tbuckley/cabot-search huggingface dataset:
Abstract Or112: Tracheal Intubation During Pediatric In-Hospital Cardiac Arrest: Trends and Association with Survival
Authors: Lindsay Shepard, Ron Reeder, Jesse Hsu, Garrett Keim, Robert Berg, Robert Sutton, Alexis Topjian, Nadir Yehya, Ryan Morgan
Journal: Circulation (2024)

Background: Pediatric life support guidelines defer recommendation for or against intra-arrest intubation during IHCA. A prior observational study (2000-2014) identified an association of intra-arrest intubation with lower rates of survival to hospital discharge (SHD). Changes in clinical practice (e.g., patient selection, delaying intubation, CPR quality) may have mitigated potential harm. Aim: Determine the association between intra-arrest intubation and SHD in a recent cohort of children with IHCA. Hypothesis: Intra-arrest intubation is associated with increased odds of SHD. Methods: Retrospective cohort study of children with index IHCA without an invasive airway at time of CPR in the Get with the Guidelines registry from 2000-2022. We performed a time-dependent propensity-score matched analysis. Patients intubated in a given minute were matched with patients at-risk of intubation in the same minute based on a propensity score derived from multiple patient, arrest and hospital characteristics, with forced matching on stratification variables (age group, illness category) and replacement of controls. We assessed the association between intra-arrest intubation and SHD using a mixed-effects logistic regression model, with random effects to account for matched data and clustering by hospital, and weighting for the number of times a patient was included as a control. Results: Of 3,262 patients with median age 1 [IQR: 0.3, 8] years, 2,164 (66.3%) were intubated, and 1,748 (53.6%) survived to hospital discharge. Intubation rates decreased from 84.6% to 66.7% across the study period (Figure 1, non-parametric test for trend, p&lt;0.001). Median time to intubation was 7 [4, 12] minutes and increased across the study period (p&lt;0.001). In the recent cohort (2017-2022, n=1192), there was no association between intra-arrest intubation and SHD (aOR 1.18, 95% CI: 0.90, 1.53). In a subgroup analysis of children &gt;8 years, being intubated compared to not being intubated in a given minute was associated with increased odds of SHD (aOR 1.91, 95% CI: 1.09, 3.33) (Figure 2). Conclusions: In a recent (2017-2022) cohort of children with IHCA, intra-arrest intubation was not associated with increased odds of survival to hospital discharge. In a subgroup of children &gt;8 years, intra-arrest intubation was associated with increased odds of survival. We speculate that secular changes in airway management may partially explain the lack of harm identified in our recent cohort.
Abstract 4147323: The Effects of Illicit Drug Use on Congestive Heart Failure Patients and Hospital Readmission Rates at Harlem Hospital Center
Authors: Rosemarie Majdalani, Mariel Magdits, Asmaa Alshammari, Anna Hughes, Lily McCann, Sriraman Devarajan, Myint Thu, Ihab Jameel, Shaunak Mangeshkar, Ifeoma Kwentoh, Pooja Roy, Subash Dulal, Sapana Jha, Jialu Shou, Simran Rijhwani, Natalia Ionescu, Meghana Kakade, Damian Kurian, Farbod Raiszadeh
Journal: Circulation (2024)

Introduction: CHF is defined as a chronic disease that impacts more than 5 million adults in the United States with significant population-wide impact on morbidity, mortality and hospitalization burden, especially amonth high-risk and vulnerable populations. Although the intricacies of CHF and readmission risk have been well documented, there have been fewer studies investigating the effect of illicit drug use on CHF patients and readmission outcomes especially in a population at high risk of health disparities. Objective: The purpose of this study was to examine the effects of illicit drug use on CHF patients and hospital readmission rates at Harlem Hospital Center with a high density of patients with health disparities. Methods: We included all patients admitted during a 2 year period (2019-2020) with a primary diagnosis of heart failure to Harlem Hospital Center and conducted in depth assessment of drug use history including patient history, available laboratory analysis, and collateral EMR information. Rehospitalization was assessed by review of EMR by trained medical professionals. Our results were analyzed using standard statistical methods between the two groups with and without history of drug use. Results: Our study population included 380 admitted CHF patients. The overall prevalence of illicit drug use in CHF patients was 32.89%, with the most common drug used being cocaine. CHF patients who used illicit drugs had a 22.58% 30-day readmission rate in comparison to 13.78% among CHF patients who didn’t use illicit drugs. In addition, CHF patients who used illicit drugs had higher all-time hospitalizations and were more likely to be admitted than non-illicit drug users in terms of heart failure hospitalizations. Overall, CHF patients who used any type of illicit drug were twice as likely to be readmitted after index hospitalization compared to CHF patients who didn’t use illicit drugs. We also found that CHF patients who used illicit drugs were slightly younger, more likely to be male, and more likely to smoke cigarettes. Lastly, we observed that at least 50% of CHF patients who used illicit drugs were on government assistance, lacked family support, and were unemployed. Conclusion: Drug use is a common problem among patients with CHF in this vulnerable population and is associated with significant adverse outcomes such as increased rehospitalization. Systemic efforts to address this at the patient and community level are justified.
Abstract Sa905: Differential Outcomes After Cerebrovascular Accident-Related Out-of-Hospital Cardiac Arrest With and Without Initial Shockable Rhythm
Authors: KAZUYA TATEISHI, Yuichi Saito, Hideki Kitahara, Yoshio Kobayashi, Yoshio Tahara, Naohiro Yonemoto, Takanori Ikeda
Journal: Circulation (2024)

Backgrounds: Although the prognosis of out-of-hospital cardiac arrest (OHCA) may be worse in patients with cerebrovascular accident (CVA) than in those with other etiologies, clinical outcomes are not fully elucidated, particularly between CVA-related OHCA with and without initial shockable rhythm. This study aimed to investigate the prognostic outcome associated with initial shockable and non-shockable rhythms in patients with CVA-related OHCA. Methods: Using a nationwide OHCA registry database from 2005 to 2021 in Japan, a cohort of 2,059,417 patients with OHCA were retrospectively reviewed. After excluding patients aged &lt; 18 years and with missing data on initial rhythm, 1,934,897 individuals were included and were divided into two groups according to the initial rhythm (shockable or non-shockable group). The primary outcomes of this study were all-cause mortality and neurologically favorable survival, defined by the cerebral performance category score of 1 or 2, at 1 month. Characteristics and outcomes of OHCA patients with and without CVA were compared between the shockable and non-shockable groups. Results: Overall, patients with CVA-related OHCA were younger and more likely to be women than those without. In the shockable group, patients with CVA had a lower number of defibrillation attempts and a higher likelihood of achieving prehospital return of spontaneous circulation (ROSC) (31.3% vs. 28.4%, p&lt;0.0001). However, a neurologically favorable survival rate was significantly lower in patients with CVA than in those without (10.5% vs. 18.6%, p&lt;0.0001). In the non-shockable group, the rates of prehospital ROSC (13.2% vs. 5.7%, p&lt;0.001) and 30-day survival (3.2% vs. 2.8%, p&lt;0.0001) were significantly higher in patients with CVA, while neurologically favorable survival was similar between patients with and without CVA (0.9% vs. 0.8%, p=0.439) (Table and Figure). Conclusions: Although patients with CVA as an etiology of OHCA were more likely to achieve prehospital ROSC than those with other etiologies of cardiac arrest irrespective of initial rhythm, a neurologically favorable survival rate was lower in patients with CVA, particularly in the shockable group. Further studies are warranted to clarify the underlying mechanisms of OHCA with shockable rhythm in patients with CVA.
Abstract 4147663: Higher LDL Across Lifespan Among Women: A Real-World Analysis
Authors: Priyanka Nadar, Prerna Gupta, Steven Simon, David Kao, Michael Rosenberg
Journal: Circulation (2024)

Introduction: Lower low-density lipoprotein (LDL) leads to greater cardiovascular disease risk reduction over the lifespan. Despite this, women are less likely to reach guideline-recommended LDL goals, perhaps due to bias in statin prescription or statin intensity. and disparities in adherence. There are known sex differences in cardiovascular disease and statin response, but little is known about how these differences manifest under real-world conditions. Aim: We aim to characterize long-term LDL between men and women who have been prescribed statin therapy as a function of age at initial statin therapy. Methods: We retrospectively identified patients within the UCHealth electronic health record among adults from 2012 to 2023 prescribed a statin with at least 3 LDL levels. Patients prescribed concomitant lipid-lowering agents were excluded. We performed a multivariate linear regression model to predict long-term average LDL between genders, adjusting for age at the time of statin prescription, race, ethnicity, BMI, interval from statin prescription, creatinine, and the following diagnoses: diabetes mellitus, ischemic heart disease, ischemic stroke, and smoking history. Results: Among 75,276 encounters, 14,902 patients had at least 3 LDL-C measurements and an interval statin initiation. Post-treatment LDL was obtained 212 (± 177) days after statin initiation. The cohort was 49% (7,303 patients) female, with 86% (12,819) white, 4% (648) African American, and 8% (1,249) Hispanic patients. At age 30, men started on statin therapy had a predicted LDL of 117 (95% CI: 114-121 mg/dL), whereas women began with a predicted LDL of 115 (95% CI: 112-119 mg/dL). At age 70, that value was 94.1 (95% CI: 93.4-94.8 mg/dL) among men vs 105.6 (95% CI: 104.9-106.3 mg/dL) in women (Figure). Discussion: In this single-center, retrospective observational study, we found that women had a higher predicted LDL compared to men across the lifespan, with a greater difference in those whose first prescription was at an older age. More work is needed to determine if this reflects less aggressive treatment of women than men. Further research needs to be done to bridge this gap in therapy.
Abstract 4146902: Invasive versus Echocardiographic Hemodynamics in Two Genetically Modified Porcine to Human Cardiac Xenotransplants
Authors: Alice Tang, Muhammad Mohiuddin, Cullen Soares, Susie Hong-Zohlman, Andrew Tully, Javier Galindo, Timm Dickfeld, Brian Barr, Sadegh Asadi, Anuj Gupta, Alison Grazioli, Allison Lankford, Erika Feller, Bartley Griffith, Manjula Ananthram
Journal: Circulation (2024)

Background: Our institution performed two transgenic porcine to human cardiac xenotransplantations. There is limited data with the first cardiac xenograft suggesting echocardiographic assessment of the cardiac xenograft in humans correlates with invasive hemodynamic assessments. We investigated whether echocardiographic-derived hemodynamic indices would correlate with invasive measurements in both cardiac xenotransplants. Methods: Serial transthoracic echocardiography (TTE) and right heart catheterizations (RHC) were performed in the cardiac xenografts. Retrospective analysis of TTE and invasive hemodynamics were analyzed in both the first and second xenotransplant to assess correlation between various parameters. Invasive hemodynamic measures include right atrial pressure (RAP), pulmonary artery systolic and diastolic pressures (PASP, PADP), Fick cardiac output (CO), cardiac index (CI), right ventricular stroke work index (RVSWI), and cardiac power output (CPO). TTE measurements and calculations included: RAP, PASP calculated via tricuspid regurgitation velocity (TRV), PADP based on end diastolic pressure gradient, tricuspid annular plane systolic excursion (TAPSE), right ventricular outflow time-velocity integral (TVI RVOT), pulmonary vascular resistance (PVR) = [TRV/TVI RVOT x 10 + 0.16], CO, CI, CPO = [mean arterial pressure echo-derived CO / 451], and right ventricular stroke work index (RVCPI) = [4x(TRV)^2) x TAPSE], as a surrogate of RVSWI. Results: Pearson correlation using invasive measurements at the time of TTE for cardiac output showed a positive correlation of 0.69 (p = 0.06) with a trend towards significance. Pearson correlation of RVSWI and RVCPI demonstrated a significant positive correlation of 0.83 (p = 0.04). Conclusions: In the first two cardiac xenotransplants, there remains a positive correlation in hemodynamic markers between invasive and noninvasive measurements. Given the intense interest in cardiac xenotransplant, continued investigation in correlating noninvasive and invasive hemodynamic markers will provide real-time prognostic and clinical value for future research.
Abstract Or114: Development of an Innovative Cardiac Arrest Recovery Pilot (CARP) Program
Authors: Rachel Beekman, Joanna Gray, Kaile Neuschatz, Christine Nguyen, Kenia Lucey, Celia Fung, Jeremy Moeller, Sarah Perman, Laurel Lovelett, Jennifer Coutinho, Lucas Driskell, Emily Gilmore
Journal: Circulation (2024)

Background: Cardiac arrest survivorship is wrought with psychological, physical, and cognitive disability, much of which goes underrecognized by healthcare professionals. Discharge planning is not standardized, thus limiting access to critical evaluations and services that have the potential to impact intermediate and long-term outcomes. Aims: We describe the development of a novel cardiac arrest recovery clinic. Methods: At our institution, all unresponsive cardiac arrest survivors are followed prospectively by our neurocritical care consult service who provide recommendations on brain centered resuscitation and neuroprognostication. Eligibility for CARP included patients admitted to an intensive care unit following out-of-hospital (OHCA) or in-hospital cardiac arrest (IHCA) who subsequently regained consciousness and were following commands prior to discharge. Nurse navigators (JG, KN) and neurointensivists (RB, EG) tracked inpatient recovery and coordinated with the primary medical team and rehab colleagues to ensure optimal discharge planning. The primary outcome was incidence of cognitive deficits at hospital discharge. Secondary outcomes included discharge disposition. Results: Between February 1 and June 4, 2024, 54 patients, including 24 IHCA and 30 OHCA, were screened for eligibility, of which 22 (41%) were enrolled in the CARP program. Patients with IHCA were more likely to be enrolled than patients with OHCA [13 (54%) vs. 9 (30%)]. Prior to discharge, all eligible patients underwent cognitive screening performed by speech and language pathology, which identified 18 (82%) with cognitive deficits. All CARP enrollees were referred to neurology resident clinic; of those with cognitive impairment, 16 (89%) were also referred to neuropsychology. Discharge disposition included 8 (40%) to home ± services, 7 (35%) to acute rehab, 4 (20%) to short term rehab, and 1 (5%) to inpatient substance abuse recovery program. Follow up data is pending. Conclusions: Amongst cardiac arrest survivors, in-hospital cognitive screening by speech and language pathology was feasible and frequently identified cognitive impairment not detected on crude bedside assessments. Using a prospective screening approach, we were able to track inpatient recovery, anticipate discharge needs, and facilitate expedited outpatient neuropsychological evaluations. CARP will continue to perform a needs assessment regarding resources with the potential to improve survivorship.
Abstract Sa1207: Reducing Socioeconomic Disparities in Out-of-Hospital Cardiac Arrests in Denmark through 30-minute, Cost-free Cardiopulmonary Resuscitation Courses
Authors: Emma-Emilie Knudsen, Carolina Malta Hansen, Fredrik Folke, Annam Pervez Sheikh, Annette Kjær Ersbøll, Christian Torp-Pedersen, Anne Juul Grabmayr
Journal: Circulation (2024)

Background: The Danish Heart Foundation has offered 30-minute, cost-free, and easily accessible Save-a-Life courses to disseminate CPR training since 2017. Research Question: Can Save-a-Life courses effectively reach neighbourhoods with low socioeconomic status and reduce socioeconomic disparities in OHCA? Aim: To investigate the distribution of Save-a-Life courses according to area-level educational or income status. Methods: We included Save-a-Life courses in residential areas in Denmark (2017-2023). Save-a-Life courses were geocoded using QGIS3 and merged with demographic data organized within 100x100 meter grid cells from the Danish Grid System (2020). Data were provided by the Danish Heart Foundation and Statistics Denmark. Socioeconomic status was assessed by 1) area-level educational status, defined as the percentage of inhabitants with primary or lower secondary school as their highest education (High: 0-25%, Middle: 25-50%, Low: 50-100%), and 2) area-level income status, defined as mean household income divided into quartiles (High, Upper-middle, Lower-middle, Low). We compared course participation (participants/1,000 inhabitants) by educational or income status using a Poisson regression model, presented as risk ratio (RR). Educational status was adjusted for age and ethnicity, while income status was adjusted for age, educational status, and ethnicity. Results: A total of 9,123 Save-a-Life courses with 84,641 participants were included, covering 426,225 grid cells with 5,814,763 inhabitants. Areal-level characteristics and distribution of Save-a-Life courses are shown in Tables 1 and 2. Areas with high educational status had 14 participants/1,000 inhabitants (RR=1, reference); middle had 18 participants/1,000 inhabitants (RR=1.26, 95% CI 1.23-1.28); and low had 23 participants/1,000 inhabitants (RR=1.32, 95% CI 1.24-1.4). Areas with high income status had 14 participants/1,000 inhabitants (RR=1, reference), upper-middle had 12 participants/1,000 inhabitants (RR=0.84, 95% CI 0.82-0.86), lower-middle had 13 participants/1,000 inhabitants (RR=0.83, 95% CI 0.81-0.84), and low had 16 participants/1,000 inhabitants (RR=1.03, 95% CI 1.01-1.05). Conclusion: Areas with low educational or income status had higher course participation compared to high-status areas. This indicates that the distribution strategy for Save-a-Life courses effectively reach neighborhoods with low socioeconomic status, potentially mitigating socioeconomic disparities in OHCA.
Abstract 4147657: Are Females More Fraily than Males at Time of Heart Failure Diagnosis?
Authors: Mary Roberts Davis, Nathan Dieckmann, Christopher Chien, Lissi Hansen, Elise Erickson, Nabil Alkayed, Jackilen Shannon, Quin Denfeld
Journal: Circulation (2024)

Background: In chronic heart failure (HF), physical frailty is more prevalent in females than males, and studies have shown that frailty is associated with worse symptoms. However, sex differences in frailty at the time of HF diagnosis are not well understood, including associations with symptoms. Research Question: What are the relationships between frailty, sex, and symptom burden at the time of initial HF diagnosis? Aims: 1) to quantify sex differences in frailty at the time of HF diagnosis, and 2) to determine if sex influences the association between frailty and symptoms at time of HF diagnosis. Methods: This was an analysis of data collected from a study of symptoms among patients with a new diagnosis of Stage C HF and New York Heart Association (NYHA) Functional Classification I-IV symptoms. Frailty was measured using the FRAIL Scale (Fatigue, Resistance, Ambulation, Illnesses,&amp;Loss of Weight). Symptom burden was measured using the Heart Failure Somatic Perceptions Scale (HFSPS). We used comparative statistics to examine differences in frailty (frail vs. robust or pre-frail) by sex, age, and HFSPS score. Then, we used robust linear regression with an interaction between sex and frailty to examine the relationship between HFSPS score and frailty. Results: The sample (n=50) was 58.2±16.4 years old, 46% female, and 63% NYHA Classification III/IV. There were no sex differences in HF type, with the majority of participants with HF with reduced ejection fraction (n=38 (67%)). Females were more likely to be frail than males (n=16 (67%), p=0.005, Cohen’s d =.85). Age was not significantly different between those who were frail or not. Frail participants reported higher symptom burden in the HFSPS (=47.4±20.8) compared to those who were not (=35.8±21.9), t(48)=-1.91, p=0.06, Cohen’s d =-.54). Frailty, sex, and age accounted for 17.1% of the variability in HFSPS (F(4, 45)=2.54, p.05). Individuals who were frail were significantly more symptomatic as measured by the HFSPS (β=22.8± 9.6; 95%CI (3.3, 42.2)), controlling for sex and age. There was a not a significant interaction between frailty and sex (b=20.2, 95% CI (-44.9, 4.5)). Conclusions: At the time of HF diagnosis, female patients are more frail and frail patients are more symptomatic, but sex does not moderate the relationship between frailty and symptoms. Larger studies of the role of sex in frailty and symptoms in new HF may contribute to more timely diagnosis and treatment, particularly in females.
Abstract Su1104: Examining the Need for Lifesaving Skills Training Among the Homeless Through Review of Homeless-Involved EMS Cases
Authors: Netsanet Gurmu, Gnanesh Gutta, Danielle Schnauber, Jorge Gumucio, LEONARD WEISS, Christian Martin-Gill, Ankur Doshi, David Salcido
Journal: Circulation (2024)

Background: Individuals experiencing unsheltered homelessness (those living in encampments) are at greater risk of experiencing health issues, including consequences of cardiovascular disease and opioid abuse, compared to sheltered individuals. They also face more significant barriers to care, one of which may be access to emergency medical care. Many individuals in homeless encampments are concealed within urban areas, often making it challenging for Emergency Medical Services (EMS) to precisely pinpoint their location. Furthermore, the lack of phone access and delays in bystanders notifying EMS can lead to delayed response times and inadequate medical attention. Objective: We aimed to categorize EMS calls and analyze EMS unit arrival times for homeless individuals on the street versus those in shelters, focusing on events requiring life-saving skills amenable to bystander intervention. Methods: The study is a retrospective review of EMS records for incidents in Allegheny County, PA, from January to July 2023. Cases were included that had documented evidence of a homeless patient treated by EMS, occurring near or in homeless encampments, as well as cases with homeless patients occurring at known homeless shelters as defined by EMS charting. The primary outcome was the response time of 911-initiated EMS (time of dispatch to arrival). Case characteristics and chief complaints were summarized and stratified by sheltered and unsheltered homeless status. Results: 1204 cases were reviewed, with 424 (35.2%) involving unsheltered and sheltered homeless patients. Unsheltered individuals experienced more traumatic injuries and were disproportionately involved in drug overdose and intoxication incidents, with a mean overdose/intoxication of 20 with 95% CI ( 16.5, 24) compared to the mean of 10.7 with 95% CI (8.1, 14) for sheltered individuals. The mean EMS response time did not significantly differ between unsheltered and sheltered individuals, averaging 7.95 and 8.15 minutes, with a p-value of 0.79 for both groups respectively. Conclusion: In Allegheny County, although unsheltered individuals have equal timely access to EMS services, they exhibit higher rates of trauma and drug overdoses, which require timely intervention, and can benefit from trained lay people assisting prior to EMS arrival. Future training in these skills may be of benefit to this population.