bluuebunny/crossref_metadata_2025 huggingface dataset:
Exogenous Fibroblast Growth Factors Maintain Viability, Promote Proliferation, and Suppress GADD45α and GAS6 Transcript Content of Prostate Cancer Cells Genetically Modified to Lack Endogenous FGF-2
Authors: Shain Sydney A.
Published: May 2022

Understanding processes regulating prostate cancer cell survival is critical to management of advanced disease. We used prostate cancer cell transfectants genetically modified to be deficient in either endogenous fibroblast growth factor (FGF-1) or endogenous FGF-2 to examine FGF maintenance of transfectant survival and proliferation and FGF-2-regulated expression of transfectant growth arrest DNA damage (GADD) and growth arrest sequences (GAS) family genes (known modulators of cell cycle progression and survival) and the AS3 gene (an androgen-modulated effector of prostate cell proliferation). When propagated in the absence of exogenous FGFs, FGF-2-deficient transfectants undergo exponential death, whereas FGF-1-deficient transfectants proliferate. Exogenous FGF-1, FGF-2, FGF-7, or FGF-8 promote survival and proliferation of FGF-2-deficient transfectants and enhance FGF-1-deficient transfectant proliferation. Transfectants express FGF receptor FGFR1, FGFR2(IIIb), FGFR2(IIIc), and FGFR3 transcripts, findings consistent with the effects of exogenous FGFs. FGF-2-deficient transfectants express high levels of AS3, GADD45α, GADD45γ, GAS8, and GAS11 transcripts and moderate levels of GADD153, GAS2, GAS3, and GAS6 transcripts and lack demonstrable GAS1 or GAS5 transcripts. FGF withdrawal-mediated death of FGF-2-deficient transfectants did not significantly affect cell AS3, GADD153, GADD45γ, GAS2, GAS3, GAS7, GAS8, or GAS11 transcript content, whereas GADD45α and GAS6 transcript content was elevated. These studies establish that endogenous FGF-2 dominantly regulates prostate cancer cell survival and proliferation and that exogenous FGFs may assume this function in the absence of endogenous FGF-2. Additionally, we provide the first evidence that FGFs regulate prostate GADD45α and GAS6 transcript content. The latter observations suggest that GADD45α and GAS6 proteins may be effectors of processes that regulate prostate cancer cell survival. Additional studies are required to examine this possibility in detail.
Efficacy and Safety of the Medium Cut-Off Elisio HX Dialyzer
Authors: Maduell Francisco , Broseta José Jesús , Rodríguez-Espinosa Diana , Del Risco-Zevallos Jimena , Gómez Miquel , Rodas Lida M. , Arias-Guillén Marta , Vera Manel , Fontseré Néstor , Salgado Maria del Carmen , Rico Nayra
Published: May 2022

Introduction: The medium cut-off Elisio HX dialyzer by Nipro became commercially available in Europe in 2021, but there are still no reports of in vivo data. This study aimed to evaluate the safety and efficacy of it compared with previously evaluated hemodialysis (HD), expanded HD (HDx), and postdilution hemodiafiltration (HDF) treatments. Methods: A prospective study was carried out on 18 patients who underwent 5 dialysis sessions: FX80 Cordiax in HD, Elisio H19 in HD, Elisio HX19 in HDx, Theranova 400 in HDx, and FX80 Cordiax in HDF. The reduction ratios of urea, creatinine, ß2-microglobulin, myoglobin, kappa FLC, prolactin, α1-microglobulin, α1-acid glycoprotein, lambda FLC, and albumin were compared. Dialysate albumin loss was measured. Results: The comparison between the different dialysis modalities revealed no difference for small molecules, but HDx and HDF were significantly more efficient than HD for medium and large molecule removal. The efficacy of Elisio HX19 dialyzer in HDx was similar to the Theranova 400, superior to both dialyzers in HD, and slightly lower than HDF. Albumin losses in dialysate with HD dialyzers were less than 1 g, but between 1.5 and 2.5 g in HDx and HDF. The global removal score (GRS) values with HDx treatments were statistically significantly higher than those with HD. The highest GRS was obtained with the helixone dialyzer in HDF. Conclusions: The new MCO dialyzer, Elisio HX, performs with excellent behavior and tolerance. It represents an upgrade compared to their predecessor and is very close to the removal capacity of HDF treatment.
The Water-energy-food nexus: what the Brazilian research has to say
Authors:   Universidade de São Paulo. Faculdade de Saúde Pública, Moreira Fabiano de Araujo , Fontana Michele Dalla ,   Universidade de São Paulo. Faculdade de Saúde Pública, Malheiros Tadeu Fabrício ,   Universidade de São Paulo. Escola de Engenharia de São Carlos, Di Giulio Gabriela Marques ,   Universidade de São Paulo. Faculdade de Saúde Pública
Published: May 2022

The Food-Water-Energy (FWE) nexus represents, above all, a perspective, a way of looking at the world, the problems, the solutions, providing a view of the three main resource systems of food, water and energy, not in isolation, but as a system, with many and diverse cross-links between the subsystems. So, analytically speaking, it is a unifying concept, an antidote to the relentless pressures towards reductionism. Human society and its interactions with the natural environment form a dynamic socio-ecological system of such impressive complexity that reductionist approaches seem inevitable to make research and management on the subject viable. This development is not just an illusion - this book already presents some real examples of inter and transdisciplinary approaches, with the FWE nexus as a shared lens to better observe where problems occur and where sustainable solutions can be found.
O direito à cidade e os enredos pós-modernos de um projeto social dirigido a jovens moradores da metrópole paulistana: um estudo sobre o Programa “Jovens Urbanos”
Authors: Andrade Aline , Schilling Flávia
Published: May 2022

Este artigo trata dos contornos teóricos que fundamentam um projeto social dirigido a jovens moradores da metrópole de São Paulo denominado “Programa Jovens Urbanos”. Um dos principais objetivos expresso pelo Programa é ampliar e qualificar as possibilidades de circulação dos jovens na cidade, partindo-se do pressuposto de que jovens moradores de determinadas regiões da cidade – chamadas no Programa de periferias urbanas – são afetados por diferentes condições de exclusão, dentre elas a exclusão socioespacial. Interessa, nos limites deste artigo, problematizar a própria ideia de restrição da circulação: que saberes informam tais teses? Por que, afinal, haveria de se criar um empreendimento social que mobiliza uma gama de atores sociais (poder público, iniciativa privada, organizações comunitárias e os próprios jovens moradores dessas regiões, cuja identidade mais reconhecida é aquela que se apresenta nas drásticas estatísticas da vulnerabilidade social) para fazer o jovem circular fisicamente na cidade, movimentar-se em seus espaços? Diante disso, torna-se necessário reconhecer o ponto de vista assumido pelo projeto social, identificando em quais campos teóricos se instalam suas afirmações e proposições e, no diálogo com as ideias mapeadas, identificar possibilidades de leitura, lentes pelas quais se possam ver, interpretar e registrar os desafios da metrópole.
Aprender com o imigrante: a produção Multi/Intercultural da diversidade em Portugal
Authors: Ennes Marcelo Alario
Published: May 2022

Este artigo tem como objeto central de análise três publicações produzidas e divulgadas no âmbito do II Plano de Integração de Imigrantes cujo objetivo mais abrangente é promover o convívio e o diálogo com a diversidade cultural, religiosa e linguística. Objetivo principal do artigo é confrontar as publicações com as ideias que têm norteado o debate sobre a diversidade em suas versões multi/interculturais e, assim, contribuir para o aprofundamento de estudos sobre políticas de integração de imigrantes e gestão da diversidade. O artigo foi desenvolvido com base em revisão de literatura e fundamentação teórica, dados secundários publicados pela ONU e observação de campo nas cidades de Lisboa, desenvolvida durante a realização de meu estágio de pós-doutoral. A análise empreendida com base na discussão sobre multi/interculturalidade me permite dizer que as publicações não apresentam modelos prontos de integração e gestão da diversidade e, ao mesmo tempo, leva ao leitor a uma situação e, também, a um imigrante ideal com os quais o/a português/a pode aprender.
Familial Recurrence Patterns in Congenitally Corrected Transposition of the Great Arteries: An International Study
Authors: Tortigue Marine , Nield Lynne E. , Karakachoff Matilde , McLeod Christopher J. , Belli Emre , Babu-Narayan Sonya V. , Prigent Solène , Boet Angèle , Conway Miriam , Elder Robert W. , Ladouceur Magalie , Khairy Paul , Kowalik Ewa , Kalfa David M. , Barron David J. , Mussa Shafi , Hiippala Anita , Temple Joel , Abadir Sylvia , Le Gloan Laurianne , Lachaud Matthias , Sanatani Shubhayan , Thambo Jean-Benoit , Gronier Céline Grunenwald , Amedro Pascal , Vaksmann Guy , Charbonneau Anne , Koutbi Linda , Ovaert Caroline , Houeijeh Ali , Combes Nicolas , Maury Philippe , Duthoit Guillaume , Hiel Bérengère , Erickson Christopher C. , Bonnet Caroline , Van Hare George F. , Dina Christian , Karsenty Clément , Fournier Emmanuelle , Le Bloa Mathieu , Pass Robert H. , Liberman Leonardo , Happonen Juha-Matti , Perry James C. , Romefort Bénédicte , Benbrik Nadir , Hauet Quentin , Fraisse Alain , Gatzoulis Michael A. , Abrams Dominic J. , Dubin Anne M. , Ho Siew Yen , Redon Richard , Bacha Emile A. , Schott Jean-Jacques , Baruteau Alban-Elouen
Published: May 2022

Background:

Congenitally corrected transposition of the great arteries (ccTGA) is a rare disease of unknown cause. We aimed to better understand familial recurrence patterns.

Methods:

An international, multicentre, retrospective cohort study was conducted in 29 tertiary hospitals in 6 countries between 1990 and 2018, entailing investigation of 1043 unrelated ccTGA probands.

Results:

Laterality defects and atrioventricular block at diagnosis were observed in 29.9% and 9.3%, respectively. ccTGA was associated with primary ciliary dyskinesia in 11 patients. Parental consanguinity was noted in 3.4% cases. A congenital heart defect was diagnosed in 81 relatives from 69 families, 58% of them being first-degree relatives, including 28 siblings. The most prevalent defects in relatives were dextro-transposition of the great arteries (28.4%), laterality defects (13.6%), and ccTGA (11.1%); 36 new familial clusters were described, including 8 pedigrees with concordant familial aggregation of ccTGA, 19 pedigrees with familial co-segregation of ccTGA and dextro-transposition of the great arteries, and 9 familial co-segregation of ccTGA and laterality defects. In one family co-segregation of ccTGA, dextro-transposition of the great arteries and heterotaxy syndrome in 3 distinct relatives was found. In another family, twins both displayed ccTGA and primary ciliary dyskinesia.

Conclusions:

ccTGA is not always a sporadic congenital heart defect. Familial clusters as well as evidence of an association between ccTGA, dextro-transposition of the great arteries, laterality defects and in some cases primary ciliary dyskinesia, strongly suggest a common pathogenetic pathway involving laterality genes in the pathophysiology of ccTGA.
Abstract 12: Oral Anticoagulant Prescribing For Older Adults Newly Diagnosed With Atrial Fibrillation During Hospitalization
Authors: Troy Aaron , Herzig Shoshana , Anderson Timothy
Published: May 2022

Background:
Oral anticoagulants are indicated in patients with atrial fibrillation (AF) at elevated thromboembolic risk. AF is often diagnosed during hospitalization, yet little is known about rates of anticoagulant initiation in this setting.

Methods:
We examined a 20% national sample of Medicare fee-for-service beneficiaries enrolled in Part D, aged
>
65 years, who were hospitalized in 2016, and who received a new diagnosis of AF. The primary outcome was anticoagulant claim within 7 days of discharge home. We used multivariable logistic regression and post-estimation predicted probabilities to identify predictors of discharge with an anticoagulant, hypothesizing that thromboembolic risk, bleeding risk, and frailty would independently influence anticoagulant initiation.

Results:
Among 31,889 patients diagnosed with AF while hospitalized (mean age, 78; 52% female; 84% white; 95% CHA
2
DS
2
-VASc ≥2; 84% HAS-BLED ≥2; 37% frail), one-quarter initiated an anticoagulant following discharge. In multivariable models, rates of anticoagulant initiation varied by primary reason for hospitalization, with the highest predicted probability of initiation among those with a primary diagnosis of AF (46.3%; 95% CI 45.1-47.5), followed by cardiac surgery (42.8%; 39.6-46.0), other cardiovascular conditions (25.1%; 24.3-26.0), non-cardiac diagnoses (18.6%; 17.3-19.9), and bleeds (3.6%; 2.3-5.0). Higher CHA
2
DS
2
-VASc score was associated with a small increase in anticoagulant initiation (predicted probability 19.8% [15.4-24.2] for CHA
2
DS
2
-VASc <2 and 25.2% [24.7-25.7] for ≥4). Higher HAS-BLED score was associated with a small decrease (25.7% [24.6-26.8] for HAS-BLED <2 and 23.4% [22.7-24.1] for ≥3). Increased frailty was associated with decreased likelihood of anticoagulant initiation, with robust and moderately-severely frail patients having predicted probabilities of 25.0% (23.3-26.6) and 17.6% (15.9-19.2) respectively.

Discussion:
Anticoagulant initiation is uncommon among older adults newly diagnosed with AF during hospitalization, even among those hospitalized primarily for AF and those with high thromboembolic risk. Providers should carefully weigh risks and benefits of anticoagulants with all inpatients found to have AF.
Abstract 158: Burden And Predictors Of Mortality And Major Adverse Cardiovascular Outcomes In Heart Failure Preserved Ejection Fraction Patients Admitted With Acute Respiratory Distress Syndrome (ARDS)
Authors: Dhaduk Kartik , Patel Viralkumar , Verma Jyoti , Merugu Bhavyasri , Klair Harroop Singh , Dhakal Roshan , Shingala Ravi , Bambhroliya Zarna , Rizvi Bisharah , Jain Akhil , Desai Rupak
Published: May 2022

Background:
Relation between Acute Respiratory Distress Syndrome (ARDS) and heart failure with preserved ejection fraction (HFpEF) are understudied and the data on these two concomitantly is lacking in the literature. Therefore, we sought to assess the burden and predictors of major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality in ARDS patients with HFpEF.

Methods:
The National Inpatient Sample (NIS) database was used to identify patients with HFpEF (after excluding patients with heart failure reduced ejection fraction) who required inpatient hospitalization for ARDS. Administrative ICD10 codes were used to identify the population of interest. Multivariate regression analysis was performed to assess the predictors of all-cause mortality and major adverse cardiovascular outcomes in the selected cohort.

Results:
Of 28,731,562 hospital admissions, 3,010 (0.14%) patients were admitted with ARDS and had HFpEF. Of those patients, 1,095 (36.4%) had all-cause mortality, and 1,415 (47.0%) had MACCE. In multivariate regression analysis, older age (OR 3.60, CI 1.40-9.28), 26-50
th
quartile income (OR 2.10, CI 1.13-3.91), urban hospital admissions (OR 2.19, CI 1.20-4.01) as well as comorbidities such as coagulopathy (OR 1.77, CI 1.09-2.88), fluid and electrolyte imbalance (OR 1.65, CI 1.05-2.60), prior CABG (OR 2.99, CI 1.19-7.47), need for mechanical ventilation (OR 2.18, CI 1.12-4.23) were significant predictors of all-cause mortality. In our analysis, chronic pulmonary disease, valvular heart disease, hypertension, smoking, obesity were not significant predictors. The result of our analysis is reported in Table 1.

Conclusion:
These results suggest HFpEF remains important comorbidity in ARDS patients. Here, we identified predictors of poor outcomes in this patient population which may help physicians to identify the high-risk patients and decrease mortality.
Abstract 161: Trends In Time-Incremental Mortality After Hospitalization For Incident Acute Myocardial Infarction Among Medicare Beneficiaries, 2008-2017
Authors: Kini Vinay , Magid David J , Luo Qian , Masoudi Frederick A , Black Bernard , Moghtaderi Ali
Published: May 2022

Background:
New medical technologies and advancements in care quality have transformed care of patients hospitalized with incident acute myocardial infarction (AMI). While some advances may impact short-term mortality (e.g., mechanical circulatory support), others may take much longer to impact mortality (e.g., cardiac rehabilitation). Little is known about trends in time-incremental AMI mortality rates.

Methods:
We identified all patients hospitalized with incident AMI using a 5% sample of Medicare fee-for-service beneficiaries from 2008 to 2017. We used a three-year look back to exclude patients with a prior AMI hospitalization. We calculated unadjusted in-hospital, 30-day, 1-year, 2-year, and 3-year mortality rates by dividing the total number of all-cause deaths during each period by the corresponding number of patients who were hospitalized. We used logistic regression models to adjust mortality rates for patient demographics (age, sex, race/ethnicity) and a variety of comorbid conditions. Using 2008 as the baseline, we calculated annual incremental mortality rates for each time period. We performed subgroup analyses among AMI patients with ST-segment and non-ST-segment elevation.

Results:
From 2008 to 2017, we identified 42,567 patients hospitalized with incident AMI (mean age 81 years, 44% male, 86% white). The largest incremental declines in mortality rates were observed for the in-hospital (2.9% [CI 2.7 to 3.1%]), 30-day (2.1% [CI 1.9 to 2.3%], and 1-year (2.9% [CI 2.6 to 3.2%] time periods. Mortality declines were smaller but persisted for the 2-year (1.5% [CI 1.2 to 1.8%]), and 3-year (0.5% [CI 0.2 to 0.8%]; Figure) time periods. Similar patterns were observed among both ST-segment and non-ST-segment elevation AMI patients.

Conclusions:
For patients hospitalized with incident AMI, advances in care have led to incremental declines in mortality across time periods spanning the hospital stay through 3 years after discharge.
Abstract 169: Assessment Of Adverse Childhood Experiences In The South Bronx On Risk Of Developing Chronic Diseases As Adults
Authors: Faiz Mohammad , Shariff Masood A , Khan Hira W , Njoroge Alexander , Kasubhai Moiz , Jackson Tranice
Published: May 2022

Background:
Adverse Childhood Experiences (ACE) are understood to have a negative impact on health outcomes. Events such as abuse, neglect, family dysfunction early in life have shown a strong association with cardiovascular disease (CVD), as well as, premature death in adulthood. Our objective was to identify the prevalence of ACE events within the South Bronx, NY population and the relationship these stressors have with chronic disease affecting CVD health and high-risk behaviors in adults.

Methods:
Patients were recruited from a hospital-based ambulatory primary care. The survey was conducted between September 2017 and January 2018 with questions on demographics, ACE events, high-risk behavior (smoking, alcohol dependence, substance abuse), mental health, and chronic disease (hypertension, diabetes, hyperlipidemia) with patients of the S. Bronx. The chronic disease was stratified to assess for association with ACE score (1 to 11) and ACE event subcategories.

Results:
A total of 454 patients participated in the study. The overall age was 53.1±14.2 years and females were 49%. Hispanic were 54% followed by Black at 20%. Subjects had a high prevalence of both chronic disease (82%) and ACE events (69%) within the community. Our findings demonstrated a significant relationship between ACE events with chronic disease and high-risk behavior with higher odds among subjects with exposure to childhood stressors (OR 1.26, 95% CI- 1.1-1.5, p<0.01). Each ACE category - Physical & Sexual abuse, Household substance abuse, Separation from parents, Incarcerated household member, Parental separation/divorce, and Bullying - was associated with one and more chronic CVD diseases (OR-2.03, 21.53, 2.82, 2.94, 2.61, 3.83, & 4.84, respectively) significantly, p<0.01. High-risk behaviors were significant and correlated with an ACE score of more than 4.

Conclusion:
Among residents of the S. Bronx, having one or more ACE events had a significant association with chronic disease. Socio-economically deprived regions, such as S. Bronx, should entail ACE surveillance to detect exposure to risk factors that stimulate a need for evidence-based interventions that can be assigned to social determinants of health and aid with mental health and early screening for CVD risk factors.
Abstract 186: Anatomically Indexed Distributions Of Aortic Calcification In A Reference Population
Authors: Horbal Steven R , Derstine Brian A , Ross Brian E , Brown Edward , Su Grace L , Wang Stewart C , Holcombe Sven A
Published: May 2022

Introduction:
Cardiovascular disease remains the leading cause of death in the United States. Aortic calcification shows strong promise towards preventative screening efforts for cardiovascular risk in clinical and subclinical populations. While still relatively novel, granular distributions of aortic calcium in reference populations are absent from the literature.

Methods:
All participants of the Reference Analytic Morphomics Population, an approximation of vehicle occupants in the United States, with abdominal scans were considered for this analysis (n=4080). Analytic Morphomics was used to obtain vertebral-indexed anatomical measurements of the aorta and calcium characteristics (area, volume, density, and aortic wall obfuscation). Calcification was specifically identified as regions with a given morphology and pixel value three standard deviations above the defined central lumen zone.

Results:
Participant mean age was 33 (SD 22.6) and were mostly male (62.6%) due to the prevalence of males involved in trauma. Age and calcification distributions were right skewed among all vertebral levels and highest for the L3-L4 reference levels [~3% wall obfuscation (SD 10.5-11.3)]. Males demonstrated a progressive increase in total calcium volume from the 4
th
decade of age, while females had comparatively smaller increases and a dramatic increase in total calcium after the 7
th
decade. The largest increases in observed calcium volumes were observed in the 8
th
decade for males (~2300 cm
3
) and 7
th
for females (~4500 cm
3
).

Conclusion:
Aortic calcium prevalence was higher with reference to lower vertebral levels. Dramatic differential distributions of calcium were observed by age and sex.
Abstract 19: Assessing The Impact Of Stroke Systems Of Care Policies On Stroke-related Outcomes
Authors: Fulmer Erika , Gilchrist Siobhan , Ye Zhiqiu , Shantharam Sharada , Rasool Aysha , Omeaku Nina , Coleman King Sallyann , Garraza Lucas G , Xu Ye , Baffo Linda , Brown Amanda , Donald Bruce , Lue Brittany , Popoola Adebola , Dawkins-Lyn Nicola , Keener Mast Dana
Published: May 2022

Introduction:
Stroke systems of care (SSOC) laws have been adopted across the US as early as 2002 to improve access to time- sensitive, life-saving treatments and care for stroke patients. However, the impact of these laws on stroke care delivery and patient outcomes remains largely unknown. The study goal was to determine whether the policy interventions are associated with improved stroke outcomes by examining SSOC laws implemented by states.

Methods:
We developed a policy surveillance dataset of the 50 states and D.C. SSOC laws in effect at any time from 2002-2018. A stakeholder group of federal, state, and local SSOC experts informed the study. Based on an evidence-informed conceptual model, the study linked the policy surveillance dataset with three state-level outcomes: 1) age-adjusted overall stroke mortality rates; 2) percentage of hospitals certified as primary stroke centers (PSC); and 3) percentage of patients who received brain scan results within 45 minutes of arrival at a stroke center. To estimate policy effectiveness, we used Bayesian Additive Regression Trees to predict outcomes as if no policies were in effect and compared them to the actual observed outcomes in each state that put at least one policy into effect. For each modeled outcome, we controlled for state-level contextual factors such as stroke prevalence, percent rural population, non-white population, density of hospital closure, Paul Coverdell National Acute Stroke Program participation, and Medicaid expansion status.

Results:
Results identified 38 states with at least one SSOC law in effect during the study period. Of these states, 11 states had lower and 3 had higher overall stroke mortality rates than predicted; 9 states had a higher and 4 had a lower proportion of PSCs than predicted; and 12 states had higher and 2 had lower brain scan rates within 45 minutes than predicted.

Conclusion:
Having one or more SSOC laws in effect is associated with improved stroke outcomes. This information can inform national chronic disease organizations and state decisionmaker efforts to improve SSOC at state and regional levels.
Abstract 217: Assessing Medication Non-Adherence In Heart Failure Patients: A Resident Driven Quality Improvement Initiative
Authors: Burgess Kisha , Nyange Christabel , Pintor Jimenez Katiria , Joung Yoojin , Charaf Christine , Chang Eric Y
Published: May 2022

Introduction:
Non-adherence to guideline directed medical therapies (GDMT) is responsible for significant health care costs, morbidity, and mortality in heart failure (HF) patients. Assessing and improving medication adherence (MA) is challenging in this patient population given its multifactorial nature. We aimed to evaluate trainee assessment of MA in HF patients while identifying potential barriers to addressing MA during patient encounters.

Methods:
This was a single-institution study performed at a large safety net hospital in Atlanta. An anonymous questionnaire was used to assess MA strategies of interns, residents, and medical students for HF patients. This data was compiled and analyzed to identify the most commonly perceived barriers to medication non-adherence.

Results:
100 surveys were returned. 99% (99/100) noted that addressing MA is important in HF patients. However, only 83% (83/100) reported that they discussed the specific reasons for non-adherence with their HF patients, with 9%, 12%, and 78% addressing MA in the outpatient, inpatient, and both settings, respectively; the lack of time was reported as the most common contributor in all settings. The most common reasons reported by trainees for patient non-adherence include misunderstanding of their regimen (71%), cost (62%), and polypharmacy (57%). Although, 40% (40/100) of survey responders believed that ≥50% of their HF patients were nonadherent, strikingly, only 12% (12/100) discussed these MA barriers at all HF patient visits.

Conclusion:
Improving outcomes in HF patients is multifactorial. Medicine teaching teams can play a crucial role in this process by recognizing and addressing the specific barriers to MA in HF patients while promoting GDMT adherence. Our study demonstrates that although trainees recognize the importance of MA, the unique patient characteristics that contribute to non-adherence are under appreciated. Our long-term goal is to not only identify these barriers, but to implement educational interventions, then re-assess trainee comfort level with discussing MA, to demonstrate that trainee driven interventions can improve MA in HF patients while simultaneously reducing HF related re-admissions and hospital costs.
Abstract 227: Long Term Outcomes In Patients With Type 2 Myocardial Infarction With And Without Significant Change In Troponin Levels
Authors: Jenkins Christopher , Bob-Manuel Tamunoinemi , Kelly Jayna , Tivis Rick , Effron Mark B
Published: May 2022

Background:
It is well known that morbidity and mortality are higher in patients with Type 2 Myocardial Infarction (T2MI) compared to Type 1 MI. Few studies have compared outcomes in T2MI patients with significant increase in troponins (Tpn) (Myocardial infarction [Inf]) vs Tpn elevation with no or an insignificant Tpn increase (Myocardial Injury [Inj]).

Method:
Single center retrospective observational study evaluating patients admitted with an elevated Tpn-I and no evidence of obstructive coronary artery disease. Inj was defined as <50% increase if Tpn-I ≤ 1.0 ng/mL or <20% increase if Tpn-I > 1.0 ng/mL. Inf was defined as Tpn increase ≥ 50% if Tpn-I ≤ 1.0 ng/mL or ≥ 20% increase if Tpn-I > 1.0 ng/mL. Primary outcome was a composite of all-cause mortality, coronary revascularization, or admission for heart failure within 1 year.

Results:
The study included 3,123 patients with a hospital admission between March 2019 to September 2019: 1609 patients with Inj and 1514 patients with Inf. Adjusted primary outcome was higher with Inf than Inj (p=0.02), as was revascularization (p=0.0017). Readmission for heart failure was not significantly different (p=0.26). Risk factors for primary outcomes (history of stroke, diabetes, ESRD, hypertension, and heart failure) were higher in the Inj group with lower primary outcomes. (Table)

Conclusion:
Patients with T2MI (Inf pattern of Tpn) are more likely to have an adverse outcome within 1 year than patients with Inj.
Clinical Implications:
True T2MI (rise in Tpn) are more likely to have an adverse outcome and require catherization than patients with flat Tpn elevation who are more likely to have heart failure.
Abstract 233: A Network Meta-analysis Comparing The Performance Of Magnetic Resonance Imaging, Positron Emission Tomography And Bone Scintigraphy Techniques In Detecting Cardiac Amyloidosis
Authors: Osman Abdul Fatawu , Elshafie Ahmed , Murthy Venkatesh L , Hummel Scott L , Nallamothu Brahmajee K , Dwamena Ben
Published: May 2022

Aims:
Diagnosing cardiac amyloidosis with non-invasive imaging studies can be challenging. We aims to systematically review the published literature and compare the performance of magnetic resonance (CMR), positron emission tomography (PET) and bone scintigraphy (BS) for diagnosis of cardiac amyloidosis.

Methods:
Medical electronic databases were searched for studies evaluating the diagnostic performance of CMR, PET or BS in diagnosing cardiac amyloidosis where histopathological examination of endomyocardial biopsy tissue or extra-cardiac organs were used as reference standards. We evaluated; CMR: extracellular volume (ECV), late gadolinium enhancement (LGE), T1 mapping; PET: F18-Amyloid, F18-Sodium Fluoride (NaF), and C11-PIB; BS: Technetium-99m (Tc) hydroxymethylene diphosphonate (Tc-HMDP), Tc-3,3-diphosphono-1,2-propanodicarboxylicacid (Tc-DPD), Tc- pyrophosphate (Tc-PYP). Methodological quality was assessed using a Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). To summarize sensitivity, specificity, and superiority, we used an arm-based hierarchical model which expresses the logit transformed sensitivity and specificity as the sum of fixed effects for test, correlated study-effects to model the inherent correlation between sensitivity and specificity and a random error associated with various tests evaluated in each study.

Results:
Of the 2871 studies identified, 39 studies met the inclusion criteria. Sensitivity and specificity and Superiority of the various imaging modalities in diagnosing cardiac amyloidosis were calculated (Figure).

Study quality assessed by QUADAS-2 was generally good with negligible evidence of bias.

Conclusion:
Various non-invasive imaging modalities have been studied for diagnosing cardiac amyloidosis with varying sensitivity and specificity. Comparative studies may be warranted to improve non-invasive diagnostic algorithms of suspected cardiac amyloidosis.
Abstract 241: Length Of Hospital Stay Is Lessened In Patients That Present With Chest Pain When Serial Troponins Are Measured Every Three Hours Compared To Every Six Hours
Authors: Grees Andrew , Lachhar Garry G , Mahbub Elnaz , Saxby Kathryn , Kim Anita , Beard Meghan , Kazi Ananna , Lamar Katie , Melek Andrew , Joshi Raj , Lubrano Lavadera Mariana , Reilly John P
Published: May 2022

Troponins have close to 100% sensitivity when drawn 6 to 12 hours after the start of chest pain in acute coronary syndrome (ACS). Length of hospital stay (LOS) is a marker of efficient hospital management. Since troponin measurements at 3 (Q3H) and 6-hour (Q6H) intervals have comparable efficacy for ACS, we suggest considering Q3H troponins as opposed to Q6H in chest pain admissions to shorten LOS.

A retrospective review of 389 patients who presented to Stony Brook Southampton Hospital in 2020 and 2021 with chest pain was conducted. Two patient care strategies were examined, one involved collecting troponins Q6H and the other Q3H. 319 patients with the Q6H strategy were analyzed and 61.1% were ruled in for ACS. For the Q3H strategy, 70 patients were analyzed in which 42.9% were ruled in for ACS. LOS was defined as hours between triage and submission of discharge instructions. A two-sample t-test was performed to find correlation between frequency of troponins and LOS.

A two-sample t-test assuming unequal variance was conducted to compare LOS in hours between Q6H and Q3H strategies. There was a significant difference in LOS for Q6H (M = 123, SD = 201) and Q3H (M = 66, SD = 135) troponins; t = 2.91, p = 0.002. These results suggest that LOS is lessened when troponin intervals are shorter. The variance was elevated (40249,18343), possibly due to patients who stayed longer for other needs, but mean LOS and standard deviation remained decreased both when excluding patients that stayed longer than one week, and when including all patients in the analysis.

Optimizing LOS has a variety of benefits. In patients with chest pain, shortening the interval of troponin collection can lessen LOS. Studies of comparable efficacy of shorter troponin intervals in evaluation of ACS have led to the practice of trending at Q3H intervals in Europe. Our study demonstrates that trending troponins Q3H is viable in a community hospital in the United States and should be further investigated and considered in the future.
Abstract 243: Length Of Hospital Stay Is Lessened In Patients That Present With Chest Pain When Admitted To The Cardiology Service Compared To Other Services Within Our Teaching Hospital
Authors: Lachhar Garry G , Mahbub Elnaz , Grees Andrew , Kim Anita , Saxby Kathryn , Beard Meghan , Blair Jeffrey , Melek Andrew , Seligson John , Gul Rahat , McCarthy Michael , Reilly John P
Published: May 2022

Length of stay (LOS) in the hospital for patients presenting with chest pain can be influenced by several factors. In patients evaluated for acute coronary syndrome (ACS), admission to a cardiology service may allow patients to have a shorter LOS, while admission to a non-specialty service has been shown to potentially cause worse outcomes. In this analysis, we evaluate whether specialized care decreases LOS in patients who present with chest pain.

A retrospective review of 389 patients who presented to Stony Brook Southampton Hospital in 2020 and 2021 with chest pain and underwent ACS evaluation was conducted. The two strategies involved admissions to the cardiology service or to other hospital services. We analyzed 95 cardiology admissions, 56.8% of which ruled in for ACS, and 294 admissions to other hospital services, 58.2% of which ruled in for ACS. LOS was defined as hours between triage and submission of discharge instructions. A two-sample t-test was performed to find correlations between admission service and length of hospital stay.

A two-sample t-test assuming unequal variance was conducted to compare LOS in hours between patients admitted to the cardiology and non-cardiology services. There was a significant difference in LOS for the cardiology service (M = 48, SD = 55) and non-cardiology service (M = 134, SD = 214) conditions; t = 6.30, p < 0.001. These results suggest that LOS is lessened when chest pain patients are admitted to the cardiology service. The variance was elevated (2985, 45849), possibly due to patients who stayed longer for other needs, but mean LOS and SD remained decreased when excluding patients that stayed longer than one week, and when including all patients in the analysis.

When admitting a patient, there are many ways to optimize LOS. Admission of patients who present with chest pain to a specialty cardiology service may allow patients to have a more efficient LOS and should be further investigated and considered in the future.
Abstract 259: Outcomes And Success Of Ventricular Tachycardia Ablation In Patients With Implantable Cardioverters Defibrillators
Authors: Giedrimiene Dalia , Kluger Jeffrey
Published: May 2022

Implantable cardioverter defibrillators (ICDs) have proven efficacy in terminating ventricular tachycardias (VT) by antitachycardia pacing (ATP) or implantable cardioverters defibrillators (ICD) shock and reducing the risk for sudden cardiac death (SCD). However, they do not prevent VT recurrences, and these patients may have a subsequent heart failure or death. For patients with ICDs and failure to antiarrhythmic drug (AAD) therapy the major alternative is catheter ablation (CA). The goal was to assess the outcomes of VT ablation, including inducibility, early VT recurrences and ATP effectiveness after CA in pts with ICDs.

Methods:
We analyzed the data of 38 patients, age 43-84 (avg.= 68.76±14.2 years), 33 (90%) males with monomorphic VT and implanted ICD who underwent radiofrequency CA during last 2.5 years (2019 Jan - 2021 July); 32 (82.1%) have failed AAD therapy; 17 (43.6%) patients had an ICD implanted for primary and 22 (56.4%) for secondary prevention; 18 (46.2%) of them had reduced ejection fraction (EF) <35%. The time from ICD implantation to CA was av. 3.61 years.

Results:
During first year of follow-up after CA procedure 14 (36.8%) pts experienced an early recurrence of VT, which required the therapy from their ICD device: 5 (35.7%) of them had EF <35%. The inducibility of VT post-CA was identified in 15(39.5%) pts, 8(53.43%) of them with EF <35%. Average time of the reoccurrence of VT was 23.7 days (range 0 - 12.2 months). The frequency of VT storm was significantly lower post-CA comparing to pre-CA: 30 (78.9%) vs 8 (21.1%), p <0.001. The effectiveness of ATP was higher post-CA as 6 (42.9%) vs 6 (19.4%) pre-CA pts have received successful VT termination by ATP and the need for ICD shock was lower: 25(80.6%) pre-CA vs 9 (62.3%) post-CA. The success of ATP was in 2 (11.8%) pts with EF <35% vs 4 (21.1%) in pts with EF ≥35%. Patients with non-ischemic cardiomyopathy (NICM) required less ICD shocks as compared to ICM - 2(12.5%) vs 6 (88.9%), p<0.001.

Conclusions:
The inducibility of VT post-CA is higher in patients with lower EF. The frequency of VT storm is significantly reduced post-CA. The success of ATP for VT termination is higher in pts with EF ≥35% and in pts with NICM.
Abstract 261: Best Practice Advisories Effects On Telemetry Ordering Habits
Authors: Johnson Trent B , Pahwa Amit , Knight Amy , Metkus Thomas , Latifi Niloofar , Dungarani Trushar
Published: May 2022

Background:
Inpatient Telemetry detects dysrhythmias. However, data from telemetry influences management on < 1% of patients, and telemetry is often used in cases with no benefit. We are conducting a multi-center study to evaluate the impact of an EMR-based best practice advisory (BPA) on telemetry ordering practice

Methods:
To assess the effectiveness of a BPA encouraging cessation of telemetry, we performed an analysis of time on telemetry and the number of BPA alerts before and after October 2019 [Figure 1]. We redesigned the telemetry BPA to restrict firing to the hours of (8 AM to 6 PM) and to restrict notifications to the first call and Attending provider. We used Epic-generated data from 88, 832 unique patient telemetry orders and 121, 621 BPA responses from 3 hospitals. The data was normalized for variation in patients hospitalized over time using admission contact serial numbers (CSN) and inpatient admission orders for non-ICU medicine floors.

Results:
We analyzed data from 243,280 BPA alerts. Pre-BPA implementation mean alerts were 150.01 std 43.07 and post BPA implementation mean alerts were 76.33 std 33.461 p-value 0.00. Mean time on telemetry pre BPA 4481.262 mins std 6531.82 post BPA 4311.14 mins std 6011.18 mins p value 0.001

Conclusion:
Despite practice standards, telemetry use outside of the ICU varies widely amongst providers. Reduction in the number of telemetry minutes can lead to a decrease in clinician telemetry review time and offer improvement in patient satisfaction and comfort by not being connected to the device.
Abstract 34: 12-month Clinical Outcomes Among Patients With Heart Failure And Reduced To Preserved Ejection Fraction Based On Sacubitril/valsartan Versus Angiotensin Converting Enzyme Inhibitor Or Angiotensin Receptor Blocker Use - A Retrospective, Parallel, Multi-group Study
Authors: Albert Nancy M , Bena James F , Morrison Shannon L , Williams J. Bradley , Faulkenberg Kathleen , Levay Michelle , Shen Xian
Published: May 2022

Introduction:
Real-world 12-month outcomes of sacubitril/valsartan (sac/val) vs. ACEi or ARB use among patients with HFrEF (EF < 40%) through HFpEF (HFmrEF EF 40-49% and HFpEF EF 50-60%) are not well known. A better understanding of hospitalization (hosp), emergency department (ED) visits and mortality provides new information about medication benefits in patients with HF and a wide range of ejection fractions (EF).

Methods:
Data were retrieved from a multi-state healthcare system database. Patients prescribed sac/val from Aug. 1 2015-Jul. 31 2018 were matched to those on ACEi or ARB based on age, sex, EF, comorbidity status, hospital vs. ambulatory index date reflecting medication use and systolic

blood pressure. Twelve-month outcomes based on sac/val vs. ACEi or ARB were assessed using linear, logistic, and Poisson models with generalized estimating equations.

Results:
Of 3588 patients (1794 per group), mean (SD) age was 64.2 (13.0) years, 70.3% were male, 20.7% were Black, and mean systolic blood pressure was 122.1 (16.1) mmHg. By HF factors, 47.6% were NYHA-FC II and mean EF% was 29.0 (9.9); 349 (9.7%) had HFmrEF or HFpEF. At baseline, 92.4% were on beta-blockers, 43% were on aldosterone antagonists and 63.1% were on loop diuretics. Over 12 months, 125 patients died (38 sac/val vs. 87 ACEi or ARB; p <0.001). Sac/val use was associated with fewer 12-month all-cause and HF hosp, HF ED visits and the composite outcome (all p <0.001); see Figure of adjusted event rate (%) odds ratios.

Conclusions:
Among patients with HFrEF, HFmrEF and HFpEF (EF up to 60%), use of sac/val was associated with fewer 12-month death and morbidity (all-cause and HF hosp and HF-related ED visits). Patient and provider factors that facilitated sac/val use and improved clinical outcomes should be studied.
Abstract 57: Impact Of Body Mass Index In Functional Capacity And Hemodynamics In Patients With Pulmonary Arterial Hypertension
Authors: Munir Rayyan , Meyyappan Lakshmi , Liu Emily , Kline-Rogers Eva M , McDevitt Susanne , Moles Victor , McLaughlin Vallerie
Published: May 2022

Background:
Prior studies demonstrate a higher prevalence of pulmonary hypertension (PH) and more severe hemodynamics in patients with higher body mass index (BMI). However, this association was only described in post-capillary PH. To better understand the relationship between pre-capillary PH and BMI, we compared various PH parameters stratified by BMI class.

Methods:
Data from right heart catheterization (RHC), 6-minute walk (6MW), and functional class (FC) were collected from the University of Michigan Pulmonary Hypertension Patient Registry from 2016-2020 at baseline and 3-month follow-up. Group 1 pulmonary arterial hypertension (PAH) patients were grouped into 4 BMI weight classes: under/normal weight (BMI < 25), overweight (25 < BMI < 30), obesity class 1 (30 < BMI < 35), obesity class 2/3 (BMI > 35).

Results:
Among 175 PAH patients, obese patients exhibited higher right atrial and pulmonary capillary wedge pressures. There were no major differences in mean pulmonary artery (PA) pressures, pulmonary vascular resistance (PVR), cardiac index Fick, 6MW distance walked, or peak Borg Dyspnea score among BMI groups. Despite having similar mean PA pressure and PVR (major determinants of functional capacity in PAH), patients in higher weight classes had higher dyspnea symptom burden by WHO FC. Specifically, a greater prevalence of normal/overweight patients were in FC 1 while more obese patients were in FC 3.

Conclusions:
Overall, in patients with PAH, higher BMI classes presented with worse FC for dyspnea, higher RA and PCW pressures, with similar PA pressures and 6MW results. Our data suggests that BMI may be an important factor that influences PAH symptoms. The impact of BMI in PAH outcomes is yet to be determined. It is possible that patients with higher BMI may exhibit more frequent comorbid conditions contributing to multifactorial symptoms of dyspnea; further study is warranted.
Abstract 78: Cardiovascular Implantable Electronic Device Lead Safety: Harnessing Real-world Remote Monitoring Data For Medical Device Evaluation
Authors: Caughron Hope , Raitt Merritt H , Whooley Mary A , Tarasovsky Gary , Shen Hui , Matheny Michael E , Selzman Kimberly A , Wang Li , Major Jacqueline M , Odobasic Hetal , Dhruva Sanket S
Published: May 2022

Background:
Current important regulatory resources and methods to identify cardiac implantable electronic devices (CIED) lead failure include post-approval studies, which may be limited in scope, participant numbers, and by attrition; studies relying on administrative codes, which lack specificity in multi-chamber systems; and voluntary adverse event reporting, which cannot determine incidence or attribution to the lead. We determined whether adjudicated remote monitoring (RM) data can help to address these limitations and augment lead safety evaluation.

Methods:
We evaluated 48,148 patients from the Veterans Affairs National Cardiac Device Surveillance Program (VANCDSP), 4/1/19-4/1/21. We identified RM transmissions signifying incident lead abnormalities (possible lead failure, failure to capture, impedance out of range). We queried VA electronic health record (EHR) and Medicare fee-for-service claims data to determine if patients had administrative codes for lead failure. We verified structural lead failure through manual EHR review. Among patients with EHR-confirmed lead failure, we categorized subsequent clinical actions by cardiac chamber.

Results:
Of 48,148 actively monitored patients with CIEDs, 1174 (2.4%) had incident lead abnormalities detected on RM; 356 (30.3%) with administrative codes for lead failure and 818 (69.7%) without. Of the 356 patients, 220 (62%) had lead failure verified through chart review (positive predictive value [PPV], 62%). Among 276 patients randomly selected from 818 without administrative codes, 58 (26%) had EHR-confirmed lead failure (PPV, 21%). Patients with isolated right atrial or left ventricular lead failure were less likely to have claims and lead replacement procedures than those with right ventricular high-energy lead failure (Table).

Conclusion:
Remote monitoring may strengthen accurate real-world assessment of lead failure, particularly for leads where patients do not undergo replacement.