tbuckley/cabot-search huggingface dataset:
Abstract 4147547: Sex-Based Disparities in Paroxysmal Atrial Fibrillation Outcomes: An Analysis of the National Readmission Database
Authors: Lauren Klei, Anne Marie Arcidiacono, Vera Hapshy, James Arcidiacono, Steven Imburgio, Joseph Heaton, Mohammad Hossain, Swapnil Patel
Journal: Circulation (2024)

Background: Paroxysmal atrial fibrillation (PAF) is an intermittent irregular arrhythmia that terminates within seven days. Prior studies have shown that females with atrial fibrillation are at increased risk of mortality and readmissions compared to men. Given the dramatic rise in PAF diagnoses over the past several years, the impact of sex on clinical outcomes in this patient population requires further analysis. This study aims to investigate sex-based disparities in clinical outcomes over recent years for patients with PAF. Methods: In this large scale, retrospective cohort study, patients who were admitted with PAF were analyzed from 2016 to 2020 using the National Readmissions Database. The study population was divided into male and female groups. Diagnoses were classified according to the International Classification of Diseases Tenth (ICD-10) Revision codes. The primary outcome was 30-day readmissions. Secondary outcomes included inpatient mortality and length of stay. Results: During the study period, a total of 548,617 patients with PAF meeting inclusion criteria were admitted. Of this population, 55.3% were female (n = 303,412) and 44.7% (n =245,205) were male. The mean age was 73.7 ± 11.9 years for females and 65.7± 13.6 years for males. After adjusting for baseline characteristics, female sex was associated with a higher 30-day readmission rate (HR: 1.06, CI: 1.03-1.09, p &lt; 0.001). Multivariate regression analysis for inpatient mortality and length of stay was higher for females than males (p &lt; 0.01 for both). Conclusion: Female patients experienced worse overall outcomes compared to male patients with higher readmission rates, inpatient mortality, and longer length of stay. These data suggest that targeted intervention for females may be required to improve these outcomes.
Abstract 4147428: Breaking the Cycle: 'Snak-Chat' Intervention Transforms Heart Failure Management with MRA Optimization
Authors: Tina Marvasti, Kevin R Murray, Stella Kozusko, Margaret Brum, Natasha Verhoeff, Steve Fan, Gloria Ho, Heather Ross, Juan Duero Posada, Yas Moayedi
Journal: Circulation (2024)

Introduction: Heart failure (HF) remains an epidemic with high rates of hospitalization and mortality. Despite the proven efficacy of guideline directed medical therapy (GDMT), there is disparity between guidelines and real-world implementation. Of the pillars of GDMT, initiation and uptitration of mineralocorticoid antagonists (MRAs) pose challenges related to hyperkalemia. To address this, we developed an interdisciplinary intervention called "Snak-Chat" aimed at facilitating MRA optimization using a stepwise approach involving collaboration with a dietitian, and monitoring via our local remote patient monitoring application, Medly. This study aims to assess the rate of MRA optimization, incidences of hospitalization, and improvements in ejection fraction (EF). Hypothesis: The implementation of the Snak-Chat strategy will lead to a higher rate of MRA optimization, a reduction in hospitalization rates and improvements in ejection fraction (EF) among HF patients. Methods: This is a single center study of adult patients with HFrEF and history of hyperkalemia. Baseline potassium level, LVEF, and MRA dose were obtained. Patients were followed for one year, and MRA dose optimization, hyperkalemic incidents, HF-related hospitalization, and mortality were compared and matched to a standard-of-care (SoC) cohort followed on Medly. Time-to-event analyses were performed using Kaplan-Meier for mortality and Fine and Gray’s subdistribution methods for reaching MRA optimization and the incidents of hyperkalemia, and HF-related hospitalization. Between-group differences in mortality and cumulative incidence rates were evaluated using log-rank and Gray’s tests. Results: A total of 185 patients were included, with 51 in the intervention arm. Baseline potassium levels (5.1 vs. 4.2 mmol/L, p&lt;0.0001) and hyperkalemic events (68.8% vs. 10.5%, p&lt;0.0001) were significantly higher in the intervention group prior to enrollment. After a 12-month follow-up, there was a substantial increase in reaching MRA optimization (Figure 1A) with an associated improved LVEF (30.2% to 38.5%, p=0.0003) in the intervention group. There was a significantly lower rate of hospitalization in the intervention arm and no differences in the number of hyperkalemic or mortality events (Figure 1B-D). Conclusion: Our targeted interdisciplinary approach to MRA optimization led to near-complete optimization of MRA and improved EF, without an increase in hyperkalemic events and resulted in lower hospitalization.
Abstract 4147486: In-Hospital Outcomes in Patients with Takotsubo Cardiomyopathy and Malnutrition: Analysis from the National Inpatient Sample
Authors: Oghenetejiri Gbegbaje, FAVOUR NELSON, Chidubem Ezenna, Gabriel Alugba, Ovie Okorare, Haris Muhammad, Samantha Gallimore, Dipal Patel, Garly Saint Croix, Andrew Goldsweig
Journal: Circulation (2024)

Introduction: Takotsubo, or stress cardiomyopathy, can result in substantial morbidity and mortality. Malnutrition can affect the prognosis of hospitalized patients. Objective: To compare Takotsubo cardiomyopathy outcomes between patients with severe protein-calorie and mild-moderate malnutrition. Methods: We queried the National Inpatient Sample (NIS) from 2016 to 2020 for adults hospitalized with Takotsubo cardiomyopathy and severe or mild-moderate protein-calorie malnutrition. The primary outcome was inpatient mortality. Secondary outcomes included cardiac arrest, cardiogenic shock, respiratory failure/mechanical ventilation, acute kidney injury, vasopressor use, palliative consult, length of stay (LOS), and total hospital charges (TOTCHG). Multivariate logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Results: Among 159,395 patients with Takotsubo cardiomyopathy, 10,638 had severe protein-calorie malnutrition, while 5,907 had mild-moderate malnutrition. Respectively, the groups had mean age 67 vs. 68 years, male sex 27.0% vs. 24.8%, and White race 76.5% vs. 78.6% (Table 1A). Compared to the mild-moderate malnutrition group, the severe malnutrition group had higher odds of in-hospital mortality [OR 1.53, CI (1.12-2.07), P=0.006], palliative consults [OR 1.74 CI (1.29-2.34) P&lt;0.0001], longer LOS (15 vs. 13 days), and higher charges ($215,441 vs. $188,171) (Table 1B). Other outcomes showed no significant differences. Conclusion: In patients with Takotsubo cardiomyopathy, severe protein-calorie malnutrition significantly worsens clinical outcomes.
Abstract 4147532: Left Ventricular Global Longitudinal Strain is Associated with Appropriate Implantable Cardioverter Defibrillator Shocks Independent of Left Ventricular Ejection Fraction
Authors: Muhammad Soofi, Gregory Burkman, Mario Gonzalez, Gerald Naccarelli, Ankit Maheshwari
Journal: Circulation (2024)

Background: Left ventricular ejection fraction (LVEF) &lt;35% is the principal criterion to select patients for primary prevention of sudden cardiac death (SCD) from ventricular tachyarrhythmias (VTAs) with Implantable Cardioverter Defibrillator (ICDs). Unfortunately, many SCDs occur in people with LVEF &gt;35% and many people with LVEF &lt;35% are actually at low risk for VTAs and SCD. Thus, identification of novel risk factors for VTAs independent of LVEF is paramount. LV Global Longitudinal Strain (LVGLS) has been associated with adverse cardiovascular events and heart failure independent of LVEF. Objective: To evaluate the association between LVGLS and appropriate ICD shocks for VTAs. Methods: 223 consecutive patients who had ICDs implanted for primary prevention of SCD at a tertiary care medical center (1/2016-12/2017) were retrospectively evaluated in 2024. Patients were excluded for inadequate transthoracic echocardiogram data (n=44) and follow-up &lt;3 years (n=55). TTEs were retrospectively analyzed with speckle tracking to calculate LVGLS (TomTec; Unterschlessheim, Germany). Appropriate ICD shocks were physician adjudicated after review of ICD reports from the medical chart. Cox proportional hazards models and Kaplan-Meier survival analyses were used to evaluate the association between LVGLS and appropriate ICD therapies for VTAs. All statistics were completed in SPSS (Version 29.0.2.0 Armonk, NY: IBM Corp). Results: 124 patients were included (52% with ischemic cardiomyopathy (ICM), 74% male, mean age 66.3 +/- 15.3 years) with a mean (standard deviation) follow-up time 5.6 (2.3) years. Increased (less negative) LVGLS was independently associated with appropriate ICD shocks in ICM patients. The association was attenuated after adjusting for LVEF when modeled as a continuous variable per 5% increase. When modeled as a categorical variable, LVGLS &gt; -4.5% was associated with appropriate ICD shocks independent of LVEF, age, and gender. In patients with non-ischemic cardiomyopathy (NICM), LVGLS was not associated with appropriate ICD shocks. Interestingly, LVEF was not associated with appropriate ICD shocks patients in either ICM or NICM patients. Conclusion: If our findings are validated in larger cohorts, future studies should evaluate whether analysis of LVGLS can guide therapies such as implantation of primary prevention ICDs and/or prophylactic treatment in patients with ICDs to prevent VTAs and occurrence of ICD shocks.
Abstract 4146739: HBA1C Level Affects Stroke Outcome in AF Patients
Authors: Mayana Bsoul, Ala' Assaf, ghassan bidaoui, Francisco Tirado Polo, Yuxuan Gu, Mario Mekhael, Hadi Younes, Yishi Jia, Yingshuo Liu, Han Feng, Chanho Lim, Yanpei Hui, Abboud Hassan, Swati Rao, Omar Kreidieh, Amitabh Pandey, eoin donnellan, Nassir Marrouche
Journal: Circulation (2024)

Background: The CHA2DS2-VASc score quantifies stroke risk for atrial fibrillation (AF patients), but considers one point for diabetic patients, regardless of glycemic control. Objective: We aim to study the impact of the level of HBA1C on the stroke risk in AF patients. Methods: Utilizing data from the Research Action for Health Network (REACHnet) database, we studied patients within the Tulane University health system from 2010 to 2019. We only included patients diagnosed with AF with at least one HbA1c measurement. For each patient, the average HbA1c was used if there were multiple HbA1c measurements. Patients were categorized to 2 groups; group 1 is patients with HbA1c ≥7% but &lt;9%, while group 2 is Hba1c level more than ≥9%, which is severe hyperglycemia. Patients were followed up for 5 years from the diagnosis of AF. Cox regression was used to investigate the correlation between HBA1C level and ischemic strokes, with potential confounders corrected using the model. Results: We included 1120 patients, there was no significant difference in age (65± 10 vs 64 ± 11, p= 0.308), gender (39.1% vs 33% females, p= 0.287), BMI (30.85 ±8.9 vs 30.74 ±7.9, p=0.672) or race (35.6% vs 36.0% African Americans, p=1.000) between the 2 groups. Group 1 included 87 (7.8%) patients, while group 2 included 1033 (92.2%) with severe hyperglycemia. There was no significant difference between anticoagulants between the 2 groups (74.7% vs 71.4%, p=0.620). Our analysis showed that patients with severe hyperglycemia are at a significantly higher stroke risk compared to those with lower levels (p = 0.027, [HR] = 2.146, CI= [1.09-4.224]), correcting for age, sex, race, CHA2DS2-VASc score, anticoagulants, CAD, hyperlipidemia, and CKD. (Table.1) Conclusion: The analysis showed that severe hyperglycemia doubles the risk of stroke among AF patients. The findings of our study suggest that the severity of hyperglycemia may be more important than the binary status of diabetes. This study further underscores the importance of glycemic control of HBA1C in reducing thromboembolic events.
Abstract 4147960: Intensive treatment compared to Standard for hypertension in elderly patients, is it safe and effective? A Systematic Review and Meta-Analysis
Authors: Guilherme da Rocha, Vinicius Pelozzi dos Santos, Emilton Lima Junior
Journal: Circulation (2024)

Introduction: Blood pressure targets for the elderly are still controversial, there is a lack of certainty about the benefit and safety of targeting ≤ 130mmHg systolic blood pressure. Evaluate the benefit in important cardiovascular outcomes and safety in elderly patients of a blood pressure control ≤ 130mmHg compared to standard of care. Methods: The research was performed in PubMed, EMBASE, Scielo, LILACS, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1st, 2013 to May 1st, 2023. Randomized controlled trials that were published between January 1st, 2013 and May 1st, 2023 that included hypertensive patients over 60 years old which reported major adverse cardiovascular outcomes (MACE) or all-cause mortality, cardiovascular mortality and safety outcomes were selected. The data extraction was performed independently by two investigators following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A meta-analysis was performed using a fixed-effect model. The results were reported as the pooled results using risk ratio (RR) and a confidence interval (CI) of 95%. Results: The 4 trials included a number of 16,834 patients, the mean age was over 65 years, there was a good balance between genders, 13.3% of patients had cardiovascular disease, 10.9% diabetes, and 15.5% chronic kidney disease. The mean achieved blood pressure was roughly under 130mmHg, only one study was over (135mmHg) and the mean follow-up time was over 32 months. The intensive therapy decreased the outcomes for mortality (RR = 0.75, 95% CI 0.64 – 0.87, p &lt;0.001), cardiovascular outcomes (RR = 0.72, 95% CI 0.63 – 0.82, p&lt;0.001), and stroke (RR = 0.71, 95% CI 0.57 – 0.89, p =0.004) and proved to be safe. The heterogeneity was moderate for the first two outcomes (I2 =51%, p = 0.10 and I2= 43%, p = 0.15) and low for stroke (I2 = 0%, p = 0.70). For severe safety outcomes (RR = 0.90, 95 % CI 0.71 – 1.15, p = 0.40) and general safety outcomes (RR = 1.05, 95% CI 1.00 – 1.11, p = 0.05) there was no difference with low heterogeneity (I2 = 0%, p = 0.40 and I2 = 0%, p = 0.44). In the sub-analysis of patients over 70 years old, there was a lower incidence of the composite outcome (RR = 0.66, 95% CI,0.54 – 0.78, p &lt; 0.001) with a high heterogeneity (I2 = 65%, p = 0.04). Conclusions and Relevance: Aiming for a systolic blood pressure ≤ 130mmHg in the elderly appears to be more efficacious than the standard therapy and is safe.
Abstract 4146702: Analysing the Global Landscape of Hypertension-Related Aortic Aneurysm Mortality: Insights from 31-Year Analysis of Global Burden Of Disease 2021
Authors: Muhammad Talha Shaukat, Wania Rehman, Aleenah Mohsin, Aqeeb Ur Rehman, Saad Ur Rahman, Muhammad Ahmad Qureshi, Ali Mohsin
Journal: Circulation (2024)

Background: Aortic aneurysm, a potentially life-threatening condition characterized by weakness of the aortic wall, poses a significant health risk, especially when concurrent with high systolic blood pressure. In an aging population experiencing the effects of smoking and atherosclerotic disease, it is imperative to explore the burden associated with hypertension-related aortic aneurysm mortality. Methods: The Global Burden of Diseases (GBD) study was used to extract data for high systolic blood pressure-related aortic aneurysm from 1990-2021. Dataset was stratified globally, continent wise, and by World Bank income levels. Age-standardized death rates (ASDRs), disability-adjusted life years (DALYs), and years of life lost (YLL) were examined. Jointpoint regression was used to quantify these estimates and calculate average annual percentage changes (AAPCs). Results: Globally, the age standardized death rates (ASDR) for hypertension-related aortic aneurysm rupture had a declining trend from 1990-2021. In 1990, the ASDR was 0.52 (95% UI 0.39-0.65), which declined to 0.32 in 2021 (AAPC=-1.53; 95% CI -1.57 to -1.48). The disability-adjusted life-years (DALYs) were 9.55 in 1990 and decreased to 6.19 in 2021 (AAPC=-1.38; 95% CI -1.42 to -1.33). The age standardized years of life lost (YLL) also showed a uniform drop over the same period (AAPC=-1.38; 95% CI -1.42 to -1.33). In continent wise analysis, North America and Europe exhibited significant decline [(AAPC=-2.44; 95% CI -2.48 to -2.40) and (AAPC=-1.58; 95% CI -1.64 to -1.51) respectively], while Africa showed minimal variation. Importantly, however, Asia was the only continent with a rising mortality during this period (AAPC=0.77; 95% CI 0.73-0.81). According to World Bank income levels, high income countries had continuous decline in death rates while lower-middle income countries had increasing deaths rates. Upper-middle and low-income countries both had minimal variation in death rates during this period. Conclusion: Global efforts to reduce hypertension-related aortic aneurysm mortality have yielded positive results, but regional disparities persist. Continued research, prevention, and healthcare interventions are crucial to further mitigate this health risk.
Abstract 4146626: CYP2C19 Genotyping Decreases 5 and 10-year Mortality in Patients With History of In-Stent Restenosis Undergoing Percutaneous Coronary Intervention
Authors: Dev Patel, Bilal Ali, Zafer Sattouf, Sanjana Datla, Roshan Patel, Julie Adams, Shilpkumar Arora
Journal: Circulation (2024)

Introduction: CYP2C19 genotyping is a genetic test that checks for variations in the gene that codes for an enzyme that metabolizes clopidogrel. Testing has been shown to accurately predict response to clopidogrel; however, the impact of testing on mortality is not currently known. Hypothesis: Our objective was to compare the mortality among patients with a history of in-stent restenosis after percutaneous coronary intervention and initiation of dual antiplatelet therapy who have undergone CYP2C19 genotyping to those who have not undergone CYP2C19 genotyping. We hypothesize that patients who underwent CYP2C19 genotyping will have decreased 5 and 10-year mortality. Methods: A large retrospective database, Trinetix, was used to identify patients aged greater than 18 years old with a history of in-stent restenosis after percutaneous coronary intervention and initiation on dual antiplatelet therapy with either CYP2C19 genotyping or without CYP2C19 genotyping. Two cohorts were subsequently followed depending on if genotyping was performed. Student’s t-test was performed to compare baseline characteristics between cohorts. Demographics and comorbidities were used for 1:1 propensity matching. Kaplan-Myer curves and hazard-ratios were calculated to compare 5 and 10-year mortality. Results: Patients that underwent CYP2C19 genotyping (n=144) and did not undergo CYP2C19 genotyping (n=35,039) were propensity matched yielding 142 patients per cohort. In patients with a history of in-stent restenosis, CYP2C19 genotyping was associated with a decreased 5-year mortality (18.98% vs 29.93%; HR=0.542; 95% CI [0.331, 0.887], log-rank p= 0.0134) and 10-year mortality (23.36% vs. 34.31%; HR=0.542; 95% CI [0.345, 0.852], log-rank p=0.0071) compared to no CYP2C19 genotyping. Conclusion: In patients with a history of in-stent restenosis, undergoing CYP2C19 genotyping was associated with a decreased risk for mortality when compared to not undergoing CYP2C19 genotyping. Prospective randomized trials are needed to further guide patient selection for CYP2C19 genotyping.
Abstract 4147923: Role of Adipocyte Circadian Rhythm in the Exacerbation of Diabetic Ischemic Heart injury
Authors: Huilan Tan, Yalin Wu, Jianli Zhao, Taslima Akter Shila, yanwen liu, John Zhang, Kayleigh Wyatt, Amr Mahmoud, Xinliang-Xin Ma, Martin E Young, Yajing Wang
Journal: Circulation (2024)

Diabetes worsens myocardial infarction (MI) pathologic progress, termed diabetic exacerbation of ischemic heart failure (IHF), with mechanisms and effective therapies remaining poorly understood. Circadian rhythm (CR) disruption is associated with heart failure, but its impact on diabetic IHF has not been studied. Adipocytes involve in maintaining physiological homeostasis and exhibit diurnal oscillations. However, the effects of circadian rhythm disruption on adipocyte dysfunction and diabetic IHF are unclear. Adult C57BL6J mice and adipose tissue-specific BMAL1 (master circadian gene) knockout (ABK) adult C57BL6J mice were used as a diabetes model with a high-fat diet (HFD) fed for 12 weeks, and a normal diet (ND) as control. Myocardial ischemia-reperfusion (MI/R) injury was induced at Zeitgeber Time 12 (ZT12) in diabetic and ABK animals. Cardiac function assay revealed that, following MI/R, diabetic mice at ZT12 showed a significant worsening of cardiac ejection fraction (EF) (-5.2±2.2%), fractional shortening (FS), left ventricular radial strain (-4.5%±1.83), longitudinal strain, and radial (-1.31 ±0.54 1/s) and longitudinal strain rates. Mechanistically, the role of adipose circadian oscillation was investigated in ABK animals. Loss of BMAL1 in adipose tissue resulted in an increased cardiac injury, and further reduction of cardiac function in diabetic ABK animals on ZT12. Moreover, myocardial infarction was observed to be enlarged at ZT12 in the diabetic MI/R group compared to the ABK post-MI/R group, as indicated by TTC/Evans blue stain. This finding was further supported by TUNEL staining assays (cardiomyocyte apoptosis). Western blot analysis revealed an upregulation of apoptosis-related proteins, including cleaved caspase-3 and cleaved caspase-9, in the diabetic MI/R group at ZT12. Meanwhile, BMAL1 insufficiency (ABK) led to an increase in cleaved caspase-3 and cleaved caspase-9, with further augmentation observed in diabetic ABK animals post MI/R. Additionally, the amount of EVs was significantly increased at ZT12 in diabetic mice, whereas this phenomenon was not observed in ABK animals. Our study suggests that disrupted circadian rhythms in adipose tissue promoted heart dysfunction and diabetic exacerbation of ischemic heart failure (IHF). Moreover, we propose that BMAL1 may alter adipose tissue EVs profiles to communicate with cardiomyocytes, with potential implications for improving therapeutic approaches for diabetes-related cardiomyopathy.