tbuckley/cabot-search huggingface dataset:
Abstract 4147608: Trends in Mortality and 30-Day Readmission Rates Among Heart Failure Patients Undergoing Cardiac Rehabilitation: A Nationwide Analysis from 2017 to 2020
Authors: Henry Aiwuyo, Mayank Jha, Jamal Perry, Oluwasegun Akinti, Yonael Ayinalem, Yonathan Asfaw, Anna Nevolina, Rita Offor, Bisrat Nigussie, Ekenedilichukwu Nnadi, Cristina Mitre
Journal: Circulation (2024)

Background: Heart failure (HF) is a significant public health concern, affecting approximately 6.2 million adults in the United States, with high mortality and readmission rates. Cardiac rehabilitation (CR) programs have been widely recognized as a crucial component of HF management, aiming to improve physical function, reduce symptoms, and enhance quality of life. Despite the established benefits of CR, there is a need to understand the trends in mortality and readmission rates among HF patients participating in these programs. We aim to analyze mortality and 30-day readmission rate trends among heart failure patients undergoing cardiac rehabilitation from 2017 to 2020 using NRD data. Hypothesis: We hypothesize a significant downward trend in mortality rates and significant yearly variation in 30-day readmission rates among heart failure patients undergoing cardiac rehabilitation. Methods: We analyzed NRD data from 2017 to 2020, including patients with ICD-10 codes I50 (heart failure) and Z5189 (cardiac rehabilitation). Trend analyses were performed using Ordinary Least Squares (OLS) regression for mortality rates and the Cochrane-Armitage test for binary data. Multivariate regression adjusted for age, sex, and comorbidities. Statistical analyses were conducted using STATA version 18. Results: From 2017 to 2020, annual mortality rates were 6.9% (95% CI: 0.95% to 12.85%), 5.5% (95% CI: 0.47% to 10.52%), 4.6% (95% CI: -0.51% to 9.68%), and 1.9% (95% CI: -1.90% to 5.74%), respectively. The mean age was 78 years, with 54% were female. OLS regression showed a significant downward trend in mortality (p = 0.025), while the Cochrane-Armitage test did not (p = 0.998). Multivariate regression also indicated a downward trend, though individual predictors were insignificant (p=0.576). For 30-day readmission rates from 2017 to 2020, annual margins were 21.5% (2017), 21.7% (2018), 18.0% (2019), and 34.3% (2020), showing significant yearly variation. Conclusion: Despite the varying range of 30-day readmission within the years of interest, there seems to be a significant downward trend in mortality for heart failure patients who underwent cardiac rehabilitation. Further studies are required to corroborate these findings as understanding CR program outcomes can help identify improvement areas, guide resource allocation, and inform healthcare policy decisions.
Abstract 4141472: Birthweight is Associated with Left Ventricular Mass Index in Childhood
Authors: Jordan Sill, Jessica Woo, Elaine Urbina
Journal: Circulation (2024)

Introduction/Background: Increased left ventricular mass (LVM) is a risk factor for adult CV disease and is associated with cardiac development in utero. Associations of birthweight with LVM have been demonstrated in young children and adolescence, however, the association between birth weight and LVM in mid-childhood is not well described. Research Questions/Hypothesis: Utilizing an existing longitudinal data set of healthy children, we aimed to determine the association of birthweight to increased LVM at 6-8 years of age. Methods/Approach: A longitudinal cohort of 372 term-born children was enrolled at age 3 and followed until age 6-8 years. Anthropometrics, echocardiography, and maternal recall of birth weight were collected. LVM from echocardiography was indexed to height 2.7 . Multiple linear regression analysis was performed to assess the association of birthweight with LVM index at 6-8 years of age, adjusting for race, sex, body mass index (BMI) z-score, and systolic blood pressure (SBP) percentile collected at the time of echocardiography. Results: 303 children were included in the analysis (21.5% Black and 88.5% White, mean age 7.4 ± 0.3 years at the time of echocardiography, mean birthweight 3.4 ± 0.6 kg, mean SBP percentile 42.7 ± 21.6 percentile). Greater birthweight significantly contributed to greater LVM index (1.2 ± 0.6, p = 0.03), along with Black race (1.9 ± 0.8, p = 0.02) and greater current BMI z-score (2.1 ± 0.3, p &lt; 0.01). Sex and SBP percentile were included in the model but were not significantly related to LVM index (p = 0.23 and 0.51 respectively) in this analysis. Conclusions: Greater birthweight is significantly associated with greater left ventricular mass in childhood, independent of BMI z-score at the time of echocardiography. This suggests a critical period in fetal cardiac development that affects cardiac structure in mid-childhood.
Abstract 4147616: Targeting Skeletal Muscle Growth Improves Diastolic Dysfunction and Left Ventricular Hypertrophy in Obesity-Related Diabetic Cardiomyopathy
Authors: Tomas Baka, Fuzhong Qin, Aifeng Zhang, Salva Yurista, david pimentel, Varshith Kotagiri, Hunter Smith, Adam Lehar, Thomas Stoklasek, Wilson Colucci, Se-Jin Lee, Ivan Luptak
Journal: Circulation (2024)

Background and Significance: Mice fed a high-fat, high-sucrose (HFHS) “Western” diet develop a cardiac phenotype similar to patients with type 2 diabetes mellitus-related heart failure with preserved ejection fraction (HFpEF). This includes obesity, insulin resistance, left ventricular hypertrophy (LVH), and diastolic dysfunction. Skeletal muscle is responsible for up to 80% of whole-body glucose disposal, making the relationship between muscle mass and insulin resistance crucial for identifying new therapeutic targets in HFpEF. Myostatin is an evolutionally conserved skeletal muscle growth-limiting signaling molecule. Although whole-body deletion of myostatin/activin signaling (MAS) promotes skeletal muscle hypertrophy (SH) and provides metabolic benefits, overall benefits are complicated by direct inhibition in the myocardium. Hypothesis: Sedentary mice with skeletal muscle-specific deletion of MAS will be protected from the adverse cardiac effects of HFHS diet. Methods and Results: BL6 mice with floxed alleles for myostatin Acvr2 and Acvr2b receptors were crossbred with mice expressing Cre recombinase from a myosin light chain promoter, rendering the MAS downregulation skeletal muscle specific. Four months of HFHS feeding resulted in similar increase in body weight between Cre+ and Cre- (34% and 37%, respectively). SH was present in Cre+ mice as the muscle weight/tibia length ratio of m. pectoralis, triceps and quadriceps was elevated by 44, 22 and 25%, respectively. Oral glucose tolerance was improved in Cre+ vs Cre-. Echocardiography showed improved LV hypertrophy and diastolic function (increased E/A ratio and Em by 27 and 21%) in the Cre+ group. Moreover, exercise capacity was improved in Cre+ mice by 59%. Conclusion: Our novel study demonstrates that targeting skeletal muscle growth through the inhibition of MAS, without direct cardiac effects, can ameliorate the cardiac dysfunction associated with obesity-related diabetic cardiomyopathy. Increased muscle mass improves glucose tolerance, LVH, and diastolic function, demonstrating skeletal muscle-to-myocardium cross-talk. This highlights the potential for muscle-targeted therapies in managing HFpEF, particularly in insulin-resistant conditions.
Abstract 4145834: Comparison of 30-Day Outcomes of TAVR vs. SAVR in Patients with Prior CABG: A Meta-Analysis
Authors: Muhammad Ahmad Qureshi, Shahan Haseeb, Danyal Bakht, Maaz Amir, Muqaddas Hussain, Omair Ahmed, Aqeeb Ur Rehman, Hafsa Ahmed, Umair Ansari, Shafia Munir, Muhammad Zulqarnain, Ali Akram Qureshi
Journal: Circulation (2024)

Introduction: Managing severe aortic stenosis in patients with a history of coronary artery bypass grafting (CABG) is challenging. Traditionally, surgical aortic valve replacement (SAVR) was the standard treatment, but transcatheter aortic valve replacement (TAVR) offers a less invasive alternative. This meta-analysis compares the 30-day outcomes of TAVR versus SAVR in patients with prior CABG. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Studies comparing TAVR and SAVR in patients with prior CABG were included. The primary outcomes were 30-day (cardiovascular) CV mortality, all-cause mortality, stroke, and myocardial infarction. Heterogeneity was assessed using the Chi-squared test and I-squared statistic. P value &lt;0.05 was considered statistically significant. Results: Nine studies with a total of 8,487 patients were included for the 30-day outcomes. The pooled odds ratio (OR) for 30-day CV mortality was 1.00 (95% CI: 0.48-2.06), with no significant difference between TAVR and SAVR (p=0.99). For 30-day all-cause mortality, the pooled OR was 0.75 (95% CI: 0.51-1.10), also showing no significant difference between TAVR and SAVR (p=0.14). The pooled OR for 30-day myocardial infarction was 0.34 (95% CI: 0.09-1.27), indicating no significant difference between TAVR and SAVR (p=0.11). However, the pooled OR for 30-day stroke was 0.67 (95% CI: 0.50-0.90), showing a significantly lower incidence with TAVR compared to SAVR (p=0.007). Detailed results in Figure 1. Conclusion: In patients with a history of CABG, TAVR appears to have comparable 30-day outcomes to SAVR in terms of CV mortality, all-cause mortality, and myocardial infarction. However, TAVR is associated with a significantly lower incidence of 30-day stroke. These findings suggest that TAVR may be a safer option in the short term for this high-risk patient population. Further research is needed to confirm these results in larger, randomized controlled trials.
Abstract 4147647: Effects on Cognition, Sleep, Quality of life and Exercise Capacity of a 12-week Tele-yoga Intervention in Persons with Heart Failure - Results from 3 and 6 Months Follow-up
Authors: Anna Stromberg, Leonie Klompstra, Joanna-Maria Papageorgiou, Towe Hedbom, Dola Pathak, Marie Lundberg, Lotti Orvelius, Ingela Thylen, Tiny Jaarsma
Journal: Circulation (2024)

Background and Objectives: Yoga may be a promising form of mind-body rehabilitation for patients with long term illness. Digitally delivered yoga increases access to participation but has not previously been evaluated in the heart failure population. The aim of this study was to examine the effects of tele-yoga on cognition, sleep, health-related quality of life and exercise capacity in persons with heart failure. Methods: The Tele-yoga study (ClinicalTrials.gov, ID: NCT 03703609) was a parallel two-arm randomised controlled trial (RCT) with 1:1 distribution to an intervention and control group. Study participants were randomised to tele-yoga including live-streamed group-yoga for 60 minutes twice weekly during 12 weeks and yoga individually for 10 minutes/day using an app, or to a control group receiving individual exercise advice. Cognition (Montreal Cognitive Assessment: MoCA), sleep (minimal insomnia symptom scale; MISS), health-related quality of life (EQ-5D VAS) and sub-maximal exercise capacity (6 minute walk test; 6MWT) were assessed at baseline, after 3 and 6 months. Linear mixed model with random intercept for patients as the random effect and group-time interaction along with age was taken as the fixed effects to analyse outcomes. Results: A total of 311 participants were included (tele-yoga n=156 and active controls n=155), mean age 66 years, 70% men. Adherence to the group yoga was very good. The linear mixed models showed a significant change in cognition, health-related quality of life and exercise capacity favouring the tele-yoga group. No significant differences between the groups were seen regarding sleep. When analysing the fixed effects of all outcomes, age, group assignment and time-points interaction had significant effects on EQ-5D VAS score, 6MWT distance and MoCA scores. For EQ-5D VAS the tele-yoga group performed significantly better than the control group at 3 months, but not at 6 months. For the 6MWT distance, the tele-yoga group performed better than the control group at 3 months, but not at 6 months. The tele-yoga group had significantly higher MoCA scores than the control group at both 3 and 6 months. Conclusion: This adequately powered RCT showed that digitally delivered mind-body training in the format of group and individual yoga during 12 weeks lead to an improvement in cognition, quality of life and exercise capacity at the end of the intervention. The effect was sustained for cognition also after 6 months.
Abstract 4145845: The Impacts of Albumin Levels on Clinical Outcomes in Patients in the Coronary Care Unit
Authors: Yu-Yu Lu, Chin-Chou Huang
Journal: Circulation (2024)

Background: Hypoalbuminemia is frequently observed in critically ill patients, yet its significance regarding short-term mortality among these patients remains uncertain. We aimed to investigate the impact of albumin levels and their changes on clinical outcomes among patients who were admitted to intensive care units due to cardiac causes. Methods: This is a retrospective, single-center, cohort study. Consecutive patients admitted to coronary care unit (CCU) were enrolled between January 2011 and December 2020. Serum albumin levels were obtained upon CCU admission and tracked for changes. Clinical outcomes were defined as 30-day mortality. Results: A total of 4,004 patients were enrolled. Among them, 1,129 (28.2%) had acute coronary syndrome, 1,915 (47.8%) had coronary artery disease, 1,039 (25.9%) had arrhythmia, and 1,825 (45.6%) had heart failure. There were 643 deaths and 3,361 survivors within 30 days. When comparing to survivors, those who died within 30 days had lower initial albumin levels (3.2 ± 0.9 vs. 3.4 ± 0.8, P &lt; 0.001) and albumin level reduction (-0.1 ± 0.9 vs. 0.0 ± 0.9, P = 0.005). Cox regression multivariate analysis indicated that higher initial albumin levels (HR, 0.638; 95% CI, 0.538 – 0.756, P &lt; 0.001) and increase in albumin levels (HR, 0.638; 95% CI, 0.541 – 0.752, P &lt; 0.001) were independently associated with lower 30-day mortality rates. Conclusions: Higher initial albumin levels and increase in albumin levels were linked to better clinical outcomes in patients admitted to CCU.
Abstract 4140169: Neonatal Electroencephalogram Alpha:Delta changes precede neurologic injury during Antegrade Cerebral Perfusion and Deep Hypothermic Circulatory Arrest
Authors: Gabrielle Orie, Michael Swartz, Aubrey Duncan, Laurie Seltzer, Shuichi Yoshitake, George Alfieris
Journal: Circulation (2024)

Background: Although neurologic injury commonly occurs following neonatal aortic arch reconstruction, the mechanism(s) are poorly understood. A decrease or inter-hemispheric difference in the electroencephalogram (EEG) Alpha:Delta ratio (A:D) precedes cerebral ischemia during antegrade cerebral perfusion (ACP). However, it is unknown if A:D changes precede neurologic injury during deep hypothermic circulatory arrest (DHCA). We hypothesized during DHCA, the A:D would decrease and that a significant A:D inter-hemispheric difference would precede neurologic injury. Methods: Neonates requiring aortic arch reconstruction underwent simultaneous quantitative EEG monitoring. Left vs. right hemispheric, anterior, and posterior A:Ds were recorded at baseline, arterial cannulation, cooling, ACP vs. DHCA, and the rewarming phases of the operation. Left vs. right A:D differences &gt; 25% were considered significant for ischemia and the cumulative duration of a significant A:D inter-hemispheric difference was calculated. Post-operative neurologic injury was defined as either stroke or seizure. Results: From 86 neonates, 16.2 % (14) required DHCA and 83.8 % (72) ACP. There were no significant differences in the pre-operative demographics or baseline A:Ds between groups. Although the A:Ds remained similar during ACP, after 15 minutes the hemispheric A:Ds decreased significantly during DHCA (Figure 1). Eleven neonates (ACP-7 vs. DHCA-4) developed neurologic injury. The duration of an anterior A:D inter-hemispheric difference &gt; 25% was significantly greater within neonates that developed neurologic injury (25 {IQR:0,65 minutes} vs. 5 {IQR: 0, 15 minutes}; p&lt;0.001). Multivariate analysis demonstrated that the duration of an anterior A:D difference &gt; 25% was independently associated with neurologic injury using either ACP or DHCA (Odds Ratio:1.081, 95% CI: 1.025, 1.141; p-value=0.004). Conclusion: Unlike ACP, the A:D decreased significantly during DHCA. During either DHCA or ACP, a significant anterior inter-hemispheric A:D difference was independently associated with neurologic injury and suggests the importance of quantifying the A:D during neonatal arch reconstruction.
Abstract 4145883: Elevated International Normalized Ratio Is Associated with Severity of Intracerebral Hemorrhage for Patients Taking Direct Oral Anticoagulants
Authors: Jay Lusk, jie-lena sun, Brian Mac Grory, Lee Schwamm, Eric Smith, Gregg Fonarow, Deepak Bhatt, Jeffrey Saver, Mathew Reeves, Roland Matsouaka, Ying Xian
Journal: Circulation (2024)

Introduction/Background: While the international normalized ratio (INR), a marker of functioning of the extrinsic and final common pathways of the coagulation cascade is associated with increased intracerebral hemorrhage (ICH) mortality for patients taking warfarin, it is not understood how it might be associated with outcomes in patients taking direct oral anticoagulants (DOACs), given the inconsistent and variable effect of DOACs on INR. Research Questions/Hypothesis: To determine whether INR is associated with increased ICH severity in patients with recent exposure to a DOAC. Methods/Approach: We included patients taking Apixaban or Rivaroxaban prior to acute presentation with ICH to hospitals participating in the Get With the Guidelines - Stroke registry, a nationwide quality improvement registry. The primary exposure was INR, which we modeled as a continuous variable with restricted cubic splines. The primary endpoint was stroke severity on presentation, measured by the National Institutes of Health Stroke Scale (NIHSS). Secondary endpoints included Glasgow Coma Scale (GCS) &lt;=8 on admission, in-hospital mortality, composite of in-hospital mortality and discharge to hospice, and modified Rankin Scale (mRS) at discharge. We adjusted for key confounding factors, specifically age, sex, race/ethnicity, insurance status, and medical history, while taking into account within-hospital clustering. Results/Data: In total, 13,251 patients were included of whom 7,545 were exposed to apixaban and 5,706 were exposed to rivaroxaban. As shown in Table 1, for patients taking Apixaban, elevated INR was associated with increased likelihood of NIHSS &gt;=21 (aOR 1.02 [95% CI 1.00-1.04, p=0.03] per 0.1 above 1.1) and in-hospital mortality (aOR 1.11 [95% CI 1.05-1.16, p&lt;.001) per 0.1 above 1.1). For patients taking Rivaroxaban, similar trends were seen (aOR 1.21 [95% CI 1.08-1.35, p&lt;.001] per 0.1 up to 1.2 for NIHSS &gt;=21, aOR 1.13, [95% CI 1.09-1.16, p&lt;.001] per 0.1 up to 1.6, for in-hospital mortality). Conclusion(s): Elevated INR at admission is associated with worsened ICH severity for patients taking Apixaban or Rivaroxaban.
Abstract 4146306: Rural Urban Disparities in Inpatient Outcomes of Chronic Limb-Threatening Ischemia in the United States
Authors: Aman Goyal, Mohammed Quazi, Amir Sohail, Abu Baker Sheikh
Journal: Circulation (2024)

Background: Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease characterized by chronic ischemic rest pain, non-healing wounds, or gangrene in one or both legs. With prevalence rates of 1-2% in the United States (increasing with age, with over 20% of adults over 70 diagnosed with CLTI) and 1-year mortality rates approaching 20-25%, CLTI is a critical public health issue due to its significant impact on patient morbidity, mortality, and healthcare resources. Aims: To understand if disparities exist between rural and urban inpatient outcomes for patients with CTLI. Methods: A retrospective analysis of the National Inpatient Sample database from 2016 to 2021 was conducted to identify patients admitted with CLTI according to ICD-10 codes. Patients were stratified by rural and urban status, followed by propensity-matched analysis to compare inpatient outcomes between these groups. Results: A total of 2,667,279 patients with CLTI, with 445255 (16.7%) categorized as rural status and the remaining 83.3% categorized as urban status, were included in this study. Patients belonging to rural status had an increased odds of in-hospital mortality (aOR)=1.35; 95% CI 1.26-1.45; p&lt;0.001), in-patient sudden cardiac arrest (aOR=1.27; 95% CI=1.13-1.43; p&lt;0.001), cerebrovascular accidents (aOR=1.31; 95% CI=1.19-1.45; p&lt;0.001), venous thromboembolism (aOR=1.18; 95% CI=1.09-1.27; p&lt;0.001), surgical site infection (aOR=1.25; 95% CI=1.16-1.35; p&lt;0.001), requirement for vasopressors (aOR=2.02; 95% CI=1.76-2.32; p&lt;0.001), invasive (aOR=1.18; 95% CI=1.10-1.26; p&lt;0.001) and non-invasive (aOR=1.37; 95% CI=1.25-1.50; p&lt;0.001) mechanical ventilation, hemodialysis (aOR=1.11; 95% CI=1.06-1.15; p&lt;0.001), major amputation (aOR=1.38; 95% CI=1.32-1.43; p&lt;0.001), surgical revascularization (aOR=1.53; 95% CI=1.46-1.60; p&lt;0.001), endovascular revascularization (aOR=1.53; 95% CI=1.46-1.60; p&lt;0.001), and blood transfusion (aOR=0.92; 95% CI=0.88-0.97; p=0.001). No difference was observed in the odds of acute myocardial infarction (aOR=1.06; 95% CI=0.99-1.14; p=0.082) and risk of acute kidney injury (aOR=0.99; 95% CI=0.96-1.02; p=0.485). Conclusions: Disparities in CLTI outcomes are evident, with patients from rural areas experiencing worse outcomes than their urban counterparts. Future research should focus on understanding the underlying causes of these disparities and developing targeted interventions to bridge the gap between rural and urban health care outcomes.