Medicine and Health Sciences Commons^™

Axillary Transvalvular Microaxial Pump As Bridge To Transcatheter Aortic Valve Replacement In Cardiogenic Shock, Jacob Abraham, Lian Wang, V Kumar, Eric B Kirker, Kateri Spinelli

Articles, Abstracts, and Reports

No abstract provided.

Successful Pivot Of A Community Exercise Program To Virtual During The Covid-19 Pandemic, Letracia Rose, James G Beckerman

Articles, Abstracts, and Reports

No abstract provided.

Temporal Trends And Predictors Of Surgical Ablation For Atrial Fibrillation In A Large Western Us Healthcare System, Scott Brancato, Mansen Wang, Kateri Spinelli, Alison Leiataua, James Brevig, Zachary M Deboard, Torin Fitton, Maheer Gandhavadi, Jonathan P. Piccini, Neil Worrall, Tyler J Gluckman

Articles, Abstracts, and Reports

No abstract provided.

Rapid, Successful Adoption Of Virtual Outpatient Cardiology Care During The Covid-19 Pandemic, Lesley Jones Larson, D Christensen, S Long, Lian Wang, Kateri Spinelli, Xiaoyan Huang

Articles, Abstracts, and Reports

No abstract provided.

Lower Rates Of Heart Failure And All-Cause Hospitalizations During Pulmonary Artery Pressure-Guided Therapy For Ambulatory Heart Failure: One-Year Outcomes From The Cardiomems Post-Approval Study., David M Shavelle, Akshay S Desai, William T Abraham, Robert C Bourge, Nirav Raval, Lisa D Rathman, J Thomas Heywood, Rita A Jermyn, Jamie Pelzel, Orvar T Jonsson, Maria Rosa Costanzo, John D Henderson, Marie-Elena Brett, Philip B Adamson, Lynne W Stevenson, Cardiomems Post-Approval Study Investigators, Jacob Abraham (Cardiomems Post-Approval Study Investigator)

Articles, Abstracts, and Reports

BACKGROUND: Ambulatory hemodynamic monitoring with an implantable pulmonary artery (PA) sensor is approved for patients with New York Heart Association Class III heart failure (HF) and a prior HF hospitalization (HFH) within 12 months. The objective of this study was to assess the efficacy and safety of PA pressure-guided therapy in routine clinical practice with special focus on subgroups defined by sex, race, and ejection fraction.

METHODS: This multi-center, prospective, open-label, observational, single-arm trial of 1200 patients across 104 centers within the United States with New York Heart Association class III HF and a prior HFH within 12 months evaluated …

Abstract 219: Use Of Machine Learning Models To Identify Atherosclerotic Cardiovascular Disease Patients At Very High Risk For Future Events In A Multi-State Health Care System, Hsin-Fang Li, Amir Ali, Kateri Spinelli, A Sajja, Ss Virani, Ss Martin, Tyler J Gluckman

Articles, Abstracts, and Reports

Background: In the 2018 AHA/ACC Blood Cholesterol Guideline, it is recommended that ASCVD patients be classified as very high-risk (VHR) vs not-VHR (NVHR) to guide treatment decisions. This has important implications for ezetimibe and PCSK9 inhibitor eligibility. We aimed to develop a tool that could assist in more easily identifying VHR patients based on machine learning (ML) techniques. This approach offers a powerful, assumption-free alternative to conventional methods, such as logistic regression, to identify potential interactions among risk factors while incorporating the hierarchy of interaction among variables.

Method: We used EHR-derived ICD-10 codes to identify patients within our health system …

Adoption Of A Strategy Of Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement Is Associated With Fewer Neurologic Events In A Large Volume Center, Ec Korngold, Eb Kirker, Robert W. Hodson, Ruyun Jin, Kateri Spinelli, Shih-Ting Chiu, S Verburg, V Kumar, Bm Jones

Articles, Abstracts, and Reports

No abstract provided.

Patient And Physician Predictors Of Ffr/Ifr Utilization In Acs And Sihd, Payal Kohli, Peiqi Wang, Andrew Wang, Lucy Liu, Ali Weinstein, Jeptha P. Curtis, John A. Spertus, Jonathan P. Piccini, Marty Makary, Tyler J Gluckman

Articles, Abstracts, and Reports

Background

Despite guidelines supporting FFR/iFR to guide PCI, these modalities remain underutilized. We sought to characterize factors associated with FFR/iFR use in patients undergoing index PCI for an acute coronary syndrome (ACS) or stable ischemic heart disease (SIHD).

Methods

ICD-9/10 codes were used to identify patients undergoing PCI and receiving FFR/iFR for an ACS (n=1,042,896) or SIHD (n=255,213) in a Medicare claims database from Jan. 1, 2013-June 30, 2018. Patients with functional/anatomical testing were excluded (5d prior in ACS; 60d prior in SIHD). Individuals with FFR/iFR performed 1-60 days prior to PCI were also excluded to limit analysis to non-staged …

Clinical Characteristics Of Patients Classified As Very High Risk And Not Very High Risk Based On The 2018 Aha/Acc Multi-Society Cholesterol Guideline, Aparna Sajja, Amir Ali, Hsin-Fang Li, Kateri Spinelli, Salim S. Virani, Seth Shay Martin, Tyler J Gluckman

Articles, Abstracts, and Reports

Background

The 2018 AHA/ACC Cholesterol Guideline recommendation to classify ASCVD patients as very high-risk (VHR) vs not-VHR (NVHR) has important implications for ezetimibe and PCSK9 inhibitor eligibility. We aimed to define the clinical characteristics of these two groups within a large multi-state healthcare system in the Western U.S.

Methods

We performed a retrospective cohort analysis of patients defined as having ASCVD in 2018 using EHR ICD-10 codes. VHR was defined by ≥2 major ASCVD events (ACS ≤12 months, history of MI >12 months, ischemic stroke, or symptomatic PAD) or 1 major ASCVD event and ≥2 high-risk conditions (age ≥65, DM, …

Comparison Of Echocardiographic Outcomes Following Transcatheter Aortic Valve Replacement With Edwards S3 23 Mm Versus Medtronic Evolut 26 Mm Valves, Michael Ring, Ruyun Jin, Rollie Parrish, Brydan Curtis, Matthew Forrester, Branden Reynolds, Sameer Gafoor

Articles, Abstracts, and Reports

Background

Patients with small aortic valve annulus (SAVA) undergoing TAVR are prone to higher post TAVR trans-valve gradients. In many such patients, the choice of TAVR valve commonly involves choosing between the Edwards S3 23 mm (ES23) versus the Medtronic Evolut 26 mm (ME26). The supraannular design of the Evolut has been touted as providing superior hemodynamics in SAVA. We sought to compare performance of these two valves in SAVA, particularly in regard to occurrence of elevated trans-valve gradients.

Methods

We queried the Providence St Joseph Health STS/ACC TVT Registry database for patients undergoing TAVR for SAVA with either the …

Covid-19 Clinical Guidance For The Cardiovascular Care Team, Thomas M. Maddox, Eric C. Stecker, Biykem Bozkurt, Nathalie Demichelis, John U. Doherty, Andrew Freeman, Tyler J Gluckman, Dipti Itchhaporia, Andrew P. Miller, Andrea L. Price, Lonny Reisman, Prem Soman, Mohammad Madjid, Scott D. Solomon, Orly Vardeny

Articles, Abstracts, and Reports

COVID-19 is a quickly evolving public health emergency. The guidance provided in this document is based on the best available published information and expert evaluation. This document is intended to supplement, not supersede, relevant guidance from the Centers for Disease Control and Prevention, state and local health authorities, and your institution’s infectious disease containment, mitigation, and response plan.

Implementation Of A Cardiogenic Shock Protocol And Data Review Process Is Associated With Improved In-Hospital Survival, Adrienne Jones, Renee Swanson, Kateri Spinelli, Joshua Remick, Daniel Westerdahl, Jill M Gelow, David Hotchkin, Jason Wells, Tim Lewis, Robert Kim, Jeff Robinson, Roxanna Barr, Sarah Ramelli, Jacob Abraham

Articles, Abstracts, and Reports

Background: Despite increasing use of mechanical circulatory support devices (MCS), cardiogenic shock (CS) mortality is persistently high, with worsening outcomes in later stages of CS. Delays in diagnosis and practice variation may contribute to in-hospital mortality.

Methods: In June 2018, we devised and implemented a CS protocol at two hospitals from one health system in Portland, OR. The CS protocol was designed to promote early CS recognition, rapid notification of a multi-disciplinary specialty team lead by a heart failure cardiologist, invasive hemodynamic evaluation, and institution of MCS as appropriate. CS was defined by widely accepted clinical and hemodynamic criteria. Patient …

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 …

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.

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], …

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.

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.

Standard Ablation Versus Magnetic Resonance Imaging-Guided Ablation In The Treatment Of Ventricular Tachycardia., Tarek Zghaib, Esra G Ipek, Rozann Hansford, Hiroshi Ashikaga, Ronald D Berger, Joseph E Marine, David D Spragg, Harikrishna Tandri, Stefan L Zimmerman, Henry Halperin, Scott Brancato, Hugh Calkins, Charles Henrikson, Saman Nazarian

Articles, Abstracts, and Reports

No abstract provided.

Natural History Of Gutter-Related Type Ia Endoleaks After Snorkel/Chimney Endovascular Aneurysm Repair., Brant W Ullery, Kenneth Tran, Nathan K Itoga, Ronald L Dalman, Jason T Lee

Articles, Abstracts, and Reports

OBJECTIVE: Alternative endovascular strategies using parallel or snorkel/chimney (chimney endovascular aneurysm repair [ch-EVAR]) techniques have been developed to address the lack of widespread availability and manufacturing limitations with branched/fenestrated aortic devices for the treatment of complex abdominal aortic aneurysms. Despite high technical success and midterm patency of snorkel stent configurations, concerns remain regarding the perceived increased incidence of early gutter-related type Ia endoleaks. We aimed to evaluate the incidence and natural history of gutter-related type Ia endoleaks following ch-EVAR.

METHODS: Review of medical records and available imaging studies, including completion angiography and serial computed tomographic angiography, was performed for all …