tbuckley/cabot-search huggingface dataset:
Abstract 13834: Changes in Treatment Patterns and Incremental Healthcare Utilization Due to P2Y <sub>12</sub> Associated Disorders in Patients With Acute Coronary Syndrome
Authors: Ami Vyas, Lori D Bash, Mehul D Patel, Ross J Simpson
Journal: Circulation (2016)

Introduction: Data on the effect of P2Y 12 associated disorders on adherence to antiplatelet therapy (APT) in acute coronary syndrome (ACS) patients are sparse. We describe the characteristics, treatment patterns, associated disorders and healthcare utilization (HU) among ACS patients on P2Y 12 APT. Methods: Patients age ≥18 discharged from an ACS hospitalization in 2012-2014 who initiated P2Y 12 APT (ticagrelor, prasugrel, or clopidogrel) were identified from the MarketScan commercial claims database. The proportion of patients within each treatment group who experienced P2Y 12 associated disorders within one year, and who were adherent to APT were determined. Adjusted poisson regressions estimated the association between P2Y 12 non-adherence and HU (hospitalization, emergency visits, outpatient visits, cardiac events, transfusions). Results: Among 11,629 ACS patients, most were male, 45% had hypertension and 21% had diabetes. Clopidogrel use was common, and ticagrelor less common. Among all groups, about a third experienced P2Y 12 associated disorders. One-year adherence to APT was suboptimal (68%) and highest among prasugrel users (71%); switching was most common in ticagrelor users. Non-adherent patients experienced 1.34, 1.09, and 1.85 (p&lt;0.05) times as many hospitalizations, emergency room visits, and transfusions, respectively, compared to adherent patients. Also, patients not adherent to ticagrelor experienced 1.9 times as many cardiac events as adherent patients. However, this association was not significant for clopidogrel or prasugrel users. Conclusions: P2Y 12 associated disorders were common. Adherence was suboptimal and non-adherence was associated with increased HU. Disease management strategies to improve adherence and reduce treatment-associated adverse events through individualized patient care, alternative secondary treatment options and physician awareness should be assessed.
Abstract 199: Relationship Between the Blood Hemoglobin Concentration and the Initial Rhythm in Out-of-Hospital Cardiac Arrest (Interim Analysis From SOS-KANTO 2012)
Authors: Masaru Suzuki, Yukio Satoh, Kei Hayashida, Shingo Hori, Yoshio Tahara, Arino Yaguchi, Naoto Morimura, Ken Nagao
Journal: Circulation (2013)

BACKGROUND: Tissue metabolism that is reflected by oxygen consumption is regulated by the blood hemoglobin concentration (Hb) and cardiac output. Cardiac output during cardiac arrest has been suggested to be related to the quality of CPR. Although Hb might theoretically play a crucial role in maintaining tissue metabolism during cardiac arrest, this has not yet been well studied. If myocyte metabolism during cardiac arrest were affected by Hb, the sustainability of myocytes’ electrical activities may be correlated with the Hb. HYPOTHESIS: The probability of asystole being observed as the initial rhythm by emergency personnel at the scene of a cardiac arrest (CA) is higher in cardiac arrest patients with lower Hb than in those with higher Hb. METHODS: In an interim analysis of the data in the SOS-KANTO 2012 Study, a multicenter prospective observational study, there were 6,019 CA registrations in the KANTO area, Japan. Of these, Hb was checked in 4,611 cases. Of the 4611 cases, there were 705 subjects 15 years old or over of out-of-hospital CA with a presumed cardiac etiology, in whom the CA was confirmed by emergency personnel at the scene and who were identified as having no disabilities of daily living. Of the 705, 130 males who received bystander chest compressions in whom Hb ranged between 5.0 and 20 g/dl (median 13 g/dl) were included in this study. Results: Of the 130 cases, asystole and VE/VT were confirmed as the initial rhythm at the scene by emergency personnel in 39 (30%) and 61 (47%) cases, respectively. Hb was lower in the asystole group than that in the non-asystole group (12.3+/-2.7 g/dl vs. 13.3+/-2.6 g/dl, P=0.04). A multivariate logistic regression analysis showed that Hb and later arrival of emergency personnel at the scene of emergency collapse were independent predictors of identification of asystole as the initial rhythm at the site of CA (odds ratio [95%CI]: 0.82 [0.75-0.90], P&lt;0.01, 1.18 [1.06-1.30], P&lt;0.01, respectively). CONCLUSIONS: Lower Hb in the blood was associated with a higher likelihood of asystole at the scene of CA. Our findings suggested that VF/VT and/or PEA easily disappear and change to asystole in victims with lower Hb, although further study is needed.
Abstract 198: Sudden Death While Bathing in Japan
Authors: Masaru Suzuki, Yohsuke Kobayashi, Shingo Hori
Journal: Circulation (2013)

BACKGROUND: Japanese people have a unique bathing custom, wherein they immerse themselves in hot water. Many elderly subjects die while bathing, which accounts for an estimated 17,000 deaths annually. The reason for this phenomenon still remains to be elucidated. OBJECTVE: The aim of this study was to clarify the recent actual situation of death while bathing. METHODS: We investigated the data of all victims for whom the emergency medical system needed to be activated because of accident and/or acute illness in relation to bathing in Tokyo between October 2012 and January 2013. Reports describing each event were obtained from emergency personnel and emergency physicians. Results: During the study period, there were 2,630 events in relation to bathing. The number of such events increased as the atmospheric temperature decreased (number of events/mean temperature: October: 383/19.4 Celsius degree; November: 580/12.7; December: 871/ 7.3; January: 796/5.5). Of the 2,630 events, cardiac arrests accounted for 889 events (34%). Of the 889 cardiac arrests, 818 (92%) occurred while the patients bathed in a bathtub filled with hot water. Of the total of 2,630 events, 1,600 (61%) events occurred while the patients were immersed in hot water in their bathtubs (cardiac arrest: 818, trauma: 30, acute illness: 752). Of the 752 patients who became acutely ill while immersed in hot water, 546 needed to be rescued out of the bathtub as they could not get out of the tub by themselves. The major symptoms were lethargy and/or consciousness disturbance. There were a few cases with organic diseases, including cerebrovascular events. Many got better by themselves, without intervention, and did not require in-hospital care. Discussion: It was considered that hot water immersion plays a key role in events related to bathing. Many events occurring during bathing, other than cardiac arrest, appeared to be self-limiting conditions. Because hot water immersion easily causes the body temperature to increase, it is possible that events including sudden death, may be related to hyperthermia occurring during hot water immersion. Acknowledgement: This study was supported by a Health Labour Sciences Research Grant.
Abstract 208: Emergency Medical Service Resuscitative Interventions in North-Central West Virginia Trauma Activation Criteria Patients: A Ten Year Experience
Authors: Charles Whiteman, Russell Doerr, Erica Shaver, Danielle Davidov, Stephen M Davis, Owen Lander, Frederick Blum
Journal: Circulation (2013)

Introduction: West Virginia (WV) is the second most rural state, with 51.3% of the population living in a rural area and 97.3% of the land area considered rural by the US Census Bureau. West Virginia University (WVU) MedCom provides medical command for Emergency Medical Services (EMS) in 26 north-eastern WV counties. EMS transport times often exceed 20 minutes in rural counties. However, little is known about the specific provider capabilities and interventions that occur in the rural pre-hospital setting. Methods: This was a retrospective, observational review of EMS interventions for “trauma activation criteria patients” (based on CDC Field Triage Guidelines) in the WVU MedCom database. Trauma activation criteria EMS encounters from January 1, 2002 to December 31, 2011 were analyzed for EMS provider capability, receiving hospital capability, and pre-hospital resuscitative interventions. Results: There were 11,853 patients available for analysis in the time period. Basic Life Support (BLS) providers provided 21.0% of the care. The distribution of receiving Trauma Centers was as follows: 83.2% Level I, 4.7% Level II, 3.9% Level III, 5.0% Level IV; 3.2% were taken to a facility without trauma center designation. Airway intervention occurred in 7.5% of patients; 2.3% had endotracheal tube (ETT) placement (0.88% had failed ETT placement), 0.34% had King/Combi-tube placement, and 4.0% had positive pressure ventilation with bag valve mask. Vascular access was attempted in 78.7% of the patients; 73.0% had vascular access established (72.9% by IV and 0.08% by intra-osseous access) and 5.1% had an IV fluid bolus administered. CPR was performed on 1.0% of the patients and needle thoracostomy was performed on 0.32% of the patients. Discussion: In rural north-central WV, BLS responders provided the pre-hospital care to 1 in 5 patients. Although treatment at a Level I Trauma Center has been shown to decrease patient mortality by 25%, only 83.2% of trauma patients in rural north-central WV were initially treated at a Level I Trauma Center. Pre-hospital airway intervention was needed in 7.5% of patients. Vascular access was established in only 73.0%; 5.1% received a fluid bolus. Additional studies will be needed to assess the impact of these treatments on patient outcomes.
Abstract 211: Blockade of Na+-Sensitive K+ Channels Alleviates Frequency-Dependent Electrical Failure in an Ex-Vivo Model of VF-Induced Cardiac Arrest
Authors: Vivek Garg, Tyson G Taylor, Paul W Venable, Katie J Sciuto, Junko Shibayama, Alexey Zaitsev
Journal: Circulation (2013)

Ventricular fibrillation (VF), global ischemia and beta-adrenergic stimulation form the common context of sudden cardiac arrest. Regional and global loss of excitability under these conditions sets the stage of resuscitation failure due to either asystole or post-reperfusion VF recurrence. We hypothesized that Na+-sensitive K+ current (IKNa) significantly contributes to electrical failure under combined conditions of ischemia, high excitation frequency, and beta-adrenergic stimulation. We performed optical mapping of voltage-sensitive dye RH237 in the anterior right and left ventricle (RV and LV) of Langendorff-perfused rabbit hearts subjected to normothermic global no-flow ischemia, isoproterenol (30 nM) and pacing at the cycle length (CL) of either 300 ms or 200 ms. 2,3-butanedione monoxime (20 mM) was used to reduce motion artifact. Excitable area was measured in optical maps based on the criterion of the minimum time-derivative of the upstroke of the optical action potential. Decrease of the pacing CL from 300 to 200 ms dramatically accelerated loss of excitability in both RV and LV (Figure, p&lt;0.0001). Treatment with IKNa blocker R56865 significantly postponed frequency-dependent electrical failure (p&lt;0.0001), the protective effect being larger in RV than in LV (see Figure). After 5 min of reperfusion, R56865 treatment group also showed better recovery of excitability, effect being predominant in the LV in comparison to 200 ms CL group. This is the first study to show that IKNa activation can promote electrical failure under conditions mimicking VF-induced cardiac arrest.
Abstract 19100: Comparison of Exercise Blood Pressure Response in Patients With Coarctation of Aorta: Surgical Repair vs. Endovascular Stent
Authors: Michael M Ross, Jason G Ho, Lauren E Sterrett, John P Breinholt
Journal: Circulation (2013)

Background: Percutaneous stent placement has been shown to be a safe and effective treatment option for patients with coarctation of the aorta. Immediate post-procedural and short term hemodynamic assessments comparing stent placement to surgical correction show equivalency. Little is known about the effects of either treatment modality on blood pressure response during exercise. Methods: This study prospectively compares the hemodynamic response to exercise by treadmill testing in patients at least one year after intervention. Patients included were greater than seven years of age without complex congenital heart disease or single ventricle physiology. Patients underwent standard Bruce Protocol treadmill testing with periodic arm leg blood pressure and metabolic measurements. Results: Twenty-five patients underwent treadmill testing: 18 with surgical correction, 7 with stent placement. Median age was 13 years (IQR: 11-15.5yrs). The median arm-leg gradient prior to exercise was 12mmHg (IQR: 9.25-21.75mmHg) for surgical patients and 16mmHg (IQR: 3 - 25mmHg) for stented patients. The median peak exercise arm-leg gradient was 28mmHg (IQR:16 - 44mmHg) for surgical patients and 30mmHg (IQR:17.5 - 40mmHg) for stented patients. The median increase in the arm leg gradient with exercise was 16mmHg for surgical patients and 14mmHg for stented patients. Median Actual VO2Max/Predicted VO2Max was 100% for surgical patients compared to 96% for stented patients. Median Actual VO2Max/Predicted VO2Max was 100% for surgical patients compared to 96% for stented patients. Conclusions: Few studies have compared surgery and endovascular stenting for coarctation of the aorta, with only one prior study comparing the effects of exercise on blood pressure. Stenting and surgery offer excellent hemodynamic results acutely and at maximal exercise. Stent placement demonstrates equivalent results in blood pressure response during exercise testing when compared to surgical therapy.
Abstract 19130: Characteristics of Atrial Fibrillation in Hemodialysis Patients
Authors: Naim Ata, BÜnyamin Yavuz, Emre Oto, Deniz Katircioglu öztÜrk, Kudret Aytemir, Kudret Aytemir, Eda Karaismailoglu, Altay GÜvenir, SelÇuk özcan, Emre Ertugay, Emre Ertugay, Rasim Koselerli, AbdÜlkadir BÜrkan, Mustafa Kuruca, Yadigar Gokalp Ilhan, John Camm, Ali Oto
Journal: Circulation (2013)

Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia in general population. Although several studies reported a high incidence and prevalence of AF in haemodialysis patients there is no substantial data on thromboembolic risk scales such as CHADS2 or CHADS-Vasc predicting stroke and mortality. The aim of this analysis was to evaluate the effectivenes of these scales for predicting stroke and mortality in haemodialysis patients with AF. Methods: A total of 402674 patients over the age 18 who had the diagnosis of non-valvular atrial fibrillation (AF). From this database haemodialysis patients were separated and reanalyzed. The main descriptive statistics of population contained in the database include major bleeding including intracranial and gastrointestinal bleeding, mortality, hospitalizations, and thoromboemboli risk scales. Results: There were 5505 haemodialysis patients with AF (52.4 % men).The four year follow-up data of the 2008 cohort of 992 haemodialysis patients with AF demonstrated 67.4 % mortality and 38.6 % ischemic stroke in four years. Mortality among hemodialysis patients have been shown to be significantly higher than the rest of the cohort (67.4% vs. 31.4% in the rest of the cohort, p &lt; 0.000). The median CHA2DS2-VASc and CHADS score were 4 and 2 respectively among the 5505 heamodialysis patients in the registry. Acording to time dependent ROC curve analysis, CHADS2 was a more accurate scale than CHA2DS2-VASc for predicting stroke in heamodialysis patients upto 40 months-to-stroke after first AF diagnosis, beyond which CHADS2 and CHA2DS2-VASc perform similarly. Hemorrhagic stroke and major bleeding including GI bleeding were higher in warfarin users of haemodialysis patients than the rest of the cohort under warfarin ( 3.2% and 2 % respectively .p &lt; 0.000). Conclusion: This analysis demonstrated that 1) The prevalence of AF in haemodialysis patients were significantly higher than those of general population, with higher mortality,2) CADS2 was a more accurate scale to CHA2DS2-VASc for predicting stroke up to 40 months. 3) Among the warfarin users ,in the Registry population major bleeding was much higher in the haemodialysis patients.
Abstract 200: Pressure Overload Causes Right Ventricular Lethal Arrhythmias: Analysis by Optical Mapping in Pulmonary Artery Banding and Pneumonectomy Model
Authors: Bonpei Takase, Yoshihiro Tanaka
Journal: Circulation (2013)

Right ventricular (RV) pressure overload due to severe pulmonary hypertension (svr-PH &gt; 40 mmHg) sometimes causes lethal arrhythmias, although the mechanisms are unclear. To investigate if RV pressure overload produces RV arryhythmogenic vulnerability, we serially performed optical mapping analysis (OMP) with electrophysiological study (EPS) to the heart excised from pneumonectomy-induced (LP+H) and/or pulmonary artery banding-induced (PBI) svr-PH rats. In PBI-svr-PH, experiments were only conducted for 2 hours after PB because PBI-svr-PH was lethal. Action potential duration dispersion (APDd) and connexin43 (Cx43) expression were measured in RV. LP+H-svr-PH transiently sustained. OMP revealed abnormal RV conduction and increased APDd accompanying ventricular fibrillation/tachycardia (VF/VT) induction by EPS with normal Cx-43 in LP+H -svr-PH while PBI-svr-PH showed abnormal RV conduction and nonsustained VF/VT induction, but not increased APDd and without Cx-43 abnormality. Conclusions: Transiently sustained (&gt;24-hours) svr-PH can cause lethal arrhythmias possibly due to the mechanoelectric transduction not including Cx43degradation.
Abstract 209: Focused Training Results in a Decrease in Inpatient Respiratory Arrests
Authors: Anushirvan Minokadeh, Rebecca E Sell, Steve A Aguilar, Sheri J Viillanueva-Reiakvam, Ruth W Chappel, Wayne J McNulty, Halsey T Barlow, Daniel P Davis
Journal: Circulation (2013)

Background: The leading cause of inpatient arrests are due to respiratory causes and in our hospital, due to apneic/hypopneic events. Objective: To characterize patterns of apneic and hypopneic events in at risk population. Methods: This study was performed in one urban, academic inpatient facility. Eighteen at risk postoperative patients were identified in the post-anesthesia care unit (PACU) and admitted to the intermediate care unit (IMU) with continuous pulse oximetry and capnometry. Criteria included apnea, hypopnea, bradypnea (less than 8 breaths per minute), and inability to wean of nasal cannula oxygen. Major and minor events were identified (Fig. 1). Results: Patients who exhibited major apneic events had a significantly greater number of minor apneic events per shift relative to those who only had minor events (8.3 vs 2.5, Fig. 2). The day shift (8am-8pm) had more major apneic events (83.4% vs 16.6, Fig. 3) than the evening shift (8pm-8am). Incidentally, the training for this trial effectively reduced the number of total respiratory arrests in the hospital (Fig. 4).
Abstract 14769: Reproductive Duration, Number of Live Births, and Incidence of Heart Failure in the Women's Health Initiative Study
Authors: Philip S Hall, Gregory Nah, Barbara Howard, Cora E Lewis, Matthew A Allison, Gloria E Sarto, Molly E Waring, Lisette T Jacobson, JoAnn E Manson, Liviu Klein, Nisha I Parikh
Journal: Circulation (2015)

Introduction: Reproductive factors that are reflective of endogenous sex hormone exposure may have an impact on cardiac remodeling and the development of heart failure. We sought to identify the association between key reproductive factors, including number of live births, age at first pregnancy, and reproductive duration (age at menopause - age at menarche) with the subsequent incidence of heart failure. Methods: We studied women in the University of North Carolina heart failure adjudication cohort of the Women's Health Initiative who were systematically evaluated for the presence of heart failure hospitalization from enrollment through 2010. We employed Cox Proportional Hazards Regression analysis in age and multivariable-adjusted models to relate the number of live births, age at first pregnancy, and reproductive period to incident hospitalized heart failure. Multivariable models were adjusted for age, income, education level, ethnicity, region, body mass index, hypertension, diabetes, hyperlipidemia, breastfeeding, pregnancy loss, hysterectomy, oral contraception, and hormone replacement. Results: Among n=28,516 who completed menopause at enrollment and who had non-missing reproductive history data, there were n=1,494 cases of adjudicated heart failure with mean follow up of 13.1 years. The mean age was 63 years, mean reproductive duration was 34 years, mean age at first pregnancy was 22 years, and mean number of live births was 3. Reproductive duration was inversely associated with heart failure even after adjustment for covariates (see Table 1). Early age at first pregnancy and nulliparity were significantly associated with incident heart failure in age-adjusted models, but not in multivariable-adjusted models. Conclusions: Shorter reproductive period is associated with incident heart failure in postmenopausal women. Whether or not exposure to endogenous sex hormones underlies this relationship should be investigated in future studies.
Abstract 19345: Development and Validation of a New Scoring System for Predicting Wound Healing in Critical Limb Ischemia With Tissue Loss following Endovascular Therapy
Authors: Norihiro Kobayashi, Toshiya Muramatsu, Reiko Tsukahara, Yoshiaki Ito, Hiroshi Ishimori, Keisuke Hirano, Masatsugu Nakano
Journal: Circulation (2013)

Background: Wound healing is very important endpoint in critical limb ischemia (CLI) with tissue loss. The aim of this study was to design a scoring system for predicting wound healing in CLI patients who were treated with endovascular therapy (EVT) in consideration of various factors including patient background, intervention outcomes, and also wound characteristics. Methods: Between April 2007 and October 2012, 184 patients (217 limbs) were treated with EVT for CLI with tissue loss in our institute. In these limbs, 236 individual wounds existed and were divided into a development group (n=118) and a validation group (n=118). Each variables which seem to be associated with wound healing were analyzed using the univariate Cox proportional hazards model. All variables tested in univariate analysis with p&lt;0.25 were included in multivariate Cox hazards model. The scores for each variables were transformed from regression coefficients and computed in a total score. Results: In multivariate Cox proportional hazard analysis, no direct blood flow to the wounds (HR 0.38, 95%CI 0.16-0.93, p=0.034), dependence on hemodialysis (HR 0.46, 95%CI 0.27-0.80, p=0.006), infectious wound (HR 0.54, 95%CI 0.30-0.99, p=0.044), heel wound (HR 0.38, 95%CI 0.16-0.91, p=0.029) and extensive wound extending onto the forefoot or midfoot along the dorsal or plantar surfaces (HR 0.09, 95%CI 0.02-0.39, p=0.001) were adverse predictors of wound healing. Each item’s score ranged from 0 to 4 and the total score ranged from 0 to 10. The area under the receiver operating characteristics curve revealed that there was 90.5% accuracy in the total scores predicting the likelihood of wound healing. In the development group, the wound healing rates at 12 months were 83% in low-risk group (scores≦2), 33% in moderate-risk group (scores 3-5), and 4.0% in high-risk group (scores≧6) (p&lt;0.001). In the validation group, the corresponding wound healing rates were 80%, 49%, and 12%, respectively (p&lt;0.001). Conclusions: This new scoring system is useful for the risk stratification of wound healing in patients with CLI.