tbuckley/cabot-search huggingface dataset:
Abstract 12965: Prolonged Travel Time to Transplantation Center is Associated With Poor Outcomes Following Heart Transplantation
Authors: Alejandro Suarez-Pierre, Jack Zakrzewski, Chiagoziem Anigbogu, John Iguidbashian, Laura L Peters, Amrut V Ambardekar, Jordan R Hoffman, T B Reece, Joseph C Cleveland, Jessica Y Rove
Journal: Circulation (2023)

Background: The influence of home-to-transplantation center travel time as a potential barrier to healthcare accessibility and its impact on clinical outcomes has not been examined following heart transplantation. Hypothesis: Prolonged travel time to the transplantation center leads to worse outcomes and access to healthcare. Aims: Study the impact of travel time as an exposure variable in the Organ Procurement and Transplantation Network database. Methods: This is an observational study of adult heart transplant recipients who received a graft between 2012-2022 in the United States. Patients who underwent multiple organ transplantation, repeat transplantation, or lacked ZIP codes were excluded. Travel time was calculated using the Google Distance Matrix API in the driving mode between the recipient’s residence and the transplantation center at 9:00 am local time. The primary outcome measured was 5-year survival. A multivariable parametric survival model was fitted to minimize confounding bias. Results: Among the 25,923 recipients that met the selection criteria, the median travel time was 65 min (interquartile range 28-111). The group breakdown was as follows: &lt;30 min=7,071 recipients, 30-60 min=7,422, 1-2 hours=5,561, &gt;2 hours=5,869, and 95% of recipients lived within a 5-hour radius of their center. White recipients experienced longer median travel times (62 min, p&lt;0.001) compared to Black (36 min) or Hispanic (40 min) recipients. A travel time of 1-2 hours (survival time ratio [STR] 0.867, 95% CI 0.768-0.978, p=0.035) or &gt;2 hours (STR 0.873, 95% CI 0.773-0.985, p=0.026) away from the transplantation center was independently associated with lower long-term survival rates compared to recipients living &lt;30 min away. Conclusion: Extended commute times to transplantation centers may negatively impact long-term survival outcomes for heart transplant recipients, suggesting a need for addressing this potential barrier to healthcare accessibility.
Abstract 12912: Effect of Real-Time Ambulatory Electrocardiography on Time-to-Intervention
Authors: Melissa Feuerborn, Michael Torre, Ann Lyons, T J Bunch, Benjamin A Steinberg
Journal: Circulation (2023)

Background: Mobile cardiac telemetry (MCT) and event monitors are ambulatory electrocardiography (AECG) monitors to aid in the detection/diagnosis of arrhythmias. They are unique in their real-time alerts to clinicians. This contrasts with Holter monitoring, which is continuous but where results are not available until after completion of the exam, uploading, and clinician over-read. There is limited data on relative benefit for time to electrophysiology procedure and interventions. Hypothesis: Does real-time monitoring of AECG reduce the time to cardiac implantable electronic device procedure, ablation procedure, or healthcare encounter when compared to AECG without real-time monitoring? Methods: This is a retrospective observational analysis of University of Utah Health patients who underwent AECG studies from 2010-2022. The study cohort was stratified by patients with an ambulatory ECG that provides real-time event notification (CEM and MCT; hereafter Non-holter) versus those that do not (Holter). The outcomes of interest were cardiac device implantation, ablation procedure, and ER/hospitalization within 12 months, analyzed based on time-to-event using log-rank tests. Results: We identified 50 patients in the Holter group and 137 for the Non-holter group. The groups had similar baseline characteristics in terms of age, gender, and co-morbidities. The mean number of days to device implant was 68.1 and 66.36, to ablation procedure was 77.68 and 67.77, and to ER/hospital visit was 61.12 and 55.38 in the Holter and Non-holter groups respectively (Figure). Conclusion: There was not a statistically significant difference between AECG monitoring in real-time (Non-holter) and those without (Holter), however, there was a trend toward decreased time to intervention in the Non-holter group for each of the three outcomes. Future, larger cohorts may provide adequate power to determine if real-time monitoring does reduce time to the studied interventions.
Abstract 12852: Process Mapping the Aortic Stenosis Patient Journey
Authors: Gary Myers, Kayli Saathoff, Aaron Leesch, Liz Olson, Jean Luciano, Roseanne Hemmitt, Tharen Leesch, Michelle Congdon
Journal: Circulation (2023)

Introduction: In November 2019 the American Heart Association (AHA) launched Target: Aortic Stenosis, an initiative to improve outcomes of aortic stenosis (AS) patients. Utilizing a learning collaborative model with 15 hospitals, the AHA sought to impact the patient journey from diagnosis by echo through definitive treatment. At three years, process mapping was undertaken to outline learnings from the sites. Goals: The goals were to determine the steps that an AS patient follows from diagnosis to definitive treatment, identify gaps in process that prevent diagnosed patients from progressing to appropriate treatment, analyze areas that impact timeliness of this process, and identify changes that can improve identification and movement to definitive treatment. Methods: Site interviews were conducted utilizing the “Five Whys” approach of determining root cause. Sites analyzed three segments of the patient journey: identification, echo report findings, and multidisciplinary valve team (MDT) meeting occurrence. An ideal process map was created identifying areas that impact the patient journey. A prioritization matrix was created outlining the impact and effort of needed changes. Results: Reporting capability in both echo registries and medical records are key to identifying patients but are not commonly available. Previously unreferred patients were identified. Lack of surveillance tools impacts the ability of hospitals to monitor AS patient care. Lack of defined next steps detailed within echo reports prevents patients from receiving appropriate, timely treatment. The MDT meeting is not often recorded in patient records. Surgical patients often do not go through the MDT process. It is difficult for hospitals to impact patients that are initially identified but that do not continue in the system for unknown reasons. Conclusions: There are elements of the patient journey that impact the identification and treatment of moderate and severe AS patients. The prioritization matrix demonstrated solutions to improve processes that range from low effort - low impact to high effort - high impact. Hospitals participating in Target: Aortic Stenosis have identified changes to improve identification of AS patients and impact the timeliness of treatment.
Abstract 12955: Shear-Dependent Changes in Blood Viscosity Negatively Affect Energetic Efficiency in Patient-Specific Models of the Fontan Circulation
Authors: Heng Wei, Kellie Cao, Niema M Pahlevan, Andrew L Cheng
Journal: Circulation (2023)

Introduction: Since blood flow through the lungs is passive in patients with the Fontan circulation, cardiac output is sensitive to power loss through the pulmonary vasculature. Prior small in vitro studies of how changes in blood viscosity at venous shear rates (“non-Newtonian behavior”) affect power loss have yielded conflicting results. The purpose of this study was to evaluate the extent to which non-Newtonian behavior contributes to power loss in a large number of pediatric patient-specific models of the Fontan circulation. Hypothesis: Shear-dependent changes in blood viscosity cause increased power loss in the low-shear Fontan circulation. Methods: Pulmonary vascular geometry was segmented from clinical cardiac MRI images. Pressure and velocity fields were then calculated using computational fluid dynamic simulations. Cardiac index was set at 2 L/min/m2 to simulate a low cardiac output state. A constant viscosity model (“Newtonian”) was compared to a shear-dependent viscosity model (“non-Newtonian”). Power loss was calculated by simplified power loss (using bulk flow and pressure changes) and viscous dissipation rate (using element-wise shear rates and viscosities). Both metrics were indexed to adjust for cardiac output and body surface area. Wilcoxon signed-rank test was used to compare differences between the two viscosity models. Results: Twenty patients (mean 10.9 years, 35% female) were included. Mean viscosity was nearly 10-fold higher in the non-Newtonian vs. Newtonian simulations (mean non-Newtonian to Newtonian viscosity ratio 9.7, SD 0.6). Accordingly, power loss by both metrics was significantly larger for the non-Newtonian simulations ( Figure ). Conclusions: Shear-dependent increases in blood viscosity cause increased power loss in computational models of the Fontan circulation under low cardiac output conditions. Further studies are needed to evaluate the degree to which this correlates with clinical outcomes.
Abstract 14044: Association Between Home Diuretic Dose and Optimal Initial Intravenous Diuretic Dosing in Acute Decompensated Heart Failure
Authors: Joshua A Jacobs, Spencer J Carter, Griffin Bullock, Jessica R Carey, Irene Z Pan, Mary Shea Kinsey, Alexander R Zheutlin, Chris J Kapelios, Shilpa Raju, James C Fang, Kevin S Shah, Adam P Bress
Journal: Circulation (2023)

Introduction: Nearly half of adults admitted with acute decompensated heart failure (ADHF) are discharged with a patient-reported or objective physical evidence of unrelieved congestion, which increases the re-hospitalization risk. This may be due to suboptimal initial intravenous (IV) loop diuretic dosing upon admission, which is often based on a patient’s home diuretic regimen. Methods: We performed a cross-sectional analysis of adults admitted to a large, quaternary healthcare system for ADHF between Jan. 1, 2014 and Dec. 21, 2021 to determine the association between oral home loop diuretic dose and receiving optimal initial IV dosing, as well as receiving optimal initial IV dosing and hospital length of stay (LOS). Patients were categorized based on home oral loop diuretic dose: low (≤40 mg furosemide equivalents [FEs]) and high (&gt;40 mg FEs). We defined optimal initial IV dosing at least twice the home oral diuretic dose. Multivariable Poisson regression models estimated prevalence ratios (PRs) and confidence intervals (CIs) for the association between home oral diuretic dose and receiving optimal initial IV diuretic dosing. Results: Among 3,269 adults (mean age 63 years, 62% male, 82% non-Hispanic White, 51.7% ejection fraction ≤40%, mean home oral diuretic dose 71.8 mg FEs) admitted for ADHF, optimal initial IV loop diuretic dosing occurred in 2,218 (67.9%) patients. Optimal initial IV diuretic dosing was more likely to occur among patients on a low (95.5%) vs. high home dose (35.9%; PR 0.46; 95% CI 0.42-0.50). Among those who were on low oral home diuretic doses, LOS was decreased in those who received optimal initial IV dosing (estimate 0.84; 95% CI 0.77-0.91; P&lt;0.001). Conclusion: Despite loop diuretics being the primary initial therapy for ADHF, there is significant heterogeneity in practice patterns. Understanding why clinicians use suboptimal doses and patients who are at risk of undertreatment may improve outcomes for patients admitted with ADHF.
Abstract 12968: Atorvastatin for the Treatment of Endocardial Fibroelastosis Formation in a Preclinical Animal Model
Authors: Gregor Gierlinger, Lavinia Rech, Sophia Koutsogiannaki, Sitaram M Emani, Pedro J Del Nido, Ingeborg Friehs
Journal: Circulation (2023)

Background: Endocardial fibroelastosis (EFE) frequently associated with development of HLHS or critical AS, restricting growth of the left ventricle (LV). The mechanism of EFE formation is the transition from endocardial endothelial cells to mesenchymal cells (EndMT). Regulation of EndMT in cardiac fibrosis is mainly through the TGF-β pathway, and upregulated Krüppel-like factor 2 (KLF2) inhibits the TGF-ß pathway by blocking SMAD2/3. Besides their plasma lipid-lowering effect, statins (e.g. Atorvastatin) directly upregulate KLF2 and are thereby atheroprotective (i.e., inhibit EndMT). The aim was to evaluate whether the upregulation of KLF2 with Atorvastatin inhibits EFE formation. Methods: Heterotopic rat heart transplantation was performed using 2-4 day-old donor hearts into adolescent recipients, which induces LV EFE growth. Atorvastatin (n=7) was administered daily at 3 mg/kg intraperitoneally for two weeks and compared to untreated/vehicle (n=5) controls. At postoperative day 14, LV EFE thickness was determined on Masson’s trichrome-stained slides. Gene expression of KLF2 was analyzed by qRT-PCR and protein expression by Westernblot and quantified via densitometry for SMAD2/3 and collagen. Results: Mean LV EFE thickness was significantly decreased in the Atorvastatin group (22.3±2.5μm) compared to 176.8±22.6μm in the untreated/vehicle-treated group (p&lt;0.0001, A ). KLF2 was significantly upregulated in Atorvastatin treated hearts (p=0.0173, B ). SMAD2/3 and collagen were significantly elevated in the control group, p=0.0014 and p=0.048, respectively ( C, D ). Conclusion: LV growth restriction through EFE formation precludes patients from biventricular repair. Until now, surgical resection has been the only available therapeutic option. With this study, we show that Atorvastatin impedes EFE formation within the LV cavity in neonatal rat hearts through the upregulation of KLF2. Atorvastatin is, therefore a promising therapeutic agent.
Abstract 12825: Comparison of Workout Heart Rates in Obese and Non-Obese Individuals Using Wearable Devices
Authors: Yong Eun, Terrence Henry, Raji Ayinla, Farbod Raiszadeh
Journal: Circulation (2023)

Introduction: The impact of exercise on the body is influenced by various factors, including obesity. Existing research on how exercise affects heart rates of obese individuals, especially in a real-world, unsupervised setting, is limited. Our study aims to address this gap by comparing heart rates recorded during workouts in both obese and non-obese individuals using Fitbit data from the All of Us database. Methods: This study analyzed data from the "All of Us" Dataset v6, which included data from 258,188 individuals. ICD codes were used to identify people with obesity. A control group was generated using propensity score matching, accounting for age, gender, race, ethnicity, cigarette exposure, drug use, and Charlson Comorbidity Score. The heart rates during Fitbit-recorded workouts were analyzed for both the obesity cohort and the control group. The maximum and minimum heart rates for each workout session were averaged per individual, and the mean of these averages was compared between the two groups. Results: A total of 63,704 obese and 63,704 matched non-obese individuals were analyzed. Demographics for the two groups were not significantly different for variables used for matching. By recruiting available Fitbit workout data and after discarding erroneous data points, 160,248 workout records from 1,092 obese individuals and 142,065 records from 967 non-obese individuals were included in the study. The mean and the standard deviation (SD) of the average minimum and maximum heart rate for the non-obese group were 99.98 (SD=12.24) and 127.53 (SD=13.06), respectively, and for the obese group were 101.05 (SD=11.61) and 128.55 (SD=12.53), respectively (Figure 1). Conclusion: The heart rates, both maximum and minimum, during workouts were found to be higher in the obese group compared to the non-obese control group. This difference was statistically significant but small, and further research is warranted regarding the less-than-expected difference in heart rates.
Abstract 12936: Quality of Life Assessments as Inclusion Criteria in Heart Failure Clinical Trials
Authors: Matthew Dimond, Mohammad S Khan, Mona Fiuzat, John G Cleland, Ankeet Bhatt, Mitchell Psotka, Stefan D Anker, Javed Butler, Michael Felker, Daniel B Mark, Peter E Carson, William T Abraham, Tariq Ahmad, Joann Lindenfeld, Muthiah Vaduganathan, David J Whellan, Orly Vardeny, Scott Solomon, Eldrin F Lewis, Gerasimos Filippatos, Christopher M OConnor
Journal: Circulation (2023)

Background: Patient-reported quality of life (QoL) assessments, such as the Kansas City Cardiomyopathy Questionnaire (KCCQ) or Minnesota Living with Heart Failure Questionnaire (MLHFQ), reflect an individual’s health status and symptom severity at a given timepoint, and may have utility as inclusion criteria in heart failure (HF) clinical trials. Method: The Heart Failure Collaboratory-Academic Research Consortium, a group of stakeholders including patients, investigators, and representatives from government and industry, convened to review data from multiple HF clinical trials discuss the use of patient reported QoL-based inclusion criteria in clinical trials of HF. Result: Patient-reported QoL assessments, such as the KCCQ, have high test-retest reliability and, in contrast with the physician-assigned New York Heart Association (NYHA) class, are not subject to clinician bias or influenced by knowledge of prognostic variables such as Left Ventricular Ejection Fraction (LVEF) or N-terminal pro B-type Natriuretic Peptide (NT-proBNP). The U.S. FDA has qualified KCCQ as an effective clinical outcomes assessment for HF, and recent clinical trials that demonstrated substantial reductions in morbidity and mortality also showed improvements in KCCQ scores, provided patients had a decrement at baseline. However, KCCQ use is limited by both complicated clinical interpretability, with total symptom score consisting of aggregate scores from different physical and symptomatic domains and uncertainty around the threshold of clinically important difference, and by its length, with average completion time of 5 to 8 minutes. Conclusion: Patient-reported functional assessments have potential as inclusion criteria in clinical trials of HF by ensuring the enrollment of patients with a diminished QoL who have the potential to improve in response to therapeutic intervention, especially in clinical trials with QoL-based endpoints.
Abstract 12748: Continuous Measurement of Percutaneous Oxygen Saturation During 6-Minute Walk Test is Useful for Predicting the Prognostic Risk in Patients With Heart Failure
Authors: Isamu Sunayama, Kyung-Duk Min, Yoshiyuki Orihara, Junichi Ohno, Yuki Matsumoto, Yuko Soyama, Eri Manabe, Makiko Oboshi, Kohei Azuma, Masataka Sugahara, Akiyo Eguchi, Yoshiro Naito, Masanori Asakura, Masaharu Ishihara
Journal: Circulation (2023)

Background: The 6-minute walk test (6MWT) is an established test to assess functional exercise performance and the 6-minute walk distance (6MWD) is strongly correlated with the functional capacity and the prognosis in patients with heart failure (HF). However, the clinical implication of sequential changes in percutaneous oxygen saturation (SpO2) during 6MWT has not been investigated in HF patients. Purpose: To prospectively clarify the association between sequential changes in SpO2 during 6MWT and prognosis in patients with HF. Methods: Fifty patients admitted with acute heart failure were enrolled. The 6MWT was performed at the time before discharge, after hemodynamic stability was confirmed. The average of SpO2 was calculated from data obtained at rest and during 6MWT by employing the wearable pulse-oximeter which is designed to record the SpO2 value every second. Alternations in SpO2 (ΔSpO2) were obtained by subtracting the average during 6MWT from that at rest. Patients were followed up to 9 months for the composite outcome of heart failure-hospitalization and death. Results: The mean age of participants was 78.8 years, and 23 (46%) were female. The mean EF was 46.1% and the number of patients with EF ≦40 was 22. The 6MWD was 250 ± 112m and the ΔSpO2 was 2.88 ± 4.3%. All cases were classified by walk distance and ΔSpO2; long- (&gt;220m) vs. short-distance group (≦220m) and low- (&lt;3.5%) vs. high-ΔSpO2 group (≧3.5%). There were no significant differences in cardiac parameters and respiratory function between long- and short-distance group as well as between low- and high-ΔSpO2 group. Kaplan-Meier analysis revealed that higher ΔSpO2 showed a more strong and statistically significant impact on cardiovascular outcome compared to longer 6MWD (HR=3.25, CI=1.40-7.51, p=0.006, HR=2.24, CI=0.94-5.32, p=0.067, respectively). Conclusions: This study showed that, compared to walk distance, ΔSpO2 during 6MWT was more predictive of the prognosis of heart failure patients.
Abstract 12940: The Power of Engagement: How Stakeholder Engagement Influenced the Design and Conduct of a Clinical Trial With Home Health Aides and Their Heart Failure Patients
Authors: Cisco G Espinosa, Sasha Vergez, Margaret McDonald, Monika M Safford, Faith Wiggins, Ann Lee, Jonathan N Tobin, Penny Feldman, Samprit Banerjee, Nicola Dell, Madeline R Sterling
Journal: Circulation (2023)

Background: Although home health aides and attendants (HHAs) frequently provide care to community-dwelling adults with heart failure (HF), they have rarely been the focus of interventions aimed at improving patient outcomes. Engaging HHAs and other key home health care stakeholders in the research process is essential to designing user-friendly interventions and feasible clinical trials that can leverage their role in delivering care, as well as identifying effective implementation strategies that improve service delivery and patient outcomes. Aim: Herein, we aimed to demonstrate how stakeholder engagement influenced all aspects of HF clinical trial design with this marginalized workforce. Methods: This study involved an academic community partnership between Weill Cornell Medicine and two non-profit organizations, VNS Health, a large, non-profit organization that provides home care, population and care management, community health services, and hospice care in New York, NY; and the 1199SEIU Training and Employment Fund, the largest union of healthcare workers in the US that provides training to HHAs. A stakeholder-engaged research approach was used to a) develop a novel intervention that trains HHAs on HF and integrates them into the care team through an mHealth application, and b) design a pilot randomized clinical trial (RCT) testing this intervention among HHAs caring for adults with HF who receive home care from VNS Health. Results: Over the course of four years, stakeholders in home health were engaged in every aspect of the research process, from the motivation and rationale for the study, to intervention development and refinement, selection of outcomes, and planning and conduct of an ongoing pilot study for a future pragmatic RCT [Table 1]. Conclusion: This study offers an example and methods for how stakeholders can be engaged in the design, conduct and dissemination of a trial aimed at improving HF care.