tbuckley/cabot-search huggingface dataset:
Abstract 4140489: COMPARE CABG: A Meta-Analysis of Comparative Outcomes in On-Pump vs. Off-Pump Coronary Artery Bypass Grafting.
Authors: José Victor da Nóbrega Borges, Manuella Machado, Samira Leila
Journal: Circulation (2024)

Background: Coronary artery bypass grafting (CABG) can be performed using on-pump or off-pump techniques. The optimal approach remains debated. Objectives: The COMPARE CABG (Comparative Outcomes of Mortality, Perioperative complications, cARdiac function, and Hospital stay in On-Pump versus Off-Pump Coronary Artery Bypass Grafting) study aims to systematically compare the outcomes of these surgical approaches. Methods: A comprehensive search was conducted in Pubmed, Cochrane Library, and other databases. Studies with a sample size &gt; 4000 were included. Outcomes analyzed included mortality, complications, cardiac function, and hospital stay. Results: Meta-analysis of 5 studies with 58,232 patients showed that off-pump CABG was associated with a slightly lower complication rate: 15% for on-pump CABG and 13.5% for off-pump CABG with a pooled effect size of 0.90 (95% CI: 0.85-0.95). In terms of cardiac function and hospital stay, results were also favorable to off-pump CABG with an effect size of 1.12 (95% CI: 1.05-1.19) and 1.15 (95% CI: 1.10-1.20), respectively. The pooled mortality rate was 2.5% for on-pump and 2.4% for off-pump CABG, with an effect size of 1.05 (95% CI: 0.98-1.12), indicating no significant difference between the groups. Conclusion: These findings suggest that off-pump CABG may be a preferable option for reducing surgical complications, though both techniques yield comparable mortality outcomes. Further research is needed to explore long-term cardiac function and patient-specific factors influencing the choice of surgical method.
Abstract 4139996: Impact of Anticoagulation on Incidence of Cerebrovascular Accident After Epicardial Left Atrial Appendage Occlusion: A Retrospective Descriptive Analysis
Authors: Daniel Feldman, Tariq Emaish, Lianteng Zhi, Dina Murad, Zaid Ammari
Journal: Circulation (2024)

Introduction: Atrial fibrillation is one of the most prevalent cardiac arrhythmias globally. In patients with atrial arrhythmias, the left atrial appendage (LAA) has been implicated in up to 90% of thrombus formation. Surgical LAA exclusion in addition to continued anticoagulation (AC) is recommended as a Class 1A recommendation, however true incidence of cerebrovascular accident (CVA) after LAA occlusion in the absence of continued AC is uncertain. Aims: This retrospective analysis aims to further explore the impact of AC on cerebrovascular accidents after epicardial LAA occlusion. Methods: A retrospective cohort analysis of individuals who underwent open cardiac surgery where LAA occlusion was performed. All patients who were 18 years or older at the time of admission were included and only those who died during the index admission were excluded. The study spanned from October 2015 to December 2022 at a tertiary healthcare system in the northeastern United States. The exposure is whether the patient was discharged on AC. The primary outcome was the incidence of CVA, and the secondary outcome was bleeding events, both at one-year post-index visit. Results: A total of 934 patients were included in the analysis with 471 (50.4%) being discharged without AC. Of those, 462 subjects had a history of atrial arrhythmia. A total of 5 subjects had a CVA, 3 of which were not discharged on anticoagulation. A total of 37 (4.0%) subjects had a major bleeding event, of which 21 (2.3%) were discharged on AC. (Table 1) A subgroup analysis of only those with a history of arrythmia revealed 327 (70.8%) patients in the subgroup were discharged on AC. Of this subgroup, the mean CHA2DS2-VASc score was 4.0 + 2.1 for those discharged on AC and 3.5 + 2.3 for those not discharged on AC. A total of 2 CVA occurred, both in the group not discharged on AC. Bleeding events occurred in 19 (4.1%) subjects, 14 (3.0%) of which were discharged on AC. (Table 2) Conclusion: The findings of this retrospective analysis suggest that AC after surgical LAA intervention may be beneficial in reducing the risk of CVA, particularly in patients with a history of atrial arrhythmias. This is, however, accompanied by a higher incidence of bleeding events. Ultimately, given the low number of outcomes recorded, larger multicenter prospective studies will need to be conducted to understand the true impact of AC on CVA and bleeding risks following surgical LAA intervention.
Abstract 4139823: Decline In Treatment, Testing and Control of Lipids Amongst Diabetic Patients, a Population-Level Analysis
Authors: Daniel King, Daniel Harris, Ashley Akbari, Michael Gravenor, Julian Halcox
Journal: Circulation (2024)

Background: In patients with diabetes mellitus (DM), lipid-lowering therapy (LLT) with statins +/- adjuvant LLT are recognised treatment approaches. It is unknown what proportion of patients with DM are prescribed LLT, have documented low-density lipoprotein cholesterol (LDL-C) levels, or achieve guideline LDL-C targets. Aims: To document population trends in (i) the incidence and prevalence of DM, (ii) prescribing of LLT, and (iii) testing and achievement of LDL-C targets in patients with or without atherosclerotic cardiovascular disease (ASCVD). Methods: We conducted a retrospective, population-level, observational study using linked anonymised health record data amongst 269,735 diabetic patients in Wales (UK). Associations between patient characteristics and (i) statin prescription and (ii) achievement of LDL-C target of (&lt;1.8 mmol/L) were evaluated. Results: The prevalence of DM increased from 6,519 to 8,128 per 100k, and incidence increased from 543 to 633 per 100k per year (2010-21). The proportion of patients prescribed any LLT decreased from 89.5% to 82.9% in those with ASCVD and from 53.2% to 37.8% without. An increasing and greater proportion of patients with ASCVD were prescribed high-intensity statin therapy (14.1% to 36.1%) over the study period, compared to those without (2.3% to 5.1%; Figure 1). The proportion of patients with documented LDL-C decreased (from 68.1% to 52.3% in those with ASCVD and 64.7% to 48.3% without) over the study period. A greater proportion of those with ASCVD achieved an LDL-C &lt;1.8 mmol/L (43.1% to 45.4%) than those without (22.2% to 22.0%). In a multivariate logistic regression, presence of ASCVD and history of hypertension were associated with prescription of statin therapy (ORs = 4.01, 1.75, respectively; both p &lt; 0.01). Male sex and presence of ASCVD were associated with achievement of LDL-C target (ORs = 1.25, 8.15; both p &lt; 0.01). Conclusions: The incidence and prevalence of DM is increasing over time, but the overall quality of lipid management is decreasing, as evidenced by documented testing, treatment and control of LDL-C. In order to realise the full evidence-based benefit from LLT, improvement in the implementation of guideline-recommended care is required.
Abstract 4140588: Temporal Variation in Out-of-Pocket Costs for Guideline-Directed Medical Therapy Among Patients with Heart Failure
Authors: Alexander Gunn, Akshay Pendyal, Robert Mentz, Anna Sinaiko, Caroline Sloan
Journal: Circulation (2024)

Background: Patients with HF average &gt;$4000/year in out-of-pocket (OOP) costs for their care, including GDMT. High OOP costs lead to nonadherence and poor outcomes. The OOP costs of GDMT often fluctuate over the course of the year due to deductibles and other variable cost-sharing requirements. Poor understanding of these changes present a barrier to cost-conscious treatment decisions. Objective: To characterize fluctuations in OOP GDMT costs over the course of the year for patients with HF. Methods: We used electronic health record and real-time prescription benefit (RTPB) data to conduct a retrospective analysis of insured adults (Medicare, Medicaid, or private) with a diagnosis of HF at a large academic system in Jan 2021-Dec 2023. We described RTPB-estimated 30-day OOP costs of all 4 major HF drug classes. We compared OOP costs at end-of-year (Oct-Dec) vs beginning-of-year (Jan-March) using Kruskal-Wallis test. An ordinary least-squares model was used to assess differences after adjustment for age, sex, race, and comorbidities. Results: Of 2965 patients with HF, 86% were enrolled in Medicare, 10% in private insurance, and 4% in Medicaid. Among patients with private insurance, median 30-day OOP costs for ARNi were $9.54 (IQR $0.00-$28.81) in Oct-Dec and increased seven-fold to $71.14 (IQR $26.68-$115.99) in Jan-March (p=0.03) ( Figure ). SGLT2i costs increased from $0.00 (IQR $0.00-$21.58) in Oct-Dec to $35.57 (IQR $28.81-$115.61) in Jan-March (p&lt;0.001). For patients with Medicare, 30-day OOP costs for ARNi increased from $35.40 (IQR $2.00-$68.65) in Oct-Dec to $41.80 (IQR $10.89-$84.08) in Jan-March (p&lt;0.001), while no differences were noted for SGLT2i. Costs varied minimally for patients with Medicaid and for medications with generic options available, regardless of payor type. In an adjusted model, between-period differences persisted for those with private insurance (ARNi $49.99, 95% CI 11.27-88.71, p=0.01; SGLT2i $23.63, 95% CI 3.10-44.16, p=0.02). Conclusion: Among patients with HF, OOP costs for 30 days of GDMT varied significantly over the course of a year, especially for patients with private insurance. The largest variations were for patented drug classes (ARNi and SGLT2i). These findings can inform cost-conscious treatment decisions for clinicians and patients.
Abstract 4140387: Evaluating the Mental Health of Adolescent Patients with Cardiac Implantable Electronic Devices
Authors: Lindsey Gakenheimer-Smith, Zhining Ou, Angela Presson, Susan Etheridge, Thomas Pilcher, S Yukiko Asaki, Benjamin Hammond, Laura Bennett Murphy, Laura Wood, Sean Cunningham, Mary Niu
Journal: Circulation (2024)

Background: Adolescents with cardiac implantable electronic devices (CIEDs) face greater psychological distress than their peers. Fluctuations over time and mitigating factors remain unclear. Objectives: We assessed the mental health symptom burden among adolescents with CIEDs over time, measured its impact on health-related quality of life (QoL) and executive functioning (ExF), and identified factors associated with mental health distress. Methods: In a single center, prospective study from 1/2023 – 5/2024, 41 CIED patients, median 18 years (range 12-21) completed serial validated mental health measures of anxiety, depression, post-traumatic stress disorder (PTSD), cardiac QoL, and ExF. Primary outcome: abnormal mental health screen in any of the domains. Secondary outcome: clinically significant change in anxiety or depression scores, defined as ≥6 and ≥5, between baseline and 3-month follow-up. Univariable linear regression model assessed association between QoL score and select variables. Results: Fifty-four percent of patients had abnormal baseline mental health screens (39% poor cardiac QoL, 36% trauma history, 28% anxiety, 17% depression, 13% abnormal ExF, 5% PTSD). At follow-up, 34% of anxiety or depression scores were clinically significant (Figure). Higher anxiety and depression scores, male sex, and higher PTSD scores were associated with lower cardiac QoL (coefficients: -2.00, p&lt;0.001; -2.23, p&lt;0.001; -10.53, p=0.007; and -0.75, p=0.002). Higher resilience score correlated with increased overall QoL (coefficient: 1.06, p=0.004) but not cardiac QoL (coefficient: 0.54, p=0.11). Mental health scores were not associated with cardiac diagnosis, CIED type or date of implant, or number of ICD shocks. Conclusion: Over 50% of adolescents with CIEDs had abnormal mental health screens. Anxiety and depression scores fluctuated significantly over 3 months. Higher baseline anxiety, depression, and PTSD scores and male sex were linked to lower cardiac QoL. Higher resilience improved overall QoL. Mental health measures showed no association with cardiac diagnosis type, CIED type or duration, or ICD shocks. Routine mental health screening is crucial for improving mental health and quality of life in this population.
Abstract 4139995: Scoring System-Based Approach for Identifying Patients With Positive Intracoronary Acetylcholine Provocation Tests: The Original and Modified ABCD Score
Authors: Yoshiyuki Ohnaga, Yuichi Saito, Hideki Kitahara, Yoshio Kobayashi
Journal: Circulation (2024)

Background: Although intracoronary acetylcholine (ACh) provocation testing is a guideline-recommended invasive standard for the diagnosis of vasospastic angina (VSA), ACh tests are largely underused in clinical practice globally. Recently, Rinaldi et al. developed a risk-scoring system, the ABCD score, to predict positive ACh test results. However, the ABCD score, consisting of clinical presentation, myocardial bridge, C-reactive protein, and dyslipidemia, has not been externally validated yet. We aimed to examine the diagnostic ability of the score and attempted to improve the predictivity for identifying patients with VSA. Methods: From May 2012 to September 2023, a total 1029 patients underwent ACh provocation test for diagnosing VSA. Patients without data on C-reactive protein and high-density lipoprotein cholesterol and those who had a history of coronary artery bypass grafting and stenting in the left anterior descending artery were excluded. The original and modified ABCD score were calculated as shown in Figure 1. The positive ACh provocation test (i.e. VSA) was defined as significant angiographic vasospasm accompanied by chest pain and/or ischemic electrocardiographic changes. Results: Of the 723 patients included in this study, 383 (53.0%) had positive ACh provocation tests. The receiver operating characteristics curve analysis indicated that the original ABCD score was significantly predictive of VSA, but the diagnostic ability was modest (Figure 2). Using best cut-off values on receiver operating characteristics curve analyses, we developed the modified ABCD score (Figure 1), resulting in significantly greater diagnostic accuracy (Figure 2). The modified ABCD score better stratified positive ACh test results than the original score (Figure 2). Conclusions: The original ABCD was predictive of VSA in this external validation study with modest diagnostic accuracy. The modified ABCD score achieved better predictivity for identifying patients with VSA.
Abstract 4139838: The Role of Tele-Training And Tele-Support During Transitional Care From Hospital To Home In The Caregivers of Stroke Survivors : A Longitudinal Moderation Analysis
Authors: Davide Bartoli, Francesco Petrosino, Eleonora Lombardi, Ercole Vellone, VINCENZO DAMICO, Gianluca Pucciarelli
Journal: Circulation (2024)

INTRODUCTION: Stroke is the most common cause of adult disability and has a significant impact on the quality of life(QOL) of survivors and caregivers.It is important to implement a tailored intervention that could improve caregiver preparedness for the transition home after a stroke.A patient-and caregiver-centred educational approach,which directly involves caregivers,may have better long-term results.In the light of a recent review,it was identified that it improves dyadic QOL if teletraining and telesupport interventions are developed simultaneously and early in the transition of care from hospital to home. AIM: Is to investigate whether, from 0 to 3 months after hospital discharge, preparation by video-training and telesupport moderates the QOL over time of caregivers of stroke survivors. METHODS: A multicentre longitudinal study was carried out in 6 Italian centres, with video-training before discharge and supported by care transition nurses.Data were collected through interviews starting in January 2024.The WHOQOL-BRIEF was used for QOL and the Caregiver Preparedness Scale and Preparedness Assessment For The Transition Home for preparedness, the care problems of the family nucleus were investigated Caregiver Strain Index,the Multidimensional Scale of Perceived Social Support was used for perceived social support,burden was investigated with the Caregiver Burden Inventory and finally mutuality between caregiver and stroke survivor was investigated with the Mutuality Scale.The structural equation modeling was estimated using the Maximum Likelihood with robust standard method with NLMINB optimization used by Mplus. RESULT A total of 27 dyads were enroled,88% of the caregivers were female.The model showed a good fit to the data(X 2 (84)=90.5,p=.295,SRMR = .096,RMSEA=.031,CFI=.996,TLI= .995).Support had a significant positive effect on QOL(β= .4304,p &lt; .001), while evolution showed a significant negative effect on QOL(β = -.3258,p = .001).The perceived burden did not have a significant effect on QOL(β = .0258, p = .707).Support had a significant negative effect on evolution(β =-.2407,p = .036),whereas perceived burden showed a nonsignificant effect on evolution(β = .1483,p= .111). DISCUSSION: The model describes how teletrainig and telesupport improves caregivers' QOL as early as 3 months after hospital discharge,compared with previous studies where QOL with traditional supportive interventions or training improves but not significantly or with longer time frames.
Abstract 4140034: Orthostatic Pulse Pressure, A Novel Indicator of Preload Insufficiency, May Predict Clinical Response to SGLT2 Inhibition in HFpEF: <i>Findings from the PRESERVED-HF Trial</i>
Authors: Hidenori Yaku, Andrew Sauer, Shachi Patel, Evan Keefe, Barry Borlaug, Dalane Kitzman, Sheryl Windsor, Taiyeb Khumri, Guillermo Umpierrez, Mikhail Kosiborod, Sanjiv Shah
Journal: Circulation (2024)

Introduction: Preload insufficiency can mimic HFpEF or complicate its treatment, and SGLT2 inhibitors may worsen preload insufficiency by reducing stressed blood volume. A drop in pulse pressure (PP) when going from supine to standing (i.e., orthostatic PP) may indicate an inability to vasoconstrict the splanchnic circulation, leading to preload insufficiency. We, therefore, sought to determine baseline characteristics associated with orthostatic PP and whether the effects of dapagliflozin vary by baseline orthostatic PP in patients with HFpEF. Hypothesis: In patients with HFpEF, the magnitude of treatment response to dapagliflozin – in terms of efficacy and safety - may be associated with orthostatic PP at baseline. Methods: We measured orthostatic PP (standing PP – supine PP) at baseline in 321 of the 324 patients with HFpEF randomized in the PRESERVED-HF trial. We categorized patients into tertiles of orthostatic PP and compared baseline characteristics. We examined the interaction between baseline orthostatic PP, treatment, and the following outcomes during 12 weeks of follow-up: (1) Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS); (2) 6-minute walk distance (6MWD); (3) volume depletion events. Results: At baseline, the median orthostatic PP was 0 mmHg (25 th -75 th percentile, -8.0, +5.3 mmHg). Patients with lower orthostatic PP had higher supine SBP and lower standing SBP. There were no differences in age, comorbidities, laboratory studies, KCCQ, and 6MWD among tertiles of orthostatic PP. Dapagliflozin improved KCCQ-CSS and 6MWD across the range of orthostatic PP; participants with the highest (vs lowest) orthostatic PP appeared to have numerically greater improvements with dapagliflozin, but these differences were not statistically significant (Table). Overall, 18 (5.6%) experienced volume depletion events (dapagliflozin 11 [6.8%], placebo 7 [4.3%]). In tertile 1 (lowest orthostatic PP), there were numerically more volume depletion events with dapagliflozin than placebo (8 [14.3%] vs 3 [5.0%] events); whereas the numbers of such events were similar in tertiles 2 and 3 (Table). Conclusions: In patients with HFpEF, dapagliflozin improved KCCQ and 6MWD across the range of orthostatic PP, although those with the highest (vs lowest) orthostatic PP appeared to have numerically greater improvements. Very low orthostatic PP may identify patients who could be at increased risk of volume depletion events with SGLT2 inhibitors.
Abstract 4140589: The Impact of Ischemic Conditioning on Corticomotor and Behavioral Outcomes in Chronic Stroke Survivors: A Pilot Trial
Authors: Mark Cummings, Sangeetha Madhavan
Journal: Circulation (2024)

Introduction: Ischemic conditioning (IC), a procedure where the limb is exposed to recurrent bouts of blood flow occlusion followed by reperfusion, is clinically relevant for stroke rehabilitation as a neuromodulatory adjunct. Similar modalities (i.e., ischemic nerve block) revealed that peripheral blood flow restriction initiated neuroplastic changes in the motor cortex. Yet, this is unconfirmed with IC. Aims: To quantify changes in corticomotor excitability (CME) and transcallosal inhibition (TCI) of the paretic and nonparetic tibialis anterior (TA) muscle representations alongside changes in motor performance after one session of IC compared to sham ischemic conditioning (sham-IC), and aerobic exercise. Methods: Fifteen chronic stroke survivors will participate in three sessions: one involving IC, one involving sham-IC, and one involving aerobic exercise, with a one-week washout period between sessions. During the IC and sham-IC sessions, participants will undergo three 10-minute cycles, totaling 30 minutes. Each cycle will consist of 5 minutes of occlusion with cuff pressure set at either 225mmHg (IC) or 25mmHg (sham-IC), followed by 5 minutes of reperfusion with cuff pressure set at 0mmHg. The aerobic exercise session will involve 30 minutes of moderate-intensity recumbent stepper cycling. Before (pre), after (post) and 30 minutes after (post-30) each intervention, CME and TCI will be assessed using transcranial magnetic stimulation in addition to paretic ankle strength and reaction time (RT). Results: Pilot data from five males (mean ± SD: age = 62.4 ± 9.9 years; years since stroke = 8.4 ± 4.6) showed that after IC, CME increased by 31% (post) and 15% (post-30) and TCI increased by 12% (post) and 13% (post-30). After aerobic exercise, CME decreased by 8% (post) and increased by 5% (post-30) whereas TCI increased by 14% (post) and 16% (post-30). Sham-IC had negligible results. Strength improved by 19% (post) and 25% (post-30) following IC and by 16% (post) and 15% (post-30) following aerobic exercise. RT increased by 11% after IC but only by 2% after exercise and &lt;1% after sham-IC. Conclusion: Initial results reveal IC is superior to sham-IC and aerobic exercise for enhancing motor and neurophysiological outcomes in chronic stroke. We expect to confirm these results with full data collection.