tbuckley/cabot-search huggingface dataset:
Abstract 13353: Sleep Health Phenotypes Predict Symptoms, Cognitive Function, and Adverse Events in Patients With Heart Failure
Authors: Sangchoon Jeon, Samantha Conley, Christopher Hollenbeak, Meghan O'Connell, Christine Tocchi, Henry K Yaggi, Zequan Wang, Nancy S Redeker
Journal: Circulation (2023)

Introduction: Poor sleep contributes to outcomes in heart failure (HF). Phenotypes reflecting multi-dimensional sleep health may better predict outcomes and support more precise interventions than single measures, but few studies have used this approach. Aims: 1) Describe phenotypes of sleep health and 2) Evaluate whether sleep health phenotypes predict symptoms, cognitive function, and time to first hospitalization and emergency department (ED) visits among HF patients. Methods: We performed secondary analysis of a randomized controlled trial of cognitive behavioral therapy for insomnia compared with HF self-management education with HF patients. We measured sleep [rest-activity rhythms, sleep duration, and efficiency (2-week wrist actigraphy/follow-ups); insomnia; CPAP use; and daytime sleepiness (Epworth Scale)]; perceived stress; fatigue; anxiety; depression; pain; and cognitive ability (Patient-Reported Outcomes Measurement System: PROMIS) at baseline and 3, 6, and 12 months post-intervention and tracked hospitalizations and ED visits. We used K-means clustering to identify sleep phenotypes and generalized linear mixed models and Cox models to predict outcomes, adjusted for demographic factors. Results: Among 166 participants (M age = 63.2 (SD = 12.8) years; 57% female; 23% NYHA Class 3/4 HF; 35% EF less than 45%), there were 4 phenotypes [poor sleep (14%); short sleep/high sleep efficiency (39%); long sleep/low sleep efficiency (25%); and healthy sleep (21%)] at baseline. The healthy sleep group was older and had lower BMIs and less comorbidity and had better outcomes compared to all other phenotypes. In particular, this group had better fatigue (-2.43±0.87), pain (-1.86±1.05), anxiety (-1.50±0.89), stress (-1.46±0.69), and cognitive ability (1.76±0.80) than the poor sleep group. The poor sleep group had shorter time to adverse events compared to the other phenotypes (Hazard ratios of 0.41 to 0.56 for hospitalizations and 0.35 to 0.60 for ED visits). Conclusions: Multidimensional aspects of sleep predict HF outcomes and may improve on prediction with single measures. Future tailored sleep interventions focused on phenotypes may more precisely improve outcomes among HF patients than traditional approaches.
Abstract 14227: Fatty Acid-Binding Protein-3 and Renal Function Decline in Patients With Chronic Coronary Syndrome
Authors: Chin-Chou Huang, Jiunn-Tyng Yeh
Journal: Circulation (2023)

Introduction: Renal dysfunction is common in patients with coronary artery disease. To delay the development of end-stage kidney disease and improve chronic kidney disease prognosis, early detection and management of chronic kidney disease are crucial, especially for high-risk populations. Hypothesis: We hypothesized that the fatty acid-binding protein-3 (FABP-3) is a novel biomarker associated with renal dysfunction. Methods: This is a multicentre prospective cohort study. Patients with chronic coronary syndrome were classified into three groups based on the initial serum FABP-3 levels. The Modification of Diet in Renal Disease (MDRD) equation was used to estimate the patient’s renal function. Renal events were defined as &gt;25% and &gt;50% decline in estimated glomerular filtration rate (eGFR). Multivariable Cox regression was employed to delineate the correlation between FABP-3 and renal dysfunction. Results: A total of 1606 subjects were included. During a mean follow-up of 35.9 months, there were 274 patients with eGFR &gt;25% reduction and 60 patients with &gt;50% reduction. The Kaplan-Meier survival curves showed that increased levels of FABP-3 were significantly correlated with eGFR &gt;25% reduction ( P &lt; 0.001) and &gt;50% reduction ( P &lt; 0.001). Multivariate Cox regression model revealed that subjects with higher FABP-3 exhibited a greater risk of eGFR &gt;25% reduction (Group 2: HR = 1.742, 95% CI = 1.222–2.483; Group 3: HR = 2.643, 95% CI = 1.847–3.784) and &gt;50% reduction (Group 2: HR = 3.818, 95% CI = 1.261–11.564; Group 3: HR = 9.769, 95% CI = 3.291–29.002). Conclusions: Serum FABP-3 may serve as a novel biomarker to predict eGFR decline in patients with chronic coronary syndrome. 1
Abstract 13597: Treatment Patterns and Outcomes for Young Adults With Atrial Fibrillation: The KP YOUNG-AF Study
Authors: Matthew D Solomon, Dongjie Fan, Elisha Garcia, Deborah Low, David R Vinson, Taylor Liu, Alan S Go
Journal: Circulation (2023)

Introduction: Young adults with atrial fibrillation (AF) may be most vulnerable to adverse outcomes such as cardiac remodeling and stroke, due to exposeure to AF for a longer time over their life course. Research Question What are contemporary treatment patterns and outcomes for young adults with AF treated with rate or rhythm control strategies? Methods: We identified patients aged 21-60 years with incident AF diagnosed from 2010-2018 within a large, integrated healthcare system caring for &gt;4.5M, and categorized them by treatment strategy within their first year after AF diagnosis: no treatment, rate control (AV nodal blockers only), or rhythm control (cardioversion, anti-arrhythmic drugs, or ablation). We examined crude outcomes of new onset heart failure (HF), stroke or transient ischemic attack (TIA), and use of oral anticoagulants (OAC), and examined multivariable associations between treatment strategy and outcomes using Cox regression. Results: Among 11,824 young adults with incident AF (mean [SD] age 51 [8.5] years; 32% female), 31% were treated with rhythm control, 50% with rate control, and 19% with no treatment. Those with no treatment were younger with fewer comorbidities. Crude rates (per 100 person-years) of incident HF and OAC were higher among rhythm control patients (HF: 4.45 for rhythm control, 2.51 for rate control, 0.56 for no treatment; OAC: 41.8 for rhythm control, 15.2 for rate control, 3.8 for no treatment), but rates of stroke/TIA were lower (0.71 for rhythm control, 0.92 for rate control, 0.51 for no treatment) (Figure). In adjusted analyses, no significant association was found for rhythm control (vs no rhythm treatment) for HF or stroke/TIA, but OAC use was higher (HR 1.66, 95%CI:1.57-1.70). Conclusions: Less than one third of young adults with AF received initial rhythm control therapy. Adverse outcomes were not associated with treatment strategy, but future studies should further examine long-term outcomes from sustained AF in young patients.
Abstract 19098: Physical Activity is Associated With Better Quality of Life and Perceived Health
Authors: rochelle G szuba, Thomas Hoffmann, Mary Whooley, Abdelaziz Elnaggar, Mijung Park, Julene Johnson, Linda G Park
Journal: Circulation (2023)

Background: People living with coronary heart disease (CHD) experience decline in physical and social functioning, contributing to poor quality of life (QOL) and perceived health. Evidence shows that physical activity in the adult population is associated with improved QOL and better perceived health, but little is known about its benefits for community-dwelling older adults with chronic CHD. Hypothesis: Engagement in the self-care activity of physical activity is strongly related to better perceived health and QOL. Objective: Describe the association between physical activity and perceived health and QOL among older adults with long-standing CHD (&gt;20 years). Methods: In this cross-sectional study, 20-year follow-up survey data were collected from 126 survivors from the Heart and Soul prospective cohort study of people living with CHD. To identify variables associated with perceived health and QOL, we utilized nested ordinal logistic regression models (four-level model). Results: The mean age for 126 surveyed survivors was 80.9 ± 9.1 years; 71.8% (n=94) were males, less than half being physically active (47.3%, n=62) and 23.7% had heart failure. Analysis adjusted for socioeconomic status (SES), physical activity, and activities of daily living (ADL) revealed a positive association between physical activity and perceived health ( aOR =2.316, p =.023) and a strong association with QOL ( aOR =2.070, p =.046). The QOL adjusted model found heart failure diagnosis was associated with lower QOL ( aOR= .431, p &lt;.033). Conclusions: Physical activity was positively associated with perceived health and QOL among older adults with CHD, even after adjusting for SES, physical activity levels, and ADL suggesting that engagement in self-care activities such as physical activity is associated improve the overall perceived health and QOL of individuals with CHD. Furthermore, the study highlighted the impact of heart failure on QOL, even after adjusting for physical activity. These findings underscore the need for interventions and programs to promote physical activity among older adults with CHD and targeted interventions in managing heart failure.
Abstract 18546: Vasoactive Medication Variability in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock
Authors: Christopher Schenck, Soumya Banna, Fouad Chouairi, Cory Heck, Megan Grammatico, Ajar Kochar, Jennifer Miao, Tariq Ali, Jacob C Jentzer, Sean Van Diepen, Elliott Miller
Journal: Circulation (2023)

Background: Patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) often require vasoactive medications to maintain organ perfusion. However, there are limited data on the real-world use of vasoactive medications in this population. Methods: We used the Vizient® Clinical Data Base to identify patients aged ≥18 years who were admitted between 2015-2019 with AMI-CS and required mechanical ventilation. We report the proportion of patients receiving vasoactive medications by day as well as site-level variability for vasoactive medication strategies using the median odds ratio (MOR), which quantifies the odds that a patient receives a strategy at two randomly selected sites after adjusting for covariates. Results: We identified 10,758 patients from 160 centers admitted with AMI-CS. The median age was 65.8 years, 29.8% were female, 83.6% received vasoactive medications in the first 5 days, and 56.9% received temporary mechanical support. The most used vasoactive medication on day 1 was norepinephrine (48.2%), followed by epinephrine (31.5%), and dopamine (16.9%) ( Figure ). On day 1, 65.9% and 36.2% of patients receiving vasoactive medications were prescribed ≥2 or ≥3 different medications, respectively, including 111 different combinations. Among patients receiving inotropes (N=4,485), there was a nearly 3-fold difference in milrinone use across sites after accounting for differences in patient characteristics (MOR 2.89; 95% confidence interval [CI]: 2.39-3.38). For patients receiving either norepinephrine, dopamine, or epinephrine on day 1 (N=3,224), there was a nearly 2-fold difference in the use of norepinephrine as a first-line vasopressor across sites (MOR 1.84; 95% CI: 1.59-2.06). Conclusion: Norepinephrine is the most commonly used vasoactive medication in patients with AMI-CS. However, there is substantial site-level variability in vasoactive medication strategies, which require further study.
Abstract 16475: Mitral Valve Transcatheter Edge to Edge Repair: A Real-World Analysis of Racial Differences in Uptake and Outcomes
Authors: Balakrishnan Pillai, Tariku J Beyene, Paul A Heidenreich, Celina M Yong
Journal: Circulation (2023)

Introduction: Recently, percutaneous mitral valve transcatheter edge to edge repair (TEER) with the MitraClip system has grown as a treatment option for mitral regurgitation. However, data describing the real-world adoption of this technology are limited, especially regarding differences by race and ethnicity. Research Question: What have been the trends in usage of mitral valve TEER during its early uptake in the United States, and has there been equitable adoption across racial and ethnic groups? Methods: In a comparative study using the Veterans Affairs (VA) Clinical Assessment Reporting and Tracking database from Jan 1,2017 to Dec 31, 2022, we describe temporal changes in mitral valve TEER use within the VA system, and differences in uptake by race/ethnicity (White non-Hispanic, Black non-Hispanic, Hispanic). We further describe 30-day and 1-year mortality following TEER by race/ethnicity. Results: The rate of mitral valve TEER use increased significantly overall (p=0.008), and across each race/ethnic group studied ( Figure 1 ). However, relative to White non-Hispanic patients, Black non-Hispanic and Hispanic patients were less likely to receive mitral valve TEER (adjusted OR 0.45 [95% CI 0.28-0.70] and adjusted OR 0.47 [95% CI 0.19 -0.98] respectively) ( Figure 2 ). The adjusted 30-day and 1-year mortalities following mitral valve TEER were similar between races/ethnicities. Conclusions: Although patients benefit similarly following mitral valve TEER, adoption among non-Hispanic Black and Hispanic patients trails non-Hispanic White patients. This highlights the importance of identifying and addressing barriers to adoption among underrepresented groups.
Abstract 18529: Early Coronary Revascularization Among "Stable" Patients With Non-ST-Segment Elevation Acute Coronary Syndromes: The Role of Diabetes and Age
Authors: Natalia Fabin, Edina Cenko, Giuseppe Vadalà, Guiomar Mendieta Badimon, Sasko Kedev, Jorgo Kostov, Marija vavlukis, Davor Milicic, zorana Vasiljevic, Marija Zdravkovic, Lina Badimon, Alfredo Galassi, Olivia Manfrini, Raffaele Bugiardini
Journal: Circulation (2023)

Introduction: Despite improvement in the management of patients with non-ST-elevation acute coronary (NSTE-ACS), this condition is still linked to a substantially increased mortality and morbidity among diabetic patients. Specifically, it remains uncertain whether patients whose condition can safely be stabilized at hospital admission should routinely receive an early coronary revascularisation. Hypothesis: We tested the hypothesis that a strategy of early coronary revascularization within 24 hours of diagnosis is superior to an initial conservative strategy in terms of clinical outcomes in diabetic patients who met stabilisation criteria at hospital admission. Comparison was made with a cohort of nondiabetic patients. Methods: The ISACS-TC database was queried for a sample of diabetic and nondiabetic patients with diagnosis of NSTE-ACS. Those with recurrent angina after hospital admission, cardiac arrest, haemodynamic instability, and serious ventricular arrhythmias were excluded. The characteristics between groups were adjusted using inverse probability of treatment weighting models. Co-primary end points were all cause 30-day mortality and the composite end point of all cause 30-day mortality and left ventricular (LV) systolic dysfunction. Risk ratios (RRs) with their 95% CIs were employed. Results: Of the 7,473 NSTE-ACS patients identified, 2,220 were diabetics. Early revascularization was associated with survival benefit only in the elderly (≥65 years) both in diabetics (3.7% vs 6.6%; RR: 0.56; 95% CI: 0.32-0.96) and nondiabetic patients (2.8% vs 5.1%: RR: 0.55; 95% CI: 0.34-0.87). In the elderly population, an initial conservative strategy increased the risk of death or LV systolic dysfunction by 15.2% in diabetics compared with nondiabetic patients (37.7% vs 32.7%; RR: 1.15; 95% CI: 1.02-1.30). Conclusions: Early coronary revascularization does not lead to any survival advantage within 30 days from admission in a large number of NSTE-ACS patients who present to hospital in stable conditions. An early invasive management strategy may be best reserved for the elderly either with or without diabetes. The benefit of this strategy appears to be more pronounced in the diabetic population.
Abstract 262: Mediating Factors Between Community Race/Ethnicity and Initial Shockable Rhythm
Authors: Ryan Huebinger, Eric Power, Marina Del Rios, Carrie A Bakunas, Benjamin Karfunkle, Micah Panczyk, Bryan F McNally, Bentley Bobrow
Journal: Circulation (2023)

Background: Initial shockable rhythm is an important predictor of favorable out-of-hospital cardiac arrest (OHCA) outcomes. While patients from minoritized communities suffer from lower rates of initial shockable rhythm, the reason for this disparity is not known. Hypothesis: OHCA characteristics contribute to disparities in initial shockable rhythm. Methods: We performed a retrospective study of the 2014-2021 Texas Cardiac Arrest Registry to Enhance Survival, including adult, non-traumatic OHCAs. Linked to census tract data, we stratified OHCAs based on having a majority of a race/ethnicity: &gt;50% White, &gt;50% Black, and &gt;50% Hispanic/Latino. To evaluate if initial shockable rhythm impacts outcome disparities, we compared logistic regression models between race and OHCA outcomes: 1) unadjusted, 2) adjusted for bystander CPR (bCPR), and 3) adjusted for initial rhythm. Using structural equation modeling, we then performed a mediation analysis between race/ethnicity, OHCA characteristics, and shockable rhythm, reporting the mediations proportions. Results: We included 39,596 OHCAs, 16,702 White, 5,461 Black, and 17,433 Hispanic. The rate of shockable rhythm was 19.0% for White, 14.3% for Black, and 14.6% for Hispanic. Odds of favorable neurologic outcome were lower for Black (OR 0.5, 95% CI 0.4-0.6) and Hispanic (OR 0.6, 95% CI 0.6-0.7). While adjusting for bCPR did not change these odds, adjusting for shockable rhythm increased odds for Black (OR 0.6, 95% CI 0.5-0.7) and Hispanic (OR 0.7, 95% CI 0.6-0.8). On mediation analysis, the proportion of initial shockable rhythm mediated for Black census tract were: age&gt;65 (-7.3%), male gender (6.8%), public location (6.9%), healthcare facility location (-17.2%), bystander witnessed (19.2%), bCPR (4.3%), and bystander AED (6.4%). The proportion mediated for Hispanic census tract were: age&gt;65 (-4.8%), male gender (0.5%), public location (-4.0%), healthcare location (-13.5%), bystander witnessed (20.8%), bCPR (8.7%), and bystander AED (6.2%). Conclusion: Bystander witnessed arrest was the most significant mediator of shockable rhythm for OHCA in Black and Hispanic communities, while bCPR was a modest mediator of shockable rhythm for Hispanic OHCA victims.
Abstract 14724: Health Status and Long-Term Outcomes After Acute Myocardial Infarction in Patients Without Standard Modifiable Risk Factors
Authors: Nobuhiro Ikemura, Dan Nguyen, Mitsuaki Sawano, Yuan Lu, Kensey Gosch, Harlan M Krumholz, John Spertus
Journal: Circulation (2023)

Background: Prior studies examining patients who experienced acute myocardial infarction (AMI) as their initial presentation of coronary disease have shown that those without Standard Modifiable Risk Factors (SMuRF; diabetes, dyslipidemia, hypertension, and smoking) had worse in-hospital but better long-term survival than those with SMuRFs. However, the health status outcomes, patients’ symptoms, function, and quality of life among those without SMuRF are unknown. Research questions: Are there differences in long-term health status and mortality between patients who survived hospitalization following AMI with and without SMuRFs? Methods: We analyzed data from two prospective registries, PREMIER and TRIUMPH, comprising patients hospitalized to 31 US hospitals with AMI between 2003-2008. We compared the clinical characteristics, 1-year health status (with the Seattle Angina Questionnaire [SAQ]), and 5-year all-cause mortality between patients with and without SMuRFs. Patients with prior coronary artery disease were excluded. We used hierarchical linear mixed models for health status outcomes and Cox-proportional hazard models for mortality, adjusted for clinical and sociodemographic characteristics, including baseline SAQ scores. Results: Among 4076 patients with AMI (mean age 58.4±12.4 years, 34% female, 22% Black), 569 (13.9%) presented without SMuRFs. Despite similar mean age, patients without SMuRFs were more likely to be male, Non-Hispanic White, have higher income and education, fewer depressive symptoms, and higher SAQ Summary Scores at baseline (83.5±13.2 vs. 79.6±16.5). At 1-year follow-up, patients without SMuRFs had higher SAQ Summary Scores (93.9±10.1 vs. 89.9±14.7), although the difference between groups was attenuated after adjustment (1.69 points, 95% CI 0.40-1.97). Furthermore, there were no significant differences in all-cause mortality over 5 years between groups (adjusted HR= 0.83, 95% CI: 0.59-1.16). Notably, besides sex or race category, a higher incomes and better depression status were negative independent predictors for health status and clinical outcomes. Conclusions: AMI survivors, both with and without SMuRFs, had comparable long-term health status and survival after rigorous adjustment.
Abstract 15944: Aspirin Use for Primary Prevention in High-Risk Patients: Insights From a Large Healthcare Network
Authors: Pallavi Muluk, Jianhui Zhu, Erin D Michos, Floyd W Thoma, Oscar C MARROQUIN, Eli Hay, Anurag Mehta, Suresh R Mulukutla, Anum Saeed
Journal: Circulation (2023)

Background: Recently, the value of routine use of aspirin in primary prevention for atherosclerotic cardiovascular disease (ASCVD) has come into question. We investigated patients with a high 10-year ASCVD risk profile to evaluate the magnitude of protection afforded by aspirin with and without statin in prevention of ASCVD events. Methods: Primary prevention patients were stratified based on 10-year ASCVD risk (High [20%]). Aspirin use was categorized over the 6-year follow-up period as “None”, “seldom” (&lt;30% of follow up time), “sometimes” (&gt;30 to =&lt;70%), and often used (≥70% of the time). Cox regression models were used to assess HRs of MI, ischemic stroke and mortality with aspirin or statin use alone compared to a combination of aspirin and statin. Results: 69,955 patients qualified as “high” 10-year ASCVD risk. In fully adjusted models, aspirin use ≥ 30% was associated with significantly lower risk of MI [HR ASA use ≥ 70% 0.76 (0.72-0.80), p &lt;0.001], ischemic stroke [HR ASA use ≥ 70% 0.83 (0.77-0.90), p &lt;0.007], and mortality [HR ASA use ≥ 70% 0.78 (0.74-0.82), p &lt;0.001] in high-risk patients compared to no aspirin use ( Table ). Compared to patients on both a statin and aspirin, patients on statin alone had increased risk of MI [HR 1.30 (1.06-1.60), p = 0.013]. Patients on aspirin alone had increased risk of MI [HR 1.74 (1.34-2.26), p &lt;0.001] and mortality [HR 1.70 (1.27-2.28), p &lt; 0.0004] versus those on aspirin and statin. Patients not on any aspirin or statin were at significantly increased risk for MI [HR 2.28 (2.08-2.49), p&lt;0.001], ischemic stroke [HR 1.77 (1.56-2.00), p&lt;0.001), and mortality [HR 2.16 (1.60-2.90), p&lt;0.001] compared to those taking both aspirin and statin. Conclusions: Low dose aspirin may still have a role in primary prevention of ASCVD events amongst high-risk patients when added to statin therapy. Risk-benefit profile of each high-risk primary prevention patient should be assessed for initiating or discontinuing low dose aspirin therapy