tbuckley/cabot-search huggingface dataset:
Abstract 14004: Geographic and Racial Variation in Oral Anticoagulant Treatment Among Commercially Insured Patients With Non-Valvular Atrial Fibrillation in the United States
Authors: Brett D Atwater, Risho Singh, Shashi Parmar, Augustina Ogbonnaya, Amiee Kang, Cristina Russ, Dong Cheng, Melissa Hagan, Serina Deeba, Dionne M Hines, Nipun Atreja
Journal: Circulation (2023)

Background: Oral anticoagulants (OACs) are recommended for non-valvular atrial fibrillation (NVAF) patients with high stroke risk. Guidelines endorse the use of direct oral anticoagulants (DOACs) over warfarin. Limited data exist on geographic variation in OAC use in the United States (US), particularly by race. Aim: To describe OAC utilization patterns among commercially insured NVAF patients with high stroke risk by geographic region and race. Methods: NVAF patients ≥18 years were identified from January 1, 2016, to August 31, 2021, in the Komodo claims database, which represents ≥140 million patients enrolled in US commercial health plans. Patients with ≥12 months of enrollment before and after NVAF diagnosis and with high stroke risk (defined as CHA 2 DS 2 -VASc Score ≥2) were included for analysis. Patients with other valvular diagnoses and/or procedures or pregnancy were excluded. Patients were classified based on treatment status as untreated, warfarin-treated, or DOAC-treated (apixaban/edoxaban/rivaroxaban/dabigatran). Results were stratified by geographic region and race (Black, White, other/unknown) and were visualized using SAS software. Results: After selection criteria, 619,111 NVAF patients with high stroke risk were identified with a mean age of 71 years. Over 50% of patients were untreated after NVAF diagnosis, and the untreated rate was highest in the South and West US regions. Additionally, the untreated rate was higher among Black patients than White patients (55% vs 49%, respectively). Of the treated, the overall rate of DOAC and warfarin use was 85% and 15%, respectively, with the highest rates observed in the Northeast for DOAC and Midwest for warfarin. DOAC use was lower among Black patients compared to White patients (Figure 1) . Conclusion: Among NVAF patients with high stroke risk, there are geographic and racial differences in OAC utilization that highlight areas of unmet need and opportunity for further research on these disparities.
Abstract 12696: Association Between Aortic Valve Calcification and Aortic Valve Size in Patients With Severe High Gradient Aortic Stenosis
Authors: Roya Anahita Mousavi, Gudrun Lamm, Maximilian Will, Philipp Hoebart, Andreas Kammerlander, Nikolaus Voith, Konstantin Schwarz, Paul Vock, Philip Krackowizer, Uta Hoppe, Julia Mascherbauer
Journal: Circulation (2023)

Introduction: It is known that women require less aortic valve calcification (AVC) to develop severe aortic stenosis (AS) than men. Thus, gender specific AVC thresholds for the diagnosis of severe AS are recommended by the ACC/AHA guidelines. However, it is also known that women have smaller hearts and aortic valves (AV) than men. Hypothesis: We hypothesize that AVC is associated with AV size independently from sex. Methods: Consecutive patients with severe high gradient AS who underwent cardiac computed tomography (CT) were included in our study. AV annulus area and AVC assessed with the Agatston score were measured in CT. Linear regression model adjusted for age and sex as well as spearman correlation analysis were performed. Results: 437 patients with severe high gradient AS (mean age 80±6 years, 47% female) were included. Significant differences in AVC (3363 [2582-4398] AU vs. 1984 [1354-2856] AU, p&lt;0.001) and AV annulus area (509 ± 75 mm 2 vs. 408 ± 67 mm 2 , p&lt;0.001) between men and women were found. We observed a significant correlation of AV annulus area with AVC (r=0.6, p&lt;0.001). On multivariate regression AV annulus area was significantly associated with the Agatston score (β=7.5, p&lt;0.001). Furthermore, separate regression analyses for men and women confirmed the significant association of AV annulus area with AVC independent from sex (β (men) =7.0, p&lt;0.001; β (women) =8.2, p&lt;0.001). Conclusions: In patients with severe high gradient AS AV annulus area is associated with AVC independent from sex. Thus, an indexation of AVC thresholds to AV size should be applied rather than using fixed sex-dependent AVC cut-offs for the definition of severe AS.
Abstract 11841: Gene Therapy Improves Pathological Cardiac Remodeling in Human Hypertrophic Cardiomyopathy Gene Variant Knock-In Mice
Authors: Norimichi Koitabashi, Ryo Kawakami, Takeshi Tokuyama, Razan E Ahed, Fuad G Torizal, Tatsuya Anzai, Yasumitsu Nagao, Hideki Ishii, Hideki Uosaki
Journal: Circulation (2023)

Introduction: Some patients with hypertrophic cardiomyopathy (HCM) has been reported to develop ventricular systolic dysfunction, called the dilated phase of HCM (d-HCM). Although d-HCM is associated with increased morbidity and mortality, precise mechanism for the development of the pathological cardiac remodeling and gene-targeted therapy are still under investigation. It has been shown that cardiac myosin binding protein C (Mybpc3) missense mutation (R820Q) is associated with familial HCM and d-HCM. Methods and Results: We generated a knock-in mouse model, carrying the R820Q mutation of Mybpc3 (MyBP-KI mice). MyBP KI mice spontaneously developed cardiac hypertrophy and mild systolic dysfunction at 8 weeks of age, reproducing the d-HCM phenotype, while their littermate control mice showed normal cardiac mass and function. Transcriptome analysis by RNA-seq showed that, in addition to upregulation of heart failure-related fetal genes, mitochondria-related gene sets (oxidative phosphorylation and fatty acid metabolism) were suppressed in MyBP-KI mice compared to control mice. We examined adeno-associated virus (AAV)-mediated gene therapy on MyBP-KI mice. AAV vectors with wild type Mybpc3 controlled by the cardiac troponin T promoter were administered intravenously to MyBP-KI mice that began to develop hypertrophy at 8 weeks of age. Echocardiography and cardiac catheter examinations showed that the deterioration of cardiac function over time was significantly suppressed by AAV gene therapy. Overexpression of fetal genes of cardiomyocyte was significantly suppressed, mitochondrial gene abnormalities were also significantly attenuated, and histological myocardial fibrosis was also significantly suppressed by administration of AAV harboring wild type Mybpc3. Conclusions: Our MyBP-KI mice spontaneously recapitulated human d-HCM phenotype. Gene therapy with AAV, even when administered at a stage when cardiac remodeling has already begun to progress, successfully suppressed cardiac dysfunction at the genetic level and prevented the transition to d-HCM.
Abstract 140: Near-Infrared Spectroscopy, Pupillometry and End-Tidal Co2 as Predictive Factors of Survival for Patients With Out-of-Hospital Cardiac Arrest
Authors: Nicolas Segond, Dominique Savary, Pierre Bouzat, Melanie Veloso, Julien Turk, Caroline Sanchez, Jean-Luc Bosson, Damien Viglino, Jean-François Payen, Guillaume Debaty
Journal: Circulation (2023)

Background: During out-of-hospital cardiac arrest (OHCA), early prognostication of patient’s outcomes at the early phase is difficult and based on a combination of factors. EtCO2 is one of the validated parameters associated with survival. Near-infrared spectroscopy (rSO2) and infrared automated pupillometry measurements could in addition be of value in the prehospital setting. Hypothesis: To assess the prognostic value of rSO2, pupillometry and EtCO 2 alone or in association with other prognostic factors for patients with OHCA. Methods: We conducted a prospective cohort analysis in 3 French prehospital intensive care units. Adult patients with a presumed medical OHCA were included. Measurements were made at medical team arrival every 5 minutes for 15 minutes by the ambulance driver in order to ensure blindness for the medical team. The primary outcome was the prognostic value of rSO2, pupillometry, bystander CPR and initial cardiac rhythm alone or in association for survival at hospital admission. The secondary outcome was the prognostic value of capnography (EtCO2) alone or in association with primary outcomes parameters for survival at hospital admission. Results: 112 patients were included and analyzed. Bystander CPR was initiated for 72 (65.5%) patients, 19 (17.3%) survived to hospital admission. For survival at hospital admission, rSO2 alone had an AUC of 0.74 (IC95% 0.59-0.88) and the optimal threshold was 29% with a negative predictive value of 90.8% (IC95% 81-96.5). All patients with rSO2 ≥ 45% survived at hospital admission. Pupillometry alone had an AUC of 0.65 (IC95% 0.51-0.79) and no optimal threshold was found. The association of rSO2 and pupillometry adjusted on bystander CPR and initial rhythm provided an AUC of 0.77 (IC95% 0.61-0.92). EtCO2 alone had an AUC of 0.77 (IC 95% 0.64-0.89) and the optimal threshold was 25 mmHg with a negative predictive value of 97.7% (IC95% 87.7-99.9). In association, EtCO2 and rSO2 provided an AUC of 0.85 (IC 95% 0.73-0.96). Conclusion: During OHCA, near-infrared spectroscopy alone and in association with EtCO2 could be a major prognostic factor of survival at hospital admission. Pupillometry alone failed to be a prognostic factor of survival at hospital admission.
Abstract 14011: Micra AV Leadless vs. Dual-Chamber Transvenous Pacing Outcomes Among Patients With End-Stage Renal Disease in the Medicare Population
Authors: Colleen Longacre, Lucas Higuera, George H Crossley, Mikhael F El-Chami
Journal: Circulation (2023)

Introduction: Leadless pacing is often considered a useful alternative for patients with end-stage renal disease (ESRD) due to their limited vascular access and high infection risk. However, there is limited evidence on the comparative outcomes of leadless pacing vs. transvenous pacing in this population. Hypothesis: The reduction in complications and reinterventions associated with leadless pacing in the broader population extends to patients with ESRD. Aims: To compare complications and reinterventions between ESRD patients implanted with a Micra AV leadless pacemaker vs. a dual-chamber transvenous pacemaker. Methods: Data from the Micra Coverage with Evidence Development (CED) Study were used to identify ESRD patients implanted with a Micra AV leadless pacemaker (N=1,116), or a dual-chamber transvenous pacemaker (N=2,163) between February 5, 2020 and December 1, 2021 in the Medicare population. Logistic regression was used to compare unadjusted and propensity score overlap weight-adjusted 30-day acute complication rates. Cox models were used to compare 6-month chronic complications and reinterventions between groups. Results: ESRD patients implanted with Micra AV had a higher overall comorbidity burden (mean Charlson Comorbidity Index 7.9 vs. 7.6, P=0.001) and higher rates of emergency admission (18.6% vs. 14.0%, P=0.001). Despite these differences, there was no difference in the rate of complications at 30 days (unadj. 13.9% vs. 13.8%, P=0.92; adj. 12.9% vs. 14.6%, P=0.20). At 6 months, Micra AV patients had significantly lower rates of chronic complications (unadj. HR 0.72, 95% CI: 0.54-0.96, P=0.02; adj. HR 0.64, 95% CI: 0.48-0.87, P=0.004) and reinterventions (unadj. HR 0.50, 95% CI: 0.29-0.86, P=0.01; adj. HR 0.53, 95% CI: 0.30-0.91, P=0.02) (figure) . Conclusion: In patients with ESRD, AV synchronous leadless pacing is associated with lower rates of complications and need for reintervention compared to dual-chamber transvenous pacing.
Abstract 13795: Reduced Fetuin-A Levels Are Associated With Exercise Intolerance in Patients With Heart Failure and Predict the Risk of Adverse Outcomes
Authors: Yusuke Tomita, Tomofumi Misaka, Yukiko Sugawara, Fumiya Anzai, Yu Sato, Yusuke Kimishima, Tetsuro Yokokawa, Takamasa Sato, Masayoshi Oikawa, Atsushi Kobayashi, Akiomi Yoshihisa, Yasuchika Takeishi
Journal: Circulation (2023)

Background: Impaired exercise tolerance is a feature of heart failure (HF) and predicts adverse outcomes in patients with HF. Hepatokines are proteins synthesized and secreted by the liver, which regulate systemic metabolisms of peripheral tissues. However, the clinical impact of hepatokines on exercise capacity has not been well understood. Aims: Our objective was to investigate the relevance of a hepatokine, Fetuin-A, in relation to exercise capacity in HF. Methods and Results: We conducted a prospective study involving 120 consecutive hospitalized patients (mean 57.3 years old, 75.0% male) with HF who underwent cardiopulmonary exercise testing. The serum concentration of Fetuin-A was measured by an enzyme-linked immunosorbent assay. Patients with impaired exercise tolerance (peak oxygen uptake (VO 2 ) &lt; 14.0 mL/kg/m) exhibited lower Fetuin-A levels than those without ( Figure A ). Correlation analysis revealed that Fetuin-A was positively correlated with peak VO 2 and negatively correlated with minute ventilation to carbon dioxide production ratio and its slope. We then followed up patients and found 12 composites of cardiac events that included 5 cardiac death and 7 worsening HF. Based on classification and regression tree to determine the cut-off of Fetuin-A, Kaplan-Meier analysis revealed that patients with lower Fetuin-A levels (&lt; 22.2 ng/mL) and impaired exercise tolerance had the highest risk of cardiac events ( Figure B ). In a multivariable Cox proportional hazard model, the presence of both lower Fetuin-A and exercise intolerance was independently associated with an increased risk of cardiac events (hazard ratio, 18.8; P = 0.009). Conclusions: Reduced Fetuin-A levels were associated with exercise intolerance in patients with HF, and those with decreased levels of both Fetuin-A and peak VO 2 were at the highest risk of adverse outcomes.
Abstract 12161: Trends in Age, Sex and Racial Differences in the Incidence of Infective Endocarditis in Florida and New York
Authors: Anderson C Anuforo, Ehimen Aneni, Emmanuel O Akintoye, Nnabuchi Anikpezie, Smit D Patel, Ayorinde Soipe, Eloho H Olojakpoke, Devin Burke, Gene Latorre, Priyank Khandelwal, Seemant Chaturvedi, Bruce Ovbiagele, Fadar O Otite
Journal: Circulation (2023)

Introduction: How the incidence of infective endocarditis (IE) changed in various demographic subgroups of the United States along with the worsening opioid epidemic over the last decade is unknown. Methods: This retrospective cohort study used data from the 2005-2018 State Inpatient Databases of Florida and New York. Cases of incident IE were combined with census data to compute age, sex- and race-specific incidence. Joinpoint regression was used to quantify the annualized percentage change (APC) in incidence over time. Results: Of 98,221 incident IE admissions, 70.0% were Non-Hispanic White (NHW) and 60.6% were ≥ 65 years old (yo). The average annual age and sex-standardized incidence of IE in cases/100,000 population was 19.2 (95%CI 18.7-19.6) but this varied by age, sex, and race. Incidence was ≈20% higher in men (20.9 [95%CI 20.2-21.7]) compared to women (17.5 [95%CI 16.8-18.2]) and increased with age in both sexes. Incidence was higher in Black: 22.5 (95%CI 21.0 - 23.9) vs NHW: 20.0 (95%CI 19.3 - 20.6), Hispanic: 13.2 (95%CI 12.3 -14.1) and Asian/Pacific Islander patients: 5.9 (95%CI 4.7 - 7.1). The age and sex-standardized incidence did not change over time (APC 0.5%, p=0.646). However, incidence increased in women 18-44 (APC 11.0%, p&lt;0.001), men 18-44 (APC 7.3, p&lt;0.001) and men 45-64 yo (APC 1.5%, p=0.002) but declined in women ≥ 65 yo(APC -2.8, p=0.049). Most of this increased incidence occurred in NHW women and men 18-44, NHW men 45-64 and Hispanic Men 18-44 yo (Figure 1). Incidence did not change over time in other age/sex groups. Prevalence of opioid use disorder increased by &gt;2-fold in all age/sex groups over time but the pace of increase was faster in NHW women and men 18-44 yo compared to other races of similar demography (p-for-time interaction &lt;0.001). Conclusions: Over the last decade, among residents of Florida and New York, incidence of IE increased in several demographic groups, but the most prominent rise was among young NHW patients, especially young NHW women.
Abstract 12052: Association Between the Shock Index on Admission and In-Hospital Mortality in the Cardiac Intensive Care Unit
Authors: Mitchell Padkins, Kianoush Kashani, Meir Tabi, Ognjen Gajic, Jacob C Jentzer
Journal: Circulation (2023)

Introduction: An elevated shock index (SI) predicts worse outcomes in multiple clinical arenas. We aimed to determine whether the SI can aid in mortality risk stratification in unselected CICU patients. Methods: We included admissions to the Mayo Clinic from 2007 to 2015 and stratified them based on admission SI, defined as heart rate divided by systolic blood pressure. The primary outcome was in-hospital mortality, and predictors of in-hospital mortality were analyzed using multivariable logistic regression. Results: We included 9,939 unique CICU patients with available data for SI. The mean age was 69 years old (37% female). Median HR, SBP, and shock index for our cohort were 79 beats per minute (BPM), 121 mmHg, and 0.65 BPM/mmHg, respectively. Patients were grouped by SI as follows: &lt; 0.6, 3,973 (40%); 0.6-0.99, 4,810 (48%); and ≥ 1.0, 1,156 (12%). After multivariable adjustment, both HR (adjusted OR 1.06 per 10 BPM higher; CI 1.02-1.10; p-value 0.005) and SBP (adjusted OR 0.94 per 10 mmHg higher; CI 0.90-0.97; p-value &lt; 0.001) remained associated with higher in-hospital mortality. As SI increased there was an incremental increase in in-hospital mortality (adjusted OR 1.07 per 0.1 BPM/mmHg higher, CI 1.04-1.10, p-Value &lt; 0.001). A higher SI was associated with increased mortality across all examined admission diagnoses, including acute coronary syndromes, heart failure, and cardiogenic shock. Conclusions: The SI is a simple and universally available bedside marker that can be used at the time of admission to predict in-hospital mortality in CICU patients across a variety of cardiac conditions.
Abstract 12315: Healthcare Resource Utilization and Costs Associated With New York Heart Association Functional Class in Patients With Obstructive Hypertrophic Cardiomyopathy in the United States
Authors: Yan Wang, Weihua Gao, Sophie Gao, Anand Dubey, Xu Han
Journal: Circulation (2023)

Background: In obstructive hypertrophic cardiomyopathy (HCM), New York Heart Association (NYHA) class has been associated with increased risks of adverse cardiovascular (CV) outcomes that may require more intensive healthcare. Research Question: Is NYHA class associated with healthcare resource utilization (HCRU) and costs in obstructive HCM? Aims: To describe all-cause and CV-related HCRU and costs by NYHA class in obstructive HCM. Methods: This was a retrospective cohort study of adults with obstructive HCM and ≥1 documented NYHA class in Optum’s de-identified Market Clarity database (administrative claims linked with electronic health records [EHR]) from 1/1/2017 to 3/31/2022. Index date was the date of the first NYHA class (i.e., index NYHA class) on or after the earliest date for diagnosis of obstructive HCM or, if any, septal reduction therapy. Annualized all-cause and CV-related HCRU and costs, overall and stratified by the index NYHA class, were assessed using claims during the 182 days after index (i.e., follow-up). Costs were adjusted to 2022 USD. Results: A total of 754 patients were included, with 20.0%, 44.0%, 30.2%, and 5.7% having NYHA class I, II, III, and IV at index, respectively ( Table ). The annual number of all-cause hospitalizations increased with higher index NYHA classes (mean ± SD 0.3 ± 1.0, 1.0 ± 1.8, 1.6 ± 2.6, and 2.1 ± 2.8 for class I, II, III, and IV, respectively). A similar trend was observed for emergency room visits, outpatient visits, and other visits. The total all-cause costs were higher for patients with worse index NYHA classes (mean ± SD $35,339 ± 64,594, $62,899 ± 86,765, $77,727 ± 109,519, and $123,058 ± 139,867 for class I, II, III, and IV, respectively). CV-related HCRU and costs were also generally higher for patients with a worse index NYHA class. Conclusion(s): Obstructive HCM was associated with a substantial economic burden. A worse NYHA class was associated with higher all-cause and CV-related HCRU and costs in obstructive HCM.
Abstract 13948: Real World De-Escalation Practices in Genotype Guided P2Y12 Inhibitor Therapy and Pharmacoeconomic Implications
Authors: Andrii Maryniak, Joel Van Heukelom, Amanda Massmann, April Schultz, Max Weaver, Catherine Hajek, Tom P Stys
Journal: Circulation (2023)

Background: Tailored P2Y12 inhibitor therapy is gaining popularity and is described as a method to balance safe and effective prescribing of clopidogrel. Based on previous work, 28% of our patients with CYP2C19 genotyping do not metabolize clopidogrel effectively (intermediate or poor metabolizers). Aim: We aim to describe the economic impact of a guided P2Y12 inhibitor strategy and the practice of escalation (clopidogrel to ticagrelor/prasugrel) and de-escalation (ticagrelor/prasugrel to clopidogrel) practices at a single health system. We hypothesize a guided approach is economically feasible vs. a universal ticagrelor or prasugrel approach. We also aim to determine how quickly clinicians escalate or de-escalate in response to CYP2C19 results. Methods: 3-year (2020-2022) data was collected from our EMR. Annually an average of 950 patients received CYP2C19 testing to guide P2Y12 inhibitor therapy (n=2799), and an average of 316 patients were either escalated or de-escalated (n=949). Of the 2799 patients, clopidogrel was most often the initial P2Y12 inhibitor (n=2240), followed by ticagrelor (n=525), and prasugrel (n=34). We estimated overall medication and CYP2C19 testing costs over the course of an average year (Figure 1) based on the assumption that over the course of 1-year patients would begin on 30 days of either ticagrelor, prasugrel, or clopidogrel and escalate/de-escalate therapy thereafter as guided by testing. Results: The time to escalation was similar if the CYP2C19 result was ordered before or after the first order for P2Y12 inhibitor therapy, median of 6.2 and 6.5 days respectively (p = .07). There was a difference in time to de-escalation based on time of CYP2C19 testing in comparison to medication ordering with a median time of 32.1 and 8 days when testing was ordered before initiation and after, respectively (p &lt;.001). Conclusion: Overall, clinicians were highly responsive to CYP2C19 test results for both escalation and de-escalation of therapy.