tbuckley/cabot-search huggingface dataset:
Abstract 17657: The Effect of Medical Therapy on Reducing the Risk of Pacing Induced Cardiomyopathy
Authors: Mahdi Agha, Rishi Rikhi, Krupal Hari, George Bodziock, Prashant Bhave
Journal: Circulation (2023)

Introduction: Right ventricular (RV) pacing results in left ventricular dyssynchrony that can lead to pacing induced cardiomyopathy (PICM). The risk of PICM increases with RV pacing burden. No prior trials have investigated the effect of medical therapy on preventing PICM in patients with high RV pacing burden. The goal of this study was to investigate whether ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), and beta blockers (BB) reduce the risk of PICM in patients with high RV pacing burden. Methods: This was a retrospective study which included patients with normal ejection fraction (EF) and complete heart block who underwent single- or dual-chamber pacemaker placement at Wake Forest Baptist Medical Center between 1992 - 2013. Exclusion criteria were age &lt;18 and myocardial infarction. The medical therapy group included patients who received ACEI/ARB, BB, or both. The control group included patients who received neither ACEI/ARB nor BB. The primary endpoint was PICM, which was defined as upgrade to a biventricular device or reduction in EF by ≥10% without another etiology identified. Follow-up was 10 years or until development of PICM. Kaplan-Meier and multivariable Cox proportional hazards ratio survival analysis was performed. Results: The study included 642 patients. Average age was 71 ± 14. Females were 51%. ACEI/ARB only was prescribed for 80 (12%), BB only was prescribed for 55 (9%), and both were prescribed for 114 (18%). PICM occurred in 12 out of a total of 249 in the medical therapy group (4.8%) and 28 out of a total of 393 in the control group (7.1%). The risk of PICM was significantly lower in the medical therapy group compared to the control group (HR 0.34, 95% CI 0.16 - 0.71, P&lt;0.01) in a model fully adjusted for age, sex, hypertension, diabetes mellitus, chronic kidney disease, and atrial fibrillation. Conclusions: In patients who have high RV pacing burden, medical therapy with ACEI/ARB and BB appears to reduce the risk of PICM.
Abstract 16891: High Molecular Weight Hyaluronan Inhibits Macrophage Phagocytosis
Authors: Caitlin M Howard, Danielle Little, Sarah Belcher, Juliette Smith, Marcin Wysoczynski, Robert Brainard, Steven P Jones
Journal: Circulation (2023)

Background: After a myocardial infarction (MI), macrophages are recruited to the site of injury to begin the process of wound healing. Macrophages are important because they clear cellular debris via phagocytosis. This period of acute inflammation in the heart coincides with extracellular matrix (ECM) remodeling. Hyaluronan (HA), one of the most abundant ECM components, accumulates in a high molecular weight form (HA HMW ). The relationship between HA HMW accumulation and macrophage function in is not fully understood. Goal: To determine the extent to which hyaluronan impacts phagocytosis in polarized macrophages. Methods and Results: Tissue sections were collected from mice one-week post-MI and stained for hyaluronan binding protein (HABP) to assess HA accumulation. A significant increase in HA was seen in both male (n=4, p=0.0031) and female (n=4, p=0.0210) MI hearts compared to sham hearts. Separately, bone marrow was isolated from naïve mice and cells were treated in culture with macrophage colony stimulating factor (M-CSF) for 7-10 days. The resultant macrophages were then polarized into a pro-inflammatory (M1) phenotype using LPS and INF-γ, or pro-reparative phenotype (M2) using IL-4 and IL-13. Macrophage polarization was confirmed via qRT-PCR. In additional experiments, macrophages were polarized for 24 hours and then incubated for 30 min with FITC-labeled, IgG-coated latex beads in the presence or absence of 1 μM HA HMW . Flow cytometry was used to assess phagocytosis of the beads. HA HMW treatment resulted in a significant reduction in the percent of FITC positive cells in M1 female (n=6, p=0.005), M2 female (n=5, p=0.0406), and M2 male (n=5, p=0.0314) macrophage subsets indicating a decrease in phagocytosis. No significant changes were seen in the M0 and M1 male macrophage subsets. Additionally, the mean fluorescence intensity (MFI) measured in the FITC channel was significantly decreased in all the female subsets as well as the M2 male macrophages (n=5-6, p&lt;0.05). No significant changes were seen in the M0 and M1 male subsets. Conclusion: HA HMW impairs opsonin-induced phagocytosis in macrophages. Given that HA HMW accumulates post-MI, these findings may partially explain the incomplete immune response in the failing heart.
Abstract 18319: Regional Disparities in the Cardiovascular Deaths Among Sarcoidosis Patients: A CDC-Wonder Database Analysis From 2005-2020
Authors: Mohammed Faisaluddin, Ambica V Nair, Muhammad Osama, Harsh P Patel, Samarthkumar Thakkar, Richard Alweis, Shruti Hedge, Sourbha Dani, Uzma Iqbal, Scott Feitell, Mahwash Kassi
Journal: Circulation (2023)

Background: Sarcoidosis can manifest as “Cardiovascular Death (CVD)” in undiagnosed patients. Regional Impact and Disparities In CVDs among sarcoidosis have not been identified. Methods: We analyzed data from the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) database from January 2005, to December 2020. All deaths related to CVS were included from 4 different regions. Data for deaths related to sarcoidosis and CVD were obtained by querying “Sarcoidosis” using ICD 10th Revision code “D86”. Rates per year for trends and disparities were calculated using cumulative CVD. Results: A total of 8211 CVD from 2005-2020 were identified among sarcoid patients- 1666, (20.2%) in north east, 1,697 (20.64%) in midwest, 3,684 (44.81%) in south and 1,164, (14.15%) in west . The CVDs occurred mostly in the ages(55-74) in the northeast, (45-74) in the Midwest, (35-84) in the south and (45-84) in the west. Incidence of cardiovascular death among females with sarcoid was greater than males in all regions .(12.03% vs 8.25% in northeast , 12.65% vs 8.02% in midwest , 8.12 %vs 6.05% in west , 27.13%v/s 17.73% in south ). The South showed a significantly higher population of blacks suffering from CVD (31.3% blacks vs 12.61% whites) whereas in other regions , the rates were comparable. The most common cause of CV death was found to be cardiac arrest (28.8 %) in the north east, cardiomyopathy(27.09%) in the midwest , cardiac arrhythmias (17.13%) in the west and conduction disorders (52.17%) in the south. An increasing trend of CVD was recorded in the south with an increase in rates from 42.5% in 2005 to 45% in 2020. Conclusion: Incidence of CVD related to sarcoidosis is highest in the south and females had higher mortality in all regions. Pulmonary hypertension, cardiac arrest and CHF were the major causes of CVD.
Abstract 18569: Patient and Provider Factors Associated With the Initiation of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i) in the Year Post FDA Approval for HFpEF and HFmrEF
Authors: Trejeeve M Martyn, Joshua Saef, Agam Bansal, Kathryn Martinez, Hunter Block-Beach, Jessica Hohman, Nancy M Albert, Randall Starling, Wai Hong W Tang
Journal: Circulation (2023)

Introduction: Despite robust evidence for, and Food and Drug Administration (FDA) approval of sodium-glucose cotransporter-2 inhibitors (SGLT2i) for heart failure with preserved and mildly reduced ejection fraction (HFpEF/HFmrEF), use of this therapy is suboptimal. Hypothesis: We aimed to determine 1) prescribing context (inpatient/outpatient) and prescriber type of SGLT2i; 2) patient and provider level predictors of SGLT2i prescription in the year following FDA approval. Methods: All patients in a diverse, multi-state (Ohio and Florida), multi practice/hospital integrated system who had least 1 ambulatory encounter for HF and documented EF &gt; 40% were included. Data come from the electronic health record. We compared patients who were prescribed SGLT2i in the year post FDA approval 2/24/22-2/24/23 against those who were not using multivariable logistic regression to assess independent predictors of SGLT2i prescription. Results: 20,255 patients with HFpEF/HFmrEF were included in the study. Mean age 73±9 yrs, female (49.8%), Black (17.4%), DM2 (34%), AFib (43%), CKD (35%), baseline medications: BB (52.4%), ACEi/ARB (41%), MRA (19.7%), ARNI (6.5%), SGLT2i (3.2%). There were 1118 (5.6%) patients were newly prescribed SGLT2i in the study period. SGLT2i were most commonly initiated by cardiology 54.2%, general medicine 25.3% and endocrinology 8.5%. Of prescriptions, 82.9% were outpatient, 17.1% inpatient. Independent patient level predictors of SGLT2i prescription were DM2 2.82 (2.09-3.82), p&lt;0.001; AFib 1.42 (1.07-1.92), p=0.018; higher eGFR 1.16 (1.09-1.25), p&lt;0.001 and increasing EF 0.88 (0.81-0.97), p&lt;0.001. Insurance type/median income were not significant. Provider level predictors were total HF visits with each specialty: HF cardiology, 1.21 (1.13-1.29), p&lt;0.001; general cardiology, 1.1 (1.04-1.15), p&lt;0.001; and primary care, 1.1 (1.08-1.17), p&lt;0.001. After excluding patients with DM2, predictors were total visits with HF specialists, and general cardiologists. Conclusions: In the year post FDA approval, there has been significant underutilization of SGLT2i. Diabetes status and provider factors were associated with SGLT2i use, the majority of which were initiated in the outpatient setting by cardiology providers.
Abstract 13431: Safety and Efficacy of Pulmonary Artery Denervation Therapy for the Treatment of Pulmonary Artery Hypertension
Authors: Mounica Vorla, Usman Akbar, Sai Sri Harsha Rallabhandi, Dipsa Shastri, Aditi Chitteti, Srikanth Yandrapalli
Journal: Circulation (2023)

Background: Despite recent advances in the treatment of pulmonary arterial hypertension (PAH), the survival rate remains poor in severe PAH. Pulmonary artery denervation (PADN) therapy for PAH is gaining popularity, although the safety and efficacy of PADN were not fully evaluated. Therefore, we conducted an updated systematic review and meta-analysis of the safety and efficacy of PADN in the treatment of patients with PAH. Methods: Using PRISMA guidelines, we searched PubMed, Embase, Cochrane, and the Clinical Trials.gov databases from inception till May 2023 for placebo-controlled outcome studies that compared PADN therapy to placebo in patients with moderate-severe PAH. The literature was screened for appropriate randomized clinical trials (RCT) and prospective studies, and data were extracted and analyzed. Comprehensive meta-analysis software (CMA v3, Biostat Inc. Englewood, NJ, USA) was utilized to perform statistical analyses. Results: The metanalysis included 8 studies (7 RCTs and 1 prospective) with 577 patients (PADN group = 270, placebo = 307). PADN treatment was associated with a significant reduction in mean pulmonary artery pressure [weighted mean difference (WMD) = -6.9 mmHg; 95% CI = -9.7, -4.1; P &lt; 0.01; I 2 = 61] and pulmonary vascular resistance [WMD = -3.2 dyne.s.cm -5 ; 95% CI = -5.4, -0.9; P = 0.005; I 2 = 95]. There was a statistically significant improvement in the cardiac output [WMD = 0.3 l/min; 95% CI = 0.07, 0.6; P=0.012; I 2 = 76] and numerical improvement in 6-minute walking distance [WMD = 67.7m; 95% CI = -3.73, 139.2; P = 0.06; I 2 = 95] in the PADN group. There were fewer side effects in the PADN group as compared to the placebo group. Conclusion: This updated metanalysis supports PADN as a safe and efficacious therapy for moderate-severe PAH. Findings are limited by small sample size, medium-quality literature, and large data heterogeneity, necessitating larger RCT with clinical endpoints comparing PADN therapy with optimal medical treatment.
Abstract 15182: Evaluation of an Electronic Clinical Decision Support Tool for Incident Elevated Blood Pressure in Adolescents
Authors: Catherine P Benziger, Clayton I Allen, Laura A Freitag, Madison Suess, Stephen E Asche, Heidi L Ekstrom, Inih J Essien, Abhilash Muthineni, Vijayakumar Thirumalai, Phuong H Vo, Kay A Kromrey, Elizabeth A Ronkainen, Daniel Saman, Patrick J Oconnor, Elyse O Kharbanda
Journal: Circulation (2023)

Introduction: The PedsBP Clinical Decision Support (CDS) is an electronic health record-linked tool developed in an urban health system that aims to improve the quality of blood pressure (BP) measurement and recognition of hypertension in children. Aims: To describe the feasibility of implementing the PedsBP tool for use in a rural health system, and to describe repeat BP measurement among patients 6-17 years with an incident hypertensive BP at high-intensity clinics using the PedsBP CDS. Methods: This is a 3-arm, parallel group, cluster randomized controlled pragmatic trial in 40 community-based primary care clinics in a rural Midwestern health system (Essentia Health). Clinics were randomized 1:1:1 to usual care, low-intensity implementation (PedsBP CDS only), or high-intensity implementation (Peds BP CDS plus in-person training, monitoring CDS use, and feedback). The PedsBP CDS includes an alert to re-measure a hypertensive BP at that visit, an alert that a hypertensive BP should be repeated in 1-3 weeks, and patient-specific order sets. Study outcomes include repeat BP measurement at an index visit and diagnosis of hypertension within 6 months of meeting clinical criteria. Safety outcomes include stroke, transient ischemic attack, acute renal failure, uncontrolled hypertension within 6 months of index visit. Results: Among 22,238 (50.9% female, mean age 11.7 years, SD=3.5 years) patients with visits between 8/1/22-1/31/23 at participating clinics, 4008 (18.0%) had an incident hypertensive BP and 239 (1.1%) met clinical criteria for hypertension. Among those who met clinical criteria for hypertension, there were no cases of uncontrolled hypertension or other safety outcomes. Of 7974 patients with encounters at 13 high-intensity clinics and with a BP measured, the initial BP was elevated for 1307 (16.4%) and remeasured in 628 (48.1%). Among 1265 patients at high-intensity clinics with a BP elevated and with body mass index (BMI) information, 482 (38.1%) were obese (BMI percentile ≥95%), 209 (16.5%) were overweight (BMI percentile 85% to &lt;95%), and 574 (45.4%) were not overweight or obese (BMI percentile &lt;85%). Conclusions: The PedsBP CDS is feasible to implement in a new health system and has the potential to improve the quality of pediatric BP care.
Abstract 15921: Reaching Patients With Hypertension: A Model of Remote Blood Pressure Monitoring Plus Team-Based Care
Authors: Bassel M Shanab, Leslie Y Tseng, Lauren Kelley, Millie Landock, Katia Astudillo, Carolyn Hickman, Yanting Wang, Peter Ellis, Katherine LaMonaca, Kathleen O'Connor Duffany, Giselle Carlotta-McDonald, Yamira Ramirez, Alycia Santilli, Erica S Spatz
Journal: Circulation (2023)

Background: Social determinants of health (SDoH) significantly impact hypertension (HTN) control, yet are not addressed as part of the medical model. We used a team-based approach, integrating remote blood pressure monitoring (RBPM), pharmacists, and community health workers (CHWs) to address HTN among patients with persistently uncontrolled HTN referred from cardiology fellows clinics. This study assesses the impact of this model in achieving BP control. Methods: Pharmacists screened patients for SDoH using a tool adapted from the Accountable Health Communities initiative and managed BP during biweekly virtual visits. Patients with SDoH were referred to Project Access-New Haven for CHW support. We describe clinical characteristics, SDoH, program metrics, and BP changes among the first 100 patients. We also assessed predictors of BP control (&lt; 130/80 mmHg) using multivariable logistic regression. Results: Among referred patients, multiple SDoH were identified; 18% of whom accepted support by a CHW (Table). BP decreased from a mean of 154/86 mmHg to 135/78 mmHg (mean reduction 20/8 mmHg). BP control was associated with greater medication adherence, having diabetes and competing health priorities. There was no association between SDoH and BP control. Conclusions: A team-based care model with pharmacists and CHWs was effective in reducing BP among low income patients with multiple SDoH and persistently uncontrolled HTN. SDoH was not associated with achieving BP control, suggesting that this model may overcome or attenuate SDoH impacting BP control. Still, half of patients did not achieve BP control, highlighting the need for continual partnership and program improvement.
Abstract 15412: Unusual Case of Cardiac Sarcoidosis Unmasked by COVID 19
Authors: Mansi Oberoi, Marshall Hyden
Journal: Circulation (2023)

Background: COVID-19 can present with a constellation of symptoms and cardiac dysfunctions. It can mimic cardiac sarcoidosis clinically which can lead to diagnostic challenges and treatment delays. We describe a case of cardiac sarcoidosis which was unmasked by a recent COVID-19 infection. Case: A 72-year-old Caucasian male with history of post-traumatic epilepsy as a child and otherwise no significant health issues until March 2022 when he had COVID-19 infection presented with worsening fatigue, dizziness, lightheadedness, abnormal eye movements, brain fog and inability to exercise since his COVID infection. Prior to this, he was very active and was riding his bike 50 miles a week. He underwent extensive neurological work up including CT head/neck/temporal bone, MRI brain and continuous EEG that was unrevealing. Echocardiogram showed normal left and right ventricular size and function with no significant valvular abnormalities. 2-week Holter monitor revealed bradycardia with HR 30 beats per minute and sinus pauses with longest of 3.9 seconds. Cardiac MRI was obtained which showed late gadolinium enhancement (LGE) in the basal septum (Image). Subsequent, PET scan revealed mid myocardial FDG uptake with preserved perfusion involving the proximal segments of the heart raising the possibility of early inflammation related to cardiac sarcoidosis or other inflammatory process. He underwent dual chamber pacemaker implantation for sinus pauses. Decision making: Cardiac MRI with LGE in basal septum and PET scan showing increased FDG uptake along with bradycardia and pauses leading to pacemaker implantation led to the diagnosis of cardiac sarcoidosis. He was treated with prednisone with repeat PET scan in 3 months. Conclusion: It remains unclear if COVID 19 plays a role in inducing inflammatory process of sarcoidosis. Further studies are required to understand the cardiac sequalae of COVID 19 infection and association with sarcoidosis.
Abstract 16499: Social Determinants and Racial Disparities Among Hospitalized Individuals With Hypertensive Crisis; a Retrospective Population-Based Cohort Analysis
Authors: Endurance O Evbayekha, Abiodun Idowu, Garba Rimamskep R Shamaki, Bede Nriagu, Ovie Okorare, Henry Aiwuyo, Faizal Ouedraogo, Olanrewaju Adabale, Akanimo Antia, Olayiwola Bolaji, Vikash Jaiswal, Alexis K Okoh, Tamunoinemi Bob-Manuel
Journal: Circulation (2023)

Introduction: Hypertensive crisis (HC) encompasses hypertensive emergencies (HE) and urgencies (HU). Recent literature on HC's social determinants (SD) and racial disparities (RD) of the inpatient population is scarce. We aimed to examine these factors. Hypothesis: We hypothesized that there would be variations in the RD and SD of hospitalized individuals with HC. Methods: A retrospective analysis of the 2016-2020 National Inpatient Sample was conducted, and all hospitalizations for HC were identified with their ICD-10 codes. A multivariate logistic regression analysis was performed to account for confounders and estimate the probability of outcomes. Our primary outcomes were SDs of HC. Secondary outcomes were myocardial infarction (MI), stroke, acute kidney injury (AKI), and transient ischemic attack (TIA). Results: Of the 32,355,827 of all hospitalizations, 2.4% (762,185) had a diagnosis of HC (48.5% (369735) HU, 37.3% (284350) HE, and 14.2% (108100) ‘HC unspecified’), with 49.8% (285,634) Caucasians, 34% (188,255) Blacks, 11.2% (63,952) Hispanics and 2.8% (16,173) were Asians. When stratified by age, the Black population was the youngest of all the races; 57.6 years ±15.6 vs. 67.9 years ±15.5 Caucasians, vs. 60.5 years ±17 Hispanics, vs. 65.2 years ±17 Asians, p&lt;0.0001. The minority populations were more likely than the Caucasians to be diagnosed with HCs; Blacks 2.7 (2.6-2.9), Hispanics 1.2 (1.2-1.3), and Asians 1.4 (1.3-1.5),(p&lt;0.0001, all). Furthermore, being male 1.1 (1.09-1.2, p&lt;0.0001), those with ‘self-pay’ insurance type 1.02 (1.01-1.03, p&lt;0.0001), and those in the &lt;25th percentile of median household income 1.3 (1.2-1.3, p&lt;0.0001), were more likely to be diagnosed with HCs.The Black population had the highest likelihood of end-organ damage; MI 2.7 (2.6-2.9), Stroke 3.2 (3.1-3.4), AKI 2.4 (2.2-2.5), and TIA 2.8 (2.7-3.0), (p&lt;0.0001, all), compared to their Caucasian counterpart. Conclusions: Being of a minority population, male sex, low-income status, and uninsured were associated with a higher likelihood of hypertensive crisis. Blacks were the youngest and had the highest risk of end-organ damage. Targeted interventions and healthcare policies should be implemented to address these disparities and improve patient outcomes.
Abstract 13580: Impact of Chronic Kidney Disease on the Association of Ankle Brachial Index With Cardiovascular and All-Cause Mortality
Authors: Fatima Aurangzeb, Maryam Afridi, Salman Waheed
Journal: Circulation (2023)

Introduction: The association of low Ankle brachial index (ABI) with increased risk of cardiovascular (CV) as well as all-cause mortality is well established. Similarly, there is an independent association of chronic kidney disease (CKD) with CV and all-cause mortality. Little is known about the association of low ABI with CV and all-cause mortality by CKD status. Methods: We used data on 4,614 subjects from the National Health and Nutritional Examination Survey (NHANES) from January 1, 1999, to December 31, 2002. Those with available data on ABI and CKD status were included. Subjects were categorized as: 1) normal ABI ( &gt; 0.9), no CKD (eGFR &gt; 60 ml/min/m 2 , reference), 2) normal ABI and CKD, 3) Abnormal ABI, no CKD, 4) Abnormal ABI and CKD. NHANES-linked National death index records were used to determine CV and all-cause mortality. We used Cox proportional-hazards models and controlled for age, race, gender, income, educational status, smoking history, diabetes, systolic blood pressure, HDL and total cholesterol levels and history of CV disease. Results: Mean age was 55.7 years with 51% females and 4% blacks. Low ABI was present in 7%, while 6.4% had CKD and 1.3% had both low ABI and CKD. Median follow-up was 10.3 years. ABI&lt;0.9 was associated with risk of all-cause [Hazard ratio: 1.59 (95% confidence interval: 1.21-2.01)] and CV mortality [2.80 (1.72-4.56)] compared to normal ABI. Similarly, CKD was associated with risk of all-cause [1.34 (1.04-1.71)] and CV mortality [1.69 (1.0-2.96)] compared to no CKD. Among categories, the risk was [1.29 (0.9-1.8)], [1.57 (1.1-2.2)] and [1.92 (1.3-2.6)] for all cause mortality, and [1.2 (0.5-2.9)], [2.3 (1.3-4.0)] and [4.72, (2.6-8.4)] for CV mortality in groups normal ABI with CKD, abnormal ABI without CKD and abnormal ABI and CKD both, respectively compared to the reference group. Conclusion: Low ABI confers a much higher risk of CV and all-cause mortality in those with CKD than those without CKD. More aggressive risk factor modification might be warranted in those with CKD and low ABI to lower risk.