tbuckley/cabot-search huggingface dataset:
Abstract 13456: Association of Chronic Inflammatory Diseases With Incident Atrial Fibrillation
Authors: Yoshihiro Tanaka, Adovich Rivera, Arjun Sinha, Ravi B Patel, Rod S Passman, Matthew J Feinstein
Journal: Circulation (2020)

Introduction: Inflammation plays a vital role on the pathophysiology of atrial fibrillation (AF). Although it is hypothesized that chronic inflammatory diseases (CIDs) may increase the risk for incident AF, data are scarce regarding whether CIDs are associated with incidence of AF. Objectives: To determine associations of CIDs with incident AF in a large cohort comprised of patients with multiple different CIDs. Methods: Patients who visited outpatient clinic regularly due to CIDs (human immunodeficiency virus infection, inflammatory bowel disease, psoriasis, rheumatoid arthritis, systemic sclerosis [SSc], and systemic lupus erythematosus [SLE]) and frequency-matched controls (in regular primary care/general medicine clinic) were extracted from the Northwestern electronic health records between 1/1/2000-1/1/2019. Multiple imputation was used for imputing missing values and all following statistical analyses. Cumulative incidence of AF was estimated by the Kaplan Meier Curve, and adjusted Cox proportional hazard models were used to compute hazard ratio (HR) for each CID. Results: We analyzed a total number of 37,601 patients (18,847 CIDs and 19,871 controls without CIDs, median age 48.4 years, male 43%). During a median follow-up period of 3.6 years, 1076 cases (2.9%) of incident AF were observed. After adjusting for covariates included in CHARGE-AF risk score, baseline year, insurance type, baseline hypertension, and estimated glomerular filtration rate, both SSc (HR, 2.29: 95% confidence interval [CI], 1.72 - 3.06; p &lt; 0.01) and SLE (HR, 2.18; 95% CI, 1.65 - 2.90; p &lt; 0.01) were associated with a significantly elevated incidence of AF (Table). Conclusions: Patients with SSc or SLE had a significantly elevated incidence of AF after multivariable adjustment. Future studies should investigate mechanisms underlying these findings to generate both disease-specific knowledge and more generalizable knowledge regarding inflammatory contributors to AF.
Abstract 13949: Quantitative Assessment of the Left Atrial Appendage as a More Reliable Method of Thromboembolic Risk Stratification
Authors: KEVIN Lee, Michael Trybula, Brody D Slostad, Lee J Frazin, Sreenivas Konda, Victor Macrinici, Mayank M Kansal
Journal: Circulation (2020)

Introduction: Assessment of the left atrial appendage (LAA) in patients with atrial fibrillation (AF) undergoing cardioversion for thromboembolic risk stratification is inherently qualitative. Oftentimes, interobserver assessment may disagree, leading to differences in risk stratification and patient management. We propose a novel method of quantitative LAA assessment and examine its predictive value for future thromboembolic events. Hypothesis: Evaluation of LAA using ImageJ pixel density quantification software in patients with AF will be superior to qualitative assessment by expert readers in assessing and predicting future thromboembolic risk. Methods: A total of 124 patients (mean age 59 ± 13 years, 70% male) undergoing transesophageal echocardiography to exclude LAA thrombus prior to radiofrequency pulmonary vein isolation or electrical cardioversion for AF were retrospectively studied. LAA were examined by two expert readers and identified as thrombus ( n = 9), sludge ( n = 11), spontaneous echocontrast ( n = 90), or normal ( n = 138). LAA were then separately examined using ImageJ to calculate a gain-independent ratio between the average pixel density of the LAA cavity and the average pixel density of the LAA wall (C/W ratio). Results: There was significant disagreement between the two expert readers in LAA assessment (weighted Kappa 0.510, p &lt; 0.0001). Qualitative LAA analysis was significantly related with C/W ratio ( p &lt; 0.0001) and thromboembolic events ( p &lt; 0.0002). C/W ratio was also significantly related with thromboembolic events (OR 1.60, 95% CI 1.095 - 2.347, p &lt; 0.0152). According to Area Under the Curve (AUC) of the ROC curve, C/W ratio (AUC 0.73, 95% CI 0.60 - 0.86) was a more reliable predictor for future thromboembolic when compared to qualitative LAA assessment (AUC 0.72, 95% CI 0.53-0.90). Conclusions: Quantitative LAA assessment using the C/W ratio provided by ImageJ software is more reliable than qualitative assessment by expert readers for identifying future thromboembolic events while reducing reader variability.
Effect of Antibiotic Use Within First 48 Hours of Life on the Preterm Infant Microbiome
Authors: Christina S. Kim, Nicole Grady, Matthew Derrick, Yueyue Yu, Kaitlyn Oliphant, Jing Lu, Erika C. Claud
Journal: JAMA Pediatrics (2020)

This randomized clinical trial investigates whether withholding the standard 48 hours of intravenous empirical antibiotics immediately after birth in preterm infants protects the developing microbiome and improves clinical outcomes.
Abstract 16276: Lipoprotein (a) Predicts Recurrent Worse Outcomes in Type 2 Diabetes Mellitus Patients With Prior Cardiovascular Events: A Prospective, Observational Cohort Study
Authors: Yan Zhang, Jinglu Jin, Yexuan Cao, Hui-Wen Zhang, Yuan-Lin Guo, Na-Qiong Wu, Cheng-Gang Zhu, Ying Gao, Qi Hua, Yan-Fang Li, Rui-Xia Xu, Jian-jun Li
Journal: Circulation (2020)

Introduction: Merging studies have reported the association of lipoprotein(a) [Lp(a)] with poor outcomes of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, the prognostic importance of Lp(a) for recurrent cardiovascular events (CVEs) is currently undetermined in patients with T2DM and prior CVEs. Methods: From April 2011 to March 2017, we consecutively recruited 2,284 T2DM patients with prior CVEs. Patients were categorized into low, medium, and high groups by Lp(a) levels and followed up for hard, recurrent CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Caplan-Meier, Cox regression and C-statistic analyses were performed. Results: During 7,613 patient-years’ follow-up, 153 recurrent CVEs occurred. Lp(a) levels were significantly higher in patients with recurrent CVEs than counterparts (20.44 vs. 14.71 mg/dL, p=0.002). Kaplan-Meier analysis revealed that the event-free survival rate was dramatically lower in high and medium Lp(a) groups than that in low group irrespective of HBA1c status (&lt;7.0%; ≥7.0%, both p&lt;0.05). Furthermore, multivariate Cox regression models indicated that Lp(a) was independently associated with high risk of recurrent CVEs [HR(95% CI): 2.049(1.308-3.212)], such data remains in different HBA1c status (HR(95% CI): &lt;7.0%, 2.009(1.051-3.840); ≥7.0%, 2.162(1.148-4.073)). Moreover, the results of C-statistic were significantly improved by 0.029 when added Lp(a) to the Cox model. Conclusions: Our data, for the first time, confirmed that Lp(a) was an independent predictor for recurrent CVEs in T2DM patients with prior CVEs, suggesting that Lp(a) measurement may help to further risk stratification for T2DM patients after they suffered a first CVE.
Abstract 13525: The Association Between Multiparity and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Carla P Rodriguez, Oluseye Ogunmoroti, Renato Quispe, Olatokunbo I Osibogun, Chiadi E Ndumele, Justin B Echouffo Tcheugui, Anum Minhas, Alain G Bertoni, Matthew A Allison, Erin D Michos
Journal: Circulation (2020)

Background: Multiparity is a risk factor for cardiovascular disease (CVD). However, the mechanism of this relationship is unknown. Adipokines may predispose multiparous women to certain cardiometabolic complications that can increase their risk of future CVD. Methods: We studied 975 female MESA participants (ages 45-84 yrs and initially free of CVD) who had complete data on parity assessed at baseline and adipokine levels measured at either Exam 2 or 3. Parity was categorized as nulliparity (reference), 1-2, 3-4 and ≥5 live births. Multivariable linear regression was used to evaluate the association of parity categories with log-transformed levels of leptin, resistin, and adiponectin. Results: The women (38% white, 23% black, 13% Chinese, and 26% Hispanic) had mean age at MESA visit 2/3 of 63±9 yrs. Median adipokine levels by parity group are shown in the Table . Compared to nulliparity, a history of 3-4 live births was associated with higher leptin levels, even after full covariate adjustment including body mass index (BMI) and CVD risk factors (model 4). Grand multiparity (≥5 births) was associated with greater leptin after adjustment for demographic and lifestyle factors (models 1 &amp; 2), but these associations were no longer significant after BMI adjustment (model 3). Grand multiparity was also associated with lower adiponectin levels in demographic/lifestyle-adjusted models but not after adjustment for BMI. In contrast, grand multiparity remained associated with higher resistin levels after full covariate adjustment (model 4). Conclusions: In a multiethnic U.S. cohort of women, multiparity is associated with adipokine levels, specifically with higher leptin and resistin levels. Further studies are needed to determine whether adipokines mediate the relationship between multiparity and CVD.
Abstract 13690: Association of Serum Fatty Acids With Age at the Onset of Acute Ischemic Stroke in Patients Aged 50 Years or Older
Authors: Takahisa Mori, Kazuhiro Yoshioka
Journal: Circulation (2020)

Introduction: There are few reports about the association of concentrations and proportions of serum fatty acids with age at the onset of acute ischemic stroke (AIS) in elderly patients. Hypothesis: A higher level of saturated FA (SFA) and n-6 polyunsaturated FA (PUFA) cause a younger onset of AIS, and a higher level of n-3 PUFA causes an older onset of AIS. Methods: For the retrospective cross-sectional study, we included patients aged 50 years or older who: 1) were admitted to our institution between August 2016 and July 2019 within 24 hours of AIS onset, and 2) underwent an examination of serum fatty acids. We evaluated concentrations of palmitic acid (PA) and stearic acid (SA) as SFA, oleic acid (OlA) as n-9 PUFA, linoleic acid (LiA), dihomo-gamma-linolenic acid (DGLA), arachidonic acid (AA) as n-6 PUFA on admission. We evaluated the concentration of alpha-linolenic acid (AlA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) as n-3 PUFA on admission. We evaluated the proportion of PA, SA, OlA, LiA, DGLA, AA, AlA, EPA, and DHA on admission. Furthermore, we evaluated their correlations with age at the AIS onset. Results: Three hundred sixty-six patients met our inclusion criteria. Their median average age was 75 years. Age at the onset was negatively correlated with concentrations of PA, SA, OlA, LiA, DGLA, AA, and AlA. Age at the onset was negatively correlated with the proportion of SA, OlA, and DGLA and positively correlated with the proportion of EPA and DHA. Multiple regression analysis showed that DGLA was an independent factor for the younger onset of AIS. Multiple regression analysis showed that DHA proportion was an independent factor for the older onset and that proportions of SA and DGLA were independent factors for the younger onset of AIS. Conclusions: The higher proportion of SA (SFA) and higher concentration and proportion of DGLA (n-6 PUFA) were significantly correlated with the younger onset of AIS, and the higher proportion of DHA (n-3 PUFA) was significantly correlated with the older onset of AIS.
Abstract 15484: Combined Coronary and Carotid Artery Involvement in a Caucasian Patient With Moyamoya Disease
Authors: Ahmed H Qavi
Journal: Circulation (2020)

Introduction: Moyamoya disease (MMD) is a rare, progressive steno-occlusive disease of the intracranial carotid arteries. This is primarily a cerebrovascular disease and is mostly seen in young Japanese patients. We report a case of severe stenosis in the distal left circumflex artery (dLCx) in a non-Japanese patient with previously diagnosed MMD. Case presentation: A 33-year-old Caucasian female with history of MMD and 2 CVAs presented with chest pain for 2 days. Her only medication at home was aspirin. There was no history of hypertension, diabetes mellitus, or tobacco use. There was no family history of early CAD. Physical examination was positive for tachycardia but negative for carotid or femoral bruits. Neurologic examination revealed decreased touch sensation and diminished deep tendon reflexes on the left side. ECG demonstrated tachycardia with T wave inversions in leads III and ST depression in lead II. Acute CVA was ruled out with an MRI. Cardiac troponins were minimally elevated with peak of 0.12 ng/dl. An initial diagnosis of NSTEMI was made; patient was loaded with aspirin, clopidogrel and started on a heparin drip. Cardiac catheterization on the following day revealed single vessel CAD in the dLCx, with 80% stenosis and TIMI flow 2. A drug eluting stent was successfully placed in the dLCx. Angiogram post-stent placement showed optimal angiographic result with TIMI 3 flow. The patient was discharged home on dual antiplatelet therapy, statin, beta-blocker and ACE inhibitor. Discussion: MMD is thought to affect the coronary arteries from fibrous intimal thickening and histopathology of these coronary lesions show a homogenous, soft intimal proliferation with minimum lipid deposition and without substantial inflammatory cell infiltration. Although the combined involvement of carotid and coronary artery stenosis is rare, coronary involvement should be considered as one of the causes of ischemic heart disease in young patients with MMD. To the best of our knowledge, this is the first reported case of combined involvement of carotid and coronary artery stenosis in a Caucasian patient with previously diagnosed MMD. It is imperative to educate patients with MMD about possible CAD so that they seek immediate medical attention if cardiac symptoms occur.
Machine Learning–Guided Adjuvant Treatment of Head and Neck Cancer
Authors: Frederick Matthew Howard, Sara Kochanny, Matthew Koshy, Michael Spiotto, Alexander T. Pearson
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Postoperative chemoradiation is the standard of care for cancers with positive margins or extracapsular extension, but the benefit of chemotherapy is unclear for patients with other intermediate risk features. <h3>Objective</h3> To evaluate whether machine learning models could identify patients with intermediate-risk head and neck squamous cell carcinoma who would benefit from chemoradiation. <h3>Design, Setting, and Participants</h3> This cohort study included patients diagnosed with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx from January 1, 2004, through December 31, 2016. Patients had resected disease and underwent adjuvant radiotherapy. Analysis was performed from October 1, 2019, through September 1, 2020. Patients were selected from the National Cancer Database, a hospital-based registry that captures data from more than 70% of newly diagnosed cancers in the United States. Three machine learning survival models were trained using 80% of the cohort, with the remaining 20% used to assess model performance. <h3>Exposures</h3> Receipt of adjuvant chemoradiation or radiation alone. <h3>Main Outcomes and Measures</h3> Patients who received treatment recommended by machine learning models were compared with those who did not. Overall survival for treatment according to model recommendations was the primary outcome. Secondary outcomes included frequency of recommendation for chemotherapy and chemotherapy benefit in patients recommended for chemoradiation vs radiation alone. <h3>Results</h3> A total of 33 527 patients (24 189 [72%] men; 28 036 [84%] aged ≤70 years) met the inclusion criteria. Median follow-up in the validation data set was 43.2 (interquartile range, 19.8-65.5) months. DeepSurv, neural multitask logistic regression, and survival forest models recommended chemoradiation for 17 589 (52%), 15 917 (47%), and 14 912 patients (44%), respectively. Treatment according to model recommendations was associated with a survival benefit, with a hazard ratio of 0.79 (95% CI, 0.72-0.85;<i>P</i> &lt; .001) for DeepSurv, 0.83 (95% CI, 0.77-0.90;<i>P</i> &lt; .001) for neural multitask logistic regression, and 0.90 (95% CI, 0.83-0.98;<i>P</i> = .01) for random survival forest models. No survival benefit for chemotherapy was seen for patients recommended to receive radiotherapy alone. <h3>Conclusions and Relevance</h3> These findings suggest that machine learning models may identify patients with intermediate risk who could benefit from chemoradiation. These models predicted that approximately half of such patients have no added benefit from chemotherapy.
TELEMEDICINE ADOPTION MAINTAINS SIMILAR ACCESS TO CARE PROVIDED TO VETERANS WITH CIRRHOSIS DURING THE SARS-CoV2 PANDEMIC
Authors: J. Lin, A. J. Sheinbaum, S. H. B. Han, A. Dreskin, D. Bhattacharya, M. Goetz, J. Pisegna, K. Cordasco, A. A. Patel
Journal: Hepatology (2020)

Background: The SARS-CoV2 pandemic has increased interest in telemedicine use among hepatology providers On 3/17/2020, all patient visits at VA Greater Los Angeles (GLA) Healthcare System were converted from face-to-face to telephone or video visits in our hepatology clinic As part of a quality improvement effort, we evaluated our ability to reach and provide consultative care to GLA Veterans with cirrhosis during this time Methods: We examined outpatient encounters from 1/1/2020-5/31/2020 in our two weekly hepatology specialty clinics Validated ICD- 10 codes and manual chart review were used to confirm a diagnosis of cirrhosis We abstracted demographics, encounter characteristics (type, successful contact), clinical characteristics, and documented care provided during encounters (health care maintenance counseling;medication refills or changes;ordering of bloodwork, imaging, or endoscopy;and referrals)  We classified a patient as having been 'reached' if we were able to complete at least one encounter with them over the study period We compared, with t-tests and Chi-squared tests, our ability to reach patients, patient characteristics, and care delivered before and after 3/17/2020, using STATA 14 2 Results: We identified 145 Veterans with cirrhosis scheduled over 322 encounters Most Veterans were male (98%), with a mean age of 68 (SD=9 9) years;40% were White Thirty six percent of Veterans had decompensated cirrhosis and 21% had hepatocellular carcinoma Before 3/17/2020, 93/104 (89%) of Veterans with scheduled encounters were successfully reached, of which all were in-person consultations Among Veterans with scheduled encounters March 17th, 2020 and after, 83/89 (93%), were reached, of which 87% used telemedicine (84% phone, 3% video) There were no major demographic differences among Veterans reached before and after telehealth implementation (see Table) Rates of health care maintenance counseling, medication changes or refills, as well as ordering of bloodwork, imaging, endoscopy, and new referrals, were similar Veterans reached post-telemedicine adoption had a significantly higher number of encounters with our clinic (1 35 vs 1 07, p=0 01) Conclusion: Adoption of telemedicine practices during the SARS-CoV2 pandemic led to similar rates of care being provided to Veterans pre-pandemic, though over more encounters  We observed no significant disparities in age, gender, or race/ethnicity in reaching Veterans using thispractice However, use of video visits was low These results suggest that telemedicine is a feasible strategy to manage patients with cirrhosis in our clinic However, more information is needed on the reasons for low uptake of video visits, as well as Veteran experiences, adherence, and outcomes with telemedicine-delivered cirrhosis care
Abstract 15863: Prevalence, Trends and Impact of Cannabis Use on Hospitalizations With Prior Myocardial Infarction and Revascularization
Authors: Rupak Desai, Sandeep Singh, Zainab J Gandhi, Faizan Ahmad Malik, Virmitra G Desai, Vraj Patel, Prince Khimani, falah abu hassan, Zarna Bambhroliya, Rushik Bhuva
Journal: Circulation (2020)

Background: With the rise of cannabis use in the USA, we aim to assess its prevalence and impact on admissions with prior myocardial infarction and revascularization [percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG)]. Methods: We queried the National Inpatient Sample (2007-2014) to identify admissions with prior MI/PCI/CABG for the prevalence, trends and impact of cannabis use disorder. Results: Patients cohort with prior MI and revascularization with cannabis use consisted of younger (median age years 53 (46-59) vs 72 (63-81), African American (34.3% vs. 10.0%) male (76.5% vs. 61.5%) patients v/s non cannabis users (p&lt;0.001). Co-morbid conditions such as hypertension (71.7% vs. 74.8%), diabetes, uncomplicated (23.6% vs. 32.9%), dyslipidemia (51.3% vs. 57.8%) (p&lt; 0.001) were significantly lower in cannabis users. There were increasing trends of cannabis use from 0.2 to 0.7% over the study period with a higher rate of AMI (7.2% vs 4.5%), PCI (6.2% vs 5.5%) and CABG (1.9% vs 1.5%) in cannabis users as shown in Fig 1a and 1b . All-cause mortality (0.8% vs 2.5%), hospital charges (21556 vs 24872) were low among cannabis users. Subsequent AMI in cannabis users was 67% v/s 41% in non-cannabis users. Conclusion: There are alarmingly rising trends in cannabis use in patients with prior MI/PCI/CABG from 2017-2014. Even with younger and overall lower comorbidity burden in cannabis users, the frequency of recurrent AMI and revascularization was seen higher but lower inpatient mortality.
Abstract 17289: NSAID Use and Clinical Outcomes in COVID-19
Authors: Michael Pan, Tariq Azam, Husam Shadid, Hanna Berlin, Chelsea Meloche, Rafey Feroze, Jeff Leya, Patrick O'Hayer, Elizabeth Anderson, Rayan Kaakati, abbas bitar, Kishan Padalia, Daniel Perry, Pennelope Blakely, Peiyao Zhao, Lili Zhao, Salim Hayek
Journal: Circulation (2020)

Introduction: There have been concerns that NSAID use may worsen outcomes in coronavirus disease 2019 (COVID-19) through upregulation of the ACE2 receptor used by the SARS-CoV-2 virus for cell entry. Hypothesis: We sought to determine whether prior use of NSAIDs in patients hospitalized with COVID-19 is associated with worse in-hospital outcomes. Methods: The Michigan Medicine Covid-19 Cohort (M 2 C 2 ) is an ongoing prospective observational study in which detailed clinical, laboratory and outcomes data were collected from chart review of consecutive adult patients hospitalized for COVID-19. Patients who were positive for SARS-CoV-2 infection but without symptoms of COVID-19 were not included in this cohort. We identified 553 patients who presented to University of Michigan Hospital between March 1 st and May 1 st for COVID-19, of whom 519 had data on whether they took NSAIDs prior to hospitalization. We examined the association between NSAID use and outcomes during their hospitalization. Results: 52 (10.0%) patients were taking NSAIDs prior to hospitalization (NSAID group; mean age 55.8 [SD 15.2]; 46.2% men) and 467 (90.0%) were not taking NSAIDs (non-NSAID group; mean age 61 [SD 16.0]; 57.7% men). There was no significant difference between the inflammatory markers on presentation to hospital between groups including CRP (median 8.0 vs median 9.7, p-value 0.79), procalcitonin (median 0.18 vs median 0.21, p-value 0.66), d-dimer (median 0.90 vs median 1.25, p-value 0.12), and IL-6 (median 36.7 vs median 49.3, p-value 0.43). All-cause mortality was not significantly different between the NSAID and non-NSAID groups (11.5% vs 16.8%, p-value 0.36) and neither was the risk of ICU admission (46.2% vs 48.9%, p-value 0.62). Conclusions: Among patients presenting to hospital with COVID-19, prior use of NSAIDs was not associated with significantly different levels of inflammatory markers on admission and was also not associated with significantly different mortality or rates of ICU admission.