tbuckley/cabot-search huggingface dataset:
Abstract 11645: Virutal Simulation-Based Continuing Medical Education Improves Diagnosis and Management of Atrial Fibrillation
Authors: Margaret Harris, Michael Lacouture, Philippe Guedj, Jennifer Hakkarainen
Journal: Circulation (2023)

Introduction: The ability of virtual patient simulation (VPS) case-based interventions to improve clinical decision making for patients with atrial fibrillation (AF) is unknown. Methods: Two patient cases were presented using a VPS platform where learners could order tests, make diagnoses, and order treatments in a manner matching the scope and depth of actual practice. Clinical decisions were analyzed, and learners received clinical guidance (CG) based on current evidence and expert recommendations. Learners could modify their decisions post-CG. Pre-(baseline) vs. post-CG decisions were compared using McNemar’s test. The intervention launched in August, 2022 and data were collected through December, 2022. Results: Overall, 1599 physicians participated. Physician specialties included cardiology (65%) and primary care physicians (35%). Significant improvements were seen for appropriate, timely diagnosis of AF and treatment selection in the overall learner population; treatment improvements were greatest for tailoring anti-arrhythmic drug (AAD) therapy in patients with recently diagnosed AF ( Table ). Improvements in selection of appropriate anti-arrhythmic drug (AAD) was observed for all specialties, although specialty-specific differences were apparent ( Table ). Significant improvements were also observed for selection of appropriate monitoring strategies to determine response to treatment and reaching treatment goals ( Table ). Conclusion: Case-based AF intervention employing VPS was associated with improvements in diagnostic and therapeutic decision-making among cardiologists and PCPs. Despite the observed improvements, gaps remain in diagnosing and selecting appropriate rhythm control management strategies for patients with AF.
Abstract 11734: Allopurinol &amp; Plaque Stabilization in Patients With Acute Coronary Syndrome: A Randomized Clinical Trial
Authors: Miao Yu, Jin Gu, shi heshui, Zheng-Feng Zhu, Fen Yang, Yuan-Fan Yuan, You-Cai Zhou, xiang cheng
Journal: Circulation (2023)

Background: Allopurinol, a xanthine inhibitor that lowers uric acid (UA) concentration, has been proven to reduce inflammation and oxidative stress in patients with cardiovascular disease. However, it is unknown whether these beneficial effects translate into favorable plaque modification in acute coronary syndromes (ACS). Aims: This study aimed to investigate whether allopurinol therapy could improve plaque stabilization in ACS patients using coronary computed tomography angiography (CCTA). Methods: This was a prospective, single-center, randomized, double-blind clinical trial began in March 2019 (clinical trial.gov identifier NCT03745729). A total of 162 acute coronary syndromes (ACS) patients aged 18-80 years with a blood level of high-sensitivity C-reactive protein (hsCRP) &gt; 2 mg/L were included. The subjects were randomly assigned in a 1:1 ratio to receive either allopurinol sustained-release capsules (at a dose of 0.25 g once daily) or placebo for 12 months. The primary efficacy endpoint was the change in low-attenuation plaque volume (LAPV) from baseline to the 12-month follow-up. Results: Among 162 patients, 54 in allopurinol group and 51 in placebo group completed the study. There were no significant differences between the allopurinol and placebo groups in terms of baseline data for age (58.5±10.2 years vs. 56.8±10.0 years, P=0.392) and sex (male/female, 40/14 vs. 40/11, P=0.600). The median follow-up duration was 14 months in both groups. Compared with placebo, allopurinol therapy did not significantly alter LAPV (-13.4±3.7% vs. -17.8±3.6%, P=0.390), intermediate attenuation plaque volume (-16.1±3.0% vs. -16.2±2.9%, P=0.992), dense calcified plaque volume (12.2±13.7% vs. 9.7±13.0%, P=0.894), total atheroma volume (-15.2±3.2% vs. -16.4±3.1%, P=0.785), remodeling index (2.0±3.9% vs. 5.4±3.8%, P=0.536) or hsCRP levels (-73.6 [17.9-91.6] % vs. -81.2 [47.7-95.4] %, P=0.286). Conclusions: Our findings suggest, for the first time, that allopurinol therapy does not improve atherosclerotic plaque instability or inflammation in ACS.
Abstract 11768: Regression of Inflammation by Cardiac Magnetic Resonance in Chronic Chagasic Patients Treated With Benznidazole
Authors: Silvana Silva, Marcio V Barros, Maria D Nunes, Lea Silva, Thor Edvardsen, Fernanda Araujo, Carlos Souza Filho, Fernanda Coelho Rodrigues Fernandes, Gabriel Venturim Porto, Henrique Lacerda, João Pedro de Barros Moretzsohn, Thiago Veiga, Ester Cerdeira Sabino, Antonio L Ribeiro
Journal: Circulation (2023)

Introduction: Chagas disease (CD) is a neglected disease caused by Trypanosoma cruzi ( T. cruzi ), and benznidazole (BZN) is the most prescribed trypanocidal drug in Brazil in function of its best tolerability profile. While treatment with this drug is effective in acute disease, there is no consensus on its effectiveness in adults with chronic infection. Although it is now accepted that treatment directed against T. cruzi is necessary to avoid the long-term sequelae of the disease, the lack of reliable markers for assessment of treatment efficacy is a major obstacle to evaluating new drugs. Hypothesis: the objective of this study is to determine if BZN treatment reduces cardiac inflammation/fibrosis as assessed by magnetic resonance imaging (MRI), using parametric mapping techniques. Methods: Prospective, multi-center study of chronic CD patients underwent MRI T1 and T2 mapping and extracellular volume measurement (ECV) using the modified Look-Locker inversion recovery (MOLLI) sequence, undergoing treatment with BZN, at a dose of 300 mg/kg daily divided into two doses and taken for 60 days. Absolute change T1 and T2 mapping, ECV, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricle ejection fraction (LVEF) were analyzed from baseline to 6-month follow-up. Results: 53 patients (females 83%, 53.9 ± 11.9 years old) were studied. LVEDV (149 ± 27ml vs 147 ± 29ml, p = 0.52), LVESV (66 ± 29 vs 64 ± 15, p = 0.65) and LVEF (55 ± 11% vs 57 ± 8%, p = 0,28) did not change between baseline and post treatment. Native T1 time showed reduced values among anterior (1030 ± 41ms vs 1011 ± 52ms, p = 0.011), septal (1052 ± 53ms vs 1006 ± 38ms, p = 0.000) and lateral (1042 ± 55ms vs 1019 ± 44ms, p = 0.003) LV walls. T2 mapping showed reduction in LV septal wall (53 ± 4ms vs 52 ± 3ms, p = 0.005). ECV showed significant reduction from baseline to 6-month follow-up (29.9 ± 3,3% vs 28.2 ± 3.5%, p = 0.0001). Conclusions: For the first time, we observe favorable changes in CMR ECV, T1 and T2 mapping induced by benznidazole therapy in chronic Chagas disease patients. These findings suggest that there may be an opportunity to decrease fibrosis/inflammation in chronic CD patients with the use of this therapeutic approach.
Abstract 11662: Efficacy And Safety Outcome Of Intravenous Vernakalant For Recent-onset Atrial Fibrillation: A Systematic Review And Meta-analysis
Authors: Abiodun Idowu, Rahman Mohibur, Matthew Nguyen, Bruce Adrian Casipit, Olayiwola Bolaji, Mohammad Al madani, Ola Khraisha
Journal: Circulation (2023)

Introduction: Vernakalant hydrochloride is a relatively new atrial-selective antiarrhythmic approved in &gt;40 countries to pharmacologically cardiovert patients with recent-onset atrial fibrillation (ROAF). Due to safety concerns, it is yet to be approved in the USA. Objectives: To determine the effectiveness and safety of vernakalant in patients with ROAF. Methods: We systematically searched PubMed, EMBASE, Ovid MEDLINE, and CENTRAL from inception to December 2022 for studies that compared intravenous vernakalant to another drug(s) or placebo in patients with ROAF (onset ≤7 days). The pre-specified efficacy endpoint was conversion to sinus rhythm within 90minutes of administering interventions. Safety outcome of interest was mortality rate. Random-effects model meta-analysis was performed on extracted quantitative data. Results: 886 patients got vernakalant, 353 received placebo, and 401 got an antiarrhythmic agent. Vernakalant was significantly superior to placebo (conversion rate: 49.5% vs 6.2%, OR: 14.94, 95% CI: 7.18-31.07, P&lt;0.001, I 2 : 49%), Flecainide (72.3% vs 53.8%, OR: 2.44, 95% CI: 1.46-4.06, p&lt;0.001, I 2 : 0%), Amiodarone (55.7% vs 8.5%, OR: 17.42, 95% CI: 7.75-39.13, p&lt;0.001, I 2 : 0%), but not Ibutilide (62.4% vs 47.3%, OR: 1.77, 95% CI: 0.61-5.08, p=0.29, I 2 : 67%) in efficacy endpoint. In the vernakalant group, there was significantly lower incidence of ventricular arrhythmia (OR:0.65, 95% CI: 0.45-0.95, p=0.027) but higher incidence of bradycardia (OR:8.58, 95% CI: 4.69-15.67, p&lt;0.0001) and dysgeusia (OR:14.51, 95% CI: 7.03-29.95, p&lt;0.0001). No significant difference in mortality rate between vernakalant and other groups combined (OR: 2.51, 95% CI: 0.26-24.21, p=0.427). Conclusions: This hypothesis-generating study showed that intravenous vernakalant, though associated with a higher incidence of bradycardia and dysgeusia, is superior to placebo, Flecainide, and Amiodarone not Ibutilide in converting ROAF to sinus rhythm.
Abstract 12030: Predicting Atrial Fibrillation in Critically Ill Patients: A Machine Learning Approach
Authors: Laith Alomari, Zaid Al-Fakhouri, Yaman Jarrar
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is the most prevalent arrhythmia in critically ill patients, with significant implications for morbidity and mortality. Early prediction of AF risk is crucial for proactive management. This study aims to develop and validate a machine learning-based risk prediction model for AF in intensive care unit (ICU) patients. Methods: Using the Medical Information Mart for Intensive Care (MIMIC-IV) database, we conducted a retrospective cohort study that included adult ICU patients and collected 47 clinical and laboratory variables. The primary outcome variable was the development of AF within the first 48 hours of ICU admission. Various machine learning models were evaluated for their performance in predicting AF, and the best-performing model was further optimized using hyperparameter tuning. A compact model, incorporating only 15 variables and two novel features, was also developed to facilitate potential clinical implementation. The first new feature, ‘ older septic ’ indicated patients aged 70 or older with sepsis, capturing the combined effect of age and sepsis as a risk factor for AF. The second new feature, ‘ cardiac risk score ’ was a composite score considering patient’s pre-existing cardiac risk factors. Model interpretability was assessed using Shapley Additive exPlanations (SHAP) analysis. Results: The cohort comprised 46,266 ICU patients, with 4.6% developing AF within 48 hours of admission. The CatBoost Classifier model demonstrated superior performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.850 (95% CI: 0.811-0.889) on the test set. The compact model with new features yielded an AUC of 0.820 (95% CI: 0.782-0.858), which is a comparable performance using a fraction of the variables. SHAP analysis highlighted the importance of the newly created features as key predictors, indicating the significance of age, sepsis, and cardiac risk factors in AF development. Conclusions: This study underscores the potential of machine learning models in predicting AF development in ICU patients. The compact model, with a satisfactory AUC, can be a valuable tool for identifying high-risk patients, enabling timely interventions to mitigate the adverse outcomes associated with AF.
Abstract 11804: Implementing a Digitally-Enabled Community Health Worker Intervention for Patients With Heart Failure: A Randomized Controlled Trial
Authors: Jocelyn A Carter, Eric Isselbacher, Karen Donelan, Anne N Thorndike
Journal: Circulation (2023)

Introduction: Heart failure (HF) readmissions are a leading cause of US 30-day hospital readmissions. Factors related to clinical complexity and unmet social needs are among the key drivers associated with HF negative clinical outcomes. Digital platforms have shown promise in improving HF outcomes but limitations like patient lack of familiarity with technology and unmet social needs continue to limit implementation and adoption. Hypothesis: An intervention pairing HF patients with a digital platform and a community health worker (CHW) for 30 days post-hospital discharge is (a) feasible, (b) acceptable, and (c) can demonstrate preliminary effectiveness in reducing 30-day hospital readmissions, emergency department (ED) visits, and missed clinic appointments compared to control (CHW only). Methods: Participants (n=50; enrolled 9/2022-6/2023) were randomized to intervention (CHW + digital platform) or control (CHW only). Intervention participants received a digital platform within a mobile phone application (daily symptoms questionnaire, educational videos) connected to a biometric sensor (tracking heart rate, oxygenation, steps taken), a digital weight scale, and a digital blood pressure monitor. Feasibility (use of the platform and engagement with the CHW), acceptability (willingness to use the intervention again), and clinical outcomes (30-day readmissions, ED visits, and missed appointments) were tracked. Results: As of June 1, 2023 (n=42), preliminary analysis demonstrates intervention feasibility (participant use of the sensor (avr 11.1 hrs/day), digital blood pressure (1.3 times/day; SD=0.22) and weight scale (1.1 times/day (SD=0.18) on 81-86% of study days; symptom questionnaire completion on 75% of study days; &gt;3 CHW interactions occurred for 71% of participants) and acceptability (84% of participants indicated willingness to use the intervention again). Clinical outcome data analysis completion is forthcoming September 2023. Conclusions: A novel intervention combining a digital platform with CHW social needs care in HF was feasible and acceptable. Clinical outcome data analysis completion is forthcoming September 2023. A larger future clinical trial is needed to determine the intervention’s true effectiveness.
Abstract 12048: Aortic Vulnerable Plaques Including Cholesterol Crystals: Non-Obstructive General Angioscopy and Pathological Study
Authors: Yudai Tanaka, Keisuke Kojima, Yuta Hotsubo, Kurara Takahashi, Yuki Nakajima, SHOHEI MIGITA, Saki Mizobuchi, Masatsugu Miyagawa, Katsunori Fukumoto, Riku Arai, Tomoyuki Morikawa, Mineki Takashi, Daisuke Kitano, Nobuhiro Murata, Mitsumasa Sudo, Yasuo Okumura
Journal: Circulation (2023)

Introduction: Severe atherosclerosis of the aorta is known to be a risk of embolism to peripheral organs such as cerebral infarction and acute lower limb ischemia. Non-obstructive general angioscopy (NOGA) has high spatial and temporal resolution, and it is possible to dynamically observe various atherosclerosis in the aorta. Cholesterol crystals (CCs) which could be observed by NOGA scattered into the blood from ruptured plaques and caused inflammation. However, which NOGA-derived aortic plaques are high risk has not fully investigated yet. Aims: The purpose of our study was to evaluate aortic vulnerable plaques based on their frequency of scattering CCs. Methods: We investigated 52 consecutive patients with coronary artery disease who underwent NOGA between September 2021 and May 2023. Blood specimens were taken from a total of 118 NOGA-derived atheromatous plaques in the infrarenal abdominal aorta. Then, presence of CCs at each plaque was evaluated with polarized light microscopy using the filter paper rinse method. Results: The mean age of 52 patients in this study was 67.4 years, 82.7% were male, 36.5% had diabetes, 76.9% had dyslipidemia, and 82.7% had hypertension. CCs were detected in 28.8% (n=34/118) of the samples. The frequency of detection of CCs in aortic plaques was 52.5% for Puff Chandelier Rupture (PCR), 15.4% for Puff Rupture (PR), 4.5% for yellow plaques (YP), 0% for thrombi, and 0% for ulcer and fissure. P &amp;lt; 0.0001). Conclusions: Among aortic atherosclerotic plaques, many CCs were detected from PCR. PCR may be a vulnerable plaque that has a high impact on peripheral organs.
Abstract 11708: Examining the Impact of Social Determinants of Health in Cardiovascular Disease Risk Factors: Insights From an Implementation Study in a Rural Primary Care Clinic
Authors: Sameer Acharya, Yogesh Yadav, Dibyata Rana, Eric Elzinga, Amna Riaz, Kaili Du, Judy Griffin
Journal: Circulation (2023)

Introduction: The social determinants of health (SDoH) are associated with uncontrolled cardiovascular disease (CVD) risk factors and warrant attention. Methods: We describe methods and cross-sectional results of the SDoH screening and referral system at a resident-run primary care clinic at Cayuga Medical Center (total 30 residents ~539 patients seen/month with 12% no shows) starting from Nov 2019. Eight domains of SDoH including food security, utility, housing, childcare, finances, transportation, literacy, and social support were selected based on local county data and focus group discussions. We developed an annual screening tool and referral system integrated into the electronic medical record for any SDoH positive patients to the community health and social workers (CHW/SW), who facilitated access to community resources. Patient education about available community resources, regular follow-up visits with the physician and CHW/SW, and periodic SDoH screening were other key components. Results: Among 741 patients (Hypertension and Diabetes), 607 (82%) patients underwent SDoH screening (Table). 200 (33%) patients had at least one domain of SDoH (SDoH +) and received SDoH interventions whereas, 407 (67%) did not have any SDoH. The three most common SDoH were lack of social support (61%), transportation (35%) and finance issues (25%). Patients in the SDoH+ group were younger, with higher percentage of non-White race/ethnicity, unemployment, disability, living alone, current smokers, illicit substance use, anxiety, depression, obesity, and opioid use with statistical significance. However, there were no significant differences in CVD risk factors like SBP (138.3 vs 138.4 mmHg), DBP (84 vs 83 mmHg), HbA1c (6.4 vs 6.2) and LDL-c (103.7 vs 101.5 mg/dL). Conclusions: In addition to controlling standard CVD risk factors, implementation of SDoH routine screening and referral system in a primary care clinic may help in mitigating CVD burden as seen in our study.
Abstract 11711: Factors Predicting Acute Ischemic Stroke Following Surgical Repair of Acute Type A Aortic Dissection (ATAAD) in Adults
Authors: Prince K Pekyi-Boateng, Isaac Prempeh, George Blankson, Rex Bonsu, Babbel Agbinko-Djobalar, Nana Agyeman Badu, Balkiranjit Kaur Dhillon, Rahat A Memon, Nadia I Wuni, George Blewusi, Derick Boateng, Smith Frimpong, petras lohana, Joshua Asempa, Stephen K Gbekor, EWURADJOA AYIREBI-ACQUAH, Hamilton Abimbilla, Richmond Buckner, Kwame Adjei-Sefah, Patrick D Pekyi-Boateng, Hemamalini Sakthivel, Kamleshun Ramphul, Fiifi Duodu
Journal: Circulation (2023)

Introduction: Acute type A Aortic dissection (ATAAD) may require urgent surgical repair, and a major complication is acute ischemic stroke (AIS) post-surgery. Aim: To explore characteristics associated with AIS in ATAAD patients post-surgical repair (PSR). Hypothesis: We assessed the hypothesis that multiple factors influence events of AIS in ATAAD patients PSR. Method: Multivariate regression analysis for factors influencing AIS in adults with a principal diagnosis of ATAAD and undergoing surgical repair was performed via the 2016-2020 National Inpatient Sample. Results: Among the 20335 ATAAD cases with surgical repair, 14.7%(2985 cases) reported an event of AIS. Individuals ≥60 years (vs. ages 18-39 years, aOR 1.323, p=0.007) and presence of hypertension (aOR 1.228, P&lt;.001), acute kidney injury (AKI) (aOR 1.353, P&lt;.001), Charlson Comorbidity Index (CCI) ≥3 (aOR 15.129, p&lt;.001), and Private insurances (vs. Medicare, aOR 1.454, p&lt;.001) or Medicaid (vs. Medicare, aOR 1.673, p&lt;.001) showed higher odds of developing AIS. On the contrary, smoking (aOR 0.613, p&lt;.001), obesity (aOR 0.882, p=0.027), cirrhosis (aOR 0.309, p&lt;.001), dyslipidemia (aOR 0.732, p&lt;.001), diabetes (DM) (aOR 0.508, p&lt;.001), peripheral vascular disease (PVD) (aOR 0.615, p&lt;.001), Chronic Kidney Disease (CKD) (aOR 0.446, p&lt;.001), prior MI (aOR 0.461, p&lt;.001) and prior stroke (aOR 0.788, p=0.04) and Black race (aOR 0.736, p&lt;.001) indicated lower odds. No significant difference was seen in age 40-59 (aOR 1.06, p=0.545), drug abuse (aOR 1.093, p=0.451), alcohol abuse (aOR 0.925, p=0.476), Females (vs. Males, aOR 0.973, p=0.579), and Hispanics (vs. Whites, aOR 1.102, p=0.285). Conclusion: In conclusion, a 14.7% rate of AIS in ATAAD PSR was observed. Ages ≥60, hypertension, AKI, CCI ≥3, and Private and Medicaid insurance holders appeared prone to AIS following such events, while smoking, obesity, cirrhosis, dyslipidemia, DM, PVD, CKD, prior MI, prior stroke, and Blacks had reduced odds.
Abstract 11810: Is the Presence of Statin Use Before Onset of Disease Associated With In-Hospital Mortality in Elderly Patients With Acute Myocardial Infarction?
Authors: Hiroyuki Tabata, Daisuke Kanda, Kenta Ohmure, Daichi Fukumoto, Hirokazu Shimono, Nobuhiro Ito, Yoshiyuki Ikeda, Mitsuru Ohishi
Journal: Circulation (2023)

Introduction: The effect of statin on preventing cardiovascular events is clear, and aggressive lipid-lowering therapy with statins is strongly recommended for patients with coronary artery disease including of acute myocardial infarction (AMI). Hypothesis: The relationship between in-hospital mortality of AMI and statin use before onset of AMI in the elderly patients is unknown, we thus assessed. Methods: The subjects were 207 consecutive AMI patients aged 65 years or older who underwent successful percutaneous coronary intervention (PCI) at Kagoshima university hospital between January 2015 and March 2021. We investigated the association between in-hospital mortality after PCI and baseline characteristics including Global Registry of Acute Coronary Events (GRACE) risk score, which is widely used for estimating mortality in AMI patients. Results: Twenty-three patients (11%) died in-hospital. The mortality rate was significantly lower in patients who were taking statins at presentation compared to those who were not (3% vs. 16%, p=0.002). Univariate logistic regression analysis of risk factors for in-hospital mortality revealed that statin use before onset of AMI, level of serum albumin, level of high sensitivity C-reactive protein (hs-CRP) and GRACE risk score were associated with in-hospital mortality. Multivariate logistic analysis models adjusted for age, statin use, level of serum albumin, level of hs-CRP, and GRACE risk score showed that statin use [Odd's ratio (OR): 0.13, 95% confidence interval (CI): 0.02-0.81, p=0.029] and GRACE risk score (OR: 1.04, 95% CI: 1.02-1.06, p &lt;0.001) were independently associated with in-hospital mortality. The optimal cut-off on the receiver-operating characteristic curve of GRACE risk score for predicting in-hospital mortality was 160. In addition, multivariate logistic analysis models using GRACE risk score ≥160 and non-use of statin before the onset of AMI showed greater risk of in-hospital mortality (HR 19.24; 95% CI 6.62-55.94; p &lt;0.001) after PCI as compared to patients with GRACE risk score &lt;160 and statins use. Conclusions: In elderly AMI patients undergoing PCI, statin use before the onset of AMI was an independent risk factor for in-hospital mortality, as was the GRACE risk score.