bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 127: Novel Approach to the Management of Clinical Alarm Fatigue
Authors: Whalen Deborah , Covelle Patricia , Piepenbrink James , Villanova Karen , Cuneo Charlotte , Awtry Eric 
Published: July 2021

Is the answer to clinical alarm fatigue to silence an increasing number of alarms as many centers have done to improve staff sensitivity to alarms or to layer additional technology such as viewing stations or alarm alert paging systems to capture clinician attention? An Alarm Management Pilot at Boston Medical Center shows a different strategy.
BMC clinicians observed that RN staff frequently did not respond to Arrhythmia and HR violation Warning Alarms allowing these often to self reset. They were almost always continuously present in the background competing with other alarms even call lights. A QI initiative was proposed for a Pilot on a 24 bed general cardiology floor to remove Warning Alarms for Arrhythmia and HR Limit violations.
We chose not to silence HR violations as had been done in other medical centers but to elevate these to Crisis Alarm slightly widening their defaults. We did this having seen bradycardia or tachycardia alarms precede life threatening events not caused by sudden death from VF. As a Crisis Alarm these alarms would now require RN staff to view and act on the alarm in real time either responding to the patient or modifying alarm limits .
The Pilot was an overnight success the noise reduction immediately noticed by staff and as this occurred alarm culture changed.
We saw a startling 87% decrease in the total number of audible alarms from 87823/ week Pre Pilot to 9967/ week Post Pilot on pilot unit with the average number of daily alarms dropping from 12546 to 1424. The decibel level too decreased from an average peak value in the mid 80s Pre Pilot to the mid 60s Post Pilot.
RNs queried with a Monkey Survey tool when asked “ Do you believe that the Pilot has improved the noise level on the unit?", 100% of respondents said yes. Among their comments
~The monitors were an irritant. Now they no longer seem that way.
~I can spend more time on patient care instead of answering meaningless alarms.
~I feel so much less drained going home at the end of my shift.

Patient Satisfaction scores Post Pilot showed significant improvement :
noise level in and around room
increasing by 7%,
nurse domain
increasing by 30%,
promptness to call light
increasing by 31% and
overall assessment
increasing by 59%. Since there had been no interventions targeted specifically at improving the scores it suggest that the improvement in scores had been effected by the alarm changes and perhaps clinical alarm fatigue played a role as a major patient dissatisfier as well.

Boston Medical Center is among the hospitals nationally attempting to tackle clinical alarm fatigue. This Alarm Management Pilot now rolling out to the rest of BMC provides a strategy for managing clinical alarm fatigue without adding additional technology or costs and demonstrates such a strategy not only can improve patient safety but can have a measurable positive effect on staff and patient satisfaction .
Abstract 236: Poor Recurrent Stroke Prevention Knowledge in High Risk Stroke Survivors
Authors: Scobie Janice V , Fei Kezhen , Negron Rennie , Turhim Stanley , Boden-Albala Bernadette , Horowitz Carol R 
Published: July 2021

Stroke is highly prevalent. Control of hypertension, hyperlipidemia and appropriate antithrombotic use are important in preventing recurrent stroke. Inadequate control of cardiovascular (CV) risk factors and poor stroke knowledge among transient ischemic attack (TIA) and stroke survivors impact stroke recurrence.
We used a community-based participatory approach to recruit TIA/stroke survivors from community and clinical sites into a randomized controlled stroke prevention educational intervention trial. We conducted a cross-sectional analysis of baseline survey responses describing demographics, clinical characteristics, and stroke knowledge.
The sample (n=600) had a mean age of 63 and was mostly female (60%), Black or Hispanic (81%), and insured (98%). 72% had 2 or more CV risk factors: hypertension (33%), high low-density lipoprotein levels (43%), obesity (41%), and tobacco use (17%). 47% had 2 or more poorly controlled risk factors, and 65% did not have controlled blood pressure and cholesterol levels and antithrombotic use. Stroke knowledge of effective stroke prevention measures was poor. Most believed that diet (60%), exercise (36%), and stress reduction (36%) were most important for stroke prevention. Despite poor risk factor control and stroke prevention knowledge, 82% had a doctor and 2 or more visits in the past 6 months.
Inadequate control of CV risk factors and poor stroke knowledge is widely prevalent among TIA/stroke survivors. A silent high risk for progression of recurrent strokes and CV comorbidities persists despite regular medical care. Interventions that improve knowledge, support behavioral change, and improve patient self-management skills are critical for effective secondary stroke prevention.
Abstract 260: Risk Factors for Readmission from Medical Cardiology Services. A Medication Reconciliation Perspective.
Authors: Disdier Moulder Magali , LaRock Jenna , Garofoli Adrian C , Foley David 
Published: July 2021

BACKGROUND:
Hospital readmissions for cardiac diseases have a strong socio-economic impact. Medication reconciliation is one of the current interventions intended to improve quality of care, in which pharmacists play an important role. We aimed to determine risk factors and identify patients who are at risk of re-hospitalization by gathering data from the medication reconciliation process.

METHODS:
We included adults from our local community admitted to a medical cardiology service from September 2011 to August 2012. Two pharmacists led interviews within 48 hours of presentation. In addition to a rigorous medication reconciliation evaluation at admission and discharge, we assessed medication handling habits, adherence, familiarity with prescriptions, health literacy and reading impairment. We determined Potential Adverse Drug Events (PADE) by assessing discrepancies within medication records. Multivariate analyses were performed to look for association among factors and outcomes.

RESULTS:
We included 258 patients, mean age 70.5, 52 % male, 19% received help with medications, 83 % were adherent, 14% reported reading impairment, 40% heart failure (HF). The mean number of prescriptions was 7.5 and the mean Charlson comorbidity index 3.5. Medication errors reached 39% of patients on admission and 20% at discharge; no clinical complications were detected. The number of prescriptions was associated with PADEs at admission (p=0.0001) and discharge (p=0.03). Presence of PADE on admission or discharge did not affect the readmission rate.

At 30 days 18% of 258 patients were readmitted, 9% visited the Emergency Department (ED) and 2.3% died; meanwhile at 6 months 38% were hospitalized, 46% went to the ED and 5.8% died. We identified a diagnosis of HF and the need for help handling medications at home as the strongest predictors of readmission at both 1 and 6 months. Other factors associated with higher readmissions rates and ED visits were the number of prescriptions, number of hospitalizations within the prior year, lack of familiarity with medical regimen and reading impairment.
HF was associated with lower adherence (p=0.025); more admissions in the previous year (p=0.002), higher number of medications (p=0.001), reading impairment (p=0.02), higher readmissions at 1 and 6 months (p=0.003 and 0.0008 respectively) as well as ED visits (p=0.016) at 6 months compared with non-HF subjects.

CONCLUSION:
We found several characteristics, key examples being presence of HF and receipt of help with medications, that may warrant formal assessment during medication reconciliation as they seem associated with re-hospitalization. These patients may benefit from close follow-up during and post hospitalization.
Abstract 164: Adherence to Oral Antiplatelet (OAP) Therapy among ACS Patients Undergoing Percutaneous Coronary Intervention (PCI)
Authors: Kern David M , Bhandary Durgesh , Tunceli Ozgur , Wu Bingcao 
Published: July 2021

Background:
The benefit of oral antiplatelet therapy following PCI is well established. Dual antiplatelet therapy is guideline recommended treatment for one year following a PCI.

Objective:
To examine discontinuation and adherence rates of oral anti-platelet therapy of patients with acute coronary syndrome (ACS) in the year following a PCI.

Methods:
From the HealthCore Integrated Research Environment, patients ≥18 years old and hospitalized for ACS (inpatient hospitalization with a primary diagnosis for acute myocardial infarction or unstable angina) during 8/1/09-6/30/13 (index hospitalization) were identified and followed up to 12 months. Patients with an OAP prescription fill within 6 months prior to the index hospitalization, those with a fill for ticagrelor at any time during the study period, those simultaneously starting clopidogrel and prasugrel following the index hospitalization, and those who had a coronary artery bypass graft during index hospitalization were excluded. OAP prescription utilization patterns were examined drug class (clopidogrel or prasugrel) as a whole and by branded versus generic clopidogrel. Medication adherence to OAP therapy was assessed as discontinuation (a period of >45 days not covered by supply of OAP therapy) and the proportion of days covered (PDC; calculated as total day supply during the follow-up divided by days from first fill to end of follow-up).

Results:
Of 38,626 ACS patients identified, 20,753 were revascularized with PCI during the index hospitalization, and 17,237 (83.1%) went on to fill an OAP prescription (12,714 with clopidogrel as first OAP treatment; 4,523 with prasugrel). On average, patients filled OAP medication 6.7 days following index hospitalization discharge (71% filled on discharge date).

The study also found that 20% of patients discontinued OAP therapy during follow-up and 86% of follow-up days were covered by an OAP therapy supply on average. Other medication classes within the same patients had higher discontinuation rates and lower PDC: anti-hypertensive (27% discontinuation; 82% PDC), anti-diabetics (27%; 83%) statins (27%; 82%), and beta-blockers (37%; 72%).
Discontinuation rates were considerably lower in patients taking generic clopidogrel versus those filling branded drug (11% for generic vs. 37% for branded) and PDC was higher for generic clopidogrel (90% PDC vs. 75% for branded).

Conclusions:
Adherence to OAP therapy compares favorably to adherence rates of other cardiovascular/metabolic medications taken by the same patients. Lower out of pocket costs were also associated with better refill compliance. The above findings present healthcare providers with an opportunity to further improve on medication adherence post-PCI in ACS patients by reducing the economic burden on patients.
Abstract 174: Organization of Cardiologists in the United States - An Early View in the Era of Accountable Care Organizations
Authors: Meier Sarah K , Shah Nilay D , Nallamothu Brahmajee K 
Published: July 2021

Objective:
To understand the organization of cardiologists in the United States and territories with an emphasis on identifying the characteristics of practices where cardiologists practice.

Data:
The Healthcare Organization Services database, which provides information on the designation, specialties and business associations, or affiliations, of healthcare professionals across the US and territories. These data were updated as of September 2013.

Methods:
Cardiologists were defined as providers with an MD or DO, who have an active clinical practice, and either: (1) have Cardiology as primary specialty, or (2) who have Internal Medicine, Pediatrics or Family Medicine indicated as primary specialty, with Cardiology as secondary specialty. Cardiologists were linked to businesses and descriptive analyses were conducted to characterize the organization of cardiologists.

Findings:
We identified 33,745 cardiologists; 22,461 of these cardiologists had at least one affiliation with an ambulatory practice or independent physician association (AP/IPA), while 30,567 had at least one hospital affiliation. Approximately 57.6% (19,453 of 33,745) of cardiologists were affiliated with both the AP/IPA and hospital settings.

The overwhelming majority of ambulatory practices linked to hospital-AP/IPA affiliated cardiologists are medical groups (7,839 of 9,838), while independent physician practices comprise the next largest category (1,498 of 9,838). Of the 7,839 medical groups, 3,809 are cardiology specialty, 1,316 are multispecialty group practices, and 2,060 are family practice, general practice, geriatric medicine, internal medicine, pediatric medicine or primary care. Among all non-multispecialty medical groups (n=6,523), 59.2% (3,862 of 6,523) have 1-2 affiliated cardiologists, 21.7% (1,413 of 6,523) have 3-5, 12.6% (821 of 6,523) have 6-10 and 6.5% (427 of 6,523) have more than 10 affiliated cardiologists.
Focusing at the provider level, 17,639 hospital-AP/IPA cardiologists had any affiliation with a medical group (MG), with 12,840 cardiologists with any cardiology specialty MG affiliation, 3,215 with any multispecialty group practice MG affiliation, and 3,051 with any family practice, general practice, geriatric medicine, internal medicine, pediatric medicine or primary care MG affiliation. Overall, 15,476 hospital-AP/IPA cardiologists had any affiliation with at least one non-multi-specialty group practice (non-MSGP), with 4,279 affiliated with one or more non-MSGP(s) with 1-2 cardiologists, 4,378 with one or more non-MSGP(s) with 3-5 cardiologists, and 4,861 and 5,099 affiliated with one or more non-MSGP(s) with 6-10 and >10 cardiologists, respectively.

Conclusion:
The majority of cardiologists were affiliated with both a hospital and ambulatory practice or IPA. Of this subset, most cardiologists were affiliated with at least one group practice.
Abstract 247: The Use of a World Health Organisation Derived Safe Surgery Checklist to Improve Patient Experience in the Cardiac Catheterisation Laboratory
Authors: Lindsay Alistair C , Bishop Jeremy , Davies Simon W , Haxby Elizabeth J 
Published: July 2021

Background:
The WHO safe surgery checklist has reduced morbidity and mortality during surgery. Whether or not a modified WHO checklist could improve patient and staff experience in the cardiac catheterisation laboratory (CCL), where the majority of procedures are carried out under local anaesthetic, has not previously been investigated.

Methods:
Starting in March 2013, a WHO-derived checklist, specifically modified for the CCL, was introduced at the Royal Brompton Hospital. For three months, weekly PDSA cycles and staff feedback were used to optimise checklist design, followed by a full rollout. Patient experience (n=76, taken throughout the six-month period) and staff safety climate (taken 2 and 7 months after checklist introduction) surveys were undertaken to measure subjective impact. Clinical outcomes and efficiency data were obtained from in-house databases.

Results:
• By six months, a full checklist (Figure 1) was completed in 367/417 (88%) of procedures (Figure 2). Patient surveys revealed that the majority of patients (57%) noticed the staff ‘Time Out’ and when questioned, strongly associated the checklist with safety (mean score 9.3/10 using Likert scale) and found it highly reassuring (mean 8.9/10).

• The majority of procedures that used the checklist (56%) were shorter than average, whereas the majority of procedures that did not use a checklist took longer than average (P<0.0001)
• When the full checklist was used, screening time was correspondingly reduced in 25% more procedures

Conclusions:
The introduction of a WHO-derived checklist was associated with high levels of patient satisfaction, improved efficiency, and enhance team cohesion during procedures in the cardiac catheterisation laboratory.
Abstract 127: Cardiovascular Risk and Outcomes in Patients with Diabetes: Using Medical Education to Improve Care
Authors: Larkin Amy , Healy Colleen 
Published: July 2021

Introduction:
Mortality rates due to cardiovascular disease (CVD) are 2-4 times higher among people with diabetes than in those without. Glucose control reduces the risk of any CVD event by 42% and the risk of heart attack, stroke, or death from CVD by 57%. We assessed the hypothesis that continuing medical education (CME) improves knowledge and performance of cardiologists in managing glycemic control and other CV risk factors in patients with type 2 diabetes (T2D).

Methods:
Cardiologists who treat patients with coronary artery disease participated in at least 1 of 2 online CME activities within a curriculum on CV risks and outcomes in patients with T2D. Participant responses to a case-based survey after activity completion were compared with responses from demographically similar control groups of nonparticipants. Educational effect size was calculated using Cohen’s
d
formula, with a value of <0.4 representing a small effect, 0.4-0.8 a medium effect, and >0.8 a large effect.

Results:
Participating cardiologists (n = 151) were more likely to make evidence-based practice choices than were nonparticipating cardiologists. Activity 1: Improving CV Outcomes in Patients with T2D Multi-media format Increased Likelihood to Make Evidence-Based Practice Choices Post-Education: 33.5% Effect Size: 0.51 (N = 78) Activity 1: Assessing CV Risk in Patients with T2D Multi-media format Increased Likelihood to Make Evidence-Based Practice Choices Post-Education: 50.3% Effect Size: 0.87 (N = 73)

Domain 1: Managing Glycemic Control and Other CV Risk Factors in Patients with CVD and T2D. Participating cardiologists significantly improved their consideration of comorbid conditions when deciding on a glucose management strategy (73% pre vs. 85% post) and selection of treatment for early intervention (85% pre vs. 96% post).
Domain 2: Identification of Outcomes Data on Glucose-Lowering Agents in Patients with T2D and CVD. Participating cardiologists significantly improved in the recognition of antihyperglycemic agents shown in clinical trials to be safe for high risk CV patients (36% pre vs. 79% post) and in identification of the effect of saxagliptin on CV events in high risk CV patients with T2D (SAVOR TIMI 53 trial) (55% pre vs. 86% post).
Domain 3: Application of Outcomes Data on Glucose-Lowering Agents in Patients with T2D and CVD. Participating cardiologists significantly improved in their selection of a DPP-4 inhibitor as the most appropriate antihyperglycemic agent for patients with T2D and CV risk factors or previous CV events (59% pre vs. 81% post and 53% pre vs. 73% post, respectively).

Conclusion:
This study demonstrated the success of a curriculum-style educational intervention using multimedia technology on improving knowledge and performance of cardiologists which can lead to enhanced management of CV risks and, thus, improved outcomes in patients with T2D and CVD.
Abstract 157: Gender Differences in the Ambulatory Treatment of Hypertension in Patients with Heart Failure
Authors: Garcia Rachel A , Piatetsky Yana , Scheidler Matthew , Norton Mary-Alice , Philbin Edward F , Torosoff Mikhail 
Published: July 2021

Background:
We investigated gender-specific differences in treatment of hypertension (HTN), and how they may affect outcomes in congestive heart failure (CHF) patients.

Methods:
Records of 194 (100 male, 94 female) unselected consecutive patients with HTN enrolled in the CHF clinic were reviewed. Left ventricular ejection fraction (LVEF) was compared to LVEF at time of enrollment in the clinic. The average interval between the two echocardiograms was 30 months.

Results:
ANOVA, chi-square, and logistic regression analyses demonstrated that men were more likely than women to have baseline LVEF ≤35%, (50% vs. 36%, p=0.108), coronary artery disease (63% vs. 43%, p=0.004), diabetes mellitus (p=0.095), and be ever smokers (66% vs. 40%, p<0.0001). Factors such as age, peripheral vascular disease, hyperlipidemia, serum K+, creatinine clearance, body mass index, and heart rate were similar in both genders.

Optimal BP control noted during the most recent visit was more often achieved in men (59% vs. 46%, p=0.002). Remarkably, during follow up, more men experienced decline in LV dysfunction (29% vs. 18%, p=0.081), women were more likely to have no change in LVEF (51% vs 34%, p=0.081), and men were only slightly more likely to show improvement (37% vs. 31%, p=0.081).
There was no gender difference in utilization of angiotensin converting enzyme inhibitors (ACE), beta blockers (BB), or aldosterone receptor antagonists (ARA). Women were more likely to be treated with angiotensin receptor blockers (ARBs, p=0.054) and men were more likely to be on diuretics (57% vs. 43%, p=0.069).

Conclusions:
In patients with HTN enrolled in the HF clinic, male gender was associated with increased cardiovascular comorbidities and lower LVEF at baseline. Despite improved blood pressure control and similar utilization of evidence-based therapy, men experienced more decline in LVEF, had LV systolic function that was less likely to remain unchanged, and were only slightly more likely to demonstrate improvement of LVEF compared to women. This study suggests a potential gender-related pharmacodynamic difference in response to guideline therapy, or perhaps the manifestation of an already described gender difference of adaptation to chronic elevated after load.
Abstract 505: Specific Activation of the Ang all/AT1R-Jak2-Rho Kinase Pathway in Salt Sensitive but not in Salt Independent Hypertension: Clinical and Pathophysiologically Implications
Authors: Chadipiralla Kiranmia , Juncos Ramiro , Zhou Ming-sheng , Raij Leopoldo 
Published: July 2021

In hypertension aortic (Ao) stiffness is a main determinant of increased systolic (SBP) and pulse- pressure (PP). Brachial and Ao SBP and PP often differ; Ao pressures predict cardiovascular events more accurately than brachial pressures. It is surmised that increased pressure-workload is cause and effect of Ao stiffening but the mechanisms involved are poorly understood. Rho Kinase is a master regulator of vascular tone and remodeling: In endothelium Rho kinase decreases eNOS expression and NO production. In VSMC Ang II/ AT1R specifically activates Rho Kinase via phosphorylation of Jak2 /Arhgef1 which phosphorylates (inhibits) myosin light chain phosphatase (MYPT1) thereby promoting vasoconstriction. Groups (n= 6) of Dahl SS (DS) rats fed either 0.5% or 4% NaCl diets for 10 weeks were matched with SHR of similar age (6 and 16weeks old) and SBP (147+8 & 211+7). Hypertensive DS rats, but not SHR showed increased Ao weight/length (17%, P<0.05) and left ventricle weight/ body weight ratios (16%, P<0.05). Compared to normotensive DS, Ao AT1Rs in hypertensive DS rose 230% accompanied by increased pJak2/Jak2 (3.5 fold) and pMYPT1/MYPT1 (3.95 fold) all p<0.05. Switch of hypertensive DS to a 0.5 % NaCl diet for 4 additional weeks did not reduce either SBP or the activated Ang l1/Rho Kinase pathways. The ARB Candesartan prevented Angll/AT1-Jak2-Rho Kinase activation in hypertensive DS fed 4% NaCl diet and normalized SBP, LVH and Ao weight/length in hypertensive DS switched to a 0,5% NaCl diet. Hypertensive SHR did not show Ao upregulation of AT1Rs or activation of the Angll/Jak2-Rho Kinase pathway. These studies show for the first time that in low renin salt sensitive hypertension there is specific Ao activation of the Ang II/Jak2-Rho Kinase pathway that is independent of the severity of SBP.
Clinically the variable end-organ disease observed in individuals with similar severity of hypertension may be linked, at least in part, to genetically conditioned differences in Angll/AT1R, Jak-2 activation in response to high dietary salt. These novel studies extend and complement previous studies by us and others implicating abnormal bioactivity of NO and aldosterone in salt sensitive hypertension and unravel a new and intricate pathway in which Rho Kinase plays a pivotal role.