Search Results for: I numeri del cancro in Italia 2019

Circulation, Volume 150, Issue Suppl_1, Page A4147018-A4147018, November 12, 2024. Background:Understanding patient factors associated with successful clinically meaningful health status results after undergoing endovascular or surgical revascularization for chronic limb threatening ischemia (CLTI), will enable targeted allocation of care resources. We examined predictors of meaningful improvements in 1-year health status following endovascular or surgical revascularization 1 year after the procedure.Methods:We applied distribution-based (0.5 standard deviation of baseline health status scores) minimally clinically important difference (MCID) thresholds to 1-year health status change scores derived from a pooled cohort of the endovascular and surgical arms for the Best Endovascular versus Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial. The trial was conducted during 2014-2019 and enrolled patients with CLTI from 150 international sites. Patients completed the peripheral artery disease (PAD)-specific VascuQol prior randomization and 1 year following randomization. Multivariable logistic regression models (improved vs. remained the same/worsened) for 1-year VascuQol changes were constructed, including demographic and clinical factors. Cubic splines were explored for presenting baseline VascuQol health status scores.Results:A total of 1,533 patients were included, (71.9% male, mean age 66.9 ± 9.7 years). Absence of diabetes, history of claudication, and lower Wifi stage was more likely to be associated with successful health status response at 1 year (R2=0.77). Baseline presenting health status was associated with the odds of achieving a successful health status response, with those presenting with lower baseline scores (VascuQol score

Circulation, Volume 150, Issue Suppl_1, Page A4144401-A4144401, November 12, 2024. Introduction:Radiation therapy (RT) is associated with high efficacy in treating thoracic malignancies. However, it has been linked to potentially limiting cardiotoxicity, including anecdotal reports of profound hypertension (HTN). Yet, the long-term incidence and implications of HTN development after RT is unknown.Aims:We aimed to define the relation between RT and HTN development in patients with lung and esophageal cancers, as well as the association of RT with major adverse cardiac event (MACE) and overall survival.Methods:From a large cohort of consecutive esophageal and lung cancer patients treated with thoracic RT from 2007-2019, we assessed the incidence and outcomes of incident (new) or worsened HTN [systolic blood pressure (SBP) ≥130mmHg] after RT initiation. Secondary outcomes were MACE (heart failure, myocardial infarction, stroke, arrhythmia and sudden death) and overall survival by RT dose. Differences in outcomes by HTN status were also evaluated via landmark analysis, excluding those with undiagnosed HTN. Observed new HTN rates were compared to Framingham predicted rates, and absolute excess risks were estimated. Multivariate regression was used to define the relation between clinical and RT measures (including cardiac and aorta substructure dose) and outcomes.Results:Overall, 439 RT-treated patients (238 esophageal; 201 lung; 66.7% male; mean age 63.2 years; 57.9% baseline HTN) were identified. Most (67.4%) had advanced T3-4 disease. Over a median follow-up of 23 months, 262 (59.7%) developed new or worsened HTN; median SBP increase of 8 mmHg. In landmark analysis, the cumulative incidence of new or worsened HTN by 1 year was 48.0% and 68.5%, respectively. Using the JNC 8 cutoff of ≥140/90 mmHg, the new HTN rate was 19.1% at 1 year, translating to a 1.7-fold higher rate than the Framingham predicted rate (RR 1.72,P

Circulation, Volume 150, Issue Suppl_1, Page A4140400-A4140400, November 12, 2024. Background:Evidence linking cancer diagnosis to risk of incident atherosclerotic cardiovascular disease (ASCVD) remains inconclusive.Research Questions:Do cancer patients experience a higher risk of ASCVD independent of shared risk factors? How does the risk of ASCVD evolve over time following a cancer diagnosis?Aims:To determine the association between cancer diagnosis and subsequent risk of ASCVD (coronary heart disease and stroke), and its trajectory over time after cancer diagnosis.Methods:We prospectively followed 108,689 women in the Nurses’ Health Study (NHS) (1984-2020), 113,608 women in the NHSII (1991-2019) and 45,327 men from the Health Professionals Follow-up Study (HPFS) (1986-2016) who were free of ASCVD and cancer at baseline. We conducted multivariable-adjusted time-varying Cox proportional hazards models to assess ASCVD risk following individual cancer diagnosis. We conducted restricted cubic spline analyses to assess the varied ASCVD risk over time after cancer diagnosis.Results:During up to 36 years of follow-up, 48,069 incident cancer cases and 32,592 ASCVD cases were documented. After adjusting for shared risk factors, ASCVD risk was significantly elevated after diagnosis of cervical cancer (HR: 1.63; 95%CI: 1.10-2.42) and Hodgkin lymphoma (HR: 2.17; 95%CI: 1.42-3.30) compared with non-cancer participants. Prostate cancer diagnosis was associated with a lower ASCVD risk (HR: 0.91; 95% CI: 0.85-0.97). Breast cancer diagnosis was associated with decreased ASCVD risk during the first 15 years after diagnosis, but this risk gradually increased afterward (P =0.02). Bladder cancer was associated with increased ASCVD risk during the first 10 years and attenuated afterward (P=0.03). The risk of ASCVD increased over time after cancer diagnosis among patients with cancers of colorectum (P=0.003), lung (P=0.007), and endometrium (P=0.05). No significant association with ASCVD risk was observed for cancers of oral cavity and pharynx, sarcoma, melanoma, kidney, thyroid, leukemia, or ovary. Results were consistent across sensitivity analyses.Conclusions:Increased ASCVD risk was observed for patients diagnosed with cervical cancer or Hodgkin lymphoma, independent of shared risk factors. ASCVD risk trajectories varied over time after diagnosis according to different cancer types. These findings support a need for tailored ASCVD screening among cancer survivors based on specific cancer types and post-diagnosis durations.

Circulation, Volume 150, Issue Suppl_1, Page A4138864-A4138864, November 12, 2024. Background:The Etanercept as Adjunctive Treatment for Acute Kawasaki Disease study, a phase 3 randomized placebo-controlled clinical trial, evaluated etanercept, a TNF-alpha inhibitor, as an adjunct to IVIg for Kawasaki Disease (KD). In children presenting with coronary artery (CA) aneurysm, etanercept resulted in reduction in progression of CA dilation and earlier aneurysm regression compared to placebo. Following study conclusion, our institution implemented etanercept as a first line IVIg adjunctive treatment for patients presenting with early CA aneurysm formation.Hypothesis:Real world use with etanercept as adjunct to IVIg in children with KD and CA aneurysm shows high patient compliance, is safe and results in early CA regression.Methods:We reviewed charts and echocardiograms for all children admitted to Seattle Children’s Hospital from 5/2019 to 4/2024 and treated with etanercept for KD with CA aneurysms at presentation (Z-score ≥2.5 per AHA aneurysm definition). Etanercept is injected subcutaneously at 0.8 mg/kg with IVIg at diagnosis and then with 2 repeat weekly doses at outpatient visits.Results:Thirty-six patients with KD and CA aneurysms received at least one dose of etanercept. Sixteen (44%) were

Circulation, Volume 150, Issue Suppl_1, Page A4137559-A4137559, November 12, 2024. Background:Extant literature suggests that transgender and gender diverse (TGD) individuals experience a higher burden of CVD risk factors and psychosocial stressors than their cisgender (cis) peers. However, prior studies have been limited by self-reported outcomes or small samples.Aim:To determine whether TGD veterans have greater CVD (MI, ischemic stroke, cardiac revascularization) incidence than cis veterans using large, nationwide data.Methods:We used EHR data from the Veterans Healthcare Administration to identify veterans with >2 outpatient encounters in fiscal years 2010-2019. Veterans’ gender identity was classified using natural language processing in combination with gender-affirming hormone therapy (GAHT) and a previously validated algorithm for identifying TGD individuals using ICD codes and VHA data. Of 1,105,082 veterans without prior CVD, 42,149 were classified as TGD. We examined sample characteristics by gender identity and used Cox regression to assess the association of gender identity with incident CVD.Results:TGD veterans’ mean age (years) was 46 (cis females=40; cis males=53). Cis females had the fewest CVD risk factors, followed by TGD veterans and cis males. Adjusting for age, race, and Hispanic ethnicity, TGD veterans had 1.49 [1.42-1.56] and 0.93 [0.90-0.97] times the risk of CVD compared to cis females and cis males, respectively. Upon additional adjustment for other CVD risk factors, renal function, alcohol use disorder, depression, anxiety, and sexual minority status, results remained statistically significant. Significance also held in sensitivity analyses which matched each TGD veteran to cis female and male veterans on age within 2 years. In analyses stratified by gender identity, trans feminine (HR [95% CI]: 1.26 [1.14-1.40]) and uncategorized TGD veterans (HR [95% CI]: 1.29 [1.22-1.37]) were at higher CVD risk than cis female veterans; trans masculine (HR [95% CI]: 0.85 [0.77-0.93]) and trans feminine veterans (HR [95% CI]: 0.90 [0.82-0.99]) were at lower CVD risk than cis male veterans. Among TGD veterans, GAHT receipt was associated with an 11% decrease in CVD risk.Conclusion:TGD veterans’, particularly trans feminine and uncategorized TGD veterans’, CVD risk was greater than that of cis females. Contrary to prior findings, GAHT was associated with decreased CVD risk. These results invite further study into the mechanisms by which GAHT and other factors impact CV health across and within gender identities.

Circulation, Volume 150, Issue Suppl_1, Page A4145958-A4145958, November 12, 2024. Background:Sarcopenia is an objective and comprehensive marker of frailty and an important predictor of outcomes after cardiac surgery. Its utility is challenging due to difficulty in its assessment.Hypothesis:We hypothesize that sarcopenia defined as pectoralis major cross-sectional area (PMA) from CT Chest is a useful predictor of cardiac surgery outcomes.Aim:The aim of this study is to develop Gender Specific Cut-off Points for PMA as a marker for sarcopenia and to evaluate the associations between sarcopenia and post-operative cardiac surgery outcomes.Methods:This study includes 237 subjects with pre-operative CT Chest scans who underwent any Cardiac Surgery involving sternotomy from 2019 to 2023 at the Townsville University Hospital, Australia. The Pectoralis Major Muscle Area, Density and Thickness measurements were performed at the level of 4th thoracic vertebra in Axial view. The sarcopenia cut-off value was defined as the lowest sex-specific quartile in PMA. Intra and post-operative outcomes up to 30-days, were collected.Results:The Cut-off values for PMA were set at 1045mm2for males and 609mm2for females, with 59 subjects meeting the criteria for sarcopenia. Sarcopenic patients required longer hospitalization (10.8±6.93 vs 8.37±5.26 days; P=0.006), longer intubation and stay in ICU, and experienced more post-operative complications within the first 30 days after surgery (p=0.002). Post-operative mortality was similar in both groups.Logistic regression analysis revealed that sarcopenia is associated with increased risk in days of extended hospital stays (OR=5.08, 95% CI: 2.35-10.96, p

Circulation, Volume 150, Issue Suppl_1, Page A4146528-A4146528, November 12, 2024. Introduction/Background:Patients with heart failure and those waiting for a heart transplant often experience a significant decrease in their ability to perform daily activities and exercise, leading to a lower quality of life. Although exercise-based cardiac rehabilitation (EBCR) is a possible treatment option, its effectiveness has not been well measured, resulting in limited adoption.Research Questions/Hypothesis:Could physical rehabilitation before receiving a heart transplant improve functional status and better outcomes?Goals/Aims:Our objective is to evaluate the effect of pre-transplant physical therapy on the standardized improvement of AM-PAC scores, measured from the earliest pre-transplant assessment to the most recent pre-transplant evaluation. Our second objective is to assess the impact of the latest Pre-Transplant AM-PAC Score on the number of hospital-free days following transplantation.Methods:We conducted a retrospective study on 91 heart transplant patients who received Impella support from January 2019 to April 2023, approved by the Mayo Clinic Institutional Review Board. We collected data on demographics, AMPAC scores, and outcomes at three time points. Continuous variables were compared using the T-test or Mann-Whitney test, and categorical variables using the Chi-square or Fisher’s exact test. We used a linear regression model to investigate the relationship between rehabilitation duration and AMPAC scores. Quantile regression was preferred due to the non-normal distribution of the outcome, hospital-free days.Results:We conducted a linear regression analysis and found a statistically significant association between increased hours spent in PT and greater improvement.After one hour of physical therapy, there was an average increase of 1.07 (95% CI 0.1, 2; p=0.03) in AMPAC scoore. We also compared the change in the AMPAC score with hospital-free days, and it was statistically significant in quantile regression analysis, indicating an increase of 0.28 (95% CI 0.2, 0.55; P=0.03) points in the AMPAC Score, corresponding to an additional hospital-free day.Conclusion:Increased hours spent in physical therapy show a significant positive association with greater improvement in standardized AM-PAC Mobility scores and hospital-free days. These findings encourage increasing uptake and support of cardiac rehabilitation programs.

Circulation, Volume 150, Issue Suppl_1, Page A4128457-A4128457, November 12, 2024. Background:The U.S. population has seen a dramatic increase in the burden of hypertension (HTN) among younger adults. However, HTN-related mortality trends among younger adults have not been investigated.Aim:We examined the trends and demographic differences in HTN-related mortality among younger adults in the U.S.Methods:Data from the CDC WONDER database was examined from 1999 to 2021 for HTN-related mortality in adults between 15 to 45 years of age. The International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes employed were as follows: I10-I15 (hypertensive diseases). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated and stratified by year, sex, race/ethnicity, urbanization status and census region.Results:Between 1999 and 2021, 201,860 HTN-related mortalities occurred among younger adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC, 35.3 [20.6 to 44.5]), after which it steadily increased to 9.4 in 2019 (APC 3.1, [2.7 to 3.5]), and sharply increased to 13.9 in 2021 (APC 22.3; 95% CI 15.1 to 26.4). Men had consistently higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). Non-Hispanic (NH) Black or African American young adults had the highest AAMR in 2020 (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islanders (5.0). AAMR also varied substantially by region (overall AAMR: South 9.3; Midwest 6.4; West 5.8; Northeast 5.4), and rural areas had higher HTN-related mortality (8.5) than their urban counterparts (7.0).Figure 1.Conclusion:Following a steady increase until 2019, HTN-related mortality increased among young adults between 2020 and 2021. The highest AAMRs were observed among men and Black or African American young adults, and people residing in the Southern and non-metropolitan areas. This emphasizes the necessity of tailored interventions to mitigate the burden and reduce the current disparities in HTN-related mortality among young adults in the U.S.

Circulation, Volume 150, Issue Suppl_1, Page A4142993-A4142993, November 12, 2024. Introduction:Assessment of invasive hemodynamics is a critical aspect of heart failure (HF) management influencing treatment decisions. However, standard metrics including intracardiac filling pressures and cardiac output do not consistently predict clinical outcomes. The myocardial performance score (MPS) is a novel hemodynamic parameter that combines myocardial power and efficiency into a single variable. We aimed to evaluate the prognostic significance of MPS and assess whether it can improve risk stratification compared to traditional measures.Methods:All patients who underwent isolated right heart catheterization for chronic, or acute on chronic HF between 2013-2019 at our institution were retrospectively analyzed. MPS is calculated as [aortic pulsatility index (API) x cardiac power output (CPO)]/2. The primary outcome was a composite endpoint of death or need for left ventricular assist device or heart transplant over a two-year period. MPS thresholds of 0.5 and 1.0 were selected from prior analyses showing declining efficiency less than 0.5 in addition to balanced power and efficiency greater than 1.0. Kaplan-Meier curves were calculated with statistical significance determined by log-rank tests.Results:A total of 709 patients (60±14 years; 54% male) were included, of which 102 (14%) had an MPS

Circulation, Volume 150, Issue Suppl_1, Page A4136398-A4136398, November 12, 2024. Introduction:A recent study by Women As One highlighted the prevalence of “MANuscripts” (publications authored solely by men) and their potential impact on equity in academic promotions within cardiology. The study revealed notable differences in citation rates and online attention between publications in cardiology journals led by male and female authors. To further explore these disparities, we examined publications in prominent thoracic surgery journals.Hypothesis:Thoracic surgery publications where women hold key authorship roles (primary and senior) receive lower citations and online attention compared to those with men as leading authors.Methods:We analyzed data from peer-reviewed publications in 2019 from two high-impact thoracic surgery journals: The Annals of Thoracic Surgery and The Journal of Thoracic and Cardiovascular Surgery. Citation metrics and Altmetric Attention Scores (AAS) were sourced from Google Scholar paired with the Altmetric Google Chrome extension. Citation rates, AAS, and names of primary and senior authors were manually collected between September 22, 2023 and December 21, 2023. The genders of key authors were determined using Genderize, a gender-determination software, supplemented by manual searches for authors not detected by the software. A minimal number of publications were excluded if either their AAS or citation metrics were unavailable. Significant differences in the data were analyzed using one-sided Mann-Whitney U-tests.Results:Of the 1,482 authors included in the analysis, 18.4% were females in primary or senior roles. Our analysis found no significant differences in citation rates or AAS between male and female primary authors (p=0.09 and p=0.31, respectively), or between male and female senior authors (p=0.48 and p=0.38, respectively). Furthermore, after combining the data of male primary and senior authors and comparing it to the combined data of female primary and senior authors, no significant discrepancies were found for both citations (p=0.13) and AAS (p=0.28).Conclusion:Contrary to analyses of cardiology journals, our data from thoracic surgery articles does not indicate a gender disparity between male and female authors in terms of citations and online attention. While this does not definitively rule out the presence of inequity in thoracic surgery research, it suggests that male-authored manuscripts may not be a primary source of gender disparity in this field.

Circulation, Volume 150, Issue Suppl_1, Page A4137423-A4137423, November 12, 2024. Background:Elevated lipoprotein(a) [Lp(a)] is an inherited, currently non-modifiable risk marker that increases lifetime ASCVD risk. Guidance vary on Lp(a) levels at which risk increases; hence prevalence of “elevated” Lp(a) depends on putative thresholds e.g. >1.3 billion people globally have Lp(a)≥125 nmol/L. Lp(a) levels are >90% genetically determined and stable throughout life; hence measurement once in adulthood is recommended. Awareness of Lp(a) levels may change patient management with more intensive control of traditional risk factors. However, testing all adults is costly and the test is not universally available.Research Question:Can Machine Learning (ML) models reduce the number needed to screen (NNS) compared to population universal screening for identifying individuals with elevated Lp(a)?Aims&Objectives:To derive a model from ML to help prioritise individuals likely to have high levels for Lp(a) testing and compare its yield to universal screening at different Lp(a) cut-points. This approach could enable automatic screening of large databases like EHRs for Lp(a) testing.Method:We conducted a cross-sectional predictive analysis using UK Biobank, including individuals ≥40 years old with Lp(a) measurements, split into feature importance, derivation, and validation datasets. Eight ML classification algorithms were used for feature importance analysis and model derivation. Models’ performance was evaluated in the validation set using sensitivity and NNS in comparison with the discrimination ability of the following guidelines across different populations: The 2019’s Heart UK and European Atherosclerosis Society (EAS) and Society of Cardiology guidelines, the 2022 EAS Consensus Statement, and threshold used in clinical trial —respective cut-offs: 90,430,125,200nmol/L.Results:438,579 patients were included. The best ML models were neural networks with different weights. Regardless of the Lp(a) threshold used, ML models resulted in higher rates of high Lp(a) cases identified per million tests with lower NNS compared to universal screening (Table 1). Using higher Lp(a) thresholds (200-430nmol/L) increased models sensitivity with far fewer tests required to identify those with high Lp(a).Conclusion:ML models could reduce the number of tests needed to identify individuals with high Lp(a), increasing efficiency and potentially helping to prioritize Lp(a) testing, with a potentially scalable cost-effective option for health systems.Work supported by Novartis

Circulation, Volume 150, Issue Suppl_1, Page A4135741-A4135741, November 12, 2024. Background:Although recent studies have showed improved outcomes, aortic valve replacement (AVR) for chronic aortic regurgitation (AR) in the presence of reduced left ventricular ejection fraction (LVEF) is associated with a higher surgical risk. Contemporary long-term outcome remains poorly investigated.Methods:Between January 2004 and August 2019, we identified 122 patients who underwent AVR for pure chronic severe AR with LVEF less than 50%. Patients with severe reduced LVEF (

Circulation, Volume 150, Issue Suppl_1, Page A4147146-A4147146, November 12, 2024. Introduction:Peripheral arterial disease (PAD) carries a high prevalence of around 200 million individuals worldwide, and is known to significantly contribute to mortality, morbidity and healthcare expenditures in the elderly. Co-morbidities such as hyperlipidemia, diabetes, hypertension, and smoking are all risk factors associated with development of PAD. The rising prevalence of such co-morbidities has affected the mortality trends of PAD despite the significant advances in both medical and interventional therapeutic options over the past 30 years.Research Question:Has there been any changes in PAD associated mortality trends in the last 30 years?Methods:Mortality trends of PAD across the USA were evaluated through calculating Annual percentage change (APC) and average APC (AAPC) of mortality via JoinPoint Analysis software. The data was obtained from the Global Burden of Diseases 2019 database.Results:From 1990 to 2019, there have been 268,129 PAD associated deaths in the US. Mortality trends over different age groups revealed an overall statistically significant decrement in those older than 75 (AAPC –0.3953, 95% CI –0.4590 to –0.3336; p

Circulation, Volume 150, Issue Suppl_1, Page A4137053-A4137053, November 12, 2024. Introduction:Childhood Opportunity Index (COI) measures access to quality education, safe housing, and healthcare based on zip codes. These scores can influence patient behaviors, such as no-shows (NS), which can affect resource utilization and health outcomes.Objective:To quantify the correlation between COI and NS through odds ratio (OR) in a pediatric cardiology clinic.Methods:Patient data was collected from a single, independent pediatric cardiology practice for all visits between 2019 to 2021. COI was categorized into 3 subdomains; education, health and environment, social and economic according to zipcode from Diversitydatakids. The COI was split into low (60U). Additional variables included age, insurance type, lead time (time from scheduling to appointment date), and telehealth status. Multiple logistic mixed-effect models, both unadjusted (single predictor) and adjusted (multiple predictors), were used to obtain OR for NS.Results:There were 11,474 total encounters. 92% were completed appointments and 8% were NS. Unadjusted model showed statistical significance (p

Circulation, Volume 150, Issue Suppl_1, Page A4144822-A4144822, November 12, 2024. Background:The relationship between anion gap (AG) and short-term mortality in intensive care unit (ICU) sepsis patients complicated by pulmonary hypertension (PH) remains unclear.Methods:Retrospective analysis of incident sepsis patients complicated by PH first admitted to ICU in MIMIC database (2008 to 2019) were enrolled. Short-term outcomes include in-hospital mortality and 28-day mortality. According to the AG value (17.0 mmol/L), patients were divided into high and low AG groups. The Kaplan-Meier survival curve was used to compare the cumulative survival rates of the high and low groups using the log-rank test. Multivariable Cox regression analyses were constructed to assess the relationship between AG and short-term outcomes in sepsis patients complicated by PH.Results:2012 sepsis patients with pulmonary hypertension were included. The in-hospital mortality rates (11.4%) and 28-day mortality rates (12.8%) in the high AG group were higher than those in the low AG group (5.0% or 7.2%, respectively;P< 0.001). The Kaplan-Meier curve showed that the in-hospital and 28-day cumulative survival rates were lower in the high AG group than that in the low AG group (P< 0.001). Multivariable Cox regression analysis confirmed that elevated AG was an independent risk factor of in-hospital mortality, 28-day mortality, length of stay in ICU and hospital. The relationship between elevated AG and in-hospital mortality remain stable after subgroups analyses.Conclusions:Elevated serum AG is associated with increased risk-adjusted short-term mortality in sepsis patients complicated by PH, and it may remind clinicians to identify patients with poor prognosis as early as possible.

Circulation, Volume 150, Issue Suppl_1, Page A4145582-A4145582, November 12, 2024. Background:Previously described algorithms evaluated defibrillator biosignalsduring ongoing CPRto characterize the underlying rhythm and its physiologic phenotype. We hypothesized that a “smart” resuscitation strategy incorporating these algorithms could reduce CPR interruptions and better align rescuer actions with patient-specific physiology.Methods:In a cohort study of ventricular fibrillation OHCA from 2017-2019, rescuer actions (rhythm analysis, shock delivery, pulse check and medication administration) were extracted from EMS, audio, and defibrillator recordings. Previously validated algorithms were combined to assess both cardiac rhythm and physiologic measures. The combined smart algorithm was compared to observed clinical practice with respect to rhythm accuracy and CPR interruption. The frequency of potentially misdirected drug therapy, defined as epinephrine use with >50% probability of spontaneous pulse or antiarrhythmic use with a predicted rhythm of asystole or bradycardia, was determined. Low vitality physiologic phenotype was defined as a shockable rhythm with low probability of post-shock ROSC or a non-shockable rhythm with low probability of a pulse during a clinical pulse check. Vitality phenotypes were compared with respect to post-shock ROSC following shock delivery and pulse prevalence during pulse checks.Results:: Of 390 VF-OHCA cases, median age was 64, and 46% survived to hospital discharge. There were a median of 5 rhythm analyses, 3 shocks, and 2 pulse checks per case. The smart strategy achieved comparable shock accuracy (95% sensitivity, 98% specificity) to observed care while decreasing the median CPR interruption from 12 to 6 seconds. Of 597 epinephrine doses, the algorithm identified 17% (n=99) with predicted probability of ROSC over 50%. Of 248 antiarrhythmic doses, the algorithm predicted the rhythm was asystole or bradycardic organized in 9% (n=23). Following 1334 VF shocks, post-shock ROSC differed by phenotype: 4% (9/217) with low vitality versus 22% (244/1117) with high vitality (p