tbuckley/cabot-search huggingface dataset:
Abstract MP67: Estimated Health Impact, Cost, and Cost-Effectiveness of Mandating Sodium Benchmarks in Australia’s Packaged Foods
Authors: Matti Marklund, Kathy Trieu, Leopold Aminde, Linda Cobiac, Daisy Coyle, Liping Huang, Bruce C Neal, J. Lennert Veerman, Jason H Wu
Journal: Circulation (2024)

Objectives: To estimate the potential health impact, cost, and cost-effectiveness of Australia mandating either A) the World Health Organization’s (WHO) global sodium benchmarks or B) the currently non-mandatory national sodium reformulation targets. Methods: We used a multiple cohort proportional multi-state life table model to simulate the impact of the interventions on the adult (≥ 20 years) population. We estimated sodium intake in the base case (i.e., maintaining current sodium intake) and intervention scenarios, using nationally representative data on dietary intake, sodium levels in packaged foods, and food sales volume. Blood pressure and disease burden data were obtained from the Global Burden of Disease study. The effect of sodium reduction on blood pressure and disease risk was modelled using evidence from meta-analyses of randomized trials and prospective studies. Net costs, including implementation and healthcare costs, were used to calculate the incremental cost per health-adjusted life year (HALY) gained. Outcomes were discounted at 3%. Results: Compared to the base case scenario, mandating the WHO benchmarks was projected to be cost saving over the first 25 years (99% probability), with 19K deaths (95% uncertainty interval [UI]: 11-28), 138K incident CVD events (95% UI: 81-200), and 100K new CKD cases (95% UI: 60-150) averted (Figure). The intervention could generate around 76K HALYs (95% UI: 44-110) and save $770 million (95% UI: 118-1,715) in healthcare costs. Mandating the less comprehensive and less stringent national targets could also be cost saving (97% probability), but with only about 1/3 of the health benefits of to the WHO benchmarks (Figure). Conclusions: Our findings support mandating sodium thresholds for packaged foods as a cost-effective strategy to prevent death and disease in Australia. Making Australia’s voluntary reformulation targets mandatory may save thousands of lives, but mandating the WHO global benchmarks could generate substantially larger health gains.
Abstract P449: Closing the Gender Gap in Bystander Cardiopulmonary Resuscitation: Unveiling Disparities and Pathways to Equal Lifesaving
Authors: Jynx Frederick
Journal: Circulation (2024)

Introduction: Gender disparities in CPR persist, with women receiving CPR less frequently than men during out-of-hospital cardiac arrests. This abstract emphasizes the importance of addressing this disparity through awareness campaigns and offers innovative strategies for prevention, including gender-sensitive CPR training methods and a community program example from New Orleans. Methods: A comprehensive literature review was conducted to identify studies on gender disparities in bystander CPR. Factors contributing to these disparities were analyzed, including hesitations related to physical contact, challenges in recognizing cardiac arrest in women, and societal biases. Survival data were assessed to highlight the lifesaving potential of gender-equal CPR. Results: Research revealed that gender disparities in CPR provision are common, influenced by factors such as reluctance to perform chest compressions on women, difficulties in identifying cardiac arrest in female patients, and the perpetuation of gender stereotypes. These factors result in significantly different survival rates, with women facing a higher risk of worse outcomes. Discussion: Addressing gender disparities in bystander CPR provision requires a multifaceted approach, including community-based CPR training programs that emphasize gender sensitivity. These programs should feature anatomically correct CPR training dolls with breast attachments to ensure trainees are prepared to perform CPR on anyone. It is crucial that CPR course instruction also incorporate information on gender disparities to raise awareness among trainees. Public awareness campaigns should work to dispel myths and biases related to gender and CPR, promoting more equitable lifesaving practices. An exemplary program from New Orleans demonstrates the impact of community-based initiatives. In this effort, community members were trained in CPR using gender-inclusive materials, including CPR dolls with breast attachments. The training included statistical information on gender disparities, bias assessments, survivor testimonials, and discussions aimed at dispelling myths about providing CPR to women. This program successfully empowered the community with the knowledge and skills to overcome gender biases in CPR, promoting gender-equitable lifesaving measures. Conclusion: Preventing gender disparities in bystander CPR provision to women is essential to enhance survival rates for female cardiac arrest victims. Using public platforms to advocate for these initiatives and emphasizing the need for collaborative efforts to eliminate gender bias in lifesaving practices and CPR training is crucial. By illuminating the issue, proposing innovative solutions, and sharing successful community programs, a standard can be cultivated where every individual, regardless of gender, receives timely and effective CPR.
Abstract P211: Burden and Temporal Trend of Peripheral Artery Disease in the United States and Its Attributable Risk Factors From 1990-2019: An Insights From the Global Burden of Disease Study 2019
Authors: Rafael Cortorreal Javier, Anusha Parisapogu, Nmair Alziadin, Anjani Kumar Thota, Khush Dadhania, Vinay Kumar Gadamidi, Priyatha VEMPARALA, Juhi PATEL, Hardik Dineshbhai Desai
Journal: Circulation (2024)

Background: Peripheral Artery Disease (PAD) ranks as the 10th primary cause of mortality and the 11th for disability among all cardiovascular diseases in the U.S. Method: We employed the Global Burden of Disease 2019 framework. PAD non-fatal health outcomes were analyzed using the DisMod MR 2.1 (Bayesian meta-regression tool) and determined fatal health outcome with the cause of death ensemble model (CODEm), segmented by age, gender, year, and location from 1990-2019 across the U.S. Results: The annual percentage change (APC) revealed a 26% (9.9-12.4 million) increase in overall prevalence and incidence, a significant 152% (5,757-14,527) rise in deaths, and a 98% (119,253-236,031) uptick in DALYs during 1990-2019. Notably, while the age-standardized incidence rate dipped by 28% (267-193), death and DALY rates climbed by 33% (1.7-2.27) and 11% (36-39) respectively. Delaware witnessed the highest APC in deaths 118% (2.33-5.08) per 100,000, trailed by Colorado with a 58% (35-55) rise in DALYs. Individuals under 70 experienced a 118% (1052-2294) surge in APC for deaths and a 28% (458,357-588,135) increase in incidence. In absolute numbers, males bore a heavier PAD burden, yet females exhibited elevated age-standardized rates from 1990-2019. Conclusion: The study underscores a concerning rise in PAD in the U.S. from 1990-2019, accounted for 1.52% deaths of all cardiovascular related casualties in 2019. Delaware and Colorado have notably high increases in PAD-related outcomes. From both a clinical and public health perspective, addressing high fasting plasma glucose and sodium-rich diets is crucial, as they stand as leading risk factors in PAD's burgeoning prevalence.
Abstract P215: Activity Behaviors and Cardiometabolic Health Outcomes in People Living With HIV
Authors: Raymond Jones, Michael J Hankes, Nicole D Armstrong, Kelley P Gabriel, Thomas W Buford, Erin E Dooley
Journal: Circulation (2024)

Introduction: Physical activity (PA) and sedentary behavior (SB) are independently associated with cardiometabolic health; data on activity behaviors and cardiometabolic health among people living with HIV (PWH) are limited. Hypothesis: Activity behaviors would differ by age and that not meeting PA Guidelines would be associated with an increased risk of cardiometabolic diseases among PWH. Methods: Using NHANES 2007-08 through 2017-18, PWH (n=125; age 44.3 yrs) were characterized as emerging (18-29 yrs), early (30-44 yrs) and middle (45-59 yrs) adulthood. Achieving Guidelines (≥150 min/wk) was derived from self-reported PA across three domains. SB was reported as time spent sitting. Chronic conditions were high cholesterol, obesity, hypertension, and chronic kidney disease. Prevalence estimates of joint high SB (≥8 h/day) and inactivity (&lt;10 min/wk) were calculated, and regression models were used to estimate differences in behaviors by age and investigate the association between achieving Guidelines and chronic conditions. Results: PWH reported 395.8 min/day of SB with 37.5% spending over 8 h/day sitting. There was no significant difference in SB across lifestage. A total of 67.2% achieved Guidelines although 14% were jointly inactive and highly sedentary. Compared with early adult PWH, middle adult PWH spent more time performing transport-related PA (β= 102.7 min/wk, p =0.009) and less time performing leisure-time PA (β= -211 min/wk, p =0.044) ( Figure ). Compared with PWH meeting Guidelines , those that did not meet Guidelines had higher diastolic blood pressure (β= 6.1 mmHg [CI: 2.6, 9.6]) and higher odds of obesity (OR=2.5[CI: 1.0, 6.4]). Conclusions: Domain-specific differences occurred in transportation and leisure time PA among PWH - a high-risk group for cardiovascular disease. Not meeting the Guidelines resulted in greater odds of obesity and higher diastolic blood pressure. Future research should incorporate device-based measures of movement to understand its relation to chronic disease in PWH.
Abstract MP41: Associations Between Reallocations of Daytime Movement Behaviors and Self-Reported Sleep Quality and Insomnia Severity in Desk Workers
Authors: Christopher E Kline, Rachel M Sanders, Caitlin A Cheruka, Andrew G Kubala, Mara E Egeler, Subashan Perera, Sanjay R Patel, Bethany Barone Gibbs
Journal: Circulation (2024)

Introduction: While moderate- to vigorous-intensity physical activity (MVPA) is commonly associated with better sleep, few studies have considered the influence of sedentary behavior (SB) or light-intensity PA (LPA) on sleep or how reallocation of these daytime movement behaviors are associated with sleep. Purpose: To examine the association of reallocating time spent in daytime movement behaviors (SB, LPA, MVPA) with self-reported sleep quality and insomnia severity. Methods: Using baseline data from a clinical trial, 170 adults with desk jobs were included in analyses (84.1% white; 51.2% female; body mass index [BMI]=31.1±6.6 kg/m 2 ; age=44.7±10.8 y). Daily SB and MVPA were measured with activPAL and ActiGraph GT3x accelerometers, respectively, over ~7 days; SB was categorized into short- and long-bout SB (time spent in &lt;30 or ≥30 min bouts, respectively). Daily LPA was calculated as activPAL-assessed wear time minus SB and MVPA. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) assessed sleep quality and insomnia severity, respectively. Isotemporal substitution analyses utilized linear regression to demonstrate the effects of replacing one movement behavior (short-bout SB, long-bout SB, LPA, MVPA) with an equivalent amount of another movement behavior on sleep. All analyses adjusted for age, sex, BMI, and device wear time. Results: On average, participants spent 4.7±1.3 h/day in short-bout SB, 6.3±2.2 h/day in long-bout SB, 4.3±1.6 h/day in LPA, and 37.3±21.8 min/day in MVPA. Mean PSQI and ISI scores were 5.5±3.0 and 7.2±4.8, respectively; 42.4% had poor sleep quality (PSQI&gt;5) and 40.6% had at least mild-severity insomnia (ISI≥8). Reallocating time from short-bout SB to MVPA was significantly associated with better sleep quality (-0.73±0.37 unit change in PSQI score per 30-min reallocation [P=.05]); reallocations from long-bout SB or LPA to MVPA trended toward significantly better sleep quality (P=.08 and P=.09, respectively). Reallocating time from SB or LPA to MVPA was not significantly associated with lower insomnia severity (each P&gt;.16). Conclusions: Increasing moderate-vigorous physical activity at the expense of sedentary behavior or light-intensity physical activity was associated with better sleep quality, though the strengths of these associations were mild at best. Support: NIH R01 HL134809, R01 HL147610.
Abstract P502: Lifestyle Modification for Secondary Prevention of Atrial Fibrillation: A Pilot Study
Authors: Jeffrey M Ashburner, Taylor Carmichael, Romit Bhattacharya, Aneesh Bapat, Pradeep Natarajan, Steven Atlas, Daniel E Singer, Anne N Thorndike
Journal: Circulation (2024)

Background: Addressing modifiable cardiovascular risk factors through lifestyle interventions may be effective for secondary atrial fibrillation (AF) prevention. Aims: To assess feasibility, acceptability, and preliminary effectiveness of an exercise and nutrition-based cardiac rehabilitation-like program for patients with symptomatic AF. Methods: We enrolled overweight (body mass index [BMI] ≥ 28 kg/m 2 ) adults aged ≥ 30 years with symptomatic AF in a 12-week cardiac lifestyle group program, which included 6 virtual and 6 in-person visits. All visits included discussion and education about nutrition, exercise, and behavior modification. In-person visits included supervised aerobic exercise and strength training. Patients were evaluated to assess health history, diet, and baseline cardiac risk factors. Outcomes at baseline and 12 weeks included feasibility of participation, change in weight and BMI, acceptability, and changes in survey-based AF burden and symptoms, and AF-related quality of life (QOL). Results: From 84 invitees, 11 (13.1%) were enrolled (mean age 64; baseline BMI 38 kg/m 2 ; 45% female); 9 (82%) completed the program. Patients attended an average of 9.7 (81%) visits (Range: 6-11). Mean weight loss was 9.1 pounds (Range: 0-16) and mean BMI decrease was 1.4 kg/m 2 (Range: 0-2.6). Nine of 11 patients completed baseline and follow-up surveys (Table) . Patients found the program helpful overall: all reported making diet and exercise changes during the program; 8 (89%) were confident in continuing dietary changes and 7 (77%) were confident in continuing exercise changes after the program. Patients reported decreased AF burden and symptoms, and increased QOL at the conclusion of the program (Table) . Conclusions: Participation in a cardiac rehab-like program was feasible and acceptable for overweight patients with symptomatic AF. Results suggest preliminary effectiveness of the program for reducing AF burden and symptoms and increasing quality of life.
Abstract P429: Coffee Intake is Associated With Enhanced Insulin Sensitivity, Lower Post-Load Glucose Responses, and Lower Truncal Adiposity
Authors: Magdalena Sevilla-Gonzalez, Deirdre K Tobias, Meryl LeBoff, Olga Demler, Aruna D Pradhan, Samia Mora, I-Min Lee, Julie Buring, JoAnn Manson, Jun Li
Journal: Circulation (2024)

Higher coffee consumption has been associated with lower type 2 diabetes (T2D) risk, but the underlying mechanisms remain unclear. We tested the hypothesis that coffee intake is associated with improved glycemia insulin sensitivity, and reduced adiposity. We leveraged data in the VITamin D and OmegA-3 Trial (VITAL), a completed placebo-controlled 5-year trial including 25871 participants. Coffee intake was assessed by a diet questionnaire at baseline and year 2. In the VITAL clinical subcohort (n= 1054), glucose metabolism and insulin resistance were assessed by a 2-hr oral glucose tolerance test, body composition was measured by the dual X-ray absorptiometry, at baseline and year 2. We analyzed the association of coffee intake with glycemic traits and body composition, leveraging repeated assessments using multivariable-adjusted linear mixed models. Secondarily, we tested associations between coffee intake and T2D risk, in 22327 initially T2D-free individuals (482 cases in 5 years of follow-up) using multivariable-adjusted Cox regression. While coffee intake was not associated with fasting glucose or insulin levels, it was significantly associated with lower levels of 2-hr post-load glucose (SD difference per cup increment β = -0.062, P = 0.04) and insulin (β = -0.064, P = 0.02), and a higher metabolic clearance rate of glucose (β= 0.057, P = 0.007) and insulin sensitivity index (β= 0.059, P = 0.02). The associations were consistent for caffeinated and decaffeinated coffee. Further, caffeinated coffee intake was associated with higher body weight (β= 0.018, P = 0.02), but total coffee intake was associated with a lower truncal to limb fat ratio before and after adjusting for BMI (β= -0.057, P = 0.03). We did not observe evidence of association with incident T2D (HR =0.63; 95% CI 0.15-2.50). Higher coffee intake was associated with improved post-load glucose metabolism and insulin sensitivity, and lower truncal adiposity. The figure displays result estimates of linear mixed models. Asterisks represent associations P &lt; 0.05.
Abstract P321: Clinical Correlates of Medication Adherence to Antihypertensives and Bipolar Medications in Individuals With Hypertension and Bipolar Disorder
Authors: Jennifer B Levin, David J Moore, Farren Briggs, Mahboob Rahman, Jessica Montoya, Colin Depp, Rodrigo Machado-Vieira, Celeste Weise, Taylor Maniglia, Joy Yala, Gracie Howard Griggs, Richard Barigye, Clara Adeniyi, Martha Sajatovic
Journal: Circulation (2024)

Introduction: Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality largely from cardiovascular causes. In the current analysis, we examined screening and baseline data from an ongoing randomized controlled trial and assessed clinical correlates of adherence to antihypertensives and BD medications in 55 patients with bipolar disorder and hypertension. Hypothesis: We assessed the hypothesis that adherence to antihypertensives would correlate with systolic blood pressure (SBP) and adherence to BD medication would correlate with psychiatric symptoms. Method: Inclusion criteria were a BD Type 1 or 2 diagnosis, being prescribed antihypertensives, and uncontrolled hypertension (SBP ≥130mmHg). Adherence was measured for the prior week with 1) self-reported Tablets Routine Questionnaire for antihypertensives (TRQ-HTN) and BD (TRQ-BD) with higher percentage reflecting worse adherence and 2) objective electronic monitoring using an eCAP © for one antihypertensive medication. Average SBP was calculated from 12 readings over one week. Symptoms of BD were measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS). Results: Mean age of the sample (N=55) was 53.91±9.97, a majority female (61.8%), 49.1% Black and 45.5% White. Mean years of education was 14.09 ±2.83 and 95% had Bipolar Type I. At screen, TRQ-HTN was 35.80% ± 21.78 (N=55); at baseline, mean TRQ-HTN was 12.94 ± 16.88%. At screen, TRQ-BD was 29.61% ±28.02 (N=55); at baseline, TRQ-BD was 19.43% ±28.54 (N=50). At baseline, eCAP (N=43) was 39.53 ± 35.11%. There was a significant improvement in TRQ-HTN from screen to baseline (t(52) = -6.75 r &lt;0.001) and a trend for TRQ-HTN (t(49) = 1.80, p = 0.078). There was a significant correlation between TRQ-HTN and eCAP at baseline (rs=0.307, p&lt;.05, N= 43) yet eCAP reported more missed days than TRQ-HTN (Mean = -25.581 t(42) = -4.903 p&lt;0.001). TRQ-BD was significantly correlated with BPRS ( r = 0.313, p &lt;.05, N = 50) but not with MADRS. Neither TRQ-HTN nor eCAP were correlated with SBP. SBP significantly decreased from screen to baseline (t(53) = 2.357 p&lt;.05). Conclusion: In conclusion, adherence levels vary widely and objective measurement identified rates of missed medications that were approximately 26% higher than self-report. Self-reported BD adherence was related to global psychiatric symptoms but not depression while antihypertensive adherence did not relate to SBP. Greater BD symptom severity may be a clinical indicator to assess for adherence problems and medication and BP monitoring alone may improve adherence and SBP.
Abstract P102: Costs, Accessibility, and Utilization: Disparities in Anti-Arrhythmic Drug Use in Atrial Fibrillation Patients
Authors: Connor Workman, Daniel Won, James Walker, S. Christopher Malaisrie, Ciaran Kohli-Lynch
Journal: Circulation (2024)

Background: Patients with atrial fibrillation (AF) have an increased risk of stroke, heart failure, and other cardiac-related complications. AF is recognized as a significant contributor to rising healthcare costs due to increased hospitalizations, medical visits, and medications. However, utilization and costs of anti-arrhythmic drugs (AADs) for AF treatment remain unknown. Methods: This cross-sectional study uses data from the Medical Expenditure Panel Survey for 2016-21 and includes AF patients prescribed Class I-V AADs. Our survey-weighted model calculates national estimates and adjusted odds ratios (OR) for associations between demographic factors, days of medication supplied, and out-of-pocket (OOP) cost. Results: Patients with AF were significantly more likely to receive the lowest decile of days’ supply of AADs (&lt;85 days) if they were below age 60 (OR 4.93, p = 0.005) compared to patients older than age 80 or insured through only Medicare (OR 2.93, p = 0.023) or other federal or state insurances (OR 3.70, p = 0.007) compared to private insurance. Compared to patients with a family income of less than $15k per year, AF patients were significantly more likely to pay in the top decile for cost per day supply of AADs (91 cents/day) if they had a family income between $15-30K. AF patients with Medicaid were significantly less likely to pay in the top decile for cost per day supply of AADs (OR 0.19, p = 0.001) compared to patients with private insurance. Patients with AF underutilized AADs significantly more in 2021 compared to 2016 (OR 3.28, p = 0.029). Conclusions: Younger age and public insurance were associated with a lower days’ supply of AADs for AF patients. Patients with a family income around the typical state’s Medicaid income limit ($15-30K) pay significantly higher OOP costs for AADs. To increase AAD adherence, policies should aim to decrease AAD cost for patients marginally above public insurance income limits and to educate patients below age 60 on the importance of AADs in treating AF.