tbuckley/cabot-search huggingface dataset:
Abstract 4118668: Understanding Medication Adherence to Oral Anticoagulants in Atrial Fibrillation Management: Patient and Provider Perspectives in a Mixed Methods Study
Authors: Monique Gill, Kyle Jones, Ritu Ghosal, Aisha Gilmore, Angela Johnson, Eleni Wilson, Mary Imboden, Mohammad Ateya, Feng Dai, Laura Manzey, Kevin Townsend, Staci Wendt
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) increases risk of stroke. National guidelines recommend oral anticoagulant (OAC) use to reduce this risk. Medication adherence is pivotal for effective AF management, necessitating an understanding of adherence barriers. Aims: This mixed-methods study aimed to identify patient and provider factors influencing OAC adherence. Methods: Patients with nonvalvular AF and OAC prescriptions were sampled from a large community health system serving seven states. A stratified random sample of 2,000 patients was surveyed by mail, achieving a 13.3% response rate (266 patients). Twenty-eight semi-structured interviews were conducted with a purposive sample of patient survey respondents. Eligible providers were surveyed by email, resulting in a 3% response rate (78 providers). Survey data were analyzed descriptively and using multivariable regression models. Interview data were analyzed thematically. Results: Of 213 patients with an adherence score available, 31.5% reported non-adherence. Nonadherent patients were more likely to report poor healthcare experiences, including discrimination in a healthcare setting and poorer mental/emotional health. Receiving information from providers was significantly associated with adherence, especially among younger patients and those with fewer chronic conditions. High self-efficacy score was associated with adherence, particularly among older and rural patients. Interview analyses showed provider communication about AF medications, perceptions of AF as a serious illness, and a sense that medication was helping manage AF were all important for medication adherence. In contrast, most providers (87%) perceived high non-adherence among AF patients, citing forgetfulness, cost, and side effects as the main reasons. Providers’ responses indicate a need for improving communication and support for addressing adherence barriers. Conclusion: Most patients reported adherence to their medications, with adherence being associated with positive healthcare experiences and better mental/emotional health. Providers perceived relatively low adherence among their patients but aligned with patients on the need for improved communication and shared decision making. Tools that encourage discussion with patients and open communication between providers and patients are pivotal for optimizing patient care and enhancing medication adherence and treatment outcomes.
Abstract 4119611: Catheter ablation approach and outcome in HIV+ patients with atrial fibrillation: a systematic review and meta-analysis
Authors: Roberto Mazetto, Elisio Bulhoes, Ivo Queiroz, Vanio Antunes, Maria Luiza Rodrigues Defante, Pedro Romeiro, Lucas Barbosa, Beatriz X. Mendes, Catarina Silva, Eduarda Bastos, Camila Guida
Journal: Circulation (2024)

Background: Catheter ablation has emerged as an effective treatment option for atrial fibrillation (AF) in the general population. However, limited data exist on the outcomes of catheter ablation in patients infected with the Human Immunodeficiency Virus (HIV+) with concomitant AF. Objectives: This systematic review and single arm meta-analysis aims to comprehensively evaluate the literature on catheter ablation approach and outcome in HIV+ patients with AF. Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted following PRISMA guidelines.Studies meeting the intervention of catheter ablation for AF in HIV+ patients, using radiofrequency, cryoballoon, or pulsed field ablation techniques, were included and data were collected and synthesized using proportion meta-analysis techniques. Statistical analysis was carried out using R software. Results: Three studies met the inclusion criteria, involving 89 HIV+ patients, with an average age of 51.5 years, of whom 83.1% were men, undergoing catheter ablation. Two studies performed received isolation of the pulmonary vein (PV) + posterior wall and superior vena cava. And one study evaluated only the isolation of the pulmonary veins. Of these patients, 43.8% had paroxysmal AF and 56.1% had persistent AF. In two studies reporting freedom from atrial arrhythmias, all patients (62) experienced recurrence of atrial arrhythmias within 5 years of follow-up. Freedom from repeat ablation was 6.26% (Figure 1A). The rate of Pulmonary Vein Trigger was 31.28% (Figure 1B), while the rate of Non-Pulmonary Vein Trigger (non-PV) was 76.64% (Figure 1C). Conclusion: In this systematic review and meta-analysis assessing outcomes of ablation in HIV patients with AF, we observed a similar prevalence of paroxysmal and persistent AF. Furthermore, contrary to the non-HIV+ patients, a high incidence of non-pulmonary vein triggers of AF was noted in this population.
Abstract 4121672: Multi-level Factors Mediated the Associations Between Perceived Neighborhood Measures and Type 2 Diabetes: The Midlife in the United States III
Authors: Kosuke Tamura, Mohammad Moniruzzaman, Breanna Rogers, Yangyang deng, Lu Hu, Ram Jagannathan
Journal: Circulation (2024)

Introduction: The determinants of type 2 diabetes (T2D) are multifaceted, encompassing individual, psychosocial, health, and neighborhood factors. While these factors have been explored, the mechanisms underlying perceived neighborhood measures and T2D remain understudied. We aimed to test whether psychosocial, health, and inflammatory factors mediate the association between perceived neighborhoods and T2D among adults. We hypothesized that these factors mediate the relationship between perceived neighborhoods and T2D. Methods: Data from the Midlife in the United States 3 (MIDUS3, 2013-2014; MUDIS3 Biomarker Project, 2017-2022) were used (n=564, mean age: 60.7y, female:53.2%, White adults:95.7%). Higher perceived neighborhood scores (social cohesion, safety, quality) represent favorable neighborhoods. T2D (y/n) was defined as either A1c≥6.5%, FGL≥126mg/dL or self-reported T2D. Physical activity (PA), BMI, depression, stress, and CRP were tested as mediators in the cross-sectional association between perceived neighborhood measures and T2D using linear regression (reported odds ratio [OR]) with bootstrap-generated 95% bias-correct confidence intervals (BC CIs) adjusted for covariates (Table). Results: Higher neighborhood social cohesion was indirectly related to lower odds of T2D by PA (OR: 0.93 [95%BC CI: 0.86, 0.98]), BMI (OR: 0.90 [0.80, 0.99]), depression (OR: 0.86 [0.75, 0.97]), stress (OR: 0.88 [0.78, 0.97]), and CRP (OR: 0.91 [0.82, 0.98]). Higher neighborhood safety was indirectly related to lower odds of T2D by depression (OR: 0.90 [0.79, 0.98]) and stress (OR: 0.89 [0.77, 0.97]). Higher neighborhood quality was indirectly related to lower odds of T2D by PA (OR: 0.90 [0.82, 0.98]), depression (OR: 0.82 [0.68, 0.96]), stress (OR: 0.83 [0.70, 0.96]), and CRP (OR: 0.88 [0.75, 0.98]). Conclusions: Favorable perception of neighborhoods had significant indirect associations with T2D via PA, BMI, depression, stress, and CRP. These mediators could be potential targets for intervention alongside promoting better neighborhoods to improve T2D outcomes. Future studies should replicate this line of research in diverse cohorts to address T2D disparities by socioeconomic status.
Abstract 4122590: Sex Differences in the Prescription of P2Y12 Inhibitor Agents Following Percutaneous Coronary Intervention
Authors: William Laband, Surik Sedrakyan, M Faisal Khan
Journal: Circulation (2024)

Background: There remain significant gender inequalities in the delivery of healthcare. Third generation P2Y12 inhibitors (P2Y12i), Prasugrel and Ticagrelor, are the standard of care for dual antiplatelet therapy (DAPT), especially in the setting of acute coronary syndrome (ACS). We hypothesized that women are less likely to be prescribed 3 rd generation P2Y12i than clopidogrel, due to concealed gender inequalities. Methods: We examined gender differences in post percutaneous coronary intervention (PCI) care in a cohort of 12,354 PCI cases from all 14 hospitals within the Steward Health Care system in the United States of America (USA). After removal of duplicates, 10,415 patients were included in the final analysis, with 7,191 males (69.04%) and 3,224 (30.96%) females. We conducted statistical analyses using the Chi-Square test of independence to explore associations between categorical variables, and logistic regression analysis to model the probability of clopidogrel prescription based on patient characteristics, adjusting for confounders. Results: We found that women were less likely than men to be prescribed 3 rd generation P2Y12i compared to clopidogrel with an odds ratio (OR) of 0.74 (CI 0.69-0.80, p&lt;0.001). We adjusted for the following variables: age, weight, insurance type, number of stents, and relevant co-morbidities. The association remained significant with an OR of 0.83 (CI 0.76-0.90, p&lt;0.001). In a subgroup of ACS patients, the association was also statistically significant with an OR of 0.77 (CI 0.67-0.88, p&lt;0.001). Conclusions: Our study reveals that significant gender disparities exist in the prescription of P2Y12i after PCI, with women having a greater likelihood of being prescribed clopidogrel compared to more effective and guideline directed, 3 rd generation agents. This association held true after accounting for confounding variables including older age and an increased prevalence of co-morbidities in the female group. Our conclusions are likely to have been influenced by unmeasured socioeconomic factors, such as household income and medication costs. Therefore, further research ought to be conducted to better understand the reasons behind the association observed.
Abstract 4118641: Trend, Survival, and Disparity Analysis of Heart Transplantation in a Single Large Transplant Center
Authors: ANIL KC, Devang Sanghavi, Anirban Bhattacharyya, Parag Patel, Si Pham, Pramod Guru, Sanjay Chaudhary
Journal: Circulation (2024)

Background: In the landscape of organ transplantation, heart transplantation stands as a life-saving procedure for patients with end-stage heart failure. Comprehensive analyses of transplant programs are imperative to optimize outcomes and understand the complexities. Hypothesis: This study hypothesizes that an increasing trend of heart transplant service and short-term mechanical circulatory support (STMCS) is the bridge to transplant; the UNOS (United Network for Organ Sharing) guideline positively impacts STMCS utilization. Even with the standard of care, there might be a disparity in receiving care in terms of gender and race. Goal/ Aims: By examining this center's collective experience, this research provides valuable insights into the evolving landscape of heart transplantation, ultimately contributing to advancements in patient care and transplant policy. Methods: This retrospective cohort study includes heart transplant patients in a single large transplant center. For statistical analysis, Cox regression, Mann-Whitney test, Kruskal Wallis, and Chi-Square test were used in IBM SPSS 25. Result: Trends: This retrospective study covering 2010 to 2022 comprehensively analyzed 1513 heart transplant patients. The cohort consisted of 1071 (70.78%) males and 442 (29.21%) females, 31.9% were bridged through STMCS. 76.7% of Caucasian and 16.1% were African American.The mean utilization of STMCS was 20.08% before the UNOS policy change, increasing to 53.81% after that (p &lt; 0.001). Disparity Analysis: There was a statistically significant difference in STMCS utilization between white and black patients (p= 0.008) but no difference in between obese and non-obese cohorts (P=0.362).Wait time was similar among the genders (p=0.161) and different races (p=0.302). Survival Analysis: There is a significant survival discrepancy between patients bridged through MCS and those without STMCS(p&lt; 0.001). However, yearly trend analysis showed an evolving survival trajectory favoring STMCS users. There are statistically significant survival differences among whites and blacks (P =0.008) but similar among the genders (p=0.589). Summary: The study reveals significant changes in the trend of transplants regarding STMCS utilization since the UNOS guideline. There are substantial differences in survival between STMCS vs. non-STMCS groups and among the races.There was a significant difference in STMCS utilization among the races.
Abstract 4120716: Aspirin plus clopidogrel versus aspirin alone in patients with mild-to-moderate stroke: A systematic review and meta-analysis
Authors: Mushood Ahmed, Zain Nadeem, Areeba Ahsan, Eeshal Fatima, Laveeza Fatima, Rubab Zahra, Hritvik Jain, Raheel Ahmed, Shrey Gole, Adeel Ahmad, Kamleshun Ramphul, Farhan Shahid
Journal: Circulation (2024)

Background: Studies have shown that dual antiplatelet therapy (DAPT) is superior to aspirin monotherapy in patients with minor stroke or transient ischemic attacks. However, there is limited evidence regarding the efficacy and safety of DAPT in mild-to-moderate stroke. Aims: We conducted a systematic review and meta-analysis to evaluate whether DAPT is superior to single antiplatelet among patients with mild to moderate ischemic stroke. Methods: PubMed/MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov were searched from inception till March 2024 for published randomized controlled trials (RCTs) and observational studies that compared aspirin plus clopidogrel versus aspirin monotherapy in patients with mild-to-moderate stroke. R version 4.3.2 was used to calculate risk ratios (RRs) with 95% confidence intervals (95% CIs). Results: A total of 4 studies reporting data for 15,173 patients were included. DAPT was associated with a reduced risk of early neurological deterioration (END) (RR: 0.55, 95% CI: 0.28 to 1.05, p = 0.07 Figure 1A) and recurrent ischemic stroke (RR: 0.65, 95% CI: 0.41 to 1.04, p = 0.07 Figure 1B) without reaching statistical significance. The risk of recurrent hemorrhagic stroke (RR: 0.94, 95% CI: 0.47 to 1.86, p = 0.86 Figure 2A), all-cause death (RR: 0.75, 95% CI: 0.52 to 1.08 Figure 2B), or myocardial infarction (RR: 0.83, 95% CI: 0.45 to 1.54 Figure 2C) was comparable across the two groups. DAPT was not associated with an increased risk of any bleeding event (RR: 0.70, 95% CI: 0.36 to 1.36 Figure 2D). Conclusion: DAPT possibly reduces the risk of END and recurrent ischemic stroke as compared to aspirin monotherapy in mild or moderate stroke without increasing the risk of bleeding events.
Abstract 4122247: Impact of serum chloride levels for ventricular arrhythmias in patients with heart failure undergoing cardiac resynchronization therapy
Authors: Yoshiaki Minami, Atsushi Suzuki, manami ono, Shota Shirotani, Noriko Kikuchi, Hidetoshi Hattori, DAIGO YAGISHITA, Morio Shoda, Junichi Yamaguchi
Journal: Circulation (2024)

Background: As previous reports of ventricular arrhythmia (VA) as a prognostic marker of mortality in heart failure (HF) patients included those with implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices, little is known about the risk factors of VA among patients undergoing cardiac resynchronization therapy (CRT), especially those without previous VA. The prognostic role of electrolyte abnormalities has been highlighted in HF patients. This study evaluated the impact of serum chloride levels for VA and all-cause death in patients with HF who underwent CRT without VA before CRT implantation. Methods: From the retrospective cohort of 397 HF patients (age 63+/-13, male 74%) who undergoing CRT implantation between 2010 and 2020, this study enrolled 175 patients (82% implanted CRT with a defibrillator) without a previous history of VA (sustained ventricular tachycardia (VT) of ventricular fibrillation (VF)). We studied the impact of serum chloride levels before CRT implantation. The primary endpoint was defined as VA, VA with ICD therapy and sudden cardiac death. The secondary endpoint was all-cause mortality. Results: During median follow-up of 35 months, 53 patients (30%) experienced VA. Patients with VA had a tendency toward high LVESV (172ml vs. 150ml, p&lt;0.09) and low left ventricular ejection fraction (26 vs. 29, p&lt;0.09), and significantly reduced rate of angiotensin converting enzyme inhibitors or angiotensin receptor blockers (30% vs. 70%, p&lt;0.05) at the time of CRT implantation. The rate of CRT responders was significantly higher in patients without VA than with VA (59% vs. 40%, p&lt;0.05). The cut-off value of chloride for VA was determined to be 102mEq/l using receiver operating characteristic analysis. The patients with chloride ≤102mEq/l had significantly higher rates of VA (41% vs. 25%, log-rank p&lt;0.05) and mortality (33% vs. 18%, log-rank p&lt;0.05) (Figure). By multivariate cox analysis, the level of chloride had an independent predictive value of VA in patients with CRT (hazard ratio [HR] 1.08 per 1mEq/l decrease, 95% confidence interval [CI] 1.00-1.16, p&lt;0.05) (Table). Conclusions: The chloride level had a predictive value for VA after CRT implantation in HF patients without previous VA. The management of electrolytes, including chloride, might be important for preventing fatal arrhythmia in patients with HF undergoing CRT implantation.
Abstract 4122008: Bayesian modeling to forecast mortality due to Ischemic Heart Disease, Stroke, and Peripheral Artery Disease in Brazil until 2040
Authors: Pedro Salerno, Antoinette Cotton, Bruno Nascimento, Zhuo Chen, Gabriel Tensol Rodrigues Pereira, Alexandre Abizaid, Luis Augusto Palma Dallan, Pedro Rafael Salerno, Sadeer Al-Kindi, Fanny Petermann-Rocha, Salil Deo
Journal: Circulation (2024)

Introduction: Atherosclerotic cardiovascular disease, specifically ischemic heart disease (IHD), stroke, and peripheral artery disease (PAD) together are among the leading causes of cardiovascular mortality in Brazil. As the obesity, hypertension, and diabetes rates in the Brazil continue to increase, projecting mortality rates related to these conditions are important for guiding health policy. Hypothesis: We hypothesized that there are differences in the future trends of IHD, stroke and PAD in Brazil. Aims: We sought to forecast the trends in IHD, stroke, and PAD in Brazil until 2040 to fill in this important knowledge gap and inform public health policy development. Methods: We collected the annual death counts for IHD, stroke, and PAD and the mid-year population estimates in 5-year age brackets (40 – 79 years) between 1990 and 2019 from the Global Burden of Disease. We calculated the annual crude and age-standardized mortality rates (per 100 000 residents) for IHD, stroke and PAD between 1990 and 2019. Using this observed data, we estimated the projected mortality rates for these conditions till 2040 using Bayesian age-period-cohort (BAPC) models. Results: Brazil`s population (aged 40-79 years) will increase by 237.5% between 1990 and 2040. Nationally, compared to 2019, the age standardized IHD mortality is projected to reduce by 31.66 % [2019: 131.13, 2040:89.6 (IQR: 65.83, 113.37)] and stroke rates are estimated to reduce by 16.75% [2019: 91.09, 2040: 75.83 (IQR: 51.68, 99.98)]. However, PAD rates are projected to increase by 1.2% in the same period [2019: 1.58, 2040: 1.66 (IQR: 1.24, 2.07)]. The age standardized IHD and stroke mortality rates will reduce in males and females. However, the age standardized PAD rates will increase in females [2019: 1.33, 2040: 1.48 (IQR: 1.06, 1.89), 11.28% difference] and remain reasonably constant among males. Conclusion: In Brazil, the age standardized rates for IHD and stroke mortality are projected to decline till 2040. However, PAD related mortality is likely to be an important issue among females. Our findings highlight the need for early and targeted interventions to address these potential cardiovascular health disparities.
Abstract 4118724: Validity of a NYHA Classification Guide with Six Minute Walk Test Outcomes
Authors: Marilyn Prasun, Kelly Stamp, Lisa Rathman, Thomas McCoy
Journal: Circulation (2024)

Background: The New York Heart Association (NYHA) classification is a subjective tool that is commonly used in clinical practice to assess symptoms and functional capacity of patients with heart failure (HF). Correct assignment of NYHA is essential to facilitate evidence-based management. Research Question: What is the validity of the CLASS-HF Guide compared to the 6-minute walk test (6MWT)? Purpose: To examine the validity of the new investigator-developed CLASS-HF guide to assist in appropriate assignment of NYHA Class relative to the 6MWT. Methods: A multi-site, cross-sectional study in three cardiology clinical sites (two specializing in HF) recruited 103 patients in various classes and stages of HF. Providers assigned patients their NYHA Classification using the CLASS-HF guide. Patients then performed the 6MWT with test staff blinded to the assigned NYHA class. Exertion, dyspnea, and walk distance were captured post-test. The validity of the guide-assisted classification was then examined for convergent validity with 6MWT outcomes. Data analysis was performed with correlations, ANOVA, and multivariable regression. Results: Of the 103 total participants, 65.1% were male, 18.4% were non-White, with an average age of 66.0 ± 15.5 years old. A little less than one-third (30.1%) had HFpEF (LVEF ≥ 50%). Provider-assigned NYHA Class was 22.3% I, 38.8% II, 35.0% III and 3.9% IV. The average distance walked during the 6MWT by class was: 367.1 ± 85.6 m for I, 343.7 ± 104.7 m for II, 261.6 ± 73.9 m for III, and 184.6 ± 114.0 m for IV. Convergent validity of NYHA class with Borg exertion (Spearman’s r = .546, p &lt; .001) and dyspnea ( r = .504, p &lt; .001) was strong. A statistically significant inverse correlation was found between NYHA assigned class and meters walked during the 6MWT ( r = -.469, p &lt; .001), with significant mean differences (ANOVA F (3,99) = 10.72, p &lt; .001) in distance walked for: NYHA Class I vs. III ( md = 105.5 m), I vs. IV ( md = 182.6 m), II vs. III ( md = 82.1 m), II vs. IV ( md = 159.2 m). Increasing NYHA class remained significantly associated with lower 6MWT distance ( F (3,90)=5.22, p = .002) in multivariable regression (Adj. R -squared= .575) controlling for age, sex, race/ethnicity, diagnosis, site, Borg exertion and dyspnea, and 6MWT stopping/pausing. Conclusion: Validity evidence was found for NYHA class assignment after use of the CLASS-HF guide with respect to 6MWT distance and post-test perceived exertion and dyspnea.