tbuckley/cabot-search huggingface dataset:
Abstract 14572: Polypharmacy and Major Adverse Events in Atrial Fibrillation: Observations From the Korea National Health Insurance Service Data
Authors: Hongju Kim, Pil-sung Yang, Daehoon Kim, Jung–Hoon Sung, Hee Tae Yu, Tae-Hoon Kim, Hui-Nam Pak, Moon Hyoung LEE, BOYOUNG JOUNG
Journal: Circulation (2023)

Introduction: Previous evidence suggests that atrial fibrillation (AF) patients who receive polypharmacy are at an increased risk of experiencing adverse events. In this study, we investigated the prevalence of polypharmacy, identified risk factors associated with polypharmacy, and assessed the impact of polypharmacy on clinical outcomes in a ‘real-world’ data. Methods: We included 451,368 participants without AF (54[48.0-63.0] years; 207,748[46.0%] female) in the Korea National Health Insurance Service-Health Screening (NHIS-HealS) cohort from 2002 to 2013. All concomitant drugs were carefully collected and recorded. Polypharmacy was defined as the intake of ≥5 concomitant drugs. All-cause death, ischemic strokes/transient ischemic attacks (TIAs), major bleeding, heart failure admission were recorded. Results: With up to 7.7 (6.8-8.3) years of follow-up and 768,306 person-years, 12,241 incident AF cases occurred. Among included AF patients (40.0% females, 63.0[54.0-70.0] years), the prevalence of polypharmacy was 30.9 % (3,784). In new-onset AF, older age (per 10 increases, OR 1.32, 95% CI 1.26-1.40), hypertension (OR 4.00, 95 % CI 3.62-4.43), diabetes mellitus (OR 3.25, 95 % CI 2.86-3.70), COPD (OR 3.00, 95% CI 2.51-3.57), ischemic stroke/TIA (OR 2.36, 95% CI 2.03-2.73), dementia (OR 2.30, 95% CI 1.06-4.98), ESRD or CKD (OR 1.97, 95% CI 1.38-2.82), and heart failure (OR 1.95, 95% CI 1.69-2.26) were independently associated to the polypharmacy. Patients with polypharmacy showed significantly higher incidence and risk of major bleeding (aHR 1.26, 95% CI 1.12-1.41). All-cause mortality showed higher incidence, the risk was higher but not statistically significant (aHR 1.11, 95 % CI 0.99-1.24). The risks of stroke and heart failure admission were not changed by polypharmacy. Conclusions: In this “real world” nationwide AF cohort, polypharmacy was highly prevalent and conditioned worse prognosis due to its association with major bleeding events.
Abstract 14953: Racial and Ethnic Disparities in Preterm Birth Among Individuals With Hypertensive Disorders of Pregnancy in the United States, 2020-2021
Authors: Tejasvi Peesay, Ian K Everitt, Nilay S Shah, Lynn M Yee, Sadiya S Khan, Natalie A Cameron
Journal: Circulation (2023)

Introduction: Preterm birth (PTB) is a common adverse outcome in pregnancies complicated by hypertensive disorders of pregnancy (HDP). PTB and HDP are each associated with higher risk of cardiovascular disease (CVD) in both the pregnant individual and their offspring. Racial and ethnic disparities have been described individually in PTB and HDP but the frequency of PTB among individuals with HDP, and whether differences exist by maternal race and ethnicity, is not known. Methods: We used cross-sectional data from the National Center for Health Statistics and included nulliparous individuals aged 15-44 years with a singleton, live birth who had new-onset HDP (gestational hypertension or preeclampsia) in the US in 2020 and 2021. We calculated the frequency of PTB (gestational age &lt; 37 weeks) among those with HDP (%), overall and stratified by self-reported maternal race and ethnicity group (American Indian/Alaskan Native [AIAN], non-Hispanic Asian/Pacific Islander [API], Hispanic, non-Hispanic Black [NHB], non-Hispanic White [NHW]). We compared the frequency of PTB in each racial and ethnic group to the referent group (NHW) with age-standardized rate ratios (aRR). Results: Among 302,817 individuals with HDP, 0.7% were AIAN, 0.8% API, 18.7% Hispanic, 15.5% NHB, and 57.2% NHW. The frequency of PTB among individuals with HDP was 17.6% (95% 17.4-17.8) in 2020 and 18.0% (17.8-18.2) in 2021. Significant racial and ethnic differences were observed in the frequency of PTB with HDP in 2020 and 2021 ( Table ). In 2021, compared with NHW individuals, AIAN (aRR 1.2 [1.0-1.4]), Hispanic (aRR 1.1 [1.1-1.2]), and NHB (aRR 1.4 [1.3-1.4]) individuals had a significantly higher risk of PTB with HDP. Conclusions: In 2020-2021, nearly 1 out of 5 nulliparous individuals with HDP also experienced PTB. Identifying and addressing drivers of racial and ethnic differences in the co-occurrence of PTB and HDP may offer an opportunity to mitigate disparities in intergenerational CVD risk.
Abstract 13747: Undernutrition Severity Correlates With Worse Outcomes in Patients Admitted With Peripheral Artery Disease
Authors: Mohamad Alhoda Mohamad Alahmad
Journal: Circulation (2023)

Introduction: Malnutrition has been associated with inferior outcomes in general. However, there is a lack of data to assess if the degree of malnutrition correlates with worse outcomes in patients with peripheral artery disease (PAD). Methods: We used Nationwide Readmission Database (NRD) for 2016-2019 in our study. First, we extracted all cases older than 18 years that include a primary diagnosis of PAD. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4. Results: We identified 599,717 discharges with PAD. Malnutrition was present in 8% of the study cohort (or 49,853 cases). Half of the patients with malnutrition (or 26,090) had moderate to severe malnutrition. Malnourished patients had similar age distribution compared to those without malnutrition (mean age 71 years vs. 72 years) and slightly more women (42% vs. 37%, p&lt;0.001). Patients with malnutrition had a higher prevalence of underlying heart failure, dementia, coagulopathy, malignancy, and chronic (liver, renal, and lung) diseases (p&lt;0.001), but similar frequency of hypertension and diabetes. They also had significantly higher inpatient mortality (6% vs. 1.4%, p&lt;0.001), length of stay (mean of 15 days vs. 11 days, p&lt;0.001), and all-cause 30-day readmission rates (27% vs. 22%, p&lt;0.001). Inpatient mortality on readmission was also higher in those with malnutrition (9% vs. 3.8%, p&lt;0.001). Univariate analysis showed that the severity of malnutrition also correlated with higher inpatient mortality (OR 3.8[3.4-4.2] for mild malnutrition and 5[4.6-5.5] for advanced malnutrition). Figure 1 shows that malnutrition is associated with higher inpatient mortality even after adjustment for significant comorbidities and vascular interventions. Conclusions: In patients hospitalized with PAD, underlying malnutrition is an adverse prognosticator.
Abstract 14750: Performance of a Polygenic Risk Score for Coronary Artery Disease Across the Spectrum of ASCVD: An Analysis of 60k Patients From 6 TIMI Randomized Trials
Authors: Andre Zimerman, Frederick Kamanu, Giorgio Melloni, Carolina Roselli, Elliott M Antman, Deepak Bhatt, Marc P Bonaca, Christopher P Cannon, Robert Giugliano, Michelle O'Donoghue, Benjamin Scirica, Stephen D Wiviott, Eugene Braunwald, Patrick T Ellinor, Marc S Sabatine, Christian Ruff, Nicholas A Marston
Journal: Circulation (2023)

Background: Coronary artery disease (CAD) polygenic risk scores (PRS) may improve risk stratification, but whether performance differs by ASCVD status remains unclear. Purpose: To compare the predictive ability of a CAD PRS for coronary events in pts with ASCVD and prior event, ASCVD without event, and without overt ASCVD. Methods: We studied genotyped pts from 6 multinational TIMI RCTs. Using a 2.3 million SNP CAD PRS, we first assigned pts to low (Q1), intermediate (Q2-4), or high (Q5) genetic risk, after which pts were grouped by ASCVD status at baseline. The primary endpoint was any coronary event, a composite of death from coronary disease, myocardial infarction, or coronary revascularization. Cox proportional hazards models were used to estimate risk of events, adjusted for ancestry (principal components 1-5), age, sex, SBP, eGFR, diabetes, smoking, and trial. Results: We included 59,905 pts (mean age 66 yrs; 71% male; 79% with prior ASCVD; 49% with diabetes), of whom 10.6% had coronary events during follow-up. Compared with low genetic risk pts, event rates were greater in intermediate (HR 1.59 [95% CI 1.47-1.71]; p&lt;0.001) and high (HR 2.08 [1.91-2.27]; p&lt;0.001) genetic risk pts. There was a significant interaction between the CAD PRS and clinical ASCVD (P interaction &lt;0.001), such that genetic risk discriminated relative risk of future coronary events more strongly in pts without overt ASCVD ( Fig 1A ). In this subgroup, high genetic risk pts had a nearly 5-fold higher hazard of events than low genetic risk pts (8.5% vs 1.6% at 3 yrs; HR 4.63 [3.46-6.21]; p&lt;0.001). Pts without clinical ASCVD and high genetic risk had event rates comparable to pts with established ASCVD and low genetic risk ( Fig 1B ). Conclusion: The gradient of relative risk prediction of coronary events from a CAD PRS depends on the presence of known ASCVD and is strongest in patients without clinical disease. Genetic risk stratification may be more useful in pts without overt ASCVD to help focus preventive measures.
Abstract 11667: Red Cell Indices and Long-Term Prognosis of Heart Failure Patients
Authors: Otto Mayer, Jan Bruthans
Journal: Circulation (2023)

Introduction: It has been demonstrated that some properties of red blood cells also play a role in the etiology of cardiovascular diseases and their complications. Hypothesis: We determined to what extent red blood cell indices observed during hospitalization for heart failure (HF) affect the long-term prognosis of these patients. Methods: We followed 3697 patients [mean age 71.4 years (±SD10.1), 59.1% males] hospitalized for decompensated HF between 2010-20. In the multivariate model, we assessed the five-year all-cause mortality risk associated with red cell distribution width (RDW), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and hemoglobin concentration (dichotomized by tertiles). Results: Kaplan-Meier survival curves comparing the tertiles of red cell indices are in Figure. Patients with RDW in the top tertile showed roughly two-fold higher 5-year mortality risk than those in the bottom tertile; increased risk we also observed in the middle tertile of RDW. This association remained significant even after complex adjustments for individual characteristics (age, gender, ejection fraction, HF etiology, history of malignancy, revascularization, hypertension, diabetes, LDL, atrial fibrillation, and glomerular filtration) as well as treatments (furosemide, beta-blockers, RAS blockers, MRA′s, statins). [HRR 1.83 (95% CIs: 1.53-2.18), p&lt;0.0001, 3 rd versus 1 st ; 1.42 (95%CIs: 1.19-1.68), p&lt;0.0001, 2 nd versus 1 st ] Similarly, we observed increased mortality risk in the bottom tertile of MCHC [HRR 1.34 (95%CIs:1.14-1.59), p=0.001, 1 st versus 3 rd ( fully adjusted)] or hemoglobin [HRR 1.37 (95%CIs: 1.15-1.62), p&lt;0.0001]. In contrast, MCV did not show any additive mortality risk. Conclusions: High degree of anisocytosis and low red cell status of hemoglobin represents independent indicators of poor prognosis in heart failure patients, even long-term after an acute manifestation.
Abstract 15139: Applying an Artificial Intelligence-Enabled Electrocardiographic System for Reducing Mortality: A Pragmatic Randomized Clinical Trial
Authors: CHIN LIN, Chin-Sheng Lin, Wei-Ting Liu
Journal: Circulation (2023)

Introduction: The early identification of high-risk patients for sequent intensive care is a significant challenge. Hypothesis: We aimed to evaluate the outcome of an artificial intelligence (AI)-enabled electrocardiogram (ECG) in identifying patients at high risk of mortality. Methods: In this single-blind, patient-level randomized controlled trial (NCT05118035), we recruited 39 attending physicians and their patients from emergency and inpatient departments. The AI-ECG intervention involved an AI report in electronic health records and an active warning message to physicians for high-risk patients. Primary endpoint was 90-day all-cause mortality. Secondary analyses included medical behavior changes and causes of death. Results: Data from 15,965 patients (8,001 intervention; 7,964 control) with a mean age of 61±18 years were included. The intervention group had a significantly reduced cumulative proportion of death (HR: 0.83, 95% CI: 0.70-0.99) compared to the control group (3.6% vs. 4.3%). High-risk cases (709 intervention; 688 control) identified by AI-ECG showed a 31% reduction in mortality (16.0% in intervention arm vs. 23.0% in control arm, HR: 0.69, 95% CI: 0.53-0.90; p for interaction = 0.026). The intervention group with high-risk ECGs received more intensive care, arrhythmia interventions, echocardiographic and electrolyte examinations, contributing to a significant reduction in cardiac death (0.2% in intervention arm vs. 2.4% in control arm, HR: 0.07, 95% CI: 0.01-0.56). Conclusions: AI-ECG effectively identifies high-risk patients, facilitating intensive care and resulting in reduced all-cause mortality.
Abstract 13696: Sotagliflozin is Associated With Early Clinical Benefit for Heart Failure and Atherosclerotic Events
Authors: Rahul Aggarwal, Deepak Bhatt, Michael Szarek, Michael J Davies, Phillip Banks, Bertram Pitt, Philippe G Steg
Journal: Circulation (2023)

Background: SGLT inhibitors reduce cardiovascular (CV) death and heart failure (HF)-related outcomes in HF patients, with benefits observed within 1 month. Less data exist for the time to clinical benefit for reducing HF or major cardiovascular events (MACE; CV death, myocardial infarction, and stroke) with SGLT inhibitors in patients with chronic kidney disease at high CV risk. Objective: This analysis evaluates the time to clinical benefit for HF-related events and MACE with sotagliflozin, a dual SGLT1 and SGLT2 inhibitor, in SCORED. Methods: SCORED was a randomized, double-blind study of 10,584 patients with type 2 diabetes, chronic kidney disease, and other CV risk factors, where patients were randomized 1:1 to sotagliflozin or placebo. The primary endpoint was total CV death, hospitalization for HF, or urgent visit for HF. A prespecified secondary endpoint was total MACE. The present post hoc analysis calculated the sotagliflozin:placebo hazard ratios (HR) and 95% confidence intervals (CI) for each of these outcomes and determined the day after randomization where the treatment effect reached statistical significance (p&lt;0.05) and remained statistically significant for the duration of follow-up. Results: The overall risk of the primary endpoint was reduced by 26% (HR (95% CI) = 0.74 (0.63, 0.88); p&lt;0.001) with sotagliflozin, with a sustained significant reduction 95 days after randomization (HR (95% CI) = 0.70 (0.50, 0.98) at 95 days; Figure A). For MACE, the overall risk reduction with sotagliflozin was 23% (HR (95% CI) = 0.77 (0.65, 0.91); p&lt;0.001), with a sustained significant reduction 94 days after randomization (HR (95% CI) = 0.69 (0.47, 0.99) at 94 days; Figure B). Conclusion: In this stable, outpatient population at high risk for CV events, the time to clinical benefit with sotagliflozin was very early at approximately three months for both HF- and MACE-related outcomes.
Abstract 17945: Characterization and Treatment of Primary Cardiac Rhabdomyosarcoma in the Last Three Decades
Authors: Sanya Ahmed
Journal: Circulation (2023)

Introduction: Cardiac rhabdomyosarcomas are rare, aggressive neoplasms comprising 5% of cardiac sarcomas overall. Due to the low prevalence, there is little consensus on the appropriate identification and treatment of this condition. This research aims to characterize trends in the clinical presentation of the disease and identify improvements for therapeutic management. Methods: A literature review was conducted by identifying cases of primary cardiac rhabdomyosarcoma published in English to PubMed between 1993 and 2023 and available via the SUNY Downstate Library. Studies were analyzed for patient demographics, clinical course, treatment, and recovery. Results: The analysis included 31 identified cases. Most cases were reported in male (52%) adults (87%) with an average age of 44 (STD: 21). Patients frequently presented with dyspnea (59%) and cardiac issues (52%), including chest pain (19%) and conduction disorders (19%). Tumors were detected via echocardiogram (79%) and CT (18%) and frequently left-sided (60%), with the most cases arising in the left atrium (47%). There was valvular involvement in 43% of cases. Surgery was performed in 86% of patients, of which 33% were fully resected via sternotomy and 13% were cardiac transplants for unresectable tumors. 56% of patients survived at 12 months follow-up. Surgical management was combined with chemotherapy (46%), such as the VAC regimen (40%), and radiation (14%), which improved patient 1-year mortality by 26%. 26% of patients developed recurrence of the primary tumor and 42% of patients developed metastatic disease; osseous metastases (38%) were the most common. 13% of patients had a prior history of cancer. Conclusions: The rare rhabdomyosarcoma may present as a middle-aged patient with dyspnea and cardiac concerns refractive to standard management. A left atrial mass mimicking a benign lesion such as a myxoma may be seen on echocardiogram, and suspicious lesions should undergo surgical resection to relieve symptoms and confirm the diagnosis. Supplementation of surgical management using chemotherapy and radiation may improve outcomes in patients. Clinicians should closely monitor the patient for osseous and lung metastases. A prior history of cancer may be a risk factor for the disease.
Abstract 15099: Sex Disparities in Patients With Cardiac Sarcoidosis Undergoing Implantable Cardioverter-Defibrillators Implantation in the United States
Authors: Raheel Ahmed, Kamleshun Ramphul, Ali Hasan, Muzammil Farhan, Azeem Hassan, Hasan Ahmad, Joseph Okafor, Caleb Carver, Taimurzeb Durrani, Ayesha Jadoon, Khadija Amanullah, Yumna Jamil, Maham Bilal, Sajeel Ahmed, Rahat A Memon, Hemamalini Sakthivel
Journal: Circulation (2023)

Introduction: In patients with cardiac sarcoidosis (CS), implantable cardioverter-defibrillators (ICDs) are utilized to avoid sudden cardiac death. We aimed to compare the sex disparities in CS patients undergoing ICD implantation.Hypothesis:Higher ICD implantation would be observed in male CS patients as compared to females. Methods: Males and females with CS receiving ICD were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models. Results: Of the 760 cardiac sarcoidosis patients undergoing ICD implantation, 505 (66.4%) were males and 255 (33.6%) were females. Around 94.1% of all procedures (715 cases) were conducted in urban teaching centres. In comparison to females, males were younger (55.0 vs 56.9 years, p&lt;0.01) with higher prevalence of diabetes (31.7% vs 21.6% p&lt;0.01) and chronic kidney disease (CKD) (16.8% vs 7.8% p&lt;0.01) and a lower occurrence of reported depression (5.0 vs 19.6 p&lt;0.01). Atrial fibrillation (AF) (23.5% vs 11.9%, p&lt;0.01), sick sinus syndrome (SSS) (7.8% vs 4.0%, p=0.024) and ventricular fibrillation (VF) (15.7% vs 9.9%, p=0.02) were more prevalent in female CS receiving ICD. The percentages of ICD use in those with a history of hypertension, smoking, obesity, lipid disorder, previous myocardial infarction, supraventricular tachycardia, ventricular tachycardia, 2nd degree AV block and complete AV block were similar for both male and female CS patients. Following ICD implantation, the mean length of stay and mean hospital charges were comparable between the two groups. Incidence of acute kidney injury (AKI) post-ICD was more common in males (23.8% vs 15.7%, p=0.01) (Table 1). Conclusion: AF, SSS and VF are more prevalent in female CS patients with ICD. However, ICD use in CS patients is generally more common in males who also have a greater prevalence of diabetes, CKD and post-ICD AKI.
Abstract 16495: Cellular Senescence and Mitochondrial Dysfunction in Very Low-Density Lipoprotein-Induced Cardio-Lipotoxicity
Authors: Yi-Hsiung Lin, Hsiang-chun Lee
Journal: Circulation (2023)

Dyslipidemia, the hallmark of the metabolic syndrome, plays an important role in cardiovascular and cardiometabolic diseases. The heart utilizes lipids as major source of ATP and cardiomyocytes expresses abundant receptors for very low-density lipoprotein (VLDL), which is found exhibiting cardio-lipotoxicity in the metabolic syndrome. This study investigates the effects of VLDL in cardiomyocyte senescence and mitochondrial function. VLDL from metabolic syndrome patients was used to treat H9C2 cardiomyocytes for 72 hours. The RNA-sequencing was conducted to find novel senescence-associated signaling pathways in VLDL-induced lipotoxicity. The newly-found targets and regulators were validated using qPCR and Western blot. In addition, the senescence-associated secretory phenotype, the effects of VLDL on mitochondrial ATP production, NAD + /NADH, and mitochondrial membrane potential were also determined. The results showed that VLDL upregulated 97 cardiac hypertrophy-related genes expression. Among them, 84 genes were related to senescence, and 30 genes were apoptosis-related. Besides, 63 autophagy genes were also affected by VLDL treatment. The KEGG analysis showed that VLDL induced multiple senescence-related signaling pathways such as TP53, ERK-FOXO4, and TGF-β-related pathway. VLDL also exhibited dose-dependent influence on intra-mitochondrial Ca 2+ , and associated molecule Hmox1, Htt and Xdh expression. This study revealed novel mechanisms for the VLDL-induced cardio-lipotoxicity, which was shown involving multiple senescence-related signaling pathways and mitochondrial function regulators. The results suggested that the senescence signaling is a potential therapeutic target for cardiometabolic diseases.