tbuckley/cabot-search huggingface dataset:
Abstract 15958: Comparison of In-hospital Outcomes of Patients Undergoing Catheter Ablation for Typical versus Atypical Atrial Flutter
Authors: Bertrand Ebner, Jennifer Maning, Jelani Grant, Louis Vincent, Odunayo P Olorunfemi, Neal Olarte, Rosario A Colombo, ivan mendoza
Journal: Circulation (2020)

Introduction: Catheter Ablation (CA) is indicated as definitive therapy for patients with atrial flutter (AF) which is unresponsive to medical therapy. While atrial flutter may be typical (TAF) or atypical (AAF), there is a paucity of data regarding in-hospital outcomes of patients undergoing CA. Methods: This retrospective cohort study used the Nationwide Inpatient Sample to identify all patients above 18 years who underwent CA between 2015 and 2017. Individuals were identified using ICD-10-CM/PCS for TAF, AAF and CA. Statistical analysis was performed comparing TAF to AAF. Results: A total of 17,390 patients underwent CA for AF, with 33% having AAF and 67% TAF. Patients with TAF were younger (median 67 years vs. 68 years), with lower proportion of females (29.6% vs. 42.8% p≤0.05 for both) compared to patients with AAF. TAF group had higher rates of emergent admission (85.7% vs. 65.5% p≤0.05). Interestingly, subjects with AAF had earlier interventions than patients with TAF (≤3 days of admission, 76.4% vs. 71% p≤0.05). Patients with TAF have a higher rate of hypertension, diabetes, smoking, heart failure, liver disease, and chronic obstructive pulmonary disease (p≤0.05 for all). However, patients with AAF had increased prior strokes and percutaneous coronary interventions (PCI) (p≤0.05 for both). The mean CHA2DS2-VASc score was found to be 2.3 in AAF compared to 2.1 in TAF (controlled for comorbidities, p≤0.05). Multivariable regression showed a significantly higher proportion of cardiogenic shock, acute coronary syndrome, sepsis, cardiac catheterization, PCI, thromboembolism event, transfusion, and longer length of stay in patients with TAF (p≤0.05 for all). Although we found that patients with AAF have significant higher rates of cardioversion, implantation of cardiac device, pericardial complications, and increased hospital charges (p≤0.05 for all), no significant difference was found in mortality. Conclusion: In this retrospective cohort study, we found higher complication rates in CA of patients with TAF, even when adjusting for pertinent comorbidities, but no difference in in-hospital all-cause mortality. Variation in CA depending upon the mechanism of AF may underlie these differences, and warrant further study.
Abstract 16165: Inorganic Arsenic Induces Sex-Dependent Pathological Cardiac Hypertrophy
Authors: Raihan Kabir, Prithvi Sinha, Sumita Mishra, Obialunanma V Ebenebe, Nicole Taube, Christian Oening, Gizem KECELI, Rui Chen, Nazareno Paolocci, Ana M Rule, Mark J Kohr
Journal: Circulation (2020)

Exposure to inorganic arsenic (iAS) through drinking water is well-associated with adverse cardiovascular outcomes, yet the mechanisms through which it induces these effects are not fully understood. Recent epidemiological findings highlight an association between iAS exposure and altered left ventricular geometry in both the presence and absence of hypertension. We therefore tested the hypothesis that iAS exposure has a bimodal impact on cardiac-intrinsic and hemodynamic mechanisms that together induce pathological remodeling of the myocardium. Adult male and female mice were exposed to an environmentally relevant dose of 615 μg/L NaAsO 2 for eight weeks. Males (n=9-10 mice/group) exhibited increased systolic blood pressure (115.1±3.0 vs. 106.0±2.3 mmHg, p=0.0350) via tail cuff photoplethysmography, left ventricular wall thickening (0.98±0.01 vs. 0.88±0.01 mm, p&lt;0.0001) via transthoracic echocardiography, increased heart weight to tibia length (8.56±0.21 vs. 7.15±0.24 mg/mm; n=24 mice/group), and increased plasma atrial natriuretic peptide (47.85±12.0 vs. 15.14±3.73 pg/mL, p=0.0379) via enzyme immunoassay. Myocardial mRNA transcript levels (n=10 hearts/group) of Acta1 (1.36±0.18 vs. 0.73±0.11, p=0.0037), Myh7 (1.53±0.15 vs. 1.04±0.10, p=0.0138), and Nppa (2.40±0.29 vs. 1.02±0.07, p=0.0001) were increased, and Myh6 (0.92±0.17 vs. 1.14±0.23, p=0.0001) was decreased, evidencing pathological hypertrophy in the male heart. Female hearts, however, were largely protected at this eight-week timepoint as similar changes were not detected. Further investigation found that Rcan1 was upregulated (1.47±0.19 vs. 0.97±0.04, p=0.0161; n=10 hearts/group) in male hearts, suggesting that calcineurin-NFAT was activated. Interestingly, iAS was sufficient to activate NFAT (0.82±0.11 vs. 0.46±0.05, p=0.0214; n=8 wells/group) independent of blood pressure via luciferase assay. In conclusion, these results demonstrate for the first time that iAS may cause pathological cardiac hypertrophy not only by increasing hemodynamic load, but also by activating calcineurin-NFAT and inducing fetal gene expression in the male heart, thus providing novel mechanistic insight into the threat of iAS exposure to the cardiovascular system.
Epidemiological characteristics and outcomes of COVID-19 cases: mortality inequalities by socio-economic status, Barcelona, Spain, 24 February to 4 May 2020
Authors: Julieta Politi, Mario Martín-Sánchez, Lilas Mercuriali, Blanca Borras-Bermejo, Joaquín Lopez-Contreras, Anna Vilella, Judit Villar, Angels Orcau, Patricia Garcia de Olalla, Cristina Rius
Journal: Eurosurveillance (2021)

BackgroundPopulation-based studies characterising outcomes of COVID-19 in European settings are limited, and effects of socio-economic status (SES) on outcomes have not been widely investigated. AimWe describe the epidemiological characteristics of COVID-19 cases, highlighting incidence and mortality rate differences across SES during the first wave in Barcelona, Catalonia, Spain.MethodsThis population-based study reports individual-level data of laboratory-confirmed COVID-19 cases diagnosed from 24 February to 4 May 2020, notified to the Public Health Agency of Barcelona and followed until 15 June 2020. We analysed end-of-study vital status and the effects of chronic conditions on mortality using logistic regression. Geocoded addresses were linked to basic health area SES data, estimated using the composed socio-economic index. We estimated age-standardised incidence, hospitalisation, and mortality rates by SES.ResultsOf 15,554 COVID-19-confirmed cases, the majority were women (n = 9,028; 58%), median age was 63 years (interquartile range: 46-83), 8,046 (54%) required hospitalisation, and 2,287 (15%) cases died. Prevalence of chronic conditions varied across SES, and multiple chronic conditions increased risk of death (≥ 3, adjusted odds ratio: 2.3). Age-standardised rates (incidence, hospitalisation, mortality) were highest in the most deprived SES quartile (incidence: 1,011 (95% confidence interval (CI): 975-1,047); hospitalisation: 619 (95% CI: 591-648); mortality: 150 (95% CI: 136-165)) and lowest in the most affluent (incidence: 784 (95% CI: 759-809); hospitalisation: 400 (95% CI: 382-418); mortality: 121 (95% CI: 112-131)).ConclusionsCOVID-19 outcomes varied markedly across SES, underscoring the need to implement effective preventive strategies for vulnerable populations.
Abstract P085: Racism, Resilience, And Quality Of Life In Black Stroke Survivors: A Mixed-methods Cohort Study Protocol
Authors: Mary F Love, Andrea N Brooks, Sonya Cox, Anjail Z Sharrief
Journal: Circulation (2021)

Introduction: Annual age-adjusted incidence and death rates for stroke are significantly higher among Black Americans than among White Americans. Racism, which operates at structural, cultural and interpersonal levels, exerts significant stress on Black Americans and contributes to health disparities, including those related to stroke. Health-related quality of life (HRQoL) encompasses an individual’s self-perception of physical, mental, and social health. The combined effects of racism, stroke-related stress, and psychosocial stressors can result in negative outcomes, including poor HRQoL for Black stroke survivors. Resilience refers to maintaining relatively stable, healthy psychological and physical functioning in the aftermath of a stressful event like stroke. The purpose of this study will be to examine the effects of racism, resilience, and key psychosocial variables on Black stroke-survivor HRQoL. Hypothesis: We hypothesize racism and lower resilience will be associated with lower HRQoL. Methods: We will conduct a mixed-methods cohort study to examine the effects of racism and resilience on HRQoL of Black stroke survivors recruited from a stroke clinic in a large metropolitan area in the southeast US. Adult community-dwelling stroke survivors who self-identify as Black or African American and who have experienced a stroke event in the past 1 to 2 months will be eligible for study inclusion. Baseline quantitative data collection will occur at the initial clinic visit, with follow-up data collection at 5 to 6 months’ post-stroke. The exposure variables will be racism and resilience, and the outcome variable will be physical, mental, and social HRQoL. Qualitative data will be collected via focus groups. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines will be followed to report study results. Results: Power calculations for a two-tailed linear regression analysis with α ≤ .05, β .80, and an effect size of .15 (medium) resulted in a required sample size of 68. Our targeted sample size of 82 participants (41 males and 41 females) accounts for an attrition rate of 20%. The statistical approach to test the direct effects of each exposure variable on HRQoL will be multiple-level models. An interaction term for resilience will be included in the racism model. Qualitative data will be audio recorded, transcribed, and analyzed for themes regarding racism and resilience. Conclusions: Studies of the effects of racism on outcomes for Black stroke survivors are largely absent. This study will provide a first step toward identifying Black stroke survivors at risk for poor HRQoL in early stroke recovery.
Abstract 16057: First-line Ablation of Ventricular Tachycardia in Ischemic Cardiomyopathy: Stratification of Outcomes by Left Ventricular Function
Authors: David Briceno, Jorge Romero, Kavisha Patel, Juan C Diaz, Isabella Alviz, Dhanunjaya Lakkireddy, Domenico G Della Rocca, Rakesh Gopinathannair, Andrea Natale, Luigi Di Biase
Journal: Circulation (2020)

Introduction: Randomized controlled trials (RCTs) have shown improved outcomes in patients undergoing first-line catheter ablation of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with ischemic cardiomyopathy (ICM). Nonetheless, the impact of Left ventricular ejection fraction (LVEF) on the outcomes after catheter ablation (CA) have not been studied. Hypothesis: LVEF has a strong impact on the outcome after CA for VT in patients with ICM. Methods: RCTs evaluating first-line ablation versus medical therapy in patients with VT and ICM were included. Risk estimates and 95% confidence intervals (CI) were measured. Results: Four RCTs with a total of 505 patients (mean age 66 ± 9 years, 89% male, 80% with previous revascularization) were included. Mean LVEF was 35 ± 8%. At a mean follow-up of 24 ± 9 months, a significant benefit in survival-free from appropriate ICD therapies was observed in all patients undergoing first-line catheter ablation compared to medical management (RR 0.70, 95% CI 0.56-0.86). In patients with moderately depressed LVEF (&gt;30-50%), first line VT ablation was associated with a statistically significant reduction in the composite endpoint of survival-free VT/VF and appropriate ICD therapies (HR: 0.52, 95% CI: 0.36-0.76), whereas there was no difference in patients with severely depressed LVEF (&lt;/=30%) (HR: 0.56, 95% CI: 0.24-1.32). Funnel plots did not show asymmetry suggesting lack of bias. Conclusions: Patients with ICM and VT undergoing first-line ablation have a significant lower rate of appropriate ICD therapies without a mortality difference compared to patients receiving an initial approach based on medical therapy. The beneficial effect was only observed in patients with moderately depressed LVEF (&gt;30-50%).
Abstract 16089: Clinical Outcomes Associated With Anti-coagulation versus No Anti-coagulation for Atrial Fibrillation Among Octogenarians and Nonagenarians; a Meta-analysis
Authors: Kiro Barssoum, Ashish Kumar, Devesh Rai, Ahmed Elkaryoni, Samarthkumar J Thakkar, Mounir Ibrahim, Adnan Kharsa, Muhammad Waqas Tahir, Mohan Rao
Journal: Circulation (2020)

Background: Octogenarians and nonagenarians are under-represented in major clinical trials studying the role of anticoagulation (AC) in atrial fibrillation (AF). These patients are at an increased risk of bleeding owing to their frailty, their propensity for falls, and frequently impaired kidney function. We performed a meta-analysis of studies that investigated the role of AC in these patients. Methods: We queried Medline, EmCare, CINHAL, Cochrane Database, and Google Scholar for studies investigating the role of AC for AF in octogenarians and nonagenarians. Our primary efficacy outcome was major thromboembolism (TE), and secondary safety outcome was major bleeding (MB). We used the PM method with HKSJ adjustment to estimate risk ratio (RR) with a 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 . R version 3.6.2 was used for statistical analysis. Heterogeneity was addressed using outlier analysis. dmetar() package in R was used, and the pooled estimate was re-calculated, excluding the outliers. Results: Ten observational studies, including a total of 34,697 patients were included. There was no difference in the risk of TE [RR: 0.82, 95% CI: 0.49-1.38, I 2 =74%] or MB [RR: 1.00, 95% CI: 0.55-1.83, I 2 =88%] between the AC and Non-AC group. However, the pooled estimates were associated with considerable heterogeneity. Outlier analysis identified two studies "Perera et al., 2009" and "Yamashita et al., 2016" as an outlier for pooled estimation of TE, while [1] "Siu et al., 2014", "Bertozzo et al., 2016", "Ekerstad et al., 2018" and "Alnsasra et al., 2018" were outliers in the pooled estimate of MB. Following exclusion of outliers for each endpoint, the reanalyzed RR for TE and MB were [RR: 0.94, 95% CI: 0.82- 1.09, I 2 =0%] and [RR: 1.57, 95% CI: 1.41- 1.74, I 2 =0%]. Conclusion: There was no difference in the risk of TE, while the risk of MB increased with the use of AC for AF in octogenarians and nonagenarians.
Abstract P177: Discordantly Normal ApoB Relative To Elevated LDL-C In Persons With Metabolic Disorders: A Marker Of Atherogenic Heterogeneity
Authors: Alexander C Razavi, Lydia A Bazzano, Jiang He, Marie Krousel-Wood, Kirsten S Dorans, Michael A Razavi, Camilo Fernandez, Seamus P Whelton, Tanika N Kelly
Journal: Circulation (2021)

Introduction: A significant proportion of persons with metabolic syndrome, prediabetes, or type 2 diabetes do not develop atherosclerotic cardiovascular disease (ASCVD). Discordantly normal apolipoprotein B (ApoB) relative to elevated LDL-cholesterol (LDL-C) may help to explain underlying heterogeneity in ASCVD risk among these individuals. Hypothesis: We hypothesized that discordantly normal ApoB (&lt;90 mg/dL) relative to elevated LDL-C ( &gt; 100 mg/dL) would be associated with a lower atherosclerosis burden among individuals with metabolic disorders. Methods: There were 331 Bogalusa Heart Study participants with metabolic syndrome (n=107), prediabetes (n=291), or type 2 diabetes (n=34) and LDL-C &gt; 100 who were free of carotid plaque at baseline (2001-02) and underwent carotid ultrasound at follow-up (2013-16). Carotid plaque was defined as a focal wall thickening &gt;1.5 mm. Modified Poisson regression with robust error variance estimated the long-term absence of plaque for normal ApoB after adjusting for established risk factors. Results: Participants were on average 36.3 years old at baseline, 202 (61.0%) were women, and 93 (29.9%) were African American. Overall, LDL-C explained 42.3% of the variability in ApoB as the lipoprotein markers were only modestly correlated (r=0.65). Participants with ApoB &lt;90 (51.1%) were more likely to remain free of carotid plaque compared to those with ApoB &gt; 90 (74.6% versus 57.4%, p=0.001, Figure ). In multivariable modeling, persons with ApoB &lt;90 were 21% more likely to have long-term absence of plaque (RR=1.21, 95% CI: 1.03-1.43), independent of traditional ASCVD risk factors, including LDL-C. Conclusions: More than half of persons with metabolic disorders and elevated LDL-C had normal ApoB with a lower burden of carotid atherosclerosis over 13 years follow-up. ApoB better represents the atherogenic lipid burden among persons with metabolic disorders compared to LDL-C and may be especially helpful for persons with the pattern of high triglycerides and low HDL-cholesterol.
Factors Associated With Use of an Online Telemedicine Service to Access Self-managed Medical Abortion in the US
Authors: Abigail R. A. Aiken, Jennifer E. Starling, Rebecca Gomperts
Journal: JAMA Network Open (2021)

<h3>Importance</h3> People in the US have been seeking self-managed abortions outside the formal health care system using medications obtained through online telemedicine. However, little is known about this practice, including potential motivating factors. <h3>Objective</h3> To examine individual reasons for accessing medication abortion through an online telemedicine service as well as associations between state- and county-level factors and the rate of requests. <h3>Design, Setting, and Participants</h3> This population-based cross-sectional study examined all requests for self-managed medication abortion through an online consultation form available from Aid Access, a telemedicine service in the US, between March 20, 2018, and March 20, 2020. <h3>Main Outcomes and Measures</h3> Individual-level reasons for accessing the telemedicine service were examined as well as the rate of requests per 100 000 women of reproductive age by state. Zip code data provided by individuals making requests were used to examine county-level factors hypothesized to be associated with increased demand for self-managed abortion: distance to a clinic (calculated using location data for US abortion clinics) and the population proportion identifying as a member of a racial/ethnic minority group, living below the federal poverty level, and having broadband internet access (calculated using census data). <h3>Results</h3> During the 2-year study period, 57 506 individuals in 2458 counties in 50 states requested self-managed medication abortion; 52.1% were aged 20 to 29 years (mean [SD] age, 25.9 [6.7] years), 50.0% had children, and 99.9% were 10 weeks’ pregnant or less. The most common reasons cited by individuals making requests were the inability to afford in-clinic care (73.5%), privacy (49.3%), and clinic distance (40.4%). States with the highest rate of requests were Louisiana (202.7 per 100 000 women) and Mississippi (199.9 per 100 000 women). At the county level, an increase of 1 SD (47 miles) in distance to the nearest clinic was significantly associated with a 41% increase in requests (incidence rate ratio, 1.41; 95% CI, 1.31-1.51;<i>P</i> &lt; .001), and a 10% increase in the population living below the federal poverty level was significantly associated with a 20% increase in requests (incidence rate ratio, 1.20; 95% CI, 1.13-1.28;<i>P</i> &lt; .001). <h3>Conclusions and Relevance</h3> In this cross-sectional study, clinic access barriers were the most commonly cited reason for requesting self-managed medication abortion using an online telemedicine service. At the county level, distance to an abortion clinic and living below the federal poverty level were associated with a higher rate of requests. State and federal legislation could address these access barriers.
Abstract 16553: Association Between Family History and Isolated Early-Onset Atrial Flutter Across Race-Ethnicity
Authors: Victor Qiao, Ana Ongtengco, Aylin Ornelas, Yining Chen, Zain Alzahrani, Dawood Darbar
Journal: Circulation (2020)

Introduction: There is a genetic predisposition to early-onset atrial fibrillation (EOAF) but the role of family history in the pathogenesis of isolated EO atrial flutter (AFL) across racial and ethnic minorities remains unclear. Here, we determined whether probands with isolated EOAFL across race and ethnicity have a higher rate of AF in first-degree family members than matched control patients with late-onset (LO) AFL. Methods: In this cohort study, patients prospectively enrolled in a clinical and genetic biorepository were administered baseline questionnaires that included questions about family history of AFL. EOAFL was defined as AFL occurring in probands aged 60 years or younger in the absence of structural heart disease. All other forms were categorized as LOAFL. The main outcome measure was the reported family history of AFL in first-degree relatives. Results: Of 106 patients enrolled, 23 (23%) were European American; 53 (52%) were African American, 22 (22%) were Hispanic/Latino (H/L) and 3 (3%) were Asian American. There was a family history of AFL in 11 probands with EOAFL (18%) compared with 3 (7%) patients with LOAFL (Table 1). There was a significantly greater prevalence of CHF in the EOAFL group (40%) than the LOAFL group (21%). Conclusion: Probands with isolated EOAFL are more likely to have a first-degree relative with AFL when compared to matched controls with isolated LOAFL. Our findings support genetic predisposition to isolated EOAFL across racial and ethnic minorities.
Abstract 13186: Prevalence, Predictors, and Outcomes of Both True- and Pseudo-resistant Hypertension in the Action to Control Cardiovascular Risk in Diabetes Trial (ACCORD)
Authors: Nicholas Chiu, Julie Lauffenburger, Jessica Franklin, Niteesh Choudhry
Journal: Circulation (2020)

Introduction: Resistant hypertension (RH) has been poorly studied due to the difficulty distinguishing RH from medication non-adherence—exclusion of which is necessary to accurately diagnose RH. Therefore, little is known about prevalence, predictors, and outcomes of true RH, particularly for patients with diabetes. Objective: To characterize prevalence, predictors, and outcomes of true RH under a definition accounting for adherence in a study with strict adherence monitoring. Methods: We analyzed data from 1838 patients in the standard BP arm of ACCORD. Patients were classified into 3 mutually-exclusive groups: “true RH”, “pseudo-RH” (i.e., patients with BP treatment levels that would classify them as having RH, but who were non-adherent), and “Other” (i.e., those without “true RH” or “pseudo-RH” classifications). Predictors of true- and pseudo-RH were identified with logistic and boosted regression models. Relationship between true RH and primary composite outcome of nonfatal MI, nonfatal stroke, or cardiovascular death was evaluated with cox models. Results: Among 1838 participants with complete information, 489 (26.6%) met the definition of true RH, and 94 (16.1%) of RH patients had “pseudo-RH” on ≥1 visit over the first 12 months. Multivariable predictors of RH included: baseline SBP ≥160 mmHg (OR=8.79; 95CI:5.70-13.68), baseline SBP between 140-159 (OR=2.91; 95CI:2.13-4.00) compared to SBP &lt;140, additional baseline BP medication (OR=3.40; 95CI:2.83-4.11), macroalbuminuria (OR=2.35; 95CI:1.50-3.67), CKD (OR=1.53; 95CI:0.99-2.33), history of stroke (OR=1.73; 95CI:1.04-2.82), and black race (OR=1.39; 95CI:1.02-1.88); Overall, multivariable model had a cross-validated C-statistic of 0.80, indicating strong discriminative ability. “True RH” patients had a 65% increased hazard in primary outcome compared with other groups (HR=1.65; 95 CI:1.13-2.42). Conclusions: The majority of patients classified as RH had “true RH,” with only 16% being “pseudo-RH” due to non-adherence. True RH is more common among those who are black, have macroalbuminuria, CKD, history of stroke, higher baseline SBP, and are taking more baseline anti-hypertensives. “True RH” patients are at increased risk for cardiovascular and mortality events.