tbuckley/cabot-search huggingface dataset:
Abstract 4135630: Improving Cardiac Rehab Referral and Enrollment Post-Percutaneous Coronary Intervention Through a Workflow Intervention at the Minneapolis VA: A Quality Improvement Study
Authors: Danny Mohama, LAURIE SUBLETT, Viorel Florea, Jennifer Ferguson, Eric Lindquist
Journal: Circulation (2024)

Introduction: Cardiac rehabilitation (CR) is a Class 1A recommendation post-percutaneous coronary intervention (PCI), yet it remains underutilized. At the Minneapolis VA, the referral and enrollment rates for CR post-PCI are significantly below the national goal of 70%, indicating a need for improved strategies to enhance veteran participation. Research Questions: This study investigates the impact of a workflow intervention on CR enrollment rates and seeks to understand how staffing changes may influence these rates. It also explores the potential for advanced practice providers to affect CR enrollment. Aim: We aim to increase CR enrollment to 40% and referrals to 50% post-PCI at the Minneapolis VA by August 2023, utilizing a nurse practitioner dedicated to interventional cardiology patients post-PCI. Methods: Utilizing the VA CART database, demographic data for patients undergoing PCI between October 2017 and August 2023 were analyzed, excluding those who died within 30 days of PCI. CR referrals within 90 days and enrollments within one year were tracked. Statistical process control charts were used to detect variations in referral and enrollment rates, with a t-test determining significance. The staffing change intervention occurred in May of 2020. Results: The intervention led to a significant increase in both referral and enrollment rates. The average monthly referral rate rose from 24% to 37%, and the enrollment rate from 14% to 28%. A statistical process control chart indicated special cause variation in the sample after the intervention, suggesting meaningful change. Statistical analysis confirmed these increases as significant (p&lt;0.001). Conclusion: The staffing intervention at the Minneapolis VA significantly improved CR referral and enrollment rates post-PCI. This suggests that dedicated cardiac care providers can play a crucial role in enhancing CR utilization, potentially informing future quality improvement initiatives.
Abstract 4120534: Long-Term Outcomes After Medication, Coronary Stenting or Surgery for Men and Women With Three-Vessel Coronary Disease
Authors: Jiawen Li, Kailun Yan, Kexin Zhang, Menglu Liu, Yuejin Yang, Jinqing Yuan, Xueyan Zhao
Journal: Circulation (2024)

Background: Sex is a vital prognostic factor in patients with coronary heart disease, however, the data on sex-treatment interaction among real-world patients with three-vessel coronary disease (TVD) are limited. Objectives: This study aimed to investigate the long-term outcomes after medication therapy (MT), percutaneous coronary intervention (PCI), and coronary artery bypass grafting surgery (CABG) according to sex in patients with TVD. Methods: Consecutive 8943 patients with TVD [2421 (27.1%) MT, 3825 (42.8%) PCI, and 2697 (30.2%) CABG] were enrolled from April 2004 to February 2011 at Fu Wai Hospital. The primary endpoint was cardiac death and major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction (MI), stroke or repeat revascularization. The secondary endpoints were the components of MACCE. Results: Among 8943 TVD patients, 7122 (79.6%) were men and 1821 (20.4%) were women. While the number of women undergoing PCI was comparable to men, women opted for more MT and fewer CABG (Figure 1). During a median 6.6-year follow-up, CABG showed a lower risk of MACCE compared to PCI, with a similar treatment effect for women and men (female HR: 0.76; 95% CI: 0.60 to 0.97; male HR: 0.61, 95% CI: 0.55 to 0.69; p for interaction=0.222) (Figure 2 and Figure 3). CABG also showed lower risks of all-cause death, MI, and repeat revascularization, and a higher risk of stroke, which had no significant interaction with sex. PCI, compared to MT, was associated with lower risks of MACCE, all-cause death, and stroke and a higher risk of MI and repeat revascularization, without significant gender disparities. CABG versus MT was associated with lower risks of MACCE, all-cause death, MI and repeat revascularization and a higher risk of stroke, with a similar treatment effect for female and male patients (Figure 3). Conclusion: There was no significant sex differences in the risks of long-term outcomes of PCI vs. CABG, PCI vs. MT, and CABG vs. MT in real-world TVD patients.
Abstract 4136900: Left-to-right ventricular volume ratio as a predictor of cardiovascular events: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Malak Hoballah, Omar Chehab, Ashkan Abdollahi, Colin Wu, Bruna Scarpa, Wendy Post, Norrina Allen, David Bluemke, Bharath Ambale-Venkatesh, Joao AC Lima
Journal: Circulation (2024)

Background: The left ventricle (LV) and right ventricle (RV) are closely connected anatomically and functionally. Therefore, relative volume alterations signify pathologic disequilibrium even when within the normal range for chamber volumes. We aimed to define the prognostic value of volumetric imbalance between the LV and RV in the general population. Methods: The study sample consisted of 4073 asymptomatic participants from the Multi-Ethnic Study of Atherosclerosis who had a cardiac MRI at baseline. The left to right ventricular volume ratio (LRVR) was defined as LV volume/RV volume at end diastole. LRVR was categorized into balanced reference category 0.8-1.3, low (RV predominance) &lt;0.8, and high (LV predominance) &gt;1.3. Multivariable cox regression models were used to study the association between LRVR and heart failure (HF), atrial fibrillation (AF), and death. Results: The mean age of participants was 61.3±10 years, with 52% females. Participants were followed for a median of 17.8 years for HF, 16.7 years for AF, and 17.1 years for death. During follow up, 239 (5.9%) participants developed HF, 772 (19%) developed AF, and 906 (22.2%) died. When compared with the reference balanced LRVR group, those with high LRVR had increased risk of HF (HR 2.55; 95% CI 1.7-3.8; p &lt;0.01), AF (HR 1.57; 95% CI: 1.2-2.06; p&lt;0.01), and death (HR 1.63; 95% CI: 1.29-2.07; p&lt;0.01) after adjusting for demographics and traditional cardiovascular risk factors. Participants with low LRVR had increased risk of HF (HR 1.88; 95% CI 1.1-3.2; p=0.02) and death (HR 1.51; 95% CI 1.12-2.04; p&lt;0.01) in crude models. Adjusting for risk factors maintained increased risk of HF and death, but statistical significance was lost. Low LRVR was not associated with increased risk of AF. In a subgroup of participants with both absolute RV and LV volumes within normal ranges, high LRVR was still associated with increased risk of HF, AF, and death after adjusting for risk factors. Conclusion: In healthy asymptomatic participants at baseline, LV volume exceeding RV volume by at least 30% is associated with increased risk of HF, AF, and death. This relationship is independent of cardiovascular risk factors and absolute dilatation of either ventricle.
Abstract 4141437: Identification of Mitochondrial-related Diagnostic Biomarkers of Acute Type A Aortic Dissection and Pan-Cancer Analysis
Authors: Fangshun Tan, yu jiang, miao yu, Hai-Yan Qian, WeiXian Yang
Journal: Circulation (2024)

Background: Acute Type A Aortic Dissection (ATAAD) is a lethal disease with limited predictability globally. Cancer, a severe public health issue worldwide, has now become the second leading cause of death in America. In this study, we aimed to explore potential common mechanisms and therapeutic targets between ATAAD and cancer. Aims: Identify mitochondrial-related diagnostic biomarkers of ATAAD and their roles in various cancers. Methods: ATAAD-related datasets GSE52093, GSE98770, GSE190635 were downloaded from GEO and merged after removing batch effects. We verified 119 mitochondrial-related differentially expressed genes (DEGs), followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Using five machine learning methods (LASSO, SVM, Decision Tree, Random Forest, and Boruta algorithm), we identified two mitochondrial-related diagnostic biomarkers of ATAAD: PPIF and CASQ1. The diagnostic accuracy was performed using receiver operating characteristic (ROC) curves. RT-qPCR was used to detect PPIF and CASQ1 expression. Immune infiltration analysis suggested that PPIF may play a key role in tumor immune microenvironment. We utilized TCGA and GTEx databases, Kaplan-Meier analyses and Cox regression analyses to assess PPIF expression and survival analysis in 33 cancer types. qPCR and Western Blot (WB) assays verified PPIF overexpression in lung adenocarcinoma (LUAD) and uterine corpus endometrial carcinoma (UCEC). CCK-8, wound-healing and transwell assays further verified PPIF’s proliferative, migratory and invasive abilities in LUAD and UCEC. Results: Our study identified PPIF and CASQ1 as hub mitochondrial-related diagnostic biomarkers of ATAAD. Besides its close association with tumor immune infiltration, PPIF also overexpressed in multiple cancer types. Survival analysis suggested the prognostic value of PPIF in most cancers. Experimental results further verified that PPIF promotes the proliferation, migration, and invasion of LUAD and UCEC. Conclusions: PPIF and CASQ1 are potential mitochondrial-related diagnostic biomarkers of ATAAD, not previously reported. Pan-cancer analysis implies that PPIF may serve as a key prognostic and therapeutic target in multiple cancers. PPIF may act as a hub gene linking ATAAD and cancer, offering new insights to reduce ATAAD incidence in cancer patients.
Abstract 4140167: Lipid Management among US Veterans with Prevalent Atherosclerotic Cardiovascular Disease (ASCVD) * Veteran Affairs Lipid Optimization Reimagined Quality Improvement Program (VALOR-QI)
Authors: Jeff Leya, Kyle Hines, HEPSI KALAPALA, CHRISTINA QUILLIAN, Salvator Gutierrez, Sonia Thomas, marianne tully
Journal: Circulation (2024)

ASCVD is the most prevalent form of cardiovascular disease and the main cause of morbidity and mortality for Veterans in the VA healthcare system. Management of cholesterol is one of the most effective approaches for reducing CV disease, however, over two-thirds of Veterans with ASCVD are not optimally managed. Veterans with ASCVD are at high risk for recurrent CV events and can benefit greatly from more effective management of their low-density lipoprotein (LDL-C) cholesterol. The reasons for the current undertreatment of dyslipidemia in Veterans with ASCVD are multifaceted, including factors such as low disease awareness among the patients, patient’s preference, statin intolerance, and poor adherence to medications. Purpose: VALOR-QI is a collaborative effort between the U.S. Department of Veterans Affairs (VA) and the American Heart Association (AHA) with the goal of positively impacting Veterans’ cardiovascular health. Method: This project targets at risk veterans over 18 years of age, with ASCVD and LDL-C ≥70 mg/dl or non-HDL-C ≥100 mg/dl identified across 50 VA medical centers nationwide. As part of the program, VA sites work with an AHA QI Consultant to develop and deploy a local quality improvement plan to help overcome site specific barriers preventing Veterans from achieving optimal cholesterol levels. Health coaches at these centers aid in lipid optimization through patient counseling, medication adherence support, appointment reminders, and referrals to a nutritionist or clinical pharmacist as required. The plan’s effectiveness will be assessed by tracking LDL-C goal achievement rates, LDL-C changes with therapy use, and veteran demographics. Our primary endpoints are for over 30% of veterans to reach the LDL-C target and a significant drop (around 10%) from baseline in veterans with ASCVD and LDL-C not at target. Best practices are shared among sites using the PDSA implementation science model. Results: As of May 2024, 182 patients at the Hines VA are engaged in the project. Among them, 84.8% are on lipid-lowering therapy, 83.1% are on statins (with 57.9% on a high intensity dose), and 11.3% are on dual therapy with a statin plus an additional medication (PCSK9 inhibitor or ezetimibe). So far, 59.5% of enrolled patients reached their LDL-C cholesterol target of &lt;70 mg/dl. Conclusion: Lipid lowering strategies with collaboration of patients, network providers, dieticians and health coaches improved lipid control in veterans with ASCVD.
Abstract 4145873: Optimal Timing for Coronary Artery Bypass Grafting in NSTEMI Patients: A Retrospective Cohort Analysis of In-Hospital Mortality and Stroke Prevalence Over 2017 to 2021
Authors: Viet Nghi Tran, Doan Ngoc Chau Nguyen, Thanh Bilo, Hoang Nhat Pham, Thoai Hoang Phu, Thach Nguyen
Journal: Circulation (2024)

Background: Recent studies have suggested performing coronary artery bypass grafting (CABG) within 24 hours of acute myocardial infarction increases mortality risk. However, the ideal timing after the first day remains unclear. This study aims to suggest an optimal timing of CABG in NSTEMI patients using the large National Inpatient Sample (NIS) database over a 5-year period. Methods: This retrospective cohort study analyzed survey-weighted NIS data over 2017-2021, including adult-age admissions with NSTEMI as the principal diagnosis who underwent CABG without prior transfer from another hospital. Patients were categorized into eight groups based on days from admission to CABG (0, 1, 2, 3, 4, 5, 6, and ≥7 days). Baseline characteristics were compared across groups. Multivariate regression analysis adjusted for multiple confounders to assess the association between Time-to-CABG and in-hospital mortality and stroke prevalence. Results: Table 1 presents the baseline characteristics across the eight groups, encompassing 142,200 included admissions (mean age 65.24 years; 26.78% female). In-Hospital Mortality: The adjusted odds ratios (OR) were less than one for groups 1 through 7 compared to group 0, indicating that immediate CABG (day 0) is associated with higher mortality risk. While the reduced odds in the day 1 group were not statistically significant, substantial and statistically significant reductions in mortality were observed between days 2 and 5 (OR: 0.624 - 0.609; p&lt;0.05). After day 5, the OR for mortality trended up, reaching 0.667 (p&lt;0.05) on day 6 and 0.692 (p&lt;0.05) for surgeries performed on day 7 or later. Stroke Prevalence: The adjusted ORs for stroke prevalence were significantly lower for groups 1 through 7 compared to the CABG within 24-hour group (all p-values &lt;0.05). The lowest ORs were observed between days 2 and 4 (OR: 0.654 and 0.542, p&lt;0.05, respectively). After day 4, the ORs increased, reaching 0.672 (p&lt;0.05) for surgeries performed on day 5 and 0.609 (p&lt;0.05) on day 7 and beyond. Conclusion: The mortality risk in NSTEMI patients remained higher if CABG was performed in the first 48 hours of admission (end of day 1) compared to later. This risk also increased if CABG was done after day 5. Combined with the possible risk of stroke being increased from day 5, we suggest the optimal time-to-CABG is between admission day 2 and day 4 in NSTEMI patients. Future prospective studies are warranted to confirm these findings and guide clinical practice.
Abstract 4139186: Bempedoic Acid and Limb Outcomes in Statin-Intolerant Patients with Peripheral Artery Disease
Authors: Marc Bonaca, Mario Enrico Canonico, Na Li, William Sasiela, Steven Nissen, Abraham Lincoff, Stephen Nicholls
Journal: Circulation (2024)

Introduction: Patients with peripheral artery disease (PAD) are at high risk of major adverse limb events (MALE) and CV events and have high rates of recurrence of these events. Recently, bempedoic acid was shown to reduce MACE in primary and secondary prevention patients. Whether bempedoic acid reduces the risk of MALE is unknown. Methods: CLEAR Outcomes randomized 13,970 patients to bempedoic acid 180 mg or placebo. A clinical history of PAD was reported by investigators at baseline. Two blinded vascular medicine specialists independently adjudicated all adverse events for limb outcomes including worsening PAD symptoms leading to revascularization, chronic limb threatening ischemia, and acute limb ischemia events with the composite defined as MALE. Outcomes were assessed as time to first event as well as total (including recurrent) events using a negative binomial approach. Results: A total of 1,624 of the enrolled patients had PAD at baseline. Over a median of 41.1 months the rate of first and total MALE events in patients with PAD in the placebo group were 8.3% and 13.7% respectively. Bempedoic acid reduced first MALE events by 36% (HR 0.64, 95% CI 0.44-0.93) with an absolute risk reduction (ARR) of 2.5% and number needed to treat (NNT) of 40, compared to placebo (figure, panel A). Similarly, when considering total events, bempedoic acid reduced MALE by 45% (RR 0.55, 95% CI 0.35 – 0.85, figure panel b). Consistent benefits were observed for MALE in the overall population as well as composites of MACE and MALE in both populations (Figure panel b). There was no evidence of effect modification for the benefit of bempedoic acid for MALE on the basis of PAD at baseline (p-interaction 0.09). Conclusions: Bempedoic acid significantly reduces MALE. Benefits appear potentially greater when considering total (i.e. recurrent) events. These findings support the importance of LDL-C lowering therapy in patients with PAD. In addition, these findings support the early use of therapies with proven MALE benefit, including bempedoic acid, to optimize outcomes in PAD.
Abstract 4148083: Mechanism of Acute Mitral Regurgitation in Patients with Acute Coronary Syndrome As A Predictor Of Mortality
Authors: Raul Rodrigo Neri Bale, Eder Jonathan Amaro Palomo, Eder Gonzalez Macedo, Ximena Latapi Ruiz Esparza, Romeo Arias-Escarpulli, Mariana Garcia Villarejo, Alberto Santiago Hernández, Diego Araiza, Rodrigo Gopar-Nieto, Alexandra Arias-Mendoza
Journal: Circulation (2024)

Introduction: Mechanical complications after acute myocardial infarction (MI) have decreased in the context of readily available pPCI and other reperfusion therapies, however, many patients still cannot achieve adequate reperfusion status. Acute Mitral Regurgitation (AMR) is associated with worse clinical outcomes, and can be classified according to three main mechanisms; papillary muscle ischemia, papillary muscle rupture and left ventricular remodeling. Data regarding AMR an association between disease mechanism and mortality is lacking. Objective: To assess the association between AMR mechanism and mortality Methods: We performed a retrospective cohort study and included patients who visited the ED in a Mexican National Institute due to ACS who also presented AMR from February 2006 through to October 2023. A univariate Cox regression model was performed and adjusted by age and sex, and the only Killip-Kimball class (K-K) and Type of ACS at admission showed significance, which both persisted in individual adjusted multivariate analyses. A survival analysis with Kaplan-Meier curve was done. Results: We included 161 patients in the analysis. The frequency per AMR mechanism was 98 (60.4%) for ischemia of papillary muscle, 33 (20.3%) for papillary muscle rupture, and 30 (19.3%) for left ventricular remodeling. The multivariate Cox regression models were done by subgroup analysis, by each different type of AMR mechanism. Ischemia of Papillary Muscle showed a significantly increased risk for mortality when analyzed by K-K (HR 1.48, 95% CI 1.01-2.17, p=0.045), but showed a decreased risk by ACS type (HR 0.39, 95% CI 0.18-0.82, p=0.014). Papillary Muscle Rupture was associated with increased risk for mortality in the model with K-K (HR 1.8, 95% CI 0.95-3.38, p=0.067) but not by ACS type. Left Ventricular Remodelling was not significantly associated with an increased risk in any model. Conclusions: In patients presenting AMR and ACS, there was an increased risk of mortality in the subgroup of patients with ischemic mitral regurgitation.
Abstract 4145877: Association of heat exposure with cardiovascular and all-cause hospitalizations among elderly adults in the United States
Authors: Esha Bansal, Jagadeesh Puvvula, Kaitlyn Shultz, Sameed Ahmed Khatana
Journal: Circulation (2024)

Background: Heat exposure is associated with an increase in cardiovascular mortality, particularly among older adults. Climate change has led to an increase in days with hot temperatures. The burden of hospitalizations associated with heat exposure is not well known. Methods: Data on all hospitalizations among Medicare beneficiaries 65 years of age and older in summer months (May through September) for 2016 to 2019 were obtained from Medicare Provider Analysis and Review (MEDPAR) files. Total daily cardiovascular and all-cause hospitalizations in each US county in the contiguous United States (US) were determined and daily county-level maximum heat index levels were obtained from the gridMET dataset. Counties with &lt;100 elderly residents were excluded. The association between daily heat index and hospitalizations was quantified using the distributive lag non-linear framework, with a generalized linear regression model – assuming a quasi-Poisson distribution. The model accounted for the lagged association, for up to 10 days, for daily heat index as well as covariates (ozone, particulate matter, and precipitation levels). Estimates from this model were used to determine the number and fraction of hospitalizations attributable to high temperatures on hot days. Hot days were defined as those with a heat index level in the 90 th percentile based on a county-specific historical period (1979-2015). Results: A total of 2085 counties (out of 3108) were included. The median threshold for hot days was 90.2°F (IQR 84.8°F to 95.5°F) [32.3°C (IQR 29.3°C to 35.3°C)]. Between 2016 and 2019, hot days were associated with 3044.0 (95% CI 2641.5 to 3380.9) or 0.067% (95% CI 0.058% to 0.074%) of all cardiovascular hospitalizations. Hot days were associated with 42132.2 (95% CI 41159.9 to 43082.1) or 0.22% (95% 0.21% to 0.225%) of all hospitalizations among Medicare beneficiaries. Conclusions: Between 2016 and 2019 days with high heat index levels were associated with higher levels of cardiovascular and all-cause hospitalizations among elderly Medicare beneficiaries across the contiguous US. As the number of hot days continues to increase due to climate change, the burden of heat related hospitalizations is likely to continue to increase.