tbuckley/cabot-search huggingface dataset:
Abstract 4139554: Overview of Direct Oral Anticoagulation Trends in the North Bronx: Patient and Systemic Factors Contributing to Medication Nonadherence
Authors: Sujoy Khasnavis, Nichola Davis, Ephraim Leiderman
Journal: Circulation (2024)

Introduction: Anticoagulation nonadherence has historically been attributed to myriad factors in patient populations worldwide. While direct oral anticoagulants (DOACs) have demonstrated advantages such as less routine monitoring and fewer interactions with other medications over other anticoagulant classes, nonadherence persists and the underlying contributors vary by geography. The goal of this retrospective review was to highlight on the patient and systemic characteristics associated with DOAC nonadherence in the North Bronx. Methods: This review used records between 2017-2024 from two major hospital centers in the North Bronx. Patients receiving outpatient primary care and active DOAC therapy were included in the analysis. Adherence and nonadherence groups were determined based on prescription fill status and MD documentation of medication intake patterns. The groups were compared in the categories of age, gender, race, ethnicity, insurance type, diagnosis, pharmacy type, employment status, comorbidity burden, outpatient medications, primary language, and zip code. Chi square analysis was done between the categories and outcomes as well as between categories. A p value of &lt; 0.05 was deemed significant. Results: The cohort had 863 patients with nonadherence of 24.9%. The adherent group's mean age was higher than that of the nonadherent (70.3 years vs 66.8 years, p &lt; 0.005). Females were more adherent than males (79.0% vs 70.5%, p &lt; 0.005). The adherent group was also more likely to be receiving DOAC from a retail pharmacy than from a hospital pharmacy (81.7% vs 59.9%, p &lt; 0.005). The nonadherent group was more likely to be insured under medicaid (69.3% vs 63.0%, p &lt; 0.005) and to be taking fewer than 10 outpatient medications (62.3% vs 54.0%, p &lt; 0.05). English was the primary language of more patients in the nonadherent group (78.6% vs 65.7%, p &lt; 0.005). Conclusion: DOAC nonadherence in the North Bronx correlates with patient age, gender, pharmacy type, insurance type, number of outpatient medications, and primary language. Nonadherence does not correlate with comorbidity burden, diagnosis, or zip code. Associations with race/ethnicity and employment status were uncertain and warrant further study.
Abstract 4139584: Serendipitously Discovered Wild-Type Transthyretin Cardiac Amyloidosis in the Setting of Familial Hypertrophic Obstructive Cardiomyopathy
Authors: Matthew Santer, Christopher Bianco
Journal: Circulation (2024)

Introduction: We present a case of hypertrophic obstructive cardiomyopathy (HOCM) with incidental wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) discovered after septal myectomy. Case presentation: A 62-year-old male with a history of bilateral carpal tunnel syndrome as well as a family history of sudden cardiac death consistent with HOCM on autopsy (patient's father) presented to the clinic with symptoms of exertional shortness of breath, hypotension, and pre-syncope. An external monitor revealed one episode of non-sustained supraventricular tachycardia, otherwise was unremarkable. He experienced worsening symptoms for which emergency department evaluation revealed anterior lead T-wave inversions on EKG. Cardiac catheterization revealed non-obstructive coronary artery disease. Shortly thereafter, a cardiac MRI was significant for probable HOCM based on septal hypertrophy, late gadolinium enhancement (LGE) with mid-wall fibrosis in the basal/mid inferolateral segments, and systolic anterior motion (SAM) of the mitral valve. Pre-stress echocardiogram revealed a sigmoid septum with septal wall thickness of 1.6 cm and no left ventricular outflow tract (LVOT) gradient. Post-stress echocardiogram revealed severe SAM with septal contact, LVOT gradient of 70 mmHg, as well as hypotension. Genetic testing was negative, and the patient underwent successful septal myectomy with papillary muscle reorientation and resection of secondary chordae. The pathology of the myocardium obtained during surgery resulted with histological features suggestive of HOCM in addition to confirmed ATTRwt-CA for which tafamidis was initiated. Discussion: Literature reporting HOCM and ATTRwt-CA within the same patient is rare. Both conditions cause increased myocardial thickness which can present phenotypically similar, making diagnosis difficult. Utilization of modern imaging modalities such as cardiac MRI and echocardiography should provide valuable information for differentiation, but as in our case, direct tissue visualization can be required for diagnosis. Each diagnosis has unique imaging characteristics that help define them such as asymmetric septal hypertrophy with dynamic LVOT obstruction, SAM of the mitral valve, and fibrotic areas on LGE in the setting of HOCM compared to diffuse and symmetric global subendocardial LGE and concentric hypertrophy with ATTRwt-CA. Conclusion: Our case reveals the importance of avoiding anchoring bias as concomitant diagnoses can present.
Abstract 4139607: Endothelial Dysfunction is Associated with Major Adverse Cardiovascular Events in Prediabetes
Authors: Dariya Kozlova, Colin Gimblet, Linder Wendt, Patrick Ten Eyck, Sadaf Akbari, Adeyinka Taiwo, Diana Jalal
Journal: Circulation (2024)

Background: Prediabetes is an intermediate stage of hyperglycemia associated with an elevated risk of major adverse cardiovascular events (MACE). Vascular dysfunction is a non-traditional risk factor that worsens with hyperglycemia and elevates the risk of MACE in high-risk populations. It is currently unknown whether vascular dysfunction contributes to MACE in prediabetes. We hypothesized that vascular dysfunction would associate with an elevated risk of MACE in individuals with prediabetes independent of traditional risk factors. Methods: We conducted an observational study (n=4557) in the Framingham Offspring and Generation III cohorts. Prediabetes status was defined by ADA criteria as fasting plasma glucose between 100-125 mg/dL or HbA1c between 5.7-6.4%. Endothelial function was determined via brachial artery flow-mediated dilation (BA-FMD), aortic stiffness via carotid-femoral pulse wave velocity (cfPWV), and coronary artery calcium (CAC) score via computed tomography. Cross-sectional general linear models were utilized with appropriate transformation of the outcome variable to evaluate if BA-FMD, cfPWV, and CAC score differed by prediabetes status. Cox regression was used to assess the association of BA-FMD, cfPWV, and CAC score with time to MACE in prediabetes. MACE was defined as coronary artery disease, stroke, and all-cause mortality. Models were adjusted for age, sex, smoking status, cardiovascular disease, and blood pressure. Results: Median age of the prediabetes group was 55 (48,62) years and 42% were female, whereas median age of the normoglycemic control group was 45 (39,51) years and 61% were female. In unadjusted models, individuals with prediabetes had lower BA-FMD and higher cfPWV and CAC score (p&lt;0.001). After adjustment, prediabetes remained associated with lower BA-FMD [Beta -2.1 (95% CI, -2.3,1.8; p &lt;0.001)] and higher cfPWV [exp(Beta) 1.30 (95% CI, 1.28-1.32; p &lt;0.001)], however the association with CAC score was abolished [OR 0.83 (95% CI, 0.67-1.01; p=0.06)]. In unadjusted analyses, BA-FMD, cfPWV, and CAC score &gt; 100 were associated with MACE in the prediabetes group (p&lt;0.001). After adjustment, BA-FMD [HR 0.94 (95% CI, 0.88-1.00; p=0.035)] and CAC score &gt; 100 [HR 2.67 (95% CI, 1.26-5.64; p=0.010)] remained associated with MACE. Conclusions: Individuals with prediabetes exhibit impaired vascular function compared with controls. Moreover, peripheral endothelial function and CAC score &gt; 100 associate with MACE in prediabetes.
Abstract 4139524: Impact of Internet Use on Knowledge of Clinical Trials: An Analysis Using the Health Information National Trends Survey (HINTS) Dataset
Authors: Zaib Hussain, Erin Michos, Hailey Miller, Cheryl Dennison Himmelfarb, Payam Sheikhattari, Rifath Ara Alam Barsha, Timothy Plante
Journal: Circulation (2024)

Background: Clinical trial (CT) participation is paramount for the advancement of medical knowledge and clinical practice. However, there are significant gaps in the literature surrounding effective CT engagement, particularly for increasing CT awareness and knowledge. We seek to bridge these gaps by assessing the role internet use plays in improving access to health information, knowledge of, and participation in CTs. Objective: To examine the association between internet use and CT knowledge among US adults and the modalities adults seek to access the internet. Methods: We used HINTS 5, Cycle 4, a cross-sectional, nationally representative survey of American adults aged ≥18 years [range: 18–104 years] to conduct this analysis. Participants self-reported the use of internet and knowledge of CTs (none or little vs. higher knowledge). Multivariate logistic regression was used to estimate relative odds of higher knowledge of CTs (outcome) by internet use (exposure) in models adjusting for demographic, health-related, and socioeconomic factors. The analysis was stratified by different modalities of internet use to explore variations in knowledge acquisition. Analyses applied sample weights. Results: Among a weighted sample of 249,896,898 participants (mean [SD] age 47 [20.2] years, 50% women), 86% used the internet, and 10% reported higher CT knowledge. As shown in the figure, there were significantly greater odds of CT knowledge among adults using the internet in partially adjusted models. In fully adjusted models, this was no longer significant (OR 1.76, 95% CI 0.83-3.74). In analyses stratified by internet modalities, both mobile phone and home-based internet use were positively associated with higher knowledge about CT (OR=4.77, 95% CI=1.26-18.0). Conclusions: Mobile phone and home-based internet use show significant association with higher knowledge of CTs among adults. This underscores the importance of employing online platforms to engage potential participants. Investing in internet-based recruitment strategies could significantly augment the efficacy of CT recruitment efforts. Furthermore, a wider net should be cast for CT recruitment to ensure non-users of the internet get equitable access to information.
Abstract 4139536: Incidence of Severe QT Prolongation and the Assoicated Risk of Ventricular Arrhythmias and Sudden Cardiac Death in Patients Taking Antipsychotics or Antidepressants
Authors: Chun-Li Wang, Victor Wu, Yu-Tung Huang, Shang-hung Chang
Journal: Circulation (2024)

Background: Limited data exist on the incidence of severe QT prolongation (SQTP) in patients using antipsychotics or antidepressants and the associated risk of ventricular arrhythmias (VA) and sudden cardiac death (SCD). Aims: This study aimed to investigate the incidence, risk factors, and outcomes of SQTP in patients using antipsychotics or antidepressants. Methods: Electronic medical records from a multicenter healthcare system in Taiwan were analyzed to identify patients using antipsychotics or antidepressants with baseline and follow-up electrocardiograms. SQTP was defined as a corrected QT interval exceeding 500 ms post-treatment or an increase of &gt;60 ms compared to baseline. Risk factors for SQTP development and associated risks of VA and SCD were assessed using multivariate logistic regression. Results: Following antipsychotic use (n = 28,892) and antidepressant use (n = 14,634), mean corrected QT interval increases were +7.7 ± 39.0 ms and +6.7 ± 36.1 ms, respectively. Over 10% of patients using haloperidol, amisulpride, olanzapine, quetiapine, or risperidone experienced SQTP. Antipsychotics with a known or conditional risk of torsades de pointes and antidepressants with a known risk of torsades de pointes had a higher likelihood of SQTP compared to alprazolam control. Risk factors for SQTP included age &gt;65 years, electrolyte imbalances, renal insufficiency, amiodarone use, left ventricular ejection fraction &lt;50%, and the use of drugs with known torsades de pointes risk. In antipsychotic users, SQTP was significantly associated with increased risks of VA (odds ratio 2.91; 95% CI 2.29–3.70) and SCD (odds ratio 2.16; 95% CI 1.50–3.12). Similarly, in antidepressant users, SQTP was significantly linked to VA risks (odds ratio 2.78; 95% CI 1.63–4.74). Subgroup analyses for females and patients aged 18-50 years yielded consistent results. Conclusions: Over 10% of patients on certain antipsychotics experienced SQTP, often with related risk factors. SQTP was significantly associated with elevated risks of VA and SCD in antipsychotic users, and increased VA risk in antidepressant users. Clinicians should be alert to SQTP in patients taking antipsychotics or antidepressants.
Abstract 4139515: Association Between Maximum Daily Atrial Fibrillation Duration and Ischemic Stroke Among Patients with Continuous Rhythm Monitoring
Authors: Graham Peigh, Jodi Koehler, Shubha Majumder, Yong Cho, Sean Landman, Shantanu Sarkar, Paul Ziegler, Rod Passman
Journal: Circulation (2024)

Background: Recent clinical trials demonstrate the benefit of oral anticoagulation (OAC) for all device-recognized atrial fibrillation (AF) &gt; 6 minutes. However, AF is not binary and those with greater AF burden generally have a higher risk of stroke. To date, there are limited data on a specific threshold of AF duration that is independently associated with the risk of ischemic stroke. Objective: To assess the association between baseline maximum daily AF duration (MDAFD) and ischemic stroke among patients with cardiac implantable electronic devices (CIEDs) capable of continuous AF detection. Methods: Using the Optum ® de-identified electronic health record (EHR) (2007-2021) linked with the Medtronic CareLink ® heart rhythm database, CIED patients with healthcare activity recorded in the EHR &gt; 12 months pre- and &gt; 6 months post-CIED implant were identified. Exclusion criteria included presence of a prescription for OAC. MDAFD was assessed during the first 30 days post-implant (baseline period). Associations between baseline MDAFD and ischemic stroke in follow-up were evaluated, adjusting for CHA 2 DS 2 -VASc and chronic kidney disease. Results: Of 26,400 patients (68±13 years; 60% male) analyzed, 2,544 (9.6%) had AF at baseline. The distribution of maximum daily AF duration during baseline was as follows: 6 min-&lt;1 hour: 734 (28.9%); 1 hour-&lt;5.5 hours: 565 (22.2%); 5.5 hours-&lt;23.5 hours: 519 (20.4%); &gt; 23.5 hours: 726 (28.5%). In total, 664 patients (2.5%) suffered an ischemic stroke through 2.6±1.6 years of follow-up. Presence, compared to absence, of AF at baseline was associated with a greater risk of ischemic stroke. Among those with AF, only patients with MDAFD &gt; 5.5 hours had an increased risk of stroke compared to those with no AF (Figure). Conclusions: Within a large cohort of patients with CIEDs without a prescription for OAC, &gt; 5.5 hours of MDAFD was needed to increase the risk of ischemic stroke compared to those with no AF. These results suggest that there is a threshold of MDAFD, measured in hours, that may benefit from treatment with OAC.
Abstract 4139527: Prognostic Characteristics of Patients with Electrocardiograms Masquerading as ST Elevation Myocardial Infarction
Authors: Sina Fathieh, Tu Hao Tran, Amir Faour, Viet Dang, Asala Aljazaery, Oliver Gibbs, Joseph Assad, Steven Faddy, Mitchell Long, Reece Pahn, Rohan Rajaratnam, Sidney Lo, Craig Juergens, Gladys Tam, John French
Journal: Circulation (2024)

Background: Prehospital identification of STEMI reduces time to reperfusion by timely primary PCI or fibrinolytic therapy. We previously reported that 40-50% of prehospital ECG transmissions meeting Glasgow algorithm (GA) criteria for STEMI did not meet STEMI criteria on adjudication using the 4th Universal Definition of MI (4UDMI). These cases, herewith called ‘masquerading STEMI’, had high rates of late clinical complications. Here, we determined clinical factors predictive of late clinical outcomes among patients with masquerading STEMI. Methods: From June 2010 to October 2021, 2,992 patients with prehospital ECG transmissions to Liverpool Hospital, Sydney, Australia, who met GA criteria for STEMI were identified. These were adjudicated according to the 4UDMI as confirmed STEMI or masquerading STEMI. Using multivariate logistic regression, we identified baseline patient characteristics that were associated with the outcome of cardiovascular death, MI and stroke at 2 years, among the masquerading STEMI cohort. Results: 1553 (51%) patients were true-positive STEMI, while 1439 (49%) were masquerading STEMI. In the masquerading STEMI cohort, age, current smoking, and CKD (eGFR&lt;60) were significant predictors of the 2-year cardiovascular death, MI stroke with OR of 1.05, 2.07, and 3.58, respectively (p&lt;0.05 for all). Diabetes predicted MI re-presentation within 2 years (OR 3.76, p&lt;0.05), and CKD predicted heart failure hospitalisation (OR 2.55, p&lt;0.05). Conclusions: Among patients with masquerading STEMI, current smoking and CKD were associated with the 2-year cardiovascular death, MI stroke. Diabetes predicted a higher risk of re-presenting with MI within 2 years, and CKD predicted a higher risk of hospitalisation with heart failure. Therefore, in this cohort of patients with masquerading STEMI, despite not having a true STEMI, smoking cessation and opportunistic management of diabetes and CKD may modify prognosis.
Abstract 4139801: Predicted efficacy of Inclisiran compared to active comparators on Cardiovascular Outcomes in patients with established atherosclerotic cardiovascular disease: results from the In Silico SIRIUS trial
Authors: Bertrand Cariou, Denis Angoulvant, Pierre Amarenco, Alexandre Bastien, Emmanuelle Bechet, Jean-Pierre Boissel, Eulalie Courcelles, Anne Filipovics, Solene Granjeon-Noriot, Riad Kahoul, Guillaume Mahe, Emmanuel Peyronnet, Lolita Portal, Yishu Wang, Philippe Steg, Franck Boccara
Journal: Circulation (2024)

Background: Inclisiran, an siRNA targeting PCSK9 mRNA, administered twice-yearly, substantially and sustainably reduced LDL-C. Data quantifying how lowering LDL-C with inclisiran translates into a reduced risk of major adverse cardiovascular events (MACE) and comparison to available lipid-lowering therapies are lacking. In silico trials applying a disease computational model to virtual patients receiving various treatments allow such predictions in large scale clinical trials. Purpose: The aim of the in silico SIRIUS trial (NCT05974345) was to predict the effect of inclisiran compared to ezetimibe or evolocumab on MACE in participants with atherosclerotic cardiovascular disease (ASCVD). Methods: Two distinct in silico trials were conducted using knowledge-based mechanistic computational model of ASCVD applied to virtual populations (Vpop) with ASCVD and LDL-C ≥ 70 mg/dL, each virtual patient being its own control. This model was previously calibrated to reproduce the results of FOURIER and ORION-10 trials and validated based on the results of other trials results including ODYSSEY-OUTCOMES. The first trial compared inclisiran efficacy to ezetimibe as an adjunct to high-intensity (HI) statins, while the second one compared inclisiran efficacy to evolocumab as adjunct to HI statin and ezetimibe. In both trials, the main outcome was a 3-Point-MACE defined as a composite of time to first occurrence of cardiovascular (CV) death, nonfatal myocardial infarction or nonfatal ischemic stroke over 5 years. Results: In a Vpop of 162,453 ASCVD patients under HI statin, the difference in mean percentage reduction in LDL-C with inclisiran as compared to ezetimibe was 32.7% from a median baseline value of 91.1 mg/dL to 48.3 mg/dL and 77.2 mg/dL at 5 years. Inclisiran was more effective than ezetimibe to lower the risk of 3P-MACE (11.3 vs. 13.3%; HR 0.82, low degree of prediction uncertainty). In a Vpop of 42,238 ASCVD patients under HI statin and ezetimibe, similar mean percentage reduction in LDL-C with inclisiran as compared to evolocumab was achieved at 5 years. Inclisiran and evolocumab had similar efficacy on lowering the risk of 3P-MACE (12.5 vs. 12.4%; HR 1.01, medium degree of prediction uncertainty). Conclusions: These in silico trials provide early insights into the potential effect of inclisiran on ASCVD events compared to alternative treatments suggesting a higher 3P-MACE reduction compared to ezetimibe and a similar effect compared to evolocumab.
Abstract 4139654: Effects of Exercising Sports on Cardiovascular Health among Youth Athletes: Basketball, Baseball, Football and Soccer
Authors: Grace Qiu, Seong Kyu Kim, Douglas Corsi, Imran Masood, Alexander Hajduczok, Brian Osler, Drew Johnson, Renee Langstaff, David Shipon
Journal: Circulation (2024)

Introduction: The impact of exercise on the adult heart has been well studied and associated with better cardiovascular health. However, the exercise-induced physiological adaptations of the youth athlete's heart are not well understood. Research Questions/Hypothesis: Cardiac screening data will differ significantly based on which sport a youth athlete plays. Goals/Aims: To assess the impacts of different sports on youth athletes' cardiovascular health. Methods: The HeartBytes National Youth Database produced by Simon’s Heart was used for this study. The database contains demographics, exercise-related symptoms, ECG data obtained during Simon’s Heart PPEs, and data on various types of sports that athletes participate in. To investigate the effects of each specific sport, we excluded those playing multiple sports from the data set, and employed a propensity score match method to control the confounding influences of race, sex, and exercise intensity. This study used an odds ratio statistic and p-value of 5% criterion to evaluate associations between specific sports and cardiovascular risk factors. Results: Of the 7425 athletes in the HeartBytes database, the majority were male (60.6%) and White (83.1%). The mean BMI was 21.4 with SD 4.6. The median age was 15.0 years old with an interquartile range 13.5-16.5. There were 279, 120, 179, 552 athletes playing basketball, baseball, football, and soccer only respectively. Athletes playing basketball had higher odds of exertional symptoms of feeling easily tired (p=0.017), ECG abnormalities (p=0.032), and T wave inversion (p=0.017), but lower odds of ADHD (p=0.03). Athletes playing baseball had higher odds of asthma (p=0.02) and T wave inversion (p=0.046) if exercising less than 5 hours/week, and higher odds of murmurs (p=0.023) and exertional syncope (p=0.04) if exercising more than 10 hours/week. Athletes playing football had higher odds of obesity (p&lt;0.0001), hypercholesterolemia (p=0.048), and diabetes (p=0.037) if exercising more than 10 hours/week. Athletes playing soccer had higher odds of voltage ECG left and right ventricle hypertrophy respectively (p&lt;0.01), but lower odds of obesity (p&lt;0.001). Conclusion: All sports showed significant impact on youth athletes' health. Further studies are required to understand the physiological adaptations of youth athlete heart.