tbuckley/cabot-search huggingface dataset:
Abstract 15787: Ventricular Assist Devices May Cause Changes in Implantable Cardioverter Defibrillator Lead Parameters
Authors: Tariq Z Issa, Jessica Charron, Jeremiah Wasserlauf, Soo Howell, Rebecca Harap, Bradley P Knight, Jonathan D Rich, Alexandru B Chicos
Journal: Circulation (2020)

Introduction: Ventricular assist devices (VAD) are a primary method of treatment for patients with advanced heart failure. Previous studies have provided some evidence for alterations in ICD lead parameters following VAD implants, but all have had a very small sample size. Hypothesis: VAD implantation causes alterations in ICD lead parameters. Methods: Electronic medical records of a large patient cohort receiving VAD implants at Northwestern Hospital from 2012-2018 were manually reviewed. When available, high-voltage (HV) impedance, right ventricular (RV) lead pacing impedance, pacing threshold, and sensing amplitude were compared both immediately (I) and late (L), at 6-12 months follow-up after VAD implant, to baseline (B) pre-implant values. Results: A total of 271 VAD patient records were reviewed. Long-term, HV impedance changed from 51 ± 16 Ω to 49 ± 15 Ω (N=63, p=0.04), and 29% of patients had a long-term absolute change of at least 10 Ω. RV pacing impedance decreased slightly acutely from 405± 84 to 427 ±78 (N=96, p=.006), but there was no significant change long-term: 443 ± 201 Ω vs 449 ± 94 Ω (N=85, p=0.77). Yet, 19% of patients had a long-term change ≥ 100 Ω. Long-term RV pacing threshold was not significantly changed 1 ± 0.8 V to 1.1 ± 0.7 V (N=47, p=0.5), and all leads were still functional for pacing. RV sensing amplitude decreased acutely from 10.8 ± mV to 8.6 ± 4.3 mV (N=81, p&lt;0.001). Additionally, 17% of patients had a change that was more than 50%, and new R waves below 5 mV were noted in only 13 patients (16%). Long-term RV sensing amplitude decreased from 11.3 ± 5 mV to 8.2 ± 4.3 mV (N=73, P&lt;0.001), and 18 patients had a decrease in R wave of at least 50%. Conclusions: In conclusion, our data suggest that VAD implantation in patients with an ICD may result in immediate and long-term ICD parameter changes. For many patients, these changes may be clinically insignificant, but careful monitoring is warranted. The clinical impact of those changes merits further investigation.
Abstract P225: Health Care Access And Health Indicators In Puerto Rico Pre- And Post- Hurricane Maria: Analysis Of Data From 2015-2018 Behavioral Risk Factor Surveillance System
Authors: Yamnia I Cortes, Patricia Pagan Lassalle, Krista Perreira
Journal: Circulation (2021)

Background: In September 2017, Hurricane Maria devastated Puerto Rico (PR), in what is now regarded as one of the worst natural disasters in United States (US) history. Natural disasters can impact health directly as well as indirectly through their impacts on health behavior, health utilization, and migration. Population-based estimates of the health of PR residents before and after Hurricane Maria have not been assessed. Objective: The overall goal of this project is to compare key health indicators, particularly cardiovascular disease risk factors, among PR residents pre- and post-Hurricane Maria. Methods: This study used data from the Behavioral Risk Factor Surveillance System (BRFSS) in PR. We included data from four survey years: 2015 (N=4556), 2016 (N=5765), 2017 (N=4462), and 2018 (N=4814). The sample consisted of non-institutionalized adults age ≥18 years with access to a landline or a cellular telephone. Since BRFSS data collection in PR were completed in the Spring, and Hurricane Maria struck in Fall 2017, we analyzed three yearsof pre-hurricane data (2015, 2016, 2017) and one year post-hurricane (2018). We will soon be including a second year of data post-hurricane (2019). We used logistic regression analyses to compare health care utilization (health insurance coverage, routine checkup within past year), health behaviors (alcohol use, smoking), and health outcomes (obesity, diabetes, depression) pre- and post-Hurricane Maria. Survey year 2017 was the referent in all models. Final models were adjusted for age, sex, race, education, employment, income, and marital status. Results: Compared to survey year 2017, in 2018 (post-hurricane) participants were more likely to have a college degree or higher, be currently employed, and not married/partnered. Post-hurricane, participants were less likely to have health insurance coverage (AOR, 95% CI: 0.75, 0.58-0.97) and had lower rates of diabetes (AOR: 0.82, 0.70-0.96). The odds of being overweight/obese were lower in 2015 (pre-hurricane) compared to 2017 (AOR, 95% CI: 0.88, 0.79-0.97). There was no significant difference in health behaviors across survey years. Conclusions: Participants who completed the BRFSS in PR post-Hurricane Maria had a higher socioeconomic status and lower rates of diabetes. Our results may suggest that PR residents with a lower socioeconomic status and/or chronic illness were more likely to emigrate, resulting in a compositional change in the population post-hurricane. This analysis highlights the need for long-term follow-up of PR residents to better determine the impact of Hurricane Maria, and adequately design public health programs to address healthcare needs, access, and outcomes.
Abstract 16587: More Than Five Years After FDA Approval, There Remains Very Limited Adoption of New Evidence-Based, Highly Effective Medications for the Treatment of Patients With Heart Failure, Especially Among Those on Medicare
Authors: Joseph B Muhlestein, Heidi T May, Tami L Bair, Stacey Knight, Kirk U Knowlton, Benjamin D Horne, Viet T Le, Jeffrey L Anderson
Journal: Circulation (2020)

Background: Over the past decade, the FDA has approved several new medications that are highly effective when added to existing standard therapy in the treatment of heart failure with reduced ejection fraction (HFrEF). It is possible that, despite the presence of substantial evidence regarding the clinical effectiveness of these new medications, their high cost and the complex medical reimbursement system in America may prevent their routine adoption. Methods: We analyzed 5,824 Intermountain Healthcare patients, age ≥18 years with a new clinical diagnosis of HFrEF (LVEF ≤35%), from 1/1/2015 onward, for the use of newly-approved sacubitril/valsartan or any sodium-glucose cotransporter-2 inhibitor (SGLT2-I). We collected baseline characteristics and medication utilization data. We followed the patients for 1.7±1.4 years for future major adverse cardiovascular events (MACE), including death, myocardial infarction (MI), stroke, and heart failure hospitalization (HFH). We identified differences between groups by multivariable Cox regression analysis. Results: Baseline characteristics and incidence of MACE, according to insurance status and the use of common HFrEF medications, are shown in the Table. Overall, only 344 (5.9%) and 169 (2.9%) of patients ever received a prescription for sacubitril/valsartan or an SGLT2 inhibitor, respectively. The figures show survival curves for MACE of patients receiving or not receiving the newly-approved medications. Conclusion: In this large, modern, real-world HFrEF population, the adoption of newly-approved evidence-based HFrEF medications is minimal in all patients and especially in Medicare patients. This lack of adoption is associated with a significant worsening in patient outcomes. These findings demonstrate a critical need to resolve our present healthcare financial crisis, which is almost certainly the reason for these findings.
Life Happens, Even to Surgical Trainees
Authors: Elizabeth L. George, Paige Fox, Mary T. Hawn
Journal: JAMA Surgery (2021)

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Abstract 13795: Race and Gender Differences in Mortality From Atrial Fibrillation in the United States: 1999 to 2018
Authors: Arshi Parvez, Justin Salciccioli, Augustin DeLago, Joseph Shalhoub, Adam Hartley, Dominic Marshall, Rick Goodall, Matthew Hammond-Haley, Mohammed Essa, Binu Philips
Journal: Circulation (2020)

Objective: To assess differences in mortality trends from atrial fibrillation (AF) among different races and genders in the United States (US). Background: AF is the most common sustained cardiac arrythmia in the US. No up to date analysis has assessed AF mortality trends by race and gender across the US. Methods: For this observational analysis US AF mortality data from 1999 to 2018 for individuals &gt;45 years of age were extracted from the CDC WONDER database. International Classification of Diseases code I48 was used to define AF. Mortality data were age-standardized to the US 2000 standard population, and stratified by gender and race (Caucasian, Black, Asian). Joinpoint regression analysis was used to assess for significant changes in trends over the observation period, and provide estimated annual percentage changes (EAPC)s with 95% confidence intervals (CIs). Results: From 1999 to 2018, the mortality rate per 100,000 population, increased significantly from 3.7 to 8.3 (+124%, the greatest increase observed) amongst Asian men (AM), from 5.4 to 10.8 (+100%) amongst Black men (BM), and from 9.2 to 19.2 (+108%) amongst Caucasian men (CM). Mortality increases, per 100,000 population, were seen from 4.0 to 7.4 (+85%, the smallest increase observed) in Asian women (AW), 5.3 to 12.8 (+121%) in Black women (BW), and 8.9 to 19.7 (+121%) in Caucasian women (CW) over the same time period. Joinpoint analysis demonstrated significant increasing AF mortality trends for both genders and all races studied. AW had the highest EAPC of 8.6 (95% CI 6.0-11.3) between 1999-2008, which slowed to 2.2 (95% CI 0.1-4.3) between 2009-2018. AM followed a similar EAPC pattern: 7.7 (95% CI 5.7-9.8) between 1999-2008, decreasing to 0.5 (95% CI -1.1-2.2) between 2009-2018. Between 1999-2018, EAPCs increased for BW (3.8, 95% CI 3.2-4.4), CW (4.4, 95% CI 4.0-4.8), BM (4.0, 95% CI 3.4-4.6) and CM (4.8, 95% CI 4.4-5.2). Conclusion: Between 1999 and 2018, there are increasing AF mortality trends amongst both genders and all races, with Caucasians having the greatest overall increases during the observation period. EAPCs demonstrate that the rates of increases in AF mortality are greatest in Caucasians, followed by Asian then Black Americans.
Abstract P033: Identifying Racial/Ethnic Differences In Patterns Of Early Childhood Cardiovascular Health Using Electronic Health Record Data
Authors: Lindsay Pool, Xiaoyun Yang, Amy Krefman, Amanda M Perak, Matthew Davis, Marc Rosenman, Lifang Hou, Bradley S Marino, Linda Van Horn, Darwin R Labarthe, Donald M Lloyd-Jones, Norrina B Allen
Journal: Circulation (2021)

Introduction: Racial/ethnic differences in CVH beginning at age 8 have been identified and linked with the development of cardiometabolic disease in adulthood; however, there is scarce research on CVH in very childhood. Our objective was to use a large, diverse pediatric EHR consortium to identify racial/ethnic patterns of clinical CVH from ages 2-12 years. Methods: We used ambulatory visit data spanning 2010-2018 from children aged 2-12 years within CAPriCORN - an EHR repository that combines medical records throughout the city of Chicago. The 4 clinical CVH metrics - BMI, blood pressure, cholesterol, and glucose - were categorized as ideal or non-ideal using available values of weight, height, blood pressure, laboratory readings, and ICD diagnosis codes. Multiple measurements within a given integer age were averaged by individual. Frequency of ideal and non-ideal status for each CVH metric was plotted by age in years and stratified by race/ethnicity (Figure). Results: There were 162,621 children included (47% female) with a median of 2 visits during follow-up. The race/ethnicity distribution was 4% Asian/Pacific Islander (API), 26% non-Hispanic Black (NHB), 44% non-Hispanic white (NHW), 18% Hispanic, and 8% other/unknown. Sustained decrease in ideal BMI occurred across race/ethnicity groups; however, proportion in ideal was consistently lower for NHB and Hispanic children. Ideal BP appeared to increase across childhood with few racial differences. Ideal cholesterol levels were constant across childhood, but the proportion of NHW children in ideal was lower than NHB and Hispanic children. Almost all individuals had ideal glucose levels throughout early childhood. Conclusions: Early childhood declines in CVH appeared to be driven by changes in ideal BMI. Racial/ethnic differences in ideal BMI and cholesterol were present by age 2 and were mostly sustained through age 12. Selection bias may account for some of these findings; consistent monitoring in early childhood is needed to better understand observed differences.
Abstract P077: Trends In Prevalence Of Cardiometabolic Diseases By Food Security Status, 1999-2016
Authors: Junxiu Liu, Stella Yi, Rienna Russo, Donglan Zhang, Janani Rajbhandari-Thapa, Yan Li
Journal: Circulation (2021)

Introduction: Cardiometabolic diseases (CMDs), which include coronary heart disease (CHD), hypertension (HTN), type 2 diabetes (DM) and obesity, are an interrelated set of highly preventable conditions. Food insecurity, another pervasive public health issue, is associated with CMDs. We aim to characterize the prevalence of CMD by food security (FS) status over time. Hypothesis: Prevalence of DM and obesity increased while that of HTN and CHD decreased over time, with pervasive disparities among FS status. Methods: Adults ≥20 years from the 1999-2016 NHANES were included in this analysis. CMD outcomes included DM (prior diagnosed or FPG≥126 mg/dL or HbA1c ≥6.5%), CHD (prior diagnosis of myocardial infarction, angina or any other type of CHD), obesity (BMI ≥30 kg/m 2 ) and HTN (≥1 of the following: systolic blood pressure (BP) ≥130 mmHg, diastolic BP ≥80, or currently taking BP medications). FS status was measured through the US Household Food Security Survey Module and recategorized into three levels (full, marginal and low). All estimates were age-standardized to the 2010 US census population. All analyses accounted for the complex survey design. Logistic regressions were conducted to calculate P-values. Results: Our sample included 46,879 adults (79.5% of full, 7.67% of marginal and 12.8% of low FS). HTN prevalence decreased from 50% to 44.4% among the full FS group and from 54.9% to 50.4% among the marginal group (P-trends&lt;0.001, P-interaction=0.009). CHD prevalence decreased from 6.33% to 4.81% (P-trend&lt;0.001) among the full group. Obesity prevalence increased from 31.0% to 38.0% among the full group and from 38.3% to 50.5% among the low group (P-trend&lt;0.001, P-interaction=0.02). DM prevalence increased from 8.30% to 11.3% for the full group, from 14.9% to 21.8% for the marginal group and from 14.8% to 20.1% for the low group (P-trend&lt;0.001) ( Figure ). Conclusion: From 1999 to 2016, the prevalence of CMDs were lowest among participants who were in full FS group and disparities by FS status persisted or worsened.
Abstract P305: Psychosocial Stressors and Tobacco Use: Views of the Transgender Community in a 2016 Focus Groups Study
Authors: Rose M Robertson, Aida L Giachello, Robyn Landry, Joy L Hart, Thanh-Huyen T Vu, Kandi L Walker, Allison Groom, Anshula Kesh, Thomas J Payne
Journal: Circulation (2018)

Background: Studies have found that cigarette smoking is higher among lesbian, gay, bisexual, transgender and queer (LGBTQ) groups compared to heterosexual individuals. However, limited research is available about factors related to tobacco initiation or continuation among transgender adults. Methods: During summer 2016, the AHA-Tobacco Regulatory and Addiction Center (A-TRAC) conducted 27 focus groups and 196 surveys among smokers and non-smokers (ages 18-64) who self-identified as lesbian, gay, bisexual, transgender, or queer (LGBTQ). Study participants were of diverse racial and ethnic backgrounds and were recruited in Chicago, New York City and San Diego. Using qualitative data analyses, we analyzed a subsample of the LGBTQ data to examine the views and experiences of transgender individuals and identified themes related to psychosocial stressors linked to tobacco use. Atlas ti.v 7.5 qualitative software was used for analysis. Results: A total of 26 participants were identified as transgender, representing 13.9% of the total LGBTQ sample. Psychosocial stressors that were often mentioned by study participants and were associated with initial and continuing tobacco use included: childhood and adulthood trauma due to family, peer and community rejection and/or exposure to partner and/or community violence; surgery and the side effects of medication; use of hormones and/or other experiences related to the process of transitioning. Structural discrimination associated with low income, housing, and employment was also mentioned. These psychosocial stressors were also associated with depression and the use of intoxicating substances (i.e., alcohol and drugs). Tobacco use was felt to provide relief from these stressors. Conclusion: Transgender individuals perceived tobacco use as a relief from everyday chronic psychosocial stressors and appears to be associated with tobacco initiation and continued use. Health communication messages stressing healthy lifestyle practices and encouraging drawing on professional and informal support systems may prevent tobacco use.
Abstract 16147: Sex, Gender Factors and Cardiovascular Health in Canadian and Austrian Populations
Authors: Zahra Azizi, Teresa Gisinger, Uri Bender, Valeria Raparelli, Colleen M Norris, Karolina Kublickiene, Maria T Herrero, Khaled El Emam, Alexandra Kautzky-Willer, Louise Pilote
Journal: Circulation (2020)

Introduction: Little evidence exists differentiating the effect of biological sex from gender-related (i.e. psycho-socio-cultural) characteristics in cardiovascular outcomes. Hypothesis: Here, we explored the association between sex, gender, and cardiovascular health (CVH) among Canadians (CAN) and Austrians (AT). Methods: Data from the Canadian Community Health Survey (CCHS) (n=63,522, 55% Females) and Austrian Health Interview Survey (AT-HIS) (n=15,771, 56% Females), were analyzed. The CANHEART index, a measure of ideal CVH composed of 6 cardiometabolic risk factors ranging from 0 (worst) to 6 (ideal), was calculated in the CCHS as well as AT-HIS databases (ATHEART). A country-specific gender score was computed using principal component analysis-derived propensity score methods. The final gender scores (Range=0-1, higher score identifying characteristics traditionally ascribed to women) included: i) household size, perceived life stress, education, sense of belonging to community, marital status, and income (CAN); ii) household size, frequency of negative emotions, education, marital status and income (AT). Results: Median CANHEART and CAN gender scores were 4 [3-5] and 0.53 [0.49-0.60] while median ATHEART and AT gender scores were 4 [3-5] and 0.55 [0.46-0.64]. Although higher gender scores (CCHS: β=-1.33, 95%CI (-1.44,-1.22); AT-HIS: β=-1.11, 95%CI (-1.30,-0.91)) were associated with worse CVH, female sex (CCHS: β=0.35, 95% CI (0.33,0.37); AT-HIS: β=0.59, 95%CI (0.55,0.64)) was associated with better CVH in both populations. Additionally, higher gender scores were associated with a higher risk of heart disease, compared to female sex. The magnitude of this risk was higher in AT population (Table1). Conclusions: Individuals with characteristics typically ascribed to women reported poorer CVH and exhibited higher risk of heart disease independent of biological sex. Gender factors must be targeted for improving cardiovascular health.
135P Relationship between low muscle mass pre-chemotherapy with hematological toxicity in breast cancer patients after 3 cycles of chemotherapy
Authors: A. Kurniawan, D.A. Halim, C. Jodhinata, P.P. Lukito, R.D. Hatma, A. Adisasmita, S.S. Panigoro, N. Sutandyo, T.Z. Tamin, F. Witjaksono, R. Sumantri, D.S. Rivami
Journal: Annals of Oncology (2021)
Abstract 16582: Costimulation Blockade With Anti Cd80 and Cd86 Monoclonal Antibodies Prolonged Graft Survival in Allogeneic Ips Cell-Derived Cardiomyocyte Patch Transplantation
Authors: Masaro Nakae, Shigeru Miyagawa, Takuji Kawamura, Koichiro Uchida, Ko Okumura, Yoshiki Sawa
Journal: Circulation (2020)

Introduction: How to avoid immune rejection after transplantation should be elucidated for confirmed efficacy in clinical application of allogenic induced pluripotent stem cell derived cardiomyocyte patch. The blockade of CD28-CD80/86 costimulation is known to induce T cell anergy and immune tolerance by the recruitment of regulatory T cells (T reg) and prolong graft survival in organ transplantation. Hypothesis: We hypothesized that the blockade of CD28-CD80/CD86 costimulatory pathway by anti-CD80/CD86 monoclonal antibodies (mAbs) induces T cell anergy in vivo and suppresses immune rejection in allogeneic iPSC-CMs subcutaneous transplantation mice model. Methods: T cell anergy was induced in vitro by co-culture of Balb/c and 25Gy irradiated C57BL/6 splenocytes with anti-CD80/86 mAbs for 5 days. The inhibitory effect of anergic cells was evaluated by mixed lymphocyte reaction (MLR) in C57BL/6 and Balb/c splenocytes with anergic cells. IFN-g in MLR supernatants was measured by ELISAs to assess immune response. C57BL/6 iPSC-CMs expressing luciferase were subcutaneously transplanted into Balb/c. Anti-CD80/CD86 mAbs were injected intraperitoneally 250μg/dose on day 0, 1, and 2 (treated mice, n=6). In control mice (n=6), equivalent volume of saline was injected. To evaluate iPSC-CMs graft survival, photon counts of iPSC-CMs were measured by bioluminescence imaging system (BLI). Cells of harvested grafts were analyzed by immunofluorescence staining (IF). Results: On ELISAs, IFN-g in MLR supernatants co-cultured with anergic cells was significantly lower as compared with those without anergic cells (12.3±14.4 vs. 251±80.2 pg/ml, p=0.007). The ability to suppress the alloresponses was dose-dependent. BLI showed that photon counts on day 14 in treated mice were significantly higher than in control mice (7397±2651 vs. 2703±1271, p=0.003). IF showed a siginificantly higher ratio of CD4 and Foxp3 double positive cells to CD4-postive cells in the grafts on day 7 in treated mice as compared with in control mice (23±3% vs. 9±3%, p=0.009) Conclusions: The blockade of CD28-CD80/CD86 costimulatory pathway might suppress immune rejection in allogeneic iPSC-CMs transplantation mice model and T reg might involve this immune tolerance.