bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 143: A Meta-analysis of the Short and Long Term Effects of Home Blood Pressure Monitoring
Authors: Arrieta Alejandro , Mahomed Adam , Hess Camry , Woods John , Jay Stephen , Nasir Khurran , Veledar Emir
Published: March 2022

Background:
The effectiveness of home blood pressure monitoring (HBPM) in diagnosing and controlling hypertension is well stablished. HBPM is known to reduce blood pressure (BP) levels among patients with uncontrolled hypertension. However, it is unknown whether the BP lowering effects of HBPM are sustained over time.

Methods:
We performed a meta-analysis study to assess the effect of HBPM on systolic and diastolic BP reduction over multiple periods of time. 53 randomized control trials published between 1975 and 2014, and representing 13,290 participants were included in this meta-analysis. A multiple-outcome, random-effect model was used to estimate the effect size of HBPM at 0 to 3, 4 to 6, 7 to 12 and more than 12 months compared to baseline.

Results:
BP (systolic, diastolic) was improved with HBPM at 0-3 months (-0.574 mmHg, -0.582 mmHg) and at 4-6 months (-0.269 mmHg, -0.263 mmHg). However, BP reduction was not statistically significant for either diastolic BP at 7-12 months, or for systolic and diastolic BP beyond 12 months. Moreover, average BP reductions became progressively smaller over time (see Figure 1 for average diastolic and systolic average BP reduction and 95% confidence interval).

Conclusions:
Our analysis is consistent with previous studies reporting small but statistically significant effects of HBPM on systolic and diastolic BP reductions. Here we show in addition that the BP lowering effects of HBPM occur primarily in the first 3 to 6 months, with non-significant lowering of BP after 6 months. Our results suggests a “honeymoon effect” in the clinical benefit of HBPM when applied to uncontrolled hypertensive patients. Interventions intended to produce longer-term control of hypertension will require strategies specifically designed to prolong the benefits of HBPM, possibly by providing periodic educational reinforcement sessions or by incorporating regular positive feedback to patients.
Abstract 146: Clinical and Economic Consequences of Statin Intolerance in the U.S.: Results from an Integrated Health System
Authors: Sanchez Robert J , Graham Jove H , Evans Michael A , Mallya Usha G , Panaccio Mary P , Steinhubl Steven R
Published: March 2022

Background:
Low-density lipoprotein cholesterol (LDL-C) is a key therapeutic target for reducing risk of cardiovascular (CV) events. While statins are the mainstay of therapy due to efficacy and safety, observational studies indicate patients prescribed statins are unable to tolerate them to varying degrees. The study objective was to examine the clinical and economic consequences of statin intolerance (SI) comparing SI patients to non-SI patients on statin therapy.

Methods:
This retrospective cohort study used data from an integrated health system’s electronic health record from 2009-2014. Adult patients diagnosed as statin intolerant (identified through a custom diagnosis code), with ≥ 6 months pre- and post-index date eligibility were considered for the study. All patients were hierarchically ordered into 6 mutually exclusive CV risk categories: recent acute coronary syndrome (ACS, < 12 months pre-index); coronary heart disease (CHD); ischemic stroke; peripheral artery disease (PAD); diabetes; or primary prevention. Index dates were defined as the SI diagnosis date for SI patients and a matched encounter date within ±90 days for controls. A total of 5,252 SI patients were matched to 15,756 non-SI statin users (1:3 ratio) using a propensity score that included CV risk, Charlson comorbidity index, and other clinical characteristics as covariates. Time to first myocardial infarction, unstable angina, coronary revascularization, ischemic stroke, and CV death were compared between groups using Kaplan-Meier plots and Cox proportional hazard models. Total medical costs and LDL-C goal attainment were compared using generalized linear models and conditional logistic regression, respectively.

Results:
The mean age of the study population was 62 years with the majority being females (61%). Three percent were categorized as recent ACS, followed by 22% for CHD, 1% ischemic stroke, 5% PVD, 17% diabetes and 52% primary prevention patients. Before matching, 5% of statin users were deemed statin intolerant by their provider; although, 86% were still able to tolerate at least asymmetric statin dosing. Compared to the matched cohort, SI patients experienced significantly higher risk of unstable angina (hazard ratio (HR)=1.55, 95% CI=1.29-1.86) and revascularization procedures (HR=1.78, 95% CI=1.47-2.17) but lower risk of CV death (HR 0.42, 95% CI=0.33-0.55). Patients with statin intolerance also experienced higher costs (cost ratio=1.21, 95% CI=1.12, 1.29) and a higher risk of not achieving LDL-C goal (odds ratio=1.84, 95% CI=1.58-2.13). All p-values were <0.0001.

Conclusion:
While the majority of SI patients were on a statin, SI patients demonstrate a higher risk of some cardiovascular events; incur higher healthcare costs; and difficulty reaching LDL-C goals compared to patients without SI. Alternative treatment strategies are needed to better serve this at-risk patient population.
Abstract 153: Post-procedural New Onset Atrial Fibrillation in Patients Undergoing Transcatheter Aoritc Valve Implantation versus Surgical Aortic Valve Replacement for Severe Aortic Stenosis: A Meta-analysis.
Authors: Bhatheja Samit , Panchal Hemang , Rahman Zia , Barry Neil , Paul Timir
Published: March 2022

Background:
Transcatheter aortic valve implantation (TAVI) is performed in patients with severe aortic stenosis who are not a candidate for surgical aortic valve replacement (SAVR). New onset post-operative atrial fibrillation is a common complication after SAVR and has also been reported after TAVI in clinical trials and registries. The objective of this meta-analysis is to compare incidence of post-procedural new onset atrial fibrillation in patients who underwent TAVI versus SAVR.

Methods:
PubMed and the Cochrane Center Register of Controlled Trials were searched through January 2015. Six studies (n= 1173) which reported incidence of post-procedural new onset atrial fibrillation comparing TAVI (n=596) and SAVR (n=577) were included. End point was post-procedural new onset atrial fibrillation. The odds ratio (OR) with 95% confidence interval (CI) was computed and p<0.05 was considered as a level of significance.

Results:
The studies were homogeneous. Incidence of post-procedural new onset atrial fibrillation was significantly higher in SAVR group compared to TAVI group (OR: 3.10, CI: 2.20-4.35, p<0.00001) (Figure 1).

Conclusion:
The results of this meta-analysis of 1173 patients suggest that SAVR is associated with higher incidence of post-procedural new onset atrial fibrillation compared to TAVI procedure. This complication may lead to significant morbidity due to need of long term anticoagulation as well as possibility of tachycardia induced cardiomyopathy; however, randomized controlled studies are needed to further evaluate the long-term clinical outcomes.
Abstract 158: Delirium is a Robust Predictor of Morbidity and Mortality Among Cardiac Intensive Care Unit Patients
Authors: Lishmanov Anton , Pauley Eric , Schumann Sara , Katz Jason N
Published: March 2022

Background:
Delirium is common in the medical and surgical intensive care unit (ICU), and its association with morbidity and mortality is well described. Despite emerging data which has highlighted a growing critical care burden in the contemporary cardiac ICU (CICU), much less is known about delirium in this specialized setting.

Methods and Results:
Records for consecutive CICU patients >18 years who were admitted to our academic, tertiary-care institution from December 2012 through March 2014 for a primary cardiovascular diagnosis were reviewed. Only those with a documented Confusion Assessment Method for ICU (CAM-ICU) score were included in the final analysis. Baseline characteristics, resource use, and outcomes were collected. Disease severity was assessed using the modified Acute Physiology and Chronic Health Evaluation II (APACHE II) Score and the Simplified Acute Physiology Score II (SAPS II). Multivariable logistic and linear regression models were constructed to evaluate the association between CICU delirium, length of stay (LOS), and death.

Among 590 patients included, the prevalence of CICU delirium was 20.3%. Delirious patients were older, had greater disease-severity, required longer ICU stays (5 vs. 2 days, p<0.001), and had higher CICU mortality: 27% (32 of 120 patients) vs. 3% (14 of 470 patients), p<0.001). After multivariable adjustment, delirium had the greatest independent association with both mortality (p<0.001) and LOS (p=0.001).

Conclusions:
In those with cardiac critical illness, delirium is common and associated with worse survival and greater resource consumption. Future study is needed to validate these findings and to develop effective strategies for the early identification and treatment of the delirious CICU patient.
Abstract 162: The Impact of Data Quality on Outcomes From The National Cardiac Surgery Registry in Australia - Can Derivable Data Help?
Authors: Tran Lavinia , Shardey Gilbert C , Dahya Dhenisha , Marrow Nicole , Smith Julian , Reid Christopher M ,   ANZSCTS Database Program Steering Committee
Published: March 2022

Introduction:
The Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) Database Program collects pre-, peri-, and post-operative clinical information on patients undergoing cardiac surgery across Australia. It is a clinical quality registry aimed at improving patient outcome by reporting and benchmarking hospital and surgeon performance. Reports for the Database is dependent on the capturing of accurate and complete data by trained data managers at 28 participating Units. The ANZSCTS Database was audited to determine the adherence of Units to the current data definitions of post-operative New Renal Failure (NRF).

Methods:
Data between 1st January 2009 and 31st December 2013 (N=45322) from the ANZSCTS Database Program was analysed for reported NRF in patients undergoing cardiac surgery each Unit. To assess the accuracy of the reported data, NRF was also derived using pre- and post-operative renal status variables according to the ANZSCTS Database Data Definitions criteria for NRF. The reported and derived NRF data was then evaluated by procedure type and stratified by Units.

Results:
Overall, reported NRF was 5.1% (2308/45129) compared to derived NRF of 4.9% (2223/45322) across the 28 Units over the 5 year period. In isolated coronary artery bypass graft, reported NRF was 3.6% (853/24017) compared to derived NRF of 3.4% (824/24081). Unit-specific evaluation showed large variation in reported versus derived NRF across the Units. Out of the 28 Units, 10 Units had under-reported NRF and 18 Units had over-reported NRF post cardiac surgery (see figure).

Conclusion:
This study demonstrates that Units may not always adhere to the data definitions when collecting and entering data into the Database. As such, derivable data is a good indicator of potential data entry error within Units. In the case of NRF, the overall rates of NRF are similar (both derived and reported), however, large variations exists when NRF rates are evaluated at Unit level. This demonstrates that reporting overall rates of NRF in ANZSCTS Database routine activities may not be as useful as providing Unit-specific data as feedback. Therefore in future, reported NRF rates will be cross-checked against derived NRF, and both overall and Unit-specific rates of NRF should also be included in future Annual Reports.
Abstract 163: Use of a Free, Non-proprietary Iphone App (STEMISend) to Substantially Improve Pre-hospital ECG Transmission Capability
Authors: Burt David R , Ballinger Zachary , Geipel Clayton , Jones Tristan
Published: March 2022

Introduction:
Pre-hospital diagnosis of ST-segment Elevation Myocardial Infarction (STEMI) promotes pre-arrival decision making and minimizes reperfusion delays. However, many commercial ECG transmission systems are expensive and based on proprietary technology. Recent advances in phone and app technology suggest another approach. As an alternative, a smartphone app (STEMISend) was developed and partnered with an inexpensive cell signal booster. This combination was then tested in multiple head-to-head comparisons with commercial systems. Results showed the app + booster approach to be non-inferior or superior to commercial systems -particularly in signal-limited environments.

Hypothesis:
Based on preliminary testing, the STEMISend smartphone app was suggested as a cost-effective alternative to commercial systems. Extensive field testing looking at percent success, cycle reliability and comparative performance in low-signal environments was conducted.

Procedure:
The STEMISend/booster combo was field-tested on 2 national cell networks and compared to an existing commercial system. Success was defined as a successful transmission within 120 seconds. Data was collected at 125 individual waypoints at all signal strengths. Testing was in geographically diverse areas of central Virginia. App performance was evaluated on a success/failure basis and on the time required to transmit the image. Commercial system performance was similarly evaluated and the two approaches were compared.

Results:
Figure 1 shows STEMISend performance compared to an existing commercial system. In signal-rich environments (3-5 bars), both showed nearly equal performance. However, in signal-limited environments (2 bars or less), the app/booster combo displayed slightly higher success. In terms of transmission duration, the cell signal booster decreased transmission cycle time in both signal -rich and signal-limited environments, though the effect is more pronounced in signal-limited environments.

Conclusion:
The STEMISend iPhone app is a potential alternative to commercial ECG transmission systems--particularly when coupled with inexpensive cell signal boosters. STEMISend is easy to use, reliable and non-proprietary. Additional testing in EMS environments is in progress.
Abstract 164: A Field Synopsis of Gender Effects in Clinical Prediction Models for Cardiovascular Disease
Authors: Paulus Jessica K , Lai Lana , Raman Gowri , Lutz Jennifer S , Wessler Benjamin S , Kent David M
Published: March 2022

Introduction:
Gender differences in incidence, prognosis and treatment response have been observed across the spectrum of cardiovascular diseases (CVD). However, despite several decades of investigation, consistent findings regarding the magnitude and directionality of gender differences in CVD are elusive. We therefore conducted the first field synopsis of the role of gender on CVD conditions using a registry of clinical prediction models (CPMs).

Methods:
The Tufts PACE Center (CPM) Registry is based on a systematic review of cardiovascular CPMs published in English-language articles from 1/1990-5/2012. All included CPMs permit calculation of outcome probabilities from information provided in an equation, point score or nomogram. For the 15 most common unique index condition-outcome pair models, we calculated the proportion of models that included coefficients for the effect of gender on CVD incidence or prognosis, or presented gender-stratified models. The sample size, age distribution and proportion of females in the model development cohorts were summarized.

Results:
Out of 579 CPMs with CVD as either an index condition or outcome, 169 (29%) contained a coefficient for gender and 33 (6%) presented gender-stratified models. Gender was more frequently included as a covariate or stratification variable in models predicting incident CVD versus prognosis for patients with known CVD. Gender was included in 60/74 (81%) models predicting morbidity and/or mortality among a population sample, yet in only 9/53 (17%) of models predicting morbidity and/or mortality among patients with stroke, and 9/53 (17%) of models predicting mortality among patients with congestive heart failure. Gender was more likely to be included in CPMs developed from cohorts with larger sample sizes (150/299 cohorts with n≥2000 versus 54/277 cohorts with n<2000, p<0.001). For each 10% increase in the proportion of women in the model development cohort, there was a 22% increased odds of including gender in the CPM (OR = 1.22, 95% CI 1.08-1.39, p=0.002).

Conclusions:
Gender is an important prognostic factor in CVD, but is only included in about one third of published CPMs. Gender is much more frequently included as a predictor of incident CVD among the disease-free than of prognosis in those with established CVD.
Abstract 168: The ADHERE Risk Model for In-hospital Worsening Heart Failure
Authors: DeVore Adam D , Greiner Melissa A , Sharma Puza P , Qualls Laura G , Schulte Philip J , Cooper Lauren B , Mentz Robert J , Pang Peter S , Fonarow Gregg C , Curtis Lesley H , Hernandez Adrian F
Published: March 2022

Background:
A subset of patients hospitalized with acute heart failure (HF) experience in-hospital worsening heart failure (WHF), defined as persistent or worsening signs or symptoms requiring an escalation of therapy. These patients are at increased risk for mortality and readmission resulting in increased costs, yet predictors for the development of WHF remain poorly characterized and an in-hospital WHF risk model has not been derived and validated.

Methods:
We analyzed data from the Acute Decompensated Heart Failure National Registry (ADHERE) linked to Medicare claims to develop and validate a risk model for in-hospital WHF. Based on previous work, in-hospital WHF was defined by any of the following: use of inotropes or vasodilators >12 hours after admission; initiation of mechanical circulatory support, hemodialysis, or ventilation after the first inpatient day; or transfer to an intensive care unit. We considered candidate risk prediction variables routinely assessed on admission including age, medical history, biomarkers and renal function. Logistic regression with robust standard errors was used to generate a risk model for in-hospital WHF in a 66% random derivation sample; the model was validated in the remaining 34% sample. We evaluated the calibration and discrimination of the model in both samples.

Results:
We evaluated 23,696 patients hospitalized with acute HF. Baseline characteristics were well-matched in the derivation and validation samples. The mean age was 81 years (standard deviation [SD] 7.7), mean systolic BP was 145 mm Hg (SD 29.8), and mean creatinine was 1.5 mg/dL (SD 0.9). The occurrence of in-hospital WHF was similar in the derivation, 15.4% (2403 of 15,640), and validation samples, 15.6% (1257 of 8056). After multivariable adjustment, the strongest predictors of in-hospital WHF were positive admission troponin and admission creatinine (Table). The model was well-calibrated. The risk model had strong discrimination in the derivation (c statistic=0.74) and validation samples (c statistic=0.72).

Conclusion:
The ADHERE WHF risk model is a validated clinical tool with good discrimination for use in hospitalized acute HF patients to identify patients at risk for in-hospital WHF. This tool may be useful to target treatment strategies for patients at high risk for in-hospital WHF.
Abstract 169: Contemporary Trends in Utilization and Outcomes of Percutaneous Ventricular Assist Devices in Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction in the United States
Authors: Gupta Tanush , Harikrishnan Prakash , Kolte Dhaval , Khera Sahil , Aronow Wilbert S , Mujib Marjan , Palaniswamy Chandrasekar , Jain Diwakar , Ahmed Ali , Lanier Gregg M , Cooper Howard A , Fonarow Gregg C , Gass Alan , Panza Julio A
Published: March 2022

Background:
Percutaneous ventricular assist devices (pVAD) can be rapidly deployed in cardiac catheterization laboratory and have emerged as an effective modality for short-term hemodynamic support in patients with cardiogenic shock. There are limited data on contemporary trends in utilization and outcomes of pVAD in patients with cardiogenic shock complicating ST-elevation myocardial infarction (STEMI).

Objectives:
To determine the temporal trends in utilization and outcomes of pVAD in patients with cardiogenic shock complicating STEMI.

Methods:
We queried the 2007-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥ 18 years with STEMI and cardiogenic shock. Patients who underwent pVAD implantation were then identified using ICD-9 procedure code 37.68. Temporal trends in utilization of pVAD in STEMI patients with cardiogenic shock and in-hospital outcomes in these patients were analyzed.

Results:
From 2007-2011, of 1,053,161 patients with STEMI, 100,881 (9.6%) had cardiogenic shock. The in-hospital mortality in patients with cardiogenic shock decreased from 39.2% in 2007 to 33.9% in 2011 (P
trend
<0.001, adjusted OR [per year] 0.98, 95% CI 0.97-0.99). Of the STEMI patients with cardiogenic shock, a total of 1,068 (1.1%) patients underwent pVAD implantation. The use of pVAD in STEMI patients with cardiogenic shock increased from 0.1% in 2007 to 2.6% in 2011 (P
trend
<0.001). The incidence of acute cerebrovascular accident in patients with pVAD was 6.7% with no significant temporal change in incidence (P
trend
=0.99). The incidence of acute gastrointestinal bleeding in these patients was 14.3% with no significant temporal change in incidence (P
trend
=0.52). The overall in-hospital mortality in patients who received pVAD was 49.6% with an increase in in-hospital mortality during the study period (P
trend
=0.03, adjusted OR [per year] 1.22, 95% CI 1.02-1.47). The average length of stay in these patients increased from 12 days to 15 days (P
trend
<0.001), whereas the average total hospital charges increased from $180,849 to $361,050 (P
trend
<0.001).

Conclusion:
In recent years, there has been an increase in utilization of pVAD in patients with cardiogenic shock complicating STEMI. However, this trend was not accompanied with a decrease in overall in-hospital mortality among patients who underwent pVAD implantation. There were also adverse temporal trends in the average length of stay and average hospital cost in STEMI patients with cardiogenic shock undergoing pVAD implantation.
Abstract 17: The Use of Thrombolysis among Acute Ischemic Stroke Patients with Limited English Proficiency
Authors: Mejia Nicte , Siddiqui Khawja A , Erfe Betty , Schwamm Lee
Published: March 2022

Background:
Over 17.2% of the U.S. population primarily speaks a language other than English at home. Limited-English proficiency (LEP) may negatively impact patients, yet its influence on stroke patients’ receipt of thrombolysis remains unknown.

Objectives:
To evaluate the influence of LEP on acute ischemic stroke patients’ receipt of thrombolysis.

Methods:
We analyzed data from 3,894 acute ischemic stroke patients who participated in “Get With The Guidelines - Stroke” at Massachusetts General Hospital 1/1/2003-4/30/2014. Information included patients’ language in which they preferred to receive medical care; those who identified a language other than English were considered to have LEP. We performed descriptive statistics and stepwise logistic regression models to examine associations between patients’ LEP status and the use of IV tPA, adjusting for relevant covariates.

Results:
A total of 307/3894 (9.3%) acute ischemic stroke patients met LEP criteria, representing 25 different languages [Table 1]. Multivariable analyses showed that patients with LEP were more likely than English-speaking patients to receive IV tPA when adjusting for socioeconomic factors (OR=1.64, CI=1.09-2.48, p=0.02). Models that also incorporated patients’ age, sex, and initial NIHSS did not find a statistically-significant effect for LEP on patients’ receipt of IV tPA but highlighted that patients’ NIHSS seemed to be the driving force of IV tPA receipt (OR=1.15; CI=1.13-1.16; p<0.001) [Table 2].

Conclusion:
Contrary to our hypothesis, acute ischemic stroke patients with LEP were more likely to receive IV tPA than English-speaking patients; this seemed to be driven by their worse stroke severity.
Abstract 173: Regional Variation in Cardiac Rehabilitation Participation within the Medicare and Veterans Health Administration Populations
Authors: Beatty Alexis L , Schopfer David W , Ho P M , Fortney John C , Whooley Mary A
Published: March 2022

Introduction:
Cardiac rehabilitation is a guideline-recommended therapy for patients after acute myocardial infarction (MI), percutaneous coronary intervention (PCI), and coronary artery bypass surgery (CABG). However, participation in cardiac rehabilitation is notoriously poor. Evaluating variation in health care delivery can help to identify best practices that improve quality of care more broadly. Therefore, we sought to examine regional variation in the percent of patients who participate in cardiac rehabilitation across the United States.

Methods:
We used ICD-9 codes from Medicare and Veterans Health Administration (VHA) data to identify patients hospitalized for MI, PCI, or CABG between 1/1/2007 and 12/31/2009 (in a 5% Medicare sample) or 10/1/2006 and 9/30/2011 (in VHA). After excluding patients who died within 30 days of hospitalization, we calculated the percent of patients who participated in one or more outpatient visits for cardiac rehabilitation (CPT code 93797 or 93798) during the 12 months after hospitalization. We then compared the percent of patients who participated in cardiac rehabilitation by state. Hawaii and Alaska were excluded from the analysis because they do not have VHA inpatient facilities.

Results:
Overall participation in cardiac rehabilitation was 20% (13,435/67,115) in Medicare and 8% (3,955/47,051) in VHA. Similar regional variation was observed, with the North-Central United States having the highest participation in both health care systems (Figure). Within Medicare, participation in cardiac rehabilitation ranged from 10% (Nevada) to 52% (Nebraska). Within VHA, participation ranged from 0 (Delaware, New Jersey) to 30% (Nebraska).

Conclusion:
Similar regional variation in participation in cardiac rehabilitation was observed in two separate health care systems. Nebraska had the highest rate of participation in both Medicare and VHA populations. Further study of reasons for regional variation and differences in regional variation in these populations may reveal opportunities for improving delivery of cardiac rehabilitation.
Abstract 179: Trends in Pericarditis Admissions, Outcomes and Costs, 1999- 2012: A National Healthcare Utilization Analysis
Authors: Mody Purav , Wang Yun , Krumholz Harlan
Published: March 2022

Background:
Healthcare burden associated with pericarditis is currently not known. The last decade has marked multiple advancements in the management of pericarditis and the impact of this emerging evidence on outcomes such as readmissions, mortality and costs associated with pericarditis is lacking.

Methods:
The Inpatient Medicare data from 1999 to 2012 were used to determine trends in hospitalization, readmission, mortality rates and costs associated with pericarditis. Patients aged ≥ 65 years who had a primary discharge diagnosis of acute pericarditis (ICD-9-CM codes 429.90 or 429.91 or 429.99) from 1999 to 2012 were including in the analysis. We linked the inpatient data with the Medicare denominator file to report hospitalization rates per one hundred thousand person-years. Mortality and readmission rates were ascertained through corresponding vital status and inpatient files.

Results:
A total of 45, 504 hospitalizations for pericarditis through the study were identified. The hospitalization rate for pericarditis decreased from 15 in 1999 to 9 per 100,000 person-years in 2012. Hospitalization rates for pericarditis decreased across all age, sex and race subgroups through the study period, with consistently higher rates among those aged 75-84 years and whites. No sex differences in hospitalizations were noted. The length of stay decreased from 6 (SD=6.2) days in 1999 to 5.2 (SD=5.3) days in 2012. The 30-day mortality decreased from 7.9% (95% Confidence interval [CI], 7.11% - 8.85%) in 1999 to 4.8% (95% CI, 4.00% - 5.76%) in 2012 and 1-year mortality slightly decreased from 20.1% (95% CI, 18.9 % - 21.4%) in 1999 to 18.1% (95% CI, 16.6-19.7) in 2011 respectively. The 30-day readmission rate increased marginally from 18.5% (95% CI, 17.2% - 19.9%) in 1999 compared with 20.5% (95% CI, 18.8% - 22.2%) in 2012. The CPI-adjusted cost per hospitalization increased slightly, from $11,649 in 1999 to $12,582 in 2012.

Conclusion:
Hospitalization for pericarditis is relatively uncommon. Although mortality rates associated with pericarditis have improved, mortality and readmission rates continue to remain high. These findings support a need to identify factors associated with high mortality and readmission rates.
Abstract 183: In Patients Evaluated for Chest Pain or Dyspnea, Right Bundle Branch Block and/or Right Ventricular Dysfunction Are Associated With Inferior Long Term Outcomes Independent of Stress Test Results
Authors: Yager Neil , Badr Salem , Zhang Lulu , Ramineni Tina , Torosoff Mikhail
Published: March 2022

Background:
Association between right bundle branch block (RBBB) and/or right ventricular (RV) dysfunction or dilation and outcomes in patients evaluated with stress testing are not well investigated.

Methods:
Records of 404 consecutive patients referred for chest pain or dyspnea evaluation with stress echocardiogram at a single tertiary care center were reviewed. In 140 patients, baseline echocardiogram included assessment of RV dimensions and function. Demographic, clinical data, and outcomes were collected. ANOVA, chi-square, and logistic regression analyses were used. Mean follow up length was 76+/-18 months. Study was approved by the IRB.

Results:
Demographic data and co-morbidities, including DM, CAD, HTN and PVD, were similar in patients with RBBB and/or RV dilation or dysfunction.

Baseline, pre-stress RV dysfunction or dilatation were associated with an approximate fourfold increase in mortality during follow up, regardless of stress test outcome (44% vs. 11%, p=0.0052). Ischemia during stress test was also more likely in patients with RV dysfunction or dilatation (44% vs. 15%, p=0.019).

In patients with RV dilatation and/or dysfunction, RBBB on baseline ECG was noted in 33% vs. 8% in patients with normal RV size and function (p = 0.0159). However, baseline RBBB was not associated with increased mortality, ability to reach THR, or ischemia during stress test.

Conclusions:
RV dilation and/or dysfunction pre-stress testing was associated with increased mortality and ischemia on stress testing. Observed in 1/3 of our study patients RV dilatation and/or dysfunction, RBBB was not associated with worst outcomes. Additional studies investigating utility of pre-stress echocardiogram in assessment of RV dimensions and function are warranted.
Abstract 203: Community Based Outpatient Stroke Rehabilitation Program Achieves Excellent Outcomes Including Return to Work, Driving, Improved Blood Pressure Control, and Other Rehabilitation Outcomes
Authors: Breen Joan , Andrusin Jeanne , Ferlito Tom , Tucker Anne , Hutchins Shelby , Pollard John
Published: March 2022

Background:
Return to Driving and Employment are goals for many stroke survivors. These person-centered goals are often the motivators for participation in outpatient rehabilitation. However, standardized measure sets and patient assessments are not in place or required for outpatient rehabilitation programs. As such, few outpatient rehabilitation programs measure and report patient centered outcomes like return to work or employment in addition to functional status and disease management measures.

Methods:
Prospective observational study of recovery of stroke patients treated between 12/2011-1/2015 in an interdisciplinary outpatient rehabilitation program that addresses health literacy, risk factors, physical, psychosocial, cognitive, communicative and vocational issues.

Results:
Among 96 consecutive patients (69 ischemic, 27 hemorrhages), with admit NIHSS scores 0-16, there were 59 men, 37 women, with an age range of 18-90 years. At baseline(admission to the outpatient program), 36.5% were aphasic(communication impairment), 88% had impairments and needed assistance with activities of daily living (55% and 33% with modified Rankin Scale [mRS] Scores of 3 and 4, respectively), compared with mild impairments (12%mRS 1-2). Of 46 patients working pre-stroke, 48% had returned to work and an additional 13% were work capable at discharge. Of 86 patients driving pre-stroke, 38% returned to driving at completion of the program and 27% began using public transportation. Stroke Impact Scale (SIS) stroke recovery Domain scores increased an average of 38%, SIS ADL scores 33%, SIS mood scores 17%. Cardiovascular and medication education sessions with the Nurse Practitioner(NP) were based on AHA guidelines that included Life’s Simple 7’s curriculum. Stroke Knowledge scores improved an average of 14% and stroke risk factor knowledge improved an average of 19% across program participants. Program treatment also emphasized blood pressure control and exercise, with all but 1 patient receiving an average of 23 physical therapy visits over the duration of program involvement. Compared with baseline, 6 minute walk and Berg Balance scores improved an average of 79% and 33%, respectively. Blood pressures(BPs) measured during the 1st 75% of PT visits were compared to BPs during the last 25%. 56% of patients had fewer moderate(140-159/91-99) to severe(>160/100) BPs and more normal(<120/80) to mild (121-139/81-90) range BPs. 15% had no change in mild-normal range and 29% had some worsening of BPs over the course of PT treatment.

Conclusions:
Participants in our interdisciplinary community-based rehabilitation program demonstrated improvements in stroke knowledge, physical function, blood pressure control, and mood, while also returning to work, driving, and participation in the community. Comparative research and multi-site studies are needed.
Abstract 212: Evaluation of Written Materials for Patient Handoffs on an Inpatient Cardiology Service
Authors: Buggey Jonathan , Doll Jacob , Wyrembak Joanne , Seidelman Jessica , Ward Cary C
Published: March 2022

Background/Aims:
Transferring responsibility of patient care (handoff) is an increasingly frequent occurrence in hospitals, with the potential for errors leading to adverse outcomes. Written patient summaries are commonly used to facilitate information transmission during handoff and may be integrated into the electronic health record. No prior studies have examined cardiology-specific handoff practices or assessed differences in handoff needs by provider class. We aimed to evaluate the elements of written handoff requested and provided by clinicians on a large academic inpatient cardiology service.

Methods:
We performed an online survey of resident, fellow, nurse practitioner (NP), physician assistant (PA), and attending physician providers. Providers selected requested elements of written handoff from a list of 31 potential elements. An ANOVA was used to compare the difference in the mean number of requested elements between provider groups. Subsequently, we audited written handoff materials for inclusion of commonly requested elements.

Results:
Of 161 invitations there were 95 responses (59% response rate) including 38 residents, 26 fellows, 20 attending physicians, and 11 NP/PAs. The
Figure
shows the frequency of the top 10 most requested elements of all providers. Compared with residents (mean 18.4), significantly fewer elements were requested by fellows (13.5), NP/PAs (13.5), and attending physicians (13.2) (p<0.05 for each comparison). Audit of 661 written handoffs identified rate of inclusion of 6 requested elements: admitting diagnosis, 92% (610 of 661); general hospital course/events of last shift, 70% (464 of 661); tasks to complete, 69% (455 of 661); ejection fraction, 52% (346 of 661); anticipatory guidance, 32% (212 of 661); and the overall health status, 14% (92 of 661).

Conclusions:
We identified elements of written handoff commonly requested by cardiology providers in a large academic hospital. Residents request more written information than other providers. On review of clinical materials, we found even the most frequently requested elements were often omitted. These data provide the rationale for a standardized cardiology written handoff to include conserved requested elements.
Abstract 215: Validation of a Simple White-light 3D Body Volume Scanner to Assess Body Composition
Authors: Medina-Inojosa Jose R , Somers Virend , Jenkins Sarah , Zundel Jennifer , Johnson Lynne , Jean Nathalie , Lopez-Jimenez Francisco
Published: March 2022

Introduction:
Estimating body fat content has shown to better predict adiposity-related cardiovascular risk than the commonly used body mass index (BMI). The white-light 3D Body Volume Index Scanner (BVI) is a non-invasive device normally used in the clothing industry to asses body shapes and sizes. We assessed the hypothesis that volume obtained by BVI is comparable to the volume obtained by air displacement plethysmography (BodPod) (COSMED Concord, CA, USA) and thus capable of assessing body fat mass using the bicompartmental principles of body composition.

Methods:
We compared BVI to BodPod, a validated bicompartmental method to assess body fat percent that uses pressure/volume relationships in isothermal conditions to estimate body volume. Volume is then used to calculate body density (BD) applying the formula density= Body mass/Volume. Body fat mass percentage is then calculated using the Siri formula (4.95/BD – 4.50) х 100.

Subjects were members of the Mayo Clinic Dan Abraham Healthy Living Center undergoing a wellness evaluation. Measurements from both devices were obtained the same day. A prediction model for total BodPod volume was developed using linear regression based on 80% of the observations (N=971), as follows: Predicted BodPod Volume (L) = 9.498 + 0.805*(BVI volume, L) - 0.0411*(Age, years) - 3.295*(Male=0, Female=1) + 0.0554*(BVI volume, L)*(Male=0, Female=1) + 0.0282*(Age, years)*(Male=0, Female=1). Predictions for BodPod volume based on the estimated model were then calculated for the remaining 20% (N=243) and compared to the volume measured by the BodPod.

Results:
Mean (SEM) age was 41.5(0.41) years, 39.4% were men, weight 81.6(0.67) kg, BMI was 27.8 (0.20) kg/m2. Average difference between volume measured by BodPod- predicted volume by BVI was 0.0 L, median: -0.4 L, IQR: -1.8 L to 1.5 L. Average difference between Body fat % measured - predicted was -1%, median: -2.7%, IQR: -13.2 to 9.9, R2 = 0.9845 (Figure 1-A, B).

Conclusion:
Body fat mass can be estimated using volume measurements obtained by a white- light 3D body scanner (Figure 1-A).
Abstract 228: Heart Failure Self-management: Engaging Social Networks in Symptom Evaluation
Authors: Reeder K M , Sims Jessica L , Shetty Shivan S , Craddock Heidi E , Wallendorf Mike
Published: March 2022

Aims:
The aim of this project was to describe patient perceptions of seeking lay advice in symptom evaluation prior to hospitalization for acute decompensated heart failure.

Methods:
Semi-structured interviews were conducted with 90 patients hospitalized for acute decompensated heart failure. Frequencies and Chi-square tests were used to characterize patient perceptions of lay consultations for symptom evaluation before hospitalization.

Results:
Seventy-five (83.3%) patients consulted persons in their social networks about symptoms before hospitalization. Forty-six (52.3%) patients received symptom attributions from their lay consultants, and most often lay consultants identified cardiac causes for patients’ symptoms (n=35, 76.1%). Sixty-six (76.7%) patients received advice about what to do for symptoms; most often that advice was to seek medical care (n=55, 83.3%). Lay consultants who identified causes for patients’ symptoms more often gave advice on what to do about symptoms than those consultants who did not provide symptom attributions (95.7% vs. 75.0%, p<.0008). Overall, women consulted with adult children about their symptoms significantly more often than men (48.0% vs. 8%, p≤.0001). Among patients who were married, women (vs. men) more frequently consulted with adult children about symptoms (50% vs. 6.45%, p=.001). No other gender differences were found.

Conclusions:
Heart failure self-management is complex, and this study is a first step toward understanding how patients, with contributions from their lay consultants evaluate and manage their symptoms beyond the walls of acute care hospital environments. Findings have implications for designing community-based self-care interventions and effectively reducing re-hospitalizations.
Abstract 23: Temporal Trends in Percutaneous Coronary Intervention Appropriateness: Insights from the Clinical Outcomes Assessment Program
Authors: Bradley Steven M , Bohn Chad , Malenka David J , Graham Michelle M , Bryson Chris L , McCabe James M , Curtis Jeptha P , Lambert-Kerzner Anne , Maynard Charles
Published: March 2022

Background:
It is unknown if the appropriate use of percutaneous coronary intervention (PCI) has improved over time and whether trends in PCI appropriateness have been accompanied by changes in the rate of PCI use.

Methods:
We applied 2012 Appropriate Use Criteria to determine the appropriateness of all 51,872 PCI performed in Washington State from 2010 through 2013. PCI procedural rates were studied from 2006 through 2013 to provide a comparator period that preceded statewide appropriateness assessment beginning in 2010. Procedural appropriateness and rates of use were determined separately for acute (ST segment elevation myocardial infarction, non-ST segment myocardial infarction, unstable angina) and elective (stable angina) indications.

Results:
Between 2010 and 2013, the overall rate of PCI decreased by 6.8% (13,267 PCI in 2010 to 12,193 in 2013) with a 43% decline in the rate of PCI for elective indications (3,818 PCI in 2010 to 2,193 PCI in 2013) (Figure). The rate of decline in elective PCI procedures was significantly larger following the onset of statewide PCI appropriateness assessment in 2010 (P = 0.03). The proportion of PCI for acute indications classified as appropriate remained >92% throughout the study period. The proportion of elective PCI classified as appropriate increased from 26% in 2010 to 38% in 2013 while the proportion of inappropriate PCI decreased from 16% to 13% (P<0.001 for trends) (Table). Improvements in the rate of inappropriate PCI were limited to the tertile of hospitals with the largest decline in PCI classified as inappropriate (25% in 2010 to 12% in 2013; P=0.03).

Conclusions:
In Washington State, the use of PCI for non-acute indications has decreased over time with concurrent improvements in PCI appropriateness. However, improvements in PCI appropriateness were limited to a minority of hospitals. Understanding processes at these high-performing hospitals may inform efforts to improve PCI appropriateness.
Abstract 231: Impact of Insurance Type on Initial Rejection Requiring Hospitalization Post Orthotopic Heart Transplant
Authors: Breathett Khadijah , Willis Shannon , Foraker Randi , Smith Sakima
Published: March 2022

Background:
Rejection is one of the largest causes of morbidity and mortality early post heart transplant. Patient selection is made to help reduce this risk. We hypothesized that comorbid diseases and socioeconomic status (SES) would lead to earlier readmission post heart transplant.

Methods:
We retrospectively evaluated 188 patients who underwent orthotopic heart transplant between 7/1999- 11/2013 at our facility. All patients were followed until 9/2014 for rejection hospitalizations and death. Multivariable analysis with adjustment for median household income (MHI), insurance status, age, gender, and race was performed.

Results:
Medicaid insurance is a significant predictor for time to readmission post heart transplant compared to Non-Medicaid insurance (NMI) [Hazard Ratio (HR) 1.78, p= 0.047]. MHI was not a predictor (HR 1.04, p=0.835). After adjusting for SES, diabetes mellitus (DM) alone remained a significant independent predictor for time to first hospitalization for rejection (HR 3.47, p=0.001). In univariable analysis, race and hypertension approach significance as factors associated with time to first hospitalization respectively (HR 0.057, p=0.09; HR 1.97, p=0.08). SES and comorbidities did not impact time to death post transplant.

Conclusions:
Medicaid insurance was a significant predictor of time to first hospitalization for rejection, further raised in diabetics. This suggests that immunosuppression medications especially in diabetics require heightened attention.
Abstract 235: Impact of Short-term Anticoagulant Use on the Risk of Recurrent Venous Thromboembolism: Evidence From Insurance Claims in the United States
Authors: Merli Geno , Li Qian , Kumar Raut Monika , Damaraju CV , Chitnis Abhishek , Chen Sharon , Schein Jeff , Bookhart Brahim
Published: March 2022

Background:
Duration of oral anticoagulant therapy for venous thromboembolism (VTE) is debatable. Moreover, literature shows that approximately 12% of the VTE patients discontinue warfarin therapy within 3 months and 63% discontinue within 1 year.

Aim:
To assess the real world impact of short term use of anticoagulants on the risk of recurrent VTE in the United States.

Methods:
Retrospective analyses of a large national claims dataset from 01/01/2007 to 12/31/2011 were conducted. Adult patients who had at least 3 months of continuous anticoagulant use (vitamin K antagonist or low molecular weight heparin) following an incident VTE were selected. Time to recurrent VTE after anticoagulant discontinuation was assessed using Cox proportional hazard regressions, adjusting for baseline characteristics. Subgroup analyses were conducted in unprovoked VTE, provoked VTE, and VTE patients with cancer.

Results:
We identified 31,906 patients with incident VTE. Within 1 year after the incident VTE, therapy was discontinued among 75.4% of the patients, with an average of 6 months of treatment. Patients with treatment discontinuation were younger than those without (mean age: 57 vs. 60 years), more likely to be females (51% vs. 46%) and had more co-morbidities (all P<0.05). The adjusted rate of recurrent VTE was 94% higher in patients with treatment discontinuation than in those without (hazard ratio [HR] = 1.9, 95% CI: 1.5-2.5). The higher rate of recurrent VTE associated with anticoagulant discontinuation was observed regardless of the timing of discontinuation (discontinued in 3-6, 6-9, or 9-12 months after incident VTE). The HR was found to be similar in the subgroups.

Conclusion:
Even after 3 months of anticoagulant treatment, the patients remained at high risk for recurrent VTE once the treatment was stopped by the physician or discontinued by the patient. Thus, longer-term use of anticoagulants may be warranted to prevent recurrent VTE.