tbuckley/cabot-search huggingface dataset:
Abstract 326: The Impact of a Critical Care Outreach Team on the Collection of In-Hospital Cardiac Arrest Resuscitation Quality Data
Authors: Kipp Shipley, Megan M Shifrin, Kathryn Roach
Journal: Circulation (2023)

Introduction: Critical Care Outreach Teams (CCOTs) serve to recognize clinical deterioration and respond to rapid response activations prior to in-hospital cardiac arrest (IHCA) in non-intensive care unit (ICU) patient care areas. In some hospitals, the CCOT operates separately from the IHCA resuscitation team. However, limited data exist regarding the outcomes of CCOT and IHCA resuscitation team collaboration during IHCA. Research Question: The purpose of this pilot study was to determine if the addition of a CCOT member to an IHCA resuscitation team would improve the collection of quality metrics during adult IHCA resuscitations. Goals: The primary goal of this study was to increase the documentation of two quality metrics identified by the American Heart Association’s Get with the Guidelines®-Resuscitation (AHA GWT-R) program during adult IHCAs in non-ICU patient care areas: 1) documentation of initial pulseless rhythm and 2) documentation of time to first intervention (epinephrine or defibrillation). The secondary goal was to increase the percentage of completed IHCA records/code sheets integrated into the electronic medical record (EMR). Methods: All non-ICU IHCAs that occurred prior to the intervention during a year-long period (June 1 st , 2021, to May 31 st , 2022) were used to establish baseline resuscitation quality metrics. During the intervention period (June 1 st , 2022, to May 31, 2023), a member of the CCOT responded to inpatient IHCA activations to serve as the designated event recorder and assist with the resuscitation. At the end of the study period, all IHCA activations were reviewed. Results: There were 74 IHCAs in the pre-intervention group and 76 IHCAs in the post-intervention group. In the post-intervention group, integration of IHCA records/code sheets into the EMR increased in the post-intervention group from 56.8% (42/74) to 96% (73/76). In the post-intervention group, there was also an increase in the documentation of initial pulseless rhythm from 75.7% (56/74) to 96% (73/76) and documentation of the first intervention from 71.4% (n=40) to 98.6% (n=72). Conclusions: This pilot demonstrated that adding a CCOT member to non-ICU IHCA resuscitations improves the accuracy of IHCA documentation and AHA GWT-R quality metrics.
Abstract 12981: Digital Health for the Management of Oral Anticoagulation Therapy: A Systematic Review and Meta-Analysis
Authors: Letícia B Ferreira, Milena S Marcolino, Rodrigo Lanna de Almeida, Thais M Pedroso, Samuel Rosa Ferreira, Antonio L Ribeiro, Eric Boersma
Journal: Circulation (2023)

Background: Direct oral anticoagulants (DOACs) have progressively replaced vitamin K antagonists (VKAs). However, in certain conditions, especially antiphospholipid syndrome, mechanical heart valves and rheumatic mitral stenosis, VKAs remain the only drugs with established safety and efficacy. In low-income contexts, they are frequently the preferred option due to the high costs of DOACs. Its management is often challenging, and different digital health strategies have been implemented to support it. Aims: To systematically review the evidence on the impact of digital health strategies to support anticoagulation management compared to usual care on thromboembolic and bleeding events. Methods: Randomized controlled trials were searched in 5 databases from inception to September 2021. Two independent reviewers performed study selection, data extraction, and quality assessment using the Cochrane risk of bias tool (RoB2). Total thromboembolic events, major bleeding, mortality, and time in therapeutic range were assessed. Results were pooled using random effect models. Results: In total, 25 randomized controlled trials were included (25,746 patients) and classified as moderate to high risk of bias. Telemedicine resulted in a trend of reduced risk of thromboembolic events (13 studies, relative risk [RR] 0.75, 95% CI 0.53-1.07; I2=42%), comparable rates of major bleeding (11 studies, RR 0.94, 95% CI 0.82-1.07; I2=0%) and mortality (12 studies, RR 0.96, 95% CI 0.78-1.20; I2=11%), and an improved time in therapeutic range (16 studies, mean difference 3.38, 95% CI 1.12-5.65; I2=90%). In the subgroup of multitasking intervention, telemedicine resulted in an important reduction of thromboembolic events (RR 0.20, 95% CI 0.08-0.48). Conclusions: Digital health strategies resulted in similar rates of major bleeding and mortality, a trend for fewer thromboembolic events and better anticoagulation quality compared to standard care. Given the potential benefits of digital health-based care, such as greater access to remote populations, these findings may encourage further implementation of these strategies for anticoagulation management, particularly as part of multifaceted interventions for integrated care of chronic diseases.
Abstract 13048: Outcomes of Transcatheter Edge-to-Edge Repair in Hypertrophic Cardiomyopathy: A Patient-Level Meta-Analysis
Authors: Lorraine Mascarenhas, Gloria Yang, Scott Hubers, Selcuk Adabag
Journal: Circulation (2023)

Background: Hypertrophic cardiomyopathy (HCM) is a genetic heart disease, commonly associated with left ventricular outflow tract (LVOT) obstruction and mitral regurgitation (MR). Septal myectomy and alcohol septal ablation are the current treatment options for LVOT obstruction and MR in symptomatic patients who are unresponsive to medical therapy. Recently, transcatheter edge-to-edge repair (TEER) of the mitral valve has been introduced as a new therapeutic alternative for these individuals, but there are insufficient outcome data. Objective: Perform a systematic review and patient-level meta-analysis of the studies reporting the outcomes of TEER in HCM. Methods: Original studies published in English in PubMed and Google scholar were included if ≥1 of the following pre- and post-TEER measures were reported: peak resting or provoked LVOT gradients, MR grade, or New York Heart Association (NYHA) class. Variables were presented as means with 95% confidence intervals. Paired t-test was used to compare variables pre- and post-TEER. A p-value &lt;0.05 was statistically significant. Results: A total of 15 publications reporting the outcomes of 30 patients (mean age 74 years, 45% female, average follow-up of 10 months) were included. Compared to pre-TEER measures, there was a significant reduction in resting LVOT gradient (68.29 vs. 11.76 mmHg), provoked LVOT gradient (119.67 vs. 14.11 mmHg), MR grade (3.52 vs. 1.07), and NYHA class (3.14 vs. 1.38) post-TEER (all p&lt;0.0001) (Figure). However, mean MV gradients increased post-TEER (2.00 vs. 3.55 mmHg, respectively, p=0.0018). There was 1 procedural complication noted in which a patient developed a severe mitral valve (MV) gradient of 10 mmHg after complete leaflet clip closure. This decreased to 6 mmHg when the clips were re-deployed partially open (30°). Conclusion: TEER can be an effective therapeutic option for improving LVOT gradient, MR severity, and NYHA class in patients with obstructive HCM.
Abstract 15622: Impella Use in Patients With Cardiogenic Shock is Associated With the Highest Inpatient Mortality in Comparison to Lowest Mortality Seen With the Use of Intraaortic Balloon Pump Using Large Nationwide Inpatient Sample (NIS) Database
Authors: Mohammad Reza Movahed, Armin Talle, Mehrtash Hashemzadeh
Journal: Circulation (2023)

Introduction: Impella and intra-aortic balloon pumps (IABP) are commonly used in patients with cardiogenic shock. However, the effect on mortality in this population has not been well established. Hypothesis: To evaluate the effect of Impella or IABP on mortality in patients with cardiogenic shock. Methods: We utilized the very large Nationwide Inpatient Sample (NIS) database to evaluate any association between the use of IABP or Impella on mortality in adults with cardiogenic shocks using uni- and multivariate analysis adjusting for comorbid conditions. Results: ICD-10 codes for Impella, IABP, and cardiogenic shock for available years 2016-2020 were utilized. A total of 844,020 patients had a cardiogenic shock. 101,870 (mean age 65.2) were treated with IABP and 39,645 (mean age 64.4) with an Impella. Total inpatient mortality without any device was 34.2% vs only 25.1% with IABP but was highest 40.7% with Impella. Using multivariate analysis adjusting for age, gender, race, three-vessel intervention, left main myocardial infarction, cardiomyopathy, systolic heart failure, acute ST-elevation myocardial infarction, peripheral vascular disease, chronic renal disease, diabetes, and smoking, Impella utilization remained associated with the highest mortality (OR: 1.56, CI 1.48-1.64, p&lt;0.001) whereas IABP remained associated with the lowest mortality (OR: 0.69, CI 0.66-0.72, p&lt;0.001). Conclusions: Using the largest database of its kind revealed that the use of Impella was associated with much higher mortality compared to no use as opposed to utilization of IABP showing the lowest mortality in patients with cardiogenic shock.
Abstract 18563: Unraveling the Interplay Between Age, Obesity, and Mortality Across Adulthood: Insights From National Health and Nutrition Examination Survey 1999-2018
Authors: Yuan Lu, Yunhan Mou, Yuntian Liu, Jeph Herrin, Harlan M Krumholz
Journal: Circulation (2023)

Introduction: Obesity is a major public health concern in the US, but the specific effects on mortality by age remain unclear. This study examined the complex relationship between age, obesity, and mortality. Methods: We analyzed data from the National Health and Nutrition Examination Survey (1999-2018) and linked mortality of adults aged 18 to 80 years. We examined interactions between age and obesity measures (body mass index [BMI], waist circumference, and weight) in relation to all-cause and cardiovascular mortality using Cox regression models. Results: The study included 44,041 adults (mean age: 44.8; SD=16.2). Among them, 50.5% were female, 12.2% were Black, 72.4% were White, and 15.4% were Hispanic. Significant age-obesity interactions were observed for all-cause and cardiovascular-specific mortality (P&lt;0.01). Younger individuals had a higher hazard ratio (HR) for all-cause mortality per one SD increase in BMI (Age &lt; 50, HR: 1.18, 95% CI: [1.06, 1.30]) and (Age 50-70, HR: 1.07 [1.00, 1.15]) compared with older individuals (Age &gt; 70, HR: 0.98, 0.90, 1.06]), after adjusting for covariates including sex, race/ethnicity, education, income, health insurance, physical activity, and smoking. Similar patterns were observed for all obesity measures, all-cause and cardiovascular mortality. Being underweight had a greater impact on risk in younger individuals compared with older individuals. Conclusions: Our findings indicate significant age-obesity interactions for all-cause and cardiovascular mortality. Younger individuals who were overweight or underweight faced a higher risk of mortality compared with older individuals.
Noncoding SNPs decrease expression of FABP5 during COPD exacerbations
Authors: Manale El Kharbili, Sarah K Sasse, Lynn Sanford, Sean Jacobson, Katja Aviszus, Arnav Gupta, Claire Guo, Susan M Majka, Robin D Dowell, Anthony N Gerber, Russell P Bowler, Fabienne Gally
Journal: Journal of Clinical Investigation (2023)
Abstract 15494: Racial and Ethnic Differences in Cardiovascular Health Among US Adults With a History of Cancer
Authors: So Mi J Cho, Ohad Oren, Satoshi Koyama, Michael C Honigberg, Whitney Hornsby, Gina Peloso, Pradeep Natarajan
Journal: Circulation (2023)

Introduction: Evidence reports co-occurring risk factors between cardiovascular disease (CVD) and cancer and treatment-resultant cardiotoxicities amplifying CVD risks. Hypothesis: Given demographic disparities in CVD and cancer outcomes, we illustrated race and ethnicity-specific distributions of cardiovascular health (CVH) and quantified the contributions of socioeconomic factors to racial disparities in CVH among those with prior cancer. Methods: In the National Health Examination and Nutrition Survey 2011-2020, we identified 2628 adults aged ≥18 years with prior cancer. CVH was assessed based on the American Heart Association’s Life’s Essential 8 metrics. The Kitagawa-Blinder-Oaxaca decomposition quantified the magnitude of individual socioeconomic factors contributing to racial differences in CVH. Results: Of the 2628 US adults with prior cancer (mean[SD] age, 63.4[13.8] years; 57% women), 6.0% identified as Hispanic or Latino, 1.6% as non-Hispanic (NH) Asian, 5.2% as NH Black or African American, 84.1% as NH White, and 3.1% as uncategorized or multiple categories. NH Asian had the highest Life’s Essential 8 score (out of 100, women: 66.0; male: 69.2) in contrast to the poorest CVH in NH Black women (59.0) and Hispanic men (57.7). Overall, diet, physical activity, and body mass index were suboptimal. Across race, NH Black had the poorest blood pressure (women: 52.6, men: 41.8) and sleep (women: 74.3, men: 70.2), whereas uncategorized or multiracial group had high tobacco exposure (women: 43.6; men: 53.2). NH White women had the worst lipids (62.4), whereas NH Asian women (65.2) and Hispanic men (69.0) had the lowest glycemic score. Differences were partly explained by deprivation and low education contributing to poorer CVH among Hispanic and NH Black, whereas lower US nativity contributed to better CVH in NH Asian. Conclusions: CVH in US adults with prior cancer was suboptimal with significant racial disparities explained by socioeconomic factors.
Abstract 13057: The Role of Ischemic and Bleeding Scores in Patients With Acute Coronary Syndromes Submitted to Coronary Surgical Revascularization During the Same Hospitalization
Authors: Jose C Nicolau, Jorge L Montero Ribera, Adriadne Bertolin, Luciano Baracioli, Roberto Giraldez, Felipe G Lima, Maria Andrade, Santiago Castro Vintimilla, Leonardo Salis, Fabio Jatene, Fabiane Freitas, Luis Alberto Oliveira Dallan, Luiz Augusto Lisboa, Omar Asdrubal Vilca Mejia, Remo Furtado, Lucas C Godoy, michael farkouh
Journal: Circulation (2023)

Introduction: The role of bleeding and ischemic scores in ACS patients (pts) submitted to coronary artery bypass surgery (CABG) is poorly understood. Hypothesis: To analyze the role of ACUITY/HORIZONS bleeding score (BlS), TIMI ST-elevation myocardial infarction (TIMI-STEMI)/non-ST-elevation ACS (TIMI-ACS), and GRACE in CABG pts. Methods: From an administrative databank, we analyzed 999 ACS pts submitted to CABG in the same hospitalization (70.6% men, median age 64 years), from 1999 to 2022. From the whole population (pop.) 504 pts had all above scores available; the whole and sub-group pop. were similar in baseline characteristics, median score values and area under the ROC curves (AUC). Categorical variables were compared with chi-square test; continuous variables (non-Gaussian distribution) were compared with Mann-Whitney test. Multivariable logistic regression, with in-hospital mortality as dependent variable, was performed. The AUC ROC were compared with De Long test. Results: 1) Association between risk scores and in-hospital mortality: The median (25 th -75 th ) for pts dead or discharged alive were 19.00 (13.00-26.00) vs 14.00 (10.00-19.00), P&lt;0.001; GRACE 166.00 132.00-202.00 vs. 115.00 96.00-133.00, P&lt;0.001; TIMI STEMI (N=100) 7.00 (4.75-8.00) vs. 4.00 (3.00-5.50), P=0.004; TIMI-ACS (N=404) 4.00 (3-4.50) vs. 4.00 (3.00-4.00), P=0.119. 2) AUC (±SE) for ROC curves: BS 0.674 ± 0.044 P&lt;0.001; GRACE 0.815 ± 0.037 P&lt;0.001; TIMI STEMI 0.775 ± 0.077 P=0.004; TIMI-ACS 0.579 ± 0.046 P=0.131. The predictive value of GRACE score was superior to BlS P=0.015 and TIMI-ACS score P&lt;0.001. 3) Adjusted models: only GRACE was associated with in-hospital mortality in all models; OR=1.032 P&lt;0.001 for the whole pop.; OR=1.078, P=0.002, for STEMI; and OR=1.036, P&lt;0.001for non-STEMI. Conclusions: In ACS pts submitted to CABG, BlS, GRACE and TIMI STEMI scores were associated with in-hospital mortality. GRACE score showed the highest discrimination for predicting death.
Abstract 14108: Eicosapentaenoic Acid and Docosahexaenoic Acid and Their Association With Oral Inflammatory Markers in Subjects With Clinical Coronary Artery Disease
Authors: Bushra Ahmad, Abdulaziz Malik, Ralph Daher, Francine K Welty
Journal: Circulation (2023)

Background: Our group previously reported that subjects with coronary artery disease (CAD) randomized to the omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), had lower levels of blood inflammatory markers and prevention of progression of non-calcified coronary plaque. Macrophage inhibitory protein (MIP)-1β is an inflammatory chemokine expressed by T cells in human plaques; circulating levels are increased in patients with atherosclerosis. The relation between EPA+DHA supplementation and oral inflammatory markers is unclear. Aim: To determine if EPA+DHA supplementation lowers levels of oral inflammatory markers. Methods: Subjects with clinical CAD were randomized to EPA+DHA, 3.36 g daily, or none for 30 months; 199 underwent a dental exam. Gingival crevicular fluid was collected at baseline and 30 months and analyzed for inflammatory markers. Results: MIP-1-β level was significantly lower in the EPA+DHA group compared to control at 30 months in the left upper quadrant of the mouth but not in the right upper quadrant (Table). This difference could potentially be explained by handedness. For example, Right-handed people tend to brush the left side of the mouth better whereas left-handed individuals and ambidextrous individuals have better brushing skills on the right side of the mouth. Other inflammatory markers (MCP, TNF-a, IL-1 and IL-6) were not different between groups on either side. Conclusions: Subjects with CAD randomized to EPA+DHA had reduced levels of the oral inflammatory marker, MIP-1β, at 30 months, suggesting that EPA+DHA can confer oral health benefits in addition to lowering systemic inflammation. For greatest benefit, brushing equally on both sides of the mouth should be encouraged, for which a powered toothbrush can help as it doesn’t rely on manual dexterity and handedness. Future research should examine whether the benefit of omega-3 fatty acids on oral health increases the benefit on coronary plaque.
Abstract 13155: Safety and Efficacy of Anti-Hypertensive Medications in Patients With Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis
Authors: Mohammad Alqadi, Mohammed Al-Sadawi, Faisal Aslam, Tahmid Rahman, Paul Kim, Noelle Mann
Journal: Circulation (2023)

Introduction: Hypertension (HTN) is a co-morbidity that is commonly associated with heart failure (HF) with preserved ejection fraction (HFpEF). This meta-analysis aims to evaluate the association of anti-hypertensive medications (AHM) therapy with cardiovascular (CV) outcomes in patients with HFpEF. Hypothesis: Treatment of HTN in HFpEF patients is associated with improved CV outcomes. Methods: Performed a database search (OVID Medline, Web of Science, and Embase) for studies reporting the association of AHM with CV outcomes in patients with HFpEF. The primary endpoint was all-cause mortality. Secondary endpoints include CV mortality, worsening HF, CV hospitalization, and major adverse CV events (MACE). Results: A total of 15 studies with 17507 HFpEF participants (8732 treated with medical therapy vs 8775 treated with placebo) met inclusion criteria. Use of AHM was not associated with lower all-cause mortality or CV mortality compared to treatment with placebo (OR 1.01, 95% CI 0.80-1.27; p=0.95, OR 0.97, 95% CI 0.86-1.08; p=0.53). Use of AHM was associated with a statistically significant lower risk of MACE and CV hospitalization (OR 0.90, 95% CI 0.83-0.97; p&lt;0.01, OR 0.89, 95% CI 0.81-0.97; p&lt;0=0.04). Subgroup analysis demonstrated this to be primarily driven by studies with mixed HFpEF patients with or without HTN, not HFpEF patients with HTN. There was a non-significant trend toward lower risk of worsening HF in patients treated with AHM, and was driven by HFpEF patients with or without HTN, not HFpEF patients with HTN (OR 0.87, 95% CI 0.78-0.97; p=0.02 versus OR 0.57, 95% CI 0.18-1.86; p=0.35). Conclusion: While treatment with anti-hypertensives was not associated with lower risk of all-cause mortality, their use may be associated with reduced risk of adverse CV outcomes in patients with HFpEF regardless of whether they have HTN. Further studies are needed to clarify this association and determine the effect based on specific classes of medications.
Abstract 16019: Right Hemidiaphragm Paralysis Leading to Right Heart Failure
Authors: Shahmir Naveed, Samir P Mehta, Mark Vanderland, Wasif Qureshi
Journal: Circulation (2023)

Background Diaphragmatic paralysis occurs due to direct or indirect damage to the phrenic nerve and can cause unilateral elevation. Diaphragmatic paralysis is usually asymptomatic; however, we present a case of syncope caused by right hemidiaphragm paralysis leading to extrinsic compression of the right heart causing hemodynamic compromise. Case A 78-year-old female with a history of advanced dementia, and hypertension presented following a syncopal episode and was found altered and hypotensive. A chest X ray showed an elevated right hemidiaphragm. A Transthoracic echocardiogram demonstrated hyperdynamic systolic function of the left ventricle with an ejection fraction of 70 to 75% and a left ventricular outflow tract (LVOT) gradient of 64 mmHg. It was suspected that extrinsic compression of the right atrium and ventricle lead to underfilling of the left ventricle causing LVOT obstruction resulting in hypotension and syncope. Discussion . Due to the patient’s underlying severe dementia her family wished for a conservative approach and additional cardiac investigation was deferred. She was treated conservatively with beta blockers to increase her diastolic filling time and intravenous fluids to promote LV filling in order to reduce her LVOT obstruction. Treatment of diaphragm paralysis depends on the severity of symptoms such as dyspnea on exertion, fatigue and syncope. An option that was discussed was diaphragmatic plication to decrease the intrathoracic pressure and the extrinsic compression on the right heart. More commonly, unilateral diaphragmatic paralysis is asymptomatic and is managed conservatively with observation. Conclusion: Cardiac complications of hemidiaphragm paralysis are rare but this case illustrates how extrinsic compression of the right heart can lead to dynamic LVOT obstruction and highlights the importance of integrating imaging findings when evaluating patients for syncope.