tbuckley/cabot-search huggingface dataset:
Abstract 15443: An Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients
Authors: Neal Dixit, Neil Parikh, Boback Ziaeian, Gregg C Fonarow
Journal: Circulation (2023)

Background For patients with heart failure with reduced ejection fraction (HFrEF), suboptimal initiation and titration of guideline-directed medical therapy (GDMT) has resulted in preventable loss of life and function. The STRONG-HF trial reinforced this finding by demonstrating substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized heart failure (HF) patients who were randomized to intensive GDMT optimization compared to usual care. Research Question Whether an intensive GDMT optimization program would be cost-effective in HFrEF has yet to explored. Aim We performed an economic analysis of a hypothetical intensive GDMT optimization program over 6 months in patients hospitalized with HFrEF compared to usual care. Methods: Using a 2-state Markov model we evaluated the effect of an intensive GDMT optimization program on patients hospitalized with HFrEF. Two population models were created to simulate this intervention, the first, a “clinical trial” model, based off the participants in the STRONG-HF trial and the second, a “real world” model, based off the Get With The Guidelines-HF Registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive GDMT optimization program comprised of a HF physician, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both populations models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a United States healthcare perspective with a lifetime time horizon. Results: An intensive GDMT optimization program, resulted in an additional 1.04 and 0.59 life years in the clinical trial and real-world models, respectively. Both models showed the program would be highly cost-effective with incremental cost-effectiveness ratios &lt;$5000 and reductions in healthcare spending due to reduced hospitalizations in the 6 months after discharge. Conclusions: An intensive GDMT optimization program for patients hospitalized with HFrEF would be highly cost-effective and result in substantial gains in clinical outcomes. Clinicians, payers, and policy makers should prioritize creation of such programs.
Abstract 17558: Using Patient Reported Outcomes to Predict Patency and Revascularization in Peripheral Artery Disease: A Zilver PTX Sub-Analysis
Authors: Gaelle Romain, Jonathan Hanna, Jacob Cleman, Kim G Smolderen, Carlos Mena-Hurtado
Journal: Circulation (2023)

Introduction: Health status measured by patient reported outcomes (PROs) can predict future major cardiovascular events in patients with peripheral artery disease (PAD). It is unclear, however, whether health status outcomes can also predict revascularization success. Methods: We preformed sub-analysis of the Zilver PTX trial (multinational randomized trial and US single arm) including patients with above-the-knee symptomatic femoropopliteal disease and receiving paclitaxel-eluting stents (Zilver PTX) between 2005-August 2008. We examined the association of patients’ pre-procedural health status measured by EQ-5D-3L Index (EQ-5D), a validated PROs instrument (Value &lt; 0 means health status worse than death, 0: death and 1: full health) and the 12-month treatment durability outcomes measured as primary patency and target lesion revascularization (TLR). Point-biserial correlations were calculated between EQ-5D and outcomes. The 12-month cumulative incidence of patency and TLR was constructed using Kaplan-Meier curves and compared by EQ-5D quartile using Log-rank test. Results: The Zilver PTX arm included 704 patients with a mean age of 68±10 years, 26% women, and 3% Black/African American. The mean EQ-5D pre-procedural Index was 0.79±0.12 and 0.87±0.15 at 12 months. Correlations between the pre-procedural EQ-5D and patency and TLR were, respectively, -0.006 (P=0.82) and 0.034 (P=0.31). In the overall cohort, the cumulative incidence of patency loss was 17% 95%CI 15-21 and of TLR was 9% 95%CI 7-11. There was no significant difference in the 12-month risk of either patency loss or TLR across EQ-5D quartiles (P=0.93 and P=0.85) (Figure). Conclusions: Pre-procedural generic health status are not predictive of post procedural endpoints of revascularization success such as patency and TLR in patients receiving Zilver PTX, underscoring the need of adding these complementary measures to evaluate the full scope of success following revascularization in PAD.
Abstract 19090: Top Patient Initiated Uses of the Chronic Care Management Phone Line in a Rural Setting Reported Through Patient Survey
Authors: Samuel Miller, Garrett Jimmerson, Ghaith Al Tibi, Jered Miller, Nicolas Chronos
Journal: Circulation (2023)

Introduction: Patients can utilize Medicare’s Chronic Care Management [CCM] in different ways depending on their specific needs and conditions. It is important to have an understanding of patient utilization of this service in order to better tailor the program to their needs. Patient access to a CCM program has previously been found to reduce health expenditures, and improve engagement between the patient and the medical facility. Research Question: How do patients utilize the CCM phone line when it comes to their medical needs? Goal: The goal was to determine the top patient-initiated uses of the CCM phone line. Methods: An anonymized survey was sent out via email to patients enrolled in the CCM program of our rural clinic. Patients were asked to indicate how they have used the CCM phone line in the last 6 months. Patients also responded to their experiences with CCM as it relates to callback time and perception of access to providers. Finally, patients were asked if they would benefit from receiving a quarterly newsletter on current innovation in healthcare as part of CCM. Percentages were calculated based on patient responses. Results: Patients responded to some or all questions of the survey (N = 477). When asked, 94.78% of patients reported receiving a response within 24 hours after calling in regards to their specific request. In addition, 95.35% of patients affirmed that CCM provides an easier and more efficient access for patients to clinical providers when a need or concern arises than traditional clinical care. When asked about receiving a healthcare innovations newsletter as part of CCM, 63.48% of patients thought it would be beneficial. Conclusion: Patients utilized the Chronic Care Management Phone Line to accomplish various tasks. In conclusion, the majority of patients used the service to schedule appointments, request medication refills, and seek medical advice while agreeing that medical education (newsletter) could be a potentially beneficial aspect of CCM.
Abstract 15326: A Wearable Accelerometry and AI Framework for Phenotyping Step-Count Trajectories in Older Adults Undergoing Cardiac Rehabilitation
Authors: Souptik Barua, Kelly Tellez, Yuchen Meng, Camila Johanek, Stephanie Pena, Samrachana Adhikari, Antoinette Schoenthaler, John A Dodson
Journal: Circulation (2023)

Background: Wearable accelerometers, which record daily physical activity (PA) patterns over time, are a common component of mobile health-enabled cardiac rehabilitation (mHealth-CR). Artificial intelligence (AI) algorithms may be able to identify personalized insights of PA patterns to optimize mHealth-CR adherence. Methods: We used data from the RESILIENT trial, an ongoing randomized clinical trial of mHealth-CR in patients aged ≥65 years with ischemic heart disease. All participants in the intervention arm received Fitbit devices for activity tracking. We analyzed Fitbit step-count data collected over 3 months in these individuals using an AI framework based on functional principal component analysis (FPCA) and k-means clustering to identify distinct step count-based PA phenotypes. We then also computed adherence to using the Fitbit over time and clustered resultant adherence trajectories to identify distinct adherence patterns within the participant cohort. Results: We analyzed data from the first 75 intervention arm participants in RESILIENT (mean age 72 years, 19% female, 32% non-White). Using our AI framework, we identified four PA phenotypes based on their step count trends over 3 months: Unchanged (n=32), Steady Increase (n=14), Increase then Decrease (n=13), and Decrease and Increase (n=14) ( Figure 1A ). Two participants’ step count trajectories were not classifiable within this framework. We also examined changes in adherence to Fitbit use over 3 months based on a minimum step count cutoff for nonadherence (&lt;128 steps). Applying our AI framework, we identified four adherence phenotypes: Constantly adherent (n=39) , Mostly adherent (n=13) , Moderately adherent (n=14) , and Mildly adherent (n=9) (( Figure 1B )). Conclusions: Wearable accelerometry combined with AI can provide novel insights into PA patterns during CR, which may help inform personalized PA regimens that can maximize adherence to mHealth-CR.
Abstract 18560: External Calcium Modification Technique to Recanalize a Balloon Uncrossable Chronic Coronary Total Occlusion
Authors: Arash Hashemi, Ashkan Hashemi, Meet Shah
Journal: Circulation (2023)

Introduction: Despite improvements in equipment and techniques, uncrossable chronic total occlusion (CTO) coronary lesions remain challenging.Case: A 66-year-old male with typical angina and a history of failed CTO PCI was referred to our CTO tertiary center as he did not wish to undergo coronary artery bypass grafting. Transthoracic echocardiography revealed an ejection fraction of 45%, and cardiac MRI demonstrated viability in the LAD region. Coronary angiography revealed a long LAD CTO over 20 mm with heavy calcification (Figure 1a). The J-CTO score was calculated to be 4. The cap of the CTO was semi-ambiguous. The wire was advanced through the highly calcified lesion with the support of a microcatheter but the microcatheter and low-profile balloons were unable to be advanced despite backup with 7 French femoral access and an EBU catheter in place (Figure 1b) Upon failure on using Leopard crawl technique and grenadoplasty and with unfavorable side branch anatomy for STAR technique, cracking the calcification with a balloon advanced over a subintimal hydrophilic wire was considered. A fielder XT-A guidewire was advanced around the CTO lesion in the subintimal area (Figure 1c). A 2x12 mm balloon was inflated at 8 atm over the wire situated in the subintimal area in order the crack the calcification from outside. After extraluminal plaque modification, the wire and the balloon were withdrawn. A microcatheter was then able to be advanced with the support of an anchor balloon over the original true lumen wire (Figure 1d). Then the procedure was successfully completed with balloon dilatation and stent implantation (Figure 1e-f). Conclusion: External Calcium Modification technique which consists of plaque modification using a balloon in subintimal space (over an intentionally directed wire in subintima and around the calcium) and cracking the calcium from the outer vessel structure can be used as a last resort to overcome balloon uncrossable CTO lesions.
Abstract 18862: Optimal High Sensitivity Troponin “Delta” for Prediction of 30-Day Mace
Authors: Ria Garg, Muzna Hussain, Martin Matsumura
Journal: Circulation (2023)

Introduction: High-sensitivity troponin (hsTnT) values are used extensively in clinical practice to determine acute myocardial infarction (MI). Most hsTnT algorithms use an accelerated diagnostic protocol based on ranges of hsTnT and time-based changes within those ranges. Little is known about the performance of a protocol based on absolute change with time regardless of absolute values. Research question: Is there a level of hsTnT change (dTnT) that can be used as a single decision factor in the triage of chest pain? Goals/Aims: To assess the diagnostic value of dTnT in ruling out 30-day MI or 30-day death and to identify optimal cut-off values. Methods: Retrospective review of patients with chest pain (CP) who presented to the ED of a single tertiary medical center between September 2017 to September 2019. Patients were included if they had at least 2 hsTnT measurements. dTnT was calculated using the difference between the first and second readings. Presence or absence of MI or death at 30 days from this ED presentation was also recorded from chart review. ROC analysis was performed to determine cut-off values for predicting each event. Statistical analysis was performed using SPSS. Results: dTnT was available in 488 patients and predicted 30-day MI (4/488) with a high AUC of 0.864 (p=0.01). The Cut-off value range of 12.5 to 20.5% had a similar sensitivity of 75% but the specificity increased as the cut-off increased to 20.5%, highest specificity being 87%.dTnT was not sensitive in predicting 30-day death, the AUC was 0.524 (p=0.9). Conclusion: Without compromising on sensitivity, the specificity of this test may increase as the cut-off value is increased. The use of troponin change as a risk marker for MACE in pts with CP has optimal sensitivity and good specificity in predicting 30-day MI and its diagnostic utility should be evaluated further.
Abstract 18607: Sex-specific Metabolites Associated With Incident Stroke, Incident Coronary Heart Disease, Hypertension, And Chronic Kidney Disease In The Regards Cohort
Authors: Catharine Couch, Zsuzsanna Ament, Amit Patki, Naruchorn Kijpaisalratana, Varun M Bhave, Alana Jones, Nicole D Armstrong, Mary Cushman, W T Kimberly, Marguerite M Irvin
Journal: Circulation (2023)

Sex disparities continue to exist in cardiometabolic diseases. Metabolomic profiling offers the ability to gain insight into disease mechanisms. The purpose of the present analysis was to identify metabolites associated with sex and determine if sex-specific metabolites are associated with incident stoke, incident coronary heart disease (CHD), hypertension (HTN), and chronic kidney disease (CKD). Targeted metabolomics was conducted for 358 metabolites in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Weighted logistic regression models were used to test the association between sex and metabolites. Metabolites meeting the Bonferroni-corrected threshold were selected for replication in the Hypertension Genetic Epidemiology Network study. Cox proportional hazard models were used to calculate hazard ratios (HRs) per unit standard deviation (SD) of each replicated metabolite with incident stroke and incident CHD. Weighted logistic regression models were used to calculate odds ratios (ORs) per unit SD of each replicated metabolite with prevalent HTN and prevalent CKD. A total of 1,898 individuals were included in the analysis and 50.47% of the sample was male sex. The mean age was 68.40 ± 10.55 years and 43% of the sample was Black race. Sixteen metabolites were associated with sex, meeting the Bonferroni-adjusted p-value of 1.4 x 10 -4 . These included 8 lipids, 6 amino acids, 1 indole, and 1 quinoline. Of these 16 metabolites, none were associated with incident stroke or incident CHD. Kynurenic acid and leucine were associated with HTN in the base model adjusting for age, sex, and race (kynurenic acid: OR 1.45, 95% CI [1.19, 1.76], p=2.36 x 10 -4 ; leucine: OR 1.41, 95% CI [1.14, 1.76], p=2.03 x 10 -3 ). Indole-3-lactic acid and kynurenic acid were associated with CKD in the full model adjusting for age, sex, race, smoking, alcohol use, and BMI (indole-3-lactic acid: OR 3.83, 95% CI [2.77, 5.29], p=5.93 x 10 -16 ; kynurenic acid: OR 6.63, 95% CI [4.67, 9.41], p=1.50 x 10 -25 ). Our findings shed light on the sexual dimorphism of the metabolome and suggest that differences in biochemical pathways may contribute to sex disparities in cardiometabolic disease risk.
Abstract 18819: Detection of Systolic Dysfunction in Pediatric Patients Using an Artificial Intelligence-Enabled Electrocardiogram
Authors: Scott Anjewierden, Donnchadh O'Sullivan, Grace Greason, Zachi Attia, Francisco Lopez-Jimenez, Paul Friedman, Peter A Noseworthy, Jason Anderson, Anthony H Kashou, Benjamin W Eidem, Jonathan N Johnson, Talha Niaz, Malini Madhavan
Journal: Circulation (2023)

Introduction: Left and right ventricular systolic dysfunction (LVSD and RVSD respectively) contribute to considerable pediatric morbidity. Both LVSD and RVSD can occur in children before symptom onset, emphasizing the need for early detection. Existing deep-learning algorithms can identify LVSD in adults using 12-lead ECG; however, their efficacy in children is uncertain. Aims: We aimed to create a deep-learning model for LVSD and RVSD detection in pediatric patients using an AI-enabled ECG and compare novel pediatric models to a previously validated adult LVSD model. Methods: We identified 10,214 pediatric patients at the Mayo Clinic with a transthoracic echocardiogram (TTE) and a 10-second, 12-lead surface ECG within 14 days of TTE, performed from 2002 -2022. Our cohort comprised the first TTE-ECG pair from each patient, totaling 138 with EF ≤ 35%, 312 with EF ≤ 50%, 482 with RVSD, and 9,567 without any LVSD or RVSD. The cohort was split into training, validation, and testing datasets to develop neural networks for systolic dysfunction detection. Results: The cohort was 52.3% male, with an average age of 10.3 years. Novel models generated in the pediatric cohort demonstrated excellent performance in systolic dysfunction detection (Figure 1). Pediatric models for EF ≤ 35% and EF ≤ 50% achieved test AUCs of 0.92 (95% CI 0.89, 0.95) and 0.89 (95% CI 0.85, 0.94) respectively. The RVSD model reached a test AUC of 0.91 (95% CI 0.88, 0.94). A combined model for EF ≤ 35% or RVSD exhibited a test AUC of 0.90 (95% CI 0.87, 0.93), sensitivity 0.88, specificity 0.82, PPV 0.20, and NPV 0.95. A combined model for EF ≤ 50% or RVSD exhibited a test AUC of 0.88 (95% CI 0.85, 0.91). The previously validated adult data-derived model achieved an AUC of 0.86 (95% CI 0.83, 0.89) for EF ≤ 50% in children. Conclusions: AI-enabled ECGs demonstrate efficient detection of both LVSD and RVSD in pediatric patients. Future multi-site validation is needed to further establish the reliability of these models.
Abstract 17025: Investigating Retinal Neurovascular Interactions via Multi-View Light-Sheet Microscopy
Authors: Enbo Zhu, Jae Min Cho, Yaran Zhang, Jing Wang, Meng-chin Lin, Brian Aguirre Gamboa, Alison Chu, Tzung K Hsiai
Journal: Circulation (2023)

Introduction: Vascular retinopathy is a leading cause of preventable blindness in diabetes and retinopathy of prematurity. While most studies focus on individual neural or vascular structures, there remains a knowledge gap in understanding the retinal neurovascular interactions after injury and during repair (Fig. 1A). We seek to demonstrate 3-D neurovascular interactions with a multi-view light-sheet imaging system. Methods and Results: Intact 3-D retinas from 2-month-old mice were fixed and permeabilized followed by the optical clearance (CytoVista). Retinal vessels were stained with biotinylated isolectin B4 for microvasculature and Alexa Fluor 488-conjugated streptavidin (Fig. 1B-C) for labeling, while bipolar cells were stained with anti-PKCα (rabbit host) for neurons and Alexa Fluor Plus 555-conjugated goat anti-rabbit IgG for labeling. Refractive index matching was performed to 1.53. Multi-view light-sheet imaging was performed at 5 different angles followed by 3-D registration and reconstruction. The point spread function (PSF) demonstrates a spatial resolution of less than 5 μm (Fig. 1B, inlet). This enabled 3-D co-registration of the vasculature (Fig. 1D, in green) in relation to the bipolar cells (Fig. 1D, in red) for visualization. Conclusion: We revealed the 3-D neuro-microvascular network providing both deep tissue penetration and high spatial resolution for investigating hyperoxia and diabetes-associated vascular retinopathy.
Abstract 18650: Differences in Hypertension Prevalence, Awareness, and Treatment Between Sexual Minority and Heterosexual Adults in the All of Us Research Program
Authors: Vincent Pepe, Vince Nguyen, Danny Doan, Yashika Sharma, Billy A Caceres
Journal: Circulation (2023)

Introduction: Hypertension accounts for approximately half of cardiovascular disease morbidity and mortality globally. There is growing evidence that younger sexual minority (e.g., gay and bisexual) men and bisexual women report a higher prevalence of hypertension than their heterosexual counterparts. However, there is limited evidence on differences in hypertension prevalence, awareness, and treatment among sexual minority middle-aged and older adults. Therefore, we sought to examine differences in hypertension prevalence, awareness and treatment between sexual minority and heterosexual middle-aged and older adults. Hypothesis: Compared to heterosexual adults, sexual minority participants will: 1) have a higher prevalence of hypertension, 2) be less likely to be aware of their hypertension, and 3) be less likely to obtain hypertension treatment. Methods: We analyzed questionnaire, physical examination, and diagnostic data from the All of Us Research Program. We used sex-stratified multivariate logistic regression models to examine sexual identity differences in objective hypertension (i.e., a systolic blood pressure ≥ 130 and/or a diastolic blood pressure ≥ 80), hypertension awareness, and hypertension treatment among adults. Results: The sample included 53,582 participants with a mean age of 56.3 years (±16.4); 66% were female and 78% were non-Hispanic White. Among men who met objective criteria for hypertension, bisexual men were less likely to report they were unaware they had hypertension compared to heterosexual men (AOR = 0.67, 95% CI = 0.52-0.88). There were no differences in hypertension prevalence or hypertension treatment between sexual minority and heterosexual adults. Conclusions: This is the first study to use data from the All of Us Research Program to examine disparities in hypertension prevalence, treatment, and awareness among sexual minority middle-aged and older adults. We found few differences between sexual minority and heterosexual participants, which contradicts prior work that has largely focused on younger adults. Findings suggest that researchers should investigate factors that contribute to the narrowing of hypertension disparities among sexual minority adults as they age.