tbuckley/cabot-search huggingface dataset:
Abstract Or103: Thematic analysis of cardiac arrest survivor-caregiver dyads’ psychosocial intervention needs
Authors: Alexander Presciutti, Bonnie Siry-Bove, Robert Parker, Ona Wu, Jonathan Elmer, Michael Donnino, Sarah Perman, Ana-maria Vranceanu
Journal: Circulation (2024)

Background: Emotional distress in cardiac arrest survivors and their caregivers (dyads) is prevalent, persistent, and undermines clinical and quality of life outcomes. To date, there is an absence of interventions that address early distress to prevent chronicity. Aim: To inform psychosocial intervention content for new cardiac arrest survivor-caregiver dyads. Methods: Between September 2023 and March 2024, we conducted semi-structured interviews with consecutively admitted cardiac arrest survivor-caregiver dyads from Massachusetts General Hospital early after the survivor’s cardiac arrest (i.e., during the survivor’s index hospitalization or within 1 week of discharge). We audio recorded interviews, transcribed them verbatim, and conducted hybrid deductive-inductive thematic analysis of the transcripts. At least one member of the dyad must have screened positive for emotional distress (i.e., &gt; 8 on either subscale of the Hospital Anxiety and Depression Scale). The survivor must have demonstrated sufficient cognitive status for meaningful participation (i.e., &gt; 4 on the Short Form Mini Mental State Exam). We prespecified 4 supraordinate domains of inquiry: 1) stressors and psychosocial treatment needs, 2) coping methods, 3) reactions to preliminary content that we presented during the interview, and 4) barriers and facilitators to participation in psychosocial interventions early after cardiac arrest. Results: Dyads ( N =13; survivors: female 31%, non-Hispanic White 69%, out-of-hospital cardiac arrest 62%; caregivers: female 77%, non-Hispanic White 62%, spouse/romantic partner 77%) overwhelmingly reported a need for anticipatory guidance and coping skills to address uncertainty, trauma, existential distress, and post-arrest sequelae (Domain 1). To cope (Domain 2), dyads reported utilizing social support, distraction, mind-body techniques, gratitude, and meaning and purpose. After we previewed preliminary content (Domain 3), dyads recommended we prioritize anticipatory guidance and family distress throughout. Regarding barriers and facilitators (Domain 4), dyads suggested interventions be low burden and begin after medical stabilization. Conclusions: Early after cardiac arrest, distressed survivor-caregivers dyads recommend that psychosocial interventions include anticipatory guidance, coping skills training, be low-burden, and begin after medical stabilization. Our findings can inform various early psychosocial intervention approaches for survivors and caregivers.
Abstract Su1007: Temporal muscle thickness correlates with premorbid clinical frailty in patients resuscitated from cardiac arrest
Authors: Jonathan Tam, Cecelia Ratay, Laura Faiver, Patrick Coppler, Nicholas Case, Clifton Callaway
Journal: Circulation (2024)

Introduction: Previous work has associated frailty with mortality and neurologic outcomes in patients resuscitated from cardiac arrest. The Clinical Frailty Scale (CFS) – a 9-point ordinal scale with higher values indicating a higher degree of frailty – is the most used measure in critically ill patients, however there is no established gold-standard. Temporal muscle thickness (TMT) is a measure of sarcopenia, which represents a specific physical frailty phenotype. Aim: We assessed the correlation between TMT, measured on head computed tomography (CT), and the CFS in patients resuscitated from cardiac arrest. Hypothesis: TMT negatively correlates with pre-arrest CFS. Methods: We enrolled adult patients who were resuscitated from cardiac arrest and had a head CT obtained within 48 hours of collapse at our regional academic facility. Patient characteristics were recorded in our prospective registry. Study investigators prospectively obtained pre-arrest CFS through a patient or surrogate interview. Blinded study investigators reviewed head CTs and measured TMT bilaterally at 5mm above the superior orbital rim, adjacent to the Sylvian fissure. We then averaged the two measurements within each patient. We summarized patient demographics and arrest characteristics with descriptive statistics. We calculated Spearman rank-order correlation to assess the relationship between average TMT and CFS. Results: Of 20 included subjects, mean age was 57 (SD 13), 6 (30%) were female, 17 (85%) were out-of-hospital arrests, 6 (32%) had an initial shockable rhythm, and median Charlson Comorbidity Index was 2 (IQR 0-3). Mean TMT in our cohort was 6.7 millimeters (SD 2.6) and median CFS was 3 (IQR 2-6). There was a negative, moderate correlation between average TMT and CFS; r(18) = -0.50, p = 0.02. Conclusions: We found that TMT exhibits a moderate negative correlation with the CFS, providing face validity that TMT may be a tool to measure frailty. Measuring TMT in patients with early head CTs after resuscitation from cardiac arrest may allow for characterization of pre-arrest frailty.
Abstract Sa909: The Importance of Extended-hours Patient Recruitment in Cardiac Arrest Trials
Authors: John Lee, Jacob Vine, Max Meier, Alan Berkovitz, Lakshman Balaji, Anne Grossestreuer, Ari Moskowitz, Katherine Berg, Michael Donnino
Journal: Circulation (2024)

Introduction: Patient recruitment is a critical factor in running successful and timely clinical studies. This is particularly crucial in cardiac arrest research where the timing of presentation of study participants is unpredictable and interventions are often time-sensitive. Previous studies have identified adequate staffing as one of the most important enablers of successful recruitment. However, studies have also shown that recruitment outside of business hours is less common even at major academic centers. Hypothesis: We hypothesize that a substantial portion of potential study participants present outside of business hours and therefore providing coverage only during business hours results in missing a large number of potential study participants. Aims: The objective of this study was to analyze the timing of all patient enrollments from our previous cardiac arrest trials to identify patterns and assess the impact of providing 24/7 coverage on participant recruitment. Methods: We reviewed the patient enrollment time data for two cardiac arrest trials performed by our group (NCT02974257 and NCT03450707). We quantified the number of enrollments during business hours (9 AM - 5 PM) vs. outside of business hours and analyzed the frequency of enrollment by day of the week and time of day. Results: There were 112 patients enrolled between 2016 and 2022 across the two trials. A total of 80 patients (71.4%) were enrolled outside of business hours (Fig. 1). 75% of patients were enrolled during weekdays and 25% during weekends. By day of the week, enrollments occurred most frequently on Friday (20, 17.9%) and least on Monday (12, 10.7%) and Sunday (12, 10.7%) (Fig. 2A). By time of day, enrollments occurred most frequently during 2 - 4 PM and 6 - 8 PM (15, 13.4%) and least frequently during 4 - 6 AM and 8 - 10 AM (2, 1.8%) (Fig. 2B). Recruiting only during business hours would have resulted in additional 18 and 11 years to complete each study (Fig. 3). Conclusion: In our two most recent cardiac arrest trials, 75% of enrollment occurred outside of business hours. Limiting recruitment to only business hours would have resulted in a prohibitively longer time to complete the studies. This analysis provides a strong motivation and rationale for extending research staffing coverage beyond business hours.
Abstract 4148050: Correlates of DASH adherence among Adults with Hypertension in the 2013- 2020 National Health and Nutrition Examination Survey
Authors: Mojisola Olusola-Bello, Janice Dugbartey, Khadijat Adeleye, Chelsea Akubo, Valerie Sullivan, jennifer freeman, Ruth-Alma Turkson-Ocran, Oluwabunmi Ogungbe
Journal: Circulation (2024)

Introduction: Dietary Approaches to Stop Hypertension (DASH) dietary pattern is an effective non-pharmacologic approach to hypertension management. Several factors may influence DASH adherence, hence, we aimed to assess correlates of DASH adherence among adults with hypertension. Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2013 –2020. The outcome, DASH score was calculated from dietary intake data (fruit and vegetables, fish, whole grains, sugar-sweetened beverages, and sodium) from ≥95th percentile (top/ideal diet) to 1st–24th percentile (bottom/least ideal quartile). Weighted generalized linear models were fitted to examine the correlates between DASH adherence and adult food security, age, gender, race and ethnicity, education, poverty income ratio (PIR), marital status, employment, insurance, supplemental nutrition assistance program (SNAP) receipt. Results: Among a sample of 3303 adults with hypertension; mean age 48 (±)18 years, 52% female; mean DASH score was 26 (±3) points. Key correlates of higher DASH diet adherence in adults with hypertension were full individual food security (β = 0.61, 95% CI: 0.10, 1.13), being Hispanic (β = 1.17, 95% CI: 0.57, 1.77) or Asian (β = 2.06, 95% CI: 1.23, 2.88) compared to Whites, older age (β = 0.05, 95% CI: 0.03, 0.07), female sex (β = 0.65, 95% CI: 0.11, 1.19), college education or higher (β = 1.58, 95% CI: 0.80, 2.36), and being married (β = 0.41, 95% CI: 0.07, 0.75). A higher poverty income ratio of 1-1.99 compared to &lt;1 was also associated with better DASH adherence (β = 0.53, 95% CI: 0.19, 0.87). Conclusions: Adherence to the DASH diet among adults with hypertension in the U.S. varies based on ethnicity, individual food security, marital status, and gender. To improve adherence, targeted support should be provided, addressing the unique needs and circumstances of these different groups.
Abstract 4148102: Trends in the Burden of Ischemic Stroke and Kidney Dysfunction; An analysis of Global Burden of Disease 1990-2021
Authors: Muhammad Talha Shaukat, Wania Rehman, Malik Saad Hayat, Sara Sohail, Muhammad Khan Bahadur Ali, Muhammad Shahzaib, Saad Ur Rahman
Journal: Circulation (2024)

Introduction: Ischemic stroke and renal failure frequently coexist, impairing patient outcomes. Comprehending this association is imperative in formulating a multidisciplinary methodology to augment patient outcomes and quality of life. Objective: We offer estimates showing the evolution of kidney dysfunction related ischemic stroke from 1990 to 2021. It will utilize disability-adjusted life years (DALYs), years of life lost (YLLs) and age-standardized death rates (ASDR) to find discrepancies overall survival outcomes in both sexes. Methods: Data on ASDR, DALY, and YLL were extracted from the GBD database. After examining global trends, we analyzed continents, socio-demographic index (SDI) and World Bank income level classification of countries. Using Joinpoint regression, the average annual percentage changes (AAPC) were determined. Results: The ASDR for kidney dysfunction related ischemic stroke showed a declining trend globally between 1990 and 2021. The ASDR was 7.29(95%UI: 4.68-10.07) in 1990 and dropped to 4.24 (AAPC: -1.73; 95% CI: -1.76 to -1.69) in 2021. DALYs dropped from 130.3(95%UI: 90.36-172.67) in 1990 to 82.1 (AAPC: -1.47; 95% CI: -1.50 to -1.44) in 2021. YLL had a consistent decline from 1980 to 2021, with an AAPC of -1.66 (95% CI: -1.69 to -1.62). High-middle and middle SDI region had higher death rates throughout the study period. Asia and America had lower ASDRs, whereas Europe and Africa had higher ASDRs across the board. Africa's AAPC was -0.37 (95% CI: -0.4 to -0.32) between 1990 and 2021. Similarly, Europe's AAPC of -2.85 (95% CI: -2.93 to -2.77) showed a decline from 1990 to 2021. Asia's AAPC showed a drop, coming in at -1.19 (95% CI: -1.22 to -1.15). America's AAPC was -1.97 (95% CI: -2.02 to -1.91). According to world bank income levels, upper-middle and lower-middle income countries had higher ASDRs. Conclusion: Due to similar risk factors and bidirectional effects, the combination of ischemic stroke and renal failure worsens patient outcomes. In order to effectively address the intricate interactions between various illnesses and enhance patient prognosis, an in-depth investigation of the reasons behind stark disparities in death rates is necessary.
Abstract 4148121: Identification of Acute Air Pollution Induced Altered Metabolomic Pathways that May Lead to CAD and AMI: the BioHEART-CT Study
Authors: Sina Fathieh, Michael Patrick Gray, Owen Tang, Thomas Astell-Burt, Stuart Grieve, Gemma Figtree
Journal: Circulation (2024)

Background: Outdoor air pollution, a persistent threat since the Industrial Revolution, continues to pose a global challenge with severe implications for public health. Despite advancements, air quality issues —particularly particulate matter —are associated with diseases like coronary artery disease (CAD) and stroke. The unknown pathophysiology that links air pollution to cardiovascular diseases is a pressing issue that demands immediate attention. Understanding these mechanisms is critical for effective prevention and treatment. Methods: The BioHEART-CT Discovery cohort included 1,002 adults referred for elective CTCA (2015-2020). Blood (20-30 ml) was collected at the time of CTCA, processed, stored at -80°C, and analysed using Agilent 1260 LC and QTRAP 5500 MS. Maximum daily PM2.5 was measured using home postcodes and publicly available land-based monitors. After normalisation, PCA and PLS-DA were employed to reduce dimensionality and identify significant variables, followed by pathway analysis of significant metabolites using metabolite set enrichment analysis. Results: Using the threshold of PM 2.5 ≥12 μg/m 3 to categorise patients into high vs low-exposure, low-exposure subjects formed a distinct cluster from high-exposure subjects. PLS-DA clustering with ten-fold cross-validation identified key metabolites with high VIP scores: transHYP, betaine, and alanine. Metabolite set enrichment analysis revealed significant pathways: Glycine, Serine, and Threonine metabolism, and Arginine and Proline metabolism (p&lt;0.001, FDR &lt;0.05) (Figure 1). Conclusion: Our study's most significant finding—the enriched metabolic set of glycine, serine, and threonine metabolism, along with arginine and proline metabolism—has been implicated in the development of CAD in previous studies. These findings can potentially inform preventive and treatment strategies, making a real difference in the lives of those affected by air pollution-related cardiovascular diseases.
Abstract 4148199: Enhanced Diagnostic Value of High Sensitivity Troponin I After Indexation for Myocardial Mass, Renal Function and Age: the BioHEART-CT Study
Authors: Sina Fathieh, Michael Patrick Gray, Gillian Murtagh, Owen Tang, Stephen Vernon, Stuart Grieve, Gemma Figtree
Journal: Circulation (2024)

Background: Atherosclerotic coronary artery disease (CAD) often goes undetected until acute myocardial infarction (AMI). High-sensitivity troponin (hs-cTn) assays, known for diagnosing acute coronary syndrome, are being explored for detecting subclinical CAD. Studies suggest hs-cTn's potential in identifying coronary atherosclerosis, indicating its value in early CAD screening. Method and Results: This study used the BioHEART-CT cohort (2015-2021) of 2,000 adults undergoing CCTA for known or suspected CAD, excluding those with prior cardiomyopathy, MI, or coronary revascularization. CAD severity was assessed using CACS and Gensini scores. Myocardial mass was estimated via automated segmentation. Hs-cTnI was measured using Abbott ARCHITECT i1000 and Beckman Access 2 assays. We examined the association between hs-cTnI levels and the extent of myocardial involvement. Hs-cTnI significantly correlated with the total number of coronary artery segments containing detectable plaque (ρs = 0.25; p &lt; 0.001; Figure 1). Additionally, Spearman’s correlation of segment location and stenosis degree with hs-cTnI indicated a stronger association in the proximal segments. We examined the potential improvement of the association of hs-cTnI with clinically actionable CAD by incorporating myocardial mass (affecting baseline hs-cTnI release) and estimated glomerular filtration rate (eGFR) into the model. Using PLS with GLM regression, we projected hs-cTnI, age, eGFR, and myocardial mass into a latent feature. This improved detection of clinically actionable CAD, yielding an AUC of 0.79 and 0.80 in the participants without standard CAD risk factors. Using echocardiographic LV mass data (available for 362 patients), the AUC improved to 0.75 overall and 0.76 for SMuRF-less patients (Figure 2). Conclusion: Baseline serum hs-cTnI may indicate underlying subclinical CAD. The predictive value of troponin can be further enhanced by considering the effect of myocardial mass, renal function, and age.
Abstract Su1005: Differences in optical metrics of cerebral autoregulation after pediatric cardiac arrest
Authors: April Hurlock, Alyssa Seeney, Nicolina Ranieri, Ryan Burnett, Rebecca Douglas, Tanmay Majmudar, Rika Goto, Rodrigo Menezes Forti, Jennifer Lynch, Wesley Baker, Alexis Topjian, Robert Berg, Tiffany Ko, Matthew Kirschen
Journal: Circulation (2024)

Introduction: Cerebral autoregulation (CAR) mechanisms, which maintain cerebral blood flow (CBF) over a range of mean arterial pressures (MAP), are impaired after cardiac arrest. Metrics of CAR impairment can be calculated from MAP and a CBF surrogate. Brain tissue oxygenation (StO 2 ) derived from near-infrared spectroscopy (NIRS) has been used, but its approximation of CBF is limited. Advanced optical imaging can directly estimate CBF and StO 2 with greater precision. Aim: Compare CAR metrics derived from advanced optical modalities, including frequency-domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS), with NIRS. Hypothesis: CAR metrics derived from FD-DOS and DCS will not be significantly different from each other and NIRS. Methods: We measured StO 2 and total hemoglobin concentration (HbT) via FD-DOS, blood flow index (BFI) via DCS, and StO 2 via NIRS for up to 8 h during the first 48 h after cardiac arrest. We identified 30-min epochs during which MAP changed more than 15% relative to the mean (Fig 1). Within each epoch, CAR was assessed using a moving-window Pearson correlation between MAP and each FD-DOS, DCS, and NIRS parameter. Pearson r values closer to 1 indicated impaired CAR and 0 to -1 indicated intact CAR. CAR metrics were compared by Kruskal-Wallis, and post-hoc pairwise comparisons with Bonferroni correction identified differences between metrics. Unfavorable outcomes were defined as hospital discharge PCPC score of 4-6. Results: We identified 37 epochs of MAP change in 4 children (2 favorable, 2 unfavorable outcomes). We found significant differences between all 4 CAR metrics (p&lt;0.001; Fig 2). In pairwise comparisons, StO 2 from FD-DOS and NIRS did not differ (p&gt;0.05). The DCS BFI metric exhibited more severe CAR impairment than NIRS StO 2 across all subjects (p&lt;0.05), with larger differences in unfavorable outcomes (0.62 [0.45,0.78] vs. 0.09 [-0.09,0.17], p&lt;0.001) than in favorable outcomes (0.15 [0.05,0.31] vs. 0.15 [0.10,0.32], p&gt;0.05). Conclusion: CAR metrics derived from advanced optical modalities yielded variable results compared to NIRS in children after cardiac arrest. The DCS BFI metric demonstrated more severe CAR impairment than StO 2 from either NIRS or FD-DOS, particularly in patients with unfavorable outcomes, suggesting that a more direct measure of CBF may be more sensitive to CAR impairment in post-arrest patients with deficiencies in cerebral oxygen delivery or utilization.
Abstract 4147945: Trends in Obesity-related Ischemic Heart Disease Mortality in the United States from 1999 to 2020
Authors: Muhammad Talha Shaukat, Aleenah Mohsin, Ahmed Jamal Chaudhary, Wania Rehman, Abdullah Tahir Mirza, Aqeeb Ur Rehman, Malik Saad Hayat, Muhammad Ahmad Qureshi
Journal: Circulation (2024)

Background and Objectives: Obesity, especially central obesity, is closely linked to both traditional and novel risk factors for Ischemic Heart Diseases (IHD). In view of the ongoing obesity epidemic in the United States, here we aim to assess the trends in obesity-related IHD mortality in the United States from 1999 to 2020, and identify the racial, local, regional, age and gender-wise differences in this trend. Methods: Data from CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database was examined from 1999 to 2020 for IHD and obesity-related mortality in individuals of all ages. Both crude mortality rates and age-adjusted mortality rates (AAMR) per 100,000 individuals were determined. Using joinpoint regression analysis, annual percentage changes (APC) in AAMR were calculated. Results: A total of 226,267 deaths occurred due to obesity related ischemic heart disease from 1999 to 2020 in the United States. There was a uniform rise in AAMR from 1999 to 2020, with an AAPC of 5.03 (95% CI 4.5-5.4). Overall, males had a higher AAMR than females (AAMR men=3.9; women=2.2). The incline in the mortality rates was also more prominent in males (AAPC=5.11; 95% CI 4.1-6.1), especially those aged 55-64 (AAMR=8.5). Age-adjusted mortality was the highest among Black patients ( AAMR=? ). Significant geographical difference was also observed, with the highest mortality observed in the midwestern states (AAMR: Midwest 3.3; West 3.1; South 2.9; Northeast 2.8). More specifically, Vermont (AAMR=10.4) had the highest AAMR and Alabama (AAMR=1.5) had the lowest. It was also found that non-metropolitan areas (AAMR=4) had higher AAMRs than metropolitan areas (AAMR=2.9). Conclusion: Obesity-related IHD mortality is on a rise in the United States. Highest mortality rates can be observed among Black people, males, patients in the Midwestern states and rural locale, and ages 55-64.