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Abstract P1073: Optimizing Blood Pressure Control Strategies with Real-Time Data in Community Health Centers
Introduction: Blood pressure (BP) control in the United States among persons with hypertension (HTN) is less than 50%. Performance and quality measures to improve care and outcomes for patients with high BP were published in 2019. The American Heart Association (AHA) recently completed its federally funded cooperative agreement, the National Hypertension Control Initiative (NHCI) to improve BP control in 350 community health centers (CHCs) with 1.5 million persons with HTN. Hypothesis: Use of a population health management platform can provide CHCs with more actionable, real-time Electronic Health Record (EHR) data to advance quality improvement (QI) efforts and evaluation capabilities. Methods: AHA identified a population health management platform to source EHR-derived data from 38 of 350 CHCs participating in NHCI. The objective was to demonstrate the value of readily accessing and using established measures for BP control in a project and system not already set up to do so. Eighteen clinical measures were used based on established performance and quality measures, aligning with Healthcare Effectiveness Data Information Set (HEDIS) where possible. Data for chosen measures was pulled from CHC EHRs on a monthly, quarterly, and ad hoc basis. This data expanded beyond what is required to be reported by CHCs to the Uniform Data System (UDS). Data sharing agreements were secured from 38 NHCI CHCs and 12 non-NHCI CHCs, as a comparison group, and all measures were made available to participating CHCs and other users. Results: Data was received for 12 quarters (January 2021 through December 2023) from the 50 CHCs on over 4.3 million encounters for 2.8 million patients. Data show a 48.7% relative improvement in the number of CHCs taking a BP reading at each patient encounter from Q1 2021-Q4 2023 (57.4% to 85.4%). Additionally, CHC BP control <140/90 mm Hg and <130/80 mm Hg reached 65.4% and 27.9%, respectively, in Q4 2023, as compared to the UDS reported 2023 BP control rate <140/90 mm Hg of 60.9% for 350 NHCI CHCs. Conclusion: The expanded 18 measures allowed for more timely, frequent, detailed, and potentially actionable data to inform QI efforts. The timeliness and higher frequency of data should enable CHCs to understand the effects of their BP control strategies in real time. Using a population health management platform that emphasizes clinical performance measures based on “real-time” EHR data may strengthen and accelerate BP control QI and evaluation efforts.
Abstract P2147: Descriptive Analysis of the Reinforcing Essentials of Sleep for Teens Program: Findings from a Pilot Study
Introduction: Sleep duration is a metric of cardiovascular health included in AHA’s Life’s Essential 8. Half of adolescents sleep less than the recommended 8 hours on school nights; youth from minoritized populations are particularly at risk. Optimizing sleep quality early in life is crucial to reducing CVD risk. This was an exploratory pilot study of “REST” (Reinforcing Essentials of Sleep for Teens), a comprehensive educational program designed to support healthy sleep in teens in two major urban areas. Methods: High school students from NYC and Los Angeles ages 14-18 were enrolled in REST’s 6-wk program. Educational content consisted of 6 modules covering key contributors of poor sleep in teens: bedtime procrastination, sleep environment, and electronics use. Adolescents and their parents met with a master's level health educator weekly for individual sessions and later received electronic video brochures containing educational videos to reinforce learned concepts. Sleep quality was assessed via the Pittsburgh Sleep Quality Index (PSQI), and the Assessment of Sleep Environment (ASE) was used to assess physical sleep environment (e.g., noise, light, etc). Video brochure analytics summarized average openings, viewing time, and time/day of viewing to assess participant engagement. Results: Twelve adolescents completed the pilot program (mean age 17.2, 66.6% male, 75% from racial/ethnic minority backgrounds). At baseline, adolescents slept a mean(SD) of 7h 14min (1h 24min)/night, had a mean(SD) PSQI score of 5.33 (2.2) and mean(SD) ASE score of 11.58 (5.7). One-quarter of teens had poor sleep quality (PSQI≥5) and 58.3% had moderate/high ASE scores (≥10), indicating poor sleep environment. Video brochure analytics over 6 wks showed highest engagement in afternoons (28%) and evenings (28%). Engagement was higher on weekdays (59%) compared to weekends. While mean(SD) video length was 1:43 (0:28) min, average viewing time was 1:16 min. Conclusions: In this pilot educational program, moderately problematic physical sleep environments, poor overall sleep quality, and short sleep durations were frequently reported among adolescents at baseline. Video brochure engagement metrics suggest that teens may be motivated to learn how to improve their sleep as part of their after-school weekday routine. Shorter-length videos may be more effective in maintaining participant attention. Larger studies are needed to determine the REST program’s acceptability and effectiveness.
Global sensitivity analysis of structural seismic demand based on information entropy
Abstract P1125: Targeted Health Coaching Intervention to Improve Physical Activity and Physical Function Post-Structured Cardiac Rehabilitation Programming Among Older Adults: A Pilot Study
Introduction: Attending cardiac rehabilitation (CR) improves fitness and quality of life and decreases the risk of future death from heart disease. Unfortunately, once an individual finishes a CR program, continued participation in physical activity (PA) too often reverts to previous sedentary patterns and is even more prevalent among older adults. Thus, this pilot study tested the feasibility of a health coaching intervention to improve PA and physical function after CR among older adults. Hypothesis: Compared to education alone, we hypothesized that health coaching would maintain or improve PA participation and physical function 3 months after CR completion. Methods: A total of 13 older adults who graduated from CR were randomized to either an education or health coaching group for 3 months. The education group received one 30-minute education session within the first month of randomization. The health coaching group received 6 health coaching sessions across the 3-month study duration. Both groups received a Garmin wrist-worn device and step goal ranging from 5,000-8,000 steps per day based on baseline step count. The Senior Fitness Test assessed physical function at baseline and 3 months. Paired t -tests were used to test within-group differences in mean change of outcomes and independent t -tests were used to test between-group differences in mean change of outcomes. Results: Participants were on average 70.8 + 7.0 years old, white (84.6%), and female (61.5%). Average step count adherence was 110.4% + 26.8% and 102.7% + 18.1% for the health coaching and education groups, respectively. Regardless of group, participants significantly improved their waist circumference (-3.3 + 4.4 cm; p = 0.019), chair stands (2.0 + 2.4; p = 0.015), arm curls (2.0 + 2.0; p = 0.005), and 2-minute steps (4.8 + 7.3; p = 0.043). Participants increased their average daily step count by 1194 + 1641 and 545 + 1762 in the health coaching and education groups, respectively. There were no significant between-group differences in this small sample. Conclusions: This pilot study demonstrates utilizing health coaching and education to maintain or increase PA and physical function 3 months after CR is feasible. Future studies should employ a similar approach among a larger sample size to determine the relative efficacy and effectiveness of health coaching and education on PA and physical function after CR amongst older adult populations.
Abstract P2155: Food Insecurity and Sleep Duration among Hypertensive Patients in Jamaica
Introduction: Emerging evidence suggests food insecurity (FI) is associated with adverse sleep outcomes. The American Heart Association recommends 7-9 hours of sleep each night to reduce risk of adverse outcomes like hypertension. Though evidence suggests adverse sleep outcomes are associated with FI and hypertension, there is limited research to understand the role of sleep outcomes in the Caribbean, a region that is double burdened with food insecurity and hypertension. Objective: To describe sleep duration among patients with hypertension in two clinics in Jamaica and evaluate association between sleep duration, FI, and sociodemographic factors. Hypothesis: We hypothesize that food insecurity is associated with shorter sleep duration in Jamaica. Methods: We conducted a cross-sectional analysis from the Addressing Blood Pressure Control through Dietary Approaches (ABCD) study, recruiting patients with hypertension from a specialist clinic and a primary health care clinic within the University of the West Indies. Sleep duration was gauged by asking, "On average, how many hours do you sleep at night?" Food security was assessed using the Latin American and Caribbean Food Security Scale (ELCSA). Only participants with complete data on food security and sleep were included for analysis. Logistic regression evaluated associations between short sleep duration (5-6 hours) and normal/long sleep duration (≥7 hours) with food insecurity. Results: The sample included 252 participants (71% females; mean age 65 years). Thirty-four percent had short sleep duration (5-6 hours), while 52% slept 7-8 hours and 13% for ≥9 hours. Twenty-three percent were food secure, 41% had mild FI, 21% moderate FI, and 15% severe FI. In a model adjusted for age, sex, education, employment, and marital status, hypertensive patients with FI had higher odds of short sleep, though not statistically significant. Participants aged 55-64 years and 65-74 years were more likely to have short sleep duration (OR 2.53, p=0.033 and 4.81, p=0.003, respectively). Retired individuals were less likely to have short sleep duration (OR 0.39, p=0.025). Conclusion: While no statistically significant association was observed between FI and sleep duration in this study, the association with age and retirement are noteworthy. Given the high burden of FI and short sleep duration in this study and the importance of sleep for cardiovascular outcomes, larger studies exploring these associations are warranted.
Age-related differences in the relationship between confidence and false memory in a mnemonic discrimination task
Abstract In addition to episodic memory loss there is an increase in false remembering in ageing especially when the discrimination between studied and new items is difficult in a recognition memory task. The aim of this study was to identify the underlying psychological mechanisms of this behavior, specifically, the possible role of false recollection. We used the Mnemonic Similarity Task, a widely used task in neuroscience research developed to assess the behavioral manifestation of hippocampal computations, pattern separation and pattern completion. First, older and young adults (n = 39 and 44, respectively) were presented with images of everyday objects. Then, on a surprise recognition test, they saw old (studied) and new (non-studied) items as well as visually similar lures of the images seen in the study phase. Instead of using the original Old/New test format, we asked participants to make confidence judgments. Our response frequency and ROC (receiver operating characteristics) analyses revealed overconfidence in false memories for the lures in the group of older adults suggesting false recollection. Such overconfidence was not observed for the completely new stimuli. Our results imply that older adults tend not to acknowledge some memory problems as a consequence of very high confidence in false memories.
A cosmopolitan calcifying benthic foraminifera in agglutinated disguise as a geochemical recorder of coastal environments
Calcifying foraminifera from the orders Rotaliida and Miliolida are widely used as geochemical proxies for recording paleoceanographic conditions, while agglutinated foraminifera are often overlooked since their tests are mostly composed of foreign particles. This study investigated the geochemical properties of Textularia agglutinans, a cosmopolitan agglutinated benthic species from the order Textulariida which has an exceptional inner calcareous test and is evolutionarily basal to Rotaliida. This study confirms the evolutionary link between textulariids and rotaliids based on their geochemistry and establishes T. agglutinans as a geochemical recorder of marine environments. Specimens from the Mediterranean coast of Israel were analyzed using laser ablation ICP-MS and compared to whole-test ICP-MS measurements of rotaliid and miliolid taxa from the same location. An Mg/Ca temperature calibration was established by LA-ICP-MS analyses of cultured specimens at 15, 17, 20, and 25 °C. Results show that T. agglutinans is a mid-Mg species (~19 to ~60 mmol/mol), with an Mg/Ca temperature correlation similar to high-Mg species. Its Pb, Zn, and Mn/Ca ratios are variable, generally overlapping with rotaliids and significantly lower than miliolids. Notably, T. agglutinans exhibits significantly higher Sr/Ca ratios (3.2 to 4.7 mmol/mol) compared to most foraminifera. Raman analyses reveal that the inner wall comprises a mix of aragonite and calcite, explaining these elevated Sr/Ca ratios. Rotaliida are the most prolific group of calcifying foraminifera. Our findings suggest that rotaliid tests evolved from an agglutinated textulariid ancestor with an inner aragonitic wall, a hypothesis that is further supported by the close phylogenetic relationship of the two groups.
Abstract P1019: Patient Values and Anticoagulant Decisions in Atrial Fibrillation: a Secondary Analysis of the RED-AF Shared Decision-Making Trial
Background: Deciding to use oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF) is complex. For many, the decision between treatment and non-treatment requires a primary tradeoff between the risks of potential stroke and increased bleeding. Hypothesis: We hypothesized that patient values and empiric stroke risk measured by CHA 2 DS 2 -VASc score would influence OAC decisions. Methods: We conducted a secondary analysis of a randomized clinical trial where eligible clinicians and patients were independently randomized to one of two decision aids (DAs) – a patient decision aid and/or an encounter decision aid. Eligible patients were adults with AF with CHA 2 DS 2 -VASc≥1 for men or ≥2 for women. Patients newly prescribed (OAC-naive subgroup) or already taking OAC (OAC-experienced subgroup) were included. We assessed patient values using a 5-point Likert scale between stroke prevention and bleeding risk after SDM during a clinical encounter. We report preliminary results using descriptive statistics and adjusted analysis to investigate the effects of CHA 2 DS 2 -VASc and expressed values on OAC use. Results: 1005 patients were included in the analysis. 828 (82%) patients valued stroke prevention over bleeding risk. Among the OAC-naive group, 175 (63%) valued stroke prevention more than bleed avoidance, 58 (20%) valued bleed avoidance more than stroke prevention, and 47 (17%) were neutral. In the unadjusted analysis, patients were more likely to value stroke prevention if they were OAC-experienced (p<0.001), older (p<0.001), female (p< 0.001), had patient-reported bleeding (p=0.003), or if CHA 2 DS 2 -VASc ≥ 2 if male, ≥3 if female (p<0.001) Table 1 . After adjustments, there were significant associations for OAC use among patients who valued stroke prevention (OR 5.35, 95%CI 3.13-9.13, p<0.001) or had higher CHA 2 DS 2 -VASc (OR 2.03, 95%CI 1.26-3.27, p=0.004). Patients who valued bleed avoidance had an opposing association not to use OAC (OR 0.23, 95%CI 0.11-0.48, p<0.001). Conclusions: Patients with elevated risk (CHA 2 DS 2 -VASc score, age, and female), and those who reported a prior bleeding event valued stroke prevention more than bleeding avoidance. Both empiric stroke risk and patient values were associated with the decision to use OAC. While the tradeoff between stroke prevention and bleeding risk is only one aspect of the decision-making process, these results indicate variability in patient values may influence OAC use.
Abstract P3042: Trends and Disparities in Self-Reported Health Among US Adults with Diabetes: NHANES 2001-2018
Introduction: Self-reported health is an indicator of overall well-being, encompassing physical, mental, and social health. It predicts future morbidity and mortality. Among individuals with diabetes in the United States, most prior studies focused on diabetes treatment and control and rates of complications, but data on patient-reported outcomes such as self-reported health are lacking. The objective of this study was to characterize trends and disparities in self-reported health among US adults with diabetes. Methods: We performed serial cross-sectional analyses of adults aged ≥20 years with self-reported diabetes who participated in the 2001-2018 National Health and Nutrition Examination Survey (NHANES). Self-reported health status was categorized as high (good/very good/excellent) or low (poor/fair). We examined trends in the prevalence of high self-reported health, overall and by subgroups defined by age, race and ethnicity, income, education, and insurance. All analyses accounted for the complex survey design and were weighted to generate nationally representative estimates. Results: We included 5306 adults with diabetes (mean age, 60 years; 49% female; 63% self-identified as Non-Hispanic White; 15% Non-Hispanic Black; 15% Hispanic). Over the 18-year study period, the prevalence of high self-reported health was stable: 58.3% (95% CI 53.1 to 63.3%) in 2001-2004 to 64.0% (95% CI 59.3 to 68.5%) in 2017-2018, p-trend=0.096 ( Figure 1A ). A significant increase in the prevalence of high self-reported health was observed in adults aged ≥ 65 years (55.8% [95% CI: 49.6-61.8%] to 68.9% [95% CI: 60.6-76.1%], p-trend=0.002, Figure 1B ). Disparities by race/ethnicity have widened over time, with significantly lower prevalence of high self-reported health in Hispanic adults compared to non-Hispanic White adults in 2017-2018 (47.7% vs. 67.7%, p=0.004, Figure 2A ). Disparities in self-reported health by income, education, and insurance have also widened ( Figure 2B, 3A, and 3B ). Conclusions: Self-reported health has improved among older, but not younger, adults with diabetes in the past two decades. There were persisting or worsening disparities in self-reported health by race/ethnicity and socioeconomic status. Further research is needed to understand the factors contributing to overall well-being across age groups. Persistent disparities in self-reported health call for targeted programs that prioritize marginalized groups.
Medication time of metformin and sulfonylureas and incidence of cardiovascular diseases and mortality in type 2 diabetes: a pooled cohort analysis
Abstract P2118: Marital status is associated with meeting the aerobic physical activity guideline in Latino men
Introduction: Latino men are more likely to report never participating in aerobic and muscle-strengthening physical activity compared to non-Latino white men. Previous research suggests that spouses/partners can play an important role in promoting healthy behaviors in Latino men. However, limited research has examined the association of marital status with aerobic (e.g., walking, running) and muscle-strengthening physical activity in Latino men. Hypothesis: We hypothesized those that were married/living with a partner would be more likely to meet aerobic and muscle-strengthening physical guidelines. Methods: We used cross-sectional 2016-2018 National Health Interview Survey data on Latino men ≥18 years of age (n=5,592). Participants were asked to self-report their marital status and responses were categorized into married/living with a partner and never married/widowed/divorced/separated. Aerobic physical activity was measured based on minutes of moderate-to-vigorous leisure-time physical activity per week and categorized into 1) meeting the guideline (≥150 min of moderate-vigorous activity or ≥75 min of vigorous activity or 150 min of moderate activity/week), and 2) not meeting guideline (>0 min/week of activity but less than the recommendation). Muscle-strengthening physical activity was categorized as 1) meeting guideline (muscle-strengthening activity ≥ 2 times per week), and 2) not meeting guideline (muscle-strengthening physical activity less than twice a week, never, or were unable). Logistic regression analyses were used to estimate associations of marital status with meeting aerobic and muscle-strengthening activity guidelines. Models were adjusted for age, education, employment status, and nativity. Results: In adjusted models, compared with being never married/widowed/divorced/separated, those that were married/living with a partner were significantly more likely to meet the aerobic physical activity guideline (Odds Ratio [OR]: 1.17, 95% Confidence Interval [CI]: 1.02-1.34). Marital status was not associated with meeting the muscle-strengthening guideline (OR: 0.99, 95% CI: 0.83-1.18). Conclusions: Among Latino men, being married/living with a partner is associated with meeting the aerobic activity guideline, but not the muscle-strengthening recommendation. Given the importance placed on family in Latino culture, the role of spouses/partners should be considered in physical activity promotion among Latino men.
Abstract P1113: Periconceptional DASH Diet and Adverse Pregnancy Outcomes:
Background: A DASH (Dietary Approaches to Stop Hypertension) diet is associated with improved cardiovascular health (CVH) outcomes in non-pregnant individuals, but its association with CVH-related pregnancy outcomes is not clear. We examined whether a periconceptional DASH diet was associated with adverse pregnancy outcomes (APOs), which are associated with CVH-risk. Methods: This is a secondary analysis of data from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be (nuMoM2b) cohort. We calculated DASH diet scores from Block food-frequency questionnaires administered in the first trimester. DASH diet scores were categorized in tertiles from Tertile 1 (T1, least adherent) to Tertile 3 (T3, most adherent). APOs were evaluated individually and included small-for-gestational-age neonate [<10 th percentile, SGA], large-for-gestational-age [ > 90 th percentile, LGA]), hypertensive disorder of pregnancy (HDP), gestational diabetes mellitus (GDM), and preterm birth (PTB) <37 weeks. Individuals with hypertension or diabetes prior to pregnancy were excluded. Modified Poisson regression models were adjusted for age, income, education, and health insurance, but not cardiometabolic risk factors deemed to be on the causal pathway (i.e., BMI). Secondarily, we assessed whether the above associations varied by adequate neighborhood food access, determined at the census tract level using the USDA Food Atlas . Results: Among 7,981 nulliparous individuals with dietary and outcome data, the frequency of SGA, HDP, GDM, and PTB were lower with higher adherence to a DASH diet (p<0.05 for all). In adjusted analyses, nulliparous individuals who reported the highest adherence to a DASH diet (i.e., T3) had a lower risk of developing HDP compared with those who had the least adherence (i.e., T1) (11.6% vs 14.7%; adjusted risk ratio, aRR 0.84, 95% CI 0.71-0.99). Those in T2 compared with the T1 were at lower risk of developing GDM (3.5% vs 4.7%; aRR 0.69, 95% CI 0.52-0.92). Adherence to a DASH diet was not associated with SGA, LGA, or PTB (TABLE). The above associations between a DASH diet and HDP and GDM did not vary by neighborhood food access (interaction p-value=0.82 for HDP; 0.37 for GDM). Conclusions: DASH diet in early pregnancy was associated with lower risk of developing HDP and GDM in nulliparous individuals. Further interventional research is needed to understand whether promotion of a DASH diet in early pregnancy can reduce the risk of these APOs.
Genome-specific association study (GSAS) for exploration of variability in hemp (Cannabis sativa)
Abstract P1011: Home Blood Pressure Monitoring and Risk of Falls in Older Adults with Hypertension: the AMBROSIA-HOME Cohort Study
Background: Over-intensification of antihypertensive medication may lead to hypotension and excessive blood pressure (BP) variability and thus increase the risk for falls, a major cause of injury-related hospitalization and death among older adults. Monitoring BP at home may allow for better BP management and avoidance of falls. Objective: To evaluate the associations of home BP, white coat effect (difference between clinic and home BP), and day-to-day variability of BP with falls. Methods: The Ambulatory Blood Pressure in Older Adults Home BP Monitoring (HBPM) (AMBROSIA-HOME) study included 541 participants from Kaiser Permanente Southern California aged ≥65 years taking antihypertensive medication. Participants were instructed in proper HBPM technique and asked to take 2 BP readings each morning and each evening for 7 days. We included 499 participants (92.2%) with ≥4 days with 2 morning and 2 evening HBPM readings. For both systolic BP (SBP) and diastolic BP (DBP), the white coat effect was defined as mean clinic BP minus mean BP from HBPM and the standard deviation independent of the mean (SDIM) of morning and evening BP were calculated as measures of day-to-day variability. Participants reported any fall where their body parts hit a surface, including falls that occured on stairs, monthly for 1 year using falls calendars. We used Cox proportional hazards models to estimate hazard ratios of time to first fall across quartiles of each HBPM metric, separately, adjusting for demographic characteristics and chronic conditions. Results: The mean ± SD age of participants was 74.2±6.1 years, and 57.3% were women. The prevalence of prefrailty and frailty were 50.7% and 3.4%, respectively. Participants in the top quartile of mean SBP from HBPM were older, more frequently male, more frequently Black and Hispanic, and had higher prevalence of diabetes, arthritis, and neuropathy than those in the lowest quartile. There were 187 participants who reported falls (376 falls/1,000 person-years). We did not find evidence of associations between mean, white coat effect, or SDIM of SBP ( Figure ) or DBP from HBPM and falls. Conclusion: In this population of older US adults with treated hypertension, BP measured using HBPM was not associated with falls.
Abstract P2076: Association of High-Density Lipoprotein Cholesterol, Apolipoprotein E and A1 Concentrations With Fetal Growth, Maturation, and Placental Insufficiency
Introduction: Cholesterol is important for fetal growth and is in fetal life mainly carried by high density lipoprotein (HDL) cholesterol enriched with apolipoprotein E (apoE). The fetus is dependent on maternal/placental transport of cholesterol until de novo synthesis increases at 19 weeks of gestation. The association between HDL cholesterol concentrations and fetal growth, maturation, and placental insufficiency remains uncertain. Hypothesis: We hypothesized that HDL cholesterol, apoE, and apolipoproteinA1 (apoA1) concentrations are associated with fetal growth, maturation, and placental insufficiency. Methods: To examine this we used data from the Copenhagen Baby Heart and COMPARE studies including more than 12,600 umbilical cord blood samples and 360 corresponding venous samples at birth, with follow-up at 2 months. Results: HDL cholesterol concentrations correlated significantly with apoE and apoA1 at birth in both cord blood (Spearman’s correlation: 0.48 for apoE and 0.67 for apoA1, p-values <0.001) and venous blood (0.58 for apoE and 0.71 for apoA1, p-values<0.001) and at two months of age in venous blood (Spearman’s correlation: 0.18 for apoE (p=0.003) and 0.87 for apoA1(p<0.001)). From birth to two months of age venous blood concentrations of HDL cholesterol and apoA1 increased while apoE decreased (p<0.001). Gestational age adjusted HDL cholesterol and apoE concentrations in cord blood at birth were positively associated with birth weight (p<0.001), while apoA1 was only marginally significant (p=0.05). The clinical classification of intrauterine growth/maturation; small, appropriate, and large for gestational age, showed a significant, stepwise increase in cord blood for HDL cholesterol and apoE concentrations, but not for apoA1, from small to large for gestational age (p for trend <0.001). Multifactorially adjusted odds ratios (95% CI) for cord concentrations of HDL cholesterol, apoE, and apoA1 below the 20 th percentile among newborns exposed to placental insufficiency was 1.39 (1.17-1.66) for HDL cholesterol, 1.47 (1.23-1.76) for apoE, and 1.19 (0.99-1.43) for apoA1. Conclusions: HDL cholesterol and apoE at birth are positively associated with intrauterine growth and maturation. Placental insufficiency increases risk of having low HDL cholesterol and apoE concentrations at birth, suggesting these lipid traits as markers of placental health.
Fabrication and validation of a new device for measuring the radiation dose in ethanol-chlorobenzene dosimeters based on oscillometry method
Abstract P1166: Sex-Based Disparities in the Referral Pathway for Catheter Ablation for Atrial Fibrillation in a Large Urban Healthcare System
Background: The prevalence of atrial fibrillation is reported to be lower in women, however it remains unclear if this is a biological phenomenon or social construct representative of limited access to healthcare resources. Catheter ablation (CA) is considered first line therapy for patients with symptomatic atrial fibrillation; however, women are less likely to be referred, and when referred are older, with more advanced disease and comorbidities. To elucidate barriers in access to catheter ablation for women, we will assess potential bottlenecks in the AF referral pathway. Methods: Leveraging the large and highly diverse patient population of a large healthcare system the incidence of patients diagnosed with AF between 2015-2023 were established, and time from diagnosis to ablation was calculated. Cox proportional hazard regression analysis was performed to assess sex-specific differences in time from AF diagnosis to ablation. Kaplan Meier survival curves were generated. Results: Between 2015 and 2023, 31,186 female and 41,789 male patients were diagnosed with AF, 1,952(6.3%) and 3,751(9.0%) underwent catheter ablation, respectively. Female patients undergoing CA were significantly older (67.9±9.9 years vs 63.7±10.3, p<0.001) although more likely to be paroxysmal (41.0% vs 35.3%, p<0.00) compared to males. Over the study period, female patients were less likely to undergo catheter ablation following diagnosis of AF (HR 0.93, 95% CI 0.88-0.98, p=0.017) when adjusting for age. The rate of referral for electrophysiology consult [(Females: 68.1% vs Males: 61.5%, p<0.001) Figure 1 Panel A]. was similar, as well as the time from diagnosis to catheter ablation between groups (Males: 591± 804 days vs Females: 613± 822, p=0.37). Kaplan-Meier curve shows the divergence between male and female patients, indicating a higher rate of ablation procedures performed for males [(log rank p<0.001), Figure 1 Panel B]. Conclusion: Over an 8-year follow-up period, in a large urban healthcare system, while women were more likely to be referred for electrophysiology consult, they were less likely to undergo catheter ablation. Further investigation is needed to assess potential barriers to design evidence-based intervention to reduce this disparity.