using a deep learning approach to mine unstructured EHRs. Findings may enable targeted interventions to improve guideline-directed statin use and be readily scaled to other evidence-based therapies.
Abstract 12960: Effect of Iron Therapy on Exercise Capacity and Quality of Life in Patients With Systolic Heart Failure: A Systematic Review and Meta-Analysis
Authors: Trongtorsak Angkawipa , Adhikari Pabitra , Thangjui Sittinun , Kewcharoen Jakrin , Chitrakar Solab , Leelaviwat Natnicha , Benjanuwattra Juthipong , Rattanawong Pattara , Akbar Muhammad S
Published: June 2023

Background:
Iron deficiency in patients with systolic heart failure (HF) was found to be associated with poorer exercise capacity and quality of life. We conducted this systematic review and meta-analysis to assess whether iron supplementation in patients with systolic HF can improve exercise capacity and quality of life.

Methods:
We searched MEDLINE, and Embase databases from inception to May 2022 to identify the studies that reported the impact of iron therapy including oral and intravenous (IV) iron forms in systolic HF patients with iron deficiency. Outcomes of interest included 1) six minute walk test (6MWT) and 2) Quality of life (QoL) assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ). Data from each study were combined using the random-effects model to calculate weight mean difference (WMD) and 95% confidence interval (CI)

Results:
Five studies (4 randomized controlled trials and 1 nonrandomized open-label study) with a total of 1,075 patients (610 in the intervention group and 465 in the control group) were included. In the intervention group, 474 patients received IV iron and 136 patients received oral iron therapy. Iron therapy was associated with significant improvement of 6MWT (WMD =22.81, 95% CI 0.47-45.14, p < 0.001) and KCCQ (WMD =4.68, 95%CI 0.43-8.93, p< 0.001). Interestingly, subgroup analysis showed that the main results were driven by IV iron therapy in both 6MWT (WMD =34.68, 95%CI 25.13-44.24, p< 0.001) and KCCQ (WMD =6.78, 95%CI 3.81-9.75, p< 0.001) as there was no significant improvement after oral iron therapy in 6MWT (WMD =0.15, 95% CI -23.86-24.16, p =0.99) and KCCQ (WMD =2.71, 95% CI-1.35-6.78, p =0.19). As shown in Figure 1.

Conclusions:
Intravenous iron therapy, but not oral iron therapy is associated with improved exercise capacity and QoL in patients with systolic HF.
Abstract 12983: Diagnostic Performance of an Automated Blood Pressure Monitor With an Irregular Heartbeat Algorithm Designed to Detect Atrial Fibrillation
Authors: Ishizawa Makoto , Minamino Tetsuo , Ishihara Yu
Published: June 2023

Introduction:
Patients with atrial fibrillation (AF) are constantly exposed to the risk of developing stroke, and early detection to initiate appropriate treatment for AF is important to prolong their healthy life. In previous reports, automated blood pressure (BP) monitors manufactured by A&D Co., Ltd. was equipped with an irregular heartbeat (IHB) algorithm specifically designed to detect AF, suggesting its usefulness for AF monitoring in hypertensive patients with a high prevalence of AF.

Purpose:
The aim of this study was to evaluate the diagnostic performance for AF of the A&D BP monitor UM-212 with an IHB algorithm in a clinical setting.

Methods:
A total of 242 consecutive patients was enrolled (mean age: 67.5 years, 62.3% male). BP measurements were performed three times per one patient using UM-212 and the presence or absence of IHB detection was recorded for each measurement. The definition of IHB algorithm designed to detect AF is as follows: the number of pulse waves varying more than 15% from the mean of the pulse peak interval is greater than 20% of the total pulse wave count. A 3ch real-time ECG was recorded during all BP measurements. The interpretation by automated ECG analysis software manufactured by Fukuda Denshi Co., Ltd. and the final ECG diagnosis by two cardiologists were performed separately.

Results:
Of the 242 patients, 31 had AF and 66 had non-AF arrhythmia. On a per-measurement basis (726 total), IHB detection had 98.9% of sensitivity and 90.7% of specificity for diagnosing AF. Under the same condition, ECG analysis software had 90.3% of sensitivity and 96.5% of specificity for diagnosing AF. On a per-patient basis, IHB detection in all three BP measurements had 96.8% of sensitivity and 95.7% of specificity for diagnosing AF. Under the same condition, ECG analysis software had 80.6% of sensitivity and 99.1% of specificity for diagnosing AF.

Conclusions:
The IHB algorithm designed to detect AF built into A&D BP monitors showed high sensitivity and high specificity for diagnosing AF in a clinical setting, especially its sensitivity tended to exceed that of automated ECG analysis software. Utilizing the IHB algorithm during routine BP measurements is expected to monitor AF in hypertensive patients and contribute to their health management.
Abstract 12986: Internal Iliac Artery Occlusion With the Amplatzer Vascular Plug During Endovascular Repair of Large Abdominal Aortic Aneurysm
Authors: Tuazon Cameron B , Chavira Angela , Rahman M. Rubayat , Lahoti Ankush
Published: June 2023

Background:
Retrograde blood flow from the internal iliac artery resulting in a type II endoleak is a challenging complication of endovascular aorto-iliac aneurysm repair. Several methods have been developed to address this concern. We present a case where the Amplatzer vascular plug was used to embolize the internal iliac artery in a patient undergoing aorto-iliac stent-grafting with extension of the graft into the external iliac artery.

Case:
A 67-year-old male presented with abdominal pain. Abdominal contrast computed tomography confirmed a large infrarenal abdominal aortic aneurysm (AAA) measuring 100 mm across, extending into the common iliac artery on the right and the external iliac artery on the left, with perianeurysmal fat stranding indicating impending rupture. The patient was taken emergently to the operating room. Vascular access was obtained through bilateral common femoral arteries. The left internal iliac was occluded with an Amplatzer 16 mm by 12 mm vascular plug, with excellent angiographic apposition. A bifurcated aorto-iliac graft was then sequentially deployed to repair the aneurysm. Final angiography showed patent renal arteries with no endoleak. The patient was discharged home the following day.

Discussion:
Embolization of the internal iliac artery is indicated in endovascular aorto-iliac aneurysm repair to prevent endoleak formation. Traditionally performed with coils, the Amplatzer vascular plug has emerged as a safe and effective alternative, with the added advantage of recoverability prior to definitive release.

Conclusion:
Endovascular repair of an AAA must consider the complication of endoleak formation. In this case, the use of an Amplatzer vascular plug was successful in preventing a type II endoleak from the internal iliac artery.

Panel A.
3D reconstruction of aneurysm anatomy;
Panel B.
Angiogram showing final result of endovascular repair with successful occlusion of the left internal iliac artery
Abstract 13006: Association of Changes in Interstage Monitoring Practices and Transcatheter Intervention for Recurrent Coarctation Following the Norwood Operation
Authors: Gartenberg Ari J , Okunowo Oluwatimilehin , Smith Christopher , Glatz Andrew C , Dori Yoav , Gaynor James W , Mascio Christopher , Rome Jonathan J , Gillespie Matthew J , O'Byrne Michael L
Published: June 2023

Introduction:
Intensive interstage monitoring has been associated with lower mortality between the Norwood operation and superior cavopulmonary connection. This may be due to early identification of residual anatomic lesions like recoarctation before lasting harm occurs.

Methods:
Neonates undergoing a Norwood and followed interstage at a single center from 1/1/2005-9/18/2020 were studied. The exposure was Norwood date divided into 3 eras: 1. pre-interstage monitoring; 2. early era of monitoring; 3. current era. We evaluated the association of era and likelihood of hemodynamic insult (≥moderate ventricular dysfunction/AV valve regurgitation, initiation/escalation of vasoactive/respiratory support, cardiac arrest preceding cath, or interstage death with coarctation on autopsy) in subjects with recoarctation. We also analyzed whether era was associated with technical success in transcatheter recoarctation interventions, procedural major adverse events, and transplant-free survival.

Results:
483 subjects were studied, with 22% (n=106) treated for interstage recoarctation. Number of catheterizations per Norwood increased (
p
=0.005) with no significant change in the proportion of subjects with recoarctation (
p
=0.36). There was a lower likelihood of hemodynamic insult in subjects with recoarctation after institution of interstage monitoring (63% Era 1, 38% Era 3), but this was not statistically significant (
p
=0.06). The proportion of subjects with ventricular dysfunction at intervention decreased significantly (
p
=0.002). Rates of technical success, procedural major adverse events, and transplant-free survival did not differ (
p
>0.05).

Conclusions:
Interstage monitoring was associated with increased referral for catheterization but was balanced by a decreased likelihood of hemodynamic insult in subjects with recoarctation. Future study is needed to optimize interstage monitoring strategies for early detection of recoarctation.
Abstract 13007: Assessing Patient Engagement With a Mobile Health Application for Self-Care Of Heart Failure in a Real-World Setting
Authors: Madujibeya Ifeanyi , Lennie Terry , Pelzel Jamie , Moser Debra K
Published: June 2023

Background:
Consumer-facing mobile health applications (mHealth apps) are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patient engagement with consumer-facing mHealth apps in real-world settings and the effect of such engagement on HF outcomes.

Objectives:
This study examine the patterns of patient engagement with a consumer-facing mHealth app,and the effects of engagement on HF outcomes.

Method:
This was a longitudinal observational study of patients who used a consumer-facing mHealth app, OnTrack to Health, for self-care of HF in a real-world setting between 2012 and 2020. Patient engagement was assessed as the percentage of assigned self-care activities checked off and transmitted daily to the nursing team via the app interface, within the first 575 days of use. Bilinear spline growth models were used to examine patterns of patient engagement during free subscription and post-free subscription periods and to determine the predictors of the engagement. The effects of patient engagement on medication adherence were examined using linear mixed effect models.

Results:
A total of 229 participants (148/229, 64.6% male), with a mean age of 62.2 (SD 14) years used the app. The mean (SD) daily patient engagement and medication adherence were 77.3 (27.5)%, and 98.4 (3.7)%, respectively. Patient engagement with OnTrack to Health app decreased overtime during the free subscription (β -.490, 95% CI -0.796 to -0.184,
P
= .002 ) and post-free subscription patient engagement(β -.567, 95% CI -0.860 to -0.272,
P
<.001) periods, attainment of target doses of guideline-directed medical therapy (β .002, 95% CI 0.001 to 0.003,
P
<.001), and being a long-term vs. short-term app user (β .191, 95% CI 0.063 to 0.319,
P
=.003) were associated with a higher rate of patient engagement over time. Patient engagement was not significantly associated with the rates of changes in medication adherence over time (β .002, 95% CI -0.003 to 0.007,
P=
.360)

Conclusion:
The declining trend of patient engagement with consumer-grade apps, indicates a need for effective strategies to sustain patient engagement, and such strategies may include financing models that place no or minimal financial responsibility on patients.
Abstract 13020: A Pilot Randomized Controlled Trial on a Technology-Based Family-Centered Empowerment Transitional Program Among Heart Failure Patients
Authors: yu Doris S , Wong Chi Wing , Cheng Victor
Published: June 2023

Introduction:
Heart failure is the most common cause of hospital readmission. While the increased acceptance of mobile health, a novel virtual platform, titled Technology-based Family-centered Empowerment (T-FAME) Program was developed to enhance post-discharge outcomes of HF patients.

Hypothesis:
The T-FAME was more effective than usual care to enhance self-care, perceived control, HRQoL, and family function of post-discharge HF patients .

Methods:
From Aug2021 to Jan2022, a pilot RCT randomized 60 post-discharge HF patients (mean age=66.4, SD=2.1; NYHA Grade II/III: 70/30%) to T-FAME or usual care. The 12-week nurse-delivered T-FAME comprises an interactive mobile Apps, which allows i) daily self symptom and clinical monitoring with tailored autonomous nurses' feedback , ii) family-centered goal-setting and attainment plan on self-care , iii) personalized drug education, iv) real-time live chat with nurse, v) video-based HF compass for information navigation. The nurse visited the family for three times and conducted the Calgary family assessment and counseling. Outcome evaluation was done by Self-care Heart Failure Index, Self-care Self-efficacy Scale, Control Attitude Scale, Family Functioning Device, and Minnesota Living with Heart Failure Questionnaire at baseline and post-test. The patients and primary caregivers were interviewed for engagement experience in T-FAME.

Results:
Two-way analysis of covariance showed significant greater improvement of T-FAME group on self-care maintenance (F=4.762,p=0.033, ƞp2=0.08), management (F=18.223,p<0.001,ƞp2=0.249) and symptom perception (F=9.33,p=0.003, ƞp2=0.145). They reported non-significant greater improvement in self-care self-efficacy, perceived control and HRQL with ƞp2=0.048-0.05, indicating almost medium effect in pilot trial. More families receiving T-FAME reported non-problematic family function (50%) than the control group (16.7%) (p=0.013). The qualitative findings indicated T-FAME is highly acceptable to enable proactive person-centered disease monitoring and management.

Conclusions:
The preliminary health benefits of T-FAME supports its stringent cost-benefit evaluation in full-scale RCT.
Abstract 13038: Association of Hemolysis Biomarkers and Acute Kidney Injury in Cardiogenic Shock Patients Supported With Impella Ventricular Assist Device
Authors: Lim Daniel , Balansay Brianna , Savla Jainy , Ding Siwen , Bansal Nisha , Arora Nayan , Mahr Claudius , Li Song
Published: June 2023

Introduction:
Hemolysis is a frequent complication in cardiogenic shock patients supported with Impella and can lead to acute kidney injury (AKI). We assessed the association between three hemolysis biomarkers, lactate dehydrogenase (LDH), plasma-free hemoglobin (pfHb), and haptoglobin, and AKI to determine the optimal biomarker in predicting AKI.

Methods:
Cardiogenic shock patients on Impella support (CP or 5.0) for more than 24 hours from 6/1/2016 to 9/1/2020 at the University of Washington Medical Center were retrospectively enrolled. By institutional protocol, the three biomarkers were measured daily while patients were on Impella support. The association between each biomarker and the development of stage 2 or worse AKI (creatinine increase of ≥ 100% or requiring hemodialysis) within 24 hours of biomarker collection was assessed using logistic regression. Plots of AKI probability over the range of values of each biomarker were constructed using natural splines.

Results:
Out of 251 included patients (mean age 56.2 ± 15.8 years, 78% male, 69% white), 128 (51%) developed stage 2 or worse AKI. LDH and pfHb values had statistically significant associations with the development of stage 2 or worse AKI within 24 hours of each measurement (OR 1.016 [95% CI 1.009-1.022] per 100 IU/L of LDH, OR 1.092 [95% CI 1.067-1.117] per 10 mg/dL of pfHb, p-value < 0.001 for both) while haptoglobin values did not (p-value 0.6). The association with AKI was stronger for pfHb compared to LDH (McFadden’s R
2
0.12 for pfHb vs 0.03 for LDH). The association of each biomarker and AKI is illustrated in Figure 1.

Conclusions:
In cardiogenic shock patients supported with Impella, higher LDH and pfHb values were associated with AKI while haptoglobin values were not, and pfHb had a stronger association with AKI than LDH. Our results support the use of pfHb to detect hemolysis and risk of impending AKI in patients supported with Impella.

Figure 1.
Probability of stage 2 or worse AKI based on biomarker values.
Abstract 13039: A Rare Case of Anomalous Aortic Origin of Right Coronary Artery From Left Coronary Cusp Presenting With Recurrent Atypical Chest Pain
Authors: Arun Kumar Pramukh , Dasari Mahati , Prabhu Sushmita , Titus Anoop , Patel Boskey , hadley Michelle
Published: June 2023

Background:
The incidence of anomalous aortic origin of the right coronary artery (AAORCA) is between 0.026% and 0.25%. There is limited data regarding medical versus surgical management. We present a case of AAORCA which did not “qualify” for surgical intervention but remained symptomatic on medical management.

Presentation:
A 58-year-old female with paroxysmal atrial fibrillation presented for the eighth time in the past two years with recurrent atypical chest pain and lightheadedness. Vital signs and cardiac biomarkers were normal.

Work-up:
EKG showed normal sinus rhythm. TTE revealed EF 68%. Myocardial perfusion imaging was normal but exercise stress test showed ventricular ectopy, ventricular bigeminy, short bursts of ventricular tachycardia (VT) at peak exercise, and a 7-beat run of VT. A 30-day event monitor revealed a 17-beat run of VT at a rate of 173 bpm (Figure A).

Management:
Cardiac catheterization showed the dominant right coronary artery (RCA) arising from the left coronary cusp with a shared ostium to the left coronary system (Figure B-D). A coronary CT scan confirmed dominant RCA arising from left coronary cusp (Figure E) with an interarterial course (Figure F) and slit-like appearance of the proximal RCA, with a likely intramural course (Figure G).She was managed conservatively with restriction of vigorous exercise, up-titration of beta-blockers, addition of anti-anginal agents and implantation of loop recorder.

Conclusion:
The most updated consensus statement for AAORCA recommends surgical intervention for those with signs or symptoms of myocardial ischemia (true angina, findings on provocative testing, aborted sudden cardiac arrest or non-vagally-mediated arrhythmia).Although our patient did not “qualify” for surgical intervention, she continued to experience refractory symptoms. Hence, it is of utmost importance to consider surgical intervention in patients who have failed medical management, for improved quality of life.
Abstract 13046: Bleeding Complications During Cardiac Electronic Device Implantation With Novel Oral Anticoagulants versus Vitamin K Antagonist : A Systematic Review and Meta-Analysis
Authors: Saleem Maryam , Alhasan Faysal , Akbarshahi Nataly , arshad verda , Nabavizadeh Pooneh , Walker Jackson , Costea Alexandru , Do Duc H , Rizwan Afzal Muhammad , Weiss Raul
Published: June 2023

Introduction:
Pocket hematoma is a feared complication of cardiac implantable electronic device (CIED) placement. About half the patients undergoing the procedure are on anticoagulation with consequent increased frequency of device-pocket hematoma. The risk of hematoma is variable based on the type of anticoagulation therapy. The purpose of this study was to compare the risk of device-hematoma in patients on
interrupted
novel oral anticoagulants (NOAC) versus
uninterrupted
vitamin K antagonists (VKA) during the peri-operative period.

Methods:
We performed a meta-analysis using electronic literature search to retrieve studies with CIED surgery on uninterrupted VKA versus interrupted NOAC (range 12-96 hours). Primary outcome of interest was pocket-hematoma. Outcomes were pooled under random-effects meta-analyses and reported as risk ratios (RRs) and 95% CIs. 5 studies with low heterogeneity (I
2
=14%), 4 observational and 1
post-hoc
analysis of a randomized trial, were included. 1002 patients NOAC group=376 and VKA group=626 were followed for 4-6 weeks.

Results:
Baseline characteristics were similar, mean age 71 years and 71% male across both groups. There was no significant difference in endpoints: pocket hematoma (major and minor) {RR 0.74 (0.43-1.29), P=0.29}; major hematoma {RR 0.53 (0.24-1.19), P=0.13}; hematomas with new implants {RR 0.82 (0.46-1.48), P=0.51}; hematomas with generator changes {RR 1.90 (0.84-4.31), P=0.12}; hematomas with device-upgrade {RR 0.41 (0.15-1.07), P=0.07}; major bleed {RR 0.18 (0.03-1.09), P=0.06}; pericardial effusion {RR 1.01 (0.13-8.19), P=0.67}(Fig 1). One study reported peri-implantation infection (n=4/311 NOAC, n=2/467 VKA). One patient out of all 5 studies had systemic thromboembolism in each group (1/837 NOAC, 1/1000 VKA).

Conclusion:
Interrupted NOAC use is not associated with a higher risk of pocket hematoma compared to uninterrupted VKA after CIED placement.
Abstract 13050: Tirzepatide versus Semaglutide for Secondary Prevention of Major Adverse Cardiovascular Events in Patients Over the Age of 65 With Type 2 Diabetes Mellitus-Value per Money Analysis
Authors: Arbel Ronen , Hammerman Ariel , Aboalhasan Enis , Sluckis Ben , Azuri Joseph
Published: June 2023

Introduction:
Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) indicated to reduce major adverse cardiovascular events (MACE) in patients with Type 2Diabetes Mellitus (T2DM) and established cardiovascular disease (CVD). Tirzepatide is a novel GLP-1RA/GIP for the same purpose. Adding either agent to the standard of care may impose a significant economic burden on the healthcare system. Therefore, we compared their value for money for this indication in patients over 65.

Hypothesis:
Tirzepatide provides better value for money than semaglutide in reducing MACE in this age group.

Methods:
We calculated the cost needed to prevent one MACE with either drug by multiplying the annualized number needed to treat (NNT) to prevent one event by the annual cost of the therapy. Efficacy estimates were extracted from pre-specified subgroups of patients over 65 in relevant published randomized controlled trials. US drug costs were based on GoodRx prices as of June 2022.

Results:
The annualized NNT to prevent one MACE in patients over 65 with tirzepatide in SURPASS was 58 (95% CI: 36-∞) compared to 79 (95% CI: 45-∞) with semaglutide in SUSTAIN-6. The annual cost of tirzepatide is $12,678 versus $11,616 for semaglutide. Accordingly, the CNT to prevent one MACE with tirzepatide is $735,308 (95% CI: $456,398-∞) compared to $917,635 (95% CI: $522,703-∞) with semaglutide.

Conclusions:
Tirzepatide prescribed for secondary prevention of MACE in patients over 65 with T2DM and established CVD provides better value than semaglutide for the same purpose.
Abstract 13059: Associations of Tobacco, Nicotine, and Cannabis Use With Covid-19 and Other Respiratory Infections—Results From the American College Health Association-National College Health Assessment (ACHA-NCHA)
Authors: Tran Hy , Hitsman Brian , Yoo Joshua Y , Fox Erica N , Lloyd-Jones Donald , Vu Thanh-Huyen T
Published: June 2023

Background:
Tobacco use is the single most preventable cause of cardiovascular disease mortality and morbidity. However, evidence on associations of tobacco/nicotine and cannabis use and COVID-19 infection and severity among youth is limited. It is also unclear if associations between tobacco and cannabis use with COVID-19 are similar to other acute respiratory infections (ARIs).

Methods:
We used data from Fall-2020 and Spring-2021 ACHA-NCHA surveys. Multivariable multinomial and binary logistic regression models were used to estimate the odds of COVID-19 infection/severity and other ARIs by tobacco/nicotine product or cannabis use within last 3 months.

Results:
Of 69,868 students ages 18-24, 70% were female, 0.7% with COVID-19 confirmed-severe, 5% confirmed-moderate, 8% confirmed-mild/asymptomatic, 23% with any ARIs, 18% using any tobacco/nicotine products, and 16% using cannabis. With multiple adjustments, users of only e-cigarettes, only other tobacco products, or dual/poly products (vs. non-users) were nearly 2 times more likely to have COVID-19 (vs. confirmed-negative). A similar pattern of associations was observed for tobacco/nicotine product use and ARIs. Cannabis use had no association with COVID-19 infection, but cannabis users had 8% higher odds of ARIs than non-users. Of 9,380 COVID-19 confirmed students, no association of tobacco/nicotine product use with COVID-19 severity was observed, but cannabis users had 17% higher odds of severe/moderate (vs. mild/asymptomatic) symptoms than non-users.

Conclusion:
Aong US college students, e-cigarette or dual/poly-product users are more likely to have COVID-19 and other acute respiratory infections. Cannabis users were more likely to have more severe COVID-19 symptoms than non-users; they were also more likely to have other acute respiratory infections.