tbuckley/cabot-search huggingface dataset:
Abstract 17373: The Effect of a Multi-Level Nurse-Led and M-Health Intervention on Medication Adherence Among Adults with Uncontrolled Hypertension in the ADHINCRA Study
Authors: Nana Kwasi Appiah, Oluwabunmi V Ogungbe, Thomas Hinneh, Faith Metlock, Cheryl R Dennison Himmelfarb, Lisa A Cooper, Kathryn Carson, FRED S SARFO, Lambert T Appiah, Yvonne Commodore-Mensah
Journal: Circulation (2023)

Introduction: Poor adherence to antihypertensive therapy is a major contributor to poor cardiovascular outcomes for patients diagnosed with hypertension (HTN). However, multifaceted patient centered interventions may improve medication adherence and HTN control. Objective: To examine the impact of the nurse-led, multi-level, m-health intervention on medication adherence in adults with uncontrolled HTN in the ADHINCRA study in Ghana. Methods: Using a cluster randomized controlled pilot trial design, four hospitals were randomized to the intervention arm and enhanced usual care (EUC) arm; 120 participants in each. We estimated HTN medication adherence using the Hill-Bone Medication Adherence Scale (Range, 9-36), higher scores indicate better adherence. A logistic regression model was used to estimate dichotomized adherence score (low and high adherence) as a function of the treatment group over time. Results: Among 240 participants, mean (±SD) age was 53 (±9.7) years; 117 men (49%). Mean (SD) adherence scores for intervention and EUC arms at baseline were 33.7 (2.9) and 33.2 (3.1) respectively. At month 12, the mean adherence score was 34.8 (1.8) in the intervention group and 34.3 (2.5) in EUC arm. Comparing baseline to month 6, the intervention arm had higher odds of adherence (Odds Ratio, OR, 1.85; 95%CI, 1.14-4.45) compared to EUC arm (OR, 1.74; 95%CI, 0 .91-3.31), and similarly for month 12, the intervention arm had higher odds of adherence (OR, 3.25; 95%CI, 1.68-6.27) compared to EUC arm (OR, 2.32; 95%CI, 1.19-4.52) (Figure 1). Conclusions: The ADHINCRA Study intervention resulted in greater improvement in medication adherence in the intervention than the EUC arm. Multi-level interventions should be integrated into clinical practice in Ghana to improve medication adherence.
Abstract 17313: Evaluating the Predictive Accuracy of Viscoelastic Blood Coagulation Measurements for Postoperative Bleeding in Cardiac Surgery: A Diagnostic Accuracy Meta-Analysis
Authors: Muhammed K Elfaituri, Ala Khaled, Hazem Abdelkarem A Faraj, Ahmed BenGhatnsh, Ahmed Msherghi
Journal: Circulation (2023)

Introduction: Postoperative bleeding in cardiac surgery significantly impacts patient morbidity and mortality. Viscoelastic blood coagulation measurements, such as point-of-care (POC) viscoelastic hemostatic assays (VHAs), are proposed tools for predicting this complication and enabling proactive management. However, thoroughly evaluating existing evidence is essential to confirm their effectiveness. Hypothesis: This study aims to evaluate the diagnostic accuracy of viscoelastic blood coagulation measurements in predicting postoperative bleeding following cardiac surgery. Methods: A systematic search of studies published up to May 2022 was conducted, employing databases such as PubMed, EMBASE, and the Cochrane Library. Included studies implemented viscoelastic blood coagulation measurements in cardiac surgery settings, providing data on diagnostic accuracy for predicting postoperative bleeding. Major postoperative blood loss, as defined within each study setting, was used as the reference standard. Statistical analysis was performed using R software (version 4.0.3) with mada package. This analysis enabled various diagnostic accuracy metrics pooling, all presented with a 95% Confidence Interval (CI). Results: This analysis incorporated 10 studies comprising 2048 patients, 374 of them experienced confirmed postoperative bleeding after cardiac surgery. The pooled sensitivity and specificity of viscoelastic blood coagulation measurements for predicting postoperative bleeding were found to be 65% (95% CI: 42.9-82%, I2=89.4%) and 85% (95% CI: 69.7-93.3%, I2=95.1%) respectively. The false-positive rate was identified as 15% (95% CI: 6.7-30.3%). The diagnostic odds ratio was 10.50 (95% CI: 2.93-37.57). The positive and negative Likelihood Ratios were 4.34 (95% CI: 1.89-9.95) and 0.42 (95% CI: 0.23-0.75), respectively. Conclusions: Despite moderate sensitivity, viscoelastic blood coagulation measurements exhibit high specificity in predicting postoperative bleeding in cardiac surgery, potentially enhancing patient management through early intervention. However, due to the observed heterogeneity, further large-scale studies are required to confirm these results and assess their impact on patient outcomes.
Abstract 17343: Coronary Microvascular Function in Physician Burnout and Job Stress
Authors: Aju P Pazhenkottil, Mary Princip, Sarah A. A Holzgang, Chrysoula Garefa, Alexia Rossi, Dominik C Benz, Andreas A Giannopoulos, Philipp A Kaufmann, Ronny R Buechel, Claudia Hackl-Zuccarella, Roland von Känel
Journal: Circulation (2023)

Background: As a professional group, physicians are at increased risk of burnout and job stress, both of which are associated with an increased risk of coronary heart disease that seems more prevalent among male than female physicians. Aim: This study aimed to examine the association of burnout and job stress with coronary microvascular function, a predictor of major adverse cardiovascular events. Methods: Thirty male physicians with clinical burnout and 30 controls without burnout were included. Burnout was assessed with the Maslach Burnout Inventory and job stress with the effort-reward imbalance and overcommitment questionnaire. All participants underwent myocardial perfusion positron emission tomography to quantify endothelium-dependent (cold pressor test) and endothelium-independent (adenosine challenge) coronary microvascular function. Burnout and job stress were regressed on measures of coronary microvascular function in the same model while adjusting for age and body mass index. Results: Burnout and job stress had significant and independent effects on endothelium-dependent microvascular function. Burnout was positively associated with coronary flow reserve, myocardial blood flow (MBF) response, and hyperemic MBF (r partial: 0.29 to 0.35; p-value: 0.008 to 0.027). Effort-reward ratio (r partial: -0.32 to -0.34; p-value: 0.009 to 0.017) and overcommitment (r partial: -0.29 to -0.35; p-value: 0.008 to 0.027) showed inverse associations with these measures. Conclusions: In male physicians, burnout and high job stress showed opposite effects on coronary microvascular endothelial function. Longitudinal studies are needed to show potential clinical implications. Future studies should include burnout and job stress for a more nuanced understanding of their potential impact on cardiovascular health.
Abstract 19055: Effectiveness of Mobile Health Applications for Exercise Promotion on Cardiorespiratory Fitness After a Cancer Diagnosis: A Systematic Review and Meta-Analysis
Authors: Sanam M Ghazi, James C Stock, Weidan Cao, Saurabh Rahurkar, Megan E Gregory, Daniel Addison
Journal: Circulation (2023)

Introduction: Cancer survivors are at higher risk for cardiovascular (CV) related mortality. Smartphone application based (app-based) interventions that promote exercise and physical activity are an increasingly prevalent strategy for health promotion. Yet, whether these mobile health (mHealth) interventions improve CV risk after a cancer diagnosis is unknown. Methods: Leveraging MEDLINE/PubMed, Scopus, and Clinical Trials.gov, we identified studies through May 1, 2023. Literature searches were conducted on articles meeting study inclusion criteria and with reported cancer diagnoses. Search terms included smartphone , mobile health , mHealth , app , mobile application , exercise , cancer and cardio-oncology . The main outcomes and measures included change in cardiovascular fitness, reflected by 6-minute walk test (6MWT), VO2max, 3-minute step test and systolic blood pressure or any mention of cardiac measures. Effect sizes were calculated as Cohen’s d. Aggregate effect sizes and moderator variables were tested using random effects models. Results: Overall, from 656 articles, 7 randomized controlled trials (RCTs) with 341 participants were identified. Interventions included mobile apps (n = 6), smartwatches (n = 2), or smartwatch plus an option to also use a web, mobile, or tablet app (n = 1); median age 49.71± 5.9 years; median duration of mHealth use 12 weeks. Across the 7 RCTs, mHealth was associated with improved cardiorespiratory outcomes (Cohen’s d=0.33; 95% CI, 0.07-0.60). Results maintained significance when cholesterol outcomes were added to the other cardiorespiratory outcomes ( d = 0.30; 95% CI = 0.03-0.56). There was no heterogeneity ( Q = 5.86, P &gt;0.05) or publication bias ( P &gt; .05). Among the 4 studies examining the 6MWT, the between groups Δ Cohen’s d was 0.27 (95% CI, -0.21, 0.75). Conclusions: Smartphone app-based exercise promotion interventions appear to be a viable strategy for improving cardiorespiratory fitness after a cancer diagnosis.
Abstract 17246: Using Alerts vs Automated Tools to Better Document CHADS2-VASc Scores in Patients Hospitalized With Atrial Fibrillation
Authors: Daniel Klarr, Corey E Tabit, Matthew Cerasale
Journal: Circulation (2023)

Introduction: Atrial fibrillation (Afib) is the most common cardiac arrhythmia in the United States and a significant burden on our healthcare system. Currently as many as six million people in the United States carry a diagnosis of Afib, with that number likely increasing as our population ages and our methods of detection improve. Accurate diagnosis and risk stratification are imperative as these patients may have stroke rates as high as 20% annually. Comprehensive documentation of the CHADS2-VASc score can better determine the need for Anticoagulation for patients hospitalized with Afib Hypothesis: What is the rate of recording of CHADS2-VASc scores in patients admitted to House Staff and Hospitalist teams and what interventions would lead to better data gathering: a best practice alert or an automated diagnosis tool in the Electronic Medical Record (EMR). Methods: At The University of Chicago Medical Center, attendings on the cardiology service and hospitalists documented CHADS2-VASc without intervention. Then the response rate was measured after implementing a best practice alert, or soft stop dialog box in the EMR. Later for Hospital Medicine teams, an auto diagnosis tool, a hard stop auto-generated in the note, was added to the EMR. Results: Over the course of three years (January 2018 to December 2021) CHADS2-VASc score was charted an average of 1% of the time for hospitalists and 7% of the time for House Staff Cardiology. After implementing the EMR Best practice alert (January 2022 to January 2023 for House Staff and January 2022 to November 2022 for Hospitalists) these rates increased to 19% (p &lt;0.0001) for the hospitalist team and 54% for the House Staff Cardiology team (p&lt;0.00001). With the Auto diagnosis tool (November 2022 to January 2023) the rate increased from 19% to 56% (p &lt;1x10 -7 ) Conclusions: As our data shows, CHADS2-VASc scores recording rates remained low among both cardiology and medicine attendings. However, an EMR generated alert increased responses while an auto diagnosis tool increased documentation even more. This demonstrates the effectiveness of EMR tools. This improvement in adherence should also lead to better rates of prescribing Anticoagulation to patients with higher risk.
Abstract 17301: C-Reactive Protein and Long-Term Risk of Death in Patients With Myocardial Infarction
Authors: Julie Borchsenius, Kristian Kragholm, Martin Bødtker Mortensen, Alexander Egeberg, Christoffer Polcwiartek, Ditte Vesterlev, Christian Torp-Pedersen, Tor Biering-Srensen, Manan Pareek
Journal: Circulation (2023)

Introduction: The long-term prognostic value of C-reactive protein (CRP) in patients with myocardial infarction (MI) is unknown. Purpose: To assess the association between the first CRP measured during hospitalization and long-term mortality in patients with MI. Methods: Using Danish nationwide registries, we identified patients with a first diagnosis of MI from 2012 through 2020 who underwent a CRP measurement during index hospitalization. The primary outcome was death from any cause. The association between CRP levels and death was examined stratifying the patients into quartiles of CRP concentrations. Absolute and relative risks (RR) for death at days 0-30 and 31-365 were calculated through multivariable Cox regression with average treatment effect modeling. Models were standardized for demographic and clinical features, including high-sensitivity troponin (hsTn). Results: We included 36,021 patients with MI and a CRP measurement within 24 hours before or after the time of admission. Median age was 69.7 years and 35.2 % were women. Median CRP in the entire cohort was 4.9 mg/l, and quartile (Q) intervals were: Q1: &lt;3 mg/l, Q2: 3 to &lt;5 mg/l, Q3: 5 to &lt;17 mg/l, and Q4: &gt;=17 mg/l. CRP was significantly and nonlinearly associated with the primary outcome (p&lt;0.001). At 0-30 days, 2694 patients had died, and another 2566 had died between days 31-365. Figure 1 shows the Kaplan Meier curves. The standardized absolute risk of death at both 0-30 and 31-365 days was lowest among patients in Q1 (0-30 days: 4.1%, 31-365 days: 4.8%) and highest among patients in Q4 (0-30 days: 12.1%, 31-365 days: 10.6%). The standardized RR of death compared with Q1 were: 0-30 days 1.01 (95% CI 0.84;1.71), 1.45 (1.26;1.63) and 2.96 (2.61;3.29) in Q2, Q3 and Q4 and at days 31-365, the RR were 1.18 (1.02;1.34), 1.61 (1.42;1.79) and 2.19 (1.95;2.42), respectively. Conclusion: In patients with MI, higher CRP levels were significantly associated with a higher risk of death, independently of hsTn concentrations.
Abstract 17349: Independent and Joint Effect of Central and Brachial Systolic Blood Pressure on Incident Stroke in Hypertensive Adults
Authors: Congcong Ding, Tianyu Cao, Xiao Huang
Journal: Circulation (2023)

Introduction: It is unclear whether central systolic blood pressure (cSBP) is an independent predictor of stroke above and beyond brachial systolic blood pressure (bSBP). Hypothesis: This study aimed to investigate the difference between cSBP and bSBP in predicting first stroke and the joint effect of cSBP and bSBP on the risk of first stroke in hypertensive adults. Methods: A total of 8,122 hypertensive adults without stroke history were included in this study. cSBP was measured noninvasively using A-Pulse CASPro device. The outcome was first stroke. Results: During a median follow-up of 4.4 years, 579 first stroke were identified. The per SD increment of cSBP (HR: 1.16, 95% CI: 1.07, 1.26) and bSBP (HR: 1.16, 95% CI: 1.07, 1.26) was significantly associated with higher risk of first stroke. The differences in areas under the curves, continuous net reclassification indices, and integrated discrimination indices of bSBP and cSBP models for predicting first stroke were 0.003 (95% CI: -0.003, 0.008), 0.007 (95% CI: -0.058, 0.071), and -0.0002 (95% CI: -0.0028, 0.0013), respectively. When cSBP and bSBP were evaluated jointly, participants in the highest tertiles of both cSBP and bSBP had the highest risk of first stroke compared with their counterparts (HR: 1.59, 95% CI: 1.29, 1.96; P-interaction = 0.034). Similar results were found for ischemic stroke and hemorrhagic stroke. Conclusions: Although cSBP was not found to be superior to bSBP in predicting first stroke, cSBP and bSBP were jointly associated with the risk of first stroke among hypertensive adults.
Abstract 17374: Epigenetic Age Acceleration in Adult Congenital Heart Disease
Authors: Parag N Jain, Beryl C Zhuang, Joanne Whitehead, Michael Kobor, Paul Checchia
Journal: Circulation (2023)

Introduction: DNA methylation (DNAm) changes reflect alterations in the immune response to cardiac surgery in older adults. However, whether adults with congenital heart disease (ACHD) who underwent palliative cardiac surgery during childhood experience epigenetic age acceleration (EAA) is unknown. Hypothesis: ACHD patients with Fontan(F) procedures would have advanced EAA compared to healthy adults. Methods: A case-control study in young adults (aged 20-30 years) with Fontan circulation at a tertiary ACHD hospital with age-matched healthy adults. DNAm were measured by the EPIC Array. EAAs were calculated by extracting residuals by regressing epigenetic ages on chronological age in linear regression models for four epigenetic clocks. DNAm-based cell type proportions and EAA differences between the two groups were tested by robust linear models (rlm) adjusted for age, sex, and self-reported ethnicity. Results: Thirteen Fontan patients (6 female: 7 male) were compared with 20 age-matched controls (15 female). The median age of the F group was 23 years, compared to 27 years in control. Both subgroups had a predominant white race and non-Hispanic ethnicity. The F group has lower B memory cells and naïve CD4+ cells than controls (adjusted p&lt;0.05). The F group has statistically significant higher Grimage and Phenoage EAA than the controls (p&lt;0.01). Conclusions: Patients who underwent the Fontan procedure experience advanced EAA at a young age. Future studies evaluating the key predictors that drive EAA difference is needed to understand the impact of chronic alteration of physiology.
Abstract 17295: In Situ Recovery of Multiple Organs Using Venoarterial ECMO in a Murine Model of Uncontrolled DCD
Authors: Nodir Madrahimov, Vitalii Mutsenko, Dejan Radakovic, mohamed hassan, Mathias Rosenfeldt, Suleyman Ergun, Srikanth Karnati, Ivan Aleksic, Christoph Otto, Rainer Leyh, Constanze Bening
Journal: Circulation (2023)

Introduction: The utilization of extracorporeal membrane oxygenation (ECMO) for Donation after Circulatory Death (DCD) can substantially increase the donor pool, organ yield per donor, and organ shelf life. Clinical attempts to recover organs for transplantation after uncontrolled DCD are very complex and hard to reproduce. As a preliminary strategy for completing this endeavor, experimental protocols employing feasible animal models are strongly recommended. Hypothesis: The objective of the investigation was to develop a mouse model of ECMO-based cadaver management protocol for uncontrolled DCD donation after "out-of-hospital" death. Methods: Following 10 min after confirmed death, murine cadavers (C57BL/6 background) were administered with heparin-streptokinase and cannulated for veno-arterial ECMO. Cadaver bodies were connected to a murine ECMO machine 1 h post-mortem and subjected to extracorporeal circulation for subsequent 2 hrs. Blood gas parameters, cardiac activity, and general organ state were assessed using BGA analysis, ECG, and histology, accordingly. We have designed and incorporated into an ECMO circuit a previously unreported, miniaturized murine hemodialysis for the treatment of severe hyperkalemia and metabolic acidosis that arose following death. Results: Control BGA parameters recorded 1 h after death were incompatible with normal physiology: extremely low blood pH, profound negative base excess, and extraordinarily high lactate and K + levels. Two hours after ECMO support, blood pH values of a cadaver body restored from &lt;6.5 to 7.3 ± 0.05, pCO 2 was lowered from &gt;130 to 41.7 ± 10.5 mmHg, sO2, base excess, and HCO 3 were all elevated from below detection thresholds to 99.5 ± 0.6%, -4 ± 6.2 and 22.0 ± 6.0 mmol/L, respectively (Student T-test, p &lt; 0.05). The implementation of hemodialysis resulted in a significant decrease in both hyperlactatemia and hyperkalemia. Conclusions: Our model presents novel opportunities for the management of cadaver organs in order to promote uncontrolled DCD donation, thereby contributing to the resolution of the organ shortage problem. Our approach enables the implementation of a variety of modern blood purification techniques in cadaveric organ recovery using ECLS.
Abstract 18891: Frequency of Abnormal Cardiac Screens in US High School Athletes: Analysis of a National Cardiac Youth Registry
Authors: Nicholas Fox, Nolan Fox, Clara Farrehi, Sean Dikdan, Alexander Hajduczok, David M Shipon
Journal: Circulation (2023)

Introduction: Sudden cardiac arrest affects thousands of children annually, and many heart conditions go undetected by standard child health screens. Cardiac screening of adolescents can identify symptoms suggestive of abnormal cardiac conditions. Despite this, the benefit of cardiac screens in healthy adolescents remains equivocal. Question: At what rate do guideline based cardiac screens identify symptoms suggestive of cardiac abnormalities in the physically active youth? Methods: From 2014 to 2021, Simon’s Heart performed guideline-based heart screenings in youth athletes in Southeastern Pennsylvania. Cardiac screens included a health questionnaire, physical exam (height, weight, blood pressure, cardiac murmur findings), a 12-lead echocardiogram (ECG) read by cardiologists utilizing the international criteria, and echocardiography where recommended. An abnormal cardiac screen was classified as having any of the three abnormalities of hypertension (systolic ≥130 or diastolic &gt;80), heart murmur, or ECG abnormality. Results: 7425 students were screened during a seven-year period. Ages ranged from 12-20 (median of 15) and 61% were male. 1073 of the screened youth athletes (14.5%) had abnormal cardiac screens, 461 (6.2%) had hypertension, 268 (3.6%) had a murmur, 412 (5.5%) had an ECG abnormality and 234 were referred to cardiology for follow up (3.2%). Conclusions: This registry provides evidence that judicious youth athlete screening can uncover significant abnormalities which may require lifelong monitoring. Large registry data are needed to assess the efficacy of such programs.
Abstract 17298: Deep Learning Electrocardiogram Detecting Acute Coronary Occlusion in Myocardial Infarction Presenting Without ST-Elevation
Authors: Robert Herman, Harvey P Meyers, Stephen W Smith, DARIO TINO BERTOLONE, Anthony Demolder, Vladimir Boza, Boris Vavrik, Michal Martonak, Leor Perl, Robert Hatala, Wojciech Wojakowski, Jozef Bartunek, Emanuelle Barbato
Journal: Circulation (2023)

Introduction: One third of Non-ST-elevation myocardial infarction (NSTEMI) patients present with an acutely occluded culprit coronary artery (OMI), associated with poor short and long-term outcomes due to delayed identification and consequent delayed invasive management. Hypothesis: We sought to develop and validate an artificial intelligence (AI) model detecting OMI on single standard 12-lead electrocardiograms (ECGs) and compare its performance to existing standard criteria. Methods: An AI model was developed using 18,616 ECGs from 10,692 unique contacts (22.9% OMI) of 10,543 patients (age 66±14 years, 65.9% males) with acute coronary syndrome (ACS) from an international cohort. This AI model was tested on an international test set of 3,254 ECGs from 2,263 unique contacts (20% OMI) of 2,222 patients (age 62±14 years, 67% males) and compared with STEMI criteria and annotations of ECG experts in detecting OMI on 12-lead ECGs using sensitivity, specificity, predictive values and time to OMI diagnosis. OMI was based on a combination of angiographic and biomarker outcomes. Results: The AI model achieved an area under the curve (AUC) of 0.941 (95% CI: 0.926-0.954) in identifying the primary outcome of OMI, with superior performance (accuracy 90.7% [95% CI: 89.5-91.9], sensitivity 82.6% [95% CI: 78.9-86.1], specificity 92.8 [95% CI: 91.5-93.9]) compared to STEMI criteria (accuracy 84.9% [95% CI: 83.5-86.3], sensitivity 34.4% [95% CI: 30.0-38.8], specificity 97.6% [95% CI: 96.8-98.2]) and similar performance compared to ECG experts (accuracy 91.2% [95% CI: 90.0-92.4], sensitivity 75.9% [95% CI: 71.9-80.0], specificity 95.0 [95% CI: 94.0-96.0]) ( Figure 1 ). Conclusions: The present novel ECG AI model demonstrates superior accuracy in detecting acute OMI when compared to the STEMI criteria. Its external and international validation suggests its potential to improve ACS patient triage with timely referral for immediate revascularization.