tbuckley/cabot-search huggingface dataset:
Abstract 4138322: Do branched stent grafts for dissecting aortic aneurysms really improve long-term outcomes?
Authors: Masahide Kawatou, Takehiko Matsuo, Erika Yamamoto, Junichi Tazaki, Takahide Takeda, Fumie Takai, Hiroaki Osada, Kazuhiro Takatoku, Hiromasa Kira, Yasuyuki Fujimoto, Haruka Fujimoto, Ryo Nakanishi, Kazuyoshi Kanno, Tadashi Ikeda, Koh Ono, Kenji Minatoya
Journal: Circulation (2024)

Backgrounds: We have previously used a handmade branched stent graft (SG) to treat thoracic aortic aneurysms. In this study, we examined the long-term results of treatment for dissecting thoracic aortic aneurysms. Methods: Between 2004 and 2014, we treated 28 patients with dissecting thoracic aneurysms using the branched SGs. Results: The mean age was 65 ± 14 years; 17 were over 70, and 22 were male. The mean time from the onset of dissection was 5.7 ± 6.3 years; 6 were operated within one year. The mean aneurysm diameter was 59 ± 8 mm. All dissecting aneurysms were located after zone 3. SG branches were one in 24 cases, two in 2, and three in 2. Twenty-two were treated for entry closure and distal landing in the true lumen. Six with limited dissecting aneurysms were treated for entry closure and distal landing in a non-dissected lumen. The cause of perioperative death was pneumonia in 1. The mean follow-up was 8.3 ± 5.3 years. Entry closure was achieved at 86%, branch patency was 94%, and aneurysm diameter was reduced by an average of 5 ± 14%. There were 6 aneurysm-related deaths. Two were aneurysm ruptures, and each of the 4 was additional operative death, sudden death, SMA occlusion, and type A dissection. The aneurysm-related mortality was 26% at eight years; there was no difference between under 70 and over 70 years old. The cumulative risk of additional procedures was 57% at eight years, and the risk was higher in those over 70 than those under 70 (p&lt;0.05). Thirteen required additional procedures, and 5 required multiple. In detail, re-TEVAR to distal SINE was in 7, re-TEVAR for aneurysm enlargement due to residual false lumen was in 1, re-TEVAR for type 1a endoleak (EL) was in 4, open repair was in 3, stenting for stenosis of true lumen in iliac artery was in 1, stenting for SG branches were in 2, and embolization of the left subclavian artery after re-TEVAR was in 1. Details of open repair were partial arch and thoracic descending replacement for type 1a EL in 1, ascending and partial arch replacement for type 1a EL followed by partial arch and thoracoabdominal replacement in 1, partial arch and thoracoabdominal replacement for distal SINE and aneurysm enlargement in 1. Conclusion: The branched SG for dissecting thoracic aneurysms successfully achieved the initial goal of entry closure, which concept is promising, but requires careful observation for appropriate additional procedures.
Abstract 4138292: Smoking cessation is linked to regression of electrocardiographic left ventricular hypertrophy
Authors: Yuichi Ninomiya, Shin Kawasoe, Takuro Kubozono, Eiko Sai, Norihito Nuruki, Kei Enokizono, Hiroyuki Kamada, Issei Yoshimoto, Yasuhisa Iriki, Hironori Miyahara, Koichi Tokushige, Mitsuru Ohishi
Journal: Circulation (2024)

Introduction/Background: Electrocardiographic left ventricular hypertrophy is a strong predictor of cardiovascular morbidity and mortality. Further, smoking cessation provides a range of health benefits; however, its association with left ventricular hypertrophy is unclear. Research Questions/Hypothesis: What impact does smoking cessation have on left ventricular hypertrophy regression? Goals/Aims: We investigated the association between smoking cessation and regression of left ventricular hypertrophy. Methods/Approach: We compared electrocardiographic left ventricular hypertrophy between baseline and 6 years after smoking cessation follow-up visits in 752 non-hypertensive subjects (695 males, 47.8±9.2 years), from available datasets of 234 596 health check-ups. Left ventricular hypertrophy on ECG was assessed using the Sokolow-Lyon voltage criteria: SV1+RV5 (mV), with left ventricular hypertrophy defined as &gt;3.5 mV. Results/Data: After 6 years of smoking cessation, body weight was found to increase (from 65.7±10.5 to 68.1±10.8 kg, p &lt;0.0001) and systolic blood pressure also increased (from 112.9±12.7 to 122.0±14.2 mmHg, p &lt;0.0001). Nevertheless, left ventricular hypertrophy on ECG regressed significantly (from 2.47 to 2.41 mV, p &lt;0.0001), and the proportion fulfilling the criteria for left ventricular hypertrophy also decreased from 8.4 to 6.5%. In addition, the antihypertensive drug prescription rate due to elevated blood pressure after 6 years was 13.7% (103/752). Therefore, the regression of left ventricular hypertrophy with or without antihypertensive drug use was assessed. The results showed that left ventricular hypertrophy regressed significantly both [2.68→2.45 mV ( p &lt;0.0001)] and [2.44→2.40 mV ( p =0.01)] in the groups administered (n=103) and not administered (n=649) antihypertensive drugs, respectively. Conclusions: Smoking cessation was found to be associated with regression of electrocardiographic left ventricular hypertrophy, despite being potentially associated with future weight gain, increased blood pressure, and with or without antihypertensive drugs. The results indicated that the health benefits of left ventricular hypertrophy regression from smoking cessation may outweigh the negative effects of weight gain and increased blood pressure from smoking cessation.
Abstract 4138253: Reintervention Burden of Single and Biventricular Palliation of Pulmonary Atresia with Intact Ventricular Septum
Authors: Lindsay Nitsche, Paul Devlin, Amrita Sukhavasi, Sara McHugh-Grant, Colleen Bontrager, Nancy Burnham, J Gaynor, Andrew Glatz, Stephanie Fuller
Journal: Circulation (2024)

Introduction: Pulmonary atresia with intact ventricular septum (PAIVS) patients may proceed down a single (SV) or biventricular (BV) pathway. We evaluated the total interventional burden of both pathways including after either end-state was reached. Hypothesis: SV patients will have more interventions in comparison to BV patients. Goals: Assess the nature of interventions in PAIVS. Methods: Retrospective review of PAIVS patients from 1995-2020 who achieved SV (Fontan completion) or BV (normal saturations with no significant shunts) end-state. Demographic, procedural, and follow-up details were collected. Descriptive statistics were used and Kaplan-Meier analysis of freedom from reintervention was performed. Results: Of 79 patients who reached end-state, 40 (51%) were SV and 39 (49%) were BV. Total median in-hospital time was 48 [31-78] days and 18 [12-35] days for SV and BV (p&lt;0.01). The ratio of in-hospital days to total follow-up was a median of 1.7% [0.9-2.7] for SV and 0.4% [0.3-0.8] for BV (p&lt;0.01). SV and BV cohorts had an overall median of 4 [3-5] and 3 [2-4] interventions, respectively (p&lt;0.01). Interventions and their relationship to end-state are shown in Table 1 . The SV and BV groups achieved end-state at a median of 2.9 [2.3-3.6] and 2.1 [0.2-8.8] years (p=0.01) ( Figure 1A ). Median follow up in years after achieving end-state was similar between groups {7 [2.7-15.8] in SV and 7.4 [4.2-13.4] for BV (p=0.11)}. After end-state, there was no difference in the proportion of patients requiring reinterventions (17 (43%) SV and 12 (31%) BV, p&gt;0.05). Freedom from reintervention at 15-years was 44.1% in the SV group and 64.3% in the BV group (p=0.11) ( Figure 1B) with one late SV death. Conclusions: PAIVS therapy requires multiple interventions to achieve both SV and BV repair. While SV patients undergo more interventions and spend more days in the hospital, reinterventions and 15-year freedom from reintervention were comparable between groups with equivalent follow up.
Abstract 4138218: Meeting Physical Activity Recommendations Among Wearable Device Users: Insights from the 2022 Health Information National Trends Survey
Authors: Minjung Lee, Soohyun Nam
Journal: Circulation (2024)

Background: The benefits of physical activity for health and well-being are well documented. Promoting physical activity is crucial for enhancing population health. Wearable devices play a significant role in tracking health-related activities and have been shown to enhance engagement in physical activities. While studies have identified sociodemographic patterns in wearable device usage, little is known about their impact on real-world outcomes, such as increased physical activity. Research Question: Is there a variation in achieving the recommended level of physical activity among wearable device users? Aim: To examine factors associated with achieving the recommended weekly minimum of 150 minutes of moderate-intensity physical activity among wearable device users. Methods: Data from the 2022 Health Information National Trends Survey (HINTS 6) of wearable device users (n = 1,718) were analyzed. We reported adjusted odds ratios from multivariable logistic regression of meeting recommended levels of physical activity. Results: Among the 1,718 participants who utilized wearable devices, 64.3% were female with a mean (M) age of 48.2 ± 0.36 years. The majority were White (58.1%), followed by Asian (18.4%). Among the wearable users, 54.8% met the recommended weekly minimum of 150 minutes of moderate-intensity physical activity. The age group of 65 to 74 years (OR, 1.96; 95% CI, 1.04, 3.69; p=0.04) was more likely to achieve 150 minutes of physical activity per week. However, Asian wearable users were less likely to achieve physical activity goals compared to other racial and ethnic wearable users (OR, 0.55; 95% CI, 0.31, 0.96; p=0.04). Additionally, individuals with a body mass index ≥30 kg/m 2 (OR, 0.54; 95% CI, 0.36, 0.79; P&lt;0.01) and those with high blood pressure (OR, 0.62; 95% CI, 0.41, 0.94; p=0.03) were less likely to meet physical activity recommendations. Conclusions: This study highlights variations in physical activity outcomes among wearable device users and underscores the importance of enhancing the public's ability to use these devices to increase physical activity. Future efforts should include exploring facilitators of effective wearable use, in various sociodemographic groups, especially for those at risk of obesity or hypertension.
Abstract 4138294: Medicare Utilization and Associated Spending on Icosapent Ethyl
Authors: Shreyash Parajuli, Vidit Majmundar, Priya Pandey, Arvind kumar Venkataramana Raju, Zeynep Yukselen, Michelle Hadley
Journal: Circulation (2024)

Introduction: In 2019, Icosapent Ethyl became the first US Food and Drug Administration (FDA) approved medication for reducing cardiovascular risk beyond cholesterol-lowering therapy in high-risk patients. It was approved specifically as an adjunct to maximal tolerated statin therapy to reduce cardiovascular risk in adult patients with elevated triglyceride (TG) levels. The National Lipid Association now has a Class I recommendation for the use of icosapent ethyl (4 g/d) to reduce cardiovascular risk in patients with TG &gt; 150 mg/dl. Methods: We analyzed available data from Medicare Part D prescription drug events published from the year 2018 to 2022. All data were de-identified and made publicly available. All costs were adjusted for inflation and represented in 2022 US dollars. Results: The number of Medicare Part D beneficiaries prescribed Icosapent Ethyl increased from 141,336 to 303,971 (215%) between 2018 and 2022 (Fig. A) and the number of claims increased from 704,334 to 1,527,133 (216%) (Fig. B). The total spending increased from $278 million to $787 million (282%) within the same timeframe (Fig. C). The average spending per claim has increased from $396 to $515 (130%) (Fig. D) and the average spending per beneficiary has also increased from $1976 to $2591 (131%) (Fig. E) between 2018 and 2022. Discussion: We observed a marked increase in the use of icosapent ethyl from 2018 to 2022. We can see a sharp rise of 187% in beneficiaries from 2018 to 2019 following FDA approval. The total number of claims and total spending also increased by 181% and 200%, respectively, from 2018 to 2019. The average spending per claim and average spending per beneficiary has increased from 2018 to 2022. It also demonstrates the cost burden to Medicare with the use of such lipid-lowering agents. Many Medicare plans include icosapent ethyl as a Tier 4 drug, which is the second most expensive drug tier. Limitations: The pattern of data used may not be generalizable to other payer demographics. Policy changes can affect the comparability of data over different periods. Conclusion: Our data highlights the increasing use of icosapent ethyl as a cardiovascular risk-reduction medication in the Medicare population. There has been a steady increase in the number of claims and beneficiaries since the approval of icosapent ethyl with an increase in average spending from 2018 to 2022.
Abstract 4138333: Childhood Oral Health Associates with the Incidence of Ischemic Heart Disease, Myocardial Infarction and Ischemic Stroke in Adulthood
Authors: Nikoline Nygaard, Anne Eriksen, Lars Ängquist, Daniel Belstrom, Evelina Stankevic, Hansen Torben, Anja Olsen, Francesco DAiuto, Merete Markvart
Journal: Circulation (2024)

Introduction: Cardiovascular disease remains a considerable source of years of life lost. Thus, identification of possible risk factors and prevention strategies continues to be important. In adults, oral diseases are associated with the risk of cardiovascular disease, including ischemic heart disease (IHD), myocardial infarction (MI) and ischemic stroke (IS). Few studies have examined the effect of oral health in childhood on the risk of cardiovascular disease in adulthood, thus overlooking a potentially important avenue of early detection of high-risk individuals. Hypothesis: We hypothesize that poor childhood oral health is associated with IHD, MI, and IS in adulthood. Methods: Using nationwide Danish registry data from the National Child Odontology Register, National Patient Register, and the Central Person Register we followed individuals born between 1963 and 1972. Follow-up started in 1995 or by age 30 (whichever occurred last), and ended in 2018, where study participants were aged 46 to 56. Using Cox-proportional hazards modelling we examined the association of childhood oral health, defined as the highest registered level of dental caries and gingivitis for any one individual, with the occurrence of IHD, MI, and IS in adulthood. The highest achieved level of education between ages 25 and 30 was used as Cox-strata. Results: The study consisted of n = 569.057 individuals, 51.2% male, 48.8% female. The incidence of IHD was 26% (1.17; 1.86) higher in females with high levels of caries in childhood compared to those with low-level caries, 19% (1.08; 1.40) higher in males. Severe caries in childhood was associated with a 58% (1.19; 2.09) higher incidence of MI in females, 19% (1.01;1.42) higher in males, and a 45% (1.19; 1.78) higher incidence of IS, 52% (1.27; 1.81) in males. Females had a 52% (1.19; 1.94) higher incidence of MI, and males a 32% (1.15; 1.52) higher incidence of IS, if they had high levels of gingivitis as children (table 1). Conclusion: Poor oral health in childhood is associated with an increased incidence of IHD, MI, and IS, pointing to a potential new avenue for early identification of and prevention amongst high-risk individuals.
Abstract 4138350: Candidemia in Patients with Left Ventricular Assist Device-A Case Series
Authors: Adedoyin Johnson, Jacob Sama, Abdalla Eltayeb A.A, Roopa Rao, Laurie Schenkelberg, Onyedika Ilonze
Journal: Circulation (2024)

Introduction: Candidemia is rare but associated, have significant morbidity and mortality. Outcomes are not well-characterized in patients with left ventricular assist devices (LVADs). With an increasing number of patients living with LVADs, we sought to characterize risk factors to help optimize outcomes for this high-risk population. Methods: We retrospectively reviewed records of 97 patients who underwent LVAD implant between January 2012 to May 2024 at Indiana University Health, Indianapolis Indiana. Demographic and clinical data were extracted. Candidemia was defined as a positive blood culture with candida species. Result: We identified three patients with candidemia, with an overall attack rate of 3.09%. All patients had a HeartMate III (HM3) at the time of infection. The mean age of patients was 40.3 years (Range 29.0 – 58.0 years) and mean BMI was 35.7 kg/m 2 (Range, 30.0 – 42.0 kg/m 2 ). One patient grew Candida auris and Candida tropicana, the other patient grew Candida auris and the third patient grew Candida globrata. All patients had an automatic implantable cardiac defibrillation, a peripherally inserted central catheter line, and right heart failure. Two patients had driveline infections (one fungal, one bacterial) while one patient developed LVAD endocarditis with a right ventricular outflow tract vegetation. Two patients had persistently positive blood cultures despite treatment with a multi-drug anti-fungal regimen (Flucytosine, Amphotericin B and micafungin) and expired. The third patient initially cleared her blood cultures after treatment with IV micafungin only but was re-admitted with muti-organ failure and expired. Summarily, all patients with candidemia died with a mortality rate of 100%. None of the patients were candidates for heart transplantation. Average survival from the time of diagnosis of candidemia was 5 months (Range 1.0 – 11.0 months). RHF, chronic DL infection and high BMI were associated with candidemia in our series. Conclusion: Candidemia in LVAD patients, while less common than bacterial infections, carry high mortality without cardiac transplantation (100% mortality in our cohort). Its rare occurrence makes it challenging to identify reversible risk factors, leading to poor survival. Multicenter registries are needed to fully elucidate these risk factors and determine effective treatment strategies.
Abstract 4138273: Acceptability and Gain of Knowledge of Community Educational Tools About Rheumatic Heart Disease Integrated With Screening In Low-Income Settings
Authors: Jessica Abrams, Craig Sable, Alison Spaziani, Liesl Zuhlke, Clareci Cardoso, Wanessa Vinhal, Isabely Ribeiro, Kaciane Oliveira, Ingred Beatriz Amaral, Maria Nunes, Marina Diniz, Lucas Fraga, Luiza Paula, Cecilia Coelho, LUZ MARINA TACURI CHAVEZ, Larissa Lemos, Julliane Correia, Antonio Ribeiro, Bruno Nascimento
Journal: Circulation (2024)

Background: Rheumatic heart disease (RHD) causes 305,000 premature annual deaths, and education is one of the strategies to diminish disease burden. International RHD foundations aim do provide preventive and control efforts for RHD. We aimed to assess the acceptability and gain of knowledge of a series of education flipcharts presented during screening programs in high-burden areas of Brazil. Methods: Four flipcharts (“Introduction to rheumatic fever (RF) and RHD”, “RHD and pregnancy”, “RHD and surgery” and “RHD community awareness”) were developed over 3 years and taught during 36 months to patients, community, health and education professionals in Minas Gerais state. Training included in-person interactions and virtual workshops. Pre and post-training questionnaires were applied through an online and printed surveys in 2021 and 2022, and post-education evaluations were conducted from January 2023 to April, 2024. Results: Flipchart training was successfully delivered to 112 education professionals, 574 health providers and 598 community members (N=1284): 899 (70%) were enrolled in primary care, and 1109 (86%) responded the surveys. Among respondents of the survey for health and education professionals (N=589), 240 (41%) had been educated about RHD in the previous year. 569 (96%) learned any new information; the content was all new for 21 (4%). Nearly all professionals reported that flipcharts could improve patients’ lives (571, 97%) and felt confident to use the tool with someone with no knowledge about RHD (533, 91%); 86% of the teachers said they would use flipcharts as educational tools. In the survey for community / schoolchildren (N=520) only 128 (25%) respondents had previous education on RHD, 510 (98%) reported that learned new information, and content was completely new for 242 (47%). A total of 430 (83%) individuals reported that they will discuss RHD with families and community. All qualitative written reports were positive. In 2021/2022, 218/485 (45%) health and education professionals responded the pre/post questionnaire. Knowledge about RHD increased after training: RF as the cause of RHD (56% vs 86%), use of Benzathine Penicillin G (50% vs 97%), frequency of antibiotic prophylaxis (32% vs 90%) and overall moderate or expert understanding of RF or RHD (30% vs 82%). Conclusion: Flipchart educational sessions about RHD had a very positive acceptability in high-risk Brazilian populations, with remarkable gain of knowledge for health professionals.
Abstract 4138246: Differences in Major Adverse Cardiovascular and Lower Limb Events and Guideline-Directed Medical Therapy Among Males and Females Within an Integrated Healthcare System
Authors: Viet Le, Stacey Knight, Tami Bair, Daniel Bride, Heidi May, Kay Sadik, Kimberly Brunisholz, SPENCER GALT, Kirk Knowlton, Jeffrey Anderson
Journal: Circulation (2024)

Background: Health disparities based on gender have been recognized as having a detrimental impact on care delivery and early identification of disease processes. Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic disease mortality. It is unclear what role, if any, gender plays in the diagnosis, treatment, and outcomes of PAD. Hypotheses: Females are less likely to have guideline-directed medical therapy (GDMT) and more likely to have major adverse cardiovascular events (MACE) and major adverse lower limb events (MALE) than males. Methods: The Intermountain Health electronic database was queried for patients meeting the following criteria: ≥18-years of age, PAD diagnosis between Jan 2006 to Dec 2021, seen at least once within the 18-months following initial PAD diagnosis, and had a symptom of PAD (see table). Follow-up GDMT, based on the 2016 AHA/ACC PAD guidelines, was determined by medication and procedures. Time to outcomes of MACE (all-cause death, MI, stroke, or unstable angina hospitalization) and MALE (limb ischemia, limb revascularization, or limb amputation) were examined using Cox-proportional hazard adjusted for GDMT, age, and prior CAD. Results: A total of 7522 patients had a symptomatic PAD diagnosis, with 38% female and 62% male. Females tended to be older (70.1±13.0 vs 68.6±11.7), more likely to be obese (25% v 21%), and less likely to have Afib (21% v. 24%), CAD (30% v 41%), MI (11% v 16%), renal failure (19% v 22%) but more likely to have a bleeding history (30% v 26%) (all p&lt;0.01). Females were slightly less likely to have all the GDMT and yet had similar rates of referrals to specialists but higher rates to primary care providers (Table). After adjustment, females were less likely to have MACE (HR=0.94; 95% CI: 0.88, 0.99) and MALE (HR=0.85; 95% CI: 0.80, 0.92). Conclusion: Females had lower rates of MALE, driven by lower limb revascularization or amputation rates, and slightly lower rates, after adjustment, for MACE. This was observed despite the high rates of GDMT for both females and males (~80% in any category), with females having slightly less GDMT.