bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 248: Developing a Specialty Specific Interventional Physician Dashboard
Authors: Lawson William E , Wilbert Lisa , Gumersell Kellie , Okere Arthur , Sokoloff Lisa , Santora Carolyn
Published: March 2022

Background:
Personalized benchmarking of practice is assuming increasing importance to assure patient safety and quality, cost-effective care. Comparing performance with national and local benchmarks has value for providing feedback and opportunity for continued practice improvement to the practitioner. From a hospital and practice perspective it can be used to identify outliers and potential concerns (either system or attributable to the individual) as well as its potential uses to reduce variance, validate care, and support “value purchasing” and managed care participation.

Objectives:
With the input of physicians, hospital administration, and CQI personnel, a tool was developed to allow assessment of individual and aggregate physician performance. The developed tool was developed to meet both personal and institutional objectives. It had to be timely, standardized, and accurate, with available national or institutional benchmarks. Both process and outcome indicators were felt to be appropriate for inclusion. Mandated, validated and relevant data collection was given preference for inclusion (ranked in order of preference: NYS DOH angioplasty data base, NCDR data, in-house non reported data) and objective hard outcomes were given preference over more subjectively collected information. A rolling 4 quarters of data was included for statistically infrequent events to minimize outliers due to sample inadequacy. In addition to tracking process and outcome metrics, utilization was also felt to be appropriate for inclusion. The developed tool incorporated data from multiple data sets with different validation turn around times, which resulted in different reporting time intervals. A total of 38 measures were collected including : mortality, major comorbidity, quality and utilization concerns. Measures deviating from benchmarks or demonstrating substantial variance were targeted for drill down and intervention to improve care.

Results:
A physician dashboard was developed and applied to 18 interventionalists, permitting benchmarking of individual and overall lab performance in meeting defined process, outcome and volume metrics. The dashboard facilitates individual and system benchmarking of performance, identifies areas of concerns, provides physician feedback, and promotes process improvement. Results are highlighted in green (goal met) or red (goal not met) for rapid assessment. The developed dashboard will be displayed.

Conclusions:
A dashboard was created to provide timely, rapid, visible assessment of comparative physician performance. The developed tool has proven useful to both hospital administration and physicians in monitoring and improving performance. The dashboard continues to evolve with continued periodic modifications addressing specific goals and concerns.
Abstract 26: Retirement of a Quality Measure: The Case of Beta Blocker Use After Myocardial Infarction
Authors: Lewey Jennifer , Choudhry Niteesh K
Published: March 2022

Background:
Quality measures are increasingly used as a basis for targeting intervention and structuring compensation. Their use has lead to substantial improvements in care for acute myocardial infarction (AMI) and congestive heart failure. Because of these improvements, many cardiovascular quality metrics are slated for retirement in 2015. The consequences of removing external quality monitoring are unclear. We evaluated the National Committee for Quality Assurance (NCQA)’s retirement in 2007 of the measure for beta-blocker prescribing after AMI because of consistently high performance. This was one of the first quality measures to be retired.

Methods:
We used medical and pharmacy claims from a large national insurer from 2003-2013 to compare trends in the proportion of AMI patients who filled a beta blocker prescription within 7 days of discharge according to HEDIS specifications. The quality measure reporting period was 2003 through 2006 and the period after the measure was retired was 2007 through 2013. Pre and post trends were compared using interrupted time-series design with linear regression models.

Results:
From 2003-2013, we identified 25,648 patients with AMI eligible for beta blocker prescription. Overall 79.2% patients filled a beta-blocker within 7 days of discharge. Beta blocker prescription rates were improving at a rate of 0.28 percentage points per month during the quality measure reporting period. Retirement of the measure lead to a flattening of this trend and an abrupt 4.8 percentage point decrease in the proportion of patients discharged with a beta-blocker post-AMI (p < .001 for changes in level and slope). This decrease was highest for HMO/PPO enrollees (11.6% points, p < .001). Adjusting for baseline demographic and clinical factors attenuated the decrease in beta blocker prescription rates but did not eliminate the effect.

Conclusion:
We found that beta blocker use among post-AMI patients appears to be much lower than publically-reported national averages. Beta blocker fill rates increased during the period of NCQA quality measure reporting but decreased significantly after this measure was retired. This finding may have relevance to upcoming plans to remove external monitoring for other cardiovascular quality measures.
Abstract 276: Variation of Quality of Life Data Collection Across INTERMACS Sites
Authors: Gupta Bhanu P , Grady Kathleen , Fendler Tim , Jones Philip , Spertus John
Published: March 2022

Purpose:
To capture health-related quality of life (HRQOL) benefits and[[Unable to Display Character:  ]] risks of mechanical circulatory support (MCS), the INTERMACS registry expanded collection of HRQOL data to include the Kansas City[[Unable to Display Character:  ]] Cardiomyopathy Questionnaire (KCCQ) prior to and after MCS (beginning[[Unable to Display Character:  ]] 6/12). To better understand reasons for incomplete data collection, we examined patient- and site-associated factors.

Methods:
Descriptive analyses and hierarchical logistic regression were used to examine the frequency & site variability (median odds ratios [MOR]) for each reason for not collecting the KCCQ at baseline & at three months.

Results:
The KCCQ was not collected in 43.4% (2031 of 4682) (range across sites: 0-[[Unable to Display Character:  ]]100%) & 34.6% (1282 of 3702), (0-100%) of pts. at baseline and 3 months. The most common reason for incomplete KCCQ data at baseline was that the patient was too sick (14.4%) & consent was not obtained (12.2%); at 3 months,[[Unable to Display Character:  ]] the key reason was that the coordinator was too busy/forgot (12.4%). Variations across sites, on a logistic scale, reveal no significant variation[[Unable to Display Character:  ]] in those who were too sick at baseline, but significant variation [[Unable to Display Character:  ]]in all other reasons (Fig 1). Similarly, administrative reasons for incomplete data at three months were much more variable than patient-centered[[Unable to Display Character:  ]] reasons. If a mechanism were created for assigning KCCQ values to the “too sick” patients then the completion rates would be 71.0% at baseline and 69.1% at three months.[[Unable to Display Character:  ]]

Conclusion:
Sites vary substantially in the completeness of KCCQ data due to both patients and administrative reasons. However, the sources of missing data need to be considered in analyses; most importantly, sites need to increase commitment to complete data collection.
Abstract 277: Approaches to Missing Data Due to Illness Severity in Health-related Quality of Life Assessment
Authors: Grady Kathleen L , Jones Philip , Andrei Adin-Cristian , Naftel David C , Myers Susan , Dew Mary Amanda , Idrissi Katharine , Weidner Gerdi , Wissman Sherri , Kirklin James K , Spertus John
Published: March 2022

Objectives:
Measuring health-related quality of life (HRQOL) is challenging if data are missing. We sought to compare different methods for handling missing HRQOL data due to illness severity in heart failure patients (pts) before left ventricular assist device (LVAD) implantation.

Methods:
Adult pts from 123 institutions participating in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) had HRQOL measured with the EQ-5D-3L survey visual analog scale (VAS, 0=worst-100=best). Methods for handling missing VAS data were multiple imputation (MI) and inverse probability weighting (IPW), as well as “worst case” (WC) imputation of a score of 0 for missing data due to illness. We simulated missing data due to illness severity and compared estimated vs. actual VAS scores. All methods were then applied to the actual data and compared to observed scores.

Results:
Between 5/3/12-3/31/14, 2116 pts with INTERMACS profile 1 or 2 underwent implantation of a continuous flow LVAD implant. Before surgery, 51% (n=1085) completed the EQ-5D-3L VAS, and 21% (n=446) did not complete it due to illness severity (28% did not complete it due to other pt/administrative reasons and were excluded). Among completers simulated to have missing data due to illness severity, both MI- and IPW-estimated VAS closely matched actual VAS scores (MI: 41.4±25.9, IPW: 41.3±25.7, actual: 41.4±25.9). MI and IPW yielded approximately 1.5-point lower mean VAS scores than observed data (table). With WC imputation, the mean VAS was lower.

Conclusions:
MI and IPW are acceptable methods for generating imputed scores for pts with data missing at random and may be acceptable for generating imputed scores for pts with missing data due to illness severity, although unmeasured biases may still exist. WC imputation may underestimate the true HRQOL for a given pt, but accounts for higher levels of acuity. Sensitivity analyses on mechanisms of missing data may further elucidate this vexing issue.
Abstract 279: Troponin Testing in the Emergency Setting: Analysis of Appropriateness
Authors: Ehteshami Afshar Arash , Sabharwal Manpreet Singh , Casso Dominguez Abel Antonio , Dianati Maleki Neda , Tamis-Holland Jacqueline E , El Hayek Georges , Palazzo Angela
Published: March 2022

Background:
Troponin levels are routinely tested and trended in emergency departments even in the absence of clinical suspicion for Acute Coronary Syndrome. This can result in increased utilization of resources. We examined the rates at which troponin assays were drawn on admission to the medical service of our hospital and the appropriate use fo this assay.

Methods:
Consecutive patients admitted to the medical wards of our hospital over a one month period for which a Troponin level was obtained within 8 hours of arrival were prospectively identified. Baseline demographic and clinic characteristics and information regarding the admitting diagnosis were obtained through a detailed chart review. Cardiology testing or consults that were obtained soley for evaluation of an abnormal troponin were recorded. We defined an inappropriate troponin test (IT) as one that was drawn in the absence of a clear reason including, ischemic like symptoms (chest pain, epigastric pain, upper back pain, jaw pain or left shoulder/arm pain), unexplained shortness of breath, new ECG changes, syncope, arrhythmia or CHF.

Results:
Among 142 patients identified, 47 (33%) had IT. These patients were 61.9 ± 19.3 years of age (range 19-102 years), and 18 (38.3%) were female. Admitting diagnoses for those patients who had IT included the following: Altered mental status 8 (17%); Sepsis/Infection 8 (17%); Weakness 6 (12.8%); Other GI symptoms 5 (10.6%); GI Bleeding 2 (4.3%); Other miscellanous diagnosis 18 (38.3%). Table 1 depicts the characteristics of these patients.

Conclusion:
Significant number of patients admitted with non-cardiac diagnoses have Troponin assays drawn for unapparent reasons; This IT assay rarely results in the identification of a new cardiac diagnosis. In the long term, these IT can result in a significant and unnecessary increased utilization of hospital resources.
Abstract 282: Clinical Outcomes and In-hospital Cost of Care After Resuscitation From Cardiac Arrest: Insights From the US National Inpatient Sample 2008 to 2012
Authors: Damluji Abdulla , Al-Damluji Mohammed S , Moscucci Mauro , Cohen Mauricio G , Mitrani Raul D , Myerburg Robert J
Published: March 2022

Introduction:
Cardiac arrest remains a major public health problem that requires study with a focus on improved outcomes and cost-effective care. The aim of this study was to examine clinical outcomes and health care cost associated with hospitalization after cardiac arrest in the United States from 2008-2012.

Methods:
Clinical outcomes, including mortality and health care cost, were examined using the US National Inpatient Sample from 2008 to 2012. The International Classification of Diseases, 9th Edition, code 427.5 was used to identify patients with cardiac arrest. Total health care cost was the primary outcome of interest. We used student-t and x2 tests for comparisons. Univariable and multivariable analyses were used to evaluate the effects of clinical characteristics and medical procedures on health care cost for patients after resuscitation from cardiac arrest.

Results:
An estimated 751, 873 patients were admitted with the diagnosis of cardiac arrest. The mean age of the study population was 67 years, 45% were female, and 68% were Caucasians. Hypertension and fluid/electrolyte disorders were observed in approximately 46% of the population. Patients with > 2 comorbidities increased overtime (2008: 51% vs. 2012: 59%, p <0.001). The inpatient procedures performed on the study group were intubation (51%), coronary angiography (16%), and PTCA (8%). The rates of therapeutic hypothermia increased steadily overtime (2008: 0.6% vs. 2012: 2.8%, p <0.001). The mean in-hospital mortality was 60%, with a mean length of stay of 9 days. In a multivariable analysis, age was negatively associated with cost (Estimate: -692, CI -708 to -550, p < 0.001). Factors that were associated with increased health cost were increasing length of stay, coronary angiography or PTCA, and therapeutic hypothermia. Adjusting for clinical variables, the health care cost increased overtime (Figure).

Conclusion:
This study found an improved post-resuscitation mortality rates compared to prior decades. Further, this survival was associated with a significant steady increase in post-arrest hospital cost, likely related to increased length of stay, medical procedures, and systems of care. The figures do not include additional post-hospital costs that continue to accrue over time.
Abstract 283: Association of Body Mass Index with Outcomes in Patients with Atrial Fibrillation: Results From the ORBIT-AF Registry
Authors: Pandey Ambarish , Gersh Bernard , McGuire Darren , Shrader Peter , Thomas Laine , Kowey Peter R , Mahaffey Kenneth W , Hylek Elaine , Sun Shining , Burton Paul , Piccini Jonathan , Peterson Eric , Fonarow Gregg
Published: March 2022

Introduction:
Higher body mass index (BMI) is an independent risk factor for incident atrial fibrillation (AF). However, its impact on management strategies and clinical outcomes among patients with prevalent AF is unclear.

Methods:
The study cohort included patients with AF enrolled in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry from June 2010 through August 2011. Participants with BMI > 18.5 kg/m2 were stratified into normal (18.5 - 25 kg/m2), overweight (25 - 30 kg/m2), Class I obese (30 - 35 kg/m2), Class II obese (35 - 40 kg/m2), and Class III obese (>40 kg/m2) categories. Unadjusted and adjusted Cox frailty models were constructed to assess the categorical and continuous association of BMI with AF progression, mortality, and incidence of thromboembolic events.

Results:
We evaluated 9,606 patients with AF (mean age: 74 + 11 years; 42% women) from 174 US ORBIT participating practices. Patients in the higher BMI categories were younger and had a higher prevalence of comorbidities such as diabetes, hypertension, and obstructive sleep apnea. AF symptom burden was greatest among patients in extreme BMI categories. Proportional use of anticoagulation, antiarrhythmic drugs, and invasive rhythm control strategies was significantly greater among patients in higher BMI categories. Rates for mortality and stroke/non-CNS embolism decreased in a near linear fashion across successively higher BMI categories (P<0.001; Table). After multivariable adjustment, higher BMI categories were associated with lower risk for mortality (p = 0.0002), with the lowest risk observed among overweight patients [Hazard Ratio (HR) (95% CI): 0.65 (0.54 - 0.79) ref. group: normal weight]. For every 5-kg/m2 increase in BMI, the odds of risk-adjusted mortality were 6% lower [HR (95% CI): 0.94 (0.89 - 0.98)]. In contrast, the association between BMI and risk for stroke/non-CNS embolism was significant on unadjusted analysis (P <0.001) but attenuated after adjustment for risk factors (P = 0.78; Table). No significant association was observed between BMI and AF progression rates in either unadjusted (P = 0.35) or adjusted analyses (P = 0.17).

Conclusion:
Among patients with AF, higher BMI was associated with a greater use of anticoagulation, rhythm control strategies, and lower mortality risk.
Abstract 302: Stroke Legislation Impacts Distribution of Certified Stroke Centers in the United States
Authors: Man Shumei , Schold Jesse , Katzan Irene L , Uchino Ken
Published: March 2022

Objectives:
The Joint Commission (JC) began certifying primary stroke centers (PSC) in 2003 to improve the stroke system of care. Several states passed legislation to designate PSCs and regulate emergent stroke triage. The number of PSCs have increased dramatically over the past decade in the U.S. We aimed to understand the factors affecting PSC distribution in the U.S, especially the impact of state stroke legislation.

Methods:
PSCs certified by national organization or state until December 2013 were searched from available databases. The proportion of PSC among short-term general hospitals in each state was calculated and factors affecting its distribution were analyzed.

Results:
By the end of 2013, the proportion of PSC varied from 4% to 100% among the 50 states and District of Columbia (Figure 1). The 18 states with stroke legislation had higher PSC percentages (median 43%, range 13-100%) than the remaining states (median 13%, range 4-75%, p<0.001). Multivariate logistic regression showed that state stroke legislation, urbanization, and larger hospital size independently increased the likelihood of a hospital to be stroke certified. Comparing to states with the lowest GDP (1st quintile), the hospitals in those states of higher GDP were more likely to be PSC certified in univariate analysis, but not in multivariate analysis after adjusting for stroke legislation, urbanization and census region. From 2009 to 2013, states with stroke legislation had greater increase of PSC percentages compared to the states without legislation (median increase of PSC percentage 16% vs 6%, p=0.0067). Among the 1505 stroke centers, 74% were certified by the Joint Commission, 20% by state, and 6% by other organizations. Stroke centers certified only by state were smaller in size by hospital bed count compared to those certified by the JC (median 204 vs 300 beds, IQR 117-339 vs 202-436 beds, p<0.001).

Conclusion:
State stroke legislation significantly increased the number of certified stroke centers in the United States, potentially improving accessibility of standardized care for patients with acute ischemic stroke.
Abstract 307: Gender Differences in Recurrent Cardiovascular Events Among High-risk Patients With Hyperlipidemia
Authors: Richhariya Akshara , Fox Kathleen M , Punekar Rajeshwari S , Gandra Shravanthi R , Fisher Maxine D , Cziraky Mark J , Toth Peter P
Published: March 2022

Background:
Hyperlipidemia is associated with increased risk of cardiovascular (CV) events, especially among adults with a history of cardiovascular disease (CVD). It is unclear whether the increased risk is similar between men and women.

Purpose:
This study evaluated the occurrence of subsequent cardiovascular events among high-risk patients with hyperlipidemia and a history of prior CV events who were enrolled in US health plans, stratified by gender.

Methods:
Patients (age 18-64) with a hyperlipidemia diagnosis or using lipid-lowering therapy (LLT) from 1/1/2007 to 12/31/2008, and a history of ≥ 1 CV events (myocardial infarction [MI], ischemic stroke [IS], unstable angina [UA], coronary artery bypass graft (CABG) or percutaneous coronary intervention [PCI]) in the 12 months prior to hyperlipidemia diagnosis or LLT use were selected from the large payer claims database (HealthCore Integrated Research Database
SM
). Patientswere followed until the end of study period (02/28/2013) or end of health plan eligibility or death (whichever occurred first). Incidence and time to subsequent CV events were calculated.

Results:
In the CV event history cohort (n=9890, mean age=55 years), 67% were men and 33% were women. A significantly greater proportion of women (44.6%) had ≥1 subsequent CV event compared with men (40.5%, p<0.0001), and women also had a greater proportion of ≥3 subsequent CV events (21.0% women vs. 17.8% men, p<0.0001). In patients with subsequent events, mean (SD) time to first subsequent CV event was significantly shorter for women [741 (541) days] than for men [810 (570) days], p<0.0001. This pattern of more recurrent CV events and shorter time to first subsequent CV event among women was observed for MI, UA, PCI, and heart failure (e.g. 48.3% of women and 37.7% of men had ≥1 MI, p<0.001 and time to first event was 836 (571) days for women versus 971 (599) days for men, p=0.001). There were no differences between women and men for stroke or TIA. Mean (SD) inpatient costs for patients with subsequent CV events did not differ by gender (e.g. for MI, $37,804 (104,478) for women versus $39,705 (81,914) for men, p=0.77).

Conclusions:
Among high-risk patients (i.e. history of CV events) enrolled in US health plans, women were more likely to have a subsequent CV event and multiple CV events sooner than men. Further research is needed to ascertain whether the gender differences might reflect differences in the intensity of treatment for hyperlipidemia between men and women.
Abstract 308: Predictors of Depression Recognition and Site Variability in Depression Recognition in Young AMI Survivors
Authors: Smolderen Kim , Spertus John , Gosch Kensey , Dreyer Rachel P , D'Onofrio Gail , Lichtman Judith H , Geda Mary , Beltrame John , Safdar Basmah , Krumholz Harlan M
Published: March 2022

Background:
Depression among acute myocardial infarction (AMI) survivors is common and associated with adverse outcomes in the year following their AMI. In young women and men, about 1 in 3 patients suffer from depressive symptoms following their AMI. Early depression recognition is important to ensure timely treatment, and potentially improve outcomes. It is unknown, however, how well providers recognized potential depression in young AMI patients, what patient factors are associated with recognition, and how much variation there is across centers.

Methods:
VIRGO is a multi-center, international, prospective observational study that enrolled 3,350 AMI patients aged 18-55 years (67.1% women) between 2008-2012. During the index hospitalization for AMI, the Patient Health Questionnaire [PHQ-9] was administered to collect depressive symptoms experienced over the past 2 weeks (cut-off score ≥10 indicated potential depression). Demographic, socio-economic, cardiovascular risk, AMI-severity, and depression treatment data were collected through patient interviews and chart abstraction. Depression recognition was defined as having PHQ-9 scores ≥10 and receiving depression treatment (anti-depressants and/or counseling referral) at discharge and/or at 1-month follow-up.

Results:
During AMI admission, 1,057 (32%) patients had PHQ-9 scores ≥10. Overall, 41% were recognized by their providers. Independent predictors of having patients’ depressive symptoms recognized were: having health insurance (OR=1.46, CI95% 1.03-2.06), history of lung disease (OR=2.02, CI95% 1.36-2.99), and a higher PHQ-9 score (OR=1.06, CI95% 1.03-1.10). African Americans (OR=0.34, CI95% 0.21-0.54), males (OR=0.52, CI95% 0.37-0.74) and married patients (OR=0.72, CI95% 0.54-0.95) were less likely to be recognized. Recognition rates by AMI treating facility (Figure) ranged from 15 to 60%, with a median OR of 1.25 (CI = 1.00, 1.61).

Conclusion:
Depression recognition rates are poor in young AMI patients with substantial variation observed across AMI treating facilities. Males, African Americans, and uninsured patients are less often recognized and may continue to be at risk of poor AMI outcomes.
Abstract 326: Healthcare Costs for Cardiac Implantable Electronic Device (CIED) Revision Procedures From 2004-2012
Authors: Patel Jasmine D , Schmier Jordana , Lau Edmund , Kurtz Steven M , Greenspon Arnold
Published: March 2022

Introduction:
The healthcare costs and clinical outcomes for Medicare beneficiaries undergoing revision procedures for CIED (ICD and CRT-D) were evaluated.

Methods:
The Medicare cohort for this study was defined by the following criteria: (a) ≥ 65 years old (b) implanted with a primary ICD/CRT-D in 2004 or 2005, (c) survived through 2012 and (c) underwent their 1st revision for a generator replacement (ERI) only. Patients were excluded if the procedures were associated with a recall, complication, or faulty lead. Total medical costs for the observation period, including subsequent revisions (≥ 2 revisions) and 6 month follow-up care due to complications, were identified from the reimbursement claim amounts. Costs were adjusted to 2014 US$.

Results:
Just over one thousand (ICD=605, CRT-D=408) t met the inclusion criteria.. This cohort of revised patients was composed primarily of men (~75%) and were between the ages of 65-74 years (>60%). Nineteen percent of patients had a Charlson Comorbidity Index score of 5 or higher, indicating substantial comorbidity.

The total health care cost of these patients was approximately $185M, with just over half of the cost coming from ICD patients. Patients that had received only one revision over the eight year time period accounted for 92% of the population and cost on average $183K per patient over the study period. Patients who had undergone multiple generator replacement procedures accounted for 8% of the study cohort and cost on average $213K per patient over eight years. Preliminary cost analysis of complications associated with these revision procedures suggested that complications were also a significant financial burden.

Conclusion:
CIED revisions due to ERI are associated with a substantial clinical and financial burden. Minimizing the number of revisions will reduce the financial burden of CIED procedures. Evaluation of the costs for individual infection (sepsis, endocarditis etc.) and non-infection complications (cardiac perforation, hematoma etc.) is also underway.
Abstract 335: Practice Pattern Differences in the Early Treatment of Hospitalized Heart Failure Patients: Preserved Left Ventricular Ejection Fraction vs. Reduced Ejection Fraction
Authors: Atreya Auras R , Kashef Mohammad A , Arora Sonali , Hernandez Jaime , Shieh Meng-Shiou , Pekow Penelope , Stefan Mihaela , Valania Gregory , Pack Quinn , Slawsky Mara T , Lindenauer Peter K , Lagu Tara
Published: March 2022

Introduction:
Approximately half of patients hospitalized with acute heart failure (AHF) have a preserved ejection fraction (HFpEF), for which there are few known treatments that improve clinical outcomes. We sought to examine initial clinical management in a large national cohort of patients with HFpEF compared to those with heart failure reduced ejection fraction (HFrEF).

Methods:
We identified patients aged ≥18 years admitted with AHF between January 2009 and June 2012 to hospitals that participate in the PREMIER, Inc. data warehouse. Patients with ICD-9-CM diagnosis codes consistent with HFpEF (428.30-428.33) and HFrEF (428.20-428.23) were included. Early treatments were defined as treatments on hospital day 0, 1 or 2.

Results:
We identified 52,913 patients with HFpEF and 65,502 patients with HFrEF at 427 hospitals (Table 1). HFpEF patients were more likely to be older, female with greater burden of comorbid disease. Diuretic use was similar, but patients with HFpEF were less likely to receive beta-blockers (68.8% vs. 76.6%, p-value < 0.0001), ACE-inhibitors (37.6% vs. 48.0%, p-value < 0.0001), vasodilators (7.4% vs. 8.1%, p-value < 0.0001), inotropes (2.1% vs. 7.0%, p-value < 0.0001) and were more likely to receive early non-invasive positive pressure ventilation (17.5% vs. 12.3% p-value < 0.0001) and early invasive mechanical ventilation (7.6% vs. 6.5% p-value < 0.0001). Covariate adjusted mean length of stay and in-hospital mortality were higher for HFrEF patients.

Conclusions:
In a large national cohort of patients hospitalized with AHF, there were several differences in the demographics, early treatment strategies and outcomes for HFpEF patients compared with HFrEF patients. Further work is needed to identify variation in the use of these treatments across hospitals and association with outcomes.
Abstract 337: Comparing Time to Percutaneous Coronary Intervention in Rural States: Arriving via Ambulance vs Personally Owned Vehicle
Authors: Gallagher John , Sather Jeffrey , Stys Tomasz , Cook Mindy , Moe Pam , Myers Gary , Scharnott Michelle
Published: March 2022

Background:
Minnesota, North Dakota and South Dakota continue to build the infrastructure to improve the system of care for patients experiencing a ST-elevation myocardial infarction (STEMI). Time from symptom onset to Percutaneous Coronary Intervention (PCI) is a critical component for better patient outcomes. First responders are critical to the success of an effective STEMI system of care. However, about 52% of STEMI patients in these states are arriving by self-transport or personally owned vehicles instead of activating the system via 911. Ideally, the catheterization lab team would be notified by EMS personnel in the field or by emergency physicians after receiving the transmitted ECG indicating a STEMI and reducing the time to PCI.

Methods:
In time period, 774 STEMI patients were entered into ACTION Registry-GWTG from Quarter 3 2013 to Quarter 2 2014. The data included STEMI patients from 19 hospitals in Minnesota, North Dakota and South Dakota participating in Mission: Lifeline, an American Heart Association initiative to improve STEMI systems. The patients analyzed arrived directly to a PCI capable hospital. Patients transferred from a referring facility were excluded in time comparison. Arrival mode percentage comparison to first facility is the exception and includes all patients.

Results:
The median time from patient arrival at PCI center to catheterization lab arrival ranged between 22 and 31 minutes with a mean 26 minutes for patients arriving via EMS. Patients that came by personally owned vehicle had a median time from arrival to catheterization lab that ranged between 35 and 41 minutes with a mean of 38 minutes. The median time from hospital arrival to PCI had a mean of 42 minutes for patients arriving via EMS compared to those arriving via self-transport at 57 minutes.

Conclusion:
Patients arriving to a PCI hospital via EMS arrive in the catheterization lab and receive PCI faster than those arriving by personally owned vehicle. Thus, in the setting of STEMI, failure to activate EMS prolongs ischemic time.
Abstract 340: Perception of Overall Health and Life’s Simple 7 Health Metrics: The Baptist Health South Florida Employee Study
Authors: Ogunmoroti Oluseye , Arrieta Alejandro , Parris Don , del Campo Daniel , Rouseff Maribeth , Das Sankalp , Guzman Henry , Alvarado Namen Gladys , Roberson Lara , Latif Muhammad A , Younus Adnan , Agatston Arthur , Maziak Wasim , Feldman Theodore , Veledar Emir , Nasir Khurram
Published: March 2022

Background:
The Life’s simple 7 (LS7) health metrics were introduced by the American Heart Association (AHA) to assess cardiovascular health. Studies have linked higher numbers of ideal LS7 health metrics to lower incidence of both cardiovascular and non-cardiovascular diseases. In the workplace, employees typically complete a health risk assessment (HRA) to assess their health status. In this study, we examined the association between an individual’s perception of overall health using an HRA and the LS7 health metrics.

Methods:
Data for the LS7 health metrics and the perception of overall health were collected during the annual voluntary wellness fairs and HRAs for employees of a large nonprofit health care organization in South Florida. Each LS7 health metric (smoking, physical activity, body mass index, blood pressure, total cholesterol and blood glucose) was classified as ideal, intermediate or poor according to AHA criteria. On the HRA questionnaire, participants rated their overall health as poor to fair, good to very good or excellent. Intraclass correlation coefficient (ICC) and kappa statistics (k) were computed to determine the agreement between the LS7 classification and perception of overall health status taken from the HRA.

Results:
9364 employees had complete wellness fair and HRA data in 2014. Mean age (SD) was 43 years (12), 75% were women. The table below shows the categories of overall health by LS7 and HRA classification. Approximately 43% of study participants differed in the assessment of their health status using the HRA when compared to the LS7 categories with nearly one-third of study participants overestimating and 11% underestimating their overall health. ICC was 0.13. K and weighted k were 0.06 and 0.01 respectively (P<0.0001).

Conclusion:
In this study, we noted significant variation between the perception of overall health and the classification of health status based upon LS7 health metrics with only 57% of employees classifying their health status in agreement with their achievement of LS7 metrics. Further public health efforts should be directed towards increasing the awareness and use of the LS7 in the workplace as a measure of overall health.
Abstract 342: Differences in Health Care Utilization and Outcomes Based on Timing of In-Hospital Worsening Heart Failure
Authors: Cooper Lauren B , Hammill Bradley G , Sharma Puza S , DeVore Adam D , Mentz Robert J , Fonarow Gregg C , Pang Peter S , Curtis Lesley H , Hernandez Adrian F
Published: March 2022

Background:
Patients admitted with acute heart failure (AHF) may experience worsening symptoms requiring escalation of therapy during hospitalization. In-hospital worsening heart failure (WHF) is associated with worse in-hospital and post-discharge outcomes, but the association between timing of in-hospital WHF (i.e. early or late during hospitalization) and outcomes is unknown.

Methods:
Using the Acute Decompensated Heart Failure National Registry (ADHERE) and Medicare claims, we examined characteristics, outcomes, and costs of patients hospitalized for AHF. Based on previous work, in-hospital WHF was defined by use of inotropes or intravenous vasodilators, or initiation of mechanical circulatory support, hemodialysis, or ventilation. Patients with in-hospital WHF were categorized as early WHF (12-24 h after presentation) or late WHF (> 24 h after presentation). Patients were considered to have a complicated presentation if they required escalation of therapy within 12 h of presentation, or an uncomplicated hospital course if they did not require escalation of therapy during hospitalization.

Results:
Of 62,908 patients, 3.2% (1,990 of 62,908) had early WHF, 6.7% (4,223 of 62,908) had late WHF, 24.4% (15,361 of 62,908) had a complicated presentation, and 65.7% (41,334 of 62,908) had an uncomplicated hospital course. Patients with late WHF had the highest rate of in-hospital and post-discharge mortality, and the highest hospital costs. The complicated presentation group had lower mortality, readmissions, and Medicare payments than the early WHF group. In an adjusted analysis, late WHF was associated with higher mortality compared to early WHF, and both early and late WHF were associated with more readmissions and resultant higher costs compared to patients with an uncomplicated hospital course (Table).

Conclusions:
While late WHF was associated with higher mortality compared to the other groups, both early and late WHF were associated with more frequent readmissions and higher healthcare costs compared to those with an uncomplicated hospital course. Prevention of both early and late WHF may be an important focus in the care of hospitalized patients with AHF.
Abstract 345: Outcomes Associated with Catheter Ablation of Atrial Fibrillation: Insights From The Veteran’s Health Administration
Authors: Mathew Jehu S , Glorioso Thomas J , Marzec Lucas N , Turakhia Mintu P , Varosy Paul D , Dixit Sanjay , Piccini Jonathan P , Ho P. Michael
Published: March 2022

Introduction:
Catheter ablation has emerged as an effective intervention for atrial fibrillation (AF) in specific patient populations. However, less is known about outcomes of AF ablation in community-based cohorts and risk factors for recurrent AF hospitalization following ablation.

Methods:
Using nationwide administrative data from the Veteran’s Health Administration (VHA), we identified patients with a catheter ablation for AF between 2007-2012 by applying a previously validated algorithm based on outpatient and inpatient diagnosis and procedure codes. We excluded sites with fewer than 30 total procedures in the study period. We evaluated descriptive baseline characteristics, 30-day complications, and 1-year outcomes of stroke, heart failure, recurrent AF, and death.

Results:
The cohort consisted of 1,202 patients who were predominantly middle-aged (mean age 62.5±8.2), male (97%), and Caucasian (91%). Associated comorbidities included hypertension (76%), diabetes (30%), congestive heart failure (27%), and coronary artery disease (10%). Catheter ablation occurred at a median of 31.4 months following AF diagnosis. Medical management prior to ablation included any history of rate (21%) or rhythm (77%) control or anticoagulation therapy (91%). Following ablation, rhythm control (80%) persisted over a strict rate (18%) control strategy (n=634 patients with two years of follow-up). During the index procedure and at 30 days, vascular complications [32 (2.7%) and 63 (5.2%)] and hematomas [32 (2.7%) and 55 (4.6%)] were the most frequent procedural complications. Other rarer complications were pericardial effusion/tamponade [18 (1.5%) and 34 (2.8%)] and pneumothorax/hemothorax [1(0.08%) and 1(0.08%)]. At one year after ablation (n=885 patients with a full year of follow-up), patients were hospitalized for AF (28.9%), repeat ablation (8.5%), heart failure (4.2%), and stroke (0.5%) with an overall mortality of 2.8%. Compared to the overall cohort, recurrent AF hospitalization at one year was worse for patients less than 75 years of age (29.6%) and for those pursuing a rhythm control strategy (31.2%).

Conclusion:
Veterans undergoing AF ablation are typically older with more comorbidities than the general AF ablation population. Despite these variations, overall outcomes for AF ablation in the VHA are comparable to outcomes in the general population.
Abstract 347: Identification of Functional Limitations on Admission by Internal Medicine Resident Physicians
Authors: Milks M. Wesley , Wilson Farra , Dharod Ajay , Feiereisel Kirsten
Published: March 2022

Low functional status on admission is associated with readmission, and functional limitations affect the disposition and prognosis of patients after hospital discharge. However, a formal assessment of functional impairment may not routinely be performed among general medical physicians. The aim of this intervention is that resident physicians better identify and document the baseline functional limitations of their patients in order to anticipate post-discharge resource needs more effectively.

A dedicated Functional History section was created in the admission history and physical (H&P) documentation template in the electronic medical record for use by house staff in one internal medicine residency program. Four questions were used to assess a patient’s baseline functional status, including the ability to complete activities of daily living (ADLs) and instrumental activities of daily living (iADLs), as well as ambulation status and pre-hospital residence. H&P documentation was sampled for patients admitted to resident teaching (intervention group) and hospital medicine (control group) services over 3 periods: 1) pre-intervention, 2) 1 week post-intervention, and 3) 10 weeks post-intervention. De-identified samples of 20 charts from each group were assessed by a blinded reviewer for each of the 3 time periods. H&Ps were scored for absence of (0 points), partial (1 point), or full (2 points) description of functional limitations in each of 3 categories: ADLs/iADLs, ambulation status, and pre-hospital residence, for a total score ranging from 0 to 6.

The average H&P functional limitation score (FLS) for patients admitted to the resident teaching services was (mean ± SEM) 0.45±0.27 prior to the intervention. The FLS increased significantly both at 1 and 10 weeks following the intervention, with values of 3.15±0.45 and 3.05±0.49, respectively (p < 0.001 for each, by 2-tailed Student’s t-test). The average FLS for hospital medicine patients was 0.20±0.12 in the pre-intervention period. Despite hospital medicine providers not receiving the intervention, there was a trend towards increased FLS that did not reach statistical significance for each subsequent period: 0.9±0.42 (p=0.12) at 1 week and 0.9±0.35 (p=0.07) at 10 weeks following the intervention.

Thoroughness of pre-admission functional limitation documentation was significantly increased by the addition of a distinct Functional History section to the H&P template used by residents at one academic medical center. Further study is needed to determine whether such documentation is associated with expedited discharge planning or improved readmission rate. A dedicated Functional History section in the H&P template may be considered by other programs that aim to increase awareness of patients’ pre-hospital functional limitations among their resident physicians.
Abstract 350: Impact of Acute Kidney Injury on Outcomes of Patients Admitted with Unstable Angina in United States, Years 2005-2011
Authors: Awan Muhammad U , Malik Aaqib , Akram Yasir , Adil Malik M
Published: March 2022

Background:
Acute kidney injury (AKI) in the setting of myocardial infarction is associated with poor outcomes. However, its impact on outcomes of unstable angina is unknown. We sought to determine the prevalence and effect of AKI on in-hospital outcomes of patients admitted with unstable angina (UA) in the United States.

Methods:
We obtained and analyzed data from Nationwide Inpatient Sample (NIS 2002- 2011). Study population included all adults (>18 years old) with the primary discharge diagnosis of UA and the secondary diagnosis of AKI. The associations of AKI with in-hospital complications, procedures, discharge outcomes and mortality, were analyzed after adjusting for potential confounders using logistic regression analyses.

Results:
During the study period, 541,948 patients were admitted with UA; of which, 18,882 (3.5%) had AKI and 64 (0.3%) required dialysis during the same hospitalization. Patients with AKI had significantly higher rates of in-hospital complications such as infections, venous thromboembolism, myocardial infarction, stroke and gastrointestinal bleeding but fewer (n= 565, 3%) of these patients received percutaneous transluminal angioplasty. After adjusting for all confounding factors, UA patients in the AKI group had higher odds of in-hospital death (odds ratio, 2.5; 95% confidence interval, 1.6-3.9; P<0.0001). On trend analysis, rates of AKI had declined from 17% in the year 2002 to 6% in the year 2011 (p<0.0001). In the year 2011, mean length of stay had reduced by an average of 1 day in comparison with the year 2005 (p<0.0001). Mortality in the AKI group did not change significantly over the 10 years study period.

Conclusions:
In patients with UA, AKI is associated with significantly higher rates of in-hospital complications and mortality.
Abstract 364: Comparison Between Frequency Domain Optical Coherence Tomography and Intravascular Ultrasound in Detecting Mechanical Complications of Coronary Stent Implantation: A Meta-analysis.
Authors: Bhatheja Samit , Panchal Hemang , Rahman Zia , Barry Neil , Paul Timir
Published: March 2022

Background:
Frequency Domain Optical Coherence Tomography (FD-OCT) is a novel method for evaluation of complications related to stent. Current literature has paucity of data with limited sample size comparing FD-OCT to Intravascular ultrasound (IVUS). The objective of this meta-analysis is to compare FD-OCT to IVUS in evaluation of mechanical complications after stent implantation.

Methods:
PubMed was searched through January 2015. Four studies (n=95 vessels) comparing FD-OCT to IVUS procedures to determine mechanical complications of coronary artery stent placement were included. End points were detection of intraluminal thrombus, edge dissection, malapposition, and malapposition area. The mean difference (MD) or odds ratio (OR) with 95% confidence interval (CI) was computed as appropriate and p<0.05 was considered as a level of significance.

Results:
FD-OCT detected significantly more complications including intraluminal thrombus (OR: 5.15, CI: 1.06-24.89, p=0.04), edge dissections (OR: 6.10, CI: 2.11-17.68, p=0.0009) (figure A) and malapposition (OR: 4.83, CI: 2.21-10.99, p<0.0002) (figure B) compared to IVUS. Malapposition area measurement was not different between two modalities (p=0.27).

Conclusion:
The results of our meta-analysis suggest that FD-OCT is a better intravascular imaging modality compared to IVUS in detecting mechanical complications after coronary artery stent implantation. Additionally, this study suggests that FD-OCT and IVUS are comparable in detecting malapposition area.
Abstract 369: Greening Cardiology: Exploring the Sustainability Practices of Healthcare System Employees
Authors: Gurm Azba , Lehrich Jessica , Nallamothu Brahmajee
Published: March 2022

Background:
Despite taking initiatives to be sustainable, health care systems continue to underachieve their potential and produce exorbitant amounts of waste. We examined the personal sustainability practices of healthcare workers, contrasting their behavior at work with that at home, since the actions of people ultimately determine the effectiveness of sustainability campaigns.

Methods:
We gave 52 full-time employees of the University of Michigan Cardiac Catheterization Laboratories an anonymous online survey pertaining to sustainability practices at home and work. Paired t-tests were used to compare parallel questions about recycling and energy saving habits between work and home and the Wilcoxon Mann Whitney test was used to examine demographic trends.

Results:
Participant sustainability habits at home consistently scored lower means, indicating a higher degree of sustainability engagement, than at work_except for the recycling of bottles, containers, and paper products, which showed no significant difference, and the use of motion sensor power strips. Physicians were found to engage in energy saving habits at home significantly less than non-physician employees (mean score, 2.7 versus 2.1; p = .0014) but otherwise, no other demographic varied significantly.

Conclusion:
Healthcare employees have the personal mindset to be sustainable, but the workplace offers fewer opportunities to do so than their own homes. Healthcare systems may improve sustainability by better designing care processes to maximize recycling and minimize waste, and fostering the personal responsibility for sustainability that is found in the home environment by emulating the sustainability opportunities at home.