tbuckley/cabot-search huggingface dataset:
Abstract 4147016: Trends in Hypertension-related End-Stage Renal Disease (ESRD) across the United States from 1999-2022: An Analysis of Age, Gender, and Ethnic Disparities
Authors: Muhammad Ayyan, Saim Amir, Afra Zahid, Aiman Naveed, Mohammad Umer, Muhammad Uzair Siddique, Wajeeh Rehman, Sourbha Dani
Journal: Circulation (2024)

Introduction: One of the main causes of renal disease, in which the kidneys are unable to function properly, is hypertension. Over time, uncontrolled hypertension can harm the fragile blood vessels in the kidneys, resulting in chronic kidney disease (CKD) and eventually end-stage renal disease (ESRD). In this study, we examined the trends of hypertension-related ESRD mortality in the United States from 1999 to 2022 and determined the disparities between various epidemiological groups. Methods: Our study conducted an in-depth search of the Centers for Disease Control and Prevention’s Wide- Ranging Online Data for Epidemiological Research (CDC Wonder) database and retrieved data on hypertension-related end-stage renal disease mortality from 1999 to 2022. Age-adjusted mortality rates (AAMR) per 100,000 individuals and associated annual percent changes (APC) for the overall study population were calculated using Joinpoint Regression Analysis. The data was further stratified into epidemiological groups of age, gender, ethnicity, and census region. Results: A total of 938,095 deaths occurred from hypertension-related end-stage renal disease. It was observed that the overall AAMR for hypertension-related ESRD increased from 1999-2022 with a fixed APC of 9.08. The populations with the highest mortality rates were males, African Americans, non-Hispanics, and the age group of over 85 years. Region-wise analysis gave variable trends in the AAMR (Overall APC: Northeast: 8.42, Midwest: 10.29, West: 9.04, and South: 12.80 from 2011-2022). Conclusion: In the US, the mortality rates from hypertension-related ESRD have shown a constant incline. The need for additional research and action is highlighted by persistent differences in mortality that are related to geography and demographics.
Abstract 4147579: Nationwide trends in Major Adverse Cardiac and Cardiovascular Events and ALL-cause Mortality in Cardiovascular-Kidney-Metabolic Syndrome Among Geriatric Patients.
Authors: Kesar Prajapati, Kesha Doshi, Preet Doshi, Diksha Sanjana Pasnoor, Brian Brereton, Sambasiva Rao Mettela, CHAITANYA KALAPALA, Naga Pratyusha Cheruvu, Rupak Desai
Journal: Circulation (2024)

Background: The American Heart Association (AHA) has acknowledged the interconnection of obesity, type 2 diabetes mellitus (DM), cardiovascular disease (CVD), and chronic kidney disease (CKD) as a complex health disorder named Cardiovascular-Kidney-Metabolic (CKM) syndrome. Patients with CKM progress to major adverse cardiac and cerebrovascular Events (MACCE). The aim of the study is to analyse nationwide trends in MACE and all causes. mortality among patients aged 65 years and older with CKM syndrome. Methods: Using a National Inpatient Sample (2016–2020) geriatric admissions among patients admitted with CKD and at least One cardiometabolic risk factor (HTN, DM, HLD, and obesity) were selected using ICD-10. codes. Patients were classified into MACCE+ve cohorts if they had acute myocardial infarction, cardiac arrest or acute ischaemic stroke present otherwise into MACCE-ve. Trends, Demographics, comorbidities, and all-cause mortality were analysed between the two cohorts. Results: In our NIS study, the MACCE+ve and -ve cohorts had median ages of 78 (72–85) and 78 (72–85). years with 55.9% and 51.1% males and 44.1%. and 48.9% females, respectively. over a period of 5 years (2016–2020) in patients with CKM syndrome hospitalisation has increased with MACCE (from 10.4% to 12.7%) with an increase in hospital mortality (4.6% to 6%) (ptrend&lt;0.001). In our analysis, patients with CKM admitted to MACCE had statistically significant all-cause mortality (15.3% vs. 3.4%), total length of stay (5 vs. 4), and hospital cost ($66,824 vs. $43,727) compared to MACCE-ve cohorts (p-value &lt; 0.001). Conclusion: Our analysis suggests alarmingly rising trends in MACCE in CKM syndrome, which significantly impacts in-hospital outcomes. We need to conduct more studies to enhance our comprehension of managing CKM syndrome.
Abstract 4147236: Healing Hearts Mending Minds: Battling Anxiety and Depression in adults with congenital heart disease.
Authors: Adam Alberts, Devyani Chowdhury
Journal: Circulation (2024)

Background/Introduction: Adults with congenital heart disease have higher rates of anxiety, depression, and suicide, compared to those without congenital heart disease. A variety of factors contribute to psychological distress among adults with CHD, including functional impairment, neurocognitive deficits, the increasing concerns for reinterventions, body image due to surgical scars or body insecurity. However, screening and targeted treatment is still lacking. Methods/Approach: 96 unique patients were seen in ACHD clinic. Each was screened for anxiety and depression using the PHQ-4. Based on the results and clinical findings, 1 of 4 clinical pathways were pursued: 1 negative screening; no consult with a psychologist was recommended; 2 positive PHQ-4 with telehealth follow-up with an in-practice psychologist; 3 PHQ-4 positive with an in-practice psychologist consult during their outpatient visit; 4 already established relationship with a psychologist. Results/Data: Of the unique 96 patients seen in ACHD clinic 6 were excluded for severe developmental delays. Of the remaining 90 patients, 7% (n = 6) had an established relationship with a psychologist. The 84 that did not have an established relationship with a psychologist were screened for anxiety and depression. 49%, ( n = 44) were either seen in clinic by the psychologists and 22%, (n=20) followed up with an outpatient visit. The remaining 22% (n = 20) were screened and had a negative phq-4 with no clinically significant signs of anxiety or depression at that visit. Conclusions: Adults living with CHD have and will continue to encounter unique challenges that extend beyond the physical realm, often grappling with psychological distress that affects their overall well-being and quality of life. While depression has been a focal point in general cardiac research, elevated anxiety levels are equally significant and warrant attention. Within this study, anxiety and depression requiring mental health follow-up was underdiagnosed and undertreated in 76% of the population. Underpinning the need for routine screening for psychological and QOL impairments, as well as ntegration of mental health professionals within ACHD programs.
Abstract 4147459: Impact of Arrhythmias on Vascular Outcomes in Loeys-Dietz Syndrome
Authors: Austin Saugstad, George Bcharah, Srekar Ravi, Christine Firth, Yuxiang Wang, Mayowa Osundiji, Chadi Ayoub, Fadi Shamoun
Journal: Circulation (2024)

Introduction/Background: Loeys-Dietz syndrome (LDS) is a rare autosomal dominant aortic aneurysm syndrome characterized by arterial tortuosity resulting in arterial aneurysms and dissections, with unique craniofacial and skeletal features including bifid uvula, cleft palate and hypertelorism. While the presence of atrial fibrillation (Afib) and arrhythmias have been reported in LDS patients, limited investigation has been completed regarding the associated risk and severity of vascular complications in relationship to these arrhythmias1,2. Research Questions/Hypothesis: Are there any differences in vascular outcomes in patients with LDS when experiencing various forms of tachyarrhythmia? Goals/Aims: To evaluate the relationship between various types of arrhythmias and vascular outcomes in patients with LDS, including arterial dissection, stroke, revascularization, and death. Methods/Approach: A large sample of LDS patients (n=436) from a single tertiary referral center was assessed for ICD-10 diagnoses of arrhythmia and outcomes of interest. Arrhythmias assessed included Afib, atrial flutter (AFL), premature ventricular contractions (PVCs), and supraventricular tachycardia (SVT). Outcomes were arterial dissection, hemorrhagic and ischemic stroke, revascularization, and all-cause mortality. Results/Data: Our cohort (n=436) had an average age of 47 and was 57.8% female. A total of 26 patients had a documented history of tachyarrhythmia: 16 (3.4%) Afib, 2 (0.5%) AFL, 6 (1.4%) SVT, and 2 (0.5%) PVC. LDS patients with Afib were at significantly higher risk of arterial dissection (25% vs 6.0%, OR: 5.3, p&lt;0.01), revascularization (18.8% vs 3.3%, OR: 8.1, p&lt;0.01), stroke (25% vs 3.6%, OR: 9.0, p&lt;0.001), and death (25% vs 4.3%, OR: 7.4, p&lt;0.01) compared to those without a documented history of arrhythmia. Other arrhythmia types evaluated were not significant. Predictors of any arrhythmia type included hypertension (78% vs 31%, OR: 1.5, p&lt;0.001) and heart failure (39% vs 5.0%, OR: 2.3, p&lt;0.001). Conclusion: Although rare, Afib in LDS patients is associated with adverse vascular outcomes and mortality compared to those without a history of arrhythmia. Furthermore, the magnitude of increased risk is striking. Early identification and management of Afib in LDS patients may be critical in mitigating the risk of potential vascular complications.
Abstract 4147064: Retrospective study shows pharmacogenomic testing could reduce adverse events associated with clopidogrel use by 38%
Authors: Nicole Washington, Natalie Telis, Daniel Judge, Pamala Pawloski, Joseph Grzymski, Anwar Chahal, Catherine Hajek, Teresa Kruisselbrink, Elizabeth Cirulli
Journal: Circulation (2024)

Introduction: In recent years, genetic interactions with drugs have been demonstrated to alter drug metabolism. Efforts such as PharmGKB and the Clinical Pharmacogenomics Implementation Consortium (CPIC) have developed recommendations to alter the use of several commonly prescribed drugs based on patient genotype. However, most prescriptions are still given without pharmacogenomic testing. Objective: Demonstrate the real world implications of the use of pharmacogenomic testing through a retrospective study of clopidogrel prescriptions given without testing. Methods: We analyzed ~100K individuals with paired medical records and clinical grade exome sequencing data, from population health studies administered at multiple medical centers. We genotyped all individuals for CYP2C19 star alleles. We identified daily dosage of clopidogrel by processing the freetext prescription “sig” field with GPT-4. Then, we identified all instances of individuals with at least one prescription that is not in concordance with the CPIC clopidogrel use guidelines based on their CYP2C19 genotype (Bousman et al. 2023). We identified instances of thrombosis using a comprehensive codeset based on the medical records. Results: 25% of individuals with a calculable daily dose of clopidogrel have a mismatch between the recommended clopidogrel dosage guideline based on their CYP2C19 genotype and their prescribed dose. 12% of these mismatched individuals are poor metabolizers (PM), who should not use clopidogrel at all. The remaining 88% are intermediate metabolizers (IM). PMs and IMs receiving clopidogrel are much more likely to experience thrombosis than other metabolizers. 25% of PMs experienced thrombosis after the initiation of clopidogrel, with 40% of these occurring in the first two months (vs normal metabolizers, binomial p-value = 0.001). Conclusions: As expected from a lack of testing and a high population frequency of pharmacogenomic variants, many patients are prescribed doses of clopidogrel that are too high given their subsequently derived pharmacogenomic information. There is at least a 38% excess of adverse events (as measured by thrombosis) in this group. At minimum, this testing could prevent 1 thrombosis event per every ~30 people prescribed clopidogrel, demonstrating tangible benefits of population-based pharmacogenomic testing.
Abstract 4147011: Ticagrelor Monotherapy Following Short Dual Antiplatelet Therapy versus 12-Month Dual Antiplatelet Therapy after Percutaneous Coronary Intervention for STEMI: A Meta-Analysis of Randomized Controlled Trials
Authors: Meghna Joseph, Mrinal Murali Krishna, Chidubem Ezenna, Andrew Goldsweig
Journal: Circulation (2024)

Introduction: Guidelines recommend dual antiplatelet therapy (DAPT) for 12 months following percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). However, prolonged DAPT may increase bleeding risk. Monotherapy with the potent P2Y12 inhibitor ticagrelor after short DAPT offers a promising strategy to balance thrombotic and bleeding risks. Objective: To compare outcomes of short DAPT (≤3 months) followed by ticagrelor monotherapy until 12 months vs. 12-month DAPT in patients undergoing PCI for ACS. Methods: We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing short DAPT followed by ticagrelor monotherapy vs. 12-month DAPT following PCI. Outcomes of interest included net adverse clinical events (NACE), major adverse cardiovascular/cerebrovascular events (MACCE), and any bleeding at 12 months post-PCI. Statistical analysis was done using R software. Random effects models were used to generate risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I 2 statistics. Analysis followed the PRISMA guideline. Results: The systematic review identified 4 randomized controlled trials including 5,293 patients. Ticagrelor monotherapy was used in 2,667 (50.38%) patients. At 12 months, NACE (RR 0.81; 95%CI 0.57-1.14; p=0.227; I 2 =45%), MACCE (RR 1.11; 95%CI 0.86-1.42; p=0.415; I 2 =3%), and any bleeding (RR 0.68; 95%CI 0.46-1.01; p=0.055; I 2 =34%) were comparable between the two groups. Conclusion: After PCI for STEMI, short DAPT for ≤3 months followed by ticagrelor monotherapy was non-inferior to 12-month DAPT in terms of NACE, MACCE, and bleeding. Ticagrelor monotherapy following short DAPT may be considered for STEMI patients after PCI.
Abstract 4147746: External Validation of Supraventricular Tachycardia and Accelerated Junctional Rhythm Risk Prediction Models in Pediatric Congenital Heart Surgery
Authors: Thomas Giorgio, Eric Feins, John Kheir, Kimberlee Gauvreau, Audrey Dionne
Journal: Circulation (2024)

Background: Tachyarrhythmias are a complication of congenital heart disease (CHD) surgery associated with significant morbidity and mortality. Risk scores to predict supraventricular tachycardia (SVT) and accelerated junctional rhythm/junctional ectopic tachycardia (AJR/JET) were previously published, but their performance not evaluated. Objective: To validate risk prediction scores for post-operative SVT and AJR/JET in an external cohort. Methods: Prospective cohort of children 0-18 years undergoing surgery for CHD from 2020-2023. In-hospital telemetry and 12-lead ECGs were reviewed daily for the presence of arrhythmia. C-statistic and Hosmer-Lemeshow tests were used to quantify discrimination and calibration of the model. Results: From 1190 surgeries in 1109 patients (54% male, age 1.71 [IQR 0.3, 6.5] years), SVT occurred in 124 (10%) and AJR/JET in 68 (6%). The observed risk of arrhythmia was significantly higher in the prospective validation cohort than the retrospective cohort. Patients in the prospective cohort were older, more likely to have heterotaxy syndrome and with longer and more complex surgeries than the retrospective cohorts. The model accurately predicted the risk of SVT with a C-statistics of 0.76 [95% CI 0.72, 0.80] and AJR/JET with a C-statistics of 0.63 [95% CI 0.55, 0.70] for AJR/JET. However, the model was not well calibrated with Hosmer-Lemeshow p-value &lt;0.001. Conclusion: Risk prediction scores for post-operative arrhythmia created on retrospective cohort did not perform well in a prospective validation study. Arrhythmia outcomes were significantly higher with prospective review of telemetry than reported with diagnostic and complication codes in a retrospective cohort.
Abstract 4147673: Outcome of Impella vs. Other Temporary Mechanical Circulatory Support Devices in Acute Myocardial Infarction Patients with Cardiogenic Shock: A Bayesian Network Meta-Analysis
Authors: Prakash Oli, Dhan Shrestha, Sandesh Lamichhane, Subash Subedi, Swikriti Shrestha, Sajog Kansakar, Jurgen Shtembari, Sagun Dawadi, Daniel Katz
Journal: Circulation (2024)

Background: Cardiogenic shock (CS) affects up to 10% of hospitalized patients with acute myocardial infarction (AMI), leading to over 30% mortality despite treatment. In patients with AMI-CS refractory to vasopressors and inotropes, temporary mechanical circulatory support (MCS) devices have been used to provide hemodynamic support. Recently, Impella demonstrated significant mortality benefit in AMI-CS in the DanGer shock trial. However, it has not demonstrated such benefit over other devices, such as IABP and ECMO in other trials (ISAR-Shock, IMPRESS in Severe Shock, IMPELLA-STIC). Here we performed this network meta-analysis of all available studies including the DanGer shock trial comparing Impella with other MCS devices in AMI-CS patients. Method: We performed a Bayesian network meta-analysis to synthesize direct and indirect evidence from relevant studies published until April 2024 using PubMed, Embase, and Scopus databases comparing Impella with other strategies for treating AMI-CS patients. The primary outcome was a short-term mortality defined as in-hospital or 30-day mortality. This study is registered with PROSPERO, and data analysis was performed using the “BUGSnet” package in R. Result: Out of 7,211 studies, 17 were deemed eligible. These included five RCTs and 12 observational studies, encompassing 16,654 patients with AMI-CS assigned to 3 different MSC interventions: Impella, IABP, and ECMO in 9 different combinations or alone. Based on SUCRA value, IABP was the most effective strategy in regard to short-term mortality (73.46), long-term mortality (75.59), major bleeding (66.4), renal replacement therapy (73.02); Impella along with IABP for stroke (95.24), ischemic stroke (99.68), device-related bleeding (90.22), MI (94.38); ECMO for hemolysis (91.66); standard of care for peripheral ischemic complications (88.66), sepsis (78.71). In sub-analysis using the RCTs only, Impella was ranked best for short-term mortality (74.53). Conclusion: Based on the findings of this network meta-analysis, IABP could potentially provide both short-term and long-term mortality benefits, as well as reduce the risk of bleeding. Meanwhile, combining it with Impella could potentially reduce the risk of cerebral ischemia.
Abstract 4147424: In hospital Outcomes of Acute Myocarditis in Adults with Systemic Inflammatory Disease: A Population-based Analysis in The United States
Authors: OLUFEMI ODUGBEMI
Journal: Circulation (2024)

Systemic inflammatory diseases (SID) are associated with adverse cardiovascular (CV) events, due to derangement in innate immunity. Understanding the association with acute myocarditis (AMC) is crucial for preemptive management strategies and improving patient outcomes. Methods: We identified and compared adults (&gt;18 years) with SID vs. non-SID patients hospitalized with AMC using the National In-patient sample database from 2016-2020. Six SID were selected based on HLA antigen distribution. The risks of all-cause mortality and major adverse cardiac and cerebrovascular events (CVA, cardiac arrest, acute heart failure (AHF), Ventricular arrhythmia, complete AV block, AMI, and PCI), and use of mechanical circulatory support (MCS) were assessed in adult AMC admissions with and without SID. SID were divided into 6 cohorts: SLE, RA, psoriasis (PS), IBD, Hashimoto thyroiditis (HT), and multiple sclerosis (MS) subgroups. Results: Overall adults AMC admissions were 26,475. The rate of AMC in non-SID was 96%. Mean age of non-SID were similar in 4 cohorts, but relatively older in RA subgroup (47.5 vs 61.5 years). We observed male predominance in the PS vs IBD groups (62% vs 51% vs 63%), but more females in the SLE, RA, HT, and MS cohort. We observed comparable mortality (aOR 1.425; CI 0.062-10.23 p=0.862) and MACE (aOR 0.943; CI 0.398-2.231 p=0.894) rates across all studied subgroups. The RA-AMC cohort had significantly higher odds of MCS use (aOR 3.8; CI 1.52- 9.55, p=0.004), after adjusting for significant confounders. The IBD-AMC cohort had significantly reduced odds of AHF (aOR 0.28; CI 0.076 - 0.99, p=0.04). However, the odds of AMI and VA were not statistically significant.(Table 1) Conclusions: The RA-AMC cohort are about 4 times more likely to require mechanical circulatory support during hospitalization for acute myocarditis, while IBD-AMC are less likely to have AHF. Prospective studies would be required to further examine the cardiovascular outcome in this cohort. Prospective studies would be required to further examine the cardovascular outcomes in this cohort.
Abstract 4146941: Sex Differences in Utilization and Outcomes of Peripheral Left Ventricular Assist Devices in ST Elevation Myocardial Infarction Associated Cardiogenic Shock in the United States
Authors: Manoj Kumar, Nso Nso, Javier Gomez Valencia, Mark Ricciardi, Qamar Arman, Nomesh Kumar
Journal: Circulation (2024)

Background: Peripheral Left Ventricular Assist Devices (pLVAD) are used to achieve rapid ventricular unloading and improve systemic perfusion in myocardial infarction (MI) associated cardiogenic shock (CS). We aim to compare sex-based differences in utilization and outcomes of pLAVD use in ST elevation MI (STEMI) associated CS. Methods: Nationwide Readmissions Database (2016-2021) was used to identify STEMI-CS patients who underwent pLVAD placement. Mahalanobis Distance Matching within the Propensity Score Caliper was used to match males and females. Inverse Probability Weighting (IPW) was utilized, and Pearson’s chi-squared test was applied to the PSM-2 matched cohorts to compare outcomes. Results: Among 27,664 hospitalizations of STEMI-CS patients undergoing pLVAD support, only one-fourths (N: 7,358; 27.2%) of the patients were females. After propensity matching (N: 4,301 in each group), females had significantly higher mortality (52.1% vs. 46.8%, aOR:1.42 [95% CI: 1.29-1.55], p &lt;0.001), pericardial complications (including hemopericardium, cardiac tamponade, pericarditis or any need for pericardiocentesis) (3% vs. 1.8%, aOR:1.50 [95%CI: 1.15-1.96], p &lt;0.001) and blood transfusion requirement (17% vs. 14.4%, aOR:1.32 [95% CI:1.17-1.48 ], p &lt;0.001). From 2016-2021, mortality of STEMI-CS has remained unchanged (males: 37%; females: 40%) (p-trend &gt; 0.05). However, a decline in pLVAD utilization was observed in both males (48% to 41.6%, p-trend &lt;0.001) and females (39% to 32.8%, p-trend &lt;0.001). No significant difference was observed in 30-day, 90-day and 180-day readmission rates between the two groups (p&gt;0.05). Conclusion: Females had higher mortality and complication in STEMI-CS requiring pLVAD utilization. Mortality of STEMI-CS has not changed significantly across the years; however, utilization of pLVAD has been decreasing.