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Play Smart Youth Heart Screening Program Reduces False-Positive Rates For Screening Electrocardiograms, James G Beckerman, M Wang, Lydia Hibsch, Nancy Davis

Articles, Abstracts, and Reports

Play Smart Youth Heart Screening is a free community-based electrocardiogram (ECG) screening program sponsored by Providence Heart Institute in Portland, Oregon. Play Smart goal is to identify youths who may need further follow-up and treatment of undiagnosed, asymptomatic heart disease such as cardiac arrest. For many youths, sudden cardiac arrest is their first symptom of heart disease. Play Smart has sought to systematically improve ECG screening accuracy (specificity) by consistently adopting the most recent ECG interpretation guidelines. More accurate screening (less false-positive screens) enables Play Smart to target recommendations for follow-up treatment only to those individuals with true-positive screening results.

Abstract 13987: Underutilization Of Oral Anticoagulant Therapy In At-Risk Patients With Atrial Fibrillation—Insights From A Multistate Healthcare System, Tyler J Gluckman, Amir Ali, Mansen Wang, Howard Mun, Sally Alfred, John L. Petersen

Articles, Abstracts, and Reports

Introduction: Oral anticoagulant (OAC) therapy significantly reduces the risk of thromboembolism among at-risk patients with atrial fibrillation (AF). Current guidelines provide strong support for an OAC in men and women with AF and CHA2DS2-VASc scores of >2 and >3, respectively. In spite of this, previous data has suggested that up to 40% of these patients are not treated in accordance with guideline recommendations.

Hypothesis: We hypothesized that OAC therapy continues to remain significantly underutilized among at-risk patients with AF in real-world settings.

Methods: We sought to evaluate the prevalence of OAC underuse and contributing factors in an ambulatory population of …

Abstract 14012: Opportunities To Improve The Efficacy And Safety Of Oral Anticoagulant Therapy In Atrial Fibrillation—Insights From A Multistate Healthcare System, Tyler J Gluckman, Amir Ali, Mansen Wang, Howard Mun, Sally Alfred, John L. Petersen

Articles, Abstracts, and Reports

Introduction: Vitamin K antagonists (VKAs) effectively reduce thromboembolic risk in atrial fibrillation (AF), but are limited by a narrow therapeutic window. Patients with reduced time in the therapeutic range (TTR) also face an increased risk of bleeding and ischemic events. Based in part on this, current guidelines give preference to direct-acting oral anticoagulants (DOACs) over VKAs in AF.

Hypothesis: We hypothesized that DOACs are underutilized among those on oral anticoagulant therapy and that TTR remains suboptimal for large numbers of individuals on VKAs in real-world settings.

Methods: We sought to evaluate a) the breakdown of OAC type and b) TTR …

Tct-804 Outcomes Of Trans-Carotid Tavr In A High-Volume Center, Bm Jones, Ethan C Korngold, Robert W. Hodson, Shih-Ting Chiu, V Kumar, Eric B Kirker

Articles, Abstracts, and Reports

Background

Although the preferred route for transcatheter aortic valve replacement is through the femoral artery, alternatives remain necessary for patients with obstructive iliofemoral disease. Our valve team has developed a large experience using the carotid artery as a primary alternative vascular access approach for transcatheter aortic valve replacement (TAVR). We aim to compare short-term outcomes by access route in a single-center, high-volume, transcarotid (TC) TAVR program.

Methods

All patients undergoing TAVR between September 2012 and September 2018 were included in the study. Baseline demographics and outcomes were obtained from data our institution submitted in compliance with TVT (Transcatheter Valve Therapy) …

Tct-142 Clinical Characteristics And Outcomes Of Patients Undergoing Transcatheter Aortic Valve Replacement With Sts Prom Of ≤3%, Jackson King, Morgan Black, Ruyun Jin, Gary Grunkemeier, Brydan Curtis, Robert W. Hodson, Michael Ring

Articles, Abstracts, and Reports

Background

Transcatheter aortic valve replacement (TAVR) is the preferred treatment for most patients with aortic stenosis deemed at intermediate or higher risk for surgical aortic valve replacement (SAVR). Determination of the risk of SAVR is mainly based on the Society of Thoracic Surgeons (STS) risk calculator. However, federal regulations permit the heart team latitude to offer TAVR for patients with ≤3% predicted risk of mortality (PROM) whose perceived risk is not adequately accounted for by the STS risk model. Limited data is available on the clinical characteristics and outcomes of these patients

Methods

The study group involved 2,539 patients who …

Pc202. Evolution Of Vascular Complications In Transfemoral Transcatheter Aortic Valve Replacement, Brant W Ullery, Ruyun Jin, Eric B Kirker, Patrick Ryan, Leland Siwek, James Brevig, Robert W. Hodson, Kateri Spinelli

Articles, Abstracts, and Reports

Objective Vascular complications (VCs) after transfemoral transcatheter aortic valve replacement (TAVR) have historically been common and associated with significant morbidity and mortality. We evaluated our large multicenter experience to provide new insight on the incidence, predictors, management, and clinical impact of VCs after TAVR.

Methods Retrospective TVT registry and chart review was performed for 1573 patients undergoing commercial transfemoral TAVR across seven centers within our hospital network between 2012 and 2016. VCs and bleeding complications (BCs) were defined by Valve Academic Research Consortium-2 definitions. Incidence of 30-day VCs and BCs, treatment strategy, and outcomes were reported. A mixed-effects model with …

Association Of Ambulatory Hemodynamic Monitoring With Clinical Outcomes In A Concurrent Matched Control Analysis., Jacob Abraham, Rupinder Bharmi, Orvar Jonsson, Guilherme H Oliveira, Andre Artis, Ali Valika, Robert Capodilupo, Philip B Adamson, Gregory Roberts, Nirav Dalal, Akshay S Desai, Raymond L Benza

Articles, Abstracts, and Reports

Importance: In a randomized clinical trial, heart failure (HF) hospitalizations were lower in patients managed with guidance from an implantable pulmonary artery pressure sensor compared with usual care. It remains unclear if ambulatory monitoring could also improve long-term clinical outcomes in real-world practice.

Objective: To determine the association between ambulatory hemodynamic monitoring and rates of HF hospitalization at 12 months in clinical practice.

Design, Setting, and Participants: This case-control study of Medicare beneficiaries used claims data collected between June 1, 2014, and March 31, 2016. Medicare patients who received implants of a pulmonary artery pressure sensor were identified from the …

Abstract 103: Clinical Process And Outcome Improvements Based On Within Site Communication: Insights From The Patient Navigator Acute Myocardial Infarction And Heart Failure Program, Nancy M. Albert, Tyler J Gluckman, Robert Mcnamara, Gregg C. Fonarow, Adnan Malik, Ralph G. Brindis, Di Lu, Smita Negi, Susan Rogers, Julie Mobayed

Articles, Abstracts, and Reports

Background: Team communication about hospital quality efforts in acute myocardial infarction and heart failure (AMI-HF) may affect compliance with hospital transitional care metrics.

Methods: At 2 years, hospitals (n=35) participating in the Patient Navigator Program completed surveys on 5 types of communication (sharing meeting minutes, regular team meetings or conference calls with team leaders, a shared checklist, and electronic medical record (EMR)-directed communication) supporting program implementation. Results were assessed for association with 3 outcomes (30-day unadjusted AMI-HF readmission and in-hospital risk adjusted AMI death) and 14 processes: left ventricular systolic dysfunction evaluation, prescription of renin-angiotensin system and beta-blocker medications; identifying …

The Association Of Patient Navigator Program Features And Hospital Strategies With Processes And Outcome Metrics In Acute Myocardial Infarction And Heart Failure, Nm Albert, Tyler J Gluckman, Rl Mcnamara, Gc Fonarow, A Malik, Rg Brindis, D Lu, S Negi, S Rogers, J Mobayed

Articles, Abstracts, and Reports

No abstract provided.

Gender Differences In Takotsubo Cardiomyopathy As A Secondary Diagnosis: Higher Hospital Charges, More Procedures, And Longer Length Of Stays, Daniel Westerdahl, Hsin-Fang Li, Amir Yazdani, Kateri Spinelli, Tyler J Gluckman

Articles, Abstracts, and Reports

Background

The incidence of Takotsubo Cardiomyopathy (TC) has risen steadily over the past decade, with current estimates of 15-30 cases per 100,000 per year. Historically, men diagnosed with TC have worse outcomes compared to women. The relationship between total hospital charges, number of procedures performed, and length of stay (LOS) between genders has not been previously reported with TC as a secondary diagnosis.

Methods

National Inpatient Sample (NIS) data from 2009-2015 was used to identify encounters of adult patients (≥18 years) undergoing coronary angiography that were ultimately given a secondary diagnosis of TC (International Classification of Diseases – 9 code …

Heart Failure Symptom Biology In Response To Ventricular Assist Device Implantation., Christopher S Lee, James O Mudd, Karen S Lyons, Quin E Denfeld, Corrine Y Jurgens, Bradley E Aouizerat, Jill M Gelow, Christopher V Chien, Emily Aarons, Kathleen L Grady

Articles, Abstracts, and Reports

BACKGROUND: We have a limited understanding of the biological underpinnings of symptoms in heart failure (HF), particularly in response to left ventricular assist device (LVAD) implantation.

OBJECTIVE: The aim of this study was to quantify the degree to which symptoms and biomarkers change in parallel from before implantation through the first 6 months after LVAD implantation in advanced HF.

METHODS: This was a prospective cohort study of 101 patients receiving an LVAD for the management of advanced HF. Data on symptoms (dyspnea, early and subtle symptoms [HF Somatic Perception Scale], pain severity [Brief Pain Inventory], wake disturbance [Epworth Sleepiness Scale], …

Differential Impact Of Bleeding Avoidance Strategies On Risk-Adjusted Pci-Related Bleeding Rates Within A Large Multistate Health System, Tyler J Gluckman, L Wang, Kateri Spinelli, Jl Petersen, P Huang, Sv Rao

Articles, Abstracts, and Reports

No abstract provided.

Process To Ensure Correct Classification Of Myocardial Infarction-Related Deaths, Renee Swanson, Hannah Berg, Joanna Herzog, Curt Kandra, Cindy Keithley, Daniel Westerdahl, Adam Mizgajski, Tyler J Gluckman

Articles, Abstracts, and Reports

No abstract provided.

A Nurse Navigator-Driven Program To Increase Palliative Care Referrals For Advanced Heart Failure Patients, Margaret Richter, Linda Desitter, Adam Mizgajski, Deborah Strohecker

Articles, Abstracts, and Reports

No abstract provided.