bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10: Association Of Race And Medical Emergency Team Evaluations Prior To In Hospital Cardiac Arrest
Authors: Gathers Cody-Aaron , Morgan Ryan W , Alvey Jessica , Reeder Ron , Goldberger Zachary D , Fowler Jessica , Naim Maryam , O'Halloran Amanda , Merchant Raina , Kienzle Martha , Nadkarni Vinay M , Berg Robert A , Sutton Robert M
Published: June 2023

Introduction:
Racial disparities for in-hospital cardiac arrest (IHCA) outcomes exist. However, whether these are associated with medical emergency team (MET) activation prior to IHCA remain unknown. We aimed to evaluate the association between race and MET activation among patients with physiologic abnormalities (modified early warning score [MEWS] ≥3) prior to IHCA. We hypothesized that MET activation prior to IHCA would be less likely among Black as compared to white patients. In a secondary analysis, we hypothesized that among Black patients, MET activation would be associated with improved IHCA outcomes compared to events without MET activation.

Methods:
Retrospective cohort study of adults age ≥18 from the AHA Get With The Guidelines®-Resuscitation registry who had an IHCA outside an ICU between 2000 and 2021 with MEWS ≥3 prior to IHCA. A propensity-weighted cohort was constructed to balance confounders between Black and white patients. The association between race (Black vs. white) and MET activation (yes/no) was quantified with weighted multivariable logistic regression. A secondary analysis examined the association between any MET activation and IHCA outcomes among all Black patients.

Results:
Among 28,123 patients (average age: 68±15; 42% (42 of 100) female) with MEWS ≥3 (average 4±1), 2431 (9% (9 of 100)) had a documented MET activation prior to IHCA. Vitals were measured at a median time of 120 minutes (IQR 60, 210) prior to IHCA. Rates of MET activation were similar between Black and white patients with MEWS ≥3 prior to IHCA (aOR 1.04, CI 0.94-1.15, p=0.45). However, among Black patients, odds of ROSC were higher among patients with a MET activation prior to ICHA compared to those who did not have a MET activation (aOR 1.15, CI 1.03-1.28, p=0.02).

Conclusions:
Though racial disparities in IHCA outcomes exist, we failed to detect a significant association between race and MET activation for MEWS ≥3 as a potential mechanism for these disparities. Importantly, any MET activation improved IHCA outcomes among Black patients.
Abstract 10006: The Effect of Dapagliflozin on Hospital Admissions in Patients With Type 2 Diabetes: Post Hoc Analysis of the DECLARE-TIMI 58 Trial
Authors: Schechter Meir , Wiviott Stephen D , RAZ Itamar , Goodrich Erica L , Cahn Avivit , Langkilde Anna Maria , Gause-nilsson Ingrid A , Sabatine Marc S , Mosenzon Ofri
Published: June 2023

Background:
In the DECLARE-TIMI 58 trial, involving patients with type 2 diabetes at high cardiovascular (CV) risk, dapagliflozin reduced the risk for heart failure hospitalization and adverse kidney outcomes, compared to placebo. Whether dapagliflozin lowers the risks for the broader outcome of adverse event (AE)-related hospital admissions is unknown.

Methods:
The DECLARE-TIMI 58 trial randomized 17,160 subjects with type 2 diabetes and a high risk for or established CV disease, to receive dapagliflozin or placebo (1:1). Dapagliflozin effect on AE-related hospital admissions was assessed overall and by baseline cardiovascular and kidney subgroups. Investigator reported system organ class classification was used to evaluate dapagliflozin's effects on admissions due to different etiologies.

Results:
Over a median follow up of 4.2 years, dapagliflozin reduced the risk of AE-related hospital admissions by 11% (32.4% vs. 35.4% of participants, HR 0.89 [95% CI 0.85, 0.94]; p<0.0001). The reduction in AE-related hospital admissions was consistent across baseline cardiovascular and kidney subgroups (p-interaction≥0.30) (Figure). Dapagliflozin reduced the risk for admissions due to cardiac disorders (HR 0.91 [95% CI 0.84,0.995] p=0.0387), renal or urinary disorders (0.61 [0.49, 0.77] p<0.0001), and other non-cardiac, non-renal etiologies (0.89 [0.84,0.95] p=0.0001).

Conclusion:
Dapagliflozin reduced the risk for AE-related hospital admissions, including non-cardiac and non-renal hospitalizations, in patients with type 2 diabetes. These findings have implications for patients' quality of life and overall type 2 diabetes-attributed healthcare burden.
Abstract 10019: Access to Specialty Cardiovascular Care and Uptake of Cardioprotective Anti-Hyperglycemic Agents Among Adults With Type 2 Diabetes: A Cohort Study
Authors: Aghajani Nargesi Arash , Clark Callahan , Liu Mengni , Reddy Abraham , Amodeo Sam , Khera Rohan
Published: June 2023

Background:
Sodium glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are the only cardioprotective anti-hyperglycemic medications, but have had limited use. We evaluated whether access to specialty cardiovascular care improves the uptake of these cardioprotective medications in type 2 diabetes (T2D).

Methods:
In a retrospective cohort study between Jan 2019 and Dec 2020, beneficiaries with Medicare Advantage or commercial insurance were followed using Optum Labs’ de-identified administrative claims for the initiation of SGLT-2i and GLP-1RA among eligible adults with T2D across specialty visits. Eligibility included atherosclerotic cardiovascular disease (ASCVD), heart failure, or diabetic nephropathy for SGLT-2i and ASCVD for GLP-1RA. Detailed demographic and comorbidity information was obtained from the year before cohort enrollment.

Results:
Among eligible individuals for SGLT-2i (N=294,988) and GLP-1RA (N=198,525), 10.4% and 16.7% initiated these medications during the study period, respectively. Overall, 57% of those with an indication for SGLT-2i and 64% for GLP-1RA had at least one visit with a cardiologist. After accounting for differences in clinical characteristics and comorbidities, those with a visit with a cardiologist had higher odds of initiating SGLT-2i (OR = 1.26 [1.21-1.30]) and GLP-1RA (OR=1.05 [1.01-1.10]). However, these were not higher than those receiving care from family medicine and internal medicine providers and were substantially lower than those receiving care from an endocrinologist (Figure).

Conclusion:
In 2019-2020, among insured individuals with compelling CV indications, despite broad access to cardiovascular care, receiving care from cardiologists was only modestly associated with uptake of novel therapies. Efforts to improve the use of these medications are less likely to benefit from efforts to broaden access to specialty cardiovascular care.
Abstract 10020: Statins Are Associated With Lower Adjusted In-Hospital Mortality in Patients With COVID-19
Authors: Kostis William J , Zinonos Stavros , Moreyra Abel E , Cabrera Javier , Kostis John B
Published: June 2023

Introduction:
There are more than 250,000 publications on COVID-19. However, there is incomplete information on the effects of pharmacologic therapy in hospitalized patients.

Hypothesis:
We hypothesize that use of statin therapy will decrease all-cause mortality in patients hospitalized for COVID-19.

Methods:
A dataset of 1,064 patients with first admission for COVID-19 was used in this study. Predictive models using logistic regression, support-vector machines, and neural networks were used to predict all-cause in-hospital death.

Results:
In-hospital case fatality of patients admitted with COVID-19 was 17.5% and was higher in the first week after admission, among older individuals, those with higher body weight, and those with longer length of stay. The use of statins was associated with lower in-hospital mortality after adjustment for other medications and the factors mentioned above. The beneficial effect of statins may not be due to their effects on lipids but is probably due to their pleiotropic antioxidant effects. Using logistic regression, the duration of therapy was positively related to the beneficial effect of statins (p=0.0002).

Conclusions:
In conclusion, the in-hospital case fatality of COVID-19 patients was lower in patients receiving statins after adjustment for demographics, other medications, body weight, and length of stay (Figure).
Abstract 10031: Parvovirus Causing Severe Cardiogenic Shock With Recovery
Authors: Yan Crystal L , Thakkar Rivera Nina
Published: June 2023

Parvovirus B19 infection is common worldwide with the majority of people infected as young children. Its clinical presentation varies widely depending on the patient’s age and immune competence. Parvovirus B19 infection has been associated with myocarditis; however, its causal mechanism is unclear. A 57 year-old man who recently returned from Bolivia presented after five syncopal episodes. His initial troponin was elevated at 11.2 ng/mL. Electrocardiogram showed third degree heart block with a fascicular escape rhythm at 40 beats per minute. Echocardiogram revealed an ejection fraction of 45-50% and global hypokinesis of the left ventricle. Left heart catheterization showed mild non-obstructive coronary artery disease. His transvenous pacemaker was exchanged for a permanent pacemaker a few days later only to discover a repeat ejection fraction of 15-20%. The patient’s condition progressed to cardiogenic shock requiring inotropic and mechanical support. A comprehensive myocarditis workup was pursued which included a negative full respiratory viral panel, along with negative serum tests for coxsackievirus, hepatitis, human immunodeficiency virus, tuberculosis, syphilis, Lyme disease, strongyloidiasis and fungi. Urine toxicology prior to admission was negative for cocaine. Thyroid function tests were normal. Endomyocardial biopsy showed severe myocarditis with lymphocyte predominance. Staining was negative for fungi, spirochetes, Trypanosoma cruzi, herpes simplex virus, cytomegalovirus, or amyloid. There were no multinucleated giant cells seen on light microscopy. Subsequent PCR of DNA isolated from the biopsy specimen was positive for parvovirus (495 copies/100ng DNA) and Epstein-Barr virus (2046 IU/100ng DNA). His serum EBV viral load was undetectable. His parvovirus IgM level was negative and IgG level was positive. A diagnosis of fulminant parvovirus myocarditis was made. The patient was treated with steroids and five days of IVIG. Repeat echocardiogram showed recovery of his ejection fraction to 50-55%. Our case illustrates a complicated and rare case of fulminant parvovirus myocarditis in a previously healthy and active adult who luckily had recovery of his ejection fraction within 1 month.
Abstract 10041: Cardiopulmonary Performance Among Heart Failure Patients Before and After Left Ventricular Assist Device Implantation
Authors: Baird Andrew , Byrd Jessica , Schulte Margaret , Cornwell William
Published: June 2023

Introduction:
Continuous-flow left ventricular assist devices (CF-LVAD) improve survival and subjective assessments of health-related quality-of-life (HRqOL) when implanted into patients with advanced heart failure with reduced ejection fraction (HFrEF). However, functional capacity remains severely reduced.

Hypothesis:
LVAD flow during exercise contributes minimally to overall functional capacity. Exercise tolerance depends on intrinsic factors such as cardiac output (Qc) and arteriovenous oxygen difference (avo2
diff
).

Methods:
Ten patients (9 male, 60±10 years), underwent three invasive cardiopulmonary exercise tests on upright cycle ergometry. Visits were arranged 1) before (median, IQR: 0.3, 0.1-0.05 months) implantation, 2) after (4.2, 3.1-5.3 months) implantation with CF-LVAD speed held constant, and 3) with increases in pump speed during exercise (2.3, 1.9-3.0 months) after Visit 2. Submaximal functional capacity was measured by six-minute hall walk (6MHW). Fick Qc was measured via pulmonary artery catheter and gas exchange parameters determined by indirect calorimetry. Subjective assessments of HRqOL were obtained prior to and following implantation.

Results:
Following implantation, HRqOL and 6MHW improved. The avo2
diff
and Qc predicted Watts achieved during exercise testing pre-implantation. The avo2diff, but not LVAD flow or Qc, predicted Watts achieved on multivariable analysis with both fixed and variable pumps speeds (
Table 1
).

Conclusions:
Submaximal exercise performance and subjective HFrEF severity improved post implantation. The primary determinant of workload achieved during exercise testing, regardless of whether participants exercised at a fixed pump speed or with increases in pump speed, was the (A-V)O2 difference. LVAD flow contributes minimally to functional capacity.
Abstract 10047: A Case of Recurrent Miscarriages Due to Malignant Situational Cardioinhibitory Nerurocardiogenic Syncope Treated With Pacemaker Placement
Authors: Sierra Juan G , Rojo Grajales Laura , Matute-Martinez Carlos , Boccalandro Fernando
Published: June 2023

Case Presentation:
A 29- year-old G5A4 woman with history of seizure disorder presented with severe nausea and vomiting (N&V) with transient loss of consciousness with twitching motor activity at 7-weeks' gestation. She had no post-ictal state, but a brief period of nausea and lethargy with a rapid return to baseline. Her medical history only included a diagnosis of seizure disorder since childhood treated with different anti-epileptic agents. She reported 4 first-trimester abortions secondary to reported intractable recurrent seizures during pregnancy accompanied by significant morning sickness. Her physical examination, laboratory tests, brain CT, EEG, EKG, and a trans-thoracic echocardiogram were unremarkable. Levetiracetam was started. While monitored in telemetry she had an episode of complete heart block for 8-seconds with ventricular standstill triggered by a bout of severe N&V resulting in convulsive syncope. The diagnosis of situational cardioinhibitory malignant Neurocardiogenic Syncope (NS) was made. She underwent dual-chamber pacemaker implantation with complete resolution of her symptoms. After 6-months Levetiracetam was discontinued. Her pregnancy progressed to term delivering a healthy newborn. She remains asymptomatic
4 years
after her pacemaker implantation.

Discussion:
Malignant NS is a type of neurally-mediated syncope that can lead to significant morbidity and occasional mortality. Situational syncope occurs when a vaso-vagal reflex occurs in response to a specific trigger, in the present case straining is associated with N&V and has not been described with miscarriages. In this case, the pronounced vagal response to N&V resulted in ventricular stand-still causing brain hypoperfusion and seizures, which are associated with miscarriage due to slower fetal heart rate, fetal hypoxia, fetal injury, placental hypoperfusion, placental abruption or trauma. To the best of our knowledge, this is the first case reported in the literature of recurrent miscarriages due to NS successfully treated with a pacemaker.

Conclusions:
Convulsive syncope can result in miscarriages and should remain in the differential diagnosis in patients presenting with suspected seizures associated with vaso-vagal triggers during pregnancy.
Abstract 10071: Myocarditis in SARS-CoV-2 Infection versus COVID-19 Vaccination: A Systematic Review and Meta-Analysis
Authors: Voleti Navya , Ssentongo Paddy
Published: June 2023

Introduction:
COVID-19 infection and vaccines are associated with acute myocarditis. However, the relative risk of myocarditis is not fully characterized. The aim of this study is to compare the risk ratio (RR) of myocarditis in COVID-19 vaccines and SARS-CoV-2 infection groups and to delineate the effect modifiers.

Hypothesis:
Risk ratio of myocarditis is higher in the infection group than in the vaccinated group, and this risk is modified by age and sex.

Methods:
Multiple electronic databases and trial registries were searched to April 2022, for randomized controlled trials and observational cohort studies reporting the risk of myocarditis associated with the COVID-19 vaccines and the risk associated with SARS-CoV-2 infection. We estimated the effect of COVID-19 infection and vaccines on rates of myocarditis by random-effects meta-analyses using the generic inverse variance method. Meta-regression analyses were conducted to assess the effect of sex and age on the incidence of myocarditis.

Results:
22 eligible studies consisting of 55.5 million in the vaccinated cohort and 2.5 million in the infection cohort were included. Median age was 49 years (interquartile range (IQR): 38-56), and 49% (IQR: 43% to 52%) were male. Of patients diagnosed with myocarditis, 3.48% were hospitalized and 0.05% died. The RR for myocarditis in the infection group was15 (95% CI: 11.09 - 19.81) and 2.0 (95% CI: 1.44-2.65) in the vaccine group. Of patients who developed myocarditis after receiving the vaccine or having the infection, 61% (IQR: 39% -87%) were male. Meta-regression analysis indicated that male sex and young age were associated with myocarditis. Risk of bias assessment was moderate.

Conclusions:
In this systematic review and meta-analysis, we found that the risk of incident myocarditis is about 7 times higher in persons who were infected with SARS-CoV-2 virus than in those who received the vaccine.
Abstract 10072: Sex Disparities in Cardiovascular Events Among Sarcoidosis Patients: Insights From 2019 National Inpatient Sample
Authors: Kumar Nomesh , Verma Renuka , Ramphul Kamleshun , Ramphul Yogeshwaree , Kassem Hussien , Sombans Shaheen , Kumari Komal , Mejias Stephanie , Arti Fnu , Lohana Petras
Published: June 2023

Introduction:
Sarcoidosis involves many organs in the body, including the heart, thus triggering various cardiovascular dysrhythmias and complications. We sought to analyze the cardiovascular events seen in these patients.

Methods:
The 2019 National Inpatient Sample (NIS) is one of the most extensive inpatient databases in the United States. It was used to explore and identify patients diagnosed with sarcoidosis and a valid entry for the variable "Sex". Hospitalizations associated with several cardiac events were also examined (reported as cases per 100 males or females), and their occurrences were compared between males and females. Multiple logistic regression adjusted to non-cardiac characteristics allowed us to estimate the adjusted odds ratio (aOR) of the cardiovascular events in females relative to males.

Results:
We found 84,640 cases of sarcoidosis (61.5% females, and 38.5% males). Females were less likely to present with supraventricular tachycardia (2.1 vs. 2.4, aOR 0.804, p<0.01), ventricular tachycardia (2.4 vs. 5.0, aOR 0.481, p<0.01), paroxysmal atrial fibrillation (7.4 vs. 8.8, aOR 0.730, p<0.01), ventricular fibrillation (0.3 vs. 0.5, aOR 0.705, p<0.01), first degree atrioventricular block (0.6 vs. 1.1, aOR 0.543, p<0.01), second degree atrioventricular block (0.4 vs. 0.6, aOR 0.622, p<0.01), third degree atrioventricular block (0.8 vs. 1.6, aOR 0.510, p<0.01), and heart failure (31.6 vs. 33.3, aOR 0.763, p<0.01) than males.

Conclusions:
Males with sarcoidosis have a higher risk of cardiovascular events than females. Physicians should be encouraged to include routine cardiovascular checks in sarcoidosis patients.
Abstract 10081: The Moderator Role of Attitudes in the Relationship Between Knowledge and Self-Efficacy in Palliative Care Among Nurses: A Cross-Sectional, Correlational Study
Authors: Heo Seongkum , Kim JinShil , An Minjeong , Yang jisun , KIM MIYEONG , Park SeongHu , Cho KyungAh , Kang Junghee J
Published: June 2023

Introduction:
Provision of palliative care to patients with advanced chronic diseases or old populations is suboptimal, which results in unnecessary suffering of and burden to patients, caregivers, and society. Low self-efficacy in palliative care among nurses is a factor affecting suboptimal utilization of palliative care. Poor knowledge is a factor affecting low self-efficacy in nurses. Attitudes may contribute to the relationship between knowledge and self-efficacy, but these relationships have been rarely examined in nurses.

Hypothesis:
Attitudes moderate the relationship between knowledge and self-efficacy in palliative care among nurses, controlling for covariates.

Methods:
Data were collected from 282 nurses (Median age: 29 years) regarding self-efficacy, knowledge, attitudes, and covariates (i.e., age, marital status, work experience, experience of advance directive [AD] education, experience of AD with relatives, experience of AD education for patients, and experience of AD counseling). Process v4.1 for SPSS was used to test the hypothesis.

Results:
The levels of self-efficacy (5.9 out of 10), knowledge (14.6 out of 21), and attitudes (48.0 out of 64) among nurses were moderate. Higher levels of knowledge (p = .026) and attitudes (p < .001), the interaction term of knowledge and attitudes (p = .041), and experience of AD counseling (p = .008) were significantly associated with higher levels of self-efficacy in palliative care (F = 5.643, p < .001, R
2
= .172), indicating the moderating effect of attitudes. The relationships between higher levels of knowledge and higher levels of self-efficacy were significant only in nurses with highly (p = .005) and moderately positive attitudes (p = .026), but not in nurses with lack of positive attitudes (Figure 1).

Conclusions:
The findings of this study supported the hypothesis. To improve self-efficacy in palliative care among nurses, improvement in knowledge and facilitation of positive attitudes are needed.
Abstract 10087: Cognitive Evaluation During Pregnancy Among Women With Preeclampsia: A Pilot Feasibility Study
Authors: Ibarra Andrea , Lim Grace , Butters Meryl , Catov Janet M
Published: June 2023

Introduction:
Previous research has shown cognitive decline related to preeclampsia (preE) in women after pregnancy when using neurocognitive assessments; however, it is not known if changes in cognition occur antenatally (e.g., in the third trimester of pregnancy). This pilot study investigated if the cerebrovascular effect of preE can manifest as cognitive decline antenatally.

Hypothesis:
Pregnant preE women will score lower on cognitive tests in the executive and memory function domains compared with pregnant normotensive women.
Methods:
This was a prospective observational study in a single institution. We included women more than 28 weeks of gestation with preE or normotension. We excluded women with chronic hypertension, neurologic and developmental disabilities, and current substance use. Neurocognitive test battery included subjective (Everyday Cognition) and objective assessment of executive function (Stroop test, Trail Making), attention and working memory (Digit Span Subtest), and information processing speed (Digit Symbol Substitution) evaluated as z-scores. Baseline characteristics (e.g. pre-pregnancy Body mass index [BMI]) characteristics were collected.

Results:
We enrolled 1 to 2 women weekly over 4 months. Thirty pregnant women were included (16 preE; 14 normotensive). Those with preE had higher pre-pregnancy BMI, delivered at earlier gestational age and reported higher history of migraines. PreE vs. normotensive women had more memory complaints (p<0.001) and scored lower on objective measures of information processing speed, attention, and the executive function of inhibition (
Table
).

Conclusions:
Assessment of cognition in pregnant preE and normotensive women is feasible. PreE women reported worse subjective memory, and had lower scores in attention, information processing speed, and the executive function. Future work to determine if these cognitive differences persist postpartum is warranted.
Abstract 10095: Association of Plasma Adiponectin and Leptin Levels With All-Cause Mortality and New-Onset Ventricular Tachyarrhythmias in Patients With Hypertrophic Cardiomyopathy
Authors: Akita Keitaro , Liang Lusha W , Hasegawa Kohei , Fifer Michael A , Maurer Mathew S , Reilly Muredach P , Shimada Yuichi J
Published: June 2023

Introduction:
Hypertrophic cardiomyopathy (HCM) is one of the leading causes of sudden cardiac death in the young. The current models to predict ventricular tachycardia/fibrillation (VT/VF) and mortality perform poorly. Adipokines are secreted from the adipose tissue and regulate cardiac inflammation, fibrosis, and hypertrophy. Among the adipokines, adiponectin and leptin are related to cardiac remodeling in HCM. The present study examined the association of plasma adiponectin and leptin levels with all-cause mortality and VT/VF in patients with HCM.

Hypothesis:
Plasma adiponectin and leptin levels at enrollment are associated with all-cause mortality and VT/VF in patients with HCM.

Methods:
We performed a multicenter prospective cohort study of patients with HCM. We measured plasma adiponectin and leptin levels at enrollment. The outcome was a composite of all-cause mortality and new-onset VT/VF. After dividing the cohort into four groups according to the adiponectin and leptin levels, we compared the risk of the outcome event using the Cox proportional hazards model adjusting for age, body mass index, left atrium diameter, and maximum left ventricular wall thickness, using the largest group as a reference.

Results:
During a median follow-up of 3.3 years, the outcome event occurred in 37 out of 402 patients. The four groups divided by adiponectin and leptin levels had different risks of the outcome event (log-rank
P
<0.001). The Cox proportional hazards model revealed that the High-Adiponectin, Low-Leptin group had a significantly higher risk (adjusted HR 5.02, 95% CI 1.63-15.47,
P
=0.005.
Figure
) compared with the reference (Low-Adiponectin, High-Leptin) group.

Conclusions:
The combination of high plasma adiponectin and low leptin levels is independently associated with mortality and new-onset VT/VF in patients with HCM. These adipokines have a potential to become novel biomarkers for risk stratification in HCM to improve the current prediction models.
Abstract 10103: Polygenic Scores and Longitudinal Trajectories of Cardiometabolic Phenotypes
Authors: Braendle Simon S , Hasbani Natalie , Morrison Alanna C , Dhana Klodian , De Vries Paul
Published: June 2023

Introduction:
Genetic predisposition via polygenic scores (PGS) is strongly associated with single measurements of systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C), but it is unclear how PGS are associated with their longitudinal trajectories and how these trajectories are associated with risk of coronary heart disease (CHD).

Hypothesis:
PGS are associated with classes of longitudinal trajectories, and these trajectories are associated with CHD.

Methods:
Analyses were conducted in 8,453 white participants from the Atherosclerosis Risk in Communities study. SBP and LDL-C measurements were adjusted for medication use. Latent class models were used to group participants into longitudinal trajectory classes based on SBP and LDL-C values from 3-5 visits over up to 27 years. PGS were created by multiplying publicly available weights with participant genotype dosages. The association between PGS and trajectory classes for SBP and LDL-C was examined using logistic regression. We then examined the association of trajectory classes with incident myocardial infarction (MI) and CHD using cox proportional hazard models.

Results:
Participants were assigned to 4 classes of SBP and 2 classes of LDL-C trajectories (
Figure
). The SBP PGS was significantly associated with SBP classes 2 (OR = 1.28 per standard deviation change in the PGS, P = 4.8E-7) and 4 (OR = 1.7, P < 2E-16) relative to class 3, and with class 4 relative to class 2 (OR= 1.3, P = 2.0E-6). The LDL-C PGS was significantly associated with class 2 (OR = 1.63, P < 2E-16). There were 147 CHD and 102 MI events during 7 additional years of follow up. SBP class 2 and LDL-C class 2 were significantly associated with greater risk of incident MI.

Conclusions:
Our results highlight longitudinal trajectory classes as a tool for contextualizing the genomics of cardiometabolic phenotypes and the association of these phenotypes with CHD.
Abstract 10105: Health Disparities in Cholesterol Screening Among Older Americans: Longitudinal Analysis of the Health and Retirement Study (2008-2018)
Authors: Kuo Wan-Chin , Sorensen Serena L , Johnson Heather M
Published: June 2023

Introduction:
Hypercholesterolemia is often asymptomatic and requires cholesterol screening to be identified. Current guidelines recommend adults at low risk for cardiovascular disease (CVD) to receive cholesterol screening at least every 5 years with more frequent screenings in older adults and/or at higher CVD risk. Yet, currently, about 25% of Americans do not meet the every-5-year screening recommendations. While disparities in the prevention and treatment of hypercholesterolemia continue to rise, little is known regarding factors influencing cholesterol screening among older Americans in the past 10 years.

Methods:
This longitudinal analysis used data from the Health and Retirement Study (HRS). HRS is a nationally representative survey of older adults in the U.S. The current study focused on data collected from 2008 (Wave 9) to 2018 (Wave 14). Participants who passed away by 2019, ever had CVD or stroke, were under age 55 at baseline, had more than 3 waves of missing data in self-reported cholesterol screening, or any missing data in covariates were excluded from the current analysis. In total, 7643 participants were included. Meeting cholesterol screening recommendations was defined as those reporting more than two cholesterol screenings between waves 9-14. Poisson regression and logistic regression were used for data analysis.

Results:
Compared to Black, Indigenous, and People of Color (BIPOC), White older Americans were more likely to meet cholesterol screening recommendations (odds ratio= 1.60; p<0.001) and reported a higher frequency of cholesterol screening (incidence rate ratio=1.06; p<0.001). The racial differences remained significant after the adjustment of covariates. Non-smokers (p<0.001), females (p=0.022), having private insurance (p<0.001), higher education (p<0.001), higher BMI (p=0.003), having diabetes (p<0.001), and having hypertension (p<0.001) were associated with a higher likelihood of meeting cholesterol screening recommendations.

Conclusions:
Important disparities in cholesterol screening were identified among racial minorities, smokers, individuals without private insurance, or with lower educational attainment, highlighting important barriers to address in cardiovascular preventive care.
Abstract 10131: Real World Comparative Outcomes From Left Atrial Appendage Occlusion versus Anticoagulation Among Females and Males
Authors: Zeitler Emily P , Kearing Stephen , Coylewright Megan , Nair Devi , Hsu Jonathan C , Darden Douglas , O'Malley James , Al-Khatib Sana M
Published: June 2023

Introduction:
Clinical decision-making around AF-related stroke risk management is complicated by the widely available and safe direct acting oral anticoagulants (AC) and uncertain long term risks of left atrial appendage occlusion (LAAO) in patients who are older and more female than clinical trial participants.

Hypothesis:
Among matched sex-stratified Medicare beneficiaries with AF, there is no difference in risk of mortality, stroke, and bleeding associated with LAAO versus AC alone.

Methods:
Medicare beneficiaries with AF and CHA2DS2VASc of 2 (males) or 3 (females) (2015-2019) were divided into those who underwent LAAO or received AC only. LAAO and AC patients were propensity score matched 1:1 within sex subgroups based on available characteristics. A Cox proportional hazards model was used to model the survival time from the LAAO implant date to evaluate the comparative risks of mortality, stroke/thromboembolism, and any bleeding events based on ICD-10 codes.

Results:
Matching sex-stratified AC and LAAO patients was successful (SMD < 10% on all variables). Average follow-up was 1 year. Among females (n=4,085; mean 76 years, CHA2DS2VASc 5.1), LAAO was associated with reduced risk of mortality and stroke/thromboembolism (HR 0.51 95% CI 0.45-0.58; HR 0.66 95% CI 0.56-0.77, p<0.0001) compared with AC; similar findings were observed among males (n=5,378; mean 75.3 years, CHA
2
DS
2
VASc 4.1) regarding mortality and stroke/ thromboembolism (HR 0.54 95% CI 0.49-0.60; HR 0.65 95% CI 0.55-0.76, p<0.0001). Comparative bleeding risk varied over time with LAAO associated with greater risk early then lesser risk (females HR 1.03 95% CI 0.92-1.16; males HR 1.05 95% CI 0.95-1.17). (Figure)

Conclusion:
Within sex subgroups during an average of 1 year follow up, LAAO was associated with a reduced risk of mortality and stroke/thromboembolism when compared with AC alone among Medicare beneficiaries with AF. There was no difference in the risk of bleeding between LAAO and AC groups.
Abstract 10137: Area Deprivation Index Predicts Annual Chronic Kidney Disease Screening and Chronic Kidney Disease Development Among Newly Diagnosed Hypertensive and Type 2 Diabetic Patients in a Large Midwestern Health System
Authors: Ingle Mary , Khatib Rasha , Du Yuxian , Valuckaite Vesta , Singh Rakesh , Kong Sheldon , Williamson Todd , Baman Sarang
Published: June 2023

Introduction:
Clinical practice guidelines recommend regular chronic kidney disease (CKD) screening after a diagnosis of hypertension (HTN) or type 2 diabetes (T2DM). Annual monitoring of kidney function increases early detection of CKD and improves quality of life. However, disparities in neighborhood characteristics can impact access to routine care, including CKD screening.

Hypothesis:
We hypothesize area deprivation index (ADI), a national ranking of neighborhood sociodemographic disadvantage would predict annual CKD screening and CKD development among newly diagnosed HTN or T2DM patients.

Methods:
Electronic health records of patients (n=235,208) with an new HTN or T2DM diagnosis between 2015-2018 were abstracted using International Classification Codes. Patients were followed for three years to assess annual CKD screening (one estimated glomerular filtration rate and urinary albumin-to-creatine ratio) and CKD development (CKD or end stage renal disease). ADI ranks (1-100) were divided into quintiles (Q1=least deprived, Q5=most deprived). Multivariable logistic regression models evaluated associations between ADI quintiles with CKD screening and CKD development.

Results:
Most patients were White (57%) females (55%) with solely HTN (65%). Few with only T2DM (9%) and 26% had both. Screening was highest for patients who developed HTN and T2DM during the study (44%) compared to only T2DM (38%) or HTN (4%). CKD developed for 9% of patients with HTN and T2DM, but 0% for only HTN or T2DM. Compared to the least deprived patients, the most deprived were less likely to not be screened in the first year of HTN or T2DM diagnosis (Odds Ratio (OR)= 0.77; 95% confidence interval (CI): 0.73, 0.80). The most deprived patients were more likely to develop CKD compared to the least deprived patents (OR=1.98, 95%CI: 1.75, 2.23).

Conclusions:
The most deprived patients were more likely to be screened annually and almost twice as likely to develop CKD compared to the least deprived. Although an increase in deprivation is associated with poor lifestyle choices which can lead to an increase in CKD, it’s possible early diagnosis is due to an increase in screening, thus leading to an increase in quality of life through monitoring kidney function.
Abstract 10157: A Rare Case of Triple-Valve Endocarditis Managed Surgically
Authors: Augustin Najwan , Lima Gian
Published: June 2023

Introduction:
Triple-valve endocarditis is an extremely rare condition associated with poor prognosis and limited guidelines regarding its management. We report the unique case of a patient diagnosed with triple-valve endocarditis who underwent successful surgical intervention of all three valves.

Case:
A 79-year-old male with a history of benign prostatic hyperplasia requiring chronic indwelling urinary catheter presented with progressive dyspnea, lower extremity edema, and fevers. Physical exam was remarkable for a new holosystolic murmur at his right upper sternal border and jugular vein distention. Chest radiograph was consistent with pulmonary edema and cardiomegaly. A transthoracic echocardiogram revealed a large vegetation on his aortic valve with severe aortic regurgitation, moderate mitral and tricuspid valve regurgitation, and normal ejection fraction. Blood and urine cultures grew
Enterococcus faecalis
and
Enterococcus avium
, respectively. A transesophageal echocardiogram showed multiple mobile vegetations attached to his aortic valve, and small vegetations involving his mitral and tricuspid valve (Figure 1). He subsequently underwent surgical aortic valve replacement (23-mm Edwards), mitral valve replacement (27-mm Edwards), and repair of the tricuspid valve septal leaflet after excision of a 3 mm vegetation. He was discharged on ceftriaxone and ampicillin to complete 6 weeks of therapy. During his follow up visit 2 months after surgery, patient was feeling well and engaging in physical therapy.

Discussion:
There is a limited number triple-valve endocarditis by
E. Faecalis
in the current literature, and this is the first report of a patient successfully managed with three-valve surgery in this setting. We highlight the importance of early recognition and prompt surgical intervention to achieve favorable outcomes in this population.
Abstract 10162: Acquired Hemophilia A and STEMI: A Management Dilemma
Authors: Yabut Jevin , Lima Gian , Vankina Ritika , Kumar Swarup , Meng Joyce
Published: June 2023

Introduction:
Thrombotic events are a rare complication of recombinant activated factor VII (rFVIIa) therapy in patients with hemophilia (PWH). We present the case of a patient who developed ST-segment elevation myocardial infarction while receiving rFVIIa replacement therapy for acquired hemophilia A.

Case Presentation:
A 71-year-old male with non-invasive right ureteral urothelial carcinoma, hypertension, type 2 diabetes mellitus, hyperlipidemia, and non-obstructive coronary artery disease presented for elective robotic-assisted right distal ureterectomy and ureteral reimplantation. He had persistent hematuria after the procedure. Subsequent evaluation for coagulopathy found acquired FVIII deficiency. He received FVIII replacement therapy but failed to respond due to high levels of FVIII inhibitor. His coagulopathy partially improved after treatment with rFVIIa. Unfortunately, the patient developed ST changes on telemetry. 12 lead ECG showed ST elevations in leads II, III, and aVF. Echocardiogram showed hypokinesis of the inferior wall and preserved ejection fraction. A diagnosis of inferior ST segment elevation MI was made; fortunately, the patient was minimally symptomatic. His peak troponin I was 48 ng/mL (normal range < 0.04 ng/mL). After multidisciplinary discussion, rFVIIa was discontinued since it can promote thrombosis. Neither therapeutic anticoagulation nor coronary angiography were pursued due to concerns for bleeding. The patient completed his inferior infarct without complications. His ureteral bleeding also had stopped despite holding rVIIa.

Discussion:
Acquired hemophilia A (AHA) is a rare entity found in individuals with no history of bleeding disorders in which autoantibodies are directed against clotting factor VIII. rFVIIa is a bypass agent that is approved for acute management of bleeding and perioperative course in AHA. Thrombotic complications are rare, reported in only 0.17% of cases, but its management is challenging. Anticoagulation can be considered depending on bleeding risk. We highlight the importance of an individualized approach with careful risk-benefit assessment and multidisciplinary discussion when managing PWH with acute coronary syndrome.
Abstract 10181: Impact of Modified H2FPEF Score on Chronic Limb Threatening Ischemia in Patients With Lower Extremity Artery Disease Who Underwent Endovascular Therapy
Authors: Shikama Taku , Otaki yoichiro , Watanabe Tetsu , Kurokawa Tasuku , Hashimoto Naoaki , Wanezaki Masahiro , kutsuzawa daisuke , Tamura Harutoshi , Kato Shigehiko , Nishiyama Satoshi , Takahashi Hiroki , Arimoto Takanori , Watanabe Masahumi
Published: June 2023

Introduction:
Lower extremity artery disease (LEAD) is an arterial occlusive disease characterized by an insufficient blood supply to the lower limb arteries. The H2FPEF score, calculated using simple clinical characteristics and echocardiographic findings, has been developed to identify patients at high risk for heart failure (HF) with preserved ejection fraction. Purpose: This study aimed to assess the impact of modified H2FPEF scores on chronic limb-threatening ischemia (CLTI) in patients with LEAD.

Methods:
Since the definition of obesity differs by race, we calculated the modified H2FPEF score using a body mass index > 25 kg/m2 in 293 patients with LEAD who underwent their first endovascular therapy. Patients were retrospectively followed for a median follow-up period of 718 days. The primary and secondary endpoints were newly developed CLTI and composite events, including mortality due to worsening HF or rehospitalization in addition to CLTI, respectively.

Results:
The modified H2FPEF score significantly increased with advancing Fontaine classes. Kaplan-Meier analysis demonstrated that the highly modified H2FPEF score group (≥ 3) had a higher incidence of newly developed CLTI and composite events than the low H2FPEF score group (<3). Multivariate Cox proportional hazard analysis revealed that the modified H2FPEF score was an independent predictor of newly developed CLTI and composite events after adjustment for confounding risk factors. The net reclassification index and integrated discrimination improvement were significantly improved by adding the modified H2FPEF score to the basic predictors.

Conclusions:
The modified H2FPEF score was associated with LEAD severity and future CLTI development, suggesting that it could be a feasible marker for patients with LEAD.
Abstract 10196: Reducing Symptom Burden Using Ubiquinol And/Or D-Ribose in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Pierce Janet D , Shen Qiuhua , Mahoney Diane , Diaz Francisco , Smith Carol E , Rahman Faith , Krueger Kathryn , Clark Lauren , HIEBERT John B
Published: June 2023

Introduction:
Mitochondrial dysfunction has been implicated in the development of HFpEF, particularly a decrease in the production of adenosine triphosphate (ATP). Ubiquinol is produced in the mitochondria and is required for oxidative phosphorylation and D-ribose is an essential component of ATP. Thus, supplementing with ubiquinol and/or D-ribose could be useful to improve mitochondrial biomechanics and patient symptoms.

Hypothesis:
To determine if ubiquinol and/or D-ribose would reduce the symptoms and improve cardiac performance in patients with HFpEF.

Methods:
This study was a randomized, double-blind, placebo-controlled trial of 216 patients with HFpEF. Four study groups received various supplements over 12 weeks: Group 1 - placebo capsules and placebo powder (placebo group); Group 2 - ubiquinol (600 mg/day) and placebo D-ribose; Group 3 - placebo ubiquinol with D-ribose (15 g/day); Group 4 - ubiquinol (600 mg/day) and D-ribose (15 g/day). There were seven outcome measures for this study: Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical summary score (CSS), level of vigor using a subscale from the Profile of Mood States (POMS), ejection fraction (EF), the ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (eꞌ) (septal E/eꞌ ratio), B-type natriuretic peptides (BNP), lactate/ATP ratio, and the 6-minute walk test (6MWT).

Results:
Using ubiquinol and/or D-ribose significantly increased the KCCQ clinical summary score (17.30 to 25.82 points [compared to Group 1, p = 0.0001 (Group 2); p < 0.0001 (Group 3); p=0.0116 (Group 4)], vigor score (7.65 to 8.15 points [all p < 0.0001]), EF (7.08 to 8.03% [p = 0.0006; p < 0.0001; p = 0.0002]), and decreased BNP (-72.02 to -47.51 pg/mL [p = 0.0002; p = 0.0024; p = 0.0415]) and lactate/ATP ratio (-4.32x10
-4
to -3.35x10
-4
mmol/L/RLU) [p < 0.0001; p < 0.0001; p = 0.0006]). We found no significant improvement in septal E/e’ or 6MWT.

Conclusions:
The use of ubiquinol and/or D-ribose significantly decreased the patients’ symptoms of HFpEF and improved EF. This suggests that the ubiquinol and/or D-ribose increased mitochondrial function by increasing cellular ATP & may help reduce symptom burden and improve cardiac function. NIH: 1R01AG054486-01A1, NCT03133793, IND: 134633
Abstract 10208: Troponin Frequency for Diagnosis of NSTEMI Across Estimated Glomerular Filtration Rate: A Nationwide Sample From US Veterans Health Administration
Authors: Vellanki Shaitalya , Mahalwar Gauranga , Shroff Gautam R , Herzog Charles A , Lo Kevin B , Abuazzam Farah , Rangaswami Janani , Mathew Roy
Published: June 2023

Introduction:
Recent data suggest comparable diagnostic performance of cardiac specific troponin (cTn) in chronic kidney disease (CKD) compared to those without CKD, including when shorter time interval between tests is considered for high sensitivity (hs) assays.

Objective:
We performed a descriptive analysis of the adherence to recommended testing frequency across CKD stages in a large nationally representative dataset from the US Veterans Health Administration (VHA).

Methods:
The Loma Linda VA IRB approved the study under expedited review. Unique admissions for non-ST elevation myocardial infarction (NSTEMI) between 1999 and 2022in the VHA system with available cTn lab values (n=104, 390) were evaluated. ANOVA was utilized to compare time between first and second cTn values across CKD groups. After 2012, criteria for cTn interval reduced from 6-9 hours to 3-6 hours for hs-cTn. Criteria were considered met if time interval between cTn checks was < 9 hours before 2012, < 6 h after 2012. All analyses performed using R statistical software.

Results:
Troponin I was the assay utilized in 80% of the sample; high-sensitivity (hs) assays made up the minority (<1%) and were primarily used after 2012. Average time interval between first and second cTn checks (across all assays over entire observation period) was 8.1, 8.4, 8.5, 9.3, 9.6, 7.9, 8.1 hours for CKD G1, G2, G3a, G3b, G4, G5, ESKD, respectively (p = 0.001, for trend) (Figure). When cardiac catheterization is performed, cTn criteria met was associated with shorter time to cardiac catheterization (48.5h vs. 52.4h, p < 0.001), irrespective of baseline CKD stage.

Conclusions:
Consistent application of guideline supported practices in NSTEMI care was noted across CKD stages in VHA hospitals, associated with timely diagnostic measures.