bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P267: A Pharmacist-Led, AHA Heart 360 Supported Home Blood Pressure Monitoring Program Improves Blood Control in Patients With Uncontrolled Hypertension
Authors: Olson Kari L , Magid David J , Billups Sarah J , Wagner Nicole , Kroner Beverly
Published: March 2022

Objective:
Treating hypertension (HTN) reduces morbidity and mortality, yet blood pressure (BP) remains inadequately controlled in a large proportion of patients with HTN. The purpose of this study was to determine if a pharmacist-led home BP monitoring (HBPM) program supported by the American Heart Association's (AHA)
Heart 360 website
improves BP control for patients with uncontrolled HTN.

Methods:
This practical randomized controlled study was conducted at Kaiser Permanente Colorado. A total of 353 patients 18 to 85 years of age with uncontrolled HTN, receiving ≤ 3 antihypertensive medications, and with internet access were randomized to the Usual Care (UC, n=174) or the home BP monitoring (HBPM, n=179) group. All patients were seen in clinic at baseline and 6 months for BP measurements. The HBPM group used the AHA
Heart 360 website to
transmit home BP readings via the internet to clinical pharmacy specialists who made adjustments to patients' antihypertensive medications and/or ordered labs as necessary based on collaborative drug therapy management (CDTM) protocols. The primary endpoint was BP control at 6 months (<130/80 mm Hg for patients with diabetes or chronic kidney disease and <140/90 mm Hg for all others). The number of office, telephone, and email contacts was also compared between groups.

Results:
Six-month follow-up data were available on 245 patients (245 of 353 (70%)) (n=120 HBPM, n=125 UC). The mean age of the participants was 58 years; 61% were male. There were no significant differences in age or gender between groups. Baseline mean systolic BP was 149 mm Hg in the HBPM group and 145 mm Hg in the UC group (p = 0.08). Rates of 6-month BP control were significantly higher in the HBPM ((58%) 69 of 120) versus the UC group ((38%) 47 of 125) (p < 0.01). The 6-month decrease in systolic BP was larger in the HBPM group (-21 mm Hg) versus the UC group (-9 mm Hg) (p < 0.01). The adjusted relative likelihood of BP goal attainment was 1.5; 95% CI, 1.2 to 2.0. There were no significant differences between groups in the number of office visits; however telephone and email contacts were significantly higher in the HBPM group.

Conclusion:
A pharmacist-led, HBPM program supported by the AHA
Heart 360 website
improves BP control for patients with uncontrolled HTN compared to UC.
Abstract P27: Statistical Models of Readmission After Stroke: A Systematic Review
Authors: Lichtman Judith H , Leifheit-Limson Erica C , Jones Sara B , Watanabe Emi , Bhat Kanchana , Savage Shantal V , Phipps Michael , Bernheim Susannah M , Krumholz Harlan M
Published: March 2022

Objective:
Hospital readmission has been used to risk-stratify patients and profile hospitals by public reporting of performance measures. We conducted a systematic review to identify models developed to compare hospital rates of readmission or predict patients' risk of readmission after stroke, and identify characteristics independently associated with readmission in these models.

Methods:
We identified English-language studies published from 1989-2009 using MEDLINE, PubMed, Scopus, PsychINFO, and all Ovid Evidence-Based Medicine Reviews. Eligible publications reported readmission within 1 year after stroke hospitalization and identified 1 or more predictors of readmission in risk-adjusted statistical models. Publications were excluded if they lacked primary data or quantitative outcomes, considered composite outcomes, or had fewer than 100 patients. Investigators independently reviewed abstracts to select publications that met criteria and used a standardized instrument to perform detailed data abstraction.

Results:
Of the 177 publications identified during the initial review, only 9 met the inclusion criteria. None of these papers developed models to compare readmission rates among hospitals or predicted patients' risk of readmission. The studies presented multivariable models that showed specific patient-level and/or process of care factors associated with readmission after stroke. Studies varied in their case definition of stroke, data source (VA, Medicare, administrative data, registries), outcomes (all-cause and/or stroke-related readmission), and follow-up period. There was little consistency of candidate variables across the studies, but more commonly included factors were age (n=8/9), sex (7), race (8), prior stroke (5), hypertension (5), diabetes (6), standardized stroke severity scale (3), other variables related to stroke severity (5), and length of stay (7). Five studies provided significance levels for covariates other than their primary predictor(s); however, few characteristics were consistently associated with readmission.

Conclusions:
The lack of risk-standardized models represents an important gap for ongoing efforts to profile hospitals through public reporting of performance measures.
Abstract P282: Medical Professional Liability Claims Involving Cardiologists: A Descriptive Study of 4,527 Cases
Authors: Parikh P. D , Oetgen William
Published: March 2022

Objectives:
In this study we present data which describe a large cohort of closed cardiovascular medical professional liability claims. The purpose of this report is to provide information for cardiologists which will be useful in improving the quality of cardiovascular care and in reducing the incidence of patient injury and the consequent frequency of medical professional liability claims.

Background:
In 1985 The Physician Insurers Association of America (PIAA) established the Data Sharing Project, a registry of medical professional liability claims. This registry contains data voluntarily submitted by participating PIAA member professional liability insurance companies describing 239,756 closed claims through 2008. The registry is maintained for educational programs to improved quality of care and to reduce patient injury and consequent medical professional liability claims.

Methods:
Descriptive techniques are used to present summary information for the medical cardiovascular claims in the PIAA registry.

Results:
Of 239,756 closed claims, 4,527 (1.9%) involve cardiologists. Of the 4,527 closed claims, 836 (18.5%) resulted in an indemnity payment, and the average indemnity payment for these cases was $251,024. In the entire database, 29.5% of closed claims were paid, and the average indemnity payment was $209,156. The most prevalent allegation among cardiovascular closed claims was diagnostic error (931 cases, 20.6% of all closed claims), and the most prevalent diagnosis was acute myocardial infarction, representing 105 of 931 cases of diagnostic error (11.3% of diagnostic error closed claims.) The average indemnity paid for errors in diagnosis was $306,273. Aortic aneurysms and dissections, while relatively infrequent as clinical events, represent a substantial medical professional liability diagnostic error risk because of the high percentage of paid claims (38.2%), and the high average indemnity payment of $444,859.

Conclusions:
Medical professional liability issues are common and are important to all practicing cardiologists. Detailed knowledge of risks associated with liability claims should assist practicing cardiologists in improving quality of care, reducing patient injury and reducing the incidence of claims.
Abstract P286: Patterns of Caregiving Among Patients Hospitalized With Cardiovascular Disease
Authors: Mosca Lori , Mochari-Greenberger Heidi , Liao Ming , Suero-Tejeda Niurko , Comellas Mariceli , Rehm Lisa , Aggarwal Brooke
Published: March 2022

BACKGROUND:
Cardiac caregivers may represent a novel low cost strategy to improve patient adherence to medical follow up, guidelines, and ultimately patient outcomes. Prior work on caregiving has been conducted primarily in mental health and cancer research; few data have systematically evaluated caregivers of cardiac patients.

AIMS:
The purpose of this study was to evaluate the patterns of caregiving and characteristics of caregivers among hospitalized patients with cardiovascular disease (CVD) to determine the potential pool of caregivers for an educational intervention and assess disparities in caregiver burden.

METHODS:
Consecutive patients admitted to the CVD service line at a university medical center during a 3 month period were included in the

F

amily Cardiac Caregiver

I

nvestigation

T

o Evaluate

O

utcomes (
FIT-O
) Study. Patients [N=1415, 55% (776/1415) white, 60% (853/1415) male, >92% participation rate] completed a standardized interviewer assisted questionnaire in English or Spanish regarding assistance with medical care, daily activities, and medications in the past year and plans for post-hospitalization. Caregivers were classified as either paid/professional (e.g. nurse/home aide) or non-paid (e.g. family member/friend).

RESULTS:
Among CVD patients, 14% (195/1415) planned to have a paid caregiver and 54% (759/1415) a non-paid caregiver at discharge. Planned paid caregiving was more prevalent among black/Hispanic vs. white/other patients (OR=1.8; 95%CI=1.2-2.5); planned non-paid caregiving prevalence did not differ by race/ethnicity. Most non-paid caregivers were female [82% (325/398)]. Patients who had non-paid caregivers in the year prior to hospitalization [(33% (466/1415)] reported: grocery shopping/meal preparation [62% (287/466)], transport to/arranging doctor visits [61% (283/466)], and medication adherence/medical needs [51% (236/466)] as top tasks caregivers assisted with.

CONCLUSIONS:
Following hospitalization, a majority of patients expect non-paid caregivers, primarily females, to assist with tasks that have the potential to improve CVD outcomes such as medical follow up, medication adherence and nutrition, suggesting these are important targets for a caregiver educational intervention.
Abstract P29: Positive Attitudes Towards Risk Factor Reduction in an Urban Underserved Population Newly Diagnosed With Stroke or TIA
Authors: Dromerick Alexander W , Gibbons M C , Kidwell S C , Farr Deeonna E , Trouth Annapurni , Sanchez Brisa , Shara Nawar , Wing Jeffery J , Edwards Dorothy F
Published: March 2022

Introduction:
The transtheoretical model describes how people modify a problem behavior or acquire positive behaviors. The central construct is the stages of change, where behavior change is a continuum describing readiness to change: precontemplation, contemplation, preparation, action, and maintenance. People progress through these stages at varying rates, often moving back and forth along the continuum before attaining maintenance. We investigated whether urban underserved persons newly hospitalized for stroke or TIA intend to change their stroke prevention behaviors, and their belief about their premorbid behaviors.

Methods:
Participants in the PROTECT DC Phase II trial of health navigation to improve adherence with secondary stroke prevention behaviors were evaluated. They met the following criteria: atherogenic ischemic stroke or TIA diagnosed within 30 days, resident of the District of Columbia, community dwelling, and able to provide informed consent. Participants were recruited at 4 hospitals, and were interviewed regarding their risk factor management intentions.

Results:
In 87 participants aged 60.7 ± 12 yrs, the median NIH Stroke Scale score was 2(0-16), 45% were male, 90% were African-American. Long-term (>6 mos) medication adherence was reported by 52%, 7% reported adherence <6mos, and 32% intended to adhere during the next 6 mos. Dietary adherence >6 mos was reported by 26%, and 62% intended to start adherence. Eighty percent intended to learn more about stroke, and 94% of active smokers (30 individuals) intended to quit smoking within 6 months.

Discussion:
In a sample of urban underserved hospitalized for acute stroke, a large proportion reported the intent to adhere to risk management behaviors or already believed themselves adherent. Our data suggest that this population is quite motivated to engage in the recommended behaviors. Many report adherence to medication, diet and exercise recommendations prior to stroke onset; it is unclear how these perceptions relate to current stroke prevention guidelines. Urban underserved populations are receptive to behavioral changes associated with risk reduction, acute hospitalization may provide an important opportunity to initiate and refine effective stroke prevention behaviors.
Abstract P292: Relationship Between Coronary Atherosclerosis on Coronary Computed Tomography Angiography and New Statins Prescriptions
Authors: Alqarqaz Mohammad , Qureshi Waqas , Zaidan Mohammad , Swadia Tanmay , Khalid Fatima , Khawaja Owais , Nour Khaled , Al-Mallah Mouaz
Published: March 2022

Background:
Statins have been shown to reduce cardiovascular mortality and morbidity. However, not all patients with indications for statins are actually receiving them. The aim of this analysis is to determine the relationship between the diagnosis of atherosclerosis on coronary CT Angiography (CCTA) and new statins prescriptions.

Methods:
We included 544 consecutive patients without known coronary artery disease (CAD) who underwent CCTA for various clinical reasons and were not on statins prior to the CCTA. CCTA were interpreted as normal, non obstructive CAD (≤50% diameter stenosis) or obstructive CAD (>50% diameter stenosis). The primary endpoint was new prescription of statins within one year after the CCTA. Univariate and multivariate predictors of new statins prescription were computed.

Results:
Of the 544 patients included, 256 patients (47%) had normal CCTA, 211 patients (39%) had non obstructive CAD and 77 patients (14%) had obstructive CAD. Within one year of performing the CCTA, 132 patients (46%) were started on statins. New statins were prescribed in 9%, 33% and 53% of patients with normal CCTA, non obstructive CAD and obstructive CAD, respectively (P < 0.0001). Patients with new statins prescription were older (58 vs. 53 years, p<0.0001), more often Caucasian with higher prevalence of hypertension (77% vs. 64%, p= 0.006) and diabetes (25% vs. 9%, p<0.001). Patients with new statins prescription had higher mean low density lipoprotein (LDL) cholesterol (116 vs. 108 mg/dl, p=0.016). Using multivariate logistic regression, the presence of non obstructive CAD on CCTA (adjusted odds ratio 5.1, 95% Confidence interval 2.8 - 9.4) and obstructive CAD (odds ratio 14, 95% Confidence interval 6.7 - 29.8, p<0.001) were independent predictors of new statins therapy after adjusting for confounding variables.

Conclusion:
Our analysis demonstrates that the presence of atherosclerosis on CCTA (both obstructive and non obstructive CAD) is associated with new statins prescriptions.
Abstract P293: Small Area Analysis of ST-Elevation Myocardial Infarction Admissions to Non- Percutaneous Coronary Intervention Hospitals in Miami-Dade County, Florida, 2007
Authors: Tanner Jean Paul , Forsyth Colin J , Reader Steven , Pathak Elizabeth B
Published: March 2022

Introduction_
Percutaneous coronary intervention (PCI) is considered the preferred reperfusion therapy in patients with ST-elevated myocardial infarction (STEMI). Despite compelling evidence regarding the benefits of timely reperfusion using PCI, many STEMI patients present to or are transported to non-PCI-capable hospitals. This study identified the spatial distribution of STEMI patient residences for those admitted to non-PCI-capable hospitals in Miami-Dade County and evaluated the proximity of these patients to PCI-providing hospitals.

Methods_
First admissions of Florida residents diagnosed with a STEMI (ICD-9-CM codes 410.0 - 410.6, 410.8) to a Miami-Dade County hospital in 2007 were identified using a comprehensive inpatient surveillance system database. Residential zipcodes were available for all patients. Geographic information systems were used to geocode 22 hospitals (13 non-PCI-capable and nine medium/high volume PCI hospitals) and map the percent of STEMI patients admitted to non-PCI-capable hospitals at the 5-digit zip code level.

Results_
Miami-Dade is the 9th most populous county in the U.S., with 5 hospitals that performed >400 PCIs in 2007.Whereas the 13 non-PCI-capable hospitals were scattered throughout the county, the 9 PCI-capable hospitals were located primarily in the northeast quadrant. In 2007, 17.1% of 1,143 STEMI patients were admitted to non-PCI capable hospitals. Despite being located within 6 miles of a PCI-capable hospital, 6 zip codes within the northeast region had more than 50% of their STEMI patients admitted to a non-PCI-capable hospital. Zip codes located in the southwestern quadrant were between 9 and 20 miles from a PCI-capable hospital. The percent of STEMI patients residing in these zip codes who were admitted to non-PCI-capable hospitals varied from 50-60% (2), 25-50% (5), and 11% (1).

Conclusions_
Despite residing in close proximity to a number of PCI-capable hospitals, many STEMI patients in Miami-Dade county were admitted to a non-PCI-capable hospital in 2007. Our results suggest that a high degree of hospital competition may not improve quality of care for STEMI patients.
Abstract P308: Can a Customized Quantitative Informed Consent Document Improve Decision Quality and Be Integrated Into the Routine Process of Care
Authors: Malenka David J , Ross Cathy S , Langner Craig , Olmstead Elaine M , O'Connor Mary Ann , O'Connor Annette M , O'Connor Gerald T
Published: March 2022

BACKGROUND:
An informed consent requires reference to the risks of treatment. At best, most informed consent documents list the risks but make no specific reference to their probability. We developed a computer-based system that generates a customized quantitative informed consent document for patients considering CABG or PCI.

METHODS:
We used our northern New England PCI and CABG registries and published data to develop clinical prediction rules for patient specific estimates of the morbidity and mortality following diagnostic cardiac catheterization, ad hoc PCI, staged PCI, and CABG. Preoperative patient and disease characteristics include: age, gender, comorbidities, prior intervention, coronary anatomy (if available) and urgency. A computer-based interface was developed to easily acquire patient information and print informed consent documents with patient-specific risks. Focus groups were conducted with revascularized patients who were asked to describe their informed consent experience and their preferences for the presentation of risk.

RESULTS:
Focus group participants indicated they prefer display of numbers and not percentages. Below is an example: “I understand that the following risks, among others, are associated with the procedure(s): If 100 people like me have a CABG procedure about... 99 may survive and 1 may die in the hospital 99 may avoid a stroke and 1 person may have a stroke in the hospital 98 may avoid a serious complication (including infection of your chest wall, heart attack, kidney failure, and others) and 2 may have one of these problems in the hospital 91 may avoid a lesser complication (including kidney injury, bleeding, and others) and 9 may have these problems in the hospital” Physicians at one medical center tested the computer-based prototype. All found the data needed was readily available and the prototype easy to fill out and print. In, general patients liked the presentation and felt that it helped to stimulate some additional conversations.

CONCLUSION:
We designed a computerized system to electronically calculate risk. Clinical data needed to complete the risk assessment was readily available. Creating a customized quantitative informed consent document in “real time” for patients having CABG or PCI is possible.
Abstract P313: Using In-Situ Simulation to Reduce Door-to-Balloon Times in ST-Elevation Myocardial Infarction
Authors: Hall Laura L , Hamman William , Beaubien Jeff M , Beaudin-Seiler Beth M , Yarboro Elizabeth
Published: March 2022

BACKGROUND:
Sixteen hospitals from across the United States participated in a high-fidelity teamwork simulation exercise, which was designed to identify and resolve factors that adversely affect door-to-balloon (D2B) times.

METHODS:
The simulation scenario was the same at each participating hospital: EMS crews transported a simulated patient who was complaining of chest pain. The patient was transferred to either the ED or the cardiac catheterization laboratory, where a simulated angioplasty was performed. All of the simulations were videotaped using high-definition video cameras, and were scored by three trained raters at 7 specific “events” during the simulation. During each event, measures of team performance and D2B times were collected.

RESULTS:
The results were analyzed using hierarchical multiple regression. After statistically controlling for historical data concerning D2B performance across the 16 hospitals, the observed teamwork ratings accounted for 10-50% of the criterion variance in relevant D2B measures, depending on the specific simulation event. Despite the limited sample size, all but one of the analyses reached standard levels of statistical significance. Qualitative observations also identified several systemic problems that occurred across hospital sites: inconsistent rules which resulted in the ED team needlessly repeating time-critical behaviors that were already performed by the EMS crews; how failing to register the patient while en route led to needless delays upon arriving at the cardiac catheterization laboratory; and the lack of well-defined handoff procedures between EMS crews and their counterparts in both the ED and cardiac catheterization lab.

DISCUSSION:
Although the findings from this pilot test need to be cross-validated with a much larger sample, the preliminary results are clear: improved teamwork behaviors can result in both practically and statistically significant reductions in D2B times, and by extension, patient care. These findings complement recent research conducted with OB teams, which have shown that our research team's “in-situ” simulation method is particularly well-suited to addressing organizational challenges that compromise patient safety and quality of care.
Abstract P320: Congestive Heart Failure Readmissions: Relationship Between Preadmission Patient Determinants and 30 Day Rehospitalization
Authors: Mazimba Sula , Tan Jessica , Grant Nakash , Parvathaneni Lata , Kalra Vikas , Patel Trupti , Kothapalli Radha , Makola Diklar , Redko Cristina , Hahn Harvey
Published: March 2022

Introduction
Congestive heart failure (CHF) is the most costly disease in the US. Readmission costs contribute significantly to this healthcare expenditure. While adherence to published guidelines has increased, readmission rates have not improved. There is an urgent need to identify clinical and process measures that improve care for CHF patients. Thirty day readmission rates have often been used by third party payers as a surrogate index for quality of care in the inpatients settings. This study looked at the relationship between preadmission patient characteristics and 30 day readmissions.

Methods:
This was a single center retrospective case-control study that evaluated 6063 consecutive patients admitted with a diagnosis of CHF from December 2001 through December 2008. Data was abstracted for independent and dependent variables, including heart failure performance measures at discharge. This Ad hoc analysis focused on the relationship between patient determinants on 30 day readmissions. Statistical comparison was made between readmitted and non readmitted cohorts.

Results:
There were 6063 total patients admitted with the principal diagnosis of CHF. A total of 19.6% (1191 of 6063) of the patients were readmitted within 30 days of discharge. Another 19.9% (1211 of 6063) served as control cohort. The mean age for readmitted and non readmitted patients was 77.8(+/- 11.6) and 75.7 (+/- 11.8) years respectively. Mean duration of initial hospital stay for readmitted patients was 5.7 (+/- 4) days and 6.0 (+/-4) days for the control group. Readmitted patients were more likely to be smokers than their counterparts. (O.R= 1.5, 95% CI 1.2-1.9 p=0.002).Non usage of ACEI medication prior to hospitalization was associated with higher rates of readmission (O.R 1.30, 95% CI 1.1-1.6, p=0.003).However beta blocker therapy did not correlate with 30 day readmissions. (O.R 1.0, 95% CI 0.89- 1.19, p=0.970).

Conclusions:
In patients admitted with CHF, non usage of ACEI prior to hospitalization and smoking history may serve as indicators for early readmissions. Preadmission beta blocker use was not associated with reduced early readmissions. More studies need to be done to stratify determinants that identify patients at risk for early readmissions.
Abstract P321: Hospital Angioplasty Volumes and ST-Elevation Myocardial Infarction Patient Admission Patterns: Improvement in Florida from 2001-2007
Authors: Forsyth Colin J , Pathak Elizabeth B , Strom Joel A
Published: March 2022

Background:
The ACC/AHA guidelines recommend percutaneous coronary intervention (PCI) at high-volume centers with at least 400 procedures per year for ST-elevation myocardial infarction (STEMI), but fewer than 25% of acute care hospitals in the US are PCI capable. In Florida, a statewide system for regional STEMI patient care does not yet exist, but some local STEMI care coalitions have formed. We examined trends over time in the percent of STEMI patients admitted to hospitals categorized by PCI volume.

Methods:
Using comprehensive statewide hospital discharge data, we classified 191 acute care hospitals according to annual PCI volume: no PCI capability (n=90), low-volume (1-199 PCIs; n=33) medium volume (200-399 PCIs; n=4) and high-volume (400+ PCIs; n=64). Hospital classifications were specific for a 3-month time window; therefore a single hospital's category could vary over time. We determined the percent of STEMI patients treated at each type of hospital for the first and second half of each year from 2001-2007.

Results:
From early 2001 to late 2007, the percent of STEMI patients treated at non-PCI capable hospitals declined from 31.0 to 7.9%, while the proportion at high-volume PCI centers rose from 58.3 to 72.3%. Low- and medium-volume hospitals typically accounted for <15% of total patient volume but realized slight increases from 2001 to 2007. The percentage of STEMI patients seen at low-volume PCI hospitals rose from 6.6 to 8.7% from 2001-2007, and from 4.2% to 11.1% at medium-volume hospitals. No differences in the hospital admission trends were observed by race/ethnicity or gender.

Conclusions:
The pattern of STEMI care has changed substantially from 2001-2007 in Florida, with a greater proportion of patients seen at high-volume PCI hospitals and fewer than 10% admitted to non-PCI hospitals by 2007. These trends are likely due to implementation of STEMI protocols by many large emergency medical services (EMS) providers across the state and the positive impact of local STEMI care coalitions in some metropolitan areas. Further research is needed to determine if there has been increased STEMI patient awareness of the value of undergoing PCI at high-volume centers. A positive trend toward regionalized STEMI care appears to be in progress in Florida.
Abstract P33: The Impact of Stroke Risk on Warfarin and Aspirin Use in Patients With Non-Valvular Atrial Fibrillation Followed in Community-Based Primary Care Practices
Authors: Ewen Edward , Simon Teresa A , Jurkovitz Claudine , Jackson Joseph , Weintraub William S
Published: March 2022

Background:
The application of treatment guidelines for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) in primary care practice is not well understood. This study examined the risk of stroke at diagnosis of NVAF and the decision to initiate oral anticoagulant (OAC) therapy or aspirin (ASA) in a community-based primary care population.

Methods:
A retrospective cohort of patients with NVAF followed from 1998-2008 in a health system with a shared electronic medical record was evaluated. The presence of NVAF, OAC use, ASA use, and CHADS2 stroke risk score were collected through a review of the problem list, office and hospital records, laboratory values, and medication use. Stroke events following diagnosis were identified using office and hospital records. CHADS2 risk scores were categorized as 0, 1, and ≥ 2. We used t-test and the Chi-square to assess the association between continuous and categorical variables.

Results:
A total of 840 NVAF patients were followed for a mean of 3.1 years. Those at high stroke risk (CHADS2 ≥ 2) were older (77 vs. 67 years, p < .001), more likely to be female (56% vs. 43%, p < .001), and followed for a shorter period of time (2.4 years vs. 3.6, p <.001). A total of 400 patients (47.6%) were classified as high risk, 289 (34.4%) with CHADS2 score of 1, and 151 (18%) with CHADS2 score of 0. Overall, there were no significant differences (p = 0.2) in the choice of treatment strategy by level of stroke risk (see
Table
).

Conclusion:
In this community setting, CHADS2 stroke risk in NVAF patients at the time of presentation appears to have little impact on the choice of treatment strategy. 35.8% of NVAF patients fail to receive warfarin anticoagulation despite CHADS2 treatment recommendations for stroke prevention. Additional research is needed to determine the reasons for failing to initiate stroke prevention therapy in real practice.

Table:

Treatment Strategy by CHADS2 Stroke Risk in NVAF Patients

Treatment Strategy

CHADS2 Score, n (%)
No Treatment
ASA Only
Warfarin

0
19 (12.6)
51 (33.8)
81 (53.6)

1
37 (12.8)
81 (28.0)
171 (59.2)

≥ 2
43 (10.8)
100 (27.6)
257 (64.3)
Abstract P330: Heart Failure Patient Insights Reflected in the Kansas City Cardiomyopathy Questionnaire
Authors: Gwaltney Chad , Martin Mona , Ariely Rinat , Brede Yvonne
Published: March 2022

Background:
Heart failure (HF) reduces patient quality of life more than other chronic illnesses. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a patient-reported outcome (PRO) instrument that is completed directly by the patient and is commonly used to address the patient's perspective on HF in clinical trials. The FDA Guidance on using PROs in clinical programs emphasizes the need to use qualitative patient interviews to ensure that a PRO instrument addresses all relevant concepts in a clinical area and that it is easily understood by patients.

Objectives:
The goal of this project was to assess patient insights regarding HF symptoms, physical limitations, and other impacts and to compare these to the content of the KCCQ, and to see how well patients understand the KCCQ items.

Methods:
Participants were 28 stable Class II - IV NYHA heart failure patients ages 42 to 90. Fifteen patients were interviewed to elicit patient insights and 13 patients were interviewed to assess patient comprehension of the KCCQ items.

Results:
The most commonly endorsed HF symptoms and impacts are listed in the
table
. These concepts are assessed in the KCCQ. The majority of the KCCQ items were rated as highly or somewhat relevant by 66% or more of the patients interviewed; items assessing ability to dress and shower/bathe, need to sleep sitting up, and limitations in visiting friends or family were rated as relevant by less than 50% of patients. Patients generally understood the instructions, items, and response options of the KCCQ with no problems or complications.

Conclusions:
Qualitative data from this study support the significance of the concepts measured by the KCCQ, such as HF symptoms and physical limitations. Thus, the KCCQ and other measures of these concepts may be useful as endpoints in development programs of novel drugs that may potentially have an impact on the burden of illness of HF in terms of symptoms and physical limitations.

Category
Examples/patient descriptions
Percent of patients endorsing symptom or impact

Symptoms

Breathing problems
Shortness of breath, wheezing
93%

Tiredness
Drowsy, exhausted
93%

Swelling
Legs when up and going all day
67%

Impacts

Physical mobility
Get light headed when I bend down
93%

Physical limitations
Steer away from anything strenuous
93%

Emotional effects
Anxiety about shortness of breath
87%
Abstract P344: Prevalence of Conduction Abnormalities in a Systolic Heart Failure Disease Management Population by Race, Ethnicity, and Gender
Authors: DeWolfe Andrew P , Hebert Kathy , Dias Andre , Steen Dylan , Colombo Rosario , Franco Emiliana , Neistein Sholom , Arcement Lee
Published: March 2022

While there have been several studies evaluating the prevalence of electrocardiogram (ECG) conduction abnormalities such as left bundle branch block (LBBB) and atrial fibrillation (AF) in the general population, there are none currently describing that of the Hispanic population in patients with systolic heart failure. Given the need for examining race and ethnic differences in ECG abnormalities, the primary purpose of this study is to compare the prevalence of ECG abnormalities in three systolic heart failure populations from two indigent heart failure clinics. The study examines EKG difference among three ethnic groups: Caucasians, African-Americans, and Hispanics. We also investigated ECG differences between genders. This is a cross sectional study. A total of 926 patients were enrolled in a systolic heart failure disease management program in two safety net hospitals in Florida and Louisiana. Inclusion criteria was an ejection fraction (EF) < or equal to 40% by echocardiography, and ECGs which were obtained closest to the date of enrollment. Caucasian patients had more atrial fibrillation than African-American patients. Hispanics had more paced rhythm, left bundle branch block and abnormal QT intervals than Caucasian or African-American patients. A QRS interval greater than 120 milliseconds (ms) was less prevalent among African-Americans. ECG conduction abnormalities vary across race, ethnicity, and gender. Adequate medical attention should be addressed to these variations since relevant ECG findings can offer additional guidance for therapeutic interventions, as well as provide important prognostic information and potentially modify morbidity and mortality rates.
Abstract P346: Left Ventricular Function in Patients With Cardiomyopathy: Predictors of Long Term Improvement
Authors: Pillarisetti Jayasree , Guda Rajeshwer , Emert Martin , Biria Mazda , Dalton Kathleen , Vacek James L , Lakkireddy Dhanunjaya
Published: March 2022

Introduction:
Spontaneous improvement in ejection fraction in patients with heart failure has been shown to occur in a small percentage of patients by 8-12 months. No studies exist on the long term improvement in left ventricular function beyond 12 months in patients with ischemic and non-ischemic cardiomyopathy.

Methods:
A retrospective cohort study was conducted at a tertiary academic center. Electronic medical records were reviewed to abstract data on patients with EF≤35% between July 2001 and June 2006. Echocardiographic reports were reviewed to ascertain if EF has improved over time (>12 months from initial echo) until April 2009. Patients who had an improvement in EF in <12 months were excluded. Mortality records were obtained from social security death index. Patients with improvement in EF were compared to those without. Predictors of LV function improvement were analyzed.

Results:
Inclusion criteria were met by 718 patients and had a mean EF of 30%. 11.4% of patients improved their EF over 44±19 months from a baseline EF of 27±7% to 48±8%. Mortality in the group with EF improvement was 11% and was 37% in the group without improvement (p=<0.0001). On sub group analysis among patients with EF improvement, 35% had an ICD implanted for primary prevention. In this subgroup, mortality among patients with and without ICD was 20% and 5% respectively (p=0.03). Univariate predictors of EF improvement were found to be lower age, lower QRS duration, dyslipidemia and use of aspirin and statins. Mean age of patients with and without EF improvement was 66±13 and 70±14 years respectively. Predictors of EF improvement on multivariate analysis were lower age and aspirin use.

Conclusions:
Patients with EF improvement had a lower mortality compared to those who did not. Survival benefit of ICDs in the group with EF improvement is statistically significant but not as much as the EF improvement in itself. Younger patients are more likely to improve their EF over long term. Further studies are necessary to clearly define the patients who are most likely to benefit from an ICD.
Abstract P355: Hemoglobin A1c Vs. Oral Glucose Tolerance Test for Diabetes Diagnosis in NHANES 1988-1994 and 2005-2006
Authors: Taveira Tracey H , Jankowich Matthew D , Wu Wen-Chih
Published: March 2022

Background
Approximately 6.2 million people with diabetes mellitus (DM) are undiagnosed. At diagnosis, 25% already have established microvascular disease. Earlier diagnosis may reduce the risk of DM complications. Oral glucose tolerance testing (OGTT), the gold standard for DM diagnosis, is difficult to administer, inconvenient for patients and expensive. Fasting plasma glucose is flawed by its laboratory instability and day to day variation. The use of HBA1c as a screening tool has been previously evaluated and shown to be poor (HbA1c ≥ 5.5% sensitivity 60.0%, specificity 55.0%, positive predictive value [PPV] 21.4%) but its utility as a diagnostic test is unclear since widespread assay standardization has only occurred since 1997. The objective of this study was to determine the feasibility of using HbA1c for DM diagnosis based on OGTT results.

Methods
Cross-sectional analysis of non-pregnant adults aged 40-74 years data from the 1988-1994 National Health and Nutrition Examination Survey (NHANES), who had complete data for a morning 2-h plasma during an OGTT, HbA1c and BMI, who were not taking insulin or oral hypoglycemic agents to determine an HBA1c cutoff value that have an adequate sensitivity and specificity for the diagnosis of diabetes. We then applied the obtained HbA1c cutoff value to the 2005-2006 NHANES to determine the reliability of our results.

Results
In the NHANES 1988-1994 and 2005-2006 data sets 6293 and 798 patients had complete data, respectively. The area under the curve for HbA1c was 0.752 for both the NHANES cohorts.

Table:

NHANES Cohort
HbA1c % Cutpoint
Stratified For
Sensitivity (%)
Specificity (%)
Correctly Classified (%)
Likelihood Ratio (+)

1988-1994

-
-
-
-
-

≥ 6.5
-
34.6
98.3
89.2
20.7

≥ 6.6
-
31.8
98.8
89.2
26.0

≥ 6.7
-
30.0
99.3
89.4
41.5

≥ 6.8
-
28.2
99.6
89.4
63.4

≥ 6.9
-
25.4
99.8
89.2
105.5

≥ 6.7

BMI < 30 kg/M
2

23.7
99.6
88.7
57.9

≥ 6.7

BMI ≥ 30 kg/M
2

39.1
98.5
86.1
25.3

≥ 6.7
Age 40-59 years
38.1
99.5
88.7
74.7

≥ 6.7
Age 60-74 years
24.8
98.9
86.0
23.2

≥ 6.7
Men
33.7
99.2
86.4
40.4

≥ 6.7
Women
26.8
99.4
88.4
43.4

2005-2006
HbA1c%

≥ 6.5
-
31.1
99.5
93.1
56.3

≥ 6.6
-
25.7
99.9
93.0
185.9

≥ 6.7
-
25.7
100.0
93.1
-

≥ 6.8
-
23.0
100.0
92.9
-

≥ 6.9
-
23.0
100.0
92.9
-

≥ 6.7

BMI < 30 kg/M
2

21.2
100.0

-

≥ 6.7

BMI ≥ 30 kg/M
2

29.3
100.0

-

≥ 6.7
Age 40-59 years
33.3
100.0

-

≥ 6.7
Age 60-74 years
21.3
100.0

-

≥ 6.7
Men
31.6
100.0

-

≥ 6.7
Women
19.4
100.0

-

Repeating our analysis in the 2005-2006 NHANES cohort we found a similar level of sensitivity and specificity for a HbA1c cutoff of ≥6.7%. In both the NHANES cohorts stratification for BMI, age and gender did not impact sensitivity and specificity significantly.

Conclusion
Using an HbA1c cutoff of ≥6.7% would achieve adequate sensitivity, specificity and reliability for DM diagnosis across different subgroups and time periods.
Abstract P361: Heart Failure and Fractures: A Community Study
Authors: Gerber Yariv , Melton L. Joseph , Weston Susan A , Roger Véronique L
Published: March 2022

Background:
Recent findings suggest a role for heart failure in the etiology of osteoporotic fractures, but the nature of the relationship is unclear and community data are lacking.

Methods and Results:
We conducted a community-based case-control study comparing prior osteoporotic fractures among Olmsted County, Minnesota, residents newly diagnosed with heart failure in 1979-2002 (cases) to age- and sex-matched community controls without heart failure (961 pairs; mean age: 76 years; 54% women). Subjects were then followed forward in time to July 2009 to evaluate the risk of fracture subsequent to the heart failure diagnosis. Prior fractures were more frequent in heart failure cases than controls: 23% versus 19%,
P
=0.02; adjusted odds ratio (OR) for any osteoporotic fracture 1.39 (95% CI: 1.07-1.81). This was related to hip fractures (OR: 1.82; 95% CI: 1.25-2.66) with little or no association with other fractures. Over a mean follow-up of 7.5 years, 536 new osteoporotic fractures occurred in 444 individuals. The adjusted fracture risk was higher among heart failure patients compared to controls (hazard ratio [HR]: 1.32; 95% CI: 0.98-1.79), again largely attributable to hip fractures (HR: 1.58; 95% CI: 1.03-2.41).

Conclusions:
Patients diagnosed with heart failure experience an excess risk of fractures both before and after the diagnosis of heart failure, which is related to hip fractures. These findings suggest common underlying and co-occurring mechanisms for heart failure and hip fracture and underscore the crucial importance of preventing falls in elderly heart failure patients.
Abstract P367: Temporal Trends in Cardiogenic Shock and Disparities in Use of PCI Among Patients With Cardiogenic Shock by Race/Ethnicity and Gender, Florida 2001-2007
Authors: Pathak Elizabeth B , Srinivas Vankeepuran S , Pathak Amit P , Strom Joel A
Published: March 2022

Background:
In current ACC/AHA guidelines, early revascularization for cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is a class 1 recommendation in patients aged < 75 years. However, whether the current focus on prompt revascularization during AMI has modified the prevalence of CS is unknown. Therefore, we examined state-wide temporal trends in the prevalence of CS and the use of percutaneous coronary intervention (PCI) by patient age, gender, and race/ethnicity.

Methods:
Using comprehensive inpatient surveillance for Florida hospitals, we examined all AMI patients (ICD-9-CM 410) discharged between 2001-2007. Data on age, gender, race/ethnicity, AMI type (ST-elevation (STEMI), non-ST-elevation (NSTEMI), and site unspecified), cardiogenic shock (ICD-9-CM 785.50, 785.51) and use of PCI were abstracted for each patient. Temporal trends in the prevalence of CS complicating AMI were examined. Logistic regression analysis was used to examine sociodemographic predictors of the use of PCI among patients with CS.

Results:
There were 316,285 hospitalizations for AMI in Florida from 2001-2007. Overall 4.1% were complicated by CS. Shock was present in 2.1% of NSTEMI patients, 7.5% of STEMI patients, and 6.0% of unspecified AMI patients. Over time, the prevalence of CS increased from 2001 to 2007 for all AMI patients (3.8% to 4.3%), with the greatest increase among STEMI patients (6.6% to 8.3%). The use of PCI for all AMI patients with CS increased from 28.8% in 2001 to 44.1% in 2007. STEMI patients < 75 years with CS were most likely to receive PCI (49.9% in 2001 increasing to 65.1% in 2007). Logistic regression adjusted for patient age, AMI type, and year revealed that the likelihood of receiving PCI among CS patients was significantly lower for black women (OR 0.68, 95%CI 0.54-0.87, p=0.002) and Hispanic women (OR 0.76, 95% CI 0.64-0.91, p=0.003) compared with white men. Younger CS patients were more likely to receive PCI.

Conclusions:
The prevalence of cardiogenic shock complicating AMI did not decline in Florida from 2001-2007. However use of PCI among shock patients increased, with the highest use among STEMI patients. Black and Hispanic women with CS were significantly less likely to receive PCI than other race-gender groups.
Abstract P40: Improvement in the Stroke Composite Measure Over Time: Results From the Massachusetts Stroke Collaborative Reaching for Excellence
Authors: Oddo Vanessa , D'Amore Katrina , Coe Laura , Schwamm Lee H ,   SCORE Team, Mullen Jewel
Published: March 2022

Introduction
Funded as a Coverdell Registry state, SCORE is a Massachusetts Department of Public Health/American Stroke Association quality improvement collaborative. Since 2005, SCORE has assisted Primary Stroke Service hospitals in monitoring and improving the quality of acute stroke care. Currently 56 of 69 eligible hospitals participate. SCORE has adopted the following evidence- and guidelines-based performance measures: IV rt-PA Arrive by 2 Hour, Treat by 3 Hour, Early Antithrombotics, DVT Prophylaxis, Discharged on Antithrombotics, Patients with A-Fib receiving Anticoagulation Therapy, LDL 100 or ND, Smoking Cessation Counseling, Dysphagia Screening, Stroke Education, Assessed for Rehabilitation.

Objective
To determine if the composite score for participating hospitals has significantly improved over time.

Methods
Cases entered into the registry from the 56 participating hospitals from July 2005 to September 2008 were analyzed to produce quarterly aggregate estimates for the stroke composite measure for each hospital. The composite measure is comprised of the sum of all possible care opportunities in all eligible patients divided by all care opportunities fulfilled. Joinpoint Regression Program (Version 3.3.1, Silver Spring, MD) was used to test for individual trend and calculated the number and temporal location of points where trends change direction. The percent change refers to the increase or decrease of adherence by quarter and statistical significance was set at p<0.05.

Results
Of the 56 SCORE hospitals included in the analysis, 42 (75%) showed a statistically significant improvement in their composite score since their involvement in SCORE. 11 (20%) hospitals showed upward trend, however not-significant, while 3 (5%) showed a decline in their composite score, which were not statistically significant.

Conclusions
Significant resources are required to not only implement the technical assistance provided to SCORE hospitals, but for the hospitals themselves to affect change. These findings suggest that in spite of those burdens, care for stroke patients treated in hospitals across Massachusetts has improved. Further research into hospital characteristics associated with improvement is ongoing.