tbuckley/cabot-search huggingface dataset:
Abstract 4139332: Patient-Clinician Communication and Cardiovascular Outcomes: An Analysis of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), 2008-2019
Authors: Samuel Slavin, Martha Daviglus, Olga Garcia-Bedoya, Yasmin Mossavar-Rahmani, Krista Perreira, Sylvia Wassertheil-Smoller, Alberto Ramos, Daniela Sotres-Alvarez, Andrew Telzak, Murray Mittleman
Journal: Circulation (2024)

Background: Strong patient-clinician communication may improve health outcomes for marginalized populations, including Hispanic/Latino individuals. Objective: We assessed the association between patient-clinician communication and cardiovascular (CV) events or death in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: HCHS/SOL is a longitudinal cohort study of individuals aged 18-74 who identified as Hispanic/Latino at 4 U.S. sites. Participants' ratings of communication with clinicians during the year before enrollment were used to generate a communication score. The primary outcome was the composite of myocardial infarction (MI), heart failure events (HF), stroke, and all-cause mortality. The secondary outcomes included the primary outcome components. The association between the baseline communication score and outcomes of interest was assessed with Cox proportional hazards models adjusting for possible confounders. We also used multivariable linear regression to assess the cross-sectional association between communication and AHA Life’s Essential 8 (LE8), a measure of CV risk factors. All analyses accounted for the complex survey design. Results: Our sample included 10,527 individuals without prior CV events and at least one medical encounter in the year before enrollment. The median age at enrollment was 41 years (IQR 29, 53), 59% were female, and 71% perceived high-quality communication with clinicians. The mean follow-up time was 9.4 years. High-quality communication was associated with the following results in our adjusted analyses: composite outcome (aHR 0.71, 95% CI 0.49, 1.02, p = 0.066), CV events (aHR 0.79, 95% CI 0.41, 1.51, p = 0.47), all-cause mortality (aHR 0.53, 95% CI 0.35, 0.80, p &lt; 0.01). Conclusions: High-quality patient-clinician communication was associated with a non-significant trend toward a lower rate of CV events and death, driven by a significant association with lower all-cause mortality.
Abstract 4139373: Cardiac Consequences of Acute Mania: A Case of Takotsubo Cardiomyopathy
Authors: MAHMOUD ABDELSALAM, Maram Ahmed, Shady Ezaldin, Elie Gharib
Journal: Circulation (2024)

Introduction: Takotsubo cardiomyopathy (TCM) is a transient condition characterized by left ventricular dysfunction, often triggered by stress, although its exact pathogenesis remains unclear. We are presenting a case of TCM triggered by an acute manic episode, shedding light on the interplay between psychological states and cardiac function. Additionally, this case underscores the heightened risk of QT prolongation and ventricular fibrillation associated with antipsychotic medications. Case Description: A 32-year-old female with a history of bipolar I disorder was admitted to the psychiatric unit for an acute manic episode and was immediately started on Olanzapine. On the second day of admission, the patient collapsed and was found to be in ventricular fibrillation. After three cycles of cardiopulmonary resuscitation and two direct current shocks, the patient achieved a return of spontaneous circulation and sinus rhythm. She was intubated and transferred to the ICU, where an EKG revealed a QTc of 497 ms (Figure.2). A follow-up EKG after 12 hours showed dynamic T-wave inversions and a prolonged QTc of 615 ms (Figure.1). Echocardiography indicated apical akinesis with severely decreased systolic function, with an ejection fraction of 30%. CT coronary angiography was normal. The patient was diagnosed with Takotsubo cardiomyopathy and started on metoprolol. On the fourth day of admission, an automatic implantable cardioverter-defibrillator was implanted. At six-month follow-up, the patient's EKG showed a normal QTc of 420 ms (Figure. 2), and echocardiography demonstrated an improved ejection fraction of 55%. Conclusion: This case supports the hypothesis of catecholamine-induced myocardial stunning as a primary mechanism of TCM, illustrated here in the context of acute mania. Physicians should consider TCM as a potential complication of acute mania. Screening EKGs in patients experiencing manic episodes could be beneficial. If abnormalities are detected, serial EKGs, echocardiography, and medication adjustments may help prevent this potentially fatal consequence of acute mania. Although Olanzapine is not strongly linked to QTc prolongation compared to some other atypical antipsychotics, diligent electrocardiographic monitoring and close observation for any QTc prolongation are crucial. These measures play a pivotal role in preventing potentially fatal consequences associated with cardiac arrhythmias.
Abstract 4139203: Anatomical Variations in Coronary Arteries and Implications in Spontaneous Coronary Artery Dissection
Authors: Alvaro Gabaldon Badiola, Devika Kir, Marysia Tweet, Teodora Donisan, Fernando Alfonso, Abhiram Prasad, Rajiv Gulati
Journal: Circulation (2024)

Introduction: Spontaneous coronary artery dissection (SCAD) is a poorly understood cause of acute coronary syndrome (ACS), predominantly affecting young women and frequently related to acute stressors. It has been suggested that stress induced cardiomyopathy can cause dissection via mechanical distortion of the vessel at wall-motion hinge points. Whether specific coronary anatomic configurations also predispose to distortion and hence SCAD remains unknown. Hypothesis: Patients with left anterior descending (LAD) SCAD have a higher frequency of a “wrap around” (type IV - perfuses &gt;25% of the inferior wall) LAD. Methods: Coronary angiograms of patients in the Mayo Clinic SCAD Registry were reviewed. Patients from functional angiogram registry with similar characteristics were used as controls. Patients with an LAD SCAD were compared to patients who never had an LAD SCAD. For identifying predictors of LAD SCAD, patients who never had an LAD SCAD were compared to patients that had an LAD SCAD as a recurrent event, but not as the initial presentation. Results: A total of 456 patients with SCAD (46±6 years; 96% women) were included. The control group consisted of 178 patients (44±7 years, 97% women). Type IV LAD was more common in the SCAD cohort (Figure 1), and patients in the LAD SCAD group had a higher proportion of type IV LAD when compared to non-LAD SCAD (47.6% vs 23.0% p &lt; 0.001). Bifurcation involvement was also more frequent (48.6 vs 25.8%, p &lt;0.001). Individual predictors of an LAD SCAD during follow-up were diagnosis of hypertension, peripartum SCAD, involvement of a bifurcation and type IV LAD. After multivariate analysis, only bifurcation involvement (OR 2.49, p = 0.01) and type IV LAD (OR 2.26, p = 0.02) remained as predictors of LAD SCAD during follow-up. In patients in whom the PDA perfused the apex (LAD I and II), PDA was more likely to be involved by SCAD (OR 6.17, p&lt;0.001). There were no other differences in coronary distribution after stratifying by LAD types. Conclusions: Type IV LAD variant is more common in patients with LAD SCAD. This finding suggests that coronary anatomic variants predispose to SCAD and lend further support to the mechanical distortion hypothesis.
Abstract 4139107: Association of Patient Healthcare Information Exchange Systems at US Hospitals with 30-day Excess Days in Acute Care after Heart Failure Hospitalization
Authors: Aline Pedroso Camargos, Zhenqiu Lin, Joseph Ross, Rohan Khera
Journal: Circulation (2024)

Background: Given its chronicity and high hospitalization burden, heart failure (HF) requires close coordinated care. Health Information Exchange (HIE) systems can improve care by enabling seamless information sharing between healthcare providers and patients. We evaluated whether hospitals that have invested in more comprehensive HIE access for patients have better risk-standardized post-discharge outcomes after HF hospitalization. Methods: We defined a range of contemporary HIE services at all US acute care hospitals using the American Hospital Association (AHA) Information Technology (IT) Annual Survey (2022). HIE services included mobile access to health records, the ability to import, export, and update health records online, and the option to share patient-generated data with the health system, representing health measurements and data generated from smart devices ( A ). We identified each hospital’s corresponding 30-day excess days in acute care (EDAC) for HF – a risk-standardized metric of all acute care needs in the post-hospitalization period from the Centers for Medicare&amp;Medicaid Services Quality Report (2019-2022) and examined the association between HIE services and 30-day EDAC for HF using multivariable linear regression. Results: There were 2,581 US hospitals (22% rural, 9% teaching, with a median bedsize of 162 [IQR 76, 307]) in the AHA-IT survey, with a median EDAC of 5.9 (IQR -8.6, 20.9) days for HF. The vast majority (99%) of hospitals had online health record portals, but access to specific HIE services varied widely across hospitals ( B ): 84% offered access via mobile application, 86% allowed data import, 55% data export to other health systems, and 77% online data updates, with fewer than half (47%) allowing patients to share patient-generated health data. After accounting for differences in hospital characteristics, only hospitals with HIE configured to enable patients to share their personal health data directly with the health system had significantly lower risk-standardized 30-day EDAC for HF (-3.9, 95% CI -1.04, -3.48) ( C ). Conclusions: Hospitals with HIE services that include the sharing of patient-generated data have significantly better risk-standardized post-hospitalization outcomes for HF. There is a need to evaluate the role of broader access to bidirectional data sharing as a strategy to enhance care and outcomes at hospitals treating patients with ongoing post-discharge needs.
Abstract 4139277: Activation of the Histamine-3 Receptor Prevents Cardiac Fibrosis and Diastolic Dysfunction by Opposing a Profibrotic Cardiac Fibroblast Phenotype through Inhibition of cAMP Signaling
Authors: Heather Connery, Anja Herrnreiter, William Campbell, Alexander Widiapradja, Scott Levick
Journal: Circulation (2024)

Introduction: Cardiac fibrosis is a major contributor to adverse cardiac remodeling that underlies heart failure. Previously, we identified the presence of the histamine-3 receptor (H 3 R) in the left ventricle (LV), including on fibroblasts, and demonstrated that exogenous H 3 R activation with imetit reduced cardiac fibrosis in angiotensin II (Ang II)-infused mice. Objective: We sought to determine the extent to which activation of H 3 R improved diastolic function, and to identify cellular mechanisms by which H 3 R opposes a profibrotic cardiac fibroblast phenotype. Methods: Eight-week-old male C57/B6 mice received saline or Ang II (1500 ng/kg/d) via osmotic pump for 7 days. Separate saline or Ang II mice also received subcutaneous injections of imetit (40 mg/kg/d). LV function was assessed by pressure-volume catheter. TruPath assay was used to identify H 3 R-induced G proteins in HEK293T cells. For signaling studies, primary LV fibroblasts were isolated from C57/B6 mice and treated with TGF-β1 (30 ng/mL) as a profibrotic stimulus, together with imetit (300 nM). Collagen release and cell migration were assessed for fibroblast phenotype. The cAMP/PKA/CREB signaling pathway was also assessed. Results: LV end-diastolic pressure was increased in Ang II mice (p&lt;0.03 vs Saline). This was prevented by imetit (p&lt;0.02 vs Ang II). There was also a trend towards an increase in tau , a measure of LV stiffness, in Ang II mice that was normalized by imetit. Cardiac fibrosis occurred in Ang II mice (p&lt;0.0001 vs Saline), which was normalized by imetit (p&lt;0.0001 vs Ang II). In cardiac fibroblasts, TGF-β1 increased collagen I release, with this being inhibited by imetit (TGF-β1 594.1±59.97 vs TGF-β1+Imetit 274±38.2 ng/mg, p&lt;0.0001). TGF-β1 inhibited fibroblast migration, with imetit restoring a normal migratory response (p&lt;0.003 vs TGF-β1). H 3 R activation induced the Gα i subunit in HEK293T cells, which would suggest inhibition of cAMP. Consistent with this, imetit significantly decreased both pPKA/PKA and pCREB/CREB ratios in cardiac fibroblasts following TGF-β1. The cAMP pathway inhibitor cAMPs-Rp reduced TGF-β1 induced collagen production and restored the cell migratory response lost due to TGF-β1. Conclusions: Activation of H 3 R improves diastolic function in part by preventing cardiac fibrosis. This antifibrotic effect can be at least partially attributed to inhibition of a profibrotic cardiac fibroblast phenotype, likely through Gα i inhibiting the cAMP/PKA/CREB signaling axis.
Abstract 4139249: Cost or Benefit? Analysis of a Virtual Health Coaching Intervention for Caregivers of Patients with Heart Failure
Authors: Chuxuan Sun, Karen Hirschman, Austin Matus, Michael Stawnychy, Miatta Goba, Gladys Thomas, Rebecca Ashare, Deborah Gordon, Kathy Bowles, Barbara Riegel, Norma Coe
Journal: Circulation (2024)

Background: Despite the large role of informal caregivers in heart failure (HF) care, the cost-effectiveness of interventions supporting informal caregivers of patients with HF is unclear. Aim: Compare the cost-effectiveness of a virtual health coaching intervention ("ViCCY,” Virtual Caregiver Coach for You) designed to improve self-care vs. health information alone for informal caregivers of patients with HF. Methods: In this randomized controlled trial, 250 informal caregivers were randomized in a 1:1 ratio to receive a combination of ViCCY and health information or health information only for 6 months. Caregiver healthcare utilization (i.e., hospitalization, emergency visits, ambulance use, diagnostic/therapeutic procedures, and home care) was self-reported at 1, 3, 6, 9, and 12 months after randomization. Incremental cost-effectiveness ratio (ICER) was calculated as incremental costs per quality-adjusted life-year (QALY) within the 12-month trial period. Both unadjusted and adjusted regression analyses were used to measure healthcare utilization and cost. Primary analyses were conducted on the 164 caregivers with complete data on both QALY and healthcare costs. Sensitivity analyses were conducted on samples with complete data for either QALY or healthcare costs. Calculations were made to estimate the ICER for a hypothetical scaled version of the intervention, with 12 health coaches serving 336 informal caregivers per year, including training and fidelity costs. Results: The intervention improved QALYs by 0.036 at a cost of $862.4 per caregiver for an ICER of $23,956 for the ViCCY group (Table). The overall effect of the ViCCY intervention was a reduction of $1,114.8 in healthcare spending, which was mainly driven by lower utilization and costs associated with hospitalization. The results were robust to sensitivity analyses. Scaling the intervention could lead to even greater gains. Conclusions: At a conservative threshold of US$50,000/QALYS, these findings indicate that ViCCY can be a cost-effective and affordable way of enhancing the self-care of informal caregivers of patients with HF while simultaneously reducing caregiver healthcare costs, particularly the costs associated with caregiver hospitalization.
Abstract 4139343: The Prevalence, Treatment, and Control of Cardiovascular Risk Factors Are Similar Among Medicare Advantage and Traditional Medicare Beneficiaries: A National Analysis
Authors: Andrew Oseran, Rahul Aggarwal, Rishi Wadhera
Journal: Circulation (2024)

Background: The federal government spends billions of dollars per year on payments to Medicare Advantage (MA) plans based largely on beneficiaries’ risk scores. Despite this, little is known about the true burden of cardiovascular risk factors among MA beneficiaries, or whether they receive better management of these conditions, compared to those in traditional Medicare (TM). Goal: To determine whether the prevalence of cardiovascular risk factors, as well as treatment and control rates, differ between MA and TM beneficiaries. Methods: We performed a cross-sectional analysis of adults &gt; 65 years enrolled in MA or TM participating in the National Health and Nutrition Examination Survey (2015-2018). We compared the prevalence of hypertension, obesity, hyperlipidemia, diabetes, and chronic kidney disease between MA and TM beneficiaries, and examined treatment and control rates for hypertension, hyperlipidemia, and diabetes. All outcomes were age- and sex-adjusted. Results: The age- and sex-adjusted prevalence of hypertension (67.8% vs 67.4%, OR 0.96 [95% CI 0.72, 1.26]), obesity (40.8% vs 40.7%, OR 1.02 [95% CI 0.81, 1.29]), hyperlipidemia (75.8% vs 76.2%, OR 0.96 [95% CI 0.75, 1.22]), and chronic kidney disease (19.9% vs 22.2%, OR 0.80 [95% CI 0.55, -1.16], p=0.25) were similar between MA and TM beneficiaries, while the prevalence of diabetes was higher in MA (31.5% vs 24.2%, OR 1.48 [95% CI 1.21, 1.80]). Adjusted rates of hypertension treatment (82.3% vs 79.1%, OR 1.25 [95% CI 0.94, 1.65], p=0.14) and control (53.3% vs 58.7%, OR 0.86 [95% CI 0.62, 1.20], p=0.38), hyperlipidemia treatment (56.4% vs 56.0%, OR 1.02 [95% CI 0.79, 1.32], p=0.87) and control (82.0% vs 74.9%, OR 1.63 [95% CI 1.02, 2.61], p=0.051), as well as diabetes treatment (76.3% vs 82.5%, OR 0.73 [95% CI 0.45, 1.20], p=0.23) and control (53.3% vs 55.1%, OR 0.88 [95% CI 0.57, 1.36], p=0.56) were all similar between these groups. Conclusions: In this nationally representative study using physical examination, biometric, and laboratory data from NHANES, the prevalence of common cardiovascular risk factors was similar between MA and TM beneficiaries. There were no differences in treatment or control rates for hypertension, hyperlipidemia, and diabetes.
Abstract 4139369: Estimating PPCM Prevalence in the US Reveals Striking Differences by Race and Ethnicity, Income, and Chronic Comorbidities
Authors: Ishaan Pathak, Adam Vaughan, Elena Kuklina, Ashley Busacker, Janet Wright, Lisa Hollier, Fatima Coronado
Journal: Circulation (2024)

Introduction: Peripartum cardiomyopathy (PPCM) is cardiomyopathy of unknown etiology occurring in pregnant people shortly before or following delivery. Cardiovascular diseases are a large contributor to maternal morbidity in the US. We estimated PPCM prevalence to understand its contribution to this burden. Methods: We used National Inpatient Sample (NIS) data, a nationally representative sample of US hospital discharge records, from 2010-2020. We identified PPCM and deliveries among people aged 15-55 years using ICD and DRG codes. We excluded discharges missing age and race or ethnicity (n=512,639), and those with other cardiomyopathy codes (n=1010), leaving 7,820,420 delivery discharges. Using NIS survey weights, we calculated PPCM prevalence by age, race and ethnicity, comorbidities, and neighborhood income and adjusted prevalence ratios (aPR) using Poisson regression. Results: After weighting, our analytic set represented 38,672,513 delivery discharges and 41,182 PPCM cases. The overall PPCM prevalence was 109.4 (95% CI: 106.0-112.7) cases per 100,000 delivery discharges (Figure). Overall, PPCM prevalence remained steady from 2010-2020, but increased with advancing maternal age and decreasing neighborhood income. The prevalence in the lowest income quartile was more than double that of the highest income quartile (aPR: 2.4, 95% CI: 2.2-2.6). Compared to non-Hispanic (NH) White people, NH Black people had the highest prevalence (aPR: 3.7, 95% CI: 3.4-3.9), followed by Native American people (aPR: 1.9, 95% CI: 1.5-2.4). Hispanic and NH Asian people both had an aPR of 0.7 (95% CI: 0.6-0.8). Compared to those with no comorbidities, PPCM prevalence was significantly higher among those with certain comorbidities, notably diabetes (aPR: 5.6, 95% CI: 5.1-6.1) and chronic hypertension (aPR: 17.1, 95% CI: 16.0-18.2). Discussion: PPCM prevalence presents significant racial and ethnic, and economic disparities. The higher PPCM prevalence among those with diabetes and hypertension emphasizes the need to strengthen management of chronic conditions. Intensification of efforts to address root causes of these disparities and to enhance cardiovascular health before and during pregnancy may be needed.
Abstract 4139212: Long Term Outcomes of Patients with Hypoplastic Left Heart Syndrome and Left Ventricle-Coronary Artery Fistula
Authors: Ryan Kobayashi, Kaylah Brown, Kimberlee Gauvreau, Ele Valencia, Aditya Kaza, Nicholas Boscamp, Kathryn Stack, Tajinder Singh
Journal: Circulation (2024)

Introduction: Hypoplastic left heart syndrome (HLHS) with mitral stenosis/aortic atresia (MS/AA) is associated with worse outcomes compared to other anatomic variants. It is unclear whether this is related to left ventricle-coronary artery (LV-CA) fistula. Research Question: We sought to compare outcomes for patients with HLHS (MS/AA) with and without LV-CA fistula. Methods: Retrospective cohort study of patients with HLHS (MS/AA) who underwent stage 1 palliation at Boston Children’s Hospital 2008-2023. Presence of LV-CA fistula was defined by angiography. Results: Among 91 patients, 58 (64%) had LV-CA fistula and 33 (36%) did not. LV-CA fistula was diagnosed prior to initial palliation in 31 (53%) patients. Birth weight (BW) and gestational age (GA) were similar between groups. Mean postnatal echocardiogram ascending aorta diameter z-score was -4.29 ± 0.74 and was similar between groups. In total, 67 (75%) of patients underwent surgical stage 1 palliation and 22 (25%) underwent hybrid palliation; hybrid palliation was more common in the fistula group (36% vs 6%, p=0.007). Transplant-free survival at 1 year was 63% (95% confidence interval [CI]: 49%, 74%) and 79% (95% CI: 61%, 89%) in those with and without fistula, respectively. There was a trend towards shorter time to death or transplant in patients with LV-CA fistula than for those without (Figure 1, p=0.083). In univariate analysis, lower GA (↓1 week; HR 1.34, 95% CI 1.18, 1.51), lower BW (↓0.5 kg; HR 1.69, 95% CI 1.28, 2.23), and initial hybrid palliation (HR 3.55, 95% CI 1.82, 6.94) were associated with an increased hazard of death/transplant (all p&lt;0.001). After adjusting for either GA or BW, there was still a trend towards shorter time to death/transplant in children with LV-CA fistula which was not statistically significant (p=0.09, p=0.13, respectively). Conclusions: Mortality remains high for children with HLHS (MS/AA) and there is a trend toward worse transplant-free survival for those with LV-CA fistula.