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

Circulation, Volume 150, Issue Suppl_1, Page A4123478-A4123478, November 12, 2024. Background:The impact of social determinants of health (SDOH) on growth in patients with hypoplastic left heart syndrome (HLHS) is understudied. In a secondary analysis of the Pediatric Heart Network SVR III study, we explored the impact of SDOH on longitudinal somatic growth through age 10 years in transplant-free survivors with HLHS.Methods:Z-scores adjusted for age for weight (WAZ), height (HAZ), and BMI (BMIZ) were categorized at age 10 years. To assess relationships between z-scores at 10 years and SDOH variables, we modeled all annual measurements for each z-score outcome using a multivariable mixed effects regression that included an interaction between the SDOH predictor and age. We included Hollingshead Score (HH) as a SDOH marker. A higher HH indicates better family socioeconomic status.Results:Of 555 subjects enrolled in the SVR trial, 191 had 10-year growth data. The mean WAZ and HAZ were below normal, with values of -0.3±1.3 (p

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 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 A4145692-A4145692, November 12, 2024. Introduction:Adherence to statin therapy is suboptimal in the primary prevention population, despite extensive data regarding efficacy and safety.Hypothesis:Introducing autonomy in the decision-making process will increase statin adherence and reduce perceived side effects.Goals:Compare six-month rate of statin adherence and perceived side effects in patients who initially decline atorvastatin, between those given reassurance and those offered a supplement trial prior to statin therapy.Methods:Patients > 40 years without a history of ASCVD at a moderate ASCVD risk who decline statin therapy underwent block randomization. The control group was provided education and reassurance regarding the statin therapy and prescribed 30mg atorvastatin. The intervention group was offered a trial of red yeast rice extract 20mg and a goal LDL-C 100 mg/dL. After 2 months those not at the goal LDL-C were then prescribed 30mg atorvastatin (Figure 1). The primary endpoint was the number of monthly pharmacy refills at 6 months. The secondary endpoints were rates of self-reported myalgias, fatigue, mental fog, and gastrointestinal upset at 6 months. The Wilcoxon rank sum test and the Chi-square test was used to assess the primary and secondary endpoints, respectively.Results:The final analysis included 276 patients; baseline demographics, labs and lipid profiles were similar between the two groups. Statin prescriptions filled was higher in the intervention group (Figure 2). The intervention group had lower rates of fatigue and mental fog, but not myalgias or gastrointestinal upset (Figure 3).Conclusion:Introducing autonomy in the decision-making process improved adherence to atorvastatin therapy and reduced the rate of perceived side effects.

Circulation, Volume 150, Issue Suppl_1, Page A4146920-A4146920, November 12, 2024. Introduction:Perioperative anemia can cause a host of complications, such as renal injury, stroke, and mortality. However, the use of transfusions preoperatively also can cause various complications, such as an overload of fluids and the risk of infection. Learning if, and how much an effect transfusion has in cardiac surgery can lead to better decision-making to reduce postoperative complications.Hypothesis:The hypothesis tested was that there is a significant difference in postoperative outcomes between cardiac transplant patients who received a blood transfusion preoperatively and those who did not.Methods:The UNOS database was used to find adult patients who received a heart transplant between 2000 and 2023 (n = 51,325). The remaining individuals were split into groups that received preoperative blood products (n=10,873) or did not (n=40,452). Endpoints analyzed include mortality, length of stay, graft status, and acute rejection. Mortality was analyzed using a Kaplan-Meier curve and log-rank tests, and Cox proportional hazards were used to find risk factors. All analysis was done in JMP.Results:After analysis, it was found that there was a significant difference in length of stay (p

Circulation, Volume 150, Issue Suppl_1, Page A4145352-A4145352, November 12, 2024. Introduction:Sodium-glucose cotransporter-2 (SGLT2) inhibitors are drugs designed to lower plasma glucose concentration by inhibiting Na+-glucose–coupled transport in the proximal tubule. Clinical trials demonstrate these drugs have favorable effects on cardiovascular outcomes including including slowing the progression of CKD. Although most patients tolerate these drugs, a potential complication is development of ketoacidosis, often with a normal or only a minimally elevated plasma glucose concentration mostly in diabetic patients. We present a case of SGLT-2 inhibitor induced ketoacidosis in a patient without any risk factor.Case Presentation:The patient is a 56-year-old gentleman without significant past medical history who presented to the emergency room with prolonged chest pain for more than 12 hours. He was hemodynamically stable with EKG evidence of acute Q-wave and ST elevation in the anteroseptal leads and high sensitivity troponin of about 78,000. He underwent successful PCI along with placement of two DES at mid LAD and proximal OM. Transthoracic echocardiography post catheterization showed LVEF of 25% with dyskinetic apical and apical inferior segment. Subsequently, GDMT for ischemic cardiomyopathy. Approximately after two days of initiation of GDMT, he was noted to have low bicarbonate of 18 and an AG of 16 following which ABG was drawn that showed metabolic acidosis with a nadir pH of 7.30 and an associated Pco2level of 29 mmHg. Despite an abnormal lab, he was clinically asymptomatic with no active complaints. His A1C was found to be 5.4. UA revealed ketones (2+) without glucose. β-Hydroxybutyrate level was elevated to 3.34 mmol/L. On further review of his chart, we saw that he had received two doses of empagliflozin. Diagnosis of euglycemic ketoacidosis, presumably related to SGLT2 inhibitor therapy was made. Endocrinologist recommended the usual management like diabetic ketoacidosis. The patient was then started on dextrose and insulin drip. Following closure of anion gap, drips were discontinued. Later, the patient was discharged home on GDMT without SGLT2 inhibitor.Conclusion:Given the tremendous benefits of SLGT-2 inhibitors in patients with diabetes, heart failure, and CKD, their use is expected to grow significantly. Providers should remain vigilant for potential evidence of the development of euglycemic ketoacidosis even in nondiabetic patients using SGLT-2 inhibitors, so that appropriate intervention is done in a timely manner.

Circulation, Volume 150, Issue Suppl_1, Page ASa909-ASa909, November 12, 2024. Introduction:Patient recruitment is a critical factor in running successful and timely clinical studies. This is particularly crucial in cardiac arrest research where the timing of presentation of study participants is unpredictable and interventions are often time-sensitive. Previous studies have identified adequate staffing as one of the most important enablers of successful recruitment. However, studies have also shown that recruitment outside of business hours is less common even at major academic centers.Hypothesis:We hypothesize that a substantial portion of potential study participants present outside of business hours and therefore providing coverage only during business hours results in missing a large number of potential study participants.Aims:The objective of this study was to analyze the timing of all patient enrollments from our previous cardiac arrest trials to identify patterns and assess the impact of providing 24/7 coverage on participant recruitment.Methods:We reviewed the patient enrollment time data for two cardiac arrest trials performed by our group (NCT02974257 and NCT03450707). We quantified the number of enrollments during business hours (9 AM – 5 PM) vs. outside of business hours and analyzed the frequency of enrollment by day of the week and time of day.Results:There were 112 patients enrolled between 2016 and 2022 across the two trials. A total of 80 patients (71.4%) were enrolled outside of business hours (Fig. 1). 75% of patients were enrolled during weekdays and 25% during weekends. By day of the week, enrollments occurred most frequently on Friday (20, 17.9%) and least on Monday (12, 10.7%) and Sunday (12, 10.7%) (Fig. 2A). By time of day, enrollments occurred most frequently during 2 – 4 PM and 6 – 8 PM (15, 13.4%) and least frequently during 4 – 6 AM and 8 – 10 AM (2, 1.8%) (Fig. 2B). Recruiting only during business hours would have resulted in additional 18 and 11 years to complete each study (Fig. 3).Conclusion:In our two most recent cardiac arrest trials, 75% of enrollment occurred outside of business hours. Limiting recruitment to only business hours would have resulted in a prohibitively longer time to complete the studies. This analysis provides a strong motivation and rationale for extending research staffing coverage beyond business hours.

Circulation, Volume 150, Issue Suppl_1, Page A4143017-A4143017, November 12, 2024. Background:Decentralized clinical trials using direct-to-participant recruitment can potentially engage large, representative participant pools.Research Question:Can a decentralized clinical trial use a multichannel approach to recruit patients >65 years old across the United States?Goals/Aims:To share insights on multichannel strategies for participant recruitment in the decentralized, app-based Heartline study.Methods:Heartline is a randomized trial testing the impact of a mobile app-based heart health program with the electrocardiogram (ECG) and Irregular Rhythm Notification (IRN) features on Apple Watch for early diagnosis, treatment, and outcomes of atrial fibrillation. Eligible participants were US adults aged ≥65 years with an iPhone and Medicare coverage. Multiple pathways for broad outreach were explored, including digital (eg, email, social media) and traditional channels (eg, direct mail, community outreach). Recruitment efforts were assessed and refined to reach a large eligible population.Results:A multichannel approach led to ~300,000 Heartline study app installations. In total, 34,244 participants completed enrollment (Feb 2020-Dec 2022), of whom 28,155 completed baseline demographic assessments. Participants were widely distributed geographically, with notable representation of outlying and rural areas (Figure 1). Women accounted for 54% of the participants. Overall, most participants were White (93.0%), with Asian, Black, and Hispanic participants representing 2.8%, 2.7%, and 2.5%, respectively.Conclusion:The Heartline study demonstrated the ability to recruit large numbers of participants aged ≥65 years using a direct-to-participant approach. Broad outreach strategies ensured gender and geographic diversity, enrolling a higher percentage of women than typical cardiology trials, and participation from rural areas. However, underrepresentation across racial/ethnic groups persisted and strategies to increase enrollment are needed. For similar trials, a strategic multichannel approach, with strong data and analytics capabilities may be beneficial to effectively target and enroll eligible participants.

Circulation, Volume 150, Issue Suppl_1, Page A4139613-A4139613, November 12, 2024. Description of Case:A 67-year-old female with a long-standing history of chronic lymphocytic leukemia (CLL, stage 0) on surveillance protocol, end stage heritable cardiomyopathy (titin mutation positive) with ejection fraction 15% and severe mitral regurgitation was referred to our center for advanced therapy evaluation. On evaluation, right heart catheterization showed normal filling pressures but decreased cardiac index (RA 4, PCWP 8, CI 1.6), so she was started on milrinone and listed for transplant as UNOS status 4 exception after extensive discussion regarding advanced therapies in the setting of her low-grade malignancy with favorable outcome. She underwent orthoptic heart transplantation (OHT) with DCD donor and ex-vivo perfusion. The preoperative total leukocytes count was 71,700/μl with mild anemia but no thrombocytopenia. Retrospective crossmatch was notable for flow cytometry crossmatch positive but CDC negative. The post-operative course was significant for an increase in total leukocyte count to 110,000/μl in absence of fever or infective source but was complicated with SVC stenosis at anastomotic site and thrombosis of the SVC and innominate vein necessitating thrombectomy and stent placement in the SVC. She also had bilateral pleural effusions for which she had bilateral chest tubes for three weeks post-transplant. Standard immunosuppression without induction was given and graft function was preserved with biopsies negative for rejection.Discussion:This case describes a successful OHT in a patient with long-standing chronic lymphocytic leukemia with a favorable outcome. OHT is the most effective therapy for end-stage heart disease, however historically cancer patients were considered ineligible for this therapy, given the increased risk with post-transplant immunosuppression. Though literature is limited, it is suggested that a careful selection of patients may have favorable outcome with slightly increased risk of cancer. These patients are at increased risk of infections and complications related to immunosuppression, which may exacerbate the immunocompromised state and potential rapid progression of underlying malignancy. Hematologic malignancies increase thromboembolism risk, as seen with this patient. A multi-disciplinary team approach involving oncology and infectious disease is integral for optimizing care in this complex population.

Circulation, Volume 150, Issue Suppl_1, Page A4144894-A4144894, November 12, 2024. Objectives:Evidence behind frail patients preferentially undergoing endovascular interventions for peripheral arterial disease remains sparse; thus, we evaluated the association of frailty and revascularization-approach with long-term mortality and major adverse limb events (MALE).Methods:VQI-Medicare linked VISION databases were queried for patients who had their first infrainguinal open or endovascular (endo) procedure between 2011-2015 [N=27,200]. Frailty was measured using the VQI-Risk Analysis Index (RAI) and dichotomized into “frail” (RAI≥37) and “non-frail” (RAI

Circulation, Volume 150, Issue Suppl_1, Page A4146939-A4146939, November 12, 2024. Background:New onset AF during acute illness has a high rate of AF recurrence within 5-yr. However, little is known about AF progression in patients with new onset AF during COVID illness. It is also unknown whether the time of COVID diagnosis (early vs late) impacts AF progression. More specifically, did the potentially different immune and inflammatory responses during early vs late COVID produce structural and electrical cardiac remodeling that would increase the likelihood of AF progression.Objective:We sought to compare AF progression in patients with new onset AF during early vs late COVID and hypothesized that early COVID was associated with increased AF progression compared to late COVID.Methods:From Apr 2020 to Feb 2024, patients receiving a SARS-2-CoV test without a history of AF with new onset AF and at least 3-mo of follow up were included (N=11,767). Patients were subdivided based on pos vs neg SARS-2-CoV test and time of diagnosis. Early COVID diagnosis (n=3052) included Apr 2020-Aug 2021 and late COVID (n=8715) included Sep 2021-Feb 2024. AF progression endpoints at 3-, 6- and 12-mo included AF hospitalization, AF emergency department (ED) visit, cardioversion and AF ablation.Results:Patients with late COVID were more likely females with hypertension, coronary artery disease and hyperlipidemia compared to early COVID patients. At 3- and 6-mo follow-up there was no difference in AF progression between the early and late COVID groups for any endpoint. In contrast, at 12-mo follow up there was in increase in late diagnosis group AF ED visits (11% vs 7.6%,p

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 A4143844-A4143844, November 12, 2024. A 35-year-old gravida 1, para 0 with biventricular heart failure (LVEF 25%), nonischemic cardiomyopathy, history stroke, history of left ventricular thrombus, class III obesity, and chronic kidney disease who had been followed by Cardio-Obstetrics throughout her pregnancy presented at 34 weeks gestation for planned induction of labor. Upon presentation, she underwent assessment with a pulmonary artery catheter (PAC) and was noted to be in cardiogenic shock with elevated biventricular filling pressures and low cardiac index necessitating hemodynamic stabilization followed by primary cesarean section.The patient was admitted to the cardiac ICU for medical optimization prior to delivery. Home medications including isosorbide dinitrate, metoprolol, and hydralazine were continued. The patient was briefly placed on inotropic support with dobutamine, which was discontinued due to ectopy. After PAC-guided IV diuresis, anticoagulation transition from enoxaparin to heparin, and twice daily fetal monitoring via non-stress test, a multidisciplinary team, including cardiology, maternal fetal medicine, cardiac anesthesia, and cardiothoracic surgery assembled for the C-section. Following pre-delivery cannulation for potential ECMO support, the patient underwent C-section and elective salpingectomy under epidural anesthesia with delivery of a healthy neonate.Post-delivery, the patient was monitored in the ICU, focusing on fluid management, anticoagulation transition to warfarin, and titration of heart failure medications, as the patient did not plan to breastfeed. After discharge, she was scheduled for a 2-week postpartum visit including echocardiogram, EKG, and NT-proBNP.Discussion:Given the patient’s acute decompensation and fluid overload, medical optimization was essential prior to delivery. However, stabilization was expected to be temporary due to ongoing physiologic changes of pregnancy. Her limited mobility and concern for multiorgan compromise, such as new oxygen dependency and rising creatinine, made a prolonged induction of labor unfeasible. Due to concern for maternal intolerance of labor, unstable fetal lie, fetal distress due to decreased perfusion, and an increased likelihood of emergency C-section, a primary C-section was recommended as a safer option. The successful delivery of a healthy neonate and post-operative maternal stabilization highlights the importance of a multidisciplinary approach in managing complex cardio-obstetric cases.

Circulation, Volume 150, Issue Suppl_1, Page A4146005-A4146005, November 12, 2024. Aortic valve replacement (AVR) with biological valve prostheses (BV) avoids long-term anticoagulation compared with mechanical vale prostheses. Their durability is limited due to structural valve dysfunction (SVD). Valve degeneration is gradual, leading to bioprosthetic valve failure (BVF). We present the first case reported of acute aortic Avalus bioprosthesis SVD with severe aortic regurgitation (AR) secondary to flail leaflet.A very active 52-year-old male with CAD, atrial fibrillation/flutter, and bicuspid aortic valve (AV) with symptomatic severe aortic stenosis treated with a 25 mm Abbott St. Jude/EPICTMSupra valve 16 years ago required a redo surgery for infective endocarditis with an aortic root abscess treated with a 25 mm Medtronic Avalus BV 5 years prior and aortic root reconstruction. He presented with a 3-day history of chest pain and severe dyspnea. On arrival, cardiogenic shock and respiratory failure ensued, requiring vasopressors and endotracheal intubation. CXR revealed pulmonary edema. Coronary angiogram revealed non-obstructive CAD. TEE revealed preserved LV function with severe acute AR. He underwent emergent AVR. Surgery revealed a sterile flail prosthetic valve leaflet with complete prolapse of the noncoronary cusp. A 27-mm Medtronic Evolute BV was placed. His course was complicated by transient complete heart block. He continued improving and was then discharged.Acute AR should be suspected in patients with acute hemodynamic instability and history of AVR. TTE or TEE are crucial for the assessment of BV and diagnosis of AR. The only effective treatment for acute severe AR is emergent AVR. Newer generation BVs offer the possibly of not requiring long-term anticoagulation and enhanced durability. The PERIGON trial evaluating the Avalus bioprosthesis in AVR showed no cases of SVD with excellent durability and hemodynamic profile during the 5-year follow-up, being this the first case reported in the literature of acute catastrophic failure of this valve.Our case highlights the importance of rapid diagnosis and intervention in acute aortic BVF. While newer BVs offer improved durability and hemodynamic properties, clinicians must remain vigilant for acute complications secondary to SVD. Studies with longer follow-up are needed to better characterize the safety and performance of the Avalus bioprosthesis. The lack of standardized definitions for SVD may have led to underreporting and underestimation of its incidence.

Circulation, Volume 150, Issue Suppl_1, Page A4143869-A4143869, November 12, 2024. Introduction:Previous research has described barriers and facilitators for adherence to care guidelines among adults with congenital heart disease (CHD). However, uncertainty remains on how to best support patients in clinical practice within time and resource constraints.Aim:To examine how patients incorporate CHD into their identity and how that influences the management of their condition.Methods:We conducted 48 semi-structured qualitative interviews with adult CHD patients and providers (cardiologists, nurses, patient coordinators, and social workers). Purposive sampling was used to gain patient diversity in CHD lesions, race/ethnicity, SES, geography, and prior gaps in care. Interviews were conducted by a single interviewer using a semi-structured guide based on the “Capability, Opportunity, Motivation-Behavioral (COM-B)” Framework to explore perceived determinants of behavior for managing CHD and navigating the adult health system. Rapid qualitative analysis was conducted to develop two structured data matrices displaying themes about the influence of CHD on identity and enablers of patient engagement.Results:Of 31 patients, 39% were male, 58% were People of Color, and 35% had prior gaps in care (of 3 or more years). Five domains (from 15 themes) emerged to characterize how patients viewed CHD as influencing their ability to engage with care. Themes included 4 Illness Identity domains (Rejection, Acceptance, Engulfment, and Enrichment) and a fifth domain of Indifference – characterized by a lack of emotional valence that accompanies the other four domains. Variance in these domains could be tracked to differences in patient outcomes, such as perceived ability to navigate the healthcare system (Figure 1). Providers and patients demonstrated concordance regarding the perceived influence of illness domains on patients’ mental health but less concordance regarding its impact on patient engagement and healthcare navigation.Conclusion:Considering the extent to which a patient views their CHD as a component of their identity could help providers support adult CHD patient engagement, tailor counseling about care guidelines, and likely enhance the effectiveness of patient-provider relationships.

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.