tbuckley/cabot-search huggingface dataset:
Abstract 4127562: Age, Adiposity-Related Anthropometrics, and Clinical Outcomes in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: A Participant-Level Pooled Analysis of Randomized Trials
Authors: John Ostrominski, Mats Lassen, Jawad Butt, Brian Claggett, Inder Anand, Akshay Desai, Pardeep Jhund, Carolyn Lam, Marc Pfeffer, Bertram Pitt, Faiez ZANNAD, Michael Zile, John McMurray, Scott Solomon, Muthiah Vaduganathan
Journal: Circulation (2024)

Background: Age has been shown to modify the population-level association between body mass index (BMI) and mortality. However, whether age modifies the association between adiposity-related anthropometrics and adverse outcomes in heart failure (HF) populations has not been systematically explored. Methods: In this participant-level pooled analysis of five international, multicenter, randomized-controlled trials enrolling adults with HF and either mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), the association between age and adiposity-related anthropometrics (BMI, waist circumference [WC], and waist-to-height ratio [WHtR]) and the primary composite outcome of time-to-first HF hospitalization or cardiovascular (CV) death was evaluated using multivariable adjusted Cox proportional hazards models (stratified by treatment and trial) and restricted cubic splines. Results: Among 21,606 participants in the analysis (mean age, 71±9 years; 49% female; 83% White; mean BMI, 30±6 kg/m 2 ), 5,350 (25%) were aged &lt;65 years, 8,273 (38%) were aged 65-74 years, and 7,983 (37%) were aged ≥75 years at baseline. Older individuals were more likely to be female, have lower BMI and WC, and higher left ventricular ejection fraction. Overall, BMI, WC, and WHtR were steeply and non-linearly associated with the primary outcome ( Figure ). Age, as either a categorical or continuous variable, significantly modified the covariate-adjusted association between all anthropometrics and the primary composite outcome ( P ≤0.001 for all) ( Figure ). A J-shaped relationship, characterized by higher incidence of the primary outcome with lower anthropometric values, was observed only for BMI and was substantially attenuated among younger adults. Irrespective of the anthropometric used, increasing adiposity was most steeply associated with primary events among adults aged &lt;65 years. Conclusions: In this pooled analysis of HFmrEF/HFpEF trials, age was a powerful modifier of the relationship between excess adiposity and HF hospitalization or CV death. An “obesity-survival paradox” – observed only for BMI – was not apparent in younger participants, who exhibited the steepest increase in the rate of clinical events with higher adiposity.
Abstract 4128261: Heart Failure-Associated Sudden Cardiac Death: Trends and Demographic Differences in the United States Adults, 1999 to 2020
Authors: Ahmed Siddiqi, Muhammad Talha Maniya, Jasninder Dhaliwal, Saif Syed, Jishant Mattumpuram, Naser Yamani, Sharath Vipparthy, Simra Siddiqui, Sarah Faisal, Tariq Jamal Siddiqi, Michael Hall
Journal: Circulation (2024)

Background: The US population has seen a dramatic increase in the burden of heart failure (HF) and sudden cardiac death (SCD) mortality. SCD is one of the prominent causes of mortality in HF patients. However, HF-associated SCD-related mortality trends have not been established yet. Aims: This study aims to highlight the annual trends and demographic differences in HF-associated SCD mortality among adults in the U.S from 1999-2020. Methods: The CDC WONDER multiple-cause of death database was examined from 1999 to 2020 for HF-associated SCD mortality in adults over the age of 25. Age-adjusted mortality rates (AAMRs) per 1,000,000 persons was calculated. Trends and annual percent changes (APCs) were assessed overall and stratified by sex, race/ethnicity, urbanization status, and census region. Results: Between 1999 and 2020, 39,660 HF-associated SCD-related deaths occurred among US populations. Following a reduction from 10.9 in 1999 to 6.8 in 2018 (APC, -2.5 [-2.8 to -2.3]), AAMR increased to 8.2 in 2020 (APC, 10.3 [3.6 to 13.7]) in the overall population. Men had consistently higher AAMRs than women from 1999 (AAMR men: 15.1 vs women: 7.9) to 2020 (AAMR men: 11.3 vs women: 5.6). Non-Hispanic (NH) Black or African Americans had the highest AAMR (14.0), followed by NH Whites (8.3), and Hispanics or Latinos (3.4). Southern region had the highest AAMR (10.4), followed by Midwest (9.6), West (5.8), and Northeast (5.8). Moreover, rural areas had consistently higher AAMR (14.6) than urban areas (6.9). Conclusion: Following a steady decline until 2018, HF-associated SCD mortality in adults increased between 2018 and 2020. The highest AAMRs were observed among Black or African American adults and men, and patients living in the Southern and non-metropolitan areas. Tailored strategies focusing specifically on arrhythmic events and related mortality in HF patients are needed to address the recent surge in mortality rates among these demographics.
Abstract 4127990: Inactive Matrix Gla Protein and Cardiovascular Outcomes: the Multi-Ethnic Study of Atherosclerosis
Authors: Ashley Berlot, Xueyan Fu, Kyla Shea, Russell Tracy, Matthew Budoff, Ryung Kim, Mahim Naveed, Sarah Booth, JORGE KIZER, Anna Bortnick
Journal: Circulation (2024)

Background: Matrix Gla protein (MGP) inhibits arterial calcification. Higher inactive MGP, dephosphorylated-uncarboxylated (dp-ucMGP), is positively associated with vascular calcification, possibly portending cardiovascular events. The objective was to determine the association of dp-ucMGP with incident cardiovascular disease (CVD) events and mortality in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods: MESA is a cohort study of 45-84 year-old individuals enrolled between 2000-02 with adjudicated outcomes through 2019. Dp-ucMGP was measured at baseline in n=2663 participants with cardiac computed tomography at Exams 1 (2000-02) and 5 (2010-12). Using age-stratified Cox proportional hazard models, adjusted for sex, race-ethnicity, body mass index, systolic blood pressure, statin use, anti-hypertensive medication use, smoking status, physical activity, alcohol use, diabetes, high density lipoprotein, low density lipoprotein, triglycerides, phosphate, and estimated glomerular filtration rate, we determined the association of dp-ucMGP with risk of all CVD (mean follow-up 16 + 4 years), hard CVD (17 + 3 years), hard CHD (17 + 3 years), and all-cause mortality (18 + 2 years). Results: The youngest age quartile (45-53-years-old) with higher dp-ucMGP levels (520-2934 pmol/L) had an increased risk of all CVD (HR 3.01 [95% CI 1.56, 5.80], p=0.001), hard CVD (HR 2.78 [95% CI 1.29, 6.02], p=0.009), hard CHD (HR 3.37 [95% CI 1.29, 8.81], p=0.013) and all-cause mortality (HR 2.69 [95% CI 1.06, 6.79], p=0.037) compared to dp-ucMGP levels between 150-519 pmol/L in maximally adjusted models. There was no relationship with any outcomes for the other age quartiles (Table). Conclusions: Middle aged individuals with elevated dp-ucMGP levels ( &gt; 520 pmol/L) had an increased risk of incident CVD, CHD, and all-cause mortality.
Abstract 4128698: Mental Health and Sleep Quality as Determinants of Physical Activity Levels in Depressed Rural Patients with Coronary Heart Disease
Authors: Geunyeong Cha, JungHee Kang, Chin-Yen Lin, Nicholas Heebner, Jia-Rong Wu, Martha Biddle, Misook Chung, Ashmita Thapa, Terry Lennie, Debra Moser
Journal: Circulation (2024)

Background: Disparities in coronary heart disease (CHD) and other chronic related conditions, such as poor sleep quality and psychological distress, have been observed in rural areas. Both conditions can negatively affect disease progression, possibly through their impact on physical activity. The relationships, however, among sleep quality, psychological distress, and physical activity among depressed rural CHD patients have not been examined. Purpose: The purpose of this study was to determine the association of sleep quality (i.e., sleep fragmentation [frequent sleep interruption] and nocturnal/sleep movement [increased rates of movement, ‘tossing and turning’ during sleep]) and psychological distress (i.e., anxiety and perceived stress) with levels of physical activity (i.e., sedentary, light, and moderate to vigorous) in depressed rural patients with CHD. Methods: A total of 142 depressed rural CHD patients (aged 57.0±11.9 years, 97% White) completed surveys on demographic characteristics, anxiety (Brief Symptom Inventory), and stress (Perceived Stress Scale-4). Participants also wore accelerometer activity monitors for seven days (ActiGraph GT9X Link) to capture physical activity levels and sleep quality. Three different hierarchical regression models were conducted to predict each level of physical activity (sedentary, light, and moderate-vigorous) with predictor variables entered in blocks. Block 1 included demographic variables (i.e., age, sex, marital status, employment status). Block 2 included sleep quality measures, and Block 3 included psychological distress. Results: Participants spent 466±126.0 min/day while awake being sedentary, 483±119.9 min/day in light activity, and 90±65.9 min/day in moderate to vigorous activity. We found that stress was significantly associated with greater sedentary time (B = 6.56, p = .043) and less time in light activity (B = -7.99, p = .024). Nocturnal/sleep movement was significantly associated with increased sedentary time (B = 3.14, p &lt; .001) and decreased time in light (B = -5.29, p =.002) and moderate-vigorous activity (B = -2.58, p = .003). Anxiety was not associated with physical activity. Conclusions: Poor sleep quality and greater perceived stress are associated with a more sedentary lifestyle, a major risk factor for CHD. Addressing both stress and sleep management may play a role in reducing CHD risks associated with inactivity among depressed rural patients with CHD.
Abstract 4132159: Dietary Intake of Niacin and Risk of Cardiovascular Mortality in The Golestan Cohort Study
Authors: Mohammad Hosein Yazdanpanah, Maryam Sharafkhah, Hossein Poustchi, Arash Etemadi, Farin Kamangar, Christian Abnet, Veronique Roger, Reza Malekzadeh, Maryam Hashemian
Journal: Circulation (2024)

Introduction: Recent studies have linked niacin metabolism with vascular inflammation and cardiovascular disease (CVD); however, the association is still inconclusive regarding dietary intake, and the findings may not be generalizable to various populations. In this longitudinal study within a Middle Eastern population, we aimed to assess the relationship between dietary intake of B vitamins, including niacin, and the risk of CVD mortality. Methods: Our study utilized data from the Golestan Cohort Study, which has tracked 50,045 participants aged 40-75 years since 2004. We excluded subjects who reported extreme total energy intake or had a positive history of cancer, CVD, or diabetes at baseline. Vitamin B intake estimations including thiamin, riboflavin, niacin, pyridoxamine, folate, and cobalamin intake were derived from the baseline food frequency questionnaire, noting that supplement use was uncommon in this cohort. To adjust for calorie intakes, we employed the nutrient density method. Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cardiovascular mortality, using the lowest quintile of intake as the reference group for vitamins and adjusting for potential confounders. Results: We analyzed 42,456 subjects with a mean age of 51.5 ± 8.7 years at baseline. During 579,339 person-years of follow-up (median: 14.1 years), 3,065 CVD deaths were recorded. The median dietary intake of niacin was 25.3 mg/d (Recommended Dietary Allowance = 14-16 mg/d). We observed significant associations between niacin intake (HR Q5 vs. Q1 = 1.13, 95% CI = 1.01-1.26, P trend &lt;0.05) and CVD mortality. When niacin was modeled as a continuous linear variable, it was associated with a greater risk of CVD mortality (HR = 1.05, 95% CI = 1.01-1.09) per 2 mg/1000Kcal/d increase. None of the other B vitamin intakes evaluated were associated with CVD mortality in this population. Conclusion: These findings suggest that among B vitamins, only dietary niacin intake was positively associated with CVD mortality. Further confirmation in larger studies is needed.
Abstract 4127664: Influences of Age on Improvement of Health-Related Quality of Life in Patients with Atrial Fibrillation following Initial Treatment
Authors: Ryo Nakamaru, Nobuhiro Ikemura, Shun Kohsaka, Takehiro Kimura, Katsumata Yoshinori, Takahiko Nishiyama, Ikuko Ueda, Kojiro Tanimoto, Koji Negishi, Seiji Takatsuki, John Spertus, Masaki Ieda
Journal: Circulation (2024)

Background: The prevalence of Atrial Fibrillation (AF), the most cardiac common arrhythmia, increases with age. Various treatment strategies are available to improve health-related quality of life (HRQoL) in patients with AF; however, the impact of age on HRQoL treatment benefits is unknown. Aims: To investigate the association of age with HRQoL benefit across different treatment strategies. Methods: Using data from a multicenter registry for outpatients with early recognized AF, HRQoL at enrollment and 1 year later was measured with the Atrial Fibrillation Effect on Quality-of-life quesTionnaire (AFEQT). The association between age and the 1-year changes in AFEQT-overall summary (OS) and subdomain scores with either rate or rhythm control strategies were assessed using generalized additive models (GAM) to address non-linear relationships. To support clinical interpretation, multivariable linear regression models were performed with categories of age ranges. Results: Among 2786 patients (31.7% women, 54.7% rhythm control); 946 were &lt;65 of age, 1019 were ≥65–75, and 821 were ≥75 years old. Rhythm (vs. rate) control was pursued in 76.6%, 58.0%, and 33.6% and mean AFEQT-OS changes were 11.1 (SD 16.6), 8.0 (17.0), and 4.7 (18.2) in those aged &lt;65, 65–74, and ≥75, respectively. The GAM showed improvements in AFEQT-OS attenuated with advancing age with both treatment strategies ( Figure ). Linear regression analyses showed lesser improvements in AFEQT-OS as higher age categories (≥65–75 vs. &lt;65, β -1.12 [95% CI, -2.33 – 0.09]; ≥75 vs. &lt;65, β -3.86 [-5.29 – -2.42]), which were mainly driven by lesser improvement in AFEQT-daily activities scores, without differences in AFEQT scores for symptom or treatment concerns ( Table ). Conclusions: In AF patients, HRQoL benefits after treatment were attenuated by advancing age, primarily driven by less improvement in functional limitations, underscoring the need for further research to identify optimal treatment strategies for older adults.
Abstract 4128599: Facility-level Variation Underlying Low Inferior Vena Cava Filter Retrieval in the United States
Authors: Premal Trivedi, Evan Carey, Lei Wang, Savannah Mierau, Richard Lindrooth, Jonathan Lindquist, Robert Ryu, Michael Ho
Journal: Circulation (2024)

Background: Inferior vena cava (IVC) filters are commonly implanted in patients with venous thromboembolism (VTE) who are unable to receive anticoagulation, to protect against clot migration to the heart. With prolonged implantation, IVC filters are associated with complications: device fracture, migration, penetration into adjacent organs and worsened VTE. Two Federal Drug Administration advisories and multi-society guidelines have emphasized the importance of timely retrieval but national retrieval rates remain low (&lt;30%). Aims: To quantify hospital-level variation in IVC filter retrieval , describe time-based retrieval rates and examine factors associated with retrieval. Methods: IVC Filter implantation for all patients &gt;= 18 years was identified in the 2016-2020 inpatient and outpatient 100% limited data set Medicare files using claims codes. Hospital information for the implanting facility was cross-linked from the American Hospital Association and Healthcare Cost Report Information System files, including identifying information, teaching status, census location, operating margin and % uncompensated care. IVC filter retrieval rates and time to retrieval from implantation was calculated. Bayesian hospital profiling methods were used to quantify 1-year retrieval rate for all U.S. facilities, adjusting for patient factors – demographics, diagnostic indications and comorbidities. Results: Among Medicare beneficiaries, there were 140,481 IVC Filter implantations across 2,850 facilities. Excluding patients who died within 90 days of implantation (25.7%), retrieval rates at 3 months, 1 year and anytime were 7.9%, 18.7% and 20.0% respectively. IVC Filter retrieval within 1 year varied significantly at the facility-level, from 0-100% . Focusing on facilities with at least 13 IVC filter implantations each year (top 25%ile volume), 1-year retrieval ranged from 0 to 74.5%. Higher 1-year retrieval was seen among higher implantation volume (12.4% bottom quartile, 20.5% top quartile), teaching (21.1% teaching vs. 16.9% nonteaching) and non-safety net (21.1% low uncompensated care, 15.0% high uncompensated care) hospitals. Retrieval rates did not vary significantly by hospital operating margin or rurality. Conclusion(s): There is low overall IVC filter retrieval in the United States with large underlying facility-level variation. Focused examination of high-performing facilities could yield insights on how to improve device retrieval nationally.
Abstract 4129182: Transendocardial Stem Cell Therapy Improves Cardiac Parameters in Chronic Ischemic Heart Failure: A Meta-analysis of Randomized Controlled Trials
Authors: Ibrahim Al-Sawalha, Mohammad Al-Bdour, ABDEL QADER ABU SALIH, Rula Al-Shimi, Mohammad Al-Slehat, Suhel Batarseh, Nebras Jaloudi, Amjad Almansi
Journal: Circulation (2024)

Introduction: Despite recent advances in therapy, chronic ischemic heart failure remains a significant cause of morbidity and mortality worldwide. Stem cell (SC) therapy has recently emerged as a potential therapeutic approach, yet its efficacy remains debatable. We aimed to systematically review and meta-analyze the current evidence to evaluate its effectiveness. Methods: A comprehensive literature search was conducted across the following databases: PubMed, Embase, and Cochrane, from inspection to April 2024. We identified RCTs with a blinded study design, done on patients diagnosed with chronic ischemic HFrEF, and utilized mesenchymal stem cells as an intervention in comparison to placebo/sham intervention using percutaneous endomyocardial catheter systems. Meta-analysis was conducted using RevMan v5.4 to calculate the odds ratio (OR) at 95% confidence intervals (CI) and a p-value of 0.05. I 2 was indicated for the assessment of heterogeneity. Sensitivity analysis was done in case of heterogeneity between studies. Results: A total of twenty studies were included in our meta-analysis. The overall change in left ventricular end-systolic volume (LVESV) and stress SPECT significantly favored the stem cell group (pooled effect size -7.59, 95% CI [-12.28 to -2.89], P=0.002), and (pooled effect size -5.33, 95% CI [-6.73 to -3.93], P=0.00001), respectively. Initially, the change in left ventricular end-diastolic volume (LVEDV) did not favor either group. However, sensitivity analysis which excluded one study at a time, reduced heterogeneity (P=0.01, I 2 =54%) and showed a significant effect favoring the stem cell group (pooled effect size -3.87, 95% CI [-6.77 to -0.97], P=0.009). However, the overall changes in left ventricular ejection fraction (LVEF) did not favor either of the two groups (pooled effect size 0.08, 95% CI [-0.1 to 0.26], P=0.39). Similarly, the overall change in myocardial oxygen consumption (MVO2) did not favor either group (pooled effect size 0.66, 95% CI [-0.1 to 1.32], P=0.05). Conclusion: Transendocardial SC therapy demonstrates promising results by significantly improving specific cardiac parameters. While the therapy shows potential, particularly after sensitivity adjustments, its impact on other critical measures like LVEF and MVO2 remains inconclusive. These findings highlight the need for further investigation to fully understand and enhance the therapeutic potential of stem cell interventions in heart failure management.
Abstract 4128526: Brain Natriuretic Peptide is Not Predictive of Days Alive and Out of Hospital During the Interstage Period in Infants with Hypoplastic Left Heart Syndrome
Authors: Ilana Schwartz, Jan Leonard, Alexis Zavez, Luma Essaid, Alyson Stagg, Chitra Ravishankar, Therese Giglia, Monique Gardner, Rachel Shustak
Journal: Circulation (2024)

Background: Infants with hypoplastic left heart syndrome (HLHS) have the highest risk of morbidity and mortality during the interstage period. Brain natriuretic peptide (BNP) is frequently measured during the Stage I palliation (S1P) hospitalization. However, there is limited data on the association of BNP with interstage morbidity and mortality. In this context, we sought to examine the association between maximum BNP during the S1P hospitalization and last BNP prior to S1P discharge with days alive and out of hospital (DAOH) during the interstage period. We hypothesized that patients with higher BNPs during their S1P hospitalization would have fewer DAOH during the interstage period. Methods: We performed a single-center retrospective cohort study of infants with HLHS who underwent S1P at our institution between December 1, 2010 and December 31, 2022. Subjects were categorized based on maximum BNP and pre-discharge BNP tertiles. DAOH was calculated by subtracting the number of days hospitalized from the number of days alive during the interstage period. Multivariable zero-truncated negative binomial regression models were used to examine whether there was an association between BNP and DAOH. Models were adjusted for demographic, operative, and discharge characteristics and included an offset for interstage duration. Results: Of 251 infants, 221 (88%) had at least one BNP measured during their S1P hospitalization. The median maximum BNP was 529 (289-944) pg/mL, pre-discharge BNP was 346 (216-589) pg/mL, and DAOH was 97 (89-100) per 100 interstage days. The median maximum BNP in patients who remained admitted during the interstage period (n=32) was 1,027 (446-1,968) pg/mL which was significantly higher than the study cohort (p&lt;0.001). Patients in the maximum BNP upper tertile were more likely to have moderate to severe atrioventricular valve regurgitation (p=0.04) and had higher pre-discharge and pre-Stage 2 palliation BNPs (p&lt;0.001). There was no association between either maximum BNP or pre-discharge BNP with DAOH. Patients in the maximum BNP upper tertile had significantly more BNPs collected during their S1P hospitalization and interstage period. Conclusions: BNP during the S1P hospitalization is not predictive of interstage DAOH. In patients deemed candidates for discharge after S1P, repeated BNP measurements may have limited utility. Further work is needed to assess the association between BNP measured in the interstage period and longer-term outcomes.