tbuckley/cabot-search huggingface dataset:
Abstract 4146104: The Supplementary Anti-Obesity Medication Integration into a Longitudinal Weight Loss (SAIL) Program: Early Experience in a Remote Comprehensive Weight Management Solution In Patients with CardioMetabolic Risk
Authors: John Ostrominski, Michela Tucci, David Zelle, Heather Baer, Ozan Unlu, Ashley McCarthy, Dan Gabovitch, Caroline Apovian, Benjamin Scirica, Alexander Blood
Journal: Circulation (2024)

Background: There is substantial imbalance between the prevalence and treatment of overweight/obesity. Team-based remote care programs have shown promise in closing healthcare delivery gaps for several cardiometabolic disorders, but whether this strategy can enhance the uptake of guideline-directed therapy for weight management remains uncertain. Methods: In this quality improvement program, we developed and deployed a remote, patient navigator and pharmacist-led, pharmacotherapy-oriented weight management intervention (Supplementary Anti-Obesity Integration into a Longitudinal Weight Loss [SAIL] program). SAIL was conducted within the Partnerships for Reducing Overweight and Obesity with Patient-Centered Strategies 2.0 (PROPS 2.0) program, an ongoing 12-month digital health program pairing an online weight management program (RestoreHealth; HealthFleet, Inc.) with personalized support from health coaches. After 6 months, PROPS 2.0 participants who did not experience weight reduction were offered possible enrollment in SAIL. Pharmacists, enabled by a collaborative drug therapy management program, prescribed, titrated, and monitored anti-obesity medications (AOM) with physician (cardiologist) supervision. Results: Overall, 2,540 invitations for participation in SAIL were sent to the 5,061 patients enrolled in PROPS 2.0, of whom 200 responded. Of the respondents, 98 (49%) were eligible for SAIL, and 75 patients were enrolled. Based randomly by enrollment period, 45 patients participated without a remote physician visit, while 30 had a video telemedicine visit. Among the 75 program participants, 70 (93%) received a prescription for AOM (29/30 with a visit vs. 41/45 without; P=0.64). After a median follow-up of 143 days (IQR 79-193), 61/70 were taking prescribed AOM (26/29 with a visit vs. 35/41 without; P=0.73) ( Figure ). Conclusion: This study extends prior experiences leveraging remote, team-based care, emphasizing the potential of this approach to enhance weight management. Given the dramatic cardiometabolic detriments of prolonged exposure to overweight and obesity, innovative approaches are necessary to meet demand. Remote and team-based care are proven methods to improve care and outcomes and may provide a novel model for delivering care for overweight and obesity. Further studies are needed to ascertain the effectiveness of this strategy on weight-related health outcomes.
Abstract 4145971: Characteristics and in-hospital outcomes of Illicit drug users in the FRENCHIE acute coronary syndrome cohort
Authors: Franck Boccara, Claire Bouleti, Philippe Steg, Alexandra Rousseau, Soufiane Lebal, Patrick Henry, Theo Pezel, Jean Guillaume DILLINGER, Yves Cottin, Guillaume Cayla, Denis Angoulvant, pierre coste, Gilles Lemesle, Tabassome Simon, Nicolas Danchin
Journal: Circulation (2024)

Background: The prevalence and prognosis of illicit drug use (IDU) in the setting of acute coronary syndrome (ACS) are poorly documented. Aim: This study aimed to assess the prevalence of drug use and its potential impact on in-hospital outcomes after ACS. Methods: The multicenter prospective FRENCHIE cohort of ACS evaluated the prevalence of self-declared drug use and its impact on patients’ characteristics and in-hospital outcomes. The composite endpoint of in-hospital outcomes included death, need for intensive care unit, cardiac arrest, sustained ventricular tachycardia, stroke, or stent thrombosis, which was assessed according to drug use status. Results: Between March 2019 and December 2022, 16,265 ACS patients (53% STEMI) were included in the cohort, with a mean age of 64 ± 13 years, 76% male. IDU was reported by 3% (n=482) of patients. Cannabis and cocaine were the most prevalent drugs, with 438 (91%) and 57 (12%) patients declaring use, respectively. Polydrug use was reported in 51 (11%) patients. IDUsers were significantly younger than non-drug users (47±10 vs 64±13 years; P&lt;0.0001), more frequently male (91% vs 76%) with fewer traditional cardiovascular risk factors (diabetes, hypertension, dyslipidemia, obesity), and comorbidities (Heart failure, chronic kidney disease, stroke, coronary artery disease). STEMI was more prevalent in IDUsers than in non-users (73% vs 56%;P&lt;0.0001) and initial left ventricular ejection fraction (LVEF) &lt; 40% was more frequent (17.3% vs 13.6%, p= 0.02). The proportion of normal coronary angiogram was similar in both groups, as was patients’ presentation (STEMI (1.7% vs 1.0%) or NSTEMI (6.9% vs 5.2%)). The composite in-hospital outcome endpoint rate was similar in both groups (8.7% vs 8.7%, p=0.98). However, in-hospital cardiac arrest (ventricular fibrillation) was twice as high in the IDU group (3.7% vs 1.9%;P&lt;0.006). In multivariate analysis, a history of diabetes, high blood pressure, and an older age were significantly associated with in-hospital outcomes. Conclusion: In this large contemporary registry, 3% of ACS patients reported IDU, representing the largest population of drug users with ACS studied to date. Despite being much younger, IDUsers had an intra-hospital prognosis comparable to the non-IDU group, with a higher prevalence of decreased LVEF and ventricular fibrillation. Whether the long-term prognosis differs remains to be evaluated.
Abstract 4145943: Recidivism in the Cardiac Intensive Care Unit: Insights from the Multinational Critical Care Cardiology Trials Network
Authors: Jason Katz, Shashank Sinha, Carlos Alviar, Michael Kontos, Anthony Carnicelli, Lori Daniels, Matthew Pierce, Jeffrey Wang, Vivian Baird-Zars, Michael Palazzolo, Sean Van Diepen, Erin Bohula, David Berg, David Morrow
Journal: Circulation (2024)

Background: Intensive Care Unit (ICU) readmission, or recidivism, can lead to increased resource use, longer hospital length-of-stay (LOS), higher costs,&amp;worse survival. Given the potential clinical&amp;financial impact of recidivism, it may be a useful quality metric for unit-&amp;hospital-level comparisons. No prior studies, however, have comprehensively explored recidivism – its potential causes or consequences – across Cardiac Intensive Care Units (CICUs). Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter registry of advanced CICUs coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions were captured (n=16,705)&amp;those with &gt; 1 readmission during the same hospitalization were identified. Multivariable logistic regression was used to determine baseline variables associated with recidivism, as well as the association of recidivism with in-hospital mortality. Results: A total of 1287 pts (7.7%) had CICU readmission. These pts were younger (p=0.015), had more diabetes (p=0.04), prior heart failure (HF)&amp;chronic kidney disease (CKD) (p&lt;0.001 for both), more frequently presented with decompensated HF or cardiogenic shock (p&lt;0.001), were more often transferred from outside facilities (p&lt;0.001), and had higher Sequential Organ Failure Assessment (SOFA) scores at presentation (p&lt;0.001). Rates of CICU recidivism highly varied across institutions ( Fig-A ). Compared to those who were not readmitted, those readmitted to the CICU had greater critical care resource use during their 1 st CICU stay ( Fig-B ), along with longer initial CICU LOS (2.8 vs 2.2d)&amp;hospital LOS (20.4 vs 7.6d) (both p&lt;0.001). Hospital mortality was 20.3% in those readmitted to the CICU compared to 4.5% in those without readmission ( Fig-C ); adjusted odds ratio 6.22 (95% CI 5.25-7.38, p&lt;0.001). This remained statistically significant after adjustment for code status. Conclusions: CICU recidivism varies significantly across centers and is associated with numerous comorbidities, higher illness severity, and greater resource use. One of every 5 pts readmitted to the CICU died in the hospital. Recidivism should be measured in future CICU-based studies, and could help to assess quality of CICU care.
Abstract 4145444: GLP-1 Receptor Agonists And Clinical Events After Anthracycline-Based Chemotherapy: A Propensity Score-Matched Cohort Study
Authors: Nicole Felix, Lucas Tramujas, Thomaz Costa, Alleh Nogueira, Pedro de Barros e Silva
Journal: Circulation (2024)

Introduction: Anthracyclines are associated with cancer therapy-related cardiovascular dysfunction and heart failure (HF). The role of GLP-1 receptor agonists for patients with cancer undergoing anthracycline-based chemotherapy remains unknown. Hypothesis: GLP-1 receptor agonists are associated with reduced mortality and cardiovascular events after chemotherapy with anthracyclines. Aims: Evaluate the association between GLP-1-treated patients undergoing chemotherapy with anthracyclines and mortality and cardiovascular events. Methods: We conducted a retrospective cohort study of de-identified, aggregated data from 120 centers using the TriNetX Global Collaborative Network. Patients with ≥18 years old, a diagnosis of cancer, a history of use of anthracyclines, and either type 2 diabetes mellitus or overweight/obesity were included. We excluded patients with end-stage kidney disease, ischemic heart disease, or aortocoronary bypass graft. Patients were stratified according to treatment with GLP-1 receptor agonists or not and underwent propensity score matching. We compared HF exacerbation, hospitalizations or urgent emergency department visits, and all-cause mortality rates using Cox proportional hazard models over an 8-year follow-up. Results: After propensity score matching, 2,575 patients remained in each cohort. At 8 years, GLP-1 use was associated with significantly lower rates of HF exacerbation, defined as the need for diuretics, pulmonary edema, systolic and/or diastolic acute decompensated HF, or reaching a left ventricular ejection fraction &lt;40% (HR 0.49; 95% CI 0.42–0.57; p&lt;0.001; Fig. 1A). In addition, GLP-1 use was also associated with lower rates of hospitalizations or urgent emergency department visits (HR 0.45; 95% CI 0.35–0.58; p&lt;0.001; Fig. 1B) and all-cause mortality (HR 0.43; 95% CI 0.38–0.49; p&lt;0.001; Fig. 1C). Conclusion: In this propensity score-matched cohort study comprising 5,150 patients with obesity or type 2 diabetes mellitus undergoing chemotherapy with anthracyclines, the use of GLP-1 receptor agonists was associated with lower incidences of HF exacerbation, hospitalizations, and mortality.
Systemic capillary leak syndrome
Authors: Kirk M. Druey, Laurent Arnaud, Samir M. Parikh
Journal: Nature Reviews Disease Primers (2024)

The vascular endothelial barrier maintains intravascular volume and metabolic homeostasis. Although plasma fluids and proteins extravasate continuously from tissue microvasculature (capillaries, post-capillary venules), systemic vascular leakage increases in critical illness associated with sepsis, burns and trauma, among others, or in association with certain drugs or toxin exposures. Systemically dysregulated fluid homeostasis, which can lead to hypovolaemia, hypotensive shock and widespread tissue oedema, has been termed systemic capillary leak syndrome (SCLS) when overt secondary causes (for example, heart or liver failure) are excluded. In severe forms, SCLS is complicated by compartment syndrome in the extremities and multi-organ dysfunction syndrome due to shock and systemic hypoperfusion. The different forms of SCLS include idiopathic SCLS (ISCLS) and secondary SCLS (SSCLS), which can be triggered by several conditions, including certain infections and haematological malignancies. A subgroup of patients with ISCLS have monoclonal gammopathy-associated SCLS (also known as Clarkson disease), which is an ultra-rare and extreme form of ISCLS. ISCLS can be managed effectively with monthly prophylactic immunoglobulin therapy whereas SSCLS frequently does not recur once the underlying condition resolves or the offending agent is discontinued. Thus, differentiation between ISCLS, SSCLS and other causes of oedema is crucial for quick diagnosis and positive patient outcomes. Systemic capillary leak syndrome occurs when there is systemically dysregulated fluid homeostasis. This can lead to hypotensive shock, widespread tissue oedema and multi-organ dysfunction syndrome. In this Primer, Druey and colleagues summarize the epidemiology, pathophysiology, diagnosis and management of this condition.
Abstract 4146016: Trend-Analysis of Atrial Fibrillation and Atrial Flutter Related Mortality from 1999 to 2022: A CDC-Wonder Database Study
Authors: Muhammad Ayyan, Luqman Munir, Afra Zahid, Aiman Naveed, Muhammad Ehsan, Wajeeh Rehman, Sourbha Dani
Journal: Circulation (2024)

Introduction: Atrial Fibrillation is the most common arrhythmia, causing an irregular and rapid heart rate. This occurs due to electric and structural remodeling of the atria, which creates the rapidly discharging foci. Aims: This study aims to explore the national mortality trends resulting from Atrial Fibrillation and Flutter in the United States from 1999-2022 while also studying the discrepancies among the various socio- demographic groups. Methods: The death certificate data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiological Research (CDC Wonder) database were explored to investigate the Atrial fibrillation and flutter mortality from 1999 to 2022, focusing on the Age-Adjusted Mortality Rate (AAMR) per 1,000,000 individuals. We employed Joinpoint Regression Analysis to compute Annual Percent Changes (APC) with a 95% Confidence Interval. The data was further stratified into epidemiological groups of age, gender, ethnicity, and census region. Results: There was a steady rise in mortality from 1999 to 2017 (APC: 2.96), followed by a rapid surge in mortality trends from 2017 to 2022 (APC: 7.35). The mortality rate rose fairly equally among both genders over the years, with males having a slightly steeper incline (Male AAPC: 4.27, Female AAPC: 3.43). African Americans had the greatest number of deaths due to atrial fibrillation and flutter and the greatest rise was during recent years from 2017 to 2022 (APC: 9.64). The atrial fibrillation and flutter related mortality was the greatest among 25-34-year-olds, with the mortality decreasing among the older populations. All US Census regions had similar mortality rates and trends. Conclusion: This study reveals an overall rise in mortality associated with atrial fibrillation and flutter. It also highlighted disparities across gender, age, and geographic regions. These findings emphasize the need for further research and the development of targeted interventions to reduce mortality and alleviate the burden of this debilitating condition.
Abstract 4146405: Blood Volume Prediction Equations Do Not Precisely Estimate Blood Volume in Adults with Heart Failure with Preserved Ejection Fraction (HFpEF)
Authors: Meera Sooda, Denis Wakeham, Mitchel Samels, Tiffany Brazile, Michael Leahy, Giorgio Manferdelli, James Macnamara, Satyam Sarma, Christopher Hearon, Benjamin Levine
Journal: Circulation (2024)

Background: In heart failure with preserved ejection fraction (HFpEF) expanded blood volume (BV) can result in significant hemodynamic stress that contributes to disease pathogenesis. Due to the lack of routine access to methods of BV measurement, clinicians typically rely on BV prediction equations. However, current prediction equations do not accurately or precisely estimate BV, or its components, in HFpEF. The aim of our analysis was to directly measure blood volume in adults with HFpEF and compare newly developed BV prediction equations (Oberholzer et al ., 2023) to previously validated equations (Nadler and Pearson). Methods: In 52 adults with HFpEF (65% female; age: 70±7 years; BMI: 38±7[GM1] kg/m 2 ) we assessed total hemoglobin mass via carbon monoxide rebreathing, enabling calculation of BV. We estimated BV with the Oberholzer simple (age, sex, height and body mass) and clinical (age, height, and lean mass) equations, as well as Nadler and Pearson equations. Data were compared via either paired or independent samples t-tests or a one-way ANOVA with values presented as mean [95% CI] or mean ± standard deviation. Results: Unlike the Oberholzer simple (-226 [-507 – 55] ml, P =0.113) equation, the Oberholzer clinical equation significantly underestimated measured BV (-513 [-807 – 219] ml, P =0.001); both of which were imprecise with large typical error values (TE; Simple: 11%; Clinical: 11%). Compared to the Oberholzer equations, the mean estimated-measured difference was greater with the Nadler ( P &lt;0.001; TE=12%) and Pearson ( P &lt;0.001; TE=11%) equations (Figure 1A). We observed greater accuracy and precision of all prediction equations for females compared to males (Figure 1B-C): Oberholzer simple ( P =0.070); Oberholzer clinical ( P =0.047); Nadler ( P &lt;0.001); Pearson ( P &lt;0.043). Conclusions: The Oberholzer simple equation yielded the most accurate and precise prediction of BV in adults with HFpEF, with greater accuracy and precision in females. However, all prediction equations remain imprecise with substantial error up to 11% and should therefore be used with caution. As such, there needs to be more widespread measurement of BV to refine prediction equations utilized in clinical settings.
Abstract 4146327: MIRACLE2 Score Effectively Stratifies Short-term Prognosis in Patients with Out-of-Hospital Cardiac Arrest Due to Acute Coronary Syndrome
Authors: KOTARO MIYOSHI, Takuro Abe, Kai Kitagawa, Junki Hashimoto, Miki Numaga, Fumika Yoneyama, Madoka Ogata, Yuki Kawahara, Nozomiko Okuda, Akihiro Tani, Toshiyuki Ando, Shiro Ishihara, Hidenori Komiyama, Kentaro Jujo
Journal: Circulation (2024)

Background: Despite advances in treatment strategies for out-of-hospital cardiac arrest (OHCA), prognosis remains poor. The MIRACLE2 score is an established risk stratification tool for cardiogenic OHCA, but its utility in acute coronary syndrome (ACS), a leading OHCA etiology, is unclear. Aims: To validate the prognostic performance of the MIRACLE2 score in OHCA patients with ACS undergoing urgent/emergent percutaneous coronary intervention (PCI). Methods: We conducted a single-center, observational study (COEDO-CPA registry) of consecutive cardiogenic OHCA patients from 2018-2024. Patients with OHCA due to ACS who underwent urgent/emergent PCI were stratified into high-risk (MIRACLE2 score &gt;5), medium-risk (3-4), and low-risk (0-2) groups based on their MIRACLE2 scores. The primary endpoint was 30-day all-cause mortality, compared among risk groups using Kaplan-Meier analysis. Results: Of 124 cardiogenic OHCA patients, 80 with ACS-related OHCA undergoing PCI were analyzed (mean age 64.7 years, 89% male). The mean MIRACLE2 score was 3.2, with 18 high-risk, 30 medium-risk, and 32 low-risk patients. Mechanical circulatory support was used in 58%. The high-risk group tended to be older with higher lactate levels, worse renal function, elevated D-dimer, and longer cardiopulmonary resuscitation duration compared to lower-risk groups. Kaplan-Meier analysis demonstrated a graded increase in 30-day mortality across risk groups, with effective risk stratification by the MIRACLE2 score (log-rank p=0.003). Conclusion: Among OHCA patients with ACS undergoing PCI, the MIRACLE2 score effectively stratified short-term mortality risk. This validated risk stratification tool could guide treatment strategies and resource allocation in this critically ill population. Incorporating the MIRACLE2 score into OHCA management pathways may optimize care for ACS-related OHCA.
Abstract 4145376: Carbon Monoxide-Induced Atrial Fibrillation: Unveiling the Cardiovascular Spectrum Through a Case Report and Systematic Review of Reported Cases.
Authors: Qusai Alqudah, Omar Obeidat, Munther Hammad, Hashim Al-Ani
Journal: Circulation (2024)

Background: Carbon monoxide (CO) poisoning is a significant public health threat, with emerging attention on its cardiovascular consequences such as myocardial injury, heart failure, and arrhythmias. Notably, atrial fibrillation (AF) has been sporadically reported, suggesting a potential link between CO exposure and cardiac dysrhythmias. Case Report: A 72-year-old female with hypothyroidism and IBS presented to the emergency department with sudden gait imbalance, dizziness, and an occipital headache. Her ECG showed new-onset atrial fibrillation, with subsequent unremarkable echocardiography and brain imaging. Remarkably, her husband exhibited similar symptoms and both had recently been camping. Suspecting CO poisoning, carboxyhemoglobin was tested and found to be 2.9%, with no methemoglobinemia. The patient spontaneously converted to normal sinus rhythm during hospitalization and maintained it during hospitalization without hyperbaric oxygen therapy. Systematic Review of Case Reports: We identified seven cases of carbon monoxide-induced atrial fibrillation from 45 citations. Patients were mostly male (57.14%), aged 21 to 82, and presented with diverse symptoms, primarily headache (57.1%) and nausea (57.1%). Rapid ventricular response occurred in 85.7% of cases, none with a prior history of atrial fibrillation. Most (85.7%) returned to normal sinus rhythm upon discharge, and 71.4% maintained it on follow-up. Normobaric oxygen therapy was given in 57.1% of cases, and hyperbaric oxygen in 42.9%. Most patients (85.7%) had no known cardiovascular disease. Discussion: Despite being underexplored, evidence suggests a notable escalation in dysrhythmia risk, particularly in patients with pre-existing cardiovascular conditions, following acute CO poisoning. Potential mechanisms for CO-induced dysrhythmias include the strong binding of CO to hemoglobin, resulting in hypoxia-induced myocardial changes, and molecular alterations affecting cardiac voltage-gated channels. Conclusion: While the association between acute CO poisoning and dysrhythmias warrants further investigation, emerging evidence underscores the necessity of raising awareness among healthcare providers regarding the potential cardiovascular consequences of CO exposure.