tbuckley/cabot-search huggingface dataset:
Abstract Su1103: Resuscitation Reality: A Review on Current CPR Training for Older Adults
Authors: Jonathan Xiong, Gnanesh Gutta, Alexandria Chiaberta, Nina Lane, Ankur Doshi, David Salcido
Journal: Circulation (2024)

Background: Older adults are at high risk for experiencing out-of-hospital cardiac arrest, and therefore they are an important target for CPR training efforts. Physical, mental, and other barriers associated with advanced age present plausible obstacles to training/learning, and may warrant a need for tailored training programs. Hypothesis: Barriers to CPR training for older adults may be widely characterized, but efforts to resolve them are limited. Goal: This literature review’s purpose is to consolidate existing knowledge on teaching CPR to older adults and identify any gaps for future study. Methods: A complete search in both CINAHL and PubMed was conducted for the capture period 2014-2024. The terms “CPR”, “bystander CPR”, “older adult”, “training”, “development”, “out-of-hospital cardiac arrest”, “chest compressions”, and synonyms were used. The full search strategy will be shared at time of presentation. Search results not mentioning CPR, elderly people, and training of older adults were excluded. Any duplicates between the two databases were resolved. Included articles were reviewed by 2 researchers. Age, sex, and study designs were documented and summarized, with ranges, percentages or means reported where appropriate. Results: A total of 14 articles from CINAHL (n=8) and PubMed (n=6) were selected and were either qualitative surveys (n=4) or randomized control trials (n=10). In the studies reviewed, disparate knowledge or retention of CPR skills in older adults was linked to increased course duration or intricacy, physical or mental limitations (real or perceived), and lack of confidence. When analyzing the participants, the definition of older adult ranged from 55 to 65 years old and above with variable sample sizes (n=21-119, median=58). All the studies that documented sex had over 53% of older adults being female (n=53%-100%, median=64.85%). Studies identified methods to address limitations in older adults, including employing continuous chest compression delivery (versus 30:2) to improve quality/compliance, and Andrew’s Maneuver, also known as 4-hands CPR, for increasing effective compression depth while mitigating limited mobility and frailty. Conclusion: Within current literature, established best practices for teaching older adults CPR are limited, and few studies attempt to characterize the limitations of training older adults. Of those studies available in the literature, valuable foundations are available for future work.
Abstract 4147807: Peak Oxygen Uptake Changes as a Function of Lean Mass After Cardiac Rehabilitation
Authors: Wiaam Elkhatib, Thomas Olson
Journal: Circulation (2024)

Introduction: Peak oxygen uptake (VO 2 peak), standardized to total body mass (ml/kg/min) is a predictor of morbidity and mortality in cardiovascular disease patients. However, subsets of individuals undergoing exercise based cardiac rehabilitation (CR) show no improvement or reduction in VO 2 peak despite improvement in other functional measures. Hypothesis: Change in peak VO 2 post-CR, adjusted for lean mass rather than total mass better reflects peak VO 2 improvements. Aim : To assess the influence of CR on lean mass and the effect of lean mass compared to total body mass changes on peak VO 2 following CR. Methods: This observational cohort study included adults &gt;18 years old who completed CR between 2015-2022 at Mayo Clinic, Rochester. All patients completed both dual energy X-ray absorptiometry (DXA) and cardiopulmonary exercise testing (CPET) for measurement of body composition (total mass and lean mass) and VO 2 peak pre- and post-CR. Improvement in VO 2 peak was defined as &gt;% increase. Paired t-tests, one-way ANOVA, and descriptive statistics were performed. Results: Of 145 subjects, 81% were male and 63% Caucasian with a mean (SD) age of 62.8±12.6 years, BMI of 30.3±5.7, and 33.4±8.2 of 36 prescribed (92.8%) CR sessions completed. Pre-CR, patients demonstrated absolute VO 2 peak of 1,997.0±693.5 mL/min, relative of 22.1±6.2 mL/kg/min, and relative to lean mass of 35.2±9.6 mL/kg lean/min. After CR, patients demonstrated 1.2±3.1 kg reduction in total mass (p&lt;0.05) and 0.4±1.7 kg increase in lean mass (p&lt;0.05). Post-CR VO 2 peak increased by 17.1±117.0% absolute units (mL/min) (p&lt;0.05), 9.0±16.1 % relative units (mL/kg/min) (p&lt;0.05), and 15.9±111.9% units relative to lean mass (mL/kg lean/min) (p&lt;0.05). Absolute and relative to lean mass units demonstrated greater improvements in VO 2 peak compared to relative units (p&lt;0.05). Dependent on units, 70.3% of patients demonstrated an improvement in absolute VO 2 , 75.2% patients improved relative VO 2 , and 62.8% patients improved VO 2 relative to lean mass. Conclusions: These data demonstrate significant increases in lean mass and VO 2 following CR, with larger improvements reflected in units adjusted for lean mass compared to traditional relative units. In contrast, the largest proportion of patients showed positive improvements in VO 2 peak relative units with the smallest proportion relative to lean mass. These data suggest the reporting methodology for change in VO 2 following CR may impact overall findings.
Abstract 4147972: Trends In Racial and Demographic Disparities In Cardiovascular Disease-Related Mortality In Prostate Cancer Patients In The United States From 1999-2022
Authors: Emaan Amin, Muhammad Memon, Ankur Kalra
Journal: Circulation (2024)

Introduction: Recent studies have highlighted the cardiotoxic effects of novel androgen deprivation therapy for prostate cancer. The association of demographic and geographic background on cardiovascular disease (CVD)-related mortality in patients with prostate cancer is unclear. Goals: We aimed to analyze the trends in CVD mortality among patients with prostate cancer in the United States (US) from 1999-2022, with stratification by age, race, census region, rural-urban status, place of death, and specific CVD types. Methods: The age-adjusted mortality rates (AAMR) per 100,000 people were extracted using the Centers for Disease Control and Prevention WONDER database from 1999-2022. Joinpoint regression was utilized to calculate annual percentage change (APC) with 95% confidence intervals to assess for significant differences in change in AAMR over time. Results: A total of 440,318 deaths occurred due to CVD in patients with prostate cancer in the US in the last 20 years. The AAMR declined from 1999 to 2016 (APC -3.0 [-3.3, -2.8]) and rose till 2022 (APC 4.6 [3.4, 6.2]). AAMRs were stable in recent years for Non-Hispanic (NH) Asian or Pacific Islanders (2018-2020; APC (11.7 [-0.9, 17.9]) and NH American Indian or Alaska Native men (1999-2022, APC (-0.6 [-1.6, 0.3]). NH Black, NH White, and Hispanic men had a significant increase in AAMR from 2017 (APC 4.9), 2016 (APC 5.1), and 2018 (APC 7.0) to 2022, respectively, after an initial decline. NH Black men had the highest AAMR across all census regions. Mississippi, the District of Columbia, Nebraska, and California had the greatest overall AAMRs. The AAMRs were higher in rural than urban areas (5.9 vs 5.3/100000 people). Most deaths occurred in the decedent's home (35.3%) and in men aged &gt;85 years. Ischemic heart disease (AAMR 2.0), hypertensive disease (AAMR 1.7), and cardiac arrest (AAMR 1.4) were the top 3 causes of CVD-related mortality among patients with prostate cancer. Conclusion: CVD mortality in prostate cancer patients has increased in recent years with the greatest AAMR in NH Black and elderly men, and those living in rural areas. Identifying the causes and creating policies to reduce disparities requires further research.
Abstract 4148010: Evaluation of Echocardiography and Biomarkers for Prognostication of RV Failure in COVID-19 Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO)
Authors: Deepika Potarazu, Qiong Zhao, mehul desai
Journal: Circulation (2024)

Background: Severe COVID-19 infection has been associated with acute respiratory distress syndrome (ARDS) and right ventricular (RV) dysfunction. In this study, we report associations between echocardiographic findings and laboratory markers that portend RV failure in patients with ARDS secondary to COVID-19 infection on ECMO. Methods: A single-center study was conducted in the cardiovascular ICU of our institute. A retrospective chart review was performed on 41 patients with COVID-19 on ECMO between March and October 2020. Twenty-two patients had transthoracic echocardiograms (TTE) completed while on ECMO (VV-ECMO = 19, VA-ECMO = 3). Echocardiograms (echo) were obtained pre-cannulation, during ECMO, and post-ECMO decannulation. RV parameters analyzed included tricuspid annular plane systolic excursion (TAPSE), basal diastolic RV diameter, right ventricular fractional area of change (RV FAC), and S’. Laboratory values including BNP, CRP, D-dimer, ferritin, fibrinogen, lactate and troponin were analyzed for correlation with echo findings. Results: TAPSE was significantly lower in deceased patients (1.9± 0.4cm vs 1.3±0.6 cm, P&lt; 0.05). RV FAC and S’ were also lower in the deceased group. TAPSE while on ECMO showed a positive association with peak D-dimer levels in survivors and a negative association in deceased patients. Peri-ECMO fibrinogen and CRP levels were negatively associated with TAPSE in survivors while fibrinogen showed positive association in deceased patients. LDH peak, fibrinogen initial and lactate peak were higher in the deceased[ZQ1] group. There is a trend of increased RV basal diameter in the deceased group (3.9±0.9 vs 4.2±0.9 cm). Last troponin levels were negatively associated with basal diastolic RV diameter while on ECMO in deceased patients. Conclusion: Preservation of RV longitudinal contractility, as reflected by TAPSE, may play an important role in the survival of COVID-19 patients on ECMO. Laboratory markers such as LDH, D-dimer, fibrinogen and lactate may have prognostic value in predicting RV failure. Further studies are required to determine if early initiation of therapies to improve RV systolic function in COVID-19 ECMO patients with ARDS improves outcomes.
Abstract 4147863: Temporal Trends and Regional Disparities in Ischemic Heart Disease Mortality Across the Americas: A Two-Decade Analysis from the PAHO Database
Authors: Noman Khalid, Safee Ullah Haider, Muhammad Abdullah, Saad Asghar, Abeer Bin Awais, Ameer Muhammad, Muhammad Hassan, Muhammad Adil Afzal, Yezin Shamoon, Patrick Michael, Rahul Vasudev, fayez shamoon
Journal: Circulation (2024)

Background: Ischemic heart disease (IHD) affects over 120 million people and is the leading cause of death globally. Our study aims to assess the trends in IHD-related mortality in the regions of the Americas. Research Questions/Hypothesis: Has IHD-related mortality decreased from 2000 to 2019 in all regions of the Americas? Aims: Analyze differences in IHD-related mortality in different regions of the Americas. Methods: We analyzed the Pan American Health Organization (PAHO) database for IHD-related mortality rates in 2000, 2010, and 2019. The age-standardized mortality rates per 100,000 population were extracted, and trends were analyzed by gender and region. Results: The IHD-related mortality was consistently higher in males as compared to females in the last 2 decades. The mortality rate decreased in males in all regions from 2000 to 2019 apart from the Mexico, Central America and Latin Caribbean region where it increased from 115.12 in 2000 to 119.50 in 2019.The greatest decrease in IHD-related mortality in males was seen in the North America region from 164.49 in 2000 to 93.73 in 2019. This opposite trend was seen in females where mortality decreased in all regions from 2000 to 2019. Conclusion: The sociodemographic and temporal trends highlighted by this study need to be further investigated, and targeted policy measures are required to reduce the disparities in IHD-related mortality.
Abstract 4147916: Limitations of Brain Natriuretic Peptide in Detecting Early Stage Heart Failure
Authors: Derek Rinderknecht, W. Brian Chiu, Joanna Krupa, Christopher Jerdonek, Kendra Cook, Weiwei Jin
Journal: Circulation (2024)

Introduction: Brain natriuretic peptide (BNP) is commonly used for the diagnosis and management of heart failure (HF), as its presence strongly predicts cardiovascular events and risk of death. Detecting HF early has a substantial impact on quality of life and outcomes. Measurement of left ventricular end diastolic pressure (LVEDP) is the gold standard method for diagnosing HF, including early stage HF in the absence of signs and symptoms. BNP has been proposed as another means to screen for early stage HF, specifically in high-risk patients. Here, we compare BNP to elevated LVEDP across a range of LVEDP values to assess its ability to detect HF early. Methods: The dataset (154 subjects, 66 +/- 10 yrs of age and above; 64% male) consists of patients referred for coronary angiography and left heart catheterization for clinical indications inclusive of direct measurement of LVEDP. LVEDP was measured using high-fidelity Millar Mikro-tip pressure catheters. BNP was measured during the same visit. Mean LVEDP thresholds from 15 mmHg to 25 mmHg were analyzed. The sensitivities and specificities of BNP thresholds of 35 pg/ml and 100 pg/ml were assessed. Results: The receiver operating characteristic (ROC) curves with the area under the curve (AUC) for the classification models are shown in Fig. 1. AUC appears to increase linearly with the level of measured BNP, displaying only good performance (&gt; 80%) when LVEDP is substantially elevated (AUC = 81%, at 25 mmHg). At a BNP decision threshold of 35 pg/ml (Ambulatory, AHA algorithm for suspected HF) the ROC curves for an LVEDPs &gt;15 mmHg and &gt;25 mmHg yield sensitivities of 74% and 92% and specificities of 47% and 41%, respectively. At a BNP decision threshold of 100 pg/ml (Hospitalized/Decompensated) the ROC curves for LVEDPs &gt;15 mmHg and &gt;25 mmHg yield sensitivities of 43% and 75% and specificities of 74% and 71%, respectively. Conclusion: While BNP is adept at identifying patients already exhibiting signs and symptoms of HF, these results suggest the diagnostic utility of BNP may be limited in detecting early stage HF.
Abstract 4147904: Chronotropic Incompetence in Amyloid Cardiac Disease: A Marker of Severity?
Authors: Sebastian Santos Patarroyo, Laura Ortega Aviles, Martha Grogan, Thomas Allison
Journal: Circulation (2024)

Background: Cardiac amyloidosis is a rapidly progressing and severe condition leading to heart failure and reduced quality of life. Amyloid deposits impair both chronotropic and pumping functions of the heart. The Cardiopulmonary Exercise Test (CPET) is a vital tool in assessing the severity and progression of this disease. Aims: This study aims to investigate the differences in chronotropic function associated with the stages of heart failure in patients with cardiac amyloidosis and outcomes. Methods: A retrospective cohort study was conducted involving 194 patients diagnosed with cardiac amyloidosis who underwent at least one CPET from February 2010 to February 2024. Medical records were reviewed for data on the type of amyloidosis, comorbidities, and CPET results. The cohort was divided into two groups according to the Weber Classification: Weber Class A/B and Weber Class C/D. Patients who had CPET studies post-heart transplant were excluded. Statistical analyses, including Fisher’s exact test and chi-square test, were used. Cox regression model analysis, proportional hazards model for time to event. Adjustment for beta-blocker use was made to assess chronotropic incompetence. A p-value &lt;0.05 was considered significant. Results: Among the 194 patients, 94 were classified as Weber A/B and 100 as Weber C/D. The average age at the time of the stress test was similar between the groups: 62.9 ± 11.7 years for Weber A/B and 62.3 ± 10.7 years for Weber C/D (p=0.087) Table 1 . Chronotropic function, evaluated through CPET, showed significant differences. Heart rate reserve was significantly lower in the Weber C-D group compared to the A-B group (p&lt;0.001). The chronotropic index was also significantly lower in the Weber C-D group Figure 2. Chronotropic incompetence was observed in 43.9% of the Weber A and increased progressively, being significantly more prevalent in the Weber D group (100%) (p&lt;0.001). Additionally, Chronotropic incompetence was strongly associated with the composite outcome of (hospitalization for heart failure and death) HR 1.932 (1.126 -3.313) p =0.0167 (Table 2). Conclusion: CPET assessment of chronotropic function correlates with VO2 parameter evaluated in Weber classification. Patients with higher Weber stages of heart failure in amyloidosis exhibited a higher prevalence of chronotropic incompetence, indicating it could serve as a marker of cardiac function.
Abstract Su1008: Head-to-Pelvis CT Angiography Compared to Clinical Autopsy in Patients After Out of Hospital Arrest
Authors: Khoi Ha, Xavier Sendaydiego, john lacy, Peter Kudenchuk, Martin Gunn, Nicholas Johnson, Medley Gatewood, Charles Maynard, Michael Sayre, Catherine Counts, Kelley Branch
Journal: Circulation (2024)

Introduction: Head-to-pelvis sudden death computed tomography (SDCT) protocol has a high diagnostic yield for causes and complications of out-of-hospital cardiac/circulatory arrest (OHCA). While a gold standard of morbidity and causes of mortality has been autopsy examination, comparative analysis of SDCT has not been explored. Methods: Study patients were those resuscitated from OHCA between December 2015 and August 2019 who received 1) SDCT (non-contrast head CT, ECG-gated chest CT, and non-ECG gated venous phase abdominopelvic CT) within 6 hours of hospital arrival and 2) autopsy examination after death. Findings from SDCT readings blinded to autopsy and clinical pathology reports were tabulated. The primary outcome was differences in neural, chest-vascular, pulmonary, and gastrointestinal diagnoses between SDCT and autopsy reports. Results: Thirty one patients were included in this prospective cohort whose major clinical findings are reported in the Table. SDCT was performed at a median of 2.4 (IQR 2.1,3.2) hours from OHCA event and death occurred at a median of 2.2 (IQR 1.0,4.7) days. There were 82 clinically important SDCT and 52 autopsy findings with 45 diagnostic discrepancies between the two. Organ procurement caused 5 discrepancies. The most common discrepancies identified by SDCT but not autopsy were pneumothorax, pneumonia, and sternal/rib fractures. Discrepancies identified by autopsy but not SDCT were mostly related to cerebral bleeding and infarction. Conclusions: Both concordant and discrepant findings were observed between autopsy and early head-to-pelvis CT after initial resuscitation from OHCA, potentially due to differences in time and treatment between the SDCT and death. These results suggest complementary roles of pre-mortem imaging as well as post-mortem examination to identify important abnormalities after a resuscitated OHCA event.
Abstract 4147882: Multiple Arterial Graft Use: Sustained Quality Improvement Following a Targeted Assessment and Programmatic Intervention
Authors: Ifeanyi Chinedozi, Maria Daskam, Jessica Briscoe, Nivedita Kumar, Zachary Darby, Janelle Sangalang, Jin Kook Kang, Vesa Kpuska, Kim Behrens, Jennifer Lawton
Journal: Circulation (2024)

Introduction/Background: Multiple arterial grafting (MAG) provides superior outcomes compared to single arterial grafting in coronary artery bypass graft (CABG) patients. Studies and meta-analyses demonstrate MAG's association with improved survival, reduced major adverse cardiac events, and lower repeat revascularization rates. Despite strong evidence and guidelines, MAG utilization remains low nationally, ranging from 4-11%. Surgeons cite concerns such as advanced age, diabetes, and high body mass index (BMI) for not employing MAG. An educational and quality improvement initiative raised MAG usage from 11% to over 30% at one academic institution. This study reassesses MAG adoption trends and barriers three years later at the same institution. Research Question/Hypothesis: We investigated whether the increased adoption of MAG after a quality improvement initiative was sustained three years later. We hypothesized that MAG utilization would remain elevated due to the lasting impact of initial educational efforts, though some barriers might persist. Methods/Approach: We assessed MAG utilization and surgeons' reasons for not using MAG in isolated CABG procedures with two or more grafts over a four-month period. This evaluation aimed to determine if the previous quality improvement initiative's adoption of MAG was sustained post-implementation. The study analyzed MAG use frequency and surgeons' justifications for alternative methods, including patient outcomes, surgeon preferences, and institutional practices. Results: A total of 92 patients were included, with MAG used in 28 cases (30.4%). The MAG use rate three years earlier following the quality initiative was 30.5%. Predominant reasons for not using MAG were age &gt; 65 (29.9%), diabetes (18.8%), BMI ≥35 (14.1%), and non-critical disease (9.4%), similar to concerns from three years prior: age &gt;75 (30.8%), diabetes (23.1%), and BMI &gt; 35 (22.9%) (Figure 1). Conclusions: The sustained adoption rate of MAG among cardiac surgeons at one institution highlights the complexities of changing surgical practices, even with targeted educational efforts. Continuous support and educational initiatives led by surgeon-champions are crucial for enhancing long-term adoption of evidence-based practices like MAG, ultimately improving patient care. Dedicated mentoring and regular training updates significantly influence the integration of advanced surgical techniques into routine practice, advancing patient treatment quality.
Abstract 4147905: A Machine Learning Readmission Risk Prediction Model for Cardiac Disease
Authors: Angela Bailey, Wei Wang, Clarence Shannon, Jared Huling, Christopher Tignanelli
Journal: Circulation (2024)

Introduction: Circulatory disease ranks ninth highest amongst all-cause US readmissions, and despite an increase in quality improvement initiatives, emergency department visits have increased. Diagnosis specific cardiac machine learning readmission risk prediction models have been created, and at least one general readmission risk model has demonstrated a 25% relative readmission rate reduction in a focused setting. Hypothesis/Aims: The objective of this study was to create a high performing 30-day hospital readmission/emergency department (ED) visit or death risk prediction model. We hypothesized that the model would perform equitably and with high accuracy. Methods: The model was derived from a cohort of acute, cardiac inpatient admissions during 2010-2023 within ten integrated Midwestern hospitals. Encounters in which patients died or were discharged to hospice were excluded. A total of 1,498 clinical and non-clinical predictors were included in three machine learning models. Primary composite outcome was 30-day hospital readmission/ED visit or death. Results: The primary outcome rate was 23.8% and ED visit rate was 7.7% amongst 73,926 encounters spanning 49,144 patients. Heart failure, dysrhythmias, and acute myocardial infarction were the most common readmission diagnoses. XGBoost had the overall highest performance (AUROC of 0.691 and PR-AUC of 0.4158). At a precision of 0.5, XGBoost demonstrated a net benefit relative to current practice. Top predictors include the LACE index and total hospitalized days in the past year. The DeLong test yielded a significant difference in model performance between men and women. Conclusions: We successfully built a 30-day cardiac readmission/ED visit or death risk prediction model that demonstrated a net benefit relative to current practice. The difference in model performance could be driven by gender gaps in cardiac disease recognition, presentation, and treatment. Future directions include external model validation.