tbuckley/cabot-search huggingface dataset:
Abstract 4146291: Trends and Disparities in Circulatory Disease Prevalence in U.S. Adults: A National Health Interview Survey Database Analysis (2019-2022)
Authors: Farah Yasmin, Abdul Moeed, Maryam Shaharyar, Hafsah Alim Ur Rahman, Muhammad Ahmed Ali Fahim, Rohan Kumar Ochani, Muhammad Sohaib Asghar
Journal: Circulation (2024)

Background: Circulatory diseases represent the primary cause of mortality in the US. Comprehending trends and potential disparities in the prevalence of circulatory conditions, such as angina pectoris (AP), myocardial infarction (MI), hypertension (HTN), and coronary heart disease (CHD), is essential for forming public health strategies. Aim: To investigate trends in the prevalence of circulatory conditions, including AP, MI, HTN, and CHD among US adults from 2019 to 2022. Methods: Prevalence percentages for all available circulatory diseases from the Centers for Disease Control and Prevention's National Health Interview Survey (NHIS) database were retrieved for patients aged &gt;18 years from 2019 to 2022. Annual Percentage Changes (APCs) along with their respective 95% CIs were calculated using regression analysis with Join point. The data was stratified by year, gender, age, race, nativity, veteran status, social vulnerability, employment status, metropolitan statistical area (MSA) status and census region. Results: Between 2019 and 2022, HTN was steadily the most prevalent, staying relatively constant at 27.0% (95% CI: 26.4, 27.7) in 2019 and 27.2% (95% CI: 26.5, 27.8) in 2022. Males consistently had higher prevalence than females with significant increases noted from 2019 to 2022 (APC: 1.0234). Black or African American had the highest prevalence (34.4% in 2022). The South (30.1% in 2022) and the West (22.5% in 2022) had respectively the highest and lowest rates. The second highest prevalence was seen in CHD increasing from 4.6% (95% CI: 4.3, 4.9) in 2019 to 4.9 (95% CI: 4.7, 5.2) in 2020. Males consistently exhibited a higher prevalence than females, with both genders showing significant increases in recent years (Male APC: 3.1448) (Female APC: 2.0165). For MI, a slight decrease was noted from 3.1% (95% CI:2.9, 3.4) in 2019 to 3.0% (95% CI:2.7, 3.2) in 2022. White individuals exhibited the highest prevalence (3.3% in 2022). AP had the lowest overall prevalence staying relatively consistent (1.7% in 2019 and 1.6% in 2022) (Figure 1). Conclusion: Significant trends (Figure 2) in most common circulatory diseases have been identified. Targeted interventions are imperative, particularly for high-risk demographics such as males, older adults, veterans, and unemployed individuals.
Abstract 4146331: Unraveling the Enigma of Acute Myocardial Infarction-Related Mortality in Malignancy Among Older Adults (≥65 years), A Decadal Dive into U.S Trends (1999-2020): A CDC WONDER Database Analysis
Authors: Muhammad Abdullah Naveed, Rabia Iqbal, Ahila Ali, Muhammad Omer Rehan, Bazil Azeem, Faizan Ahmed, Mustafa Sajjad Cheema, Yasar Sattar, Brijesh Patel, Muhammad Ahmad
Journal: Circulation (2024)

Background: Acute Myocardial Infarction (AMI) in malignancy is a significant cause of mortality globally. This study analyzed demographic trends and disparities in mortality rates due to AMI in malignancy among adults aged 65 and older from 1999 to 2020. Methods: A retrospective analysis was performed using death certificate data from the Centers for Disease Control and Prevention database from 1999 to 2020. The analysis utilized ICD* codes I21 for AMI and C00-C97 for malignancies. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons, and trends were assessed using Average Annual Percentage Change (AAPC) and annual percent change (APC). Data were stratified by year, sex, race/ethnicity, and geographical regions. Results: Between 1999 and 2020, AMI in malignancy caused 172,691 deaths among U.S. older adults aged ≥65 years. The majority of deaths occurred in medical facilities (56.9%) and at decedents’ homes (24.2%). The overall AAMR for AMI in malignancy-related deaths decreased from 30.2 in 1999 to 14.2 in 2020, with an AAPC of -3.90 (p &lt; 0.000001). Men showed higher AAMRs than women (28.6 vs. 12.3), with a more pronounced decrease in men (AAPC: -4.22, p &lt; 0.000001) compared to women (AAPC: -3.78, p &lt; 0.000001). Racial disparities were significant, with Black individuals having the highest AAMR (22.7), followed by Whites (19.3), American Indians or Alaska Natives (14.4), Hispanics (12.2), and Asians or Pacific Islanders (10.8). The decline in AAMR throughout the study was most pronounced in Black individuals (AAPC: -4.30, p &lt; 0.000001). Geographically, the highest AAMRs were observed in Arkansas (32.3) and the lowest in Nevada (8.1). The Northeastern U.S. had the highest regional AAMR (20.2), followed by the Midwest (19.9), South (18.3), and West (17.4). Nonmetropolitan areas had higher AAMRs than metropolitan areas, though both saw significant declines from 1999 to 2020 (Metropolitan: AAPC: -3.97, p &lt; 0.000001; Nonmetropolitan: AAPC: -2.64, p &lt; 0.000001). Conclusion: This study reveals significant demographic disparities in mortality rates related to AMI in malignant older adults. These findings emphasize the need for targeted interventions and improved access to care to reduce mortality and enhance outcomes in this vulnerable population.
Abstract 4146349: Coronary atheroma burden and structural vascular dysfunction in women with suspected ischemia and no obstructive coronary artery disease.
Authors: Sachini Ranasinghe, Amelie Paquin, Yujie Cui, Jenna Maughan, G B John Mancini, Michael Nelson, Carl Pepine, Janet Wei, C Noel Bairey Merz
Journal: Circulation (2024)

Background: Different mechanisms have been proposed to explain abnormal coronary flow reserve (CFR), with authors describing structural vs functional endotypes of coronary microvascular dysfunction (CMD). Epicardial coronary atheroma burden (AB) index is a marker of vascular remodeling confirmed by intravascular ultrasound and is estimated by the measurement of coronary artery tapering. Atheroma burden index is inversely related to CFR in women with suspected ischemia and no obstructive coronary artery disease (INOCA). We hypothesized that AB could help better understand the pathophysiology of these CMD endotypes. Purpose: To evaluate the association between epicardial AB, baseline average peak velocity (APV), and resting coronary blood flow (CBF) to better understand endotypes (structural vs functional) of vascular dysfunction. Methods: Women with suspected INOCA (n=180) enrolled in two prospective cohort studies (NCT02582021, NCT03876223) who underwent clinically indicated invasive coronary function testing with a Doppler wire measuring CFR, baseline APV and resting CBF, were included in this analysis. Epicardial AB was measured by core laboratory and was derived for the left main and anterior descending coronary segments. The association of AB with CBF and APV was assessed using Pearson’s correlation coefficient. Results: Mean age was 55±10 years, body mass index 27.5±5.9 kg/m 2 , 33% had hypertension, 12% diabetes, 18% dyslipidemia and 27% were former smokers. Mean average AB was 1.33±0.37, mean maximal AB was 2.02±0.54 and mean CFR was 3.23±2.35. Both average and maximal AB negatively correlated with resting CBF (r=-0.23, p=0.005; and r=-0.20, p=0.015, respectively) and positively correlated with baseline APV (r=0.23, p=0.002; and r=0.18, p=0.015, respectively). (Figure) Conclusions: These results suggest that the findings of a low resting CBF and high baseline APV, among women with suspected INOCA, is associated with a higher epicardial coronary AB. The use of baseline APV and resting CBF could help identify those who are affected by a structural endotype of coronary vascular dysfunction.
Abstract 4146287: Social Determinants of Health: Impact on Mortality and Care Status for Adults with Congenital Heart Disease
Authors: Jamie Jackson, Rittal Mehta, Rose Hardy, Keila Lopez, Lindsey Rudov, Ruth Phillippi, Anushree Agarwal, MARK ROEDER, Sneha Saraf, Matthew Lewis, Arwa Saidi, Ronald Kanter, Satinder Sandhu, THOMAS YOUNG, Roni Jacobsen, Emily Ruckdeschel, Adam Lubert, Harsimran Singh, Ali Zaidi, Dan Halpern, Scott Leezer, Thomas Carton, Anitha John
Journal: Circulation (2024)

Introduction: Social determinants of health (SDOH) impact health outcomes for adults with congenital heart disease (CHD). We sought to understand how SDOH impacted access to care and mortality in adults with CHD. Methods: Electronic health records were queried across 13 PCORnet clinical sites to identify adults with CHD (CHI-RON study). Those with moderate or complex CHD lesion types were included in the current analyses. Social deprivation index (SDI), our predictor, was calculated using zip code scores (0-100) and were categorized into quintiles (from least to most deprived). Out of care status was defined as no cardiology visit for &gt;2 years (complex CHD) or 3 years (moderate CHD) as of 2/28/20. Only centers with &gt; 90% positive predictive value on care status validation were included in the care status analysis. Mortality was confirmed through the National Death Index. Multivariable logistic regression assessed the association between SDI and outcomes (mortality, care status) with fixed effects for CHD complexity, age, sex, and random effects for sites. Results: Our cohort included 20495 patients with a median age of 33 years (range: 23-48), 50% with moderate CHD, 50% male, 10.3% non-Hispanic Black, 13.2% Hispanic, and 42% urban. Of 5916 included in the care status analysis, 41.7% were out of care. Higher (worse) SDI scores had greater odds of being out of care, with the greatest risk in the highly (OR 1.3, CI: 1.1-1.6, p&lt; 0.001) and most deprived (OR 1.4, CI: 1.2-1.7, p&lt;0.001) communities. SDI factors most associated with being out of care included regions with lower educational attainment (OR 1.6, CI: 1.4-1.8, p&lt;0.001), lower vehicle (OR 1.5, CI 1.4-1.7, p&lt;0.001) or home (OR 1.7, CI 1.5-2.0, p&lt;0.001) ownership, and higher unemployment (OR 1.8, CI 1.5-2.2, p&lt;0.001). Mortality rate was ~3% (n=618). Factors associated with higher odds of mortality included: living in highly deprived (OR 1.7, CI: 1.3-2.1, p&lt;0.01) or most deprived (OR 1.6, CI: 1.2-2.1, p&lt; 0.01) communities, Black (OR: 1.9; CI: 1.5-2.3, p&lt;0.01) or Hispanic (OR: 1.6; CI: 1.2-2.1, p&lt;0.01) race and ethnicity, and living in rural areas (OR: 2.0; CI 1.5-2.6, p&lt;0.001). Conclusions: Adults with CHD living in areas with higher SDI scores may be at greater risk for not receiving recommended cardiology care and mortality; Black, Hispanic, and rural ACHD patients may be at higher risk for mortality. Further study is needed to understand how social and systemic drivers intersect with race to impact CHD.
Abstract 4146421: Efficacy of Atrial Shunt Devices in Heart Failure with Preserved Ejection Fraction: A Systematic review and Meta-analysis of randomized trials.
Authors: Alonzo Prata, Eric Katsuyama, Pedro Gabriel Scardini, Ana Carolina Coan, Christian Fukunaga, Julia Fernandes, Wilson Falco Neto, Rafael Petri Santos Pinheiro, Naieli Andrade, Luciana Gioli-Pereira
Journal: Circulation (2024)

Background: The potential benefit of an iatrogenic interatrial shunt in heart failure (HF) is based on observations wherein decompression of the pressure-overloaded left atrium appears beneficial. Consequently, devices designed to mimic this effect have been developed. However, their effectiveness remains controversial. Methods: We searched PubMed, Cochrane, and Embase for randomized controlled trials (RCTs) comparing the use of atrial shunt devices (ASD) versus standard therapy in patients with heart failure with preserved ejection fraction (HFpEF). The outcomes of interest were: (1) quality of life assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and (2) HF events after ASD intervention. Heterogeneity was examined with I2 statistics. Statistical analysis was performed using R Studio 4.3.2. Results: A total of 3 RCTs were included, encompassing 966 patients, of whom 479 (49.5%) were in the ASD group. Most of the participants were female (53%), had a three or higher NYHA class(92%), with a mean age of 72.5 years and a mean follow-up of 1.2 years. In the pooled analysis, there was no difference between groups in improvement of KCCQ (MD 0.65; 95% CI −2.22,3.52; p=0.66;I2=0%; Fig 1) and HF events (RR 1.06; 95% CI 0.81,1.39; p=0.68;I2=0%; Fig 2). Conclusion: In this meta-analysis of patients with HFpEF, ASD therapy was not associated with improvements in quality of life and HF events.
Abstract 4146286: Embolization of an Amplatzer Amulet Through a MitraClip Causing Torsades and LVOT Obstruction: A Case Report
Authors: Clayton Davis, Bria Giacomino
Journal: Circulation (2024)

Introduction: The morphology and blood stasis of the left atrial appendage (LAA) in tandem with disorganized conduction in atrial fibrillation (AF) creates favorable conditions for thrombus formation. Left atrial appendage occlusion (LAAO) devices have become increasingly utilized for stroke prevention in select patients with AF who have contraindications to oral anticoagulation (OAC). We present a unique case of an embolized Amplatzer Amulet LAAO device through a MitraClip into the LV causing polymorphic VT and obstructive shock. Case Presentation: An 80-year-old man with AF and mitral valve prolapse status post MitraClip presented to the hospital for difficulty breathing and palpitations two days after implantation of a 31mm Amplatzer Amulet LAAO device. Notably, he underwent failed attempt at Watchman LAAO implantation due to peridevice leak one year prior. On arrival, he was hypotensive with numerous episodes of polymorphic VT, requiring cardioversion, vasopressors, and mechanical ventilation. TTE located the Amulet within the LV outflow tract (LVOT) creating LVOT obstruction and revealed single-leaflet attachment of the MitraClip. He was evaluated for device retrieval and mechanical support but was deemed not a surgical candidate due to severe thrombocytopenia and guarded prognosis. Despite ongoing resuscitative efforts, the patient became increasingly unstable and died in the cardiac ICU. Discussion: In patients who are unable to tolerate OAC, occlusion of the LAA for stroke prevention has garnered growing interest; however, these devices are not without complication and do not guarantee full occlusion of the LAA. Despite our patient’s history of failing Watchman deployment, he was discharged on the same day after implant of the Amulet device without post-procedure TTE. We postulate that the Amulet device dislodged shortly after deployment and was held within the left atrium by the MitraClip until detachment, allowing for device embolization and severe MR. To our knowledge this is the first documented instance of Amulet device migration into the LV in a patient with a MitraClip. This case highlights the need for heightened post-procedure monitoring, surveillance, and imaging in select patients.
Abstract 4146083: The Restricted Fluid Intake Compared With Liberal Fluid Intake In Patients With Heart Failure – A Meta-Analysis
Authors: Agata Bielecka-Dabrowa, Maciej Banach, Vikash Jaiswal
Journal: Circulation (2024)

Background: Although fluid overload is inextricably linked to heart failure (HF), dehydration is also possible in HF patients. Maintaining euvolemia is the cornerstone of HF management. Physicians should find a balance between decongestion therapy and the risk of dehydration. In the absence of enough supportive evidence, the US and European guidelines for the diagnosis and treatment of acute and chronic HF provide only a general recommendation supporting fluid restriction (FR) for selected patients with symptomatic HF, without providing a level of evidence. Thus, we aimed to evaluate the risk of all-cause mortality, hospital readmissions, and change in BNP, sodium, potassium, creatinine, and perceived thirst in HF patients with FR vs liberal fluid intake. Methods: We performed a systematic literature search on PubMed, EMBASE, and Scopus for relevant randomized controlled trials (RCTs) from inception until May 2024. Risk ratios (RR), weighted mean differences (WMD), and 95% confidence intervals (CI) were pooled using a random-effect model. Results: A total of 8 RCTs with 767 patients (364 in the FR group and 403 in the non-FR group) were included in the study. The mean age of patients among FR and non-FR groups was 69.49 and 68.62 years, respectively. The mean follow-up duration was 95 days. Pooled analysis of primary and secondary outcomes showed that there are no statistically significant differences between FR and liberal fluid intake in the risk of HF hospital readmissions [RR, 0.64; 95%CI: 0.24-1.70; P=0.37], and all-cause mortality [RR, 0.62;95% CI: 0.31-1.25; P=0.18] (Figure 1). No significant difference in thirst was also observed [WMD: 2.94, 95% CI: -3.61 to 9.48, P=0.38]. For FR, BNP at follow-up showed a non-significant increasing trend (WMD: 21.34, 95% CI: -144.28 to 186.97, P=0.80). Sodium levels showed a non-significant increase in FR vs liberal fluid intake (WMD: 1.94, 95%CI: -1.10 to 4.99, P=0.21). Creatinine and potassium levels showed no significant differences at any time point. Conclusion: Fluid restriction does not significantly reduce the risk of HF rehospitalizations and all-cause mortality in HF patients. Further randomized controlled trials are warranted to confirm these findings and result in suitable recommendations and clinical practice changes.
Abstract 4146297: Cardiovascular Risk Prediction with the Kidney Failure Risk Equation Among Patients with Chronic Kidney Disease: Insights from CRIC
Authors: Simon Correa, Iris Beldhuis, Brendon Neuen, Muthiah Vaduganathan, F. Perry Wilson, Finnian Mc Causland
Journal: Circulation (2024)

Background: The Kidney Failure Risk Equation (KFRE) is an established calculator to predict the risk of kidney failure among patients with chronic kidney disease (CKD). Patients with CKD are more likely to die from cardiovascular (CV) causes than from renal causes, and more likely to experience a non-fatal CV event than to progress to kidney failure. The CV predictive ability of the KFRE among patients with CKD is unclear. Methods: We investigated the association of the 8-variable (age, sex, urine albumin-creatinine ratio [UACR], estimated glomerular filtration rate [eGFR], serum albumin, serum phosphate, serum bicarbonate, serum calcium) 5-year KFRE with CV disease (CVD) and death among 3,034 patients with CKD (eGFR 15-60 mL/min/1.73m 2 ) in the Chronic Renal Insufficiency Cohort (CRIC). KFRE was modeled continuously and by quartiles. CVD was defined as the composite of heart failure hospitalization, myocardial infarction, or stroke. All-cause mortality was a key secondary endpoint. Results: Mean eGFR was 39 ±11 mL/min/1.73m 2 ; median UACR was 89 mg/g [25-75th percentile 13, 619]. Median KFRE 5-year score was 0.7% [25-75th percentile 0.2, 2.9]. Five-year event rates for the primary endpoint for the lowest to highest quartiles of KFRE were 11.6%, 17.7%, 25%, and 31% (P&lt;0.001). KFRE score (per 1-unit higher log-transformed KFRE score) was associated with a 27% higher risk of CVD (HR 1.27; 95%CI 1.22, 1.33), and a 24% higher risk of death (HR 1.24; 95%CI 1.19, 1.30). When analyzed by quartiles, higher KFRE was associated with more than a 3-fold higher risk of CVD (HR Q4:Q1 3.31; 95%CI 2.67, 4.10), and more than a 3-fold higher risk of death (HR Q4:Q1 3.28; 95%CI 2.62, 4.11). Conclusions: Among participants of CRIC, a higher KFRE was associated with a higher risk of CVD and all-cause death. As patients with CKD are at higher risk of both adverse kidney and CV outcomes, this suggests that KFRE could be used as a broad and simple risk-stratification tool for patients with CKD.
Abstract 4146454: Managing Depression in Rural Depressed Cardiac Patients in the Face of Perceived Depression Stigma: A Randomized Controlled Trial of Two Types of Online Cognitive Behavioral Therapy
Authors: Debra Moser, Jia-Rong Wu, Abigail Latimer, JungHee Kang, Chin-Yen Lin, Misook Chung
Journal: Circulation (2024)

Introduction: Rural areas experience marked disparities in cardiac and mental health and access to health care. Rural cardiac patients with depressive symptoms (DS) do not receive needed therapy because of lack of mental health providers, worries about stigma, and difficulty accessing mental health care. Cognitive behavioral therapy (CBT) reduces DS in cardiac patients, but in its traditional form (in-person meetings) is inaccessible to most rural patients. Wireless internet technology has the potential to make CBT more accessible. Hypothesis: Our aim was to determine whether patient perceptions of stigma would moderate the impact on DS of two types of remote-delivery CBT: 1) real-time, face-to-face, video-conferenced CBT with a therapist (vcCBT); and 2) self-administered internet-based CBT without a therapist (iCBT). We hypothesized that patients with high perceptions of stigma would have a better response to iCBT than vcCBT, but that both would be effective in patients with lower perceptions of stigma. Methods: In this randomized controlled trial (N = 303, mean age 58 ± 12 years, 49% women) rural cardiac patients who had at least mild-moderate DS underwent 6-8 weeks of CBT delivered as either vcCBT or iCBT. DS were measured using the Patient Health Questionnare-9. Stigma was measured using the Depression Stigma Scale. Data were collected at baseline, 3, 6 and 12 months. Data were analyzed using mixed models for repeated measures. Results: Patients in the vcCBT compared to the iCBT group had similar levels of DS at baseline (11.2±5 vs 11.3±5, p=0.45; respectively). Patients with higher levels of perceived stigma had worse DS compared to those with lower levels of stigma (10.6±5 vs 11.9±5, p=0.018; respectively). Both intervention groups experienced statistically and clinically significant improvements in DS (Figure), with DS decreasing from moderate levels to non-depressed at 3 months (p&lt;0.001), which was maintained at 12 months. Perceived stigma did not moderate the impact of the intervention, rather, patients with higher levels of perceived stigma demonstrated a lesser response to either intervention. Conclusion: Both types of intervention were effective at managing DS, however, contrary to our hypothesis, high levels of stigma alone rendered patients less responsive to either intervention. Nonetheless, all patients regardless of intervention type of level of stigma experienced meaningful reductions in DS.