tbuckley/cabot-search huggingface dataset:
Abstract 4125999: Elderly patients with HF with reduced ejection fraction and renal failure: are SGLT2i a good option?
Authors: jorge Balaguer German, MARCELINO CORTES GARCIA, Carlos Rodriguez Lopez, Jose Maria Romero Otero, Jose Antonio Esteban Chapel, Luis Nieto Roca, Mikel Taibo Urquia, Ana Maria Pello Lazaro, Jose Tunon
Journal: Circulation (2024)

SGLT-2 receptor inhibitors (SGLT-2i) have been shown to reduce cardiovascular mortality and hospitalisations for heart failure (HF) in patients with HF with reduced ejection fraction (HFrEF) and to have a nephroprotective role in patients with chronic kidney disease (CKD). However, the available evidence in patients older than 75 years and with CKD is limited. We conducted a retrospective, single-centre study including patients aged &gt;75 years diagnosed with HFrEF (defined as ejection fraction &lt;40%), CKD (eGFR &lt;60mL/min) and with an indication for treatment with SGLT-2i for HF between November 2019 and November 2022. Clinical, analytical, electrocardiographic and echocardiographic variables were collected. A total of 173 patients were included with a mean follow-up of 31.6 months (SD ±13.2). Mean age 84.7 years (SD ±4.9), 66.5% were male, 85.5% were hypertensive, 34.7% diabetic and 39.3% dyslipidaemic. Peripheral vascular disease was present in 11.6%. Mean glomerular filtration rate was 45.9 mL/min and only 2.3% were on haemodialysis. LVEF at inclusion was 29.5% (SD ±7.9), with 53.1% being of ischaemic aetiology and the most frequent functional class being NYHA II (53.2%). Thirty-seven percent had atrial fibrillation and 34.1% had complete left bundle branch block. At the end of follow-up 80.3% were on beta-blockers, 48.6% on ACE inhibitors, 37.6% on aldosterone antagonists, 23.7% on ARNI and only 11% on SGLT-2i. Survival analysis was performed using Cox logistic regression (multivariate analysis), where SGLT-2i was shown to be the only protective factor for all-cause mortality (HR 0.3 [0.1-0.9]). Male sex (HR 2.2 [1.3-3.9]) and diabetes (HR 1.6 [1.0-2.6]) were associated with higher mortality. The attached figure (figure 1) shows the Kaplan-Meier survival curves for total mortality in those patients with and without SGLT-2i (p log-rank 0.05). In our population, SGLT2i showed a significant reduction in total mortality in patients older than 75 years, with HFrEF and CKD. However, the treatment rate in this subgroup of patients is very low. Further implementation of SGLT2i treatment in this type of patient could be of significant clinical and prognostic benefit.
Abstract 4125636: Impaired blood pressure regulation in post-COVID-19 postural orthostatic tachycardia syndrome: novel disease mechanisms beyond sinus tachycardia
Authors: Madeleine Johansson, Marcus Stahlberg, Fabrizio Ricci, Christian Lewinter, Viktor Hamrefors, Peter Nilsson, Richard Sutton, Artur Fedorowski
Journal: Circulation (2024)

Background: Postural orthostatic tachycardia syndrome (POTS) is a prevalent cardiovascular disorder after COVID-19 infection. Although POTS is characterized by the presence of sinus tachycardia, other hemodynamic disturbances including blood pressure (BP) regulation, remain largely unexplored. Aims: We investigated BP changes using 24-hour ambulatory-BP-monitoring in patients with new-onset POTS after COVID-19 compared with pre-pandemic healthy controls. Methods: We performed a case-control study in 100 verified COVID-19 patients with new-onset POTS (mean age 40.0±12.9 years, 85% women) diagnosed by positive head-up tilt-testing versus 100 healthy controls (mean age 45.0±14.6 years, 70% women) from a population-based cohort with negative active standing test, no history of syncope, orthostatic intolerance, or endocrine disease. We analyzed 24-hour Systolic BP (SBP) and hypotensive SBP episodes (&lt;80, &lt;90, and &lt;100mmHg). Results: Study characteristics are illustrated in the Table . Post-COVID-19 POTS patients had significantly higher nighttime-SBP, but not daytime-SBP, and more daytime SBP hypotensive episodes (&lt;80, &lt;90, and &lt;100 mmHg, Figure ) compared with controls. Non-dipper (34% vs 19%, p&lt;0.001) and reverse dipper patterns (9% vs 0 %, &lt;0.001) were more frequent in post-COVID-19 POTS. In the logistic regression, post-COVID-19 POTS was associated with significantly higher mean 24h SBP (odds ratio (OR) 1.08, 95%CI 1.04-1.11, p&lt;0.001) and nighttime SBP (OR 1.07, 95%CI 1.04-1.10, p&lt;0.001), independently of age and sex. Conclusions: Post-COVID-19 POTS patients demonstrate higher mean 24h and nighttime systolic BP, and show signs of disrupted BP regulation compared with healthy controls. They also have more daytime hypotensive episodes. Future studies are needed to assess if post-COVID-19 POTS patients may benefit from tailored BP therapy.
Abstract 4125667: National Estimates of Patient Eligibility for Renal Denervation Therapy Post-FDA Approval
Authors: Nathan Watson, William Earle, David Kandzari, Ajay Kirtane, Felix Mahfoud, Jennifer Cluett, Anna Krawisz, Stephen Juraschek, Eric Secemsky
Journal: Circulation (2024)

Background: Renal denervation (RDN) has been shown in randomized trials to improve blood pressure compared with a sham procedure. Currently, there are two FDA-approved RDN devices in the United States (US). While nearly half of the US population has hypertension (HTN), the number of patients who may benefit from RDN therapy remains uncertain. In this study, we used a nationally representative dataset to approximate the proportion of patients with HTN who may be eligible for consideration of RDN based on selective criteria. Methods: All adult patients with HTN who participated in the National Health and Nutrition Examination Survey (NHANES) between the years 2009-2020 were identified. We characterized the proportion of these participants that met eligibility criteria based on 1) the FDA indication, 2) the SCAI 2023 RDN position statement, and 3) enrollment criteria from the RDN on-medication randomized trials. National estimates were obtained utilizing survey weighting from the NHANES multistage probability survey design. Results: In total, we identified 16,677 patients with HTN in the US, representing a weighted total of 113,786,149 patients ( Table ). Using the FDA indication, 31.6% (95% CI, 30.7%-32.6%) of patients meet eligibility criteria for RDN, corresponding to 35,988,870 US adults. By the SCAI 2023 position statement selection criteria, 21.5% (95% CI, 20.7%-22.3%) of patients are eligible for consideration of RDN. Based on enrollment criteria from the RDN on-medication randomized trials, 2.05% (95% CI, 1.81%-2.33%) of US adults meet eligibility for consideration of RDN ( Figure ). Conclusions: Our findings indicate that nearly one third of US adults with HTN are eligible for consideration of RDN based on the FDA indication; however, a smaller proportion of patients would be eligible based upon society recommendations and randomized trial inclusion criteria. Future studies are needed to further inform which patients will best benefit from this intervention.
Abstract 4126650: Prognostic Value of Femoral-Ankle Pulse Wave Velocity for Cardiovascular Outcomes in Older Adults: The Atherosclerosis Risk in Communities (ARIC) study
Authors: Tatsuhiro Shibata, Yejin Mok, Shoshana Ballew, Hirofumi Tanaka, Kunihiro Matsushita
Journal: Circulation (2024)

Background: Carotid-femoral pulse wave velocity (cfPWV) is a representative measure of central arterial stiffness and an independent predictor of cardiovascular disease (CVD). Femoral-ankle PWV (faPWV) represents peripheral arterial stiffness, but its association with CVD has not been specifically studied. Aim: To compare faPWV and cfPWV regarding their associations with CVD outcomes. Methods: We analyzed 3,402 ARIC participants without prior heart failure (HF), coronary heart disease (CHD), or stroke at visit 5 (2011-13) (mean age 74.8 [SD 4.9] years, 36.1% male, and 78.0% White). faPWV and cfPWV were measured by Omron VP-1000 Plus. The outcomes of interest were composite and individual outcomes of CVD (HF, CHD, and stroke). We ran unadjusted and multivariable Cox proportional hazards models. Results: During a median follow-up of 9.0 years, there were 607 CVD events. Overall, faPWV showed an inverse association with CVD (Table). P-for-trend reached statistical significance in Models 1 and 2 and was borderline significant in Model 3 (p=0.077). In contrast, as anticipated, cfPWV was positively associated with CVD in all Models, although the association was somewhat attenuated in Model 3 (p-for-trend=0.045 and hazard ratio [HR] for top vs. bottom quartile 1.22 [95%CI 0.95-1.56]). Given their opposite patterns, we explored the ratio of cfPWV and faPWV (“cf/fa ratio”) and found that its association with CVD appeared stronger (p-for-trend=0.004 and HR for top vs. bottom quartile 1.37 [1.08-1.74]) than cfPWV. When each CVD subtype was examined separately, HF showed most consistent associations with our stiffness measures, and only the cf/fa ratio remained significant for HF up to Model 3 (p-for-trend=0.010 and HR for top vs. bottom quartile 1.40 [1.03-1.90]). Conclusions: faPWV was inversely associated with CVD, and cf/fa ratio appeared more strongly associated with CVD compared to cfPWV. Our findings indicate distinct prognostic implications of central vs. peripheral arterial stiffness and suggest cf/fa ratio as a new stiffness measure predicting CVD.
Abstract 4126950: Program Evaluation of a Team-Based Telemedicine Hypertension Intervention by Patients
Authors: Sunit Chhetri, Srista Manandhar, Justin Kramer, Austin Seals, Danielle Sutton, Animita Saha, Suneet Kaur, Kate Callahan, Jeff Williamson, Yhenneko Taylor, Hayden Bosworth, Justin Moore, Yashashwi Pokharel
Journal: Circulation (2024)

Background: We pilot tested a 12-week, team-based, telemedicine hypertension management intervention tailored for patients with greater social needs. Our study included home blood pressure (BP) guided pharmacotherapy, frequent self-management support, and social support by pharmacists, nurses, community health workers and social workers. Twenty patients, including 17 Black patients, from 2 clinics in NC participated. We conducted program evaluation to inform future research. Methods: After program completion, we conducted semi-structured interviews and administered validated surveys for program evaluation. We used Exploration, Preparation, Implementation, and Sustainment and Health Equity Implementation Frameworks to guide our study design. We utilized inductive and deductive coding methods, with thematic analysis to organize emergent themes. We used descriptive statistics to summarize survey results. We triangulated themes from interviews with survey results during analysis/results interpretation using concurrent embedded mixed methods (Qual + quant) for convergence/complementarity. Results: Nineteen patients completed the interviews and 18 completed the surveys. A patient withdrew from the study. Several themes emerged around acceptability, appropriateness, feasibility, and patient centeredness about the program (Table). Patients’ perceptions that the program was acceptable and measuring BP at home was easy were most salient. Program was found to be highly patient centered. Conclusions: Patients found our team-based telemedicine intervention acceptable, appropriate, feasible, and patient centered. The tailored telemedicine program holds promise for adoption by patients with greater social needs.
Abstract 4125511: L-shaped association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and arterial stiffness: a cross-sectional study
Authors: Taotao Wei, XIN LIN, Jing Yu
Journal: Circulation (2024)

Background: Serum lipids and ratios are known to be associated with cardiovascular disease (CVD). However, studies on NHHR and the association with arterial stiffness in the US population have not been reported. We sought to investigate the relationship between NHHR and arterial stiffness by arterial stiffness in subjects from the US population assessed by ePWV. Methods: This study included 23, 456 adults from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. Multivariate linear regression analysis, threshold effects, smooth curve fitting, and subgroup analysis. We aimed to elucidate the relationship between NHHR and risk of arterial stiffness. Results: The mean age of the population in this study was 49.56 ± 17.58 yrs. The mean NHHR was 2.97 ± 1.48, and in the fully adjusted model, a negative correlation was observed between NHHR and ePWV scores (β = -0.01, 95% CI: -0.02, -0.00), with the highest tertile of the NHHR having a mean ePWV score that was 0.06 units lower than the lowest quartile of the NHHR by 0.06 units (β = -0.06, 95% CI: -0.09, -0.02; P for trend = 0.0068). An L-shaped relationship between NHHR and ePWV scores was found by using smoothed curve fitting. The cutoff value was 2.13, and in the hypertensive population, the cutoff value was 1.93. Conclusions: There is an L-shaped association between NHHR levels and atherosclerosis in adults in the United States, and controlling NHHR is clinically important for reducing the risk of developing atherosclerosis.
Abstract 4126000: The Association of Cardiologist Vertical Integration With Care Quality, Patient Outcomes, and Utilization
Authors: Ali Moghtaderi, David Magid, Frederick Masoudi, Qian Luo, Bernard Black, Vinay Kini
Journal: Circulation (2024)

Introduction: U.S. healthcare has experienced substantial growth in vertical integration (physicians employed by hospitals), but little is known about its effect on patient care. Aims: To assess the association between cardiologist vertical integration and patient outcomes, care quality, and utilization among patients hospitalized with incident acute myocardial infarction (AMI) or heart failure (HF). Methods: We used a sample of all Medicare fee-for-service beneficiaries hospitalized with incident AMI and a 75% sample of beneficiaries hospitalized with incident HF between 2008-2019. We identified the accountable cardiologists that cared for these patients and determined their integration status using tax identification numbers. We used difference-in-differences methods to compare outcomes for patients treated by integrated cardiologists after switching from non-integrated to integrated practice, to outcomes for patients treated by cardiologists who remained non-integrated. Patient outcomes were in-hospital mortality, 30-day mortality, and 30-day readmission. Quality measures were the proportion of patients that received 1) a guideline-recommended test to assess cardiac function and 2) a 30-day follow-up clinic visit. Utilization measures were length of stay and the proportion of AMI patients receiving percutaneous coronary intervention. Models were adjusted for time trends and patient, hospital, and cardiologist characteristics. Results: The proportion of U.S. cardiologists employed by hospitals increased from 26% in 2008 to 61% in 2018. We identified 186,052 AMI patients and 259,849 HF patients cared for cardiologists who switched to integrated practice and 168,052 AMI patients and 245,769 HF patients cared for by non-integrated cardiologists. Patients were similar in age, sex, race/ethnicity, and comorbidities. We found no significant differences in clinical outcomes (e.g., adjusted difference in 30-day mortality 0.03% [95% CI = -0.39%, 0.45%] for AMI and -0.05% [-0.37%, 0.27%] for HF patients); no differences in most quality metrics, and no differences in utilization between patients treated by integrated versus non-integrated cardiologists. Conclusions: We found minimal evidence that cardiologist employment by hospitals improves care quality or outcomes. Regulation of vertical integration should focus on other effects of integration such as higher prices paid by insurers.
Abstract 4125939: Bayesian re-analysis of the STeroids to REduce Systemic inflammation after infant heart Surgery (STRESS) trial
Authors: Kevin Hill, Jake Koerner, Hwanhee Hong, Jennifer Li, Marshall Jacobs, Prince Kannankeril, Scott Baldwin, Jeffrey Jacobs, Christoph Hornik, Alexis Benscoter, Andrew Van Bergen, Brett Anderson, Brian Blasiole, David Overman, David Vener M D, Eric Graham, Adil Husain, Eric Wald, John Scott, John Kim, Michael Swartz, Pirooz Eghtesady, Ryan Butts, Tara Karamlou, Sean OBrien
Journal: Circulation (2024)

Background: Prophylactic steroids are often used to reduce the systemic inflammatory response to cardiopulmonary bypass in infants undergoing heart surgery. The STRESS trial found that the likelihood of a worse outcome did not differ between infants randomized to methylprednisolone vs placebo in a risk-adjusted primary analysis (adjusted odds ratio [OR], 0.86; 95% CI, 0.71 to 1.05; P=0.14). However, secondary unadjusted analyses showed possible benefits with methylprednisolone. We re-analyzed the STRESS trial using Bayesian analytics to assess probability of benefit with methylprednisolone. Methods: We used a covariate-adjusted proportional odds model using the original STRESS trial model covariates and primary outcome (a ranked composite of death, transplant, major complications and post-op length of stay). We assessed effect thresholds from OR 0.6 to 1.25 (OR &lt;1 conveys benefit, OR &gt;1 conveys harm). We assumed a neutral probability of benefit vs harm with weak prior belief (SD of the normal prior distribution = 0.425). In sensitivity analyses, we evaluated pessimistic (5%-30% prior likelihood of benefit), neutral and optimistic (70%-95% prior likelihood of benefit) prior beliefs, and controlled strength of prior belief as weak (SD = 0.425), moderate (SD = 0.215) and strong (SD = 0.135). We compared posterior distribution of the OR under these priors with the reference results under the vague prior distribution. Analyses consisted of 10 Markov Chain Monte Carlo simulations each consisting of 2000 iterations with a 1000 iteration burn-in to ensure proper posterior convergence. Results: In primary analysis, the posterior probability of benefit from methylprednisolone was 92% and the probability of harm was 8%. The mean absolute benefit was 12%. In sensitivity analyses, the probability of benefit was ≥ 79% for all informative priors except the most pessimistic (Table/Figure). Conclusion: In Bayesian re-analysis of the STRESS trial, probability of benefit with prophylactic methylprednisolone is high and harm is unlikely. Assessing probability of benefit or harm may be more informative than frequentist analytics relying on a p-value threshold. Another advantage is the ability to consider a range of prior evidence.
Abstract 4125606: Systolic Blood Pressure During Sleep Determined by Pulse Transit Time Predicts Worsening Heart Failure in Patients with Heart Failure
Authors: Naoto Ohashi, Akiomi Yoshihisa, Yu Sato, Ryohei Takeishi, Toranosuke Sekine, Kazuto Nishiura, Ryo Ogawara, Shohei Ichimura, Yusuke Kimishima, Tetsuro Yokokawa, Shunsuke Miura, Tomofumi Misaka, Takamasa Sato, Masayoshi Oikawa, Atsushi Kobayashi, Takayoshi Yamaki, Kazuhiko Nakazato, Yasuchika Takeishi
Journal: Circulation (2024)

Introduction: Intensive blood pressure (BP) lowering therapy is associated with lower rates of major adverse cardiac and cerebrovascular events in the general population. On the other hand, lower daytime systolic BP (SBP) is associated with higher mortality in patients with heart failure (HF). However, prognostic impact of SBP during sleep was unclear in patients with HF. Methods and Results: We measured continuous SBP during sleep non-invasively by pulse transit time in 379 patients with HF (median age 71, male 53.6%). Beat-to-beat SBP was calculated based on pulse transit time, which was defined as the travel time from the R-wave of electrocardiogram to the pulse wave at the finger detected by plethysmography. Mean values of SBP during sleep were used in the present study. The primary endpoint was hospitalization for worsening HF. The patients were divided into three groups based on the tertiles of SBP during sleep: High SBP group (median SBP 138 mmHg, n = 127), Middle SBP group (median SBP 117 mmHg, n = 127), and Low SBP group (median SBP 100 mmHg, n = 125). The Low SBP group showed the youngest age (High, Middle, and Low groups; 73, 73, 68 years, P &lt; 0.001). Levels of B-type natriuretic peptide (207.7, 216.7, and 407.2 pg/mL, P = 0.039) and estimated glomerular filtration rate (52.6, 54.0, and 57.1 mL/min/1.73 m 2 , P = 0.041) were the highest in the Low SBP group. During the follow-up period of median 1,083 days after SBP measurement, 66 patients experienced hospitalization for worsening HF. Kaplan-Meier analysis revealed that primary endpoint occurred most frequently in the Low SBP group ( Figure ). Multivariable Cox proportional hazard analysis showed that the lowest SBP tertile was associated with the primary endpoint compared to the highest SBP tertile (hazard ratio 2.546, 95% confidence interval 1.257–5.158, P = 0.009). Conclusion: Low SBP during sleep was associated with hospitalization for HF in patients with HF.
Abstract 4125679: Physical activity among gender minority adults: A systematic review
Authors: David Lopez Veneros, Yashika Sharma, Walter Bockting, Kasey Jackman, Billy Caceres
Journal: Circulation (2024)

Introduction: Gender minority (GM; e.g., transgender, non-binary) adults have a higher prevalence of cardiovascular disease (CVD) than their cisgender (i.e., non-transgender) counterparts. Physical activity (PA) is associated with a lower risk of CVD and all-cause mortality. Compared to cisgender adults, GM adults face unique challenges (e.g., discrimination, lack of safe spaces) to meeting aerobic and muscle-strengthening PA recommendations, which may negatively impact their overall health and well-being. There is also limited evidence on factors associated with lower PA among GM adults. Goal: To understand differences in the prevalence of PA between GM and cisgender adults and to identify factors associated with PA among GM adults. Methods: Following the PRISMA guidelines, we performed a comprehensive search using five databases (PubMed, Embase, Web of Since, CINAHL, and Scopus). We included peer-reviewed, English-language, quantitative empirical studies focused on PA among GM adults published between 2004 and 2024. We excluded qualitative studies, reviews, editorials, conference abstracts, and grey literature. We performed quality appraisal using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Results: A total of 5,163 articles were retrieved and 24 met inclusion criteria. The included studies had a low to moderate risk of bias. Methodological weaknesses of the included studies were an overreliance on self-reported PA with no objective assessment using accelerometry, use of non-validated PA measures, and limited assessment of muscle-strengthening PA. Most studies (n = 15) reported lower aerobic and muscle-strengthening PA among GM adults compared to their cisgender counterparts. Two studies found that GM adults with higher perceived psychological stress reported lower PA. One study found that GM adults who were on gender-affirming hormone therapy reported higher PA than GM adults who were not. Conclusions: Findings highlight that GM adults report lower aerobic and muscle-strengthening PA than cisgender adults. There is a need for more comprehensive research to understand these disparities and their impact on GM adults’ cardiovascular health. This systematic review can inform future research and the development of tailored interventions to increase PA among GM adults.