bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 19427: Epidemiology and Outcomes of Out-of-hospital Cardiac Arrest in Qatar
Authors: Irfan Furqan B , Bhutta Zain A , Tariq Tooba , Shaikh Loua A , Govender Pregalathan , Owen Robert C , Suwaidi Jassim A , Singh Rajvir , Djarv Therese , Thomas Stephen , Smith Karen , Castren Maaret , Cameron Peter 
Published: July 2021

Aim:
There is a scarcity of population based studies on out-of-hospital cardiac arrest (OHCA) in the Middle East and the wider Asian region. This study describes the Epidemiology and outcomes of OHCA in Qatar, a Middle Eastern country.

Methods:
Data was extracted retrospectively from a national registry on all adult cardiac origin OHCA patients attended by Emergency Medical Services (EMS) in Qatar, from June 2012 - May 2013.

Results:
The annual crude incidence rate of cardiac origin OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence rate was 87.83 per 100,000 population. The annual sex-standardized incidence rate for males and females was 91.5 and 84.25 per 100,000 population respectively.

Of 447 adult, cardiac origin OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51 years (IQR = 39-66). Frequently observed nationalities of OHCA cases were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%).
Common initial cardiac arrest rhythms were asystole (n=301, 67.3%), ventricular fibrillation (n=82, 18.3%) and pulseless electrical activity (n=49, 11%).
OHCA was unwitnessed (n=220, 49%) in nearly half of the cases while bystanders witnessed it in 170 (38%) patients. Bystander CPR was carried out in 92 (20.6%) of the cases. Of 187 (41.8%) patients who were given shocks, bystander defibrillation was delivered to 12 (2.7%) patients.
Prehospital outcomes; 332 (74.3%) patients did not achieve return of spontaneous circulation (ROSC), 40 (8.9%) patients achieved unsustainable ROSC, 58 (13%) achieved ROSC till Emergency department (ED) handover and 5 patients achieved ROSC but rearrested again before reaching ED.
Survival to hospital discharge occurred in 38 (8.5%) patients. Neurological outcomes were assessed utilizing Cerebral Performance Category [CPC] scores with a favorable CPC score of 1-2 at discharge in 27 (6%) patients, while 11 (2.5%) patients had a poor CPC score of 3-4. Of those with CPC score 1-2 at hospital discharge, 59% and 26% had CPC score 1-2, at 1 and 3 years follow-up respectively. Overall survival was 9.7%.

Conclusion:
Standardized rates are comparable to western countries, there are significant opportunities to improve outcomes, including better bystander CPR.
Abstract P257: Between-pedigree Genome-wide Linkage Screen Identifies a Locus on Chromosome 9 Influencing Coronary Artery Calcification in the Family Heart Study
Authors: Hicks James E , Province Michael A 
Published: July 2021

Coronary artery calcification (CAC) is the buildup of calcium deposits in the arteries leading to the heart, and is an indicator of atherosclerosis. CAC is known to have a genetic component. To identify the genes underlying CAC, a genome-wide linkage screen was performed in the Family Heart Study.
There are two established loci influencing CAC identified by genome-wide association scans, at chromosome 9p21 and 6p24. However, there may be rare variants on haplotypes in the population that influence CAC. These would not be able to be identified by genome-wide association scans, but linkage scans could detect them.
From the study, 2,687 individuals of European descent from 508 pedigrees with CAC scores were genotyped on the Illumina Human 1M-DuoV3 single nucleotide polymorphisms (SNP) array. CAC scores were determined by cardiac CT scan and adjusted for age, sex, and principal components before analysis.
Using 484,358 common SNPs (minor allele frequency greater than 5%), common ancestry across the genome was determined for all pairs of individuals in the study. A segment of the genome was considered to be inherited from a common ancestor (identical-by-descent, IBD) if it contained more than 1,000 matching SNP genotypes over a length of at least one megabase.
To test the influence of IBD at a locus on CAC, a linear mixed effects model was fit, including random effects to account for covariance due to relatedness and IBD states at each locus. All pedigrees were considered jointly in the model. Statistical significance was determined by comparing this model to one without IBD covariance via the likelihood ratio test. This model was evaluated approximately every megabase across all 22 pairs of autosomes. Since IBD states are determined solely by dense genotype data, IBD can be detected both within and between pedigrees in the study. This allows the inclusion covariance due to IBD in individuals in different pedigrees. If there is a haplotype shared across pedigrees, power to detect linkage is increased.
CAC was found to have a narrow-sense heritability of 37.4% in this sample. Significant evidence of linkage was encountered at rs13293430 (chromosome 9, 31,050,747bp, LOD=3.042). When considering IBD between pedigrees, 914 pairs of individuals from different pedigrees were IBD at this position. This locus is near DDX58. Mutations in DDX58 cause Singleton-Merton syndrome, a disease characterized by calcification of blood vessels, making it an intriguing candidate gene for influence on CAC.
Abstract P005: Improving Heart Health in the Workplace: Results From the First Year of the American Heart Association’s Workplace Health Achievement Index
Authors: Calitz Chris , Pham Kristin , Santana Adela , Sanchez Eduardo , Arena Ross , Fonarow Gregg C 
Published: July 2021

Background:
Comprehensive workplace wellness programs (CWWPs) have the potential to improve the heart health of the US workforce. To accelerate the adoption of these programs, the American Heart Association launched the Workplace Health Achievement Index (WHAI). The WHAI is an online scorecard that evaluates a workplace’s culture of health and the aggregate heart health score of its workforce as measured by Life’s Simple 7. Evidence from other workplace scorecards indicate that smaller companies achieve lower scores.

Objective:
To quantify differences in WHAI scores and score components between smaller (<250 employees) and larger (250+ employees) worksites.

Methods:
The total WHAI score is derived from 55 structure and process measures across seven best-practice domains and performance metrics based on employee Life’s Simple 7 data. Data from the first WHAI cycle (Feb 1 - June 30, 2016) were analyzed from 239 worksites that provided structure and process information. All data were stratified according to company size (smaller vs. larger). Differences in practice and performance measures were assessed across groups using Pearson chi-square tests or paired t-tests.

Results:
Overall, 5% of workplaces submitted the required amount of heart health metrics data (≥25% of employees) for eligibility. Smaller companies achieved a lower total WHAI score and lower scores across all domains except for Partnerships (Table 1).

Conclusion:
Lower WHAI scores for smaller companies may be due to limited resources and capacity to implement CWWPs. Low submission of performance metrics highlights the challenge of including these data in a comprehensive assessment of CWWPs. To meet its 2020 Goals, AHA should consider providing smaller companies with resources to implement CWWPs and develop strategies to increase submission of employee Life’s Simple 7 data.

Table 1: Differences in mean AHA Index scores between small and large companies
*Sample sizes too small for meaningful comparison.
Abstract P093: Analysis Commons: Team Science in a Big-data Environment for Genetic Epidemiology
Authors: Brody Jennifer A , Morrison Alanna , Bis Joshua C , O’Connell Jeffrey , Huffman Jennifer , Lewis Joshua P , Psaty Bruce M , Boerwinkle Eric , Cupples L A ,   on behalf of the TOPMed Hemostasis and the CHARGEAnalysis and Bioinformatics Working Groups
Published: July 2021

The growing volume and complexity of whole-genome sequence (WGS) and multi-omic data requires new analytic approaches beyond those developed for the GWAS era. In response to this challenge, we present an Analysis Commons, which brings together genotype and phenotype data from multiple studies along with a suite of powerful and validated analysis tools into a secure cloud-computing framework that is equitably accessible by associated investigators. This framework is designed to address the emerging challenges of multi-center WGS analyses—data sharing mechanisms, phenotype harmonization, -omics integration, annotation—and the need for flexible, secure, efficient, high-performance computing for numerous users.
The Analysis Commons is built on the DNAnexus cloud platform, which provides large parallel compute resources and robust security protocols. To permit multi-center data sharing, we implemented two parallel data sharing approaches: (1) a multi-lateral consortium agreement that enables data sharing across multiple studies, and (2) coordinated dbGaP applications among groups of institutions. Investigators with detailed knowledge of the phenotypes and contributing studies harmonize data from multiple sources for maintenance in a central database. The Analysis Commons supports multiple association-analysis software packages, as well as tools for annotation and visualization. Importantly, approved investigators have full access to the combined data sets, facilitating the rapid development and deployment of new methods.

We demonstrate the Analysis Commons model with an analysis of fibrinogen in 3999 participants from the Old Order Amish Study and the Framingham Heart Study with WGS from the Trans-Omics for Precision Medicine (TOPMed) Program. We performed and validated single-variant and SKAT analyses using GENESIS and MMAP pipelines, accounting for relatedness with linear mixed models. We confirmed a known association of a nonsynonymous variant in
FGG
(p=2.5e-9, MAF=0.34%, rs148685782)
.
No other single variant or SKAT association was significant after correcting for the number of tests. Analyses were run in parallel across 1408 cores and took less than one hour of wall-clock time.

The Analysis Commons offers the necessary infrastructure support for analysis of WGS and multi-omic data in a setting that empowers phenotype, analytic, and computational experts to transform raw data into knowledge of the determinants of cardiovascular health.
Abstract P203: Combination of Diet and Exercise is Preferred for Weight Loss and Weight Loss-Induced Blood Pressure Reduction
Authors: Masuo Kazuko , Hiromi Rakugi , Ogihara Toshio , Lambert Gavin W 
Published: July 2021

Obesity and sympathetic activation are independent risk factors for cardiovascular disease. Weight loss (WL) is the first choice as the treatment for obesity and hypertension, however, there were few studies to compare the efficacy and mechanisms of WL and WL-induced BP reduction between a diet alone (D), exercise alone (EX) and a combination of diet + exercise (D+EX).
The present study compared the effects of WL achievement on WL-induced BP reduction over 24 weeks between D alone, EX alone and a combination with D+EX, especially focusing on the relationships of the sympathetic nervous activity (observed with plasma norepinephrine (NE) levels) and insulin resistance (homeostasis model of insulin resistance, HOMA-IR). The 3 groups were each composed of 20 obese hypertensive men. BMI, fat-mass, waist-to-hip ratio, BP, plasma NE, and HOMA-IR were measured at every 4 week period over 24 weeks.

All basal parameters were similar among the 3 groups. At 24 weeks, the combination group with D+EX had significantly higher prevalence of normotensive subjects (n=16) than the D alone (9) or EX alone group (6) (χ
2
=10.81, P<0.05). In the D alone group, plasma NE decreased significantly at 4 weeks, BMI, fat-mass and BP levels reductions were observed at 8 weeks, and waist-to-hip ratios decreased at 12 weeks. In comparison, in the EX alone group, significant reductions of fat-mass were observed at 4 weeks, BMI, waist-to-hip ratio, plasma NE and HOMA-IR significant reductions were observed at 8 weeks, and significant decreases in BP levels were detected at 12 weeks. In the D+EX group, BMI, fat-mass, waist-to-hip ratio, BP levels, plasma NE and HOMA-IR decreased significantly at 4 weeks. The magnitude of reductions of BMI, fat-mass, waist-to-hip ratio, BP, plasma NE, HOMA-IR and leptin were greatest among the 3 groups throughout the study.These results demonstrate that D+EX has stronger effects on WL, WL-induced BP reduction, normalization of hypertension and suppression of sympathetic activation compared to D or EX alone. In the 3 study groups, suppression of plasma NE was followed by reductions of HOMA-IR and BP reduction, suggesting that the suppression of sympathetic activation accompanying the improvement of insulin resistance might play a major role on WL-induced BP reduction.
Abstract 146: Medical Home Model in the management of Heart Failure
Authors: Houston-Feenstra Linda , Jutzy Kenneth , Larsen Reane 
Published: July 2021

Purpose:
Heart failure (HF) continues as the most expensive diagnosis to manage in the US. Patient failure to adhere to medication regimens and fluid overload have been identified as causative factors in frequent exacerbations requiring hospitalization. This study was designed to evaluate outcomes over time of a Medical Home interdisciplinary team management and patient education design compared to standard of care in HF.

Methods:
The study was designed as a prospective case-control study. Enrollment occurred post HF hospitalization. During hospitalization all pts received education in Guideline-driven management of HF, and were discharged on evidence-based medications. Patients provided informed consent allowing review of medical records for 5 years. One group of pts agreed to participate in a Medical Home for the management of HF (MHHF) while another group chose management of HF by their own cardiologists. Data analysis was performed using case controlled pairing of pts based on age, gender and socio-economic status. Data represents results at 48 months. The Intervention group (22 pts: mean age 60.8) was followed in a MHHF which includes a HF specific clinic and a 12 week comprehensive HF management and exercise program (both clinic and HF management program have the same disease management protocols) and the Control group (48 pts: mean age 62.2) returned to standard follow up care for HF. In MHHF medications were optimized per evidence -based recommendations and education included use of medications, diet and effective sodium balance.

Results:
Functional Capacity

Results:
Medication adherence/Hospitalizations/ED visits

Note:
* baseline to 48 months. Hosp. visits = # hospitalizations/yr/ patient, ED Visits = # ED visits/yr/ patient. Medical record review of medication use for Standard of Care pts failed to provide adequate information on dose /patient. **Adherence was often self reported so true adherence may be lower than reported for this group.

Conclusions:

1. Patients participating in MHHF demonstrated long-term improvement in medication adherence and smoking cessation.
2. Patients participating in MHHF demonstrated significantly fewer HF related Hospitalizations and ED visits 48 months following their baseline hospitalization.
Abstract 240: Differences in Test-related Clinical and Economic Outcomes between Patients who underwent Single-photon Emission Computed Tomography using Regadenoson versus Patients who underwent Echocardiograms using Dobutamine
Authors: Xie Lin , Spalding James , Baser Onur 
Published: July 2021

Adult patients who underwent single-photon emission computed tomography (SPECT) myocardial perfusion imaging testing with regadenoson and echocardiogram (ECHO) testing with dobutamine on the same day or within 1 day of testing (07/01/2006-05/31/2011) were selected from the MarketScan Commercial and Medicare Supplemental Database (01/01/2006-06/30/2011). The latest test date was designated as the index date. Continuous health plan benefits 6-month pre- and 30-day post-index date, and no stress, planar, SPECT or ECHO test, or regadenoson, dipyridamole, adenosine or dobutamine prescriptions during the 6-month baseline period were required. Test-related complications, symptoms, adverse events, healthcare costs and utilizations were defined as being measured on the index and next day. One-month follow-up healthcare costs and utilizations were estimated and compared. Propensity score matching controlled for baseline age, gender, region, comorbidities, medications and healthcare cost and utilization differences.
A total of 161,834 regadenoson and 12,842 dobutamine patients were included. Regadenoson patients were older (66.60 vs. 63.40, p<0.0001), more likely male (49.68% vs. 41.60%, p<0.0001) and with cardiovascular disease (27.16% vs. 19.96%, p<0.0001), and less likely with COPD or asthma (13.51% vs. 15.87%, p<0.0001) and renal failure (7.58% vs. 8.34%, p<0.0001) than dobutamine patients at baseline. At follow-up, regadenoson patients had fewer test-related ER and inpatient visits, lower dyspnea and renal failure rates, and lower inpatient and outpatient costs. After matching, 7,786 patients were included per cohort. Risk-adjusted results showed that regadenoson patients had fewer test-related ER (2.41% vs. 4.16%) and inpatient visits (0.60% vs.1.35%), and other arrhythmias (2.03% vs. 3.63%) (all p<0.0001). Test-related dyspnea (3.19% vs. 6.04%, p<0.0001), chronic airway obstruction (0.62% vs. 1.07%, p=0.0021) and renal failure (0.66% vs. 1.37%, p<0.0001) were also lower for regadenoson patients. Regadenoson patients incurred lower test-related inpatient ($122 vs. $360, p=0.0005), but higher total outpatient ($1,882 vs. $1,412, p<0.0001) and total costs ($2,032 vs. $1799, p=0.0021). In the 1-month follow-up, regadenoson patients had fewer inpatient (10.65% vs.14.5%, p<0.0001) and ER visits ($7.58% vs. 9.17%, p=0.0003) and lower inpatient ($3,057 vs. $4,137, p<0.0001) and higher outpatient costs ($3,887 vs. $3,112, p<0.0001). There was no significant difference in total costs ($7,333 vs. $7,641, p=0.2739).
Regadenoson patients had fewer test-related inpatient and ER visits and adverse events, and lower inpatient costs, compared to dobutamine patients. Although total test-related costs were higher for regadenoson, inpatient costs remained significantly lower in the 1 month after testing. The total cost burden was similar for both cohorts.
Abstract 45: Hemodynamic and Clinical Determinants of Coronary Sinus Flow in Patients Referred for Cardiac Catheterization
Authors: Saunders Jessica , Lyubarova Radmila , El-Hajjar Mohammad , Torosoff Mikhail 
Published: July 2021

Background:
Coronary sinus blood flow (CSBF) can be used as a measure of total coronary blood flow. Hemodynamic and clinical determinants of coronary sinus flow are not well investigated. Decreased CSBF is expected in obstructive coronary artery disease (CAD) and elevated left ventricular end-diastolic pressure (LVEDP).

Material and Methods:
A prospective cohort study of patients referred for cardiac catheterization was performed. CSBF (ml/min) was measured non-invasively as a product of heart rate, coronary sinus cross-sectional area (obtained in modified apical 4 chamber view), and coronary sinus time velocity integral (obtained in modified right ventricular inflow view). In patients with normal sinus rhythm and preserved atrial contraction, retrograde diastolic CSBF was subtracted from forward CSBF. Repeated measures ANOVA and chi-square analyses were used.

Results:
Study cohort consisted of 39 patients (19 females, 63+/-11 years old, 9 with diabetes, 30 with hypertension (HTN) and 6 with atrial fibrillation). CSBF was obtained in 24 (61%) patients.

CSBF was increased in patients with normal blood pressure (1353+/-862 vs. 647+/-397 in patients with HTN, p=0.011) and in patients with right atrial (RA) pressure exceeding 5 mmHg (1228+/-654 vs. 478+/-356 in RA pressure less than 5 mmHg, p=0.002). HTN appeared to be a less important determinant of CSBF than RA pressure (RAP) in multiple ANOVA comparison (HTN p=0.643, RAP p=0.005, Figure).
There was also a trend towards decreased CSBF in patients with diabetes (647 +/-507 vs. 937 +/-685 ml/min in patients without diabetes, p=0.327) and /or obstructive CAD (663+/-381 vs. 832+/-748 ml/min in non-obstructive CAD or normal coronaries, p=0.613) and females (680+/-419 vs. 1095+/-828 ml/min in males, p=0.119). There was no significant correlation between CSBF and LVEDP.

Discussion and Conclusions:
Coronary sinus blood flow is determined by patient morbidities and central hemodynamic parameters. CSBF tends to be lower in patients with obstructive CAD, diabetes and/or HTN. Increased RA pressure and systemic HTN are associated with augmented CSBF. We speculate that effects of RA pressure on CSBF are reflective of preload and intrathoracic pressure parameters. Increased intrathoracic pressure may augment coronary blood flow by compression of the aorta and improved coronary perfusion gradient.
Abstract 282: Assessing Levels of Active Participation through a VA Provider Network to Improve Quality of Care for Veterans with Heart Failure
Authors: Sahay Anju , Heidenreich Paul 
Published: July 2021

Objective:
The goal of the Dept. of Veterans Affairs (VA) Chronic Heart Failure (CHF) QUERI program is to improve the quality of care for heart failure (HF) patients and implement evidence-based practices throughout the VA system. One strategy to achieve this goal was to create a VA heart failure provider Network which occurred in 2006. We sought to characterize provider participation in this mature network.

Method:
We tracked all members of the HF Network including their title, location at one of 144 VA facilities; date joined and if applicable, date left the HF Network. We considered the following activities to be evidence of “active” participation: attended a web-based meeting or the annual in-person meeting, requested meeting materials, or completed a periodic survey of providers. Participation of all other members is considered “passive”.

For this project we assessed each facility’s level of participation in the HF
Network from July 2006 till June 2013 (7 years). Facility participation level was characterized as “None” (no member at that facility with active participation), “Low” (at least one member at that facility attended 1-2 activities) and “High” (at least one member at that facility participated in ≥3 activities).
Data were linked to existing facility-level data that included presence of an HF clinic, cardiac cath lab, use of pharmacist, bed size, membership in Council on Teaching Hospitals (COTH), and presence of an Accredited Graduate Medical Education (ACGME) program.

Results:
Altogether, 1205 providers have participated in the HF Network. As of June 2013, 987 providers from 144 VA facilities participate in this network. They include VACO leadership (1%), VISN leadership (4%), facility leadership (9%), Chiefs of Cardiology (7%), staff physicians (32%), nurses (28%), pharmacists (5%) and others (14%).

Participation at the facility-level has increased from 2008 (None=37, Low=43 and High=64) to 2013 (None=8, Low=16 and High=120, (p <0.001). High participating facilities were more likely to be classified as tertiary (p <.016), COTH members (p <0.001), having ACGME programs (p <0.001), and located in the West or Southeast United States (p =.03). High participating facilities are also more likely to have a HF clinic (p <0.001), a cardiac catheterization lab (<0.001), and use a pharmacist in routine HF care (p <.03).

Conclusions:
Involvement and active participation in the VA HF Network has grown and is more likely at academic facilities and those providing more intensive services.