tbuckley/cabot-search huggingface dataset:
Abstract 16261: Pharmacy-Led Optimization of Guideline-Directed Medical Therapy in Heart Failure With Reduced Ejection Fraction Program Improves Heart Failure Metrics in a Safety-Net Hospital
Authors: Gabrielle Barbera, Kelsey Norman, Meissane Lee, Kyle Jones, Alexandra Pipilas, Kelly Wulff, Alana Surjanhata, Ludwine Paul, Monica Ahluwalia, Matthew G Nayor, Deepa M Gopal
Journal: Circulation (2023)

Introduction: Quad-therapy with guideline-directed medical therapy (GDMT) improves HFrEF outcomes but is challenging to implement in safety-net centers. We expanded an outpatient pharmacy-led medication titration program (OPTIMAL-HF) to improve HF care. Research Question: Does a safety-net pharmacy-led program lead to significant change in medication rates, all-cause/HF admissions, and HF metrics? Methods: From a Boston Medical Center HF hospital discharge or ambulatory visit, 122 patients were referred. A cardiology clinical pharmacist conducted either in-person/telemedicine visits. Scales and blood pressure monitors were provided for remote monitoring. HF GDMT was titrated based on an algorithm until goal doses/maximally tolerated doses of GDMT were achieved signaling OPTIMAL-HF graduation. Chart review was performed with an approved IRB. Results: Of the 28 graduates of the program, 76% were Black/Hispanic, 71% resided in an area deprivation index ≥ 5 (scale, 1-10, higher score signifying greater neighborhood disadvantage). The median time to complete the program was 22 weeks (interquartile range (IQR) 8, 29 weeks) with median of 6 visits (IQR 3, 8 visits). In the 3 months prior to program enrollment, there were 13 hospitalizations (8 due to HF); in the 3 months after OPTIMAL-HF graduation (n=20), only 3 hospitalizations (0 due to HF) were noted. At graduation, 64% were on quad-therapy with 100% on beta-blockers, 96% on ace-inhibitors/angiotensin-receptor blocker/angiotensin-receptor-neprilysin inhibitor, 71% on mineralocorticoid receptor antagonist, and 89% on sodium-glucose cotransporter-2 inhibitors. An increased number of OPTIMAL-HF graduates reached maximum-tolerated/goal doses of GDMT with significant improvements in LVEF ( Figure) Conclusions: OPTIMAL-HF improved HF metrics including medication rates, all-cause/HF hospitalizations, and LVEF in graduates of this program supporting an effective model in a safety-net center.
Abstract 17780: Trends in Clinical Characteristics and Short-Term Mortality in STEMI Patients in Senegal
Authors: Serigne Cheikh T NDAO, Mame Madjiguène KA, Waly N MBOUP, Rabab YASSINE, Khadidiatou DIA, Mouhamed C MBOUP
Journal: Circulation (2023)

Introduction: The prevalence of in-hospital ACS has risen from 4% to 10% in Dakar cardiology departments over the past 15 years. Hypothesis: The aim of this study was to describe the epidemiological, clinical profile and short-term prognosis of patients with acute ST Segment Elevation Myocardial Infarction (STEMI) treated by percutaneous coronary intervention (PCI). Methods: This was a single-center descriptive study using prospective data collection from September 2020 to July 2022, including all patients with acute STEMI managed by PCI in with Hôpital Principal Dakar (HPD). The latter is the main military hospital of Senegal. Results: Among the 1146 patients admitted in HPD cardiology department, 156 (13.61%) had STEMI and 92 (58.97%) of them had undergone PCI. The mean age of the patients was 60.04 ± 11 years, with a male predominance (78.26%). Eighty-three patients (90.2%) were seen within the first 12 hours, with an average of 3.26 ± 3 hours. Regarding clinical presentation, almost all patients (98.9%) were in Killip I or II class. Seventy-eight patients (84.8%) had a diagnostic ECG within the first 12 hours of symptoms initiation, with a mean of 3.95 ± 2.95 hours. Thrombolysis was performed in 10.86% of the patients with a success rate of 70%. The radial approach predominated largely (89%) and primary PCI was performed in 71.73% of patients. Overall, PCI with stent implantation, exclusively drug eluting stent (DES), was done in 95.65% of cases with a success rate of 98.91%. Three non-fatal periprocedural complications were reported and in-hospital mortality rate was 4.34%. Conclusions: In Dakar, the prognosis of acute STEMI has been improved since the availability of PCI with routine primary PCI 24/7. However, the intervention delays need to be perfected.
Abstract 17613: Discharge Planning and Resource Utilization for Minimizing Readmissions in Acute Exacerbation of Chronic Heart Failure: Insights From an Observational Study in a Community Hospital
Authors: Mohamed R Abouzid, Muhammad Siddiqi, Samar Eldahtoury, Karim Ali, Mohammed Ghanim, Dania Mofleh
Journal: Circulation (2023)

Introduction: This cross-sectional study aimed to analyze the discharge disposition distribution among readmitted patients in a large community facility due to acute exacerbation of chronic heart failure (AECHF) and to examine the association between sex and age and discharge disposition. Methods: A total of 1,584 patients aged 65 years or older with AECHF were readmitted to a large community hospital in the Southeast Texas area from April 2021-April 2022. Descriptive analysis was used to examine discharge disposition among AECHF-readmitted patients. A multinomial logistic regression model was used to assess the association between age groups (65-74, 75-85, and 85 or older) and sex (male, female) and discharge disposition. We used SAS version 9.4 to perform all analyses. We report odds ratios (ORs) and 95% confidence intervals (CIs). Results: Overall, 55.6% of patients had a discharge disposition to home with self-care, while 27.3% had a discharged disposition to home with external home health support and 17.1% to skilled nursing facilities. The logistic regression analysis showed no significant differences in disposition discharge when comparing the 75-85 age group (OR=0.93, 95% CI, 0.72-1.20) and the 85 or older age group (OR=1.28, 95% CI, 0.92-1.78) to 65-75 age group. Additionally, no statistically significant differences were observed by sex when comparing males to females (OR 0.99, CI 0.79-1.24). Conclusion: This study highlights the importance of effective discharge planning in reducing readmissions for AECHF. Gender did not significantly influence disposition distribution, suggesting that other factors play a more prominent role. Comprehensive optimal discharge planning and appropriate resource allocation, including transfer to home with home health support, skilled nursing facilities, long-term acute care, or rehabilitation, based on the patient's condition at discharge are recommended to improve patient outcomes and reduce the burden of readmissions due to AECHF.
Abstract 14800: Alzheimer’s Disease and Related Dementias (ADRD) Limits Days at Home Among Medicare Beneficiaries Hospitalized for Heart Failure (HF)
Authors: Madeline R Sterling, Cisco G Espinosa, Hannah Mitlak, Raya E Kheirbek, Mike P Thompson, Deborah A Levine, Jason Falvey
Journal: Circulation (2023)

Background: Alzheimer’s disease and related dementias (ADRD) are highly prevalent among adults with heart failure (HF). HF is associated with disability among older adults, especially those with ADRD. This may impact aging in place after HF hospitalizations, which is concerning given this is an important outcome for patients recovering from serious illnesses. We aimed to examine the association between ADRD and aging in place among Medicare beneficiaries hospitalized for HF. Methods: We identified 80,694 fee-for-service beneficiaries hospitalized for HF between 2017 and 2019 in a 20% random sample of Medicare claims. HF hospitalization and ADRD were identified using ICD codes. The primary outcome was restricted home time, a patient-centered claims-based measure of successful aging in place defined as spending ≥ 10 days not at home (e.g., hospitalized, nursing home, inpatient facility) over 6 months post-discharge. Multivariable logistic regression was used to examine the association between ADRD and restricted home time adjusting for demographic and clinical characteristics; secondary analyses evaluated the likelihood of returning to pre-hospitalization days at home 6 months post-discharge. Results: Eighteen percent (n= 14,503/80,694) of adults hospitalized for HF had concurrent ADRD. HF patients with ADRD were older (83 vs 77 years), more likely to be female (56% vs 48%), and have dual Medicaid/Medicare eligibility (27% vs 21%), but had similar hospital length of stays and days at home preceding HF hospitalization compared to those without ADRD. Of HF patients with ADRD, 63% had restricted home time (vs. 51% without ADRD) and 52% failed to return to baseline days at home (vs. 42% without ADRD). In adjusted models, older adults with ADRD had 34% greater odds of experiencing restricted home time (OR=1.34, 1.30-1.40), and 20% lower odds of returning to baseline days at home (OR=0.80, 0.77-0.83) 6 months post- discharge than those without ADRD. Conclusions: HF hospitalizations impact the ability of older adults to successfully age in place, especially among those with ADRD. Tailored post-discharge care solutions are urgently needed to address the challenges faced by HF patients with ADRD.
Abstract 14709: Association Between Esophageal and Cardiac Autonomic Dysfunction in Chagas Disease
Authors: Sandra M Dumont, Gabriela Paixao, Viviane S Marino, Bruno R Nascimento, Manoel Otávio C Rocha
Journal: Circulation (2023)

Introduction: Chronic Chagas disease (ChD) may manifest as the indeterminate form, or with chronic cardiopathy (CCM), digestive or mixed forms. CCM is characterized by complex arrhythmias and sudden death, linked to autonomic dysfunction. Pathological involvement of the enteric nervous system triggers the development of the digestive form, and esophageal dysmotility may be another surrogate for dysautonomia. We aimed to assess the association between esophageal autonomic denervation and cardiac autonomic dysfunction in individuals in the indeterminate (ICF) and CCM forms of ChD. Methods: Consented patients with serological diagnosis of ChD and ICF ( n = 30) and CCM ( n = 33) forms were enrolled. All patients underwent esophageal scintigraphy, and esophageal transit time (ETT) and percentage of esophageal emptying (%EE) were recorded. They also underwent 24h Holter monitoring, and heart rate variability (HRV) indices and burden of ventricular extrasystoles (VES) were revised by a cardiologist. The correlation between ETT, %EE and HRV indices ((SDNN (standard deviation of adjacent RR intervals), low and high-frequency power (LFP, HFP(ms)), in addition to the number of VES in 24h was assessed with the SPSS 23 software. Results: 63 patients were enrolled, 54% women, with mean age of 58 years. Left ventricular ejection fraction was lower in the CCM group (44,0 ± 10,8 vs. 64,9 ± 6,6, p&lt;0.001). Autonomic dysfunction showed a distinct pattern between ICF and CCM, with lower SDNN and LF/HF values in the CCM group (100,0 ± 49,9 vs. 124,6 ± 43,2, p=0.042 and 1,4 (0,9 - 2,2) vs. 4,5 (1,5 - 9,5), p&lt;0.001, respectively). The CCM group also had higher 24h VES values (890,0 (120,0 - 2743,0) vs. 47,0 (1,7 - 395,7), p=0.002). There was significant inverse correlation between ETT and SDNN (ß=-0,449, p=0.001), LFP (ms) (ß=-0.288, p=0.025), HFP (ms) (ß=-0.368, p=0.004) and LH/FH (ß=-0.334, p=0.008) in the total sample. There was also a statistically significant and direct correlation between ETT and VES (ß=0.578, p&lt;0.05) in the total sample. Conclusions: ChD individuals with greater esophageal dysmotility showed a decrease in the oscillatory components of HRV and greater arrhythmic density, possibly as a result of more severe sympathetic and parasympathetic cardiac denervation.
Abstract 15936: Prospective Evaluation of Anti-Ro Pregnancies Supports the Utility of Ambulatory Fetal Heart Rate Monitoring in Detecting Fetal Atrioventricular Block
Authors: Bettina F Cuneo, Alfred Abuhamad, Joshua Copel, Kristopher Cumbermack, Tam Doan, Mary T Donofrio, Melanie Gropler, Caitlin Haxel, Whitnee Hogan, Lisa Howley, Gary Joffe, Michelle Kaplinski, Katherine Kohari, Anita Krishnan, Stephanie Levasseur, Chris Lindblade, Majd Makhoul, Jyothi Matta, Anita J Moon-Grady, Sonal Owens, Erin A Paul, Nelangi Pinto, Colin K Phoon, Gary M Satou, Elena Sinkovskaya, Stacy Killen, James Strainic, Nicola Fraser, Mala Masson, Robert Clancy, Jill Buyon
Journal: Circulation (2023)

Introduction:: The management of anti-Ro/SSA positive pregnancies is challenging because fetal atrioventricular (AV) block is rare and fetal echo seldom detects reversible injury. Hypothesis: We hypothesized that ambulatory fetal heart rate/rhythm monitoring improves detection of fetal AV block when compared with echo. Methods: Anti-Ro antibody subjects from 21 US centers at less than 20 weeks of gestation were risk stratified into high and low anti-Ro60 and 52 titers at the New York University (NYU) core laboratory. Low titer was defined by previous NYU data demonstrating no fetal AV block in subjects with anti-Ro60 and 52 less than 1000 arbitrary units per mL. High titer subjects performed 3x/day fetal heart rate/rhythm monitoring and underwent weekly or bi-weekly surveillance fetal echos at 18-26 weeks of gestation. Low titer subjects underwent site-specific surveillance. Abnormal fetal heart rate/rhythm monitoring prompted urgent diagnostic fetal echo. All infants received electrocardiograms. Results: We enrolled 405 subjects (fig). None of the 150 (37%) low titer subjects developed fetal AV block. Of 255 high titer subjects, 241 completed surveillance. High titer subjects monitored 44,187 times; 37 (0.08% ) monitoring episodes were deemed abnormal. Urgent fetal echos of the 37 diagnosed 9 with fetal AV block (7 with 2° AV block), 14 with atrial ectopy and 14 with normal rhythms. No fetal AV block, endocardial fibroelastosis or cardiac dysfunction was detected in the 871 surveillance fetal echoes of high titer subjects following normal FHRM. No fetus developed AV block after the surveillance period; one baby had transient prolonged PR interval, which resolved spontaneously. Conclusions: This prospective study suggests that ambulatory fetal heart rate/rhythm FHRM is superior to echo surveillance for fetal AV block, and antibody titers are useful in risk stratification of anti-Ro positive pregnancies.
Abstract 17603: Novel Cardiac Dynamics Modeling of Clinical Cardiac MRIs Can Identify Who Has Clonal Hematopoiesis of Indeterminate Potential With High Accuracy
Authors: Emanuele Zappala, James Cross, Anthos Christofides, Carlos Matute Martinez, Ritujith Jayakrishnan, Yunju Im, Ana Ferrigno Guajardo, Shawn Ahn, Alokkumar Jha, Stephanie Halene, Jennifer VanOudenhove, David Van Dijk, Jennifer M Kwan
Journal: Circulation (2023)

Background: Clonal hematopoiesis of indeterminate potential (CHIP) has been shown to be an independent risk factor for heart disease, heart failure and is associated with aging. CHIP is diagnosed by DNA sequencing of blood. It is unclear whether imaging can help predict who has CHIP, which would then be able to help stratify patients at risk for adverse cardiovascular events. Hypothesis: We investigated whether use of cardiac dynamics modeling on routine cardiac MRI (CMR) would be able to help 1) predict who has CHIP and 2) predict age of the patient Methods: Whole exome sequencing of peripheral blood DNA and subequent analysis on our somatic variant pipeline using MUTECT2 was used to identify those who had CHIP. Using dynamical modeling based on neural integral equations, dynamic imaging assessment of the cine images of the CMRs were used to identify CHIP and age of the myocardium using both supervised and unsupervised approaches. Results: We identified 98 unique patients with both CMR and CHIP status and found that 40 (41%) had CHIP. Majority were female 65 (66%) and there was no significant difference in median age between CHIP vs no CHIP patients (69, IQR 62-78 vs 65, IQR 54-72). There were no significant differences in co-morbidities between those with CHIP or no CHIP, including CAD, diabetes, hypertension, heart failure. Dynamic imaging was able to predict CHIP with 74% accuracy (Figure) with an unsupervised approach and above 90% accuracy with a supervised approach. In addition, this technique was able to accurately predict the age of the patient with accuracy within 1 year of the patient’s age (standard deviation of 0.0012 years) at the time of the MRI, using a supervised approach. Conclusions: Cardiac dynamics modeling is a promising deep learning technique that can both accurately classify CHIP and age. Ongoing work shows promise in predicting the outcome of cardiomyopathy using similar techniques. Ongoing validation is underway using a large cohort from UK Biobank.
Abstract 16244: Oncologic Disease and In-Stent Restenosis: A Nationwide Analysis
Authors: Sara Diaz Saravia, James Choi, Darren Kong, Christopher Matthews, Alaa Omar
Journal: Circulation (2023)

Introduction: Recent studies have shown that Ischemic Heart Disease (IHD) is leading cause of cardiovascular mortality in cancer patients. There is little information about In-Stent Restenosis (ISR), one complication of IHD treatment. ISR has been associated with the presence of underlying risk factors but there is no clear association between cancer and ISR. Methods: A retrospective cohort study was made selecting a sample of adult patients using the National Inpatient Sample (NIS) database from January 2017 to December 2019. Patients with cancer were identified and stratified by 5 main sites: lung, breast, gastrointestinal, prostate, and hematological tissue. Main outcome was odds of ISR in the oncologic population. Secondary outcomes were Major Adverse Cardiovascular Events (MACE) and mortality in patients with ISR, stratified by presence or absence of cancer. Univariate and multivariate analysis were done, adjusting for possible confounders. Results: A total of 90,900,000 adults were identified, of which 4,888,734 had cancer. From the adult population, 197350 patients with ISR were identified. Primary analysis revealed that cancer is not associated with increased odds of ISR but rather decreased, adjusted for other comorbidities, with an OR=0.181(IC95%=0.167-0.198, p=0.001). Paradoxically, secondary analysis of the ISR subpopulation showed statistically significant differences between cancer and non-cancer patients in the rate of composite MACE, and other cardiovascular outcomes such as Heart Failure, Atrial Fibrillation, and other arrhythmias (Table 1). Conclusions: The present study shows that cancer is associated with decreased odds for ISR, but in with patients with ISR cancer was associated with higher prevalence of composite MACE, mainly due to arrhythmias and heart failure. Further studies are needed to explain the dynamic relationship between cancer and endothelial dysfunction.
Abstract 17464: Peripheral Immune Cell Inflammatory Activation and Metabolic Dysregulation in Single Ventricle Congenital Heart Disease
Authors: Erin E Sanchez, Phillip Zegelbone, Ashley E Pietra, Mary E Turner, Brett A Li, Stephanie J Nakano, Anastacia Garcia
Journal: Circulation (2023)

Introduction: While heart failure (HF) is a leading cause of death and indication for transplant in single ventricle (SV) patients, the molecular mechanisms underlying HF progression are poorly understood. Chronic inflammation can initiate and accelerate pathological outcomes in patients with virtually every form of cardiovascular disease, yet our understanding of the impacts of immunologic alterations in SV are inadequate. Here, we test the hypothesis that peripheral immune cells (PBMCs) from SV patients display a pro-inflammatory and metabolically dysfunctional phenotype that contributes to progressive cardiac dysfunction. Methods: Pediatric SV patients were categorized based on ventricular function, including those with reduced systolic function (SVHF, n=32), Fontan failure (Fontan Failure, n=7), or healthy control (healthy control, n=18). PBMCs were isolated from whole blood by density gradient centrifugation. To assess the impact of the PBMC extracellular milieu, we treated isolated cardiomyocytes with human plasma. Mitochondrial bioenergetics were assessed using the Seahorse Bioanalyzer (Agilent). Statistical analysis was performed using a Kruskal-Wallis and post-hoc Dunn’s multiple comparisons test. Total RNA sequencing was performed to identify dysregulated pathways. Results: PBMCs from SVHF patients display decreased metabolic function (OCR, A) and increased glycolysis (ECAR, B). PBMCs from SVHF patients also display significant alterations in immune, inflammatory, and metabolic pathways (C). Moreover, plasma from SVHF patients decreases cardiomyocyte energetics. Conclusions: These data suggest that immune cells from SV patients display a pro-inflammatory and metabolically dysfunctional phenotype, with an increased dependence on glycolysis. Therefore, our data highlight a role for SV PBMCs to potentiate progressive cardiac dysfunction in this population and provide a novel avenue for therapeutic intervention.
Abstract 16234: Higher 30-Day Mortality Following Diagnostic Coronary Angiographies Performed at Community versus VA Hospitals Despite Similar Pre-Procedure Mortality Risk
Authors: Denise M Hynes, Diana J Govier, Alex Hickok, Howard S Gordon, Tai Kobayashi
Journal: Circulation (2023)

Introduction: Polices to improve access increased referrals to VA community care (VACC), including diagnostic coronary angiography (DCA). Yet, studies showing higher mortality rates following percutaneous coronary intervention at VACC vs VA facilities (VAF), raise concern about VACC quality. Hypothesis: 30-day mortality following DCA would be greater at VACC vs VAF. Methods: We identified outpatient DCAs at VAF and VACC from October 2014-June 2019 (N=75,950) and were matched to balance DCAs on eight characteristics including baseline mortality risk. DCAs with same-day PCI, missing covariates or without a good match were excluded (n=33,060). Primary exposure was DCA at VACC (vs. VAF). We examined weighted characteristics of DCAs and 30-day mortality by VACC status; used weighted logistic regression, adjusting for Veterans’ age, race, rurality, insurance, distance to VAF, Elixhauser mortality risk score and presence of ischemic heart disease, to compare 30-day mortality following DCA at VACC vs VAF. We used instrumental variables analysis to explore any confounders. Results: Among 42,890 DCAs, 27% were at VACC. Weighted characteristics of DCAs were similar by VACC status; were predominantly among male, white race, older aged patients. VACC vs VAF patients had similar mean pre-DCA mortality risk scores (4.7 [SD 9.2]) vs 4.8 [SD 9.2]), respectively (SMD=-0.01). Overall, 30-day mortality was 0.9%; 2.5% at VACC and 0.4% at VAF (SMD=0.18). Overall, predicted probabilities of 30-day mortality were greater in VACC vs VAF (Figure 1).In weighted regression analysis, odds of 30-day mortality were greater in VACC vs VAF (aOR 7.07, 95% CI=4.88, 10.24, p lt0.001). Instrument variable analysis suggested selection on unobserved factors contributed to VACC assignment and mortality. Conclusions: Risk of 30-day mortality was greater following DCAs performed at VACC vs VAF, despite comparable baseline mortality risk. Further research is needed to explain this difference.