tbuckley/cabot-search huggingface dataset:
Abstract 18033: Nationwide Trends in Major Adverse Cardiac and Cerebrovascular Events Hospitalizations and Cardiac Arrests in Young Women (18-44 Years), 2016-2019
Authors: Gayatri Bondi, Vamsikalyan R Borra, Sai Goutham Reddy Yartha, Dharshana Prem Anand, Shruti Sandeep Jain, Karthikeya Ramasahayam, reshmanth prathipati, Ayushi Parsottambhai Dudhat, Simran Patel, Raja Akshay Pingilati, Hemaswini Kakarla, Rupak Desai
Journal: Circulation (2023)

Introduction: Incidence of Major Adverse Cardiac and Cerebrovascular Events (MACCE) and cardiac arrests are increasing in younger women aged 18 - 44 years in the context of increasing metabolic syndrome and nontraditional risk factors such as stress, anxiety, and depression. We aim to assess recent trends in hospitalizations associated with MACCE and cardiac arrest in them. Methods: National Inpatient Sample database from 2016 - 2019 was used to examine temporal trends, risk factors, disparities, and outcomes related to hospitalization for MACCE and cardiac arrest in young women (18-44 years). We used the Chi-square test to evaluate the differences and multivariate logistic regression analysis for outcome analysis. Results: A total of 24,882,601 young women admissions were identified, in which 0.8% had MACCE and 0.1% had cardiac arrest. Between 2016 - 2019, there is a statistically significant increase in MACCE (0.7 % to 0.9 %) and cardiac arrests (0.1% to 0.2 %), p&lt;0.001. African Americans experienced higher adjusted odds of MACCE compared to whites (OR 1.06, 95% CI: 1.02-1.09, p&lt;0.001). Asian, white, and Hispanics experienced the lowest (0.1%) increase, while Native Americans experienced the highest (0.6%) increase in MACCE. There is a decrease in adjusted odds in Hispanics and Asians compared to whites in both MACCE and Cardiac arrest with statistical significance. Hypertension was African Americans’ most prevalent risk factor (62%). Length of stay was the same in all races (4 days) except in whites (3 days), with p value &lt; 0.001. The total cost of hospitalization was highest in Hispanics (95067USD) and least in blacks (75074USD). Conclusion: The rise in MACCE and cardiac arrest cases among young women highlights the need to expand the literature on the causes of these trends, female specific risk factors and racial disparities. The declining cardiovascular health of this population demands targeted prevention, early treatment and management strategies.
Abstract 14850: Streptococcus Constellatus: A Rare Cause of Cardiac Tamponade and Constrictive Pericarditis
Authors: Saad Ur Rahman, Seemab Imtiaz Gill, Mobeen Haider, Yousra Khalid, Timothy Shih, naveed adoni
Journal: Circulation (2023)

Introduction: Cardiac tamponade is an emergency medical condition referring to the buildup of fluid in the pericardial sac, which can compress the heart and lead to hemodynamic instability. Streptococcus constellatus, a member of the Streptococcus viridans group, has been implicated as a rare cause of cardiac tamponade with only 3 cases reported in the medical literature. We present a unique case of Streptococcus constellatus (S. constellatus) induced purulent pericarditis leading to cardiac tamponade and constrictive pericarditis. Case presentation: A 56-year-old female with no significant past medical history presented with intermittent fever, non-productive cough, and worsening shortness of breath for 2 weeks. She initially went to Convenient Care a week ago for a sore throat with a low-grade fever and was sent home with oral antibiotics. Initial vitals revealed hypotension, high-grade fever, and tachycardia. Physical examination was remarkable for elevated jugular venous pressure and muffled heart sounds. Lab work showed significant leukocytosis. EKG was remarkable for diffuse ST-elevation, low QRS voltage, and electrical alterans. A transthoracic echocardiogram (TTE) revealed severe pericardial effusion. Emergent pericardiocentesis was performed draining 370 ml of purulent fluid and post-operative TTE revealed trace pericardial effusion. Blood and pericardial fluid cultures came back positive for S. constellatus. Another trans-esophageal echocardiogram (TEE) was performed during the hospital stay that was negative for any vegetation however, revealed thickened pericardium with septal bounce suggesting constrictive pericarditis. Cardiothoracic surgery recommended repeat TTE in 3 months for possible pericardiectomy if pericardial changes persist. The patient was discharged on oral antibiotics and colchicine in stable condition. Discussion: S. constellatus is typically part of oral, respiratory, and gastrointestinal flora. It can reach the pericardial space through hematogenous spread or direct extension from nearby infections. Our case highlights prompt identification and appropriate treatment which are crucial for managing this potentially life-threatening and unique condition.
Abstract 14862: Electrophysiological Predictors of Susceptible Atrial Substrate for the Onset and Recurrence of Atrial Fibrillation
Authors: Michael Mayer, Zaid Aziz, Amrish Deshmukh, Hatem Al Kassem, Andrew Beaser, Gaurav A Upadhyay, Maryam Emami, Cevher Ozcan
Journal: Circulation (2023)

Introduction: Atrial electro-anatomical substrate is essential for pathogenesis of atrial fibrillation (AF). Electrophysiological markers of AF susceptibility, however, are not well characterized. Identifying markers of atrial substrate has significant clinical implications in early detection and intervention for AF or stratifying patients at higher risk of AF recurrence following ablation. Hypothesis: We hypothesized that conduction indices on surface electrocardiogram (ECG) and intracardiac electrogram (EGM) may predict susceptibility and/or AF recurrence following ablation. Methods: We studied all consecutive patients who underwent electrophysiological study and catheter ablation for AF or atrioventricular nodal reentrant tachycardia (AVNRT) from 2013 to 2018. Atrial conduction indices were measured on ECG and EGM during the electrophysiology study. We evaluated correlations between both AF and AF recurrence with conduction indices, and associations between AF recurrence and conduction indices were evaluated with univariate logistic regression analyses and machine learning. Results: The study population included 387 patients with AF (mean age 63 years, 31% female) and compared to patients with AVNRT (n=94) who were considered as a control group. AF was associated with significant prolongation of all measured surface ECG and EGM parameters (p&lt;0.05). During a mean follow up of 5±2 years, recurrence of AF (48%) after successful ablation occurred in patient with longer P wave duration, left atrial (LA) conduction duration, proximal to distal coronary sinus (pCS-dCS) interval, and P-dCS interval (p&lt;0.05). Prolonged P wave duration, LA duration, pCS-dCS interval, and QRS duration were predictors of AF recurrence. Machine learning modeling determined that pCS-dCS interval, QRS duration, and LA duration (lead V1 and II) were the most impactful conduction indices for AF recurrence. Conclusions: Atrial conduction indices are markers of susceptible substrate for the onset and the recurrence of AF after successful ablation. LA conduction parameters can be used for risk stratification to facilitate early detection and management of AF.
Abstract 17959: Cardiovascular Outcomes and Readmissions of Atrial Fibrillation Among Patent Foramen Ovale Occluder Device Recipients : A Propensity Matched National Readmission Study
Authors: Amro Taha, Shafaqat Ali, Sanchit Duhan, Lalitsiri Atti, Sundal Aziz, Sheref Elseidy, Fadi Khir, Varun Victor, Maja Boshkovska Spaseski, Saliha Erdem, Ammar ElJack, Talal Almas, Shehzad Ali, M Chadi C Alraies
Journal: Circulation (2023)

Introduction: Patent foramen ovale (PFO) occluder devices are increasingly utilized minimally invasive procedures used to treat cryptogenic stroke. Data on the impact of Atrial Fibrillation (AF) among PFO occluder device recipients are limited. Methods: The Nationwide Readmissions Database was queried between 2016 to 2019 to identify PFO patients with and without AF. The two groups were compared using propensity score matching (PSM) and multivariate regression models. The outcomes included in-hospital mortality, acute kidney injury (AKI), Mechanical circulatory support use (MCS), Cardiogenic shock (CS) acute ischemic stroke, bleeding and other cardiovascular outcomes. Statistical analysis was performed using STATA v. 17. Results: Out of 6,508 Weighted hospitalizations for PFO occluder device procedure over the study period, 877 (13.4%) had AF compared to 5,631 (86.6%) who did not. On adjusted analysis, PFO with AF group had higher rates of MCS (PSM, 4.5% vs. 2.2 %, p value=0.011) and SCA (PSM, 7.6% vs. 4.6 %, p value=0.015) compared to PFO with no AF. There was no statistically significant difference in the rate of in hospital mortality (PSM, 5.4% vs. 6.4 %, p value=0.39), CS (PSM, 8.3% vs. 5.9 %, p value=0.075), AKI (PSM, 32.4% vs. 32.3 %, p value=0.96), bleeding (PSM, 2.08% vs. 1.3 %, p value=0.235) or the readmission rates among both cohorts. Additionally, AF was associated with higher hospital length of stay (9.5 +/-13.2 vs. 8.2 +/-24.3 days, p value =0.012 ) and total cost ($66,513+/-$80,922 vs. $52,013+/-$125,136, 0.025, p value = 0.025) compared to PFO without AF. Conclusions: The presence of AF among PFO occluder device recipients is associated with increased adverse outcomes including MCS use and SCA with no difference in mortality and the readmission rates among both cohorts. Long term follow up needs further studies.
Abstract 16390: Polygenic Risk Scores Predict Future Atrial Fibrillation-Related Stroke/Systemic Embolism
Authors: Hanjin Park, Daehoon Kim, Eunsun Jang, Hee Tae Yu, Tae-Hoon Kim, Jung-Hoon Sung, Hui-Nam Pak, Moon Hyoung LEE, Pil-sung Yang, BOYOUNG JOUNG
Journal: Circulation (2023)

Introduction: Targeted screening for atrial fibrillation (AF) should include those at highest risk of future AF-related stroke/systemic embolism, which might be potentially preventable. Hypothesis: To investigate whether AF polygenic risk score (AF-PRS) can predict future AF-related stroke/systemic embolism. Methods: A total of 41,337 individuals (≥65 years) free of AF and additional risk factor for stroke at baseline were included from the UK Biobank. A stroke/systemic embolism event was considered AF-related and potentially preventable when a previously undiagnosed AF was identified at the time of stroke/systemic embolism or up to 3-years after the event. Results: For a median of 11.4 (10.5-12.3) years, 334 AF-related stroke/systemic embolism developed. After adjusting for CHARGE-AF, AF-PRS identified significant gradient for AF-related stroke/systemic embolism with 3.78-fold higher risk in the top quintile of the AF-PRS (HR 3.78, 95% CI 2.57-5.58, p&lt;0.001) whereas not for AF-unrelated stroke/systemic embolism (HR 0.97, 95% CI 0.78-1.23, p=0.860). The number needed for 5-years of AF screening to find 1 AF-related stroke/systemic embolism was 79 for high CHARGE-AF and high AF-PRS whereas 831 for low CHARGE-AF and low AF-PRS. AF-PRS added to CHARGE-AF resulted in a significant improvement in C-indices for AF-related stroke/systemic embolism [C index (standard error) 0.606 (0.011) to 0.676 (0.010), ΔC-index &lt;0.001] whereas not for AF-unrelated stroke/systemic embolism. Conclusions: AF-PRS predicted future AF-related stroke/systemic embolism beyond traditional clinical risk factors. Targeted AF screening on high genetic risk patients might identify more screening preventable stroke/systemic embolism events.
Abstract 295: Predicting Outcomes in Adult Patients With Out-of-Hospital Cardiac Arrest; Results From the All-Japan Utstein Registry
Authors: Tsukasa Yagi, Ken Nagao, Naohiro W Yonemoto, EIZO TACHIBANA, Shigemasa Tani, Nobutaka Chiba, Tadashi Ashida, Yasuo Okumura, Yoshio Tahara, Takanori Ikeda
Journal: Circulation (2023)

Background: The recent cardiopulmonary resuscitation (CPR) Guideline addressed that there was no evidence to clearly define what should constitute selected patients in case of performing invasive CPR, such as extracorporeal CPR, for patients with cardiac arrest (CA). However, emergency physicians often need to determine the treatment strategy immediately upon arrival in emergency departments. The present study aimed to clarify the helpful factor of prehospital care to predict adult CA patients' prognosis using the All-Japan Utstein Registry data, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA). Methods: From the data of this registry, between 2005 and 2020, we included adult OHCA patients due to cardiac etiology. The endpoint was the favorable neurological outcome at 30 days after OHCA. The multivariable logistic regression analysis included potential confounding factors based on biological plausibility and previous studies. We scored based on the odds ratio. Receiver operating characteristic analysis was performed, and the area under the curve (AUC) was calculated for factors of the total score in order to assess the 30-day neurological outcome. Results: Of the 1,930,273 patients registered in this Registry, the data of 1,099,908 patients were included in this analysis. The table showed the adjusted odds ratio for 30-day favorable neurological outcomes in OHCA patients in the multivariate analysis, and the score based on the odds ratio. The AUC of the total scores was 0.956 (p &lt; 0.001) with a cutoff value of 7, a sensitivity of 92%, and a specificity of 88%. In the case of this total score of less than 7, the 30-day favorable neurological outcome in CA patients was significantly low (total score &lt; 7 vs. total score &gt; 7 = 0.3% vs. 18.7%: p&lt;0.001). Conclusion: This score might be a helpful factor in prehospital care information in CA patients to determine the treatment strategy upon arrival in emergency departments.
Abstract 15973: Ambient Air Pollution is Associated With Coronary Artery Disease and Adverse Outcomes in Patients With Stable Chest Pain Across the U.S.: Insights From the PROMISE Trial
Authors: Marcel C Langenbach, Thomas Mayrhofer, Isabel L Langenbach, Michael T Lu, Julia Karady, Neha J Pagidipati, Svati H Shah, Maros Ferencik, Alison Motsinger-Reif, Pamela S Douglas, Borek Foldyna
Journal: Circulation (2023)

Introduction: Air pollution is associated with coronary artery disease (CAD) and cardiovascular (CV) outcomes. Hypothesis: The relationships of air pollutants to CAD and outcomes are independent of traditional CV risk factors and socioeconomic determinants of health (SDoH) and vary by pollutant type. Methods: Clinical and CT data from stable chest pain patients without known CAD in the PROMISE trial, were linked by home zip code to U.S. EPA-derived PM 2.5 and PM 10 (Figure 1a) . CT metrics included any plaque, obstructive CAD (≥50%), and high-risk plaque (HRP); major adverse CV events were defined as death (all cause or CV), myocardial infarction, or unstable angina. Logistic and Cox regressions were adjusted for age, sex, obesity, ASCVD risk, statins, and US Census-based SDoH by zip code. We conducted a mediation analysis for the effect of pollutants on events using obstructive CAD as mediator. Results: In 4,343 individuals (48% men; age: 61±8 years), 46.9% were exposed to PM 2.5 above the standard cut point of 9.5 μg/m 3 and 62.1% to PM 10 ≥15 μg/m 3 . Participants exposed to PM 2.5 ≥9.5 μg/m 3 had 27% higher odds of obstructive CAD (aOR=1.27, 95%CI: 1.03-1.56, p=0.026), not significant for PM 10 . No associations existed between pollutants and any plaque or HRP. PM 2.5 and PM 10 were independently associated with CV events in fully adjusted models (Figure 1b) . In mediation analysis, the effects of PM 2.5 on events were significant (direct effect: OR=1.66, 95%CI: 1.11-2.50, p=0.014; indirect effect: OR=1.06, 95%CI: 1.01-1,12, p=0.022) with comparable results for PM 10 . Conclusions: Air pollution relates independently to adverse events in stable chest pain patients, only partly driven by CAD phenotypes, specifically an association between small particular matter and obstructive CAD. Further studies investigating the pathogenesis of atherosclerotic disease in people exposed to pollution may help form strategies to reduce exposure.
Abstract 16216: Sociodemographic Disparities in Severity of Multisystem Inflammatory Syndrome in Children: The National MUSIC Study
Authors: Keila N Lopez, Dongngan Truong, Brett R Anderson, Carissa M Baker-Smith, Tamara T Bradford, Audrey Dionne, Kirsten Dummer, Daniel E Forsha, Wayne J Franklin, Stephanie Handler, Ashraf S Harahsheh, Keren Hasbani, Chenwei hu, Pei-Ni Jone, Sean Lang, Kimberly E McHugh, Matthew Oster, Gail D Pearson, Michael A Portman, Tamar Preminger, Mark Russell, Yamuna Sanil, S Sexson Tejtel, Divya Shakti, Ryan Shea, Felicia Trachtenberg, Shuo Wang, Jonathan P. P Wong, Jane W Newburger
Journal: Circulation (2023)

Introduction: The long-term outcomes after the Multisystem Inflammatory Syndrome in Children (MUSIC) study investigates sequelae in multisystem inflammatory syndrome (MIS-C) post-COVID across 33 US and Canadian sites. Among children with COVID-19, the adjusted MIS-C incidence rate ratios are higher in children who are Hispanic or Black. Our objective was to assess sociodemographic disparities associated with MIS-C severity and adverse outcomes. Methods: This multicenter cross-sectional study included US persons &lt;21 years-old with MIS-C from 6/2020-1/2022. The primary composite outcome of greater illness severity included &gt; 1 findings: vasoactive medications, cardiac dysfunction or elevated troponin, intubation, or mechanical support. Secondary outcomes were days from symptom onset to hospital admission and hospital length of stay (LOS). Predictor variables were patient distance to the hospital, neighborhood social deprivation index (SDI-higher score is worse), race/ethnicity, and non-primary English language. Covariates were age, insurance, asthma, and obesity. Multivariable models used backwards selection at significance p&lt;0.05. Results: There were 1115 MIS-C patients, with a median age of 9 years old (IQR 5.6, 12.7), 39.2% female, 28.1% non-Hispanic Black, 27.8% Hispanic, 47.3% with public insurance, and a median SDI of 54 (IQR 25.0, 82.5). On multivariable analysis, increased odds of more severe illness included Hispanic ethnicity, odds ratio (OR) 1.5 (95% CI 1.1, 2.2); non-Hispanic Black race, OR 1.7 (95% CI 1.1, 2.4) compared to non-Hispanic whites; and ages 13-17 years, OR 3.7 (95% CI 2.4, 5.6) compared to those ages 0-5 years. Longer time to hospital admission was associated with lower SDI (i.e., less deprivation; p=0.009) and further distance from hospital (p=0.006). Risk factors for longer LOS were adolescent age (p=0.002) and non-Hispanic Black race (p=0.018). Asthma and obesity had no association with MIS-C severity. Conclusion: MIS-C severity and adverse outcomes are associated with sociodemographic factors, including being Black and/or Hispanic. Future studies should explore risk mechanisms , including systemic racism, environmental and genetic causes, quality of medical care, or multifactorial interactions.
Abstract 14482: Low Utilization of Guideline-Recommended Genetic and Pharmacogenetic Testing Among Patients With Cardiovascular Conditions in the United States (US)
Authors: Brady DeHart, Pamela Morin, Jamie Tucker, Scott Spencer, Bela Bapat, Kalliopi Trachana, Damon Hostin, Brock Schroeder, John Belmont, MD,PhD
Journal: Circulation (2023)

Introduction: Cardiovascular disease (CVD) continues to be the leading cause of death in the US and globally. Clinical practice guidelines recommend genetic testing for the diagnosis of select CVDs to improve disease management, reduce incidence of cardiac events, and positively impact major cardiac adverse events. Professional guidelines also recommend pharmacogenomic (PGx) testing for patients being prescribed certain medications. Research Question: What is the utilization of genetic diagnosis and PGx testing in patients with CVD in the US? Methods: This study used data from the Optum Labs Data Warehouse, composed of de-identified administrative claims data for both commercially insured and Medicare Advantage enrollees to assess rates of genetic testing among adult patients diagnosed with 4 major types of CVD conditions (arrhythmias (N=518,316), familial hypercholesterolemia (FH) (N=38,068), cardiomyopathies (CM) (N=74,597), and aortopathies (N=58,316)) and PGx testing rates in patients prescribed CVD medications with PGx test recommendations (per CPIC guidelines) between January 1, 2017 to December 31, 2021. Patients were required to have ≥12 months of continuous enrollment prior (baseline) to diagnosis (index date) and ≥12 months post-index period unless they died (follow-up). Genetic and PGx testing was captured using Current Procedural Terminology (CPT®) codes in both baseline and follow-up periods. Results: Low genetic testing utilization was found across the 4 major types of CVD conditions. Genetic testing rates were 1.3% in the arrythmia cohort, 1.9% in the CM cohort, 2.0% in the aortopathy cohort and 1.9% in the FH cohort. PGx testing rates in patients prescribed with CVD relevant medications were 0.6% (N=2,094/377,111) in the arrhythmia cohort, 0.8% (N=501/60,632) in the CM cohort, 0.7% (N=247/37,344) in the aortopathy cohort, and 1.3% (N=329/25,835) in FH cohort. Conclusions: Despite clinical practice guidelines, genetic and PGx testing in patients with CVD conditions remains underutilized. Future work will help us understand the barriers to guideline adherence both for genetic diagnosis and PGx testing that could impact clinical management and patient outcomes.
Abstract 15470: Increased Risk of Major Adverse Cardiac and Cerebrovascular Events in Elderly Non-Smokers With Cannabis Use Disorder: A Population-Based Analysis
Authors: Avilash Mondal, Qiming Dong, Bhaswanth Bollu, Nimra Shafi, Maneeth Mylavarapu, Poojan Parmar, SRIHARSHA DADANA, Abeera Kali, Muhammad Hassan Khan, Srija Shanker, Samia butt, Rupak Desai
Journal: Circulation (2023)

Background: Tobacco smoking confounds CVD risk studies. No large-scale investigation has been performed yet to examine cannabis use disorder (CUD) in elderly non-smokers with established CVD risk and major adverse cardiac and cerebrovascular events (MACCE). Methods: The National Inpatient Sample (2019) was queried using relevant ICD-10 codes to identify elderly (&gt;65 years) admissions with established CVD risk without known tobacco use disorder and stratified into CUD and non-CUD cohorts. Logistic regression evaluated MACCE odds as primary outcomes and secondary outcomes as predictors of MACCE incidents in CUD users. P&lt; 0.05 was considered significant. Results: Of 28,535 elderly cannabis users with CVD risk and no tobacco use disorder, 13.9% reported MACCE episodes. CUD patients were more likely to be male, black, and non-electively admitted from urban teaching and Western region hospitals. AIDS, alcohol abuse, depression, uncomplicated hypertension, and drug abuse were greater in the CUD cohort, while the non-CUD group had more complicated hypertension, diabetes with and without chronic comorbidities, hyperlipidemia, obesity, thyroid issues, previous strokes, VTE, cancer. The CUD cohort reported higher MACCE (OR 1.20; 95% CI 1.11-1.29). ACM (3.3% vs. 1.7%), dysrhythmia (34.9% vs. 24.9), acute myocardial infarction (7.6% vs. 6.0%, p 0.001), transfer to other facilities (28.9% vs. 19.0%), and home health care (22.4%) compared to non-CUD cohort (p 0.001). Chronic lung disease, renal disease, hypertension, and hyperlipidemia were predictors of MACCE episodes in CUD users. Conclusion: Even after controlling for smoking, elderly cannabis users having CVD risk had 20% more MACCE events encountered than non-users. Cannabis use in older non-smokers deserves investigation into CVD. risks