tbuckley/cabot-search huggingface dataset:
Abstract 4146987: Forecasting US state-level health expenditures for cardiovascular diseases through 2050
Authors: Feras Wahab, Megan Lindstrom, Gregory Roth, Joseph Dieleman
Journal: Circulation (2024)

Introduction: The cost of cardiovascular care in the United States has increased rapidly but detailed future cost forecasts are unavailable. To address this gap, we estimated conservative future health expenditures for specific cardiovascular diseases and types of care through the year 2050 for each US state and nationally. Methods: We used data from the Institute for Health Metrics and Evaluation’s Disease Expenditure Project for the years 2000-2019, which captures &gt;85% of all US healthcare spending at the age, sex, cause of death, risk factor, type of care, and state-specific level. Input data included insurance claims, drug prescriptions, emergency department visits, inpatient stays, ambulatory care visits, and nursing facility stays. Using population forecasts from the Global Burden of Disease study and holding utilization and cost rates constant, we estimated, in 2019 dollars, cardiovascular expenditures for 2020-2050 per age, sex, type of care, cause, and state to forecast conservative lower bounds for costs. Results: Total cardiovascular spending in the US was forecasted to rise from $324 billion in 2019 to $460 billion in 2050. Across all types of care, inpatient care expenditure was the highest and remained so at 42.6% of total spending by 2050. Spending was forecasted to rise the most for nursing facility care and home healthcare, from 11.8% to 13.9% and 7.1% to 8.2% of the total respectively. By 2050, spending was highest for ischemic heart disease at $110 billion, up from $79 billion in 2019, followed by heart failure at $102 billion, up from $64 billion in 2019. As a proportion of overall spending, heart failure was forecasted to increase from 19.7% in 2019 to 22.1% in 2050. Over the same period, spending on treating obesity was forecasted to rise from $13 to $15 billion, but as a proportion of overall cardiovascular spending, this represented a fall of 0.8% due to increases for other conditions. Conclusion: Cardiovascular expenditures in the US were projected to increase by at least 41.9% by 2050, using conservative projection methods. The largest increases across types of care were for those associated with an aging population. Updates to forecasts will be needed as data on the impact of the COVID pandemic and new obesity pharmacotherapies become available and modelling methods improve. Large increases in the absolute cost of cardiovascular care in the US over the next 3 decades will require changes in health policy and system reform.
Abstract 4147683: The Impact of Midodrine on Heart Failure Outcomes: Emergency Visits, Mortality, and Complications
Authors: Usman Akbar, Ahmed Muaaz Umer, Fnu Muhibullah, Mohammad Rehman, Ayesha Akbar, Urooj Rehman, Abhi Lohana, Besham Kumar, Ribal Sajjad, Michael Cheshire
Journal: Circulation (2024)

Background: Midodrine, an FDA-approved peripheral alpha1-adrenergic agonist for treating orthostatic hypotension, is also used off-label to manage hypotension in patients with advanced heart failure (HF). Hypotension, whether due to HF itself or as a side effect of its treatment, often restricts the optimization of medical therapy in these patients. By increasing baseline blood pressure, midodrine can enhance the tolerance of HF medications, potentially improving patient outcomes. The use of midodrine is limited due to the risk of supine hypertension, making it crucial to investigate its effects in this patient population. Methods: This study utilized data from the US Collaborative Network, focusing on heart failure patients with a Left Ventricular Ejection Fraction (LVEF) of less than 50%. It compared outcomes between patients treated with midodrine (22,178 patients) and those not treated (376,686 patients). After Propensity Score Matching (PSM), each group consisted of 21,893 matched patients. The outcomes measured included emergency department visits, mortality, shock, and CHF exacerbation, aiming to assess the impact of midodrine on these aspects of heart failure management. Results: Midodrine treatment was associated with significant improvements in key outcomes for heart failure patients: it reduced emergency department visits (OR: 0.68, 95% CI: 0.57-0.81, p&lt;0.001), lowered mortality rates (OR: 0.75, 95% CI: 0.65-0.87, p&lt;0.001), decreased occurrences of shock (OR: 0.59, 95% CI: 0.46-0.76, p&lt;0.001), and mitigated CHF exacerbation (OR: 0.82, 95% CI: 0.74-0.91, p&lt;0.001), underscoring the potential benefits of midodrine in managing heart failure. Conclusion: The study demonstrates that midodrine treatment in heart failure patients significantly reduces emergency department visits, mortality, shock, and CHF exacerbation, highlighting its potential as a beneficial off-label option. These findings suggest an important role for midodrine in enhancing the management and outcomes of patients with advanced heart failure.
Abstract 4147597: Venoarterial Extracorporeal Membrane Oxygenation With and Without Left Ventricular Unloading in Patients With Cardiac Arrest
Authors: Abdilahi Mohamoud, nadhem abdallah, Mahmoud Ismayl, Abdirahman Wardhere, Andrew Goldsweig
Journal: Circulation (2024)

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) using venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a promising strategy for refractory cardiac arrest. However, the role of left ventricular (LV) unloading during ECPR remains uncertain. Methods: We queried the United States National Inpatient Sample (2016-2021) to identify adult patients with out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA) who received ECPR. Patients were stratified based on the use of either VA-ECMO only or VA-ECMO with intra-aortic balloon pump (IABP) or VA-ECMO with Impella (ECPELLA) for ventricular unloading. Multivariable logistic regression was used to compare in-hospital outcomes between the groups. Results: Among 6,915 patients receiving ECPR, VA-ECMO alone was used in 5,145 (74.4%), VA-ECMO-IABP in 809 (11.7%), and ECPELLA in 961 (13.9%). The LV unloading groups more frequently presented with ventricular tachycardia/fibrillation (61.1% and 72.4% vs. 43.9%, both p&lt;0.01), while the VA-ECMO only group more often presented with pulseless electrical activity/asystole (56.1% vs. 38.9% and 27.6%, both p&lt;0.01). In IHCA patients, ECPELLA was associated with 50% lower odds of in-hospital mortality compared to VA-ECMO alone (adjusted odds ratio [aOR] 0.50, 95% CI 0.31-0.81, p&lt;0.01). No significant difference was found in OHCA patients. VA-ECMO-IABP was not associated with a mortality benefit vs. VA-ECMO alone in either OHCA or IHCA (Figure 1). Cardiovascular complications were significantly higher in both LV unloading groups compared to the VA-ECMO only group in OHCA subgroup (90% and 95% vs. 73.3%, both p&lt;0.01) while IHCA subgroup only showed higher significant rates in ECPELLA compared to VA-ECMO alone (89.3% vs. 81%, p=0.04) (Figure 2). After adjustment for potential confounders, VA-ECMO-IABP (aOR 2.79, 95% CI 1.02-7.60, p=0.04) and ECPELLA (aOR 6.92, 95% CI 2.09-22.94, p&lt;0.01) were associated with significantly higher odds of cardiovascular complications compared to VA-ECMO alone among OHCA patients, but not among IHCA patient. There were no statistically significant differences in neurologic, renal, and hematologic complications between the three groups in either OHCA or IHCA patients (Figure 3). Conclusion: In this nationwide study, LV unloading with ECPELLA was associated with improved survival in IHCA patients but not in OHCA patients compared to VA-ECMO alone. The addition of IABP to VA-ECMO was not associated with a mortality benefit.
Abstract 4147391: Cardiovascular Outcomes among Giant Cell Myocarditis compared with cardiac sarcoidosis: A Propensity score matched analysis
Authors: Vikash Jaiswal, Muhammad Hanif, Akash Jaiswal, Hira Akhlaq, Zarghoona Wajid, FNU Danisha, Song Peng Ang, FNU Sundas, Abhigan Shrestha, Kripa Rajak
Journal: Circulation (2024)

Background: Giant cell myocarditis (GCM) and cardiac sarcoidosis (CS) are rare inflammatory diseases of the myocardium with poor prognosis. Cardiovascular outcomes among both the disease have not been well studied with limited literature. Objective: This study aims to investigate the cardiovascular outcomes among patients with GCM and CS. Method: We queried the TriNeTX Global Collaborative Network for adult patients with Giant cell myocarditis and Cardiac sarcoidosis between January 2000 to May 2023 and created two groups: one with Giant cell myocarditis and second with Cardiac Sarcoidosis. Both the groups were followed for 6 months and 12 months. Propensity score matched analysis (PSM) was done for age, gender, race, BMI, hypertension, diabetes mellitus, chronic kidney disease, hemoglobin level, low-density lipoproteins level, left ventricular ejection fraction and various drugs including beta blockers, ACEi, ARBi, and statins. The primary outcome was all-cause mortality (ACM), while secondary outcomes were heart failure, heart transplant, ventricular tachycardia (VT), AV nodal block, and atrial flutter and fibrillations. Result: After PSM, amongst the 4804 patients (2402 patients in each group), the mean age of patients was 57.1 and 57.6 years in GCM and CS groups respectively. PSM analysis showed that primary outcomes i.e., ACM was significantly higher in GCM both after 6 months (RR, 2.332 (95% CI: 1.645-3.305), P&lt;0.001) and 1 year follow up (RR, 1.547 (95% CI: 1.209-1.981), P&lt;0.001) as compared with CS group. However, secondary outcomes i.e., Heart failure at 6 month (RR 0.668, 95% CI: 0.523-0.854), P=0.001), and at 1 year (RR 0.604, 95% CI: 0.498-0.733), P&lt;0.001), VT at 6 months (RR 0.342, 95% CI: 0.254-0.461), P&lt;0.001), and at 1 year (RR 0.328, 95% CI: 0.257-0.419), P&lt;0.001), AV nodal block at 6 month (RR 0.454, 95% CI: 0.336-0.613), P&lt;0.001), and at 1 year (RR 0.437, 95% CI: 0.342-0.557), P&lt;0.001), and atrial flutter and fibrillation at 6 months (RR 0.674, 95% CI: 0.484-0.942), P=0.020), and at 1 year (RR 0.592, 95% CI: 0.457-0.767), P&lt;0.001) were found significantly lower in GCM group as compared with CS. On the other hand, heart transplant incidence was comparable between both the groups. Conclusion: These findings suggest that giant cell myocarditis patients were having high risk of mortality and lower risk of heart failure, ventricular tachycardia, AV nodal block, and atrial flutter and fibrillation compared with cardiac sarcoidosis.
Abstract 4147421: Disparities in Myocardial Infarction Mortality among Patients with Chronic Obstructive Pulmonary Diseases: A 22-Year Retrospective Analysis
Authors: Muhammad Ahmad, Mustafa Shehzad, Dawlat Khan, Dawood Shehzad
Journal: Circulation (2024)

Background: COPD and cardiovascular disease (CVD) share common risk factors. Myocardial Infarction (MI) is a major cause of death in patients with COPD; however, temporal, sex-based, racial, and geographic variations in mortality are poorly defined. Methods: We conducted a retrospective analysis using the CDC WONDER dataset, extracting age-adjusted mortality rates (AAMR) per 100,000, calculating the annual percentage change (APC) and its weight average, the average annual percentage change (AAPC) through Joinpoint regression. The results were stratified to identify temporal, sex-based, racial, and geographic variations in mortality. Results: From 1999–2020, a total of 191,215 deaths among adults over 25 years old with COPD were attributed to MI. During this period, the AAMR declined significantly, from 6.83 to 2.76, reflecting an average annual percentage change (AAPC) of -4.54% (95% CI: -4.79 to -4.31). Males exhibited a higher AAMR (5.57; 95% CI 5.54 to 5.60) than females (2.88; 95% CI 2.86 to 2.90). Both sexes experienced a marked decline in AAMR over the study duration. Non-Hispanic (NH) Whites had the highest AAMR (4.43), followed by NH blacks (3.03), NH American Indians/Alaskan Natives (3.57), Hispanics or Latinos (1.90), NH Asians/Pacific Islanders had the lowest AAMR (1.28). Significant state-wise variations were observed, with AAMRs ranging from a high of 7.57 in West Virginia to a low of 1.47 in Hawaii. Three states—Arkansas, New Mexico, and South Dakota—reported an overall increase in AAMRs over the study duration. Regionally, the Midwest exhibited the highest AAMRs (4.52), while the Northeast had the lowest (3.51). Additionally, micropolitan (5.89) and noncore (6.30) areas experienced higher AAMRs compared to large central metropolitan areas (3.14). Conclusion: Mortality from acute MI in patients with COPD has decreased overall. However, certain sociodemographic groups have not secured the same deceleration in mortality. Opportunities to decrease COPD-related death rates still exist.
Abstract 4147422: Risk of Stroke in Patients with Left Ventricular Thrombosis who undergo Coronary Angiography: A system-wide Retrospective Analysis
Authors: Ashraf Ahmed, Shaun Abid, Abhinav Aggarwal, Samdish Sethi, Ilia Ryzhkov, Nur Rahman, Asad Ur Rehman, Mohamed Badheeb, Isaac Opoku, Rasha Kaddoura, Rajvir Singh, SUNDEEP NAYAK, Gilead Lancaster
Journal: Circulation (2024)

Background: Left ventricular thrombus (LVT) has been associated with an increased risk of cardioembolic stroke. However, it has not been established if coronary angiography (CAG) or percutaneous intervention (PCI) would enhance that risk. This study aims to determine the risk of cardioembolic stroke among patients with LVT who underwent CAG or PCI. Methods: This retrospective study includes patients diagnosed with LVT between June 1 st , 2017, and May 31 st , 2023 across the Yale New Haven Health System. The data was retrieved using ICD-10 and CPT codes, followed by manual review of the patients’ charts. The patients were divided into two groups, those who had a stroke versus those who did not. The data retrieved includes patient demographics, pre-existing medical conditions, LV function as assessed by echocardiogram, along with the findings on CAG and PCI. The statistical analyses were performed using t-test, ANOVA, and Fisher's exact test. Results: A total of 1,104 charts were manually reviewed, of which 311 patients met the inclusion criterion of a confirmed LVT. Among these, 54 patients (17.4%) experienced an ischemic stroke. The mean age of these patients was 65.3 ± 14.8 years, with 219 patients (70.4%) being male, of whom 39 had a stroke. Among all the studied parameters (Table 1), only CAG was found to be associated with a significantly increased risk of stroke in these patients (RR: 1.47, 95% CI: 1.04-2.09, P = 0.014). There was no significantly increased risk of stroke among those patients who underwent PCI. Conclusion: Coronary angiography appears to carry a significantly increased risk of cardioembolic stroke among patients with LVT in a 6-month follow-up period, that is independent of subsequent percutaneous coronary intervention. Clinicians should carefully weigh the benefits and risks of CAG in patients with LVT and consider alternative diagnostic and therapeutic strategies when appropriate. Further studies are recommended to identify specific patient populations that might benefit from more targeted stroke prevention strategies post angiography.
Abstract 4147267: Utilization, Risk Stratification, and Management of Lipoprotein(a) Results in a Large Academic Medical Center
Authors: Francis Zirille, Victoria Clair, David Saxon, Steven Simon, Ed Gill
Journal: Circulation (2024)

Introduction: Evidence has grown around the relationship between lipoprotein(a) [Lp(a)] and cardiovascular disease risk. The 2024 focused update on Lp(a) from the National Lipid Association recognizes elevated plasma Lp(a) as an important independent, causal risk factor for atherosclerotic cardiovascular disease and aortic valve stenosis, as well as delineates risk classifications. It is now recommended for patients to have Lp(a) measured at least once in their adult life, with Lp(a) levels &lt;75 nmol/L (30 mg/dL) classified as low risk, individuals with Lp(a) levels ≥125 nmol/L (50 mg/dL) as high risk, and individuals with Lp(a) levels between 75 and 125 nmol/L (30–50 mg/dL) as intermediate risk. Aims: With Lp(a) lab testing recommendations changing and leading to a steady increase in patients who have had Lp(a) drawn, we aimed to understand these patients’ relative risk of cardiovascular comorbidities and events, in addition to current management. Methods: Within a university-based health system, a large data extraction model was used to identify all patients who had undergone Lp(a) testing. In a system of roughly 4,553,100 patients, 1,976 unique patients have had Lp(a) drawn since 2013. This population was then subclassified by risk groups, as outlined above. Results: Testing thus far, using new recommendations for classifications of patients, places 1491 patients in the low-risk category, 241 in the intermediate-risk category, and 211 in the high-risk category, summarized in Table 1. In this population, patients in the high risk Lp(a) group, tended to have higher rates of CAD, PAD, ACS and CVA events. Notably, no significant differences exist regarding more aggressive management of these patients with either escalation of lipid lowering therapy including high-intensity statins, ezetimibe and PCSK9-i or with subspecialist referrals. There are, however, 7 patients undergoing apheresis from the high-risk group. Conclusions: Consistent with current literature, patients stratified to the higher risk lp(a) group had higher rates of cardiovascular comorbid conditions and events, though do not seem to be managed more aggressively than those in lower risk groups. Opportunity exists in escalating therapy and referring to subspecialists for consideration of therapies like PCSK9-inhibitors, lipoprotein apheresis, and soon, direct Lp(a) lowering medications.
Abstract 4147027: Apolipoprotein A-I Proteoforms, Cardiometabolic Status, and Coronary Heart Disease: Insights from the Dallas Heart Study
Authors: Anamika Gangwar, Benjamin Soye, Suzanne Saldanha, Shailesh Jaiswal, Parthvi Bharatkumar Patel, Amil Shah, Ambarish Pandey, John Wilkins, Anand Rohatgi
Journal: Circulation (2024)

Background: Coronary heart disease (CHD) is marked by dysfunctional high-density lipoproteins (HDL; impaired cholesterol efflux (CE), elevated oxidative stress, and inflammation). HDLs have a diverse proteome (&gt;250 proteins), but simple protein abundances fail to fully capture its complexity and disease links. A proteoform is a specific molecular form of a protein that includes information of post-translational modifications (type, location, and combinations), which directly affect function. While HDL-associated apolipoproteins (apo), specially apoA-I, mediate HDL functions, it remains unknown whether apoA-I proteoforms are linked to CHD. Our prior work linking 15 apoA-I proteoforms to cardiometabolic traits supports uncovering proteoform-CHD relationships for mechanistic insight into CHD. This study aims to explore the spectrum of apoA-I proteoforms linked with incident CHD. Method: From Dallas Heart Study cohort (&gt;2,000 participants without prevalent CVD at baseline), 33 incident myocardial infarction (MI) cases during follow-up and 32 matched controls (age, sex, and race/ethnicity) were selected. We analyzed plasma using top-down proteomics to quantify apoA-I proteoforms. Unadjusted associations of apoA-I proteoforms with cardiometabolic traits were stratified by CHD status and analyzed using correlation analysis. Results: Mean age was 56 years (45% women, 66% Black and 9% Hispanic). We identified 15 apoA-I proteoforms. Proteoform abundances were similar in cases vs. controls, the direction and magnitude of associations with cardiometabolic traits varied substantially. E.g., canonical (unmodified) apoA-I was positively correlated with oxidized LDL (Ox- LDL) in incident MI cases, but not in controls. Acylated apoA-I proteoforms showed different correlation directions with CE, TG and Ox-LDL in controls vs incident MI (Fig.1, p &lt;0.05). Conclusion: We observed different patterns of association between apoA1 proteoforms and cardiometabolic traits in individuals who experienced CHD events compared to those who did not. These findings suggest that proteoform biology may vary and be involved in CHD pathogenesis. Further investigation in larger cohorts may unveil therapeutic targets for CHD, improving patient outcomes.
Abstract 4147750: Electronegative HDL and LDL Particles Synergistically Compromise Vascular Innate Immunity
Authors: Omer Akyol, Huan-Hsing Chiang, Wen-Li Hsu, Ming-Hsien Tsai, Darren Woodside, Chu-Huang Chen
Journal: Circulation (2024)

Introduction: It is now recognized that the quality of lipoprotein particles may impact atherogenesis more than their plasma concentration. HDL and LDL can be separated into five subfractions increasingly electronegative subfractions (H1 to H5 and L1 to L5), with H1 and L1 being beneficial and H5 and L5 being dysfunctional. This study examines the effects of H5 and L5 on the viability of endothelial cells (ECs) and monocytes, key components of vascular immunity. Hypothesis: We hypothesize that L5 induces cytotoxic responses in monocytes (THP-1 cells) and bovine aortic ECs (BAECs), with H5 exacerbating these effects, thereby promoting inflammatory and atherogenic processes in atherosclerosis. Methods: H5 and L5 were fractionated by anion-exchange chromatography. Cells were treated with 50 µg/mL of L1, L5, H1, and H5 for 24 hours. Cell viability was assessed using a fluorescence-based viability detection method after trypan blue exclusion staining. Image-based cytometric quantification was performed using the Nexcelom Cellometer. Lipidomics was used to characterize L5 and H5, and transcriptomic analysis was performed on BAECs treated with H1 and H5 to identify differentially expressed genes. Results: H5 slightly and L5 moderately reduced cell viability, while their combination significantly decreased both cell numbers and viability (Figures A and B). In contrast, H1 and L1 increased cell numbers compared to PBS control (Figure C). Lipidomic analysis revealed that H5 and L5 have higher triglyceride and lower phosphatidylcholine content than H1 and L1. Transcriptomic analysis indicated that H5 is associated with changes in cell cycle regulation and cellular senescence, affecting DNA damage response and chromosome organization. Conclusion: L5 and H5, particularly in a synergistic manner, significantly impact EC and monocyte viability, impairing vascular innate immunity and contributing to atherosclerosis pathogenesis. Conversely, H1 and L1 increase cell proliferation, indicating their non-cytotoxic role and potential nutrient provision. Lipidomic and transcriptomic analyses further support the distinct roles of these lipoprotein subclasses in impaired vascular innate immunity and their contribution to atherogenic processes.