tbuckley/cabot-search huggingface dataset:
Abstract 15738: Synthetic Data Generation for the Get With the Guidelines® Registry
Authors: Lanjing Wang, Holly Picotte, Chandler D Beon, Jennifer L Hall, Juan Zhao, Xue Feng
Journal: Circulation (2023)

Introduction: The American Heart Association (AHA) Get With The Guidelines® (GWTG) registry is a vital resource for cardiovascular/stroke research. Encompassing over 13 million records, the GWTG registry offers valuable insights into cardiovascular/stroke care and outcomes across more than 2,600 participating hospitals. However, the governance policies of the GWTG registry data limit use to academic researchers with approved manuscripts and funded awards. Goal: The goal of this project was to generate a synthetic dataset for the AHA GWTG registry data, aiming to increase accessibility while preserving data privacy. It provides researchers with the ability to explore the data format, variables and learn how to analyze the data on the AHA’s Precision Medicine Platform, which is a cloud-computing environment designed for researchers. Methods: Data was utilized from the GWTG Stroke registry from 2005 to 2021. We randomly sampled 1000 records from the registry and implemented a privacy-preserving data transformation process, which involved shifting datetime variables and replacing identifiable sensitive field values with randomly generated eight digit-numbers. We evaluated the synthetic data generation process by comparing distributions of patient demographics (age, race, gender) and time metric measures. Results: The original data from the GWTG Stroke registry includes 7.8 million individuals and 1233 columns with mean (SD) age of 69.56 (14.78) years (White 73.64%, Black 16.47%, Male 48.84%, and Female 51.1%). The synthetic data exhibits similar distributions compared to the original data (synthetic data: mean [SD] age, 69.61 [14.66] years, White 75.3% and Black 14.9%, Male 48.4%, and Female 51.6%). Moreover, all time differences are maintained, such as door-to-needle time, time to Intravenous Thrombolytic Therapy. Conclusion: This project demonstrates successful development and evaluation of synthetic data generation methods for the AHA GWTG registry. The synthetic data is accessible to researchers on the AHA’s Precision Medicine Platform, enabling broader access and analysis while preserving privacy to advance cardiovascular and stroke care research.
Abstract 18106: Keeping up With the Newest Guideline Directed Medical Therapy for Heart Failure With Reduced Ejection Fraction, Resident-Driven Quality Improvement Project
Authors: Seema Sharma Gautam, Konstantin Golubykh, Kripa Rajak, Aslan Amirian, Iuliia Kovalenko, Anupam Halder, Taaha M Mirza, Jesus Vargas, Roberto Hodara, Yijin Wert, Kriti Taneja, Anas Atrash
Journal: Circulation (2023)

Introduction: Chronic Heart Failure (CHF) is an epidemic associated with high morbidity and mortality. As per 2022 AHA/ACC/HFSA guidelines, the management of Heart Failure with reduced Ejection Fraction (HFrEF) includes Angiotensin Receptor-Neprilysin Inhibitors (ARNIs), Angiotensin-Converting Enzyme Inhibitors (ACEIs)/Angiotensin Receptor Blockers (ARBs), Beta-Blockers (BB), Mineralocorticoid Receptor Antagonists (MRA) and Sodium-Glucose co-transporter 2 Inhibitors (SGLT2I) as class 1 recommendations. Considering the new guidelines for HFrEF we decided to perform a quality improvement project to improve the GDMT prescription rate in patients with HFrEF. Methods: Our project included: dot phrase creation for all physicians through electronic medical records (EMR) system, educational sessions, monthly emails and weekly EMR chat messages regarding GDMT and CHF order set to physicians, A4 sized posters distributed on all hospital floors. We then performed retrospective review and analysis of patient charts who were admitted to three UPMC Central PA hospitals with diagnosis of HFrEF exacerbation during December 2019 to January 2021 (pre-intervention) and March 2022 to September 2022 (post-intervention). Results: Total 615 patients were included. There were no significant differences in demographics between pre intervention (357) and post intervention (258) groups including age, sex, race. There were no differences in prescription rate and target dose at discharge between BB groups (92.72% vs 91.86%%, p=0.693 and 7.25% vs 7.17%, p=0.978). The intervention helped in increasing prescription of ARNIs from 6.2% to 30.62%, p&lt; 0.0001 and 13.92% were discharged on target dosages. The prescription of MRA was increased (47.62%vs 51.55%). Furthermore, initiation of SGLT2I was achieved in 41.47% in post-intervention from 0% in the pre-intervention group. Conclusions: Despite higher awareness of GDMT and the trend towards having more patients discharged on therapeutic dosages of GDMT, it is evident that GDMT is still underused among patients with HFrEF. Our results indicate that more emphasis should be placed on rapid up-titration of GDMT.
Abstract 14050: Association of Health Literacy With Hospital Readmission and Mortality After Heart Transplantation
Authors: Debra D Dixon, Meng Xu, Brandon D Lowery, Kayla A Buttafuoco, Lauren Lee Shaffer, Quinn S Wells, Sunil Kripalani, Deepak K Gupta, Kelly H Schlendorf
Journal: Circulation (2023)

Background: Higher health literacy is associated with lower risk of hospitalization and mortality in patients with heart failure (HF). Health literacy assessment is recommended in patients undergoing heart transplant evaluation, yet few data report health literacy status or its associations with post-heart transplant outcomes. Objective: To characterize health literacy among heart transplant recipients and investigate its associations with post-transplant hospital readmissions and mortality. Methods: We retrospectively analyzed 513 patients (median age 57 years, 28% female, 27% Black) who underwent heart transplantation at Vanderbilt University Medical Center between 2015-2021. Health literacy was assessed using the validated 3-item Brief Health Literacy Screen (BHLS). Each item is on a 5-point Likert scale yielding a total score range of 3-15, with 15 indicating optimal health literacy. All cause readmissions post-transplant were ascertained from the electronic medical record (EMR). Vital status was determined through linkage with the Social Security death index or the EMR through March 2023. Ordinal logistic and Cox models adjusted for age at transplant, sex, race, body mass index, hypertension, dialysis at time of transplant, length of stay post-transplant, and wait list status at transplant were used to quantify associations between health literacy and readmissions or mortality, respectively. Results: The median BHLS score was 14 and 42% of patients had a score of 15. In the year following transplantation, 288 (56%) patients had 661 rehospitalizations. In the multivariable adjusted model, BHLS of 15 compared to any lower score associated with 29% lower odds of readmission (OR 0.71, 95% CI: 0.51, 0.99). Over a median 2.8 years (IQR 1.7, 4.9) follow-up, 90 individuals died. Health literacy was not associated with mortality (HR 1.10, 95% CI: 0.69, 1.73). Conclusions: At a high-volume heart transplant center, optimal health literacy was present in the minority of patients and associated with lower risk of post-transplant hospital readmissions, but neutral association with mortality. Screening for health literacy and providing transplant education that is clear and accessible at all literacy levels may improve post-transplant outcomes.
Abstract 16765: Association of Evening or Bedtime Dosing of Antihypertensive Medications With Nighttime Blood Pressure and Cardiovascular Prognoses
Authors: keisuke narita, Satoshi Hoshide, Kazuomi Kario
Journal: Circulation (2023)

Introduction: Previous studies suggested that bedtime use of antihypertensive medications does not improve cardiovascular outcomes. However, there is a few studies reporting the association of bedtime dosing of antihypertensives with nighttime blood pressure (BP) and cardiovascular prognoses. Hypothesis: Evening/bedtime dosing of antihypertensives may improve cardiovascular outcomes through reductions in nocturnal BP. Methods: We used the dataset of nationwide prospective, the Japan Ambulatory Blood Pressure Monitoring Prospective (JAMP) study to assess the association of evening/bedtime dosing with nighttime BP and cardiovascular prognoses. Among whole 6,359 participants underwent 24h ambulatory BP monitoring, participants with pre-history of cardiovascular disease and not use antihypertensives were excluded in this analysis. Evening or bedtime and two occasions (morning and evening/bedtime) use of antihypertensives were defined as the group of evening/bedtime dosing. Results: Among 4,085 participants (69.1 years and 45% of male), there was no difference between the group of evening/bedtime and morning/others dosing in 24h systolic BP (SBP) (132.9±14.2 vs. 132.0±14.0, p=0.086). Nighttime SBP was higher in evening/bedtime dosing (123.1±17.5 vs. 121.4±16.8, p=0.004). During the median 4.9-years followed-up, 150 cardiovascular events (coronary artery disease, stroke, heart failure) occurred. The evening/bedtime dosing was not associated with cardiovascular events risk adjusted by 24h ambulatory BP (adjusted HR [95%CI], 1.11 [0.78-1.57]) or nighttime BP (Figure). In stratified analysis of participants with or without nocturnal hypertension (nighttime SBP≥120 mmHg or diastolic BP≥70 mmHg), evening/bedtime dosing was also not associated with cardiovascular outcomes. Conclusions: Our study suggested that evening/bedtime dosing of antihypertensives did not give benefit for nighttime BP control and cardiovascular prognoses.
Abstract 15065: A Novel Predictor of Unsustained Return of Spontaneous Circulation in Patients in Cardiac Arrest Through a Combination of Capnography and Pulse Oximetry
Authors: Jing Yang, Hanqi Tang, Shihuan Shao, Feng Xu, Yangyang Fu, Shengyong Xu, Chen Li, Yan Li, Yang Liu, Joseph H Walline, Huadong Zhu, Yuguo Chen, Jun Xu
Journal: Circulation (2023)

Introduction: Unsustained return of spontaneous circulation (ROSC) is a critical barrier to survival in cardiac arrest patients. However, no parameter so far can be used to predict the sustainability of ROSC. Research Questions: End-tidal carbon dioxide (ETCO 2 ) is regarded as an indicator of ROSC in cardiac arrest patients. Pulse oximetry photoplethysmogram (POP) parameters have been shown to be associated with peripheral perfusion in critically ill patients. We hypothesized that the combination of ETCO 2 and POP parameters might be discriminative for early recognition of patients at risk of unsustained ROSC before rearrest. Aims: This study examined whether ETCO 2 and POP parameters can be used to identify unsustained ROSC. Methods: We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest managed from 2013 to 2014. Patients’ general information, ETCO 2 , and POP parameters, including area under the curve (AUCp) and amplitude (Amp) of POP waveform, were collected and statistically analyzed. Results: The included 105 ROSC episodes (from 80 cardiac arrest patients) comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes. Patients with unsustained ROSC had lower 24-hour survival rate than sustained ROSC patients (11.5% vs. 25.0%, respectively; P&lt;0.05). The logistic regression analysis showed that, ΔETCO 2 (difference in ETCO 2 between after to before ROSC) and ΔAUCp (difference in AUCp between after to before ROSC) were independently associated with sustained ROSC (OR = 0.931, P = 0.011 and OR = 0.998, P &lt; 0.001). The area under the receiver operating characteristic curve of ΔETCO 2 , ΔAUCp, and the combination of both to predict unsustained ROSC were 0.752 (95% CI 0.660-0.844), 0.883 (95% CI 0.818-0.948), and 0.902 (95% CI 0.842-0.962). Conclusion: Patients with unsustained ROSC have a poor prognosis. Combined ΔETCO 2 and ΔAUCp showed significant predictive value for unsustained ROSC.
Abstract 13180: Cardiovascular Disease and Cholesterol Lowering Therapy in Women and Men With Molecularly Proven Familial Hypercholesterolemia
Authors: Kleisson A Maia, Marcio H Miname, Flavia C Maia, Viviane Z Rocha, Ana P Chacra, Marjorie Mizuta, Cinthia Elim Jannes, Alexandre Pereira, Jose E Krieger, Raul D Santos
Journal: Circulation (2023)

Introduction: Familial Hypercholesterolemia (FH) is an autosomal dominant disease affecting women and men on the same proportion. There is scant evidence on cardiovascular disease (CVD) and therapy adequacy on contemporary FH cohorts according to sex. Goals: Evaluate whether there were differences in CVD outcomes and treatment intensity in women and men with molecularly proven FH at a specialized lipid clinic. Methods: Initially a cross-sectional analysis of 801 patients with FH enrolled between 2011 and 2022 on a genetic cascade screening program was done . All had a positive FH molecular diagnosis. Participants were then followed by a median of 5 years (0.08 to 11 years). Clinical, laboratory and, treatment parameters were compared at baseline and during follow-up according to sex. Results: The cohort consisted of 455 women (57%) and 346 men (43%), mean age 47± 15 years. At baseline there were no sex differences regarding LDL-C (196±74 mg/dL men vs 200±75 mg/dL women, p= 0.567) as well as percentage of those with LDL-C &lt; 100 mg/dL (6.8% men vs 6.1% women, p=0.712) or &lt; 70 mg/dL at baseline (0.3% men vs 0% women, p=0.238). Intensive lipid lowering treatment use was similar between men and women at baseline (75.1% vs. 74.4%; p= 0.848) and during follow-up (87.6% vs. 88.3%; p= 0.785). At baseline 23.1% of women and 38.1% of men had a previous history of CVD (p= 0.000). After follow-up, 41 women (9%) and 52 men (15%) had an incident CVD event (p=0.009). Multivariate Cox regression analysis showed that risk factors related to incident events were age (HR=1.028, 95% CI 1.005-1.052 per year, p =0.019), presence of corneal arcus (HR 1.794, 95% CI 1.096-2.937, p= 0.02), current smoking (HR 2.534, 95% CI 1.304-4.927, p=0.006) and a previous CVD event (HR= 1.793, 95%CI 1.041-3.087, p= 0.035). Conclusions: Overall FH men had a greater risk of CVD events than FH women. There was no difference in treatment intensity and CVD outcomes were associated with traditional risk factors or previous CVD.
Abstract 13750: Concomitant Transcatheter Debulking of Right Heart Vegetations During Extraction of Transvenous Device System for Endocarditis: An Eight Case Series
Authors: Brandon K Doty, Bridget Lee, Jamarcus Brider, Arun Mahtani, Kirollos Gabrah, Feross Al-Hindi, Devi Nair
Journal: Circulation (2023)

Background: Right heart (RH) infective endocarditis (IE) is a rare but serious complication of transvenous devices (TVD) often requiring system extraction. Surgery is often necessary for large vegetations or when bacteremia persists despite antibiotics. Objective: To evaluate outcomes of patients who underwent transcatheter debulking of IE-related RH vegetations in the setting of a transvenous device endocarditis. Methods: Patients with TVD and IE with RH vegetations were included in this analysis. Half of the patients were debulked using a thrombus aspiration system, while in the other half a hydrodynamic thrombectomy system was used. This was completed via a femoral approach with intracardiac echocardiography guidance. Intra and post-procedural outcomes were recorded. Results: Eight patients with a median age of 58 years, 62.5% male, with TVD, IE, and RH vegetations were included. Vegetations were located on the TV (2), RA lead (4), RV lead (2) and the floor of the RA along the cavotricuspid isthmus (1). The largest vegetation in this series was 5 cm by 2 cm with a volume of 62.83 cm3 and the smallest was 0.4 cm by 0.3 cm with a volume of 0.15 cm3. All patients had substantial vegetation burden causing clinically significant valve dysfunction. The vegetations were successfully debulked in all eight cases. Post-procedure imaging in all eight patients showed at least a 80% reduction in vegetation burden. All patients with TVP leads underwent successful extraction of the pacing systems. All patients tolerated their procedures well and remained free of infection at follow-up after completing a 6-week course of intravenous antibiotics. There were no procedure-related adverse events recorded within 30 days of intervention. Conclusion: TCD is a potential alternative in patients with device infection and large vegetations who are not candidates for surgical intervention. Long-term implications of this intervention in this high-risk population needs further studies.
Abstract 19030: Growth Arrest-Specific 5, a Novel Regulator of Adipose Tissue Browning
Authors: Dilbar Mehdi, Shiyou Chen
Journal: Circulation (2023)

Background: Obesity is a global epidemic with significant health risks, including type 2 diabetes and cardiovascular diseases. Increasing white adipose tissue (WAT) browning has shown metabolic benefits in both animal models and humans. Long non-coding RNAs (lncRNAs), have been implicated in various diseases, including metabolic disorders. Growth arrest-specific 5 (GAS5), a tumor suppressor lncRNA decreased in type 2 diabetic patients, has been found to be involved in adipocyte differentiation, however, the role of GAS5 in WAT browning has not yet been established. We hypothesized that in the presence of an adipose tissue browning stimuli, GAS5 promotes WAT browning Methods: In vitro approaches through knocking down or overexpressing GAS5 were used to determine its role in regulating thermogenic genes and thermogenesis. To test the role of GAS5 in adipose tissue browning in vivo , adenovirus AAV8 expressing GAS5 was administered specifically in epidydimal adipose tissues followed by the treatment of browning stimuli CL-316,243. Results: Knockdown of GAS5 increased Smad3 phosphorylation, which was blocked by Smad3 inhibitor, SIS3. Conversely, overexpression of GAS5 inhibited Smad3 phosphorylation. On the other hand, Smad3 overexpression blocked the stimulatory effects of GAS5 on the expression of thermogenic genes PGC-1α and UCP1. Moreover, overexpression of GAS5 inhibited, while knockdown of GAS5 enhanced, Smad3 nuclear translocation and tis binding to PGC-1α promoter. In vivo experiments with GAS5 overexpression in epididymal adipose tissues revealed that GAS5 promotes CL-316,243-induced WAT browning in mice. Conclusions: Our study demonstrates that GAS5 promotes WAT browning by suppressing Smad3 signaling, which in turn increases thermogenesis via stimulating PGC-1α and UCP1 expression. These findings establish GAS5 as a novel regulator of WAT browning with potential implications for mitigating obesity and associated metabolic disorders.
Abstract 127: Trends of Racial Disparities and the In-Hospital Outcomes of Patients With Pulmonary Artery Catheterization for Cardiogenic Shock
Authors: Akanimo antia, Favour Markson, Carlos L Alviar
Journal: Circulation (2023)

Introduction: The use of pulmonary artery catheterization (PAC) in patients with cardiogenic shock (CS) has been associated with improved outcomes in non-randomized studies. However, the racial difference in PAC utilization and outcomes in CS have not been assessed. Methods: We identified all patients with CS who had PAC from the national inpatient sample of the Health Care Utilization Project database between 2016 - 2020. Patients were classified according to ethnic groups as white, black, Hispanic, and Asians Outcomes of interest included in-hospital mortality and use mechanical circulatory support (MCS) by ethnic group. Result: From 76,815 patients who underwent PAC during CS admission 64.18% of were Whites, 24.78% Blacks, 8.19% Hispanics, and 2.85% Asians. Black patients were younger, had higher prevalence of obesity, CHF, nicotine use and oxygen dependence. Compared to whites, blacks had lower mortality (aOR: 0.79; CI: 0.69 - 099, p=0.043), respiratory failure (aOR: 0.67; CI: 0.59 - 0.81, p&lt;0.001), mechanical support device utilization (aOR: 0.73, CI; 0.67 - 0.81, p&lt;0.001), and pacemaker utilization (aOR: 0.37; CI: 0.18 - 0.78, p=0.008). Hispanics had a longer length of stay (21 days vs 17.7 days). Blacks had higher rates of PAC use than other racial minorities between and mortality rates in blacks were noted to decline significantly in patients that had PAC during hospitalizations for CS (aOR: 0.49, CI; 0.46 - 0.52, p&lt;0.001). Conclusion: The utilization of PAC in patients with CS is associated with better outcomes, including mortality and this was noted as well in the individual racial subgroups. Despite these findings, racial disparities persist. These disparities could be alleviated by equitable distribution of healthcare resources.
Abstract 14960: Coronary Artery Calcium Distribution Patterns Are Independently Predictive of Adverse Cardiovascular Events: Observations From the Dallas Heart Study
Authors: Shyon Parsa, Amit Khera, Parag H Joshi, Fernando Kay, Anand Rohatgi
Journal: Circulation (2023)

Introduction: The coronary artery calcium (CAC) diffusivity index (DI) may improve risk stratification for those with Agatston CAC &gt; 0 in older individuals. We aimed to assess whether the distribution of CAC would improve risk prediction of cardiovascular (CV) events beyond the traditional Agatston CAC score in a younger population. Methods: Among Dallas Heart Study 2 (DHS2) participants with Agatston CAC &gt; 0 and no history of CVD (35% of entire cohort), we studied 1013 participants with CAC DI at DHS2. The raw CAC DI was calculated as 1 - (CAC in most affected vessel/total CAC) and categorized into concentrated (&lt;25th%), standard (25-75th%), and diffuse (&gt;75th%) patterns. Multivariable Cox proportional hazards regression and C statistics were calculated for coronary events (CHD) and all CVD, and all-cause mortality. Models were adjusted for total Agatston score, race, gender, BSA, smoking history, diabetes, and statin use. Results: Mean age of the DHS2 study cohort was 55 ± 9.4 years (48% women, 45% Black). The median follow up was 9 ± 2.5 years (55 CHD, 97 CVD, and 120 all-cause mortality events) (Figure, A) . CAC DI was modestly correlated with Agatston CAC (Spearman rho = 0.60, p&lt;0.01). In models adjusted for total Agatston score, risk factors, and demographics, compared with a concentrated pattern, a diffuse CAC pattern was associated with incident CHD (HR [95%CI]: 5.32 [1.68-16.86]); CVD (HR [95%CI]: 3.21 [1.66-6.21]), and all-cause mortality (HR [95%CI]: 2.02 [1.18-3.47] (Figure, B) . Findings were similar for continuous CAC DI. Addition of continuous CAC DI to adjusted models including Agatston CAC improved the C-statistic for CHD (0.79 to 0.81, p&lt;0.01) and CVD (0.71 to 0.73, p&lt;0.01). Conclusions: Beyond the validated Agatston score, higher CAC DI at baseline improves risk prediction of incident CHD and CVD events in a younger population-based cohort. Further studies are warranted to evaluate the clinical utility of assessing distribution patterns of CAC.