bluuebunny/crossref_metadata_2025 huggingface dataset:
Splenic Rhythms and Postprandial Dynamics in Physiology, Portal Hypertension, and Functional Hyposplenism: A Review
Authors: Weinzirl Johannes , Garnitschnig Lydia , Scheffers Tom , Andrae Lukas , Heusser Peter
Published: May 2020

Background: Before the discovery of immunological and haematological functions of the spleen, it had for centuries been considered to be a digestive organ of variable size with a role in the portal vein system and nutritional metabolism. In the 19th and 20th centuries, volume changes in the spleen related to nutrition were studied using plethysmographic measurements. Rhythmical and regulatory functions of the spleen were demonstrated in the haemodynamics of the splanchnic region and were described as a “hepatolienal pendulum,” a “Windkessel function,” or a “pressure compensation.” These studies were mainly published in German-speaking countries and have not, as far as is known, been discussed in the English-speaking world so far. Summary: This review explores the historical development of the rhythmical regulatory function of the spleen in the splanchnic region. Older studies and results are followed up in the modern literature, wherever possible, up to the present. The clinical relevance is illustrated with portal hypertension (with congestive or hyperdynamic splenomegaly), coeliac disease, and chronic inflammatory bowel diseases (with functional hyposplenism). Key Message: The spleen’s rhythmical regulatory function in nutrition is based on an autonomous rhythm comprising cycles of contractions and dilations of the spleen of around 1 min. These cycles can be influenced by sympathetically mediated single contractions with a release of pooled blood or by portal vein congestion. After food ingestion, the spleen responds either with contraction according to a vasomotor reaction or postprandial congestion with significant increases in volume. The spleen’s rhythmical function is lost in the clinical picture of portal hypertension or in coeliac disease and chronic inflammatory bowel diseases. In the aforementioned gastrointestinal diseases, we recommend taking more account of the haemodynamics between the spleen, liver, and intestine. New innovative techniques for recording splenograms are required which, besides elastographic measurements of spleen stiffness, could offer an important tool for early detection, diagnosis, and therapeutic evaluation.
What Does Resilience Signify? An Evaluation of Concepts and Directions for Future Research
Authors: Infurna Frank J.
Published: May 2020

Throughout the life course, individuals are confronted with adversities that challenge their ability to live the life they imagined. Adversities that are the most prominently studied and shown to bring about the most serious consequences for adjustment across the adult lifespan include job loss, disease and disability onset, and spousal and child bereavement. However, not all individuals show sustained declines to adversity; some are able to bounce back. The resilience literature is built on the premise that individuals are able to bounce back, or adapt to adversity. The past 15–20 years have seen an abundance of resilience research examining resilience to diverse types of adversity across the adult life­span. The overarching goal of this paper is to evaluate psychological concepts of resilience in adulthood and old age and recommend avenues for future research. To do so, I first evaluate and discuss definitions of resilience and their overlap across literatures with an emphasis on sociological approaches to studying adversity across the adult lifespan. Second, I discuss promising conceptual and methodological approaches to advance the resilience literature in adulthood and old age. Conceptual approaches to furthering the resilience literature include incorporating an anticipation component into the definition of resilience. Methodological approaches to furthering the resilience literature include prospective longitudinal designs that incorporate quantitative and qualitative approaches, multidimensional assessments, and the need to examine repeated adversities or multiple adversities that transpire in relatively close proximity to one another.
Targeting Arousal and Sleep through Noninvasive Brain Stimulation to Improve Mental Health
Authors: Geiser Tim , Hertenstein Elisabeth , Fehér Kristoffer , Maier Jonathan G. , Schneider Carlotta L. , Züst Marc A. , Wunderlin Marina , Mikutta Christian , Klöppel Stefan , Nissen Christoph
Published: May 2020

Arousal and sleep represent fundamental physiological domains, and alterations in the form of insomnia (difficulty falling or staying asleep) or hypersomnia (increased propensity for falling asleep or increased sleep duration) are prevalent clinical problems. Current first-line treatments include psychotherapy and pharmacotherapy. Despite significant success, a number of patients do not benefit sufficiently. Progress is limited by an incomplete understanding of the ­neurobiology of insomnia and hypersomnia. This work summarizes current concepts of the regulation of arousal and sleep and its modulation through noninvasive brain stimulation (NIBS), including transcranial magnetic, current, and auditory stimulation. Particularly, we suggest: (1) characterization of patients with sleep problems – across diagnostic entities of mental disorders – based on specific alterations of sleep, including alterations of sleep slow waves, sleep spindles, cross-frequency coupling of brain oscillations, local sleep-wake regulation, and REM sleep and (2) targeting these with specific NIBS techniques. While evidence is accumulating that the modulation of specific alterations of sleep through NIBS is feasible, it remains to be tested whether this translates to clinically relevant effects and new treatment developments.
ImageVI’s: the software that collects the vegetation indices you need: user manual
Authors:   Centro Estadual de Educação Tecnológica Paula Souza, Virgílio Adriano Aparecido , Tech Adriano Rogerio Bruno ,   Universidade de São Paulo, Faculdade de Zootecnia e Engenharia de Alimentos, Pereira Lilian Elgalise Techio ,   Universidade de São Paulo, Faculdade de Zootecnia e Engenharia de Alimentos
Published: May 2020

This manual contains the software’s basic information, but it also provides tips and important information about the standardization of image acquisition procedures, pointing out common mistakes to avoid in this step. We hope that the software can be used as practical tool, easily accessible and widely used for extracting VI's in vegetation studies, providing fast results for your research or studies.
In Vitro Lineage-Specific Differentiation of Vascular Smooth Muscle Cells in Response to SMAD3 Deficiency
Authors: Gong Jian , Zhou Dong , Jiang Longtan , Qiu Ping , Milewicz Dianna M. , Chen Y. Eugene , Yang Bo
Published: May 2020

Objective:

SMAD3 pathogenic variants are associated with the development of thoracic aortic aneurysms. We sought to determine the role of SMAD3 in lineage-specific vascular smooth muscle cells (VSMCs) differentiation and function.

Approach and Results:

SMAD3
c.652delA, a frameshift mutation and nonsense-mediated decay, was introduced in human-induced pluripotent stem cells using CRISPR-Cas9. The wild-type and
SMAD3
−/−
(c.652delA) human-induced pluripotent stem cells were differentiated into cardiovascular progenitor cells or neural crest stem cells and then to lineage-specific VSMCs. Differentiation, contractility, extracellular matrix synthesis, and TGF-β (transforming growth factor-β) signaling of the differentiated VSMCs were analyzed. The homozygous frameshift mutation resulted in SMAD3 deficiency and was confirmed in human-induced pluripotent stem cells by Sanger sequencing and immunoblot analysis. In cardiovascular progenitor cell-VSMCs, SMAD3 deletion significantly disrupted canonical TGF-β signaling and decreased gene expression of VSMC markers, including SM α-actin, myosin heavy chain 11, calponin-1, SM22α, and key controlling factors, SRF and myocardin, but increased collagen expression. The loss of SMAD3 significantly decreased VSMC contractility. In neural crest stem cells-VSMCs, SMAD3 deficiency did not significantly affect the VSMC differentiation but decreased ELN (elastin) expression and increased phosphorylated SMAD2. Expression of mir-29 was increased in
SMAD3
−/−
VSMCs, and inhibition of mir-29 partially rescued ELN expression.

Conclusions:

SMAD3-dependent TGF-β signaling was essential for the differentiation of cardiovascular progenitor cell-VSMCs but not for the differentiation of neural crest stem cell-VSMCs. The lineage-specific TGF-β responses in human VSMCs may potentially contribute to the development of aortic root aneurysms in patients with
SMAD3
mutations.
Effects of a Hypercaloric and Hypocaloric Diet on Insulin-Induced Microvascular Recruitment, Glucose Uptake, and Lipolysis in Healthy Lean Men
Authors: Emanuel Anna L. , Meijer Rick I. , Woerdeman Jorn , van Raalte Daniel H. , Diamant Michaela , Kramer Mark H.H. , Serlie Mireille J. , Eringa Etto C. , Serné Erik H.
Published: May 2020

Objective:

In mice fed a high-fat diet, impairment of insulin signaling in endothelium is an early phenomenon that precedes decreased insulin sensitivity of skeletal muscle, adipose tissue, and liver. We assessed in humans whether short-term overfeeding affects insulin-induced microvascular recruitment in skeletal muscle and adipose tissue before changes occur in glucose uptake and lipolysis.

Approach and Results:

Fifteen healthy males underwent a hypercaloric and subsequent hypocaloric diet intervention. Before, during, and after the hypercaloric diet, and upon return to baseline weight, all participants underwent (1) a hyperinsulinemic-euglycemic clamp to determine insulin-induced glucose uptake and suppression of lipolysis (2) contrast-enhanced ultrasonography to measure insulin-induced microvascular recruitment in skeletal muscle and adipose tissue. In addition, we assessed insulin-induced vasodilation of isolated skeletal muscle resistance arteries by pressure myography after the hypercaloric diet in study participants and controls (n=5). The hypercaloric diet increased body weight (3.5 kg;
P
<0.001) and fat percentage (3.5%;
P
<0.001) but did not affect glucose uptake nor lipolysis. The hypercaloric diet increased adipose tissue microvascular recruitment (
P
=0.041) and decreased the ratio between skeletal muscle and adipose tissue microvascular blood volume during hyperinsulinemia (
P
=0.019). Insulin-induced vasodilation of isolated skeletal muscle arterioles was significantly lower in participants compared with controls (
P
<0.001). The hypocaloric diet reversed all of these changes, except the increase in adipose tissue microvascular recruitment.

Conclusions:

In lean men, short-term overfeeding reduces insulin-induced vasodilation of skeletal muscle resistance arteries and shifts the distribution of tissue perfusion during hyperinsulinemia from skeletal muscle to adipose tissue without affecting glucose uptake and lipolysis.

Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02628301.
Abstract 201: Sex Differences in Management and Outcomes in Young Adults With Myocardial Infarction
Authors: Patil Nikita , Max Ryan , Qamar Arman , Vavalle John P , Arora Sameer
Published: May 2020

Objectives:
Sex differences are known to exist in the management ofolder patients presenting with myocardial infarction (MI). Whether inpatient MI management, outcomes and readmissions differ by sex in young adults is not known.

Methods:
Nationwide Readmissions Database (NRD) was queried for hospitalizations with MI in adults between 18 and 50 years of age from October 2015 and November 2016 using ICD-10 CM codes. Hospitalizations with discharges in December were excluded as 30-day follow-up for these could not be completed in NRD. Logistic regression analysis was used to estimate the association between gender and percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), coronary angiography, non-invasive testing, death and 30-day readmissions. ST-elevation MI (STEMI) subset was similarly analyzed.

Results:
Of 33,981 hospitalizations, 29% were females. Mean age was 43 years. STEMI constituted 13,177 hospitalizations with 22% females. As compared with men, women were more likely to have peripheral vascular disease (6% vs 4%), chronic pulmonary disease (17% vs 10%), diabetes mellitus (36% vs 28%); and less likely to have a prior history of MI (10% vs 12%). Women were less likely to undergo noninvasive testing (10% vs 11 %, p=0.002) and were revascularized less often than men with PCI (45% vs 56%, p<0.0001) and CABG (6% vs 7%, p<0.0001). Women underwent PCI less often in STEMI as well (72% vs. 76%, p<0.0001). Inpatient mortality and 30-day readmissions were higher in women overall (1.9% vs 1.6%, p=0.04) and (14% vs 9%, p<0.0001); as well as in STEMI: (4% vs 3%, p<0.0001) and (12% vs 8%, p<0.0001). In adjusted analysis (Figure 1: A, B), women were less likely to undergo non-invasive testing or revascularization in the overall cohort; and were less likely to undergo PCI in the STEMI cohort. Additionally, women had higher odds of 30-day readmissions overall, while the odds of inpatient mortality were higher only in STEMI subset.

Conclusion:
In a large MI cohort, young women were less likely to undergo ischemic workup and be revascularized, and had higher odds of 30-day readmissions. Women had higher odds of mortality in STEMI
Abstract 202: A Pilot Study to Evaluate the Impact of Decision Aid Timing on Mandatory Shared Decision Making for Defibrillator Implantation
Authors: Rao Birju , Dickert Neal W , Howard David , Matlock Dan D , Darghosian Leon , Merchant Faisal
Published: May 2020

Background:
In 2018, CMS required shared decision-making (SDM) with a decision (DA) prior to implantation of a primary prevention cardioverter defibrillator (ICD). Little is known about how DAs should be incorporated, but the implementation strategy may affect the process. Providing DAs prior to the SDM visit may facilitate informed discussion. However, this requires identifying ICD candidates ahead of time which may be logistically challenging. Providing the DA during the office visit requires less administrative effort but may reduce the impact of the DA.

Objective:
To evaluate the impact of DA timing on SDM outcomes.

Methods:
Patients referred for ICD implantation were block randomized across 3 clinics to receive the DA 30 minutes prior to, or at the end of the SDM visit. Patients were surveyed on implant day in several SDM domains including knowledge about ICDs, decisional conflict, values-choice concordance and the extent to which patients felt engaged in the decision-making process. Patients who chose not to have an ICD implanted after the SDM visit were surveyed by mail. Implanting physicians were also surveyed to assess perceptions about the impact of the DA.

Results:
Of 42 randomized patients, 24 completed the survey with 9 who received the DA before and 15 after the SDM visit. Three chose not to have an ICD implanted: 1 received the DA before and 2 after the visit. Though overall knowledge about ICDs was similar between groups (Table), every patient who received the DA before the encounter understood the primary purpose of the ICD, compared with 10/15 who received the DA after the visit. Receiving the DA earlier showed a numerically higher rate of understanding the risk of inappropriate ICD shocks. No significant differences were observed in decisional conflict, values-choice concordance, or reported patient engagement in decision-making.

Conclusion:
Patients who received a DA prior to the visit had numerically, but not significantly, higher rates of understanding the purpose of the ICD and risk of inappropriate shocks. These pilot data suggest that efforts to provide DAs ahead of time may strengthen SDM interaction and that an implementation strategy is critical to study. Important knowledge gaps remain in both groups, suggesting opportunities to improve SDM for ICDs.
Abstract 209: Prevalence and Prognostic Significance of Aortic Stenosis in Patients With Acute Decompensated Heart Failure: The Atherosclerosis Risk in Communities Study
Authors: Sivaraj Krishan , Arora Sameer , Slehria Trisha , Chang Patricia , Weickert Thelsa , Qamar Arman , Vaduganathan Muthiah , Cavender Matthew A , Rosamond Wayne D , Vavalle John P
Published: May 2020

Background:
Heart failure (HF) patients with aortic stenosis (AS) constitute a high-risk population posing diagnostic and therapeutic challenges. Few studies have characterized the burden of AS in patients admitted with acute decompensated HF (ADHF), stratified by ejection fraction (EF).

Methods:
The Atherosclerosis Risk in Communities study conducted community-based surveillance of a random sample of ADHF hospitalizations for residents ≥55 years of age in four US communities. ADHF cases were subclassified as having reduced (HFrEF) or preserved (HFpEF) EF using a 50% cutoff. AS severity was determined from echocardiogram reports obtained during abstracted hospitalizations. Odds of moderate or severe AS in patients with varying sex and race, and odds of all-cause 1-year mortality in those with higher AS severity were estimated using multivariable logistic regression.

Results:
From 2005-2014, there were 14,289 weighted ADHF hospitalizations of whom 7,357 had HFrEF (45.0% female, 36.6% black) and 6,932 HFpEF (62.9% female, 26.5% black). The prevalence of moderate or severe AS was 5.67% in HFrEF and 9.43% in HFpEF. Patients with higher AS severity were older than those with none or mild AS in both HFrEF ([mean age] 79.7 vs. 74.4 years, p<0.0001) and HFpEF (81.7 vs. 76.3 years, p<0.0001). No difference in odds of higher AS severity was detected between females and males in both HFrEF (5.49% vs. 5.81%, OR: 1.03, 95% CI: 0.83-1.27) and HFpEF (9.10% vs. 9.99%, OR: 0.89, 95% CI: 0.75-1.06). Moderate or severe AS was more likely in whites than blacks in both HFrEF (8.32% vs. 1.67%, OR: 0.23, 95% CI: 0.17-0.32) and HFpEF (11.1% vs. 6.38%, OR: 0.70, 95% CI: 0.56-0.88). Higher AS severity was independently associated with increased all-cause 1-year mortality after ADHF hospitalization in both HFrEF (44.3% vs. 30.5%, OR: 1.25, 95% CI: 1.16-1.35) and HFpEF (33.4% vs. 26.1%, OR: 1.16, 95% CI: 1.08-1.24).

Conclusion:
In ADHF patients with HFrEF or HFpEF, whites are more affected by AS than blacks, as are older patients when compared to their younger counterparts. Higher AS severity in ADHF patients is independently associated with all-cause mortality at 1 year after hospitalization, regardless of EF.
Abstract 216: Statistical Code Availability From Studies of Medicare Data in General Medical Journals
Authors: DeBlanc Jennie , Nallamothu Brahmajee K , Lehrich Jessica , Trumpower Brad , Kamdar Neil , Valley Thomas , Ayanian John , Kay Bradley
Published: May 2020

Background:
Open science improves methodological rigor, limits duplication, and helps researchers build upon existing findings. Yet despite the importance of open science in cardiovascular outcomes research, it may be limited by difficulties in accessing statistical code after publication. We evaluated the ease of obtaining statistical code from published research in high-profile journals.

Methods:
We identified all studies published in 6 general medical journals that utilized Medicare Parts A and B data in 2017 and 2018:
Annals of Internal Medicine, BMJ, JAMA, JAMA Internal Medicine, Lancet,
and
New England Journal of Medicine
. We focused on studies utilizing national Medicare data given their widespread use in outcomes research. We targeted recent studies to minimize barriers to accessing code as research teams change over time. Using these criteria, we identified 51 research articles with 41 unique corresponding authors. We contacted these authors to request statistical code for their publications via email up to 3 times at 2-week intervals. When code was provided to us, we assessed its integrity and completeness.

Results:
Of 51 studies we identified, 3 had full or partial code already publicly available. Of the remaining 48 studies, 7 codes (corresponding to 6 authors) were sent to us, leading to a total of 10 out of 51 articles with full or partial code availability (Figure 1). Overall, we received responses from 19 of the 41 authors. Thirteen corresponding authors declined to share code for numerous reasons. Reasons given for not sharing code included researchers leaving prior positions, analysts leaving research teams, and likelihood of significant delays due to seeking permission from research sponsors. We received no responses from 22 of 41 corresponding authors (Figure 1).

Conclusion:
We found significant barriers to accessing statistical code after publication in research articles utilizing Medicare data in general medical journals, and we were unable to access statistical codes in over 80% of cases. The inability to obtain codes associated with scientific analyses may represent an important challenge for reproducibility in cardiovascular outcomes research.
Abstract 217: Are Discharge Rate Control Medications Adequate for Future Atrial Fibrillation Needs?
Authors: White Katherine E , Carter William H , Tiwari Shabnam , Davis Elaine , Kemper Suzanne , Adhikari Shubash
Published: May 2020

Background:
Rate control medications (RCM) for atrial fibrillation (AF) usually prescribed are diltiazem (DTZ) and beta blockers. Patients entering the Emergency Department (ED) with AF often convert to a normal sinus rhythm (NSR) by means of spontaneous conversion to normal sinus rhythm (SCNSR), electrical cardioversion, or medications. However, recurrent AF often leads to repeat ED visits and frequent hospitalizations within one year.

Goals:
To evaluate admission and discharge metoprolol (MTP) and DTZ doses for patients presenting to the ED with rapid AF.

Methods:
Retrospective, single center chart review of MTP and DTZ doses on admission and discharge for patients admitted with a primary diagnosis of AF. Patients who received new or an increase of other RCMs, or antiarrhythmic medications with RCM properties were excluded.

Results:
Of 402 patients, 310 (77%) had a heart rate ≥110 bpm on admission. Of those with a rapid rate, 235 (76%) converted to NSR after admission predominantly due to SCNSR. The mean daily dose of MTP was 61mg on admission and 65mg at discharge. The mean DTZ dose on admission was 188mg and 157mg at discharge.

Discussion:
The discharge doses of 65mg of MTP and 157mg of DTZ were well below the recommended doses of RCMs for AF. The RATAF trial demonstrated adequate rate and symptom control with MTP 100mg/day and DTZ up to 360mg/day. The current study demonstrated significant under dosing of RCMs to manage future rapid ventricular rate. It is possible patients with rapid ventricular rates who convert to NSR, which by itself, results in rate control, would not have attention by the provider focused on the rapid admission rate. Most patients who convert to NSR do not have the substrate leading to AF corrected. Thus, it is not surprising recurrence of AF, regardless of the method of cardioversion, occurs in approximately 70% of patients within one year. It is likely when AF recurs it will have the same rapid rate unless RCMs are increased before discharge from the first initial admission dose. It is possible at discharge an order set may lead to a more logical assessment of targeted RCMs. Lack of long term follow-up to address outcome of apparent under dosing of RCM is a limitation.

Conclusion:
This single center study found no significant increases in MTP and DTZ dosing at the time of discharge for patients with rapid AF who reverted to NSR after admission. It is possible that modification of RCMs before hospital discharge may decrease future ED admission for symptomatic AF.
Abstract 229: Family Caregiver Stress and Patient Symptom Severity in Heart Failure
Authors: Bidwell Julie T , Higgins Melinda K , Abshire Martha A , Dunbar Sandra B
Published: May 2020

Background:
In chronic illness caregiving, greater family caregiver exposure to patient symptoms is predictive of greater caregiver psychological and physiological stress. Although heart failure (HF) carries high symptom burden, this phenomena is not well-studied in HF caregivers.

Objective:
To test the hypothesis that caregiver perception of patient HF symptoms is associated with elevated caregiver psychological and physiological stress.

Methods:
This was a secondary analysis of baseline data from 125 HF caregivers in the Caregiver Opportunities for Optimizing Lifestyle (COOL) study. Psychological stress was measured by caregiver report of care-related strain (Oberst Caregiving Burden Scale), depression (Center for Epidemiological Studies Depression), anxiety (State-Trait Anxiety Index), and general stress (Perceived Stress Scale). Physiological stress was quantified by markers of HPA axis dysfunction (elevated cortisol awakening response [CAR]), endothelial dysfunction (increased PAI-1), and inflammation (increased IL-6, hsCRP). HF symptoms were quantified by caregiver assessment of New York Heart Association (NYHA) Class, dichotomized as asymptomatic [Class I] versus symptomatic [Class II-IV]. Generalized linear models were used to test relationships between symptoms and stress (one model per indicator). IL-6, hsCRP, and PAI-1 were natural log transformed, and CAR was dichotomized based on a cutoff for elevated stress response (>75% increase). All models controlled for sociodemographic confounders (age, gender, race, education, caregiving relationship), with biomarker-specific confounders (comorbidity, adiposity, medications) added to physiological stress models.

Results:
Caregivers were mostly female (n=115, 92.0%), in their mid-fifties (55.4±11.5), African American (n=72, 57.6%), and the patient’s spouse (n=68, 54.4%) or adult child (n=30, 24.0%). One quarter perceived the patient to be asymptomatic (Class I: n=31, 24.8%; II: n=31, 24.8%; III: n=47, 37.6%; IV: n=15, 12.0%). Symptomatic HF was significantly associated with greater caregiver depression, anxiety, and general stress (β=4.0±1.9, p=0.04; β=3.9±1.4, p<0.01; and β=7.7±2.9, p<0.01, respectively), but not greater care-related strain (β=4.7±3.0, p=0.12). Symptomatic HF was also significantly associated with markers of HPA-axis dysfunction (elevated CAR: OR=3.1, 95% CI=1.0-9.7, p=0.05), endothelial dysfunction (PAI-1: β=0.39±0.16, p=0.01), and increased inflammation as measured by hsCRP (β=0.47±0.22, p=0.04), but not IL-6 (β=0.18±0.15, p=0.21).

Conclusions:
Overall, patient HF symptoms were associated with greater caregiver psychological and physiological stress. To inform timing and mechanisms for much-needed caregiver interventions, research is needed to determine which aspects of HF symptomatology are most stressful for caregivers across the HF trajectory.
Abstract 235: A Joint Cardiometabolic Program: An Innovative Approach to Providing Care for High-Risk Patients With Cardiovascular Disease
Authors: Joshi Amogh , Corotto Paul , Vengrove Marc , Kluck Margaret , Secheresiu Paul , Khan Jahangir , Perilli Gretchen
Published: May 2020

Introduction:
There are over 400 million adults with diabetes mellitus (DM) worldwide. Diabetes is associated with multiple vascular complications; atherosclerotic cardiovascular disease (ASCVD) and coronary heart disease (CHD) are major mediators of morbidity and mortality in diabetic patients. In fact, the association between these disease states is so strong that DM is considered a CHD equivalent. New consensus guidelines in both the cardiology and endocrinology literature now support the use of DM medications that enhance cardiovascular health and significantly reduce major adverse cardiovascular events (MACE).

Hypothesis:
Collaboration among disciplines, particularly endocrinology, cardiology, social work, diabetes education and pharmacy will improve care of patients with co-morbid diabetes and cardiovascular disease. This will be demonstrated by improved adherence to guideline recommended risk modifying treatments.

Methods & Conclusions:
A collaborative cardiometabolic clinic has been established at a large tertiary care center. The focus of this venture is on the optimization of guideline directed medical therapies through joint office visits with both cardiology and endocrinology. Patients admitted with Type II DM, MI (STEMI or NSTEMI), or CHD requiring CABG, are identified by inpatient providers and referred to our clinic. Prior to the appointment, the patient’s insurance formulary is screened, so that appropriate medications are prescribed at the time of the visit. Patients are then returned to their primary outpatient providers with recommendations for long term management. Observational data from this clinic will be compared to retrospective outcomes analysis of a similar demographic of patients prior to the establishment of this collaborative clinic. As our therapeutic landscape broadens comprehensive cardiometabolic care will continue to be of paramount importance for patients with co-morbid cardiovascular disease and diabetes.
Abstract 237: Prevalence of Cardiovascular Risk Factors and Cardiovascular Disease in Transgender Persons in The United States
Authors: Malhotra Aditi , Skopicki Hal A , Kort Smadar , Mann Noelle , Parikh Puja
Published: May 2020

Background:
There is a paucity of data regarding prevalence of cardiovascular disease (CVD) and corresponding cardiovascular (CV) risk factors in transgender individuals. We sought to assess the prevalence of CV risk factors and CVD in transgender persons in the United States.

Methods:
The 2018 Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 1,038 transgender individuals in the United States. Presence of CVD was noted with a single affirmative response to the following questions: “Has a health care professional ever told you that you had any of the following:” (1) a heart attack or myocardial infarction, (2) angina or coronary heart disease, (3) a stroke?

Results:
Among the 1,038 transgender individuals studied, a total of 145 (14.0%) had CVD while 893 (86.0%) did not. No differences in prevalence of CVD was noted in transgender individuals who transitioned from male-to-female (n=387), female-to-male (n=400), and gender nonconforming status (n=251) (15.0% vs 13.8% vs 12.7%, p=0.72). Transgender individuals with CVD were older, had lower annual income, higher rates of smoking (28.4% vs 18.1%, p=0.004), and higher rates of multiple co-morbidities including asthma (26.6% vs 17.4%, p = 0.009), skin cancer (21.8% vs 5.0%, p <0.001), non-skin cancers (16.8% vs 6.8%, p <0.001), chronic obstructive pulmonary disease (27.5% vs 7.0%, p <0.001), arthritis (65.3% vs 28.7%, p<0.001), depressive disorder (42.7% vs 31.0%, p= 0.006), chronic kidney disease (16.2% vs 3.3%, p< 0.001), and diabetes mellitus (42.0% vs 12.7%, p <0.001). No significant differences in race, health insurance status, or body mass index was noted between transgender individuals with CVD versus those without. In multivariable analysis, independent predictors of CVD in transgender individuals included older age, diabetes mellitus [odds ratio (OR) 2.82, 95% confidence interval (CI) 1.73 - 4.58], chronic kidney disease (OR 3.69, 95% CI 1.80 - 7.57), chronic obstructive pulmonary disease (OR 2.18, 95% CI 1.19 - 3.99), and depressive disorder (OR 1.82, 95% CI 1.09 - 3.03).

Conclusions:
In this observational contemporary study, CVD was prevalent in 14% of transgender individuals in the United States. Predictors of CVD in the transgender population exist and transgender persons should be appropriately screened for CV risk factors so as to minimize their risk of CVD.
Abstract 240: Assessing the Lack of Appropriate Anticoagulation in Patients With Atrial Fibrillation - Implications for Cardiology Registry-Based Care
Authors: Daly Danielle , Searl Como Jennifer , Wasfy Jason H
Published: May 2020

Intro:
Anticoagulation is indicated for many patients with atrial fibrillation (AF) for prevention of cardioembolic stroke, although national proportions of eligible patients receiving anticoagulation remain suboptimal. Automated and semi-automated quality improvement techniques including registries and population health coordinators may help identify and increase eligible patients to receive anticoagulation.

Methods:
We queried our electronic health record to identify patients without anticoagulation but with atrial fibrillation (as identified as either paroxysmal atrial fibrillation, persistent atrial fibrillation, chronic atrial fibrillation, typical atrial flutter, atypical atrial flutter, or unspecified atrial flutter) either on the problem list or as billed administrative claims between September 2016 - September 2019 in MGH outpatient cardiology clinics. All patients were participating in MGH cardiology, with their primary care based either within MGH or outside of MGH. Then, we conducted detailed chart review to calculate thromboembolic risk with respective CHADS-VASC score and confirmed that the patient was not receiving anticoagulation. A typology was developed as charts were reviewed to categorize reasons for lacking anticoagulation. These categories were grouped into broader categories representing a (1) potential quality problem or (2) appropriate lack of anticoagulation.

Results:
Of 100 patients, 59 were deemed to have a potential quality problem and 41 were deemed to have appropriate lack of anticoagulation. Of the patients with a potential quality problem, 11 have a CHADS VASC score of 1, 18 have a CHADS VASC score of 2, 6 have a CHADS VASC score of 3, 10 have a CHADS VASC score of 4, and 8 have a CHADS of 5, and 6 have a CHADS VASC of 6 or above. Additionally, 3 patients have been lost to follow up, 12 patients had presented with current symptoms of AF within the last year, and 44 patients exhibited acute history of AF symptoms. 41 patients did not present concern for multiple reasons including: CHADS VASC=0, deceased, patients declined medication, followed by outside cardiologist, technology and medication discrepancies, inaccurate administrative data for AF, and prior major bleeding.

Conclusions:
We found that most un-anticoagulated AF patients identified by administrative claims and EHR problem lists are likely eligible for anticoagulation. Of those, most have a history of paroxysmal AF. As such, registry-based strategies based on queries of past AF may improve rates of anticoagulation in this population. Since automated queries still detect many patients with contraindications such as bleeding or inaccurate administrative data, manual review of administrative queries is likely to be important in quality efforts for AF.
Abstract 241: Health-related Quality of Life in Patients With Recurrent Pericarditis: Results From a Phase 2 Study of Rilonacept
Authors: Lin David , Klein Allan L , Cella David , Beutler Anna , Fang Fang , Magestro Matt , Cremer Paul , Lewinter Martin M , Luis Sushil , Abbate Antonio , Ertel Andrew , Litcher-Kelly Leighann , Klooster Brittany , Paolini John
Published: May 2020

Background:
Recurrent pericarditis (RP) episodes and conventional treatments result in morbidity, but the impact on patient health-related quality of life (HRQoL) has not been quantified. The Phase 2 trial NCT03980522 of rilonacept (IL-1α/IL-1β inhibitor) evaluated HRQoL.

Methods:
Patients with active RP who were symptomatic at Baseline (A-RP, n=16) and RP patients who were not currently experiencing a recurrence but were corticosteroid-dependent at Baseline (CSD-RP, n=9) were enrolled. All received rilonacept weekly for 6 weeks to end of base treatment period (TP) plus an optional 18-week extension treatment period (EP). Corticosteroid tapering occurred in the EP. Physical and mental HRQoL (PROMIS Global Health v1.2 Physical and Mental Component Scores [PCS/MCS]) were assessed at baseline and follow-up.

Results:
Figure 1 presents the PROMIS PCS/MCS and pain scale scores (both patient-reported) as well as C-reactive protein levels over time. Mean PCS/MCS scores at baseline were 39.9/44.5 and 43.3/46.5 for A-RP and CSD-RP groups respectively (versus the norm mean of 50). In A-RP, PCS/MCS scores improved by 11.4/5.6 points by end of base TP, and this improvement was sustained throughout the EP (increase of 11.4/6.0 points from baseline at end of EP). In CSD-RP, PCS/MCS scores increased by 1.8/1.4 points by end of TP and improved by 3.5/4.2 points at end of study, after tapering or discontinuation of corticosteroid without disease recurrence.

Conclusion:
Impaired baseline HRQoL suggests negative impact of RP. For A-RP, rilonacept rapidly improved pericarditis signs and symptoms which was associated with HRQoL improvements. For CSD-RP, rilonacept supported tapering/withdrawal of corticosteroids without recurrence, with maintained/improved HRQoL. These results suggest rilonacept can improve RP patient HRQoL while providing an alternative to corticosteroids.
Abstract 246: Effect of Racial Factors on Timing of Readmissions After Myocardial Infarction
Authors: Nair Raunak , Johnson Michael , Kravitz Kathleen A , Anabila Moses , Rajeswaran Jeevanantham , Blackstone Eugene H , Menon Venu , Lincoff A Michael M , Kapadia Samir R , Khot Umesh
Published: May 2020

Background:
Readmissions following acute myocardial infarction (MI) are associated with increased cost, healthcare utilization, and morbidity. The purpose of this study was to assess racial factors in influencing time for readmission after being admitted with myocardial infarction.

Methods:
We reviewed 6,626 cases of MI at a single quaternary care medical center from January 1
st
, 2010 to January 1
st
, 2017 (29% STEMI, 71% NSTEMI), and we identified all readmissions within 90 days after index MI. The patients were categorized according to their race into White Americans (72%), African Americans (25%) and others (3%). Readmissions were stratified into early (0-30 days) and late (31-90 days) time periods depending on the timing of readmission and these readmissions were also separated according to their corresponding race into White Americans (62%), African Americans (35%) and others (3%). Since White Americans and African Americans contributed to the bulk of our patient population, we analyzed the difference between these two groups.

Results:
There were a total of 2051 readmissions within 90 days after index MI. Overall, 50% of readmissions were in the early time period and 50% in the late period (after 30 days). 46% of African Americans were readmitted in the early time period compared to 52% of white patients whereas 54% of African Americans were readmitted in the late time period compared to 48% of white patients (P=0.0037).

Conclusions:
The temporal pattern of readmissions after myocardial infarction differed between Whites and African Americans. These findings may have implications regarding the development of readmission reduction strategies.
Abstract 251: Geriatric Syndromes Associated With Reduced Anticoagulant Use in Older Adults With Atrial Fibrillation
Authors: Shah Sachin J , Fang Margaret C , Jeon Sun , Gregorich Steven , Covinsky Kenneth
Published: May 2020

Background:
While guidelines recommend focusing primarily on stroke risk when considering anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls, disability) are important when considering anticoagulants. However, little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use.

Methods:
We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older adults. We included patients ≥67 years with 2 years of continuous Medicare fee-for-service enrollment and 1 inpatient or 2 outpatient AF diagnosis claims. We evaluated five geriatric syndromes: falls, activities of daily living impairment (ADL), instrumental activities of daily living impairment (IADL), cognitive impairment, and incontinence. We measured their prevalence and associations with anticoagulant use via log-binomial regression models adjusting for CHA2DS2-VASc score.

Results:
In this study of 779 patients with AF (median age 80 years, median CHA2DS2-VASc score 4), 83% (CI 79-86%) had ≥1 geriatric syndrome. Adjusting for stroke risk, lower rates of anticoagulant use were reported in those with ADL dependency (RR 0.87, CI 0.79-99), IADL dependency (RR 0.86, CI 0.77-0.98), and dementia (RR 0.72, CI 0.60-0.86).

Conclusion:
Most older patients with AF have at least one geriatric syndrome, and geriatrics syndromes are associated with less anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulants use in older adults. Since the benefits and harms of anticoagulants in this group are ill-defined, it is unclear if lower anticoagulant use is appropriate.
Abstract 255: Electronic Health Record Alerts Decreased Non-Steroidal Anti-Inflammatory Drug Prescriptions in Patients With Congestive Heart Failure: A Quality Improvement Initiative
Authors: Vincent Louis T , Jacobs Mark , olarte neal , Pyarali Fahim , Salter Jonathan , Quevedo Patricia , Carrasquillo Mara , Labrada Mabel , Andreu Aileen , Marzouka George R
Published: May 2020

Background:
Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with increased morbidity and mortality in patients with congestive heart failure (CHF). Current guidelines recommend discontinuation of NSAIDs in all patients with CHF, but in clinical practice, many patients remain with active prescriptions. We sought to reduce prevalence of active NSAID prescriptions in a veteran patient population with CHF by implementing an electronic health record (EHR) alert advising against NSAID prescriptions.

Methods:
This single-center quality improvement project was initiated at the Miami Veterans Affairs Medical Center. In patients with any diagnosis of heart failure, when a provider attempted to initiate or renew an NSAID prescription, an EHR alert was activated warning of the potential harms. Providers were required to acknowledge the alert prior to electronic signature. NSAIDs activating the alert included celecoxib, ibuprofen, diclofenac, and naproxen. The primary outcome of interest was the number of patients with CHF and active NSAID prescriptions, assessed 6 months before and after alert implementation. Analysis of the combined long-term secondary outcomes of hospitalization for acute decompensated heart failure and all-cause mortality is ongoing. Relative risk reductions with statistical significance determined by p<0.05 were calculated for both primary and secondary outcomes.

Results:
A total of 144 patients were included in this study. In the 6 months preceding alert implementation, NSAIDs were discontinued in 30.9% (17/55) of patients. At 6 months follow-up after EHR alert initiation, NSAIDs were discontinued or left to expire in 65.2% (58/89) of patients in which the EHR alert was activated. The relative risk of patients with CHF being prescribed NSAIDs was significantly reduced by 49.6% (relative risk=0.504; 95% confidence interval [0.361-0.704], p=0.0001). After intervention, death was reported in 3.2% of patients persisting on NSAID therapy, compared to 1.7% of patients that had NSAIDs discontinued (p=0.65).

Conclusions:
Implementation of an EHR alert advising of the harm of NSAIDs in patients with CHF in a veteran population has resulted in a statistically significant decrease in the number of active NSAID prescriptions. Further study with larger patient populations and extended follow-up will help determine whether these findings are sustainable and lead to a clinically significant reduction in mortality and hospitalizations.
Abstract 256: Length of Stay, Type of Stroke and NIHSS Score in Persons With Self-reported Diabetes
Authors: Gaillard Trudy R , Ibrahimou Boubakari , Belnap Starlie , Starosciak Amy K , De Los Rios Felipe
Published: May 2020

In the U.S., diabetes is the 7th leading cause of death and 65% of these deaths are attributable to cardiovascular disease or stroke or to both. Among patients admitted for acute stroke, diabetes was associated with a higher risk of death, functional dependency and stroke recurrence. The purpose of this investigation was to examine the relationship between length of stay (LOS), type of stroke [ischemic stroke (IS), Transient Ischemic Attack (TIA), Subarachnoid Hemorrhage (SAH), Intracerebral Hemorrhage (ICH)] and the NIH Stroke Scale (NIHSS) in patients admitted to the hospital with an initial diagnosis of stroke or TIA and self-reported diabetes. There were N=5105 subjects (2448 males and 2657 females) in our center’s Get With The Guidelines-Stroke (GWTG-S) database from April 2014 to March 2019. Age, race, sex, insurance type, lipids and lipoproteins, initial serum glucose on admission, blood pressure, stroke type, and initial stroke severity (NIHSS) were the variables analyzed in a multiple regression analysis, with p <0.05 considered statistically significant. Mean LOS was 7.4 days (d) (range 0-119 d). LOS was negatively associated with age (as age (years) increased, the length of stay decreased by 0.05 d). We found that LOS to be positively associated with NIHSS score. Compared to those with mild NIHSS (0-5), those with severe NIHSS (>10) had LOS increased by 4.3 d, whereas moderate NIHSS (6-10) had LOS increased by 1.9 d. When compared with IS, we found that TIA was associated with a 2.6 d decrease in LOS whereas SAH and ICH were associated with a 6.7 and 3 d increase, respectively. Insurance type also was associated with LOS. Those on Medicaid had a 2.7 d increase in LOS compared to those who had Medicare. No statistically significant difference was found between Medicare and private insurance. There was no difference between ethnicities and LOS among our subjects. As expected, higher initial serum glucose level was positively associated with increased LOS. Specifically, for every 1 unit increase in initial serum glucose level was an associated 0.01 d increase in LOS. Thus, in the current study, we demonstrated that diabetes and initial serum glucose level continue to be important criteria in estimating the LOS in person admitted with a stroke. We recommend that these variables be considered for discharge planning and length of stay benchmarks in persons with history of diabetes.