Risultati per: Passo 10. Intervenire sul singolo paziente in visita: GPG Patient

Circulation, Volume 150, Issue Suppl_1, Page A4126000-A4126000, November 12, 2024. Introduction:U.S. healthcare has experienced substantial growth in vertical integration (physicians employed by hospitals), but little is known about its effect on patient care.Aims:To assess the association between cardiologist vertical integration and patient outcomes, care quality, and utilization among patients hospitalized with incident acute myocardial infarction (AMI) or heart failure (HF).Methods:We used a sample of all Medicare fee-for-service beneficiaries hospitalized with incident AMI and a 75% sample of beneficiaries hospitalized with incident HF between 2008-2019. We identified the accountable cardiologists that cared for these patients and determined their integration status using tax identification numbers. We used difference-in-differences methods to compare outcomes for patients treated by integrated cardiologists after switching from non-integrated to integrated practice, to outcomes for patients treated by cardiologists who remained non-integrated. Patient outcomes were in-hospital mortality, 30-day mortality, and 30-day readmission. Quality measures were the proportion of patients that received 1) a guideline-recommended test to assess cardiac function and 2) a 30-day follow-up clinic visit. Utilization measures were length of stay and the proportion of AMI patients receiving percutaneous coronary intervention. Models were adjusted for time trends and patient, hospital, and cardiologist characteristics.Results:The proportion of U.S. cardiologists employed by hospitals increased from 26% in 2008 to 61% in 2018. We identified 186,052 AMI patients and 259,849 HF patients cared for cardiologists who switched to integrated practice and 168,052 AMI patients and 245,769 HF patients cared for by non-integrated cardiologists. Patients were similar in age, sex, race/ethnicity, and comorbidities. We found no significant differences in clinical outcomes (e.g., adjusted difference in 30-day mortality 0.03% [95% CI = -0.39%, 0.45%] for AMI and -0.05% [-0.37%, 0.27%] for HF patients); no differences in most quality metrics, and no differences in utilization between patients treated by integrated versus non-integrated cardiologists.Conclusions:We found minimal evidence that cardiologist employment by hospitals improves care quality or outcomes. Regulation of vertical integration should focus on other effects of integration such as higher prices paid by insurers.

Circulation, Volume 150, Issue Suppl_1, Page A4125667-A4125667, November 12, 2024. Background:Renal denervation (RDN) has been shown in randomized trials to improve blood pressure compared with a sham procedure. Currently, there are two FDA-approved RDN devices in the United States (US). While nearly half of the US population has hypertension (HTN), the number of patients who may benefit from RDN therapy remains uncertain. In this study, we used a nationally representative dataset to approximate the proportion of patients with HTN who may be eligible for consideration of RDN based on selective criteria.Methods:All adult patients with HTN who participated in the National Health and Nutrition Examination Survey (NHANES) between the years 2009-2020 were identified. We characterized the proportion of these participants that met eligibility criteria based on 1) the FDA indication, 2) the SCAI 2023 RDN position statement, and 3) enrollment criteria from the RDN on-medication randomized trials. National estimates were obtained utilizing survey weighting from the NHANES multistage probability survey design.Results:In total, we identified 16,677 patients with HTN in the US, representing a weighted total of 113,786,149 patients (Table). Using the FDA indication, 31.6% (95% CI, 30.7%-32.6%) of patients meet eligibility criteria for RDN, corresponding to 35,988,870 US adults. By the SCAI 2023 position statement selection criteria, 21.5% (95% CI, 20.7%-22.3%) of patients are eligible for consideration of RDN. Based on enrollment criteria from the RDN on-medication randomized trials, 2.05% (95% CI, 1.81%-2.33%) of US adults meet eligibility for consideration of RDN (Figure).Conclusions:Our findings indicate that nearly one third of US adults with HTN are eligible for consideration of RDN based on the FDA indication; however, a smaller proportion of patients would be eligible based upon society recommendations and randomized trial inclusion criteria. Future studies are needed to further inform which patients will best benefit from this intervention.

Circulation, Volume 150, Issue Suppl_1, Page A4143989-A4143989, November 12, 2024. Background:Heart failure (HF) is not a homogeneous condition, and comorbidities, such as renal dysfunction, commonly complicate the clinical picture. However, differences in patient-centered outcomes (PCO), such as depressive symptoms, health-related quality of life, functional status, adherence, and self-care behaviors, have not been explored in patients with HF with and without renal dysfunction.Hypothesis:We hypothesized that there is a significant difference in PCO between patients diagnosed with heart failure with renal dysfunction and those without renal dysfunction.Methods:A secondary data analysis was conducted using the RICH Heart Program Heart Failure Database. We included 517 patients (61 ± 13 years old, 66% male, 66% NYHA class III/IV) with HF with (22%) and without (78%) renal dysfunction. Depressive symptoms were measured using the Patient Health Questionnaire-9, health-related quality of life using the Minnesota Living with Heart Failure Questionnaire, functional status using the Duke Activity Status Index, adherence using the Medical Outcomes Study Specific Adherence Scale, and Self-care using the Self-care of Heart Failure Index. Independent samples t-tests were conducted to compare PCO between the two groups.Results:All PCO were significantly different between the two groups. Compared to patients without renal dysfunction, those with renal dysfunction had worse depressive symptoms (8.1 ± 5.9 vs 10.0 ± 6.0, respectively, p = 0.001), poorer health-related quality of life (50.5 ± 24.9 vs 58.0 ± 25.6, p = 0.005, respectively), and lower functional status (11.7 ± 11.7 vs 77.0 ± 7.1, p < 0.001, respectively). Patients with renal dysfunction had better scores on self-reported adherence (29.2 ± 6.0 vs 25.6 ± 7.7, p < 0.001), self-care maintenance (61.6 ± 21.1 vs 54.3 ± 23.2, p = 0.03), and self-care management (60.9 ± 23.0 vs 53.8 ± 22.9, p = 0.04) than those without.Conclusions:Even though patients with HF and renal dysfunction reported better adherence and self-care behaviors, they still had higher levels of depressive symptoms, worse health-related quality of life, and lower functional status. This suggests that knowledge of their comorbidity prompted better self-care, but other PCO remained poor. Increased attention to promoting specific self-care behaviors that focus on renal dysfunction in the context of HF should be tested to determine if PCO can be improved in this patient population.

Circulation, Volume 150, Issue Suppl_1, Page A4139043-A4139043, November 12, 2024. Introduction:Point-of-care ultrasonography (POCUS) is routinely performed across emergency departments (EDs), but interpretation is generally restricted to acute pathology. We sought to evaluate the outcomes of individuals who had undergone an ED POCUS, but were never diagnosed with cardiomyopathy, using artificial intelligence (AI)-defined signatures of left ventricular hypertrophy (LVH) and key sub-phenotypes (hypertrophic cardiomyopathy [HCM], transthyretin amyloid cardiomyopathy [ATTR-CM], and aortic stenosis [AS]) on POCUS.Methods:First, using 261,756 videos from 9,667 standard transthoracic echocardiograms (TTEs) across a large, diverse health system, we trained a view quality-adapted, video-based deep learning model to detect a) LVH, representing the mean of a multi-label classifier for i) moderate or greater nominal severity as reported by the echocardiographer; ii) left ventricular posterior wall thickness [LVPWd] of ≥1.3 cm, and/or iii) interventricular septum thickness [IVSd] of ≥1.3 cm, and b) known cardiomyopathy defined by non-mutually exclusive labels of i) ATTR-CM, ii) HCM, and/or iii) AS (Fig. 1A). We deployed these tools among adult patients without known cardiomyopathy who underwent clinical POCUS across EDs (2013-2023) linked to in-hospital and out-of-hospital death data. We explored the association between distinct label output probabilities and all-cause mortality in age- and sex-adjusted Cox regression models (Fig. 1B).Results:Among 24,448 individuals (median age 58, [IQR 40-73] years; 13,478 [55.1%] women) followed over 2.2 [IQR: 1.1-5.8] years, higher AI-POCUS probabilities for LVH were associated with worse long-term prognosis, with a 29% higher mortality risk in the highest vs lowest AI-defined quintile (adj. HR 1.29 [95%CI: 1.13, 1.46]) (Fig. 2A). When stratifying based on the probability of distinct phenotypes, an ATTR-CM-like phenotype in the highest (vs lowest) quintile conferred a 39% higher adjusted risk of death (adj. HR 1.39 [95%CI: 1.22, 1.59]) (Fig. 2B). Similarly, there was a 14% (adj. HR 1.14 [95%CI: 1.01, 1.30]) and 15% (adj. HR 1.15 [95%CI: 1.02-1.29]) higher risk of death in the highest (vs lowest) AS (Fig. 2C) and HCM (Fig. 2D) phenotypic quintiles, respectively.Conclusions:AI-enabled automated identification and phenotyping of LVH is feasible on routine POCUS studies and identifies individuals who are at risk of premature mortality, potentially due to undiagnosed cardiomyopathy.

Circulation, Volume 150, Issue Suppl_1, Page A4117856-A4117856, November 12, 2024. Introduction:Guidelines have recognized the critical role of self-care in heart failure (HF), but people with HF do not adequately practice self-care. The Common-Sense Model (CSM) of Self-Regulation is a widely used theoretical framework for promoting behavior change and improving disease prognosis among patients. However, studies on the effects of the application of this model among people with HF are limited and present mixed results.Aims:To examine the effects of a nurse-led CSM of Self-Regulation-based self-care intervention on illness perceptions, self-care behaviors, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, anxiety, symptom burden, sleep quality, healthcare service utilization, and mortality among people with HF.Methods:A randomized controlled trial was conducted. Participants were recruited from a university-affiliated hospital and randomized at a 1:1 ratio into the intervention or the control groups. Participants in the intervention group received a 6-week nurse-led CSM of Self-Regulation-based self-care program and usual care. Control group participants only received the usual care. Outcomes of interest were measured at baseline, 6 weeks (T1), and 3 months (T2) after enrollment. The generalized estimating equations model and Mann-Whitney U test were used to examine the intervention effects on the study outcomes.Results:138 subjects were enrolled in the study between March and May 2023. Participants in the intervention showed statistically greater improvements in illness perceptions, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, symptom burden, and sleep quality compared with the controls at T1 and T2. We also observed a statistically significant reduction in the number of HF-related unscheduled outpatient department visits in the intervention group compared to the control group at T2. However, no significant differences were found in anxiety, number of HF-related hospital readmissions, length of HF-related hospital stays, number of HF-related emergency department visits, or HF-related mortality between the study groups at T1 and T2.Conclusion:Our program generates favorable effects on promoting behavior change and improving health outcomes among people with HF. It also fills the knowledge gaps around the application of CSM of Self-Regulation in people with HF and provides more empirical evidence supporting the effectiveness of nurse-led interventions.

Circulation, Volume 150, Issue Suppl_1, Page A4145901-A4145901, November 12, 2024. Introduction:Current guidelines recommend preprocedural fasting for at least 6 hours for solid food and 2 hours for clear liquids before cardiac transcatheter procedures. However, the supporting data are limited.Research Question:Does non-fasting impact (NF) patient safety and comfort compared to fasting (F) in transcatheter cardiac procedures?Aims:To compare the effects of fasting vs. non-fasting on patient outcomes in cardiac transcatheter procedures.Methods:We searched the Cochrane, Embase, and Medline databases for RCTs comparing fasting versus non-fasting states for cardiac transcatheter procedures. Risk ratios (RRs) and standardized mean difference (SMD) with 95% confidence intervals (CIs) were pooled for binary and continuous outcomes, respectively, using a random-effects model. Endpoints were hunger, thirst, incidence of aspiration, nausea/vomiting, acute kidney injury (AKI), length of stay, and patient satisfaction.Results:Our meta-analysis included 8 studies with 2,930 patients. Hunger sensation was significantly lower in the NF group (SMD -0.91; 95% CI: -1.71 to -0.11; P = 0.026; I2 = 96%; Figure 1A), with no difference in thirst. The incidence of aspiration (RR 2.20; 95% CI 0.29–17.02; P = 0.449; I2 = 0%; Figure 1B), nausea/vomiting (RR 1.09; 95% CI 0.67-1.78; P = 0.723; I2 = 0%), and AKI (RR 1.90; 95% CI 0.84–4.31; P = 0.126; I2 = 0%) were not significantly different between groups. Similarly, length of stay (MD -0.01 days; 95% CI -0.39 to 0.36; P = 0.940; I2 = 3%; Figure 2A), and patient satisfaction (SMD -0.74; 95% CI: -1.54 to -0.07; P = 0.073; I2 = 98%; Figure 2B) were also similar in both groups.Conclusions:Our study suggests a non-fasting strategy is a safe option before transcatheter cardiac procedures.

Circulation, Volume 150, Issue Suppl_1, Page A4143615-A4143615, November 12, 2024. Background:A coronary artery calcium score of zero (CAC=0) is generally accepted as a marker of a very low 5y risk for coronary events. However, whether the prognostic value of CAC=0 varies by sex is unclear. For example, non-atherosclerotic causes of coronary ischemia present more often in women, including spontaneous coronary artery dissection and microvascular angina, which may be undetected by CAC. Further, CAC is performed at a later age in women. Whether these factors impact the utility of CAC=0 in women vs men is uncertain.Methods:We tested whether the prognostic value of CAC=0 differs by sex. We searched the Intermountain Health electronic medical record (eMR) database for patients (pts) at primary coronary risk who underwent positron emission tomography/computed tomography (PET/CT) stress testing and had a zero CAC score. We assessed coronary prognosis (i.e., coronary death [CD] or non-fatal myocardial infarction [MI]) during follow-up. Primary events were adjudicated by chart review. We compared outcomes in women vs. men. Given the small number of events, chi-square rather than time-to-event analyses were performed. We also compared all-cause death or MI rates in those with CAC=0 vs. CAC >0 by sex.Results:The eMR search identified19,495 women and 20,523 men undergoing PET/CT who were at primary coronary risk. Of these, 7967 (19.9%) had CAC=0 on CT. Of CAC=0 patients, 5400 (67.8%) were women and 2567 (32.2%) were men. Overall age averaged 60.5y (SD 12.0) in women and 53.8y (SD 12.6) in men. In total, 13 events occurred (MI=12, CD=1) over a follow-up of 2.1y (SD 1.6). By sex, 7 events (0.13%) occurred in CAC=0 women and 6 (0.24%) in men (p=0.28). Rates of all-cause death or non-fatal MI comparing CAC=0 to CAC >0 were 3.3% vs 9.5% in women and 3.3% vs 10.2% in men (both p

Circulation, Volume 150, Issue Suppl_1, Page A4148118-A4148118, November 12, 2024. Background and Objectives:Data regarding readmission rate following ICD placement in heart failure patients with Cardiac amyloidosis are scare. We attempted to study 30-day readmission rate following ICD placement in these patients and the common causes of readmission.Methods:We utilized the Nationwide Readmission Database from 2016 to 2020 and included patients more than 18 years of age who were admitted for placement of Implantable Cardiac Defibrillator (ICD) and had secondary diagnosis of heart failure and amyloidosis. We used International Classification of Disease, Tenth Revision, Clinical Modification (ICD10 CM) codes to identify patients. The primary outcome was the 30-day readmission rate, and secondary outcomes were mortality rates, and common reasons for readmission.Results:We identified a total of 457 patients who underwent placement of ICD and had heart failure with amyloidosis, among which mean age was 69 years and 25.42% were females. The 30-day readmission rate was 19.50%. Mortality rate was higher in readmitted patients (7.12%) as compared to index admission (3.82%). Most common causes of readmission were hypertension and heart failure with CKD stage 1 to 4(22%), hypertensive heart disease with heart failure (8.35%), hypertensive heart disease with CKD 5 or ESRD (7.58%), Acute Kidney Injury (5.94%), Non-specific chest pain (5.56%), Organ specific amyloidosis (5.43%), Cellulitis (3.68%), Acute on chronic systolic heart failure (3.56%), and Acute systolic heart failure (3.17%)Conclusion:The thirty-day readmission rate was 19.50% and most common cause of readmission was hypertension and heart failure with CKD. Improvement of management strategies is needed to address these causes and improve patient outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4145425-A4145425, November 12, 2024. Introduction:Smartphone applications increasingly are utilized to enhance patient education for optimal implementation of care plans to improve overall outcomes. We demonstrate the use of an app with instructions and built-in reminders for patients in the peri-operative phase of cardiothoracic surgery to reduce readmission rates and improve patient satisfaction.Hypothesis:We postulated that patients undergoing cardiothoracic procedures who used a smartphone application pre and post-procedure would demonstrate improved outcomes compared to non-users, including reduced 90 day rates of hospital readmission, wound complications, or post-op thoracentesis, as well as demonstrate enhanced patient satisfaction.Methods:We prospectively enrolled patients in the pre-operative phase undergoing cardiothoracic procedures including coronary artery bypass graft (CABG), valvular replacement, or patent foramen ovale closure, who either downloaded or declined the app. Patients were tracked for successful registration and use of the app. Post-operative outcomes including readmissions, wound complications, and need for thoracentesis were tracked for 90 days. Patients were also administered an in-person satisfaction survey at 14 days post-op with responses recorded.Results:App users (n=392) and non-users (n=334) with median age 67 years underwent cardiothoracic surgery between May 29, 2023 and February 2, 2024. Among app users, 23 experienced 90-day readmission compared to 49 non-users (5.9% vs 14.7%, p=

Circulation, Volume 150, Issue Suppl_1, Page A4139107-A4139107, November 12, 2024. Background:Given its chronicity and high hospitalization burden, heart failure (HF) requires close coordinated care. Health Information Exchange (HIE) systems can improve care by enabling seamless information sharing between healthcare providers and patients. We evaluated whether hospitals that have invested in more comprehensive HIE access for patients have better risk-standardized post-discharge outcomes after HF hospitalization.Methods:We defined a range of contemporary HIE services at all US acute care hospitals using the American Hospital Association (AHA) Information Technology (IT) Annual Survey (2022). HIE services included mobile access to health records, the ability to import, export, and update health records online, and the option to share patient-generated data with the health system, representing health measurements and data generated from smart devices (A). We identified each hospital’s corresponding 30-day excess days in acute care (EDAC) for HF – a risk-standardized metric of all acute care needs in the post-hospitalization period from the Centers for Medicare&Medicaid Services Quality Report (2019-2022) and examined the association between HIE services and 30-day EDAC for HF using multivariable linear regression.Results:There were 2,581 US hospitals (22% rural, 9% teaching, with a median bedsize of 162 [IQR 76, 307]) in the AHA-IT survey, with a median EDAC of 5.9 (IQR -8.6, 20.9) days for HF. The vast majority (99%) of hospitals had online health record portals, but access to specific HIE services varied widely across hospitals (B): 84% offered access via mobile application, 86% allowed data import, 55% data export to other health systems, and 77% online data updates, with fewer than half (47%) allowing patients to share patient-generated health data. After accounting for differences in hospital characteristics, only hospitals with HIE configured to enable patients to share their personal health data directly with the health system had significantly lower risk-standardized 30-day EDAC for HF (-3.9, 95% CI -1.04, -3.48) (C).Conclusions:Hospitals with HIE services that include the sharing of patient-generated data have significantly better risk-standardized post-hospitalization outcomes for HF. There is a need to evaluate the role of broader access to bidirectional data sharing as a strategy to enhance care and outcomes at hospitals treating patients with ongoing post-discharge needs.

Circulation, Volume 150, Issue Suppl_1, Page A4142124-A4142124, November 12, 2024. Background:Persistent systolic anterior motion (SAM) following robotic mitral valve repair can lead to symptomatic left ventricular outflow tract (LVOT) obstruction. Percutaneous mitral valve edge-to-edge repair using MitraClip to manage LVOT obstruction from SAM following mitral valve repair has been rarely reported.Case:A 64-year-old male with history of mitral regurgitation from posterior leaflet prolapse who underwent robotic mitral valve repair with posterior leaflet butterfly resection and 38 mm Cosgrove annuloplasty band presented with progressive dyspnea with exertion and fatigue three years later. Transesophogeal echocardiogram (TEE) revealed 3+ mitral regurgitation (MR) (mean mitral valve pressure gradient 4.2 mmHg, heart rate 88 bpm) and SAM of the mitral valve with LVOT obstruction (resting gradient of 78 mmHg). He underwent a left heart catheterization to accurately measure the LVOT gradient with Dobutamine infusion. Baseline LVOT gradient was 20 mmHg that increased to 40 mmHg, 60 mmHg, and 140 mmHg with Stage 1 (5 mcg/kg/min), Stage 2 (10 mcg/kg/min), and Stage 3 (20 mcg/kg/min) of Dobutamine infusion, respectively.Decision-Making:Given his symptomatic LVOT obstruction from SAM, he was initially referred to CT Surgery for consideration of mitral valve replacement, however, given his desire to avoid long-term anticoagulation and risk of redo surgery, he was evaluated for percutaneous management. He underwent TEE guided transcatheter mitral edge-to-edge repair using a single XTW MitraClip with capture of the A2 and P2 leaflets. Post-procedural transthoracic echocardiogram (TTE) revealed trace MR and no SAM or LVOT obstruction with a resting LVOT gradient of 8 mmHg. At outpatient follow up, his shortness of breath and fatigue had significantly improved.Conclusion:Mitral valve edge-to-edge repair using MitraClip can be a safe and effective management option for patients who develop persistent SAM resulting in symptomatic LVOT obstruction following mitral valve repair.

Circulation, Volume 150, Issue Suppl_1, Page A4147894-A4147894, November 12, 2024. Background:Patients undergoing epicardial access for ventricular tachycardia (VT) have a higher rate of complications and VT recurrence post-procedure. Data regarding electrophysiological factors driving the outcomes are scant.Objective:To compare the factors and outcomes associated with epicardial vs endocardial VT ablation.Methods:A single-center, retrospective study of patients undergoing catheter ablation for scar-related VT was conducted. Data collected included demographics, comorbidities, medications, relevant laboratory abnormalities, electrocardiograms, echocardiograms, detailed procedural characteristics, and outcomes.Results:Our cohort of 554 patients had 89 (16.1%) epicardial and 465 (83.9%) endocardial VT ablations. Patients undergoing epicardial ablation had a greater frequency of NICM, and more patients had undergone sympathetic modulation for VT (p < 0.05) but had lesser frequency of valve surgery, and CABG. Epicardial ablation was associated with greater use of both short-term (6 months) anti-arrhythmic drugs (AAD) (p

Circulation, Volume 150, Issue Suppl_1, Page ASu906-ASu906, November 12, 2024. Background:Cardiac rearrest post-return of spontaneous circulation (ROSC) is a critical concern in emergency care, as it is associated with worse outcomes. Patient characteristics and arrest factors associated with rearrest remain poorly understood, making predicting rearrest after out of hospital cardiac arrest (OHCA) challenging.Aim:To examine rearrest patterns, identify patient-specific risk factors for rearrest, and assess the impact of rearrest on patient outcomes.Hypothesis:Patients that experience rearrest after OHCA will have greater cardiac comorbidities, unfavorable arrest characteristics, and greater mortality.Methods:We performed an observational single-site clinical trial of consecutive adult EMS OHCA patients with ROSC (1/01/2018 to 3/31/24). EMS reports, continuous EMS ECG recordings, and electronic health records were analyzed to determine rearrest occurrence at any time during EMS and ED care. Patient demographics, comorbidities, and arrest/rearrest characteristics were determined. The primary outcome was survival at 6 months. Statistical significance was determined using Chi-square and logistic regression (LR) analyses.Results:We examined 344 patients with OHCA and ROSC, of whom 173 patients rearrested and 171 did not. Patients experiencing rearrest were older (p

Circulation, Volume 150, Issue Suppl_1, Page A4140912-A4140912, November 12, 2024. Background:The “Appropriate Use Criteria for Coronary Revascularization” guide clinicians in delivering high-quality care and optimizing medical resource utilization. While previous studies have indicated an approximately 10% rate of inappropriateness of non-acute percutaneous coronary interventions (PCI), there is a lack of similar data in Brazil.Research Question:This study sought to determine the rate of appropriate elective PCI at a cardiology reference hospital in Brazil.Goals:The primary goal was to ascertain the frequency of elective PCI categorized as appropriate, potentially or rarely appropriate. The secondary objective aimed to identify patient characteristics associated with PCI inappropriateness.Methods:In this retrospective study, we included stable patients with chronic coronary syndromes (CCS) who underwent elective PCI between 2017 and 2020 at a cardiology hospital in Sao Paulo, Brazil. The appropriateness of the PCI was assessed using the ACC/AHA criteria proposed in 2017. The adequacy of the procedure was assessed at the “territory level” of the coronary arteries (left main [LM], left anterior descending [LAD], circumflex [CX], and right coronary artery [RCA]). Clinical variables associated with rarely appropriate PCI were identified from the cohort of patients with single-vessel procedure.Results:467 patients underwent 474 elective PCI with 543 treated coronary territories. We classified 59 (10.9%), 263 (48.4%), and 221 (40.7%) PCI as rarely appropriate, possibly appropriate, and appropriate, respectively. Single-vessel PCI was found in 332 patients. Factors associated with an increased rate of rarely appropriate were male (OR 2.83, 95% CI 1.14-7.02), no symptoms (OR 8.24, 95% CI 3.79-17.91), and having a positive functional test (OR 13.12, 95% CI 3.94-43.72). Factors associated with a decreased rate of rarely appropriate were depending on the public health system (OR 0.20, 95% CI 0.095-0.43), previous myocardial infarction (OR 0.21, 95% CI 0.07-0.6), previous PCI (OR 0.22, 95% CI 0.08-0.63), and current use of beta-blockers (OR 0.24, 95% CI 0.12-0.49).Conclusion:Rarely appropriate PCI was more prevalent among asymptomatic men with no previous myocardial infarction, not adequately medicated, and having a private health plan. These findings suggest a possible overuse of elective PCI in those patients, prompting health care providers to carefully review the indications of a costly, potentially risky procedure such as PCI.

Circulation, Volume 150, Issue Suppl_1, Page A4145759-A4145759, November 12, 2024. Introduction:Despite new advances in heart failure (HF) management, underutilization of guideline-directed medical therapy (GDMT) persists. In addition, contemporary data on GDMT utilization and whether sex differences exist is unclear. We aim to characterize GDMT use across HF subtypes, investigate sex-based disparities in utilization, and explore these impacts on patient quality of life markers and clinical outcomes.Methods:Patients with HF were enrolled in the heart function clinic (HFC) in Edmonton, Alberta, from Feb 2018 to Nov 2022. Medication records (renin-angiotensin system inhibitors [RAASi], angiotensin receptor neprilysin inhibitors [ARNI], β-blockers, mineralocorticoid inhibitors [MRA], sodium-glucose cotransporter 2 inhibitors [SGLT2i], and glucagon-like peptide 1 receptor agonist [GLP-1 RA]) over 3 years and clinical comorbidities using ICD-10 codes were obtained. We administered the Kansas City Cardiomyopathy Questionnaire Score (KCCQ-12) at enrolment and 6—or 12-month follow-ups, with changes ≥5 defined as clinically significant. We assessed the association between GDMT and sex to changes in KCCQ-12 scores and clinical outcomes.Results:Our HFC cohort of 1431 HF patients (median age 68, 29% female) included 52% with reduced (HFrEF), 20% with mildly reduced (HFmrEF), and 28% with preserved (HFpEF) ejection fraction. Median baseline KCCQ-12 score was 75 (IQR 33) and was similar between HF subtypes. ARNI, SGLT2i, and MRA use in HFpEF remains lower compared to HFrEF/HFmrEF (p

Circulation, Volume 150, Issue Suppl_1, Page A4139262-A4139262, November 12, 2024. Background:Rheumatic heart disease with involvement of all the four valves is extremely rare with anecdotal case reports. Severe symptomatic multivalvular involvement is also rare.Case:A 12-year-old boy presented with gradually progressive dyspnea over two years to current New York Heart Association (NYHA) class IV status. He was hospitalized for a week with fever, sore throat and migratory polyarthralgia three years ago. Examination- pallor, facial and pedal edema, malnutrition (height= 127 cm, weight= 27 kg, body-mass index= 16.8 kg/m2), Harrison’s sulcus, pulse= 90/minute, blood pressure= 104/64 mm of Hg, severe mitral and tricuspid stenosis, severe pulmonary arterial hypertension, and right ventricular failure. Electrocardiogram- sinus rhythm with right axis deviation and QRS morphology consistent with systemic pulmonary hypertension and severe mitral stenosis. X-Ray chest- bi-atrial enlargement with pulmonary arterial and venous hypertension. Echocardiography- severe mitral stenosis (mitral valve area= 0.3 cm2), trivial mitral regurgitation, Wilkins Score= 8/16, mean gradient= 16 mm of Hg (maximum= 40 mm of Hg), doming of the thickened tricuspid valve with severe tricuspid stenosis, thickened aortic valve leaflets with mild aortic stenosis and trivial aortic regurgitation, and doming of thickened pulmonary valve with a c notch and trivial pulmonary regurgitation. There was associated severe pulmonary hypertension (suprasystemic) with right ventricular systolic pressure of 140 mm of Hg.Discussion:In view of young age, malnutrition and a fulminant presentation of severe mitral and tricuspid stenosis, the management hinged around the percutaneous versus the surgical options. Key factors included young age, financial constraints, and repeated reluctance of parents for open heart surgery. The patient underwent a percutaneous dilation of mitral and tricuspid stenosis with an Inoue balloon in a single intervention.Conclusion:We describe quadrivalvular rheumatic heart disease with severe symptomatic mitral and tricuspid stenosis in the youngest ever reported case. The combined balloon dilation of both valves at this age is also not reported.