tbuckley/cabot-search huggingface dataset:
Abstract 16732: Medical Malpractice Claims and Percutaneous Coronary Intervention Mortality Among Interventional Cardiologists - Evidence From New York
Authors: Vishal S Arora, Robert W Yeh, Changyu Shen, Rishi Wadhera
Journal: Circulation (2020)

Introduction: The medical malpractice liability system aims to identify poorly performing providers and improve the quality and safety of health care by deterring negligence, but there is concern that the current system may not accomplish these objectives. We evaluated whether interventional cardiologists who previously lost or settled a malpractice lawsuit had higher risk-adjusted mortality rates (RAMR) for percutaneous coronary intervention (PCI) in New York State. Methods: We used the Physician Profile website to identify information on demographics as well as lost or settled malpractice lawsuits for interventional cardiologists in New York State between 2010 and 2016. Publicly reported data from the New York State Department of Health was used to determine RAMR for interventional cardiologists who performed PCIs between 2014 and 2016. We then fit a multivariable linear regression model to examine the association between a prior lost or settled malpractice lawsuit and RAMR among interventional cardiologists, adjusted for years in practice, domestic vs. foreign medical graduate, and case volume. Results: We identified 201 interventional cardiologists in New York State between 2014-2016, of whom 16 (8.0%) had lost or settled a malpractice lawsuit. Those with these prior malpractice lawsuits were more likely to be male (100%), domestic graduates (62.5%), spent more years on average [Standard Deviation] in clinical practice (28.8 [9.3] vs. 20.9 [11.2]), and had higher average case volumes (557.0 [290.1] vs. 386.0 [302.1]). After multivariable adjustment, interventional cardiologists with a prior lost or settled malpractice lawsuit had similar RAMRs than those without such a lawsuit (difference: -0.02%, 95% confidence interval -0.47% to +0.42%). Conclusions: We found no relationship between having lost or settled a prior malpractice lawsuit and PCI mortality rates among interventional cardiologists in New York State. These findings raise the possibility that prior malpractice claims do not reliably identify poor-performing providers.
Phenotypes and personalized medicine in the acute respiratory distress syndrome
Authors: Michael A. Matthay, Yaseen M. Arabi, Emily R. Siegel, Lorraine B. Ware, Lieuwe D. J. Bos, Pratik Sinha, Jeremy R. Beitler, Katherine D. Wick, Martha A. Q. Curley, Jean-Michel Constantin, Joseph E. Levitt, Carolyn S. Calfee
Journal: Intensive Care Medicine (2020)
Abstract 328: Aversive Cognitions and Engagement in Physical Activity at Hospital Discharge and 1 Year After Cardiac Arrest
Authors: Sarah Diaddigo, Michelle Chee, David Roh, Soojin Park, Jan Claassen, Donald Edmondson, Sachin Agarwal
Journal: Circulation (2020)

Introduction: We have shown that cardiac arrest-induced psychological distress is associated with an increased risk of cardiovascular disease (CVD) events and death. Low physical activity (PA) is a known risk factor for recurrent CVD events. We hypothesize that aversive cognitions about PA due to fear of trauma-related bodily sensations may lead to poor engagement in PA after cardiac arrest (CA). Methods: We prospectively enrolled 58 adults with a return of spontaneous circulation after in-hospital or out-of-hospital CA between 9/2015-8/2018 at a high-volume, major academic center. We studied 58 patients who survived CA and were discharged from Columbia University. Aversive cognitions about PA were measured with the following items: 1) “I am anxious when I think about doing PA at home;” 2) “I worry that doing PA at home will trigger another cardiac event;” 3) “I fear that I won’t know what is and isn’t safe;” 4) “I worry that I will die.” Patients responded using a 4-point Likert scale and “extremely” or “moderately” responses were classified as having aversive cognitions for each item. Items were adapted from the Anxiety Sensitivity Index. Results: Of 58 patients included (50% women, 52% minorities, average age 55±17 years) greater than 2/3 of the respondents reported at least one of the concerns about PA both at discharge and 12 months after discharge. Many (62% at discharge and 65% at 12 months) are not engaged in recommended levels of physical activity. Patients who reported at least 1 concern were almost 4 times more likely to have NOT engaged in PA at home (vs those who reported no concerns) since the CA event (OR= 4 (1.3-14) P=0.01), after adjusting for age, sex, and time since the event. Fear of death was independently associated with low engagement after adjusting for age, sex, and time since the event (OR 1.9 (1-3.7) P=0.05). Of all 58 participants, 71% at discharge and 76% at 12 months reported feeling that any PA done at home without medical supervision was either “not safe at all” or “only somewhat safe.” Conclusion: Survivors of CA frequently experience PA-induced anxiety and avoid PA because of the fear of recurrence or death. PA avoidance as an underlying mechanism by which psychological distress worsens prognosis in CA patients should be tested prospectively.
Abstract 15082: Repolarization Vulnerability is Rarely Observed in COVID-19 Patients With Low Comorbidity Treated With a Combination of Hydroxychloroquine Azithromycin
Authors: David E Goldgrab, Sokol Kalaveshi, Ruifang Yang, Mauricio Gomez, Jearim Craig, Stephen Mester, Christian Perzanowski
Journal: Circulation (2020)

Background: Global pandemic of COVID-19 has attracted a number of proposed treatment therapies. Hydroxychloroquine/Azithromycin (HA) combination has been reported to potentially affect repolarization by prolonging the QTc and causing torsades de pointes (TdP). Methods: We prospectively followed hospitalized patients with PCR confirmed COVID-19. Hydroxychloroquine was administered 400mg twice daily on day 1 and daily for the last 4 days plus daily Azithromycin 250mg. QTc interval was measured via 12 lead ECG prior to initiation of therapy, 3 hours post second dose of hydroxychloroquine, and subsequent daily QTc evaluation via telemetry. Potassium and magnesium were checked daily and replaced accordingly. QTc prolonging medications were discontinued when possible. Results: Sixteen patients were followed for 5 days, 56% were male with average age of 67. Comorbidities were 31% coronary artery disease, 31% diabetes mellitus, 13% congestive heart failure, 69% hypertension, 19% chronic obstructive pulmonary disease, 25% atrial fibrillation, and average BMI of 29. Average Tisdale score was 11/21. Mean QTc prior to HA therapy was 442 ms, 3 hours post second dose 429 ms and on day 5 was 441 ms with a change of (-)3ms compared to prior starting therapy as seen in figures below. Fifteen patients recovered and 1 patient expired. Twenty five percent of patients required ET intubation and mechanical ventilation. Zero patients required stopping of HA therapy. Only 1 patient required 2 extra days of QTc monitoring due to 5th day QTc being 504ms. Conclusion In acutely infected COVID-19 patients with limited comorbidities, repolarization/risk for TdP appears to be low in the presence of HA. With close monitoring and the right patient population, this combination therapy for short term treatment appears to be safe in regards to QTc and the risk for TdP. Although larger published studies have shown repolarization risk, we did not find that to be the case in our relatively healthy population.
CC-90009, a novel cereblon E3 ligase modulator, targets acute myeloid leukemia blasts and leukemia stem cells
Authors: Christine Surka, Liqing Jin, Nathan Mbong, Chin-Chun Lu, In Sock Jang, Emily Rychak, Derek Mendy, Thomas Clayton, Elizabeth Tindall, Christy Hsu, Celia Fontanillo, Eileen Tran, Adrian Contreras, Stanley W. K. Ng, Mary Matyskiela, Kai Wang, Philip Chamberlain, Brian Cathers, James Carmichael, Joshua Hansen, Jean C. Y. Wang, Mark D. Minden, Jinhong Fan, Daniel W. Pierce, Michael Pourdehnad, Mark Rolfe, Antonia Lopez-Girona, John E. Dick, Gang Lu
Journal: Blood (2020)
Lung cancer control in the UK hit badly by COVID-19 pandemic
Authors: Elizabeth Gourd
Journal: The Lancet Oncology (2020)

Severe delays in detection, diagnosis, and treatment have been observed across all types of cancer in the UK because of the COVID-19 pandemic. Yet a report by the UK Lung Cancer Coalition (UKLCC) published in October, 2020, suggests that lung cancer might be one of the worst affected due to a combination of factors, including overlapping symptoms with COVID-19 and specific pressures on respiratory health-care services caused by the pandemic.
Baseline prognostic nutritional index and changes in pretreatment body mass index associate with immunotherapy response in patients with advanced cancer
Authors: Paul Johannet, Amelia Sawyers, Yingzhi Qian, Samuel Kozloff, Nicholas Gulati, Douglas Donnelly, Judy Zhong, Iman Osman
Journal: Journal for ImmunoTherapy of Cancer (2020)

Background Recent research suggests that baseline body mass index (BMI) is associated with response to immunotherapy. In this study, we test the hypothesis that worsening nutritional status prior to the start of immunotherapy, rather than baseline BMI, negatively impacts immunotherapy response. Methods We studied 629 patients with advanced cancer who received immune checkpoint blockade at New York University. Patients had melanoma (n=268), lung cancer (n=128) or other primary malignancies (n=233). We tested the association between BMI changes prior to the start of treatment, baseline prognostic nutritional index (PNI), baseline BMI category and multiple clinical end points including best overall response (BOR), objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS). Results Decreasing pretreatment BMI and low PNI were associated with worse BOR (p = 0.04 and p = 0.0004), ORR (p = 0.01 and p = 0.0005), DCR (p = 0.01 and p &lt; 0.0001), PFS (p=0.02 and p=0.01) and OS (p &lt; 0.001 and p&lt;0.001). Baseline BMI category was not significantly associated with any treatment outcomes. Conclusion Standard of care measures of worsening nutritional status more accurately associate with immunotherapy outcomes than static measurements of BMI. Future studies should focus on determining whether optimizing pretreatment nutritional status, a modifiable variable, leads to improvement in immunotherapy response.
Abstract 13322: Association Between Allergic Diseases and Development of Kawasaki Disease Among Children: A Systematic Review and Meta-analysis
Authors: Ramya Ramachandra, John Rafael, Po Yang Tsou, Chien Chang Lee
Journal: Circulation (2020)

Introduction: Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. It is the leading cause of pediatric acquired heart disease in developed countries. Growing evidence points to the role of immunoregulatory abnormalities for its causation. Hypothesis: It is hypothesized that a history of allergic diseases is associated with the development of KD in children. Methods: A systematic review and meta-analysis of observational studies was performed to ascertain the association between history of allergic diseases and KD. Major electronic databases were searched from inception through March 2020 using pre-defined index terms such as “allergic disease”, “Kawasaki disease” and “children”. Random effects model was used to derive pooled estimates of odds ratios (OR) and 95% confidence intervals (CI). The Newcastle-Ottawa Scale was used for qualitative assessment. This study was reported according to MOOSE (Meta-analyses Of Observational Studies in Epidemiology). Results: Of 854 articles identified, 8 studies were considered eligible. History of allergic diseases was significantly associated with the development of KD (OR 1.99; 95% CI 1.26-2.73). On subgroup analysis of case-control studies (n=6), allergic diseases remained significantly associated with KD (OR 1.61; 95% CI 1.10-2.12). However, subgroup analysis with allergic diseases limited to asthma (n=5) revealed no significant association with KD (OR 1.17; 95% CI 0.45-1.90). Qualitative assessment found minimal concerns for bias. Conclusions: The available evidence suggests a strong association between history of allergic diseases and development of Kawasaki disease among children.
Abstract 13544: Cardiologist Underutilization of New Antihyperglycemic Medications in Diabetic Patients With Cardiovascular Disease
Authors: Gregory Desrosiers, Alaa Mohammed, Daniel Fort, Mark B Effron
Journal: Circulation (2020)

Introduction: Sodium Glucose Cotransporter-2 inhibitors (SGLT2i) and Glucose-Like Peptide-1 receptor agonists (GLP-1ra) showed significant reduction in cardiovascular (CV) events in type 2 diabetes (T2DM) patients (pts). The ADA and ACC recommend using SGLT2i/GLP-1ra in CV patients with T2DM (T2DM-CV). This study evaluated prescribing patterns in T2DM-CV to distinguish characteristics between those pts receiving SGLT2i/GLP-1ra from those not receiving SGLT2i/GLP-1ra. Hypothesis: SGLT2i/GLP-1ra are underutilized in T2DM-CV pts. Methods: Ochsner Health’s EPIC database was queried for T2DM-CV pts treated between Jan 2016 - Dec 2018. Baseline demographics and clinical characteristics were compared using ANOVA for numerical covariates, χ-square test for categorical covariates and multivariate logistic regression. Results: A total of 4,741 T2DM-CV pts were identified with approved indication for SGLT2i/GLP-1ra. Only 686 received a prescription for one of the approved SGLT2i/GLP-1ra with CV indication at the time of the study (empagliflozin, canagliflozin, liraglutide). Pts receiving SGLT2i/GLP1-ra were younger, had higher BMI, A1c, hypertension, hypercholesteremia, and/or commercial insurance or self-pay. Pts with CAD, atrial fibrillation, prior TIA or stroke, or heart failure were less likely to receive these drugs. (Table) Cardiologists rarely prescribed SGLT2i/GLP-1ra (2.2%) compared with primary care physicians (PCP) (45.6%) or endocrinologists (44.6%) (p&lt;0.001). Conclusions: T2DM-CV pts rarely received guideline directed SGLT2i/GLP-1ra, and cardiologists rarely prescribed them. Younger pts with higher A1c, CV risk factors, and commercial insurance were more likely to be prescribed SGLT2i/GLP-1ra than pts with CV disease, despite reduction in CV events in randomized trials and societal guidelines. Cardiologists need to work with endocrinologists and PCPs to drive use of these medications to improve outcomes in T2DM-CV pts.
Abstract 14131: Proof of Concept: Interpretation of EKG With Image Recognition and Convolutional Neural Networks
Authors: Subrat Das, Matthew Epland, Jiang Yu, Ranjit Suri
Journal: Circulation (2020)

Introduction: EKGs are the cornerstone of management in cardiovascular diseases. There have been multiple efforts to computerize the EKG interpretation with algorithms, which unfortunately are machine specific and proprietary. We propose the development of an image recognition model which can be used to read EKG strips (which use standard notations) and hence be used universally. Method: A convolutional neural network (CNN) was trained to classify 12-lead EKGs between seven clinically important diagnostic classes (Figure 1a). Pre-labeled EKG recordings (6-60s) from a publicly available data set on PhysioNet were used to construct the images. The EKG images displayed the 12 channel traces, of 2.5s each, on a consistent 4x3 grid at a resolution of 800x800 pixels (Figure 1a). The data set (23,336 images) was divided into training, tuning, and validation sets; containing 70%, 15%, and 15% of the images, respectively. An austere variation of the MobileNetV3 model was trained from the ground up on the labeled training set. Stochastic gradient descent (SGD) was used to minimize the cross-entropy loss. Training was halted when the tuning loss had not improved from its previous minimum by 0.05% over the past 10 epochs. Results: The model trained over 52 epochs of batches of 32 images. The model’s accuracy was tested using the validation set (which was not used for development of model) and reported as a confusion matrix (Figure 1b). The accuracy per class varies from 69-91%. Conclusion: We used a labeled dataset of EKG images to develop a CNN model to predict seven different diagnostic classes with good accuracy. This is a novel approach to EKG interpretation as an image recognition problem and thus generates the ability to create diagnostic algorithms that are not dependent on proprietary voltage signals generated by commercial EKG machines. With the addition of more images to the data set and higher computing power we are confident that we can achieve enhanced accuracy.
Abstract 16120: The Utilization of Neutrophil-lymphocyte Ratio and Platelets-lymphocyte Ratio as Prognostic Markers for Coronary Artery Disease in Person Living With Human Immunodeficiency Virus
Authors: Iyad Farouji, Kok Hoe Chan, Jihad Silm
Journal: Circulation (2020)

Background: Coronary artery disease (CAD) has emerged as an important cause of death in PLWH. T-lymphocyte cells has been shown to regulate the inflammatory response and have an inhibitory effect on atherosclerosis. NLR and PLR has been studied as severity prediction for CAD. However, to our knowledge, there were no studies to date that identify the relationship of NLR and PLR with CAD severity and outcome in PLWH. The aim of the study is to determine if NLR and PLR can be used as independent predictors of CAD severity in PLWH in our population in the United States. Methods: A retrospective cohort study of PLWH 18-year-old who underwent cardiac percutaneous coronary intervention was conducted between 2010 and December 2019. Their demographic, clinical and biochemical characteristics were extracted from the electronic medical record. Univariate and multivariate analysis were employed to identify the markers that can be used to predict CAD severity in PLWH. The study end point was number of coronary artery stenosis (85%) vessels involved. Results: A total of 74 PLWH were included in this retrospective cohort study. The median age was 60 years old (range from 30 to 79 years old). The male to female ratio was 2:1 (49 males and 25 females). As for ethnicities, 59 (80%) were African American, 9 (12%) were Caucasian and 6 (8%) were Hispanics. Comorbidities present in 64 patients (86%), with hypertension being the most common (77%), followed by CKD/ESRD (39%), diabetes mellitus (27%) and dyslipidemia (24%). Smoking and alcohol use were reported in 56 (76%) and 23 (31%) patients respectively. Female gender (p=0.042), higher triglycerides (r=0.29; p=0.014), history congestive heart failure (p=0.041) and higher CD4/CD8 ratio (r=0.30; p=0.011) were significantly correlated with greater number of coronary artery vessels involved. NLR (p=0.205) and PLR (p=0.567) are otherwise not significant. In multivariate analysis, NLR (odds ratio [OR] 1.553; 95% confidence interval [CI], 0.928-3.611), PLR (OR 0.997, CI 0.983-1.011) and CD4/CD8 ratio (OR 0.676, CI 0.042-1051) were not independently associated with the severity of CAD. Conclusion: This cohort study demonstrated that there is no relationship between the NLR and PLR with the severity of CAD in PLWH in our population in USA.
Abstract 13022: Hemodynamic Parameters of Pulmonary Circulation in Acute Coronary Syndrome: Incremental Prognositic Value for Long-term Survival
Authors: Ruilin Quan, Jianguo He
Journal: Circulation (2020)

Objectives: To identify right heart catheterization (RHC)-assessed hemodynamic parameters of pulmonary circulation that were prognostic predictive of long-term survival in acute coronary syndrome (ACS), and to explore the incremental value of those parameters to the established risk models of coronary heart disease. Methods: Consecutive patients with ACS who underwent coronary angiography together with RHC were retrospectively reviewed. The primary endpoint was all-cause mortality. To identify the association between hemodynamic parameters and survival, Cox proportional hazards models were conducted. The optimal parameter identified was included in three subsequent models, which contained the Global Registry of Acute Coronary Events (GRACE), the Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) and the Cardiovascular Disease Research Using Linked Bespoke Studies and Electronic Health Records (CALIBER) models respectively. Model performance was evaluated before and after the addition of hemodynamic parameters. Results: A total of 251 patients were enrolled, with a median follow-up time of 34.7 months. By Cox analyses, systolic pulmonary arterial pressure [hazard ratio (HR): 1.043, 95% confidence interval (CI): 1.013-1.074], diastolic pulmonary arterial pressure (HR: 1.086, 95% CI: 1.014-1.164), mean pulmonary arterial pressure (HR: 1.077, 95% CI: 1.024-1.132), right ventricular systolic pressure (HR: 1.039, 95% CI: 1.008-1.070) and diastolic pressure gradient (HR: 1.101, 95% CI: 1.015-1.193) were found to be independent predictors of long-term survival. Furthermore, the addition of mean pulmonary arterial pressure to the established risk models yielded an improvement in model performance (integrated discriminatory index for the GRACE, LIPID and CALIBER model: 4.3%, 4.4% and 4.7%, respectively; all had a P&lt;0.05). Conclusions: Hemodynamic parameters of pulmonary circulation can be predictive of long-term survival and provide incremental prognostic value to risk assessment in patients with ACS.
Abstract 14505: Risk Reclassification by Circulating Immune Markers in Ambulatory Us Adults Without Prevalent Cardiovascular Diseases: Insights From National Health and Nutrition Examination Survey
Authors: Kartik Gupta, Rajat Kalra, Mike Pate, Shivaraj Nagalli, Sameer Ather, Pankaj Arora, Ankur Gupta, Wunan Zhou, Raul Estepar, MARCELO DI CARLI, Sumanth D Prabhu, Navkaranbir S Bajaj
Journal: Circulation (2020)

Introduction: Inflammation is associated with worse cardiovascular (CV) prognosis. We evaluated the impact of adding elevated monocyte lymphocyte ratio (MLR) to 10-year atherosclerotic CV disease (ASCVD) risk score. Hypothesis: Adding elevated MLR improves risk classification by 10-year ASCVD risk score. Methods: We used data from 6 cycles of NHANES (1999-2010) to identify ambulatory US adults aged ≥ 18 years without prevalent cardiovascular disease and total leukocyte count in normal range (4,000-11,000 cells/μL). Elevated MLR (≥0.3) was defined using optimal cutoff to predict CV mortality by Youden index. CV mortality was derived from linked National Center for Health Statistics data. We compared the change in reclassification of the 10-year ASCVD risk score at a pre-specified cutoff of 5% (low risk) and reported the net reclassification index (NRI). We further compared predictive value of the circulating immune with risk factors in ASCVD risk score using time-to-event and logistic models. Results: Among 21,599 eligible participants with median age 47 years (IQR, 34, 63; 49.2% women and 49.5% non-Hispanic White), there were 627 CV deaths with annual incidence rate of 0.3% over median follow-up of 9.6 years (IQR 6.8, 13.1). Median ASCVD risk score was 5% (IQR 1.6, 16.7). Adding elevated MLR to categorical 10-year ASCVD risk score correctly up classified 3.2% participants with CV mortality and incorrectly up classified 0.4% participants with no CV mortality. There was significant improvement in risk classification (NRI 2.7±1.4%, p=0.044, Panel A). Adding elevated CRP (≥0.3 mg/dL) did not change risk class (NRI -0.2±0.0%, p=827, Panel B). Among ASCVD components, MLR had higher predictive value than race, smoking, high-density lipoprotein, and total cholesterol in both time-to-event and logistic models. Conclusions: Elevated MLR significantly improves CV risk reclassification in ambulatory adults without prevalent CV disease and is better than CRP.