bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12: Gender Trends in Authorship of Cardiology Academic Literature - A 40-Year Perspective
Authors: Ouyang David , Sing David , Shah Sonia , Harrington Robert , Rodriguez Fatima
Published: July 2021

Background:
Despite advances in the representation of women in medical training, women continue to be underrepresented in cardiology, academic medicine, and senior positions within academic medicine. This study seeks to determine the representation of female physician-investigators in cardiology through review of published literature in three prominent cardiology journals over time. Understanding disparities in research productivity can highlight barriers to female representation in academic cardiology.

Methods:
Authors of original research articles between 1980 and 2017 from three high impact cardiology journals (Journal of the American College of Cardiology, Circulation, and European Heart Journal) were extracted from PubMed. Author sex were determined and the proportion of female first and senior authors were calculated for consecutive time cohorts.

Results:
We identified 78,558 unique authors of 55,085 primary research articles. Female authors accounted for 33.1% of all authors, however they represented only 26.7% of first authors and 19.7% of senior authors (p < 0.001 for both). Looking at the most prolific authors, female authors are also underrepresented, accounting for only 5% of the top 100 authors.

Conclusions:
Using a large database of published manuscripts, we found that female representation in cardiology research has increased over the last four decades. However there is still disproportionate underrepresentation in first authorship, senior authorship and in authors with the most publications. In addition to recruiting more women into cardiology, further efforts should be made to identify and address barriers in advancement for female physician-scientists.
Abstract 122: Comparative Effectiveness of Primary Prevention Implantable Cardioverter-Defibrillators in Older Adults With Diabetes Mellitus: Insights From the Get With the Guidelines - Heart Failure Registry
Authors: Sharma Abhinav , Wu Jingjing , Hernandez Adrian F , Felker G. M , Al-Khatib Sana , Green Jennifer , Matsouaka Roland , Fonarow Gregg , Singh Jagmeet , Ezekowitz Justin , Heidenreich Paul , DeVore Adam D
Published: July 2021

Introduction:
Patients with diabetes mellitus (DM) and heart failure with reduced ejection fraction (HFrEF) are at increased risk of sudden death. However, given the burden of competing causes of death in patients with DM, therapies to reduce the risk of sudden death may have reduced efficacy. We aimed to assess the effectiveness of implantable cardioverter-defibrillators (ICDs) in a large US registry.

Methods:
We linked data from the GWTG-HF registry to the Centers for Medicare/Medicaid Services claims (January 2010 to December 2014). Using Cox proportional hazard models with propensity score matching for baseline covariates, among patients with and without DM, we compared patients who received an ICD (or were prescribed an ICD at discharge) to those without an ICD. The primary outcome was all-cause mortality.

Results:
Among the 17,186 patients in our study cohort, 6683 (38%) had DM. For patients with DM, those with an ICD (n=663), compared to those without and ICD, were younger (74.0 vs. 78.0 years of age), more likely to be male (66.3% vs. 55.7%) and more likely to have coronary disease (67.8% vs. 60.4%) Similar trends were seen among patients without DM (n=1,031). Among patients with DM, in matched cohorts, an ICD was associated with a reduced risk of mortality (54.4% vs. 60.0%; adjusted HR [aHR] 0.74, 95% CI 0.65-0.83; figure panel A). Similar results for mortality were seen in patients without DM (47.4% vs. 57.0%; aHR 0.68, 95% CI 0.61-0.75; figure panel B). Diabetes did not modify the relationship between ICD and mortality (interaction p-value = 0.24).

Conclusion:
Among patients with HFrEF, primary prevention ICD was associated with reduced mortality in patients with and without diabetes. These findings support current guideline recommendation for primary prevention ICDs among eligible patients with DM.
Abstract 14: The Influence of Provider Specialty on Anticoagulation Prescription Fills and Stroke Risk in Atrial Fibrillation Patients With History of Cancer
Authors: O’Neal Wesley T , Claxton J’Neka , MacLehose Richard , Chen Lin , Bengtson Lindsay G , Chamberlain Alanna M , Norby Faye , Lutsey Pamela , Alonso Alvaro
Published: July 2021

Background:
Early cardiology involvement within 90 days of atrial fibrillation (AF) diagnosis is associated with greater likelihood of oral anticoagulant use and a reduced risk of stroke. Due to variation in cardiovascular care for patients with cancer, it is possible that a similar association does not exist for AF patients with cancer.

Methods:
We examined the association of early cardiology involvement with oral anticoagulation use among non-valvular AF patients with history of cancer (past or active), using data from 388,045 patients (mean age=68±15 years; 59% male) from the MarketScan database (2009-2014). ICD-9 codes in any position were used to identify cancer diagnosis prior to AF diagnosis. Provider specialty and filled anticoagulant prescriptions 3 months prior to and 6 months after AF diagnosis were obtained. Poisson regression models were used to compute the probability of an oral anticoagulant prescription fill and Cox regression was used to estimate the risk of stroke and major bleeding.

Results:
A total of 64,016 (17%) AF patients had a prior history of cancer. Cardiology involvement was less likely to occur among patients with history of cancer than those without (relative risk=0.92, 95% confidence interval (0.91, 0.93)). Similar differences were observed for cancers of the colon (0.90 (0.88, 0.92)), lung (0.76 (0.74, 0.78)), pancreas (0.74 (0.69, 0.80)), and hematologic system (0.88 (0.87, 0.90)), while no differences were observed for breast or prostate cancers. Patients with cancer were less likely to fill prescriptions for anticoagulants (0.89 (0.88, 0.90)) than those without cancer, and similar results were observed for cancers of the colon, lung, prostate, pancreas, and hematologic system. However, patients with cancer were more likely to fill prescriptions for anticoagulants (1.48 (1.45, 1.52)) if seen by a cardiology provider, regardless of cancer type. A reduced risk of stroke (hazard ratio=0.89 (0.81, 0.99)) was observed among all cancer patients who were seen by a cardiology provider than among those who were not, without an increased risk of bleeding (1.04 (0.95, 1.13)).

Conclusion:
AF patients with cancer were less likely to see a cardiologist, and less likely to fill an anticoagulant prescription than AF patients without cancer. However, cardiology involvement was associated with increased anticoagulant prescription fills and reduced risk of stroke, suggesting a beneficial role for cardiology providers to improve outcomes in AF patients with history of cancer.
Abstract 148: Observational Study of Efficacy of Low-Dose Amiodarone
Authors: Memon Adil , Shah Kuldeep , Ali Zubair , Pak Crystal , Hancock Brian , Dunn Josh , Robinson Kyle , Yousaf Ahmed , Yousaf Muhammad , Kemper Suzanne , Carter William
Published: July 2021

Importance:
Atrial fibrillation (AF) is the most common rhythm abnormality of the heart and is projected to double between 2010 and 2030. Many patients with AF remain symptomatic after rate control with medications and hence need anti-arrhythmic medications to maintain sinus rhythm. Among the multiple medications to prevent AF recurrence, amiodarone (AM) is the most effective. AM and dofetilide are the only 2 medications approved to prevent recurrence of AF in patients with left ventricular dysfunction. Most papers considered “low dose” AM to be between 200 and 300 mg daily. Even a recent review in a major journal recommended maintaining sinus rhythm (SR) with AM 200 to 300 mg daily. Two very small studies from China showed AM 100 mg to be effective. A recent unpublished report by McGrew demonstrated the impressive effectiveness of 100 mg or less of AM to prevent recurrence of AF.

Objective:
To determine the known AF free interval after first identification of receiving 100 mg AM or less to prevent recurrence of AF.

Methods:
An observational retrospective chart review of randomly selected adult patients identified to be taking AM 100 mg for AF recurrence for at least 2 months at Charleston Area Medical Center (CAMC) or community clinics during January 1, 2008 to June 30, 2014.

Results:
Fifty-one patients who were taking AM ≤ 100 mg were identified. Mean duration of apparent AF free continuous treatment was 25.2 ± 23.3 months. AM was decreased in 4% (2 of 51) patients and stopped in 31% (16 of 51) patients for AF recurrence, perceived side effect or unknown reasons. SR was maintained for 25.7 ± 27.7 months.

Conclusion:
This small study showed that very low dose AM is commonly used in the community and appears to be an effective option for AF prophylaxis. It is important, the providers selecting medications to prevent recurrence of AF be aware of this option.
Abstract 18: Center Variation in 90-Day Episode Expenditures for Cardiac Surgery - The Role of Healthcare-Associated Pnuemonia
Authors: Thompson Michael P , Harrington Steven D , Strobel Raymond J , Cabrera Lourdes , Zhang Min , Wilton Penny , Gandhi Divyakant , DeLucia Alphonse , Paone Gaetano , Prager Richard L , Likosky Donald S
Published: July 2021

Objective:
Pneumonia is the most common healthcare-associated infection following cardiac surgery, and associated with poorer clinical outcomes and substantially higher hospital costs. Less understood is the role that the care and treatment of post-operative pneumonia may have on a hospital’s 90-day episode payments. We hypothesize that expenditures associated with pneumonia may significantly impact a hospital’s 90-day episode payments for coronary artery bypass graft (CABG) surgery.

Methods and Results:
Using Medicare Part A and B claims data, we identified 49,573 patients undergoing isolated CABG in 1,001 hospitals with greater than 10 cases (2014-15). We applied an established claims-based algorithm to identify 3,135 (6.3%) patients as having a new onset of pneumonia during their index admission and after their surgical procedure. Using hierarchical logistic regression models, we estimated risk-adjusted hospital-level pneumonia rates, adjusted for age, sex, race, Medicaid eligibility, Elixhauser comorbidities, and hospital-random effect. There was weak correlation (r=0.20, p<0.001) between observed and predicted (adjusting for only patient factors) hospital-level pneumonia rates, indicating patient factors explained little of the variation between hospitals. We placed patients into quartiles based on rank-order of hospital risk-adjusted pneumonia rates; the pneumonia rate in the lowest and highest quartile was 3.4% and 13.9% (p<0.001), respectively (Table). Average risk-adjusted 90-day episode expenditures were 10% higher for patients in the highest quartile hospitals compared to the lowest quartile ($41,936 vs. $46,095 vs., p<0.001). Payments for outlier hospitalizations were 100% greater in the highest quartile hospitals compared to the lowest quartile, and accounted for 28.5% of the total difference between high and low spending hospitals.

Conclusion:
New onset pneumonia after cardiac surgery varies widely across hospitals, and counter to conventional wisdom, is not driven by patient risk. Cardiac surgical programs should consider the prevention and management post-operative pneumonia as a component of their overall strategy for reducing 90-day episode payments.
Abstract 221: Bradycardia at the Onset of Pulseless Electrical Activity Arrests in Hospitalized Patients is Associated With Improved Survival to Discharge
Authors: Nguyen Dan , Kritek Patricia A , Greco Sheryl A , Prutkin Jordan M
Published: July 2021

Background:
Recent studies have suggested that the incidence of in-hospital pulseless electrical activity (PEA) arrests is increasing. Bradycardia in patients with in-hospital PEA is common but it is unknown if it is associated with patient outcomes.

Objective:
To determine risk factors and outcomes associated with bradycardic-PEA arrests.

Methods:
This was a retrospective study of all inpatient cardiac arrests at an academic medical center. Patient demographics, comorbidities, vital signs, arrest event data, and outcomes were abstracted from the medical record. PEA arrest was defined as a non-shockable rhythm with loss of pulse requiring cardiopulmonary resuscitation and having organized electrocardiographic activity. Bradycardia was classified as a HR < 60 bpm at the time of pulse loss. Obvious vasovagal events were excluded. The primary outcomes were survival of arrest and survival to hospital discharge.

Results:
Between July 2013 and August 2017, there were 176 in-hospital PEA arrests. While 105 (59.7%) survived the arrest, only 38 (21.6%) survived to discharge. A total of 65 (36.9%) were bradycardic-PEA arrests. Bradycardia was associated with improved survival to hospital discharge (χ2 8.60, p=0.003), but not survival of arrest (χ2 2.15, p=0.14). Hypoxemia increased (OR 2.72, 95% CI: 1.26-5.87, p=0.01) and a cardiac implanted electronic device decreased (OR 0.17, 95% CI: 0.04-0.78, p = 0.02) the odds of an arrest being preceded by bradycardia. On multivariate analysis, bradycardia remained a predictor of survival to discharge (OR 2.46, 95% CI 1.14-5.32, p=0.02). Other predictors of survival to discharge included hypoxemia (OR 3.38, 95% CI 1.45-7.89, p=0.005) and coronary artery disease (OR 2.29, 95% CI 1.03-5.09, p=0.04).

Conclusion:
While a significant proportion of hospitalized patients survive a PEA arrest, many fewer survive to discharge. Bradycardia at the time of PEA arrest was associated with improved survival to discharge but not survival of arrest. Bradycardia was associated with hypoxemic arrests, in which rapid airway management should be a priority to improve the chance of successful resuscitation.
Abstract 267: A Single-page Best Practice Algorithm Reduces Stroke Risk and Improves Arrhythmia Management Decisions in Patients With Acute Atrial Fibrillation: A Quality Improvement Project
Authors: Maclean Edd , Patel Shreena , Joseph Olaminposi , de Block Golding Daniella , Maden Samantha , Boot Jesca , Denning Max , Rear Roger
Published: July 2021

Objectives:
In response to a serious incident involving an atrial fibrillation (AF) associated stroke, a quality improvement project was established to examine and abrogate unnecessary thromboembolic risk in patients presenting with acute AF to London’s North Middlesex University Hospital (NMUH).

Methods:
The presenting complaint was examined for 2,105 consecutive medical admissions to identify 100 patients (4.7%) with acute AF. For each patient, 36 indices and performance indicators were collected and analysed against international standards and the collective best practice of the local Cardiology team. Deficiencies were identified throughout the inpatient experience, including documentation, risk stratification, anticoagulation and arrhythmia management decisions. With cross-specialty collaboration, a single-page AF management algorithm was subsequently established using sequential PDSA methodology, and following its introduction a further 100 consecutive patients with acute AF were analysed prospectively.

Results:
Algorithm implementation significantly reduced the proportion of patients exposed to unnecessary stroke risk (30% -> 4%, p<0.0001); improved identification and documentation of thromboembolic potential (50% -> 88%, p<0.0001), reduced incorrect drug decisions (12% -> 2%, p=0.01), reduced contraindicated rhythm control (8% -> 0%, p=0.007), and increased direct oral anticoagulant (DOAC) prescribing (38% -> 86%, p<0.0001) over warfarin. There was a trend towards reduced mean inpatient stay (4.7 -> 3.5 days, p=0.11).

Conclusions:
Using established quality improvement methodology and cost-neutral multi-disciplinary expertise, this novel management algorithm has significantly improved the quality and safety of care for patients with acute AF at NMUH. Prospective analysis of long-term adverse outcomes is now required to establish morbidity or mortality benefit.
Abstract P113: Use of Guideline Recommended Therapies for Heart Failure in Outpatient Settings Among Medicare Beneficiaries
Authors: DiMartino Lisa D , Shea Alisa , Hernandez Adrian F , Curtis Lesley H
Published: July 2021

Background:
Most information about the use of guideline recommended therapies for heart failure (HF) is based on what occurs at discharge following an inpatient stay. Using a nationally representative, community-dwelling sample of elderly Medicare beneficiaries, we examined how use of angiotensin-converting enzyme (ACE) inhibitor, angiotensin-receptor blocker (ARB), and beta-blocker therapies has changed over time and factors associated with their use.

Methods:
We used data from the Medicare Current Beneficiary Survey Cost and Use files matched with Medicare claims to identify beneficiaries for whom a diagnosis of HF was reported from January 1, 2000-December 31, 2004. Medications prescribed during the calendar year of cohort entry were obtained from patient self-report. We used descriptive statistics to examine prescription medication use over time. Multivariable logistic regression was used to explore the relationship between use of an ACE inhibitor/ARB or beta blocker and patient demographics.

Results:
There were 2,689 unweighted, or 8,288,306 weighted, elderly, community-dwelling Medicare beneficiaries with HF identified. Between 2000 and 2004, the reported use of ARBs increased from 12% (unweighted, 88/725) to 19% (unweighted, 82/421), while use of beta-blockers increased from 30% (unweighted, 215/725) to 41% (unweighted, 170/421). Use of ACE inhibitors remained constant at 45% (unweighted 2000, 329/725; unweighted 2004, 192/421). In multivariable analysis, beneficiaries reporting any prescription drug coverage were 32% (95%CI=1.09-1.59) more likely to have filled a prescription for an ACE inhibitor/ARB and 26% (95%CI=1.03-1.53) more likely to have filled a prescription for a beta-blocker. Compared to beneficiaries diagnosed with HF in 2000, beneficiaries diagnosed in 2004 were 38% (95%CI=1.06-1.79) more likely to have filled a prescription for an ACE inhibitor/ARB and 62% (95%CI=1.23-2.13) more likely to have filled a prescription for a beta-blocker.

Conclusion:
Although use of guideline recommended therapies for HF has increased over time, their use remains suboptimal. Further efforts are necessary in order to ensure all Medicare beneficiaries have adequate drug coverage for these therapies.
Abstract P140: Blood Pressure Control in Veterans Following Percutaneous Coronary Intervention (PCI)
Authors: McGraw Sloane A , Scholfield Michael , Murthy Ragu , Mohamedali Burhan , Shivaraju Anupama , Shroff Adhir
Published: July 2021

Background:
Control of blood pressure (BP) in patients with underlying coronary artery disease (CAD) provides a decreased risk in morbidity and mortality. According to the US Joint National Committee VII (JNC-7) recommendations, patients with underlying CAD should have goal blood pressures of systolic <130 and diastolic <80. These goals can be attained by using multiple classes of drugs including beta-blockers (BB), angiotensin agonists (ACE-I/ARB), calcium channel blockers (CCB), diuretics and nitrates.

Methods:
We conducted a retrospective cohort study focusing on attaining JNC-7 guidelines for BP in a diverse population of 772 patients undergoing PCI between September 2004 and September 2008 at the Jesse Brown Veterans Hospital in Chicago, IL. Data was collected which compared both BP measurements and antihypertensive regimens pre and post PCI.

Results:
For the 772 patients, the overall population mean systolic blood pressure (SBP) decreased from 134 to 128mmHg (p < 0.0001) and mean diastolic blood pressure (DBP) decreased from 73 to 70mmHg (p < 0.0001). With regards to JNC-7 guidelines, the percent of patients who reached SBP goals increased from 44 to 54% (340 to 417 of 772) (p < 0.0001) and with DBP goals rose from 72 to 78% (556 to 602 of 772) (p = 0.0031). At 6 months, there was a statistically significant (all p values <0.0001) change in the use of each drug class; the use of ACE-I/ARB increased from 64% (494 out of 772) to 76% (587 of 772) and BB from 73% (564 of 772) to 89% (687 of 772). There was also increased utilization of diuretics 41% (317 of 772) to 43% (332 of 772) and nitrates 23% (178 of 772) to 29% (224 of 772), however a decrease in the use of calcium channel blockers, 34% (262 of 772) to 31% (239 of 772).

Conclusions:
There was improvement in BP in the six months after PCI and although there were higher rates of attainment of JNC-7 goals for SBP and DBP at six months, overall percentage values are still suboptimal. Additionally, the medication usage improved in most drug classes with exception of calcium channel blockers; however these increases still leave some room for improvement.
Abstract P190: Younger Women With Peripheral Arterial Disease Are at Increased Risk of Depressive Symptoms
Authors: Smolderen Kim G , Spertus John A , Vriens Patrick W , Kranendonk Steef , Nooren Maria M , Denollet Johan
Published: July 2021

Objectives:
Gender disparities, particularly among young women with cardiovascular disease, are a growing cause for concern. Depression is a prevalent and prognostically important comorbidity in peripheral arterial disease (PAD), but its prevalence has not been described as a function of gender and age. We compared depressive symptoms at the time of PAD diagnosis and 6 months later by gender and age.

Methods:
In this 2-center observational follow-up study, 444 Dutch outpatients with newly diagnosed PAD (32% females) completed the 10-item CES-D at baseline and 6 months later (significant depressive symptoms reflected by scores ≥4).

Results:
Initially, 33% of women <65 years had significant depressive symptoms, and 6 months later, 19% of the younger women without significant depressive symptoms at baseline developed them. These rates were much higher than other gender-age groups (range at baseline=11-16%, 6-month incidence=6-10%;
P
≤.03). Adjusting for demographic and clinical factors, women <65 years experienced a 4-fold greater odds of baseline (OR=4.3 [95%CI 2.2-8.7]) and follow-up depressive symptoms (OR=4.1 [2.0-8.4]) as compared with men ≥65 years. Other gender-age groups were not at increased risk (Figure). Adjusting for changes in ankle-brachial index did not erradicate the increased risk in younger women (OR=3.5 [1.2-10.2]).

Conclusions:
Depressive symptoms are more common in younger women with PAD than in other gender-age groups, both at the time of diagnosis and 6 months later. To eradicate gender-based disparities in PAD, depression screening and monitoring in younger women may be an important direction for future research and intervention.
Abstract P208: Transient Ischaemic Attack: How the Patient Perceives it
Authors: MacLeod Mary J , Abdullah Ali
Published: July 2021

Background:
The risk of stroke after Transient Ischaemic Attack (TIA) is 8-11 % within a month. Rapid assessment and early use of preventative therapies can reduce this risk by 80-90%. Many patients do not seek timely medical attention, and may minimise their symptoms. The purpose of this study was to assess patients' perception of the significance of TIA/ minor stroke, and their beliefs and attitudes to secondary prevention interventions.

Methods:
120 patients with a recent TIA/minor stroke were given a questionnaire after clinic/ward review. This included the validated Brief Illness Perception Questionnaire (Brief-IPQ: scores 0-10), and Beliefs about Medicines Questionnaire (BMQ: scores 5-25). Patient adherence to secondary prevention medications was assessed by self-report.

Results:
There was a 56% return rate. Within the brief-IPQ, patients had a mid score for perceived consequences of their event (4.88 (sd2.67)). Only 22% took urgent action at the time of the event. 60% were persuaded to take action by family or friends. Patients scored the midpoint for emotional distress (4.9 (sd 3.4)) and felt they could not exert personal control (4.0(3.2)). They did believed treatment would control their condition (7.7(2.1)). The majority of patients (86.3%) believed in the necessity of medication, with mean necessity score of 18.36(3.5). 14% reported concerns about becoming dependent upon medications and the potential adverse consequences of taking medication. 78% of patients said they complied with their treatment.

Conclusions:
Patients may not regard TIA or minor stroke as having important implications for their future health. Many only seek medical advice as a result of external pressure. Patients do not feel they have personal control over the condition, but believe medication is necessary and beneficial. These findings will inform strategies for education and behavioural change interventions in people at risk of or who have had a TIA/minor stroke
Abstract P225: Creating a Platform for National Longitudinal Quality Assessment for Percutaneous Coronary Intervention (PCI)
Authors: Shah Bimal R , Cowper Patricia A , Lytle Barbara L , Mitchell Kristi R , Slattery Lara , Fingerman Arielle , Wright Janet S , Legnini Mark , Jensen Neil , Peterson Eric D
Published: July 2021

Background:
Current quality and performance measures are generally limited to in-hospital care and outcomes due to a lack of longitudinal data. We examined the feasibility of linking detailed clinical data from the ACC NCDR CathPCI Registry to claims data sources from UnitedHealthCare (UHC) and Center for Medicare and Medicaid Services (CMS) to allow for longitudinal quality of care assessment for patients undergoing PCI.

Methods:
Using a two-step probabilistic matching strategy, we linked patients in ACC NCDR CathPCI with both UHC and CMS claims data. This matching strategy was used since these databases were limited datasets with encrypted patient identifiers. An ACC expert panel identified several measures of quality based on a literature review to test the feasibility of longitudinal care assessment.

Results:
Between July 1, 2006, and June 30, 2008, 471,641 CathPCI records and 38,018 UHC PCI records (patients age 18-64 years) and 1,553,481 CMS PCI records (patients age ≥ 65 years) were included in the matching strategy. Among linked sites, 81% and 89% of UHC and CMS records, respectively, were linked to CathPCI records. The final linked dataset included 16,485 unique records for the CathPCI-UHC matched dataset and 886,648 unique records for the CathPCI-CMS matched dataset. The
Table
displays initial CathPCI-UHC test performance results.

Conclusions:
For the first time, we have linked two separate claims data sources to ACC NCDR CathPCI to create a unique resource for assessing longitudinal quality of care following PCI. Future work is required to determine whether these data can used as feedback to providers to stimulate improved care quality for PCI patients.

Table:

Preliminary data for potential performance metrics from linked datasets.

Potential Performance Metric
NCDR CathPCI + UHC

Patients with staged PCI (repeat PCI within 30 days on non-target lesion)
5.2%

Patients with at least 1 lipid profile within 1 year of discharge
14%

Patients on statin therapy at discharge with at least 1 liver function test within 1 year of discharge
16%

Patients with at least 1 non-invasive stress testing with 6 months of discharge
29%

Patients requiring repeat target lesion revascularization within 15 months of index PCI
12%
Abstract P234: Cost-Effectiveness of Platelet Reactivity Testing in Clopidogrel Exposed Patients Scheduled for Coronary Artery Bypass Surgery
Authors: Alimohammad Rizwan , Britton Lewis W , Torosoff Mikhail , Fein Steven A
Published: July 2021

Background:
Coronary artery bypass surgery (CABG) is typically delayed until 5 days after last clopidogrel dose, waiting for restoration of platelet reactivity units (PRU). We have investigated cost-effectiveness of CABG timing strategy involving daily platelet PRU testing and operating when platelet inhibition (PI) is less than 30%.

Material and Methods:
All consenting patients underwent daily PRU testing with point of care VerifyNow P2Y12 assay after receiving 600 mg of clopidogrel at the time of catheterization. Twenty-four hour interval was given between integrillin administration and testing. 29 patients (41% females, 34% with diabetes) comprised study cohort. Daily hospital cost for room and board was $3,770; cost of PRU testing was $49.The study was approved by the institutional IRB.

Results:
83% of patients were operated on day 6 after the last clopidogrel dose; an additional 5 patients waited for more than 6 days. At least 75% of the tested patients demonstrated less than 30% PI, traditionally considered “safe” for a surgical intervention. There were no significant differences in RBC (p=0.949) or platelet (p=0.864) transfusion, fresh frozen plasma (p=0.295) or cryoprecipitate (p=0.654) administration in patients whose surgery was delayed for more than 6 days. Employing a strategy of operating on the day when PI is less than 30%, time to the surgery can be decreased from 5.3+/- 0.6 days to 2.8+/-1.5 days, Mann-Whitney p<0.0001. Assuming no other expenses than cost of room and board in patients managed traditionally and added cost of daily PRU testing in platelet reactivity directed approach, average cost would decrease from $19,890+/-2,447 to $10,535+/-5,558 (Mann-Whitney p<0.0001).

Conclusions:
Unless dictated by other clinical considerations, delaying CABG beyond 5 days after last clopidogrel dose is not justified. Five day waiting period is excessive with the majority of clopidogrel-treated patients achieving “safe” platelet responsiveness in less than 5 days. A strategy, involving daily platelet reactivity testing and performing CABG when PI is less than 30%, promises to bring significant cost-savings without compromising quality of delivered care.
Abstract P256: Clinical Outcomes and Costs of a Pocket-Sized Ultrasound Device for Screening for Abdominal Aortic Aneurysm
Authors: Shah Manan , Patel Pankaj A , DSouza Anna O , Min James K
Published: July 2021

BACKGROUND:
While one-time ultrasound screening for abdominal aortic aneurysms (AAA) may reduce AAA-related adverse events--including death, aortic rupture, and emergent surgery--screening rates have averaged only 72% since the 2007 Medicare coverage policy was initiated. The introduction of a pocket-sized ultrasound (PSU) may enhance availability and convenience in the point-of-care setting, thereby enabling increased screening rates with reductions in AAA-related outcomes.

OBJECTIVE:
To develop a model to assess the clinical and economic impact of PSU versus standard ultrasound for AAA screening of eligible Medicare beneficiaries.

METHODS:
The model was developed from Medicare's perspective, including a study population of 65-74 year old males who had smoked ≥100 cigarettes in their lifetime. Our model assumed 100% of eligible males could be screened with the PSU, as compared to 72% actually screened with standard ultrasound. Model inputs were derived from major clinical trials, and included 4-year rates of mortality, aortic rupture, and elective and emergency surgeries. Model outputs of deaths reduced, ruptures avoided and costs (2009 USD) were calculated. One-way sensitivity analyses were performed to evaluate the robustness of model outcomes.

RESULTS:
A PSU strategy yielded a 16.8% and 25.6% reduction in rates of AAA-related mortality and rupture, respectively, as compared to the standard ultrasound strategy. During an 8-year follow-up period, the higher cost of elective surgeries by the PSU strategy was offset by lower rates and costs of emergency surgeries, as compared to the standard ultrasound strategy. The higher screening rate with the PSU strategy resulted in an incremental cost of $32 per screened eligible male over 8 years (annualized $4/year). Sensitivity analyses demonstrated reductions in deaths and aortic ruptures ranging from 7% to 28% and 1% to 52%, respectively, at an incremental cost/year ranging from -$2 to $52.

CONCLUSION:
Use of a PSU device to screen for AAA may reduce deaths, aortic ruptures, and surgery costs with a modest overall incremental cost of $4 per screened eligible male per year.
Abstract P263: Computer-Assisted Decision Support in the Treatment of Acute Coronary Syndromes and Impact on Cardiovascular Outcomes
Authors: Milani Richard V , Lavie Carl J , Morin Daniel P , Rubiano Andres
Published: July 2021

Background:
Evidence from clinical trials and consensus guidelines suggest that in-hospital initiation of key therapeutics can reduce mortality and morbidity in patients admitted with acute coronary syndrome (ACS). As a result, the AHA and ACC have co-developed guideline-based “performance measures” for ACS patients, such that when every measure has been performed, the patient is considered to have achieved optimal or “perfect” care (PC). Computer-assisted decision support (CADS) is a tool that can improve quality of care and is well suited for complex algorithms governing treatment decisions. We sought to determine if CADS tailored to ACS would enhance the likelihood of achieving PC, and whether achievement of PC would translate into reduced mortality.

Methods:
452 consecutive patients (mean age 68±13 years) admitted with ACS in 2009 were evaluated (unstable angina 29%, NSTEMI 61%, STEMI 10%). Physicians had the option of using either pre-printed ACS orders (standard orders) versus CADS generated orders. The CADS system utilized patient clinical data including risk scoring, to suggest specific therapeutics and drug dosing based on consensus guidelines. Endpoints were attainment of PC and 30-day mortality.

Results:
The 77 patients admitted using CADS generated orders were statistically similar (age, gender, ACS diagnosis, TIMI risk) to the 375 patients admitted with the standard order set. Attainment of PC was almost twice as likely when using CADS versus standard orders (84% vs. 44%, p<0.05). PC patients trended towards higher TIMI risk scores (3.2 ±1.7 vs 2.9 ±1.6, p = 0.09) but had half the 30-day mortality (2% vs 4%, p=0.05) compared to patients not achieving PC.

Conclusions:
Use of CADS in the setting of ACS is feasible and doubles the likelihood of attaining PC. Although patients achieving PC had higher baseline risk, their mortality was reduced by 50% compared to those not achieving PC. These data support the use of CADS in the setting of ACS to improve quality of care and subsequent outcomes.
Abstract P297: Comparing Blood Pressure Control in Diabetic verses Non-Diabetic Veterans following Percutaneous Coronary Intervention (PCI)
Authors: McGraw Sloane A , Scholfield Michael , Murthy Ragu , Shivaraju Anupama , Mohamedali Burhan , Shroff Adhir
Published: July 2021

Background:
Blood pressure (BP) control in patients with coronary artery disease (CAD) is beneficial on morbidity and mortality, however the US Joint National Committee VII (JNC-7) also recommends systolic BP (SBP) <130 and diastolic BP (DBP) <80 for diabetic patients because diabetes itself is an additional risk for a cardiac event. This can be attained using beta-blockers (BB), angiotensin agonists (ACE-I/ARB), calcium channel blockers, diuretics and nitrates.

Methods:
We conducted a retrospective cohort study focusing on attaining JNC-7 guidelines, comparing outcomes between 302 diabetic to the 469 non-diabetic patients; all underwent PCI between September 2004 and September 2008 at the Jesse Brown Veterans Hospital in Chicago, IL. We collected data of BP values and antihypertensive regimens on admission and at six month follow up, and correlated these into percentages of which have attained goals.

Results:
Among diabetics, mean SBP decreased from 134 to 130mmHg (p = 0.002) and mean DBP decreased from 72 to 70mmHg (p= 0.004); in the non-diabetics, the mean SBP decreased from 133 to 127mmHg (p<0.0001) and the mean DBP decreased from 73 to 71mmHg (p<0.0012). With regards to guidelines, the percent of diabetics at SBP goal increased from 41% to 51% (124 to 154 of 302) (p= 0.006), however the percent at DBP goal was not significant. In non-diabetics, percent at goal for SBP increased 46% to 57% (216 to 267 of 469) (p=0.0002) and for DBP increased 69% to 76% (324 to 356 of 469) (p=0.0131). At 6 months, among diabetics the medication usage increased with BB, 80% to 92% (241 to 278 of 302) (p<0.0001) and nitrates 30% to 36% (91 to 109 of 302) (p=0.035). Similarly, among non-diabetics, use of BB, 68% to 87% (319 to 408 of 469) (p<0.0001) and nitrates 19% to 24% (89 to 113 of 469) (p=0.006) increased, as well as ACE-I/ARB 52% to 71% (244 to 333 if 469) (p<0.0001).

Conclusions:
There were improvements in BP among both populations at six months post-PCI; both attained JNC-7 SBP goal, but only non-diabetics achieved DBP goal. Medication use increased for both groups with BB and nitrates, but also with ACE-I/ARB for non-diabetics only. This analysis suggests that tighter control needs to be obtained among diabetics, especially because they are a higher risk population than those solely with CAD.
Abstract P303: Impact of an Employee Health Promotion Program on Cardiovascular Goal Attainment and Cardiovascular Related Medical and Hospital Claims and Costs
Authors: Glover Kenneth , Neilson Thomas J , ter Riet Linh B
Published: July 2021

CSX Transportation, a national company with 30,000 employees, developed a comprehensive health promotion program to address cardiovascular (CV) disease. High employee CV risk compared to national benchmarks and rising healthcare costs resulted in the need to create the program in 2004. Over time a variety of interventions (ie, biometric screenings, nutrition/exercise health coaching, on-site fitness centers, etc) were implemented at multiple employee locations. An integrated analysis of the impact of the program on goal attainment rates and CV-related medical and hospital claims was completed using 2006 to 2008 data on 5,768 non-union employees. Data integration was completed by linking 3 data sets: biometric results, medical and pharmacy claims. Statistical analysis was completed using Chi Square and Two-Sample T-Tests. In employees with dyslipidemia, mean total cholesterol declined from 196.4 to 185.2 mg/dL (p=0.001), HDL increased from 38.7 to 42.1 mg/dL (p=0.003), and TChol/HDL ratio declined from 5.5 to 4.9 (p<0.001). The percentage of employees reaching LDL goals increased from 48.0% (47/98) to 62.4% (111/178) (p=0.021). In employees with hypertension, mean blood pressure (BP) declined from 137.2/86.1 to 125.4/80.2 mm Hg (p<0.001, for systolic & diastolic). BP goal attainment increased from 42.5% (68/160) to 67.4% (319/473) (p<0.001). In employees with diabetes, mean fasting blood glucose (BG) remained unchanged [129.7 vs 129.6 mg/dL (p=NS)], while non-fasting BG declined from 152.3 to 146.2 mg/dL (p=NS). Analysis of medical claims data for all employees with at least 1 of the 3 conditions revealed reductions in CV-related medical and hospital claims relative to total medical claims. The percentage of employees with a CV-related medical claim declined from 56.6% (1158/2047) to 48.3% (1391/2878) (p<0.001) and CV-related medical claims declined from 14.1% (5479/38770) to 13.1% (6755/51581) (p<0.001). The percentage of employees with a CV-related hospital claim declined from 6.0% (122/2047) to 4.3% (123/2878) (p=0.007) and CV-related hospital claims declined from 2.5% (951/38770) to 1.7% (874/51581) (p<0.001). As a result of the program, CV related medical and hospital costs both declined significantly relative to total medical costs.
Abstract P306: Physician Directed Nurse Practioner Model of Care Using Get With The GuidelinesSM is Superior in Attaining Centers for Medicare and Medicaid Services Core Measure Compliance for Patients With Acute Myocardial Infarction Amongst Urban Hospitals With Large Minority Populations
Authors: Faillace Robert T , Magdon-Ismail Zainab , Chambers Rebecca , Brissette Ian F , Duggan Lorraine , Matza Ilene , Terrone Deborah , Walsh Cathleen , Crowther Maryanne
Published: July 2021

The goal of the Centers for Medicare and Medicaid Services acute myocardial infarction core measure program (AMI-CM) is to provide standards of care at the point of service. The American Heart Association's Get With The Guidelines (AHA-GWTG) program has previously been shown to be independently associated with significantly improved adherence to AMI-CM. However, a physician directed nurse practioner managed GWTG model of care (PDNP-GWTG) in an urban hospital with a large minority population (UH-LMP) has not yet been compared to GWTG and non-GWTG hospitals with similar demographics for compliance to AMI-CM. St. Joseph's Regional Medical Center (SJRMC) is an UH-LMP located in Northern NJ with a diverse and large minority composition. The objective of this study was to compare SJRMC's PDNP-GWTG model of care to GWTG and non-GWTG UH-LMP for AMI-CM.

Methods:
All UH-LMP hospitals' AMI-CM with a percent white population within +/- 5% of SJRMC and a similar Urbanicity Ranking, n= 113, were compared to SJRMC's AMI-CM for 2008. Differences in compliance for each of the 8 AMI-CM and for the composite AMI-CM (8-CM) were assessed using the Chi Square test for contingencies.

Results:
SJRMC 8-CM compliance of 96% (1275 of 1329) was superior to UH-LMP of 94% (55270 of 58798), p=0.0007. For individual AMI-CM compliance SJRMC was superior to UH-LMP for: Aspirin at arrival (100% (260 of 260) vs. 97% (12060 of 12434), p=0.007); Beta-Blocker (BB) at arrival (99% (230 of 232) vs. 95% (9533 of 10035), p=0.003); BB at discharge (98% (308 of 314) vs. 96% (13279 of 13832), p=0.03); and tobacco counseling (100% (116 of 116) vs. 94% (3870 of 4117), p=0.004). UH-LMP was superior to SJRMC compliance for PCI within 90 minutes of arrival (PCI-AMI) (56% (605 of 1080) vs. 29% (11 of 38), p=0.001).

Conclusion:
SJRMC PDNP AMI-CM compliance for the composite and 4 of the core measures that are also GWTG performance measures is superior to UH-LMP. UH-LMP PCI-AMI-CM performance (not a GWTG performance measure) was superior to SJRMC.
Abstract P314: The Impact of Hospital Cardiac Specialization on Outcomes After Coronary Artery Bypass Graft Surgery: Analysis of Medicare Claims Data
Authors: Girotra Saket , Lu Xin , Vaughan-Sarrazin Mary , Popescu Joana , Horwitz Phillip , Cram Peter
Published: July 2021

Background
Hospital volume has been widely embraced as a proxy for hospital quality; little attention has been focused on an alternative quality metric - hospital specialization. While specialization occurs on a continuum, prior studies of specialization have largely focused on a small number of highly specialized (
specialty)
hospitals. Studies on the broad relationship between hospital specialization and outcomes after cardiac surgery are lacking.

Methods
We used Medicare data to identify 705084 patients who underwent CABG at 1130 hospitals during 2001-2005. We stratified hospitals into quintiles of cardiac specialization based on the relative proportion of all Medicare discharges at each hospital classified as Major Disease Category 5 - diseases of cardiovascular system. We obtained hospital characteristics from the 2001-2005 AHA survey. We used multivariable hierarchical regression to examine the association of cardiac specialization with risk of 30-day mortality adjusting for patient characteristics & CABG volume.

Results
The mean age of CABG recipients was 75 years, 65% were men, 92% were white. Patient demographic & comorbidity was generally similar between quintiles of hospital specialization. The median cardiac specialization was 29.7% for all hospitals (mean cardiac specialization in lowest quintile of hospital specialization was 23.2% vs. 45.2% for highest quintile). Compared to the highest quintile, hospitals in the lowest quintile had fewer beds (296 vs. 314, p < .01), were less likely to be teaching hospitals (22% vs. 26%, p < .01) and had lower CABG volume (63 vs. 239, p < .01). They also admitted less transfer patients (8.3% vs. 17.5%, p < .01) and performed less concurrent valve surgery (13% vs. 15%, p < .01). Unadjusted 30-day mortality was higher at least specialized hospitals compared to most specialized hospitals (4.9% vs. 4.3%, p < .01). Odds of mortality remained higher at these hospitals after adjustment for patient characteristics (OR 1.15 95% CI [1.07 - 1.24] p trend < .01) but was similar after further adjustment for CABG volume (OR 1.05 95% CI [0.97 - 1.15] p trend 0.65).

Conclusion
After accounting for hospital volume, hospitals with greater cardiac specialization did not have better CABG outcomes than less specialized hospitals.
Abstract P324: Quality of Life Outcomes of Cardiac Surgery in Octogenarians: Comperision Between Isolated Revascularization and Aortic Valve Replacement Surgery
Authors: Chaturvedi Rakesh K , Iqbal Sameena , Goldberg Peter , DeVarennes Benoit , Lachapelle Kevin
Published: July 2021

Background:
Aortic stenosis (AS) in octogenarians is most common and debilitating second to coronary artery disease, leading to poor quality of life (QOL). AS has higher mortality comparison to isolated revascularization (CABG) surgery. Studies indicated the benefits of both types of surgeries in octogenarians in improvement of functionality and QOL. Objective of this study was to assess long-term survival, functional status, living arrangements and QOL in the octogenarians in aortic valve and CABG surgery.

Methods:
Between September 2000 and September 2006, 304 consecutive patients aged 80-92 years (mean: 83.2 ± 2.8) who had CABG (196) and AVR (108) with or without CABG were identified. All survivors were followed prospectively for a mean period of 36.5 months (7-78). Their QOL and functional status was assessed by using items from the Barthel index and Karnofsky performance score. In this study we used observable descriptive measures to describe QOL (i.e. Phenomenology: the study of lived experience), in a number of domain activities of day-today life in our elderly patients.

Results:
Overall 30-day in-hospital mortality (CABG/AVR; n::%) rate was (24/10::12.2/9.2%). The non-adjusted survival rate was 82.7/78.2% and 72.4/66.5% at 1 and 3 years respectively. Among the 207 (136/71::69.4/65.7%) survivors from a cohort of 304, (89/44::65.4/62.0%) were autonomous, (38/18::27.9/25.4%) were semiautonomous, and 9/9::6.6/12.6%) were dependents. Among the survivors (103/47::75.7/66.2%) living in own homes, (24/15::17.6/21.1%) in residences and (9/9::6.6/12.6%) in the supervised setting. The surviving patients were involved social (133/68::97.8/95.8%), cognitive (132/68::97/95.9%), physical (126/65::92.6/91.5%), and/or volunteer and creative activities (27/18::19.8/25.3%). All survivors were cardiac symptoms free.

Conclusions:
Early and long-term survival in CABG and AVR group was not significantly different. More than 90% of survivors were physically active. Functional status and QOL were not significantly different in two groups. This long-term information can help when considering risks and benefits of Cardiac surgery and planning the future need for health care resources among octogenarians.