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

Circulation, Volume 150, Issue Suppl_1, Page A4139554-A4139554, November 12, 2024. Introduction:Anticoagulation nonadherence has historically been attributed to myriad factors in patient populations worldwide. While direct oral anticoagulants (DOACs) have demonstrated advantages such as less routine monitoring and fewer interactions with other medications over other anticoagulant classes, nonadherence persists and the underlying contributors vary by geography. The goal of this retrospective review was to highlight on the patient and systemic characteristics associated with DOAC nonadherence in the North Bronx.Methods:This review used records between 2017-2024 from two major hospital centers in the North Bronx. Patients receiving outpatient primary care and active DOAC therapy were included in the analysis. Adherence and nonadherence groups were determined based on prescription fill status and MD documentation of medication intake patterns. The groups were compared in the categories of age, gender, race, ethnicity, insurance type, diagnosis, pharmacy type, employment status, comorbidity burden, outpatient medications, primary language, and zip code. Chi square analysis was done between the categories and outcomes as well as between categories. A p value of < 0.05 was deemed significant.Results:The cohort had 863 patients with nonadherence of 24.9%. The adherent group's mean age was higher than that of the nonadherent (70.3 years vs 66.8 years, p < 0.005). Females were more adherent than males (79.0% vs 70.5%, p < 0.005). The adherent group was also more likely to be receiving DOAC from a retail pharmacy than from a hospital pharmacy (81.7% vs 59.9%, p < 0.005). The nonadherent group was more likely to be insured under medicaid (69.3% vs 63.0%, p < 0.005) and to be taking fewer than 10 outpatient medications (62.3% vs 54.0%, p < 0.05). English was the primary language of more patients in the nonadherent group (78.6% vs 65.7%, p < 0.005).Conclusion:DOAC nonadherence in the North Bronx correlates with patient age, gender, pharmacy type, insurance type, number of outpatient medications, and primary language. Nonadherence does not correlate with comorbidity burden, diagnosis, or zip code. Associations with race/ethnicity and employment status were uncertain and warrant further study.

Circulation, Volume 150, Issue Suppl_1, Page A4125940-A4125940, November 12, 2024. Background:The future risk of cardiovascular disease (CVD) after a diagnosis of hypertensive disorders of pregnancy (HDP) is well established. Blood pressure (BP) assessment and management after delivery is one essential part of downstream risk mitigation of future CVD. This requires intentional follow-up by clinicians and understanding by patients. We sought the perspectives of patients regarding solutions to barriers for health care interventions and self-care support after a HDP diagnosis.Methods:Phone interviews were conducted three to six months following a delivery from a random sample of women diagnosed with HDP, determined by ICD-10 codes. Interview questions were designed by a multidisciplinary team that included those who specialize in women’s CVD health and pregnancy. Interviews were conducted by a senior qualitative researcher. Questions aimed to discover health care and self-care steps taken following HDP diagnosis, reasons why these were not started or used consistently, education recalled, and areas for improvement.Results:A total of 20 women were interviewed from ages 21-42 (20-29, n=10; 30-39, n=8; and 40-42, n= 2) among 9 different hospitals (1 quaternary, 3 tertiary care hospitals, and 5 small-medium-rural community hospitals). Of the respondents, 50% were diagnosed during their third trimester, 25% in their second trimester, 20% in their first trimester, and 5% within a week after delivery. A total of 8 (40%) of the women were induced early given HDP concerns. Table 1 describes health care and self-care steps taken for HDP during and after pregnancy. If health care and/or self-care for HDP did not start or did not continue beyond the fourth trimester ( >12-weeks post-delivery), reasons included BP stabilized or returned to normal, the clinician ‘wasn’t concerned’, and/or they didn’t have a history of a hypertension diagnosis. Table 2 lists suggested areas from those interviewed for improving support to women with HDP.Conclusion:This study suggests a high prevalence of unclear education with low patient recall and incomplete follow-up after delivery among women with HDP, with health care support and self-care diminishing after the fourth trimester. Understanding the perspectives of women with HDP and its associated risk factors can help in developing effective clinician and patient education and clinical pathways to reduce barriers for long-term care and CVD risk mitigation.

Circulation, Volume 150, Issue Suppl_1, Page A4140639-A4140639, November 12, 2024. Background:Remote patient monitoring (RPM) has proven highly effective in managing hypertension (HTN). A key strength of RPM lies in its ability to continuously monitor patients, especially those with limited access to traditional healthcare settings.Hypothesis:Do patients in Federally Qualified Health Centers (FQHCs) respond to RPM for HTN management as effectively as patients in traditional primary care settings (PC)?Goals/Aims:To compare the effectiveness of RPM between FQHC and traditional primary care populations. Specifically, we focused on patients who transmitted data at least 50% of the time, consistent with the CPT code for RPM billing, and who had been on the program for at least one year.Methods:Patients were equipped with cellular-enabled BP cuffs. Clinical staff met monthly with patients to review data and discuss lifestyle changes. Patients with an average SBP ≥140 mmHg or DBP ≥90 mmHg during the first 7 days, enrolled for ≥365 days, and transmitted data ≥50% of days, were analyzed. Data comparisons were made between the average of the first seven BP readings and the last seven BP readings.Results/Data:The PC group (n = 495) averaged 640 ± 280 days on the program, while FQHC patients (n = 429) averaged 599 ± 136 days. Both groups demonstrated significant improvements (p < 0.0001) with RPM. PC patients reduced SBP from 150.7 to 135.2 mmHg (-15.5), and FQHC patients improved from 152.3 to 134.9 mmHg (-17.4). Baseline and final SBP readings were not significantly different between groups. DBP also markedly improved (P < 0.0001): PC from 86.4 to 77.7 mmHg (-8.7 mmHg) and FQHC from 92.4 to 81.9 mmHg (-10.6 mmHg). FQHC patients had higher DBP at both baseline and study end (p < 0.0001). Surprisingly, FQHC patients experienced a greater improvement in mean arterial pressure (MAP) compared to PC patients (-11.1% vs. -9.9%; p < 0.05). Average transmission frequency was higher in PC patients (73.3%) compared to FQHC patients (70.3%; p < 0.01).Conclusion:RPM significantly improves HTN management, leading to substantial reductions in blood pressure and MAP in both FQHC and primary care populations. These findings support RPM as an effective tool for managing hypertension remotely and enhancing health equity, making it a valuable strategy in diverse healthcare settings.

Circulation, Volume 150, Issue Suppl_1, Page A4146655-A4146655, November 12, 2024. Introduction:Ventricular septal defect (VSD) is the most common pediatric defect which benefits from closure at an early age. This study describes the procedural and follow-up data from a 10-year experience of VSD device closure at a tertiary referral center in southern India.Methods:We conducted a retrospective clinical data review of all pediatric patients who underwent transcatheter device closure for isolated VSD in the past ten years, from May 2014 to May 2024. We included patients with body weights less than 30 lbs. and excluded patients with VSD diameter >10mm and those with other congenital cardiac anomalies.Results:We included 40 patients with a mean age of 18.95 ± 13.02 months, mean weight of 17.87 ± 6.64 lbs. and male:female ratio of 23:17 (Table 1). The most common symptom at presentation was failure to thrive (22, 55.0%), and five patients (12.5%) had VSD associated with Downs syndrome. 34 (85%) children had perimembranous VSD, and the rest had muscular VSD (6, 15.0%). The mean VSD size was 6.01 ± 2.29 mm, with a mean peak gradient of 49.55 ± 23.57 mm Hg. Either Amplatzer ADO II (14, 35.0%) or Lifetech Konar MF (26, 65.0%) devices were used, mainly via the retrograde approach (37, 92.5%) with a mean total fluoroscopy time of 21.82 ± 10.01 mins. Complications associated with the procedure were minimal (as in Table 2), with 77.5% (31 of 40) patients having no residual shunts at their follow-up ECHO after 6 months.Conclusions:Transcatheter VSD device closure is a safe and effective procedure in young children weighing less than 30 lbs., with minimal complications and good outcomes at follow-up.

Circulation, Volume 150, Issue Suppl_1, Page A4138374-A4138374, November 12, 2024. Introduction:Although coronary endothelial dysfunction is thought to affect coronary atherothrombogenic processes, there has been little practical evidence for the relationship between clinical evolution of fatal or non-fatal acute coronary syndrome and coronary endothelial dysfunction.Hypothesis:We assessed hypothesis that coronary endothelial dysfunction has clinical impacts on development of acute coronary syndrome and fatal cardiovascular events.Methods:Coronary endothelial dysfunction was practically graded by the flow-mediated endothelium-dependent reactive changes in coronary artery diameter (CFMD) to infusion of adenosine triphosphate (ATP ; 50μg) into the normal left coronary artery using quantitative coronary arteriography in 150 patients with stable coronary artery disease. The enrolled patients were categorized into tertile groups according to the values of CFMD, and we prospectively followed-up major adverse clinical cardiac events including acute coronary syndrome and cardiovascular death.Results:For a mean follow-up period of 132 months (range; 120 to 144) with complete follow-up, the patients in the lower third with severe coronary endothelial dysfunction (Group-L) more frequently developed acute coronary syndrome than those in the middle third with mild coronary endothelial dysfunction (Group-M) plus those in the higher third without coronary endothelial dysfunction (Group-H) [Group-L versus Group-M plus Group-H: 15(30%) versus 5(10%) plus 0(0%), p

Circulation, Volume 150, Issue Suppl_1, Page A4141927-A4141927, November 12, 2024. Background:Prior data suggest the MI risk may be higher with paroxysmal AF (PAF) vs. non-paroxysmal AF (non-PAF). Proposed mechanisms include tachycardia-induced oxidative stress (via LOX-1) with microvascular flow abnormalities, ischemia downstream of a fixed coronary obstruction, and plaque rupture.Methods:We compared MI rates in pts with PAF vs. non-PAF in COMBINE AF, a patient-level metanalysis of 4 RCTS of DOACs vs warfarin (ARISTOTLE, ENGAGE AF-TIMI 48, RE-LY,ROCKET AF). Secondary endpoints were ischemic stroke and CV death. Cox proportional-hazards models stratified by trial and adjusted for elements of the CHADS-VASc score were constructed. Sensitivity analyses were performed across subgroups, omitting pts on lower-dose DOAC regimens, and accounting for competing risk of death.Results:Of 71,466 pts, 16,609 (23%) had PAF at enrollment. Pts with PAF vs non-PAF were similar age (median 72 vs 72. P=0.15), but more likely women (43 vs 36%), with prior CAD (35 vs 31%), and on aspirin (41 vs 32%); but less likely Asian race (12 vs 15%) or with CHADS-VASc score >4 (59 vs 60%), p160,000 pt-yrs of follow-up, 1033 MIs occurred: 277 (1.67%) in pts with PAF vs 766 (1.40%) in pts with non-PAF, corresponding to rates of 0.81% and 0.70% per pt-year. The HRadjfor MI with PAF vs non–paroxysmal AF was 1.17 [1.02-1.35], p=0.028 (Fig). Ischemic stroke occurred in 364 (2.19%) vs 1425 (2.60%) pts with PAF vs non–paroxysmal AF (HRadj0.81 [0.72-0.91], p

Circulation, Volume 150, Issue Suppl_1, Page A4147922-A4147922, November 12, 2024. Background:Patient-reported outcomes, such as quality of life (QoL) scores, provide a comprehensive measure of health status from the patient’s perspective, which may be relevant for predicting survival after cardiac resynchronization therapy (CRT).Hypothesis:We hypothesize that a healthier QoL score at 6 months post-CRT is associated with better long-term survival.Aim:To evaluate the association between a validated QoL at 6 months post-CRT and two-year survival in CRT patients.Methods:A prospective cohort study recruited 524 patients who received CRT at the Cleveland Clinic between May 2016 and June 2022. The 5-level EuroQol-5 Dimension (EQ-5D-5L) was used to assess QoL at 6 months post-CRT (higher scores indicating worse QoL) and patients were divided into two strata (EQ-5D-5L ≤ or > 10). Our primary endpoint was Event-Free Survival (EFS) – defined by the absence of both significant cardiac interventions (LVAD implantation or heart transplant) and mortality.Results:The population had a median (IQR) age of 71 years (IQR: 62-78), with 343 (65.5%) men and 419 (80%) received a defibrillator. Median EQ-5D-5L was 7 (IQR: 5-9). The response rate at 6 months post-CRT was 321 (68.2%), and the 2-year EFS rate was 397 (75.8%). Univariate analysis re revealed that EQ-5D-5L >10 was significantly associated with increased EFS. The Cox proportional hazard model showed it to be an independent predictor of EFS (HR: 2.33, 95% CI [1.53-3.56], p10 (log-rank test: p

Circulation, Volume 150, Issue Suppl_1, Page A4147366-A4147366, November 12, 2024. Background and Objective:Mobile Integrated Health (MIH) interventions enable community paramedics to perform structured assessments, physical exams, and medication reconciliation, provide disease education, review follow-up instructions, and adjust medications or administer intravenous diuretics under the direction of the telehealth physician. MIH has been shown in other studies to reduce emergency department (ED) transfers and healthcare costs while maintaining high patient satisfaction. We aimed to assess ED transfer rates and satisfaction in our population of largely medically underserved patients living with heart failure (HF) managed at home by MIH.Methods:Patients at a large, urban, academic medical center were enrolled in MIH via clinician referral as needed. After receiving an MIH visit, patients were invited to complete anonymous satisfaction surveys via REDCap. Paramedics documented whether an MIH home visit resulted in an ED transfer. Descriptive statistics were performed to evaluate the survey response distribution percentage and calculate ED transfer rates.Results:Between January 2021 and March 2024, 2,678 MIH visits were conducted for heart failure patients in NYC, with some patients receiving multiple visits. Among these, 239 patients completed at least one survey; only the first was considered for analysis. The average age of respondents was 74.01 (SD 14.8). Patient satisfaction was high: over 90% of participants expressed satisfaction across domains of ease of technology use, self-management and preference for receiving care at home. The net promoter score (patients recommending MIH to others) was 9.56 out of 10 (SD 1.27). Only 67 visits (2.5%) resulted in immediate ED transport during an MIH visit.Conclusions:High patient satisfaction with MIH care management at home and low rate of immediate transfers to ED indicate effective at-home care. These findings support MIH as a viable model for improving healthcare delivery and patient outcomes in HF management.

Circulation, Volume 150, Issue Suppl_1, Page A4143004-A4143004, November 12, 2024. Different patient-reported outcome (PRO) measures have been used and validated in studies of patients with heart failure (HF), including disease-specific measures like the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ). However, there is limited research available regarding the content validity (i.e., comprehensiveness, relevance, and comprehensibility) of those measures specifically as it relates to patients with acute HF (AHF).This study used a stepwise approach to identify PRO measures used in AHF studies and evaluate their content validity through a landscape analysis, concept mapping, and cognitive debriefing (CD) interviews with US-based patients.A landscape analysis was performed to identify PRO measures used in AHF studies. To assess concept coverage, items in each PRO measure were mapped to concepts (i.e., signs/symptoms and impacts on daily life) from the AHF conceptual model developed by Moshkovich et al. (2020). PRO measures with the most comprehensive and/or appropriate concept coverage were further evaluated through CD interviews with US adults who had been hospitalized for AHF within the last six months.The landscape analysis resulted in the identification of 15 PRO measures for use in AHF; nine were deemed appropriate for concept mapping. Following mapping, four measures were selected for further research based on their comprehensive concept coverage (KCCQ, PROMIS®+HF-27), effectiveness at measuring health utility (EQ-5D-5L), and suitability for measuring shortness of breath (a dyspnea numeric rating scale [NRS]). The KCCQ, in particular, showed good concept coverage, addressing more than half (n=12) of the key concepts in the Moshkovich et al. (2020) model. Twenty adults with AHF, representing NYHA classes I (n=4), II (n=8), and III (n=8), a mean age of 64 years (range: 39-81), and an average of 110 days since hospitalization (range: 26-183), participated in CD interviews. Participants found each measure easy to understand and answer, with items relevant to their experience of AHF. Participants found the recall periods, ranging from 24-hours to 2-weeks, appropriate and easy to use.This study’s stepwise approach allowed for the systematic identification and evaluation of the content validity of four PRO measures—the KCCQ, dyspnea NRS, EQ-5D-5L, and PROMIS®+HF-27—for use with adults with AHF. This research fills a gap in the current published literature regarding measures appropriate for use with adults with AHF.

Circulation, Volume 150, Issue Suppl_1, Page A4145543-A4145543, November 12, 2024. Introduction:Heart failure consists of complex management involving lifestyle modifications such as daily weights, fluid and sodium restriction, and blood pressure monitoring placing additional responsibility on patients and caregivers. Successful adherence requires comprehensive counseling and understandable patient education materials (PEMs). Prior research has shown that many PEMs related to cardiovascular disease exceed the American Medical Association’s 5th-6thgrade recommended reading level. The large language model (LLM) Chat Generative Pre-trained Transformer (ChatGPT) may be a useful adjunct resource for patients with heart failure to bridge this gap.Research Question:Can ChatGPT-4 improve heart failure institutional PEMs to meet the AMA’s recommended 5th-6thgrade reading level while maintaining accuracy and comprehensiveness?Methods:There were 143 heart failure PEMs collected from the websites of the top 10 institutions listed on the 2022-2023 US News&World Report for “Best Hospitals for Cardiology, Heart&Vascular Surgery”. The PEMs of each institution were entered into ChatGPT-4 (Version updated 20 July 2023) preceded by the prompt “please explain the following in simpler terms”. The readability of the institutional PEM and ChatGPT prompted response were both assessed usingTextstatlibrary in Python and theTextstat readabilitypackage in R software. The accuracy and comprehensiveness of each response were also assessed by a board-certified cardiologist.Results:The average Flesch-Kincaid grade reading level was 10.3 (IQR: 7.9, 13.1) vs 7.3 (IQR: 6.1, 8.5) for institutional PEMs and ChatGPT responses (p< 0.001), respectively. There were 13/143 (9.1%) institutional PEMs meeting a 6thgrade reading level which improved to 33/143 (23.1%) after prompting by ChatGPT-4. There was also a significant difference found for each readability metric assessed when comparing institutional PEMs with ChatGPT-4 responses (p

Circulation, Volume 150, Issue Suppl_1, Page A4146993-A4146993, November 12, 2024. Introduction:Anthracyclines (AC), a class of chemotherapeutic drugs, are used to treat various cancers, including breast cancer (BC). However, AC cause dose-dependent cardiac toxicity. Practice guidelines list pre-existing cardiomyopathy as a risk factor for cancer therapy-related cardiac dysfunction (CTRCD), but there is a lack of data on cardiotoxicity risk in patients with left ventricular (LV) hypertrabeculation without LV hypertrophy/dilation. We present a patient with LV hypertrabeculation who developed LV dysfunction after AC chemotherapy for BC.Description of Case:A 55-year-old woman diagnosed with multicentric invasive ductal carcinoma (IDC) of the right breast, stage IIA (cT3 cN1 cM0), grade 2, ER+/PR+/HER2-, was treated with neoadjuvant Paclitaxel for 3 months. Before AC-based chemotherapy, stress cardiac MRI due to residual post-COVID-19 dyspnea showed LV hypertrabeculation with a non-compacted/compacted ratio of 2.3, LVEF 56%, and no delayed enhancement. Transthoracic echocardiography (TTE) reported an LVEF of 52% with GLS of -17%. The patient’s electrocardiogram (ECG) showed normal sinus rhythm, and NT-pro BNP levels were

Circulation, Volume 150, Issue Suppl_1, Page A4144833-A4144833, November 12, 2024. Introduction:The advent of Large Language Models (LLMs) such as ChatGPT and Google Gemini yields a new paradigm for patient education. Coronary artery bypass grafts (CABGs) are open-heart surgeries that naturally gives to many questions in potential patients. Prior research suggested that patient education material should be written at a 6thgrade reading level maximally to be comprehended by the majority of the US adult population. However, most education material is written at a much higher literacy level. Now with the increasing use of LLMs, the potential for informing patients at an appropriate readability level exists.Research Question:Can ChatGPT and Google Gemini improve the readability of their primary responses to patient education questions about Coronary Artery Bypass Grafts to a 6thgrade reading level?Methods:We obtained 80 questions from 4 independent participants regarding information they would want to know prior to undergoing a CABG procedure. Questions that could not be answered using public information, required clinician input, and repeats were filtered out leaving 20 questions. These questions were asked to ChatGPT 3.5 and Google Gemini. Then both LLMs were asked to answer the question at a 6thgrade level within the same conversation. A new conversation was created each of the 20 questions. All responses were then evaluated using a Flesch-Kincaid calculator where the Flesch-Kincaid reading ease score (FKRE) and the Flesch-Kincaid grade level (FKGL) were obtained. Data analysis was performed using Microsoft Excel and Graphpad Prism.Results:For the ChatGPT responses, the average FKRE was 31.865 and FKGL was 12.545. Following the 6thgrade level request for ChatGPT, the average FKRE was 74.57 (p < 0.0001) and FKGL was 5.93 (p < 0.0001). For the Google Gemini responses, the average FKRE was 46.395 and FKGL was 10.545. Following the 6thgrade level request for Google Gemini, the average FKRE was 72.945 (p < 0.0001) and FKGL was 6.76 (p < 0.0001).Conclusion:Both LLMs significantly increased the readability of their responses and did so to a 6thgrade level. However, ChatGPT was closer than Google Gemini in reaching the desired FKGL. Nonetheless, our work showed that both LLMs could successfully work with CABG information and yield responses at a readability level befitting the US population. Future studies need to assess the accuracy of this information for LLMs to have practical use in cardiac surgery patient education.

Circulation, Volume 150, Issue Suppl_1, Page A4141955-A4141955, November 12, 2024. Introduction:Whereas low testosterone levels have been associated with poor cardiovascular outcomes and testosterone replacement therapy (TRT) in middle-to-older age adults with cardiovascular risk factors is considered safe, there is little data on the adverse cardiovascular effects of TRT in young adults.Case Report:A 38-year-old male with a past medical history of hypogonadism, recently started on intramuscular testosterone cypionate injections, presented to the hospital with altered mentation. Laboratory workup was remarkable for hemoglobin of 19 g/dL. Computed tomography (CT) angiogram of the head demonstrated a left middle cerebral artery infarct with a filling defect, requiring mechanical thrombectomy. A transthoracic echocardiogram (TTE) was done which revealed a dilated left ventricle (LV) with severely reduced LV systolic function, EF 20%, and global hypokinesis. There was no LV thrombus or evidence of a patent foramen ovale with contrast saline injection. He did not have any episodes of atrial fibrillation on telemetry monitoring. His hospital course was further complicated by an inferolateral ST elevation myocardial infarction (STEMI) due to distal left anterior descending (LAD) artery occlusion. He underwent drug-eluting stent placement and was started on dual antiplatelet therapy. Repeat TTE demonstrated new apical akinesis along with an LV apical thrombus of 1.1 x 0.8 cm. CT abdomen/pelvis with contrast demonstrated left renal and right iliofemoral thrombosis and the patient was also started on systemic anticoagulation.Discussion:Data suggests that physiologic levels of testosterone exhibit cardioprotective effects and low testosterone levels are associated with increased cardiovascular mortality. However, studies have also shown that testosterone use is associated with an increased risk of thrombosis and coronary artery disease. Additionally, testosterone use has been associated with myocardial apoptosis and adverse cardiac remodeling from dysregulation of androgenic receptors, which results in dilated cardiomyopathy. There is an ongoing debate on the safety of TRT, however, studies on TRT have largely included the middle and older male population and there is little data on younger patients. Herein, we demonstrate a case of TRT in a patient with several cardiovascular risk factors, who developed evidence of possible TRT-associated cardiomyopathy in addition to hypercoagulability.

Circulation, Volume 150, Issue Suppl_1, Page A4140803-A4140803, November 12, 2024. Vasomotion is the oscillation of vascular tone which gives rise to flow motion of blood into an organ. As is well known, spontaneous contractile organs such as heart, GI, and genitourinary tract produce rhythmic contraction. It imposes or removes pressure on their vessels alternatively for exchange of many substances. It was first described over 150 years ago, however the physiological mechanism and pathophysiological implications are not well understood. This study aimed to elucidate underlying mechanisms and physiological function of vasomotion in human arteries. Conventional contractile force measurement, immunohistochemistry, and Western blotting were employed to study human left gastric artery (HLGA) and uterine arteries (HUA). RESULTS: Circular muscle of HLGA and/or HUA produced sustained tonic contraction by high K+(50mM) which was blocked by 2µM nifedipine. Stepwise stretch and high K produced nerve-independent spontaneous contraction (vasomotion) (around 45 % of tested tissues). Vasomotion was also produced by application of Bayk 8644, 5-HT, prostagrandins, oxytocin. It was blocked by nifedipine (2µM) and blockers of intracellular Ca2+stores. Inhibitors of Ca2+-activated Cl-channels (DIDS and/or niflumic acid) and ATP-sensitive K+(KATP) channels inhibited vasomotion reversibly. Metabolic inhibition by sodium cyanide (NaCN) and several neuropeptides also regulated vasomotion in KATPchannel-sensitive and -insensitive manner. In Next step, we identified TMEM16A Ca2+-activated Cl-channels and subunits of KATPchannels (Kir 6.1/6.2 and sulfonylurea receptor 2B (SUR2B)), and c-Kitpositivity by Western blot. Fianally, we also foud regulation of vasomotion by other second messengers in HLGA and muscle specific events too. We conclude that vasomotion is sensitive to TMEM16A Ca2+-activated Cl-channels and metabolic changes in human gastric and uterine arteries. Vasomotion might play an important role in the regulation of microcirculation dynamics even in pacemaker-related autonomic contractile organs in humans.

Circulation, Volume 150, Issue Suppl_1, Page A4143872-A4143872, November 12, 2024. Introduction:Patients with comorbid heart failure (HF) and chronic kidney disease (CKD) face excess risks of mortality, but limited data are available examining specific modes of death across the spectrum of kidney function.Methods:We leveraged individual patient level data from 5 trials of HF with mildly reduced or preserved ejection (CHARM-Preserved, I Preserve, TOPCAT [Americas region], PARAGON-HF, and DELIVER). Causes of death (sudden, heart failure, other CV, and non-CV) were adjudicated by clinical events committees in each respective trial.Results:Among 17,947 patients across the 5 trials with available eGFR data, mean age was 71.6 ± 9.0 years, 51% were women, median NT-proBNP was 840 [25-75thpercentile 424, 1566] pg/ml. Overall, 2084 (12%) had eGFR ≥90 mL/min/1.73m2, 7977 (44%) had eGFR 60 – < 90, 4701 (26%) had eGFR 45-60, 3185 (18%) had eGFR

Circulation, Volume 150, Issue Suppl_1, Page AOr105-AOr105, November 12, 2024. Introduction:Data around Family Presence During Resuscitation (FPDR) and the Family Facilitator role are rapidly evolving in inpatient care settings. Yet, there is little formal preparation available for pre-hospital clinicians. A large Canadian paramedic group identified this gap in preparation for FPDR and requested practical, practice-changing education for their clinicians.This project aimed to develop and deliver virtual education regarding patient- and family-centered care using current FPDR evidence and foundational care theories. Additionally, we aimed to evaluate the learner’s baseline knowledge, comprehension of the content, and perspective of the framework’s application to practice.Methods:Three interprofessional resuscitation experts used current FPDR evidence and theories to develop the ABCD framework. The purpose of this simple schema is to provide memorable mental cues to prepare resuscitation team members for patient- and family-centered care during cardiac arrest. The ABCD tool emphasizes (A) Awareness of the family facilitator role and needs of the family, (B) Being Present emotionally and physically, (C) Connecting patients and family to the team and other resources, and (D) Debriefing and, in the case that ROSC is not achieved, leading a Pause to recognize the life lost. This framework was introduced during an hour-long pilot session for 75 Paramedics in a large Canadian province. The learning objectives included (1) identifying ways to be emotionally present, (2) communicating effectively with families during and after cardiac arrest care, and (3) recognizing the benefits of real-time reflection and team debriefing. An online survey was used to evaluate the impact of this virtual education on the participants’ confidence in their communication skills and caring for family members during resuscitation.Results:Exposure to the ABCD framework positively influenced the confidence with which paramedics responded to families during resuscitation. Attendees responded positively to case studies; many said they felt strongly that they could lead a Pause in the case of patient death and planned to do so. At 3 months post-education, most respondents had already applied the content to their clinical practice.Conclusion:The ABCD framework demonstrates potential to prepare interprofessional learners to provide patient- and family-centered care during resuscitation, and this work represents a first step to validating the framework’s content.