tbuckley/cabot-search huggingface dataset:
Abstract 4117645: Ischemic Heart Disease Trends in Canada: A 30-Year Epidemiological Study
Authors: Valerie Wang, Neo Hou, Avi Gajjar, Herbert Wang
Journal: Circulation (2024)

Introduction: Ischemic heart disease (IHD) results from coronary artery blockages that impede myocardial blood flow. We aim to examine the temporal trends of IHD in Canada from 1990 to 2019, assessing age-standardized mortality, disability-adjusted life years (DALYs), and other health indicators. Methods: We analyzed data from the 2019 Global Burden of Disease study on Canadian IHD cases over three decades. The study investigated age-standardized deaths, DALYs, years lived with disability (YLDs), years of life lost (YLLs), prevalence, and incidence across both sexes. We performed statistical analyses using Microsoft Excel 16.63.1. Results: Over the period from 1990 to 2019, Canadian men and women experienced notable decreases in IHD incident rates [-45.11%], overall mortality [-60.64%], YLLs [-62.824%], prevalence [-26.778%], YLDs [-48.729%], and DALYs [-50.467%]. Detailed analysis revealed a reduction in death rates by 61.311% in men and 61.119% in women, while YLLs decreased by 63.115% for men and 63.808% for women. Similarly, DALYs showed a decline of 62.67% for men and 63.25% for women. Prevalence rates fell by 25.417% in women and 29.594% in men, whereas YLDs decreased by 51.148% for women and 49.172% for men. The 2019 data confirmed a per 100,000 population count of 48.78 YLDs, 1020.28 YLLs, and 1069.06 DALYs across both sexes. Conclusions: This study illustrates a significant decrease in ischemic heart disease (IHD) metrics in Canada from 1990 to 2019, highlighting notable reductions in mortality, prevalence, and disability rates among both genders. The findings underscore the effectiveness of healthcare improvements and public health initiatives and IHD. Despite these advancements, IHD continues to pose a substantial health challenge, indicating the need for ongoing efforts in medical care, policy-making, and lifestyle modifications to further alleviate the disease's burden in Canada.
Abstract 4116981: Sex- and Racial/Ethnic Mortality Trends Across Separate Time Periods Following Hospitalization for Acute Myocardial Infarction
Authors: Matthew Tran, Qian Luo, Ali Moghtaderi, Vinay Kini
Journal: Circulation (2024)

Intro: Mortality for patients hospitalized with acute myocardial infarction (AMI) has improved over time, but sex- and racial/ethnic disparities remain. Whether disparities have changed over specific time periods following hospitalization is poorly understood. Aim: To assess mortality trends across separate time periods following incident AMI hospitalization by sex and race. Methods: Using Medicare fee-for-service data covering all patients with incident AMI hospitalizations from 2008 to 2018, we examined unadjusted mortality rates by sex and race/ethnicity for the following time periods: acute (in-hospital), post-acute (0-30 days after hospital discharge), short term (31 days to 1 year after discharge), and long term (1-3 years after discharge). Each period was considered separately (i.e., patients who died during one period were not counted in later periods). Results: We identified 768,084 patients hospitalized with incident AMI (mean age 81 years, 48% male, 87% White) between 2008-2018. Figures 1 and 2 show annual mortality rates and trends. From 2008-2018, men and women had similar in-hospital and post-acute mortality, but women had persistently higher short- and long-term mortality compared to men. In 2008, Black patients had higher mortality rates compared to White patients for every period studied. In-hospital mortality rates were similar by 2018 but remained higher for Black patients for every other time period. Conclusions: For incident AMI patients, mortality rates have improved across subgroups through 3 years after discharge. However, women have had persistently higher mortality rates 1-3 years following hospitalization compared to men, while Black patients have had persistently higher mortality rates 30 days – 3 years following hospitalization compared to White patients. These results suggest that opportunities to reduce sex- and race-based AMI disparities might be particularly effective in longitudinal outpatient care following hospital discharge.
Abstract 4117438: Machine Learning Predicts Successful Transcatheter Mitral Valve Edge to Edge Repair: A Systematic Review and Meta-Analysis
Authors: Ethan Sacoransky, Danny Yu Jia Ke, Wael Abuzeid
Journal: Circulation (2024)

Introduction: Transcatheter Mitral Valve Edge to Edge Repair (TEER) is an established percutaneous treatment for patients with severe symptomatic Mitral Regurgitation (MR). The current AHA/ACC guidelines recommend TEER for inoperable patients with severe primary MR or patients with symptomatic severe secondary MR despite medical therapy. Machine learning (ML) has emerged as a tool for TEER risk stratification due to the paucity of established risk scores. To address the lack of consensus on its efficacy, we conducted a systematic review and meta-analysis of studies that utilized ML to predict the success of TEER. Methods: Electronic databases, including Embase, MEDLINE, and the Cochrane Library, were searched from inception through April 2024. We included studies that used TEER and employed at least one ML model to predict the success of TEER. The Area Under the Receiver Operating Characteristic Curve (AUC) was used to measure the accuracy of ML risk stratification algorithms. Results: 102 publications were screened, with seven eventually included in this analysis. Two studies employed clustering techniques, two utilized extreme gradient boosting, and three used multiple ML algorithms to predict outcomes. Of the four studies that compared the accuracy of ML with traditional Cox regression, all four demonstrated higher accuracy with ML, and this difference was statistically significant in three of the four studies. The mean AUC of the aggregated ML data was 0.737 [95% CI: 0.717, 0.758], compared to 0.627 [95% CI: 0.600, 0.653] for the pooled traditional methods. Conclusions: To our knowledge, we conducted the first systematic review and meta-analysis of ML methods for prediction of TEER success. ML outperformed established risk scores, demonstrating promising potential. Future ML models, trained on larger patient datasets, may further improve predictive accuracy in this patient population.
Abstract 4119472: Predictors of Sudden Cardiac Death in Patients with Atrial Fibrillation and No Apparent Risk Factor of Sudden Cardiac Death
Authors: Sheng Nan Chang, Jien-Jiun Chen, Pang-Shuo Huang, Fu-chun Chiu, Cho-Kai Wu, Chia-Ti Tsai
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) is associated with sudden cardiac death (SCD). It is known that AF is associated with multiple traditional risk factors of SCD, such as coronary artery disease (CAD), history of myocardial infarction (MI), left ventricular hypertrophy (LVH) and low left ventricular ejection fraction (LVEF). However, AF per se could predispose SCD not mediated by these cardiovascular risk factors, and predictors of SCD in AF patients without these apparent SCD risk factors are unknown. Methods: Using the NTUH iMED database, AF patients without apparent SCD risk factors were longitudinal followed up from Jan. 2010 to Dec. 2021. The primary outcome was implantation of implantable cardioverter defibrillator (ICD) due to SCD. Cox regression was used to identify the predictors of SCD. Results: A total of 11250 AF patients without cardiovascular SCD risk factors and LVEF ≥55 % were longitudinally followed up. We first found CHA2DS2-VASc score did not predict SCD event. We found male gender (hazard ratio [HR ] 1.71 [1.05-2.78 ], p =0.032), hyperthyroidism (HR 3.50 [1.40-8.77 ], p=0.007）and paroxysmal AF (PAF)(HR 2.86 [1.63-5.04 ], p&lt;0.001）were associated with higher SCD risks. We created a AFSCD score using these parameters. We found SCD risk incrementally increased with increasing AFSCD score (p &lt;0.001 for trend). Patients with highest score (5 points) had more than 3-fold SCD risk compared with those with 0-point score (1.18 % person-year vs 0.36 %, p&lt;0.001). The C statistic of AFSCD score was significantly higher than CHA2DS2-VASc score (0.64 [0.57-0.70] vs 0.40 [0.33-0.48], p &lt;0.01). Conclusions: Male gender, hyperthyroid AF and PAF were predictors of incident SCD in AF patients and AFSCD scoring scheme based on these risk factors could possibly be implemented in clinical practice.
Abstract 4117856: Effects of a Nurse-led Common-sense Model of Self-regulation-Based Heart Failure Self-care Program on Patient Outcomes: A Randomized Controlled Trial
Authors: Zehao HUANG, Sek Ying Chair
Journal: Circulation (2024)

Introduction: Guidelines have recognized the critical role of self-care in heart failure (HF), but people with HF do not adequately practice self-care. The Common-Sense Model (CSM) of Self-Regulation is a widely used theoretical framework for promoting behavior change and improving disease prognosis among patients. However, studies on the effects of the application of this model among people with HF are limited and present mixed results. Aims: To examine the effects of a nurse-led CSM of Self-Regulation-based self-care intervention on illness perceptions, self-care behaviors, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, anxiety, symptom burden, sleep quality, healthcare service utilization, and mortality among people with HF. Methods: A randomized controlled trial was conducted. Participants were recruited from a university-affiliated hospital and randomized at a 1:1 ratio into the intervention or the control groups. Participants in the intervention group received a 6-week nurse-led CSM of Self-Regulation-based self-care program and usual care. Control group participants only received the usual care. Outcomes of interest were measured at baseline, 6 weeks (T1), and 3 months (T2) after enrollment. The generalized estimating equations model and Mann-Whitney U test were used to examine the intervention effects on the study outcomes. Results: 138 subjects were enrolled in the study between March and May 2023. Participants in the intervention showed statistically greater improvements in illness perceptions, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, symptom burden, and sleep quality compared with the controls at T1 and T2. We also observed a statistically significant reduction in the number of HF-related unscheduled outpatient department visits in the intervention group compared to the control group at T2. However, no significant differences were found in anxiety, number of HF-related hospital readmissions, length of HF-related hospital stays, number of HF-related emergency department visits, or HF-related mortality between the study groups at T1 and T2. Conclusion: Our program generates favorable effects on promoting behavior change and improving health outcomes among people with HF. It also fills the knowledge gaps around the application of CSM of Self-Regulation in people with HF and provides more empirical evidence supporting the effectiveness of nurse-led interventions.
Abstract 4119327: Tyrosine Kinase Inhibitor and Their Cardiotoxic Profile in the African American Population at a Community Safety Net Hospital
Authors: Kapil Chandora, Ridwan Azees, Hafsa Gundroo, Carey Green, Akshay Chandora
Journal: Circulation (2024)

Intro: Tyrosine Kinase inhibitors (TKI) have been an effective treatment option for multiple cancer types. Unfortunately, TKIs have shown to have off-target Kinase binding to cardiac tissue. The examination of these cardiotoxic side effects have not been sufficiently explored in minority populations and studies such as DASISION and ENESTnd with high NAA homogeneous demographics reflect this issue. AA tend to have higher rates of HTN and HF at baseline, so further evaluation of TKI cardiotoxicity in this population is warranted. Methods: A total of 181 patients (pts) charts were reviewed in this study, who were exposed to either Ibrutinib, Imatinib and Sorafenib. First, Patients’ demographic data, such as age, gender, race, malignancy type were obtained along with their corresponding exposure to TKIs discussed above. Next, each patient (pt) chart was examined for any cardiotoxic etiologies after starting a TKI, such as arrhythmias, new- onset heart failure (nOHF) , cardiac arrest (CA), and Myocardial infarction (MI). Echocardiography reports were examined for Ejection fraction ( EF). In summary, this is an observational study looking at Cardiotoxicity secondary to TKI use in the AA population. Results: This study's demographics consisted of 149 AA and 32 NAA (non- african american), with the average age of 64.2, and had 128 males and 53 females. A total of 89 pts were on imatinib, 57 on Ibrutinib, 35 on sorafenib. In our population, 64 pts received cardiac echography while on TKIs, with 9 of them demonstrating nOHF. In terms of cardiac arrhythmias, a total of 67 pts experienced this while on TKI, with about 34% (51/149) of AA compared to 50% (16/32) of NAA. A total of 18 pts in the study required hospital management as a sequelae of their cardiotoxicity. Conclusion: There were a few trends that diverged from most studies regarding cardiotoxicity associated with TKIs in our study. When looking at individual items, such as rate of Atrial Fibrillation (AF), seen commonly in patients on Ibrutinib, our rate seen is 4.6% which is lower compared to earlier pooled homogenous population studies (6-7%). Earlier clinical trials of Sorafenib had a 2 % rate of HF in mostly homogenous NAA populations, and our study had 0% rate in total. Overall, several cardiotoxicity trends seen with the TKIs in this observational study warrant need for future studies to enable improved cardiac surveillance strategies post treatment in heterogeneous populations.
Abstract 4118762: Large-scale multinational trends in the use of cardioprotective antihyperglycemic agents as first-line therapy in patients with type 2 diabetes and cardiovascular disease: a LEGEND-T2DM study
Authors: Phyllis Thangaraj, Arya Aminorroaya, Lovedeep Dhingra, Aline Pedroso Camargos, Jin Zhou, Clair Blacketer, Fan Bu, Yi Chai, Shounak Chattopadhyay, David Dorr, Talita Duarte-Salles, Wallis Lau, Yuntian Liu, Yuan Lu, Kenneth Man, Evan Minty, Lauren Richter, Joseph Ross, Nigam Shah, Patrick Ryan, Martijn Schuemie, George Hripcsak, Harlan Krumholz, Marc Suchard, Rohan Khera
Journal: Circulation (2024)

Background: US guidelines for type 2 diabetes (T2DM) recommend metformin as first-line anti-hyperglycemic therapy (AHT), but prioritizing the use of AHTs that reduce cardiovascular disease (CVD) risk – GLP1-RAs and SGLT2is – is increasingly suggested for people with CVD. We examine the multinational use patterns of GLP1-RAs, SGLT2is, DPP4is, and sulfonylureas (SUs) as first-line therapies for patients with CVD. Methods: In 10 US and 6 non-US databases between 2016 and 2021 mapped to a common data model [A], we measured yearly initiation of GLP1-RAs, SGLT2is, DPP4is, and SUs as first-line AHTs in patients with T2DM with and without CVD [B]. We also compared the initiation of the drug classes as second-line after metformin. We calculated the annual rate of change in proportional initiation of each drug class as first-line AHT and assessed differences in trends as group x time interactions in linear mixed models. Results: Across all data sources, 3.3 million patients with T2DM used GLP1-RAs, SGLT2is, DPP4is, or SUs as first-line AHTs, and 3.9m initiated these drug classes as second-line AHT after metformin. Within the first-line cohort, 1.4m (41%) had established CVD compared with 1.2m (31%) in the second-line cohort. For GLP1-RAs and SGLT2is, the annual rate of their relative use as first-line agents increased among patients with T2DM with CVD (GLP1RAs: ranging 1.3-5.4% in US [C] and 0.3-0.8% in non-US [D], SGLT2is: 2.1-12.9% in US [E] and 8.1-10.6% in non-US databases [F]). There was a larger relative increase in the use of SGLT2i and a smaller increase in GLP1RA use in CVD vs non-CVD cohorts (P interaction &lt;.001). While there was a larger increase in GLP1RAs uptake in the US cohorts, SGLT2i use increased more in non-US cohorts ([C-F], P interaction &lt;.001 for all, except .01 for SGLT2i). Of note, across cohorts, the uptake of GLP1RA and SGLT2i as first-line was higher than second-line use among those with CVD (P interaction &lt;.001). In contrast, DPP4i and SU use as first-line was lower than GLP1RA and SGLT2is and decreased over time (P&lt;.001). Conclusions: In a large-scale multinational, federated cohort of patients with T2DM, the use of cardioprotective agents increased as first-line AHT, with variation in SGLT2i and GLP1RAs uptake across study cohorts.
Abstract 4119941: Identification of individuals who benefit from omega-3 fatty acid supplementation to prevent coronary heart disease: A machine-learning analysis of the VITAL
Authors: Rikuta Hamaya, Nancy Cook, Howard Sesso, Samia Mora, Julie Buring, JoAnn Manson
Journal: Circulation (2024)

Backgrounds: Randomized controlled trials (RCTs) have demonstrated benefits of marine omega-3 polyunsaturated fatty acids (omega-3 FA) supplementation for the prevention of coronary heart disease (CHD). However, it has not been clear which individuals would benefit the most from the supplementation. We sought to predict the individual treatment effect of omega-3 FA supplementation on CHD prevention and to develop an omega-3 effect score to stratify individuals according to their expected benefit from the supplementation. Methods: Among the 25,871 randomized participants without history of CVD in the VITamin D and OmegA-3 TriaL (VITAL), we applied machine-learning (ML) approaches to predict individual treatment effect of omega-3 FA supplementation on 5-year CHD risk (a composite of myocardial infarction, coronary revascularization, and CHD death) using 11 covariates pre-specified in the VITAL trial protocol. A 10-fold cross-validation was used and held-out test dataset was used for the evaluation. An omega-3 effect score was developed such that each covariate contributed linearly, and utility of the score was further evaluated by transportability analysis using the National Health and Nutrition Examination Survey (NHANES) data as the target population. Results: Omega-3 FA intervention led to absolute 0.48% [SE: 0.20] reduction in CHD in the total population. ML algorithms effectively stratified participants by their expected benefit according to individual factors; decreased CHD risk was observed in those with quintile 1 and 2 of the expected benefit (absolute CHD risk reduction %: 1.30 % [0.55] and 1.32 % [0.51] in quintile 1 and 2, respectively). Race, diabetes, and fish intake most contributed to the omega-3 effect score. CHD incidence rates per 1000 person-year were 5.5 [0.44] if treated and 8.5 [0.55] if not treated (35.3% reduction) in individuals with the score ≥11 (upper 40th percentile), and 3.9% [0.31] if treated and 3.4% [0.55] if not treated (14.7% increase) in those with the score &lt;11, respectively. The transportability of the utility of the score to baseline NHANES data was confirmed. Conclusion: In VITAL, ML approaches identified individuals who experienced greater CHD reduction from the omega-3 FA intervention, and an omega-3 effect score stratified the expected benefit. Although it warrants testing in a new RCT, the omega-3 effect score holds promise for guiding the indication of omega-3 FA supplementation in US primary prevention population.
Abstract 4117868: The Mediation Effect of Self-care Self-efficacy between Illness Perceptions and Self-care Behaviors among People with Heart Failure
Authors: Zehao HUANG, Sek Ying Chair
Journal: Circulation (2024)

Introduction: Heart failure (HF) self-care behaviors are related to patient outcomes. The Common-sense Model of Self-Regulation indicates that illness perceptions and self-care self-efficacy are crucial predictors of self-care behaviors. However, research evidence is limited on these relationships. Aims: To explore the associations among illness perceptions, self-care self-efficacy, and self-care behaviors in people with HF. Methods: A cross-sectional study design was adopted. People with HF were recruited from a tertiary hospital between February and April 2023 in China. All the participants were assessed for illness perceptions, self-care self-efficacy, and self-care behaviors. Data were analyzed using Pearson correlation and mediation analyses. The study was reported following the STROBE checklist. Results: A total of 164 people with HF were enrolled. Pearson analysis reported the negative correlations between the scores of illness perceptions and the scores of self-care maintenance (r=-0.344, p&lt;0.001), symptom perception (r=-0.352, p&lt;0.001), and self-care management (r=-0.519, p&lt;0.001), as well as the positive associations between the scores of self-care self-efficacy and the scores of self-care maintenance (r=0.689, p&lt;0.001), symptom perception (r=0.697, p&lt;0.001), and self-care management (r=0.771, p&lt;0.001). Moreover, a significant negative relationship between the scores of illness perceptions and the scores of self-care self-efficacy was observed (r=-0.527, p&lt;0.001). Mediation analysis reported that the scores of self-care self-efficacy completely mediated the negative relationships between the scores of illness perceptions and the scores of self-care maintenance, symptom perception, and self-care management, and the mediation effect accounted for 71.4%, 72.5%, and 88.2% of the total effect, respectively. Conclusions: Among people with HF, self-care self-efficacy completely mediated the relationships between illness perceptions and self-care behaviors. Interventions targeting improving illness perceptions and self-care self-efficacy may enhance HF self-care behaviors.