tbuckley/cabot-search huggingface dataset:
Abstract 4139443: Patient Decision Aids and Encounter Decision Aids Improve Shared Decision Making and Patient Knowledge About Stroke Prevention In Patients with Atrial Fibrillation
Authors: Angie Fagerlin, Geoffrey Barnes, Kenzie Cameron, Kerri Cavanaugh, George Crossley, Tom Greene, Preeti Kansal, Victor Montori, Peter Noseworthy, Rod Passman, Dan Roden, Benjamin Steinberg, Daniel Witt, Elissa Ozanne
Journal: Circulation (2024)

Background: Guidelines recommend shared decision-making (SDM) for patients with atrial fibrillation (AF) making decisions regarding anticoagulation for stroke prevention. Decision support tools (e.g., Decision Aids [DAs]) facilitate SDM. However, little research has compared the effectiveness of the two most common types of DAs: (1) encounter decision aid (EDA) and (2) pre-encounter patient decision aid (PDA). Our study assessed the comparative effectiveness of PDAs and EDAs on SDM during AF clinical encounters where stroke prevention strategies were discussed. Research Question: Do decision aids (PDA or EDA), alone or in combination, improve patients’ AF decision-making experience compared to usual care? Methods: A cluster randomized multi-center trial in patients with AF comparing usual care (no DA) vs. one DA (EDA or PDA) or both DAs. Clinicians and patients were randomized independently into 4 study arms. Clinicians were randomized to use or not use the EDA for all study visits, and patients were randomized to use or not use the PDA. Co-primary outcome domains were: (1) quality of SDM (2) patient knowledge, and (3) decisional conflict. Secondary outcomes included: (1) treatment choice, (2) treatment initiation, and (3) treatment persistence. Patient characteristics were assessed. We will present comparisons of the randomized DAs on the co-primary and secondary outcomes and subgroup analyses. Results: Between December 2020-July 2023, investigators in 6 U.S. healthcare systems enrolled 1117 patients (mean (M) age 69, 63% male, 89% White) and 107 clinicians. Compared to usual care (no DA, M=31.6), SDM was better in patients receiving PDA (M=35.4) and EDA (44.5) alone or together (M=43.7; p’s&lt;0.001). Knowledge about AF was greatest for those receiving both DAs or the PDA alone (84% accurate responses for PDA and both vs 76% with no DA, p&lt;0.001), followed closely by the EDA alone (82%, p=0.003). Finally, both DAs (M=19.5) and EDA alone (M=20.0) had better decisional conflict scores compared to usual care (M=25.8; p’s&lt;0.001). We will present analyses that assess the impact of DAs on secondary outcomes and interactions with DA, patient, and clinical characteristics across each outcome. Conclusions: In one of the first randomized trials examining the comparative effectiveness of EDAs and PDAs on SDM in clinical medicine, both PDAs and EDAs improved shared decision-making, decisional conflict, and knowledge compared to patients receiving usual care.
Abstract 4139569: The Importance of Family-Focused Care In The Evaluation of Children with Aortic Dilation
Authors: Bradley Schwartz, Lois Starr, Drew Cratsenberg, Angela Yetman
Journal: Circulation (2024)

Background: Most connective tissue disorders (CTD) that cause aortic dilation (AoD) are hereditary. Children suspected of CTD may be referred to a pediatric cardiology or genetics clinic (PC) where the focus of care is on the child. While recommendations for screening of adult family members may be made, it is not typically performed on-site leading to potential gaps in care. We sought to evaluate the impact of a family-focused cardiovascular genetics (CVG) clinic on outcomes and to compare the impact of such a clinic to PC in preventing premature adverse aortic events (AE) in patients and family members. Methods: A retrospective records review of all pediatric (age &lt; 21 years) encounters for CTD performed during the current era of genetic testing was conducted. Patients were included if AoD was identified. Location of initial clinic visit (PC vs. CVG) was noted. Children referred for a family history of known AoD were excluded. Recommendation for-, completion of-&amp;results of- family screening were noted. Preventable adverse events, defined as AoD-related death/dissection in an undiagnosed proband or family member occurring after initial clinic encounter were recorded. Screening practices&amp;outcomes were compared between clinic types. Results: Of 154 children who met inclusion criteria with a mean age of 11.1 (+/- 9.3) years, initial evaluation was performed in PC in 94 (61%)&amp;CVG in 60 (39%) patients. Screening was recommended in 37 (39%) vs. 60 (100%) families seen in PC vs. CVG clinic (p&lt;0.00001) and was completed in 23/37 (70%) referred by PC (average of 2.1 (+/- 1.2) family members screened), vs 53/60 (88%) in CVG (average of 3.8 (+/- 5.9) family members screened) (p=.002). Of the 47 screened in PC, 30 (64%) were found to have AoD or the same pathogenic mutation as the proband, compared to 99 (43%) of 230 family members in CVG clinic. Preventable AE occurred in 4 (4%) probands and 30 (31%) families seen in PC compared to 0 probands and 6 (10%) families in CVG (p=.38 for probands, p=.002 for families). Of the 154 families, pathogenic variants in FBN1 [77], TGFBR1 [5], TGFBR2 [9], Col3A1 [4], SMAD3 [6], and other genes [25] were identified as the source of AoD. Gene negative hereditary thoracic aortic aneurysm disease was suspected in 22 (14.3%). Conclusion: When a child is diagnosed with a hereditary aortopathy, whole family screening is essential to preventing AE. Clinics offering family-based care facilitate timely diagnosis in other family members.
Abstract 4139444: Benign Metastasizing Leiomyoma: A Challenging Case with Multifocal Involvement in the Heart, Liver, and Uterus
Authors: Huong Vu, Hanh Bui, Hai Huynh, Duc Vo, Le Huu Nhat Minh, Hien Nguyen
Journal: Circulation (2024)

Case Presentation: A 39-year-old Southeast Asian female presented with fatigue and exertional dyspnea. She underwent a myomectomy four years ago. Examination showed vital signs within normal limits, except for an SpO2 of 87%. Blood tests indicated microcytic hypochromic anemia and elevated D-Dimer levels of 1479 ng/mL. A transthoracic echocardiogram revealed a large mass occupying almost the entire right atrium, extending into the inferior vena cava. A CT scan showed a large, low attenuation, and minimally enhanced mass extending from the right atrium into the inferior vena cava and right hepatic vein, possibly invading segments VII-VIII of the liver (Figure 1). Abdominal CT and MR images revealed multiple degenerating uterine fibroids, bilateral dilated uterine tubes, and mild right hydronephrosis (Figure 2). The patient underwent surgical removal of the cardiac mass under general anesthesia with extracorporeal circulation and hypothermia. Pathological examination confirmed a benign tumor characterized by bundles of smooth muscle cells (Figure 3). Immunohistochemical staining with Actin (+), Progesterone receptor (+), Desmin (+), Ki67 (+) was consistent with a diagnosis of benign metastasizing leiomyoma (BML) of the heart. Subsequently, elective hysterectomy and bilateral salpingo-oophorectomy were performed. Discussion: Although rare, uterine leiomyoma can exhibit metastatic behavior, disseminating to extraneous anatomical sites. BML should be considered in the differential diagnosis when patients present with an atypical cardiac mass and have a history of uterine leiomyoma, myomectomy, or hysterectomy. BML of the heart is an exceptionally rare condition, predominantly affecting middle-aged women who have undergone hysterectomy or myomectomy. While BML commonly occurs in pre-menopausal patients and shares a potentially similar mechanism with endometriosis, as indicated by its response to estrogen-blocking agents, the occurrence of BML in post-menopausal women suggests the involvement of other contributing factors. Multiple imaging modalities play a significant role in the diagnosis and preparation for surgical management.
Abstract 4140051: Healthcare utilization trends for adolescents and young adults with moderate and severe congenital heart disease
Authors: Victoria Yatsenko, Sarah Mathena, Jennifer Andrews, brent barber, Andrew Hoyer, Kenneth Fox, Omar Meziab, Claudia Guerrero, Scott Klewer, Michael Seckeler
Journal: Circulation (2024)

Background: Improved congenital heart disease (CHD) care allows &gt;90% of patients to live into adulthood, but young adult CHD patients are challenged by managing their own care as well as the risk of other comorbidities that may increase healthcare resource utilization. There is limited data on hospitalizations of adolescents with CHD, specifically during the transition from pediatric to adult care. Hypothesis: We hypothesized that as adolescents age into adult care, utilization of healthcare resources will increase. Methods: We conducted a retrospective review of the Vizient® Clinical Data Base (national, administrative database) for admissions from 10/2019-12/2023 aged 10-29 years with ICD-10 codes for moderate or severe CHD and stratified into age categories (10-14, 15-19, 20-24 and 25-29 years). Data included: demographics, hospital outcomes, insurance status, costs and admissions through the Emergency Department (ED). Comparisons were made using ANOVA for normally distributed data and χ 2 for categorical data; Bonferroni test was used for post-hoc analysis. A p -value &lt;0.05 was considered significant. Results: There were 16,284 admissions during the study period; details in Table 1. With increasing age, there was an increase in female admissions, an increasing prevalence of Whites individuals and decreasing prevalence of Hispanic individuals. There was a decrease in public insurance and an increase in uninsured status and ED admissions with increasing age. Complications increased between 10-14 to 25-29 years old. Mortality rates had peaks at 15-19 years old and 25-29 years old. Despite increased ED visits, complications and mortality, costs decreased between the younger age groups and older age groups. Conclusions: There is an increase in uninsured status and ED admissions for hospitalized young adults transitioning from pediatric to adult care. Despite this trend, overall hospital costs decrease, which may be due to more procedural admissions in children and adolescents. More studies are needed to help guide improvements in care during this at-risk time.
Abstract 4139234: Association of Social Determinants of Health (SDOH) with Incident Hypertension and Mediation by Epigenetic Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Mindy Szeto, Hongyan Ning, Havisha Pedamallu, Yinan Zheng, Lisa Schneper, Orna Reges, Lifang Hou, Norrina Allen, Daniel Notterman, Donald Lloyd-Jones
Journal: Circulation (2024)

Background: Social disadvantage, estimated by social determinants of health (SDOH) measures, is associated with subsequent incident hypertension (inc-HTN). We sought to determine whether associations between SDOH and inc-HTN may be mediated by epigenetic changes in DNA methylation represented by GrimAge acceleration (GrimAA). Methods: The CARDIA study enrolled 5,115 Black and white men and women participants (ppts) in 1985-1986. The current analysis focused on 3,067 participants with SDOH data and without HTN at CARDIA exam year 15 (Y15) in 2000-2001. Social disadvantage was defined by variables representing the 5 domains of SDOH: difficulty paying for basics, medications, or healthcare; food insecurity; census tract poverty; residential racial segregation; and parental education. GrimAA (a summary measure of DNA methylation) at Y15 was calculated as the difference between epigenetic age and chronological age. Inc-HTN was defined as blood pressure ≥140/90 or treatment after Y15. Age-, sex-, and race-adjusted Cox regression models assessed associations between each SDOH variable with inc-HTN prior to formal mediation analysis by GrimAA. Results: Study ppts had a mean age of 40y, 42.5% self-identified as Black, and 63.6% as female. Greater social disadvantage in every SDOH domain was associated with higher proportions of inc-HTN. Difficulty paying for basics or medications, the summed difficulty paying index, food insecurity, and parental education were each significantly associated with inc-HTN on adjusted Cox regression (Table). For example, those with food insecurity had a 34% higher hazard for inc-HTN (hazard ratio [HR] 1.34; 95% CI 1.12-1.60). Each level of parental education (e.g., completed college vs high school) was associated with 19% lower hazard for inc-HTN (HR 0.81, 95% CI 0.73-0.90). GrimAA mediated 14.6% of the food insecurity/inc-HTN association, and 34.9% of the parental education/inc-HTN association. Conclusions: Social disadvantage measures are associated with inc-HTN. DNAm measured by GrimAA appears to statistically mediate associations of SDOH with inc-HTN, suggesting potential molecular mechanisms by which SDOH may get “under the skin” to accelerate development of HTN over the life course.
Abstract 4139708: Social determinants of health in early pregnancy and racial and ethnic differences in cardiovascular health 2-7 years after delivery
Authors: Xiaoning Huang, Lucia Petito, Lynn Yee, Natalie Cameron, David Haas, Brian Mercer, Samuel Parry, George Saade, Robert Silver, Hy Simhan, Uma Reddy, Jasmina Varagic, Ernesto Licon, Philip Greenland, Donald Lloyd-Jones, Rebecca McNeil, Kiarri Kershaw, William Grobman, Sadiya Khan, kartik venkatesh
Journal: Circulation (2024)

Background: Racial and ethnic disparities exist in cardiovascular health (CVH) in pregnancy. While social determinants of health (SDOH) affect CVH, the extent to which SDOH assessed in early pregnancy explain racial and ethnic differences in CVH postpartum remains to be defined. Objective: This study examines the relative contribution of SDOH in early pregnancy to racial and ethnic differences in maternal CVH 2-7 years after delivery. Methods: This is a secondary analysis of the prospective nulliparous pregnancy outcomes study: Monitoring Mothers-to-be Heart Health Study (nuMoM2b-HHS) cohort. The outcome was maternal CVH defined using the American Heart Association’s Life’s Essential 8 (LE8) framework, which included body mass index, blood pressure, lipids, fasting glucose, diet, physical activity, sleep health, and smoking status, and calculated as a score of 0-100. We used the Blinder-Oaxaca decomposition to quantify the statistical contributions of differences in demographic (age and nativity), socioeconomic status ([SES], education, income, insurance, and health literacy), and psychosocial (resilience, social support, anxiety, depression, and stress) factors in early pregnancy to differences in mean postpartum CVH between the two largest self-identified minoritized racial and ethnic groups (non-Hispanic [NH] Black and Hispanic) and NH White individuals. Results: Of 4,161 assessed pregnant individuals, 17.7% identified as Hispanic, 15% as Black, and 67.3% as White. After adjusting for demographic, SES, and psychosocial factors, the average CVH score in White individuals was 12.2 (SE 1.2) points higher (better) than in Black individuals and 3.3 (SE 0.8) points higher than in Hispanic individuals ( Figure , all p&lt;0.001). If the distribution of SES factors among Black and Hispanic individuals were similar to White individuals, the CVH score would be 6.6 (SE 0.8) points higher (better) in Black individuals (i.e., 50% of the CVH difference) and 3.9 (SE 0.6) points higher in Hispanic individuals (i.e., 100% of the CVH difference). Conclusions: The majority of racial and ethnic differences in CVH 2-7 years after delivery were explained by differences in SES factors present in early pregnancy. Public health and structural policies that target SES factors in or before pregnancy may reduce racial and ethnic disparities in postpartum maternal CVH.
Abstract 4139425: Timing of Percutaneous Coronary Intervention for Non-infarct-related Coronary Artery in Patients with Acute Myocardial Infarction and Multivessel Disease: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials
Authors: Toshiaki Toyota, Kanna Nakamura, Madoka Sano, Yuta Azumi, Hayashi Hideyuki, Ryosuke Murai, Junichi Ooka, Yasuhiro Sasaki, Tomohiko Taniguchi, Kitae Kim, Atsushi Kobori, Natsuhiko Ehara, Makoto Kinoshita, Yutaka Furukawa
Journal: Circulation (2024)

Introduction: Although prior reports suggest that percutaneous coronary intervention (PCI) of non-infarct-related artery (NIRA) in patients with acute myocardial infarction (AMI) and multivessel disease improves clinical outcomes, the optimal timing for NIRA-PCI remains debated. Research Questions: When is the preferred timing to perform NIRA-PCI after infarct-related-artery (IRA)- PCI? Aims: We aimed to compare the clinical outcomes based on PCI strategies classified by the timing of NIRA-PCI in AMI patients with multivessel disease. Methods: We performed a systematic review and network meta-analysis of randomized controlled trials (RCTs) evaluating clinical outcomes to compare PCI strategies for multivessel disease in AMI patients until September 2023. The primary outcome measure was all-cause death, while the secondary outcomes included myocardial infarction, stroke, coronary revascularization, and bleeding. Results: We included 22 RCTs (N=13,093) comparing the IRA only-PCI and NIRA-PCI strategies. Immediate NIRA-PCI strategy was defined as performing NIRA-PCI after IRA-PCI without delay. Staged NIRA-PCI strategies were categorized into three groups based on the protocol-defined or treated timing for NIRA-PCI from the IRA-PCI: within one week (Staged_Within1W), one week to one month (Staged_1Wto1M), and after one month (Staged_After1M). Compared with IRA-only PCI, Staged_Within1W had significantly lower risks for all-cause death, myocardial infarction, and coronary revascularization. The immediate PCI strategy relative to IRA-only PCI favored for myocardial infarction and coronary revascularization; however, there was no significant difference for all-cause death. Although Staged_1Wto1M or Staged_After1M showed trends similar to Staged_Within1W, all outcome measures had no significant difference. The risk for bleeding or stroke was comparable among the four strategies. Conclusions: This meta-analysis demonstrated a consistent benefit of the NIRA-PCI strategies relative to IRA-only PCI strategy in patients with AMI and multivessel disease. Among the NIRA-PCI strategies, NIRA-PCI within one week appeared the most preferred strategy in patients with AMI and multivessel disease.
Abstract 4139090: Cardiovascular Outcomes in Patients with Giant Cell Arteritis: A Meta-Analysis
Authors: Usman Akbar, Ahmed Muaaz Umer, Fnu Muhibullah, Nouman Shafique, Sarmad Ali, Faisal Naseer, Hassan Nawaz, Abhi Lohana, Faizan Ahmed, Muhammad Abdullah Naveed, Muhammad Aslam Khan, Michael Cheshire
Journal: Circulation (2024)

Background: Cardiovascular outcomes in patients with giant cell arteritis (GCA) compared to non-GCA patients remain a significant concern due to the inflammatory nature of GCA and its potential impact on cardiovascular health. We conducted the first meta-analysis of its kind to compare cardiovascular events in the GCA versus non-GCA populations. Methods: A meta-analysis was conducted on studies comparing cardiovascular outcomes between GCA and non-GCA cohorts. The analysis focused on three outcomes: major cardiovascular events (MACE), cerebrovascular accidents, including stroke or hemorrhage (CVA), and myocardial infarction (MI). The studies provided odds ratios (ORs) with 95% confidence intervals (CIs) to quantify the association between GCA and cardiovascular events. Results: This meta-analysis compared cardiovascular outcomes between patients with giant cell arteritis (GCA) and non-GCA patients across several studies, including a total population of 30,672 participants. The results indicated that GCA patients have a significantly higher risk of composite cardiovascular events, with a pooled odds ratio (OR) of 1.44 (95% CI: 1.10-1.89, p = 0.008), despite significant heterogeneity (I2 = 77%). Additionally, GCA patients were found to have a higher risk of cerebrovascular accidents (CVAs) with an OR of 1.27 (95% CI: 1.08-1.48, p = 0.004), showing consistent results across studies (I2 = 0%). For myocardial infarction (MI), GCA patients also faced a higher risk, with a pooled OR of 1.56 (95% CI: 1.09-2.25, p = 0.02), although there was considerable variability in the study results (I2 = 82%). (Figures 1, 2, and 3). Conclusion: GCA patients are at higher risk for composite cardiovascular outcomes and CVAs compared to non-GCA patients, but there is no significant difference in MI risk. The variability in study results indicates a need for further research to confirm these findings and understand the underlying mechanisms.
Abstract 4139333: An Echocardiogram-Based Risk Model to Predict Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Daokun Sun, Lap Sum Chan, Faye Norby, Riccardo Inciardi, Elsayed Soliman, Alvaro Alonso, Scott Solomon, Amil Shah, Wei Pan, Lin Chen
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) is often asymptomatic and detection of AF is challenging. 2D-Echocardiogram (2DE) provides a comprehensive assessment of cardiac structure and function, and hence, may be used to predict AF. Aim: To derive a 2DE-based risk model to predict AF using supervised machine learning (ML). Methods: We included 5,445 older adults from the Atherosclerosis Risk in Communities (ARIC) study who underwent transthoracic 2DE at baseline (visit 5, 2011-2013) and had no known history of AF. Individuals were randomly allocated to the training and testing sets in a 7:3 ratio. Incident AF was ascertained from hospitalization records and death certificate during follow-up. Missing values of 2DE measures with &lt;10% missingness were imputed 50 times via Multiple Imputation by Chained Equations (MICE), and those with ≥10% missingness were excluded from the analysis. The Lasso approach was used for variable selection based on the consensus of the 50 imputed datasets. Significant variables (P&lt;0.05) were used to build a model for prediction of incident AF in the training set by Cox proportional hazards regression. Harrell’s C-index was used to assess model performance. Results: The median (IQR) age was 74 (71-79) years (59% female, 23% Black). During a median (IQR) follow-up of 7.0 (5.4-7.8) years, 738 participants developed AF. The cumulative incidence of AF was 1.4%, 5.0%, and 9.6% at 1, 3, 5 years, respectively. The table shows the hazard ratios for AF of each predictor in the final model. The Harrell’s C-index at 1-, 3-, and 5-year was 0.80, 0.72, and 0.73, respectively in the training set and was 0.76, 0.74, and 0.75, respectively in the testing set. Conclusion: Our ML derived 2DE-based risk model has good model discrimination for prediction of AF, setting the stage for a deep learning model using 2DE images for AF prediction.