bluuebunny/crossref_metadata_2025 huggingface dataset:
Building a Performance Management System for Hospitals Based on Diagnosis-Related Group (DRG) Payment
Authors: Zhao Shaolin , Gu Yingying , Huang Zhenju
Published: March 2022

With the deepening of the national medical and health system reform, various supporting reform measures are being promoted. The reform of medical insurance payment methods is an important part of the process, and payment through diagnosis-related groups (DRGs) will gradually become the main way for medical insurance to pay medical institutions. According to the analysis of the impact of DRG payment on hospital performance management, this research examines the construction and implementation of the internal performance management system (IPMS) based on DRG payment in hospitals. The IPMS based on DRG payment includes four elements: organizational management system, assessment system, communication and feedback system, and information support system. In addition, this study explores how IPMS can be implemented in hospitals, including the preparation before implementation, key points to be grasped during implementation, and considerations to be focused on.
Stress-Strain Relationships of Fiber Reinforced Phosphogypsum under Uniaxial Compression
Authors: Zhou Li , Chen Bo , Huang Yong
Published: March 2022

To investigate the stress-strain relationship of fiber reinforced phosphogypsum (PG) under uniaxial compression, a total of twenty-seven PG prism specimens were fabricated and tested. The influences of the content of admixture, content of fiber, and water-solid ratio on the stress-strain curve of the specimens were investigated. Three kinds of failure modes were summarized by observing the experimental phenomena; they were called “compaction failure,” “tension failure,” and “mixed stress failure,” respectively. Through in-depth analysis of the test data, it was found that decreasing the water-solid ratio can lead to increasing the peak stress and secant modulus of specimens; increasing the fiber content can lead to improving the mechanical property of PG mixture specimens. However, adjusting the contents of the cement and quicklime has no significant effect on the mechanical property of specimens. In addition, according to the test data and the characteristics of stress-strain curves, the stress-strain curve of PG specimens was divided into four parts, and a mathematical model was developed to predict the stress-strain curve of PG specimens. The validations of the model showed that the curves calculated by the proposed model were well in agreement with the test data of this study and previous studies.
Relational Decision Model Building for the Purchase of Rural Fresh Products Based on the Supply
Authors: Liu Chang
Published: March 2022

The achievements of China’s reform and opening up in the past 40 years have contributed to the great transformation of China’s economic model and accelerated industrialization reform. With the emergence of the supply chain model, the traditional resistance to economic development is reversed, and fresh impetus is injected into economic development. Fresh products are the primary target of the supply chain service, so it is of high academic significance to study its stability. Fresh products, as the principal components of agricultural products, have supported half of the operations of the supply chain model. It is of great help to study the purchase of fresh products in various regions by analyzing the Internet economy of purchasing from a new perspective of the relational decision model of fresh product purchasing. Based on the reasonable planning of the supply chain, this model can support the economic profit of fresh products quickly, which will be analyzed and discussed in this paper.
Effects of Electron Microscope Parameters and Sample Thickness on High Angle Annular Dark Field Imaging
Authors: Yang Pucheng , Li Zheng , Yang Yi , Li Rui , Qin Lufei , Zou Yunhao
Published: March 2022

Scanning transmission electron microscopy (STEM) developed into a very important characterization tool for atomic analysis of crystalline specimens. High-angle annular dark field (HAADF) scanning transmission electron microscopy (STEM) has become one of the most powerful tools to visualize material structures at atomic resolution. However, the parameter of electron microscope and sample thickness is the important influence factors on HAADF-STEM imaging. The effect of convergence angle, spherical aberration, and defocus to HAADF imaging process has been analyzed through simulation. The applicability of two HAADF simulation software has been compared, and suggestions for their usage have been given.
Evaluation of Wide Corneal Epithelial Remodeling after Small Incision Lenticule Extraction (SMILE) with Wide-Field Optical Coherence Tomography
Authors: Ye Yiming , Chen Pei , Yu Na , Wan Linxi , Lan Min , Zheng Hua , Yu Keming
Published: March 2022

Purpose. This study aims to assess the corneal epithelial remodeling within a 9 mm diameter zone induced by small incision lenticule extraction (SMILE) and evaluate its relationship with the refractive outcomes. Methods. A total of 64 eyes of 64 patients were included. Wide-field optical coherence tomography (OCT) was used to measure the epithelial thickness (ET) across a 9 mm diameter area, preoperatively, and after one day, one week, one month, three months, and six months postoperatively. The ET changes were compared among the different time points and analyzed zones. Results. The ET increases from one week to three months and stabilized from three months to six months. Compared to the preoperative values, the mean ET changes at six months in central (2 mm), paracentral (2–5 mm), mid-peripheral (5–7 mm), and peripheral (7–9 mm) zones were 4.37, 4.36, 1.61, and −1.59 μm, respectively. The correlation between the epithelial thickening and the amount of myopia correction was positive in central (

P

 = 0.001) and paracentral zones (

P

 < 0.001) and negative in peripheral zone (

P

 = 0.006). The intended diameter of the optical zone was negatively related to epithelial hyperplasia in the central (

P

 = 0.020) and paracentral zone (

P

 = 0.006), and the correlation was positive in the mid-peripheral zone (

P

 = 0.001). The epithelial thickening of central zone (

P

 = 0.012) and the difference of mean ET between central and paracentral zone (

P

 = 0.020) were negatively related to the spherical equivalent at six months. Conclusion. An asymmetric lenticule-like pattern of epithelial remodeling occurred in 9 mm diameter cornea at six months after myopic SMILE. The epithelial remodeling may affect the refractive outcomes of SMILE.
Effect of Massage Therapy for the Treatment of Neonatal Jaundice: A Systematic Review and Dose-Response Meta-analysis
Authors: Shahbazi Marjan , Khazaei Salman , Moslehi Samad , Shahbazi Fatemeh
Published: March 2022

Background. The effectiveness of massage therapy in the treatment of neonatal jaundice has been established in previous literature, but how much the level of massage can reduce the mean of bilirubin in neonates with jaundice is a question that has been addressed in this review. Methods. Four electronic databases, including Cochrane, PubMed, Scopus, and Web of Science, were searched for relevant literature. For the dose-response association between massage therapy and treatment of neonatal icterus, we conducted a meta-analysis using the random-effects model. For any level of intervention, we calculated the overall mean difference (MD) with 95% confidence intervals (CI). Results. Twenty studies were included in our meta-analysis. There was a positive and significant increasing dose-response trend between massage therapy and the mean reduction of bilirubin in neonates with hyperbilirubinemia as follows: <50 minutes massage during the experiment -0.36 (95% CI: -0.67, -0.06;I2=66%), 50-60 minutes massage during the experiment -0.41 (95% CI: -0.95, 0.13;I2=84%), and ≥101 minutes massage during the experiment -1.20 (95% CI: -1.63, -0.78;I2=83%). The heterogeneity across studies was mild to moderate. Conclusions. The presence of a dose-response relationship favors the causal relationship between massage therapy and reduction of neonatal jaundice.
Elevated Serum IGFBP-2 and CTGF Levels Are Associated with Disease Activity in Patients with Dermatomyositis
Authors: Yang Min , Chen Yuehong , Yin Geng , Lin Sang , Liu Huan , Huang Yupeng , Tian Yunru , Zhou Yueyuan , Luo Fengming , Xie Qibing
Published: March 2022

Background. Insulin-like growth factor-binding proteins (IGFBPs) and connective tissue growth factor (CTGF) participate in angiogenesis. Dermatomyositis (DM) is characterized by microvasculopathy-derived skin lesions. Here, we investigated the clinical significance of serum IGFBP and CTGF levels in DM patients. Methods. In this study, 65 DM patients and 30 healthy controls were enrolled. Serum IGFBP and CTGF levels were examined by ELISA, and their correlation with clinical and laboratory findings was analyzed by Spearman’s correlation. Results. Serum IGFBP-2, IGFBP-4, and CTGF levels were higher in DM patients than in healthy controls (median (quartile): 258.9 (176.4–326.1) ng/mL vs. 167.7 (116.1–209.4) ng/mL,

p
<
0.0001

; 450.4 (327.3–631.8) ng/mL vs. 392.2 (339.0–480.2) ng/mL,

p
=
0.04

; and 45.71 (38.54–57.45) ng/mL vs. 35.52 (30.23–41.52) ng/mL,

p
=
0.001

, respectively). IGFBP-2 and CTGF levels were positively correlated with cutaneous (

r
=
0.257

,

p
=
0.040

and

r
=
0.427

,

p
=
0.015

, respectively) and global (

r
=
0.380

,

p
=
0.002

and

r
=
0.292

,

p
=
0.019

, respectively) disease activity in DM patients. Conclusion. Serum IGFBP-2 and CTGF levels were increased in patients with DM and correlated with cutaneous and global disease activity.
Data Mining Techniques to Analyze the Impact of Social Media on Academic Performance of High School Students
Authors: Amjad Saman , Younas Muhammad , Anwar Muhammad , Shaheen Qaisar , Shiraz Muhammad , Gani Abdullah
Published: March 2022

The main purpose of educational institutions is to provide quality education to their students. However, it is difficult to analyze large data manually. Educational data mining is more effective as compared to statistical methods used to explore data in educational settings to analyze students’ performance. The objective of the study is to use different data mining techniques and find their performance and impact of different features on students’ academic performance. The dataset was collected from the Kaggle repository. To analyze the dataset, different classification algorithms were applied like decision tree, random forest, SVM classifier, SGD classifier, AdaBoost classifier, and LR classifier. This research revealed that random forest achieved a higher score (98%). The score of decision tree, AdaBoost, logistic regression, SVM, and SGD is 90%, 89%, 88%, 86%, and 84%, respectively. Results show that technology greatly influences student performance. The students who use social media throughout the week showed low performance as compared to the students who use it only at weekends. Furthermore, the impact of other features on the performance of students is also measured.
Rock Fracture Response Exposed to Hydraulic Fracturing: Insight into the Effect of Injection Rate on Aperture Pattern
Authors: Zhang Bo , Cui Xinyi , Wang Linjun , Fu Xiaodi
Published: March 2022

Injection rate is critical to hydraulic fracturing operation, especially to the hydraulic fracture aperture, which affects the proppant and methane migration. In this study, hydraulic fracturing experiments were carried out on shale specimens to investigate the influence of injection rate on hydraulic fracture aperture. According to the experimental results, when the injection rate increases, the average aperture of hydraulic fracture shows a significant linear increase. For different injection rate, the average aperture of stimulated natural fracture is always slightly greater than that of newly opened fracture. Compared with a low injection rate, the fracture apertures induced by the largest injection rate are evenly distributed in more intervals and approximately conform to the normal distribution. The research results can provide a theoretical basis for enhancing the fracture conductivity of hydraulic fracturing in shale reservoirs.
Observation on the Effect of Solution-Focused Approach Combined with Family Involvement in WeChat Platform Management on Inpatients with Intracerebral Hemorrhage
Authors: Song Yu
Published: March 2022

Objective. To explore the effect of the solution-focused approach combined with family involvement in the WeChat platform management on inpatients with intracerebral hemorrhage (ICH). Methods. A total of 80 ICH patients hospitalized in our hospital from June 2018 to June 2021 were split into the control group (CG) and the study group (SG) according to the clinical nursing modes, with 40 cases in each group. Both groups received routine intervention, while SG additionally received the solution-focused approach combined with family involvement in the WeChat platform management to compare the self-care ability, psychological status, and hope levels between the two groups after intervention. Results. No significant differences in general data were observed between the two groups (

P
>
0.05

). The SAS and SDS scores before intervention showed mild depression and anxiety in both groups, which improved after intervention. In addition, the SAS and SDS scores after intervention were remarkably lower in SG than in CG (

P
<
0.05

). After intervention, the scores of ICH-related knowledge, self-care skills, self-care responsibility, and rehabilitation knowledge in SG were notably higher compared with CG (

P
<
0.05

). After intervention, the Herth scores of both groups increased, with a higher score in SG than in CG (

P
<
0.05

). After intervention, SG had higher quality of life (QOL) scores in general health, physiological function, physiological role, body pain, vitality, social function, emotional role, and physiological health than CG (

P
<
0.05

). Conclusion. The implementation of the solution-focused approach combined with family involvement in the WeChat platform management for ICH inpatients can effectively improve their psychological status, enhance their self-care ability and hope levels, promote body recovery, and improve their QOL after intervention.
Abstract 106: Characteristics of Payments to Cardiologists From Leading Manufacturers: An Analysis of Three-Year Open Payments Data
Authors: Annapureddy Amarnath , Murugiah Karthik , Minges Karl E , Curtis Jeptha , Higgins Angela
Published: March 2022

Background:
The Open Payments Program (OPP) mandates that biomedical companies disclose physician payments. Little is known about the spending characteristics of leading industry spenders.

Methods:
Using data from the OPP, we aggregated payments to individual cardiologists from 2014-2016, and subsequently studied payment characteristics of 10 leading companies.

Results:
From 2014-2016, payments totaling $520,167,233 were made to 30,372 cardiologists. The top 10 companies made 60% of total payments ($312,661,029). The companies with highest payment amounts were St. Jude (18%), Medtronic vascular (16%), Janssen pharmaceuticals (13%), Boston Scientific (12%), AstraZenca (11%), Pfizer (7%), Topera (7%), Bristol-Meyer Squibb (6%), Amgen (5%), and Novartis (5%). Majority of the payments were made for services such as speaking at dinner talks (59% of total payments). Other forms of payments were for food and beverages (12%), travel and lodging (10%), ownership interests (8%) and consulting fees (8%). Spending patterns of pharmaceutical companies were similar. Device manufactures such as Boston Scientific and Medtronic had a relatively higher proportion of spending on travel and ownership fees.

Conclusion:
Few major companies made a significant proportion of payments to cardiologists. Services such as speaking at dinner talks were the largest areas of spending. The impact of the OPP on the patterns of industry spending remains to be seen.
Abstract 11: Development and Comparison of Two Natural Language Processing Methods for Identifying Bleeding Events in Clinical Text
Authors: Taggart Max , Chapman Wendy W , Steinberg Benjamin A , Ruckel Shane , Pregenzer-Wenzler Arianna , Du Yishuai , Ferraro Jeffery , Bucher Brian T , Lloyd-Jones Donald M , Rondina Matthew T , Shah Rashmee U
Published: March 2022

Background:
Learning healthcare systems need techniques that can accurately and automatically identify health outcomes in large populations. Outcomes are often described in clinical narration in the electronic medical record.

Objective:
To develop and compare two natural language processing (NLP) approaches, rules-based (RB) and machine-learning (ML), for identifying bleeding events in clinical notes.

Methods:
We used de-identified notes from the Medical Information Mart for Intensive Care. We randomly selected 990 notes for a training set and 660 notes for a test set. Physicians classified each note as present or absent for a clinically relevant bleeding event during the hospitalization. We developed a dictionary of target and modifier words for the RB approach. In RB, the computer “reads” the text and tags bleeding targets as present or absent based on the modifier words; the mentions are aggregated to arrive at a classification for the note. For the ML approach, each note was represented as a high-dimensional vector where each dimension corresponds to the frequency of a certain word. Similar notes (e.g. bleeding present notes) have similar vectors; the computer learns these patterns to predict the class for an unseen note. One RB and three ML models (support vector machine (SVM), extra trees (ET), convolutional neural network (CNN)) were trained using the full 990-note training set. Another instance of each ML model was also trained on a down-sampled (DS) set of 450 notes, with equal positive and negative notes. We ran the trained models on the 660-note test set and compared classification performance using McNemar’s test.

Results:
The 660 note test set represented 527 unique patients, 40% female. Bleeding events were present in 21% of the notes. The ET-DS model was the most sensitive, followed by the RB approach (93.8% versus 91.1%, p=0.44). The PPV value for the ET-DS model, however, was <50%. The RB had the best performance overall, with 84.6% specificity, 62.7% positive predictive value, and 97.1% negative predictive value (NPV) for identifying clinically relevant bleeding.

Discussion:
A RB NLP approach, compared to ML, has the best overall performance in independently identifying bleeding events among critically ill patients. The current models have high NPV, so could be used to reduce the chart review burden.
Abstract 113: Temporal Trends in the Use of Therapeutic Hypothermia for Out-of-Hospital Cardiac Arrest: Insights From the CARES Registry
Authors: Bradley Steven M , Lui Wenhui , McNally Bryan , Henry Timothy D , Burke M. Nicholas , Mooney Michael R , Brilakis Emmanouil S , Grunwald Gary K , Adhaduk Mehul , Donnino Michael , Girotra Saket
Published: March 2022

Background:
Despite evidence that therapeutic hypothermia improves patient outcomes for out-of-hospital cardiac arrest, use of this therapy remains low. It is unknown if the use of therapeutic hypothermia and patient outcomes have changed following publication of a trial that supported more lenient temperature management.

Methods:
In the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 45,935 U.S. patients who experienced out-of-hospital cardiac arrest and survived to admission at 649 hospitals between 2013 and 2016. Using segmented hierarchical logistic regression, we determined risk-adjusted trends in the use of therapeutic hypothermia overall and stratified by presenting rhythm of ventricular tachycardia or ventricular fibrillation (VT/VF) vs pulseless electrical activity or asystole (PEA/asystole). We used mediation analysis to assess the impact of temporal trends in the use of therapeutic hypothermia on risk-adjusted survival trends at a patient- and hospital-level.

Results:
Overall use of therapeutic hypothermia was 46.4%. In unadjusted analyses, the use of therapeutic hypothermia dropped from 52.5% in the last quarter of 2013 to 46.0% in the first quarter of 2014 after publication of a trial that supported more lenient temperature management. Use of therapeutic hypothermia remained at or below 46.5% through 2016. After risk-adjustment, these trends in use persisted (see Figure). Compared with the last quarter of 2013, the risk-adjusted odds of therapeutic hypothermia was 18% lower in the first quarter of 2014 (OR 0.82, 95% CI 0.71, 0.94, P=0.006). Similar findings were observed in analyses stratified by presenting rhythm (see Figure). Overall risk-adjusted patient survival was 36.9% in 2013, 37.5% in 2014, 34.8% in 2015, and 34.3% in 2016 (P for trend<0.001). Trends in hypothermia use did not explain trends in survival.

Conclusions:
In a U.S. registry of out-of-hospital cardiac arrest, the use of therapeutic hypothermia decreased after publication of a study supporting more lenient temperature thresholds. Concurrent to this change, overall risk-adjusted survival of cardiac arrest decreased, but was not attributed to lower use of therapeutic hypothermia.
Abstract 117: Presence of Mental Health Disorders, Low Socioeconomic Status, More Closely Associated With Adverse Cardiovascular Outcomes After a Recent Hospitalization
Authors: Feldeisen Delaney , Krallman Rachel , Morgan Spencer , Montgomery Daniel , Kline-Rogers Eva , Eagle Kim A , Bumpus Sherry M
Published: March 2022

Background:
BRIDGE is a cardiac transitional care program. In previous studies, lower socioeconomic status (SES) and mental health disorders (MHD) have been associated with higher readmission rates. No research has been done on the combined effects of low SES and MHD on outcomes. This study sought to describe outcomes (ED Visits, readmission, and death) of patients by SES and MHD.

Methods:
All patients referred to BRIDGE between 2008-2015 were included in this study. Data were analyzed in three ways: 1) by SES and then by presence (or absence) of MHD (depression, anxiety, substance abuse), 2) by MHD and then by SES, and 3) patients of low SES without MHD compared to patients of high SES with a MHD (data not shown in Table 1). High and low SES were defined as above or below the state of Michigan median household income ($46,859), estimated by patients’ home zip code. Demographics and outcomes were compared within and between groups.

Results:
Among 3051 patients divided first by SES, there were a number of significant differences in demographics and outcomes between patients with and without MHD. Regardless of SES, patients with MHD were more often younger, female, single, and had higher rates of ED visits and readmissions at 180 days post-discharge than patients without MHD. Among high SES patients, patients with MHD had higher rates of ED visits within 30 days despite lower Charlson Comorbidity scores. In contrast, when divided by presence or absence of MHD first, fewer differences existed between SES groups. Regardless of presence or absence of MHDs, patients of low SES were younger and more racially diverse than patients of high SES; however, there were no differences in outcomes between these SES groups. Among patients without a MHD, low SES patients were less likely to attend BRIDGE. Patients of low SES without MHD were more likely than patients of high SES with MHD to be male (61.4% v. 51.2%, p<0.001), married (60.8% v. 52.2%, p=0.013), and non-White (75.3% v. 89.5%, p<0.001), and were less likely to have an ED visit within 180 days (31.9% v. 43.9%, p<0.001).

Conclusions:
The presence of MHDs appears to be more strongly associated with negative outcomes than low SES. Efforts to develop and improve interventional care strategies that target patients with MHDs should be made to reduce these health disparities.
Abstract 118: Factors Associated With Hospital Length of Stay for Heart Failure
Authors: Zeger Linda M , Williams Jeff , Haight Daniel O
Published: March 2022

Objective:
To identify which hospital indicators are related to hospital length of stay (LOS) for heart failure (HF) inpatients, and their associations.

Methods:
Data from Centers for Medicare & Medicaid Services from 2012 to 2015 and the Florida Agency for Healthcare Administration (AHCA) from April 2014 to June 2016 were analyzed. We explored numerous quality and hospital size indicators, which were collected for nonidentical patient populations, for their potential associations with hospital mean LOS of Florida HF inpatients. We applied machine learning methods to screen for metrics most important to predicting LOS. Next, we derived generalized linear models (GLM) using several key screened indicators and multiple imputations for missing data, while weighting hospitals’ metrics according to their numbers of HF inpatients. We considered a total of 175 general acute care hospitals in Florida, and a total of 178,987 inpatient visits to obtain the values of mean hospital LOS.

Results:
Relationships obtained from the GLM for factors with substantial associations with hospital HF LOS are: Larger values of hospital-wide total staff size, emergency department wait time, and MRSA rates were all significantly associated with larger hospital HF LOS values. Increases in total hospital staff size from 550 to 5924 (the lowest and highest deciles of the hospital staff size distribution), given a fixed value of the MRSA rate, were associated with an
average
increase
in the hospital HF LOS from its mean value over all hospitals of 5.0 to 5.9 (± .1) days. Increases in the mean time spent in the ED for
all
admitted patients from 222 to 374 minutes (the lowest and highest deciles of the distribution among hospitals for this ED wait time) were associated with an
average
increase
in the hospital HF LOS from its mean of 5.0 to 6.0 (± .1) days. The GLM coefficient estimates (p < .0001) show these associations with the
average
over Florida hospitals of HF LOS. Additional factors, such as the number of HF inpatients, were also positively associated (though less strongly) with HF LOS, and are highly correlated with the indicators above such as hospital staff size.

Conclusion:
For Florida inpatients, the mean hospital HF LOS was positively associated with
hospital-wide
metrics of total staff size, MRSA rate, and time spent in the ED. Since the data were observational and many factors were not controlled, potential causality can not be determined. Further study is needed to discover the mechanisms behind these associations, as well as any potential confounding factors.

Disclaimers:
Results here were derived from limited data sets of the Florida AHCA. However, Florida AHCA does not claim responsibility for any of the resulting analysis, interpretations or conclusions. The authors and their institutions do not claim that the associations found are causal, nor that any actions taken based on the results here will change outcome metrics.
Abstract 124: Glycemic Control and Medication Adherence in Diabetic Patients After Myocardial Infarction
Authors: Ramadurai Deepa , Adamek Kylie , Gunzburger Elise , Ho P. Michael , Raghavan Sridharan
Published: March 2022

Introduction:
Non-adherence to cardioprotective medications is associated with mortality after myocardial infarction (MI) in patients with diabetes. Therefore, identifying predictors of medication adherence could inform optimal secondary prevention after MI. We examined whether glycemic control among those with diabetes was associated with post-MI cardioprotective medication adherence.

Methods:
We studied 7,269 US Veterans with type 2 diabetes who were hospitalized for a primary diagnosis of first MI from 2011-2014, survived for one year, and prescribed a statin, beta-blocker, and angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB). The primary exposure was poor glycemic control at the time of MI, defined as hemoglobin A1c (HbA1c) ≥9%. A secondary exposure was HbA1c, categorized as <6%, 6-6.9%, 7-7.9%, 8-8.9%, and ≥9%. The primary outcome was one-year adherence to each medication class (statin, beta-blocker, and ACEi/ARB) and to all three medication classes, defined as proportion of days covered exceeding 0.8. We used adjusted risk differences and multivariable Poisson regression to compare rates of medication adherence between individuals, adjusting for demographic and clinical covariates.

Results:
Seventy-nine percent (n=5747) of participants had HbA1c <9%, and 21% (n=1522) had HbA1c ≥9%. Compared to those with HbA1c <9%, those with HbA1c ≥9% had lower rates of adherence (65% vs 73% for statin, 70% vs 79% for beta-blocker, 73% vs 80% for ACEi/ARB, and 49% vs 58% for all three, all p<0.0001; adjusted risk difference of 8.9% [95% CI 6.0, 11.8] for adherence to all three medications). Relative to those with HbA1c 6-6.9%, there was a non-significant trend towards lower medication adherence among those with HbA1c <6%, and adherence to all three medications declined with increasing HbA1c (risk ratio [RR] 0.99 [0.94, 1.04], 0.93 [0.87, 0.99], 0.82 [0.77, 0.88] for those with HbA1c 7-7.9%, 8-8.9%, and ≥9%, respectively; Figure).

Conclusion:
While medication adherence overall declined with worsening glycemic control, the greatest differences are seen in those with a HbA1c ≥9%. Thus, targeting optimal medical therapy adherence, in addition to glycemic control, could benefit those with poorly-controlled diabetes after MI.
Abstract 130: Outcomes of Transcatheter Aortic Valve Replacement in Patients With Chronic Kidney Disease
Authors: Jou Stephanie , Zhang Robert , El-Hajjar Mohammad , Nappi Anthony , Lyubarova Radmila , Sidhu Mandeep , Torosoff Mikhail
Published: March 2022

Background:
Transcatheter aortic valve replacement (TAVR) is an alternative form of treatment for patients with aortic valve disease who are otherwise considered a high risk candidate for surgical aortic valve replacement (SAVR). Chronic kidney disease (CKD) is known to adversely affect the outcomes of cardiac surgery including SAVR. We aimed to determine the outcomes of TAVR in patients with CKD, which has not been widely reported.

Methods:
A retrospective observational study was conducted on 241 consecutive TAVR patients (81.6 +/- 8.1 years old, 58% females (140 of 241)) treated between January 2011 and April 2015 at a single academic institution. CKD was defined as glomerular filtration rate (GFR) below 60 mL/min.

Results:
Ninety-five out of 241 (39.42%) TAVR recipients had CKD. Patients with CKD had a significantly higher Society of Thoracic Surgeons (STS) score (13.8% +/- 9.5, vs. 9.3% +/- 5.013; p-value <0.001), but there was no difference in age, left ventricular ejection fraction, or aortic valve area prior to TAVR. Patients with CKD had a longer intensive care unit stay (149.4 +/- 188.9 vs. 105.5 +/- 87.1 hours; p = 0.037) and hospital stay (14.4 +/- 11.7 vs. 11.5 +/- 7.5 days; p = 0.036). Postoperative worsening of kidney dysfunction (20% (19 of 95) vs. 6.9% (9 of 131); p = 0.003) and vascular complications (7.4% (7 of 95) vs 1.5% (2 of 131); p = 0.027) were more frequent in CKD patients. There were trends towards increased in-hospital mortality (3.16% (3 of 95) vs. 2.27% (3 of 132); p = 0.68) and 1-year mortality (9.47% (9 of 95) vs. 4.55% (6 of 132); p = 0.14) in CKD patients. When adjusted for significant comorbidities (i.e. diabetes, coronary artery disease, congestive heart failure and pulmonary hypertension), CKD was not associated with increased in-hospital mortality, but the risk of 1-year mortality was significantly increased (adjusted odds ratio 3.2, 95% confidence interval 1.01-9.96; p = 0.048).

Conclusions:
A significant proportion of TAVR recipients suffer from chronic kidney disease. These patients were more likely to experience vascular complications and worsening of renal dysfunction, a prolonged intensive care unit and hospital length of stay, and an increased one-year mortality. Additional prospective randomized studies of this important patient population are warranted.
Abstract 131: Recurrent Acute Cardiovascular Events and Statin Use
Authors: Tecson Kristen M , Kluger Aaron Y , DiMario Stefan , Harrison David J , McCullough Peter A
Published: March 2022

Background:
Atherosclerotic cardiovascular disease (ASCVD) increases the risk of cardiovascular (CV) events. Although 2013 ACC/AHA guidelines recommend statin treatment, many patients remain untreated after a CV event.

Objective:
To assess the impact of statin treatment on recurrent CV events in an integrated delivery network setting.

Methods:
This retrospective study used insurance claims from Baylor Scott & White’s Virtual Data Warehouse. Eligible adults survived a hospitalization for a CV event (index event) from September 30, 2013, to September 30, 2014. CV event was defined as myocardial infarction, ischemic stroke, unstable angina, or coronary revascularization. Continuous enrollment 1 year pre-index was required; patients were followed up to 1 year. A Cox model was created to investigate the effect of post-index statin use on recurrent CV events as the primary outcome.

Results:
These 1,260 patients had a median age of 74.8 [63.7, 83.2] years; 56.2% were male, 36.1% had type 2 diabetes, and 81.2% had hypertension. Coronary revascularization was the most common index event (368; 29.2%) and 79 (6.3%) individuals had at least 1 recurrent CV event during follow-up. The median time-to-event was 179 [98, 254] days, for patients who had 1 or more events following the index. CV events were independent of gender (p=0.71), age (p=0.44), and insurance (p= 0.95). Patients with a CV event in the year prior to the index were more likely to have another during follow-up (19.0% v. 9.2%, p = 0.005). Statin-treated patients increased from 531 (42.1%) to 759 (60.2%) following the index CV event (p < 0.001). Those who did not fill a statin prescription after the index had a 76% increased risk for a recurrent CV event within 1 year (hazard ratio: 1.76, 95% confidence interval: 1.13-2.74) compared to those who filled a statin prescription (Figure 1).

Conclusion:
While statin use substantially increased after an index CV event, nearly 40% of patients remained untreated, increasing their recurrent CV event risk by 76%. Initiation and continuation of statin therapy after CV events remains a large public health opportunity for patients with ASCVD.
Abstract 140: Antihypertension Treatment Disutility Among U.S. Adults
Authors: Spatz Erica S , Shahu Andi , Kliot Tamara , Desai Nihar R , Francis Darrel P , Herrin Jeph , Krumholz Harlan M
Published: March 2022

Background:
Understanding people’s thresholds for intervention is vital for designing strategies to translate effective therapies into more individualized, patient-centered disease prevention. Accordingly, we assessed the disutility inherent to taking an antihypertensive medication (versus other antihypertensive interventions).

Methods:
From March to June 2017 we conducted a survey of antihypertensive treatment preferences among 1,284 US adults recruited through Amazon MTurk and 100 patients presenting to an outpatient clinic. Participants were asked to imagine a scenario in which they had hypertension (if they did not) and to decide whether they would adopt specific interventions (tea, exercise, pill, injection) to achieve a given benefit. For example: would they drink a cup of tea daily to gain 1 month, 1 year, or 5 years of life. We estimated gains in life expectancy by age and sex, derived from meta-analyses of pills, but applied to all interventions. We calculated the difference between the calculated benefit (‘utility’) and respondents’ expressed minimum desired benefit for taking the therapy, which is a measure of undesirability (‘disutility’).

Results:
The cumulative proportion of respondents willing to adopt the intervention if it prolonged life by at least 1 month, 1 year or 5 years varied, respectively: tea (78%; 91%; 96%); pills (79%; 90%; 96%); exercise (63%, 84%; 93%); monthly injections (51%; 74%; 88%); and 6 month injections (68%; 85%; 93%). Utility exceeded disutility (benefits outweighed the burdens of treatment, in months) the greatest for tea and pills (14.8 months), followed by exercise and 6 month injections (12.7 months), then 1 month injections (10 months). However, for each intervention, more than 20% of individuals considered the burden of treatment to exceed their calculated life expectancy gain (Figure).

Conclusion:
In contrast to guidelines which recommend lifestyle changes such as exercise as first line, people’s preferences indicated that they would be more inclined to take a daily pill or tea to prolong their life. Substantial numbers of respondents desired gains in life years that were beyond what each treatment could maximally provide.
Abstract 163: Implementation of a Physician Order Set Improves Adherence to Cardiac Care Unit Policy: A Quality Improvement Initiative
Authors: Mooney John H , Kairouz Victor F , Yaranov Dmitry , Ibrahim Saif , Levine Joshua , Garcia Emilio , Acevedo Javier , Marcus Marshall , Franchi Francesco , Rollini Fabiana , Angiolillo Dominick J , Hsu Steve , Su Jialin , Kim Robert , Velarde Gladys P , Catanzaro John N
Published: March 2022

Objective:
To determine if using physician order sets within the electronic health record improves adherence with local policy in the Cardiac Care Unit (CCU) at University of Florida Health - Jacksonville (UFH-J)

Background:
In 2015, CCU at UFH-J implemented a policy to guide the utilization of wearable cardioverter-defibrillators (WCD) in patients with heart failure and ejection fraction less or equal to 35%. Adherence to this policy was sparse and needed improvement.

Methods:
We hypothesized that developing an electronic order set would improve adherence to existing CCU policy. The policy to be addressed was the CCU WCD policy. Pre-intervention data from January 1-June 30, 2016 was analyzed for compliance. We evaluated policy compliance in heart failure patients admitted to the CCU. On July 1, 2016, a CCU admission order set, including a section on the WCD policy, launched. The order set was developed with multi-disciplinary input from nursing, nutrition, pharmacy, and physicians. To ensure adequate time for adjustment to the order set, the post-intervention data set was collected from January 1 - June 30, 2017.

Results:
Implementation of the CCU admission order set resulted in a 23% absolute increase in compliance with the CCU WCD policy. Additional benefits of the implementation of the order set that were not directly evaluated in this study include standardization of initial evaluation and patient care, improvement in the selection of the appropriate diet for cardiac patients with other dietary considerations including diabetes and renal disease, and an increase in the utilization of cardiac rehabilitation upon discharge.

Conclusion:
Implementation of an order set is an effective way to improve adherence to patient care policy. Further studies to assess impact of physician order sets on morbidity and mortality, especially in patients with a WCD are warranted.
Abstract 165: Temporal Trends in FFR Utilization in Patients Undergoing Coronary Angiography: A Population Based Study
Authors: Greener Gabby E , Masih Shannon , Fang Jiming , Roifman Idan , Wijeysundera Harindra C
Published: March 2022

Background:
Invasive fractional flow reserve (FFR) has emerged as an important tool to identify a subset of patients in whom coronary revascularization may be beneficial. Our objective was to evaluate temporal trends in FFR utilization.

Methods:
In this population-based study, we identified all coronary angiograms in the CorHealth Ontario Cardiac Registry between January 1
st
, 2010 to December 31
st
, 2015. The primary and secondary outcomes were the age-sex adjusted monthly rate of FFR per 100,000 population and per 100 angiograms respectively. Piecewise regression analysis was used to evaluate the temporal trends in FFR utilization, for the entire cohort, and then stratified by indication (stable coronary disease (SCAD) versus acute coronary syndrome (ACS)).

Results:
The study cohort included 379,688 angiograms, of which 122,571 were for SCAD (32%), and 134,769 were for ACS (35%). FFR was performed in 3.2% of all angiograms (4.6% in SCAD; 2.7% in ACS). Monthly age-sex adjusted FFR utilization rates increased significantly over the study period, from 0.4 to 2.1 per 1000,000 people/month. The monthly FFR utilization rate per 100 angiograms increased from 1.3 to 4.8 per 100 angiograms/month; however, the proportion of positive FFR results was relatively constant at 27%. There was a more dramatic increase in the use of FFR in the SCAD (1.4 to 7.5 per 100 angiograms/month) compared to the ACS population (1.3 to 3.4 per 100 angiograms/month).

Conclusions:
Over time, there was a 5-fold increase in the use of FFR in patients across Ontario, which was predominantly driven by use in patients with SCAD. Case selection for FFR use was relatively unchanged with approximately a quarter of FFR cases being positive over time.
Abstract 170: Racial Disparities and Patient Reported Healthcare Experience Among Adults With Atherosclerotic Cardiovascular Disease
Authors: Okunrintemi Victor , Salami Joseph , Valero-Elizondo Javier , Osondu Chukwuemeka , Ogunmoroti Oluseye , Patrick Benjamin , Pawlik Timothy , Nasir Khurram
Published: March 2022

Background:
Studies report that barriers to the relationship between patients and their healthcare providers contribute to racial disparities in healthcare experience. Although race is thought to play a major role in the disparities seen in patient report on healthcare experience, results reported by different scholars on the effect of race on patient provider communication and overall patient satisfaction has been heterogeneous. In this study, we explore the relationship between patient race/ethnicity and various domains of patient healthcare experience [patient provider communication, shared decision making and overall patient satisfaction] in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD).

Methods:
The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. We developed a weighted average score for each domain of patient report on healthcare experience, using responses to questions from the CAHPS survey related to patient provider communication, shared decision making and patient overall satisfaction. We compared these scores across patient race/ethnicity.

Results:
The proportion of ASCVD patients with an optimal score on all domains of patient reported experience was least among Asians (patient-provider communication 37.5%, shared decision making 36.1%, satisfaction 21.9%, p<0.05). African Americans, Asians and Hispanics were less likely to report optimal patient experience when compared to non-Hispanic whites. Adjustments for covariates yielded mixed results. However, African Americans and Asians were 20% and 39% less likely to be satisfied with their healthcare providers respectively [African Americans (Adjusted OR 0.80, 95% CI 0.67-0.97), Asians (Adjusted OR 0.61, 95% CI 0.39-0.94).

Conclusion:
This study reveals a strong relationship between race and patent healthcare experience among individuals with ASCVD. Targeted policies focusing on reducing disparities and improving patient healthcare experience are needed among these vulnerable population.
Abstract 175: Atrial Fibrillation in the USF Resident Clinics: Quality-Driven Medical Therapy
Authors: Sadic Edin
Published: March 2022

Patients with atrial fibrillation (afib) have a high rate of serious complications including stroke and decompensated heart failure. While patients with afib are five times more likely to suffer a stroke in their lifetime than the general population, this risk can be reduced by 64% with appropriate anticoagulation using warfarin or approved novel oral anticoagulants (NOACs). Reducing the morbidity and mortality from excess strokes is a common interest nationwide due to unsustainable healthcare costs, increasing human resource gaps in medicine, and payment reforms that hold physicians and healthcare organizations financially accountable for having poor outcomes. Our project aims to investigate the success in achieving appropriate anticoagulation therapy for afib patients in the University of South Florida (USF) Internal Medicine resident clinics. Our goal is to achieve a 90% success rate for both linkage to follow-up and anticoagulation.

Our project identified all patients in the USF Internal Medicine clinics greater than 18 years of age who were discharged from Tampa General Hospital (TGH) between January 1, 2016 and December 31, 2016 and are diagnosed with atrial fibrillation. It investigated the percentage of eligible patients prescribed an anticoagulant (eligibility was determined by CHADSVASC criteria), as well as the percentage of patients who returned for follow-up at least once post-discharge.

Our query identified 49 patients with atrial fibrillation who met our search criteria. Of these, 28 (57%) were appropriately anticoagulated as per CHADSVASC criteria. Unfortunately, 21 patients (43%) who should have been on anticoagulation were not. Twelve patients (24%) were either lost to follow-up or were unavailable to contact. Eight (16%) were deceased since starting our project. Per chart review, zero deaths were related to afib or bleeding.

Our study revealed a significant gap in care for atrial fibrillation patients at USF resident clinics. With just over half being appropriately anticoagulated, we implemented a bundle of quality improvement methodologies. We reached out to our patients and scheduled 29 follow-up appointments in the coming months to discuss their anticoagulation. We created a best practices reminder in the electronic medical record to alert prescribers if a patient has afib in their problem list but does not have an anticoagulant in their medication list. We also plan to review the registry of afib patients yearly to schedule appointments for the patients who have no anticoagulation prescriptions. This way, we will catch patients who are newly diagnosed within the past year or those who have had a transition of care and may have had their medication inadvertently discontinued. We hope these interventions will move us closer to our goals of 90% linkage to care and anticoagulation.