tbuckley/cabot-search huggingface dataset:
Abstract 17154: Arrhythmias Associated With Acute Caffeine Toxicity
Authors: Justin T Teraoka, Janet J Tang, Jean Jacques Noubiap, Thomas A Dewland, Gregory M Marcus
Journal: Circulation (2023)

Introduction: Recent evidence has failed to demonstrate an association between caffeine consumption and arrhythmias. However, case reports have suggested an increased risk of arrhythmias associated with excessive caffeine intake. This relationship has yet to be studied in a large population. Goals: To describe the frequency and types of arrhythmias associated with caffeine toxicity. Methods: We used Emergency Department (ED) data from the California Department of Health Care Access and Information to identify California residents aged ≥ 18 years between January 1, 2005 to December 31, 2020. Caffeine toxicity and arrhythmias were identified using ICD9/10 codes. Multivariable logistic regression models were used to compare the frequency of arrhythmias between those with caffeine toxicity to those visiting the ED for any other reason. Results: Among 23,755,762 patients, 725 (&lt; 0.01%) had caffeine toxicity. Those with caffeine toxicity were younger (mean 28.9 ± 12.1 years), male (67.0%), of lower income, and had less cardiovascular comorbidities. Of these, 4 (0.6%) had atrial fibrillation, 3 (0.4%) supraventricular tachycardia, 2 (0.3%) premature ventricular contractions, 1 (0.1%) cardiac arrest, and 7 (1.0%) unspecified arrhythmias. No one with caffeine toxicity had premature atrial contractions, ventricular tachycardia or fibrillation. Before adjustment, caffeine toxicity was 1.7 times more likely to be associated with an arrhythmia (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.05 to 2.75). After adjustment, caffeine toxicity was 7 times more likely to be associated with an arrhythmia (OR 6.81, 95% CI 4.13 to 11.24) ( Figure ). Conclusions: Caffeine toxicity was strongly associated with both atrial and ventricular arrhythmias. While recent studies found no increased risk of arrhythmias associated with regular caffeine consumption, these data suggest that excessive caffeine intake may yet heighten the likelihood an arrhythmia may occur.
Abstract 13366: Effectiveness and Safety of Short-Term Outpatient Amiodarone Followed by Catheter Ablation in Management of Atrial Fibrillation
Authors: Shubash Adhikari, Mohammed Arisha, Shady Ezaldin, Frank Annie, Chafik Assal
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is the most common arrythmia with significant health system burden and emergency room/hospital admissions. We conducted this study to understand the efficacy of managing AF with first line short term outpatient amiodarone followed by catheter ablation (pulmonary vein isolation). Amiodarone was continued for 6 months post catheter ablation (CA). We looked at a primary end point of recurrence of AF and the drug side effects during the year post CA. Hypothesis: If this strategy of short-term amiodarone with early ablation of AF is effective, then we could incorporate this in an AF management care plan. Methods: In this retrospective cohort study, we used TriNetX database to collect data on patients with amiodarone initiation with CA and those who were given Dofetilide or Sotalol, followed by CA. We collected data between March 1, 2020, and June 1, 2021. We created a propensity score matching of a 1:1 to match on the covariates: Age, Male, Female, CAD, Heart Failure, Diabetes, COPD, BMI. The endpoint is occurrence of AF within 365 days of medication initiation. Results: A total of 40,640 patients were included in the analysis. Of those patients, Cohort 1 comprised amiodarone initiation with catheter ablation (n=176) compared to Dofetilide or Sotalol which had (n=40,474). After the propensity match, we included 176 individual patients in each cohort. The amiodarone group had more men (79.5% vs 58.8, P&lt;0.001) and were with higher comorbidities of CAD, Heart Failure, Diabetes, COPD. At 365 days Amiodarone group had a reduction of 12.6%, P&lt;0.001 of AF compared to Dofetilide or Sotalol patients. There has been no reported side effects requiring discontinuation of Amiodarone. Conclusions: We are excited to report a statistically significant 12.6% reduction in AF recurrence in Cohort 1 with short term outpatient Amiodarone initiation with CA compared to inpatient Dofetilide or Sotalol initiation with CA. There have been no safety issues with Amiodarone use for 6-12 months post PVI. This strategy avoids occupying beds for initiation of class III antiarrhythmic (Dofetilide or Sotalol), thus significantly reducing the burden on the health system.
Abstract 16383: The Burden of Cardio-Metabolic Disorders Among the Hospitalized Population With Renovascular Hypertension and Predictors of Mortality; a Population-Based Retrospective Study
Authors: Endurance O Evbayekha, Leonela Bastidas, Carlos Gaibor, Rani Kuttab, Dawson Foster, Yara Jelwan, Yansoun Elmasry, Purav Desai, Amer Abbas, thomas pohlman
Journal: Circulation (2023)

Introduction: Cardio-metabolic disorders (CMBD), including hypertension, diabetes, obesity, stroke, and non-alcoholic fatty liver disease, significantly burden healthcare systems globally. The impact of atherosclerotic renovascular hypertension (rHTN) on the overall cardiovascular health of hospitalized patients is of particular interest, as it may be associated with a higher risk of adverse outcomes. We aimed to study the burden of CMBD in this population. Hypothesis: We hypothesize that rHTN cohorts have a considerable burden of CMBD, and studying this will provide valuable insights for improved management. Methods: We used the ICD-10 diagnostic code (I150) to identify hospitalizations with rHTN from the National Inpatient Sample Database (NIS) (2016-2020). We excluded individuals with fibromuscular dysplasia. We analyzed the prevalence of CMBD, specifically obesity, dyslipidemia (DysL), type-2 diabetes (T2DM), and coronary artery disease (CAD). We used multivariate regression analysis to estimate the probability of each subgroup as an independent predictor of mortality. Results: There were 7899 hospitalizations diagnosed with rHTN, the mean age was 58 years ± 25, and 54% (4363) were females. There was an ethnic prevalence of 56.1% (4423) Caucasians, 23.2% (1816) Blacks, 14.7% (1162) Hispanics, and 3.3% (259) Asians. The median length and cost of hospitalization was 4 days and $41,145, respectively. CMBD burden analysis revealed that 42.8% (3381) had DysL, 37.9% (2994) T2DM, 32.8% (2591) CAD, and 16.1% (1272) had obesity. The CAD subgroup was independently associated with mortality, with an adjusted odds ratio (aOR) of 1.5 (1.05-2.1, p=0.04). The other subgroups did not have a statistically significant independent association with mortality, T2DM 0.9 (0.6-1.3, p=0.7), DysL 0.5 (0.4-1.01, p=0.06), and obesity 0.8 (0.5-1.4, p=0.4). Conclusion: rHTN remains prevalent in the middle age group, and a large proportion have cardiometabolic risk factors, including dyslipidemia, type-2 diabetes, and coronary artery disease. Coronary artery disease remains an independent predictor of mortality in this population. Prevention, early detection, and aggressive treatment of CMBD and CAD cannot be overemphasized.
Abstract 16064: Prognostication of Cardiopulmonary Exercise Testing in Heart Failure With Reduced Ejection Fraction on Optimized Guideline-Directed Medical Therapy
Authors: Riddhi Ramanlal, Chakradhari Inampudi
Journal: Circulation (2023)

Introduction: Cardiopulmonary exercise testing (CPET) is a valuable tool for predicting outcomes in patients with heart failure. Peak oxygen consumption (VO2) and minute ventilation/carbon dioxide production (VE/VCO2) are important prognostic factors in heart failure with reduced ejection fraction (HFrEF). However, prior studies have not examined the impact of optimization of guideline-directed medical therapy (GDMT) on the utility of CPET in prognostication. Hypothesis: This study aims to investigate the prognostic value of CPET in a cohort of HFrEF patients who are compliant with all four GDMT components: beta-blockers (BB), ace-inhibitors (ACEi)/angiotensin II-receptor-blockers (ARB)/angiotensin-receptor-neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonist (MRA), and sodium-glucose cotransporter-2 (SGLT2). This will be compared to patients with HFrEF who are not fully optimized on GDMT to determine variation in the statistical significance of prognostic factors. Methods: We retrospectively analyzed data from 176 HFrEF patients who underwent CPET for prognostication purposes. The patients were followed for one year after. CPET testing was completed between January 2020 to June 2022. LVEF was evaluated by echocardiography, completed within 3 months of the CPET. From the data, 125 participants had an LVEF less than or equal to 40%. Of those, 71 were compliant with all four GDMT components, while 54 were not. Results: After one year, there were 16 events (MSR, transplant, or death) in the GDMT-optimized group comprised of 71 participants. Peak VO2 was higher in the no-event group and was notably the only statistically significant predictor of adverse event (p =0.0162). Similarly, of the 54 participants on less than four GDMT components, 13 adverse events occurred, and the strongest predictor was again peak VO2 (p=0.0027). In addition, VE/VCO2 slope were lower (p= 0.0234) and circulatory power were higher (p=0.0044) in the no-event group. Conclusions: In patients with HFrEF that are optimized on GDMT, peak VO2 is consistently the most robust and only statistically significant prognostication tool on CPET for MCS, transplantation, or death within one year.
Abstract 16013: Non-Bacterial Thrombotic Endocarditis and Recurrent Cerebrovascular Accidents in Immune Checkpoint Inhibitor Myocarditis
Authors: Lindsey Mitrani, Stephanie Jou, Sean Mendez, christopher song, Joseph Yoon, Neha S Dangayach, GAGAN SAHNI
Journal: Circulation (2023)

Background: Nonbacterial thrombotic endocarditis (NBTE) is a rare condition associated with cancer, hypercoagulable state, and systemic emboli including stroke. This report presents a case of NBTE associated with metastatic lung adenocarcinoma and recurrent strokes despite anticoagulation for prior pulmonary embolism (PE) and highlights the challenges in management of NBTE. Case: 66-year-old man with stage IV non-small cell lung adenocarcinoma treated with pembrolizumab complicated by immune checkpoint inhibitor (ICI) myocarditis treated with high dose steroids and PE treated with rivaroxaban, presented with diplopia and gait instability. MRI brain revealed a left corona radiata infarct and rivaroxaban was switched to apixaban. Three weeks later, the patient developed left internal carotid artery (ICA) occlusion, and underwent emergent thrombectomy. A transesophageal echocardiogram revealed a new 1.8 cm mass on the mitral valve with negative blood cultures. Anticoagulation was switched to therapeutic enoxaparin. Cardiothoracic surgery was consulted, though patient opted for palliative care. Decision making: Patient presented with recurrent multifocal strokes despite treatment with multiple direct oral anticoagulants (DOACs), just weeks after ICI myocarditis. The challenges here were approach to anticoagulation in a patient with recurrent strokes despite anticoagulation, the risk of hemorrhagic conversion of stroke, and the mechanism of stroke. The mitral valve mass was presumed to be NBTE, due to his metastatic malignancy and negative blood cultures. However, a recent history of ICI-myocarditis raised the possibility of an immune mediated mechanism of NBTE, given the growing association of auto-immune diseases and NBTE. Conclusion: NBTE is a rare complication of metastatic disease that can commonly lead to stroke and is treated with optimal anticoagulation and addressing the underlying malignancy. However, this case highlights the failure of multiple oral anticoagulants to treat NBTE and raises the question of additional mechanisms of NBTE beyond malignancy and hypercoagulable state. Further studies are required to elucidate a common immune mediated mechanism of NBTE and ICI myocarditis.
Abstract 17038: Mineralocorticoid Antagonist Use for Transthyretin Amyloid Cardiomyopathy and Associated Outcomes
Authors: Lily K Stern, Seong Kyu Kim, Tahli Singer-Englar, Jon A Kobashigawa, Michelle M Kittleson, Jignesh K Patel
Journal: Circulation (2023)

Background: Diuretics have been the mainstay of symptomatic treatment for patients with amyloid cardiomyopathy however, there remains no established guideline directed medical therapy for this population. The anti-fibrotic properties of mineralocorticoid antagonists (MRA) are intriguing for potential use in transthyretin amyloid cardiomyopathy (ATTR CM); while they have shown promise for treatment of patients with heart failure with preserved ejection fraction, their use has never been studied specifically in the ATTR CM population. The purpose of our study is to evaluate the real-world use of MRA and associated outcomes in patients with ATTR CM at a large cardiac amyloid treatment center. Methods: Between 2009 and 2023, 168 patients with ATTR CM at our center were assessed for history of MRA use. Biomarkers, including baseline levels of troponin and natriuretic peptides, as well as kidney function were assessed. We also assessed the outcomes of 5-year survival, need for heart transplant, hospitalization, and mechanical circulatory support (MCS) use. Results: Of the 168 patients, 49 (29%) had a history of MRA use and 119 (71%) had no prior use. Between the two groups, there was no significant difference in age, frequency of ATTR CM subtype, kidney disease, or biomarker level at the time of diagnosis. While 5-year survival and need for MCS were similar between the two groups, there was a higher rate of transplant and hospitalization in the MRA use group. Conclusion: In a cohort of patients with ATTR CM, MRA use is uncommon and was not associated with improved outcomes. It was associated with higher rates of hospitalizations and heart transplantation; however, this may represent confounding by indication. Future investigations with larger registry cohorts and randomized control trials are warranted for further evaluation of biological and clinical effect of MRA use.
Abstract 16880: Perceived Control Moderates the Relationship Between Fatigue and Self-Care in Patients With Heart Failure
Authors: Hiroko Higa, Miyuki Tsuchihashi-Makaya
Journal: Circulation (2023)

Introduction: Fatigue is associated with poor self-care in patients with heart failure (HF). However, factors of fatigue include not only physical factors but also psychological factors, making it difficult to manage. Perceived control refers to the ability to cope with threats and has a significant impact on self-care and fatigue. Hypothesis: We hypothesized that a higher perceived control would lead to better self-care, even if the level of fatigue was comparable. This study aimed to determine whether the perceived control moderates the relationship between fatigue and self-care in patients with HF. Methods: In this cross-sectional study, outpatients with HF (n = 165, 78.8% male, mean age = 69.5 years) completed an assessment of fatigue using the Brief Fatigue Inventory (BFI) and perceived control using the Control Attitude Scale Revised (CAS-R). Participants were categorized into four groups with High (H) and Low (L), H/H, H/L, L/H, and L/L, using the median of BFI and CAS-R scores. Self-care was measured using the Self-Care of HF Index (SCHFI v 6.2), which consists of three subscales, maintenance (adherence to treatment), management (management of symptoms) and confidence. All SCHFI scores were standardized (0–100). A higher score indicates better self-care. Analysis of variance was used to examine differences in four groups using the SCHFI scores. Results: There was a significant difference in SCHFI-maintenance (p = 0.018), especially between H/L and L/H (61.8± 17.3 vs. 70.8 ± 17.3, p = 0.026). Additionally, H/H tended to be higher than H/L (71.3 ± 11.73 vs. 61.8 ± 17.3, p = 0.069). There was a significant difference in SCHFI-management (p &lt;0.001). H/H was significantly higher than H/L (60.1 ± 18.6 vs. 38.3 ± 22.5, p = 0.000), and L/H was significantly higher than L/L (53.3 ± 23.8 vs. 33.3 ±22.9, p &lt;0.001). Similarly, significant differences were found in SCHFI-confidence (p &lt;0.001). H/H was significantly higher than H/L (47.2 ± 21.6 vs. 28.8 ± 15.1, p &lt; 0.001), and L/H was significantly higher than L/L (50.2 ± 21.6 vs. 22.8 ± 10.7, p &lt;0.001). Conclusions: Perceived control might moderate the relationship between fatigue and self-care. Interventions for HF self-care require improvements in perceived control as well as physical factors, such as symptoms.
Abstract 18732: Investigating the Impact of Weather Conditions on Out-of-Hospital Cardiac Arrest Occurrences in Hungary
Authors: Adam Pal-Jakab, Bence Sipos, Kiss Boldizsar, Bettina Nagy, Gyorgy Papai, Gabor Csato, Nora Boussoussou, Gabor Lovas, Brigitta Szilagyi, Peter Sotonyi, Endre Zima
Journal: Circulation (2023)

Introduction: The growing recognition of environmental factors that play a crucial role in the incidence of Out-of-hospital cardiac arrests (OHCA) has been reflected in various research studies. Hypothesis: Our goal was to explore the links between various weather conditions and the frequency of OHCA in Hungary from November 1, 2018, to April 25, 2022. Methods: We conducted a comprehensive analysis using data from the Hungarian National Ambulance Service and weather records. T-tests were employed for normal distributions, and Mann-Whitney tests were used in other instances. A significance level of 0.05 was applied in both cases. Results: We observed a noticeable rise in OHCA incidents during periods of extreme cold (average daily temperature (T) below 0 °C) and extreme heat (average daily T over 25 °C). Instances of OHCAs were significantly higher on days with rapid T changes (intraday T shift above 5 °C), with a p-value of 0.013. The frequency of OHCA cases also saw a notable increase on frontal days compared to non-frontal days. However, we found no significant correlation between precipitation and OHCA cases. Conclusions: In conclusion, our analysis found significant associations between extreme cold and heat, and rapid T changes with the incidence of OHCA, while frontal days and precipitation did not reach statistical significance. Climate Change National Laboratory RRF-2.3.1-21-2021
Abstract 18987: A 10-Year Contemporary Analysis of Outcomes of Patients With Amyloidosis and VT Underdoing Ventricular Tachycardia (VT) Ablation
Authors: Rohan Umrani, Martin Matsumura, Yaser Khalid, Trinava Roy, Neethi Dasu, Kirti Dasu
Journal: Circulation (2023)

Introduction: Cardiac amyloidosis (CA) can lead to heart failure and arrhythmias as a result of electromechanical cardiac remodeling. CA is most associated with atrial fibrillation, however, small studies have shown that the highest risk population is those with ventricular tachycardia (VT). There are limited studies on the clinical implications of patients with cardiac amyloidosis and VT undergoing VT ablation (VTA) versus medical therapy. This study’s aim is to assess mortality and outcomes in patients with CA undergoing VTA vs medical therapy. Hypothesis: We anticipate CA patients undergoing VTA will have better outcomes than their medically managed counterparts. Methods: The US National Inpatient Sample (NIS) was searched for patients with CA with and without VTA as a secondary diagnosis using ICD-9/10 codes from 2010 to 2020. Primary outcomes were inpatient mortality, hospital length of stay (LOS), and total hospital charges (TOTHC). Data analysis utilized propensity matching via the Kernel Method. Results: his study included 357,350 patients with CA, of which 92,750 underwent VT ablation (Group A), which was compared with CA patients receiving medical therapy (Group B). Group A had decreased mortality (5.27% vs 11.33%, p&lt;0.0001), but increased LOS (+6.81 days, p&lt;0.0001, CI: 6.15-7.47), and TOTHC ($240,459.80, p&lt;0.0001, CI: 105,536.40-375,383.30). Secondary analysis is described in Table 1. Conclusions: Although LOS and TOTHC were increased in patients with CA with VTA, overall mortality was decreased compared to those with CA managed medically. Numerous risk factors were identified that worsen hospital outcomes in this population. Our study demonstrates that early referral to EP and early VT ablation could be the best management strategy for patients with CA and VT as they had significantly reduced mortality compared to the group which only had medical management.
Abstract 14294: Effect of Atrial Fibrillation on Patient-Reported Outcomes in Heart Failure With Reduced Ejection Fraction: Secondary Analysis of Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure: HF-ACTION Trial
Authors: Khaled Elkholey, Stavros Stavrakis
Journal: Circulation (2023)

Background: Atrial fibrillation (AF) and heart failure (HF) both significantly impact morbidity and mortality, and also account for impaired quality of life. Patient-reported outcomes represent the most direct measurement of quality of life, without influence of interpretation by the clinician. We sought to evaluate the effect of AF on patient-reported outcomes using the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with HF with reduced ejection fraction (HFrEF) enrolled in HF-ACTION trial. Methods: This was an exploratory post-hoc analysis of the HF-ACTION trial. Patients with reported KCCQ at randomization were included in this analysis. KCCQ was collected at randomization, 3, 6, 9, 12, 24, 36 months. Mixed effects regression modeling was used to explore the effect of AF status at the time of randomization on longitudinal changes in the KCCQ- overall symptom score (OSS) over the duration of follow-up. Covariates adjusted for included age, BMI, sex, race, ejection fraction (EF), NYHA class, HF etiology, smoking, revascularization, MI, and use of Beta blockers, Digoxin, Diuretics, or ACEIs/ARBs. Results: A total of 2129 patients (mean age 58.5±12.6 years, males 71.9%) with available KCCQ-OSS at baseline were included and AF was prevalent in 443 (20.8%) patients. AF patients were more likely to be older white males and had lower BMI; with higher prevalence of NYHA classes III/IV, prior MI, revascularization, and ischemic etiology for HF. AF Patients had significantly lower KCCQ-OSS at 3 years (59.9±22 vs. 67.6±19.9, p= 0.002) compared to those without AF. There was a significant time by AF status interaction (p=0.045), suggesting that KCC-OSS changed differently overtime based on the AF status. Conclusion: Among patients with HFrEF from HF-ACTION trial, prevalent AF at baseline was associated with lower quality of life and lower KCCQ-OSS over 3 years of follow-up, suggested by the significant interaction between AF status and time of follow-up.