tbuckley/cabot-search huggingface dataset:
Abstract 14763: Patients With a Perceived High-bleeding Risk in a Randomized Controlled Trial of Alert-based Computerized Decision Support for Stroke Prevention in Atrial Fibrillation: An Af-Alert Substudy
Authors: Gregory Piazza, Shelley Hurwitz, Brett Carroll, Samuel Z Goldhaber
Journal: Circulation (2020)

Introduction: A perceived increased risk of bleeding is one of the most frequent reasons for failure to prescribe anticoagulation for stroke prevention in atrial fibrillation (AF). We previously conducted a randomized controlled trial of alert-based computerized decision support (CDS) to increase prescription of antithrombotic therapy in 458 high-risk hospitalized patients with AF who were not being anticoagulated. Hypothesis: We hypothesized that patients with a perceived high risk for bleeding would have a similar HAS-BLED score and rate of major and clinically-relevant non-major bleeding. Methods: To determine the clinical characteristics and outcomes of these patients determined to be high-risk for bleeding, we analyzed the 248 patients in the alert group. Results: A perceived high risk of bleeding was the most common reason (77%) for omitting antithrombotic therapy. Median HAS-BLED scores were similar in these patients compared with those who were not deemed to have an increased bleeding risk (3 vs. 3, p=0.44). Despite being categorized as too high-risk for bleeding to receive antithrombotic therapy for stroke prevention at the time of the alert, nearly 12% of these patients were ultimately prescribed anticoagulation over the ensuing 90 days. The frequency of major and clinically-relevant non-major bleeding was similar between the two groups. Conclusions: In conclusion, a perceived high risk of bleeding was the most common reason for failure to prescribe antithrombotic therapy after the CDS alert. History of a prior bleeding event or underlying bleeding disorder was not reflected in a higher HAS-BLED score. Implementation of an alert-based CDS with specific attention to assessment of bleeding risk and mitigation warrants further study to encourage adherence to evidence-based clinical practice guideline recommendations for stroke prevention in AF.
Abstract P072: Income And Education Inequities Increase Hospitalizations In Atrial Fibrillation
Authors: Tarryn Tertulien, Andrew D Althouse, Amber E Johnson, Yimin Chen, Jared W Magnani
Journal: Circulation (2021)

Background: Individuals with atrial fibrillation (AF) experience increased hospitalization. Income and education are major social determinants of health, but their contributions to hospitalization risk in AF have had limited investigation. We examined the associations between (1) annual income and (2) educational attainment with hospitalization in a cohort with prevalent AF. Hypothesis: We hypothesized that individuals with lower income or education would have an increased risk of hospitalization. Methods: In an institutional cohort with prevalent AF, we related annual income (≤$19,000/year; $20,000-49,000/year; $50,000-99,000/year; ≥$100,000/year) and educational attainment (high school/vocational; some college; bachelor's; graduate) to hospitalization events. We used the Anderson-Gill model to accommodate multiple events per participant in models adjusted for relevant covariates and co-adjusted for income or education. Results: In 339 individuals with AF (age 72.3±10.1 years; 43% women) followed for a median of 2.6 years (range 0-3.4), we observed 417 hospitalization events. We observed an increase in hospitalization risk as income or education level decreased ( Figure A and B ). Individuals with the lowest annual income had a 2.5-fold increased hospitalization risk compared to the highest (95% Confidence Interval [CI] 1.29-4.71). Individuals with the lowest education had a 2-fold increased hospitalization risk than those with the highest education (95% CI 0.87-3.11). Conclusion: We identified inverse relations between hospitalization risk in individuals with AF and their income or education. Our findings support the consideration of social factors to reduce hospitalization risk in individuals with AF
Abstract 13008: Combined Assessment of American Heart Association Get With the Guidelines-heart Failure Risk Score With Plasma D-dimer and N-terminal Pro-b-type Natriuretic Peptide Levels Improves Prediction of Mortality in Patients Hospitalized for Worsening Heart Failure
Authors: Hiroyuki Naruse, Junichi Ishii, Hideto Nishimura, masaya ohta, Hideki Kawai, Takashi Muramatsu, Masahide Harada, Mutsuharu Hayashi, Akira Yamada, Sadako Motoyama, Masayoshi Sarai, Eiichi Watanabe, Yukio Ozaki, Hideo Izawa
Journal: Circulation (2020)

American Heart Association Get With the Guidelines-Heart Failure (GWTG-HF) risk score is a useful multivariable score model to predict mortality in patients with acutely decompensated heart failure. We prospectively investigated the prognostic value of combined assessment of GWTG-HF risk score with D-dimer and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Methods: On admission, we measured plasma D-dimer and NT-proBNP levels in 1735 patients (mean age, 75 yrs) hospitalized for worsening heart failure. GWTG-HF risk score, including race, age, systolic blood pressure, heart rate, blood urea nitrogen level, sodium concentration, and presence of chronic obstructive pulmonary disease, was calculated at admission. Results: During a follow-up period of 12 month after admission, 371 (21%) deaths occurred. Patients who died were older (mean: 78 vs. 74 years; P&lt;0.001), had a higher frequency of NYHA functional class IV (63 vs. 49%; P&lt;0.001), higher values of GWTG-HF risk score (43 vs. 38; P&lt;0.001), D-dimer (2.90 vs. 1.30 μg/mL; P&lt;0.001), and NT-proBNP (7202 vs. 3689 pg/mL; P&lt;0.001) than survivors. In the multivariate logistic analysis, elevation (more than the highest tertile value) in D-dimer (&gt;2.5 μg/mL; P&lt;0.001), NT-proBNP (&gt;7399 pg/mL; P&lt;0.001), and GWTG-HF risk score (&gt;42 point; P&lt;0.001) were independently associated with mortality within 12 months. Furthermore, adding D-dimer and NT-proBNP to the GWTG-HF risk score improved the C-index (P&lt;0.01), net reclassification improvement (P&lt;0.001), and integrated discrimination improvement (P&lt;0.001) greater than GWTG-HF risk score alone. The number of elevation in GWTG-HF risk score, D-dimer, and NT-proBNP was strongly associated with a higher risk of mortality within 12 months ( Figure ). Conclusion: The combined assessment of GWTG-HF risk score with D-dimer and NT-proBNP facilitates the risk stratification for mortality within 12 months in patients hospitalized for worsening heart failure.
Abstract 16093: Cardiology Clinic Integration Into a Primary Care Practice: Improving Access and Time to Testing
Authors: Lindsey E Scierka, Kim G Smolderen, Carlos Mena-hurtado
Journal: Circulation (2020)

Introduction: The demand for cardiovascular care has been increasing but there are numerous barriers to accessing care. No-show rates are higher for specialist visits and place an economic burden on the health care system. Integrating specialists into primary care practices can improve access and cardiovascular outcomes. We sought to describe a real-world experience of integrating a cardiology clinic into a primary care practice at a large health system and its association with access and process metrics. Methods: We compared two cohorts of patients requiring referral to a cardiologist from a primary care clinic at a large academic medical center over two years. The standard-referral cohort was referred to a cardiologist within the health system but outside of the clinic. The integrated-referral cohort was seen by a cardiologist integrated physically and clinically into the primary care clinic during a bi-weekly 4-hour clinic session. Information from both groups included demographics, medical history, referral information, and diagnostic testing. We documented patient access to a sub-specialist (as measured by time from cardiology referral to appointment), no-show rates, and time from referral to diagnostic testing. Results: The cohorts contained 27 and 39 patients, respectively. Overall, patients were 52.5% male, 68.9% non-Hispanic, 68.8% had Medicare or Medicaid as their primary insurance, and 47.6% had a prior cardiology referral. There were no statistically significant demographic differences between groups. Time to cardiologist for the standard-referral group was a mean of 49.3 + 11.1 days versus 12.4 + 1.6 days in the integrated referral group (p-value .004). Time to first diagnostic test was a mean of 60.6 + 35 days versus 20.0 + 15.9 days respectively (p-value .003). The no show rate for the standard-referral group was 33.3% and integrated-referral group was 12.8%, X 2 (1, N=66) = 4.017, p= .045. Conclusion: Integration of a cardiovascular sub-specialist into a primary care practice in a 4-hour bi-weekly session decreased time from referral to appointment, time to first diagnostic test, and no-show rate among patients in a university primary care practice. Further studies regarding the cost benefit analysis of integration would be beneficial.
Antineoplastic effect of a diphtheria toxin-based nanoparticle targeting acute myeloid leukemia cells overexpressing CXCR4
Authors: Victor Pallarès, Yáiza Núñez, Laura Sánchez-García, Aïda Falgàs, Naroa Serna, Ugutz Unzueta, Alberto Gallardo, Lorena Alba-Castellón, Patricia Álamo, Jorge Sierra, Antonio Villaverde, Esther Vázquez, Isolda Casanova, Ramon Mangues
Journal: Journal of Controlled Release (2021)
Abstract P170: Cardiovascular-related Pregnancy Complications: Associations With Health Behaviors And Mental Health During The Covid-19 Pandemic
Authors: Jennifer E Phipps, Machelle D Wilson, Imo A Ebong, Herman L Hedriana, Leigh Ann Simmons
Journal: Circulation (2021)

Pregnancies with cardiovascular (CV) complications are more likely to involve additional complications, poorer short and long-term health, and worse fetal outcomes. Additionally, CV complications are associated with poorer mental health, lower socioeconomic status, and non-White race/ethnicity. The COVID-19 pandemic has had negative effects on mental well-being and disproportionately affects people of lower socioeconomic status and non-White race/ethnicity. Thus, we hypothesized that the pandemic would differentially affect pregnant people with and without CV complications. We performed a cross-sectional survey of 465 pregnant people in California from June 6 through July 29, 2020. Twenty-three participants reported CV complications (e.g., hypertensive disorders, gestational diabetes) and 29 participants reported non-CV complications. The CV group was 56.5% (13 of 23) Latinx and 43.5% (10 of 23) White versus the uncomplicated pregnancy group, which was 33.7% (137 of 407) Latinx and 66.3% (270 of 407) White (chi-square, p=0.03; 6 respondents did not answer). The CV complications group was 9.5% (2 of 21) African American and the uncomplicated pregnancy group was 4.9% (19 of 392) African American (Fisher’s Exact, p=0.053; 23 respondents did not answer). We assessed 64 health behaviors reported on a Likert scale with the Wilcoxon 2-Sample Test and found the CV group reported more health-promoting behaviors, including: less likely to eat sweets (p=0.004), more likely to sanitize frequently used areas in their homes and their groceries (p=0.049 and 0.069, respectively). However, they were also more likely to smoke cigarettes (p=0.02). While the two groups did not differ significantly on stress, depression, or anxiety, the CV group was more likely to worry that their babies may be hospitalized after birth (p=0.01) and their provider may be unavailable during delivery (p=0.047). Concerns for self and baby trended towards significance for the CV group, which reported being more likely to worry about getting sick (p=0.077) and their babies being born early (p=0.079) or getting sick (p=0.098). While preliminary, these data suggest that COVID-19 disproportionately affects pregnant people with prenatal CV complications. Given limited research on pregnancy during COVID-19 and the primary focus on biological outcomes, these findings indicate a clear need to address the pandemic’s influence on behavioral and emotional health during pregnancy - especially for those with CV complications who are at higher risk of poor maternal and fetal outcomes.
Response to: ‘Correspondence on ‘Second COVID-19 infection in a patient with granulomatosis with polyangiitis on rituximab’’ by Tampe<i>et al</i>
Authors: Marcia A Friedman, Kevin L Winthrop
Journal: Annals of the Rheumatic Diseases (2021)

We read with great interest the report by Tampe et al regarding their patient with granulomatosis with polyangiitis on rituximab who developed a serological response to SARS-CoV-2 and attenuated viral spread only after B cell reconstitution.1 This is an important observation, which is logical and further supports the recommendations to time the SARS-CoV-2 vaccine towards the end of the rituximab cycle and, if possible, to delay rituximab until 2–4 weeks after the second SARS-CoV-2 vaccination.2 3 While we agree with the …
Direct reprogramming of somatic cells into induced hepatocytes: Cracking the Enigma code
Authors: Matthias Rombaut, Joost Boeckmans, Robim M. Rodrigues, Leo A. van Grunsven, Tamara Vanhaecke, Joery De Kock
Journal: Journal of Hepatology (2021)

There is an unmet need for functional primary human hepatocytes to support the pharmaceutical and (bio)medical demand. The unique discovery, a decade ago, that somatic cells can be drawn out of their apparent biological lockdown to reacquire a pluripotent state has revealed a completely new avenue of possibilities for generating surrogate human hepatocytes. Since then, the number of papers reporting the direct conversion of somatic cells into induced hepatocytes (iHeps) has burgeoned. A hepatic cell fate can be established via the ectopic expression of native liver-enriched transcription factors in somatic cells, thereby bypassing the need for an intermediate (pluripotent) stem cell state. That said, understanding and eventually controlling the processes that give rise to functional iHeps remains challenging. In this review, we provide an overview of the state-of-the-art reprogramming cocktails and techniques, as well as their corresponding conversion efficiencies. Special attention is paid to the role of liver-enriched transcription factors as hepatogenic reprogramming tools and small molecules as facilitators of hepatic transdifferentiation. To conclude, we formulate recommendations to optimise, standardise and enrich the in vitro production of iHeps to reach clinical standards, and propose minimal criteria for their characterisation.
Prospective Case-Control Study of Cardiovascular Abnormalities 6 Months Following Mild COVID-19 in Healthcare Workers
Authors: George Joy, Jessica Artico, Hibba Kurdi, Andreas Seraphim, Clement Lau, George D. Thornton, Marta Fontes Oliveira, Robert Daniel Adam, Nikoo Aziminia, Katia Menacho, Liza Chacko, James T. Brown, Rishi K. Patel, Hunain Shiwani, Anish Bhuva, Joao B. Augusto, Mervyn Andiapen, Aine McKnight, Mahdad Noursadeghi, Iain Pierce, Timothée Evain, Gabriella Captur, Rhodri H. Davies, John P. Greenwood, Marianna Fontana, Peter Kellman, Erik B. Schelbert, Thomas A. Treibel, Charlotte Manisty, James C. Moon
Journal: JACC. Cardiovascular imaging (2021)

The purpose of this study was to detect cardiovascular changes after mild severe acute respiratory syndrome-coronavirus-2 infection.
The clinical impact of nonsustained ventricular tachycardia to the risk for sudden cardiac death in patients with non-ischemic dilated cardiomyopathy
Authors: S Kitamura, Kazuhiro Satomi, Takashi Kurita, Wataru Shimizu, Kazuhiro Suyama, Naohiko Aihara, Shiro Kamakura
Journal: Circulation (2005)
Resurrection of Ancestral Malate Dehydrogenases Reveals the Evolutionary History of Halobacterial Proteins: Deciphering Gene Trajectories and Changes in Biochemical Properties
Authors: Samuel Blanquart, Mathieu Groussin, Aline Le Roy, Gergely J Szöllosi, Eric Girard, Bruno Franzetti, Manolo Gouy, Dominique Madern
Journal: Molecular Biology and Evolution (2021)

Extreme halophilic Archaea thrive in high salt, where, through proteomic adaptation, they cope with the strong osmolarity and extreme ionic conditions of their environment. In spite of wide fundamental interest, however, studies providing insights into this adaptation are scarce, because of practical difficulties inherent to the purification and characterization of halophilic enzymes. In this work, we describe the evolutionary history of malate dehydrogenases (MalDH) within Halobacteria (a class of the Euryarchaeota phylum). We resurrected nine ancestors along the inferred halobacterial MalDH phylogeny, including the Last Common Ancestral MalDH of Halobacteria (LCAHa) and compared their biochemical properties with those of five modern halobacterial MalDHs. We monitored the stability of these various MalDHs, their oligomeric states and enzymatic properties, as a function of concentration for different salts in the solvent. We found that a variety of evolutionary processes, such as amino acid replacement, gene duplication, loss of MalDH gene and replacement owing to horizontal transfer resulted in significant differences in solubility, stability and catalytic properties between these enzymes in the three Halobacteriales, Haloferacales, and Natrialbales orders since the LCAHa MalDH. We also showed how a stability trade-off might favor the emergence of new properties during adaptation to diverse environmental conditions. Altogether, our results suggest a new view of halophilic protein adaptation in Archaea.
Abstract 15293: Noninvasive Echocardiographic Cardiac Power Output Predicts Mortality in Cardiac Intensive Care Unit Patients
Authors: Barry Burstein, Vidhu Anand, Bradley Ternus, Meir Tabi, Nandan S Anavekar, Barry A Borlaug, Gregory W Barsness, Garvan Kane, Jae K Oh, Jacob C Jentzer
Journal: Circulation (2020)

Introduction: A low cardiac power output (CPO), measured invasively, identifies critically ill patients at increased risk of mortality. CPO can also be measured non-invasively with transthoracic echocardiography (TTE), although prognostic data in critically ill patients is not available. Hypothesis: Reduced CPO measured by TTE is associated with increased hospital mortality in cardiac intensive care unit (CICU) patients. Methods: Using a database of CICU patients admitted between 2007 and 2018, we identified patients with TTE within one day (before or after) of CICU admission who had data necessary for calculation of CPO. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality. Results: We included 5,585 patients with a mean age of 68.3±14.8 years, including 36.7% females. Admission diagnoses included acute coronary syndrome (ACS) in 57%, heart failure (HF) in 50%, cardiac arrest (CA) in 12%, and cardiogenic shock (CS) in 13%. The mean left ventricular ejection fraction (LVEF) was 47±16%, and the mean CPO was 1.0±0.4 W. CPO was inversely associated with the risk of hospital mortality (Figure A), including among patients with ACS, HF, and CS (Figure B). On multivariable analysis, lower CPO was associated with higher hospital mortality (OR 0.96 per 0.1 W, 95% CI 0.0.93-0.99, p=0.03). Hospital mortality was highest in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate. Hospital mortality was higher among patients with a CPO &lt;0.6 W (adjusted OR 1.57, 95% CI 1.13-2.19, p = 0.007), particularly in the presence of admission lactate level &gt;4 mmol/L (50.9%). Conclusions: Echocardiographic CPO was inversely associated with hospital mortality in CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine measurement of CPO provides important information beyond LVEF and should be considered in CICU patients.
Abstract 13128: Development and Initial Utilization of a Multi-institutional Distributed Data Network Designed to Evaluate Real-world Clinical Outcomes in Patients Presenting for Percutaneous Coronary Intervention (PCI): Results From the <i>Building the Unique Device Identifier (UDI) Into Longitudinal Data for Medical Device Evaluation</i> (BUILD) Network
Authors: Joseph B Muhlestein, Jove Graham, James Tcheng, Andrew McKinnon, Stacey Knight, Heidi T May, Tami L Bair, Joseph P Drozda
Journal: Circulation (2020)

Introduction: Generating real-world evidence for regulatory and research purposes is a fundamental transformation of healthcare. To develop and demonstrate the operational components, we created the BUILD network, a framework for the longitudinal follow-up of all patients undergoing PCI at three large health systems, Mercy, Geisinger, and Intermountain. It leverages consistent data through a standardized common data model using distributed analyses without site-specific programming or external transfer of clinical data. To demonstrate BUILD’s potential, we evaluated clinical outcomes between two commonly used drug-eluting coronary stents. Methods: We included all patients receiving zotarolimus, or everolimus stents from 2012-19. Data were compiled from registries and electronic health/billing records systems without explicit chart abstraction, and retained at each site in the BUILD analysis database. A common query examined 32 baseline covariates, created propensity-matched cohorts, assessed for balance, and compared 1-year major adverse cardiac event (MACE) rates between groups, with weighted data combined to create event-free survival plots. Results: We identified 11,030 patients (Mercy=4,906, Geisinger=4,109, Intermountain=127; mean age 65±12, 69% males, 23% zotarolimus). Figure 1 shows hazard ratios and survival curves for the composite endpoints in matched cohorts. Differences in subsequent PCI, mortality, and composite MACE were not significantly different between stent types. Conclusions: This large real-world, multicenter demonstration project showed no statistical differences in 1-year clinical outcomes of patients receiving zotarolimus versus everolimus stents—results similar to other studies. More importantly, it demonstrated that multi-institutional data networks can be successfully developed to provide clinically relevant evidence while maintaining the source data locally on-premise at each institution.