tbuckley/cabot-search huggingface dataset:
Efficacy of COVID-19 Vaccines Against Active Comparators or Inert Placebos
Authors: Aldo Pietro Maggioni, Felicita Andreotti
Journal: JAMA Internal Medicine (2021)

particularly within the higher ranks of cardiology and gastroenterology (Figure 2).Discussion | Our analysis of the 2018 to 2019 AAMC Faculty Salary Report from 154 US medical schools demonstrates persistent salary differences by gender and representation disparities in IM specialties, despite the increasing number of women in IM.We found that nonprocedural IM specialties exhibited closer parity in both salary and representation, whereas procedural specialties had low female representation with the largest salary disparities.Within IM, unadjusted salary differences between genders appear to be improving over time.Yet, substantial salary inequities persist at the highest faculty levels and specifically in procedural-based specialties. 4 Our findings regarding the disparities in procedural IM specialties align with recent works that examined both academic and nonacademic physician salaries and found that the largest gender differences in salary across multiple medical and surgical specialties existed among specialties and practices with the highest proportion of male physicians. 5,6 The reasons for this remain unclear; IM procedural specialties have long been male dominated in composition and leadership, despite increasing gender parity in the preceding training stages.Taken together, these findings suggest that workforce gender parity was associated with salary equity, and further investigation of the disparities in procedural specialties is needed.Limitations include inability to adjust for additional individual-level factors that may affect salary, including professional service, academic productivity, clinical volume, and ancillary funding sources, and these factors are likely also influenced by gender, race, and geography.Our findings may not be generalizable across all US medical schools given the heterogeneity in IM departmental structures.Despite the influence of potential confounders, these unadjusted genderdisaggregated data provide important insights regarding physician workforce composition and salary.Our findings suggest that salary disparities persist in US IM specialties and are most pronounced in procedural specialties with fewer women.These findings emphasize the importance of gender diversity to achieving salary parity in IM subspecialties and highlight opportunities to improve representation and salary equity in IM procedural specialties.
The Complex and Diverse Genetic Architecture of Dilated Cardiomyopathy
Authors: Ray E. Hershberger, Jason Cowan, Elizabeth Jordan, Daniel D. Kinnamon
Journal: Circulation Research (2021)

Our insight into the diverse and complex nature of dilated cardiomyopathy (DCM) genetic architecture continues to evolve rapidly. The foundations of DCM genetics rest on marked locus and allelic heterogeneity. While DCM exhibits a Mendelian, monogenic architecture in some families, preliminary data from our studies and others suggests that at least 20% to 30% of DCM may have an oligogenic basis, meaning that multiple rare variants from different, unlinked loci, determine the DCM phenotype. It is also likely that low-frequency and common genetic variation contribute to DCM complexity, but neither has been examined within a rare variant context. Other types of genetic variation are also likely relevant for DCM, along with gene-by-environment interaction, now established for alcohol- and chemotherapy-related DCM. Collectively, this suggests that the genetic architecture of DCM is broader in scope and more complex than previously understood. All of this elevates the impact of DCM genetics research, as greater insight into the causes of DCM can lead to interventions to mitigate or even prevent it and thus avoid the morbid and mortal scourge of human heart failure.
Late Outcomes of the RAPID-TnT Randomized Controlled Trial: 0/1-Hour High-Sensitivity Troponin T Protocol in Suspected ACS
Authors: Kristina Lambrakis, Cynthia Papendick, John K. French, Stephen Quinn, Andrew Blyth, Anil Seshadri, Michael J.R. Edmonds, Anthony Chuang, Ehsan Khan, Adam J. Nelson, Deborah Wright, Matthew Horsfall, Erin Morton, Jonathan Karnon, Tom Briffa, Louise A. Cullen, Derek P. Chew
Journal: Circulation (2021)

High-sensitivity troponin assays are increasingly being adopted to expedite evaluation of patients with suspected acute coronary syndromes. Few direct comparisons have examined whether the enhanced performance of these assays at low concentrations leads to changes in care that improves longer-term outcomes. This study evaluated late outcomes of participants managed under an unmasked 0/1-hour high-sensitivity cardiac troponin T (hs-cTnT) protocol compared with a 0/3-hour masked hs-cTnT protocol.We conducted a multicenter prospective patient-level randomized comparison of care informed by unmasked 0/1-hour hs-cTnT protocol (reported to <5 ng/L) versus standard practice masked hs-cTnT testing (reported to ≤29 ng/L) assessed at 0/3 hours and followed participants for 12 months. Participants included were those presenting to metropolitan emergency departments with suspected acute coronary syndromes, without ECG evidence of coronary ischemia. The primary end point was time to all-cause death or myocardial infarction using Cox proportional hazards models adjusted for clustering within hospitals.Between August 2015 and April 2019, we randomized 3378 participants, of whom 108 withdrew, resulting in 12-month follow-up for 3270 participants (masked: 1632; unmasked: 1638). Among these, 2993 (91.5%) had an initial troponin concentration of ≤29 ng/L. Deployment of the 0/1-hour hs-cTnT protocol was associated with reductions in functional testing. Over 12-month follow-up, there was no difference in invasive coronary angiography (0/1-hour unmasked: 232/1638 [14.2%]; 0/3-hour masked: 202/1632 [12.4%]; P=0.13), although an increase was seen among patients with hs-cTnT levels within the masked range (0/1-hour unmasked arm: 168/1507 [11.2%]; 0/3-hour masked arm: 124/1486 [8.3%]; P=0.010). By 12 months, all-cause death and myocardial infarction did not differ between study arms overall (0/1-hour: 82/1638 [5.0%] versus 0/3-hour: 62/1632 [3.8%]; hazard ratio, 1.32 [95% CI, 0.95-1.83]; P=0.10). Among participants with initial troponin T concentrations ≤29 ng/L, unmasked hs-cTnT reporting was associated with an increase in death or myocardial infarction (0/1-hour: 55/1507 [3.7%] versus 0/3-hour: 34/1486 [2.3%]; hazard ratio, 1.60 [95% CI, 1.05-2.46]; P=0.030).Unmasked hs-cTnT reporting deployed within a 0/1-hour protocol did not reduce ischemic events over 12-month follow-up. Changes in practice associated with the implementation of this protocol may be associated with an increase in death and myocardial infarction among those with newly identified troponin elevations. Registration: URL: https://www.anzctr.org.au; Unique identifier: ACTRN12615001379505.
Medication Use Patterns in Hospitalized Patients With COVID-19 in California During the Pandemic
Authors: Jonathan H. Watanabe, Jimmy Kwon, Bin Nan, Shira R. Abeles, Stanley Jia, Sanjay R. Mehta
Journal: JAMA Network Open (2021)

This cohort study examines trends in medication use among patients hospitalized for COVID-19–related treatment in a large US university health care system from the start of stay-at-home orders in March 2020 throughout the rest of the year.
Abstract 16025: The Association of Cardiology Billing Patterns With Healthcare Utilization and Clinical Outcomes in Atrial Fibrillation Patients
Authors: Eugene Crystal, Anna Kaoutskaia, Dennis T Ko, Cherry Chu, Shojania Kaveh, Paul Dorian, Bing Yu, Mohammed Shurrab, Jiming Fang, Heather Ross, Austin Peter, Zachary Bouck, Shaun G Goodman, Sacha Bhatia
Journal: Circulation (2020)

Introduction: The relationship between health care utilization and clinical outcomes in patients (pts) with atrial fibrillation (AF) is unknown. The objective of this study was to investigate whether cardiologists’ billing patterns are associated with different patient-level clinical outcomes. Methods: A retrospective cohort study was conducted using claims data in Ontario, Canada between April 1, 2011 and March 31, 2016. This study included all cardiologists who had at least 25 AF pts per year, and whose billings were ≥80% fee-for service. The cardiologists were stratified into quintiles based on their median billing per patient over the study period. The primary outcomes were patient-level receipt of repeat visits, cardiac diagnostic tests, medications ≤1 year of index date. The secondary clinical outcomes were death, emergency department visits and all-cause hospitalization at 1 year post-index visit. Results: The patient cohort was comprised of 182,572 AF pts (median age 74 years, 58% male) from 467 cardiologists. AF pts seen by higher billing cardiologists were more likely to undergo diagnostic tests within the first year of the index visit. Pts were 26% more likely to have an echocardiogram (adjusted odds ratio [aOR] 1.26 [95% CI, 1.13 to 1.39]), 28% a stress test (aOR 1.28 [1.15-1.42]), 25% Holter monitoring (aOR 1.25 [1.10-1.40]), and 80% more likely to get a stress echocardiogram (aOR 1.80 [1.49-2.10]), highest vs quintile 2. (Figure). Pts across billing quintiles received similar medical therapy. AF pts seen by higher billing cardiologists had a higher rate of all-cause hospitalization (aOR 1.13 [1.07- 1.19]); mortality rates were similar across cardiologists billing quintiles (e.g., aOR 0.98 [0.91- 1.04] for quintile 4 vs 2). Conclusion: Cardiologists who bill more per patient tend to order more diagnostic tests per AF patient but these are not associated with lower rates of hospitalization or death.
Abstract 16879: Utility of Transthoracic Echocardiography in Adult Patients With D-Transposition of the Great Arteries and Atrial Switch Operation
Authors: Ran Xiao, Christopher R Broda, Darren Harrison, Shivani R Aggarwal, Peter R Ermis, Angeline Opina, Wayne Franklin, Dhaval R Parekh, Wilson W Lam
Journal: Circulation (2020)

Introduction: Per 2018 ACC AHA adult congenital heart disease guidelines, routine transthoracic echocardiography (TTE) is recommended for follow-up in patients with d-transposition of the great arteries (dTGA) after atrial switch operation at least annually. Little data are available to suggest utility in clinical management with frequent surveillance, either with or without symptoms. Hypothesis: We hypothesized that frequent TTEs would not lead to significant clinical changes in management and that TTEs performed for symptoms would lead to more detection of pathology and clinically relevant management decisions. Methods: We conducted a retrospective review of all echocardiograms performed for dTGA patients corrected with the atrial switch procedure at Texas Children’s Hospital from 2000-2009 to obtain baseline TTEs and 2010-2019 to analyze for changes in clinical management, associated with TTE performance. Results: We identified 50 patients with dTGA and atrial switch operation with 54% Mustard operation. A total of 333 echocardiograms were performed (6.7/person), 30% (100) with symptoms. The average age at time of all TTEs was 35 +/- 11 years. Most frequent symptoms were palpitations (n=39), dyspnea (n=30), and fatigue (n=27). Changes in management occurred after 9% of studies (10/100 of symptomatic, 21/233 asymptomatic patients, p = NS). Most of these were medication changes (n=18, 11 asymptomatic) and advanced imaging (n=12, 9 asymptomatic). Invasive management after TTE was rare (1 baffle stenting in asymptomatic patient) but after advanced imaging included 4 baffle stent implantations (3 asymptomatic). The interval between TTEs was 1.2 +/- 0.9 years, regardless of symptoms. Conclusions: In dTGA patients after atrial switch operation, routine screening TTEs and symptomatic TTEs had similar yield in detecting pathology leading to a clinical change in management. TTE and subsequent advanced imaging preceded invasive intervention (baffle stenting) in 10% of patients, mostly asymptomatic. Less frequent surveillance TTEs in asymptomatic and advanced imaging in symptomatic dTGA patients with atrial switch operation is cost-effective and should be considered .
Covid-19: Global response was too slow and leadership absent, report finds
Authors: Jacqui Wise
Journal: BMJ (2021)

The covid-19 pandemic was a preventable disaster with weak links at every point in the chain of preparedness and response, according to a high level review panel.

The report from the Independent Panel for Pandemic Preparedness and Response, Covid-19: Make it the last pandemic , concluded that the alert system was too slow, the World Health Organization was underpowered, and global political leadership was absent.1

The report was commissioned by the WHO director general in response to a resolution at the World Health Assembly made in May 2020. The 13 member panel spent eight months reviewing the evidence on the spread, actions, and responses to the pandemic.

The report says covid-19 has been a terrible wake-up call and “the 21st century’s Chernobyl moment.” It says that the …
Abstract 17030: Stress-Related Neurobiological Activity Contributes to the Link Between Cardiovascular Polygenic Risk Score and Myocardial Infarction
Authors: Taimur Abbasi, Shady Abohashem, Tawseef Dar, Ahmed Ghoneem, Nicki Naddaf, Hadil Zureigat, Akl C Fahed, Krishna Aragam, Amit V Khera, Michael Osborne, Ahmed A Tawakol
Journal: Circulation (2020)

Introduction: A polygenic risk score for coronary artery disease (PRS CAD ) integrates information from many sites of DNA variation into a single metric of inherited susceptibility. Heightened metabolic activity of the amygdala (AmygA), a stress-associated brain center, associates with increases in leukopoietic activity, atherosclerosis and CVD risk. We hypothesized that genes included in the PRS CAD link to MI in part by encoding for heightened stress-associated neurobiological activity. Accordingly, we tested whether CVPRS associates with heightened AmygA as a contributing factor linking high CVPRS and CVD events. Methods: Individuals (N=16821, median age (IQR): 63 (52, 74) years, 46% male) were identified from the Partners Biobank where genome-wide PRS CAD and principle components of ancestry (PCI) were calculated. Using validated 18 FDG-PET/CT imaging methods, AmygA was measured in individuals with prior clinical imaging (N=854). MI incidence was derived using International Classification of Diseases (ICD) diagnoses. Traditional CVD risk factors and psychiatric history were obtained using ICD codes and questionnaires and were used for covariable adjustments. Linear and logistic regression were employed. Results: A total of 2046 (12.1%) participants experienced an MI. PRS CAD associated with increased AmygA after adjusting for age and sex (β [95% confidence interval (CI)]: 0.099 [0.015, 0.183], p=0.021) as well as increased MI incidence (odds ratio (OR) [95% CI]: 1.208 [1.120, 1.302], p&lt;0.001) ( Table 1, Figure 1 ). Concurrently, AmygA associated with increased MI incidence in adjusted analyses (OR [95% CI]: 1.451 [1.061, 1.983], p=0.003). Conclusion: High PRS CAD associates with higher AmygA and AmygA in-turn associates with MI. These findings suggest increased stress-related neurobiological activity may contribute to the link between PRS CAD and MI.
Abstract 15108: Phenotypic Associations and Clinical Outcomes of Genetically Predicted Left Ventricular End Systolic Diameter in Prevalent Heart Failure
Authors: Jacob Ramsey, Eric Farber-Eger, Brandon Lowery, Jonathan Mosley, Quinn Wells
Journal: Circulation (2020)

Introduction: Varying degrees of systolic dysfunction after myocardial injury suggest a genetic basis for cardiac contractile reserve. Left ventricular end systolic dimension (LVESD), acquired by transthoracic echocardiography (TTE), is a proxy for cardiac contractility, and common variation underlying LVESD may offer insight into the underlying biology and clinical manifestations of heart failure (HF) and related phenotypes. Hypothesis: We hypothesized that elevations in genetically predicted LVESD would be associated with prevalent HF with reduced ejection fraction (HFrEF), but not HF with preserved ejection fraction (HFpEF), and with mortality among those with established HF. Methods: LVESD measurements (n = 7,630) were extracted for adults of European ancestry with available genome-wide genotyping who had also undergone clinically indicated TTE at Vanderbilt University Medical Center (VUMC). A polygenic risk score (PRS) for LVESD was created and validated in a separate cohort. HF status was defined using a validated algorithm. Logistic regressions were used to test for association of the PRS with prevalent HFrEF and HFpEF. Cox proportional hazards was used to test for association between PRS and incident death among (2,672) subjects with HF. All models were conducted in R and adjusted for age and sex. Results: A linear model of measured LVESD was significant for PRS (R^2 = 0.092, p &lt; 0.001). The PRS was significantly associated with prevalent HFrEF (OR 1.15 per SD, p &lt; 0.003) but not HFpEF. Genetically predicted LVSD was not associated with mortality among patients with HF (OR 1.01, p = 0.83). Conclusions: Genetically predicted LVESD, assessed by PRS, was associated with risk of prevalent HFrEF but not HFpEF. LVESD PRS was not associated with incident death in subjects with overall HF. These results suggest a potential role of LVSD PRS in HFrEF risk stratification, and further research should explore the relationship between LVESD PRS and incident HF.
Abstract 16601: Impact of Insurance Status on Emergent Versus Non-Emergent Hospital Encounters Among Adults With Congenital Heart Disease
Authors: Anushree Agarwal, Michelle Z GURVITZ, Janet Myers, Sarthak Jain, Abigail Khan, gregory nah, Ian S Harris, Vaikom S Mahadevan, Peter C Kouretas, Gregory M Marcus
Journal: Circulation (2020)

Background: Arguments against universal health insurance are ongoing, but insurance coverage may be beneficial in high-risk populations such as adults with congenital heart disease (ACHD). While the number of hospital visits have exponentially increased for ACHD over the last few decades, the impact of insurance on the type of hospital encounters remains unknown. Hypothesis: Uninsured ACHD patients are more likely to have emergent hospital encounters than those insured. Methods: Using California Office of Statewide Health Planning and Development Database from 01/2005 to 10/2015, we identified all hospital encounters that were emergent (which might or might not have resulted in an admission) or nonemergent among ACHD ≥18 years old. We determined the trends over time and odds of insurance status on emergent vs. nonemergent encounters. Results: Among 69,876,425 encounters, 72,142 were in patients with CHD diagnoses (mean age 49±12 years, 43% males, 52% Caucasian, 4% uninsured). 78% had severe CHD and 75% had a comorbidity. From 2005 to 2015, while all ACHD encounters increased by 108% (p for trend &lt;0.0001), there was significantly higher increase in emergent than nonemergent encounters (331% vs. 87%; p&lt;0.0001). The ratio of emergent:nonemergent encounters was significantly higher for uninsured than insured patients (3.18 vs. 1.02; p&lt;0.0001). Non-cardiac diagnoses were more common among emergent than non-emergent encounters (68% vs. 36%; p&lt;0.0001). Both before and after multivariable adjustment, uninsured status was associated with a significantly higher odds of emergent encounters for all ACHD (Figure), irrespective of CHD type, exhibiting the largest magnitude of effect compared to any other predictor. Conclusions: Efforts to enhance the ability to obtain and maintain insurance throughout the lifetime of ACHD patients might result in meaningful reductions in emergency encounters and a more efficient use of resources.
Abstract 15118: Pulmonary Valve Preservation During Tetralogy of Fallot Repair is Associated With Enhanced Pulmonary Valve and Right Ventricular Function
Authors: Alvise Guariento, Martina Avesani, Chiara A Schiena, Ilias P Doulamis, Massimo A Padalino, biagio castaldi, GIOVANNI DI SALVO, Vladimiro L Vida
Journal: Circulation (2020)

Introduction: Many centers have recently adopted pulmonary valve (PV) preservation procedures to prevent the detrimental long-term effects of chronic pulmonary regurgitation after tetralogy of Fallot (ToF) repair. Hypothesis: Here, we investigated PV and right ventricular function after PV preservation surgical strategies compared to standard transannular patch (TAP) repair. Methods: All patients undergoing transatrial-transpulmonary repair for ToF with PV stenosis at our institution between January 2007 and May 2020 were reviewed retrospectively. Patients were divided into 2 main groups, according to the different techniques used: patients undergoing a PV preservation strategy and patients undergoing TAP repair. Results: Overall, 82 patients underwent a successful PV preservation strategy while 34 underwent a standard TAP repair. At index surgery, BSA (0.31±0.1 m 2 , P=0.3), age (4.8±0.3 months, P=0.5) and preoperative PV Z-score (-3.20±0.1, P=0.1) did not differ between groups. Five-year actuarial freedom from moderate/severe PV regurgitation was significantly higher in the PV preservation group compared to the TAP (61.3% [95% CI: 48-73%] vs 25.9% [95% CI: 12-43%], respectively; p=0.02). After adjusting for age, gender, BSA, and type of PV, the use of a TAP was still significantly associated with an increased risk for PV regurgitation at follow up (HR: 1.85, 95% CI: 1.09, 3.15; p=0.02). At a mean follow-up of 6.9±0.3 years, patients undergoing PV preservation showed an increased right ventricular fractional area change (46.9±0.8% vs 42.5±1.7%, P&lt;0.001) and tricuspid annular plane systolic excursion z-score (-3.36±0.3% vs -4.7±0.4%, P=0.005), while maintaining better PV competence in terms of pulmonary regurgitation index (87.9±1.2% vs 82.7±2.4%, P=0.02). Conclusions: Surgical repair of ToF with PV preservation provides excellent outcomes in terms of PV competence and right ventricular function and should be advocated whenever possible.
31P Association between breast cancer protein truncating variants and febrile neutropenia breast cancer patients treated with taxane or anthracycline chemotherapy in Singapore
Authors: S.S. Ong, P.J. Ho, A.J. Khng, G.H. Lim, S.H. Lim, S.G.W. Ow, J.S. Pang, B. Kiat Tee Tan, E.Y. Tan, S.M. Tan, V. Kiak Mien Tan, F.Y. Wong, J. Li, M. Hartman
Journal: Annals of Oncology (2021)
Cochrane review update leaves big questions unanswered regarding vaping: implications for medical practitioners
Authors: Kielan Darcy McAlinden, Kathryn Barnsley, Heinrich C. Weber, Greg Haug, Collin Chia, Mathew Suji Eapen, Sukhwinder Singh Sohal
Journal: European Respiratory Journal (2021)

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