tbuckley/cabot-search huggingface dataset:
Abstract 18813: Economic Burden of Pregnancy Among Privately Insured Women With Congenital Heart Disease
Authors: Anushree Agarwal, Rong Duan, Nasim C Sobhani, Aarthi Sabanayagam, Gregory M Marcus, Michelle Z Gurvitz
Journal: Circulation (2023)

Background: Women with congenital heart defects (CHD) are increasingly reaching childbearing age. Understanding their healthcare costs in pregnancy may inform resource allocation, financial planning, and pre-conception counseling. Methods: We used 2010-2016 US commercially insured beneficiaries’ data within the IBM ® MarketScan® database to identify pregnancies among 18-55-year-old women with CHD and matched controls without CHD. We assessed baseline characteristics, cardiac and noncardiac conditions, pregnancy related conditions, birth outcomes, and cesarean section. We estimated total and out-of-pocket (OOP) costs, compiled and adjusted to 2016 medical component of the consumer price index. Negative binomial mixed model was used. Results: There were 6385 pregnancies in 5077 women with CHD (672 pregnancies among severe and 5713 among nonsevere) and 9438 pregnancies in 7737 controls. Compared to controls, pregnancies with CHD were more likely to be 35+ years of age at delivery, resided in the Northeast and West regions, had flexible insurance plans, cardiac conditions, noncardiac conditions, birth outcomes, pregnancy related conditions and cesarean sections, while there was no difference in the year of delivery and gestational diabetes rates. After adjusting for all covariates, having CHD was an independent predictor of higher adjusted pregnancy-related cost ratio for total (1.49, 95% confidence interval [CI] 1.40, 1.59) and OOP costs (1.27, 95% CI 1.19, 1.35). The adjusted mean total and OOP cost difference for pregnancy per patient for any CHD, severe CHD, and nonsevere CHD was significantly higher than controls (Figure). Total expenditure and OOP cost of CHD pregnancies during the study period were $162.5 and $15.7 million dollars respectively. Conclusions: We provide novel estimates of economic burden of pregnancy among privately insured CHD patients for clinical and financial counseling and planning for patients, payors and policymakers.
Abstract 16966: Temporal Trends and Race Differences in Catheter Ablation for Atrial Fibrillation Among Patients With Heart Failure With Reduced Ejection Fraction Before and After CASTLE-AF
Authors: Anna Rosenblatt, Matthew W Segar, Neil Keshvani, Mark S Link, Jose A Joglar, Gregg C Fonarow, Jonathan P Piccini, Ambarish Pandey
Journal: Circulation (2023)

Background: Catheter ablation (CA) for atrial fibrillation (AF) reduced the risk of all-cause death or heart failure (HF) hospitalization among patients with HF with reduced ejection fraction (HFrEF) in the CASTLE-AF randomized trial. The trends in utilization of CA for AF in the setting of HFrEF before and after CASTLE-AF and whether disparities in CA by race have changed over time have not been well studied. Methods: Patients with AF and HFrEF from the GWTG-AF registry from 1/2016-6/2022 were included. Temporal trends in AF ablation in the overall cohort and across self-reported race-ethnicity groups (Black, White, and other) were examined using linear regression models with generalized estimating equations accounting for within-hospital clustering. Change in ablation rates following the CASTLE-AF publication (2/1/2018) were assessed using interrupted time-series analysis with linear splines with knots at the time of publication. Results: Overall, 26,678 patients (71.3±12.6 years, 45.4% Female, CHADS-VASc 1.3±0.6, 80.4% White) were included in the cohort. In the pre-Castle-AF period ablation rates were 5.2% with significantly lower rates of ablation in Black and other race patients compared with White patients (2.6% vs. 3.0% vs. 5.8%, respectively). The rates of CA increased post-CASTLE-AF (overall: 21.8%) and for each race group (Black: 20.3%, White: 22.6%, Other: 16.8%; Figure ) without significant difference in rate of increase across race groups (P-interaction for time*race = 0.82). Older age, female sex, non-White race, higher CHADS-VASc, and bleeding history were associated with less CA, while history of hypertension, obstructive sleep apnea, and the post-CASTLE-AF time period were associated with more CA. Conclusion: CA rates significantly increased post-CASTLE-AF among the entire cohort and across all race-ethnicity groups, however, non-White race was associated with lower utilization of CA over the entire period.
Abstract 17263: Outcomes and Trends of Percutaneous Coronary Intervention in Nonagenarians With Acute Myocardial Infarction: Results From National Inpatient Sample 2016-2020
Authors: Shivani Mehta, Vivek Mittal, Tanveer Mir, Waqas Qureshi
Journal: Circulation (2023)

Background: Acute myocardial infarction (MI) is a leading cause of mortality and morbidity among the elderly. Multiple co-morbidities and advanced age often impede the need for cardiac catheterization in these patients. The literature studying percutaneous coronary intervention (PCI) in nonagenarian patients with acute MI is limited. Methods: We examined hospitalized acute MI patients with age 90 or above that were included in the National Inpatient Sample 2016-2020. Acute MI was defined by using the International Classification of Diseases -10. Patients aged less than 90 years were excluded. Outcomes were expressed as percentages. Multivariable logistic regression analysis was used to examine the association of PCI and age 90 or above with primary outcome of mortality, and secondary outcomes [ Figure1]. We also studied the yearly trends of PCI in nonagenarian patients with acute MI patients. Results: Of the total hospitalized patients with acute MI (n = 3,120,759), 4.6% (n=142,675) patients were aged 90 years or above. Of these, 9.4% (n= 3,615) died in PCI group and 12.7% (n= 13,215) died in non - PCI group. PCI was performed in 27% (n= 38,430) of the nonagenarian patients with acute MI. The most common outcomes in PCI group were acute heart failure (37.5%), Acute kidney injury (28 %), and atrial arrhythmia (23%). PCI in nonagenarian patients with acute MI was associated with decreased odds of mortality (OR 0.75, 95% CI 0.68-0.82, p value &lt;0.001) and having any of the secondary outcomes (OR 0.74, 95% CI 0.69- 0.79, p value &lt;0.001) [Figure 1]. From 2016-2020, there are increasing yearly trends of PCI in nonagenarian patients with acute MI (p value &lt;0.001). Conclusion: Acute MI in elderly patients is associated with significant increased mortality and adverse events. PCI in acute MI patients with age 90 years or above was associated with decreased odds of mortality.
Abstract 17076: The Relationship Between Impaired Microvascular Function, Cardiovascular Risk Profile and Subclinical Atherosclerotic Burden in a Swedish Middle-Aged Cohort
Authors: Sara Bergstrand, Hanna Jonasson, Ingemar Fredriksson, Marcus Larsson, Carl - Ostgren, Tomas Stromberg
Journal: Circulation (2023)

Introduction: Microvascular function is associated with cardiovascular risk factors and deteriorates in individuals with cardiovascular disease. Hypothesis: The aim of this study was to investigate the relationship between microvascular function, cardiovascular risk profile and subclinical atherosclerotic burden. Methods: The study enrolled 3809 randomly selected individuals, 50-65 years old, participating in the population-based observational cross-sectional Swedish CArdioPulmonary bioImage Study (SCAPIS). Microvascular function was measured in forearm skin using an arterial occlusion and release protocol determining the peak blood oxygen saturation, OxyP. Cardiovascular risk was calculated using the updated Systematic Coronary Risk Evaluation (SCORE2; 10-year risk of fatal and non-fatal CVD events). OxyP was compared with Coronary artery calcification score (CACS) and plaques in the carotid arteries. Results: Individuals with OxyP values in the lowest quartile (Q1; impaired microvascular function), had a mean SCORE2 of 5.8% compared to 3.8% in those with the highest values of OxyP (Q4), a relative risk increase of 53%. In the low-risk SCORE2 level (&lt;5% risk), 19.0% of the individuals have impaired microvascular function as compared to 48.1% in the high-risk SCORE2 level (&gt;10% risk). OxyP was lower in individuals with coronary artery calcification (CACS&gt;0) and those with both carotid plaque and CACS&gt;0, as compared to individuals without subclinical atherosclerotic burden (CACS=0 and no carotid plaque; 87.5 ±5.6 % and 86.9 ±6.0 % vs 88.6 ± 5.8 %, p &lt; 0.01). Conclusion: In a population without cardiovascular disease or diabetes mellitus, impaired microvascular function is associated with higher SCORE2 risk and CACS&gt;0. Hence, assessment of microvascular function may be a useful tool for accurate cardiovascular risk prediction, in addition to imaging assessment of atherosclerosis in the coronary and carotid arteries.
Abstract 19092: Endothelial Caveolin-1 Deficiency Increases Susceptibility to Lethal Heart Failure in Male Mice With Hypoxia-Induced Pulmonary Hypertension
Authors: Jiwang Chen, Kayla L Yerlioglu, Andres Fantauzzi, Sam Lee, Ming Tang, Haibin Li, Maricela Castellon, Suellen Darc Oliveira, Richard D Minshall
Journal: Circulation (2023)

Introduction: Pulmonary arterial hypertension (PAH) is an incurable disease with high mortality. Reduced endothelial cell caveolin-1 (EC Cav1) expression contributes to idiopathic PAH, and in animal models, can be alleviated by inhibiting or deleting endothelial nitric oxide synthase (eNOS). Hypothesis: As females are at greater risk of developing PAH but exhibit a more favorable outcome compared to males, we hypothesized that EC Cav1 deficiency in male mice would contribute to EC Cav1-dependent sex differences following chronic hypoxia exposure. Methods: EC-Cav1 -/- mice ( Cdh5.Cre ERT2 ;mTmG;Cav1 f/f injected with tamoxifen; ECKO) vs. wild-type liter mates injected with oil (ECWT), and Cav1 KO, Cav1-RC, and WT mice (6-8 week old) were exposed to 10% O 2 for up to 8 weeks (hypoxia-induced PH (HPH)). Echocardiography, right ventricular systolic pressure (RVSP) and hypertrophy (RVH), lung histology, Western blot, and survival were used to quantify pulmonary and cardiac function. Data were analyzed by two-way ANOVA and Tukey’s post hoc analysis. Results: After 8-weeks of hypoxia exposure, over 90% of male and 40% of female Cav1 KO became moribund, whereas lethality was less than 10% for WT and Cav1 RC mice (p &lt; 0.01). Cav1 ECKO mice exhibited 30% lethality, whereas all ECWT siblings survived. Both Cav1 KO and ECKO mice exhibited a significant increase in pulmonary artery wall thickness, RVH, and RVSP. Hypoxia also reduced PAT and TAPSE, as well as LV systolic and diastolic function, including IVRT, CO, EF, FS, and global longitudinal strain in Cav1 KO and ECKO as compared to WT, ECWT, and Cav1-RC mice indicating EC Cav1 expression is cardioprotective in the context of HPH. In whole lung lysates, we observed reduced eNOS dimerization and an increase in eNOS pSer1179 indicative of eNOS dysfunction under normoxia which was exaggerated following hypoxia exposure to a greater extent in male Cav1 KO and ECKO as compared to Cav1-RC or WT mice. Conclusions: Chronic hypoxia-induced PH and mortality observed in Cav1 KO and ECKO mice is associated with both RV and LV failure and eNOS dysfunction to a greater extent in male mice, which was largely prevented by EC Cav1 expression.
Abstract 17227: An Artificial Intelligence Based Model for Heart Failure With Preserved Ejection Fraction Predicts Cardiac Mortality
Authors: Claire E Cassianni, Geoffrey D Huntley, Ashley P Akerman, Mihaela Porumb, Christopher G Scott, Agisilaos Chartsias, Alexander J Ryu, William Hawkes, Ayana Z Arystan, Garvan C Kane, Sorin V Pislaru, Francisco Lopez-Jimenez, Rizwan Sarwar, Jamie O'Driscoll, Paul Leeson, Ross Upton, gary woodward, Patricia A Pellikka
Journal: Circulation (2023)

Background: Diagnosis of heart failure with preserved ejection fraction (HFpEF) is challenging due to non-diagnostic imaging outputs and discordant clinical features. Using only a single videoclip from a standard transthoracic echocardiogram (TTE), we developed an artificial intelligence (AI) model to differentiate patients with HFpEF from those without HFpEF. In a separate test population, we assessed the model’s ability to predict cardiac mortality. Methods: A 3-dimensional convolutional neural network was developed and trained on apical 4-chamber videoclips to classify patients with HFpEF (cases) versus without HFpEF (controls). Overall and cardiac mortality were obtained from the National Death Index. Results: The model was independently tested in 646 cases and 638 controls from 8 centers in 4 states. Sensitivity (87.8%; 84.5-90.9%) and specificity (81.9%; 78.2-85.6%) were high and sustained in various subgroups, including increased left atrial volume index, average E/e’ ≥15, and pulmonary artery systolic pressure &gt;35 mm Hg. During follow-up (median [IQR] 3.4 [1.7-6.5] years), 540 patients died. There were 135 cardiac deaths attributable to heart failure (47%), coronary artery disease (41%), valve disease (4%), arrhythmia (4%), and others (5%). Compared to a negative output, all-cause mortality was higher in patients with a positive (HR 2.9 [2.4-3.5]) or uncertain output (HR 1.8 [1.2-2.5]), and cardiac mortality (Figure) was also higher in patients with a positive (HR 7.7 [4.5-13.3]) or uncertain output (HR 3.4 [1.4-8.1]). Cardiac mortality differences according to AI model prediction remained after age adjustment (positive: HR 5.9 [3.3-10.4], p&lt;0.001; uncertain: HR 2.8 [1.2-6.8], p=0.02). Conclusion: A novel AI model to detect HFpEF based on a single routinely acquired TTE videoclip also identifies those at increased risk of cardiac mortality.
Abstract 18608: Using Electronic Medical Record Based Tools to Assess the Prevalence of Iron Deficiency, Iron Deficiency Anemia, and Treatment With IV Iron Among Patients With Decompensated Heart Failure
Authors: Matthew R Hope, Val Rakita, David Fleece, chethan gangireddy
Journal: Circulation (2023)

Introduction: Iron deficiency (ID) and iron deficiency anemia (IDA) are common among patients with heart failure (HF). They are associated with increased hospitalizations and all-cause mortality. Intravenous (IV) iron repletion has been associated with significant improvement in these outcomes, but is underutilized during HF admissions. Electronic medical record (EMR) based tools to increase recognition of ID and IDA in patients with HF and promote treatment with IV iron have not been described. We developed an EMR based tool to identify patients admitted with HF with ID and IDA who were candidates for IV iron repletion in an urban academic medical center. Hypothesis: ID and IDA are underdiagnosed and undertreated among patients admitted for HF. EMR based tools can be used to systematically identify patients with ID, IDA, and increase appropriate use of IV iron in patients with HF. Methods: Retrospective analysis of patients admitted with HF between March and May 2023. The EMR based tool defined HF by encounter diagnosis and use of IV diuretics, anemia by hgb of &lt; 13 g/dl (male) and &lt; 12 g/dl (female), ID by ferritin &lt; 100 ng/ml or ferritin &lt; 300 ng/ml and iron saturation &lt; 20%, IDA by presence of ID and anemia, and if the patient received IV iron. Presence of HF, anemia, ID, IDA, and use of IV iron were confirmed by manual chart review. Results: The EMR based tool identified 116 patients admitted with a diagnosis of HF who received IV diuretics. In total, 103 (89.6%) had clinically decompensated HF by chart review. Three patients were excluded due to leaving AMA or on hospice. The average patient age was 63.8 years, 49 (50%) were male, and 50 (50%) were female, and 72 (73%) were African American (AA). In this sample, 81 (82%) had anemia, of which 47 (58%) had both ferritin and iron saturation levels collected during the admission. A total of 15 (19%) had no record for ferritin, iron saturation, or both. By including labs from prior admissions, a total of 64 (65%) of the 99 patients had ID while 57 (58%) had IDA. In total, 22 received IV iron (34% of patients with ID, 39% of patients with IDA). Conclusions: An EMR based tool can be used to identify patients with HF, ID, IDA, and the use of IV iron. ID and IDA are prevalent among patients with HF but remain underdiagnosed and undertreated.
Abstract 18713: The Impact of ECG-AI Design Choices on Clinical Utility: A Deep Dive Into Left Ventricular Hypertrophy, Hypertrophic Cardiomyopathy, and Cardiac Amyloidosis
Authors: Shahir Asfahan, Ausath Anto, Shiva Verma, Yash Gupta, Peter A Noseworthy, Zachi Attia, Paul Friedman, Rakesh Barve, Francisco Lopez-Jimenez, Konstantinos Siontis, Samir Awasthi
Journal: Circulation (2023)

Introduction: Artificial intelligence applied to electrocardiograms (ECG-AI) enables early and efficient detection of cardiovascular disease. The technical and clinical impact of different approaches to designing ECG-AI remains under-explored. We consider left ventricular hypertrophy (LVH) and examine the impact of disease-specific labeling of minority etiologies of left ventricular wall thickening- hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis (CA) - on ECG-AI performance. Hypothesis: ECG-AI designed to detect HCM or CA outperforms ECG-AI broadly trained to identify LVH due to differences in attention to key ECG features associated with HCM or CA. Methods: Independent neural networks were trained to identify HCM, CA, and LVH. HCM and CA patients were identified using the full depth of EHR data and validated via clinician adjudication (N = 3,025 and 4,251 patients, respectively). Moderate and severe LVH patients (N = 98,144) were identified using echocardiogram results and international LVH criteria. We compared the ability of disease-specific ECG-AI vs. LVH ECG-AI to detect HCM (or CA) by examining model performance within each of the three test sets. Results: 52.6% of HCM patients and 49.5% of CA patients met LVH criteria. Within the HCM test set, the AUROC, sensitivity, specificity, and positive predictive value (PPV) of the HCM ECG-AI were 0.94, 0.88, 0.85, and 60%, respectively, whereas the same for LVH ECG-AI were 0.83, 0.83, 0.64, and 37%. Within the CA test set, CA ECG-AI achieved AUROC, sensitivity, specificity, and PPV of 0.94, 0.81, 0.91, and 69%, respectively, whereas the same for LVH ECG-AI were 0.75, 0.73, 0.68, and 31%. ECGs positive for HCM exhibited higher P wave area, QRS deflection and R wave amplitude compared to LVH-positive ECGs (Cohen's D &gt; 0.75). ECGs positive for CA exhibited lower R wave amplitude/area, QRS deflection and QRS areas (Cohen's D &gt; 0.6). Conclusion: Models trained using carefully labeled HCM or CA identify distinct signals associated with the diseases, resulting in improved disease discrimination compared to a model trained to identify echocardiographic left ventricular thickening. Labeling choices should be communicated transparently to clinicians to ensure safe and effective use of ECG-AI.
Abstract 18937: High Prevalence of Pediatric Hypertension is Associated With Social Determinants of Health Including Childhood Opportunity Index
Authors: Abbas H Zaidi, Benjamin Brewer, Varsha Zadokar, Joanne Lopes, Colleen Witherell, Jonathan Miller, Sarah D De Ferranti
Journal: Circulation (2023)

Background: Pediatric Hypertension(HTN) is a significant public health concern. The risk for adult HTN and end-organ damage begins in childhood. Patient factors such as social determinants of health (SDOH), including the Childhood Opportunity Index (COI) and how they impact the prevalence of pediatric HTN are poorly understood. Hypothesis: Elevated blood pressure (BP) and BP in the hypertensive range are prevalent in pediatric patients. SDOH factors are associated with high BP(elevated BP or BP in the hypertensive range). Methods: Patients seen in primary care at Nemours Children’s Health (NCH) between 6-17 years formed the cohort and various SDOH factors including COI were analyzed. Results: 95,627 patients aged 6-17 years seen at NCH from DE and PA formed the cohort between August 2017 and September 2022. Children with developmental delay, anxiety, ADHD were excluded. The overall prevalence of elevated BP was 9.5% and BP in hypertensive range was 2.8% based on the definition from the American Academy of Pediatrics 2017 HTN guidelines. A multivariable analysis showed factors associated with having a high BP were living in DE(P&lt;0.001), non-English speaking(P&lt;0.001), non-white race(P=0.03), being on public insurance(P&lt;0.001), Male gender(P&lt;0.001), older age(P&lt;0.001), and low COI(P&lt;0.001) with a C statistic of 0.77. Conclusions: Elevated BP and BP in the hypertensive range are prevalent across pediatric patients. Various SDOH factors are associated with having a high BP including COI, which indicates the vulnerability of certain populations to having high BP and development of adult HTN and future cardiovascular risk. Understanding these SDOH factors could help recognize and treat pediatric patients with HTN.
Abstract 17328: A Case of Reversible Severe Systolic Cardiomyopathy; Thinking Outside the Box
Authors: Joshua Shaw, Kalyani Dhar, Neda Dianati Maleki
Journal: Circulation (2023)

Introduction: Non-ischemic systolic cardiomyopathy is associated with significant morbidity and mortality. Prompt evaluation and timely removal of the potential insult may lead to reverse remodeling and recovery of the left ventricular (LV) systolic function. Case: A 39-year-old female with BMI 40 presented with dyspnea and bilateral lower extremity edema. Vital signs significant for mild tachycardia and hypertension. ECG showed sinus tachycardia. Physical exam revealed bibasilar crackles and 3+ pitting edema of the lower extremities. Laboratory significant for NTpro BNP 563 pg/dL and TSH &lt;0.005 IU/mL with a free T4 of 2.73 ng/dL. Chest x-ray showed pulmonary vascular congestion. Echocardiogram showed severely reduced LV systolic function with ejection fraction (EF) of 27%, global LV hypokinesis and diastolic LV diameter of 6.85 cm. No significant atrial or ventricular arrhythmias noted on Telemetry. A CT angiography of the coronary arteries showed no evidence of calcification or obstructive coronary disease. Additional labs revealed severely elevated TSH receptor antibody and thyroid stimulating immunoglobulin. Diffuse thyroid enlargement noted on ultrasound. Patient was diagnosed with Grave’s disease (GD) with Burch-Wartofsky score of 30 indicating an impending thyroid storm. She was treated with Metoprolol and Methimazole. She underwent intravenous diuresis and was started on guideline-directed medical therapy for systolic cardiomyopathy. In follow-up after 6 months, her TSH had normalized. On repeat imaging, her LVEF improved to &gt; 50% with diastolic LV diameter of 5.6 cm. Discussion: This patient was diagnosed with non-ischemic dilated systolic cardiomyopathy due to severe hyperthyroidism from GD. Thyrotoxicosis-induced systolic cardiomyopathy occurs in about 1% of patients with GD and is associated with increased morbidity and mortality. Excess thyroid hormones in thyrotoxicosis can affect multiple regulatory and structural genes of cardiac myocytes resulting in abnormal intracellular calcium regulation and impaired LV systolic and diastolic function. Our experience is consistent with literature demonstrating the importance of timely diagnosis and treatment of this reversible cause of systolic cardiomyopathy.