tbuckley/cabot-search huggingface dataset:
Abstract 4139904: Trends in Atrial Fibrillation Related Mortality in Metabolic Syndrome Patients Aged 65 and Older in the United States: Insights from the CDC WONDER Database
Authors: Muhammad Abdullah Naveed, Bazil Azeem, Muhammad Omer Rehan, Ahila Ali, Rabia Iqbal, Usman Akbar, Muhammad Khan, Karthik Gonuguntla, yasar sattar, Zain Ul Abideen Asad, sudarshan balla, Bilal Munir
Journal: Circulation (2024)

Background: Atrial Fibrillation (AF) in patients with metabolic syndrome is a substantial health concern among older adults in the United States. This study investigated trends and disparities in AF mortality among older adults aged 65 and older with metabolic syndrome from 1999-2020. Methods: We used the Centers for Disease Control database for mortality statistics with an underlying cause of death of AF in metabolic syndrome (ICD code I48 for AF and scattered codes indicating metabolic syndrome i.e. E10-14, E66, E78, E88, I10) between the years 1999 – 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 deaths. The AAMR were assessed by demographic variables, including race, geographic density, sex, age, and US Census Region. Temporal trends were evaluated using Joinpoint regression software. Average annual percent change (AAPC) was considered statistically significant if p &lt; 0.05. Results: Between 1999 and 2020, AF in metabolic syndrome caused 944,960 deaths among U.S. adults aged 65+. Most deaths occurred in medical facilities (35.8%). The overall AAMR for AF in metabolic syndrome-related deaths rose from 36.6 in 1999 to 173.4 in 2020, with an AAPC of 6.48 (95% CI: 5.07 to 7.77, p &lt; 0.000001). A significant increase was noted from 1999 to 2001 (APC: 26.58; 95% CI: 6.04 to 43.91, p &lt; 0.000001), followed by a continued rise from 2001 to 2020 (APC: 4.56; 95% CI: 3.60 to 5.15, p = 0.012797). Older men had higher AAMRs than older women (116.0 vs 92.3). Among racial/ethnic groups, White population had the highest AAMRs (108.8) and AAPC (6.70; 95% CI: 5.23 to 7.95), followed by American Indians/Alaska Natives (81.7), Blacks (74.1), Hispanics (68.2), and Asians (61.6). AAMRs varied by state, from 61.1 in Nevada to 170.0 in Vermont. The Western region had the highest average AAMR (116.7). Nonmetropolitan areas had slightly higher AAMRs than metropolitan areas (113.0 vs. 99.9). Conclusion: The analysis reveals a dramatic fourfold increase in AF-related mortality within metabolic syndrome among older U.S. adults over two decades. This substantial rise in mortality rates underscores the urgent need for targeted interventions and strategies to address these trends. By addressing structural barriers to quality healthcare and health disparities, we can effectively counter this concerning trend and achieve positive outcomes for this vulnerable group.
Abstract 4139880: Trends in Atrial Fibrillation Related Mortality in Coronary Artery Disease Patients Aged 65 and Older in the United States: Insights from the CDC WONDER Database
Authors: Muhammad Abdullah Naveed, Ahila Ali, Rabia Iqbal, Bazil Azeem, Muhammad Omer Rehan, Usman Akbar, yasar sattar, Karthik Gonuguntla, Muhammad Khan, Zain Ul Abideen Asad, sudarshan balla, Bilal Munir
Journal: Circulation (2024)

Background: Patients with Coronary Artery Disease are at an increased risk of Atrial Fibrillation related mortality via various mechanisms like Ischemia, Atrial stretch and remodeling, but largely as side effects of treatments. Thus, AF in patients with CAD is a critical health concern among older adults (65+) in the United States. Our CDC analysis focuses on unraveling mortality trends among patients grappling with both conditions from 1999 to 2020. Methods: A retrospective analysis was conducted using national mortality data from the multiple causes of death files in the CDC WONDER database from 1999 to 2020, employing ICD codes I48 for AF and I25.1 for CAD. Age-adjusted mortality rates (AAMRs) per 100,000 people were calculated for the total population, stratified by gender, race, urban/rural metro status, and census region. Annual Percent Change (APC) was calculated using the Joinpoint regression software. Results: A total of 564,952 AF-related deaths among older adults aged 65+ with CAD occurred in the U.S. between 1999 and 2020. Majorly occurred in medical facilities (36.5%). The overall AAMR for AF in CAD-related deaths increased from 49.7 per 100,000 in 1999 to 84.4 in 2020, with an AAPC of 2.52 (95% CI: 2.29 to 2.76, p &lt; 0.000001). A moderate rise in AAMR from 1999 to 2016 (APC: 1.75, p &lt; 0.000001), then significant surge from 2016 to 2020 (APC: 5.88, p &lt; 0.000001). Men had higher AAMRs than Women (83.8 vs 46.6), with a more pronounced increase in men (AAPC: 3.44, p &lt; 0.000001) compared to women (AAPC: 1.23, p &lt; 0.000001). Racially, White population had the highest AAMRs (67.1), followed by American Indians or Alaska Natives (41.9), Hispanics (33.7), Blacks (32.2), and Asians (28.1). All racial groups saw significant increases in AAMRs, most notably among American Indians or Alaska Natives (AAPC: 4.64). Geographically, AAMRs varied, with Rhode Island having the highest (103.5) and Nevada the lowest (29.7). The Midwest had the highest regional AAMR (65.1), while nonmetropolitan areas exhibited higher AAMRs than metropolitan areas, both showing overall increase throughout study (3.34 vs 2.23). Conclusion: This analysis reveals increasing trends and demographic disparities in mortality rates due to AF in CAD patients among older adults in the U.S. The recent surge in mortality rates highlights the need for targeted interventions to address these disparities and improve health outcomes for this vulnerable population.
Abstract 4139542: Left or Bilateral Cardiac Sympathetic Denervation: Comparison of Antiarrhythmic Efficacy and Complications
Authors: Zachary Girvin, Adam Wright, BEN Shoemaker, David Bichell, Ashish Shah, Prince Kannankeril
Journal: Circulation (2024)

Background: Cardiac sympathetic denervation (CSD) is a well-established procedure to prevent ventricular arrhythmias in genetic and acquired arrhythmia syndromes. It is unknown whether initial bilateral (B) CSD or left (L) CSD, followed by right (R) CSD for breakthrough events is the better strategy. Aims: We compared the antiarrhythmic efficacy and complications of primary B vs L CSD at a single center where both are performed routinely. Methods: Patients who underwent CSD were retrospectively identified. At our center L CSD is performed in children while B CSD is performed in adults by operator preference. Demographic data, procedural indications, complications, and arrhythmia events (arrhythmic syncope, sudden cardiac arrest, appropriate shock) were collected. Arrhythmia events (AE) were compared before and after CSD in those with arrhythmia indications. Complications were compared in all subjects and in the subset with arrhythmia indications. Results: Between 2011 and 2023, 65 patients underwent 68 CSD procedures (39 B, 26 L, 3 R after initial L). As expected, BCSD patients were older [median 32 (IQR 21-48) years vs. 16 (6-38) years; P=0.002]. Overall complication rates were similar [BCSD 17/39 (44%) vs 12/29 (41%), P=0.85]; most were transient/minor. Complications that required intervention were rare (n=5) and only observed after BCSD. Forty CSD were for an arrythmia indication (18 B, 21 L, 1 R). AEs were reduced from a median of 3 (1-4) before CSD to 0 (0-1) after CSD (p&lt;0.001). The reduction was similar for BCSD [3.5 (2-5) before vs 0 (0-0.25) after (p&lt;0.001)] and L/R CSD [2 (1-4) before vs 0 (0-1) after (p=0.002)]. Only 1 LCSD had subsequent RCSD for an arrhythmia indication 4 years later due to breakthrough AEs: a severe long QT syndrome patient who ultimately required heart transplant. Complications that required intervention after CSD for an arrhythmia indication were seen in 4/18 BCSD and 0/22 L/R CSD (P=0.03). Conclusions: BCSD and LCSD are both highly effective in reducing arrhythmia events. Complication rates may be less frequent in unilateral CSD, although the observed difference may be due age differences in the two groups.
Abstract 4139960: AI-Derived Retinal Vasculature Features Predict Cardiovascular Risk in Patients with Chronic Kidney Disease: Insights from the CRIC Study
Authors: Rohan Dhamdhere, Gourav Modanwal, Mahboob Rahman, Sadeer Al-Kindi, Anant Madabhushi
Journal: Circulation (2024)

Background: Chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease (CVD) and mortality. Fundus imaging offers a non-invasive method for CVD risk stratification through insights into microvascular disease. Hypothesis: Artificial-intelligence (AI)-derived retinal microvascular architecture predicts major adverse cardiovascular events (MACE) in CKD patients. Objectives: To determine the associations between retinal vessel features and CVD risk, and to compare AI derived retinal vessel-based CVD risk with existing CVD risk calculators for CKD patients. Methods: We analyzed retinal fundus images from 811 CKD patients without prior CVD or end-stage renal disease from the Chronic Renal Insufficiency Cohort (CRIC, NCT00304148). Vessels were segmented and classified into arteries and veins using deep learning models. CVD risk models were developed by extracting features like angle, tortuosity, curvature, and connectivity (Fig. 1A). Cox proportional hazards models were trained with features from Vessel (M Ves ), Artery (M A ), and Vein (M V ). Models were trained using the top 8 features, selected via bootstrapping from 567 patients (70%) and validated on a holdout set of 244 (30%). Performance was evaluated using the concordance index (C-Index), hazard ratios (HR), and Kaplan-Meier (KM) curves. Feature models were compared with each other and the Framingham risk score (FRS) using the Likelihood ratio test (L.R.T.) Results: On the validation set of 244 patients, the risk score based on M A achieved a C-index of 0.69 (&gt; vs &lt; median risk, HR=3.79, 95% CI: 2.17-6.61). M Ves were comparable, with a C-index of 0.66 (HR=7.57, 95% CI: 2.63-21.76). M V had lower C-index and HR values. M A outperformed the FRS calculator (C-index=0.66, P&lt;0.01). The M A risk score was associated with MACE, independently of FRS. This suggests retinal artery features, capturing angle, connectivity, and tortuosity, encapsulate novel information not captured by FRS variables (Fig. 1B). Conclusion: AI-derived retinal artery features were strongly associated with, and predictive of, MACE in CKD patients, independently of established clinical risk scores. Further multi-site prospective validation is required.
Abstract 4140057: Defining Severe Heart Failure across the Ejection Fraction Spectrum in DAPA-HF and DELIVER
Authors: Riccardo Inciardi, Henri Lu, Brian Claggett, Akshay Desai, Pardeep Jhund, Carolyn Lam, Mikhail Kosiborod, Silvio Inzucchi, Felipe Martinez, Rudolf De Boer, Adrian Hernandez, Sanjiv Shah, Lars Kober, Piotr Ponikowski, Marc Sabatine, Magnus Petersson, Anna Maria Langkilde, John McMurray, Muthiah Vaduganathan, Scott Solomon
Journal: Circulation (2024)

Background: Patients with severe heart failure (HF) experience debilitating clinical symptoms and worse cardiovascular (CV) outcomes with an excess mortality risk. Until recently, severe HF has largely been considered only in those with reduced ejection fraction. The ESC HFA has put forth a consensus definition for severe or advanced HF that may be applicable across the ejection fraction (EF) spectrum. Hypothesis: Patients with severe HF experience a higher rate of CV outcomes. The safety and efficacy of SGLT2i dapagliflozin is consistent regardless of the severe HF status. Aims: To assess the prevalence, CV outcome risk, and treatment response to the SGLT2i dapagliflozin among patients with severe HF. Methods: DAPA-HF and DELIVER were randomized, double-blind trials, testing dapagliflozin vs placebo in 11,007 patients with symptomatic HF across the full spectrum of EF. Severe HF was adapted from the ESC HFA definition: NYHA class III/IV, evidence of HF with reduced, mildly reduced or preserved EF, elevated natriuretic peptides, HF hospitalization within previous 12 months, and adverse patient-reported symptom burden (KCCQ-TSS&lt;75). Outcomes were assessed and the treatment effect of dapagliflozin was measured for the primary endpoint of CV death or first worsening HF event (including HF hospitalization and urgent HF visit) by severe HF status. Results: Overall, 730 (6.6%) fulfilled the severe HF definition (296 [40.6%] with EF ≤40%, 192 [26.3%] with EF 41-49%, and 232 [33.2%] with EF ≥50%). Patients with severe HF had a higher comorbidity burden and higher NT-proBNP values. Over a median follow-up of 22.4 months, the primary endpoint occurred in 231 patients, at a rate of 20 (17-23) per 100py. Patients with severe HF experienced a higher rate of events compared to patients without severe HF (adjusted hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.20-1.75), across the spectrum of LVEF (P interaction =0.85). Treatment with dapagliflozin was consistently beneficial in reducing the risk of the primary endpoint regardless of the severe HF status (P interaction =0.10, Figure 1 ). The safety profile of dapagliflozin was also consistent irrespective of the severe HF status ( Figure 2 ). Conclusions: In a large, global contemporary HF trial population, “severe HF” was associated with excess risk of CV events across the spectrum of EF. Treatment with the SGLT2i dapagliflozin appears safe and effective in reducing the risk of CV death or worsening HF in this population.
Abstract 4139931: Multidisciplinary Care Coordination Between Cardiologists and Neurologists Improves Outcomes for Patients with Hereditary Transthyretin Amyloidosis with Polyneuropathy: Results of a Quality Improvement Initiative
Authors: Michel Khouri, Emily Zyborowicz, Jennifer Morgan, Jeffrey Carter, Cherilyn Heggen
Journal: Circulation (2024)

Background: Patients with hereditary transthyretin amyloidosis (ATTRv) are often referred to amyloidosis centers for manifest cardiac symptoms and treated accordingly for transthyretin amyloid cardiomyopathy (ATTR-CM). However, emerging evidence suggests that many patients with variants traditionally associated with ATTR-CM also have polyneuropathic symptoms but often do not undergo comprehensive neurological evaluation and management that could prevent irreversible disease progression and improve quality of life. Research Question: What are the root causes of suboptimal multidisciplinary care that contribute to delayed diagnosis and comprehensive management of cardiomyopathy (CM) and polyneuropathy (PN) associated with ATTRv? Goals: The objective of this program was to improve multidisciplinary care from cardiology and neurology teams for patients with ATTRv. Methods: Cardiologists and neurologists from three amyloidosis centers engaged in two focus groups, completed surveys, and collected patient chart audits to evaluate their baseline ATTRv management processes and clinical workflows. During audit-feedback sessions, care teams analyzed their performance data and designed action plans to close gaps with the highest potential to improve patient outcomes. Results: Provider surveys (N=30) reported only 13% of institutions had referral protocols for neurologic workup of ATTRv, and 51% of providers were neutral or felt care coordination was ineffective. Similarly, data from patient charts (N=151) showed only 10% of patients completed PN screening to confirm diagnosis. During post-focus group participation, cardiologists exhibited heightened commitment to refer newly diagnosed patients to neurologists (39% to 76%) and to communicate with treating neurologists on disease status (44% to 76%). Although provider surveys showed 100% of patients are seen at least every 6 months, &lt;5% received screening for emergent or progressive PN disease, whereas approximately 70% received CM screening. Identified gaps prompted practice changing initiatives including an improved intake process with PN screening and EMG referral, enhanced multidisciplinary collaboration to improve referral networks, and educational materials to heighten disease awareness. Conclusion: Practical strategies can be adopted by amyloidosis centers to ensure patients with ATTRv receive a comprehensive phenotypic workup and treatment through multidisciplinary collaboration between cardiologists and neurologists.
Abstract 4139905: Trends and Regional Variations in Chronic Ischemic Heart Disease and Lung Cancer-Related Mortality among American Adults: Insights from Retrospective CDC-Wonder Analysis
Authors: Eman Ali, Hafsah Alim Ur Rahman, Madiha Salman, Muhammad Ahmed Ali Fahim, Asim Shaikh, jawad ahmed, Ishaque Hameed, Farah Yasmin, Huzaifa Ahmad Cheema, Adeel Ahmad
Journal: Circulation (2024)

Introduction: Lung cancer remains the leading cause of malignancy-related mortality in the US. When concomitant Chronic Ischemic Heart Disease (CIHD) exists, morbidity and mortality in these patients is severely worsened. However, empirical evidence on shared mortality burden remains understudied. Therefore, we aim to retrospectively analyze mortality trends among American adults with concomitant lung cancer and CIHD. Methods: Death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database, using ICD-10 codes was retrieved for patients aged ≥ 45 years between 1999-2020. Age-adjusted mortality rates (AAMRs), per 100,000 people, and Annual Percentage Change (APCs) along with their respective 95% CIs were also calculated. Data was stratified according to year, sex, race, and geographical distribution. Results: Lung cancer with comorbid CIHD in adults aged ≥ 45 years resulted in 214,785 deaths, with an overall AAMR 8.4 (95% CI: 8.3 to 8.4). The AAMRs remained relatively stable from 1999-2005 (APC: -0.8352; 95% CI: -1.9139 to 1.5413) succeeded by periods of significant decrease from 2005-2010 (APC: -2.3654; 95% CI: -5.5832 to -0.6062) and 2010-2017 (APC: -4.7159; 95% CI: -7.6110 to -3.6000). However, another period of stability was noted between 2017-2020 (APC: 0.8579; 95% CI: -2.1682 to 5.2231). In 1999, men had triple the mortality rate when compared with women (AAMR: 17.8 vs 5.7), which non-significantly declined in 2020 (AAMR:13.3 vs 4) respectively. Non-Hispanic (NH) Whites had highest AAMR (9.3), followed by NH American Indian or Alaskan Native (7.3), NH Black or African American (6.8), Hispanic or Latino (3.3) and lastly NH Asian or Pacific Islander (3.2). Furthermore, AAMRs also varied significantly in census regions, with the highest ratios being observed in the Midwest (9.6), followed by the Northeast (8.8), South (8.4) and lastly the West (6.8). Additionally, non-metropolitan areas were found to have comparably higher AAMRs than metropolitan areas (10.3 vs 8). States in the top 90th percentile such as West Virginia, Kentucky, Vermont, Ohio and Rhode Island had nearly triple the AAMRs when compared with states in the lower 10th percentile including Utah, Nevada, Arizona, New Mexico and Hawaii. Conclusion: Mortality rates declined among American adults, with highest AAMRs being observed in men, NH Whites, residents of the Midwest and non-metropolitan patient populations.
Abstract 4140069: Improvement in left and right ventricular function in heart failure patients with reduced ejection fraction initiated or continued on angiotensin receptor neprilysin inhibitors in a GDMT clinic
Authors: Yoshiyuki Orihara, Shunsuke Eguchi, Ayumi Eguchi, Michael Pfeiffer, Omaima Ali, Gladys Baksh, Heather Reesor, Michele Haydo, Ryan Wilson, John Boehmer, John Gorcsan, Michael Farbaniec
Journal: Circulation (2024)

Background: Initiation of Guideline-Directed Medical Therapy (GDMT) in patients who have heart failure with reduced ejection fraction (HFrEF) has been shown to improve left ventricular EF, decrease hospitalizations, and reduce mortality. GDMT includes an angiotensin receptor/neprilysin inhibitor (ARNI). However, the relative importance of initiating or maintaining ARNI therapy during titration of GDMT and the impact on changes in left ventricular (LV) and right ventricular (RV) function is unknown. Methods: We enrolled 173 patients with HF in a GDMT clinic prospectively between 2020 to 2022. Of 173 patients, 63 HFrEF patients with baseline and 3-12 months follow-up transthoracic echocardiography (TTE) were included in this post-hoc analysis. Patients were divided into three groups; patients with initiation of ARNI after baseline TTE (Group 1), patients with continuation of ARNI that was started before baseline TTE (Group 2), patient who were not on ARNI during evaluation period (Group 3). LVEF as calculated by volumetric assessment, LV global longitudinal strain (LVGLS), RV fraction area change (RVFAC), and RV global longitudinal strain (RVGLS) were evaluated in this study. Strain analysis of LVGLS and RVGLS were applied using TomTec. Results: The mean age was 64 years, the mean time between TTEs was 6.9 months. Improvement in biventricular function and strain were noted between baseline and follow up data. (Figure 1) Changes of the four parameters for each group between the two TTEs are shown in Figure 2. In patients initiated on ARNI therapy (Group 1) there was a significant improvement from baseline to follow up TTEs in all parameters. (LVEF; p &lt; 0.001, LVGLS; p &lt; 0.001, RVFAC; p = 0.003, and RVGLS; p = 0.003) In group 2, we noted significant improvements in LVEF, LVGLS, and RVGLS from baseline to follow up. (LVEF; p &lt; 0.001, LVGLS; p &lt; 0.001, and RVGLS; p = 0.005) In those not on ARNI (Group 3), there was no statistical difference noted in any of the 4 parameters between baseline and follow up TTE. Conclusion: In patients with HFrEF, who had routing follow-up in a GDMT clinic, those initiated or continued on ARNI had significant improvement in biventricular function and biventricular strain measurements, compared to those who were not taking an ARNI.