tbuckley/cabot-search huggingface dataset:
Abstract 16404: Symptom Perception Predicts Short-Term Prognosis in Patients With Heart Failure
Authors: Kanako Hayashi, Akiko Okada, Miyuki Tsuchihashi-Makaya
Journal: Circulation (2023)

Background: The type and severity of symptoms perceived by heart failure (HF) patients may be a useful prognostic predictor, but the impact of symptom perception on clinical events among HF patients has not been fully tested. Aim: To assess the symptoms perceived by HF patients using the Heart Failure Somatic Perception Scale (HFSPS) and to test whether symptom perception predicts short-term prognosis in HF patients. Methods: Using the prospective observational design, we collected data from 315 outpatients with HF (mean age 73 ± 13 years, 72% male). Data included sample characteristics, BMI, BNP, comorbidities, ADL, depressive symptoms, symptom perception assessed by HFSPS at baseline, and clinical composite outcomes (readmission, all-cause death, and emergency department visits) at three months. HFSPS is a scale that assesses the degree to which 18 physical symptoms perceived by HF patients are bothersome in daily life. The study subjects were classified into low, medium, and high HFSPS total score groups. The impact of HFSPS on clinical composite outcomes was analyzed using the Cox proportional hazard model, considering the influence of covariates. Results: The mean overall HFSPS score was 11.7 ± 12.3 points, with 87 patients (28%) in the low HFSPS group, 151 (48%) in the medium group, and 77 (24%) in the high group. Symptoms reported were nocturia (74.6%), shortness of breath (58.4%), fatigue (54.6%), malaise (44.5%), and cough (42.9%). Three-month composite event rate was 25.7%, with statistically significant differences between the HFSPS groups (16.1% in the low group, 23.2% in the medium group, and 41.6% in the high group (p=0.001). The results of analysis using the Cox proportional Hazard model using age, gender, BMI, BNP, comorbidities, depression, and ADL as covariates, the high HFSPS group had a significantly higher incidence of clinical composite. The incidence of clinical composite outcomes at three months was significantly higher in the high HFSPS group than in the other groups (HR=2.090 (95% CI=1.067-4.096), p=0.032). Conclusions: Symptom perception, which can be regarded as a patient-reported outcome, is a promising predictor of short-term prognosis in HF patients.
Abstract 16329: Statin Prescription and ASCVD Outcomes in a Secondary Prevention Cohort Stratified by Race
Authors: Eli Hay, Maha Mumtaz, Jianhui Zhu, Floyd W Thoma, Amber E Johnson, Malamo Countouris, Mahmoud A Al Rifai, Anum Saeed, Suresh R Mulukutla
Journal: Circulation (2023)

Introduction: Racial disparities in ASCVD outcomes and statin prescription have been previously described. However, disparities in utilization of statin therapy in real-world practice persist. We evaluated the association of statin prescription and incident ASCVD outcomes stratified by race in a large healthcare system. Methods: Statin prescription in Black and White patients with ASCVD was evaluated (2013-2022). Guideline Directed Statin Intensity (GDSI) was defined as high intensity and “&lt;GDSI” as low or moderate intensity. Statin prescription (at index and follow-up) and ASCVD outcomes (CAD, stroke, mortality) were assessed via electronic health care records using ICD-9 and 10 codes. Cox regression models, adjusted for CVD risk factors, were used to calculate HRs for the association between statin prescription and incident ASCVD events, stratified by race. Results: Of a total 44,632 patients, 5.8% identified as Black and 94.2% as White with a similar proportion of statin therapy prescribed at baseline (47% vs. 48%, p &gt; 0.05). Black patients without statin were initiated on &lt;GDSI [2.3 vs. 1.5mo] and GDSI [3.8 vs. 2.3mo] later than White patients (all p&lt;0.05) in a 5-year time frame. When comparing no statin use to &lt;GDSI, there was a ~two-fold increase in IR of stroke (51.2 vs. 25.4 per 1000-person yrs) in Black patients versus White (23.4 vs. 16.9). GDSI was associated with lower risk of all ASCVD outcomes in patients of both races. Black patients had a greater relative benefit from GDSI for stroke than White patients. (HR stroke 0.38[0.27-0.53] vs 0.55[0.49-0.63]; p-interaction &lt;0.01) (Table). Conclusions: In a large healthcare system, only ~half of Black and White patients with history of ASCVD received GDSI. Although it took longer to start Black patients on GDSI, GDSI was associated with less recurrent ASCVD outcomes in both races more than &lt;GDSI or no statin use. The relative benefit of stroke prevention from GDSI was higher among Black patients.
Abstract 14327: Association Between Alcohol Intake and Incidence of Heart Failure With and Without Reduced Ejection Fraction Among Participants of the VA Million Veteran Program
Authors: Eiman Elhouderi, Yanping Li, Xuan-Mai T Nguyen, Jacob Joseph, John M Gaziano, Kerry Ivey, Luc Djousse
Journal: Circulation (2023)

Introduction: Little is known about the relation of total alcohol intake and beverage types on risk of heart failure (HF). This study aims to examine the relation between amount of alcohol consumed and type of alcohol with risk for HF including subtypes [heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction] in a large cohort of US Veterans. Methods: The study cohort included 329,543 Million Veteran Program participants who completed a baseline and lifestyle survey. Subjects with prevalent HF at baseline and incomplete alcohol information were excluded. Moderate alcohol intake was defined as consuming 12-24 g/day for men and 12g/day for women. We used ICD-9-10 codes and EF to define HFpEF and HFrEF. The associations between alcohol intake, beverage preference, and incidence of HFpEF and HFrEF were assessed using Cox proportional hazard model (CPHM) adjusted for age, sex, race, body mass index, cigarette smoking, education, exercise, diet, baseline prevalence of high cholesterol, hypertension, diabetes mellitus, statin use and atrial fibrillation. Results: Mean age was 65 years and 91.4% were men. With mean follow-up of 4.5 years, we observed 20,694 incident HF events (6078 HFrEF and 4531 HFpEF). The CPHM showed J shaped relationship between alcohol consumption and HF risk. Compared to never drinkers, adjusted HRs (95% CI) for HF were 0.89 (0.85, 0.95), 0.85 (0.79,0.91), 0.80 (0.74, 0.86), 0.80 (0.72, 0.88), 0.93 (0.84, 1.04) and 1.03(0.95, 1.12) for categories of current drinkers of ≤6 g/d, &gt;6-12 g/d, &gt;12-24g/d, &gt;24-36g/d, &gt;36-48 g/d and heavy drinking (&gt; 48 g/d)/alcohol use disorder, respectively. We found a similar association pattern between alcohol intake and risk of HFpEF and HFrEF (Fig). There was no difference in alcohol preference and HF risk among light and moderate drinkers. Conclusion: Light to moderate alcohol consumption is associated with a lower risk of heart failure irrespective of subtypes.
Abstract 12628: Effects of Temperature and Humidity on Cerebrovascular Disease Hospitalization in a Super-Aging Society
Authors: Toshiya Yoshida, Shunichi Doi, Kihei Yoneyama, Yasuhito Kawagoe, Michikazu Nakai, Sumita Yoko, Yuki Ishibashi, Masaki Izumo, Yasuhiro Tanabe, Tomoo Harada, Yoshihiro J Akashi
Journal: Circulation (2023)

Introduction: Cerebrovascular disease is known as one of the leading causes of death and disability in the elderly worldwide. Although weather was reported as predictor with cardiovascular disease, it was few evidence with cerebrovascular disease in Japan. Hypothesis: The weather is correlate with cerebrovascular disease hospitalizations. Methods: The Japanese registry of all cardiac and vascular diseases database includes patients with cardio-cerebrovascular disease who required hospitalization and constitutes a nationwide dataset in Japan. This study included 4,998,541 consecutive patients with cardio-cerebrovascular disease requiring hospitalization were admitted between 2015 and 2019. We investigated the relationship between cerebrovascular disease hospitalization and temperature, or humidity. Results: Data were collected from 606,807consecutive patients with cerebrovascular disease admitted. In this study population, the median age was 75.0 (66.0-83.0) years and 55.8% of subjects were male. The mean weather temperature and humidity 1 day before cerebrovascular disease hospitalization were 17.2 °C and 69%, respectively. Multilevel mixed-effects linear regression models showed the association of temperature and humidity with cerebrovascular disease hospitalizations after adjusting for air pollution, hospital, and patient demographics. Lower mean temperatures and humidity &lt;70% or humidity ≧70% are associated with an increased incidence of cerebrovascular disease hospitalization (coefficient, -1.442 [-1.473 to -1.411] per °C, p&lt;0.001, coefficient, -0.084 [-0.112 to -0.056] per%, p &lt; 0.001, and coefficient, 0.136 [0.103 to 0.168] per %, p &lt; 0.001, respectively). Conclusions: Lower mean temperatures and extremely lower or higher humidity are both associated with an increased incidence of cerebrovascular disease hospitalization in the aging society of Japan.
Abstract 13091: Chronic Thromboembolic Pulmonary Hypertension Associated With Prolonged Use of Combined Oral Contraceptives in a 27-Year-Old Woman: A Successful Case of Pulmonary Endarterectomy
Authors: Juan-Manuel Munoz-Moreno, Carlos Requena Armas, Oscar Aguirre-Zurita
Journal: Circulation (2023)

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is associated with venous thromboembolism (VTE); however, in half of the cases, no prior deep vein thrombosis is ever found. The use of combined oral contraceptives (COCs) is a known risk factor for VTE. We present the case of a young woman with CTEPH in whom timely diagnosis and intervention prevented irreversible pulmonary hypertension (PH). Case Presentation: A 27-year-old woman with 10-year use of COCs presented with progressive dyspnea for 3 weeks. The ECG showed right ventricular systolic overload and right atrial enlargement. Laboratory tests showed elevated pro-BNP and D-dimer. TTE showed right atrium and right ventricle (RV) enlargement and elevated right ventricular systolic pressure (RVSP) of 83 mmHg. The ventilation/perfusion scintigraphy showed mismatched segmental perfusion defects in both lung fields with greater involvement of the left lung, and oral anticoagulation was started. Lower extremity venous ultrasound and hypercoagulability studies were normal. CTPA revealed filling defects in the left main pulmonary artery and bilateral segmental branches. After 3 months of anticoagulation, she persisted in NYHA class III, and right heart catheterization showed mean PAP of 38 mmHg, PCWP of 8 mmHg, and PVR of 9 WU, confirming CTEPH. Due to unavailability in Peru, she was referred to a US center for pulmonary endarterectomy (PEA). After a successful intervention, she improved clinically with a reduction in RVSP to 34 mmHg. This case highlights the importance of rapid intervention in CTEPH even in situations where optimal treatment is not readily available. Conclusion: CTEPH may be associated with the prolonged use of COCs in young women. Timely intervention can reverse PH and prevent RV remodeling. Unfortunately, Peru does not have a PEA center and not every case will undergo treatment. We call for the training of local surgeons to ensure fair and equitable access for the population.
Abstract 14777: Effectiveness of Virtual vs Face-to-Face Medical Nutrition Therapy in Patients With Hyperlipidemia
Authors: Shannon Zoulek, Jackson Shriver, Navkiranjot Kaur, Beverly Kuznicki, Eric Brandt
Journal: Circulation (2023)

Introduction: Medical nutrition therapy provided by registered dietician nutritionists (RDNs) is an effective therapy for treating lipid disorders. There has been a shift in practice for patients to receive nutrition counseling virtually rather than in-person. Hypothesis: We evaluated whether virtual nutrition visits are as effective as face-to-face (F2F) visits at reducing lipid levels. Methods: We performed an observational study of patients seen by a RDN as part of the University of Michigan Preventive Cardiology lipid management program from 3/31/2019 - 9/31/22. Lipid markers, including total cholesterol (TC), high-density lipoprotein (HDL), and triglycerides (TG) were collected prior to meeting with an RDN and a median of 33 days later. Low-density lipoprotein (LDL) was calculated using the Sampson equation (patients with TG &gt;800 mg/dL were excluded). We used a paired T-test to evaluate the mean difference in lipid marker pre-post visit. Linear regression was used to compare the impact of virtual and F2F nutrition visits. Results: 192 patients were included (41 virtual visits and 151 F2F visits). After a single virtual or F2F visit with an RDN, TC, LDL, and non-HDL decreased (all p-values &lt;0.05, Figure). HDL decreased for F2F visits only. Change in TG was not significant for either group. There were no significant differences between virtual and F2F for changes in mean pre-post visit for any lipid markers (TC p=0.37, LDL p=0.54, non-HDL p=0.29, HDL p=0.72, TG p=0.67). Conclusions: Both virtual and face-to-face RDN visits lead to overall improvement in lipid profiles at post-visit follow-up. Telehealth is an effective way for patients to receive nutrition counseling and may help to overcome barriers in access to treatment for hyperlipidemia.
Abstract 18010: Trends in CardioMEMS Use Among Patients With Heart Failure in the US
Authors: Lauren Sinnenberg, Lin Yang, Taisei Kobayashi, Monique Tanna, Ashwin S Nathan, Sameed A Khatana, Peter W Groeneveld, Lauren A Eberly
Journal: Circulation (2023)

Introduction: The implantable pulmonary artery pressure (PAP) monitor, CardioMEMS, has been shown to reduce heart failure (HF) hospitalizations and improve quality of life among patients with symptomatic heart failure. However, uptake of the CardioMEMS device has been limited, and its utilization across sociodemographic groups has not been studied. Methods: This was a retrospective study of commercially insured patients in the US from October 1, 2015 to October 1, 2020, using the Optum Clinformatics Data Mart. Adult patients (age &gt; 18) with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) were included in the analysis. Multivariable logistic regression models were used to assess the factors associated with CardioMEMS placement. Results: There were 501,755 HFpEF and HFrEF patients who met inclusion criteria. Of these, 1,042 (0.002%) had CardioMEMs devices implanted. Rate of CardioMEMS implantation has increased over the last 6 years (0.04% in 2015 vs. 0.35% in 2021) but remains low, particularly among Asian and Hispanic patients (Figure 1). In a multivariable analysis, compared to patients who did not have a CardioMEMS device, those who did were more likely to have a higher income (&gt;$100,000) (Adjusted odds ratio (AOR) 1.39, 1.16-1.67, p&lt;0.001). Patients in the Southern United States (AOR 0.52, CI 0.43-0.62, p&lt;0.0001) and older patients (AOR: 0.96, CI 0.95-0.96, p &lt;0.001) were less likely to have a CardioMEMS device implanted. Patients with CardioMEMS were more likely to have chronic kidney disease, obesity, and valvular pathology (p &lt;0.0001). No gender differences were seen in CardioMEMS utilization. Conclusions: Overall utilization of the CardioMEMS device is low, but rising. CardioMEMS utilization is not distributed equally across demographic groups—younger patients and those with higher incomes were more likely to have the device implanted.
Abstract 12660: Outcomes of Pregnancy-Associated Myocardial Infarction: A Systematic Review and Meta-Analysis
Authors: Umair A Ansari, Shahan Haseeb, Ahmed T. Masoud, Chandra Chhetri, Toqeer Khan, Muhammad Ibraiz Bilal, Muhammad Zulqarnain, Tara Shah
Journal: Circulation (2023)

Background: Cardiovascular disease is the leading cause of maternal mortality worldwide. The aim of this systematic review and meta-analysis was to investigate complications associated with Pregnancy-associated myocardial infarction (PAMI), which has been linked to various obstetric and fetal complications. Methods: We included a total of 11 studies which reported complications in women who had myocardial infarction (MI) during pregnancy. Our outcomes included maternal mortality, postpartum hemorrhage, postpartum infection, preterm labor, eclampsia and pre-eclampsia. Analysis was performed to calculate the pooled proportions. Data was pooled as mean differences or risk ratio and 95% confidence interval (CI) was used. Results: Mortality was reported in 7.6% of women who had MI with effect estimate 0.189, 95% CI [0.113, 0.266] (Fig 1a). Incidence of postpartum hemorrhage was reported in 13% of women with effect estimate 0.143, 95% CI [0.060, 0.226] (Fig 1b) and postpartum infection was reported in 15.1% with effect estimate 0.269, 95% CI [0.030, 0.507]. Incidence of eclampsia and pre-eclampsia was reported in 10.98% with effect estimate 0.213, 95% CI [0.125, 0.301] (Fig 2a). Incidence of pre-term labor was reported in 12.87% with effect estimate 0.313, 95% CI [0.116, 0.510] (Fig 2b). Conclusion: Our study demonstrated that PAMI was associated with higher rates of major obstetric complications including maternal mortality, postpartum hemorrhage, pre-term labor, pre-eclampsia, eclampsia and postpartum infection.
Abstract 16679: Growth Differentiation Factor 15 in the Initial Evaluation of Suspected Coronary Artery Disease
Authors: Iman Karaji, Ole-Thomas Steiro, Gard Myrmel, Torbjorn Omland, Joerund Langoergen, Rune Bjoerneklett, Oyvind Skadberg, Vernon V Bonarjee, Oeistein Mjelva, Paul O Collinson, Kjell Vikenes, Eva Pedersen, Kristin Moberg M Aakre
Journal: Circulation (2023)

Introduction: The cytokine growth differentiation factor 15 (GDF-15) is expressed in several tissues including cardiomyocytes, and is up-regulated in conditions of tissue injury and stress. Hypothesis: We hypothesized that serum GDF-15 can predict obstructive CAD and need of revascularization among acutely admitted chest pain patients. Further, we assessed whether the combination of GDF-15 and coronary artery calcium (CAC) scoring could identify a subgroup with low risk of obstructive CAD, in whom a full coronary CT angiography (CCTA) could be avoided. Methods: GDF-15 was measured, using the assay on Cobas e801 (Roche Diagnostics), in 537 patients with chest pain and high-sensitivity cardiac troponin T concentrations ≤99th percentile. All participants underwent CAC scoring and CCTA. Obstructive CAD was defined as &gt;50% lumen diameter narrowing. Associations of GDF-15 with obstructive CAD and 30-days revascularization were calculated by multivariable logistic regression adjusting for age, sex, smoking, hypertension, HbA1c, LDL-cholesterol, GFR and prior AMI. We also evaluated whether GDF-15 could improve sensitivity and negative predictive value (NPV) of CAC=0 for ruling out the presence of obstructive CAD. Results: The median (25th-75th percentile) age was 56 (49-65) years, 217 (40.4%) of the patients were women, 83 (15.5%) had obstructive CAD, and 49 (9.1%) had revascularization within 30 days. After multivariable adjustment, elevated GDF-15 (≥1200pg/mL) predicted obstructive CAD at baseline with OR (95%CI) of 2.23 (1.14-4.36), p=0.02. The OR (95%CI) for 30-days revascularization was 2.33 (1.08-5.03), p=0.03. For CAC=0, we observed a sensitivity (95%CI) and NPV (95%CI) of 94.0% (86.5%-98.0%) and 98.0% (95.3%-99.3%) in ruling out obstructive CAD. For patients having both CAC=0 and GDF-15 levels below median (&lt;730pg/mL), sensitivity (95%CI) and NPV (95%CI) for obstructive CAD were 97.6% (91.6%-99.7%) and 98.7 (95.2%-99.8%), respectively. Conclusions: Elevated serum GDF-15 predicts obstructive CAD and 30 days revascularization among patients with chest pain, but without AMI. The combination of low GDF-15 levels and CAC=0 appears promising for the identification of low-risk patients, who can possibly be discharged without a full CCTA.
Abstract 14681: Coronary Artery Calcium is Associated With Cardiovascular Disease and Poorer Survival in Patients Undergoing Autologous Hematopoietic Cell Transplantation
Authors: Stephanie Y Wu, June W Rhee, Aleksi Iukuridze, Alysia Bosworth, Sitong Chen, Liezl Atencio, Venkat Manubolu, Rusha Bhandari, Faizi Jamal, Matthew Mei, Alex Herrera, Stephen Forman, Ryotaro Nakamura, Lennie Wong, Matthew J Budoff, Saro Armenian
Journal: Circulation (2023)

Background: Hematopoietic cell transplantation (HCT) is an established curative treatment for patients with hematologic malignancies, however survivors are at a &gt;4-fold risk of cardiovascular disease ([CVD] heart failure, myocardial infarction, stroke]) compared to the general population. Coronary artery calcium (CAC) is predictive of CVD in non-oncology patients; less is known about its association with CVD risk and outcomes after HCT. Methods: This was a retrospective cohort study of 243 consecutive patients who underwent first autologous HCT for Hodgkin/non-Hodgkin lymphoma between 2009-2014 with no history of CVD. CAC was determined from chest computed tomography performed &lt;60d from HCT; measurements (Agatston unit) were made by trained researchers blinded to patient demographics and outcomes. CAC was categorized as: 0, 1-100, &gt;100. Multivariable Cox regression analysis was used to calculate hazard ratio (HR) estimates and 95% confidence intervals (CI), adjusted for covariates (age, conventional risk factors [e.g. hypertension, dyslipidemia], cancer treatment). Results: Median age (range) at HCT was 55.7y (18.5y-75.1y), 59% were male; race/ethnicity: non-Hispanic white (60%), Hispanic (25%), Asian (11%), Black (4%); prevalence of CAC was 37%. The 5y CVD incidence for the cohort was 12%, and there was an incremental increase according to CAC score: 0 (6%), 1-100 (20%), &gt;100 (32%); p=0.001 (Figure 1A). CAC was significantly associated with CVD risk (HR 3.0, 95%CI 1.2-7.5) and worse 5y survival (77% vs. 50% p&lt;0.001 [Figure 1B]; HR 2.0, 95%CI 1.1-3.4), compared to those without CAC. Conclusions: CAC is an important and independent predictor of CVD and survival after HCT. Taken together, these data form the basis for integration of readily available imaging information into decision making prior to HCT (e.g. pre-habilitation, non-HCT approaches) or after HCT (e.g. cardiac rehabilitation), setting the stage for strategies to optimize outcomes after HCT.