tbuckley/cabot-search huggingface dataset:
Abstract P2090: Comparison of Medicare Claims Recorded and Surveillance Identified Myocardial Infarction in the Strong Heart Study
Authors: Heather Willmott, Jessica Reese, Jean Leidner, Amanda Fretts, Tauqeer Ali, Jason Umans, Shelley Cole, Richard Devereux, Ying Zhang
Journal: Circulation (2025)

Introduction: The Strong Heart Study (SHS) is a cohort study of cardiovascular disease (CVD) in American Indians. Center for Medicare and Medicaid Service (CMS) data may improve CVD outcome capture. Hypothesis: Participants with myocardial infarction (MI) events captured in CMS will align with those identified in SHS morbidity and mortality (M&amp;M) surveillance. Methods: CMS data were available from 2010-2021 for 2,144 SHS participants. A CMS-identified MI event was defined as meeting the Chronic Conditions Data Warehouse (CCW) claims criteria (at least one inpatient claim with an MI ICD-9 or ICD-10 diagnosis code in first or second position) during this timeframe. SHS MI and coronary heart disease (CHD) events were identified by medical chart review, adjudicated by physicians, and classified as definite, possible, or probable (MI only). We defined SHS-identified MI as having a fatal or non-fatal definite MI event during 2010-2021. A summary table compared participants with SHS-identified and CMS-identified MI. Cohen’s kappa coefficient, sensitivity, specificity, and positive predictive value (calculated using SHS as the gold standard) assessed diagnosis agreement. Results: We identified 206 participants with SHS-identified MI and 198 participants with CMS-identified MI. There was moderate agreement between SHS-identified and CMS-identified MI (kappa=0.601, 95% CI: 0.542, 0.660). About 63% of those with SHS-identified MI had a CMS-identified MI and 65% of those with CMS-identified MI had an SHS-identified MI. Among the 69 participants with only an SHS-identified MI, 40.3% had an outpatient MI code or an inpatient MI code in the third position or lower in CMS data. SHS M&amp;M detected possible MI, probable MI, or any type of CHD event, excluding definite MI, in 39.1% of the 77 participants with only a CMS-identified MI. Conclusions: Moderate agreement was observed between SHS definite MI and CMS MI events. CMS data may complement the identification of MI events in M&amp;M surveillance of prospective cohort studies such as the SHS.
Abstract P1095: Hair Cortisol Concentration, Perceived Stress, and Physical Activity Among Patients with Heart Failure
Authors: Lauren Pageau, Dola Pathak, Milind Karve, Darby Pickford, Pallav Deka
Journal: Circulation (2025)

Introduction: Patients with heart failure (HF) often experience chronic stress arising from symptom burden and distress about the future. Chronic stress can be measured subjectively through questionnaires and objectively through biomarkers such as hair cortisol concentration (HCC). Cortisol, a catabolic hormone associated with skeletal muscle loss, may be associated with a decrease in physical activity (PA) tolerance. The interplay between chronic stress and PA may vary across different HF etiologies, including heart failure with reduced and preserved ejection fraction (HFpEF and HFrEF), and combined HF, due to differing underlying contributing factors. Therefore, this study aimed to examine the associations between perceived stress, HCC, and PA among patients with different HF etiologies. Methods: In this cross-sectional study, perceived stress was measured using The Perceived Stress Scale (PSS-10). HCC (pg/mg) was derived from cortisol collected from hair samples (3cm long, 20mg in weight) and analyzed using enzyme immunoassay. The International Physical Activity Questionnaire Short form (s-IPAQ) was used to measure PA. Results: The sample included 28 patients with HFrEF (mean EF: 41 ± 9%), 7 patients with HFpEF (mean EF: 54 ± 6%), and 11 patients with combined HF (mean EF: 43 ± 8%). Overall, participants were 71.8 + 11.2 years old, 44% female, 87% White, 4% Black, and 9% Hispanic. HCC was not significantly associated with perceived stress in any group. However, HCC was strongly and positively associated with PA among patients with HFpEF ( r = 0.91, p &lt; 0.005), but not among patients with HFrEF ( r = -0.09, p = 0.64) or combined HF ( r = 0.26, p = 0.44). Conclusions: The absence of correlation between perceived stress and HCC suggests a potential dissociation between psychological and physiological stress in HF patients which could be due to a blunted stress response in chronic illness or to use of adaptive coping. Despite a small sample, PA was significantly and positively associated with HCC among patients with HFpEF, which was unexpected. PA in HFpEF patients may serve as a physiological stressor that increases cortisol production to help regulate metabolism. Because HFpEF is often associated with chronic inflammation, metabolic syndrome, and other morbidities, physical exertion may also augment the stress response. Further research examining the association between chronic stress and PA with larger samples and objectively measured PA measures is needed.
Abstract P2069: Racial Differences in the Impact of Elevated Systolic Blood Pressure on Incident Cognitive Impairment (ICI) Risk: The REGARDS Study
Authors: Elizabeth Pendlebury, Katherine Wilkinson, George Howard, Virginia Howard, Suzanne Judd, Russell P. Sawyer, Laura Raffield, Nels Olson
Journal: Circulation (2025)

Introduction: The number of adults living with Alzheimer’s Disease and Related Dementias (ADRD) is projected to double by 2050. Black Americans have one of the highest rates of hypertension of any racial/ethnic group in the world, which is a known risk factor for cognitive impairment. Hypothesis: Elevated systolic blood pressure (SBP) is a more potent risk factor for Incident Cognitive Impairment (ICI) in self-identified Black than White adults. Methods: REGARDS is a bi-racial cohort study initiated in 2003. 30,239 Black and White participants were enrolled from the contiguous US with oversampling in the “Stroke Belt”, a group of southeastern states known for higher rates of stroke. The present study included 14,938 REGARDS participants without cognitive impairment or stroke at baseline. ICI was evaluated during follow-up using both an Enhanced Cognitive Battery (ECB) consisting of four modified instruments adapted from the MoCA and CERAD, and a Six Item Screener (SIS) consisting of 3 temporal orientation questions and 3 delayed recall items. Participants were considered impaired if they scored ≥1.5 SD below their expected score for their age/sex group for at least 3 of the four ECB tests, or scored &lt;4 once and &lt;5 twice on the SIS. SBP was assessed at baseline and modeled as a per 10 mmHg increase. Cox proportional hazards models were used to assess associations between ICI and increases in SBP. Model 1 adjusted for age, sex, region, and antihypertensive medication use. Model 2 included Model 1 plus diabetes, history of cardiovascular disease, dyslipidemia, BMI, smoking status, alcohol use, income, and education. We tested for a race-by-SBP interaction term (p interaction &lt;0.10) and presented race-stratified results based on the a priori hypothesis. Results: There were 1263 ICI cases over an average follow-up time of 12.0 years (778 in White and 485 in Black participants). In Model 1, the hazard ratio (HR) for ICI per 10 mmHg higher SBP was 1.09 (95% confidence interval (CI): 1.03, 1.22). There was no significant difference in the association of SBP between Black and White adults (race-by-SBP interaction p-value= 0.21). The HR for ICI per 10 mmHg higher SBP was 1.12 (95% CI: 1.06,1.30) for Black adults and 1.07 (95% CI: 1.04, 1.19) for White adults (Model 1). Results were similar in Model 2. Conclusions: Higher SBP was associated with an increased risk of ICI. This association did not differ by race.
Abstract P1097: Geographic Variation of Healthcare Expenditures Among U.S. Adults with Heart Failure, 2012-2022
Authors: Brian Witrick, Megan Mayfield, Timothy Dotson
Journal: Circulation (2025)

Introduction: Heart failure is a public health burden that currently affects over 6 million individuals in the United States and is estimated to continue to increase over the coming decade. Despite improvements in clinical outcomes, heart failure is associated with increased morbidity and mortality that place a significant financial strain on individuals and the healthcare system. However, little is known about the geographic variation in healthcare expenditures for heart failure. Methods: Data from the Medical Expenditure Panel Survey (MEPS) from 2012-2022 were used to estimate the national and regional (Northeast, Midwest, South, West) heart failure-attributable healthcare expenditures. A two-part model, adjusted for demographics, comorbidities, and time, was applied to estimate the total healthcare expenditures for individuals with heart failure, as well as service-specific expenditures, including inpatient stays, outpatient care, emergency room visits, physician office visits, home care visits, and prescription medication. Results: In the final sample, 1,180 adults (0.80%) were identified as having heart failure. After adjusting for demographics and clinical comorbidities, the estimated incremental cost of heart failure in adults was $7,586 ± 1571 per person. There was significant regional variation in total heart failure-related expenditures: the Midwest exhibited the highest total incremental costs at $10,309 ± 2,974, followed by the Northeast ($7,303 ± 1,530), the South ($6,467 ± 18.92), and the West ($6,371 ± 3,388), which had the lowest expenditures. Similar differences in incremental costs by geographic regions throughout the nation were exhibited in service-specific expenditures. Conclusion: Heart failure related healthcare expenditures varied throughout the nation, with the Midwest region experiencing higher expenditures. This variation highlights the need for target interventions in these specific states. Understanding the geographic differences in overall and service-specific expenditures will have important implications for resource allocation and healthcare policy, with the ultimate goal of reducing the financial burden on affected individuals.
Abstract P3164: Impact of Neighborhood Disadvantage on Neuroimaging and Plasma Biomarkers associated with Alzheimer’s Disease and Related Dementias
Authors: Sudarshan Krishnamurthy, Lingyi Lu, Marc Rudolph, Samuel Lockhart, XIAOYAN LENG, Sarah Gaussoin, Allison Caban-Holt, Goldie Byrd, Melissa Rundle, Laura Baker, Suzanne Craft, James Bateman, Timothy Hughes
Journal: Circulation (2025)

Introduction: Stark disparities exist in the prevalence of Alzheimer’s disease (AD) and related dementias (ADRD) by social determinants of health (SDoH). Limited research is available on associations of SDoH with AD/ADRD biomarkers. This study aims to assess the impact of SDoH measures on ADRD-associated neuroimaging and plasma biomarkers. Hypothesis: SDoH measures of area deprivation index (ADI), social vulnerability index (SVI), and environmental justice index (EJI) will be positively associated with poorer ADRD-associated neuroimaging and plasma biomarkers, and cardiometabolic health will partially account for this association. Methods: This study includes participant data from the Wake Forest Alzheimer’s Disease Research Center from baseline visits. Independent SDoH variables include ADI, SVI, and EJI. Dependent variables include cortical thickness and white matter hyperintensity (WMH) volume, adjusted for intracranial volume, from MRI, and plasma glial fibrillary acidic protein (GFAP) and pTau-181. We conducted bivariate and hierarchical multivariable linear regressions, with demographics (age, sex, education,&amp;cognitive diagnosis) [Model 1], additional adjustment for cardiometabolic health with cardiometabolic index (CMI) [Model 2], and estimated glomerular filtration rate (eGFR) [Model 3; for plasma biomarkers] as covariates. Results: In bivariate analyses, a significant negative association was observed between ADI and cortical thickness (β=-0.08, p=0.047). No other significant associations were observed. In multivariable analyses (Table 1) , EJI was negatively associated with cortical thickness (β=-0.04, p=0.04), and both ADI and SVI were negatively associated with GFAP (β=-0.36, p&lt;0.01&amp;β=-0.52, p&lt;0.01, respectively), in Model 1. Additionally adjusting for CMI in Model 2, the negative associations of ADI and SVI with GFAP were preserved (β=-0.33, p=0.02&amp;β=-0.50, p&lt;0.01, respectively). In Model 3, further adjusting for eGFR, ADI remained negatively associated with GFAP (β=-0.37, p=0.03). Conclusions: Place-based environmental injustice was associated with lower cortical thickness, while neighborhood disadvantage and social vulnerability were associated with higher GFAP levels in adjusted models, suggesting place-based SDoH may be associated with structural brain changes and neuroinflammation. The impact of place-based SDoH needs to be further studied in association with ADRD biomarkers to better understand how we may tackle SDoH among older adults.
Abstract P1145: Feasibility of a Culturally-tailored Diet and Physical Activity Intervention for Zimbabwean Immigrants in the US
Authors: Clara Gona, Kenya Palmer Emrich, Olivia Thomas, Rosalia Gotora, Philimon Gona
Journal: Circulation (2025)

Background: CVD risk factors are a significant health concern among African immigrants in the US. Zimbabwean immigrants in the US have high rates of hypertension, obesity, hyperlipidemia, and diabetes. Culturally tailored interventions are effective in reducing CVD risk in African Americans but given the unique cultural differences between African immigrants and other African Americans, r interventions tailored specifically for African immigrants are needed. Objective: We assessed the feasibility of a culturally targeted lifestyle intervention (LIFESTYLE) for Zimbabwean immigrants in the US. LIFESTYLE is based on CDC dietary and physical activity guidelines for Americans, customized with input from a community advisory board comprised of members from the same community, a nutritionist, and an exercise scientist to include foods and physical activities preferred by the Zimbabwe immigrants. Methods: A 12-week community-based intervention study was conducted in the New England region. LIFESTYLE utilized a pre&amp;post-intervention design, followed by focus group interviews. Feasibility was assessed by the ability to recruit and retain participants, their engagement in prescribed intervention activities, and their feedback in post-intervention focus group interviews. Day 1 activities included consent, demonstration of recommended food portions, physical activity, educational modules on nutrition and physical activity and completion of research questionnaires. A research coordinator conducted weekly check-ins. Weight, waist-circumference, BP, HbA1C, and physical activity were recorded. Focus group interviews were conducted on the last day of the study. Results: Of the 35 participants who initially agreed to participate, 25(71%) came. Of these, 23(92%) enrolled, 1 dropped out at week 2 and another at week 11. Overall, 21(91%) completed the study. Findings from post-intervention focus group interviews include: portion control was manageable; check-in reminders were helpful; activities enhanced family time; the food questionnaire was cumbersome; and achieving 150 minutes weekly of physical activity was challenging. Conclusion: LIFESTYLE intervention for Zimbabwean immigrants was feasible as indicated by high participation and adherence to the intervention. Areas of improvement identified include recruitment as nearly 30% (10/35) who initially agreed to participate were no-shows; decreasing questionnaire burden, and enhancing support for engagement and adherence.
Abstract P3154: Out-Of-Hospital Pediatric Cardiac Arrest, Survival, And Associated Factors – A Systematic Review And Meta-Analysis
Authors: Minaz Mawani, Morgan Taylor, Ye Shen, Jessica Knight, Bryan McNally, Mark Ebell
Journal: Circulation (2025)

Introduction: Pediatric out-of-hospital cardiac arrest (OHCA) is associated with poor survival and neurological outcomes. Large variations in the incidence and survival have been reported across nations therefore, there is a need to systematically summarize the published data to report pooled survival and analyze the factors associated with survival. Methods: We conducted a comprehensive review of published literature using data from January 1, 2005, to June 30, 2023, including any observational or interventional study of OHCA in children that reported at least one survival outcome, confirmed to Utstein criteria for population selection and had a sample size of at least 50 patients. We separately looked at studies reporting all EMS (emergency medical service) assessed and treated OHCAs and those reporting only patients surviving to hospital admission following OHCA. We excluded studies focusing on specialized populations, duplicate data from the same registry, reporting combined data on in-hospital and out-of-hospital arrests or children and adults, and where data could not be separated. We used Der Simonian-Laird (DL) random-effects model to pool the results. Results: We included 34 studies with data from 69,834 pediatric OHCAs assimilating more than 20 years of global data. Pooled survival and neurological outcome for EMS-assessed and treated OHCAs were 13% (95% CI: 11% to 15%) and 6% (95% CI: 5% to 8%) respectively. For the admitted patients, survival rates were 46% (95% CI: 40% to 53%) and 28% (95% CI: 19% to 37%) respectively. Survival was highest for Europe, followed by North America, Asia and Australia. Predictors of improved survival included witnessed arrest, shockable rhythm, public location of arrest, bystander CPR, and age &gt; 1 year. Having a cardiac cause of arrest was associated with worse survival. High heterogeneity was observed for pooled survival and most of the predictors. The I 2 was reduced to 0% when reporting region-specific results. Conclusions: Survival for pediatric OHCA patients has improved over the years but remains low. Geographical disparities exist owing to differences in pre-hospital care organization. The standardized Utstein criteria need to be widely implemented to improve the comparison of global estimates.
Abstract P3153: Oral Microbiome Diversity and Premature Mortality in US Adults: Findings From The National Health and Nutrition Examination Survey (NHANES) 2009-2012
Authors: Difei Liu, Jin Dai, Yoriko Heianza, Lu Qi
Journal: Circulation (2025)

Background and Aims: The oral microbiome, comprising over 700 bacterial species along with a variety of viruses and other microbial taxa, is colonized as early as the prenatal period and is continuously shaped by various factors throughout life. While its primary role in maintaining oral health is well-recognized, recent studies suggest that the oral microbiome may also play a significant role in affecting systemic health condition, whereas the evidence from human studies is still lacking. We aimed to investigate whether oral microbiome alpha diversity was significantly related to premature mortality among U.S. adults. Materials and Methods: This study utilized data from 7,956 participants in the 2009–2010 and 2011–2012 cycles of the National Health and Nutrition Examination Survey (NHANES). Oral microbiome alpha diversity metrics, including observed Amplicon Sequence Variants (ASVs), Faith’s Phylogenetic Diversity, the Shannon-Weiner Index, and the Simpson Index, were calculated using microbial sequences obtained from oral rinse samples. Premature mortality was defined as death occurring before the age of 80 and was ascertained through linkage with the National Death Index till December 31, 2019. Results: During an average follow-up period of 8.84 years (SD: 1.54 years), 436 premature deaths (5.48%) were recorded among the 7,956 participants. After adjusting for demographic factors, smoking, alcohol drinking, and extra dental cleansing, higher alpha diversity metrics were significantly associated with a reduced hazard of premature mortality. Specifically, for each standard deviation increase, the HR were 0.81 (95% CI: 0.71–0.93) for observed ASVs, 0.82 (95% CI: 0.71–0.94) for Faith’s Phylogenetic Diversity, 0.83 (95% CI: 0.73–0.96) for the Shannon-Weiner Index, and 0.82 (95% CI: 0.72–0.95) for the Simpson Index. Adjustments for dietary factors attenuated these associations to be null. Conclusion: Our findings suggest that alpha diversity of the oral microbiome may be not a strong risk factor of premature mortality independently of dietary factors among U.S. adults.
Abstract P3151: Association Between Life’s Essential 8 and Cardiovascular Disease by Depression Status
Authors: Kareem Khairy, James Wallace, Jee Won Park
Journal: Circulation (2025)

Cardiovascular health (CVH), as measured by the American Heart Association's Life’s Essential 8 (LE8) metrics, plays a vital role in determining cardiovascular disease (CVD) risk. Depression is also known to have adverse effects on CVD outcomes and may further complicate this relationship. Thus, this study assesses the relationship between LE8 and CVD overall, and by depression status. We hypothesize that higher LE8 scores are associated with lower odds of CVD, and that depression status may modify this relationship. This cross-sectional study employed secondary data analysis using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2018, with an analytic sample size of 14,848 participants (age ≥ 20 years). Multivariable logistic regression analyses, incorporating survey weights, for CVD outcome (i.e., stroke, heart attack, angina, coronary heart disease, heart failure) were performed as a function of LE8 scores (high/moderate/low CVH) while adjusting for potential confounders. We also assessed for effect measure modification (EMM) by depression status using the PHQ-9 scores by including product terms between LE8 scores and depression in the adjusted model. The adjusted odds ratios (OR) for CVD among participants with high and moderate compared to low LE8 scores were 0.38 (95% CI: 0.19-0.75) and 0.52 (95% CI: 0.42-0.63), respectively. EMM assessment by depression status indicated strong negative associations between higher LE8 scores and CVD in both groups. Specifically, the adjusted ORs were 0.42 (95% CI: 0.21-0.83) for those reporting no depression and 0.06 (95% CI: 0.01-0.60) for those with depression. We found a clear negative relationship between LE8 scores and CVD, with higher LE8 scores associated with lower odds of CVD compared to the lower LE8 scores group. This protective relationship was particularly profound among individuals with higher levels of depressive symptoms. These findings highlight the importance of promoting CVH to mitigate the adverse effects of depression on CVD outcomes. Additional prospective studies should be conducted to establish the temporality of these associations between LE8 scores and CVD outcomes among individuals with depression.