tbuckley/cabot-search huggingface dataset:
Abstract 4140179: Impact of COVID-19 on Patients With Hypertrophic Cardiomyopathy: Causes, Predictors, and Inpatient Mortality of 30-Day Readmission
Authors: Zaid Abood, Patrycja Galazka, A. Jamil Tajik, Arshad Jahangir, M. Fuad Jan
Journal: Circulation (2024)

Background: COVID-19 has led to significant global morbidity and mortality. Its impact on patients with hypertrophic cardiomyopathy (HCM) remains unclear. Aim: To evaluate the impact of COVID-19 infection on the readmission rate and associated outcomes in patients with HCM. Methods: In a retrospective study using the 2020 National Readmission Database, we collected data on patients with HCM who were admitted with the principal diagnosis of COVID-19. The primary outcome was the all-cause 30-day readmission rate. Secondary outcomes were common causes of readmission, in-hospital mortality, and resource utilization. Results: In 2020, a total of 1503 patients with HCM (mean age 67 years, 49% female) were hospitalized for COVID-19. Among them, 1216 (80.9%) were discharged alive and 180 (14.8%) were readmitted within 30 days. In-hospital mortality for readmissions remained relatively unchanged compared with index admissions (15.4% vs 19.0%, P=.34; Table 1). The most common cause of readmission was COVID-19 infection (38%), followed by other infections (11%) and acute kidney injury (4%). The most common cardiac cause for readmission was paroxysmal atrial fibrillation (2%). The mean length of stay for readmissions was relatively similar to the index admission (7.8 vs 9.9 days, P=.43). The mean hospital charge associated with readmission was $84,976 (total hospital charges were $15.2 million). The mean hospital cost associated with readmissions was $24,603 (total hospital costs were $4.4 million). A higher Charlson comorbidity index score was the main independent predictor of higher readmission rates. Conclusions: This study highlights the significant burden of COVID-19 on patients with HCM. Despite efforts to reduce readmission rates, a considerable percentage of patients experienced readmission within 30 days, largely attributed to COVID-19 infection. Close follow-up after discharge could prevent such readmission and the associated high mortality rates.
Abstract 4140036: Long-term Prognosis of Acute Coronary Syndrome Patients with Mildly Reduced Ejection Fraction Following Emergency Percutaneous Coronary Intervention
Authors: Hikaru Hagiwara, Takuro Okamoto, KOTOMI OTSUBO, Rui Katano, Hirokazu Komoriyama, Yoshiya Kato, Toshihisa Anzai
Journal: Circulation (2024)

Background: Heart failure with reduced ejection fraction (HFrEF), defined as a left ventricular ejection fraction (LVEF) of &lt;40%, after acute coronary syndrome (ACS) is associated with increased mortality rates. However, the long-term prognostic impact of HF in patients with mildly reduced EF (HFmrEF), defined as a LVEF of 40–49%, who undergo primary percutaneous coronary intervention (PCI) remains unclear. Hypothesis: Patients with HFmrEF have a better prognosis than those with HFrEF and a worse prognosis than patients with HF with preserved EF (HFpEF), defined as a LVEF of ≥ 50%. Aims: We compared the long-term prognosis among HFpEF, HFmrEF, and HFrEF patients. Methods: A total of 836 consecutive ACS patients who underwent emergency PCI at our hospital between April 2014 and March 2024 were retrospectively recruited. We compared all-cause mortality and adverse cardiovascular events, including cardiac death and heart failure hospitalization. Patients were divided into three groups based on LVEF assessed by echocardiography within 1 month after PCI: HFpEF, HFmrEF, and HFrEF. Results: After excluding 117 patients who lacked echocardiographic data, 719 patients were included (HFpEF, 443; HFmrEF, 180; HFrEF, 96). Patients with lower EF were older and had higher plasma brain natriuretic peptide levels at admission. During a median follow-up period of 3.8 years (interquartile range: 1.5–6.3), 105 patients (13%) died. Patients with lower EF had a higher incidence of all-cause mortality and adverse cardiovascular events ( Figure ). Multivariate analysis indicated no difference in all-cause mortality between HFrEF and HFmrEF groups (adjusted hazard ratio (HR) 1.07, 95% confidence interval (CI) 0.44–2.60), although adverse cardiovascular events were significantly different (adjusted HR 0.44, 95% CI 0.24–0.82). On the other hand, there was no difference in all-cause mortality between HFmrEF and HFpEF groups (adjusted HR 0.49, 95% CI 0.31–0.79), although adverse cardiovascular events were significantly different (adjusted HR 0.35, 95% CI 0.18–0.69). Conclusion: In patients with ACS following emergency PCI, HFmrEF is associated with a better prognosis compared with HFrEF, but with a worse prognosis than HFpEF.
Abstract 4139353: <u>Geographic, Gender,&amp;Racial Trends in Mortality Due to Coronary Artery Disease in Obesity among Adults Aged 25 and Older in the United States, 1999-2020: A CDC WONDER Database Analysis</u>
Authors: Muhammad Abdullah Naveed, Mohammad Alboushi Aldabagh, Ahila Ali, Faizan Ahmed, Muhammad Omer Rehan, Rabia Iqbal, Bazil Azeem, Mustafa Sajjad Cheema, yasar sattar
Journal: Circulation (2024)

Background: Coronary Artery Disease (CAD) in obese population is the most common cause of mortality worldwide. This study examines the variation in cardiovascular mortality rates due to CAD in obese adults aged 25 and above from 1999 to 2020. Methods: We performed a retrospective cohort study using death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database from 1999 to 2020. We calculated age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) per 100,000 persons. The information was categorized based on year, gender, ethnicity, and geographic area. Results: Between 1999 and 2020, CAD in obesity accounted for 102,434 deaths among adults (≥25 years) in the United States. Majority of deaths occurred in medical facilities (49.0%), followed by decedents' homes (36.8%). The overall AAMR for CAD in obesity-related deaths increased from 1.5 in 1999 to 3.3 in 2020, with an AAPC of 3.46 (95% CI: 2.83 to 3.92, p &lt; 0.000001). Men exhibited higher AAMRs compared to women (men: 2.7; women: 1.6), with significant increases for both sex. The increase was more prominent in men (AAPC: 4.34, 95% CI: 3.73 to 4.83, p &lt; 0.000001). Racial/ethnic disparities were evident, with American Indian or Alaska Native individuals having the highest AAMR (2.9), followed by Black or African American (2.4), White (2.3), Hispanic or Latino (1.3), and Asian or Pacific Islander (0.5). All racial groups experienced an increase in AAMR from 1999 to 2020, most pronounced in American Indian or Alaska Native individuals (AAPC: 5.06, 95% CI: 2.90 to 8.64, p &lt; 0.000001). Geographically, AAMRs ranged from 1.0 in Alabama to 4.3 in North Dakota, with the Midwestern region having the highest mortality (AAMR: 2.6). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (nonmetropolitan: 2.8; metropolitan: 2.0). (Figure 1) Conclusion: This study highlights significant demographic disparities in mortality rates due to CAD in obesity among adults aged 25 and older. Despite an overall increase in mortality rates, the significant rise in recent years, particularly among certain racial groups and geographical regions, emphasize the need for targeted interventions and equal healthcare access to improve outcomes for affected populations.
Abstract 4139929: The mechanisms of Mid-ventricular obstruction in patients with hypertrophic cardiomyopathy: Insight from an echocardiographic study
Authors: Zhengyang Lu, yanhai meng, Changrong Nie, Shuiyun Wang
Journal: Circulation (2024)

Background: Mid-ventricular obstruction (MVO) is a rare subtype of hypertrophic cardiomyopathy (HCM) , but it is associated with severe symptoms and worse clinical outcomes. Whereas the mechanisms of MVO has not fully elucidated. Therefore, we sought to investigate the mechanisms of MVO via an echocardiographic analysis. Method: We retrospectively enrolled 239 patients diagnosed with HCM in this study. All patients were divided into non-obstructive HCM group (N=51), isolated left ventricular outflow (LVOT) obstructive HCM (oHCM) group (N=130), and MVO group (N=58) based on the initial echocardiographic evaluation. Result: Compared to patients with oHCM, patients with MVO were much younger (43.48±11.45 vs. 49.25±12.10, p &lt;0.05), less likely to be female (54 (41.5%) vs 12 (20.7%), p &lt;0.05), had a lower left atrial diameter (41.64±5.82 vs. 43.99±6.30, p &lt;0.05), a higher mid-septal thickness (21.40±4.24 vs. 18.88±3.30, p &lt;0.05), a lower mean global longitudinal strain (-10.59±4.31 vs. -14.41±3.83, p &lt;0.05), a longer anterior papillary muscles (APM) length ( 48.91±7.37 vs. 41.13±6.93, p&lt; 0.05), a shorter distance between APM and septum (APM-IVS) ( 11.19±2.53 vs. 17.97±3.45, p&lt;0.05), a higher prevalence of mid-septal bundle (56 (96.6%) vs. 74 (56.9%), p &lt;0.05). Multinomial logistic analysis indicated that compared to patients with non-obstruction HCM patients, BMI (Odd ratio [OR] 1.321, 95% confidential interval [CI] 1.116-1.564, p&lt; 0.001) , APM-IVS (OR 0.404, 95%CI 0.316-0.517, p&lt; 0.001), APM length (OR 1.147, 95% CI 1.051-1.251, p= 0.002), and mid-septal thickness (OR 1.202, 95% CI 1.01-1.43, p= 0.038) were independent risk factors of MVO. Furthermore, compared to patients with oHCM, APM-IVS (OR 0.430, 95%CI 0.341-0.542, p&lt;0.001), the presence of mid-septal bundle (OR 8.376, 95%CI 1.513-46.365, p=0.015), and APM length (OR 1.081, 95%CI 1.011-1.157, p = 0.023) were significantly associated with MVO. Conclusion: APM-IVS, APM length and mid-septal thickness played vital roles in the development of mid-obstruction in hypertrophic cardiomyopathy, which may offer a clue for surgical strategy.
Abstract 4140097: Effect of Disclosing a Polygenic Risk Score for Coronary Heart Disease on Adverse Cardiovascular Events: 10-year Follow-up of the MI-GENES Randomized Clinical Trial
Authors: Mohammadreza Naderian, Marwan Hamed, Ali Vaseem, Kristjan Norland, Ozan Dikilitas, Azin Teymourzadeh, Kent Bailey, Iftikhar Kullo
Journal: Circulation (2024)

Introduction: The MI-GENES randomized clinical trial (NCT01936675) assessed the effect of disclosing a polygenic risk score (PRS) for coronary heart disease (CHD), in addition to a clinical risk based on Framingham risk score (FRS), on LDL-C levels. The trial enrolled participants from Olmsted County, Minnesota, without cardiovascular disease, at intermediate CHD risk (10-y risk: 5-20%), and not on statins. There was a significant LDL-C reduction in the integrated risk score group (IRS g ; received PRS information in addition to the FRS) compared to the FRS group (FRS g ; received their risk based on FRS), due to more frequent statin initiation. Research Question: Does disclosure of an IRS for CHD lead to a lower rate of major adverse cardiovascular events (MACE)? Methods: Participants were followed from randomization beginning in October 2013 until September 2023 to ascertain cardiovascular events, testing for CHD, and risk factor changes, by blinded review of electronic health records. The primary outcome was time from randomization to the first MACE— defined as cardiovascular death, nonfatal MI, coronary revascularization, and nonfatal stroke. Analyses were done using Cox and linear mixed-effects models. Results: We followed all 203 participants, who completed the MI-GENES trial, 100 in FRS g and 103 in IRS g (mean age at the end of follow-up 68.2±5.2 years, 48% male). During a median follow-up of 9.5 years, 9 MACE occurred in FRS g and 2 in IRS g (HR, 0.20; 95% CI, 0.04 to 0.94; P =0.042, Figure 1A). In FRS g , 47 (47%) underwent at least one test for CHD, compared to 30 (29%) in IRS g (HR, 0.51; 95% CI, 0.32 to 0.81; P =0.004, Figure 1B). IRS g participants had a longer duration of statin therapy during the first four years post-randomization (Figure 1C) and a greater reduction in LDL-C for up to 3 years post-randomization (Figure 1D). No significant differences between the two groups were observed for hemoglobin A1C, blood pressure, weight, and smoking cessation rate during follow-up. Conclusion: The disclosure of 10-year CHD risk that included a PRS to those at intermediate risk was associated with lower incidence of MACE after a decade, likely due to more frequent and prolonged statin use, leading to lower LDL-C levels.
Abstract 4139067: Racial and Ethnic Variations in the Accuracy of International Classification of Diseases 10 <sup>th</sup> Revision (ICD-10) Codes for Identifying Pulmonary Embolism
Authors: Bassil Bacare, Sina Rashedi, Darsiya Krishnathasan, Candrika Khairani, Antoine Bejjani, Ying-Chih Lo, Mehrdad Zarghami, Shiwani Mahajan, Cesar Caraballo, jose victor jimenez ceja, David Jimenez, Manuel Monreal, Eric Secemsky, Erik Klok, Andetta Hunsaker, Ayaz Aghayev, Alfonso Muriel, Mohamad Hussain, Abena Appah-Sampong, Sanjay Aneja, HAMID MOJIBIAN, Samuel Goldhaber, Liqin Wang, Li Zhou, Harlan Krumholz, Gregory Piazza, Behnood Bikdeli
Journal: Circulation (2024)

Background: International Classification of Diseases, 10th Revision (ICD-10) discharge diagnosis codes are commonly used to identify patients with pulmonary embolism (PE) for research, surveillance, or quality improvement. Ethno-racial disparities exist in the presentation, treatment strategies, and outcomes of PE, but it is unknown whether disparities extend to how PE is coded in electronic health records. Methods: The PE-EHR+ study was designed to validate ICD-10 codes for PE. We used data from Mass General Brigham (MGB). The reference standard was the manual chart review by two independent investigators using predefined criteria. Sensitivity and specificity for ICD-10 codes were determined by race and ethnicity. Results: 1,712 randomly sampled patients in equal distribution with PE principal discharge codes, PE secondary discharge codes, and no discharge codes for PE were selected from MGB. The race and ethnicity of the patients were non-Hispanic White (n=1,368), non-Hispanic Black (n=160), non-Hispanic Asian (n=50), non-Hispanic other or unknown (n=84), and Hispanic or Latino (n=50). The sensitivity and specificity of ICD-10 discharge diagnosis codes for PE were similar across race and ethnicity (Table). The results for the principal discharge diagnosis codes showed low sensitivity (range: 45%-66.3%) but high specificity (range: 90.9%-96.7%) by race and ethnicity. The principal or secondary discharge diagnosis codes resulted in high sensitivity (range: 99.7%-100%) but low specificity (range: 66.2%-83.3%) by race and ethnicity. The hybrid approach encompassing principal codes or secondary codes plus diagnostic imaging codes displayed high sensitivity (range: 97%-100%) and moderately high specificity (range: 78.1%-90%) among different racial and ethnic groups. Conclusion: While the study shows the tradeoffs of various combinations of ICD-10 codes for identifying PE, reassuringly, there was no large variation by race and ethnicity.
Abstract 4139236: Artificial Intelligence–Electrocardiography to Predict Incident Atrial Fibrillation and Survival Following Kidney Transplant
Authors: JUAN FARINA, Isabel Scalia, Milagros Pereyra, Kamal Awad, Nima Baba Ali, Ahmed K. Mahmoud, Mohammed Tiseer Abbas, Said Alsidawi, D Eric Steidley, Hicham El Masry, Dan Sorajja, Chadi Ayoub, Girish Mour, Reza Arsanjani
Journal: Circulation (2024)

Background: New-onset atrial fibrillation (AF) is common among kidney transplant (KTx) recipients and is associated with reduced patient survival. Predictors of AF after KTx are not well understood, although AF can be associated with traditional and non-traditional risk factors. While artificial intelligence-enabled electrocardiography (AI-ECG) has shown promise in predicting incident AF, its predictive and prognostic implications in the KTx population have not yet been evaluated. Hypothesis: AI-ECG can predict new-onset AF and carries prognostic implications in patients undergoing KTx. Aims: To evaluate the clinical implications of applying AI-ECG to the preoperative ECGs of recipients of a KTx. Methods: Patients without a history of AF who underwent KTx at three referral centers between 2011 and 2021, with at least one preoperative ECG, were included in this retrospective study. Preoperative ECGs were analyzed using a previously developed AI-ECG algorithm to estimate the probabilities of new-onset AF. Based on these probabilities, patients were categorized into two groups: high and low probability of incident AF. The optimal cut-off value for the AI-ECG tool was determined using ROC analysis. The incidence of new-onset AF and mortality at 5 years post KTx were compared between these two groups using univariate and multivariate Cox regression analyses. Results: In total, 6246 patients were included (mean age 52.9 ±14.3 years, 58.7% males). A pre-transplant AI-ECG probability of AF &gt;10% was identified as the most accurate cutoff point to distinguish between patients at low risk and high risk of incident AF (ROC = 0.72). The study found that a preoperative AI-ECG high risk of AF demonstrated not only a strong association with new-onset AF (HR 2.54, 95%CI 2.02-3.19, p&lt;0.001 on multivariable analysis, Figure 1A ) but was also associated with an increased risk of mortality both on univariate (HR 2.73, 95%CI 2.34-3.18, p&lt;0.001) and multivariate (HR 1.57, 95%CI 1.29-1.91, p&lt;0.001 ) analysis at 5-year follow-up ( Figure 1B ). Conclusion: The application of AI-ECG to a single widely available test may help assess the risk of new-onset AF and mortality in patients undergoing KTx. Accurate risk stratification may identify a high-risk subgroup of transplant recipients who can benefit from closer AF monitoring, risk factor modification, and early management.
Abstract 4139074: Clinical characteristics and treatment of high-risk cardiovascular patients without prior myocardial infarction or stroke: VESALIUS-REAL - results from US
Authors: Queenie Chan, Swati Sakhuja, Andreas Ochs, Nafeesa Dhalwani, James O'Kelly, Erin Shannon, Gabriel PaivadaSilva Lima, Suna Avcil, Ulrich Laufs, Tomas Jernberg, Jaimini Cegla, Matthew Budoff, Ian Wong
Journal: Circulation (2024)

Background: Early intervention with lipid lowering therapy (LLT) in patients with high cardiovascular (CV) risk before myocardial infarction or stroke may have substantial public health benefits, despite being perceived as less urgent. The effect of evolocumab in this population is being investigated in an ongoing clinical trial (NCT03872401: Effect of Evolocumab in Patients at High Cardiovascular Risk Without Prior Myocardial Infarction or Stroke [VESALIUS-CV]). The current ongoing observational study examines the global burden of a VESALIUS-CV-like population in the REAL-world (“VESALIUS-REAL") in eight regions. We present data here on baseline characteristics and LLT of VESALIUS-CV like patients in the US. Methods: Using the eligibility criteria aligned with VESALIUS-CV ( Figure ), data were extracted from HealthVerity medical and pharmacy claims (2016-2023). A two-year observability period was required before index date; therefore, the first possible cohort entry was on January 1, 2018. Results: There were 518,852 VESALIUS-CV like patients with median age of 72 years (Q1-Q3: 64-79 years) and 56% were female ( Table ). Overall, 43% had coronary artery disease and 34% had high-risk diabetes mellitus (DM). Median low density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol and apolipoprotein B were 114 (Q1-Q3: 97-138) mg/dL, 141 (122-168) mg/dL and 92 (181-110) mg/dL, respectively. About 22% were on background LLT of whom 87% were on statins alone. Patients on LLT vs. no LLT were younger (median age 65 [Q1-Q3: 59-72] vs. 73 [66-80] years), had higher prevalence of tobacco users (29% vs. 17%) and high-risk DM (45% vs. 31%). Conclusions: In a large cohort of VESALIUS-CV like US patients, the majority had LDL-C sub-optimally managed with most not taking any LLT. This finding suggests an opportunity to reduce the treatment gap and improve lipid management in this population.
Abstract 4139063: Sex Differences in Age of Onset of Cardiovascular Disease and Subtypes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Alexa Freedman, Laura Colangelo, Cora Lewis, Pamela Schreiner, Sadiya Khan, Donald Lloyd-Jones
Journal: Circulation (2024)

Introduction: Historically, coronary heart disease (CHD) has been reported to develop about ten years earlier in males than females. However, whether this gap has narrowed in a contemporary sample and whether similar sex differences in age of onset exist for other cardiovascular disease (CVD) subtypes (stroke and heart failure [HF]) that are becoming more common is not known. Methods: Participants were enrolled in the CARDIA study between the ages of 18-30 years in 1985-1986. Sex differences in the cumulative incidence functions of premature CVD (defined as onset before 65 years), overall and for each subtype including CHD, HF, and stroke, were compared using Gray’s test. Results: Among 5115 participants (54.5% female, 51.6% Black), the mean age at study enrollment was 24.8 years (SD: 3.7). Over a median follow-up of 34.0 years (IQR 33.8, 35.7), cumulative incidence of total CVD, CHD, and HF was significantly higher in males compared with females (p&lt;0.05 for all). For total CVD, males reached an incidence of 5% at a younger age than females (50.1 versus 57.3 years, Figure). CHD was the most frequent CVD subtype, and an incidence of 2% occurred at a younger age among males compared with females (48.3 vs. 58.5). For HF, an incidence of 1% occurred among males by age 48.4 compared with 51.7 for females. For stroke, an incidence of 2% occurred at similar ages for males and females (56.3 and 55.1 years). Cumulative incidence for CVD, CHD, HF, and stroke, respectively, by age 50, was 5.0%, 2.7%, 1.3%, and 1.3% for males and 3.0%, 1.0%, 1.0%, and 1.3% for females. In a secondary race-stratified analysis, Black males and females reached cumulative incidences of 6.3% and 4.5%, respectively, for total CVD by age 50, in comparison to 3.7% and 1.4% among White males and females. Conclusion: Males reached 5% incidence of total CVD seven years earlier than females, with the greatest difference observed in age of onset for CHD. Age of onset for HF and stroke were similar between males and females. This may inform sex-specific prevention strategies for young adults.