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Cardiovascular Club I 11:00 AM Thursday, February 21, 2019

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Cardiovascular Club I 11:00 AM Thursday, February 21, 2019 Abstracts J Investig Med: first published as 10.1136/jim-2018-000974.354 on 28 January 2019. Downloaded from Cardiovascular club I Abstract 2 Table 1 Demographics results 11:00 AM Mean SD Age 82.5 8.1 Thursday, February 21, 2019 BMI 26.3 6.5 Length of Stay 7.3 days 5.8 days 1 QUALITY CARE ANALYSIS OF THE APPROPRIATENESS OF VETERANS AFFAIRS CARDIOLOGY CLINIC VISITS A Motwani*, K Ayinapudi, T Singh, M Cassidy, AK Irimpen. Tulane University, New Orleans, Abstract 2 Table 2 Comorbidities LA n% 10.1136/jim-2018-000974.1 Male 390 99 Hispanics 384 97.7 Purpose of study Southeast Louisiana Veterans Health Care Systolic Congestive Heart Failure 301 82.5 System (SLVHCS) provides specialty care for New Orleans Hypertension 281 76.8 and Baton Rouge. In 2016 the New Orleans VA Cardiology Type 2 Diabetes Mellitus 258 70.5 Clinic had the highest number of cardiology clinic appoint- Coronary Artery Disease 245 66.9 ments per unit time across all specialties and VA practices Atrial fibrillation/flutter 211 57.7 nationally. In 2016 we determined that high visit density was due to more frequently spaced follow-up visits than necessary. In an effort to reduce unnecessary visits we implemented an algorithm of time to appropriate follow-up. This follow up Purpose of study Our purpose was to identify sociodemo- study assesses efficacy of this algorithm. graphic, comorbidities, medication use and other health varia- Methods used A team consisting of 3 fellows, a clinic nurse, bles, as well as to measure 30 day readmission incidence and and a supervising physician was formed. We identified 220 mortality rates in the Congestive Heart Failure (CHF) popula- patient encounters in the cardiology clinic during a one-week tion of the VA Caribbean Healthcare System. Also, we aimed – period from April 16 20, 2018 and stratified them by visit to assess if a correlation existed between these variables, in type and sub-specialty. Final chart review was done on 99 order to target them and eventually decrease readmission rates. general cardiology visits seen by physicians. For each visit we Methods used We selected patients admitted to the VA Carib- identified the time of the prior and subsequent cardiology visit bean Health Care System with ICD-9 clinical diagnosis of (1, 2, 3, 6, 9, 12, 24 months,>24 months or prn if dis- Acute Decompensated Heart Failure from October 1st, 2012 to charged from clinic) and the reason for the follow up visit. Semptember 30, 2015. Over 1000 patient records were eval- This data was compared to our 2016 pre-algorithm data uated from the Computerized Patient Record System (CPRS) regarding appropriateness of follow up. database. A total of 393 patients were selected and subdivided Summary of results 99 general cardiology visits with physicians into comorbidities, laboratory values from day of readmission, were analyzed. 8% of patients were asked to follow up within medications, and 30 day mortality, among other variables. http://jim.bmj.com/ a month compared to 21% on the previous analysis Summary of results Preliminary results show that mean age (p=0.0082). 26% patients were asked to follow up within 3 was 82.3 years and 97% were Hispanic. Comorbidities months compared to 47% before (p=0.0016). 22% were included type 2 diabetes mellitus (70%), hypertension (76%), asked to follow up within 6 months compared to 17% and systolic CHF (82%), most of which belong to NYHA Class B- 11% were asked to follow up at 12 months compared to 4%. C, 66% had coronary artery disease, and anemia (60%). Only 2% of patients were discharged from the clinic. 47% of the 40% of patients in the study were enrolled at CHF clinic, a on September 24, 2021 by guest. Protected copyright. visits occurred at closer follow-up than necessary. program at VA Caribbean Healthcare System that provides fol- Conclusions The instituted algorithm resulted in a decrease in low up to patients with CHF. Mortality rate 30 days after unnecessary follow up visits at 1 month and 3 months making readmission was 8%. room for more appropriate visits. Regardless there were still Conclusions By assessing a link between health and sociode- visits occurring at higher frequency than necessary. Further mographic variables present in our patient population, we may interventions to decrease follow ups could include reiteration be able to later target these, and eventually reduce 30 day of criteria of follow up and discharge in clinics, continuing readmission rates, morbidity and mortality. physician education and designation of team leaders in clinic groups. 3 ASPIRIN ALONE VERSUS DUAL ANTIPLATELET THERAPY FOLLOWING CORONARY ARTERY BYPASS SURGERY: COMPREHENSIVE PAIRWISE AND NETWORK META- 2 SOCIODEMOGRAPHIC AND HEALTH CHARACTERISTICS ANALYSES OF RANDOMIZED CONTROLLED TRIALS PROFILE OF CONGESTIVE HEART FAILURE POPULATION: 1 1 1 1,2 1 2 30 DAY READMISSION AND MORTALITY AT THE KG Hesterberg*, PS Jagadish, SB Latham, RShah. UTHSC, Memphis, TN; VAMC, Memphis, TN VETERANS AFFAIRS CARIBBEAN HEALTHCARE SYSTEM: RETROSPECTIVE STUDY 10.1136/jim-2018-000974.3 J Mercado-Maldonado, C Rosales, S Vicenty, Z Ramos*. VA Carribean Healthcare System, San Juan, PR Purpose of study Aspirin (ASA) therapy is class 1 indication fol- lowing CABG to prevent graft occlusion. Several small-sized tri- 10.1136/jim-2018-000974.2 als suggest that dual antiplatelet therapy (DAPT) including ASA 354 J Investig Med 2019;67:350–652 Abstracts J Investig Med: first published as 10.1136/jim-2018-000974.354 on 28 January 2019. Downloaded from Abstract 3 Figure 1 A – Graft Occlusion; B – MACE; C – Major Bleeding; D – Graft Occlusion (Network Meta-analysis) Abstract 4 Figure 1 A – Demographic, Anthropometric and Clinical plus a p2y12 inhibitor could be more effective than ASA alone. correlates of plasma NT-proBNP levels stratified by race: Multivariable However, the findings of individual trials have been scrutinized Regression Results (Multivariable model adjusted for age (when sex, BMI, for small sample size and lack of statistical power. In addition, and eGFR are exposures), sex (when age, BMI, eGFR are exposure), body it is unclear whether some p2y12 inhibitors are more effective mass index (BMI) (when age, sex, eGFR are exposures), estimated than others. Therefore, we performed standard pairwise meta- glomerular filtration rate (eGFR) (when age, sex, BMI are exposures), analyses and a Bayesian network meta-analysis with the largest exercise, smoking, alcohol, systolic blood pressure, antihypertensive sample to date by including trails from recent months. medication, aspirin use, hyperlipidemia, diabetes, stroke, transient Methods used In pairwise analyses, the pooled risk difference ischemic attach, atrial fibrillation, coronary artery disease, left ventricular (RD) was estimated using a random model. For the network hypertrophy, neighborhood socioeconomic status at census block level, and heart failure); Panel B – Baseline NT-proBNP and Mortality Stratified meta-analysis, we converted events rate to events/per 10 000 by Sex and Race. *p<0.05, **p<0.01, #p<0.001. patient-days because follow-up duration varied across trials. Summary of results Data from nine trials including 1677 patients were analyzed. Compared to ASA alone, DAPT Summary of results In 4106 (27,678 weighted) participants, decreased the absolute risk for graft occlusion by 7.4% every 10 year higher age was associated with 38% (95% CI: (RD=À0.074; 95% CI, À0.132 to À0.017, p=0.011) and for 30% to 45%) and 34% (95% CI: 22% to 43%) higher MACE by 3.8% (figure 1B). It was also associated with a NTproBNP levels in whites and blacks, respectively. Female numerically higher risk of major bleeding, but without statisti- sex was associated with 27% (95% CI: 20% to 43%) higher cal significance (figure 1C). Results of the network meta-analy- NT-proBNP levels in whites and 28% (95% CI: 15% to 45%) sis was consistent with those from pairwise analyses (figure higher in blacks. There was a significant linear inverse rela- 1D). In addition, the rate of graft occlusion was not different tionship between BMI and NTproBNP in whites and a nonlin- between ASA +clopidogrel and ASA +ticagrelor (figure 1D). ear inverse relationship in blacks. Whites and blacks had a http://jim.bmj.com/ Conclusions Following CABG, DAPT seems to be more effec- similar nonlinear inverse relationship between eGFR and tive at preventing graft occlusion compared to ASA alone. NTproBNP (figure 1, Panel A). The risk of all-cause mortality Clopidogrel- and ticagrelor-based DAPT seem to be equally predicted by NT-proBNP levels differed by sex in whites effective for this indication. (p=0.03 for interaction), but not in blacks (figure 1, Panel B). Conclusions The association of age and sex with NTproBNP levels was similar in blacks and whites but the shape of the BMI relationship differed by race. NTproBNP level was a on September 24, 2021 by guest. Protected copyright. 4 RACE BASED DEMOGRAPHIC, ANTHROPOMETRIC AND stronger predictor of mortality in white females than males. CLINICAL CORRELATES OF NT-PROBNP AND MORTALITY 1NPatel*,1O Gutierrez, 1G Arora, 1GHoward,1V Howard, 1S Judd, 1SD Prabhu, 1E Levitan, 2 1 1 2 5 COOPERATIVE ROLE OF MYELOPEROXIDASE AND NOX4 MCushman, PArora. University of Alabama at Birmingham, Birmingham, AL; University of Vermont, Burlington, VT IN THE PATHOGENESIS OF ABDOMINAL AORTIC ANEURYSM 10.1136/jim-2018-000974.4 L Reid*, T Horimatsu, M Ogbi, S Li, D Weintraub, D Fulton, H Kim, N Weintraub. Medical College of Georgia, Augusta, GA Purpose of study Population studies have shown that black race is a natriuretic peptide (NP) deficiency state. We sought to 10.1136/jim-2018-000974.5 assess the effects of age, sex, body mass index (BMI) and esti- mated glomerular filtration rate (eGFR) on N-terminal-pro-B- Purpose of study Myeloperoxidase (MPO)-induced oxidative type NP (NTproBNP) levels in white and black individuals, and stress plays an important role in the pathogenesis of abdomi- determine whether the association of NT-proBNP levels with nal aortic aneurysm (AAA).
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