tbuckley/cabot-search huggingface dataset:
Abstract 14153: P2Y12 Inhibitors and Quality of Life Outcomes in Critically Ill Patients Hospitalized for COVID-19: A Pre-Specified Secondary Analysis of the ACTIV4a Randomized Clinical Trial
Authors: Lana Wahid, MD, Erinn M Hade, Mary Cushman, Michelle N Gong, Valerie Renard, Emily R Ko, Tatyana Der, Lucy Z Kornblith, Patrick R Lawler, Harmony Reynolds, Chowdhury Ahsan, Grant Bochicchio, Carlos Carpio, Nicholas Hanna, Kristin Hudock, Robert Hyzy, Fatima Ibanez Estellez, Nicole Iovine, George Lim, Jose Luis Lopez-Sendon Moreno, Jorge Moises, jesus peteiro, John G Quigley, FERNANDO WORNER, Mikhail N Kosiborod, Scott D Solomon, Matthew D Neal, Judith S Hochman, Jeffrey S Berger
Journal: Circulation (2023)

Background: Post-acute sequela of COVID-19 (PASC) is a complication of SARS-CoV-2 causing persistent symptoms and impaired functional status. We studied the effect of P2Y12 inhibitors on health-related Quality of Life (QoL) at 90 days in critically ill patients hospitalized for COVID-19. Methods: Adults hospitalized for COVID-19 who were randomized in the P2Y12 inhibitor domain of ACTIV-4a platform trial between February 2021 and June 2022. Participants were to receive usual care and either P2Y12 inhibitor (ticagrelor preferred) or no P2Y12 inhibitor for 14-days or until hospital discharge, whichever was sooner. The QoL primary outcome was determined by the EQ-5D-5L utility and visual analog scores, standardized and validated instruments. A Bayesian model estimated difference in health related QoL by randomization status adjusting for risk factors. Results: Among 1,502 participants, 860 critically ill patients were administered English and Spanish translations of EQ-5D-5L at 90-days. Median age was 57 years (IQR: 47, 65), 37% were female, 49% were under-represented minorities, and 10% resided in Spain. In those assigned to P2Y12 inhibitor, the mean EQ-5D-5L utility score was better in those assigned to usual care (adjusted difference: 0.08, 95% CrI: 0.03, 0.13; posterior probability of superiority [defined as a mean difference &gt; 0] was 99.9%). Better health related QoL was also observed with assignment to P2Y12 inhibitors; EQ-5D-5L visual analog score adjusted difference: 5.30 (95% Crl: -0.49, 10.84), probability of superiority: 96.4% (table 1). Conclusion: In secondary analysis of an international randomized trial of critically ill participants with COVID-19, treatment with a P2Y12 inhibitor vs usual care was associated with improved quality of life at 90-days and may decrease symptoms of PASC following hospital discharge.
Abstract 16198: Targeting Lipid Nanoparticles to the Blood Brain Barrier to Ameliorate Acute Ischemic Stroke
Authors: Jia Nong, Patrick M Glassman, Vladimir Muzykantov, Jacob Brenner, Oscar A Marcos-Contreras
Journal: Circulation (2023)

There are more than 7.6 million new cases of ischemic strokes annually. Despite numerous unsuccessful drug trials for acute ischemic stroke (AIS), one common reason for their failure is the limited concentration of drugs reaching the at-risk penumbra. To address this issue, we have utilized nanotechnology to significantly enhance drug concentrations in the blood-brain barrier (BBB) of the penumbra. The increased BBB permeability during AIS is believed to be detrimental to neurons due to exposure to toxic plasma proteins. To develop drug-loaded nanocarriers targeted to the BBB, we have conjugated them with antibodies that bind to various cell adhesion molecules (CAMs) on the BBB endothelium. In a mouse model of AIS induced by transient middle cerebral artery occlusion, we compared the accessibility of nanocarriers targeting platelet endothelial CAM (PECAM), intercellular CAM (ICAM), and vascular CAM (VCAM), including liposomes and lipid nanoparticles (LNP). VCAM-targeted liposomes exhibited significantly higher uptake in the ipsilateral hemisphere compared to the contralateral counterpart, and superior targeting with a 2.5-fold higher uptake than ICAM, 1.9-fold higher than PECAM, and 20-fold higher than the untargeted control IgG counterpart (A). Similarly, VCAM-targeted LNP displayed a 3.4-fold, 2.4-fold, and 12.2-fold higher uptake than ICAM, PECAM, and IgG, respectively (B). Flow cytometry analysis revealed that VCAM-targeted liposomes were primarily associated with endothelial cells and leukocytes (C). In a therapeutic study, VCAM-targeted dexamethasone-loaded liposomes or IL-10 mRNA-loaded LNP reduced the infarct volume by 35% and 73%, respectively (D). VCAM/IL-10 mRNA LNP also achieved a 100% survival rate (E) and elevated plasma levels of IL-10. In conclusion, VCAM-targeted lipid nanoparticles provide a novel platform for effectively concentrating drugs within the compromised BBB of the penumbra, thereby improving the outcomes of AIS.
Abstract 18911: Ventriculo-Atrial (VA) Interval as a Measure of Proof of Capture of the Left Bundle
Authors: Sania Jiwani, Ninad Nadkarni, Vivek Reddy, Amit Noheria, Seth Sheldon
Journal: Circulation (2023)

Introduction: Left bundle branch area pacing (LBBAP) has provided a safe and effective method of capturing the conduction system for physiologic pacing. Given direct capture of the conduction system, we hypothesized that in patients with retrograde conduction, capture of the left bundle would result in shortening of the interval from ventricular activation to atrial activation (VA interval). To our knowledge, proof of shortening of the VA interval has only previously described as a diagnostic method of confirming left bundle capture in one published case report. In our proof-of-concept study we demonstrate VA interval shortening in 3 patients with intact retrograde conduction noted intraoperatively. Hypothesis: Capture of the left bundle will result in shortening of the VA interval and can be used as a method to confirm LBB capture in patients with intact retrograde conduction. Methods: VA interval measurements were made in patients with intact retrograde conduction. VA interval measurements were performed with capture of the RV septum only and with capture of the left bundle branch. Measurements were all made during implantation and occurred either during active lead deployment, or after left bundle branch area pacing results were obtained. If left bundle branch area pacing results were obtained first, then pacing unipolar from the ring was used as a surrogate for RV septal capture and pacing unipolar from the tip was used for left bundle capture.We did not distinguish between selective and non-selective left bundle branch pacing in this study. Results: In all three patients, capture of the left bundle resulted in shortening of the VA interval. Changes in VA interval were noted to be: 208 ms to 186 msec, 239 msec to 189 msec and 245 msec to 191 msec. The image in Figure 1 illustrates shortening of the VA interval. Conclusions: In patients with retrograde VA conduction, VA interval shortening may serve as an additional useful criterion of left bundle branch capture.
Abstract 18368: Management of Incident AF in Hospitalized Patients - Deficient, Delayed, Detrimental
Authors: Nick Prinz, Daniel Soto, Oliver Monfredi, Randall Moorman
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is potentially associated with significant complications including stroke and cardiac decompensation. Early appropriate AF management mitigates this risk. However, intervention is frequently delayed - a median of 1.5 days from AF onset in the ICU to clinical response. We sought to better understand delays in detection and management of AF in patients admitted to a cardiology bed and the consequences of delays. Methods: We undertook a retrospective review of 498 patients admitted to cardiology beds at the University of Virginia Medical Center who had automated algorithmic detection of AF episodes lasting ≥6 min. Time from algorithmic detection to clinical identification, AF burden, AF interventions and complications, medical history, and demographics were identified in each patient’s chart. Results: Of the 498 patients, 171 had an algorithmically detected episode of AF that was not acknowledged medically. These undetected episodes were generally shorter relative to episodes that were acknowledged (median 8 min vs. 52 min). 96 of the 498 patients had initial clinical detection of AF following algorithm detection; of the 96, 21 received early intervention (within 60 min), 51 received late intervention (after 60 min), and 24 received no intervention at all. Patients with early intervention experienced less AF burden compared to late and no intervention groups (median 8.6 hrs vs 21.75 hrs vs 29.35 hrs). Late intervention patients had more AF related complications compared to early intervention patients (9.8% vs. 4.8%). 20.8% of patients with clinical acknowledgement of AF but no intervention suffered a complication. Patients with a history of AF were more likely to have delays in intervention and over twice as likely to suffer an AF complication compared to those with no history (15.6% vs. 7.4%). Patients of lower socioeconomic status (SES) were also more likely to experience a complication. Conclusions: In summary, cardiology inpatients at our hospital commonly experience delays in management of AF that are considerable in duration, resulting in greater AF burden and higher complication rates. Differences in management, and subsequent outcomes, following AF appear to be impacted by prior history of AF and patient SES.
Abstract 16787: Impact of Metabolic Healthy Obesity on Cardiovascular Outcomes of Hospitalized Postmenopausal Women (Age&gt;55 Years) and Associated Disparities: A Population-Based Analysis
Authors: Adhvithi Pingili, Mohit Lakkimsetti, Roopeessh vempati, Hasmitha J Madhavaram, Madhusha Vemula, Gurbina Sagoo, Mounica Majooju, Ishita Vasudev, Praveena Sunkara, Jyotsna Gummadi, Sandeep Singh, Athmananda Nanjundappa, Rupak Desai
Journal: Circulation (2023)

Introduction: Metabolically healthy obesity's (MHO) impact on cardiovascular outcomes is debated. However, MHO's impact on cardiovascular outcomes in postmenopausal women is unexplored. Our study explored MHO's prevalence and correlation with in-hospital major adverse cardiac and cerebrovascular events (MACCE) in postmenopausal women. Methods: Data was analyzed from National Inpatient Sample 2020 for admissions of postmenopausal women (&gt;age 55 years) with and without obesity. Metabolically healthy patients were identified by excluding diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity software. After propensity score matching (PSM) patients with MHO and non-MHO for age, we performed a multivariable regression analysis for in-hospital MACCE. Also, using tests of model effects, we determined predictors of MACCE in postmenopausal women with MHO. Results: In 2020, 1304185 metabolically healthy postmenopausal women over age 55 years were admitted; 1155935 (88.6%) had no MHO, and 148250 (11.4%) had MHO. However, after PSM for age, there were 148250 in each cohort. In MHO cohort, median age was 65 years, 78.6% were white, 8.1% were African-American, and 28.2% were from lowermost income quartile. Most common comorbidities in MHO cohort were chronic pulmonary disease (29.2%), hypothyroidism (20.7%), and tobacco use disorder (23.9%). We observed a statistically significant difference in overall MACCE [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.01-1.16, p=0.028] among MHO and non-MHO cohorts, especially in patients from African-American ethnicity (OR 1.23, 95% CI 1.01-1.49, p=0.035) and lowermost income quartile (OR 1.24, 95% CI 1.06-1.44, p= 0.007). However, no significant all-cause mortality was observed (OR 1.02, 95% CI 0.94-1.12, p=0.621). Several predictors of MACCE in postmenopausal women with MHO were observed, with non-elective admission being the strongest (OR 7.38, 95% CI 5.91-9.22, p&lt;0.001). Conclusion: This large population-based analysis revealed that postmenopausal patients with MHO are at risk of MACCE, particularly those from African-American ethnicity and lowermost income quartile. Larger prospective studies are needed to "demystify" the controversial MHO in cardiovascular diseases.
Abstract 18355: Trends In Ambulatory Postpartum Blood Pressure Measurement In Hypertensive Disorders Of Pregnancy
Authors: Megan M Sheehan, Tang Li, Jinbo Chen, Jennifer Lewey
Journal: Circulation (2023)

Introduction: Hypertensive disorders of pregnancy (HDP) are associated with a significantly increased risk of hypertension (HTN) in the years following delivery. Despite this, postpartum follow-up rates are low and evaluation for HTN in the first year postpartum is not well described in clinical practice. Our objective is to describe patterns of ambulatory BP measurement in the year following delivery. Methods: We identified all patients in a large health system with a delivery from 2018-2020. We describe prevalence of ambulatory blood pressure (BP) measurements according to HTN subtype: preeclampsia, gestational HTN (GHTN), or chronic HTN (CHTN), as assessed by ICD-10 codes. Logistic regression was used to examine relationship between patient factors and BP measurement. Results: We identified 25,843 patients of whom 87% had at least 1 BP check after delivery. Patients with preeclampsia and CHTN were more likely to have an outpatient BP measurement compared to normotensive patients in all time periods (Table). Patients with GHTN only had higher rates of BP measurement in the early postpartum period.Among patients with any hypertensive disorder, factors associated with BP measurement within 12 weeks included age &gt;30 years (odds ratio (OR) 1.31, 95% confidence interval (CI) 1.12-1.55) and cesarean delivery (OR 1.3, 95% CI 1.1-1.52). In contrast, patients who were non-Hispanic Black (OR 0.69, 95% CI 0.56-0.84), current smokers (OR 0.55, 95% CI 0.41-0.76), or had public insurance (OR 0.31, 95% CI 0.26-0.37) were less likely to have a BP measurement within 12 weeks. Conclusions: Most postpartum individuals have at least one blood pressure measurement within 12 weeks of delivery, though ongoing BP evaluation is less common after 12 weeks. Age and racial disparities in BP measurement are prevalent. Future work will characterize and evaluate blood pressure trends and treatment in this cohort.
Abstract 18324: Artificial Intelligence ECG as a Novel Method to Detect Cardiotoxicity After Anthracyclines
Authors: Johanna E Jacobs, Grace Greason, Hans Wildiers, Rik Willems, Stefan P Janssens, Peter A Noseworthy, Francisco Lopez-Jimenez, Jens-Uwe Voigt, Paul Friedman, Lucas Van Aelst, Bert Vandenberk, Zachi Attia, Joerg Herrmann
Journal: Circulation (2023)

Introduction: Cardiotoxicity is a serious side effect of anthracycline treatment, most commonly manifesting as a reduction in left ventricular ejection fraction (LVEF) on cardiac imaging. Cost-effective alternatives to cardiac imaging are currently not available. Artificial intelligence (AI) models have been developed to detect a reduced LVEF from 12-lead electrocardiograms (ECGs) in the general population. Hypothesis: AI-ECG model can detect a reduced LVEF after anthracycline therapy (i.e. cardiotoxicity). Methods: We included an unbiased oncological population of 989 female breast cancer patients receiving (neo)adjuvant anthracycline chemotherapy. Average follow-up time was 9.83±4.2 years. Patients with incomplete transthoracic echocardiography (TTE) data, HER-2-directed therapy, significant comorbidities, upfront metastatic disease, second primary malignancy or pre-existing cardiovascular disease were excluded from the analyses. Patients with LVEF decline for reasons other than anthracycline-induced cardiotoxicity were also excluded. Primary readout was the diagnostic performance of AI-ECG by area under the curve (AUC) for various levels of LVEF &lt;50%. Results: Using 1,877 ECGs from 703 unique patients, the AI-ECG model detected an LVEF &lt;50% and ≤35% after anthracycline therapy with an AUC of 0.93 and 0.94, respectively. Conclusions: These data support the use of AI-ECG for cardiomyopathy (cardiotoxicity) screening after anthracycline-based chemotherapy. This technology could serve as a gatekeeper to more costly testing and could enable patients to monitor themselves over long periods of time.
Abstract 17845: Logic-Based Natural Language Processing Identifies VT Recurrence in the Electronic Health Record
Authors: Kelly A Brennan, Ruibin Feng, Jatin Goyal, Zahra Azizi, Tina Baykaner, Albert J Rogers, Sanjiv M Narayan
Journal: Circulation (2023)

Introduction: With the advent of integrated electronic healthcare record (EHR) systems, it is increasingly important to identify patients who may suffer a clinical endpoint to allocate resources and develop predictive models. For the endpoint of VT recurrence after ablation, outcomes are currently assessed manually by experts, which is time consuming with few automated tools. We set out to develop a robust natural language processing model to parse cardiology and electrophysiology notes to detect VT. Hypothesis: We hypothesize that natural language processing (NLP) with logic-based algorithms can be used to accurately extract specific information on VT recurrence from complex clinical notes, compared to experts. Methods: We studied N=639 full-text clinical notes written by board certified cardiologists from N = 125 patients (32.0% female, LVEF 48.9±13.9%, 61±14.0 years). Notes were labeled as “No” or “Yes” for VT recurrence, and split into a development set of N=303 (median word count = 236) from N=75 patients and a test set of N=336 (median words = 297) from N=50 patients. We developed an NLP rule based expert system that uses hierarchical groups of keywords to identify sentences related to VT, then uses negation and quantifier functions to interpret context and assign a label. Results: The logical flow is shown in figure A. This approach achieved an 93.73% accuracy in the development set (precision = 57.14%, recall = 69.56%), and 90.48% accuracy (precision = 36.84%, recall = 63.63%) in the test set (figure B). Conclusions: An NLP logic-based approach can identify VT recurrence post ablation from complex clinical notes. NLP can thus be used to accelerate data extraction for clinical purposes or for semi-supervised learning. Future work will determine if logic-based NLP need to be augmented for noisier data, such as the entire EHR system.
Abstract 17701: Glucagon-Like Peptide-1 Receptor Agonist Weight Loss Results from an Allied Health-Led Atrial Fibrillation Risk Factor Modification Clinic
Authors: April K Watkins, Jennifer S Collins, Jane D Champion
Journal: Circulation (2023)

Introduction: Atrial Fibrillation (AF) is a global health threat associated with embolic stroke, heart failure, and death. Modifiable risk factors play a role in preventing and slowing the progression of AF. Obesity is one such modifiable risk factor with a strong association with AF. Glucagon-like peptide-1 receptor agonists (GLP1-RA), semaglutide and liraglutide, are approved by the Food and Drug Administration for weight loss. Prescribing semaglutide and liraglutide for weight loss in AF patients seen in an allied health professional (AHP) risk factor modification clinic can potentially improve patient outcomes. Hypothesis: This study aims to determine weight change, side effects, and comorbidities for patients prescribed GLP1-RA in the AHP AF clinic. Methods: Following Institutional Review Board approval and exempt status, a retrospective chart review was conducted using the AF clinical registry for 95 consecutive patients followed over 90 days in the AHP clinic from January 1 to November 30, 2022, who were prescribed GLP1-RA by the AHP or had an existing prescription from a primary care provider or endocrinologist. Results: Patients totaled (n=95), aged 26-86 years, (36.8%) women, (80%) identified as white, (51.6%) persistent or (38.9%) paroxysmal AF, and (44.2%) underwent prior ablation. Comorbidity prevalence hyperlipidemia (55.8%), DM (33.7%), CHF (16.8%), and left ventricular ejection fraction &gt;50% (85.3%). Patients receiving a GLP1-RA, either semaglutide (n=78, 82.1%) or liraglutide (n=17, 17.9%), experienced significant reductions in weight (Kg, 116.44 vs. 111.49, p&lt;.001), (BMI, 38.54 vs. 36.68, p&lt;.001), with no significant differences found in the reduction of weight (Kg/BMI) by GLP1-RA prescribed. Patients without DM experienced significantly greater reductions in weight than those with DM (Kg, p&lt;.012, BMI, p&lt;.07). Those without CHF also experienced significantly greater reductions in weight, (Kg, p&lt;.05, BMI, p&lt;.05), than those with CHF. Side effects experienced by 10.5% included nausea, constipation, or diarrhea. Conclusion: GLP1-RA has shown significance for weight loss for AF patients seen in the AHP AF lifestyle clinic. The next steps should include evaluating AF burden before and after weight loss on the medication.
Abstract 12614: Procedural Volume and Outcomes With Atrial Fibrillation Ablation: A Report From the NCDR AFib Registry
Authors: Sharma Kattel, Zhen Tan, Zhenqiu Lin, Daniel Friedman, Reed Mszar, Emily Zeitler, Paul Zei, T J Bunch, Moussa Mansour, Joseph Akar, Jeptha P Curtis, James V Freeman
Journal: Circulation (2023)

Introduction: Operator and hospital procedure volumes are associated with outcomes in many cardiac procedures. Objective: To determine the association between hospital/physician procedural volume and safety/success for atrial fibrillation (AF) ablation in the current era. Methods: Procedures reported to the NCDR AFib Registry between 7/2019 to 6/2022 were analyzed. Physician and hospital procedural volumes were annualized and stratified into quartiles (Q) to compare procedural success and major adverse events (MAE). Three level hierarchical (patient, hospital and physician) generalized linear models were used to assess the adjusted relationship between procedural volume and likelihood of acute outcomes. Results: A total of 70,296 first time AF ablation patients' at 186 US hospitals were studied. Mean age was 66.1 ± 10.3 years. 36% were women; mean CHA2DS2-VASc score was 2.7±1.6, and 57.4% were of paroxysmal AF. The median annual procedural volumes for hospitals and physicians were 230 and 66 respectively. Acute procedural success was 98.5% and the MAE rate was 1.0%. With Q4 (highest) hospital procedural volume as a reference, the adjusted likelihood of procedural success was significantly less among Q1 (OR: 0.44, CI: 0.3-0.7), Q2 (OR:0.50, CI:0.3-0.8) and Q3 (OR:0.60,CI:0.4-0.9). Similarly, for physician volume, the adjusted likelihood of success was less among Q1 (OR: 0.38,CI: 0.3-0.5), Q2 (OR: 0.51,CI: 0.4-0.7) and Q3 (OR:0.55,CI:0.4-0.7). With regards to MAE, compared to Q4, there was an inverse relationship to procedural volume for hospitals in Q1 (OR: 1.78, CI:1.3-2.5) but not in Q2 (OR: 1.06, CI 0.8-1.5) or Q3 (OR: 1.19, CI: 0.9-1.6) and for physicians in Q1 (OR: 1.93, CI 1.4-2.6) and Q2 (OR:1.49, CI: 1.1-2.0) but not in Q3 (OR: 1.22, CI: 0.9-1.6)(figure). Conclusions: In this national cohort of first time AF ablations, hospital and physician procedural volume were directly related to acute procedural success and inversely related to the rate of MAE.