bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 136: The Relationship of Changing Hospital Readmission Rates and Mortality Rates After Hospitalization for Heart Failure, Acute Myocardial Infarction, and Pneumonia
Authors: Dharmarajan Kumar , Wang Yongfei , Bernheim Susannah , Lin Zhenqiu , Horwitz Leora , Ross Joseph , Desai Nihar , Suter Lisa , Drye Elizabeth , Normand Sharon-Lise T , Krumholz Harlan
Published: June 2021

Background:
It is unknown if financial pressures to reduce hospital readmission rates following passage of the Affordable Care Act (ACA) have had the unintended effect of increasing mortality rates after hospitalization. We therefore examined correlations between paired changes in hospital 30-day readmission rates and 30-day mortality rates among Medicare fee-for-service beneficiaries hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia from 2008 to 2014.

Methods:
We used linear regression to calculate monthly changes in hospitals’ 30-day risk-adjusted readmission rates (RARRs) and 30-day risk-adjusted mortality rates (RAMRs) after discharge for HF, AMI, and pneumonia from 2008 to 2014. Adjustment was made for patient age, sex, comorbidities, hospital length of stay, and season. We then examined the correlation of hospitals’ paired monthly changes in 30-day RARRs and monthly changes in 30-day RAMRs after discharge.

Results:
From 2008 to 2014, we identified 2,962,554, 1,229,939, and 2,544,530 hospitalizations for HF, AMI, and pneumonia at 5,016, 4,772, and 5,057 hospitals, respectively. Hospital 30-day RARRs declined for all three conditions from 2008 to 2014; the monthly change in RARRs was -0.053 (95% CI -0.055, -0.051) for HF, -0.044 (95% CI -0.047, -0.041) for AMI, and -0.033 (95% CI -0.035, -0.031) for pneumonia. In contrast, the monthly change in hospital 30-day RAMRs after discharge varied by admitting condition and was 0.008 (95% CI 0.007, 0.010) for HF, -0.003 (95% CI -0.006, -0.001) for AMI, and 0.001 (95% CI -0.001, 0.003) for pneumonia. The correlation between monthly changes in hospitals’ 30-day RARRs and 30-day RAMRs after discharge was 0.060 for HF (p<0.001), 0.059 for AMI (p=0.003), and 0.106 for pneumonia (p<0.001). Representative data showing the poor correlation in hospitals’ paired monthly changes in 30-day RARRs and 30-day RAMRs for AMI is shown in the Figure.

Conclusion:
Changes in hospital readmission rates for HF, AMI, and pneumonia were poorly correlated with changes in mortality rates after hospitalization between 2008 and 2014. These findings suggest that financial incentives to improve hospitals’ readmission performance have not increased mortality after hospitalization.
Abstract 138: Impact of Depressive Disorder on Access to Care and Quality of Care in Veterans With Cardiovascular Disease
Authors: Srivastava Pallavi , Lacey Matthew , Butler Javed , Shroyer A. Laurie , Parikh Puja B
Published: June 2021

Background:
Depressive disorders have been independently associated with increased morbidity and mortality in adults with cardiovascular disease (CVD). We sought to assess the association between depressive disorder and access to care and quality of care among U.S. veterans with CVD.

Methods:
The 2013 Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 13,126 veterans with CVD. Presence of CVD was noted with a single affirmative response to the following questions: “Has a health care professional ever told you that you had any of the following:” (1) a heart attack or myocardial infarction, (2) angina or coronary heart disease, (3) a stroke? Access to care variables included report of financial barriers to medical care and/or prescription drug costs and report of delay in receiving medical care. Quality of care variables included annual blood cholesterol check, blood sugar testing, flu shot administration, antihypertensive use, and aspirin use.

Results:
Among 13,126 veterans studied, a total of 2,889 (22%) adults had a depressive disorder while 10,237 (78%) did not. Veterans with a depressive disorder tended to be younger (p<0.0001), female (7% vs 4%, p<0.0001), non-white (21% vs 14%, p<0.0001), and of Hispanic ethnicity (4.0% vs 2.2%, p<0.0001). There were less likely to be married, employed, and homeowners, and reported lower annual income. Veterans with a depressive disorder had higher rates of hypertension (78% vs 73%), hypercholesterolemia (76% vs 67%), chronic kidney disease (12% vs 8%), chronic obstructive pulmonary disease (33% vs 18%), asthma, smoking (25% vs 12%), obesity (40% vs 30%), and physical inactivity (45% vs 35%) (p<0.0001 for all). Veterans with a depressive disorder were more likely to report financial barriers to medical care (15% vs 6%, p<0.0001) and prescription drug costs (12% vs 5%, p<0.0001), and a delay in receiving medical care (24% vs 9%, p<0.0001). While no difference was noted in annual blood cholesterol check, blood sugar testing, and flu shot administration, veterans with depressive disorder reported significantly lower rates of aspirin (73% vs 78%, p=0.0003) and antihypertensive use (92% vs 94%, p<0.0001). In multivariate analysis, depressive disorder was associated with independently higher rates of reports of financial barriers to medical care (OR, 1.96; 95% CI, 1.45-2.65), financial barriers to prescription drugs (OR, 1.45; 95% CI, 1.02-2.08) and delay in receiving medical care (OR, 2.07; 95% CI, 1.65-2.60).

Conclusions:
Depressive disorder was associated with higher rates of financial barriers to care and prescription drugs, and patient-reported delays in medical care in U.S. veterans with CVD. Further research appears warranted to evaluate the impact of mental health disease upon cardiovascular care in veterans with CVD.
Abstract 143: Procedural Efficacy in Radial vs. Femoral Approach in Coronary Catheterization and Percutaneous Intervention in a Tertiary Care Teaching Hospital
Authors: Kumar Vishesh , Yee Jimmy , Higgins Jimmy , Anuwatworn Amornpol , Pham Alex , Stys Tomasz
Published: June 2021

Background:
The practice of trans-radial artery (TRA) approach for coronary angiography and percutaneous coronary intervention (PCI) has been steadily increasing in the United States since 2007 from 1% to 16% in 2012. However, when compared to trans-femoral artery (TFA) approach the procedural efficacy for TRA was found to be worse in large studies. The aim of this study was to explore procedural efficacy of TRA vs TFA approach in a tertiary care teaching hospital.

Methods:
We performed a retrospective review of data from 10,145 consecutive patients from our coronary catheterization lab database from 9/2011 to 5/2015 at University of South Dakota, Sanford Heart Hospital. Cases were analyzed for procedural efficacy as defined by duration of procedure, fluoroscopic time, and total contrast utilization.

Results:
Overall, 7,581 (76%) patients underwent TRA approach and 2,564 (24%) patients underwent TFA approach. There was a shorter procedural duration for TRA approach vs TFR approach (60.1 minutes vs 78.3 minutes; p<0.0001), shorter fluoroscopic time for TRA approach vs TFR approach (6.06 minutes vs 9.01 minutes; p<0.0001), and less contrast utilization for TRA approach vs TFA approach (64.23 ml vs 72.15 ml; p<0.0001). The procedural duration trend over the past four years in quarterly increments is seen in Figure 1.

Conclusion:
Contrary to what was seen in major trials; in our center, procedural efficacy was substantially better for TRA approach compared to TFA approach. Though procedural duration for TRA approach has remained the same over the past four years, there was also a general trend toward lengthening procedural duration for TFA approach.
Abstract 146: Evaluation of Out-of-hospital Ventricular Fibrillation Cardiac Arrest Management, With a Simulation Method
Authors: Ursat Cécile , Douge Guillaume , Groizard Charles , Ozguler Anna , Baer Michel , Loeb Thomas
Published: June 2021

Introduction:
Feed-back on quality of CPR is an important aspect to consider on cardiac arrest management. This has been pointed out during trainings organized for emergency medicine residents. In parallel, RéAC registry (registry on cardiac arrests in France) showed some difficulties in following guidelines of VF.The aim of this study was to evaluate the performance of Emergency Medical Service (EMS) in the management of patients in cardiac arrest through the use of external chest compression (CC) data from the Resusci Anne Simulator manikin from Laerdal (SimMan®), equipped with SimPad SkillReporter.

Methodology:
During 2nd to 6th of March 2015, 18 EMS teams (1 physician, 1 paramedic and 1 nurse) were asked to manage a VF on a Resusci Anne Simulator manikin. This allowed the direct measurement of CC quality parameters and the evaluation of decision algorithm, through the use of a same scenario. The scenario was introduced to each team at the beginning of each session. At first, the “patient” was still conscious, on a stretcher and had a ST-segment elevation myocardial infarction. While the patient was installed in the ambulance, he suddenly had a FV cardiac arrest that could be detected on monitoring devices (time 0 of simulation). VF lasted for 10 minutes, followed by 5 minutes of asystole. The manikin software displayed the different parameters as the scenario progressed. The simulation was performed on a stretcher in an EMS premise, with the same equipment and monitoring devices as in an advanced life support ambulance (ALS).

Results:
CC were performed 71% of CPR time. CC depth was considered as non-compliant to guidelines in 28% of cases, with a mean depth of 4.4 cm, compressions with complete release in 37% of cases. Mean compression rate was 122/minute and was correct in 49% of cases. One third used Amiodarone after the third shock. 13/18 teams resumed chest compressions immediately after defibrillation attempts.

Conclusion:
This study shows the difficulty to strictly follow guidelines. According to participants, the massage was considered as more difficult with a manikin rather than on a real patient. Although cardiac arrest occurring during transportation is quite rare, quality of CPR at pre-hospital level should be improved.
Abstract 148: American Heart Association Athlete Prescreening Recommendations: An Evaluation of Knowledge and Compliance
Authors: Witcik Michael A , Ernst Alexa A , Smith Angela L , Borgert Andrew J , Maclellan-Tobert Susan G
Published: June 2021

Objective:
The purpose of this study was to determine the level of knowledge and compliance with American Heart Association (AHA) recommended guidelines for sudden cardiac death (SCD) risk screening of providers completing prescreening exams and school officials requiring prescreening exams.

Methods:
Retrospective review was completed on 704 patient pre-participation exams (PPEs) between 1/1/2014 and 12/31/2015. Patient demographics and evidence of AHA screening recommendation documentation were collected. Surveys were sent to providers within Gundersen Health System who perform PPEs and to school officials within the service area to assess knowledge and compliance with AHA recommendations.

Results:
There were relatively equal numbers of females and males in the sample population (46% and 54%) with a mean age of 14.3. More than half of the PPEs were the first for the patient. Evidence of documentation was found on average 67% of the time for personal history criteria with the exception of prior high blood pressure at 58%. Provider survey responses indicated assessment of personal history items at always or most of the time between 81% and 100%. Evidence of documentation for family history criteria was found on average 66% of the time with the exception of a relative with unexplained fainting or seizures at 54%; whereas survey data indicated assessment rates at 71% and 97% (always or most of the time). Physical exam criteria were found documented on average 93% of the time in the electronic medical record (EMR), with the exception of Marfan syndrome screen at only 52%. Providers reported on the survey that assessment was always or most of the time done between 30% and 100% of the time. Awareness of the AHA 14-point prescreening recommendations was reported by only 50% of providers completing exams and 0% of the school officials.

Conclusions:
Knowledge and awareness of the AHA 14-point recommendations for PPEs is low in our area. Providers recall performing recommended assessments at a higher rate than what was found documented in the EMR. This study has highlighted an area for improvement and opportunities for educational efforts both within our system and in collaboration with our community.
Abstract 150: Machine Learning Methodology Predicts Comorbidities are Associated With Increased Total Healthcare Costs Among Patients With Severe Peripheral Artery Disease
Authors: Berger Jeffrey S , Haskell Lloyd , Ting Windsor , Lurie Fedor , Eapen Zubin , Valko Matthew , Alas Veronica , Rich Kelly , Crivera Concetta , Schein Jeff
Published: June 2021

Introduction:
Peripheral artery disease (PAD) is manifested over a continuum of severity with comorbidities that may significantly increase healthcare costs (HC). Little research has been completed to understand the healthcare resource use (HRU) and HC in this population, specifically among severe PAD patients. We sought to understand the economic burden in this population.

Methods:
We identified severe PAD patients (rest pain, gangrene or ulceration) from an integrated administrative claims and electronic medical records database (Optum + Humedica 2007-15) with over 7 million patients. The first PAD diagnosis was the index date. Patients were required to be age ≥50 at index date, have clinical activity and continuous enrollment in the 6-month pre-index and 12-month or until death post-index periods. Patients with history of intracranial hemorrhage, stroke and transient ischemic attack were removed. We assessed HRU and all-cause annual total HC in the post-index period or until death, and descriptive analyses, means and SDs. Reverse Engineering and Forward Simulation (REFS
TM
) models, an ensemble of Bayesian networks, were machine learned to examine baseline demographic and clinical characteristics and their association with post-index natural log all-cause annual total HC among living patients. We assessed effect estimates across the ensemble using Mean Percentage Change in Costs (MPCC) with SD.

Results:
The final study sample included 3,189 severe PAD patients. Mean number of all-cause hospitalizations was 1.3 (SD 1.8) and the mean length of stay was 8.0 days (SD 18.2). The mean all-cause annual total HC per patient was $56,973 (SD $91,523). Highly predictive factors associated with increased costs were (MPCC, SD): chronic ulcer of leg or foot (1.9, 0.1), chronic kidney diseases (CKD; 1.9, 0.2), cellulitis and abscess (1.8, 0.2), hypertension (1.6, 0.1), and carditis and cardiomyopathy (1.2, 0.1).

Conclusion:
In this study, the presence of chronic ulcers in the lower extremities and CKD were two factors most predictive of increased all-cause total HC in a geographically diverse population of severe PAD patients.
Abstract 158: Health Care Access Among Young Adults With Hypertension - The Impact Of Extended Dependent Coverage
Authors: Fang Jing , Wang Guijing , Ayala Carma , Loustalot Fleetwood
Published: June 2021

Background:
Uncontrolled hypertension among young adults increases risk for future cardiovascular events. Previous research has shown young adults were more likely to be untreated for hypertension compared to older age groups, potentially influenced by access to care barriers. In 2010, the Patient Protection and Affordable Care Act extended dependent insurance coverage to 26 years of age. It is not known if this expansion affected access to care among young adults with hypertension.

Methods:
Participants from the National Health Interview Survey in 2006-2009 and 2011-2014, aged 19-25 years, who reported a diagnosis of hypertension on at least two occasions, were included in this study. Six indicators of barriers to accessing healthcare were assessed: 1) no place to see a doctor when needed, 2) can’t afford prescribed medicine, 3) didn’t see doctor in past 12 months, 4) delayed care due to cost, 5) didn’t get care due to cost and 6) do not have any health insurance. We compared the percentage of each indicators among young adults with hypertension between 2006-2009 and 2011-2014. Using 2006-2009 as referent, the odds ratios (and 95% confidence intervals [CI]) of poor access were estimated after adjustments for sex, race/ethnicity and level of education.

Results:
During 2006-2009 and 2011-2014, there were 10,490 and 14,028 participants aged 19-25 years, and 3.2% (n=353) and 3.5% (N=505) who reported a diagnosis of hypertension, respectively (p=0.4173). The percentage of young adults with hypertension who reported “no place to see a doctor when needed” (30.5% vs 21.6%, p=0.031), “can’t afford prescribed medicine” (23.0% vs 15.3%, p=0.023) and “do not have any health insurance” (31.3% vs 23.3%, p=0.037) were significantly lower during the 2011-2014 period than the 2006-2009 period. Using 2006-2009 as the referent and adjusting for sex, race/ethnicity and level of education, the adjusted odds ratio for 2011-2014 for “no place to see a doctor when sick” was 0.57 (0.38-0.88), for “can’t afford prescribed medicine” was 0.61 (0.40-0.95), and for “do not have any health insurance” was 0.67 (0.45-0.99). However, no difference of reporting “didn’t see doctor in past 12 months”, “delayed care due to cost” and “didn’t get care due to cost” were identified between the two periods.

Conclusions:
In this analysis using a nationally representative sample, the expansion of dependent insurance in 2010 may have improved some indicators of access to care among young adults with hypertension.
Abstract 166: Female Gender Disparity Observed in STEMI System Time Performance Metrics
Authors: Mullvain Richard , Bosch Mallory , Hassinger Nancy , Kapphahn Samantha , Howard Lynn , Mollerus Michael
Published: June 2021

Background:
We suspect female disparities exist in STEMI system time performance metrics. Reducing time sensitive steps in STEMI care reduces time to reperfusion and improves outcomes. A recent AHA statement on acute myocardial infarction in women reports a need for more data on gender differences in STEMI care. In response, we sought to add to the body of knowledge on this subject by examining and sharing gender specific time performance data from 2 large rural STEMI systems of care.

Methods:
Data was combined, and retrospectively analyzed for female gender disparities by examining STEMI activation cases from 2 large rural mid-west STEMI systems of care. The Primary Percutaneous Coronary Intervention (PPCI) capable hospitals are located in Duluth, Minnesota, and Fargo, North Dakota. We evaluated 636 consecutive cases from May 2013 through March 2016, and organized them into 3 different settings: PPCI capable hospital emergency departments, non-PCI capable facilities that transfer for PPCI, and EMS field activations transported to a PPCI capable hospital.

Findings:
Upon evaluation of all cases, 73% were male, and 27% were female. We found 12 STEMI performance metrics showing longer times for females compared to males, and 5 were statistically significant. These times include: door to ECG time in a PCI capable hospital (7 vs 5 min, p=0.027), patient time spent in the ED of a PPCI capable hospital (46 vs. 43 min, p=0.022), door to ECG in a Non-PCI capable hospital (7 vs 6 min, p=0.030), Non-PCI hospital call until EMS arrival to transport the patient (25 vs 16 min, p=0.037), and symptom onset to 911 call when EMS activates STEMI Alert from the field (45 vs 30 min, p=0.013).

Conclusion:
We report data on 12 common STEMI System time performance metrics, which appear to take longer with females, of which 5 were statistically significant. The reasons for these differences are unknown. Further research and education of gender disparities in STEMI system time performance metrics appears warranted.
Abstract 168: Racial and Ethnic Differences in Contemporary Use of Left Ventricular Assist Device
Authors: Breathett Khadijah , Allen Larry A , Helmkamp Laura , Colborn Kathyrn , Daugherty Stacie L , Blair Irene V , Jones Jacqueline , Khazanie Prateeti , Lindrooth Richard , Peterson Pamela N
Published: June 2021

Background:
Rates of receipt of left ventricular assist devices (LVADs) are less than expected for racial/ethnic minorities. A major etiology of this disparity changed over the past few years with broader access to insurance. Thus, we hypothesized that changes in the census-adjusted rate of receipt of LVADs would be higher for racial/ethnic minorities than Caucasians independent of sex and age.

Methods:
Using the Interagency Registry of Mechanically Assisted Circulatory Support, we analyzed 10,795 patients (African-American 24.8%, Asian 1.5%, Caucasian 67.4%, Hispanic 6.3%, female 21.4%) who had an LVAD implanted between 2012-2015. Linear models were fit to annual census-adjusted rate of LVAD implantation, and the rate of change in receipt of LVADs was compared for each racial/ethnic minority to Caucasians, stratified by sex and age group.

Results:
Between 2012 and 2015, African-Americans had an increase in the census-adjusted annual rate of receipt of LVADs per 100,000 [+0.26 (95% CI: 0.17-0.34)], while others exhibited no significant changes [Caucasian: +0.06 (95%CI: -0.03-0.14); Hispanic: +0.04 (95%CI: -0.05-0.12); Asian: +0.04 (95%CI: -0.04-0.13)]. When stratified by sex, the observed increase in rate of receipt of LVAD for African-Americans relative to Caucasians was present for both sexes [African-American women: +0.14 (95%CI: 0.01-0.27); African-American men: +0.28 (95%CI: 0.15-0.41)]. No increase was observed in either sex among other racial/ethnic groups (
Figure 1a
). When stratified by age group, the observed increase in rate of receipt of LVAD for African-Americans relative to Caucasians was limited to those aged 40-59 years [African-Americans aged: 20-39: +0.09 (95%CI: -0.20-0.39); 40-49: +0.41 (95%CI: 0.11-0.70); 50-59: +0.31 (95%CI: 0.01-0.60); 60-69: +0.22 (95%CI: -0.08-0.51); 70+: +0.07 (95%CI: -0.23-0.36)]. No differences by age group were observed among other racial/ethnic groups compared to Caucasians (
Figure 1b)
.

Conclusions:
From 2012-2015, rates of receipt of LVADs increased for African-Americans but not other racial/ethnic groups in comparison to Caucasians. Similar patterns were seen when stratified by sex. When stratified by age, the increase in rate was limited to middle-aged African-Americans.
Abstract 180: Consultation to a Cardiologist Prior to Low Risk Procedures Generates Excessive Testing and Cost Without Affecting Outcomes in Patients with Stable Ischemic Heart Disease
Authors: Coffman Joseph , Tran Thanh , Kip Kevin , Berlowitz Michael S , Chae Sanders H
Published: June 2021

Background:
The healthcare system in the United States is often times costly and inefficient. Some estimates suggest that 20-34% of healthcare dollars are spent ineffectively. Despite efforts such as the Choosing Wisely Campaign to limit preoperative testing prior to low risk surgery, preoperative cardiac testing before low risk procedures remains common. This study assesses the frequency, outcomes, and costs associated with inpatient preoperative cardiology consultation prior to low risk inpatient procedures.

Methods:
1,284 consecutive patients underwent inpatient endoscopy or colonoscopy between November 1, 2011 and April 31, 2016 at a single academic tertiary referral center. 79 patients (6.2%) underwent preoperative consultation with a board certified cardiologist. 158 patients who did not undergo inpatient cardiology consultation prior to the procedure were matched to cases by age and gender in a 2:1 ratio. Retrospective chart review of clinical, demographic and economic variables was performed. Charges for diagnostic tests and the hospitalization were obtained from hospital billing.

Results:
Patients with cardiology consultation were more likely to have coronary artery disease (32.9% vs 11.4%, p < 0.0001) but were similar with respect to other comorbidities. There were no differences in adverse cardiac events between the two groups. Patients who received cardiac consultation had more cardiac tests, including more echocardiograms (60.8% vs 22.2%, p < 0.0001) and 12 lead ECGs (98.7% vs 54.4%, p < 0.0001). While nuclear stress tests, coronary CT angiograms, and cardiac catheterizations were more frequent after cardiology consultation, the differences were not statistically significant. Patients who were seen by a cardiologist had a longer length of stay (4.35 days vs 3.46 days, p = 0.0032) and delay from admission to procedure (3.14 days vs 2.38 days, p = .001). Evaluation by a board-certified cardiologist led to an increase in estimated charges of $839,332 for the group as a whole and an average increase in estimated charges of $10,624 per patient.

Conclusion:
Preoperative cardiac evaluation prior to low risk procedures remains common. Inpatient consultation to a cardiologist for pre-procedure evaluation generates a substantial increase in testing and cost without affecting outcomes. Further research into the reasons for persistent referral to cardiologists and overutilization of preoperative testing is needed to understand how to best implement recommendations made by campaigns such as Choosing Wisely.
Abstract 185: The Relationship of Ambulatory Visit Frequency and Hypertension Control Among Young Adults
Authors: King Cecile C , Bartels Christie M , Magnan Elizabeth M , Fink Jennifer T , Smith Maureen A , Johnson Heather M
Published: June 2021

Background:
Young adults (18-39 years old) have the lowest rates of hypertension control compared to middle-aged and older adults. Shorter follow-up encounter intervals have been associated with faster rates of hypertension control in middle-aged and older adults. However, the optimal follow-up interval is not defined in younger adults. The objective was to evaluate the relationship between ambulatory follow-up intervals, defined as the average number of provider-patient blood pressure encounters over time, and rates of hypertension control among young adults with incident hypertension.

Methods:
This was a retrospective analysis of 3,150 young adults receiving regular primary care in a large, Midwestern, academic group practice from 2008-2011. Patients were included upon meeting JNC7 clinical criteria for hypertension (≥140/90 mmHg) and followed for 24 months. Young adults with a previous hypertension diagnosis or prior antihypertensive medication were excluded. We calculated the average blood pressure encounter interval over 24 months and categorized the intervals using established categories of <1 month, 1-2 months, 2-3 months, 3-6 months, and >6 month intervals. Summary statistics were constructed using frequencies and proportions for categorical data and median (25
th
, 75
th
percentile) for continuous variables. Univariate associations between continuous variables were assessed using two-sided t-test. The probability of achieving hypertension control (<140/90 mmHg) for patients within each encounter interval category was estimated by Kaplan-Meier analysis.

Results:
Among young adults with newly diagnosed hypertension (59% male, 83% White), those with the shortest average encounter interval (<1 month) were more likely to be female, have Stage 1 (mild) hypertension, Medicaid use, diabetes mellitus, and mental health diagnoses (all p<0.007). The likelihood of achieving hypertension control within 24 months was greater for shorter encounter intervals: <1 month (91%), 1-2 months (76%), 2-3 months (65%), 3-6 months (40%), and >6 months (13%), p<0.001. Respectively, the median time in months to hypertension control (25
th
-75
th
percentile) by encounter intervals was: 2.8 (1.8-3.9), 7.1 (5.1-11.3), 10.5 (8.5-14.4), 16.4 (12.4-22.6), and 23.9 (22.5-24.1) months. Young adults with 2-3 month and 3-6 month encounter intervals had higher rates of antihypertensive medication initiation within 24 months, 28% (884/3150) and 27% (850/3150) respectively, compared to 21% (661/3150) with <1 month visit interval.

Conclusions:
A shorter encounter interval (<1 month) is associated with higher and faster rates of hypertension control within 24 months among young adults with incident hypertension. Sustainable interventions to support shorter follow-up intervals between young adults and primary care teams are needed to improve rates and timeliness of hypertension control.
Abstract 191: Identification of Adults With Congenital Heart Disease From Administrative Data
Authors: Steiner Jill M , Kirkpatrick James N , Heckbert Susan R , Curtis J R
Published: June 2021

Introduction:
With improved management, there are now more adults with congenital heart disease (ACHD) than children. However, long-term survival with moderate or severe ACHD remains limited, and there is relatively sparse literature on the intensity or quality of end-of-life care for these patients. The goal of this analysis is to examine the accuracy of administrative data for identifying patients who died with ACHD to facilitate study of care provided near the end of life.

Methods:
We created a list of ICD-9 and ICD-10 codes representing ACHD of moderate or great complexity. We performed a search for these codes in the electronic health record (EHR) of adults who received care 2010-2016 within our healthcare system. We used state death records to identify which of these patients died during the same timeframe. Manual EHR review was completed to evaluate performance of this search strategy. Identified patients were also compared to a list of patients seen in our ACHD clinic and known to have died during 2010-2016.

Results:
Using ICD data, 121 patients were identified, of which 66 actually had the moderate or greater complexity ACHD conditions by EHR review (positive predictive value, 0.55; 95% confidence interval 0.45, 0.63). EHR review confirmed 12 patients with Eisenmenger Syndrome, for which there is no specific ICD code. “Cyanosis+other” did not identify any of these, “VSD+other” (ventricular septal defect) identified 6, and there were 6 whose only ACHD code was VSD. Of the remaining 55 patients, 24 had ACHD not on the targeted list, largely due to coding error. In addition, despite being coded as having ACHD, 31 patients had no identified ACHD on EHR review. These misidentifications were attributed to coding error for 15 patients. Another 11 patients (35%) had acquired VSD due to myocardial infarction or endocarditis, for which there is no separate ICD code. Codes with the highest degree of error, incorrect more than 50% of the time, were those for congenitally corrected transposition, endocardial cushion defect, and hypoplastic left heart syndrome. The list of known deceased clinic patients included 21 with ACHD of interest. Only 1 of these was not identified by the ICD search, yielding a sensitivity for our list of ICD codes in this small sample of 0.95 (0.77,0.99).

Conclusion:
Use of administrative data to identify patients with ACHD of moderate or great complexity who have died had good sensitivity but suboptimal positive predictive value. Strategies to improve accuracy can be employed. Excluding patients who have codes for myocardial infarction or endocarditis in addition to VSD and using “VSD+other” as an additional proxy for Eisenmenger Syndrome are two examples. Administrative data is not ideal for identification of patients with ACHD of moderate or great complexity who have died, and manual EHR review is necessary to confirm these diagnoses.
Abstract 194: Diagnostic Accuracy of ICD Coding Among Young Patients With Suspected Myocardial Infarction
Authors: Singh Avinainder , Collins Bradley , Divakaran Sanjay , Qamar Arman , Baez Julio , Klein Josh , Hainer Jon , Shah Ravi , Di Carli Marcelo , Nasir Khurram , Bhatt Deepak L , Blankstein Ron
Published: June 2021

Background:
Quality-of-care and outcomes research rely on proper coding of acute myocardial infarction (MI). Given the under-appreciation of MI in younger patients, as well as other conditions which may mimic MI, our purpose was to determine the extent to which diagnostic coding can discriminate young patients with MI from those who may present with alternate diagnoses that can account for elevated cardiac biomarkers.

Methods:
Using clinical and coding data, we identified all patients presenting with a potential first MI (elevated cardiac biomarkers, ICD9 and ICD10 codes) at a young age (women < 50; men < 45 years of age) to two large medical centers over a 16-year period. Diagnosis and type of MI were adjudicated by review of medical records, as defined by the Third Universal Definition of MI.

Results:
A total of 4531 patients (1951 women and 2580 men) with suspected MI were included in the analysis. Of those who ruled-in for MI (N=1579), only 1065 (67%) were accurately identified by diagnosis codes. Of 2952 patients who ruled-out for MI, 814 (27.5%) were falsely coded for MI. These patients had alternative explanations for their presentation, including: severe renal dysfunction (20.3%), myocarditis (13.7%), pulmonary embolism (5.4%), rhabdomyolysis/myositis (2.1%), and chest wall trauma (2.1%). The overall sensitivity of diagnosis codes was 67% and specificity was 72%.

Conclusions:
Misclassifications in acute MI coding are highly prevalent in young patients with suspected acute coronary syndrome. Diagnostic codes had a modest sensitivity and specificity for diagnosing acute MI in young patients. False positive coding for MI among young individuals was largely due to confounding presentations, such as myocarditis, that increase cardiac biomarkers.
Abstract 196: Gender-based Differences in Presentation and Treatment of Patients Undergoing Peripheral Vascular Intervention
Authors: Ramkumar Niveditta , Suckow Bjoern D , Cronenwett Jack L , Goodney Philip P
Published: June 2021

Introduction:
While men and women are at equal risk for peripheral arterial disease (PAD), studies suggest that women present at an older age and with more advanced disease. The purpose of this analysis is to evaluate gender-based differences in disease presentation and its effect on treatment modality among patients who underwent peripheral vascular intervention (PVI) for PAD.

Methods:
Using national registry data from the Vascular Quality Initiative, univariate analysis, of patient-, limb- and artery-specific characteristics were performed by gender for procedures from 2010-2013. Statistical significance was determined by the Student’s T-test or Chi-squared test.

Results:
In this real-world cohort, there were 26,873 eligible procedures for 23,940 patients that had 30,668 limbs and 44,927 arteries treated. Compared to men, women presented at an older age (69 vs 71 years, p<0.001) and with more rest pain and tissue loss than claudication (RR=1.13, 95% CI: 1.10-1.16). Women had more severe lesions than men, as measured by TASC classification (TASC C or D RR= 1.81, 95% CI: 1.74-1.87) (
Table
1
). There were no meaningful gender-based differences in artery treated or treatment modality (
Figure
1
). Treatment modality was determined by disease severity (indication and TASC classification) and artery treated rather than gender.

Conclusion:
Although gender-based differences in PAD presentation exist, these differences do not extend to treatment modality, which is determined by disease severity and artery treated. Further investigation is required to appreciate the effect of disease severity and treatment modality on patient outcomes after PVI.
Abstract 208: Racial Disparities Affect In-hospital Mortality Rates Following Coronary Artery Bypass Grafting Among Patients With End-stage Renal Disease
Authors: Sergeev Alexander V
Published: June 2021

Background:
Coronary artery disease (CAD) is the leading cause of death among patients with end-stage renal disease (ESRD). ESRD patients are at a higher risk of coronary artery bypass grafting (CABG) perioperative mortality than their non-ESRD counterparts. The extent and the mechanisms of racial disparities in post-CABG outcomes among ESRD patients remain unclear.

Hypothesis:
We hypothesized that post-CABG in-hospital mortality in ESRD patients is affected by patients’ race.

Methods:
We conducted a retrospective cohort study of post-CABG in-hospital mortality among 6,590 CAD patients with ESRD during the period of 2007-2011 [mean±SD age: 64.8±11.13 years; 67.8% (4,468 of 6,590) males]. Most of the patients were white (66.0%; 4,347 of 6,590), 21.7% (1,432 of 6,590) were black, 11.0% (725 of 6,590) were Asian, and 1.3% (86 of 6,590) were American Indian. In-hospital death was defined as a binary outcome (discharged alive or deceased) due to a relatively short length of stay. Adjusted odds ratios (OR) for in-hospital death after CABG in relation to patients’ race, adjusting for major clinical and demographic covariates, were obtained with multivariable logistic regression.

Results:
Unadjusted (crude) post-CABG in-hospital mortality rate in ESRD patients was 8.8% (579 of 6,590). Mortality rate was higher among patients admitted through emergency department (ED) than non-ED admitted patients: mortality rates 10.2% (221 of 2,169 ED admitted) and 8.1% (358 of 4,421 non-ED admitted), respectively (
P
=0.0048). Deceased patients had more severe comorbidities and higher Elixhauser-Walraven comorbidity scores (12.6±6.7 points among deceased and 9.2±6.0 points among discharged alive;
P
<0.001). Blacks were more likely to experience an ED admission [with 39.2% (561 of 1,432) of blacks being ED admitted] than Asians (34.6%; 251 of 725 were ED admitted), whites (30.6%; 1,331 of 4,347 were ED admitted) or American Indians (30.2%; 26 of 86 were ED admitted). In the adjusted multivariable analysis, black patients had statistically significantly higher odds of post-CABG death than Asian patients (adjusted OR, 1.58; 95% CI, 1.09-2.30;
P
=0.0169). However, neither white patients (adjusted OR, 1.35; 95% CI, 0.96-1.89;
P
=0.0860) nor American Indian patients (adjusted OR, 2.16; 95% CI, 0.95-4.94;
P
=0.0676) had a statistically significantly higher risk of post-CABG death compared to Asian patients.

Conclusions:
Our findings indicate that racial disparities affect post-CABG in-hospital mortality rates in CAD patients with ESRD. Post-CABG mortality rate disparities may be attributed, at least partially, to racial disparities in severity of comorbidity and the type of admittance. Further studies investigating more detailed mechanisms responsible for these disparities are warranted.
Abstract 221: Environmental Scan of Telemedicine Networks With Services for Hypertension Management, 2016
Authors: Ayala Carma , Russell Zachary , Chowdhury Farah , Chang Tiffany , Mercado Carla
Published: June 2021

One of the barriers affecting continuity of hypertension care is access to health care, especially in low-income and rural areas. Telemedicine (TM) provides consultation and specialized treatment remotely, and reduces barriers of access to appropriate, high quality care. Common barriers include limited affordable transportation, job or other time constraints, and geographic isolation. TM use has increased, but there is limited information about the ease of finding TM networks and programs (TMNPs) by the general public. To address this gap, we conducted an environmental scan, during Sept.-Nov. 2016, assessing the ease of identifying existing TMNPs in the United States using simple internet searches (e.g., Google, Bing, Yahoo). First, we used the American Telemedicine Association’s 2015 Gap Analysis, Health Resources & Services Administration (HRSA) funded programs and 2013 Maryland telemedicine matrix as our template. After identifying the TMNPs, we assessed TM services provided, especially for hypertension (HTN). After compiling a consensus list of TMNPs in the US, we categorized the TMNPs based on their website’s list of services. Of the 50 states and District of Columbia (DC), we found 36 networks and 17 programs. Of these 53 TMNPs, only 1.9% (n=1) indicated that they provide TM services specifically for the management of HTN. However, there were 18 (34.0%) TMNPs that listed cardiology services. The only TMNP specifically focused on hypertension control was in the southeast, an area with a high burden of HTN. This TMNP was called the “Smartphone Medication Adherence Stops Hypertension” (SMASH), and was funded by the National Institutes of Health. The program has reported 95% control among their patient population with HTN in rural areas, including Hispanic and black adults. Other related programs included those focused on heart failure (5.7% (n=3) and diabetes management 9.4% (n=5). This initial environmental scan found most programs presented limited information about their population of interest. For example, 86.7% (n=46) did not provide information about the number of patients, area(s) served and number of partners and providers on their websites. Our results suggest common methods of obtaining information about TMNPs lack important information on TM services for HTN patients, and/or challenges in identifying existing services for patients to access. Using data collected from this environmental scan, our group will develop an exhaustive collection of data on existing TMNPs’ services (including how to participate), working directly with HRSA’s Telemedicine Resource Centers. The information from our environmental scan may produce regional and county-level telemedicine mapping to inform not only patients and their healthcare providers, but also clinicians, researchers, program managers, and decision makers on existing TMNPs that remotely provide effective HTN management.
Abstract 224: Characterizing Quality of Life Responses and Physical Functioning Improvements to an Integrated Self-care Intervention for Persons With Co-morbid Heart Failure and Diabetes
Authors: Higgins Melinda , Reilly Carolyn , Gary Rebecca , Dunbar Sandra , Butts Brittany , Butler Javed
Published: June 2021

Objectives:
In the Quality HF-DM trial, which tested an integrated self-care intervention for persons with heart failure (HF) and diabetes (DM), improved perceived HF and general health-related quality of life (QOL) and physical functioning were observed, but not for DM QOL. However, some participants did improve. This analysis examined the demographic and clinical factors associated with positive and clinically meaningful change in outcomes in response to the intervention to help inform future improvement in targeted interventions.

Methods:
HF-DM participants (n=134), mean age 57.4 ± 11 years, 66% men, 69% African American, were randomized to usual care (UC) or intervention (INT) with assessments at baseline (BL), 1, 3 and 6 months (M). Intervention included education/counseling focused on HF-DM self-care. Variables (measures, clinically meaningful change between BL-6 M) were: HF QOL (MLHFQ >5), general QOL (EQ5D-index >0.1; EQ5D-VAS >10), DM QOL (ADDQOL, >1), physical function (6 Minute Walk Test [6MWT] >50 meters). Age, gender, race, education, living arrangements, NYHA class and time with HF and DM were evaluated after adjusting for the INT group using linear and logistic regression to assess for relationship to improvements in outcomes.

Results:
For general QOL EQ5D index scores, those with less education (high school or less) (p=.024); those with NYHA class 3 or 4 (p=.036); and those with DM longer (p=.011) improved more. For MLWHF scores, whites were more likely than African Americans to improve their MLWHF scores (p=.05). For DM QOL (ADDQOL), 35% of younger participants (<=58 yrs.) in the intervention group improved their ADDQOL scores by 1 or more points compared to only 10% of the older participants (>58 yrs.) (p=.039). For 6MWT distances, males in INT group more likely to achieve improvement (p=.014), and those with NYHA class 3 or 4 more likely to improve (p=.048).

Conclusions:
When considering QOL and physical function outcomes in response to an HF-DM self-care intervention, age, education, race, gender, NYHA class, and time with DM were important. The INT improved outcomes in vulnerable groups of lower education, greater HF severity, and longer times with DM. Effects differed by EQ5D, MLWHF and ADDQOL measures highlighting the importance of evaluating multiple general and disease specific QOL dimensions, and the need to consider demographic and clinical risk factors to tailor toward more precise interventions.
Abstract 226: Strokes Worse in Women at 24 hours but Severity Reduced in Younger Women With Hormone Therapy
Authors: Brown Aliza , Onteddu Sanjeeva , Joiner Renee , Benton Tina , Culp William , Lowery Curtis
Published: June 2021

Background:
Gender related differences in stroke incidence hallmark the increased observation of women experiencing strokes later in life. Complications of women longevity has accounted for their increased risk of cardiovascular and cerebrovascular diseases. However, the severity of acute ischemic stroke (AIS) outcomes in women remains problematic. Previous studies have reported that women experience more disabilities and have poorer outcomes at three month follow-ups and may be related back to age at the time of stroke. We retrospectively examined 12 months of neurology consults in the Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) telemedicine program.

Objective:
To investigate whether gender influenced recovery at 24 hours following therapy for AIS.

Methods:
During 12 consecutive months 809 patients received neurology acute stroke consults and 238 (29%) received tissue plasminogen activator (tPA). Outcome data at 24 hours was available on 216 tPA-consults. Patient demographics, age, and gender, were analyzed along with baseline and 24 hour outcome National Institutes of Health Stroke Scale (NIHSS), onset to tPA, smoking, alcoholism, and hormone replacement therapy (HRT). Co-morbidity information collected included previous transient ischemic attacks (TIA), atrial fib (AF), diabetes, chronic obstructive pulmonary disease (COPD), hypertension (HT), hyperglycemia and coronary artery disease (CAD).

Results:
A total of 108 men and 108 women tPA treated patients showed no significant differences in age for male vs. female (mean±se 67.5±1.3 vs. 70±1.5, p=0.79). However, the men had twice the number of women in the 70-79 age range and women had twice the number of men at >80 years of age (
χ
2
p=0.0096 for all age ranges for both sexes). While baseline NIHSS was not significant in men vs. women (10.8±0.6 and 11.8±0.7, p=0.32, respectively), the women’s 24 hour NIHSS was significantly greater (5.9±0.7 vs. 9.1±0.9, p=0.0047, respectively). The incidence of HRT use in n=11 women < 80 years of age was associated with lower NIHSS’s at 24 hours vs. women without HRT (2.3±0.8 vs. 8.7±1.4, p=0.03, respectively). Males had a higher incidence of smoking (
χ
2
p=0.007). All other co-morbidities occurred equally between sexes.

Conclusion:
Women in this study had more severe 24 hour AIS outcomes than men but this improved with HRT use in women younger than 80 years. This cannot be fully explained by age differences as there could be other underlying factors. Improving 24 hour NIHSS may correctly predict later outcomes following AIS. Further study of HRT use in AIS outcomes is justified.