bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P341: A Flexible, Interpretable Approach to Recalibrate Risk Prediction Models: Adapting the Pooled Cohorts Equation to a Local New England Contemporary Population
Authors: Zinzuwadia Aniket N , Mineeva Olga , Li Chunying , Chen Lin , Cade Brian , Karlson Elizabeth , Farukhi Zareen , Paynter Nina , Mora Samia , Demler Olga
Published: March 2023

Introduction:
Atherosclerotic cardiovascular disease (ASCVD) prognostic models have well-documented poor generalizability in contemporary populations. Sustained, accurate performance of risk prediction models is challenging given demographic shifts, changes in practice patterns, and geographic variation. We propose an approach to tailor known risk prediction models for local settings while preserving known disease risk mechanisms. Here, as a case study, we recalibrate the Pooled Cohort Equations (PCE) in a contemporary (1997-2018), local electronic health records (EHR) cohort in New England.

Methods:
We conducted a retrospective cohort study using EHR from large Boston-area hospitals. 61,808 patients 45+ years old, without ASCVD in 1997-2006 and complete data to calculate PCE model were split into training (50%), validation (10%), and test sets (40%). We used XGBoost to recalibrate PCE model (XGB-PCE) using PCE risk score, age, race/ethnicity, and sex (Figure). We constrained the XGB-PCE model to preserve known physiologic trends i.e. increase in ASCVD risk with increase in total cholesterol and systolic blood pressure. Models’ discrimination and calibration were calculated in a set aside test set using the Harrell’s c-index and modified Nam D’Agostino χ2 test.

Results:
In the test set, XGB-PCE exhibited improved calibration across ASCVD risk categories (p=0.37) and race/ethnicity populations (p=0.73). In contrast, even after recalibration in the large, PCE was poorly calibrated across risk categories (p<0.001) and race/ethnicity populations (p<0.001). For model discrimination, both models produced similar c-index (Δc-index of ±.01).

Conclusions:
Our recalibration approach maintained comparable discriminative performance and demonstrated improved calibration relative to the PCE while preserving known disease risk mechanisms. Methods that are flexible and preserve disease mechanisms have the potential to locally tailor existing models to be better calibrated for contemporary populations.
Abstract P343: Do Foot Problems in Diabetes Portend Serious Consequences? Calibrating Risk by Comparing Mortality With Cardiovascular Disease Categories
Authors: Zahrieh Issa , Nicholson Andrew , Illenberger Nicholas , Lipsitz Stuart R , Natarajan Sundar
Published: March 2023

Patients with diabetic foot disease are predisposed to developing serious cardiovascular and other mortal events. Since it is not clear what the comparative risk for death among adults with diabetes and foot problems is, we conducted a formal analysis comparing these individuals with other established high-risk cardiovascular disease (CVD) categories. We analyzed data from the National Health Interview Survey’s (NHIS) sample adult files between 2001 and 2014. We used information on diabetes and podiatrist care to create a diabetes and foot disease (DFD) variable. Information regarding mortality, cause of death, and follow-up time were from the National Death Index-linked mortality files (maximum 15 years of follow-up). After initially computing mortality rates, we evaluated the independent effect of (DFD) and CVD categories (angina pectoris, coronary heart disease [CHD], heart attacks, heart failure [HF], and stroke) on death using multivariate Cox proportional hazards models that adjusted for age, sex, race, marital status, education, region, physical activity, diet habits, smoking, alcohol consumption, and obesity. Specifically, since our primary interest was in comparing (DFD) with established high-risk cardiovascular disease (CVD) categories, we directly compared (DFD) to the CVD conditions in question through separate Cox models while incorporating (DFD) and the CVD category of interest as 4-level variables and used DFD as referent. Analyses were with SAS 9.4 and incorporated the complex sampling to yield population estimates. Data from 421,106 U.S. adults between 2001 and 2014 were analyzed. There were 8,646 participants with (DFD) and 55,511 with prevalent CVD (angina pectoris 5,989, coronary heart disease 19,832, heart attack 15,065, heart failure 12,344, and stroke 12,434). Over the follow-up period, 1,961 (DFD), 1,173 angina, 4,734 CHD, 3,836 heart attack, 3,526 HF and 3,234 stroke participants died. The mortality rate (per 1000 person-years) was: (DFD) 62, angina 41, CHD 42, heart attack 68, HF 66 and stroke 72. When (DFD) was directly compared to CVD categories, the hazard ratio for death was 1.04 (95% CI 0.93, 1.22) for angina pectoris, 1.05 (95% CI 0.97, 1.14) for CHD, 1.14 (95% CI 1.03, 1.21) for heart attack, 1.15 (95% CI 0.87, 1.34) for HF, and 1.12 (95% CI 1.03, 1.22) for stroke. Individuals with diabetes and foot problems were at equivalent risk for mortality compared to angina or CHD, and at slightly lower mortality risk than heart attack, heart failure or stroke. This population-based analysis quantifies and calibrates the magnitude of the mortality-risk in patients with diabetes and foot disease by comparing it to CVD categories. Current recommendations for care and the structure of care may need to be further refined to match intensity of treatment to mortality risk.
Abstract P344: Trends and Disparities in Lifestyle Quality Among US Adults With Diabetes
Authors: Feng Chengwu , Feng Li , Shan Zhilei , Han Han , Cao Yaying , Sheng Aili , Guasch Marta , Wang Liang , Zong Geng
Published: March 2023

Introduction:
Lifestyle modification is the cornerstone of diabetes management, yet, little is known about trends in overall lifestyle quality among people with diabetes (PWD).

Hypothesis:
We hypothesized that the lifestyle quality of PWD would be improved and the disparities would be narrowed given the great efforts made in the past two decades.

Methods:
We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey to assess national trends in lifestyle quality among PWD from 1999 through 2018. Accordingly, a well-established healthy lifestyle score involving four low-risk factors: never smoking, moderate alcohol consumption (women
≤
1 drink/day, men
≤
2 drinks/day), regular physical activity (top third of physical activity), and healthy diet (top two-fifths of healthy eating index 2015) was constructed with the range from 0 to 4.

Results:
Among 7410 participants included (weighted mean age, 59.8 years; 51.0% men), the estimated mean healthy lifestyle score slightly increased from 1.4 (95% CI: 1.3 to 1.5) in 1999-2002 to 1.6 (1.5 to 1.8) in 2015-2018 (P for trend=0.002). Only 22.0% of PWD reported adhering to 3-4 low-risk lifestyle factors in 2015-2018. During this period, the non-Hispanic Blacks caught up with the non-Hispanic White in overall lifestyle quality (1.7 vs 1.6 in 2015-2018), but large disparities remained by poverty-income ratio, education level, and health insurance status. By 2015-2018, the estimated mean lifestyle score was lower among participants with lower (1.2, 95% CI: 1.0 to 1.3) vs higher income (1.7, 1.6 to 1.8), lower (1.4, 1.3 to 1.5) vs higher education (1.8, 1.7 to 2.0), and among uninsured (1.4, 1.2 to 1.6) vs insured adults (1.7, 1.5 to 1.8).

Conclusions:
The overall lifestyle quality of US adults with diabetes was far below optimal levels and large socioeconomic disparities remained. The potential for lifestyle improvement remains large and may further facilitate long-term survival among PWD whose metabolic control has plateaued and whose causes of death diversify.
Abstract P354: Trends in Malignancy and Cardiovascular Disease Related Mortality in the United States
Authors: Ibrahim Ramzi , Ravi Soumiya , Salih Mohammed , Habib Adam , Alabagi Abdulla , Singh Vikram , Singh Simar , Ferng Jonathan , Lee Justin Z
Published: March 2023

Introduction:
In the United States (US), malignancy and cardiovascular disease (CVD) make up the majority of the burden of chronic diseases, leading to greater morbidity and mortality. As the general population grows older, the prevalence of these two disease entities are likely to increase. Efforts in cardio-oncology have been focused on disease prevention and treatment, however, little is known about existing disparities in this population.

Hypothesis:
Unequivocal burden of CVD-related mortality exists among certain gender, racial, and geographic subgroups.

Methods:
Data was obtained from the CDC Wide-ranging Online Data for Epidemiologic Research database using death certificate information from the National Vital Statistics system. All CVD-related death (I00 - I78) as the underlying cause of death in individuals with malignancy (C00 - C97) as the multiple causes of death were queried from 1999 - 2020. Underlying cause of death was defined as the disease that directly led to death and the multiple causes of death were defined as the diseases that contributed to death. Quantified measures included age-adjusted mortality rate (AAMR) per 100,000 population, 95% confidence intervals, and average annual percentage change (AAPC). Joinpoint regression (National Cancer Institute) was utilized for trend analysis and AAPC calculation.

Results:
There was a total of 595,446 deaths between 1999 and 2020. The AAMR in 1999 was 24.85 which decreased to 12.811 by 2020 (p <0.05), with an AAPC of -3.1%. Males (23.14) had a higher AAMR compared to females (11.05) (p <0.05), and AAPC for both males and females were -3.4%. AAMR was disproportionately higher in non-Hispanic populations (16.26) compared to Hispanic populations (9.17) (p <0.05), with similar AAPC (-3.1% and -3.0%, respectively [p >0.05]). Black individuals (18.87) had the highest AAMR, followed by White individuals (15.81), American Indian/Alaska Native individuals (9.40), and Asian/Pacific Islander individuals (8.26) (p <0.05). All AAPC for the racial subgroups were similar (-3.3%, -3.1%, -2.7%, and -4.1%, respectively [p >0.05]). Non-metro regions (17.20) had higher AAMR compared to metro regions (15.54) (p <0.05) with an AAPC of -2.4 and -3.3%, respectively (p >0.05). The Northeast (17.93) had the highest AAMR, followed by similar AAMR in the Midwest (16.44) and West (16.30) regions, and then South regions (13.98) (p <0.05). AAPC was similar among all US census regions (-3.6%, -3.3%, -3.4%, and -2.8%, respectively [p >0.05]).

Conclusion:
Even with decreasing rates of AAMR from 1999 to 2020, there remains a disproportionate burden of AAMR among gender, racial, and geographic subgroups. Continued efforts targeted at mitigating CVD-related mortality in patients with underlying malignancy is warranted.
Abstract P356: Does Out-Migration Contribute to Poorer Health in Rural Communities? An Investigation Using Mortality in the US
Authors: Jones-Antwi Rebecca E , Judd Suzanne E , Argeseanu Cunningham Solveig
Published: March 2023

People living in poor rural communities, particularly in the South, live shorter and less healthy lives than those residing elsewhere in the United States. The basis of this very high rural burden of heart, lung, and blood disease, which does not spare any race, is unclear. We hypothesized that a potential contribution to this phenomenon is differential selection of healthy individuals to migrate out of rural communities. We examined how county-level migration patterns relate to county-level mortality with a specific focus on rural counties. We compiled nationally representative county-level data migration data from Internal Revenue Services for years 2011-2019 and mortality data from National Center for Health Statistics at the Centers for Disease Control and Prevention for years 2018-2019. We standardized characteristics to a mean=0 and standard deviation=1 and modeled county-level age-adjusted death rate in 2019 using 2-level hierarchical linear regression. Out- and in-migration in 2019 was not significantly associated with age-adjusted death rate in 2019 after adjustment for social, economic and population factors at the county-level. However, when stratified by 6 categories of urban/rural, greater out-migration in the smallest rural counties (non-core) was associated with higher age-adjusted death rate after adjustment for other county factors [Beta (95% CI); 7.2 (0.11,14.28)] (Table 1). When including lagged out-migration rates for years prior to 2019, previous out-migration was associated with age-adjusted death rate in the second smallest rural county categorization (micropolitan). These findings help to ascertain another component potentially contributing to differentially poorer health in rural communities. Future work at the conference will further evaluate decade trends in migration across the US by county.
Abstract P360: Social and Psychosocial Determinants of Racial and Ethnic Differences in Cardiovascular Health: The MESA and MASALA Studies
Authors: Shah Nilay S , Huang Xiaoning , Petito Lucia , Bancks Michael , Kanaya Alka M , Talegawkar Sameera , Farhan Saaniya , Carnethon Mercedes R , Lloyd-Jones Donald , Allen Norrina B , Kandula Namratha , Khan Sadiya S
Published: March 2023

Background:
Social and psychosocial factors are associated with cardiovascular health (CVH) and may underlie race/ethnic differences in CVH. Quantifying the contribution of individual-level social and psychosocial factors to racial and ethnic differences in CVH may guide strategies to reduce disparities.

Methods:
In the MESA and MASALA cohorts, Kitagawa-Blinder-Oaxaca decomposition quantified the contributions of social and psychosocial factors to differences in mean CVH score (range 0-14, with 14 indicating optimal CVH) in Black, Chinese, Hispanic, or South Asian compared with White participants.

Results:
Among 7,978 adults (mean age 61 [SE 10] years, 52% female), there were 1,892 Black (mean CVH score 7.96), 804 Chinese (CVH 9.69), 1,496 Hispanic (CVH 8.00), 1,164 South Asian (CVH 9.16), and 2,622 White (CVH 8.91) participants. The factors that statistically contributed the most to explained differences in mean CVH score were income for Black participants (if mean income in Black participants were equivalent to White participants, Black participants’ mean CVH score would be 0.14 points higher, p<0.05); place of birth for Chinese participants (if proportion of US-born and foreign-born individuals among Chinese adults were equivalent to White participants, Chinese participants’ mean CVH score would be 0.22 points lower, p<0.05); and education for Hispanic and South Asian participants (if educational attainment were equivalent to White participants, Hispanic and South Asian participants’ mean CVH score would be 0.55 points higher and 0.37 points lower, respectively, p<0.05 for both).

Conclusions:
In this multiethnic US cohort, social and psychosocial factors statistically explained racial and ethnic differences in CVH. Socioeconomic and immigration-related factors contributed the largest magnitude to CVH differences between race and ethnic groups.
Abstract P364: Healthcare Utilization Among Asian, African, and Latino Immigrants With Hypertension or Diabetes in the 2010-2018 National Health Interview Survey
Authors: Azoba Chinenye C , Turkson-Ocran Ruth-Alma N , Commodore-Mensah Yvonne
Published: March 2023

Background:
Cardiovascular disease (CVD) morbidity and mortality disproportionately affect racial and ethnic minority groups and can be mitigated by preventative services. However, research describing healthcare use in immigrants with CVD risk in the US is limited.

Hypothesis:
Immigrants with hypertension or diabetes will have lower healthcare utilization (HCU) than US-born non-Hispanic (NH) White adults.

Methods:
We analyzed cross-sectional data from the 2010-2018 National Health Interview Survey on 75,631 adults including Asian (N=3,120), African (N=393), and Latino (N=7,315) immigrants and US-born NH White adults (N=64,803) with hypertension or diabetes. HCU was defined as seen/talked to a general doctor, ≥1 doctor’s office visit, and ≥1 emergency department (ED) visit in the past 12 months. We used logistic regression to examine HCU disparities between immigrants and NH White adults and compared HCU among immigrants stratified by length of US residence.

Results:
Participants had a mean (±SE) age of 60.4 (±0.1) years, and 52% were female. Compared to NH White adults, Asian (adjusted odds ratio [aOR]: 0.79, 95% CI: 0.69-0.89,
Table
), African (aOR: 0.68, 95% CI: 0.50-0.93), and Latino (aOR: 0.68, 95% CI: 0.62-0.74) immigrants were less likely to have seen/talked to a doctor in the past 12 months. All immigrant groups were also less likely to have ≥1 doctor office visit. Asian (aOR: 0.61, 95% CI: 0.55-0.68) and Latino (aOR: 0.85, 95% CI: 0.79-0.91) immigrants were less likely to have ≥1 ED visit than NH White adults. Compared to those with <10 years of US residence, HCU improved in immigrants with ≥10 years of residence (data not shown).

Conclusion:
Immigrants with CVD risk use less health services than NH White adults, yet HCU improves with longer US residence. CVD health policies must account for heterogeneity among immigrant groups, with targeted efforts toward recent immigrants, to improve HCU and prevent CVD complications.
Abstract P365: Number of Beds and Volume of Patients Correlates With Increased Uptake of Novel Cardiovascular Medications in the Veterans Affairs System
Authors: Salahuddin Taufiq , Hebbe Annika , Daus Marguerite , Simons Carol , Gilmartin Heather , Doll Jacob A
Published: March 2023

Background:
Novel therapies such as angiotensin receptor-neprilysin inhibitors (ARNI), sodium-glucose cotransporter-2 Inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have well-established benefit, but use remains low for heart failure (HF) and coronary artery disease (CAD).

Methods:
Patients were identified by diagnosis codes for HF, myocardial infarction, or coronary revascularization between 2017-2021 at 114 sites within the Veterans Health Administration (VA). HF and CAD cohorts included 82,376 and 74,210 patients, respectively. Hospital-level data for ARNI, SGLT2i, and GLP-1 RA were assessed for filled outpatient prescriptions at hospital admission, discharge, or within 6 months of discharge. Patient and site-level characteristics were compared by high-, low-, or mixed-level use of novel medications compared with median prescribing.

Results:
In HF patients, rates of both ARNI and SGLT2i prescription were 20% and 21%, respectively, in 2021. In CAD patients, SGLT2i or GLP-1 RA use was 30% in 2021. Patient characteristics were similar among sites by high-, mixed- and low-level prescribing of novel medication usage. Sites in the "high" group compared with the "low" group of medication utilization had a greater number of patient-years per site (236 patient-years vs 127 patient-years, respectively, p=0.003) and a greater average number of hospital beds (157 vs 81 beds, respectively, p<0.001). Though nearly all sites (95%) had an academic affiliation, a numerically greater proportion of sites in the "high" group of novel medication use had academic affiliation than the "low" group (100% vs 90% with academic affiliation, respectively, p=0.236).

Conclusions:
In the VA, sites with the highest utilization ARNI, SGLT2i, and GLP-1 RA use for HF and CAD had greater patient volume and number of beds than sites in the lowest-use sites. This may suggest that centers with more experience in treating HF and CAD have a more rapid uptake of novel cardiovascular therapies.
Abstract P370: Implicit Bias Among Vascular Surgeons
Authors: Kalbaugh Corey A , Howard Kerry , Witrick Brian
Published: March 2023

Objective:
Implicit bias is an unconscious bias that may influence behavior, cognitive processes and decision-making. In clinical settings, implicit bias present in clinicians may influence the treatment that people receive and may be a root cause of health disparities. Our study measured implicit bias among vascular surgeons who participate in the management of individuals with peripheral artery disease (PAD).

Methods:
Our sampling frame included all vascular surgeons that contribute to the Vascular Quality Initiative (VQI) registry. We invited these individuals to take the race implicit association test (IAT) used to measure level of unconscious bias. The IAT asks participants to classify items presented on a computer by quickly pressing computer keys. The underpinning of the IAT is that people will match a representative group (images of African American or European American faces) to an attribute (good and bad words, such as excellent and angry) more quickly if there is already an implicit connection. Based on the differences in reaction time from several trials, participants are classified as having a no preference between African American and European Americans or a preference for one or the other. The level of preference can be slight, moderate, or strong. We stratified implicit findings by physician race/ethnicity.

Results:
Among 2765 vascular surgeons that participate in the VQI, 338 (12%) completed the IAT. Most participants (70%) showed an automatic preference for European Americans over African Americans, with more than half of participants (51%) showing a moderate or strong automatic preference. Of 195 participants who identified as Non-Hispanic White, 25% showed a slight automatic preference for European Americans, 41% showed a moderate automatic preference, and 34% showed a strong automatic preference. Of 16 participants who identified as Non-Hispanic Black, 38% showed an automatic preference for European Americans over African Americans and 31% showed an automatic preference for African Americans. We also found that participants were often unaware of their biases: More than two-thirds (n=64) of the 94 participants who disagreed with a statement asking if they are biased (“I am biased”) had an automatic preference upon testing.

Conclusions:
Implicit bias was found among vascular surgeons. The next step in our research will focus on the ability of implicit bias scores to predict a surgeon’s actual delivery of guideline care. Pending our findings, training and clinical support tools offer techniques to mitigate the impact of implicit biases on PAD-related health care.
Abstract P372: Drivers of Visit Modality in Primary Care Clinics at an Academic Medical Center
Authors: Parameswaran Vijaya , Koos Harrison , Bajra Rika , Torres Elise C , Kalwani Neil M , Qureshi Lubna , Rosengaus Leah , Scheinker David , Cola Phillip , Dash Rajesh , Stange Kurt , Lyytinen Kalle , Sharp Christopher
Published: March 2023

Background:
Informed by drivers of visit modality in specialty clinics, we sought to identify factors associated with visit modality selection (telemedicine vs. in-person) for new and return visits in primary care clinics at a large academic medical center (AMC).

Methods:
We used electronic health record data from 3/2020 - 5/2022 from 13 primary care clinics with 98 unique clinicians for new and 131 for return visits (21,031 new & 207,292 return visits), with about 55% telemedicine (telephone and video) use. We used hierarchical logistic regression and cross-validation methods to estimate the variation in visit modality associated with the patient, clinician, and visit factors (measured with Area Under the Curve).

Results:
For both new and return visits, there was significant variation in telemedicine use among clinicians (ranging from 0 - 100%) for specific clinical diagnoses (Figure 1). Most variation in telemedicine use was attributed to the clinician seen (new visits) and primary visit diagnosis (return visits). Other visit and patient characteristics were less predictive. For new visits, the clinician model had an AUC of 0.79, followed by clinic site 0.69, whereas for return visits, the primary diagnosis was 0.77, followed by the clinician seen at 0.65. Diagnoses most commonly seen via telemedicine include acute respiratory infection and suspected COVID-19 exposure. Diagnoses commonly seen in-person include annual physical and gynecological exams.

Conclusions:
Our findings show high variability in telemedicine use for the same diagnosis and differential drivers of visit modality between new and return visits in primary care clinics at a large AMC. Provider ID was the most predictive factor of visit modality for new patients, indicating that clinician preference and individual practice patterns influence the modality of care much more than patient preference. Primary care clinics may reduce the variability in visit modality through standardized processes that integrate clinical factors and patient preference.
Abstract P374: Perception of Short-Term and Lifetime Risk of Atrial Fibrillation: A Survey of American Heart Association Members
Authors: Mondesir Favel L , Thorpe Alistair , Bradley GerMya , Hills Mellanie T , Cozier Yvette , Ko Darae , Kornej Jelena , Lubitz Steven A , Anderson Christopher D , Benjamin Emelia J , Fagerlin Angela , Trinquart Ludovic
Published: March 2023

Background:
Physician communication of lifetime risk prediction can improve patient understanding of atrial fibrillation (AF) risk and motivate lifestyle changes and preventive measures. Therefore, our objective was to assess how physicians perceive short-term and lifetime risks of atrial fibrillation (AF), using a survey.

Methods:
We invited American Heart Association (AHA) members to complete an online survey via email from November 2-22, 2021. Respondents were randomized to one of 32 vignettes characterized by AF risk factors (height, weight, current smoking, systolic blood pressure, diastolic blood pressure, use of antihypertensive medication, diabetes, history of heart failure, and history of myocardial infarction). Respondents were further randomized to either estimate the 5-year or lifetime AF risk on a 0-100% scale with 10% intervals (e.g., “10-19%”) or were shown the predicted 5-year or lifetime AF risk value and asked to pick the correct interpretation in a multiple-choice question.

Results:
Of 11,330 AHA professional members who received the emailed survey, 109 (1%) physicians responded (mean age 51 years, 33% women) (Table). Most respondents estimated the 5-year AF risk correctly (7/9, 78%) but none accurately estimated the lifetime risk (0/18, 0%). Most respondents interpreted the predicted 5-year risk correctly (21/28, 75%) but about half of respondents misinterpreted the lifetime risk (14/25, 56%).

Conclusions:
In a small sample of physicians, few respondents correctly estimated and interpreted the lifetime risk of AF, suggesting that physicians may not be familiar with this risk format. It may be necessary to study the frequency and manner in which physicians communicate lifetime risk of AF.
Abstract P379: Groceries for Black Residents of Boston to Stop Hypertension (GoFresh): A Randomized Clinical Trial
Authors: Turkson-Ocran Ruth-Alma N , Aidoo Emily L , Castilla-Ojo Noelle , Cluett Jennifer , Crews Deidra , Davis Roger , Elborki Marwa , Ferro Kayla , Fitzpatrick Stephanie L , Grobman Ben , Ismail Norah , Hines Anika L , Kraemer Kristen , Kwapong Fredrick L , Miller Edgar R , Mukamal Ken J , Seager Reva , Juraschek Stephen P
Published: March 2023

Background:
Diet is a major cause of disparities in hypertension among Black adults. While the Dietary Approaches to Stop Hypertension (DASH) Eating Plan is proven to lower blood pressure (BP), access to DASH-patterned groceries is a major barrier for residents of urban food deserts.

Objective:
To test whether dietitian-assisted, home-delivered, DASH-patterned groceries lower BP among Black adults with elevated BP who reside in Boston area food deserts.

Methods:
The Groceries for Black Residents of Boston to Stop Hypertension (GoFresh) study is one of five projects in the RESTORE Network, an AHA-funded initiative focused on hypertension prevention. This individual level, parallel-arm trial will enroll up to 176 Black adults with a systolic BP (SBP) between 120 and <150 mm Hg, who reside in communities identified by the MA Department of Health as urban food deserts. Following a 1:1 randomization scheme, half of participants will be assigned to weekly sessions with a dietitian, who will assist in ordering DASH-patterned groceries online for home delivery. The remaining participants will receive an unrestricted monthly stipend (referent). Both interventions will last 3 months followed by a 9-month maintenance phase. The trial is powered to detect a difference in SBP (primary) of -5.8 mm Hg measured after 3 months (DASH vs stipend). Secondary outcomes are 24-hour ambulatory BP, body mass index, 24-hour urine sodium and potassium, hemoglobin A1C, lipids, and intake of fruits, vegetables, and saturated fat. Qualitative interviews will be conducted with 45 participants after 6 months to determine barriers and facilitators of long-term intervention maintenance. The study will establish a biorepository of blood and urine. A Community Advisory Board collaborates with the study team on all aspects of the trial.

Discussion:
Findings from this study will inform ongoing work on scalable interventions to prevent hypertension among Black adults with implications for public and healthcare-based food supplementation programs.
Abstract P381: Factor VIII and Incident Hypertension in Black and White Adults: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study
Authors: Stoutenburg Eric , Sherman Sarah , Bravo Maria Cristina , Howard Virginia J , Kamin Mukaz Debora , Cushman Mary , Zakai Neil , Judd Suzanne E , Plante Tim B
Published: March 2023

Background:
Black adults have a disproportionate hypertension burden. While some excess risk is mediated by diet and sociodemographics factors (e.g., income, education) much remains unexplained. Pro-thrombotic and pro-inflammatory states are associated with hypertension risk; higher coagulation factor VIII (FVIII) is associated with thrombosis, inflammation, and cardiovascular disease. Black adults have higher FVIII than White adults. We sought to estimate incident hypertension risk among Black and White REGARDS adults by FVIII level, and determine if FVIII mediates some of the excess hypertension burden in Black REGARDS participants.

Methods:
Hypertension was use of blood pressure (BP)-lowering medications or 140/90 mm Hg BP threshold. We included Black and White participants from REGARDS without Visit 1 (2003-2007) hypertension, and hypertension assessment at visit 2 (2013-2016), and Visit 1 ELISA-measured FVIII. Modified Poisson regression estimated risk ratios (RR) of incident hypertension by FVIII level in models controlling for known confounders, stratified by race given a significant race*FVIII interaction on incident hypertension. Inverse odds ratio weighting estimated % mediation of the Black-White hypertension risk in each model that was due to FVIII.

Results:
Among the 1,870 included participants, mean (SD) age was 62 (8), 51% were female and 36% were Black participants. Relative to White participants, Black participants had higher mean FVIII level (114% vs. 103%; P<0.001) and 46% greater hypertension risk (95% CI 30-65%) in the crude model. Higher FVIII did not associate with greater hypertension risk in any model (
Figure
). Factor VIII did not mediate excess burden of hypertension among Black participants in any models.

Conclusions:
FVIII was not associated with greater hypertension risk and did not mediate any of the excess burden of incident hypertension seen among Black participants.
Abstract P383: Trends in Multimorbidity Among U.S. Adults With and Without Hypertension, 1999-2000 to 2017-2020
Authors: Alanaeme Chibuike J , Akinyelure Oluwasegun P , Wen Ying , Christenson Ashley , Poudel Bharat , Hardy Shakia T , Foti Kathryn , Ghazi Lama , Bowling Christopher B , Long Michelle , Colantonio Lisandro , Muntner Paul
Published: March 2023

Background:
Most adults with hypertension have other chronic conditions. As obesity and diabetes are increasing among US adults, the prevalence of multimorbidity may have increased among US adults with hypertension.

Methods:
We used data from the National Health and Nutrition Examination Survey (NHANES) to assess the trend in multimorbidity among US adults (ages ≥ 20 years) with (n = 24,646) and without (n = 24,189) hypertension from 1999-2000 through 2017-March 2020. Hypertension was defined as systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥80 mm Hg, or use of antihypertensive medication. Multimorbidity was defined as the co-occurrence of ≥ 3 chronic conditions, not including hypertension. Chronic conditions were selected based on a framework from a US Health and Human Services report and data available in NHANES and included dyslipidemia, coronary heart disease, stroke, heart failure, diabetes, obesity, liver fibrosis, chronic kidney disease, asthma, lung disease (chronic obstructive pulmonary disease, emphysema, or chronic bronchitis), arthritis, hepatitis-C, cancer, and depression.

Results:
From 1999-2000 to 2017-2020, the age-adjusted mean number of chronic conditions increased from 2.4 to 3.0 among US adults with hypertension and from 1.9 to 2.2 among US adults without hypertension (Figure, top panel). During this period, the age-adjusted prevalence of multimorbidity increased from 42% to 56% among US adults with hypertension and from 32% to 34% among US adults without hypertension (Figure, bottom panel). In 2017-2020, after age, race/ethnicity, and sex adjustment, the mean difference in the number of chronic conditions among US adults with versus without hypertension was 0.70 (95% CI: 0.56 - 0.84). Multimorbidity was 1.50 (95% CI: 1.34 - 1.68) times more common among US adults with versus without hypertension.

Conclusion:
Multimorbidity has increased among US adults, and its prevalence is higher among adults with versus without hypertension.
Abstract P388: Assessment of a Tailored Peer Mentoring Program Among Medicare Advantage Members With Hypertension
Authors: Dasmariñas Micah , Jhuang An-Ting , Kamrudin Samira , Heinrich Samantha , Patel Brijesh , Patel Ashwin , Murillo Jaime
Published: March 2023

Introduction:
Disparities in access to care coupled with chronic conditions that represent 70% of healthcare spending, highlight the importance of accessible support beyond in-person primary care. In this study, we assessed the feasibility of a virtual peer mentoring program, in which individuals who have successfully managed to live with hypertension serve as peer mentors to individuals with the same condition. We measured clinical improvement through possible blood pressure (BP) reductions as well as program engagement and satisfaction among study participants.

Methods:
The study consisted of 451 participants enrolled in a Medicare Advantage plan with hypertension and/or a recent systolic BP reading ≥140 mmHg. Participants were matched with a peer mentor and provided with virtual one-on-one engagement based on their hypertension management challenges. The program was defined as feasible if the average monthly engagement rate over the 6-month study period was at least 70%. A one-sample proportion test was used to determine feasibility and the Wilcoxon signed rank test assessed changes in BP between the first month and the sixth month after enrollment. Descriptive statistics were generated from the exit survey upon program completion.

Results:
The average monthly engagement rate was greater than 70% (p < 0.001), indicating program feasibility. 116 individuals (25.7%) had a baseline systolic BP ≥ 140 mmHg, or diastolic BP ≥ 90 mmHg with both first and sixth month BP data. In this cohort, we found statistically significant median reductions in systolic BP >5 mmHg (-7.5 mmHg; p=0.003) as well as diastolic BP (-3.9 mmHg; p<0.001). The program received high satisfaction with a net promoter score of 79.

Conclusion:
This study showed a virtual peer mentoring program for individuals with hypertension is feasible. Both systolic and diastolic BP improved in the peer-matched group suggesting a beneficial intervention. In addition, the exit survey responses indicated satisfactory and positive experiences in this peer mentoring program.
Abstract P398: Using Human-Centered Design Methodology to Identify Challenges and Inform the Development of a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy From Diverse Clinician, Patient, and Patient Health Partner Perspectives
Authors: Spaulding, PhD, RN Erin M , Isakadze Nino I , Molello Nancy , Khoury Shireen , Gao Yumin , Young Lisa , Zghyer Fawzi , Azizi Zahra , Dorsch Michael P , Golbus Jessica R , Commodore-Mensah Yvonne , Gilotra Nisha A , Sandhu Alexander , Nallamothu Brahmajee K , Martin Seth S
Published: March 2023

Introduction:
Despite overwhelming evidence that guideline-directed medical therapies (GDMT) for heart failure (HF) can reduce mortality and improve quality of life, significant gaps in treatment optimization persist. GDMT initiation and up-titration are especially critical for improving patient outcomes post-hospitalization.

Objective:
Identify challenges encountered post-hospitalization in optimizing GDMT for HF management by engaging key stakeholders in human-centered design (HCD) to guide the development of a digital toolkit to increase HF GDMT optimization.

Methods:
HCD is used to solve complex problems by soliciting input from stakeholders. We recruited: a) clinicians (physicians and advanced practice providers) who provide care to patients with HF across three health systems, b) patients with HF with Reduced Ejection Fraction (HFrEF, EF < 40%) discharged from the hospital within 30 days of enrollment, and c) patient health partners when available. We conducted separate virtual sessions for clinicians and patients/health partners using semi-structured interview guides to identify challenges, motivators and themes.

Results:
We enrolled 10 clinicians, 10 patients, and 2 patient health partners. The clinicians had a median age of 37 years (IQR: 35-41) and 12 years (IQR: 14-9) experience caring for patients with HF; 80% (8/10) were women, and 50% (5/10) were physicians. Patients had a median age of 53 years (IQR: 48-64); 40% (4/10) were women, 60% (6/10) were a racial/ethnic minority, and 50% (5/10) were married. Top challenges to HF GDMT optimization (e.g. number of medications) and digital toolkit features identified during the clinician HCD sessions are reported in Figure 1.

Conclusions:
The clinician and patient/health partner HCD findings will inform the development of the digital toolkit, including a patient-facing smartphone application and clinician dashboard, for HF GDMT optimization. We will also conduct HCD sessions in Brazil to further co-design the digital toolkit for low resource settings.
Abstract P400: Effectiveness and Acceptability of Dietary Telehealth Interventions Targeting Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis
Authors: Trivedi-Kapoor Rupal , Elshafie Shaimaa , Tackett Randall L , Young Henry N , Sattler Elisabeth L
Published: March 2023

Introduction:
Dietary telehealth interventions were recommended for cardiovascular disease (CVD) management during the COVID-19 pandemic.

Objective:
To examine (1) effectiveness of dietary telehealth interventions in improving diet-related CVD risk factors and (2) their acceptability among CVD patients.

Methods:
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that examined the effect of dietary telehealth interventions on CVD risk factors (Table 1) among adult CVD patients. Two investigators searched PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases based on predetermined search terms, and included English language RCTs published before July 2022. Pooled data for each CVD outcome were assessed using a random effects model, and mean difference (MD), standardized MD (SMD), or risk ratio (RR) were calculated using R software.

Results:
A total of 15 RCTs with 3,751 participants were included in the analysis. Participants had a mean age (SD) of 60.9 (3.6) years, 23.3% were women. Most RCTs were conducted in the US (33.3%) and in urban areas (93.3%). Interventions involved either phone calls, apps, texts, or websites, and follow-up durations ranged from 4 to 56 weeks. Of the 15 studies, 4 were of high quality, 10 were of moderate quality, and only 1 was of low quality. Pooled estimates showed systolic blood pressure (MD: -3.01 [95% CI: -4.75 to -1.28]) and low-density lipoprotein cholesterol (SMD: -0.11 [95% CI: -0.19 to -0.03]) to significantly favor dietary telehealth interventions compared to usual care among CVD patients. There was no significant difference between the acceptability of dietary telehealth interventions and usual care. Significant I
2
indicated moderate to considerable heterogeneity.

Conclusions:
Dietary telehealth interventions show promise in addressing CVD risk factors.
Abstract P402: Lifestyle Management Empowered by Deep Transfer Learning of Biomechanical Dynamics
Authors: Gangadharan Kiirthanaa , Zhang Qingxue
Published: March 2023

Lifestyle management is essential for many promising applications, like cardiac health monitoring and post-stroke rehabilitation. Biomechanical dynamics during human physical movements are therefore attracting more attentions towards real-time and long-term lifestyle management. However, one challenge in biomechanical dynamics analysis is how to detect diverse physical activity types. Even more challenging is, how to quickly tune a detection algorithm that can adapt easily to a new user, who has user-specific biomechanical dynamics. We proposed and developed a deep transfer learning algorithm that, not only detects the physical activity types with a deep neural network, but also transfers the similar knowledge from non-target users to the target user. The former effort enables the algorithm to analyze the complex biomechanical patterns effectively, and the latter effort minimizes the tuning time of the algorithm when it is used on a new user. Evaluated on a fifteen-subject database, with six physical activity types, the proposed deep transfer learning algorithm achieves a detection accuracy of 90%, 92%, and 94%, with 0%, 10%, and 50% of training data from the target user, respectively. The results demonstrate that, with the transferred knowledge only, the accuracy can already reach 90%, which can be further increased with additional turning effort using the target data. This study will greatly advance deep learning of biomechanical dynamics, and further the transfer learning approach for algorithm tuning effort minimization on the new user. This study will greatly benefit lifestyle management by leveraging deep intelligence.
Abstract P405: Low Social Support Mediates the Effect of Marital Stress on 12-month Cardiac-Specific Quality of Life in Young Adults With Acute Myocardial Infarction
Authors: Zhu Cenjing , Dreyer Rachel P , Li Fan , Spatz Erica S , Caraballo Cesar , Mahajan Shiwani , Raparelli Valeria , Leifheit Erica C , Lu Yuan , Krumholz Harlan M , Spertus John , DONOFRIO Gail , Pilote Louise , Lichtman Judith H
Published: March 2023

Background:
Marital stress is associated with worse cardiac outcomes in young adults (≤55 years) with acute myocardial infarction (AMI), but whether psychosocial factors mediate this association remains largely unknown. We conducted a mediation analysis to investigate whether marital stress worsened quality of life (QoL) after AMI by increasing the likelihood of depression or low social support.

Methods:
There were 1,037 married/partnered AMI survivors aged 18-55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study (2008-2012) (67% women, mean age 47 years). Marital stress was measured by the Stockholm Marital Stress Scale at 1 month post-AMI; categorized as absent/moderate or severe. Depression (Patient Health Questionnaire-9 score ≥10), low social support (ENRICHD Social Support Instrument score ≤3 on ≥2 items and total score ≤18), and cardiac-specific QoL (Seattle Angina Questionnaire) were assessed at 1 year post-AMI. Natural direct and indirect effects of marital stress, depression, and low social support on QoL were estimated by causal mediation analysis with bias-corrected bootstrapped confidence intervals. Baseline QoL, sex, age, race, and socioeconomic factors (education, income, employment, and insurance status) were entered as covariates in all models.

Results:
There was a statistically significant direct effect from severe marital stress to lower 1-year cardiac-specific QoL after adjusting for covariates (
Figure
). Low social support and depression mediated 14.7% and 11.1% of the total relationship between marital stress and QoL, respectively; however, only the mediating effect through low social support was statistically significant.

Conclusion:
Marital stress was significantly associated with worse 1-year cardiac-specific QoL, and this effect was partially mediated by low social support. Interventions to decrease marital stress that also screen and provide resources for social support may help to improve AMI outcomes.
Abstract P413: Prevalence and Significance of Poor R-Wave Progression on Electrocardiography
Authors: Parks Alexis , Ur Rahman Mustafeez , Riad Mariam , Shah Nupur , Bardia Nikky , Mulyala Rajasekhar , Patel Maulikkumar , Sarwar Usman , Awan G. Mustafa , Malozzi Christopher , Omar Bassam A
Published: March 2023

Background:
The QRS pattern on the electrocardiogram (ECG) has an expected progressively increasing amplitude of the R waves in the anterior leads. Poor R wave progression (low R wave amplitude of < 3 mm in V3) is commonly reported, however its clinical significance is unknown. It may be related to underlying cardiac pathology, body habitus, metabolic abnormalities or ECG lead placement errors. Studying the prevalence and significance of these findings in different genders and races will also shed some light on their clinical utility and applicability. Our objective is to assess the epidemiology and clinical significance of “Poor or Abnormal R-Wave Progression” as reported on routine ECGs.

Methods:
A database of ECGs performed at the University of South Alabama Medical Center ECG database (Intellispace and/or Cerner) was downloaded and compiled into searchable PDF format. ECGs were searched for patients with “Abnormal or Poor R Wave Progression”. Available clinical data on patients with these ECG findings were analyzed and reported as absolute numbers and percentages.

Results:
The total number of ECG with “Poor R-Wave Progression” were 318. Out of these, 209 (66%) were females and 109 (34%) males; 209 (66%) were black, 105 (33%) were white and 4 (1%) other races. There were 143 (45%) black females, 65 (20%) white females, 66 (21%) black males and 40 (13%) white males. There were 234 (74%) patients < 60 years of age while 85 (26%) were 60 years of age or older. There were 233 (73%) with hypertension. Only 198 (62%) had echocardiograms, with an average ejection fraction (EF) of 52%. Out of these 49 ((25%) had mild to moderate decrease in EF ( > 30 - 50%) while 28 (14%) had severely decreased EF of 30% or less. There were 81 (41%) with wall motion abnormalities concerning for coronary disease, while 95 (48%) had diastolic dysfunction.

Discussion:
Poor R-wave progression is a commonly reported finding on ECG. It is more prevalent in females, which may be due to improper lead placement or chest size. However, its higher prevalence in blacks may be indicative of higher incidence of heart failure, coronary disease and hypertension. It is more frequent in younger patients who may be more obese, but also carry multiple risk factors for cardiac disease. Poor R wave progression showed strong correlation with any degree of heart failure and with wall motion abnormalities on echocardiogram concerning for coronary disease. Therefore this finding should trigger a diagnostic cascade with echocardiography and/or stress testing, depending on the clinical scenario, in order to identify potentially serious underlying cardiac pathology which may be amenable to therapy.