tbuckley/cabot-search huggingface dataset:
Abstract 17633: Age and Racial Disparities in Gastrointestinal Bleeding Incidence Among Atrial Fibrillation Patients on Direct Oral Anticoagulants: A Retrospective Cohort Study
Authors: Obinna T Nwankwo, Yong Eun, Chizoba N Nwankwo, Farbod Raiszadeh
Journal: Circulation (2023)

Introduction: Atrial fibrillation (Afib), a major cause of morbidity and mortality, particularly affects the elderly. Direct oral anticoagulants (DOACs), despite being the preferred stroke risk reduction treatment in Afib patients, often result in gastrointestinal bleeding. This study aims to examine the incidence of this side effect across age and racial groups. Hypothesis: The risk of gastrointestinal bleeding while on DOACs increases with age. Racial variation in GI bleeding in Afib patients taking DOACs exists due to non-modifiable and modifiable risk factors. Methods: Utilizing the 'All of Us' national database, we conducted a retrospective cohort study of 6,961 Afib patients who started DOACs from 2018 to 2023. EHR data including ICD-9/10 codes and medication history were used to conduct the analysis. Patients who developed gastrointestinal bleeding after the introduction of DOACs within this period were identified. Incidence rates were further analyzed according to age and race. Results: Out of 6,961 Afib patients on DOACs, 791 developed gastrointestinal bleeding (21.9 cases per 1000 person-year). The incidence rate was highest among patients aged under 50 years (36.8 cases per 1000 person-year) and those over 80 years (24.0 cases per 1000 person-year). Patients aged 60-70 years had the lowest incidence rate (19.7 cases per 1000 person-year). Racial analysis revealed African-Americans had the highest incidence rates (29.3 cases per 1000 person-year), followed by Asians (21.9 cases per 1000 person-year), and Whites (19.6 cases per 1000 person-year; p&lt;0.001). Conclusions: Our study revealed a bimodal peak in GI bleeding incidence in patients on DOACs for Afib, with heightened risk in those under 50 years and above 80 years. Racial disparities were also evident, with African-Americans at the highest risk. These findings underscore the need for further research to elucidate risk factors, particularly in younger patients and specific racial groups.
Abstract 18518: Exploring Sleep's Impact On Sex And Racial/ Ethnic Disparities In Cardiovascular Disease Risk: Leveraging Machine Learning And Precision Insights To Unravel Sleep-cvd Connections In 10-year Sleep Health Health Study
Authors: April Rogers, Dr Debbie Chung, Azizi A Seixas, Alicia Chung, Ferdinand Zizi, Girardin Jean Louis
Journal: Circulation (2023)

Introduction: The study aimed to explore the connection between insufficient sleep (&lt;7 hrs.) and 10-year cardiovascular disease (CVD) risk levels in black and white individuals, using Framingham risk (FRS) and Reynolds risk (RRS) scores. It also sought to identify and characterize the CVD risk factors associated with heightened or reduced risk profiles. Methods: Using the Sleep Heart Health Study (SHHS) (N=6,441) data, we investigated the independent role of insufficient sleep in explaining differences in 10-years CVD between blacks and whites via a proportional odds model of four 10-year CVD risk groups: low (&lt;5%), low-medium (5% to &lt;10%), medium-high (10% to &lt;20%) and high (≥20%), adjusting for age, sex, and apnea-hypopnea index (AHI). We performed two levels of cluster analyses; via hierarchical cluster algorithm with entire sample (Level 1), and latent profiles in the low (protective profiles) and high (risk profiles) CVD risk groups (Level 2) to determine overall CVD risk, and risk and protective CVD profiles. Results: Blacks had a higher prevalence of smoking behavior, diabetes, mean systolic blood pressure, body mass index, total cholesterol compared to whites. Conversely, whites had a higher mean HDL cholesterol, sleep hours, and sleep efficiency compared to blacks. Men had higher 10-year CVD risk than women. AHI and race/ethnicity-sleep interaction were positively associated, while sleep was negatively associated with FRS and RRS. Across all CVD risk groups, whites who slept less than 5.5 hrs. had a higher CVD risk and those who slept more than 6.5 hrs. had a lower CVD risk compared to blacks. In Level 1 cluster analyses, we found two clusters: Cluster 1 (n= 3233): 6.17 sleep hours, apnea-index 11.84, age 59, SBP 125.43, total cholesterol 209, HDL 51.39, BMI 29.03, and slightly more than 50% female; and Cluster 2 (n=1657): 5.61 sleep hours, apnea-index 13.41, age 74, SBP 131, total cholesterol 204, HDL 50.30, BMI 26.45, and slightly less than 50% female. In Level 2 cluster analyses, we found two profiles within the low and high CVD risk groups. Conclusions: These findings suggest that blacks may not receive full protection from long-term CVD risk with longer sleep duration, as their white counterparts. Support: R01HL142066, R01AG067523, R01AG075007
Abstract 15908: A Meta-Analysis Revealing an Association Between High Sensitivity C-Reactive Protein Levels and Cognitive Impairment After 3-Months of Ischemic Stroke
Authors: Suvidha Manne, Sai Prasanna Lekkala, Adil S Mohammed, Priyatham Gurram, Nanush Damarlapally, Arankesh Mahadevan, Shabnam Abrishami, Chenna reddy Tera, Nishanth Katukuri, Maharshi Raval, Rupak Desai
Journal: Circulation (2023)

Introduction: Cognitive impairment has a significant impact on functional recovery and quality of life in stroke patients. Given the emerging role of high sensitivity C-reactive protein (hs-CRP) as a biomarker for predicting post-stroke cognitive decline, we conducted a meta-analysis to investigate this association. Methods: We systematically searched SCOPUS, PubMed, and Google Scholar databases until May 2023 using relevant keywords. Pooled effect sizes were estimated using a random-effects model, and I2 statistics and leave-one-out sensitivity analysis were performed to assess heterogeneity and robustness, respectively (p-value &lt; 0.05 considered significant). Results: The final analysis included five studies spanning the years 2018-2023, with a total sample size of 9,625 patients, all from China, and predominantly male (57.85%). The median follow-up period was 3 months. Patients with higher hs-CRP levels had a higher burden of smoking, alcohol consumption, hypertension, diabetes, hyperlipidemia, and lower education levels. The meta-analysis revealed an increased risk of cognitive impairment after ischemic stroke associated with higher hs-CRP levels (adjusted odds ratio [aOR] 1.15; 95% CI: 1.01-1.30, p - 0.03). Substantial heterogeneity was observed among the studies (I2 = 79.23%; p &lt; 0.01). However, a leave-one-out sensitivity analysis confirmed the robustness of the findings, indicating that no single study strongly influenced the overall results. Conclusion: This meta-analysis provides evidence of an association between elevated hs-CRP levels and cognitive impairment following ischemic stroke. However, the limited number of studies, mainly from a specific population, highlights the need for further research to enhance the generalizability of these findings.
Abstract 14144: Higher Burden of Cardiovascular Risk Factors in Schizophrenia Patients: Results From All of Us Study
Authors: Yong Eun, Fatima Anwer, Ha Rim Kwak, Farbod Raiszadeh
Journal: Circulation (2023)

Background: Patients with schizophrenia experience a higher risk of mortality and morbidity from physical health issues, including cardiovascular disease, diabetes, and metabolic syndrome. The literature suggests that patients with schizophrenia have a higher prevalence of metabolic syndrome than the general population. However, there is limited research examining the prevalence of hypertension (HTN), hyperlipidemia (HLD), and types 2 diabetes mellitus (T2DM) among patients with schizophrenia in large biobank data. Therefore, this study aims to investigate the prevalence of three disorders among patients with schizophrenia enrolled in All of Us database. Methods: In this cross-sectional study, we included participants from All of Us dataset version 6. Schizophrenia cohort was defined as having at least one ICD diagnosis code for schizophrenia and one or more antipsychotic exposure for schizophrenia. Patients with HTN, HLD, T2DM were identified using diagnosis codes, blood pressure measurements, medication history, and laboratory results (HbA1C, fasting, and random blood glucose). The prevalence of each disease was identified in schizophrenia cohort as well as all participants enrolled in the database, and odds ratios were calculated. Results: Of 258,188 individuals with available electronic health records data, 3,246 had schizophrenia. The median age was 51.8 (SD 13.1). 1,687 (52.0%) were males, 1,407 (43.3%) were African American, and 1015 (31.3%) were White. The prevalence of HTN, HLD, T2DM in participants with schizophrenia was 38.9%, 34.6%, 16.5%, respectively, compared to 21.6%, 22%, and 7.9% in all participants. The unadjusted odds ratios of HTN, HLD, T2DM in participants with schizophrenia compared to all participants were 2.344 (95% CI 2.182-2.561), 1.889 (95% CI 1.756-2.032), 2.336 (95% CI 2.125-2.563), respectively. Conclusion: Our analysis shows that the prevalence of HTN, HLD, T2DM is higher in individuals with schizophrenia compared to all participants in All of Us database. This highlights the importance of regular screening and prevention of cardiovascular disease risk factors in patients with schizophrenia. Future studies regarding the impact of these disorders on schizophrenia patients need to be undertaken.
Abstract 17799: Increasing Incidence of Atrial Fibrillation and Flutter in the United States: A Population-Based Time-Trend Analysis Using the Global Burden of Diseases Database, 2000-2019
Authors: Saeed Abughazaleh, Omar Obeidat, Saqr Alsakarneh, Mohammad Tarawneh, Khalid Abdalla
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) and flutter (AFL) are the most common sustained arrhythmia in clinical practice. There is limited data on recent age and sex-specific incidence rates. Aim: This study aimed to analyze incidence rates of AF and AFL in the US, focusing on age and gender-specific trends using the Global Burden of Disease (GBD) 2019 database. Methods: Incidence data was obtained from the GBD 2019 database. Age-adjusted incidence rates were stratified by gender into males and females. Age-specific trends were assessed in two age sub-groups: younger adults (≤55 years) and older adults (&gt;55 years). Time-trends, reported as annual percentage change (APC) and average APC (AAPC), were estimated using Joinpoint Regression Software (v.4.9.0.1, NCI) utilizing Monte Carlo permutation analysis. Results: 607,599 patients were diagnosed with AF and AFL in the US in 2019. Overall, AF and AFL incidence rates have increased in older adults and but remained stable in younger adults (AAPC= 2.2 vs. 0.9; AAPC difference= 1.3, P&lt;0.001). Age-specific trends were neither identical (P&lt;0.001) nor parallel (P&lt;0.001) suggesting that incidence rates are different and increasing at a greater rate in older adults compared to younger adults. However, for both men and women incidence rates have increased over the past two decades at the same rate (AAPC= 2.3 vs. 2.2: AAPC difference= 0.1, P=0.67). Conclusions: Our study showed that AF and AFL incidence increased over the past two decades. This increase is primarily driven by older adults. Further research is warranted to understand the factors contributing to this increase, especially in older adults.
Abstract 15225: Hybrid Coronary Revascularization versus Percutaneous Coronary Intervention for True Left Main Bifurcation Lesions
Authors: Cheng Yang, Yong-Gang Sui, Yong-Jian Wu
Journal: Circulation (2023)

Introduction: Hybrid coronary revascularization (HCR) is an alternative and feasible treatment for true left main bifurcation lesion. Aims: This study sought to compare the clinical outcomes of patients with true left main bifurcation lesions undergoing revascularization by HCR or percutaneous coronary intervention (PCI). Methods: This was a propensity-matched cohort study. From March 1, 2010, to March 31, 2018, 40 consecutive patients with true left main bifurcation lesions underwent HCR at Fuwai Hospital. These patients were matched 1:1 to 40 contemporaneous patients who underwent PCI. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of cardiac mortality, myocardial infarction, stroke, and repeat revascularization. Results: There were no differences in patient characteristics between the two groups. During a mean follow-up of 2 years, MACCE occurred in 12 patients (3 in the HCR group and 9 in the PCI group). Kaplan-Meier survival analyses indicated that the cumulative incidence of MACCE (log-rank test, p = 0.026) and repeat revascularization ( p = 0.011) in the HCR group were significantly lower than those in the PCI group. Conclusions: Compared with PCI, HCR demonstrated satisfactory mid-term outcomes in MACCE for true left main bifurcation lesions.
Abstract 17809: Association of Fatigue Subtype With Echocardiographic Measures of Cardiac Structure and Function in Prevalent HF in the Atherosclerosis Risk in Communities Study
Authors: Noelle Pavlovic, Cheryl R Dennison Himmelfarb, Martha Abshire Saylor, Jeannie-Marie Leoutsakos, Kuni Matsushita, Amil M Shah, Chiadi E Ndumele
Journal: Circulation (2023)

Background: Fatigue is prevalent in heart failure (HF) patients and strongly linked to adverse outcomes, but the relationship of cardiac structure and function with fatigue type and severity in HF is unknown. Methods: We included 947 individuals with prevalent HF from visit 5 (2011-2013) of the ARIC study with data on general and exertional fatigue, and echocardiographic measures. We previously identified four subtypes of fatigue using latent class analysis: Low/no fatigue, high general/low exertional, moderate general/moderate exertional, and high general/high exertional fatigue. We used multinomial logistic regression to determine the relationship between 1-SD higher echocardiographic parameters and fatigue subtypes, adjusting for age and sex. Results: Our sample was 54% female and 38% Black, with mean age of 77 ± 5.5 and LVEF of 61% ± 10. Adjusting for sex and age, worse longitudinal strain (OR = 1.55 [1.13, 2.13]), higher LV mass index (OR = 1.62 [1.23, 2.14]), and multiple measures of impaired diastolic function were associated with higher odds of having the high general/high exertional fatigue subtype compared to the low/no fatigue subtype (Table) . LV mass index and impaired diastolic function were also associated with higher odds of having the moderate general/moderate exertional fatigue subtype (Table) . Adjustment for additional sociodemographic and clinical characteristics attenuated associations, with only lateral E/e` significantly associated with the high general/high exertional fatigue subtype (OR= 1.81 [1.12, 2.91]), and the moderate general/moderate exertional fatigue subtype (OR=1.44 [1.10, 1.96]). Conclusions: Associations of fatigue subtype with cardiac structure and function are largely explained by other sociodemographic and clinical characteristics. Supplementary interventions targeting non-cardiac structural and functional mechanisms of fatigue may contribute to improved fatigue symptomatology in prevalent HF.
Abstract 16631: Isolated Cardiac Sarcoidosis Presenting as Recurrent Transient Ischemic Attacks
Authors: Moises A Vasquez, Manuel Rosario, Jose Luna Alvarez Amezquita, Ivan A Mijares, Sharon Andrade-Bucknor
Journal: Circulation (2023)

Background: Cardiac sarcoidosis (CS) is a rare disease that can present with a variety of clinical scenarios including, heart failure and sudden death. We present a case of isolated CS presenting as recurrent transient ischemic attacks (TIA) in a previously asymptomatic patient. Description of Case. A 54-year-old female with a history of two previous TIAs presented 30 minutes after the onset of left-sided facial droop and incomprehensible speech. CT and MRI brain did not show acute infarction. ECG showed a right bundle branch block pattern. Transthoracic echocardiogram (TTE) showed an abnormal global longitudinal strain of 12.8%, a left ventricular ejection fraction of 40%, segmental wall motion abnormalities involving the apex and basal inferior walls, and swirling of contrast at the apex. She had no previous history of cardiomyopathy. CTA was unrevealing for coronary artery disease but a cardiac MRI showed areas of late gadolinium enhancement and a RV wall aneurysm. PET scan revealed multifocal patchy nodular areas of FDG uptake within the myocardium. A diagnosis of isolated CS was made. At a three-month follow-up, TTE showed a new apical thrombus measuring 0.8cm x 0.6 cm. The patient was started on anticoagulation with the eventual resolution of the thrombus. She had no further ischemic events. Discussion. TIAs and ischemic stroke are extremely rare complications of CS and are largely attributed to cardioembolic phenomena, in the absence of systemic disease. Cardiac structural changes that lead to arrhythmias, hypokinesis, and stasis with clot formation largely explain embolic events in these patients. In addition, evidence suggests that the inflammatory cytokines, such as IFN gamma and IL-12, released by the sarcoid granuloma may also have an independent role in clot formation. The combination of stagnant flow in akinetic areas and a strong inflammatory bed of cytokines led to recurrent TIAs in this patient and the apical thrombus that was later identified.
Abstract 14706: Outcomes of Sports Participation for Black Athletes With Implantable Cardioverter-Defibrillators: Data From the ICD Sports Registry
Authors: Merije Chukumerije, Brian Olshansky, Elizabeth V Saarel, David Cannom, Mark S Link, Michael J Ackerman, Geliang Gan, Rachel J Lampert
Journal: Circulation (2023)

Introduction: The ICD Sports Registry demonstrated that many athletes with ICDs can participate in competitive sports without death, failure to defibrillate, or physical injury. However, sudden cardiac arrest is more prevalent and has worse outcomes in Black compared to White individuals in the general population and among athletes. Outcomes of sports participation for Black athletes with ICDs have not been described. Aim: To describe the risk of arrhythmia and efficacy of ICDs in Black athletes. Methods: This is a post-hoc subgroup analysis of the ICD Sports Registry, which enrolled athletes with ICDs age 10 to 60, participating in organized, competitive sports, and followed them prospectively for four years. The endpoints and methods are reported previously. Results: Among the 440 athletes, 15 were Black and 410 white. Among the Black athletes, hypertrophic cardiomyopathy was the most common diagnosis (40%) and 87% were implanted for secondary prevention or syncope (vs 69% in White athletes). Most common sports were basketball (8), softball (4), and running (3), with 7 Black athletes competing on varsity/junior varsity/traveling teams. Among the Black athletes, there were no appropriate shocks during sports, among white athletes, 7% received an appropriate shock during sports. Among Black athletes, there was one appropriate shock event for ventricular tachycardia (7%), a VT storm in an athlete with idiopathic VF, non-sports-related. Among white athletes, 10% received appropriate shocks during non-sports activities. Two Black athletes (13%) received an inappropriate shock, one competition-related (sinus tachycardia) and the other for T wave oversensing at rest, vs 12% of white athletes. There were no sports-related deaths, arrests, or arrhythmia-related injuries in either group. Conclusions: Black athletes represented a small subset of the ICD Sports Registry. Reasons for this are unknown, but may include disparities in ICD implantation and/or in research recruitment/ participation. These Black athletes experienced both appropriate and inappropriate shocks as did white athletes. These data do not suggest a signal for harm for competitive sports participation for Black athletes with ICDs but larger studies are needed.
Abstract 17709: ICD-10 Codes Have Low Sensitivity and Suboptimal Positive Predictive Value for Identifying Cases of Pulmonary Embolism With Cor Pulmonale in Electronic Healthcare Records
Authors: Antoine Bejjani, Candrika D Khairani, Ying-Chih Lo, David Jimenez, Stefano Barco, Shiwani Mahajan, Cesar Caraballo, Eric A Secemsky, Erik Klok, Andetta Hunsaker, Ayaz Aghayev, Alfonso Muriel, Mohamad A Hussain, Abena Appah-Sampong, HAMID MOJIBIAN, Yuan Lu, Zhenqiu Lin, Sanjay Aneja, Rohan Khera, Samuel Goldhaber, Li Zhou, Manuel Monreal, Gregory Piazza, Harlan M Krumholz, Behnood Bikdeli
Journal: Circulation (2023)

Introduction: The International Classification of Diseases, 10 th revision (ICD-10) codes were updated in 2015 to include designation of pulmonary embolism (PE) with cor pulmonale . These codes can be advantageous to identify higher-risk patients with PE for research or quality improvement. However, the validity of these codes is unknown. Methods: We reviewed patient data from Mass General Brigham (MGB) health system (01/2016-12/2021). Patients were randomly selected from 3 groups: Patients with Principal discharge diagnosis codes for PE, patients with secondary discharge diagnosis of PE, and patients with no PE codes. Accuracy of codes for PE with cor pulmonale were assessed with reference to manual review by 2 independent physicians using pre-specified criteria. Weighted estimates were obtained by considering the total number of hospitalizations. Results: 1,712 patients were included (age: 60.6±17.8 years, 52.3% female). Chart review found 865 patients with PE, of whom 360 (41.6%) had PE with cor pulmonale according to predefined clinical criteria. Of these 360 PE patients, 358 (99.4%) had ICD-10 codes for PE. However, only in 36 (10.1%) cases, the specific cor pulmonale codes were used. There were 24 additional cases with ICD-10 codes for PE with cor pulmonale in whom the diagnosis was not confirmed per manual review. Sensitivity and specificity for PE with cor pulmonale codes in Principal-or-secondary position were 10.0% and 98.2% (Table, panel A). The positive predictive value (PPV) for PE with cor pulmonale in Principal-or-secondary discharge position was 63.2% in the weighted sample (Table, panel B). Conclusions: ICD-10 codes for identification of acute PE with cor pulmonale have excellent specificity, but very poor sensitivity and suboptimal PPV. These results are informative for investigators who may use such ICD-10 codes for research or quality improvement purposes.