tbuckley/cabot-search huggingface dataset:
Abstract 4114994: Nursing Management Practice Variations related to Externalized Ventricular and Lumbar Drains
Authors: Millie Hepburn
Journal: Circulation (2024)

Introduction/Background: Nursing management of neurologic patients may include placement of externalized ventricular drains (EVDs) or lumbar drains (LDs) to monitor/drain cerebrospinal fluid (CSF), but knowledge and practice related to EVD management varies widely, despite a high potential for life-threatening complications. Limited data exists relative to the relationship between intracranial pressure (ICP) and CSF drainage. These gaps may undermine patient safety. Research Question: What are the nursing practices and perspectives regarding management of EVDs and LDs? Methods/Approach: A 16-question multiple-choice/text entry survey was distributed electronically to nurses and advanced practice nurses who were members of the American Association of Neuroscience Nurses. Data analysis included chi-square test for multiple choice responses, and qualitative data was analyzed using a six-step thematic analysis and an inductive approach. Results/Data: Of 219 participants, 42.8% reported roles as Neuroscience ICU nurses, and 39.2% managed an EVD at least 75% of the time. Neuro ICU nurses were most likely to have a patient with an EVD ( p =.002). Approximately 63% of respondents reported consulting with colleagues about EVDs nearly every time they cared for a patient with an EVD. Nurses reported a very high care burden, including re-leveling the transducer 4 or more times per shift (n=76), and re-zeroing every 8 hours (n=72) to assure accurate calibration. Of these 82.2% reported that they re-zeroed the EVD more often to obtain an accurate reading. Approximately 25% reported accidental over-drainage, some with negative outcomes. Many (79.3%) reported caring for patients with LDs, 47.4% to diagnose normal pressure hydrocephalus. The nursing care workload was described as 30-120 minutes each shift. Conclusion: A wide heterogeneity of nursing practices was revealed in EVD and LD management. No standardized nursing care practices have been adopted by nurses for the management of CSF. The complications of these practice variations have been shown to result in untoward patient outcomes. Increased patient morbidity and mortality are linked to catheter infection and over/under drainage of CSF and may be directly related nursing practice. This reveals critical need for improved, standardized care nursing practices in the management of EVDs and LDs, and an empiric understanding of the relationship between intracranial pressure and the volume and rate of CSF drainage.
Abstract 4116093: High Intensity Statin Use Improved ASCVD Outcomes in Patients with Severe Hyperlipidemia in a Primary Prevention Cohort
Authors: Cameron Hallihan, Jianhui Zhu, Floyd Thoma, Vijay Nambi, Anurag Mehta, Anandita Agarwala, Oscar Marroquin, Suresh Mulukutla, Anum Saeed
Journal: Circulation (2024)

Background: High intensity statin therapy is currently recommended for primary prevention of ASCVD in patients with severe hyperlipidemia (HLD), defined as low-density lipoprotein cholesterol (LDL-C) of ≥190 mg/dL. We examined statin use for patients with severe HLD and associated ASCVD outcomes in a large contemporary healthcare network. Methods: Using EMR data, patients between the ages of 20 and 79 with a lipid bloodwork result between 2013 and 2017 without ASCVD by ICD9 and ICD10 codes were identified. Patients with LDL-C ≥ 190 mg/dL were identified. Statin use was stratified by no statin, guideline directed statin intensity (GDSI), and less than guideline directed statin intensity (&lt;GDSI). Cox proportional hazards (HR) models were used to assess the relationship between statin use, future ASCVD events, and all-cause mortality. Time to initiation of GDSI was calculated using Kaplan-Meier (KM) methods. Results: Out of 282,298 primary prevention patients, a total of 5,205 (1.8%) had LDL-C ≥ 190 mg/dL. These patients were 55.6% female and had an average age of 52.5 ± 12.2. At first encounter, 3.7% were on GDSI. Over a 5-year follow up, KM probabilities revealed 42% of high-risk patients with severe HLD not initially on GDSI would achieve new GDSI use. Compared to patients on GDSI, those on no statin therapy were at significantly higher risk of MI (HR = 2.36, 95% CI [1.38 – 4.04]) and stroke/TIA (HR= 2.70, 95% CI [1.43 – 5.09]); both p &lt; 0.05. There was no significant difference in risk of all-cause mortality (HR = 1.41, 95% CI [0.90 – 2.21]). Patients on &lt;GDSI were found to have significantly higher risk of MI (HR = 1.72, 95% CI [1.05 – 2.81]) compared to patients on GDSI. There was no significant difference between the GDSI and &lt;GDSI groups in risk of stroke (HR = 1.28, 95% CI [0.69-2.37] and all-cause mortality (HR = 0.98, 95% CI [0.65-1.47]). Conclusion: Among primary prevention patients with severe HLD, high intensity statins are underutilized. Prevalence of this suboptimal use of statins is linked to greater risk of ASCVD events. Healthcare system-wide interventions can identify measures to assess burden of high-risk patients with severe HLD and implement lipid-lowering therapies optimally.
Abstract 4113420: Assessing the Clinical Impact of Cardiac Intensivists in Cardiac Intensive Care Units.: Results from the RESCUE registry
Authors: Dae-Hwan Bae, Jang-whan Bae, Junyoung Lee, jonghee Sun, Sang Yeub Lee, Jeong Hoon Yang, Hyeon-Cheol Gwon
Journal: Circulation (2024)

Background: Presence of dedicated intensive care unit physicians is associated with reduced intensive care unit mortality. However, there is limited information regarding the impact of cardiac intensivists in cardiac intensive care units. Research Questions: What is the role of cardiac intensivists in influencing clinical outcomes for adult patients admitted to cardiac intensive care units? Aims: To investigate the association between cardiac intensivist-directed care and clinical outcomes in adult patients admitted to cardiac intensive care units. Methods: This retrospective study used data from the SMART-RESCUE registry, which is a multicenter, retrospective, and prospective registry of patients presenting with cardiogenic shock. The study involved 1,247 patients enrolled from January 2014 to December 2018 at 12 tertiary centers in Korea. These patients, who were suffering from cardiogenic shock, were divided into two groups depending on whether their care involved a cardiac intensivist. Results: The study found that the all-cause mortality rate was 33.6%. The in-hospital mortality rate was significantly lower in the group managed by cardiac intensivists (25.4%) compared to the group without (40.1%). Similarly, cardiac death rates were lower in the cardiac intensivist group (20.5%) than in the non-cardiac intensivist group (35.4%). In patients undergoing extracorporeal membrane oxygenation, mortality at centers with cardiac intensivists was 38.0%, compared to 62.2% at centers without. The use of dopamine was lower and norepinephrine use was higher and the vasoactive-inotropic score was lower in the cardiac intensivist group. Conclusion: Cardiac intensivist involvement in patient care within cardiac intensive care units was associated with a reduction in in-hospital mortality and administration of vasopressors and inotropes according to cardiogenic shock guidelines, indicating a beneficial effect on clinical outcomes.
Abstract 4120312: Patient Perspectives on Barriers and Facilitators to Familial Hypercholesterolemia Cascade Testing Through the Lens of the Socio-Ecological Model
Authors: Kelly Morgan, Christie Gilbert Klaczko, Nicole Walters, Andrew Brangan, Eric Tricou, Megan Betts, Jazmine Gabriel, Zoe Lindsey-Mills, Mary McGowan, Alanna Rahm, Amy Sturm, Laney Jones, Gemme Campbell-Salome
Journal: Circulation (2024)

Background: Low uptake of Familial Hypercholesterolemia (FH) cascade testing, the stepwise identification of at-risk relatives, leads to missed opportunities for atherosclerotic cardiovascular disease (ASCVD) prevention. The IMPACT-FH study offered strategies (packet, chatbot, and direct contact) to support FH cascade testing. Hypothesis: We hypothesized that IMPACT-FH strategies would facilitate cascade testing uptake and overcome persistent barriers to cascade testing. Aim: We aimed to understand barriers and facilitators to FH cascade testing in the context of the socio-ecological model (SEM) which provides a framework to examine the interconnected influences of intrapersonal, interpersonal, institutional, community, and policy levels. Methods: Semi-structured interviews were conducted with IMPACT-FH study participants. The SEM informed qualitative analysis to identify barriers and facilitators to FH cascade testing. Results: A total of 15 FH probands (initial family member tested) and 12 relatives were interviewed, of whom the majority (59%) were female with an average age of 55.7 years. All relatives completed cascade testing. At the interpersonal level, probands reported that relatives’ attitudes about high cholesterol, including seriousness and treatability, were a barrier or facilitator to cascade testing. Probands explained how relatives’ beliefs were informed by interactions with their clinicians and societal beliefs about cholesterol (i.e., medication stigma). Interpersonally, probands described challenges overcoming relatives’ beliefs and a reluctance to encourage relatives to complete testing despite the availability of novel strategies. Probands and relatives reported that insurance policies and concerns about testing costs informed cascade testing decision-making. Institutional strategies to provide low-cost testing and cost transparency were described as facilitators. Variable access to clinicians with genetics expertise and licensure laws were described as barriers by out-of-state relatives. Probands and relatives agreed that strategies providing direct access genetics expertise (i.e., direct contact, chatbot) helped address these barriers. Conclusion: The IMPACT-FH study ameliorated barriers at higher levels of the SEM related to access to genetics expertise and cost. Intra- and interpersonal barriers remained challenging to overcome. To improve FH detection and ASCVD prevention, it is important to address barriers at all levels of the SEM.
Abstract 4113301: A Rare Cause of Recurrent Heart Failure Exacerbations After Transcatheter Aortic Valve Replacement: Ventricular Septal Defect and Significant Paravalvular Leak
Authors: Jesse Medina, Louis Vincent, Esteban Rodriguez, Shanice Spence-Miller, Joel Fernandez, Rosario Colombo, Marian Calfa
Journal: Circulation (2024)

Introduction: Ventricular septal defects (VSD) have been reported in &lt;1% of cases following transcatheter aortic valve replacement (TAVR). A retrospective record review of VSD cases occurring after all TAVRs performed between January 2012 and September 2020 at one urban US tertiary hospital showed 0.37% incidence of these complications, mostly with small and restrictive VSD. Case Description: An 80-year-old woman with history of hypertension, HFpEF, and TAVR 8 months prior for severe aortic stenosis (AS) at an outside hospital presented with worsening dyspnea and peripheral edema over the past month. Blood pressure was 148/53mmHg, heartrate 83bpm, oxygen saturation 98% and auscultation revealed a harsh holosystolic murmur 4/6 loudest at left sternal border and bibasilar rales. Chest X-ray showed pulmonary edema and bilateral pleural effusions. NT-proBNP was 17,000pg/ml and troponin-I was negative. Echocardiogram showed EF55-60%, a membranous VSD, severe pulmonary hypertension, and moderate paravalvular leak (PVL). Coronary angiogram showed non-obstructive disease. Right heart catheterization confirmed significant left to right shunting. Treatment/Outcomes: Cardiothoracic surgery was consulted for multidisciplinary evaluation, and joint recommendation was for surgical aortic valve replacement and VSD closure which was successfully performed. One month follow-up echocardiogram showed normal aortic valve gradient without PVL and normal right ventricular pressure. Discussion/Conclusion: Numerous potential risks such as severe and uneven calcification of the native valve, an elliptic aortic annulus, excessive valve sizing, or elevated valve placement can lead to VSD. A recurrent element in many of these instances involves direct trauma to the septum caused by the implanted valve, exacerbated by subsequent annulus dilation. The presence of PVL is common post-TAVR and is an established independent prognostic factor, while VSD post-TAVR is uncommon, but may be associated with low implantation position relative to the aortic annulus or post-implantation balloon dilatation. Rarely, worsening VSD may require operative management. In this case, the improvement of heart failure symptoms and echocardiogram parameters after transthoracic surgery confirmed successful repair.
Abstract 4115235: Disparities in Youth Cardiac Screening by Childhood Opportunity Index: Insights from the Heartbytes Database
Authors: Douglas Corsi, Avinash Saraiya, Vanessa Veltre, Grace Qiu, Margaret Doyle, Blaise O'Malley, Vacha Shah, Renee Langstaff, Imran Masood, Brian Osler, Alexander Hajduczok, Drew Johnson, David Shipon
Journal: Circulation (2024)

Intro: The AHA endorses screening youth athletes to identify risk for sudden cardiac arrest (SCA). Rates of SCA can be predicted by social determinants of health (SDOH) such as education level and proportion of Black residents in ZIP Code. The Child Opportunity Index (COI) quantifies neighborhood factors that influence health and development. The link between COI and youth cardiac screening findings and outcomes remains unclear. Hypothesis: Cardiac screening data will differ significantly by COI. Aims: To identify differences in cardiac screening data in children of varying COI. Methods: The HeartBytes Database, including sports exams, self-reported physical activity (PA), and zip codes from Simon's Heart screenings was augmented with COI index zip code data. Chi-squared and logistic regression were used to analyze demographics, cardiac risk factors, and screening results. Data: Screening data of 11,431 youth athletes (median age 14.3 (IQR = 3), BMI 20.6 (4.8), 53.7% male, 70.6% White) was analyzed. The majority of children had very high overall COI (Figure 1). Hypertension, hyperlipidemia, Kawasaki disease, and heart infection were similar across COI levels (p &gt; 0.05). Levels of physical activity varied significantly across levels of overall COI, with the highest levels reported in the lowest COI group (50.4% with &gt; 10 hours PA/week) (Chi-Squared; p = 0.007). Positive screening rates varied significantly by level of COI (p = 0.013) (Figure 2). The overall level of education, health environment, and socioeconomic COI did not predict positive screening outcomes in logistic regression analysis (all p&gt;0.05). Conclusion: Prevalence of cardiac risk factors did not vary significantly across COI levels, however, positive screening rates were highest in moderate and very low COI levels. Simon’s Heart engaged communities across the COI spectrum; however, a majority of children had high or very high COI. Further efforts are needed to expand access to underserved populations of lower COI.
Abstract 4114625: Upregulation of Palmitoylating Enzymes, DHHC2 and DHHC5, in Failing Human Hearts Protects Impulse Propagation but Endangers Myocyte Survival after Ischemia/Reperfusion (I/R) Injury
Authors: Yankun Lyu, Evgeny Kanshin, Jackeline Ponce, Beatrix Ueberheide, Tytus Bernas, Gea-Ny Tseng
Journal: Circulation (2024)

Background: Palmitoylation 'Palm* catalyzed by DHHC enzymes promotes protein binding to membranes, impacting protein translocation and function. Palm* dysregulation has been linked to cancers and neurogenerative disorders; its impact on cardiac function is unclear. We have used global purification of palmitoylated proteins from human and animal hearts followed by proteomic analysis to build 'cardiac palmitoylome', whose 454 constituents are involved in organizing/stabilizing cardiomyocyte microdomains (intercalated discs 'ICD', dyads, and costameres) critical for myocyte functions/homeostasis. We confirmed 11 of the 23 DHHC genes are expressed in human&amp;animal hearts. In particular, DHHC2 and DHHC5 were upregulated in human failing hearts. DHHC enzymes are membrane-embedded, limiting their substrates to enzymes' 'territories' in cells. Objective: To identify DHHC2 and DHHC5 distribution patterns and substrates in myocytes, and to understand how upregulation of DHHC2 or DHHC5 affects myocyte function. Methods: Track adenovirus-expressed mCherry-DHHC2 and -DHHC5 (mChr-DHHCx, x=2 or 5, Adv-mChr as control) in ventricular myocytes from adult Sprague-Dawley rats. Globally purify palmitoylated proteins for proteomic analysis/quantification. Use high-resolution quantitative imaging to analyze how mChr-DHHCx affects myocyte response to ischemia/reperfusion (I/R) injury and the expression/organization of palmitoylated proteins at ICD and lateral surface. Results: mChr-DHHC2 is mainly present in cytoplasmic vesicles bearing markers of recycling or autophagy, with a minor presence along lateral surface, dyads, and ICD. mChr-DHHC5 is mainly present along the lateral surface, dyads and ICD, with a minor presence in small endosomal vesicles. Palmitoylome normalized by proteome identifies DHHC2 and DHHC5 substrates that overlap with cardiac palmitoylome, and match the enzymes' distribution patterns. I/R injury increases endocytosis in myocytes, quantified by uptake of plasma-membrane marker, wheat germ agglutinin. I/R-induced endocytosis is exacerbated by mChr-DHHC2 but, surprising, alleviated by mChr-DHHC5. mChr-DHHC2 and -DHHC5 increase internalization of ICD and lateral membrane proteins, n-cadherin and NCX1 respectively. Conclusions: DHHC2 and DHHC5 have non-overlapping distribution patterns, consistent with varying substrate groups. DHHC2, but not DHHC5, appears involved in the previously reported palm*-dependent massive endocytosis in I/R-stressed cardiomyocytes.
Abstract 4122763: Health Status Outcomes of Antianginal Therapies in Patients After Coronary Revascularization: Insights From the GREAT Disease Registry Study
Authors: xiliang zhao, Yong Zeng
Journal: Circulation (2024)

Background: The impact of antianginal therapies on the health status of coronary artery disease (CAD) patients who have undergone coronary revascularization has not been extensively researched. This study aimed to investigate the effect of nicorandil on the health status in patients after coronary revascularization, measured by the Seattle Angina Questionnaire (SAQ). Methods: We analyzed data from 1,556 patients enrolled in the GREAT Disease Registry Study (Clinicaltrial No. NCT05050773) between September 2021 and May 2022. Changes in SAQ summary score (SAQ-SS) from baseline to 3, 6, 9, and 12 months were assessed. Statistical methods included a linear mixed-effects model and propensity score matching (PSM) for comparative analysis. Results: Among the 1,038 patients receiving revascularization analyzed (22.7% female; mean age [SD], 59.9 [10.2] years), 648 (62.4%) received nicorandil, while 390 (37.6%) did not. In the linear mixed-effects model analysis, statistically significant improvements were observed with nicorandil in SAQ-SS across all time points ( Table 1 ), indicating beneficial effects of nicorandil on health status outcomes after revascularization. Sensitive analysis was conducted using the PSM method. After PSM adjustment, both groups comprised 321 patients each. The change in SAQ-SS from baseline to 12 months was significantly greater in the nicorandil group (19.2 ± 14.06 points) compared to the non-nicorandil group (14.91 ± 12.9 points, p &lt; 0.001). Conclusions: These findings indicated that nicorandil is associated with improved health status outcomes in CAD patients who have undergone coronary revascularization.
Abstract 4118402: National Burden, Trends, and Racial Disparities in Cardiovascular Mortality Among Incarcerated Individuals in the United States from 2000-2019
Authors: Lauren Eberly, Kaitlyn Shultz, Ashwin Nathan, Sarah Turecamo, Sanjay Kishore, Margaret Hayden, Sameed Ahmed Khatana
Journal: Circulation (2024)

Background: Cardiovascular disease is the leading cause of death in the U.S. Mass incarceration is a national public health issue, with the US having the highest incarceration rate in the world. However, there is a paucity of data on cardiovascular mortality among incarcerated individuals, or how the racialization of mass incarceration contributes to cardiovascular health inequities. The aim of this study was to evaluate the burden of cardiovascular mortality, trends in cardiovascular deaths, as well as racial differences in cardiovascular death and receipt of care among those incarcerated in U.S. state prisons from 2001-2019. Methods: We utilized the database “Mortality in Correctional Institutions: ICD-10 Diagnosis Codes for Natural Deaths Occurring in State Prison or Local Jail Custody, 2000-2019” from the United States Bureau of Justice Statistics. This database collects inmate death records from each of the nation’s 50 state prison systems. We extracted all deaths related to cardiovascular causes to evaluate the epidemiology of individuals with cardiovascular death, trends in cardiovascular death rates, and differences between racial groups. Results: From 2000-2019, there were a total of 18227 (28.0%) deaths secondary to cardiovascular causes among those incarcerated in US state prisons. The rate of CV death increased from 71.3 per 100,000 persons in 2001 to 94 per 100,000 persons in 2019. Black individuals who died while incarcerated had higher rates of death related to a cardiovascular cause than White individuals (30.9% vs. 27.8%, p&lt;0.0001). Black individuals had higher rates of death due to ischemic heart disease (23.2% vs 21.9%) and hypertensive-related cardiovascular deaths (3.71% vs. 2.96%) as compared to white counterparts (p&lt;0.001). Black incarcerated individuals who died from a cardiovascular cause were less likely to be evaluated by a medical provider in prison (78.6% vs. 81.9%; p&lt;0.0001), were less likely to have a diagnostic test performed (65.3% vs. 69%, p&lt;0.0001), were less likely to receive medications (68.1% vs 72.6%, p&lt;0.001), as well as treatment other than medications (49.1% vs 52.8%, p &lt;0.0001) for the condition which caused death as compared to White counterparts. Conclusions: Deaths due to cardiovascular causes are high among patients incarcerated in US state prisons. Combined with decarceral efforts to address mass incarceration, strategies to ensure quality and equitable cardiovascular care for this population are needed.