tbuckley/cabot-search huggingface dataset:
Abstract 14370: Rapidly Improving Adherence to Guideline-Directed Medical Therapies in Metropolitan Heart Failure Systems of Care
Authors: Jacqueline Tomei, Robin Y Kiser, Lynn Mallas-Serdynski, Michelle Scharnott, Michele M Bolles, Georges Chahoud, Mitchell Saltzberg, Clyde Yancy
Journal: Circulation (2020)

Background: The 2017 AHA/ACC/HFSA Focused Update of the 2013 ACC/AHA Guidelines for the Management of Heart Failure provided additional support for the clinical use of ACEI, ARBs or ARNIs in conjunction with Evidence-Based Beta Blockers and Aldosterone Antagonists in HFrEF, otherwise known as Guideline-Directed Medical Therapy (GDMT). Although these updates clarified the benefits of GDMT to patient outcomes, low rates of adherence at the provider level for both hospitalized and ambulatory patients continue to be seen. Methods: With the objective of rapidly improving GDMT utilization, as well as improving patient outcomes, the American Heart Association initiated a multidisciplinary collaborative in three metropolitan markets - Chicago, Milwaukee, and St. Louis. Utilizing Get With The Guidelines®-Heart Failure (GWTG-HF), 40 hospitals tracked patients discharged with a primary diagnosis of heart failure and entered data from their inpatient and 30-days post-acute record. An initiative benchmark group was created to track progress and revisions were made to the post-acute care form. Hospitals were provided targeted consultation using hospital-specific data compared to regional and initiative benchmarks. The initiative provided exclusive professional education, including webinars, collaboration meetings, and best-practice recommendations. Results: Between January 1, 2019 and December 31, 2019, 10,532 patients with a primary diagnosis of heart failure, were entered into GWTG-HF from the 40 initiative hospitals, in which 3807 had an EF of &lt;40%. A comparison from Q1 to Q4, 2019 of the mean adherence for GDMT was performed at discharge and yielded the following results: ACEI/ARB or ARNi from 89.3% to 91.6%, Evidenced-Based Beta Blockers from 90.3% to 94.2% and Aldosterone Antagonist from 53.6% to 64.7%; At 30-Days the mean adherence for Q1 and Q4 were calculated as follows: ACEI/ARB or ARNi from 60.4% to 72.9% and Aldosterone Antagonist from 28.2% to 55.3%. Evidence-Based Beta Blocker was only captured for Q3 and Q4, 2019 and the mean adherence improved from 70.3% to 73.8%. Conclusions: The multi-city quality initiative early results show a positive correlation in improving adherence to GDMT in both the hospital and ambulatory setting.
Response to Comment on Pantalone et al. The Probability of A1C Goal Attainment in Patients With Uncontrolled Type 2 Diabetes in a Large Integrated Delivery System: A Prediction Model. Diabetes Care 2020;43:1910–1919
Authors: Kevin M. Pantalone, Anita D. Misra-Hebert, Bartolome Burguera, Michael W. Kattan
Journal: Diabetes Care (2020)

We would like to thank Larroumet et al. (1) for their interest in our article (2) and for sharing their institution’s significant experience (3). Certainly, admission to a specialized ward can durably improve the HbA1c control in patients with uncontrolled type 2 diabetes (T2D). Investigating this concept was not part of our initial intention and research focus; rather, our focus was to develop a prediction model regarding …
Abstract 14414: Bioprosthetic Valve Thrombosis: Different Time to Response to Warfarin in Mitral and Aortic Valves
Authors: Jwan A Naser, Filip Ionescu, Alexander C Egbe, Ioana Petrescu, Vuyisile T Nkomo, Cristina Pislaru, Heidi M Connolly, Patricia A Pellikka, Sorin V Pislaru
Journal: Circulation (2020)

Background: Warfarin is known to be effective in the treatment of bioprosthetic valve thrombosis (BPVT). However, the time-course of response to anticoagulation has not been fully characterized. Hypothesis: We hypothesized that response to warfarin can differ depending on valve position. Methods: We retrospectively identified 45 patients with BPVT diagnosis between 2002 and 2019 that involved either the mitral (MV) or the aortic valve (AV) prostheses, all with eventual echocardiographic resolution with warfarin. BPVT involved AV in 26 (57.8%) patients and MV in 19 (42.2%). Mean gradients (MGs) were tracked starting from BPVT diagnosis until recovery, which was defined as MGs decreasing to initial post-implantation MGs, to 50% below MGs at BPVT diagnosis, or to &lt; 20 mmHg in AV and &lt; 5 mmHg in MV. Kaplan Meier analysis was used to compare recovery time between MV and AV. Duration is reported relative to the time of BPVT diagnosis. Results: Recovery was faster in MV than in AV patients treated with warfarin, with median time of 3.8 months in the AV and 1.8 months in the MV group, p &lt; 0.001 (Figure 1). At 1 month follow up, 15.4% recovered in AV group and 21.1% in MV, p = 0.605. At 3 months, 38.5% recovered in the AV and 78.9% in the MV, p = 0.009. At 6 months, 57.7% of AV group recovered while 100% recovered in the MV group, p = 0.001. The longest time for recovery was 30 months in 1 AV patient. Conclusion: Recovery using warfarin tended to be faster in BPVT involving the MV compared with the AV. In our study, all patients with MV BPVT recovered by 6 months, while this only happened in half the patients with AV BPVT. This suggests that a longer duration of warfarin trial may be needed in the case of AV disease. This might also suggest that the pathogenesis may differ between the two valves.
LIVER RELATED PREDICTORS OF OUTCOME IN COVID-19 ILLNESS
Authors: Rajendiran, Govarthanan, Cowman, Brice, DeVries, Jonah, Gurumoorthy, Aarabhi, Oliver, Tony
Journal: Hepatology (2020)

Background: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), commonly known as COVID-19 (Coronavirus Disease 2019), has resulted in the most significant pandemic of the 21st century  We sought to determine demographic and hepatic laboratory parameters that best predicted the severity of illness in patients infected with COVID-19 Methods: In this multicenter retrospective study, we analyzed patients with confirmed SARS-CoV-2 infection who presented to the emergency department or admitted to an inpatient unit between March and May 2020 The following variables were included as predictors - age, body mass index (BMI), gender, total bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase, albumin and international normalized ratio (INR) The four outcome measures used to assess disease severity were duration of hospitalization, supplemental oxygen requirement, mechanical ventilation requirement, and mortality If the p-value of the independent variable was less than 0 05, then the parameters were considered as an independent predictor associated with the respective outcome variable Predictors of oxygen requirement, mechanical ventilation and death were analyzed by logistic regression The duration of hospitalization was analyzed by Poisson regression Results: Three hundred and thirty-eight patients with confirmed COVID-19 were enrolled (median age 49 1 years, male to female ratio of 1:1) Elevated liver enzymes (AST, ALT, alkaline phosphatase), bilirubin, and INR were significantly associated with the duration of hospital stay  Hypoalbuminemia was significantly associated with increased length of hospitalization, supplemental oxygen, and mechanical ventilation requirements  Obesity (BMI ≥ 30) is a non-liver parameter that was significantly related to the mechanical ventilation requirement  No liver parameter was significantly associated with mortality Results were summarized in table 1 Conclusion: Our research found that COVID-19 patients with hypoalbuminemia have a higher chance of supplemental oxygen requirement, mechanical ventilation requirement, and increased length of hospitalization An abnormal liver test was associated with increased length of hospitalization However, none of the variables were significantly associated with mortality in our analysis
Measles cases and deaths are increasing worldwide, warn health agencies
Authors: Janice Hopkins Tanne
Journal: BMJ (2020)

Measles cases and deaths surged worldwide last year to the highest number of cases in 23 years, says a report from the World Health Organization and the US Centers for Disease Control and Prevention (CDC).1

Covid-19 has disrupted vaccine coverage in many countries and may lead to a further increase in cases and deaths from measles and other vaccine preventable diseases.

Measles cases declined globally from 2010 to 2016 but have increased since then. In 2019 there were 869 770 cases of measles, the highest number since 1996, and an estimated 207 500 deaths, a 50% increase since 2016. The report called the numbers “a significant step backward.”

“We know how to prevent measles outbreaks and deaths,” said Tedros Adhanom Ghebreyesus, WHO director general. “These …
Patient Adherence to Screening for Lung Cancer in the US
Authors: Maria A. Lopez-Olivo, Kristin G. Maki, Noah J. Choi, Richard M. Hoffman, Ya-Chen Tina Shih, Lisa M. Lowenstein, Rachel S. Hicklen, Robert J. Volk
Journal: JAMA Network Open (2020)

<h3>Importance</h3> To be effective in reducing deaths from lung cancer among high-risk current and former smokers, screening with low-dose computed tomography must be performed periodically. <h3>Objective</h3> To examine lung cancer screening (LCS) adherence rates reported in the US, patient characteristics associated with adherence, and diagnostic testing rates after screening. <h3>Data Sources</h3> Five electronic databases (MEDLINE, Embase, Scopus, CINAHL, and Web of Science) were searched for articles published in the English language from January 1, 2011, through February 28, 2020. <h3>Study Selection</h3> Two reviewers independently selected prospective and retrospective cohort studies from 95 potentially relevant studies reporting patient LCS adherence. <h3>Data Extraction and Synthesis</h3> Quality appraisal and data extraction were performed independently by 2 reviewers using the Newcastle-Ottawa Scale for quality assessment. A random-effects model meta-analysis was conducted when at least 2 studies reported on the same outcome. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline. <h3>Main Outcomes and Measures</h3> The primary outcome was LCS adherence after a baseline screening. Secondary measures were the patient characteristics associated with adherence and the rate of diagnostic testing after screening. <h3>Results</h3> Fifteen studies with a total of 16 863 individuals were included in this systematic review and meta-analysis. The pooled LCS adherence rate across all follow-up periods (range, 12-36 months) was 55% (95% CI, 44%-66%). Regarding patient characteristics associated with adherence rates, current smokers were less likely to adhere to LCS than former smokers (odds ratio [OR], 0.70; 95% CI, 0.62-0.80); White patients were more likely to adhere to LCS than patients of races other than White (OR, 2.0; 95% CI, 1.6-2.6); people 65 to 73 years of age were more likely to adhere to LCS than people 50 to 64 years of age (OR, 1.4; 95% CI, 1.0-1.9); and completion of 4 or more years of college was also associated with increased adherence compared with people not completing college (OR, 1.5; 95% CI, 1.1-2.1). Evidence was insufficient to evaluate diagnostic testing rates after abnormal screening scan results. The main source of variation was attributable to the eligibility criteria for screening used across studies. <h3>Conclusions and Relevance</h3> In this study, the pooled LCS adherence rate after a baseline screening was far lower than those observed in large randomized clinical trials of screening. Interventions to promote adherence to screening should prioritize current smokers and smokers from minority populations.
Abstract 14575: Systematic Review and Meta-analysis of Intravascular Ultrasound-guided Percutaneous Left-main Coronary Artery Intervention
Authors: Sameer Saleem, Shuaibahmed Arab, Waqas Ullah, Sundas Younas, Bashar Al hemyari, SALIK NAZIR, Aniruddha Singh, Jacqueline Dawson Dowe, Avnish Tripathi, Muhammad Shoaib Akbar, Mohammed Kazimuddin, Mohammad Abdul-Waheed
Journal: Circulation (2020)

Introduction: Previous meta-analyses have reported reduced cardiovascular mortality and myocardial infarction in intravascular ultrasound-guided (IVUS) stent implantation in comparison to angiography-only approach. However, these studies have unanimously excluded patients with unprotected left-main coronary artery (LMCA) disease, questioning its widespread applicability. We performed a systematic review and meta-analysis to investigate the prognostic significance of IVUS-guided LMCA intervention. Methods: Studies comparing clinical outcomes between IVUS-guided and angiography-only percutaneous LMCA intervention were identified through PubMed, Cochrane and EMBASE databases until June, 2020. Data was analyzed using a random effect model to calculate the relative odds of all-cause death, cardiac death, left-main revascularization, myocardial infarction, stent thrombosis and stroke. Results: A total of 13 studies comprising 7680 patients were included. The odds of all-cause death (OR 0.6, 95%CI 0.47-0.78; p&lt;0.0001), cardiac death (OR 0.37, 95%CI 0.26-0.54; p&lt;0.00001), left-main revascularization (OR 0.63, 95%CI 0.45-0.89; p=0.009) and myocardial infarction (OR 0.77 [95%CI 0.60-0.98; p=0.04]) were significantly lower in patients who underwent IVUS-guided LMCA stent implantation compared to angiography-only approach. There was no significant difference observed in the relative odds of stent thrombosis (OR 0.57, 95%CI 0.31-1.05; p=0.07) and stroke (OR 1.7, 95%CI 0.56-5.14; p=0.35) between the two arms at least 1-year of the index procedure. A subgroup analysis based on study design and sensitivity analysis based on the characteristics of the included studies mirrored the pooled results. Conclusion: IVUS-guided LMCA intervention is associated with overall improved cardiovascular outcomes than angiography-only approach. Large scale randomized controlled trials are needed to validate our findings.
Covid-19: Governments should demand transparency on vaccine deals, says MSF
Authors: Shaun Griffin
Journal: BMJ (2020)

Medecins Sans Frontieres (MSF) has called on governments to demand transparency from pharmaceutical companies on covid-19 vaccine licensing deals, costs, trials, and data, as a condition of funding.

Developments in covid-19 vaccines are advancing rapidly, with interim results from US Pfizer1 and Russia’s Sputnik vaccine trials announced earlier this week. According to MSF, the UK government has contributed £84m (€94m; $111m) to support the development of AstraZeneca’s covid-19 vaccine, early results from which are expected imminently.

But the terms of the …
Repurposing a neurodegenerative disease drug to treat Gram-negative antibiotic-resistant bacterial sepsis
Authors: David M. P. De Oliveira, Lisa Bohlmann, Trent Conroy, Freda E.-C. Jen, Arun Everest-Dass, Karl A. Hansford, Raghu Bolisetti, Ibrahim M. El-Deeb, Brian M. Forde, Minh-Duy Phan, Jake A. Lacey, Aimee Tan, Tania Rivera-Hernandez, Stephan Brouwer, Nadia Keller, Timothy J. Kidd, Amanda J. Cork, Michelle J. Bauer, Gregory M. Cook, Mark R. Davies, Scott A. Beatson, David L. Paterson, Alastair G. McEwan, Jian Li, Mark A. Schembri, Mark A. T. Blaskovich, Michael P. Jennings, Christopher A. McDevitt, Mark von Itzstein, Mark J. Walker
Journal: Science Translational Medicine (2020)

The hydroxyquinoline analog PBT2 breaks resistance to polymyxin class antibiotics in polymyxin-resistant Gram-negative bacteria.
Life-course socioeconomic disadvantage and lung function: a multicohort study of 70 496 individuals
Authors: Vânia Rocha, Sílvia Fraga, Carla Moreira, Cristian Carmeli, Alexandra Lenoir, Andrew Steptoe, Graham Giles, Marcel Goldberg, Marie Zins, Mika Kivimäki, Paolo Vineis, Peter Vollenweider, Henrique Barros, Silvia Stringhini
Journal: European Respiratory Journal (2020)

Lung function is an important predictor of health and a marker of physical functioning at older ages. This study aimed to quantify the years of lung function lost according to disadvantaged socioeconomic conditions across the life-course.This multicohort study used harmonised individual-level data from six European cohorts with information on life-course socioeconomic disadvantage and lung function assessed by forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). 70 496 participants (51% female) aged 18-93 years were included. Socioeconomic disadvantage was measured in early life (low paternal occupational position), early adulthood (low educational level) and adulthood (low occupational position). Risk factors for poor lung function (e.g. smoking, obesity, sedentary behaviour, cardiovascular and respiratory diseases) were included as potential mediators. The years of lung function lost due to socioeconomic disadvantage were computed at each life stage.Socioeconomic disadvantage during the life-course was associated with a lower FEV1. By the age of 45 years, individuals experiencing disadvantaged socioeconomic conditions had lost 4-5 years of healthy lung function versus their more advantaged counterparts (low educational level -4.36 (95% CI -7.33--2.37) for males and -5.14 (-10.32--2.71) for females; low occupational position -5.62 (-7.98--4.90) for males and -4.32 (-13.31--2.27) for females), after accounting for the risk factors for lung function. By the ages of 65 years and 85 years, the years of lung function lost due to socioeconomic disadvantage decreased by 2-4 years, depending on the socioeconomic indicator. Sensitivity analysis using FVC yielded similar results to those using FEV1.Life-course socioeconomic disadvantage is associated with lower lung function and predicts a significant number of years of lung function loss in adulthood and at older ages.
Abstract 13907: Patients With NSTEMI Are at Higher Risk, Have Worse Outcomes, but Less Intense Cardiology Follow-up 1-3 Years Post-discharge: Findings From the TIGRIS Registry
Authors: Sibi N Krishnamurthy, Stuart Pocock, Prashant Kaul, Ruth Owen, Jiyan Chen, Shaun G Goodman, Christopher B Granger, Jose C Nicolau, Tabassome Simon, Dirk Westermann, Satoshi Yasuda, Karolina Andersson-Sundell, Gunnar Brandrup-Wognsen, Phillip Hunt, David Brieger, Mauricio G Cohen
Journal: Circulation (2020)

Introduction: Non-ST-elevation myocardial infarction (NSTEMI) patients have more comorbidities and extensive CAD than STEMI patients. However, there is a need for comparative data on the long-term prognosis and resource utilization of stable patients after these MI subtypes. Methods: TIGRIS enrolled 9027 stable patients 1-3 years post-MI (369 centers, 25 countries) with ≥1 risk factor (age ≥65 years, diabetes, 2nd prior MI, multivessel CAD, CKD). The incidence of cardiovascular (CV) events and deaths, and self-reported EQ-D5 score were recorded over 2 years. Multivariable Poisson regression models were used to compare STEMI and NSTEMI patients for relative risks, adjusting for prognostically relevant patient factors. Results: MI subtype was known in 8494 patients (STEMI: 56%; NSTEMI: 44%). At enrollment, NSTEMI patients were more likely to be older, have diabetes, hypertension, hyperlipidemia, and prior CAD compared with STEMI patients. NSTEMI patients had significantly poorer self-rated health and a lower use of dual antiplatelet therapy at discharge and 1-3 years later. NSTEMI patients had a higher incidence of the composite of MI, stroke and CV death over 2 years (5.6% vs 4.0%, p&lt;0.001) and higher all-cause mortality (4.1% vs 2.6%, p&lt;0.001) vs STEMI patients (Figure). These excess risks for the composite outcome attenuated after adjusting for baseline characteristics (adj RR 1.18, 95% CI 0.96-1.45, p=0.11), but remained significant for all-cause mortality (adj RR 1.31, 95% CI 1.02-1.68, p=0.03). Resource utilization over 2 years was higher in NSTEMI patients, although the mean number of cardiologist visits were higher for STEMI patients (4.2 vs 2.8, p&lt;0.001). Conclusions: NSTEMI patients had a less favorable risk profile and experienced more adverse CV events during long-term follow-up than STEMI patients, but had less intense cardiology follow-up. Continued efforts are needed to optimize secondary prevention and care of stable patients after NSTEMI.
Abstract 15017: Early Post-discharge Follow-up Delay After Hospitalization for Heart Failure With Preserved Ejection Fraction Reduces Readmission for Heart Failure in the Following Year
Authors: Patrick Prudhomme, Brault Gabriel, Pusca Laurence, Coderre Roxanne, Tétrault-Langlois Marianne, Hugo Lortie, Michel T Nguyen, Serge Lepage
Journal: Circulation (2020)

Introduction: Early physician follow-up after hospital discharge for acute decompensated heart failure (ADHF) is recommended by the AHA to prevent early hospital readmission. This recommendation has not been specifically evaluated for heart failure with preserved ejection fraction (HFpEF). Hypothesis: Earlier follow-up should lead to decrease in readmissions for ADHF in the HFpEF population even when adjusting for confounding factors. Methods: Consecutive ADHF hospitalisation that occurred inclusively between 2015 and 2018 were reviewed. Main inclusion criterion was left ventricular ejection fraction ≥45%. The major exclusion criteria were: severe valvulopathy, hypertrophic cardiomyopathy, acute coronary syndrome 3 months before hospitalisation, chronic kidney failure (eGFR &lt;30 ml/min), severe chronic respiratory disease and death before discharge. Follow-up delay after discharge was dichotomized (early vs late/no follow up) by using the median delay. Main outcome was hospital readmission in the year following discharge. Multivariate logistic regression was performed for main outcome according to follow-up delay and adjusted for age, sex, medication at discharge and major comorbid conditions. Results: A total of 163 heart failure readmission (37% of patients) occurred in 438 patients in the year following the first hospitalisation. Median readmission delay was of 62 days. Median dedicated follow-up delay was 30 days and was arranged in 68% of cases. After adjusting for confounding variables, early follow-up was significantly associated with fewer readmission (adjusted odds ratio 0.57, 95% CI; 0.34-0.97). Conclusions: Early dedicated follow-up after discharge for HFpEF was associated with fewer readmission over the year following discharge even when adjusting for major confounding variables.