tbuckley/cabot-search huggingface dataset:
Abstract 4145634: Clinical Outcomes of Catheter Ablation for Atrial Fibrillation in Younger Adults: A Systematic Review and Meta-Analysis
Authors: Sawai Singh Rathore, Ameer Farrukh, Sem Josue Nsanh Yao, Vanessa Vidaurre Corrales, Zario Wint, Ibrahim Al Shyyab, Aman Goyal, Hritvik Jain, Ashish Kumar
Journal: Circulation (2024)

Background: Catheter ablation has been increasingly used for managing atrial fibrillation (AF), to restore and maintain normal sinus rhythm. Despite its widespread use, it is unclear if there are differences in clinical outcomes, particularly in maintaining rhythm control and safety outcomes, between younger and older adults undergoing catheter ablation. The objective of this meta-analysis was to compare the outcomes following catheter ablation in younger and older adults. Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Using random effect models, mantel-Haenszel odds ratios and associated 95% confidence intervals were calculated to report the overall effect size. The primary endpoints were AF/atrial tachycardia (AT) recurrence and re-ablation requirement. Secondary outcomes included in-hospital complications such as stroke/TIA, cardiac tamponade/pericardial effusion, and vascular complications such as bleeding, hematoma, AV fistula, and femoral pseudoaneurysm. The young adult group varied between studies, ranging from under 30 years to under 45 years. Results: Data from 10 articles, with a sample size of about 126,141 AF patients, were considered. Our analysis indicated that catheter ablation for AF in the younger age group was linked to reduced odds of AF/AT reoccurrence (OR: 0.60; 95% CI: 0.44 to 0.83; p=0.002) and a decreased need for re-ablation after the index procedure (OR: 0.72; 95% CI: 0.53 to 0.97; p=0.03). Furthermore, catheter ablation in younger adults was found to be associated with a lower risk of in-hospital procedural complications like stroke/TIA (OR: 0.59; 95% CI: 0.43 to 0.80; p=0.0008) and cardiac tamponade/pericardial effusion (OR: 0.53; 95% CI: 0.42 to 0.68; p&lt;0.0001). There was no difference between the two groups concerning vascular complications during the procedure (OR: 0.60; 95% CI: 0.28 to 1.27; p=0.18). Conclusion: This meta-analysis demonstrates that younger adults undergoing catheter ablation for atrial fibrillation reported significantly better clinical outcomes than older adults.
Abstract 4145745: Inter-hospital Transfer for Cardiogenic Shock patients: Contemporary Strategies and Outcomes
Authors: Ajar Kochar, Lichen Liang, Zaid Almarzooq, Yang Song, Dhruv Kazi, Eric Secemsky, Robert Yeh
Journal: Circulation (2024)

Background: Cardiogenic shock (CS) is often managed with strategies that require inter-hospital transfers. The contemporary practice patterns and outcomes of transferred CS are unknown. Methods: Patients with CS were identified using ICD-10 codes in Medicare claims from 2016-2021. We used a logistic regression model to assess the association of hospital transfer with mortality. We conducted a sensitivity analysis examining the association of early transfer (≤ 24 hours) versus later transfer (&gt;24 hours) and mortality. Results: We identified 260,092 patients with CS; of which 9.7% required inter-hospital transfer. Mean time to transfer was 3.5 days (Figure). Transferring hospitals were smaller (229 versus 396 beds), less likely teaching hospitals (43% versus 70%), and more likely rural (7% versus 0.4%). Compared with patients with CS that were not transferred, transferred patients were were older (77 versus 75 years) and had comparable co-morbidity burdens (heart failure 71% versus 73%, diabetes 55% versus 55%). Transferred patients were more likely to receive PCI (21% versus 17%), CABG (18% versus 9%), and MCS, including intra-aortic balloon pumps (21% versus 11%) and percutaneous left ventricular assist devices (11% versus 5%). Transferred patients had longer hospital length of stay (17.8 versus 9.8 days) and ICU length of stay (9.7 days versus 5.6 days). Observed mortality for transferred versus not transferred patients with CS was 37.4% and 40.4% respectively. In addition, transferred patients were associated with a lower mortality (adjusted OR 0.78; 95% CI: 0.76 – 0.81). Early transfer was associated with a slightly lower mortality compared with later transfer (36% vs 38%; p &lt; 0.01). Conclusions: Nearly 10% of older patients with CS are transferred to another hospital. Transferred patients were more likely to be treated with revascularization and MCS. Transfer of patients with CS was associated with a lower mortality, especially if the transfer is early within the first 24 hours.
Abstract 4146007: Burden of Non-Rheumatic Valvular Heart Disease in High-income Asia Pacific from 1990-2019: A Benchmarking analysis
Authors: salomi shaikh, Ashwinikumar Shandilya, Khushbu Patel, Muhammad Waqas, Saif Syed, Mohit Lakkimsetti, Paritaben Bhalodia, Hamza Islam, JUHI PATEL, VISHRANT AMIN, HARDIK DESAI, kamal sharma
Journal: Circulation (2024)

Introduction: Non-Rheumatic Valvular Heart Disease (NRVHD) stands as the 5th leading cause of mortality and the 6th leading cause of disability in High-Income Asia Pacific (HIAP) nations. Despite its profound impact, there exists a dearth of comparable and consistent country-level measures for NRVHD. Method: Using global burden of disease methodology, incidence, mortality, and disability-adjusted life years (DALYs) due to NRVHD were estimated stratified by age, sex, year across HIAP countries from 1990-2019. Results: The total prevalence of NRVHD surged from 3 million (95%UI: 2.9-3.1) in 1990 to 5.8 million (5.5-6.2) in 2019, with deaths escalating from 6,023 (5307-6368) to 16,604 (11,447-19,355) over the same period. The age-standardized incidence rate (ASIR) witnessed a 6% annual percentage change (APC) from 1990 to 2019. Notably, Singapore exhibited the highest APC in ASIR at 53%, while Brunei Darussalam reported the highest mortality rate with a 45% increase, and DALYs rate with a 30% rise from 1990 to 2019. The highest incidence occurred in the 55-59 age group, accounting for 32,069 cases, while the highest number of deaths was observed in the 90-94 age group, totaling 4,450 cases, and DALYs peaked in the 85-89 age group, reaching 43,221 cases in 2019. Regarding gender disparities, females bore a higher burden compared to males, with APC in incidence rates of 52% versus 44%, deaths at 113% versus 214%, and DALYs at 47% versus 97% from 1990 to 2019. Conclusion: The study reveals a concerning rise in NRVHD burden across HIAP countries from 1990-2019, necessitating immediate attention and targeted interventions to curb its impact on public health. These findings provide vital insights for policymakers and healthcare stakeholders to formulate effective strategies in combating NRVHD.
Abstract 4145658: Early Prediction of Inpatient Worsening Heart Failure Using Machine Learning
Authors: Apoorva Gangavelli, Rebecca Steinberg, Oreoluwa Olakunle, Alexis Okoh, Jeffrey Wang
Journal: Circulation (2024)

Background: In patients with acute heart failure (AHF), worsening heart failure (WHF) predicts mortality, prolonged length of stay and readmission. We aimed to create a predictive model to identify predictors of intensive care unit (ICU) transfer as a proxy for WHF. Methods: We developed and evaluated retrospectively a machine learning model based on the LASSO algorithm to predict ICU transfer. The algorithm was trained on 11 years of data (from 2010-2020) collected from a large regional healthcare system. We included patients admitted with acute HF, an admission BNP value &gt;100, and excluded direct ICU admissions. The input variables include demographics, vital signs, laboratory values, pre-existing diagnoses, and treatment teams. Model performance was evaluated AUROC. Results: Of 19,351 patients with an index AHF hospitalization, 5,829 (30.1%) required ICU transfer. These patients were younger (70 ± 15 vs 73 ± 16 yrs, p&lt;0.001), more likely to be male (54% vs 51%, p&lt;0.001), and be White (52% vs 40%, p&lt;0.001). These patients had higher rates of 30-day mortality (17% vs 6%, p&lt;0.001), 30-day readmission (11% vs 8%, p&lt;0.001), and a longer median length of stay (12 [7, 20] vs 4 [3, 7] days, p&lt;0.001). Model performance on training and validation datasets yielded AUC=0.78 and AUC=0.78, respectively. Internal medicine primary teams predicted lowest odds of ICU transfer (OR: 0.17 [95% CI: 0.15 - 0.18], p&lt;0.001), while atrial fibrillation predicted highest odds of ICU transfer (1.72 [95% CI: 1.59 - 1.88], p&lt;0.001) (Fig). Conclusion: WHF during index hospitalization was associated with worse 30-day outcomes and longer length of stay. Our model has excellent risk prediction for worsening HF defined by ICU transfer during HF hospitalization.
Abstract 4145692: Patient Autonomy and Statin Therapy Adherence (PASTA) Trial
Authors: Ayman Haq, Ali Aldujeli, Diana Zaliaduonyte, Michael Miedema
Journal: Circulation (2024)

Introduction: Adherence to statin therapy is suboptimal in the primary prevention population, despite extensive data regarding efficacy and safety. Hypothesis: Introducing autonomy in the decision-making process will increase statin adherence and reduce perceived side effects. Goals: Compare six-month rate of statin adherence and perceived side effects in patients who initially decline atorvastatin, between those given reassurance and those offered a supplement trial prior to statin therapy. Methods: Patients &gt; 40 years without a history of ASCVD at a moderate ASCVD risk who decline statin therapy underwent block randomization. The control group was provided education and reassurance regarding the statin therapy and prescribed 30mg atorvastatin. The intervention group was offered a trial of red yeast rice extract 20mg and a goal LDL-C 100 mg/dL. After 2 months those not at the goal LDL-C were then prescribed 30mg atorvastatin (Figure 1). The primary endpoint was the number of monthly pharmacy refills at 6 months. The secondary endpoints were rates of self-reported myalgias, fatigue, mental fog, and gastrointestinal upset at 6 months. The Wilcoxon rank sum test and the Chi-square test was used to assess the primary and secondary endpoints, respectively. Results: The final analysis included 276 patients; baseline demographics, labs and lipid profiles were similar between the two groups. Statin prescriptions filled was higher in the intervention group (Figure 2). The intervention group had lower rates of fatigue and mental fog, but not myalgias or gastrointestinal upset (Figure 3). Conclusion: Introducing autonomy in the decision-making process improved adherence to atorvastatin therapy and reduced the rate of perceived side effects.
Abstract 4145938: Intravascular Radioisotope Detection Catheter for Localization of High-Risk Plaques
Authors: Takehiro Nakahara, Shinichiro Fujimoto, Harry Strauss, Jagat Narula, Tohru Minamino, Hiroyuki Daida, Masahiro Jinzaki
Journal: Circulation (2024)

Background: Rupture-prone high-risk atheromatous plaques are characterized by large plaque and positively remodeled necrotic core volumes and thin fibrous caps with significantly inflammation by the cells of monocyte-macrophage origin. The plaque volumes and remodeling are relatively reliably identified by noninvasive and invasive imaging, however; the detection of coronary inflammation is not conveniently possible. We propose that development of a radioisotope (RI) catheter could help record quantitative uptake of specifically targeted radiotracers against inflammation. counting of be developed. Methods: We developed an RI catheter comprising scintillator and flexible optical fibers, with (sCath) and without (nsCath) shielding scintillator to obtain directionality and evaluated its utility in both in vitro and ex vivo experiments. For an in vitro study, the catheter was placed on 18 F point sources to measure the radioactivity counts. For ex vivo study, atherosclerotic lesions were induced in 6 rabbits balloon injury model. Rabbits received 18 F-fluorodeoxyglucose (FDG) and were sacrificed 2 hours later; the aortas were exposed, and RI catheter was pulled back every 1cm and counts measured the for 1 minute by nsCath, and right (sCath-R) and left (sCath-L) sided catheters. After 3 measurements, the artery was sectioned at 1cm and each segment was counted in an automatic well-type gamma-counter. Specimens were fixed overnight with 4% paraformaldehyde and serial sections were histologically analyzed and characterized immunohistochemically by anti-CD68 antibody for macrophage infiltration. Results: In vitro study showed linear correlation between counts and 18 F souse dose until at 100kBq (R 2 =0.996). For ex vivo study, 71 sections were obtained from 6 rabbits, and the cpm from each catheter was correlated with counts from well counter. The counts of both sCath-R and -L demonstrated the highest correlation (nsCath: r=0.47, sCath-R: r=0.42, -L: r=0.53, sCath-R+L: r=0.54, p&lt;0.01, respectively), and showed excellent agreement with ipsilateral CD68-positive areas, CD68-L&amp;sCath-L: r=0.50, CD68-R&amp;sCath-R=0.42, p&lt;0.01). The average CD68 area correlated with sCath-R+L, but not with nsCath (av. CD68&amp;sCath-R+L: r=0.44, p&lt;0.01, CD68 average; nsCath: r=0.18, p=0.12). Conclusions: The Shielded RI catheter counts correlated with well counts and ipsilateral CD68-positive area and are potentially useful for the detection of inflammation in high-risk plaques.
Abstract 4146189: Perioperative Aspirin and Coronary Artery Bypass Graft Surgery: An Updated Meta-Analysis of Randomised Controlled Trials
Authors: Aashray Gupta, Ammar Zaka, Alexander Lombardo, James Tsimiklis, Brandon Stretton, Joshua Kovoor, Stephen Bacchi, Fabio Ramponi, Justin Chan, Pramesh Kovoor, Julian Smith, Jayme Bennetts, Guy Maddern
Journal: Circulation (2024)

Background: The decision to continue Aspirin before elective coronary artery bypass graft surgery remains contentious due to competing thrombotic and bleeding risks. We performed a contemporary systematic review and meta-analysis to compare outcomes between CABG patients who stopped and continued aspirin before surgery. Methods: PubMed, MEDLINE and CENTRAL databases were searched from inception to 4 th May 2024 for randomized controlled trials (RCTs) comparing patients undergoing CABG who continued preoperative aspirin with those who discontinued before surgery. Studies with co-intervention arms and multivariable-adjusted or propensity matched observational studies were excluded. Summary odds ratios were calculated using a random effects model for dichotomous and continuous variables. Subgroup and sensitivity analyses were conducted in order to explore sources of heterogeneity. Results: Sixteen eligible RCTs were included with a total of 6188 patients. Patients who continued Aspirin demonstrated no significant difference in all-cause mortality [OR 1.37 (0.81-2.33)], perioperative myocardial infarction [OR 0.81 (0.55-1.18)] and postoperative blood loss [mean difference 66.12mL (-1.45-133.69)]. No significant difference was observed between low-dose and higher doses of Aspirin. There was minimal heterogeneity amongst included studies (i 2 = 0%, p=0.97 , i 2 =33%, p=0.13 and i 2 =76, p=0.06 respectively). Studies were of low methodological quality according to Cochrane Risk of Bias for Randomized Trials. Conclusion: This largest to-date systematic review and meta-analysis found no significant difference for risk of all-cause mortality, perioperative myocardial infarction, and postoperative bleeding between patients continuing and stopping Aspirin before CABG.
Abstract 4146105: Diagnostic Yield in Relatives to Sudden Cardiac Death Patients – A 10-year Follow-Up Study
Authors: Christine Groenholdt, Benjamin Hansen, Fredrik Folke, Trine Lauridsen, Anna Axelsson, Bo Winkel, Henning Bundgaard, Jacob Tfelt-Hansen, Alex Christensen, Carolina Hansen
Journal: Circulation (2024)

Introduction: International guidelines recommend cardiogenetic screening of relatives to sudden cardiac death (SCD) patients suspected of having an inherited cardiac disease. However, little is known about the long-term diagnostic yield and risk of cardiac events among relatives. This information is crucial for designing appropriate follow-up strategies for relatives. Aims: To determine the 10-year diagnostic yield and frequency of clinical outcomes in referred families to patients with all cause-SCD. Methods: In this retrospective single-center study, we included consecutively referred families to patients with all cause-SCD from 1 January 2005 until 1 October 2018. Upon referral, the cause of death in the SCD proband was assessed through autopsy reports, genetic testing, and premortem medical records. First-degree relatives were screened following a standard protocol, and diagnostic yields were assessed after five and 10 years of follow-up. Furthermore, cardiac events (i.e. death due to cardiac cause, SCD, aborted SCD, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator therapy) and relevant clinical outcomes in relatives were monitored. Results: A total of 686 relatives (304 families) were included, and mean age at follow-up was 45 years (47% males). The relatives were followed for a mean of 10.9 years during which 22 patients were lost to follow up. Screening over five years led to 73 relatives (49 families) being diagnosed, resulting in a diagnostic yield of 11%. After 10-years of follow-up, 82 relatives (56 families) were diagnosed, increasing the overall diagnostic yield to 12% with arrhythmogenic right ventricular cardiomyopathy being the most prevalent diagnosis. A total of 11 relatives experienced a cardiac event during follow-up, of whom 10 had a definite diagnosis. Conclusion: Over 10 years of follow-up, 82 (12%) relatives to patients with all cause-SCD were diagnosed with an inherited cardiac disease, primarily within the first five years. The majority of relatives who experienced a cardiac event during follow-up had a definite diagnosis. This underscores the importance of early detection and management of inherited cardiac diseases in the screening of SCD relatives.
Abstract 4145662: Mechanical Cardiac Support Reduces Frequent PVCs - Now That's a Stretch!
Authors: Anusha Saga, Jacob Agronin, Alexis Coulis, Andrew Deak, Edmond Cronin
Journal: Circulation (2024)

Background: Although ample evidence exists for the causative role of frequent premature ventricular complexes (PVCs) in the development of cardiomyopathy, they may also be found in cardiomyopathy of other causes. We describe a case of improved PVC burden following implantation of a temporary mechanical circulatory support device in a patient with advanced heart failure. Case Description: A 63-year-old male with familial non-ischemic cardiomyopathy and advanced heart failure on high dose milrinone (0.5 mg/kg/min) was admitted after outpatient right heart catheterization showed cardiogenic shock with high left ventricular (LV) filling pressures and cardiac index of 1.8 L/min/m2. On a previous admission, a high PVC burden had been noted but decreased markedly on outpatient ambulatory monitor placed on the day of discharge (Figure 1A). Telemetry was notable for a high PVC burden, predominated by bigeminy, with a predominant PVC morphology localized to the LV outflow tract (LVOT) (Figure 1B). The patient failed to improve with diuresis requiring axillary implantation of an Abiomed Impella 5.5 heart pump (Impella), with immediate improvement in cardiac output and pulmonary artery pressures. Preoperative transthoracic echocardiogram showed an LV end diastolic diameter (LVIDd) of 70mm compared to 65mm after Impella placement. Of significance, telemetry demonstrated a significantly lower PVC burden after Impella placement (Figure 1C). Discussion: Although frequent PVCs can cause or be the result of cardiomyopathy, data on the effect of volume overload on PVC burden, as demonstrated in this case, are lacking. Left ventricular unloading with mechanical cardiac support led to a dramatic and immediate drop in PVC burden. We suggest that Impella placement relieved congestion and therefore LV stretch, reducing the excitability of the LVOT. This novel observation implies that PVC burden should be assessed when patients are euvolemic and warrants further exploration of the relationship between LV congestion and PVCs.
Abstract 4145362: Sex Differences in Mortality Following ST-Elevation Myocardial Infarction between 2019-2023 : Insights from the Northern New England Cardiovascular Disease Study Group
Authors: Isabelle Lin, Tanush Gupta, Rony LAHOUD, Hannah Chaudry, Eric Rothstein, Daniel Lutz, Cathy Ross, James Flynn, Ansar Hassan, James Devries
Journal: Circulation (2024)

Background: Women have historically had higher mortality following STEMI than men. The difference in mortality is in part related to higher bleeding rates in women when compated to men. Little is known about the mortality differences in women versus men in the current era of radial first and other bleeding avoidance stategie for PCI. Methods: We queried in the NNE database to identofy all PCI cases between 2019 and 2023. From the dataset, patients who underwent PCI for an indication of STEMI were identified, and demographic as well as procedural variables were collected. Patients with shock prior to PCI were excluded. In-hosptial outcomes were assessed including bleeding and need for transfusion. Mortality was obtained from discharge vital status. Standard statisical methods were used to assess significance of differences, using STATA for calculations. Results: A total of 22,681 pateints were identified who underwent PCI between 2019 and 2023. Of these, 4,356 (19.2%) underwent PCI for STEMI and did not have shock. Of the patients with STEMI, 3,198 (73.4%) were men and 1,158 (26.6%) were women. When compared with men, women tended to be older, have smaller BSA, and similar BMI. Procedurally, the percent radial cases and IIBIIIA receptor inhibitor use were similar between men and women. In-hospital mortalty was 3.3% for women and 1.7% for men (p&lt;0.01) during this time period. Bleeding rates and need for transfusion were not different between men and women (Table 1). Conclusions: Desipite similar rates of radial access and bleeding, women undergoing PCI for STEMI in Northern New England continue to have nearly double the mortality of men. More study is needed to understand these diferences and optmimize outcomes for women.