tbuckley/cabot-search huggingface dataset:
Abstract Sa404: Implementation of a Nurse-Centric Resuscitation Institute and the Impact on Quality Metrics
Authors: Amanda Pyles, Rebecca Busch, Taylor Campbell
Journal: Circulation (2024)

Introduction: Healthcare organizations evaluate resuscitation using a wide array of methods. OThe American Heart Association’s (AHA) Get With the Guidelines-Resuscitation® (GWTG-R) database facilitates the collection of data to develop evidence-based guidelines. The four main metrics include time to shock (TTS), time to epinephrine administration, confirmation of airway (COA), and arrest monitored/witnessed. An academic health system (AHS) identified a need for improving how resuscitation data was translated at the bedside. Prior to the COVID-19 pandemic, resuscitation data within the AHS was focused on GWTG-R metrics for reporting only. The AHS’s Nursing Professional Development (NPD) department identified inaccuracies in data collection and minimal educational resources for improvement. Hypothesis: Would a nurse-centric Resuscitation Institute impact quality survivability metrics at an AHS? Goals: The NPD department reviewed GWTG-R data and survival to discharge at two hospitals. In 2021, the NPD department developed a team comprised of a data abstractor and resuscitation coordinator (NPD practitioner). The goal of this team was to improve data collection and translate identified needs from the data into resuscitation education and process improvement. Approach: The team found gaps in documentation, education, and emergency response process. GWTG-R metrics COA, TTS, and survival to discharge were lower than national benchmark and an abundance of resuscitation events were occurring than estimated. Descriptive data for GWTG-R 2021-2022 metrics identified gaps in guideline adherence and documentation standards: COA 83%, TTS 56%, and survival to discharge 36%. Based on these findings, approval from administration allowed the team to expand into a nurse-centric Resuscitation Institute comprised of three data abstractors, a resuscitation coordinator, and program manager. The Institute now collects data across the AHS on resuscitation events, and collaborates with NPD practitioners, leaders, providers, and emergency responders. Results: Since implementation of the Institute in 2023-2024 percentage increases revealed an improvement in survivability metrics: COA 87%, TTS 79%, and survival to discharge 37%. Conclusion: The Resuscitation Institute used nurses and survivability quality metrics to create a multifaceted approach to education and process improvement that improved early recognition, optimal resuscitation practices and post-cardiac arrest care.
Abstract 4147473: Development of Pre-clinical Models of Coronary Microvascular Disease
Authors: Mansi Kumar, Donna Conlon, Dale Stentz, Scott Metzler, Marie Guerraty
Journal: Circulation (2024)

Coronary microvascular disease (CMVD), or disease of the coronary pre-arterioles, arterioles, and capillaries, accounts for 30-50% of ischemic heart disease. Progress in the field requires preclinical models to assess the coronary microvasculature. There are several risk factors for CMVD including age, metabolic syndrome, and hypercholesterolemia. Here, we evaluate the effect of these risk factors on coronary microvascular function in mice. Male and female C57BL/6 mice aged 12-42 weeks (n=29) were treated with 45% high fat diet (HFD) for six months or aged &gt; 9 months. Apolipoprotein E knockout (ApoE-/-) was used to induce hypercholesterolemia as a second risk factor. To assess coronary microvascular function, we measured the intramyocardial blood volume (IMBV) under hyperemic (2.5% isoflurane) and basal (1.25% isoflurane) conditions, as previously reported. Briefly, we labeled red blood cells using pyrophosphate and Technetium 99m-pertechnatate and imaged the heart using µ-SPECT (MI Labs). Coronary microvascular function is reflected by the percent change in intramyocardial activity concentration between rest and stress conditions or △ IMBV. Outliers were removed based on Grubbs method (a=0.1) and groups were compared using Student's T test. p &lt;0.05 was considered significant (Prism 9.3.1). Mice fed HFD had a 0.75-fold change in △ IMBV (23% ± 3.4 vs. 17% ± 2.4, p=0.03). Aging had a similar reduction in △ IMBV, 0.73-fold change (17% ± 2.7, p=0.01). We saw no sex-based difference in △ IMBV in our HFD and aged cohorts (18% vs 19%, 17% vs. 19%, p=0.79, p=0.74 , respectively), consistent with human cardiac perfusion PET imaging data. Exposure to two cardiovascular risk factors, ApoE-/- and HFD (0.48-fold change) or ApoE-/- and aging (0.54-fold change) additionally decreased △ IMBV (11% ± 2.3, p&lt;0.01, 12% ± 2.6, p&lt;0.01, respectively). Of note, ApoE-/- mice on a HFD had no evidence of obstructive epicardial coronary artery disease on histology. We evaluated coronary microvascular function in various mouse models using u-SPECT-based imaging methods and commercially available tracer. Exposure to cardiovascular risk factors induced CMVD, and the degree of CMVD was worse when two cardiovascular insults were used. Further studies using preclinical mouse models of CMVD may be helpful in assessing the effects of therapies and interventions.
Abstract 4146886: Strive for Silver: A "Measure Accurately" Blood Pressure Peer Learning Accelerator
Authors: Rebecca Alicki, Alison Smith, Liz Montgomery, Katherine Overton
Journal: Circulation (2024)

Strive for Silver is a structured peer-learning quality improvement effort designed to help health care organizations adopt evidence-based approaches to blood pressure (BP) measurement and improve hypertension control rates. Developed by the American Heart Association (AHA), this opportunity also supports organizations participating in Target: BP™ to achieve annual awards. Target: BP is a national initiative created by the AHA and the American Medical Association (AMA) where participants report Controlling High Blood Pressure (MIPS 236) data and attest to 6 evidence-based BP measurement activities as of the prior year. Annual data submission for Target: BP recognizes organizations through awards for control rates ≥70% and/or adoption of ≥4 evidence-based activities. Organizations that submitted data to Target: BP in 2022 but were ineligible for awards based on performance thresholds were invited to join a Strive for Silver cohort. The initiative consisted of four 1-hour weekly sessions with a brief didactic introduction reviewing the evidence-based measurement activities and related practice tools, followed by interactive breakout groups for collaborative peer-learning. Beginning in September 2022, 14 organizations participated in the pilot peer-learning series and were monitored via their Target: BP data submissions in 2023 and 2024. Of the 14 pilot organizations, 10 submitted data in both years. When comparing pre-implementation (2022), and post-implementation (2024) Target: BP data submissions, 100% of organizations saw an increase in BP control from baseline, with an average absolute increase of 10.1%, ranging from &lt;1%-31% improved BP control. BP measurement activity attestations increased from an average of 2.4 to 3.9, respectively. A post-assessment survey showed all participants felt that the collaborative was “very valuable.” The Strive for Silver peer-learning accelerator appears to be an effective approach to helping organizations improve evidence-based practice adoption and improve BP control rates. The model has been replicated with an additional Strive for Silver cohort in 2023 and will continue to be monitored post-intervention. In 2024, Strive for Silver will expand into a Hypertension Control Accelerator with a goal of improving BP control through additional guideline-directed activities. The AHA recognizes Strive for Silver has the potential to expand into other facets of improving BP control as well as other chronic CVD conditions.
Abstract 4147050: Genetic Insights into Arrhythmogenic Mitral Valve Prolapse – A Case-Control Study from UK Biobank and NIH All of Us
Authors: Ghaith Sharaf Dabbagh, Kerrick Hesse, Ruchi Agnihotri, Gurpreet Kaur, Manasa Gurumoorthi, Ravi Shah, Babken Asatryan, Kristian Galanti, Rachel Wolfe, Saige Mitchell, Robert Pargament, Adnan Malik, Brian Schuler, Patricia Munroe, Edmond Obeng-Gyimah, Virend Somers, Fabrizio Ricci, Mohammed Khanji, Andrew Landstrom, Anwar Chahal
Journal: Circulation (2024)

Background: Mitral valve prolapse (MVP) is a common valvular abnormality. Observational studies demonstrate an association between MVP and increased risk of sudden cardiac death from ventricular arrhythmias, coined arrhythmogenic MVP. A genetic component has been postulated but remains under-investigated. Hypothesis: Predicted deleterious variants in Mendelian cardiomyopathy and arrhythmia genes are more frequent in arrhythmogenic MVP (aMVP) compared to non-arrhythmogenic MVP. Aims: To comprehensively phenotype and genotype a single-center aMVP cohort and compare to non-aMVP from two large population-based cohorts and investigate their clinical outcomes. Methods: The aMVP cohort included 46 prospectively enrolled patients from a regional referral center for inherited cardiovascular disease and had undergone multi-modality imaging and clinical gene panel testing. The non-aMVP comparator cohorts included 453 participants from the UK Biobank (UKBB), a prospective cohort of 500,000 UK residents, and 1,418 participants from the National Institutes of Health (NIH) All of Us (AoU), a prospective cohort of 450,000 USA participants. Gene variants were annotated in ANNOVAR. Participants with and without pathogenic/likely pathogenic (P/LP) variants reported on ClinVar with ≥2-star level of evidence were considered genotype positive (G+) and negative (G-) respectively. Results: The demographics for aMVP (age 61.2 ± 12.8 years, 56.5% female) and non-aMVP (UKBB: age 59.8 ± 7.3 years, 50.7% female and AoU: age 65.3 ± 13.4 years, 76.2% female) were comparable. G+ participants were more prevalent in the aMVP cohort 10/46 (21.7%) versus non-aMVP in the UKBB 8/453 (1.8%) and in the AoU 21/1418 (1.5%); p&lt;0.001. The most frequently implicated gene in aMVP was TTN . Of 46 in aMVP cohort, 33 (71%) underwent CMR. G+ participants had a higher frequency of late gadolinium enhancement [6/6 (100%) vs. 14/27 (51.8%), p&lt;0.001] and wall motion abnormalities [3/6 (50%) vs. 1/27 (3.7%), p&lt;0.001] compared to G- participants. The aMVP cohort had significantly more implantable cardioverter defibrillator (ICD) implants compared to non-aMVP cohort [5/46 (10.9%) vs. 1/453 in UKBB (0.2%), p&lt;0.001]. G+ aMVP cohort showed a trend for developing heart failure and ICD implants compared to G- aMVP . Conclusion: P/LP variants in cardiomyopathy and arrhythmia genes are more prevalent in aMVP participants compared to non-aMVP participants. This could be a hitherto unrecognized effect modifier predicting aMVP .
Abstract 4148110: Trends in Critical Limb Ischaemia Related Mortality in Patients Aged 55 and Older in the United States: Insights from the CDC WONDER Database
Authors: Muhammad Abdullah Naveed, Bazil Azeem, Faizan Ahmed, Salman Abdul Basit, yasar sattar
Journal: Circulation (2024)

Background: Critical Limb Ischaemia (CLI) is a concerning medical emergency condition with notable mortality among older adults. This study highlights the trends and demographic disparities in mortality rates due to CLI in patients aged 55 and older in the United States from 1999 to 2020. Aim: This study aimed to evaluate patterns and geographical variations in mortality associated with CLI among adults in the United States. Methods: Death certificates from CDC WONDER database from1999 to 2020 were analyzed to investigate mortality related to CLI among adults. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, stratified by year, sex, race/ethnicity, and geographical regions. Results: CLI caused a concerning 620,205 deaths among US adults aged 55+ between 1999 and 2020, primarily in hospitals (42%). The overall AAMR for CLI-related deaths showed decline from 51.6 in 1999 to 40.1 in 2020, with an AAPC of -1.51 (95% CI: -1.75 to -1.25, p &lt; 0.000001). The AAMR experienced a steeper decrease from 1999 to 2011 (APC: -3.31, p &lt; 0.000001), followed by a slight increase from 2011 to 2020 (APC: 0.94, p = 0.031174). Men had higher AAMRs than women, though both sexes experienced reductions (men: 48.3; women: 32.6). The AAMR for men decreased from 64.9 in 1999 to 42.8 in 2011, increasing to 50.1 by 2020. For women, the AAMR decreased from 42.9 in 1999 to 28.3 in 2014, followed by a slight increase to 32.3 by 2020. Racial/ethnic disparities were apparent, with Black individuals having the highest AAMRs (58.7), followed by Whites (39.0), American Indians/Alaska Natives (38.0), Hispanics (28.5), and Asians/Pacific Islanders (13.8). All racial groups experienced decreases in AAMRs. Geographically, AAMRs varied from 20.4 in Utah to 53.2 in Ohio. The highest mortality noted in the Midwestern region (AAMR: 43). Nonmetropolitan areas unveiled higher AAMRs than metropolitan areas (nonmetropolitan: 43.5; metropolitan: 38.2). Both regions showed a decrease in AAMRs from 1999 to 2020 (metropolitan AAPC: -1.36, p &lt; 0.000001; nonmetropolitan AAPC: -0.81, p = 0.001399). Conclusion: Our analysis highlights significant demographic and geographic differences in older adult mortality due to CLI in the U.S. Continued decreases over time but recent upturn in mortality rates emphasizes need for focused interventions to close these gaps and to improve population health outcomes for affected populations.
Abstract 4146930: Reported Stress Level is Associated with Cardiovascular Health in Young Adults – An Electronic Health Record Study of Nearly 1.4 Million Individuals
Authors: Robin Ortiz, Sean Heffron
Journal: Circulation (2024)

Background: Young adulthood (19–39 years) is the life stage of greatest declines in cardiovascular health (CVH). It is hypothesized that this decline may be related to competing demands (e.g., stressors) of this period of the lifecourse such as work and child-rearing. The AHA’s Life’s Essential 8 CVH framework identifies the scored domains (behavioral and clinical factors), as needing to be contextualized by the important construct of psychological health (including stress). However, scarce data are available to assess the relationship between CVH and reported stress – especially among YA. Purpose: The current study aims to be the first to use Cosmos electronic health record (EHR) data to assess the relationship between YA CVH and reported stress in a nationally representative, very large sample of YAs. Methods: Cosmos is a platform hosting de-identified Epic EHR data on &gt;250 million patients. We assessed Cosmos data from May 2022 through April 2024 to identify all YAs with reported stress data (5-point scale from “not at all” to “very much”). We then compared trends of each CVH metric across stress categories. Results: 1,397,375 individuals 19 - 39 years of age had reported stress data available. The sample was 62% White, 17% Black, 4% Asian, 12% Hispanic, and 63% female. Generally, stress levels were stable across YA age groups (Figure 1). For lifestyle behavior related domains (physical activity (PA), smoking, and BMI), the prevalence of “poor” CVH scores (worst categorization) increased in YA as reported stress amount increased (Figure 2). Prevalence of “poor” scores in clinical metrics (BP, HbA1c, nonHDL-C) were not associated with stress. Conclusion: In a very large sample of YA, greater reported stress was associated worse CVH for the behavioral domains of PA, smoking and BMI. Interventions aimed at reducing stress in YA may have the added benefit of improving CVH.
Abstract 4146800: A Retrospective Analysis of Measured Versus Estimated Resting Oxygen Uptake for Derivation of Fick Cardiac Output in Patients in the Cardiac Intensive Care Unit
Authors: Alexandra Minasian, Shaina McGinnis, Jennifer Rouvina, Chloe Newlands, Catharine Griskowitz, Alyssa Kowal, Katherine Kelly, Joseph OLoughlin, DayQuan Wallace, David Dudzinski, Ken Shelton, Rajeev Malhotra, Gregory Lewis
Journal: Circulation (2024)

Background: Estimated cardiac output using the Fick principal (estFickCO) frequently informs clinical decision making in Cardiology Intensive Care Units (CICU). Assessment of estFickCO relies on estimation of resting oxygen uptake (rVO 2 ). We hypothesized that large variance will be present between rVO 2 measured with a metabolic cart and the estimated rVO2 often used in CICUs. Methods: In this single-center study, 275 CICU patients with pulmonary arterial catheters in place to guide heart failure management underwent breath-by-breath metabolic cart measurement of rVO 2 for 10 minutes coupled with duplicate measures of arterio-venous oxygen content to derive Fick CO. Four equations to estimate rVO 2 were evaluated: weight-based only (3.5ml/kg/min, 1 MET); accounting for sex and BSA (Dehmer); sex, BSA, and age (Bergstra); and sex, BSA, age, and heart rate (LeFarge). Bland-Altman analysis and derivation of coefficients of variation were performed to evaluate the agreement between each equation and actual measured rVO 2 . Results: In this cohort of 275 patients (age 57.8±14.4, 24% female, BMI 28±6.9 kg/m 2 ) the mean measured rVO 2 was 276±71 mL/min and Fick CO was 4.7±1.6 L/min. Using 1 MET to estimate rVO 2 equated to a mean rVO 2 of 292±81 mL/min, the Dehmer equation estimated a mean rVO 2 of 283±49 mL/min, Bergstra estimated a mean rVO 2 of 248±37 mL/min, and the LaFarge equation estimated a mean rVO 2 of 239±53 mL/min. The frequency of error being &gt;25% was calculated at 24%, 15%, 17%, and 19% respective to each equation. When analyzed using Bland-Altman plots, the Dehmer equation demonstrated the lowest mean bias as well as the lowest coefficient of variation when compared to the other three estimates ( Figure ) yet limits of agreement span VO 2 values associated with &gt; 3 L/min differences in Fick CO across all 4 estimates. Conclusion: Measured VO 2 varies significantly from estimated VO 2 among CICU patients. Accounting for sex and BSA with use of the Dehmer equation was associated with the closest approximation of actual VO 2 values among 4 estimates analyzed in our study. High variance in rVO 2 estimates and impacts on management should be considered when interpreting estFickCO in CICU patients.
Abstract 4147030: Innovative Use of Large Language Models to Diagnose Pericarditis in Patients Referred to a Tertiary Center for Uncertain Diagnosis
Authors: Abdel Hadi El Hajjar, Issam Motairek, Akiva Rosenzveig, Alveena Syed, Joseph Kassab, Astefanos Al-Dalakta, Allan Klein
Journal: Circulation (2024)

Background: Accurate pericarditis diagnosis is challenging due to its subtle signs and wide differential diagnoses. Large language models such as Chat GPT-4 have been previously used to answer medical questions, but their efficacy in diagnosing medical conditions is unknown. Research Question: Can Chat GPT-4 accurately diagnose pericarditis in patients referred to a tertiary center for suspected pericarditis? Aim: We aim to evaluate the predictive capacity of a widely available AI tool (Chat GPT-4) for pericarditis diagnosis. Methods: Patients referred to the Cleveland Clinic Pericardial Center for suspected pericarditis were enrolled in a prospectively maintained registry between September 2022 and September 2023. Pericarditis diagnosis was confirmed by two physicians based on the 2015 ESC guidelines. The AI tool was provided with patient demographics, comorbidities, presenting symptoms, laboratory values and imaging findings. Chat GPT-4 was asked: “What is the probability that the patient has pericarditis?”. A probability &gt;0.5 was considered a positive pericarditis diagnosis by Chat GPT-4. Predictions were compared to physician-based diagnosis to construct a contingency table. Results: The total number of patients enrolled in the study was 170, out of which 110 were diagnosed with pericarditis. Chat GPT-4 diagnosed pericarditis in 62 patients. Physician-based diagnoses and Chat GPT-4’s diagnoses are displayed in the contingency table attached. The AI tool was able to predict pericarditis diagnosis with a Sensitivity of 52% (95% CI: 43% to 61%) and a Specificity of 94% (95% CI: 87% to 98%). In the studied population, Chat GPT-4’s Positive Predictive Value was 93% (95% CI: 87% to 98%) and its Negative Predictive Value was 53% (95% CI: 44% to 62%). Overall, Chat GPT-4 demonstrated an AUC of 0.73, indicating a moderate level of diagnostic accuracy. Conclusion: Chat GPT-4 can be used to support the diagnosis of pericarditis (rule in) in patients with suspected disease. However, it has poor sensitivity and cannot be used in the initial workup. Further studies are warranted to assess its application in clinical practice.
Abstract Sa101: Prehospital advanced airway management across age groups in out-of-hospital cardiac arrest: Registry-based cohort study from the Resuscitation Outcomes Consortium Epidemiologic Registry
Authors: Junichi Izawa, Sho Komukai, Clifton Callaway, Masashi Okubo
Journal: Circulation (2024)

Background: Emergency medical services clinicians commonly perform advanced airway management (AAM: i.e., supraglottic airway placement and endotracheal intubation) for out-of-hospital cardiac arrest (OHCA). Nevertheless, the heterogeneity of the treatment effect of prehospital AAM across age groups is still unclear. Aim: To determine the association between prehospital AAM and survival after OHCA, compared with no AAM, across age groups. Methods: This cohort study used the Resuscitation Outcomes Consortium Epidemiologic Registry database, a prospective OHCA registry at ten sites in the US and Canada from 2011 through 2015. Patients were stratified into ten sub-cohorts based on their first documented rhythm (shockable or non-shockable) and five age groups (0-9 years; 10-24; 25-44; 45-64; or ≥65) given the potential impact of rhythm and age on effect modification. To address resuscitation time bias, patients who received AAM during cardiopulmonary resuscitation (CPR) were sequentially matched with patients at risk of receiving AAM within the same minute based on time-dependent propensity scores. Matching was performed in each sub-cohort, and the matched sub-cohorts were integrated for the main analysis. The primary outcome was survival to hospital discharge. Results: Of the 44,403 eligible patients, 39,157 (88.2%) received prehospital AAM during CPR. After time-dependent propensity score sequential matching, 29,973 who received AAM were matched with patients who had not yet received AAM at the same minute. AAM was associated with survival: 5.4% vs 4.8%, risk ratio (RR) 1.40 (95% CI 1.30-1.51). The associations were similar toward better survival in both the shockable (RR 1.27 [95% CI 1.17-1.38]) and non-shockable (RR 1.75 [95% CI 1.53-2.01]) cohorts. There was no apparent heterogeneity of the treatment effect of AAM on survival in all age groups: 0-9 years, RR 1.07 (95% CI 0.45-2.56); 10-24 years, 1.61 (1.07-2.45); 25-44 years, 1.68 (1.35-2.10); 45-64 years, 1.33 (1.19-1.48); 65 years or older, 1.40 (1.23-1.59). Conclusions: In this study of the large multicenter OHCA registry in North America, prehospital AAM was associated with survival to hospital discharge regardless of the first documented rhythm. No apparent heterogeneity was found in the associations between AAM and survival among all age groups, suggesting that both pediatric and adult populations might benefit from prehospital AAM.