tbuckley/cabot-search huggingface dataset:
Abstract 12331: Cardiovascular Hospitalizations and Mortality Among Young Adults Aged 25 to 64 Years in the United States
Authors: Chantal M Henry, Andrew S Oseran, ZhaoNian Zheng, Huaying Dong, Rishi K Wadhera
Journal: Circulation (2023)

Introduction: Declines in cardiovascular mortality have stagnated in the United States since 2011. There is growing concern that these patterns may reflect worsening cardiovascular health in younger populations. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality have changed in young adults. Aim: To evaluate cardiovascular hospitalizations (AMI, heart failure, ischemic stroke) and in-hospital mortality among adults 25-64 years, overall and by income-level, as well as population-level cardiovascular mortality. Methods: We determined age-standardized cardiovascular hospitalization rates from 2012 to 2019, and fit quasi-Poisson and quasi-binominal regression models to compare hospitalizations and mortality between low- and higher-income young adults. Results: Between 2012 and 2019, age-standardized AMI hospitalization rates increased modestly among young adults from 162.0 (161.4, 162.6) to 163.7 (163.3, 164.2) per 100,000 (p&lt;0.001). In contrast, there were significant increases in heart failure (163.9 [163.3, 164.5] to 231.5 [231.0, 232.0], p&lt;0.001) and ischemic stroke hospitalizations (92.3 [91.8, 92.8] to 110.2 [109.9, 110.6], p&lt;0.001). Across all 3 conditions, low-income adults experienced a more pronounced rise in hospitalizations, and the gap between the low- and higher-income groups widened (p-interaction&lt;0.001), while in-hospital mortality decreased for heart failure and stroke. Population-level cardiovascular mortality rates increased in the subgroup of young adults aged 45-64 years (162.5 to 168.3 per 100,000, p&lt;0.001), particularly in the low-income population. Conclusions: There has been an alarming increase in cardiovascular hospitalizations and population-level cardiovascular mortality among young adults over the past decade in the US, with evidence of widening disparities between low- and higher-income populations.
Abstract 12465: The Diagnostic Pathway for Patients With Light Chain (AL) Amyloidosis: Analysis of a Large US Claims Database
Authors: Genevieve Lyons, Jeffrey Thompson, Isabelle Lousada, mathew S Maurer, Julia Catini, Richa Manwani
Journal: Circulation (2023)

Background: Light-chain amyloidosis (AL) is a rare, multisystem disease with a varied presentation, and significant morbidity and mortality. Diagnostic delay can result in poor survival, particularly in patients with cardiac involvement. Aim: To understand the path to diagnosis for patients with AL using US-based claims data. Methods: We conducted a retrospective cohort study of adults (age ≥18 years) with AL using IQVIA PharMetrics Plus data (Jan 1, 2016-Sep 30, 2022). Patients with ≥2 AL diagnosis codes (index is date of second diagnosis; ICD-10: E85.81), ≥24 months’ continuous coverage pre-index, and ≥6 months follow-up were included. Results are reported using descriptive statistics. Results: A total of 1276 patients (58% male, mean age 62 years, 64% treatment naïve) met inclusion criteria at index. In the 2 years pre-index, patients saw the highest number of cardiologists (mean 4.1) compared with hematologist/oncologists (mean 1.8) and nephrologists (mean 1.7). Cardiovascular (CV) symptoms were experienced by 87% of patients within 2 years prior to index; 55% experienced their first CV symptom &gt;1 year prior to index. 71% of patients with CV symptoms had features suggestive of renal involvement, eg, proteinuria. Almost a quarter (23%) of patients had at least 1 emergency room (ER) visit and a third (31%) had at least one inpatient hospitalization (IP) over the 6-month follow-up period. Over half of the ER visits and IP stays were due to CV-related symptoms. Among patients whose diagnosis of AL was delayed (with early onset of CV symptoms &gt;1 year pre-index) compared with those who did not, the crude unadjusted odds of experiencing a CV related ER visit were 53% higher (OR 1.53, 95% CI: 1.09, 2.14; p=0.01). Conclusions: Cardiologists are a key part of the AL diagnostic pathway, as the most visited specialty prior to diagnosis. CV symptoms are the most common experienced by patients with AL and account for the largest proportion of IP stays and ER visits. Patients with delayed AL diagnosis from their first CV symptoms experienced significantly more CV-related ER visits than those without delayed diagnosis. Prompt diagnosis may help prevent a decline and the presence of heart failure symptoms with proteinuria or monoclonal gammopathy should raise suspicion of AL.
Abstract 12339: Erythropoietin Use in Pediatric Ventricular Assist Device Patients
Authors: Christina Dillon, Justin Godown, Neha Bansal, Shahnawaz M Amdani, David W Bearl
Journal: Circulation (2023)

Background: Anemia is common in pediatric ventricular assist device (VAD) patients. Erythropoietin (EPO) has been used to reduce blood transfusions in children after VAD placement. A study in adults showed EPO use after left VAD implantation was associated with higher rates of suspected pump thrombosis. No studies have evaluated the use of EPO in pediatric patients receiving VAD support. Objectives: We aim to assess EPO use in all pediatric patients who underwent placement of a VAD and to assess outcomes for children who received EPO compared to those who did not. Methods: We identified patients from the Pediatric Health Information System who underwent VAD placement from 2010-2020. Use of EPO was described across all sites. Cohorts were compared to assess differences in blood transfusions received post-VAD, incidence of stroke and pump-exchange. Multivariable Cox proportional hazard and logistic regression models were constructed to adjust for confounding factors for outcomes of VAD exchange and stroke, respectively. Results: A total of 1260 patients were included, of which 336 (27%) received EPO. Patients who received EPO were younger (median 3.5y vs. 9y, p&lt;0.001) and more likely to have congenital heart disease (55% vs. 45%, p=0.002). Patients on EPO received fewer blood transfusions compared to those not on EPO [median 0/month (IQR 0-0.9) vs. 0/month (IQR 0-2.3), p&lt;0.001]. VAD exchange and stroke were more common in patients on EPO (10.1% vs. 5.5%, p=0.004 and 37.8% vs. 25%, p&lt;0.001, respectively). After adjusting for confounding factors, the use of EPO was not independently associated with the need for VAD exchange (adjusted hazard ratio 1.2, 95% confidence 0.78 - 1.9, p=0.378). However, EPO remained independently associated with stroke during the hospitalization (adjusted hazard ratio 1.6, 95% confidence 1.2 - 2.1, p=0.002). Conclusion: EPO was used in approximately 1 out of 4 pediatric VAD patients. Those who received EPO were younger and more likely to have congenital heart disease. The use of EPO is associated with fewer post-VAD blood transfusions. EPO was not independently associated with VAD exchange but remained independently associated with stroke during the VAD hospitalization.
Abstract 12463: Awareness and Perceptions Towards Inflammatory Risk in Atherosclerotic Cardiovascular Disease: A Multinational Survey Amongst Cardiologists
Authors: Nikolaus Marx, Issei Komuro, Amir A Mohseni Zonoozi, Preethy Prasad, Juying Qian, Jose F Saraiva, Abhijit V Shete, Alberico L Catapano
Journal: Circulation (2023)

Background: In patients (pts.) with atherosclerotic cardiovascular disease and chronic kidney disease (ASCVD+CKD), systemic inflammation (SI) contributes to high cardiovascular (CV) risk. Awareness and perception of SI and use of high sensitivity C-reactive protein (hsCRP) amongst cardiologists is less understood. Aims FLAME-ASCVD survey assessed the level of awareness and perceptions of cardiologists towards the role of SI (primary objective) and hsCRP as a biomarker in pts. with ASCVD+CKD. Methods: This was a non-interventional, cross-sectional, global online survey-based study that collected data from interventional (IC) and/or general cardiologists (GC), treating ≥15 ASCVD+CKD pts./month and practiced for ≥3 years. Survey used an online questionnaire, across 10 countries (Australia, Brazil, China, France, Germany, India, Italy, Japan, Saudi Arabia, UK) during Mar-May 2023. Data were analysed using descriptive statistics. Results: Of the 1755 who responded to the survey invitation, 602 eligible cardiologists (IC=247, GC=355) completed the questionnaire (~60/country). Overall, CV risk factors discussed with pts. were hypertension (88%), hyperlipidaemia (82%), hyperglycaemia (78%), and SI ranked tenth at 43%. Overall, 72% agreed that SI was a risk factor for ASCVD, 64% as one of the drivers for CV events and 73% agreed that SI contributed to risk of recurrent CV events. Overall, 64% (n=386) acknowledged intent to test for SI in management, and 41% of these, stated that results influenced decision to initiate anti-inflammatory treatment. 49% of those not measuring for SI (n=216), stated lack of medication for SI as a reason. Overall, 47% used hsCRP as a test for SI and 45% stated the need for guidelines as one of the factors to establish testing in practice. Conclusion: In this survey, SI was perceived as a CV risk factor, but not to the same level as traditional CV risk factors. There is a need for better understanding of SI and hsCRP testing in patients with ASCVD+CKD.
Abstract 12428: Small Apolipoprotein(a) Isoform Size is a Predictor of Postoperative Patency Following Peripheral Arterial Revascularization
Authors: Marianna Pavlyha, Madeleine D Hunter, Yihao Li, Anastasiya Matveyenko, Srinivas P Cherukuri, Virendra I Patel, Nicholas Morrissey, Danielle Bajakian, Roman Nowygrod, Gissette Reyes-Soffer
Journal: Circulation (2023)

Introduction: High Lp(a) is associated with adverse limb events in patients undergoing lower extremity (LE) revascularization. Lp(a) levels are genetically pre-determined, with LPA gene encoding for two apo(a) isoforms whose variations in size are driven by the number of kringle IV type 2 repeats. We examined the role of apo(a) size in LE revascularization outcomes. Methods: 25 subjects with symptomatic PAD, Rutherford stage 4 or less underwent open or endovascular LE revascularization (age 66.7±9.7 years; F=12, M=13; Black=8, Hispanic=5, and White=12). Pre- and post-operative medical history, self-reported symptoms, ABIs, and LE ultrasounds were obtained. Plasma Lp(a), apoB100, lipid panel, and pro-inflammatory markers (IL-6, IL-18, hsCRP, TNFa) were assayed preoperatively. Isoform size was estimated using gel electrophoresis and weighted isoform size ( wIS ) calculated based on % isoform expression. Firth logistic regression was used to examine the relationship between wIS and procedural outcomes: symptoms (better/worse), patency of treated lesion(s) in the postoperative period (&lt;1 month), change in ABI, and re-intervention &lt;6 months. We controlled for age, sex, smoking, statin and antiplatelet use. Results: Median plasma Lp(a) level was 108 (44, 301) nmol/L. The mean apoB100 level was 168.0±65.8 mg/dl. As expected, plasma Lp(a) levels were inversely correlated with wIS (R2 = 0.20; p=0.00001). Interestingly, plasma Lp(a) levels and w IS were not associated with any of the measured plasma pro-inflammatory markers. However, small apo(a) wIS was associated with occlusion of the treated lesion(s) in the postoperative period [OR=2.32 (95% CI 1.08 to 4.9, p= 0.03)]. The relationship of small apo(a) wIS with re-intervention was not as strong [OR=1.59 (95% CI 0.97 to 2.62), p=0.07)]. We observed no association between wIS with patient reported symptoms or change in ABI. Conclusions: Subjects with small apo(a) isoform sizes undergoing peripheral arterial revascularization may be more likely to experience occlusion in the perioperative period and/or require re-intervention. Further studies identifying the mechanism and possible relationship of these findings to detrimental long-term peripheral vascular outcomes are warranted.
Abstract 12445: Intracardiac Thrombosis in COVID-19 Inpatients: A Nationwide Study of Incidence, Predictors and Outcomes
Authors: Tom Kai Ming K Wang, Ankit Agrawal, Suryansh Bajaj, Umesh Bhagat, Sanya Chandna, Aro Daniela D Arockiam, Nicholas Chan, Devesh Rai, Osamah Badwan, Shashank Shekhar, Shivabalan Kathavarayan Ramu, Divya Nayar, Wael A Jaber, Brian P Griffin
Journal: Circulation (2023)

Background: COronaVIrus Disease 2019 (COVID-19) has been observed to be associated with a hypercoagulable state. Intracardiac thrombosis are potentially serious complications but have seldomly been evaluated in COVID-19 patients. We assessed the incidence, associated factors, and outcomes of COVID-19 patients with intracardiac thrombosis. Methods: COVID-19 inpatients during 2020 were retrospectively identified from the national inpatient sample (NIS) database, and data retrieved regarding clinical characteristics, intracardiac thrombosis, and adverse outcomes. Multivariable logistic regression was performed to identify the clinical factors associated with intracardiac thrombosis and in-hospital mortality and morbidities. Results: A total of 1,683,785 COVID-19 inpatients were identified in 2020 from NIS, with mean age of 63.8±1.6 years and 32.2% were females. Overall in-hospital outcomes include all-cause mortality 13.2% (222,695/1,683,785), cardiovascular mortality 3.5%, cardiac arrest 2.6%, acute coronary syndrome (ACS) 4.4%, heart failure 16.1%, stroke 1.3% and acute kidney injury (AKI) 28.3%. Intracardiac thrombosis was present in 0.001% (1,830) patients. The main factors associated with intracardiac thrombosis were history of congestive heart failure, stroke, coagulopathy and male sex. Intracardiac thrombosis was independently associated with a higher risk of in-hospital all-cause mortality (OR: 3.32, 95%CI: 2.42-4.54, p&lt;0.001), cardiovascular mortality (OR: 2.95, 95%CI: 1.96-4.44, p&lt;0.001), cardiac arrest (OR: 2.04, 95%CI: 1.22-3.43, p=0.006), ACS (OR: 1.62, 95%CI: 1.17-2.22, p=0.003), stroke (OR: 3.10, 95%CI: 2.11-4.56, p&lt;0.001), and AKI (OR: 2.13 95%CI: 1.68-2.69, p&lt;0.001), but not incident heart failure (p=0.27). Conclusion: Although intracardiac thrombosis is rare in COVID-19 inpatients, its presence was independently associated with higher risks of in-hospital mortality and most morbidities. Prompt investigations and treatments for intracardiac thrombosis are warranted when there are high index of suspicion and a confirmed diagnosis respectively.
Abstract 12423: CAD Polygenic Risk Score, a Novel Screening Tool for Predicting Likelihood of Coronary Artery Disease, Was Not Superior to Coronary Calcium Score in Predicting MACE
Authors: Andrii Maryniak, Ninad Nadkarni, Aditya Singh, Catherine Hajek, Eric Larson, Shubhi Bartaria, SHAOPENG GU, Max Weaver, Jerome I Rotter, Xiuqing Guo, Naveen Rajpurohit, Marian S Petrasko, Adam Stys, Tom P Stys
Journal: Circulation (2023)

Introduction: Coronary artery calcium (CAC) score is a well-established tool for risk assessment of coronary artery disease (CAD). Alternatively, CAD polygenic risk score (PRS) is an emerging modality for assessing risk of CAD. Our study aims to compare the sensitivity and specificity of the above scores in predicting major adverse cardiovascular events (MACE). Hypothesis: CAD PRS is a better predictor of MACE than CAC score. Methods: Adult patients had CAD PRS, CAC and baseline characteristics documented through the Sanford Heart Screening Program from 2011 to 2021. Incidence of MACE, defined as myocardial infarction, stroke, death, and revascularization, was analyzed. Chi-squared tests were used to examine the impact of stratified risk scores and MACE. A logistic regression model was trained on 70% of the data to assess prediction accuracy on 30% of the data. Results: A total of 1,380 patients were analyzed. Mean age was 63, with female (65%) and Caucasian (99%) predominance. The prevalence of diabetes mellitus, hyperlipidemia, and hypertension was 8%, 32%, and 7%, respectively. The incidence of MACE was 6.6%. Patients with MACE had higher CAC (527.1±856.2 vs. 98.3±294.3) and CAD PRS (15.5±.62 vs. 15.24±.61). Sensitivity and specificity are represented by the receiver operating characteristic curve, which was used to assess prediction accuracy whereby area under the curve (AUC) was used as a measure of fit ranging from 0 to 1. The curves showed that CAC had better AUC than PRS (Figure 1). Conclusions: In our study CAD PRS failed to be a better predictor of MACE compared to CAC score.
Abstract 12433: miR 187a-3p Prevents Septic-Induced Myocardial Dysfunction by Targeting the Inflammatory Cytokines TNFa and IL-6
Authors: Amin M Ektesabi, James N Tsoporis, Chirag Vaswani, Shehla Izhar, Jean-Francois Desjardins, Thomas Parker, Howard Leong-Poi, Claudia dos Santos
Journal: Circulation (2023)

Introduction: Patients with severe, sepsis can develop acute heart failure characterized by left ventricular dilatation and decreased contractility. Inflammatory mediators, including TNFα, IL-6 and IL-1β contribute to the activation of inflammation and ventricular remodeling. Therapeutic interventions for sepsis are lacking. Previously, we demonstrated that miR187-3p, a regulator of TNFα is dysregulated in the septic heart, in a pre-clinical model of sepsis. Hypothesis: We hypothesize that administering miR187-3p mimic would reduce inflammatory cytokine production and improve cardiac function and mortality rate. Methods: Polymicrobial sepsis was induced in mice via cecal ligation and perforation (CLP) surgery, mice undergoing sham surgery served as controls. MiR187-3p mimic, miRNA negative control, or saline were administered IV 6 hrs post-CLP. At 48 hrs post-CLP, following echocardiographic and hemodynamic assessments, the mice were sacrificed, and the hearts collected for biochemical, and molecular analysis. To complement the experimental findings, autopsy human hearts and circulatory blood samples from septic patients and healthy controls were collected and the expression of miR187a-3p and inflammatory cytokines were analyzed. Results: Administration of miR-187-3p mimic to septic mice 6 hrs post-CLP increased survival, improved echo-derived indices of cardiac function (left ventricular ejection fraction, fractional shortening), increased bacterial clearance and reduced inflammation when compared to septic mice receiving a scrambled control miR. In septic mice, miR-187-3p expression decreased in both the circulation and heart tissue. In addition to TNFα, bioinformatic analysis, confirmed by luciferase assays, identified IL-6 as a specific target of miR187-3p in cardiac myocytes. In septic patients, the expression of miR-187-3p and target inflammatory cytokines decreased in plasma and autopsied hearts. Conclusions: Delivery of miR-187-3p improves outcomes in sepsis-induced myocardial dysfunction. Thus, miR-187-3p serves as a potential biomarker and therapeutic target for prevention and prognostic reflection in sepsis-induced myocardial dysfunction.
Abstract 12427: Prescribing Patterns of Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Agonists in Patients With Type 2 Diabetes at Cardiology, Endocrinology and Primary Care Visits in a Community Health System
Authors: Dave L Dixon, Amanda Robinson, Teresa Salgado, Salvatore Carbone, Tyler Wagner, Haroon Hyder, Bryan Kirschner, Kerri Musselman, Roy Sabo
Journal: Circulation (2023)

Introduction: Both SGLT2i and GLP-1 RA are cardio- and kidney-protective, yet their uptake in clinical practice has been poor. Prescribing patterns of these drug classes at cardiology, endocrinology, and primary care visits are not well understood. Research Questions: What proportion of patients with T2DM and ASCVD, HF, or CKD were prescribed an SGLT2i or GLP-1 RA, and which medical visits were these agents prescribed? Aim: To determine the prescribing rates of SGLT2i and GLP-1 RA at cardiology, endocrinology, and primary care visits. Methods: A cross-sectional study using EHR data from Bon Secours Mercy Health clinics across Virginia (2019, 2020, 2021) included patients ≥18 yo with T2DM and either ASCVD, HF, or CKD, and ≥1 outpatient visit. Adults with T1DM, ESRD, pregnancy, or on hospice or palliative care were excluded. Visit-level prescribing rates were compared overall and for each subgroup between cardiology, endocrinology, and primary care visits using generalized linear mixed modeling with a random practice-level effect. A positive prescription was considered a prescription for either medication for the overall analysis and a prescription of the preferred drug class according to comorbidities for each subgroup. The potential dependence between repeated measurements was estimated using a compound symmetric correlation structure. Results: The 22,060 included patients had a mean age of 68 years, 50% female, 41.3% black, 80% ASCVD, 24% CKD, and 27% HF. Overall, prescriptions for either drug class occurred in 17% of the population. Endocrinology visits had the highest prescription rates per visit overall and for each subgroup, while cardiology visits had the lowest prescription rate overall and for each subgroup (Table 1). Conclusion: Overall prescribing rates for SGLT2i and GLP-1 RA were low among adults with T2DM and ASCVD, HF, or CKD. Cardiology visits had the lowest prescription rates (0.3%) versus endocrinology (7.9%) and primary care visits (2.5%).
Abstract 12225: The Association of Intensive Blood Pressure Therapy to Mortality in Older Adults After an Injurious Fall. Geriatric Insights From SPRINT
Authors: Maziyah Ogarro, Arjun Ashok, Abdulla Damluji, Parag Goyal, Michael W Rich, Daniel E Forman, Matthew Solomon, Jamal S Rana, Ashok Krishnaswami, Min Ji Kwak
Journal: Circulation (2023)

Introduction: The primary finding of the Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that intensive (IT, &lt;120 mmHg) compared to standard (&lt;140 mmHg) blood pressure (BP) treatment on an index serious adverse event (SAE), injurious falls, was similar. However, mortality after the index fall has not been well studied. We hypothesized that the occurrence of falls may be associated with reduced mortality benefits. Methods: Using the publicly available SPRINT dataset we analyzed the association of IT on the primary outcome of all-cause mortality and the secondary outcome of non-cardiovascular (CV) mortality as a function of falls. Results: Among 9,361 SPRINT participants, 7.1% (n=666) had a fall. Falls were more likely in older adults (p&lt;0.0001), among women (45.9% vs 34.8%), and those with baseline cardiovascular disease (20.3% vs 16.4%). Among those who fell, 7.8% (52/666) died which was 14.2% of all deaths in SPRINT (52/365). In those who fell, mortality increased with age (p&lt;0.0001) and was highest in those ≥ 80 years (13.7%, Figure ). For all-cause mortality- Falls independently and significantly were associated with increased risk (HR 1.41,1.04-1.91, p=0.03 ) while IT significantly decreased the risk (HR 0.73, 0.60-0.91, p=0.004) . The joint effect (IT+Fall) demonstrated a non-significant increased risk (HR 1.03, 0.56-1.88, p int =0.92). For non-CV mortality- Falls independently and significantly were associated with increased risk (HR 1.63, 1.16-2.29, p=0.005) while IT did not significantly lower risk (HR 0.81, 0.63-1.03, p=0.09) . The joint effect (IT+Fall) demonstrated a non-significant increased risk (HR 1.21, 0.63-2.35, p int =0.56). Conclusions: Our findings suggest that current reporting of potential harm of the treatment effects of IT, measured by the index SAE, may underrepresent true risk and overstate treatment benefits.