tbuckley/cabot-search huggingface dataset:
Abstract 4144857: Large Language Models to Understand Reasons for Anticoagulation Nonprescription in Atrial Fibrillation
Authors: Sulaiman Somani, Dale Kim, Eduardo Perez, Summer Ngo, Tina Hernandez-Boussard, Fatima Rodriguez
Journal: Circulation (2024)

Introduction/Aims: Anticoagulation (AC) reduces the risk of stroke in atrial fibrillation (AF), yet nonprescription rates near 50%. Reasons for this care gap are not well understood. Large language models (LLMs) may be able to extract documented reasons for AC nonprescription from unstructured text in clinical notes. Methods: We created a cohort of all index patient encounters with a clinician-billed ICD10 diagnosis code for AF at Stanford Health Care from January 1, 2015 through December 31, 2023. Three trained reviewers annotated 10% of all AF- or AC-related note excerpts for whether the reason for AC nonprescription was documented and the reason for nonprescription with an overlap of 100 notes to assess annotator performance. Zero-shot prompts were designed for a proprietary LLM (GPT4) for the same tasks. Inter-annotator reliability (IRR) and model-annotator reliability (MAR) were assessed using Cohen’s kappa coefficient. Results: A total of 35,737 AF-related encounters were identified, of which 7,712 (21.6%) did not have an active AC prescription. These encounters contained 9,143 associated notes, from which 21,573 AF- and AC related excerpts were extracted. Ten percent of these (911 notes and 2,175 excerpts) were allocated for manual annotation. Reason for AC nonprescription was recorded in 497 (54.6%) notes, with antiplatelet use (N=172, 18.6%), perceived AC contraindication (N=134, 14.7%), and low burden of AF (N=131, 13.9%) being the most common. IRR across reviewers for identifying documented reasons was 0.776 (95% CI 0.716, 0.837), while MAR with GPT4 was 0.609, (95% CI 0.460, 0.758; P = 0.011). GPT4 achieved substantial agreement (MAR &gt; 0.6) for identifying patient preference (MAR 0.763), antiplatelet use (MAR 0.676), and low stroke risk (mean MAR 0.891). There was moderate agreement for identifying perceived AC contraindication (MAR 0.589), fair agreement for low burden of AF (MAR 0.282), and poor agreement (MAR &lt; 0.2) for identifying therapeutic inertia, existing AC use, and prior AF ablation. Conclusions: Across a contemporary AF cohort, LLMs categorized reasons for AC nonprescription including antiplatelet use as alternative agents, perceived AC contraindication, and low AF burden. This approach can be leveraged to understand and mitigate actionable barriers to guideline directed cardiovascular care.
Abstract 4144806: Epidemiology of Venous Thromboembolism and the use of Antithrombotic Strategies in Pediatric Patients with Congenital Heart Disease
Authors: Amy Kiskaddon, Nhue Do, Arabela Stock, Alyssa Miles, Vera Ignjatovic, Neil Goldenberg
Journal: Circulation (2024)

Introduction: Pediatric patients with congenital heart disease (CHD) are known to be at risk for venous thromboembolism (VTE). However, data describing the rate of recurrent VTE, types of cardiac surgery, and types/locations of index VTE are limited. Aim: The objectives of this study were to determine the rate of incident and recurrent VTE in pediatric patients with CHD undergoing cardiac surgery and evaluate the type of index surgery, index VTE location/site, and antithrombotic therapies. Methods: We queried the TriNetX Research database for patients under the age of 18 years from July 2016 to May 2024, who had a diagnosis of CHD and an index VTE. Descriptive statistics were employed. Results: Of 26,792 pediatric patients who underwent congenital cardiac surgery, 2225 (8.3%) developed an index VTE. Septal defect repair (n=574, 25.8%), shunt placement (n=502, 22.6%) and correction of single ventricle/complex cardiac anomaly (n=389, 17.5%) were the most common index cardiac surgeries in patients who developed index VTE. Lower extremity VTE (n=1219, 54.8%) was the most common type of index VTE. Unfractionated heparin (n=1441, 64.8%) was the most commonly utilized antithrombotic drug for index VTE treatment. Five hundred seventy-nine (26%) patients who underwent cardiac surgery developed at least 1 recurrent VTE within 1 year of the index VTE. Conclusions: Among pediatric patients with CHD that requires cardiac surgery, the rate of incident and recurrent VTE is higher than previously expected. Multicenter prospective cohort studies are warranted to further evaluate the rate of, and risk factors for, recurrent VTE, to facilitate future risk-stratified trials of antithrombotic therapy approaches in these children.
Abstract 4145113: Association of Vasoactive-Inotropic Score and Poor Outcomes, Including Mortality, in Patients Who Underwent Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis
Authors: Nanush Damarlapally, Roopeessh Vempati, Srivatsa Surya Vasudevan, Prathibha Banda, Gaurav Mathur, Afrasayab Khan, Denise Mourad, Harshavardhan Polamarasetty, Rupak Desai
Journal: Circulation (2024)

Background: Vasoactive-inotropic score (VIS) has been previously utilized as one of the predictors in open heart procedures postoperatively, but its association with poor outcomes in patients who underwent coronary artery bypass graft (CABG) is still unclear. We aim to find the association in this population. Methods: PubMed, Google Scholar, and Scopus were systematically searched for studies showing an association of poor cardiovascular (CV) outcomes, including mortality with VIS from inception to May 2024 following CABG surgery. Pooled effect sizes were estimated using a fixed-effect model and 95% confidence intervals (CI). I 2 statistics was used to measure heterogeneity. Leave-one-out sensitivity analysis and meta-regression analysis were utilized to measure the robustness of our findings and detect influencing confounding variables, respectively. Quality assessment of the studies was done through the Joanna Briggs Institute (JBI) tool. P-value &lt;0.05 was considered significant. Results: Six studies with a total sample size of 6504 patients following CABG surgery, with a mean age of 63.6 ± 3.15 years, containing predominantly males (71.8%) reported poor outcomes such as CV morbidity, cardiopulmonary resuscitation, mechanical ventilation, stroke, and mortality. Most studies had hypertension, diabetes, and chronic kidney disease as comorbidities. Our meta-analysis found a significant association between VIS &gt; 5 and poor outcomes, including mortality in six studies with pooled unadjusted OR-1.08 [95% CI: 1.06-1.10, p &lt; 0.0001] and in four studies with adjusted OR-1.07 [95% CI: 1.04-1.09, p &lt; 0.0001] among those who underwent CABG (Figure 1a). Sensitivity analysis showed no variations among studies and confirmed the robustness of our findings (Figures 2a&amp;2b). Additionally, meta-regression analysis indicated that mean age was associated with a minimal progression rate of mortality in patients succeeding CABG with a VIS &gt; 5 (p = 0.04). (Figure 1b) High scores in the JBI tool revealed high quality among the studies selected. Conclusion: Our study suggests that there is a significant association of VIS &gt; 5 with poor cardiovascular outcomes in patients following CABG surgery. This association can help in preventing deleterious cardiovascular outcomes.
Abstract 4144977: The Association of Social Determinants of Health with Pediatric Pulmonary Hypertension Outcomes
Authors: Jai Khurana, Stuart Lipsitz, Katie Moynihan, Mary Mullen
Journal: Circulation (2024)

Background: Social determinants of health (SDoH) impact access to healthcare and outcomes. Few studies examine SDoH in pediatric pulmonary hypertension (PH) patients. Hypothesis: Outcomes in pediatric PH patients will differ according to SDoH with increased mortality in those from 1) low Child Opportunity Index (COI) areas or 2) non-local to our specialized quaternary center, with 3) public insurance, 4) limited English proficiency (LEP) and 5) underrepresented races/ethnicities. Methods: In this single center, retrospective cohort study, pediatric PH patients (&lt;18) with inpatient admission 2012-2021 were identified using ICD-10 codes. Demographics, clinical course and outcomes were compared according to SDoH. Logistic regression, with SDoH separately added, studied associations with mortality at current follow-up, controlling for clinical factors, number of admissions and follow-up length with Bonferroni correction. Results: Of 1735 pediatric PH patients, 232 (13.4%) died. Median time to last follow-up or death was 35 days (IQR 8, 241). Median age was 215 days (IQR 14, 1716) with etiological subgroups of pulmonary arterial hypertension (275, 15.9%), left heart disease (1169, 67.4%), lung disease (271, 15.6%), thromboembolic (16, 0.9%) and other (4, 0.2%). Patients had a median of 3 complex chronic conditions (IQR 2, 5), ECMO (10.3%), lung (1.5%) or heart transplant (2.8%), tracheostomy (12.1%) and utilized PDE5 inhibitors (29.9%), prostacyclins (1.7%), endothelin receptor antagonists (4.0%) and inhaled nitric oxide (11.9%). Patients that died had lower COI (median 61.5 [IQR 30.8, 80.3]) vs. those who survived (median 69.0 [IQR 43, 88] p=0.002). Mortality was higher in those with public vs. private insurance (15.5% vs 11.7%, p=0.022). Mortality differed by race/ethnicity (p&lt;0.001); 11.6% in non-Hispanic/Latino White patients, 9.5% ‘another’, 1.7% Asian, 19.6% Black, 9.5% Hispanic/Latino, 4.0% multiracial and 19.2% unknown. Survival for local vs. out of state and LEP patients were similar (p&gt;0.6). For a 10-point COI increase, adjusted mortality odds were 0.92 lower (95%CI 0.87, 0.98, p=0.009). Patients with Black (1.93 [95%CI 1.2, 3.2] p=0.011) and unknown race (1.99 [95%CI 1.4, 2.9] p&lt;0.001) had higher adjusted odds of mortality vs. White. Payer was not independently associated with mortality. Conclusions: Black PH patients or those from lower COI areas had higher mortality. Deeper understanding of disparate outcomes is needed to advance health equity.
Abstract 4144892: Thymidine phosphorylase plays a mechanistic role in lipid metabolism and obesity
Authors: Robbie Jividen, Hong Yue, Wei Li
Journal: Circulation (2024)

Background: Obesity is an independent risk factor for the development of type II diabetes (T2DM), metabolic dysfunction-associated steatotic liver disease (MASLD), and cardiovascular disease (CVD). Imbalanced lipid metabolism and chronic inflammation are the major contributing factors for the development of obesity and T2DM, and their associated MASLD and CVD. Thymidine phosphorylase (TYMP) plays an important role in platelet activation and thrombosis in response to vascular injury, including in obese and diabetic mice. Scattered studies suggest that TYMP is increased in obese individuals and is present in the lipid-rich core of human atherosclerotic lesions. Hypothesis: TYMP is essential for lipid metabolism and the development of obesity. Methods: WT and male Tymp –/– mice were fed a Western diet (WD), starting from 8 weeks of age, and food intake and body weight gain were monitored for 8 weeks. Liver and perigonadal fat tissue weights and the small intestine length were measured upon sacrifice. Fecal density was measured by the time taken to sink into water. TYMP and CD36 expressions in the small intestine of mice fed a chow diet or the WD were measured by qPCR and immunostaining. Results: TYMP deficiency dramatically reduced the gain of body weight, liver, and visceral fat weight in male, but not female, mice ( Figure 1 ). The length of the small intestine was significantly longer in male Tymp –/– mice compared to WT mice, but similar in females ( Figure 2 ). Male Tymp –/– mice showed an increased sensitivity to insulin ( Figure 3 ). The liver exhibited the highest TYMP expression in mice, followed by the lungs and small intestine. Fecal density was lower in male Tymp –/– mice consuming the WD, but there was no difference in mice consuming a normal laboratory diet. These data suggest that the feces of male Tymp –/– mice may contain more fat. WD feeding increased the expression of TYMP and CD36 in the small intestine, while CD36 expression was dramatically reduced in Tymp –/– mice. TYMP deficiency also attenuated CD36 expression in the liver of WD-fed mice. Conclusion: Our data suggest that TYMP plays a key role in regulating lipid metabolism, likely by upregulating intestinal CD36 expression, thus leading to increased lipid absorption and the development of obesity. Targeted TYMP inhibition may be a novel anti-obesity therapy.
Abstract 4144956: Identifying Inequities: The Underrepresentation of Racial and Ethnic Minorities in Guideline Informing Heart Failure Trials with Reduced Ejection Fraction and Its Implications
Authors: Eson Ekpo, Joshua Elmore
Journal: Circulation (2024)

Background: The prevalence of risk factors for heart failure and outcomes varies across racial and ethnic groups. Despite this variation, treatment guidelines for heart failure are standardized, potentially overlooking the unique needs and responses of minority populations. This study aims to critically assess the underrepresentation of racial and ethnic minority groups in major clinical trials that have significantly influenced the development of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF). Methods: We searched CINAHL, Embase, MEDLINE, and PubMed for randomized controlled trials (RCTs) that demonstrated reduced mortality or hospitalization through interventions in patients with HFrEF. We then analyzed the racial and ethnic data of the trial participants and compared minority enrollment to the 2020 United States Census demographic estimates. Results: We examined 30 trials conducted from 1987 to 2021. Thirty percent of the trials did not report racial/ethnic data. Among the remaining trials, 20 reported participation rates for non-Hispanic White (NHW) individuals, 14 reported Black participation, one reported Hispanic participation, and seven reported Asian participation rates. One trial reported participation rates for all four groups. When we analyzed the pooled participation among trials reporting race/ethnicity, most participants were non-Hispanic White (81.7%), followed by Asian (16.1%), Hispanic (6.0%), and Black (5.2%) (image). Trials primarily conducted in North America showed greater representation of racial/ethnic minorities. Compared participation rates with 2020 U.S. Census estimates showed that Black and Hispanic populations were underrepresented. Conclusion: The underrepresentation of racial and ethnic minorities in pivotal HFrEF clinical trials, which have significantly contributed to the development of guideline-directed therapy, is a matter of great concern. This lack of diversity may exacerbate health disparities by not adequately addressing the unique clinical characteristics and responses to therapy. It is not enough to acknowledge this problem; all stakeholders involved in clinical research must make sustained and collective efforts to ensure the equitable inclusion and reporting of racial and ethnic groups in trials. Improving the enrollment of ethnic minorities requires a shared and committed investment from investigators, research coordinators, oversight committees, and funding sources.
Abstract 4144876: Genetic evaluation of metabolic signatures associated with lipid-lowering medications
Authors: Pranav Sharma, Samuel Khodursky, Shuai Yuan, Scott Damrauer, Michael Levin
Journal: Circulation (2024)

Introduction: Human genetic studies have identified hundreds of risk loci for circulating lipoproteins, motivating the development of new lipid-lowering medications. Although these targets influence lipids and metabolites through unique mechanisms, the extent to which they exert shared pleiotropic effects on other effectors of atherosclerotic cardiovascular disease remains uncertain. This study explored the lipid subfraction, cytokine, and metabolic signatures associated with lipid-lowering targets using Mendelian Randomization (MR). Methods: The study focused on protein targets of novel lipid-lowering medications: PCSK9, APOB, LPA, LPL, and ANGPTL3. Instruments for PCSK9, LPL, and ANGPTL3 were derived from the UK Biobank Pharma Proteomics Project (54,219 participants), and for LPA and APOB from the Pan-UK Biobank (335,796 and 418,505 participants). These exposures were tested against outcomes including 40 cytokines (meta-analysis of 74,783 individuals), 249 lipid-subfraction measures (118,461 UK Biobank participants), and 1,400 metabolite measures (8,299 participants in the Canadian Longitudinal Study on Aging). Univariable MR was performed using the inverse-variance weighted (IVW) method to test associations. The Jaccard index quantified the similarity of effects of each target across these outcomes, focusing on significant results after adjusting for multiple testing (FDR q &lt; 0.05). Results: The lipid-lowering targets were each significantly associated with between 1-17 cytokines, 184-220 lipid subfractions, and 307-396 metabolites (FDR q &lt; 0.05). ANGPTL3 and PCSK9 showed the highest similarity of effects on lipid subfractions (Jaccard Index: 0.83, p &lt; 0.001). LPA, APOB, and ANGPTL3 were the only targets with significant cytokine effects, with low similarity scores potentially suggesting their inflammatory signatures are unique. ANGPTL3 and LPA had the highest similarity of effects on metabolites (Jaccard Index: 0.19, p &lt; 0.05). Conclusion: Our analyses indicate that lipid-lowering targets influence metabolic signatures through shared and unique mechanisms. Further exploration of how cytokine, lipid, and metabolic profiles are impacted may help in the development of more effective medications.
Abstract 4145052: Impact of Postprocedural Delirium on Inpatient Outcomes in Transcatheter Aortic Valve Replacement Patients: A Retrospective Propensity Matched Analysis
Authors: Shahan Haseeb, Muhammad Ahmad Qureshi, Omair Ahmed, Shafia Munir, Taha Siddiqui, Eric Gehres, Muhammad Zaman, Raiyan Ali, Manu Dwivedi, Umair Ansari, Muhammad Zulqarnain
Journal: Circulation (2024)

Introduction: Transcatheter Aortic Valve Replacement (TAVR) is an increasingly common procedure for patients with severe aortic stenosis. However, postprocedural delirium remains a significant complication, impacting patient outcomes. This study aims to evaluate the inpatient outcomes of delirium in patients undergoing TAVR. Methods: We performed a retrospective cohort study using the National Inpatient Sample 2018-2020, including patients who underwent TAVR with and without delirium. Propensity score matching was performed using the variables age, elective admission, sex, and comorbid conditions (congestive heart failure, cardiac arrhythmias, peripheral vascular disorders, hypertension, diabetes, chronic kidney disease, coagulopathy, and obesity) to compare patients with and without delirium. Weighted samples were utilized and p value &lt;0.05 was considered significant. Results: Out of 205,565 TAVR patients, 1,995 (0.97%) experienced delirium. Delirium was associated with older age (median age 83 vs. 80 years, p&lt;0.05), higher prevalence of congestive heart failure, cardiac arrhythmias, valvular disease, and coagulopathy. Patients with delirium had significantly longer median LOS (7 (3-15) vs. 2 (1-3) days, p&lt;0.05). Delirium was a significant predictor of in-hospital mortality (OR 4.08, 95% CI 2.55-6.52, p&lt;0.05) and MACE (OR 1.72, 95% CI 1.34-2.21, p&lt;0.05). After propensity score matching, delirium remained associated with increased median LOS (7 (3-14) vs. 2 (1-6) days, p&lt;0.05); however, the difference in mortality (3.9% vs. 1.7%, p=0.07), and MACE (20.4% vs. 15.2%, p=0.06) became statistically insignificant after propensity matching. Detailed results are mentioned in Table 1. Discussion: Our study highlights that delirium in TAVR patients is associated with significant adverse outcomes, including prolonged hospitalization, higher mortality and MACE rates compared to patients without delirium. The findings underscore the importance of identifying high-risk patients preoperatively and implementing strategies to mitigate delirium, thereby improving patient outcomes. Future research should focus on developing targeted interventions to prevent delirium in this vulnerable population.
Abstract 4144973: AI-enabled Nationwide Opportunistic Screening of Non-Contrast Chest CT: Association between Cardiac Calcium Score and All-cause Mortality/Cardiovascular Events in Taiwan
Authors: Heng-Yu Pan, Chih-Kuo Lee, Wen Jeng Lee, CHI-JENG HSIEH, Tzung dau Wang
Journal: Circulation (2024)

Background: Cardiac calcium, which includes coronary and extra-coronary calcification, is often incidentally found in chest CT scans performed for various reasons. Despite its prognostic value, manual quantification of cardiac calcium in non-gated chest CT images is labor-intensive. Goals: This retrospective study aims to perform automatic quantification and scoring of cardiac calcium in non-contrast-enhanced chest CTs. The objective is to determine associations between automatic calcium scoring and outcomes such as all-cause mortality, non-fatal myocardial infarction (MI), and non-fatal stroke. Methods: We conducted a nationwide cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2016 to 2022. Patients under 20 years old, with a diagnosis of malignancy, or with outcome events before the CT acquisition were excluded. HeaortaNet 1.0, a validated AI model, was used for cardiac calcium scoring. Comorbidities were determined using ICD diagnostic codes for ≥2 consecutive outpatient visits within the year before the index date. Outcomes were censored at the first occurrence of mortality or relevant ICD codes for MI or stroke. Results: The retrospective cohort included 279,415 patients (56.37% male, mean age 60.31±16.54). All-cause mortality occurred in 12.82% of patients within a 3-year follow-up. The 3-year incidence rates of non-fatal MI and non-fatal stroke were 0.86% and 2.07%, respectively. Multivariate-adjusted Cox hazard ratios (95% confidence intervals) for any composite outcome were 1.51 (1.46-1.57), 2.09 (2.01-2.17), 2.63 (2.53-2.74), and 3.37 (3.24-3.50) for cardiac calcium scores of 1-100, 101-400, 401-1000, and &gt;1000, compared to a score of 0. Adjusted Cox hazard ratios for all-cause mortality were 1.62 (1.56-1.69), 2.29 (2.19-2.39), 2.91 (2.78-3.04), and 3.80 (3.64-3.96) for scores of 1-100, 101-400, 401-1000, and &gt;1000, compared to a score of 0. Conclusion: AI-enabled opportunistic screening of non-contrast chest CT for cardiac calcium scoring is associated with all-cause mortality and cardiovascular events. This is the first large-scale cohort study to use an AI model for comprehensive cardiac calcium screening.