tbuckley/cabot-search huggingface dataset:
Abstract 13617: Spironolactone Use is Associated With Better Survival in Heart Failure Patients With Preserved Ejection Fraction With Concomitant Angiotensin Receptor Blocker Treatment
Authors: Xiao Liu, Yue Wang, Hong Pan, Yuan Jiang, Zhengyu Cao, Maoxiong Wu, Zhiteng Chen, Ayiguli Abudukeremu, Kaihang Yiu, Yuling ZHANG, Jingfeng Wang
Journal: Circulation (2023)

Introduction: The guidelines recommend using renin-angiotensin-aldosterone system inhibitors, including spironolactone and angiotensin II receptor blocker (ARB), and spironolactone rather than angiotensin-converting enzyme inhibitors (ACEI) for treating heart failure with preserved ejection fraction (HFpEF). However, it is unclear whether there is an additive effect of spironolactone when combined with ACEI/ARB on HFpEF. Hypothesis: Spironolactone combined with ACEI or ARB may provide additional benefits in patients with HFpEF. Methods: We conducted a post hoc analysis of the TOPCAT (Heart Failure Trial with Aldosterone Antagonist for Preservation of Heart Function) trial using Cox proportional hazards models to evaluate the effect of spironolactone on the clinical prognosis of HFpEF patients, with or without ACEI or ARB. Our primary outcomes were defined as death from cardiovascular causes, aborted cardiac arrest, and hospitalization for heart failure. Results: A total of 1767 HFpEF patients from the Americas were included (49.9% women, median age 71.5 years). During a median follow-up of 2.98 years, 522 (29.5%) primary outcomes occurred. Compared with placebo, spironolactone use was associated with a lower incidence of primary outcomes (hazard ratio [HR]: 0.69, P=0.02), cardiovascular mortality (HR: 0.45, P=0.004) and all-cause mortality (HR: 0.58, P=0.01) after adjustments in HFpEF patients who were concomitantly taking ARB at baseline but not in those without ARB use. Significant interactions were found between spironolactone use and baseline ARB use for cardiovascular and all-cause death (P=0.01). In contrast, spironolactone use was associated with lower cardiovascular death (HR: 0.59, P=0.01) in patients without ACEI baseline use but not in those with ACEI use. There was no significant interaction observed between spironolactone use and baseline ACEI for adverse outcomes. Conclusions: Among HFpEF patients enrolled in TOPCAT-Americas, the survival benefit of spironolactone was enhanced by ARB use but not ACEI use. Further prospective studies are necessary to validate these findings.
Abstract 13088: The Psychometric Properties of the Advance Care Planning Engagement Survey in Cardiovascular Diseases
Authors: Seongkum Heo, Minjeong An, SUN HWA KIM, JungHee Kang, jisun Yang, JinShil Kim, KyungAh Cho
Journal: Circulation (2023)

Background: Patients with cardiovascular diseases (CVDs) have high mortality rates, and the progress is uncertain. Advance care planning (ACP) can help these patients and their caregivers prepare for expected or unexpected end-of-life situations effectively. However, the implementation of ACP is suboptimal in this population, resulting in unnecessary suffering of patients and their caregivers and increased health costs. Different versions of the Advance Care Planning Engagement Survey (ACPES) have been used to assess ACP engagement. However, the comprehensive psychometric properties of the ACPES-9 have not been tested in South Korea. Aim: To test the reliability and validity of the ACPES-9 in patients with CVDs. Hypothesis: The reliability of the ACPES-9 is supported by Cronbach’s alpha ≥ .70, and the validity is supported by meeting the cut points of good model fit indices (chi-square test: not significant, CFI ≥ .95, TLI ≥ .95, SRMR &lt; .05, and RMSEA &lt; .07) with factor loadings &gt; .40 in confirmatory factor analysis (CFA) and significant associations of ACP engagement with registration of advance directive (AD) and the intention. Methods: In this cross-sectional study, data on ACP engagement (ACPES-9) and registration of ADs and the intention and sociodemographic characteristics (sample characteristics questionnaire) were collected from 4 hospitals or public health centers (N = 105, mean age: 66.3) between February and March, 2023. Cronbach’s alpha was used to test the reliability. Confirmatory factor analysis and independent t-tests were used to test the validity. Results: Cronbach’s alphas for the total scale and self-efficacy and readiness dimensions were .93, .82, and .97, respectively. In CFA with two factors, all indices of model fit were acceptable: chi-square test = 21.76, p = .151; CFI = .995; TLI = .989; SRMR = .024; RMSEA = .059). All factor loadings were &gt; .65. Patients who registered AD (35.3 vs. 24.3, p &lt; .001) or had the intention (28.9 vs. 20.6, p &lt; .001) had higher scores of the ACPES-9 than their counterparts, respectively. Conclusions: The findings demonstrate that the ACPES-9 was a reliable and valid instrument by supporting the hypothesis. Healthcare providers can use this instrument to assess and manage ACP engagement in patients with CVDs.
Abstract 18948: Prospective Associations Between the Life's Essential 8 Cardiovascular Health Construct, Leptin, and Inflammatory Markers Among Women Across the Menopausal Transition: Findings From the AHA Research Goes Red Weight Study
Authors: Brooke A Aggarwal, Samantha Scaccia, Pengchen Wang, Matthew A Allison, Janet M Catov, Harmony Reynolds, Dhananjay Vaidya
Journal: Circulation (2023)

Introduction: The menopausal transition is a key period of potential detrimental changes in adiposity. The hormone leptin may be relevant to obesity, inflammation, and cardiovascular health (CVH). Hypothesis: Among women across the menopausal transition, lower levels of circulating leptin, C-reactive protein (CRP) and interleukin 6 (IL-6) will be associated with better Life’s Essential 8 (LE8) CVH score. Methods: Participants were women ages 45-55y (N=291, mean age=50 ± 3.2yr, 74% with overweight/obesity, (n=98 pre-, n=94 peri-, n=99 post-menopausal) from the AHA Research Goes Red Weight Study, a 1-yr prospective observational study utilizing Verily’s online platform. At baseline and 1yr, women completed a 1-wk food record using the NIH ASA 24-Hour Dietary Assessment Tool and fasting blood samples were drawn. The LE8 CVH and component scores (range: 0-100, high: 80-100, moderate: 50-79, low: 0-49) were computed. Associations between leptin, inflammatory markers, and CVH scores were tested using multivariable linear regression models adjusted for age, race/ethnicity, education, employment, insurance, and menopausal status. Results: The mean (SD) overall LE8 CVH score at baseline was 68.0 (15.3) and did not vary by menopausal status. Individual LE8 scores were lowest for the diet metric [mean (SD)=40.2 (31.5)]. Pre-menopausal women had better scores on the blood glucose metric compared to post-menopausal [mean (SD)= 88.0 (24.4) vs. 76.2 (26.5), p=.02]. Compared to peri- and pre-menopausal women, leptin values were highest in post-menopausal women (55 ± 29.5 mg/mL vs. 41 ± 29.5 vs 39 ± 25.6, p=.047). In cross-sectional analyses, and after adjustment for confounders, higher overall LE8 CVH scores were associated with lower levels of leptin (B= -0.17, p&lt;0.0001), CRP (B= -0.34, p=0.009), and IL-6 (B= -2.85; p=0.02). In multivariable prospective analyses, lower CRP at baseline predicted better LE8 CVH scores at 1 yr (B= -0.22; p=.02), with a similar trend for an association between lower baseline leptin and better LE8 CVH scores at 1 yr (B= 0.04; p=.066). Conclusions: In a national sample of women across the menopausal transition, those with lower leptin and inflammatory markers had more favorable CVH scores as measured by the recently updated LE8 construct.
Abstract 16781: The Duration of Anticoagulant Treatment and Its Association With HRQoL and Treatment Satisfaction in Patients With AF After TAVR: Results From ENVISAGE-TAVI AF
Authors: Christian Hengstenberg, Nicolas Van Mieghem, Rosa Wang, Xiaomei Ye, Ling Shi, Shien Guo, Cathy Chen, James Jin, Xin Ye, Martin Unverdorben, George Dangas
Journal: Circulation (2023)

Introduction: The ENVISAGE-TAVI AF (NCT02943785) trial compared edoxaban vs vitamin K antagonists in patients with atrial fibrillation (AF) after successful transcatheter aortic valve replacement (TAVR). The association between anticoagulation treatment duration and patient-reported outcomes (PROs) and treatment satisfaction is unclear. Hypothesis : Longer duration of anticoagulation treatment may be positively associated with PROs and treatment satisfaction in patients from ENVISAGE-TAVI AF. Methods: HRQoL and treatment satisfaction were assessed by EQ-5D-3L, EQ-5D visual analogue scale (EQ-VAS), and the Perception Anticoagulant Treatment Questionnaire (PACT-Q). Patients were grouped by treatment duration: &lt;6 months, 6 month-1 year (yr), 1-1.5 yrs, 1.5-2 yrs, and &gt;2 yrs. A mixed-effect model for repeated measures assessed least square (LS) mean differences between treatment durations while controlling for relevant covariates. Results: Of 1426 patients enrolled in ENVISAGE-TAVI AF, 1147 (80.4%) and 1107 (77.4%) were included in the EQ-5D-5L and PACT-Q analysis sets. Baseline characteristics were similar across the treatment durations ( Table ). In patients receiving treatment &gt;1.5 years, LS mean scores for EQ-5D-5L utility index ( P = 0.012) and EQ-VAS ( P = 0.002) at month 3 were significantly higher than those treated for &lt;6 months. Prolonged treatment duration was associated with improved HRQoL and treatment satisfaction ( Figure ). Conclusions: Patients with AF and longer treatment duration after TAVR reported significantly higher HRQoL and treatment satisfaction vs shorter treatment duration. Further research is needed to determine causal effects.
Abstract 15893: A Quality Improvement Project of Increasing Utilization of SGLT2i in Patients With Heart Failure Within a Veterans Affairs Health System Through an Interdisciplinary Approach in the Primary Care Setting
Authors: Niharika Baviriseaty, Kevin Parza, Cassandra Gross, ROGER NEHAUL
Journal: Circulation (2023)

Introduction: Given the astounding beneficial effects of SGLT2i in patients with heart failure, they continue to be underutilized especially in the outpatient setting. Our project looked at increasing empagliflozin usage in patients with heart failure, preserved and reduced ejection fraction, at James A Haley VA Hospital (JAHVA). Methods: Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team was created to identify ways to increase utilization of empagliflozin in patients with heart failure. We created an actionable database using ICD codes for heart failure to identify eligible heart failure patients who were not on SGLT2i categorized by local primary care clinics at the JAHVA. We split up the responsibilities between clinic pharmacists and primary care physicians to safely start patients on SGLT2i from February to April 2023. Primary care physicians focused on patients scheduled for clinic during this period while pharmacists were responsible for patients not scheduled for clinic. Results: Our initial data showed only 19% of the 3,352 patients were on SGLT2i at JAHVA. From February to April 2023, we started 224 patients on empagliflozin with heart failure (preserved and reduced ejection fraction). We increased utilization by 13% in three months from 19% to 32% at JAHVA. Primary care physicians accounted for 46% of drug initiation while pharmacists accounted for 20% of new prescriptions. Cardiology providers prescribed 27% of all SGLT2i with 7% started by endocrinology or nephrology. Some of the characteristics of our sample included patients with an average age of 70 years old, 35% without diabetes, 50% with preserved heart failure. Conclusion: Our multi-disciplinary team approach involving pharmacists increased the utilization of SGLT2i in patients with heart failure through an actionable dashboard. Next steps for this project include improving the database to include other GDMT to further optimize medications.
Abstract 18187: Scoring System to Predict Reduced Left Atrial Appendage Emptying Velocity
Authors: Robert Enders, Cody Uhlich, Sarah Baghdadi, Ross Smith, Carine Tabak, Matthew Bajaj, Riya Parikh, Ethan Morgan, Jacob Baer, Sania Jiwani, Christopher Harvey, Amit Noheria
Journal: Circulation (2023)

Introduction: Left atrial appendage emptying velocity (LAAev) as assessed on transesophageal echocardiography (TEE) is a surrogate for propensity for LAA thrombus and cardioembolic stroke. Identifying patients with decreased LAAev is important for risk stratification. CHA 2 DS 2 -VASc score is used to stratify stroke risk in atrial fibrillation (AF) but does not incorporate rhythm, type of atrial fibrillation or transthoracic echocardiography (TTE). Objective: To create a composite scoring system using clinical and TTE variables to predict reduced LAAev. Methods: We searched TEE reports of unique patients from 2016-2022 at the University of Kansas Medical Center. Additional information was extracted from review of TEE imaging, TTE reports and detailed medical chart review. Significant univariate predictors of reduced LAAev (&lt;30 cm/s) were added to a stepwise selection multivariable logistic regression model with significance level for entry and stay 0.15. Based on their respective odds ratios, selected variables were assigned different point values to create a risk score. Results: We included 995 patients (women 38.1% men, age 71.3±12.7 yrs, white 89.3%, LAAev 41.6±21.0 cm/s). The derived score includes different points assigned for long-standing persistent/permanent AF, persistent AF, paroxysmal AF, current rhythm AF, coronary artery disease, congestive heart failure, female sex, age ≥70 yrs and negative points for &gt;moderate mitral regurgitation; categorized into high, intermediate and low risk (see Figure). The rate of reduced LAAev &lt;30 cm/s was respectively 55.7%, 35.2% and 9.0%. Conclusions: Our scoring system was able to stratify risk of reduced LAAev and needs to be validated in independent datasets.
Abstract 14848: Interplay of Cardiovascular Risk Factors, Comorbidities, Demographics, and Social Determinants of Health on Adherence to Guideline Directed Medical Therapies in Heart Failure With Preserved Ejection Fraction: The All of Us Research Program
Authors: Trinh Do, Kyrillos Grace, Yufan Gong, Divya Devineni, Dawn Lombardo, Nathan D Wong, Andy Lee
Journal: Circulation (2023)

Background: Despite its high prevalence, HFpEF is difficult to diagnose and treat due to its complex pathophysiology. Unlike HFrEF, treatments are limited for HFpEF. A combination of SGLT2i, angiotensin receptor neprilysin inhibitor (ARNi), and mineralocorticoid antagonist (MRA) has been shown to improve cardiovascular outcomes; however, acceptance of GDMT remains an obstacle in clinical practice. We sought to investigate the relationship of social determinants of health (SDOH), demographics, comorbidities, and risk factors with prescription patterns to GDMT for HFpEF. Methods: The All of Us Research Program, which began in May 2018, is a diverse database that prioritizes historically marginalized populations. Demographics, risk factors, and SDOH measurements were compared with use of GDMT for HFpEF adults aged 18 years and over. Multiple logistic regression analysis was used to examine the association among demographics, comorbidities, risk factors and SDOH with use of at least two of the recommended GDMT therapies for HFpEF (SGLT2 inhibitor, angiotensin receptor/ARNi, and MRA). Result: The study found that 38.4% (3773) of the 9823 adults with chronic heart failure had HFpEF. 51% of those with HFpEF do not take any GDMT, 11% take 2/3 of the GDMT, and only 1% take all three. Furthermore, a multiple logistic regression analysis revealed a greater odds of being on at least 2 GDMT for HFpEF among participants with known ASCVD (1.96 [1.41, 2.78]), diabetes (2.15 [1.56, 3.01]), and BMI ≥ 35 kg/m2 (1.02 [1.01, 1.04]). In addition, female sex is also associated with increased odds of being on at least two agents (1.46 [1.08, 2.00]). The likelihood of being prescribed GDMT for HFpEF was not predicted by race, education, income, or health insurance type. Conclusion: Risk factors such as ASCVD, diabetes and obesity were shown to be associated with an increased rate of GDMT use, while sex differences are also present.
Abstract 17793: Remotely Delivered Weight Loss and Exercise Intervention to Improve Cardiovascular Risk in Older Patients With Rheumatoid Arthritis
Authors: Leanna M Ross, Brian J Andonian, Alyssa M Sudnick, Johanna L Johnson, Carl F Pieper, Connie W Bales, Kathryn N Porter Starr, William E Kraus, Kim M Huffman
Journal: Circulation (2023)

Background: Persons with rheumatoid arthritis (RA) face two-fold increases in CVD, due to traditional risk factors - e.g., hypertension, dyslipidemia, obesity, and physical inactivity - and RA systemic inflammation. Despite improvements in pharmacologic management of inflammatory disease activity, the increased prevalence of RA CVD persists. Thus, developing innovative, non-pharmacologic interventions to improve clinical care is critical. The goal of the SWET-RA trial was to identify the effects of a 16-wk remotely supervised weight loss and exercise training (SWET) intervention on metabolic syndrome in older persons (60-80 years) with RA and overweight/obesity (BMI 28-40 kg/m 2 ). Methods: Participants were randomized to SWET (n =10) or a counseling health as treatment (CHAT) control group (n=10). Using video conference and mobile applications, the SWET group completed aerobic training (150 min/wk moderate-to-vigorous), resistance training (2 days/wk), and a hypocaloric diet (7% weight loss goal). The CHAT group completed two counseling visits for diet and exercise followed by monthly check-ins. Metabolic syndrome z -scores (MSSc) were derived from fasting glucose, triglycerides (TG), HDL-cholesterol (HDL-C), waist circumference (WC), and mean arterial pressure. Within groups, Wilcoxon signed rank tests assessed significance of post- minus pre-intervention change scores (p&lt;0.05). Between group comparisons were assessed using regression modeling controlling for baseline. Results: Following the intervention, the SWET group significantly improved TG and WC, yet reduced HDL-C; the CHAT group did not improve individual score components. Both groups significantly improved MSSc, with no between group differences. Conclusion: Results from this trial support the use of a remotely delivered program for older persons with RA and overweight/obesity. Both SWET and CHAT elicited improvements in a composite measure of CVD risk. Although SWET exceeded CHAT for reductions in TG and WC, HDL-C was reduced in SWET - possibly due to the hypocaloric diet - and increased in CHAT, likely accounting for the lack of MSSc group difference. More research is needed to distinguish the specific effects of exercise versus diet and weight loss for improving RA CVD risk.
Abstract 14274: Management of Severe Asymptomatic Carotid Stenosis, Best Medical versus Stenting versus Endarterectomy, a Network Meta Analysis of Randomized Controlled Trials
Authors: Ahmed K. Awad, Mohamed T Abuelazm, Mohamed Elzeftawy, Ibrahim Gowaily, Hassen Abdalshafy, Adel Mouffokes, Shafaqat Ali, Basel Abdelazeem
Journal: Circulation (2023)

Background: We conducted a network meta-analysis to investigate the efficacy and safety of best medical therapy (BMT) versus carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis. Methods: We systematically searched Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane Central till March 1 st , 2023, to include any randomized control trial (RCT) that assesses the efficacy of BMT, CAS, or CEA in the management of severe asymptomatic carotid stenosis. A network meta-analysis was conducted using R software pooling dichotomous outcomes using risk ratio (RR) and 95% confidence interval (CI). Results: Eight RCTs with 10,094 patients were included. Compared to BMT, both CAS and CEA showed a statistically significant higher risk of the 30 days composite (stroke, myocardial infarction (MI), and mortality) (RR: 4.37 [95% CI 2.35 - 8.11]) (RR: 4.04 [95% CI 2.08 - 7.85]), respectively; mortality (RR: 6.93 [95% CI 1.60 - 29.98]) (RR: 8.12 [95% CI 1.88 - 35.16]), respectively; MI with (RR: 16.03 [95% CI 1.96 - 26.14]) (RR: 27.51 [95% CI 1.65 - 45.46]), respectively; and stroke (RR: 3.42 [95% CI 1.70 - 6.88]) (RR: 2.48 [95% CI 1.23 - 4.99]), respectively. However, both CAS and CEA did not show statistically significant differences between BMT five-year mortality and MI. Finally, CEA showed a statistically significant lower risk of 5-year restenosis with (RR: 0.38 [95% CI 0.12 - 0.88]) and stroke (RR: 0.27 [95% CI 0.22 - 0.98]) compared to BMT. Conclusion: BMT for severe asymptomatic carotid stenosis holds an equal efficacy compared to CSA and CEA, yet an even lower risk regarding short-term outcomes. However, CEA shows a lower risk compared to BMT and CSA in terms of long-term (five-year) stroke and restenosis. Further research is still warranted to clarify which patients can benefit most from invasive strategies and to furtherly investigate BMT due to the currently limited evidence.
Abstract 13237: The Combined Effect of Triglyceride-Glucose Index and High Sensitivity C-reactive Protein on Cardiovascular Outcomes in Patients With Chronic Coronary Syndrome: A Multicenter Cohort Study
Authors: Qinxue Li, Jinqing Yuan
Journal: Circulation (2023)

Background: Triglyceride-glucose (TyG) index is a proven non-invasive alternative indicator of insulin resistance. There is an interconnection between insulin resistance and inflammation, and high sensitivity C-reactive protein (hsCRP) is one of the most commonly used biomarkers of systemic inflammation. We aimed to investigate the combined association of TyG and hsCRP with adverse outcomes in patients with chronic coronary syndrome (CCS). Methods: A total of 9421 patients with CCS were finally included in this study. The primary endpoint was defined as a composite of the major adverse cardiovascular events (MACE) covering all-cause death, non-fatal myocardial infarction, and revascularization. Kaplan-Meier analysis and Cox regression models were used to evaluate the relationship between TyG, hsCRP, and cardiovascular events. Results: During the 2-year follow-up period, 660 (7.0%) cases of MACE were recorded. Participants were divided equally into 3 groups according to TyG levels. Compared to the TyG T1 group, the risk of MACE was significantly higher in the TyG T3 group (adjusted HR 1.283, 95% CI 1.037-1.587, P=0.022). In addition, there was a significantly higher risk of MACE in the TyG T3 group with a higher level of hsCRP (&gt; 3 mg/l) (adjusted HR 1.735,95% CI 1.126-2.674, P=0.012). However, the association between TyG and MACE events was attenuated with hsCRP ≤ 3 mg/l (adjusted HR 1.077,95% CI 0.834-1.391, P=0.568). When patients were divided into 6 groups according to hsCRP and TyG, the Cox regression analysis showed that patients in the TyG T3&amp;hsCRP&gt;3 mg/l group had a significantly higher risk of MACE than those in the TyG T1&amp;hsCRP≤3 mg/l group (adjusted HR: 1.577, 95%CI: 1.180-2.108, P=0.002). The Cox regression analysis of secondary endpoints showed that all-cause mortality and myocardial infarction appeared to be the main contributors to the increased risk of MACE. Conclusion: Elevated TyG index serves as a strong predictor of poor prognosis in patients with CCS. Additionally, participants with concurrently elevated hsCRP and TyG had worse clinical outcomes. The concurrent assessment of TyG and hsCRP may be valuable in identifying high-risk groups among CCS patients.