tbuckley/cabot-search huggingface dataset:
Abstract 4137917: Eligibility and Preventable CVD Events in US Adults with Cardiovascular Disease and Overweight or Obesity: Projections from the SELECT Trial
Authors: Hongmei YAN, Hridhay Karthikeyan, WENJUN FAN, Qin Yang, Nathan Wong
Journal: Circulation (2024)

Background: The Trial to Evaluate Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT) showed cardiovascular disease (CVD) benefits of semaglutide therapy in patients with preexisting CVD and overweight or obesity. Purpose: To estimate the number of US adults with CVD and overweight or obesity that may be eligible for semaglutide based on SELECT eligibility criteria and the number of preventable CVD events from semaglutide treatment based on observed CVD event reductions in SELECT. Methods: We included US adults from the National Health and Nutrition Examination Survey (NHANES) 2011-2020 who had eligibility criteria from SELECT. This included patients aged &gt; 45 years who had preexisting CVD and a BMI of &gt; 27kg/m 2 but no history of diabetes. Using NHANES sample weighting, we estimated the number of SELECT-eligible US adults and primary composite and secondary CVD endpoints that would occur based on SELECT treated and placebo published event rates, with the difference indicating the number of preventable events (and annualized based on mean 3.3-year follow-up). Results: Among 8783 (projected to 77.9 million [M]) adults with overweight or obesity, we estimated 493 (4.1 million) (5.61%) to fit SELECT eligibility criteria. Compared to SELECT trial participants, our sample had a higher proportion of Black participants and was older with higher levels of diastolic blood pressure, total, LDL and HDL-cholesterol, and lower BMI, HbA1c, eGFR and triglycerides. Prior myocardial infarction was less common, but stroke was more common in our sample. From SELECT semaglutide and placebo primary composite CVD event rates of 6.5% and 8.0%, respectively, we estimated 79949 and 98399 CVD events would occur annually, the difference being 18450 potentially preventable CVD events. Moreover, we similarly estimated 104,549 and 357,928 annual preventable cases of diabetes and pre-diabetes, respectively. The Figure shows the estimated number of primary and secondary CVD outcomes that could be prevented annually. Conclusion: Semaglutide may prevent many fatal and non-fatal CVD events, as well as incident cases of diabetes and pre-diabetes if provided to US adults meeting SELECT eligibility criteria. More efforts are needed to educate clinicians and patients on the benefits of semaglutide 2.4mg in those with preexisting CVD and overweight or obesity.
Abstract 4137810: Association of Sociodemographic Characteristics on Costs of Care in Patients with Obstructive Hypertrophic Cardiomyopathy
Authors: Nosheen Reza, Michael Butzner, Kirti Batra, Qiana Amos, Ami Buikema, Amy Anderson, Sanatan Shreay, Anjali Owens
Journal: Circulation (2024)

Introduction: No evidence exists on the impact of sociodemographic characteristics on costs of care for obstructive hypertrophic cardiomyopathy (oHCM). Therefore, we evaluated 5-year cumulative costs by age, sex, and race/ethnicity. Methods: Retrospective cohort study of adults diagnosed with oHCM (January 2013 to December 2021) using Optum claims and electronic medical record data. Patients with ≥2 claims for HCM (ICD-9 and-10) at least 30 days apart (index date = earliest oHCM claim) with ≥1 additional oHCM claim or septal reduction therapy, 6-months pre-index and 5-year post-index continuous enrollment were included. HCM-related cumulative costs (2022 CPI adjusted) were reported for medical (ambulatory [AB]: office [OV] visits, outpatient [OP] visits); emergency room [ER] visits; inpatient admissions (IP); and pharmacy (Rx). Results: Among 5,129 patients with oHCM, 52% were female (mean age 63.9 ± 14.3 years; 77.6% non-Hispanic White; 40% Medicare). Compared to females (Table), male patients had greater costs including total ($71,581 vs $63,710, p= 0.014), medical ($70,395 vs $62,455, p= 0.013), ambulatory ($16,024 vs $10,776, p&lt;0.001), OV ($1,906 vs $1,573, p&lt;0.001), and OP ($14,118 vs $9,202, p&lt;0.001). Compared with White patients, Black patients had significantly greater IP costs ($54,572 vs $42,686, p= 0.01), Hispanic patients had greater ER costs ($1,724 vs $791, p&lt;0.001), and Asian patients had greater OV costs ($2,094 vs $1,800, p&lt;0.001). Patients aged 18-39 years had greater costs across all categories (p&lt;0.001; IP=NS), except Rx. Patients aged 40-54 years had the highest Rx costs ($1,557, p&lt;0.001), followed by 18-39, 55-64, 65-74, 75+ years ($1,528; $1,329; $1,197; $867), respectively. Conclusions: For oHCM patients , being male and age 18-39 years was associated with increased HCM-related healthcare costs. Differences in cost across race/ethnicity exist, including greater IP and ER costs for Black and Hispanic patients, respectively. Future research is required to understand the source of these differences among oHCM patients.
Abstract 4137636: Cardiac radiation dose and changes in physical activity and quality of life in patients with locally advanced lung cancer
Authors: Kyunga Ko, Nikhil Yegya-Raman, Ivy Han, Joshua Mitchell, Wei Zou, William Levin, Leanne Barrett, Paco Bravo, MARCELO DI CARLI, Roger Cohen, Sandra Hutton, Salma Jabbour, Wonyoung Jung, Jonathan Keltz, Raymond Mak, Suneel Nagda, Nitin Ohri, Clifford Robinson, Amanda Smith, Lova Sun, Michael Soike, Gerard Walls, Jessica Wang, Steve Feigenberg, Bonnie Ky
Journal: Circulation (2024)

Background: Physical activity is associated with prognosis in cancer. However, in non-small cell lung cancer (NSCLC), a high cardiovascular (CV) population, the relationships between RT dose, physical activity, and CV patient-reported outcomes remain unclear. We determined the associations between cardiac radiation dose-volume metrics and changes in physical activity and quality-of-life (QoL) in patients treated with definitive chemoradiation. Methods: NSCLC participants treated with chemoradiation were enrolled in a multi-center longitudinal cohort study. Self-reported physical activity via Godin–Shephard Leisure-Time Physical Activity Questionnaire (Godin) and QoL via Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue and Dyspnea Scales were collected at baseline, end of RT, 6, and 12 months post-RT. Changes in Godin and FACIT scores over time were examined using linear mixed-effects models. Multivariable linear regression via generalized estimating equations assessed the associations between: 1) mean heart dose (MHD) and longitudinal changes in physical activity and QoL, and 2) concurrent changes in physical activity and FACIT scores. Results: Across 101 participants, the mean age was 66 years, with 57% male, 66% White, and 25% Black. The median (Q1, Q3) MHD was 10.8 Gy (6.1,16.3). Very low physical activity [9 (0, 25)], high dyspnea [4 (1, 9)], and low fatigue [39 (31,46)] were reported at baseline. With chemoRT, there was a significant worsening of physical activity ( P = 0.03), fatigue ( P &lt; 0.001), and dyspnea ( P &lt; 0.001). Each 1-Gy increase in MHD was associated with a modest decline in physical activity (-0.28; 95% CI -0.53, -0.02, P = 0.03), and higher physical activity was associated with a concurrent decrease in fatigue ( P &lt; 0.001) and dyspnea ( P = 0.007) (Table). Conclusions: In locally advanced NSCLC, physical activity levels prior to RT were very low, and higher cardiac radiation dose was associated with a further decline in physical activity. Increased physical activity was associated with concurrent decreases in fatigue and dyspnea. Strategies to promote physical activity may result in improved QoL in this high CV group.
Long-Term Pattern of Psychotropic Medication Uses Among Swedish Parents of Children Diagnosed With Cancer
Authors: Yishan Liu, Zheshun Jiang, Jan Sundquist, Kristina Sundquist, Jianguang Ji
Journal: Journal of the National Comprehensive Cancer Network (2024)

Background: Parents experience a range of mental health disorders following their child’s cancer diagnosis. It is thus essential to explore how the child’s cancer diagnosis affects the dosage of psychotropic medication in both short- and long-term use, as well as potential disparities in utilization patterns between mothers and fathers. Patients and Methods: Using Swedish registers, we identified all parents whose children were diagnosed with cancer from July 2009 to December 2015 in Sweden. We randomly matched up to 5 parents of cancer-free children conditional on their baseline characteristics. All parents were followed up from 4 years before to 4 years after their child’s diagnosis. Psychotropic medication cumulative defined daily doses (DDDs) were retrieved from the Swedish Prescribed Drug Register. Using interrupted time series analyses, we sought to investigate how childhood cancer diagnosis influences the evolving pattern of parental psychotropic medication dosage across time with consideration for potential differences compared with matched parents before the child’s cancer diagnosis. We calculated the attributable proportion due to the diagnosis of childhood cancer. Results: Following a child’s cancer diagnosis, mothers experienced a steady increase in psychotropic medication use, averaging 4.9 DDDs per year compared with matched comparisons, with a 46.0% adjusted attributable proportion in the initial year. Fathers had an abrupt increase in psychotropic medication use in the first year after diagnosis, with an adjusted attributable proportion of 72.1%. Parents with lower education attainment tended to use more psychotropic medication. Conclusions: In response to a child’s cancer diagnosis, parents showed increased use of psychotropic medication compared with matched comparisons. Additionally, utilization patterns differed between mothers and fathers. Timely prevention and early support for parents are needed to alleviate their psychological challenges, potentially mitigating the strain on medical resources associated with increased psychotropic medication use.
Abstract 4137855: Hybrid Coronary Revascularization versus Traditional Coronary Artery Bypass Grafting for Left Main Disease
Authors: Elsa Hebbo, Madeleine Barker, Daniel Gold, Malika Elhage Hassan, Mariem Sawan, Michael Halkos, Wissam Jaber, Pratik Sandesara
Journal: Circulation (2024)

Background: The current guideline-recommended intervention for left main (LM) disease is coronary artery bypass grafting (CABG). Hybrid coronary revascularization (HCR) combines robotic coronary artery bypass and percutaneous coronary intervention (PCI) and offers a less invasive approach for patients with LM and multivessel coronary artery disease. We aim to compare clinical outcomes at 30 days, 6 months and 1 year between HCR and CABG in patients with LM disease. Methods: We retrospectively screened 761 patients who underwent bypass for LM disease between 2019 and 2023 at a single institution. A total of 118 patients who underwent either HCR (n=59) or CABG (n=59) were included after propensity matching for baseline characteristics. The primary endpoint was major adverse cardiovascular events (MACE), defined as death, myocardial infarction, repeat revascularization and stroke, at 30 days, 6 months and 1 year, which was assessed using chi-squared tests. Secondary outcomes are individual components of MACE at 30 days, 6 months and 1 year. Kaplan-Meier curves were used to visualize the difference in 1-year cumulative MACE-free survival across groups coupled with a log-rank test. Results: The mean age was 68.93±11 years for HCR patients and 68.41±10.11 years for CABG patients (p=0.394). SYNTAX score was high (&gt; 33) for 49.1% of HCR patients and 67.3% of CABG patients (p=0.15). Hospital length of stay was shorter for HCR compared to CABG (4.07 ± 1.21 days vs. 7.58 ± 7.71 days, p&lt;0.001). MACE events were significantly lower in the HCR group at 30 days (0% vs 10.2%; p=0.01), 6 months (0% vs 17%; p=0.002) and 1 year (2.4% vs 20.5%; p=0.01). The cumulative MACE-free survival at 1 year was significantly higher in the HCR group (p=0.007). There were no significant differences in secondary outcomes at any time point with the exception of lower repeat revascularization at 6 months in the HCR group (0% vs 10.9%; p=0.02). Conclusion: This retrospective study demonstrates that HCR is a viable alternative to CABG for LM disease. While randomized clinical trial data is still needed, this less invasive approach is a promising treatment strategy for patients with high surgical risk.
Abstract 4137570: Atherosclerotic Cardiovascular Disease Risks in Children: An electronic health record data analytics approach
Authors: Juanjuan Liu, Victoria Garcia, Maya Van Gieson, Haydn Swackhamer, Tyler Lee, Nicole Lee, Adam Cook, Alice He, Zhenglun Wei, Lisa Bailey-Davis, Shuping Ge
Journal: Circulation (2024)

Background and Aims: There is little data on atherosclerotic cardiovascular disease (ASCVD) risk conditions, factors, and tiers in the pediatric population. This study aimed to develop and validate electronic health record (EHR) data analytic algorithms to attain the prevalence of 24 risk conditions, 7 factors, and 4 tiers in children in a rural community. Methods: This study included all the 495,902 subjects from 0 to 18 years at the Geisinger Medical Center from 2004 to 2022. The demographic and clinical data were collected using ICD-10 codes, clinical and laboratory data, and a dual-coded computational algorithm was developed based on the AHA guideline to derive the ASCVD risk conditions, factors, and tiers. To validate the EHR algorithms, the algorithm (rater 1) and a clinician (rater 2) extracted and analyzed the data from 40 randomly selected subjects from this cohort. Kendall’s coefficient of concordance (W) and Gwet’s agreement coefficient were used to evaluate algorithm and clinician agreement within the ASCVD tiers, conditions and factors, respectively. Results: High concordance was observed between algorithmic and clinician raters for risk tiers (W=80%), conditions (80-97%), and factors (49% for blood pressure, and 92% to 97% for the rest of the risk factors). In this cohort, the median age was 3.9 years, 51.0% were male, 80.6% were Non-Hispanic/Latino, and 88.1% were White. Overall, 15.5% (N = 76,945) were at-risk, 7.0% (N = 34,530) at moderate risk, and 4.2% (N = 20,761) at high risk for ASCVD, respectively. The most prevalent risk conditions were obesity (9.1%, N = 45,074), chronic inflammatory conditions (6.8%, N = 33,685), severe obesity (2.7%, N = 13,442), insulin resistance with comorbidities (2.7%, N = 13,397), and hypertension (2.1%, N = 10,436). The most prevalent risk factors were elevated BMI (27.4%, N = 135,904), blood pressure (12.5%, N = 62,015), and fasting lipid profile (8.7%, N = 43,100). Conclusion: Our EHR data analytics algorithm is in high agreement with the clinician rater. The high, moderate, and at-risk ASCVD risk tiers are prevalent in a large contemporary pediatric cohort at Geisinger. Both ASCVD risk conditions and factors are also prevalent, especially obesity, diabetes, hypertension, and hyperlipidemia. These findings suggest the further application and refinement of these algorithms to design innovative approaches for ASCVD risk reduction and prevention in children.
Abstract 4137913: Role of serial evaluation of myocardial inflammatory activity and oxidative stress in determining the therapeutic efficacy of immunosuppression and clinical outcome in patients with cardiac sarcoidosis
Authors: Yusuke Nakashima, Shigeki Kobayashi, MAHO ISHIKAWA, Junya Nawata, Yoshihide Nakamura, Tatsuhiro Fujimura, Motoaki Sano
Journal: Circulation (2024)

Background: Cardiac sarcoidosis (CS) was characterized by formation of granulomas in the heart. Enhancement in myocardial inflammatory activity and oxidative stress is a crucial cause of major cardiovascular adverse events (MACE). Although immunosuppressive therapy is recommended for active CS, there is no established markers for treatment and prognosis. Hypothesis: We hypothesized that the inflammation and oxidative stress in heart were associated with MACE after steroid therapy. Aims: We identified prognostic markers for MACE in patients with CS after steroid therapy. Methods: This study was a prospective observational cohort study. Patients with CS diagnosed according to Japanese criteria were enrolled in this study. Patients with abnormal accumulation of 18 F-FDG in heart were treated with steroids with standard guideline-recommended protocol. 18 F-FDG PET were performed after more than 6 months of induction. Urinary 8-hydroxy-2'-deoxyguanosine (U-8-OHdG), a marker of oxidative DNA damage, and indices of cardiac and renal function were measured. The major outcome was a composite of the first sustained ventricular tachycardia (sVT) /sudden cardiac death (SCD), hospitalization for heart failure, and radiological relapse with exacerbation of clinical manifestation. Results: Fifty consecutive patients with CS underwent steroid therapy and followed up (median follow-up period of 58 months). 39 of 50 patients underwent 18F-FDG PET/CT more than 6 months after steroid therapy. During the follow-up period, 17 of 39 patients showed MACE, consisting of sVT/SCD (N= 11), hospitalization (N= 2) and radiological relapse (N= 4). A Cox proportional-hazard model showed that the U-8-OHdG and SUV max value of FDG-PET were independent predictors of MACE. ROC analysis revealed that the cut-off values of U-8-OHdG and SUV max for predicting the MACE were 11.6 ng/mg Cr (AUC 0.913, sensitivity 86.7%, specificity 90.0%) and 4.64 (AUC 0.878, sensitivity 76.5%, specificity 91.0%), respectively (Fig.1). Patients with a U-8-OHdG ≧11.6 ng/mg Cr or SUV max ≧4.64 had a significantly higher MACE risk (P values for U-8-OHdG and SUV max were both 0.001 by Log Rank analysis) (Fig.2). It is noted that U-8-OHdG &lt;11.6 ng/mg Cr and SUV max &lt;4.64 after steroid therapy indicate the good responses to the immunosuppressive therapy and better prognosis (Fig.3). Conclusion: U-8-OHdG and SUV max may be useful markers in determining the therapeutic efficacy and clinical outcome in patients with CS.
Abstract 4137461: Elevated Lipoprotein(a) Increases Cardiovascular-Related Healthcare Resources Utilization and Costs among US Medicare, Medicaid, and Commercial Enrollees with ASCVD
Authors: Xingdi Hu, Tony Lozama, Allison Petrilla, Barnabie Agatep, Donna McMorrow, Iman Mohammadi, Lonny Reisman, Nathan Wong
Journal: Circulation (2024)

Background: Elevated lipoprotein(a) [Lp(a)] is a recognized genetic, independent, and causal risk driver for atherosclerotic cardiovascular disease (ASCVD). Less is known about how elevated Lp(a) affects downstream cardiovascular (CV)-related healthcare resource utilization (HCRU) and costs in patients with ASCVD. Objective: To assess the association of Lp(a) levels with CV-related HCRU (hospitalizations, outpatient and emergency department [ED) visits), and CV-related costs for patients with ASCVD in a national-scale multi-insurance cohort. Methods: Patients with ASCVD were pooled from US Medicare, commercial, and Medicaid health plans from 2017 to 2022. Lp(a) levels (mg/dL and nmol/L) were linked at the patient level with HealthVerity Lab Data. Elevated Lp(a) was defined as Lp(a)≥70mg/dL (≥ 175 nmol/L) and normal Lp(a) was defined as Lp(a)&lt;30mg/dL (&lt;75 nmol/L). Generalized linear models with log link negative binomial distribution (HCRU) and log link gamma distribution (costs) adjusted for age, sex, race, insurance type, comorbidities, statin use, and prior hospitalizations, measured the association of Lp(a) levels with the annualized rate of CV-related hospitalizations, ED visits, and outpatient visits (incidence rate ratio [IRR]) and CV-related costs (annualized cost ratio). Results: A total of 180,240 ASCVD patients were identified with Lp(a) values. Median (IQR) Lp(a) was 14 mg/dL (4 mg/dL – 48 mg/dL) or 35 nmol/L (12 nmol/L – 114 nmol/L). Mean (SD) age was 68.6 (12.0) years with 49.9% being female; 72.8% of patients were from Medicare, followed by commercial (21.8%) and Medicaid (5.4%). Fully adjusted CV-related HCRU was significantly higher in those with elevated Lp(a) compared to normal Lp(a): inpatient hospitalizations (IRR=1.11), outpatient visits (IRR=1.11) and ED visits (IRR=1.06), all p &lt;0.001 (IRR and 95% CI reported in Table 1). Patients with elevated Lp(a) had 14% higher CV-related annualized healthcare costs than patients with normal Lp(a) (p &lt;0.001) with significantly higher CV-related HCRU beginning with Lp(a) levels &gt;30 mg/dL (&gt;75 nmol/L). Conclusion: Elevated Lp(a) was significantly associated with greater CV-related HCRU and costs in patients with ASCVD.
Abstract 4137996: Effects of Empagliflozin on diuresis in heart failure: Results from the CINNAMON-study and in-vivo experiments
Authors: Frederick Sinha, Susanne Klatt, Alexander Rietmann, Anna Schoepperl, Sebastian Born, Lars Maier, Frank Schweda, Stefan Wagner
Journal: Circulation (2024)

Background and Purpose: Heart failure is associated with renal dysfunction suggesting a pathophysiological link between heart and kidney. Empagliflozin, a SGLT2 inhibitor, showed beneficial effects on both cardiovascular and renal endpoints. However, mechanistically, it is unclear if empagliflozin-dependent kidney protection is mediated via inhibition of tubular SGLT2 or more indirectly via improved cardiac function. We hypothesized that Empagliflozin treatment improves left ventricular ejection fraction (LVEF) independent of diuretic effect of renal SGLT2 inhibition. Methods: We evaluated NTproBNP, hematocrit, hemoglobin and bodyweight in patients with HF with reduced (n=32) and preserved ejection fraction (n=59) after 30 and 180 days (prospective, single-arm CINNAMON-study, DRKS00031101). Furthermore, we conducted transverse aortic constriction (TAC) or sham surgery in C57BL/6J (wildtype, WT) and SGLT2 deficient mice (SGLT2 -/- ). Animals received either Empagliflozin (10 mg/kg bodyweight) or vehicle by daily oral gavage. Water intake and output was evaluated by metabolic cages at 10 weeks and cardiac function by echocardiography. Results: Empagliflozin treatment reduced NT-proBNP levels and increased hematocrit and hemoglobin levels especially in patients with reduced ejection fraction (Fig. A-C). Surprisingly, there was no change in body weight (Fig. D), which would be expected if the diuretic effects were dominant. In mice after 10 weeks, echocardiography confirmed TAC induced pressure-overload, leading to reduced LVEF. Empagliflozin attenuated changes in LVEF (Fig. G) and improved diastolic dysfunction (isovolumetric relaxation time, data not shown). To test if direct inhibition of SGLT2 in the heart and kidney is mechanistically involved, TAC surgery was repeated in SGLT2-deficient mice (SGLT2-KO). In fact, exposure to TAC resulted in comparable reduction of LVEF in SGLT2-KO and Empagliflozin prevented this deterioration similar to WT mice (Fig. G vs. I). Surprisingly, Empagliflozin did not increase drinking and urine volume neither in wildtype nor in SGLT2 deficient mice, suggesting a mechanism of cardioprotection independent of diuretic effects. Conclusion and Outlook: This is the first study investigating the role of SGLT2 in Empagliflozin treated patients and mice with heart failure. Importantly, empagliflozin treatment prevented deterioration of LVEF independent of the presence of SGLT2 and diuresis.