tbuckley/cabot-search huggingface dataset:
Abstract 16693: Trends in the Use of Oral Anticoagulation for Nonvalvular Atrial Fibrillation Vary by Specialty: Real World Results From a Large Integrated Health Care System 2011-2022
Authors: Stephen J Voyce, Stacey Grassi, Joseph Chronowski, Erin Van Enkevort
Journal: Circulation (2023)

Introduction: Direct Oral anticoagulants (DOACs) have demonstrated superiority or non inferiority to vitamin K antagonists (VKAs) for stroke/embolic prevention in patients with nonvalvular atrial fibrillation (NVAF). However, clinical inertia may delay widespread adoption of newer therapies in medicine. Hypothesis: We evaluated whether uptake of DOACs into clinical medicine varied by physician specialty. Methods: We performed a retrospective review of patients with NVAF within the Geisinger Health System from 2011-2022. Longitudinal yearly trends for new/initial prescriptions (Rx) of DOAC vs VKA by cardiology or primary care (PCP) specialties Results: We identified patients with NVAF initiated on an oral anticoagulant from the years 2011 through 2023. Figures 1 and 2 demonstrate a statistically significant linear yearly increase in new Rx for DOACs for both cardiology and PCP specialties.By 2022, DOACs currently account for 96% of all new oral anticoagulant Rx by cardiologists and 90% of Rx by PCP. New Rx for DOAC by PCP lagged cardiology at all time points. Cardiology initial Rx &gt;50% DOAC by 2015 while PCP did not achieve this mark until 2018. Conclusions: In this real-world setting, we observed a significant increase in DOAC use as the initial prescription for patients with NVAF by both cardiology and primary care specialties.Significant difference in the adoption of DOAC was noted between cardiology and primary care specialties.Primary care use of DOAC as first Rx for NVAF increased over time but lagged cardiology by 2-3 years.
Abstract 15825: County-Level Factors Explaining the Reversal of the Hispanic Mortality Paradox
Authors: Bongeka Z Zuma, Zahra Azizi, Ashish Sarraju, Summer Ngo, David Scheinker, Fatima Rodriguez
Journal: Circulation (2023)

Introduction: The Hispanic population in the United States (US) has lower-than-expected mortality rates when compared with the non-Hispanic White population; this is known as the “Hispanic Paradox.” After the coronavirus 2019 pandemic, many US counties had an unprecedented reversal in this Hispanic mortality advantage. Methods: With age-adjusted mortality rates (AAMRs) and county health rankings, we used univariable and multivariable linear regressions to measure the association between the decrease in Hispanic mortality advantage (between 2019 and 2020) and county-level factors, including demographic, socioeconomic, cardiovascular disease (CVD) risk, healthcare, and structural factors. Results: Five hundred sixteen counties had reliable all-cause mortality rates and 201 had reliable CVD-specific mortality rates for the Hispanic population. 76% of studied counties had a decrease in the Hispanic mortality advantage for all-cause deaths; the mean differences in AAMRs between non-Hispanic White and Hispanic populations were 236.7 (95% CI 219.4; 253.9) in 2019 and 89.0 (95% CI 68.3; 109.7) in 2020. 58% of studied counties had a decrease in the Hispanic mortality advantage for CVD-specific deaths; the mean differences in CVD-specific AAMRs between non-Hispanic White and Hispanic populations were 63.7 (95% CI 56.1; 71.3) in 2019 and 40.5 (95% CI 32.4; 48.6) in 2020. In adjusted analyses, all factors explained 34% of the all-cause and 33% of the CVD-specific variation in Hispanic mortality advantage. Demographic factors explained the greatest variation for both; followed by structural factors (16%) for all-cause, and CVD risk factors (7.4%) for the CVD-specific Hispanic mortality advantage ( Table ). Conclusions: Demographic factors played an important role in explaining the recent decline in the Hispanic mortality advantage for all-cause and CVD-specific deaths. Further research is needed to analyze which factors may contribute to reduced disparities.
Abstract 15076: Long-Term Recurrence Free Survival in Second Generation Cryoballoon Ablation for Persistent Atrial Fibrillation: It’s All About the Autonomic Nervous System
Authors: Denise Guckel, Mustapha El Hamriti, Thomas Fink, Vanessa Sciacca, Guram Imnadze, Martin Braun, Moneeb Khalaph, Khuraman Isgandarova, Philipp Sommer, Christian Sohns, Georg Nölker
Journal: Circulation (2023)

Introduction: Cryoballon (CB)-guided pulmonary vein isolation (PVI) is an accepted treatment option for atrial fibrillation (AF). The cardiac autonomic nervous system (ANS) plays a crucial role in the regulation of AF. Hypothesis: ANS modulation has an impact on patients’ AF free survival following CB-ablation. The aim of this observational clinical trial was to analyze the impact of vagal reactions (VRs), as a surrogate parameter for ANS modulation, on the long-term outcome of CB-ablation in patients with persistent AF (PERS AF). Methods: Data from consecutive PERS AF patients treated with a CB-guided PVI for symptomatic drug refractory AF between 2013-2023 were analyzed. VRs were defined as bradycardia &lt; 40 beats/min, asystole or higher-degree atrioventricular block. All patients were continuously followed up in our outpatient clinic. AF-recurrence was defined as AF lasting &gt; 30 seconds beyond a 3-month blanking period. Results: A total of 250 consecutive patients (mean age 63.9 ± 10.0 years, 70% male) were included. VRs were recorded in 61 patients (24%). The mean follow-up duration amounted to 84±14 months. Within this observation period 101 patients (40%) developed AF recurrence a mean of 1.75 ± 0.80 times. Re-ablation procedures were performed in 61 patients (60%) a mean of 1.28 ± 0.55 times. Reconnected PVs were documented in 41 cases (67%). An additional substrate modification was performed in 34 procedures (42%). Patients with procedure associated VRs presented with a significantly higher estimated AF-free survival rate compared to those without (log-rank p-value=0.016) (Figure1). Multivariate analyses revealed the days to first AF recurrence following primary CB-ablation as an independent predictor for AF-free survival (CI 0.841-0.928, HR, 0.883, p&lt;0.01). Conclusions: CB-ablation procedure associated VRs seem to be associated with a favorable long-term outcome in PERS AF. Thus, our findings may influence future CB-ablation strategies.
Abstract 16438: Effect of Enzyme Replacement Therapy on Diastolic Function in Patients With Fabry Disease
Authors: Minjeong Kim, Jiwon Seo, Iksung Cho, Jong-Won Ha, Chi Young Y Shim, Geu-Ru Hong
Journal: Circulation (2023)

Introduction: The effects of ERT (enzyme replacement therapy) on cardiac manifestations in patients with Fabry disease (FD) are ambiguous. We aimed to investigate the response to ERT using diastolic stress echocardiography (DSE). Hypothesis: Diastolic function of FD would be improved after ERT. Methods: 19 patients with FD who underwent ERT were analyzed. All patients had DSE prior to ERT and post ERT at 1 year follow-up. We measured early diastolic (e’) velocity of the mitral annulus at baseline, 25 Watt (W) and peak exercise. The difference of diastolic reserve (ΔDR) between pre and post ERT was calculated. Diastolic reserve is defined as the change of e’ from baseline to 25W or peak of exercise in DSE. Results: Overall diastolic reserve tends to be improved (ΔDR25W: 0.66±1.36, ΔDRpeak 1.47±2.61) after 1 year of the ERT. However, there was no significant change in left ventricular (LV) wall thickness and LV mass index before and after the ERT. When patients were classified into two groups according to ΔDRpeak (Group 1, n=6, ΔDRpeak ≤0; Group 2, n=13, ΔDRpeak &gt;0), group 2 showed more higher pre-ERT MWE (93.6±3.2 vs 84.8±5.0, p&lt;0.01). The pre-ERT longitudinal strain of LV was better in group 2 compared to group 1 (-14.6±2.6 vs -9.9±2.3m p&lt;0.01). LAVI (44.0±12.9 vs 25.5±8.0, p&lt;0.01), LVEDD (50.8±2.8 vs 46.5 ± 3.0, p&lt;0.01) and LV mass index (204.5±57.5 vs 130.4±45.6, p=0.01) of pre ERT were higher in group 1. Conclusions: Diastolic function of FD was improved generally after ERT in FD patients FD patients who have relatively preserved chamber size and mechanical function before starting ERT showed a better response to ERT. In determining the ERT effect, evaluation of diastolic function is more useful than structural evaluation in patients with Fabry cardiomyopathy.
Abstract 16789: Modeling the Optimal Strategy of Natriuretic Peptide Testing for Heart Failure Prevention in Diabetes: A Pooled Cohort Analysis
Authors: Kershaw Patel, Matthew W Segar, David Klonoff, Carolyn S Lam, Subodh Verma, Andrew P Defilippis, Khurram Nasir, Javed Butler, Muthiah Vaduganathan, Ambarish Pandey
Journal: Circulation (2023)

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with heart failure (HF) risk and measurement is recommended in diabetes. Incorporation of NT-proBNP with WATCH-DM, a HF risk score validated in diabetes, improved HF risk prediction in low-risk individuals (score &lt;13). Whether WATCH-DM can improve the yield of NT-proBNP testing and inform allocation of SGLT2 inhibitors is unknown. Methods: Adults with diabetes and free of HF at baseline from ARIC, CHS, CRIC, DHS, FOS, and MESA cohorts were included. Participants without cardiovascular disease (CVD) were stratified into high- vs. low-risk categories based on 4 approaches: 1) WATCH-DM (score ≥ vs. &lt;13); 2) NT-proBNP (≥ vs. &lt;125 pg/mL); 3) WATCH-DM plus NT-proBNP (both high vs. not); 4) WATCH-DM-based NT-proBNP (if score &lt;13, measure NT-proBNP) (either high vs. not). Five-year cumulative incidence rates of HF, number needed to treat (NNT 5 ) and number needed to screen (NNS 5 ) were estimated based on pooled treatment effects of SGLT2 inhibitors. Results: The study included 6,410 participants (47.5% women, 35.1% Black, 20.5% with CVD) with 428 (6.7%) incident HF events over 5-year follow-up. The 5-year risk of HF was 12.3% among participants with CVD and comparable to those without CVD identified as high-risk based on all 4 approaches ( Figure ). Among participants without CVD, WATCH-DM-based NT-proBNP identified 46% of participants as high-risk and accounted for 80% of HF events. The NNT 5 with an SGLT2 inhibitor to prevent 1 HF event in participants with CVD was 25 and similar to the primary prevention population identified as high-risk ( Figure ). The NNS 5 was lowest in the WATCH-DM-based NT-proBNP strategy ( Figure ). Conclusions: Selective NT-proBNP assessment based on a validated clinical risk score for HF improved the yield of testing and may represent an efficient approach to risk stratification and allocation of therapies among individuals with diabetes.
Abstract 16779: Tirzepatide Reduces High-Sensitivity C-reactive Protein in Patients With Type 2 Diabetes and High Cardiovascular Risk: A Post Hoc Analysis of the SURPASS-4 Trial
Authors: Deepak L Bhatt, Jonathan M Wilson, Russell J Wiese, Zhengyu Yang, Kevin L Duffin, Imre Pavo
Journal: Circulation (2023)

Background: People with type 2 diabetes (T2D) who have elevated levels of high-sensitivity C-reactive protein (hsCRP) face a greater risk of myocardial infarction and coronary death. Early data for tirzepatide (TZP), a GIP/GLP-1 receptor agonist, suggest a hsCRP lowering effect. Here, we compare the effect of TZP and insulin glargine (iGlar) on hsCRP in patients with T2D and established or high risk for cardiovascular (CV) disease. Methods: hsCRP concentration was quantified by immunoassay (Roche, Indianapolis, IN) with lower limits of detection at concentrations of 0.15 mg/L. Plasma was collected from 1995 fasted participants at baseline (329, 328, 338, and 1000 on 5, 10, 15 mg TZP and on iGlar, respectively) and 52 weeks in SURPASS-4. The % changes of hsCRP from baseline were estimated by mixed model with repeated measures. The shifts in hsCRP risk categories (hsCRP &gt;3 mg/L or 1-3 mg/L versus &lt;1 mg/L) from baseline to 52 weeks are reported. The linear relationship between % change from baseline of hsCRP and change in body mass index (BMI) was analyzed using Pearson correlation coefficient. Results: Baseline hsCRP (mean ± SD, 5.6 ± 12.5 mg/L) was elevated in this study population. Among the participants, 48%, 36%, and 16% were in the &gt;3, 1-3 and &lt;1 mg/L hsCRP categories, respectively. Participants in the elevated hsCRP categories had higher body weight and BMI at baseline. After 52 weeks of treatment, the 5, 10, 15 mg TZP and iGlar groups resulted in -38.0%, -44.2%, -47.8%, and 0.6% changes in the concentration of hsCRP, respectively. More TZP-treated patients improved their hsCRP categories when compared with iGlar-treated participants (Table). The reduction in hsCRP in the pooled TZP groups correlated with the reduction of BMI (r=0.07, p=0.049). Conclusions: Tirzepatide treatment significantly lowers hsCRP in patients with T2D and increased CV risk versus baseline and iGlar. Substantially more participants shift to a lower hsCRP category when compared with insulin glargine.
Abstract 14837: Increase in Left Atrial Pressure After Cryoballoon Ablation Indicates Worse Atrial Function: Evidence From APPEARANCE-AF Trial
Authors: Zhongyuan Ren, Shubin wu, Jiayu Wu, Yuan Zhong, Jun Xu, Hui Sun, Dongdong Zhao, Yawei Xu
Journal: Circulation (2023)

Introduction: Left atrial pressure (LAP) is a direct reflection of left atrial function, while LAP could fluctuate following left atrial procedure. The pattern of LAP change in response to pulmonary vein isolation (PVI) and its significance remain to be explored. Hypothesis: The change of LAP before and after PVI could indicate atrial function and predict adverse events. Methods: 28 patients from APPEARANCE-AF trial underwent PVI using cryoballoon ablation were included. Pre-ablation and post-ablation LAP were directly measured via catheter. The correlation of LAP change with demographics, biochemical measurements, and speckle traced echocardiographic indexes of left atrium (LA) were investigated. Results: The included cohort has a mean age of 73.8±8.4 years old, with 12 male (42.9%). Instant PVI was achieved in all patients without complications. The average mean LAP (mLAP) measured before and after PVI was 8.2±4.5 mmHg (pre mLAP) and 14.0±6.5 mmHg (post mLAP), with a significant increment (ΔmLAP: 5.8±4.5 mmHg, P&lt;0.001). In the evaluation of the association of LAP with LA function, the change in LAP significantly correlated with LA strain rate in reservoir (LASr, r=-0.58, P=0.001) and conduit phase (LAScd, r=0.63, P&lt;0.001) and LA ejection fraction (r=-0.48, P=0.014). Furthermore, we divided the cohort into group with significant increment of LAP (inc-mLAP, increment of mLAP &gt; 5 mmHg, n=14) and group with non-significant increment of LAP (ninc-mLAP, mLAP ≤ 5 mmHg, n=14). Correspondingly, patients with larger LAP increment presented significant worse atrial function indicated by LASr (17.3%±5.6% ninc-mLAP vs 11.5%±7.3% inc-mLAP, P=0.030), LAScd (-9.6%±2.2% ninc-mLAP vs -5.7%±3.6% inc-mLAP, P=0.003). Conclusions: PVI could significantly increase LAP, and a higher change of LAP could indicate worse atrial function. Measuring the change of LAP might be valuable in predicting the prognosis of PVI.
Abstract 13379: Guideline Directed Medical Therapy Treatment Patterns and Outcomes in Cardiac Sarcoidosis Patients With Systolic Heart Failure
Authors: Daniel Sykora, Mohamed Elwazir, Katie Young, Nikhil Kolluri, Omar F Abou-Ezzeddine, John Bois, John Giudicessi, Leslie T Cooper, Andrew Rosenbaum
Journal: Circulation (2023)

Introduction: Cardiac sarcoidosis (CS) results in HFrEF, but its natural history and response to GDMT remains uncertain. Methods: We queried a registry of 631 CS patients evaluated at our institution to identify those with LVEF &lt; 35% on TTE within 30 d of diagnosis and a follow-up TTE 12-18 months later (external CS diagnoses were excluded). Demographics, LVEF, NT-proBNP, GDMT, immunosuppression, CIED, and outcomes (hyperkalemia, LVAD/transplant, CV hospitalization, death) were recorded. Results: Overall, 25/631 (4%) of CS patients had an LVEF &lt;35% at initial presentation (36% female, 84% white; median age of 58 y; probable/not biopsy-proven CS in 52%). Mean baseline LVEF was 27% (σ=7%), NT-proBNP 1736 pg/mL (n=11), potassium 4.3 mEq/L (n=18), and median NYHA Class II (54%). Patients were on a mean 1.7 GDMT agents at CS diagnosis (Figure). Most were treated with immunosuppression (88%) for mean 0.75 y, usually prednisone (88%, mean 16 mg daily) and fewer with mycophenolate (32%, mean 1875 mg daily), methotrexate (28%, mean 18mg weekly), or TNF-α inhibitor (4%). 64% were on trimethoprim-sulfamethoxazole prophylaxis. At follow-up (median 317 d), 3 patients (12%) required LVAD and 1 (4%) required heart transplant. Mean LVEF improved to 37% (excluding LVAD/transplant, σ=11%, p=0.001). CIED prevalence increased from 48 to 81% (p=0.03). Overall GDMT did not change (mean 2.0 agents, p=0.2) and only beta-blocker dose changed (64 to 138 mg mean daily metoprolol equivalents). Potassium did not change (p=0.4) and hyperkalemic events were infrequent (16%). No patients died, but unplanned hospitalization occurred in 36% of patients. Conclusions: CS patients with HFrEF are usually on partial GDMT at diagnosis, presumably due to earlier recognition of HFrEF, but intensification of GDMT may be limited. Despite improved LVEF which may be due to GDMT, immunosuppression, and/or CIED, over 1/3 patients were hospitalized within 18 mo, highlighting the high-risk profile of HFrEF in CS.
Abstract 12752: Comparing Informatics Methods to Identify Guideline Directed Therapy From the Electronic Health Record
Authors: Jennifer H Garvin, Morgan Mirman, Patricia Blake, Eryn Bryant, Linda Dodge, Donald Logan, Youngjun Kim, Elizabeth Curtis, Anthony Mascarello, Nadezhda Myers
Journal: Circulation (2023)

Introduction: AHA Get with The Guidelines (GWTG) is a proven in-hospital approach to improving patient outcomes. The Heart Failure (HF) quality measures for quadruple therapy includes angiotensin receptor/neprilysin inhibitors, beta blockers, aldosterone receptor antagonists, and sodium-glucose transport inhibitors, device counseling, vaccination status assessment, and follow up. Capturing guideline directed therapy (GDT) retrospectively can be done in several ways including the current process of manual review of electronic records, abstraction, and submission to the HF Registry. A SmartPhrase can contribute to adherence of GDT at discharge more efficiently. Research Question: Our research question was, “Can the use of a SmartPhrase improve adherence to AHA HF guidelines?” Goal: To prompt clinicians to address GDT to meet the quality metrics endorsed by the AHA by providing a template for documentation of these therapies in the discharge summary or progress note. Methods: We compared our adherence to the GWTG-HF quality measures prior to after implementing a standard HF DC Checklist SmartPhrase. We evaluated whether the improvement was associated with the SmartPhrase. A Health Information student undertook a project with her preceptor, a Quality Data Manager to analyze SmartPhrase use by providers. Results: We found significant improvement in most GWTG-HF quality measures, including GDT quadruple therapy post-sharing this SmartPhrase. Downstream potential benefits to improved adherence to these HF GDT metrics are improvement in 30-day readmissions. Positive trends in the GWTG-HF quality metrics included an overall improvement from Q1 2022 baseline data for quadruple GDT therapy of 37.2% to Q1 2023 of 80.4%. Conclusions: The adoption of the SmartPhrase improved adherence to the quality metrics. Use of the SmartPhrase varied by provider. Providers used the dot phrase as it was given to them by the team or by copying and pasting the phrase. The use of copy and paste made tracking the use of the SmartPhrase difficult to track electronically. We are exploring additional methods to improve efficient documentation including natural language (NLP).
Abstract 14175: Risk of Cardiovascular Disease in Women Who Underwent Salpingo-Oophorectomy to Prevent Hereditary Breast Ovarian Cancer: A Systematic Review and Meta-Analysis
Authors: Francisco Cezar A de Moraes, Maria Eduarda Cavalcanti Souza, Lucca Dal moro, Anna Rodrigues, Isabelle Batista Donadon, Barbara Ferraz Barbosa, Eric Pasqualotto, Dilma do Socorro Moraes de Souza, Danielle Feio, Carlos Stecca
Journal: Circulation (2023)

Introduction: Hereditary breast and ovarian cancer (HBOC) syndrome is defined by family history and identification of germline pathogenic variants (PVs). In particular, the mutations in BRCA1/2 (BRCAm) increased approximately 44% and 17% risk of ovarian cancer or fallopian tube cancer and 72% and 69% risk of breast cancer. Risk-reducing salpingo-oophorectomy (RRSO), the physiologic removal of the ovaries and fallopian tubes, effectively reduces the risk of ovarian cancer by 80-95% in women with HBOC. Hypothesis: Is performing a RRSO in women with HBOC or BRCAm associated with the development of cardiac and metabolic diseases? Aims: To assess the risk of myocardial infarction (MI)/coronary artery disease (CAD), hypertension, diabetes mellitus (DM), and hypercholesterolemia/dyslipidemia among women with HBOC or BRCA1/2 mutation after performing RRSO. Methods: We searched in PubMed, Scopus, and Web of Science databases for studies that assessed cardiovascular and metabolic events following RRSO in women with HBOC or BRCAm. Statistical analysis was performed using RStudio v4.4.2 using the DerSimonian and Laird random-effects model. Heterogeneity was examined using the Cochran Q test and I 2 statistics. Significance for heterogeneity was set at a p-value&lt;0.01. Results: Five studies were included with a total of 1320 patients. Among them, 956/1320 (72.4%) had BRCAm: 469 (35.5%) had BRCA1 and 400 (30.3%) had BRCA2. The majority of patients (928;69.3%) had RRSO&lt;50 years, and the mean age of the study sample was 54.3 years (41.45-57, 2.35). The incidence of MI events was reported in 18/1126 patients (1.4%, 95% Cl, 5-2.3%; I 2 =40.15%). Most common metabolic comorbidities were hypercholesterolemia. Observed in 170/994 women (19.6%, 95% Cl, 4.6-34.6%; I 2 =97.88%), hypertension, in 125/994 women (12.9%, 95% Cl, 4-21.8%; I 2 =96.93%), and DM, reported in 46/1320 patients (3%, 95% Cl, 1.2-4.7%; I 2 =75.41%). Conclusions: This meta-analysis provides evidence to support that patients with HBOC or BRCAm who undergo RRSO have an increased risk of developing heart and metabolic diseases. Larger studies with longer follow-up are required to further explore these associations.