tbuckley/cabot-search huggingface dataset:
Abstract 13433: Outcomes of Chest Pain Discharge Decisions Following Launch of a Heart Score Clinical Decision Support Alert
Authors: Adrianna Vaskas, Ria Garg, Muzna Hussain, Kyle Marshall, Martin E Matsumura
Journal: Circulation (2023)

Background: The use of a bioclinical risk score such as the HEART score is recommended for the evaluation of pts presenting to the ED with chest pain (CP). Prior studies have demonstrated that CP pts with HEART score &lt; 3 and “ruled out” with cardiac troponin series are low risk for 30d death/MI (MACE). There is limited data regarding whether the addition of the HEART score to a validated high sensitivity troponin accelerated diagnostic protocol (ADP) has beneficial effects on CP patient discharge decisions in the ED. Research Question: Did the addition of an EHR-embedded automated HEART score clinical decision support alert (CDSA) have a beneficial effect on discharge decision making of ED CP pts in Geisinger Health System? Methods: Retrospective analysis of 30day MACE following ED visit for CP for the 6mo period prior to and 10mo following the launch of a HEART score CDSA (11/2021-3/2023). Discharges were stratified using a previously validated accelerated hsTnT ADP into those that ruled in (ADP+) or ruled out (ADP-). Comparison of MACE in pre- vs. post-CDSA periods was performed using chi square analysis. Results: MACE stratified by study period and ADP results are summarized in the Table. There were no significant differences in 30-day MACE pre- vs. post-CDSA, both overall and in ADP+ and ADP- subgroups. In contrast, the presence or absence of a high risk (&gt;3) HEART score in isolation did significantly predict the risk of MACE [11/2360 (0.47%) for HEART score &lt; 3 vs 36/966 (4.04%) for HEART score &gt;3, p&lt;0.001]. Conclusions: Addition of an EHR-embedded HEART Score CDSA did not have a significant effect on 30d outcomes following ED provider discharge decisions. While the HEART score by itself did stratify risk of 30d MACE, our study suggests the additive benefit of the HS CDSA to clinical decision making based on an established hsTnT ADP unclear.
Abstract 16458: Long-Term Exposure to Air Pollutants and the Risk of Hypertension: Insights From the Korean Genome Epidemiologic Survey Project
Authors: Jinah Cha, Se Yeon Choi, Seung-Woon Rha, Woo Jin Ahn, Byoung Geol Choi, Jae Kyeong Byun, Sujin Hyun, Min Woo Lee, Suhng Wook Kim, Soohyung Park, Dong Oh O Kang, Eun Jin Park, Cheol Ung Choi
Journal: Circulation (2023)

Introduction: The specific relationship between long-term exposure to air pollutants and the risk of HTN requires further investigation. This study aims to assess the association between AP and HTN occurrence and examine whether the effects differ between individuals with and without HTN in a long-term perspective. Hypothesis: Based on the previous research linking AP to cardiovascular diseases, we hypothesize that long-term exposure to air pollutants is associated with an increased risk of developing HTN. Methods: This study used modeled AP data linked with Korean Genome Epidemiologic Survey (KoGES) cohort data based on participant addresses. Among the 77,048 participants who completed the follow-up, 23,935 subjects had HTN at the baseline, while 53,113 subjects were non-hypertensive. AP exposure concentrations were evaluated using the 1-year and 3-year averages prior to the follow-up date and the average of the entire follow-up period. Logistic regression models were employed to analyze the relationship between HTN and air pollutants in the non-hypertensive group. Results: The analysis revealed that non-hypertensive subjects exposed to air pollutants had an increased risk of developing HTN, with the exception of O 3 . Notably, particulate matter 2.5 (PM 2.5 ) exposure demonstrated a gradual increase in HTN risk based on the duration of exposure (Odds Ratio [OR] 1.024, 1-year; OR 1.030, 3-year; OR 1.041, average survey period.) These findings suggest that prolonged exposure to high concentrations of PM 2.5 is associated with an elevated risk of HTN. Chronic exposure to other gaseous AP components were also similarly associated with higher risk of development of HTN. Conclusions: This study highlights the detrimental association of long-term exposure to air pollutants on the risk of HTN. Managing blood pressure in those exposed to high AP levels, even if not hypertensive is important also with a perspective of public health and environmental policies.
Abstract 12679: Thirty-Day Readmissions for Recurrent Ventricular Tachycardia Following Catheter Ablation of Ventricular Tachycardia: Predictors and Outcomes
Authors: Qi Xuan Ang, Min Choon Tan, Yong Hao Yeo, Abhishek Deshmukh, Luis R Scott, Ayman Hussein, Jakub Sroubek, Pasquale Santangeli, Oussama M Wazni, Justin Lee
Journal: Circulation (2023)

Background: Despite the optimal efficacy of catheter ablation for ventricular tachycardia (VT), recurrence of VT can occur post-procedurally. However, data on the high-risk population for VT recurrence and the in-hospital outcomes remain scarce. Objective: This study aimed to determine the predictors of 30-day readmission for recurrent VT after catheter ablation of VT and assess the in-hospital outcomes. Method: Using the all-payer, nationally representative Nationwide Readmissions Database, we identified the patients aged ≥18 years who underwent catheter ablation for VT and were readmitted within 30 days because of recurrent VT from 2017 to 2020. We performed unweighted univariable and multivariable analyses to determine the outcomes and to identify the patient and hospital variables that were predictive of 30-day readmissions for recurrent VT. A p-value of &lt;0.05 is considered statistically significant. Results: In our analysis, a total of 4,102 patients were discharged alive after VT ablation, of which 278 (6.8%) were readmitted within 30 days for recurrent VT. Recurrent VT was also the most common cause of 30-day readmission (47.7%, n=278/583). Compared to non-recurrent VT readmission, readmission due to recurrent VT had higher mortality during rehospitalization (7.55% vs 3.72%, p&lt;0.01) and higher cumulative hospitalization cost ($57584 vs $37846, p&lt;0.01). Via multivariable analysis, congestive heart failure (aOR: 1.84; 95% CI: 1.07-3.17; P=0.03) and non-elective index admissions (aOR: 1.88; 95% CI: 1.32-2.68; P&lt;0.01) were the independent predictors of 30-day readmission for recurrent VT. Conclusion: Recurrent VT was the most common cause of 30-day readmission following VT ablation. Congestive heart failure and non-elective index admissions were the independent predictors of 30-day readmissions for recurrent VT. These highlight the importance of further research in ablation strategies to improve the efficacy of VT ablation.
Abstract 17427: Smaller Hospital Bed Size is Associated With Higher Mortality in Stanford Type A Aortic Dissection
Authors: Renxi Li, Qianyun Luo, Derrick L Green, Stephen Huddleston
Journal: Circulation (2023)

Introduction: The National Inpatient Sample (NIS) database stratifies hospital bedsize according to the number of hospital beds, urban or rural, and teaching or non-teaching hospital. Larger hospital bed size stratified by these criteria has been associated with better patient care and surgical outcomes in some instances. This study aimed to examine the effect of hospital bed size on perioperative outcomes in Type A Aortic Dissection (TAAD). Methods: Patients who underwent TAAD repair were identified in the NIS from Q4 2015-2020 by ICD10-CM/PCS. NIS stratifies hospital bed size into small, medium, and large, rural vs urban, and teaching status. Patients were stratified into two cohorts: small/medium and large. Significant preoperative differences were present between groups; thus, multivariable logistic regressions were performed to compare the surgical outcomes (in-hospital). Adjusted preoperative variables included sex, age, race, socioeconomic status, comorbidity, primary payer status, hospital characteristics, length of stay (LOS), days from admission to operation, and total hospital charge were compared. Result: There were 1,106 and 3,752 cases with small/medium and large bed sizes, respectively, identified in the NIS database. Among patients admitted to small/medium bed size hospitals, there was higher mortality (17.27% vs 14.37%, aOR=1.32, 95% CI 1.09-1.60, p&lt;0.01), but shorter LOS and lower cost compared to larger hospitals (Table). There was no difference in morbidities (Table). Conclusion: Marked higher mortality is associated with admission to smaller hospital bed sizes among patients with TAAD, which may in turn decrease the average LOS and cost. Given that a significant percentage of patient are already being transferred out of the initial hospital and small/medium hospital size is associated with higher mortality, centralization of care in centers of excellence may decrease the high mortality associated with TAAD.
Abstract 13629: Increased Rate of High Risk Cardiac Outcomes in Patients With Cardiac Sarcoidosis Without Underlying Coronary Artery Disease: Analysis of the National Inpatient Sample From 2015-2019
Authors: Shreyas Singireddy, Sammudeen Ibrahim, Raghav Chawla, Saint-Martin Allihien, Haripriya Andanamala, Mandeep Brar, Favour Markson, Asha Ummidi, Onoriode Kesiena
Journal: Circulation (2023)

Introduction: Sarcoidosis is a systemic disease characterized by deposition of noncaseating granulomas. It commonly involves the lungs but can also affect other organs such as the heart. In terms of cardiac sarcoidosis, it is still a relatively under diagnosed illness with its clinical manifestations often being variable and nonspecific thus making the diagnosis challenging. There is a need to further investigate the burden of high-risk cardiac outcomes in patients with underlying sarcoidosis with cardiac involvement to further understand the extent of disease progression in this group. Methods: In this study, the National Inpatient Sample (NIS) was queried for the years 2015 Q4-2019. Our cohort of interest included patients with Sarcoidosis, more specifically, those with cardiac involvement. Patients with underlying coronary artery disease and its equivalents were excluded from the study. Multivariate logistic with linear regression analysis was used to adjust for confounders. Results: After excluding patients with coronary artery disease (CAD) equivalents, the final number of patients included in the study was 8,722,809. Out of which, 54,537 had sarcoidosis with a total of 918 having a diagnosis of cardiac sarcoidosis (CS). Patients with CS were more likely to be males and be younger than 65 (p&lt;0.001). African American race was the predominant population affected in both cohorts (p&lt;0.001). The CS group had higher rates of underlying congestive heart failure but were overall less likely to have underlying connective tissue disease, chronic pulmonary disease, and diabetes (p&lt;0.001). In terms of cardiac outcomes, they had higher rates of Cardiac Arrest (2.2% vs 0.7%, p&lt;0.001), Atrial Fibrillation (24.5% vs 10.4%, p&lt;0.001), Ventricular Tachycardia (36.6% vs 2.0%, p&lt;0.001), AV Block Type 3 (10.3% vs 0.7%, p&lt;0.001) and Heart Failure [systolic HF (54.6% vs 6.6%, p&lt;0.001), diastolic HF (20.9% vs 12.3%, p&lt;0.001)]. Conclusions: We demonstrate with the results of this study that patients with cardiac sarcoidosis had higher rates of major arrhythmias, conduction defects, and cardiac arrest. Understanding these associations may help in earlier clinical diagnosis and possibly improved outcomes with targeted therapies.
Abstract 13602: Compliance With the Atrial Fibrillation Better Care (ABC) Pathway in Public and Private Healthcare Units From a Middle-Income Country
Authors: Itamar S Santos, Alessandra C Goulart, Ana C Varella, Carla Romagnolli, Rodrigo D Olmos, Otavio C Gebara, Tiffany E Gooden, G. Neil N Thomas, Gregory Lip, Paulo A Lotufo, Isabela M Bensenor
Journal: Circulation (2023)

Introduction: The ABC pathway (A: Avoid stroke; B: Better symptoms; C: Comorbidities and lifestyle management) has been proposed to ensure a holistic or integrated care approach to atrial fibrillation (AF) management. There are scarce data about compliance with this strategy in low- and middle-income countries, where the AF populational burden is likely to increase. Hypothesis: Compliance with ABC pathway (ABC-compliance) in Brazil is low and associated with certain patient characteristics. Methods: We included 700 patients (46% women, 69±15 years) with confirmed AF. Participants were recruited from private and public healthcare units in São Paulo city. We built logistic regression models to analyze if age, sex, race, HAS-BLED scores, or healthcare sector (public or private) were associated with lack of ABC-compliance (Table 1). Results: ‘A’, ‘B’, ‘C’ and ABC-compliance occurred in 42%, 82%, 50%, and 21%, respectively. In multiple models (Table 2), lack of ABC-compliance was associated with female sex and high HAS-BLED scores. Lack of ‘B’ component compliance was associated with non-White race. Treatment in public units was positively associated with a lack of ‘A’ component compliance but this was inversely associated with a lack of ‘C’ component compliance. Age and ABC-compliance were not independently associated. Conclusions: Compliance with ABC pathway in our healthcare setting was low. Female sex and high HAS-BLED scores were markers of poor compliance with this integrated approach. Patients treated in private health units may have higher access to oral anticoagulants, while better comorbidity control in public health units may reflect a less segmented system of care.
Abstract 12755: Increased Physical Activity and Higher Perceived Social Support Are Associated With Improved Quality of Life in Patients With Heart Disease Reporting Hopelessness
Authors: Maha Alotaibi, Mia I Cajita, Nathan Tintle, Anna Luong, Madison Goodyke, Stephanie Eleanor Rivera, Heather Hrynyk, Susan L Dunn
Journal: Circulation (2023)

Introduction: Hopelessness has been identified in up to 52% of patients with ischemic heart disease (IHD). Hopelessness is associated with both decreased self-reported physical activity (PA) and lower perceived social support. Quality of life (QOL) is positively associated with PA and perceived social support in patients with IHD. However, the relationships among PA, perceived social support, and QOL in patients with IHD reporting hopelessness has not been explored. Purpose: To examine the associations among PA, perceived social support, and QOL in patients with IHD reporting hopelessness. Hypotheses: 1) Higher PA and increased perceived social support are each separately associated with higher QOL. 2) PA mediates the relationship between perceived social support and QOL. Methods: Data were collected two weeks after hospital discharge from patients with moderate to severe hopelessness using the State-Trait Hopelessness Scale. Perceived social support, PA, and QOL were measured using the ENRICHED Social Support Inventory, Cardiac Rehabilitation Exercise Participation Tool, and EQ-5D-5L, respectively. Linear regression was performed to assess the associations among study variables, controlling for age, gender, marital status, and employment. Results: The majority of participants (n = 154) were male (68.2%) and non-Hispanic white (90.9%) with a mean age of 62 years (SD = 9.68). Approximately half of participants were married (53.9%) and not working (55.2%). Higher perceived social support and higher PA were each separately associated with higher QOL after adjusting for demographic variables (perceived social support: r partial = 0.23, p = 0.011; PA: r partial = 0.23, p = 0.007). PA partially (21.30%) (r partial = 0.181, p = 0.040) mediated the relationship between perceived social support and QOL (r partial = 0.172, p = 0.066), suggesting that increasing perceived social support may improve PA, thus improving patients’ QOL. Conclusions: Our hypotheses of positive association among PA, perceived social support, and QOL were confirmed. Further research in larger, more heterogeneous samples is needed to examine potential causal relationships among PA, perceived social support and QOL in patients with IHD who report hopelessness.
Abstract 13992: A Dacron Limited Transannular Patch Prevents Progressive Pulmonary Valve Annulus Dilation: Results of Serial Early, Intermediate, and Long-Term Follow-Up
Authors: Michael F Swartz, Gabrielle Orie, Shuichi Yoshitake, Nader A Atallah-Yunes, Jill Cholette, George Alfieris
Journal: Circulation (2023)

Objective: The repair of tetralogy of Fallot (ToF) using a transannular patch can result in progressive pulmonary valve annulus (PVA) dilation, preventing the option of a future catheter-based pulmonary valve replacement and requiring early reoperation. A rigid Dacron limited transannular patch (LTAP) that nominally expands the PVA may prevent long-term annular dilation and reoperation. Hypothesis: Infants following a LTAP would have similar rates of PVA growth compared to infants requiring only a subvalvar (SV) repair. Methods: Infants &lt; 1 year between 1998-2018 requiring a SV or LTAP ToF repair were divided into two groups based on the surgical approach. Pre-operative and serial follow-up echocardiograms quantified the PVA diameter and corresponding Z-Score at 5, 10, and 15 years. Multivariate analysis examined the risk factors for reoperation. Results: From 232 ToF repairs (LTAP-94; SV-138), the LTAP group was significantly younger (103±53 vs. 138±67 days; p&lt;0.001) and had a smaller pulmonary valve annulus Z-Score (-2.9±1.4 vs. -0.8±1.4; p&lt;0.001) at the time of repair. Over a follow-up of 10.4±5.9 years, PVA growth was linear in both groups (Figure 1). The PVA diameter was similar in both groups at 5 and 10 years but was significantly smaller within the LTAP group at 15 years. The PVA diameter Z-scores remained similar at 5, 10, and 15 years in both groups, and only one patient in the LTAP group had a PVA Z-score &gt; 1.0 during follow-up. The 15-year freedom from reoperation between the LTAP and SV groups was (89 % vs. 91 % p=0.6). Greater age at the time of ToF repair was protective (Hazard Ratio: 0.989, 95% CI: 0.979, 0.998; p=0.01); however, PVA Z-Score or LTAP repair was not associated with reoperation. Conclusions: Infants following a Dacron LTAP have linear PVA growth, allowing future percutaneous pulmonary valve replacement and similar reoperation rates to those requiring only a SV repair.
Abstract 17310: Epsins Promote Atherosclerosis Through Vascular Smooth Muscle Phenotypic Modulation
Authors: Beibei Wang, Kui Cui, Yunzhou Dong, Bo Zhu, Hao Wu, Sudarshan Bhattacharjee, Bandana Singh, Donghai Wang, Scot Wong, Douglas B Cowan, Hong Chen
Journal: Circulation (2023)

Hypothesis: VSMC play crucial roles in atherosclerosis via phenotypic switching. The trans-differentiation of VSMC into other cell types might contribute to atherosclerotic lesion development, progression, and the subsequent diseases such as myocardial infarction or stroke. Epsins, a family of endocytic adaptors, are crucial for atherosclerosis development and progression; yet, the role of epsins in VSMC phenotypic modulation is unknown. Methods and Results: To decipher the role of VSMC epsins in regulating atheroma development and progression, we created WT and SMC-specific inducible epsin1/2 double knockout (SMC-iDKO) mice on ApoE -/- background fed a western diet. Using single-cell RNA-seq analysis, we found VSMC and EC population significantly changed in SMC-iDKO/ApoE -/- mice compared to ApoE -/- mice. Using immunofluorescent and FACS analysis, we observed that both VSMC and EC marker genes expressions were up-regulated in DKO-VSMCs indicating that DKO-SMCs were maintaining their SMC phenotype and may further trans-differentiating into ECs via a process called MEndoT, mesenchymal to endothelial transition. Given the critical role of KLF4 in regulating VSMCs phenotype during atheroma progression, we observed diminished KLF4 expression in DKO-SMCs compared to WT treated with oxLDL. Furthermore, we found that epsins interacted with KLF4 with Epsin-UIM domain and their interaction improved KLF4 stability and promoted KLF4 to transfer into nuclei. In this study, we found that epsins were highly expressed and positively correlated with the lesion severity in VSMCs in atherosclerotic. Using immunofluorescent and Oil Red O stainings, we observed reduced lipid accumulation, lesion size and macrophage infiltration but elevated VSMCs in the cap of lesions in SMC-iDKO/ApoE -/- mice compared with ApoE -/- mice. Conclusions: In conclusions, we demonstrated an unexpected role of epsins in regulating phenotypic switching by repressing SM-contractile and EC marker genes expression through an epigenetic regulatory mechanism. Our data suggest that epsins may be a therapeutic target for treating occlusive vascular diseases, and uncover regulatory pathways for therapeutic targeting of SMC transitions in atherosclerotic cardiovascular disease.
Abstract 260: Sociodemographic Analysis of Paediatric Out-of-Hospital Cardiac Arrest in Ontario, Canada: A Province-Wide Case-Control Study
Authors: Samina Idrees, Kelly K. Anderson, Yun-Hee Choi, Janice A. Tijssen
Journal: Circulation (2023)

Background: Paediatric out-of-hospital cardiac arrest (POHCA) is associated with significant mortality and severe neurological sequelae. Previous literature indicates that there are sociodemographic disparities in POHCA survival and in the provision of upstream interventions. However, it’s unclear if the populations impacted by these disparities also have an elevated risk of experiencing POHCA. We sought to describe the relationship between sociodemographic factors and POHCA risk in Ontario, Canada. Methods: We conducted a province-wide case-control study using health administrative data at ICES. The case group included children (1 day to 17 years of age) who experienced an OHCA between 2004 and 2020. Controls were matched up to 1:4 on age, sex, index date, and key comorbidities. We used conditional logistic regression to measure the association between POHCA and neighbourhood-level marginalization indicators, geographical context, and immigration status. Results: The case and control groups included 1,826 and 7,254 children, respectively. Children living in areas with the highest levels of material deprivation (adjusted odds ratio, aOR: 2.35, 95% CI: 1.94, 2.85) and dependency (aOR: 1.23, 95% CI: 1.02, 1.49) had a higher odds of POHCA, relative to children living in regions with the lowest levels of material deprivation and dependency, respectively. Children living in neighbourhoods with the lowest levels of ethnic diversity had a higher odds of POHCA (aOR: 1.34, 95% CI: 1.08, 1.67), as compared to children living in neighbourhoods with the highest levels of ethnic diversity. Northern urban (aOR: 1.42, 95% CI: 1.11, 1.82) and southern rural residence (aOR: 1.27, 95% CI: 1.04, 1.55) were associated with a higher odds of POHCA, relative to southern urban residence. The odds of POHCA were lower in child immigrants (aOR: 0.60, 95% CI: 0.42, 0.85) and maternal immigrants (aOR: 0.70, 95% CI: 0.61, 0.81), relative to the general population. The impact of residential instability was not significant in adjusted analyses. Conclusion: Children living in neighbourhoods with high levels of marginalization are likely at an elevated risk of experiencing POHCA. These communities should be prioritized in POHCA prevention and intervention efforts.