tbuckley/cabot-search huggingface dataset:
Behavioral interventions to improve population health outreach for hepatitis C screening: randomized clinical trial
Authors: Shivan J Mehta, Susan C Day, Anne H Norris, Jessica Sung, Catherine Reitz, Colin Wollack, Christopher K Snider, Pamela A Shaw, David A Asch
Journal: BMJ (2021)

Abstract Objective To evaluate whether opt out framing, messaging incorporating behavioral science concepts, or electronic communication increases the uptake of hepatitis C virus (HCV) screening in patients born between 1945 and 1965. Design Pragmatic randomized controlled trial. Setting 43 primary care practices from one academic health system (Philadelphia, PA, USA) between April 2019 and May 2020. Participants Patients born between 1945 and 1965 with no history of screening and at least two primary care visits in the two years before the enrollment period. Interventions This multilevel trial was divided into two studies. Substudy A included 1656 eligible patients of 17 primary care clinicians who were randomized in a 1:1 ratio to a mailed letter about HCV screening (letter only), or a similar letter with a laboratory order for HCV screening (letter+order). Substudy B included the remaining 19 837 eligible patients followed by 417 clinicians. Active electronic patient portal users were randomized 1:5 to receive a mailed letter about HCV screening (letter), or an electronic patient portal message with similar content (patient portal); inactive patient portal users were mailed a letter. In a factorial design, patients in substudy B were also randomized 1:1 to receive standard content (usual care), or content based on principles of social norming, anticipated regret, reciprocity, and commitment (behavioral content). Main outcome measures Proportion of patients who completed HCV testing within four months. Results 21 303 patients were included in the intention-to-treat analysis. Among the 1642 patients in substudy A, 19.2% (95% confidence interval 16.5% to 21.9%) completed screening in the letter only arm and 43.1% (39.7% to 46.4%) in the letter+order arm (P&lt;0.001). Among the 19 661 patients in substudy B, 14.6% (13.9% to 15.3%) completed screening with usual care content and 13.6% (13.0% to 14.3%) with behavioral science content (P=0.06). Among active patient portal users, 17.8% (16.0% to 19.5%) completed screening after receiving a letter and 13.8% (13.1% to 14.5%) after receiving a patient portal message (P&lt;0.001). Conclusions Opt out framing and effort reduction by including a signed laboratory order with outreach increased screening for HCV. Behavioral science messaging content did not increase uptake, and mailed letters achieved a greater response rate than patient portal messages. Trial registration ClinicalTrials.gov NCT03712553 .
Abstract 034: A Healthy Lifestyle Score Including Sleep Duration And Risk Of Cardiovascular Disease
Authors: Marta Guasch-Ferré, Yanping Li, Shilpa N Bhupathiraju, Tianyi Huang, Jean-Philippe Drouin-chartier, Joann E Manson, Qi Sun, Eric Rimm, Kathryn M Rexrode, Walter Willett, Meir J Stampfer, F Hu
Journal: Circulation (2021)

Objectives: The aim of this study was to evaluate the relationship between a lifestyle score including sleep duration and CVD risk, and to estimate whether adding sleep duration into a traditional lifestyle score improved CVD risk prediction. Methods: A prospective analysis was conducted among 67250 women in the Nurses’ Health Study and 29279 men in the Health Professionals Follow-up Study who were followed from 1986 to 2016. The traditional lifestyle score was defined as not smoking, normal BMI(18.5-24.9 kg/m 2 ), ≥30 min/d of moderate physical activity, higher diet quality (top 40% of AHEI), moderate alcohol intake (women:5-15g/day; men:5-30g/day). Low-risk sleep duration, defined as sleeping ≥6 to &lt;8 hours/day, was included as an additional component. Cox proportion hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of CVD, CHD, and stroke. We used the likelihood ratio test and C-statistics to compare the predictive value of the two scores. Results: A total of 11826 incident CVD cases were documented. In multivariable-adjusted models, each low-risk factor was independently and significantly associated with lower risk of CVD, CHD, and stroke. The multivariable-adjusted HRs (95% CIs) comparing six with zero low-risk factors in the healthy lifestyle score were 0.17(0.12, 0.23) for CVD, 0.15(0.10, 0.22) for CHD, and 0.19(0.12, 0.33) for stroke. Approximately 67% of CVD and CHD cases, and 62% stroke cases were attributable to poor adherence to a healthy lifestyle. P- value for likelihood ratio test comparing nested models including the traditional lifestyle score vs traditional lifestyle score plus sleep duration was &lt;0.001. Adding sleep duration to the traditional score prediction model increased the C-statistics from 0.63 (95% CI: 0.62, 0.63) to 0.64 (95% CI: 0.63, 0.65)( P &lt;0.001). Conclusions: Incorporating sleep duration into traditional lifestyle scores improves prediction of CVD risk and warrants consideration for inclusion in lifestyle recommendations.
Abstract 15238: Cardiomyocyte Specific Pellino1 Knockout Leads to Increased Oxidative Stress, Reduced Anti-apoptotic Signaling and Cardiac Dysfunction in a Murine Myocardial Infarction Model
Authors: Seetur R. Pradeep, Jacob campbell, Mahesh THIRUNAVUKKARASU, Diego Accorsi, J. Alexander Palesty, Nilanjana Maulik
Journal: Circulation (2020)

Introduction: Ischemic heart disease is the leading cause of death in adults in the US. We have shown that overexpression of E3 ligase Pellino1 (Peli1) increased vessel density, triggered anti-apoptotic signaling, and preserved cardiac function in the infarcted myocardium. In the present study, we aimed to explore whether the loss of Peli1 function in cardiomyocytes has any effect on cardiac function using a genetically-modified murine myocardial infarction (MI) model. Methods: Wild type (WT) and cardiomyocyte-specific Peli1 knockout (CP1KO -/- ) mice were divided into 4 groups [wild-type-sham (WTS), CP1KO -/- sham (CP1KO -/- S), WTMI and CP1KO -/- MI] to undergo either left anterior descending artery ligation or sham surgery. Phosphorylation of Mitogen-Activated Protein Kinase-Activated Protein Kinase-2 (p-MK2) and expression of VEGF, Bcl2, and cIAP2 were quantified by Western blot analysis. Cardiac function by two-dimensional echocardiography was performed at 30 days post-op to assess ejection fraction (EF), fractional shortening (FS), left ventricular internal diameter in both systole and diastole (LVIDs and LVIDd). Results: We observed no significant change in cardiac functions between WTS and CP1KO-/-S group. However, in MI groups, CP1KO -/- mice showed significant loss of systolic functions, represented by both EF (26.60%±2.340 vs. 33.46%±1.84; p&lt;0.029, n=13) and FS (12.43%± 1.19 vs. 15.93%±0.98; n=13, p&lt;0.03) when compared to WTMI group. Western blot analysis of heart tissue 24-hour post-MI showed a significant reduction in the expression of p-MK2 (p=0.0045) in CP1KO -/- group compared to WT mice. Similarly, expression of VEGF (p=0.0227), BCl-2 (p=0.0073) and cIAP2 (p=0.0483) was also found to be significantly downregulated in CP1KO -/- group compared to WTMI group at 4-day post-MI. We also analyzed oxidative stress marker, 3-NT, which was significantly upregulated (p=0.0001) in CP1KO mice compared to WTMI. Conclusion: Loss of Peli1 in cardiomyocyte results in the impairment of cardiac function along with increased oxidative stress, reduced angiogenic and survival protein expression, which suggests Peli1 plays an important role in the cardiomyocyte signaling during myocardial infarction.
Abstract P198: Short Sleep Duration, Greater Cognitive Arousal, And Eveningness Are Associated With Reduced Left Ventricular Function In Insomnia Disorder
Authors: Megan E Petrov, Kimiya Kasraeian, Nana Jiao, Shawn Youngstedt, farouk mookadam, Siddhartha S Angadi
Journal: Circulation (2021)

Aim: Insomnia is associated with cardiovascular disease (CVD), particularly the phenotype with objective short sleep duration and associated physiological arousal. However, what objective sleep and arousal characteristics among patients with insomnia are related to markers of cardiovascular structure and function remains unknown. The present study examined the association of objective sleep metrics and self-reported arousability with arterial stiffness, endothelial function, and left ventricular function among patients with insomnia disorder. Methods: Sixteen young, healthy adults (age: M [ SD ]=30[7]; 56.3% women) meeting diagnostic criteria for insomnia disorder and reporting no history of CVD, underwent fasting vascular testing including carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL TM ), brachial-artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300 TM ). Left ventricular function was assessed by ejection fraction (EF), global longitudinal strain (GLS), mitral valve E/e’ (MVE/e’), and lateral e’ using standardized methods. Ten participants wore a portable sleep monitor for 1 night (WatchPat200, Itamar Medical) and an actigraph for 8 nights (Actiwatch Spectrum Plus, Philips Respironics). All participants completed the Pre Sleep Arousal Scale (PSAS; somatic &amp; cognitive subscales), and the Arousal Predisposition Scale (APS). Bivariate correlations and curvilinear regressions (total sleep time [TST] only) were conducted for the associations between actigraphy-assessed TST and WatchPat (WP) TST, actigraphy-assessed mean bedtime, and PSAS and APS scores with cardiovascular markers. Each set of one sleep metric with all six cardiovascular markers were Bonferroni corrected (α level: p &lt;0.007). Results: On average, participants obtained 7h,9min of TST (range: 6h,26min - 8h,41min) and went to bed at 23:40 (range:21:47-2:13) via actigraphy, and slept 6h,51min via WP. Mean PSAS Somatic, PSAS Cognitive, and APS scores were 13.7(SD=4.5), 24.5(SD=7.5), and 27.9(SD=7.6), respectively. cfPWV (range:4.6-8.0), EF% (range:55.0-70.9), GLS% (range:-25- -19), and MVE/e’ (range:3.6-13.3) were all within age and sex normative ranges. Mean FMD was 7.8% (SD=2.6, range:4.4-14.6), and lateral e’ was 15 cm/s (SD=4.5, range:9-22). Correlations indicated that greater PSAS cognitive scores were related to worsening (less negative) GLS% ( r =0.77, p =0.001), later bedtimes were associated with lower lateral e’ ( r =-0.84, p =0.004), and shorter WPTST was associated with lower EF% (r=0.84, p=0 . 002). Conclusion: Among young adults with insomnia disorder, greater cognitive arousal, later bedtimes, and shorter objective total sleep time were associated with subclinical worsening of left ventricular strain, diastolic and systolic function.
Abstract P012: Association Between Testosterone And Sex Hormone Binding Globulin And Risk Of Ischemic Stroke: The Atherosclerosis Risk In Communities Study
Authors: Carin A Northuis, Erin Michos, Christie M Ballantyne, Ron C Hoogeveen, Pamela L Lutsey, James S Pankow, Elizabeth Selvin, Kevin Sullivan, Kamakshi Lakshminarayan
Journal: Circulation (2021)

Background: Sex hormones are associated with obesity, diabetes mellitus, and other stroke risk factors; however, studies on sex hormones and stroke risk report inconsistent results. We assessed the associations of testosterone and sex hormone binding globulin (SHBG) with risk of ischemic stroke among men and post-menopausal women in the Atherosclerosis Risk in Communities (ARIC) Study. Methods: A total of 4,349 men and 4,720 post-menopausal women who had SHBG and total testosterone measurements at visit 4 (1996-98) were followed through 2018 for the development of ischemic stroke. We examined log transformed SHBG and testosterone exposure as quartiles and as per 1 SD increment. We used Cox regression to estimate the hazard ratios (HR) for ischemic stroke, adjusting for demographic, behavioral and clinical variables. Analyses were stratified by sex and menopausal hormone therapy (HT) use. Results: Participants were aged 63±6 years at baseline, 52% were women (25% HT users), and 21% Black. There were 691 strokes over a median follow-up of 19.8 years. Mean log SHBG (nmol/L) and testosterone (nmol/L) were 4.3±0.7 and 3.1±0.5 for HT users, 3.6±0.7 and 3.2±0.5 for non-HT users, and 3.4±0.5 and 6.2±0.5 for men. Quartile 1 vs Q4 for SHBG and testosterone were ≤50.3 vs &gt;121 and ≤16 vs &gt;28 in HT users, ≤23.3 vs &gt;55 and ≤17.9 vs &gt;32.7 in non-HT users, and ≤23.3 vs &gt;41.8 and ≤388 vs &gt;657 in men. SHBG and testosterone were not significantly associated with stroke in any group (Figure). The HRs [95% confidence interval] for highest to lowest SHBG and testosterone quartiles were 1.04 [0.51-2.14] and 1.64 [0.85-3.17] in HT-users, 1.02 [0.70-1.48] and 1.16 [0.83-1.62] in HT non-users, and 0.96 [0.70-1.32] and 0.87 [0.63-1.21] in men, respectively. The HRs for stroke associated with 1 SD increase in SHBG and testosterone were 1.14 [0.88-1.46] and 1.19 [0.96-1.46] in HT users. Associations were also null among non-HT users and men. Conclusion: SHBG and testosterone were not associated with ischemic stroke risk in this cohort of older men and post-menopausal women.
Abstract P143: Effects Of Oral Anticoagulant Choice On Mortality In The Primary Treatment Of Non-cancer Venous Thromboembolism: Medicare, 2011-2016
Authors: Rob F Walker, Faye L Norby, Richard F Maclehose, Terrence J Adam, Alvaro Alonso, Neil A Zakai, Pamela L Lutsey
Journal: Circulation (2021)

Introduction: Oral anticoagulants (OAC) are the mainstay of venous thromboembolism (VTE) treatment, with newer direct oral anticoagulants (DOACs; rivaroxaban, apixaban, and dabigatran) approved for the treatment of VTE. Although clinical trials have evaluated DOACs versus warfarin individually, there are few direct comparisons of OAC treatment choice among VTE patients and risk of mortality. Hypothesis: Patients enrolled in Medicare who are prescribed DOACs for primary treatment of incident VTE will experience a lower rate of mortality compared to patients prescribed warfarin. Among different DOACs, there will be no difference in rate of mortality. Methods: We used the Medicare 20% sample to identify a cohort of 84,877 individuals with incident VTE from 2011-2016. We excluded VTE patients with evidence of prevalent cancer (N=27,603). Beneficiaries were then matched by OAC using patient characteristics at date of VTE diagnosis to create an analytic dataset of 35,922. All-cause mortality and date of death were ascertained from linkage with the National Death Index. We used Cox regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for the association of OAC choice with mortality. All analyses were limited to 6-months of follow-up. Multiplicative interaction by age (≥75 years), sex, race and kidney disease were explored. Results: In our matched sample 21,320 individuals were prescribed warfarin, 10,504 rivaroxaban and 3,681 apixaban. The average age was 77 years (SD: 8 years), 63% were female, 82.0% were white, 10.4% black and 7.6% were other/unknown. There were 2,701 deaths within 6 months of VTE diagnosis, of which 1,726 were warfarin, 604 were rivaroxaban, and 272 were apixaban. In the adjusted models, individuals prescribed rivaroxaban had 0.85 times the rate of 6-month all-cause mortality compared to those prescribed warfarin (HR: 0.85; 95% CI: 0.77, 0.93). There was no difference in mortality rates comparing apixaban to warfarin (HR: 0.98; 95% CI: 0.85, 1.13) or apixaban to rivaroxaban (HR: 1.12; 95% CI: 0.95, 1.32). For the interaction analyses among those aged under 75, apixaban users had a higher risk of mortality compared to warfarin (HR: 1.37; 95% CI: 1.06, 1.77) and rivaroxaban users (HR: 1.32; 95% CI: 0.99, 1.77). No other interactions were observed. Conclusions: We found differences in mortality related to anticoagulation choice for the treatment of VTE, with rivaroxaban having a lower mortality risk than warfarin and a similar risk overall with apixaban. However, apixaban had a higher risk of mortality in secondary analyses stratified by age, with a higher risk in those &lt;75. The age-dependent association of apixaban with mortality was not hypothesized and requires further confirmation.
Abstract 16829: Isolated Left Atrial, Biatrial or Right Atrial Dilatation - Association With Low Voltage Areas in Patients With Atrial Fibrillation
Authors: Timm Seewoester, Borislav Dinov, Sotirios Nedios, Gerhard Hindricks, Jelena Kornej
Journal: Circulation (2020)

Background: Left atrial volume (LAV) and low voltage areas (LVA) are markers for impaired outcome after ablation of atrial fibrillation (AF). Some studies reported the importance of increased right atrial volume (RAV) as a predictor for arrhythmia recurrences in AF patients. Hypothesis: to investigate association between the LAV/RAV ratio and LVA presence. Methods: Patients undergoing first AF ablation with pre-procedural cardiovascular magnetic resonance (CMR) imaging were included. LVA were assessed peri-procedurally using high-density 3D maps and defined as &lt;0.5 mV. LAV was determined using a biplane model based on cine 4- and 2-chamber views, RAV using a monoplane model based on the cine 4-chamber view. Both volumes were indexed to body surface areas, and the LAV/RAV ratio was calculated. LAV/RAV ratio &gt;1 indicated isolated LA dilatation, ratio ≤1 was defined as biatrial/isolated RA dilatation. Results: The study population included 184 patients (Age 63±10 years, 34% women, 58% persistent AF, 22% LVA). There were 148 (80%) patients with isolated LA dilatation. In univariable analysis, isolated LA dilatation was associated with LVAs (OR 6.803, 95% CI 1.395-26.514, p=0.016). This association remained robust in multivariable model after adjustment for persistent AF, CHA 2 DS 2 -VASc score, renal function, and heart rate (OR 5.981, 95%CI 1.256-28.484, p=0.025). Using ROC analysis, LAV/RAV ratio (AUC 0.668, 95% CI 0.585-0.751, p&lt;0.001, Figure) was significant predictor for LVA. Biatrial/isolated RA dilatation occurred in 36 (20%) patients. On multivariable analysis, after adjustment for age, persistent AF, and renal function, male sex remained significantly associated with biatrial/isolated RA dilatation (OR 3.040, 95% CI 1.050-8.802, p=0.040). Conclusions: LAV/RAV ratio is useful for the prediction of LVA in AF. Isolated LA dilatation was associated with LVA presence, while male sex remained associated with biatrial/isolated RA dilatation and less LVA.
Abstract P096: Association Of Accurately Measured Office, Self-measured Home, And Ambulatory Blood Pressure And Their Variability With Intracranial Arterial Stenosis
Authors: Takashi Hisamatsu, Takayoshi Ohkubo, Akira Fujiyoshi, Sayuki Torii, Hiroyoshi Segawa, Keiko Kondo, Aya Kadota, Naoyuki Takashima, Satoshi Shitara, Hisatomi Arima, Yoshihisa Nakagawa, Yoshiyuki Watanabe, Akihiko Shiino, Kazuhiko Nozaki, Hirotsugu Ueshima, Katsuyuki Miura
Journal: Circulation (2021)

Background: Few studies have compared accurately measured office, self-measured home, and ambulatory blood pressure (BP) for asymptomatic intracranial artery stenosis (ICAS). Relationship of day-by-day or short-term variability in BP to asymptomatic ICAS remains unclear. Objectives: To examine the association of office, home (mean value and day-by-day variability), and ambulatory BP indices (24-hour/daytime/nighttime mean values, short-term variability, nocturnal decline, and morning pressor surge) with asymptomatic ICAS. Methods: Data on office and 7-day home BP and magnetic resonance angiography to assess ICAS were obtained in 677 men (mean age, 70.0 years) from a population-based cohort. Among them, 468 underwent 24-hour ambulatory BP monitoring. Mild- or severe-ICAS was defined as 1-49% or ≥50% stenosis, respectively, and any-ICAS as either mild or severe-ICAS. Results: We observed mild- and severe-ICAS in 153 (22.6%) and 36 (5.3%) participants, respectively. In multivariable Poisson regression with robust error variance, higher systolic BP at office, home, or ambulatory BP monitoring was associated with the presence of any- or severe-ICAS. The associations with ICAS were comparable between office, home, and ambulatory systolic BP (all heterogeneity Ps &gt;0.1). Independent of mean systolic BP, greater nocturnal decline or morning pressor surge in systolic BP was associated with higher burden of any- or severe-ICAS. Conclusion: The magnitude of association of BP accurately measured at office for asymptomatic ICAS was comparable with that of BP at home or ambulatory BP monitoring. Circadian BP variation based on ambulatory BP monitoring may be considered when assessing ICAS in apparently healthy individuals.
Abstract 13325: Complication Rates Between Same-day and Next-day Discharge of Left Atrial Ablation Procedures: A Parallel, Intra-institutional Comparison
Authors: Matthew T Brown, Mary M Pelling, Soroosh Kiani, Donna Wise, Anand D Shah, Stacy Westerman, Angel R Leon, Faisal M Merchant, Mikhael F El-Chami, Michael S Lloyd
Journal: Circulation (2020)

Introduction: Over a two-year period, two high-volume electrophysiology centers simultaneously performed left atrial ablation with differing post-procedure discharge strategies. We sought to investigate complication rates between patients undergoing same-day (SD) or next-day (ND) discharges. Methods: We identified all patients who underwent transseptal ablation from August 2017 to August 2019 (n = 409) at two high-volume centers practicing either SD (n = 210) or ND (n = 199) discharge protocols. Atrial fibrillation, left atrial flutter and left atrial tachycardia ablations were included in the study while left atrial accessory pathway ablations were not. Complications were defined as any clinical event that resulted in procedural abortion, extended stay for either center, or readmission within 72 hours. The primary endpoint included a composite of major and minor complications ranging in clinical significance from cerebrovascular accident and cardiac tamponade to significant laboratory derangements. Results: Among this cohort, average age was 63.9 +/-11 years and 32.3% of patients were female. 93.9% of procedures were for atrial fibrillation, the remainder were for left atrial flutter or left atrial tachycardia. The composite endpoint of overall complication rate was similar between SD and ND discharge (14.3% vs 12.6%, p = 0.665). Rates of complications categorized as major (2.4% vs 3.0%, p = 0. 776) and minor (11.9% vs 9.5%, p = 0.524) were also similar. Multivariable regression modeling revealed no significant correlation between discharge strategy and complication occurrence (OR 1.565 [0.754 - 3.248], p = 0.23), but a positive association of hypertension and procedure duration with complications (OR 3.428 [1.436 - 8.184], p = 0.006) and (OR 1.01 [1 - 1.019], p = 0.046) respectively. Conclusions: Left atrial ablation complication rates were similar between SD and ND discharge practices while hypertension and procedural duration were positively correlated with complications. These data, which represent the first side-by-side comparison of discharge strategy, suggest same-day discharge is safe and feasible for left atrial ablation procedures.
92O Analysis of study drug-related interstitial lung disease (ILD) in patients (pts) with HER2+ metastatic breast cancer (mBC) treated with trastuzumab deruxtecan (T-DXd)
Authors: C.A. Powell, S. Modi, H. Iwata, S. Takahashi, K. Nie, A. Qin, J. Singh, C. Taitt, S. Verma, D.R. Camidge
Journal: Annals of Oncology (2021)