tbuckley/cabot-search huggingface dataset:
Abstract 149: Annual and Lifetime Economic Productivity Loss Due to Adult Out-of-hospital Cardiac Arrest in the United States
Authors: Ryan A Coute, Brian Nathanson, Timothy J Mader, Bryan F McNally, Michael C Kurz
Journal: Circulation (2020)

Objective: To estimate the annual and lifetime economic productivity loss due to adult out-of-hospital cardiac arrest (OHCA) in the United States (U.S.) over a 5-year study period between 2013-2018. Methods: All adult (age≥ 18 years) non-traumatic EMS-treated OHCA with complete data for age, sex, race, and survival outcomes from the CARES database for the most recently available 5-year period were included. Annual and lifetime labor productivity values, based on age and gender, were obtained from previously published national economic data. Productivity losses for OHCA events were calculated by year. Productivity losses for survivors were assigned by cerebral performance category score (CPC): CPC 1 and 2 = 0% productivity loss; CPC 3-5 = 100% productivity loss. Sensitivity analyses were performed assigning CPC 2 varying productivity losses (0-100%). Lifetime productivity values assumed 1% annual growth and 3% discount rate. Productivity data are presented in U.S. dollars and adjusted for inflation based on 2016 values. Results were extrapolated to the annual U.S. population. Results: A total of 338,492 (96.5%) cases met inclusion criteria. The mean annual and lifetime productivity losses per OHCA in 2018 were $48,224 and $638,947 respectively. Total annual and lifetime productivity losses for the study population in 2018 were $3.8 billion and $50.6 billion, respectively. Sensitivity analyses assigning CPC 2 varying productivity losses yielded similar findings. Males had a much larger lifetime productivity loss to approximately age 65 years compared to females (FIGURE 1). For the U.S. population in 2018, the total annual and lifetime productivity losses due to OHCA were $11.3 billion and $150.2 billion, respectively. Conclusion: Adult non-traumatic OHCA events are associated with significant annual and lifetime economic productivity losses and should be the focus of public health resources to improve preventative measures and survival outcomes.
Selective Depletion of Antigen-Specific Antibodies for the Treatment of Demyelinating Disease
Authors: Wei Sun, Priyanka Khare, Xiaoli Wang, Dilip K. Challa, Benjamin M. Greenberg, Raimund J. Ober, E. Sally Ward
Journal: Molecular Therapy (2020)

Current treatments for antibody-mediated autoimmunity are associated with lack of specificity, leading to immunosuppressive effects. To overcome this limitation, we have developed a class of antibody-based therapeutics for the treatment of autoimmunity involving antibodies that recognize the autoantigen, myelin oligodendrocyte glycoprotein (MOG). These agents ("Seldegs," for selective degradation) selectively eliminate antigen (MOG)-specific antibodies without affecting the levels of antibodies of other specificities. Seldeg treatment of mice during antibody-mediated exacerbation of experimental autoimmune encephalomyelitis by patient-derived MOG-specific antibodies results in disease amelioration. Consistent with their therapeutic effects, Seldegs deliver their targeted antibodies to Kupffer and liver sinusoidal endothelial cells that are known to have tolerogenic effects. Our results show that Seldegs can ameliorate disease mediated by MOG-specific antibodies and indicate that this approach also has the potential to treat other autoimmune diseases where the specific clearance of antibodies is required. Current treatments for antibody-mediated autoimmunity are associated with lack of specificity, leading to immunosuppressive effects. To overcome this limitation, we have developed a class of antibody-based therapeutics for the treatment of autoimmunity involving antibodies that recognize the autoantigen, myelin oligodendrocyte glycoprotein (MOG). These agents ("Seldegs," for selective degradation) selectively eliminate antigen (MOG)-specific antibodies without affecting the levels of antibodies of other specificities. Seldeg treatment of mice during antibody-mediated exacerbation of experimental autoimmune encephalomyelitis by patient-derived MOG-specific antibodies results in disease amelioration. Consistent with their therapeutic effects, Seldegs deliver their targeted antibodies to Kupffer and liver sinusoidal endothelial cells that are known to have tolerogenic effects. Our results show that Seldegs can ameliorate disease mediated by MOG-specific antibodies and indicate that this approach also has the potential to treat other autoimmune diseases where the specific clearance of antibodies is required.
Abstract 14052: Differences in Pediatric Cholesterol Screening Rates Between Family Medicine and Pediatrics Correlate With Conflicting Guidelines
Authors: Amy L Peterson, Ann M Dodge, Jens Eickhoff, Kathleen DeSantes, Magnolia Larson, Megan Moreno
Journal: Circulation (2020)

Introduction: In 2011, the National Heart, Lung, and Blood Institute released pediatric cardiovascular guidelines, recommending universal cholesterol screening between ages 9-11 and 17-21 years. This guideline conflicts with other organizations, notably the 2016 United States Preventative Services Task Force (USPSTF) statement which did not endorse universal screening. Our institution has utilized educational tools and electronic health record (EHR) modifications to encourage pediatric cholesterol screening. Hypothesis: Changes in pediatric lipid screening rates within a single institution correlate with release of national guidelines, as well as local educational tools and EHR modifications. Methods: Order placement was defined as ordering a high-density lipoprotein cholesterol level in a patient 9-21 years with ≥ 1 well visit in prior 3 years. Order placement rate (OPR) was calculated per month using 3 months’ moving average smoothing and analyzed based on date and specialty of ordering clinician. Timing of educational tools, EHR modifications, and national guideline release were analyzed for changes in OPR. Results: A total of 36,756 visits from 2010-2019 with 21,239 orders were analyzed. Total OPR was 57.8%. Prior to 2011 guideline, pediatrician (P) OPR was 41% (95% CI: 36-47%) and 9% (7-10%) for family medicine (FM). OPR increased in the 12 months after 2011 guideline, educational initiatives, and EHR changes for P (80%, 95% CI: 76-83%) and FM (21%, 95% CI: 19-25%) . Both P and FM had lower rates after 2016, with greater decrease for FM (p&lt;0.001 for all). Conclusions: OPR was higher in P than FM, with largest OPR changes correlating with release of guidelines. Larger positive changes in OPR were seen in P compared to FM after 2011 guideline, and larger decrease in OPR in FM compared to P correlating with 2016 USPSTF statement release. Conflicting guidelines may contribute to lower overall OPR as well as different screening rates for children cared for by P and FM.
COVID-19 Poses Pregnancy Risks
Authors: Bridget M. Kuehn
Journal: JAMA (2020)

Mikael Norman, MD; Lars Navér, MD; Jonas Söderling, PhD; Mia Ahlberg, PhD; Helena Hervius Askling, MD; Bernice Aronsson, MD; Emma Byström, MSc; Jerker Jonsson, MD; Verena Sengpiel, MD; Jonas F. Ludvigsson, MD; Stellan Håkansson, MD; Olof Stephansson, MD
City design for health and resilience in hot and dry climates
Authors: Maya Negev, Haneen Khreis, Briony C Rogers, Mohammed Shaheen, Evyatar Erell
Journal: BMJ (2020)

Cities in regions including the Middle East can use a variety of approaches to promote wellbeing among the people who live and work there despite dryness and heat, write <b>Maya Negev and colleagues</b>
Abstract 14185: Targeting Lower Oxygen Saturation Parameters in Premature Infants Does Not Increase Incidence of Pulmonary Hypertension in the Neonatal Intensive Care Unit
Authors: Maria Niccum, Fotios Spyropoulos, Jonathan Levin, Carter Petty, Mary P Mullen, helen christou
Journal: Circulation (2020)

Introduction: Lower oxygen saturation targets in preterm infants have been associated with decreased incidence of bronchopulmonary dysplasia (BPD) but increased risk of pulmonary hypertension (PH). Studies have shown that targets of &lt;90% are associated with higher incidence of PH, however data on the optimal saturation target &gt;90% are lacking. In this study, we compared the rate of BPD and PH in two cohorts with saturation targets of 94-98% and 92-97%. We hypothesized that BPD rate would be lower and PH rate would be unchanged at the lower saturation target. Methods: We performed a retrospective cohort study comparing PH and BPD rates among two cohorts of infants born at ≤32 weeks gestation at Brigham and Women’s Hospital: cohort 1 with saturation target of 94-98% (n = 129, July 2017-July 2018), cohort 2 with saturation target of 92-97% (n = 124, July 2018-July 2019). PH was defined by echocardiographic evidence of systolic septal flattening or right ventricular pressure ≥35 mmHg (estimated by tricuspid regurgitant jet velocity or shunt velocity) at gestational age (GA) ≥36 weeks. Comparisons between groups were carried out by Chi-square test, t-test, and multivariable logistic regression. Results: Subjects had a GA of 23-32 weeks; 46% were female. Groups did not differ with respect to GA, sex, or birth weight. There was no difference in rate of PH (2.4% vs. 4.2%, p = 0.12) or BPD (25% vs. 20%, p = 0.31) between cohort 1 and cohort 2. Other clinical parameters were not different between groups, including presence of patent ductus arteriosus, presence of atrial septal defect, use of diuretics, or use of steroids. After controlling for GA, birth weight, sex, and diagnosis of BPD using logistic regression, there was no difference in rate of PH between groups (p = 0.47), but there was a positive association of BPD with PH (OR 3.45; 95% CI, 1.18-10.09; p = 0.02). Conclusions: A lower oxygen saturation target was not associated with a higher rate of PH or lower rate of BPD in preterm infants. The overall rate of PH was much lower than rates previously reported at saturation targets &lt;90%. Given our low incidence of PH, and the lack of a significant difference in rate of PH between groups, a saturation target of 92-97% may be safe while also minimizing need for supplemental oxygen in this population.
Social Media and Well-Being: Pitfalls, Progress, and Next Steps
Authors: Ethan Kross, Philippe Verduyn, Gal Sheppes, Cory K. Costello, John Jonides, Oscar Ybarra
Journal: Trends in Cognitive Sciences (2020)

Within a relatively short time span, social media have transformed the way humans interact, leading many to wonder what, if any, implications this interactive revolution has had for people's emotional lives. Over the past 15 years, an explosion of research has examined this issue, generating countless studies and heated debate. Although early research generated inconclusive findings, several experiments have revealed small negative effects of social media use on well-being. These results mask, however, a deeper set of complexities. Accumulating evidence indicates that social media can enhance or diminish well-being depending on how people use them. Future research is needed to model these complexities using stronger methods to advance knowledge in this domain.
Abstract 16798: Evidence of Abnormal T1 Mapping in Arrhythmic Mitral Valve Prolapse Without Significant Mitral Regurgitation
Authors: Brian B Agbor-Etang, Lisa J Lim, Karen G Ordovas, Francesca N Delling
Journal: Circulation (2020)

Background: Prior cardiac magnetic resonance (CMR) studies have reported abnormal T1 mapping, reflective of diffuse myocardial fibrosis, in patients with mitral valve prolapse (MVP) and ventricular arrhythmias. However, T1 mapping was derived from conventional Look-Locker sequences and/or obtained in selected MVP patients with severe mitral regurgitation (MR) and a clinical indication for CMR. Hypothesis: We hypothesize that extracellular volume (ECV) fraction, a marker of diffuse fibrosis derived from research-based, MOLLI T1 mapping sequences, is increased in MVP subjects with ventricular arrhythmias, even in the absence of significant MR. Methods: We performed CMRs in 10 consecutive, randomly selected MVP patients identified through our echocardiographic database, age/gender matched to 10 controls free of significant cardiac disease. All 10 MVPs underwent ambulatory EKG monitoring. CMR images were acquired using a GE 3.0T Discovery MR750w scanner. Global ECV fraction was calculated using pre- and 10 minutes post-contrast T1 times after administration of 0.1 mmol/kg of gadobutrol (Gadavist). Late gadolinium enhancement (LGE) was also obtained. MR fraction was quantified by velocity encoded CMR. Mild MR was defined as MR fraction &lt; 16%. Results: MVP patients had significantly higher ECV fraction compared to controls (mean ECV (%) 32 ± 4 vs 20 ± 6, p = 0.0002), with 5/10 demonstrating non-sustained VT on ambulatory EKG monitoring. The majority (9/10 or 90%) of MVPs had mild or no MR (MR fraction &lt; 16%), and 1/10 or 10% had moderate MR (MR fraction 18%). Only one individual in the MVP group had late gadolinium enhancement (LGE) in the papillary muscles. Conclusion: MVP with ventricular arrhythmias is associated with increased global ECV reflective of diffuse myocardial fibrosis, even in the absence of significant MR or LGE. Our preliminary findings highlight for the first time a primary interstitial derangement in MVP. Larger studies are needed to understand the mechanisms and prognostic significance of primary diffuse fibrosis in MVP.
Abstract 14507: Suboptimal Blood Pressure Control Increases the Risk of Non-alcoholic Fatty Liver Disease
Authors: Gul Saeed, Ehimen Aneni, Bincy Abraham, Marcio S Bittencourt, Miguel Cainzos Achirica, Raul D Santos, Khurram Nasir
Journal: Circulation (2020)

Introduction: Recent blood pressure (BP) guidelines recommend aggressive control of BP to prevent target organ damage, however, no population-level studies have assessed the impact of aggressive BP control on the incidence of Nonalcoholic Fatty Liver Disease (NAFLD). In this study, we investigate the implications of suboptimal BP control for incident NAFLD. Methods: We analyzed data from 6,252 consecutive participants in an employer-mandated routine health evaluation at Hospital Israelita Albert Einstein (São Paulo, Brazil) collected between 2004 to 2016 who were free of NAFLD at baseline. NAFLD was defined as liver ultrasound detected hepatic steatosis among individuals with an alcohol use disorder identification test (AUDIT) score &lt;8. Hypertension was defined as either self-reported history and/or use of BP-lowering medications. Suboptimal BP control was defined per the 2018 ACC/AHA criteria as systolic BP &gt;/= 130mmHg and/or diastolic BP &gt;/= 80 mmHg. Multivariate analysis was conducted adjusting for possible confounders as noted in the figure. Results: Over a median follow-up period of 2.9 years (range: 0.6 - 10.6 years), the incidence of NAFLD was 25.8% among individuals with hypertension (N=473) compared to 15.2% among non-hypertensive individuals (N=5,779; p&lt;0.001). Amongst individuals with known hypertension and suboptimal BP control, the incidence was 29.7% compared to 14.3% among those with optimal BP (adjusted RR 1.80 [95%CI: 1.12 - 2.90]). Similarly, the risk of NAFLD was 18% greater among those without known hypertension but whose BP was suboptimal (adjusted RR: 1.18 [95% CI: 1.05 - 1.33]; figure). Conclusions: Among persons with known hypertension, suboptimal BP is an independent risk of NAFLD. In addition, among those without known hypertension, suboptimal BP is an independent predictor of future NAFLD. Intervention studies are needed to investigate the role of BP control in the prevention of NAFLD.
Fit older adults with advanced myelodysplastic syndromes: who is most likely to benefit from transplant?
Authors: Gregory A. Abel, Haesook T. Kim, Andrew Hantel, David P. Steensma, Richard Stone, Anand Habib, Vincent T. Ho, Martha Wadleigh, Areej El-Jawahri, Edwin P. Alyea, Daniel J. DeAngelo, John Koreth, Joseph H. Antin, Robert J. Soiffer, Corey Cutler
Journal: Leukemia (2020)
Abstract 12790: Classification of the Different Types of Hypertrophic Cardiomyopathy Responsible for Advanced Heart Failure: From Clinical, Morphofunctional Characteristics to Prognosis and Potential New Therapies
Authors: GIUSEPPE GALATI, Olga Germanova, Pierre SABOURET, Nadia Aspromonte, Laura A Dalla Vecchia, Ivana Vranic, MICHELE SENNI, Marco Metra, Alberto Margonato
Journal: Circulation (2020)

Introduction: Advanced heart failure (AdvHF) in HCM was overlooked. Hypothesis: Based on a systematic revision, we described prevalence &amp; outcomes of the main HCM phenotypes responsible for AdvHF, heart transplantation (HTx), LVAD implantation &amp; HF-death. Methods: We classified the HCM profiles responsible for AdvHF in 1) End-stage HCM (ES-HCM) defined by an LVEF≤50%; 2) LVOTO despite optimal medical therapy (OMT) (Refractory HOCM); 3) Nonobstructive HCM with preserved EF (HNOCMpEF). The study screened 130 manuscripts in MEDLINE and EMBASE on AdvHF in HCM patients (pts) published from 2000 till January 2020, in adults. 8 manuscripts were eligible for the analysis. AdvHF was defined by the presence of severe NYHA symptoms (III &amp; IV) because in all the manuscripts this definition was used. Mean follow-up = 7.6 years. Results: Figure 1: Prevalence of phenotypes responsible for AdvHF&amp;HTx/LVAD implantation/HF-Death. Of 205 HCM pts, 119 (58%) underwent HTx, LVAD implantation, or died for HF. Figure 2: Outcome per each clinical phenotype. Conclusions: AdvHF in HCM has an ominous prognosis (58% of pts met HTx/LVAD implantation/HF-death) but with significant differences among the 3 phenotypes. HOCM has a very good outcome, indeed only few cases developed a Refractory HOCM &amp; AdvHF &amp; only 1 died for HF. 29.7% of AdvHF were caused by HNOCMpEF due to massive hypertrophy &amp; restrictive physiology &amp; only 16.4% of them died due to HF. ES-HCM represents the main cause of AdvHF in HCM &amp; the major determinant for poor outcomes among all HCM pts (Only 1/3 of them were event-free). This reflects poor attention and portrays an unmet need for ES-HCM pts. Recently it was demonstrated that an extensive amount of myocardial fibrosis (MF) is the major determinant for ES-evolution. Taken together these findings show the importance of a strict follow-up for HCM pts to timely identify ES-HCM &amp; early start HF OMT. Developing specific therapies to lower the burden of MF &amp; stop adverse remodeling it's crucial.
Abstract 14778: Watchman Associated With Lower Risk of Stroke and Mortality in Patients With Atrial Fibrillation and Difficulties Taking Anticoagulation
Authors: Xiaoxi Yao, Holly K Van Houten, Lindsey R Sangaralingham, Henry Henk, Jonathan Graff-Radford, Bernard J Gersh, David R Holmes, Peter A Noseworthy
Journal: Circulation (2020)

Introduction: Watchman has been increasingly used in AF patients who have difficulties taking anticoagulation, but the RCTs only compared Watchman to warfarin. There was also a signal of increased ischemic stroke with Watchman in comparison to warfarin in RCTs, which made some clinicians question the fundamental premise that Watchman can reduce stroke. We aimed to compare Watchman to no anticoagulation in a large national cohort of patients in the US. Methods: We identified AF patients treated with Watchman (N=7,309) or no anticoagulation (N=1,234,543) between 2015-2017 from the OptumLabs Data Warehouse, which is the first to link private insurance, Medicare Advantage, and Medicare Fee-for-Service records at patient level longitudinally. One-to-one propensity score matching was used to balance patients on demographics and medical history. The primary outcomes were ischemic stroke or systemic embolism (hereafter referred to as stroke) and major bleeding. Secondary outcomes included all-cause mortality and intracranial bleeding. Results: In the unmatched cohort, the mean age was 76.6±6.4 yr in the Watchman group and 76.6 ±8.5 yr in the no anticoagulation group, but Watchman patients were more likely to have a history of bleeding (44.9% vs 13.7%) and intracranial bleeding (9.5% vs 2.6%). After matching, the two groups were similar on 18 baseline characteristics. Watchman was associated with a lower risk of stroke and mortality, but a higher risk of major bleeding and a similar risk of intracranial bleeding. The associations were largely consistent across subgroups, including those with relative contraindications to anticoagulation (Figure). Conclusions: In AF patients who had difficulties taking anticoagulation, Watchman offers an alternative approach to reduce stroke and mortality. The results provide important evidence to inform clinical decision making in the absence of RCTs, since 40% of AF patients in routine practice are not on anticoagulation.
Abstract 14953: Temporal Trends in Non-invasive Diagnostic Tests for Ischemic Heart Disease Among Us Adults Age 64 Years or Younger: Results From the Marketscan Survey, 2010-2018
Authors: Soyoun Park, Yuling Hong, Cathleen Gillespie, Robert Merritt, Laurence Sperling
Journal: Circulation (2020)

Introduction: Heart disease is the leading cause of death in the U.S. Ischemic heart disease (IHD) accounts for two thirds of heart disease deaths. Non-invasive cardiovascular tests (NITs) are often the first step to establish an IHD diagnosis. Methods: We analyzed 2010-2018 IBM® MarketScan® Commercial Databases. NITs including exercise ECG, stress echocardiography, CT coronary artery calcification score (CT-CAC), single-photon emission computerized tomography (SPECT), cardiac CT angiography (CTA), nuclear positron emission tomography/myocardial perfusion imaging (PET/MPI), stress MRI, were identified using current procedural terminology (CPT) codes. IHD using ICD 9/10 codes (410-414, 429.2/I20-I25) and chest pain (786.59/R07.89) or unspecified chest pain (786.50/R07.9) were identified. The 2000 Census population was used to calculate the age standardized prevalence. Results: The data included 20,726,587 individuals (48.1% men, mean age (standard deviation) of 49.1 (13.5) years), among which 67,339 had a diagnosis of IHD or chest pain in 2018. The age standardized prevalence of the overall population that had at least one of the 7 tests is 1.60% in 2018, down from 2.47% in 2010. The responding prevalence for those with IHD or chest pain was 54.3% in 2018 and 61.6% in 2010. Exercise ECG was the most utilized test for the overall population: 0.94% in 2018 down from 1.31% in 2010; SPECT was second most often used with 0.75% in 2018 and 1.24% in 2010. However, SPECT was the most often utilized test among those with CHD or chest pain: 38.2% in 2018, down from 45.0% in 2010, and exercise ECG second most often with 32.6% in 2018 and 34.9% in 2010. An increase in use of CT-CAC, PET/MPI, and CTA tests was observed since 2010, but the prevalence of all were low in 2018. 0.02%. 0.01%, and 0.04% for the overall population and 0.20%, 0.95% and 3.20% for those with IHD or chest pain, respectively. Conclusions: Almost 2% of the general younger US adult population and over half of those with IHD or chest pain had undergone at least one of 7 NITs in 2018. While the utilization of overall NITs for both the general population and those with IHD or chest pain has declined since 2010, it has increased for CT-CAC, PET/MPI, and CTA but still less than 1% for CT-CAC and PET/MPI..
Heterogeneous Circles for Liver Allocation
Authors: Nicholas L. Wood, Amber B. Kernodle, Andrew J. Hartley, Dorry L. Segev, Sommer E. Gentry
Journal: Hepatology (2020)

In February 2020, the Organ Procurement and Transplantation Network replaced donor service area-based allocation of livers with acuity circles, a system based on three homogeneous circles around each donor hospital. This system has been criticized for neglecting to consider varying population density and proximity to coast and national borders.