bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract P235: Superior Mesenteric Artery Calcification is Associated with Cardiovascular Risk Factors, Systemic Calcified Atherosclerosis and Mortality in Asymptomatic Adults
Authors: Lin Timothy C , Wright C. Michael , Criqui Michael H , Allison Matthew A 
Published: July 2021

Arterial calcification is a hallmark of atherosclerosis and can be detected by computed tomography (CT). There are few epidemiological data regarding the superior mesenteric artery, the atherosclerotic occlusion of which contributes to mesenteric ischemia that may, in turn, lead to increased morbidity or mortality. This study tested the hypothesis that superior mesenteric artery calcification (SMAC) is associated with cardiovascular disease (CVD) risk factors, systemic calcified atherosclerosis, and both cardiovascular and all-cause mortality.
The presence and amount of arterial calcification was evaluated by CT in 4302 adults with no known CVD who were physician- or self-referred to obtain preventative health testing at a university-affiliated outpatient center. Laboratory data and medical histories were obtained concomitantly. A multiple logistic regression model was used to determine risk factor associations for SMAC presence, adjusted for calcification in five other arterial beds. In a separate logistic regression model adjusted for CVD risk factors, SMAC presence was used as a predictor for systemic calcified atherosclerosis, represented as having calcification in all five other arterial beds. Cox models, adjusted for CVD risk factors and calcification in other arterial beds, were used to examine the association of SMAC presence and amount (expressed as log[Agatston score+1]) with cardiovascular and all-cause mortality.
In the study sample, the average age was 56 years, 43.7% (1879 of 4302) were women, and 6.7% (290 of 4302) had SMAC. Age (OR=1.08, 95%CI [1.06 to 1.10]), male sex (OR=1.97, 95%CI [1.43 to 2.71]), dyslipidemia (OR=1.38, 95% CI [1.01 to 1.88]) and any smoking (OR=1.60, 95% CI [1.20 to 2.14]) were associated with SMAC presence. Moreover, SMAC presence was associated with higher odds for calcification in all five other arterial beds (OR=5.96, 95%CI [3.72-9.54]). Over a median follow-up time of 9.4 years, there were 234 (5.4%) deaths, 76 of which were CVD-related. SMAC presence (HR=1.57, 95%CI [0.93-2.68]) and amount (HR=1.30 per unit increase in log[Agatston score+1], 95%CI [1.00-1.68]) were each associated with a greater risk for CVD mortality. Similarly, SMAC presence (HR=1.52, 95%CI [1.10-2.12]) and amount (HR=1.25, 95%CI [1.06-1.48]) were each associated with a greater risk for all-cause mortality.
In conclusion, age, male sex, dyslipidemia, and any smoking were significant risk factors for the presence of SMAC. The association of SMAC presence with greatly increased odds for calcification in all other vascular beds suggests that calcification of the superior mesenteric artery occurs with subclinical, yet widely-manifest, systemic atherosclerosis. Finally, SMAC amount was significantly associated with incident cardiovascular mortality, while both SMAC presence and amount were significantly associated with all-cause mortality.
Abstract P20: One-Year Hospitalization Costs Associated with Carotid Stenting Versus Endarterectomy: Results from the CREST Trial
Authors: Vilain Katherine , Magnuson Elizabeth , Li Haiyan , Sternbergh Charles , Clark Wayne M , Begg Richard J , Sam Albert D , Weaver Fred A , Brott Thomas G , Cohen David J 
Published: July 2021

Background:
The CREST trial demonstrated that for patients at standard risk of surgical complications, there was no significant difference in the primary composite outcome of periprocedural death, MI, or stroke, or late ipsilateral stroke between carotid artery stenting (CAS) and carotid endarterectomy (CEA), although CAS had a higher rate of stroke, and CEA had a higher rate of MI. The economic implications of these two strategies are unknown.

Methods:
We performed a prospective health economic study alongside the CREST trial. Costs were assessed from the perspective of the US health care system in 2008 dollars using a combination of resource-based and event-based methods. Costs for carotid revascularization procedures were based on measured resource use and unit costs derived from a sample of study hospitals. Non-procedural costs for these hospitalizations were estimated using hospital billing data (charges) and cost-center-specific cost-to-charge-ratios. Costs for follow-up events were estimated using national average DRG reimbursements. The primary analysis was based on a modified intention-to-treat population for which the assigned procedure was attempted (n=1212 CAS; 1193 CEA).

Results:
CAS was associated with higher total procedural costs (Δ=$675, see Table), driven mainly by higher costs for disposable supplies. Length of stay was shorter for CAS, with associated reductions in non-procedural hospital costs (Δ = -$436). Total cost for the index hospitalization remained slightly higher for CAS (Δ=$239) with similar differences at 1 year.

Conclusions:
For patients at standard risk of surgical complications, total 1-year costs are slightly higher for CAS vs. CEA, driven largely by higher initial procedural costs. Cost-utility analysis will be performed to determine whether differences in quality of life observed in CREST render CAS an economically attractive strategy.

CAS (n= 1212)
CEA (n=1193)
Δ CAS - CEA (95% CI via bootstrap)

Index Procedure Costs, $

Excluding MD Fees
6782 ± 1412
5743 ± 1370
1039 (926, 1148)

MD Fees
1114 ± 240
1478 ± 108
-364 (-379, -349)

Total
7896 ± 1551
7221 ± 1450
675 (555, 800)

Index Hospital Stay
7159 ± 5108
7595 ± 7482
-436 (-951, -59)

TOTAL Index Hosp Costs
15055 ± 5539
14816 ± 7709
239 (-302, 778)

Index Hosp LOS (days)

ICU LOS
0.7 ± 1.1
0.8 ± 1.4
-0.1 (-0.24, -0.04)

Non-ICU LOS
1.9 ± 3.2
2.2 ± 4.1
-0.2 (-0.55, 0.06)

TOTAL LOS
2.6 ± 3.3
3.0 ± 4.5
-0.4 (-0.7, -0.06)

1-year Rehosp Costs:

Repeat Revasc - CAS
295 ± 2097
273 ± 2126
-21 (-142, 201)

Repeat Revasc - CEA
287 ± 2088
477 ± 2510
-190 (-371, -11)

Ipsilateral Stroke
556 ± 3273
384 ± 2580
172 (-75, 402)

TIA
48 ± 520
33 ± 487
16 (-25, 56)

Death
63 ± 846
45 ± 779
18 (-49, 85)

TOTAL Rehosp costs
1321 ± 4827
1293± 4502
28 (-334, 396)

TOTAL 1-year costs
16375 ± 7730
16108 ± 9030
267 (-366, 961)
Abstract 269: Influence of Medical Therapy and Co-Morbidities on Long-Term Outcomes in Patients with Aortic Aneurysms
Authors: Heinecke Carl A , Bulibek Batyrjan , Ojha Chandra , Britton Lewis , Torosoff Mikhail , Huang Helen , Contino Chase 
Published: July 2021

Background:
We investigated effects of medical therapy and co-morbidities on long-term outcomes in patients with documented aortic aneurysms.

Material and Methods:
Medical records of 162 consecutive patients (64+/-13 years old, 37% females, 91% Caucasians) enrolled in the Aortic Aneurysm clinic at a single tertiary medical center were reviewed. Long-term outcomes (28+/-29 months) were determined using Social Security Death Index. ANOVA, chi-square, and logistic regression tests were employed.

Results:
Older patients (73+/-8.9 vs. 62+/-13, p=0.006; HR 2.1 per decade, 95%CI 1.2-3.6, p=0.008) or patients with larger aneurysm diameter (5.4+/-0.8 vs. 4.7+/-0.7, p=0.005; HR 3.8 per 1 cm, 95%CI 1.4-10.3, p=0.008) were more likely to die during the follow-up. There was a trend towards increased mortality when history of smoking was present (76% vs. 23% in non-smokers, p=0.042; HR 3.7, 95%CI 0.97-13.9, p=0.055). None of the 11 patients with atrial fibrillation expired (0 vs. 10% in NSR, p=0.273). Gender, body surface area, systolic and diastolic blood pressures on presentation, history of CAD, CHF, hypertension, diabetes, dyslipidemia, or renal disease had no discernible effects on mortality in our study cohort.

There was a trend towards reduced mortality in patients treated with aspirin or clopidogrel (3.4% vs. 12.1%, p=0.064; HR 0.3, 95%CI 0.05-1.1, p=0.083), beta-blockers (5.4% vs. 10.4%, p=0.282; HR 0.5, 95%CI 0.13-1.85, p=0.290) and Ca-channel blocker (0% vs. 10.6%, p=0.067; HR 0.9, 95%CI 0.9-1.1, p=0.972). Treatment with ACE inhibitors or ARBs, statins, or diuretics did not affect the outcomes.
In multivariate analysis only advanced age (HR 2.2, 95%CI 1.0-4.5, p=0.038) and larger aortic aneurysm diameter (HR 2.9 per 1 cm, 95%CI 0.9-9.1, p=0.069) were predictive of increased long-term mortality.

Conclusions:
In patients with documented aortic aneurysms mortality is largely determined by patient’s age and vessel diameter. When compared to vasodilators and diuretics, beta-blockers and Ca-channel blockers may be preferable in patients with aortic aneurysm. Treatment with anti-platelet agents is not detrimental and may have a potential to improve long-term outcomes.
Abstract 296: Characteristics Of Ambulatory Cardiovascular Patients In India: Findings From The First 18,000+ Patient Encounters In The PINNACLE India Outpatient Registry
Authors: Glusenkamp Nathan T , Grant Purvez , Kumar Ganesh , Castellino Nirmala , Gupta Rahul , Sinha Ajay , Mullen Brendan , Oetgen William J 
Published: July 2021

Background:
In India, patients usually are responsible for medical records, carrying them to ambulatory clinic visits. Little is known about the characteristics of cardiovascular (CV) patients visiting Indian hospital outpatient departments (OPDs), as this information is not collected or analyzed in a standardized fashion.

Methods:
We used paper scanners along with an electronic data collection tool to systematically collect CV patient records in hospital OPDs. Standardized data definitions were used for all elements, including demographics, vital signs, and lab values. We normalized and analyzed the data collected, producing totals, means, medians, and standard deviations for all element values.

Results:
We collected 18,804 CV patient encounters in the OPDs of two tertiary facilities in Maharastra state from 2/12 to10/12. Of 18,622 records with gender recorded, 12,386 were male (66.5%). Only 22% of records were for patients over age of 65. Mean age was 57, the same mean age for males. Mean age for females was 54.

Systolic blood pressure (BP) was documented in 8,481 (45%) of patient visits. Diastolic BP was documented in 8,477 (45%) patient visits. Mean systolic BP was 130, with a standard deviation of ± 18. Mean diastolic BP was 81 ± 9. Most BPs were high, with 6,651 (78%) greater than 120. Hypertension diagnoses could be applied to 2,566 (30%) of the encounters with a systolic BP over 140 documented.
Ejection fraction (EF) was present in 857 patient encounter records (4.5%). Most EFs (704) fell within the normal range of ≥ 50%. Mean ejection fraction was 56% ± 11. For EFs outside normal range, 74 were mildly reduced (an EF of 40-49%), 57 moderately reduced (26-29%) and 22 severely reduced (≤ 25%).
Complete lipid panel, consisting of values for total cholesterol, HDL, LDL, and triglycerides, was present in 594 patient records (3.2%). LDL values were present in 601 encounter records, with mean LDL of 101 mg/dL ± 35. 288 LDL values were over 100 mg/dL, the upper bound of optimal range.

Conclusion:
Indian ambulatory CV patients appear to be younger and more heavily male than outpatient CV populations in the US. Opportunity remains for increased documentation, allowing for performance measure generation.
Abstract 53: Health Care Utilization and Cost among Type 2 Diabetes Mellitus (T2DM) Patients with Cardiovascular Disease (CVD) or Cardiovascular Disease Risk Factors
Authors: Kern David M , DeVore Stephanie , Kim Jennifer , Wu Ying , Tunceli Ozgur , Wu Bingcao , Hirshberg Boaz 
Published: July 2021

CV events among T2DM patients are major contributors to high healthcare utilization and cost. Healthcare utilization and costs among T2DM patients with established CVD and CVD risk factors in a large US database were explored.
T2DM patients aged ≥40 years were identified from the HealthCore Integrated Research Environment from 1/1/2007 to 4/30/2011 and followed from first T2DM diagnosis (index date) until loss of eligibility or death. Established CVD [Group 1] included patients with MI, stroke, peripheral vascular disease, coronary heart disease, congestive heart failure, or revascularization in the year prior to index. CVD risk [Group 2] included patients with older age (men ≥55 y, women ≥60 y) and prior diagnosis for either dyslipidemia or hypertension. Per person year (PPY) utilization and cost following T2DM diagnosis were calculated as the total number of events/cost divided by total number of person years of follow-up.
There were 177,140 Group 1 (mean age: 68 y; 57% men) and 191,441 Group 2 (mean age: 66 y; 57% men) patients who met the selection criteria. During the 12, 24, 36, and 48 months following index, a higher proportion of Group 1 vs Group 2 patients had ≥1 inpatient visit (35%, 50%, 61%, 69% vs 16%, 27%, 36%, 44% respectively) and ≥1 ED visit (6.2%, 17%, 29%, 41% vs 2.9%, 9%, 18%, 28% respectively). T2DM patients have high healthcare utilization and costs. Those with established CVD have higher PPY event rates (Figure 1) and costs (Figure 2), compared with patients with CVD risk factors. Inpatient hospitalizations and outpatient visits are key cost drivers in this T2DM population.
Abstract 207: The Stroke Prevention Clinic, Extending Care Past The Stroke Center
Authors: Johnson Brenda , Bojang Binta , Butler Jaime , Urrutia Victor C 
Published: July 2021

Background:
While the incidence and mortality from stroke in the United States has declined in the past 20 years, there are still more than 795,000 strokes per year, of which 185,000 are recurrent events. There remains great disparity between racial groups -the incidence and mortality among African Americans, is two to four times higher than Non-Hispanic Whites.

Despite great advances in drug therapies, the impact on stroke prevention has not been fully realized. There is a need for improved delivery of effective treatments.
Several randomized clinical trials have demonstrated the effectiveness of a comprehensive; clinic based, navigator-assisted approach to disease management, although in the context of specific clinical situations. Examples are, SAMMPRIS, and Look AHEAD.
We propose that learning from the development of the “stroke center” for acute stroke care, we may apply a similar model to stroke prevention.
We have created a Stroke Prevention Clinic (SPC), organized like an outpatient “stroke center”, offering evaluation, treatment, and long-term follow up of patients for risk factor control and lifestyle interventions for secondary prevention. Our Stroke Prevention Nurse is an integral part of this model. In this abstract we report the impact of this program on follow up rates.

Methods:
In 2011 we launched our SPC. The specific elements of this program included:

A Stroke Prevention Nurse:

a. Meets the patient in the hospital.

b. Facilitates scheduling of appointments, including in the SPC, which is given to the patient upon discharge.

c. Calls the patient within 7 days to do medication reconciliation and answer questions. Also, at 90 days for a modified Rankin score and whenever it is necessary to follow up on blood pressure readings.

d. Administers screening tools upon follow up, consents for research studies.

e. Educates the patient on stroke prevention.

Dedicated day for clinic. All providers in the same area.

Use of Advance Practice Nurse and stroke fellows, as well as vascular neurology attending.

Database.

We assessed the proportion of completed appointments within 90 days after discharge from the hospital and compared it with the year prior to implementation.

Results:
A sample from July 2010 to February 2011 revealed completed follow up by 90 days of 28.3% (70/247), for the period July 2011 to February 2012 the proportion was 35.6% (89/250).

During calendar year 2014, 54.3% (233/429) completed their appointments within 90 days.

Conclusion:
Implementation of the Stroke Prevention Clinic increased follow up completion within 90 days of discharge.
Abstract 372: Health Outcomes Associated With Triple Antiplatelet Therapy for the Secondary Prevention of Atherothrombotic Events
Authors: Ozer-Stillman Ipek , Whalen John D , Bash Lori D , Oguz Mustafa , Du Mark , Singhal Puneet K , Davies Glenn M 
Published: July 2021

Vorapaxar is a protease-activated receptor-1 (PAR-1) antagonist indicated for the reduction of atherothrombotic cardiovascular (CV) events in patients with a history of myocardial infarction (MI) or with peripheral arterial disease (PAD), based on the findings of the TRA 2°P-TIMI 50 trial for patients without a history of stroke or transient ischemic attack. This analysis evaluated the health outcomes of triple antiplatelet therapy with vorapaxar when added to a standard care regimen of clopidogrel plus aspirin (ASA) in comparison with standard care alone, for patients without a history of transient ischemic attack or stroke who survived hospitalization for a qualifying MI.
A cohort-level state-transition model was developed in Microsoft Excel to estimate membership in health states over a lifetime time horizon: event-free, post-MI, post-stroke, dead due to bleeding, dead due to CV causes, and dead due to other causes. Predictive equations were developed from patient-level data from TRA 2°P, in order to estimate CV event-related transition probabilities, based on patient characteristics. These improve upon Framingham risk equations as they consider the time since the most recent myocardial infarction, and they are based on a greater number of CV events from a larger and more diverse population. Meta-analyses, national statistics, and other publications were used to estimate case fatality and bleeding rates, the risk of non-CV mortality, as well as utilities for estimation of quality-adjusted life years (QALYs). For validation, the risk equation and model results were compared with the observed event rates in TRA 2°P, risk estimates from Framingham Heart Study publications, as well as QALY and life-year outcomes from other published models.
Over a lifetime time horizon, the model predicted 8.3 fewer recurrent MIs, 3.8 fewer strokes, and 18.2 fewer CV deaths in the vorapaxar plus standard care arm in comparison with standard care alone, per 1,000 patients treated, with an increase of 26.4 transfusions, 3.6 intracranial hemorrhage, and 0.9 fatal bleeding events. Discounted life-years and QALYs increased by 0.4 and 0.3 respectively with vorapaxar treatment. In validation, modeled CV event counts were within 0.1% of the observed rates in TRA 2°P. The model’s prediction of 8.94 QALYs in the standard care arm is comparable to the prediction of 9.55 to 9.78 QALYs in a recent UK model of antiplatelet monotherapy after MI.
Based on model results, triple antiplatelet therapy with vorapaxar provides additional clinical benefit versus standard care after MI, for a patient population that is at high risk for recurrent and potentially fatal events. In validation, the model yielded projections of CV morbidity and mortality comparable to the observed outcomes from the TRA 2°P clinical trial, Framingham equations, and other models.
Abstract 247: STEMI 365: Creating a Yearlong Program to Reduce Cardiac Recidivism After STEMI
Authors: Ryczek Daniel , Burt David 
Published: July 2021

Survivors of myocardial infarctions are at increased risk of recurrent infarctions and have an annual death rate of 5%, six times that in people of the same age who do not have coronary heart disease. Despite the existence of published interventions and clinical recommendations aimed at secondary and tertiary prevention their application and adherence statistics in post-myocardial infarction patients are woeful.
The objective of this paper is to detail the creation of a template curriculum that gives best practice recommendations to post STEMI patients in an effort to reduce recidivism by combining current medical methodology with lessons learned from other fields currently addressing the problem of recidivism and relapse.
STEMI 365 is a yearlong program that aims to reduce cardiac recidivism in STEMI survivors. STEMI 365 is composed of three parts: best practice guidelines, evaluation toolkit, and template curriculum. The best practice guidelines document is broken into sections on cardiac rehabilitation, lifestyle modification, drug therapy, patient follow-up and screening, and patient education. All guidelines are informed by the latest recommendations and research in the fields of medicine and relapse prevention. The evaluation toolkit is composed of the cardiac recidivism risk tool, the self-evaluation tool, and the global evaluation tool. The goal of the toolkits is to guide resource allocation by understanding a patient’s unique cardiac recidivism risk, internal sources of potential relapse, and external sources of potential relapse. The Federal Post Conviction Risk Assessment developed by the Administrative Office of the United States Courts informs the toolkits’ construction. The template curriculum is a summation of the programs and interventions that can be utilized by a health system to decrease cardiac recidivism in STEMI survivors. The curriculum addresses one year of time divided into three phases: inpatient, outpatient, and maintenance. The interventions rage in scope from training a patient’s family members in bystander CPR to the creation of a centralized patient monitoring program and post-myocardial infarction clinic. Each phase combines the best modalities in treatment found in the fields of post-myocardial infarction care, hospital re-admission prevention, substance abuse relapse prevention, scholastic dropout prevention, and criminal justice. Personal interviews were conducted with leaders in each field to ensure the correct application of their methodologies.
STEMI 365 provides tools to identify patients at highest risk of cardiovascular relapse, to apply local and regional resources in an effective way based on patient risk, and to customize interventions to a health system’s available resources. STEMI 365 is beginning an application phase at this institution, and will be available to other health systems in the near future.