tbuckley/cabot-search huggingface dataset:
Abstract 17046: Accuracy of Apple Watch for Detection of Atrial Fibrillation: A Systematic Review and Meta-Analysis
Authors: Farah Yasmin, Abdul Moeed, Mariam Adil, Saad Ur Rahman, F. Perry Wilson
Journal: Circulation (2023)

Background: Apple Watch (AW) for the detection of silent atrial fibrillation (AF) has shown encouraging results due to its photoplethysmogram (PPG) sensors. However, clinical accuracy studies show varying results. To the best of our knowledge, this is the first meta-analysis conducted to ascertain the pooled sensitivity, and specificity in AF detection using the AW. Methods: PubMed, Google Scholar, and Scopus were queried till May 2023 for studies examining the accuracy of AW in AF detection. The outcomes of interest were the sensitivity and specificity of AW for the detection of AF. Sensitivities and specificities were calculated using true positives, true negatives, false positives, and false negatives wherever applicable. A random-effects meta-analysis was conducted using the generic inverse variance method to pool sensitivities and specificities. Further, sensitivity analysis was performed excluding studies using KardiaBand. Results: A total of 12 studies with a patient population of 421,156 were included with a mean age of 63 years. 6/12 studies used AW series 4 or higher while 3/12 studies evaluated the use of KardiaBand on top of the AW. AF was detected in 3,184 patients from a total of 420,312 patients. Following pooled analysis, an overall point estimate of sensitivity was observed to be [0.87 (0.76, 0.98); Figure 1A]. Ten studies evaluated specificity, with the pooled estimate being [0.91 (0.87, 0.95); Figure 1B]. After excluding studies using KardiaBand, the sensitivity was reported as 0.84 [0.68, 1.00] and specificity was observed to be 0.94 [0.91, 0.98]. Conclusion: AW proved to be effective in detecting AF in our analysis owing to high overall sensitivity and specificity with and without the addition of KardiaBand. However, cardiologists should still exercise caution before undertaking action based on the electrocardiographic diagnosis generated by this wrist-worn monitor.
Abstract 12715: Can 18F-Fluorodeoxyglucose Uptake Stratify the Risk of the Patients With Cardiac Sarcoidosis After Initiation of Immunosuppressive Therapy?
Authors: Hideki Kawai, Masayoshi Sarai, Hiroyuki Naruse, Yasuchika Kato, Shinichiro Morimoto, Hideo Izawa
Journal: Circulation (2023)

Introduction: While 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is well-established for diagnosing cardiac sarcoidosis (CS) initially, its potential as a risk stratification tool for patients receiving immunosuppressive therapy remains controversial. Hypothesis: We aim to assess the prognostic value of FDG-PET in CS patients after 12 months of corticosteroid treatment. Methods: Our study consists of a retrospective review of clinical data and patient outcomes of stable CS cases that underwent FDG-PET following 12 months of corticosteroid treatment initiation. We excluded patients in the previous six months who had a heart failure hospitalization, sustained ventricular tachycardia (SVT) or ventricular fibrillation (VF), recent pacemaker implantation or upgrade, changes in corticosteroid dosage, or newly introduced additional immunosuppressive therapy. Major adverse cardiac events (MACE) include a composite of cardiac death, onset of SVT/VF, appropriate implantable cardioverter-defibrillator intervention, heart failure hospitalization, and cardiac functional deterioration. Results: Among the 72 analyzed patients, 35 exhibited cardiac accumulation in FDG-PET scans. Over an average of 49 (22-76) months, 19 patients experienced MACE. The occurrence of MACE was higher in the reduced left ventricle ejection fraction (LVEF) group (&lt;50%) than in the preserved LVEF group (≥50%) (51.5% vs. 5.1%, Log rank p &lt;0.001). Similarly, MACE was more common in the SVT/VF (+) group as compared to the SVT/VF (-) group (50.0% vs. 23.4%, Log rank p =0.041). However, the presence of cardiac accumulation in FDG-PET showed no significant correlation (Log rank p =0.718). Conclusions: The presence of residual cardiac accumulation after initiation of immunosuppressive therapy was not associated with the prognosis of the patients with CS. Established predictors, such as reduced LVEF and the occurrence of SVT/VF, remain integral in predicting MACE.
Abstract 18543: Association of Nonalcoholic Steatohepatitis With Predicted 10-Year Cardiovascular Risk, Independent of Diabetes Status (NHANES 2017-2020)
Authors: Jonathan J Woolley, Jesse Fishman, Christina Parrinello, Thomas O'Connell
Journal: Circulation (2023)

Introduction: Evidence suggests patients with nonalcoholic steatohepatitis (NASH), particularly those with significant fibrosis (stages ≥F2), have elevated CV-event risk. Hypothesis: The association of NASH with diabetes may confound the relationship between NASH and CV-event risk. Goals/Aims: To estimate primary CV-event risk associated with presumed NASH, adjusting for diabetes. Methods: A cross-sectional analysis of the 2017-March 2020 NHANES cycle was conducted. Presumed NASH was defined as evidence of steatosis (controlled attenuation parameter [CAP] ≥302 dB/m), exclusion of excessive alcohol consumption or hepatitis B/C, and FibroScan-AST (FAST) score ≥0.48. Non-NASH controls were matched 3:1 based on age, sex, and race. The 10-year probability of a primary CV event was estimated using the Framingham Heart Study risk equations. Linear models were used to estimate the association of presumed NASH with CV risk, with and without adjustment for diabetes, and distinguishing fibrosis stages F0-F1 vs F2-F4 within presumed NASH. Results: The analysis included 123/369 matched participants with/without presumed NASH. Mean (SE, P value) incremental probability of a primary CV event associated with presumed NASH was 1.4% (1.2%, P =0.26) before adjustment for diabetes, and 1.8% (1.0%, P =0.10) after adjustment. In participants ages &lt;65, the association with presumed NASH was statistically significant at 2.3% (1.1%, P =0.05) before adjustment for diabetes, and 2.1% (1.0%, P =0.04) after adjustment, and elevated in fibrosis stages F2-F4 (see Table). Limited sample size challenged reliability of estimates for ages ≥65. Conclusions: Among individuals ages &lt;65, a significant association of presumed NASH and primary CV-event risk was observed, before and after adjusting for diabetes. The incremental risk was greater for fibrosis stages F2-F4, suggesting the importance of accounting for fibrosis stage in predicting CV risk.
Abstract 14598: Predictive Value of the High Bleeding Risk Criteria of the Academic Research Consortium in Black and White Individuals
Authors: Rebecca Cohen, Alessandro Spirito, Samantha Sartori, Birgit Vogel, Brunna Pileggi, Paris Pentousis, Kenneth F Smith, Samin K Sharma, Annapoorna Kini, George Dangas, Roxana Mehran, Yujin Zhang
Journal: Circulation (2023)

Introduction: The High Bleeding Risk (HBR) criteria of the Academic Research Consortium (ARC) are a valuable tool for bleeding risk stratification in White and Asian patients undergoing percutaneous coronary intervention (PCI). Hypothesis: The predictive value of the ARC-HBR criteria may vary in Black patients. Methods: Patients who underwent PCI at a large tertiary-care center from 2012 to 2019 who self-reported as non-Hispanic White or Black were included and stratified in HBR and no-HBR based on the ARC-HBR definition. The primary outcome was major bleeding (according to a study specific definition) at 1 year after PCI; secondary outcomes included post-discharge major bleeding, all-cause death and myocardial infarction (MI). Results: Among 9462 patients, 1881 (19.9%) identified as Black and 7581 (80.1%) as White. In these two groups, the HBR criteria were met by 50.8% and 45.6% of patients, respectively, and the frequency of each individual ARC-HBR criterion differed (Figure 1). HBR was associated with a consistent higher risk of major bleeding in Black (7.8% vs. 3.5%, adj. HR 2.02, 95% CI 1.29-3.17) and White patients (7.5% vs. 2.7%, adj. HR 2.49, 95% CI 1.95-3.18, interaction p-value 0.451) (Figure 1). The HBR-related risk of post-discharge bleeding tended to be higher in Black patients (adj. HR 1.67, 95% CI 0.84-3.33) and was significantly increased in White patients (adj HR 3.09, 95% 2.06-4.64, interaction p-value 0.341). All-cause death and MI were increased in HBR patients consistently in the Black and the White group. The predictive value of the ARC-HBR criteria for major bleeding and post-discharge bleeding was good in both Black (0.72 and 0.74, respectively) and White (0.70 and 0.68, respectively). Conclusions: In Black and White patients undergoing PCI, the ARC-HBR criteria were differently distributed and had a good predictive value for major bleeding in both groups.
Abstract 16496: Future Hypertension Risk Among a Peripartum Cardiomyopathy Cohort From Kaiser Permanente Northern California
Authors: Alix P Fairman, Monica Choo, Richie Houhong Xu, Nikhil Joshi, Erica P Gunderson, Seema Pursnani
Journal: Circulation (2023)

Introduction: Women have unique sex-specific risk factors related to pregnancy and reproduction that are increasingly recognized as risk-enhancing factors for atherosclerotic cardiovascular disease (ASCVD). While studies have established hypertensive disorders of pregnancy as a risk factor for long-term maternal CVD and mortality, the long-term cardiovascular sequelae following peripartum cardiomyopathy (PPCM) are not as well established. Aims: To determine whether the occurrence of PPCM increases later risk of hypertension. Methods: Retrospective case-control study of pregnant patients identified within a Kaiser Permanente Northern California (KPNC) cohort of women with and without peripartum cardiomyopathy between 1998-2004, with up to 23 years follow up. Results: We identified 62 PPCM cases, matched by age, delivery year, gestational age, pre-existing hypertension, hypertensive disorders of pregnancy, and hyperlipidemia to a control group of women without PPCM (Table 1). There was a statistically significant greater odds of incident essential hypertension among those with PPCM, 58.1% compared to 20.4% of matched controls, OR 5.39 (95%CI: 2.9, 10.02) at a mean 11 years of follow-up. Conclusion: In the KPNC cohort, PPCM was a predictor for the development of essential hypertension later in life.*P&lt;0.0001Table 1. Baseline demographic and cardiovascular risk factors for women with peripartum cardiomyopathy compared to a matched cohort. Unless otherwise specified, numbers shown represent frequency (percentage of total).
Abstract 17996: One-Year Outcomes of Patients With ST-Segment Elevation Myocardial Infarction According to Eosinophil Blood Count
Authors: Michele Golino, Giuliana Corna, Francesco Moroni, Azita Talasaz, Josh West, Georgia Thomas, Salvatore Carbone, ROSHANAK MARKLEY, Jeremy Turlington, Justin M Canada, Antonio Abbate, Benjamin Van Tassel
Journal: Circulation (2023)

Background: ST-segment elevation myocardial infarction (STEMI) elicits an intense inflammatory response but the relation between eosinophil blood count and outcomes in this setting is not clear. Hypothesis: A difference in eosinophil blood count in patients with STEMI is associated with a different incidence of death or hospitalization for heart failure (HF). Methods: In this retrospective study using the US cohort of 49 healthcare organizations in the TriNetX database, we included 41,945 patients with STEMI (identified by ICD-10-CM code) between January 1, 2012, and June 2, 2022. Patients were divided into two groups according to the median of eosinophil blood count measured 2-3 days after the acute event in our previous study (0.2x103/μL). The Kaplan-Meier method was used to compare the risks of the composite outcome of death or HF hospitalization within the two cohorts. Results: We included 15,725 and 26,220 patients with median eosinophil blood count equal/above and below 0.2x103/μL, respectively. At 1-year follow-up, the risk of death or HF hospitalization was lower in patients with eosinophil blood count above/equal to the median, 0.2x103/μL (13.6% vs 18.9%; Hazard Ratio 0.68, 95% CI [0.64-0.71]; p&lt;0.001). The incidence of the composite outcome at 1 year was 15.3% and 21.5% for patients with median eosinophil blood count equal/above and below 0.2x103/μL, respectively (p&lt;0.001 for the log-rank test). Figure 1. Secondary analysis suggested that this result was driven mainly by lower mortality in the cohort with higher eosinophil count (10.1% vs 14.9%; HR 0.63, 95% CI [0.59-0.67]; p&lt;0.001). Conclusions: In our large 'real world' analysis, a higher eosinophil blood count within the normal range during the acute phase post-STEMI is associated with a better outcome of death or hospitalization for heart failure.
Abstract 18883: Inflammatory Bowel Disease is Not Significantly Associated With Cardiac Arrest in STEMI Patients
Authors: Alexander A Rizk, Mohammed Faisaluddin, Stavros Doumas, Ashwin Kumar, Amit K Dey, Sourbha Dani
Journal: Circulation (2023)

Introduction: Systemic inflammatory diseases, such as psoriasis, lupus, and rheumatoid arthritis, have exhibited a strong association with an increased incidence of cardiovascular events over a patient’s lifetime. However, there is limited information regarding outcomes, particularly cardiac arrest, in STEMI patients with concurrent IBD. Thus, our study aims to assess potential outcomes, including cardiac arrest, in STEMI patients with IBD, utilizing a nationally representative sample of adult individuals in the United States, with a specific focus on MACE and associated risk factors. Our study provides valuable insights into the cardiovascular implications and associated risk factors in this unique patient population. Methods: The US-based National Inpatient Sample was queried between 2015 and 2020 using ICD-10 codes for adults ≥ 18 years with STEMI with and without IBD. The adjusted odds ratio of index hospitalization outcomes was calculated using a multivariate logistic regression analysis. Results: Overall, 3,960 out of 898,525 (0.44%) STEMI patients reported a history of IBD. Patients with IBD were predominantly middle aged, white, and female compared to non-IBD patients. STEMI patients with IBD had similar CVD risk factors (specifically hypertension and obesity) than non-IBD patients (P &gt; 0.05), however the prevalence of smoking and diabetes were lower in IBD patients (P &lt; 0.001). Notably, STEMI patients with IBD had a lower prevalence of cardiac arrest compared to their non-IBD counterparts (P &lt; 0.001). However on adjustment for baseline CVD risk factors and hospital characteristics, no significant difference was appreciated (P = 0.25) (Table 1). Conclusions: In a nationally representative adult US population IBD was not shown to confer an increased risk of cardiac arrest in patients with a history of STEMI. These findings underscore the need for further investigation to elucidate the complex relationship between IBD and cardiovascular outcomes.
Abstract 18525: Sex Differences in Reporting of Statin-Associated Diabetes Mellitus - A Pharmacovigilance Analysis of Us Drug Safety Data
Authors: David P Kao, Jane E Reusch, Judith G Regensteiner
Journal: Circulation (2023)

Introduction: Limited observational and clinical trial data have suggested a higher likelihood of statin-associated diabetes mellitus (DM) in women compared with men. However, real-world evidence of sex differences in statin-associated DM generally and with specific statins are lacking. Spontaneous adverse reporting pharmacovigilance systems provide an opportunity to assess these potential sex differences. Hypothesis: Statin-associated DM is reported to the FDA disproportionately more in women than in men. Methods: : Adverse event reports from the FDA Adverse Event Reporting System between 1960 and 2021 were obtained. Cases that included lovastatin, fluvastatin, pravastatin, simvastatin, atorvastatin, and rosuvastatin were analyzed together and individually with respect to reporting of DM vs. all other reactions starting at FDA approval of each. Signals of disproportionate reporting (SDR) were identified using the proportional reporting ratio (PRR) with a threshold of 2, and X2 of 4 with &gt; 3 cases of reaction if interest. Differences between SDR in men vs. women were identified using a lower bound of the 95% confidence interval of the Reporting Odds Ratio (ROR) &gt; 1 in &gt; 3 events. Results: In both men and women, DM was associated with a significantly elevated PRR for all statins combined and individually for atorvastatin, lovastatin, rosuvastatin, fluvastatin, simvastatin, and nominally for pitavastatin. Pravastatin was disproportionately reported in women only (M=1.80, W=2.32). Using ROR, statin-induced DM was reported significantly more frequently for atorvastatin, simvastatin, pravastatin, and rosuvastatin but not for pitavastatin, fluvastatin, or lovastatin. Conclusions: Statin-associated DM is disproportionately reported to the FDA in both men and women for most agents compared with other adverse events. Importantly, statin-associated DM is reported significantly more in women than men for the statins most commonly used in current practice.
Abstract 15930: Using Charlson Comorbidity Index to Predict 1-Year All-Cause Mortality in ICD Recipients
Authors: David Newhouse, Gautam Rangavajla, Mehak Dhande, Aditya Bhonsale, Krishna Kancharla, Andrew Voigt, Alaa Shalaby, Nathan A Estes, Sandeep Jain, Samir Saba
Journal: Circulation (2023)

Introduction: Primary prevention implantable cardioverter-defibrillators (PP-ICD) are indicated in patients with left ventricular ejection fraction (LVEF) ≤ 35% despite 3 months of maximally tolerated guideline directed medical therapy (GDMT), who are expected to survive at least 1 year. The Seattle Heart Failure Score, commonly used for evaluation of 1 year survival, only addresses heart failure mortality. The Charlson Comorbidity Index (CCI) is a validated model of comorbid conditions used to predict 1-year all-cause mortality. Objectives: We aimed to create a predictive model using the CCI to guide eligibility for PP-ICD based on predicted 1-year all-cause mortality in patients with severe cardiomyopathy. Methods: We analyzed clinical data from the University of Pittsburgh Medical Center, a large multi-hospital system, between January 2010 and July 2021. Patients receiving PP-ICD were included. We used a logistical regression model based on patients’ CCI, age, race, mean number of GDMT medications, the presence of coronary artery disease (CAD), and baseline LVEF. Results: Of the total cohort of 2,864 patients (mean age 67±12 years; Male 69%; White 85%; LVEF 24±7%; CAD 62%), 235 (8.2%) patients died within 1 year. Patients were on average prescribed 2.0±0.8 GDMT agents and had a mean CCI of 1.4± 1.6. CCI was significantly associated with adjusted 1-year mortality (OR 1.41 per standard deviation of CCI, 95% CI 1.35-1.71, p&lt; 0.001). A receiver operator curve was generated (Figure 1) and a CCI cutoff of 1.54, yielded a sensitivity of 71% and a specificity of 59% (AUC 0.70). Conclusions: Our data demonstrate that a model incorporating the CCI can predict 1-year all-cause mortality in PP-ICD recipients with modest accuracy and could therefore assist in shared-decision making around PP-ICD therapy. Future work should focus on refining the model for higher predictive accuracy.
Abstract 15850: Low Rates of Achievement of Low-Density Lipoprotein Cholesterol Levels &lt;55 mg/dL Among Patients With Atherosclerotic Cardiovascular Disease in the United States: Findings From the Cardiovascular Multicenter Observational Investigation of Lipid Care in the United States-2 Registry
Authors: Ann Marie Navar, Nishant Shah, Peter Shrader, Laine E Thomas, Zahid Ahmad, Clint Allred, Alanna M Chamberlain, Elizabeth A Chrischilles, Nafeesa Dhalwani, Mark B Effron, Salim Hayek, Laney K Jones, Bethany Kalich, Michael D Shapiro, Cezary Wojcik, Eric D Peterson
Journal: Circulation (2023)

Introduction: Guidelines are increasingly recommending a goal LDL-C &lt;55 mg/dL in persons with atherosclerotic cardiovascular disease (ASCVD). The proportion and characteristics of US adults with ASCVD with an LDL-C &lt;55 mg/dL remains unclear. Aims: To evaluate lipid management in ASCVD patients and factors associated with achieving an LDL-C &lt;55mg/dL. Methods: Using electronic health record data from 8 US health systems, we evaluated LDL-C levels and treatment patterns in persons with prevalent ASCVD seen as outpatients between 1/1/2021-12/31/2021 with an LDL-C level within the prior year. Multivariable logistic regression modeling with generalized estimating equations was used to evaluate factors associated with an LDL-C &lt;55 mg/dL. Results: Among 178,240 eligible ASCVD patients, 43.5% (77,472) had an LDL- C &lt;70 mg/dL and 22.0% (39,270) had an LDL-C &lt;55 mg/dL. Older age was associated with higher odds of LDL-C &lt;55 mg/dL (OR 1.10 per 10 years, 95% CI 1.07-1.13), while female sex (OR 0.71, 95% CI 0.68-0.64) Black race (OR 0.77, 95% CI 0.70-0.86), and non-coronary artery disease forms of ASCVD including peripheral artery disease (PAD, OR 0.61, 95% CI 0.58-0.64) and cerebrovascular disease (CeVD, OR 0.72, 95% CI 0.66-0.79) were associated with lower odds of LDL-C &lt;55 mg/dL in multivariable modeling. Overall, while 75.0% were on a statin, only 36.9% were on a high-intensity statin, 5.7% were on ezetimibe, and 1.7% were on a PCSK9i. Combination therapy was rare: only 4.2% were on a statin+ezetimibe, 0.5% on statin+PCSK9i, and 0.3% on all three. Conclusions: Less than a quarter of US patients with ASCVD achieve an LDL &lt;55 mg/dL. Achieving this goal is even less common among younger adults, women, Black persons, and those with PAD and CeVD. Current therapeutic regimens often fail to use high-intensity statins, and markedly underutilize combinations of statins with ezetimibe and/or PCSK9 inhibitors.