Diagnosis Codes Research Articles (Page 1)

Insomnia is highly prevalent among military personnel, with many gaps in knowledge. The purpose of this study was to quantify the medical, psychiatric, and utilization burden of insomnia among active-duty military personnel. We hypothesized that insomnia is associated with worsened health and economic outcomes. This was a retrospective case-control study. Data were derived from the Military Data Repository (2016-2021). Active-duty service members (ADSMs) younger than 65 years, with 12 months of continuous enrollment before and after first insomnia diagnosis and no evidence of previous insomnia or insomnia treatment, were matched 1:1 on demographic, clinical, and military characteristics to ADSMs without insomnia. Insomnia and psychiatric and medical comorbidities were defined using International Classification of Diseases, 10th Revision diagnostic codes. The impact of newly diagnosed insomnia on psychiatric and medical outcomes within 12 months was examined using time-to-event models. The impact of newly diagnosed insomnia on 12-month health care resource utilization (HCRU) was examined using generalized linear models. A total of 40,978 ADSMs met insomnia criteria and were matched to 40,978 ADSMs without insomnia. Participants were 78.6% male and 61.8% identified as White, with most younger than 44 years (90.3%). Insomnia was associated with increased risk of almost every studied physical and psychological health outcomes; relative to those without insomnia, ADSMs with insomnia demonstrated a 6-fold increased risk of post-traumatic stress disorder (hazard ratio [HR] 6.51, 95% CI 5.95-7.12, p < 0.001), as well as elevated risk of traumatic brain injury (HR 5.32, 95% CI 4.53-6.24, p < 0.001). ADSMs with insomnia demonstrated greater all-cause HCRU across all points of service (all p's < 0.001). Among active-duty personnel, new-onset insomnia was associated with substantially increased risk of adverse medical and psychiatric burden, as well as increased utilization, over 12 months. Key limitations include our observational study design.

To define measures of Medicare diagnosis coding intensity that capture the dynamics of changes in coding practices. Retrospective analysis of coding for risk adjustment using observational claims data from Medicare beneficiaries. Enrollment and claims data from 2017 and 2018 of a random 20% sample of Medicare beneficiaries were subset to those assigned to an Accountable Care Organization in 2018. We decompose the prevalence of a diagnosis code into incidence (proportion of beneficiaries that newly have the code) and persistence (proportion of beneficiaries who previously had the code and continue to do so). Together these define steady-state prevalence, the hypothetical long-run prevalence implied by no changes in current rates of incidence and persistence of coding. Steady-state prevalence can help explain why observed prevalence tends to grow over time without continued behavioral change. For example, our measures suggest that the prevalence of the Specified Heart Arrhythmias diagnosis would continue to rise from 18.7% in 2018 to 28.0% without changes in coding practices. Researchers and policymakers can better understand why changes in coding practices can take years to be fully reflected in data and monitor coding behavior by using our proposed measures.

Background Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires rapid identification and intervention. Predicting individuals at risk remains a clinical challenge due to its multifactorial nature and variable presentation. Objective To develop and evaluate explainable machine learning models that predict the risk of anaphylaxis using routinely collected clinical data. Methods We analysed a matched case-control dataset derived from anonymised electronic health records. After applying chi-squared-based feature selection, we trained multiple classification algorithms—including logistic regression, decision trees, random forests, XGBoost, and a stacking ensemble. Model performance was evaluated using AUC, sensitivity, specificity, precision, and F1-score. SHAP values were used to assess model explainability. Results The best-performing model achieved an AUC of 0.79, demonstrating high discrimination and balanced sensitivity/specificity. Key predictors included healthcare utilisation patterns, age, socioeconomic proxy (copayment level), and specific diagnostic codes related to allergic conditions. Conclusion This study demonstrates the potential of interpretable machine learning approaches to support the early identification of individuals at high risk of anaphylaxis. These tools can enhance clinical risk stratification and inform preventive strategies in routine practice.

The Helix Research Network program is a large population genomics initiative that screens an all-comers population of patients for Centers for Disease Control and Prevention Tier 1 genetic conditions, including familial hypercholesterolemia (FH). We evaluated changes in clinical management and low-density lipoprotein cholesterol (LDL-C) levels among patients we identified to have FH. Participants across 9 US health systems provided samples that underwent clinical-grade exome sequencing. Individuals with a positive screening result for a Tier 1 condition were offered no-cost genetic counseling through their health system. Using medication and laboratory testing records, we evaluated changes in patients' lipid-lowering therapies and LDL-C levels. Among 228 602 adults enrolled between 2017 to 2025, 1155 (≈1/198) had a pathogenic FH variant in LDLR (74%), APOB (25%), or PCSK9 (1%). Of the 622 with retrospective and prospective electronic health record data available (mean of 11.8 and 2.1 years, respectively), 84% lacked a prior clinical FH diagnosis. Overall, 33% received new/modified lipid-lowering therapy within the first year, but this proportion was higher in those with a newly documented FH diagnosis code (57% versus 17% for those without documentation; P<0.001). Patients with new/modified therapies had a mean LDL-C reduction of 52 mg/dL, compared with 20 mg/dL in patients with no therapeutic change (difference=32 mg/dL; P<0.001). Following genetic screening, many patients with a pathogenic FH variant experienced improvements in clinical management and LDL-C levels. Electronic health record documentation of the diagnosis code was associated with a greater likelihood of therapeutic modifications, which, in turn, were associated with larger LDL-C reductions. Findings underscore the powerful potential of population genomic screening for supporting optimal lipid management in individuals with FH.

Introduction Allergic rhinitis (AR) is a systemic respiratory condition that is associated with a considerable humanistic burden and is frequently underdiagnosed. Despite the known effects of AR on individual patient well-being, the wider impact of AR on the UK healthcare system remains poorly defined. We aimed to compare healthcare resource use (HCRU) posed by this disease across different age groups between patients who were diagnosed in primary care only vs. those who have a secondary care diagnosis. Methods In this retrospective, observational study, patients with an AR record (AR diagnosis) and patients with a record of presenting with AR symptoms but no previous AR diagnosis (AR presentation) in the UK between 2009 and 2019 were defined from primary care and secondary care databases. Patients in the AR diagnosis cohort were further categorized based on whether they had a diagnostic code in primary care only, or any relevant diagnostic code(s) in secondary care for allergist or Ear, Nose, and Throat (ENT) services referrals. Key outcomes included specialist referrals, general practitioner (GP) visits, respiratory-related hospitalizations, GP-prescribed AR-related prescriptions, and coincident asthma. Results A total of 3,344,716 patients were defined as presenting signs of AR and 677,771 patients were defined as having an AR diagnosis between 2009 and 2019. Only 11.7% of the AR presentation group received ≥1 referral to an allergist or ENT, and most patients in the AR diagnosis group received a diagnosis in primary care only (89.3%). Compared to their HCRU before diagnosis, patients diagnosed with AR experienced an increase in mean GP visits [7.5–10.0 per patient per year (PPPY)], respiratory-related hospitalizations (5.5–7.1 PPPY), and AR-related medications (mean 8.8–15.0 PPPY). Patients with at least one diagnostic code in secondary care generally reported higher HCRU post-diagnosis than those in primary care. The incidence rate of asthma was lower after AR diagnosis compared to before, with a shorter interval between the onset of asthma and the diagnosis of AR. Conclusion Patients with AR impose a greater burden on the UK healthcare system following their diagnosis, especially those who require follow-up from respiratory specialists.

Introduction: Atrial fibrillation (AF) is associated with significant comorbidities, including stroke and tachyarrhythmia-associated heart failure (HF). The role of patient characteristics such as race, ethnicity and sex have been implicated in AF, especially in the risk of cardioembolic stroke, however the risk of incident AF-associated HF and clinical outcomes are less established. Research Questions: This study aims to characterize clinical outcomes in new onset AF and AF mediated cardiomyopathy across race, ethnicity and sex. Methods: We conducted a retrospective propensity-score matched cohort study of adult patients between January 2010 and November 2024 at a single center who didn’t have a prior history of AF or HF by diagnostic code or EF &lt; 50% or embolic stroke. Those who developed a new diagnosis of AF were included. A HF diagnosis was defined as a new diagnosis of HFrEF by diagnostic code or a measured EF &lt; 40%. The primary exposure variables of interest were race, ethnicity and sex. We assessed outcomes among both patients with and without development of HF within 1 year of AF onset. The primary outcome included mortality, incidence of HF, stroke, and HF hospitalization. Data analysis was conducted by Atropos Health. Results: A total of 12,907 patients met inclusion criteria and 4,052 of those patients developed HF within 1 year of AF diagnosis. Among all patients with new-onset AF, males had increased risk of mortality (HR 1.18, 95% CI 1.04-1.33, p = 0.008), development of HF (HR 1.16, 95% CI 1.08-1.24, p &lt; 0.001) and HF hospitalization (HR 1.15, 95% CI 1.04-1.27, p = 0.005) compared to females. Native Hawaiian/Pacific Islander patients exhibited elevated HF incidence (HR 2.41, 95% CI 1.55-3.74, p &lt; 0.001) and hospitalization rates (HR 2.03, 95% CI 1.36-3.03, p &lt; 0.001), while Asian patients had increased stroke risk (HR 1.35, 95% 1.07-1.7, p = 0.01) but lower HF and hospitalization rates compared to whites. African American and American Indian patients showed no significant outcome differences. In the HF subgroup, Asian patients retained heightened stroke risk (HR 1.7, 95% CI 1.27-3, p = 0.002) compared to white patients. Conclusion: Our study shows that significant disparities in AF clinical outcomes with or without incident HF exist across race, ethnicity, and sex. These findings underscore the need for tailored management strategies to address sociodemographic inequities and improve cardiovascular outcomes in diverse populations.

This study aimed to describe annual trends in sodium-glucose cotransporter-2 inhibitor (SGLT2i) prescriptions among patients with rheumatoid arthritis (RA) and diabetes mellitus (DM), and to assess whether SGLT2i use increases urinary tract infection (UTI) risk, emulating a target trial. An administrative claim database identified RA patients aged ≥18 years with type 2 DM from April 2015 to April 2023. Population 1 included RA patients with DM for assessing diabetes medication status. Population 2 included those with newly initiated first- or second-line antidiabetic medications. The primary outcome was UTI, defined using diagnostic code and antibiotic prescription. For intention-to-treat (ITT) analysis, we used quasi-Poisson regression, whereas for as-treated (AT) analysis, we applied Poisson mixed-effects models. Among the 26 754 patients in Population 1, SGLT2i prescriptions notably increased, while traditional diabetes medications decreased. Population 2 included 9,772 patients (mean age 69.8 years, 60% women, 13% SGLT2i initiators, 42% on glucocorticoids). During a mean 34-month follow-up, 2,269 UTI events occurred in 1,373 patients. ITT analysis showed no significant difference between SGLT2i and other antidiabetic drug. However, AT analysis demonstrated statistically significant association (adjusted incidence rate ratio 1.64, 95% CI 1.26-2.13). The SGLT2i- daily glucocorticoid dose interaction was not significant in either model. Among RA patients with DM, SGLT2i use may inherently increase the risk of UTI compared with other antidiabetics. However, the ITT analysis findings support the safety of SGLT2i selection in routine clinical practice, including in patients receiving glucocorticoids.

Background: Sex-based disparities in cardiogenic shock (CS) remain underexplored, particularly when stratified by etiology—Acute Myocardial Infarction (AMI) versus Heart Failure (HF). The limited existing studies offer inconsistent findings, and the impact of sex on outcomes remains inadequately defined. Objective: To assess sex-based differences in in-hospital mortality among patients with CS, stratified by AMI-CS and HF-CS etiologies. Methods: This retrospective cohort study included adult patients presenting in Cardiogenic Shock to two tertiary care centers in Indiana from Jan 2020 to Dec 2023. Using clinical documentation and diagnostic coding, data was categorized into AMI-CS and HF-CS. Baseline demographics, comorbidities and outcomes were compared between sexes within each CS subtype. Primary outcome was in-hospital mortality. Multivariate logistic regression was used to compare outcomes between the groups. Results: Among 684 CS patients (AMI-CS: 442; HF-CS: 242), 33.9% were female. Female patients were older in both AMI-CS (mean age 69.1 vs. 65.3, p&lt;0.01) and HF-CS (mean age 68.5 vs 63.0, p&lt;0.01), and had a higher prevalence of hypertension. Women also had higher in-hospital mortality in AMI-CS (49.4% vs. 36.8%, p = 0.03) and HF-CS (45.4% vs. 33.9%, p = 0.04). After adjustment, female sex remained independently associated with higher mortality in AMI-CS (adjusted OR 1.22, 95% CI 1.08–1.40, p = 0.02) and HF-CS (adjusted OR 1.18, 95% CI 1.06-1.38, p = 0.03). Conclusion: Female patients experience higher in-hospital mortality in both AMI-related and HF-related Cardiogenic Shock. These disparities persist after adjustment for baseline and clinical factors. Women presented with greater severity of shock and were less likely to receive device based interventions. Larger studies are necessary to investigate these findings further and to identify potential targeted interventions.

Introduction: Transcatheter Edge-to-Edge Repair (M-TEER) is a safe and effective intervention for both primary and secondary mitral regurgitation. Cirrhosis, a common and high-risk comorbidity, can significantly increase procedural risk. This study aims to evaluate the outcomes of M-TEER in patients with cirrhosis compared to those without cirrhosis. Methods: The TriNetX U.S. Collaborative Network was utilized to identify adult patients (age &gt;18 years) who underwent M-TEER (n = 8,002), as depicted in Figure 1A. From this population, two cohorts were defined: patients with a prior diagnosis of cirrhosis (n = 373) and those without a history of cirrhosis (n = 7,629). The diagnostic codes used to define these groups are detailed in Figure 1B. Propensity score matching (PSM) was performed based on age, gender, race, comorbid diagnoses, and prior cardiac procedures. Clinical outcomes assessed at 30 and 365 days post-procedure included all-cause mortality, major adverse cardiac events (MACE), myocardial infarction (MI), stroke, cardiac tamponade, major bleeding, blood transfusion, hospitalization, and use of intravenous (IV) diuretics. Results: Following PSM analysis, 373 patients were present in each cohort ( Figure 2A). Within the M-TEER with cirrhosis group, there was a significantly increased odds of all-cause mortality, MACE, MI, and stroke at 30 days (Figure 2B) and significantly increased odds of all-cause mortality, MACE, MI, major bleeding, blood transfusion, and hospitalization at 365 days (Figure 2C). A Kaplan-Meier Analysis for all-cause mortality and MACE demonstrate a notable increased probability of event within the M-TEER with cirrhosis group (Figure 3A-B; purple line representing M-TEER with cirrhosis cohort and green line representing M-TEER without cirrhosis cohort). Conclusions: Patients with cirrhosis are at significantly elevated risk of death and adverse cardiac outcomes at 30 days. There was also a trend towards increased cardiac tamponade, bleeding, hospitalization, and IV diuresis at 30 days, both of which may suggest elevated procedural risk of M-TEER in patients with cirrhosis. The increased risk of adverse outcome at 365 days is likely a reflection of the severity of illness associated with cirrhosis, rather than procedural risk attributable to M-TEER. As a final point, this study is limited by its retrospective design and dependence on administrative coding.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia with prevalence increasing over the last decade. However, data on recent temporal trends in incidence of AF have been inconsistent, with some reports of increasing trends over time and others indicating no change in incidence over time. Therefore, we aimed to determine how the incidence of AF has changed over the last decade in a community in the Midwest USA. Methods: Between 2013 and 2023, adults (aged 18 and older) with incident AF were identified in a 27-county region in the Midwest. AF was identified using diagnostic codes by employing an electronic algorithm requiring 1 inpatient code or 2 outpatient codes separated by &gt;7 days but within 1 year. For total rates, age - and sex-adjusted incidence rates were standardized to the 2010 US total population. Poisson regression was used to calculate the incidence rate ratio of AF for 2023 vs 2013. Results: We identified 44,930 individuals with incident AF from 2013 to 2023. Of these, 56.4% were male, the mean (SD) age was 72.8 (13.5) years, and 95.8% were non-Hispanic white. The age-and sex-adjusted incidence rates (per 1,000) and 95% confidence intervals standardized to the 2010 US total population were 5.24 (5.07-5.41) in 2013, 5.73 (5.56-5.91) in 2018, and 5.44 (5.28-5.61) in 2023. Although a drop in incidence was observed corresponding to the COVID-19 pandemic, a small increase in the overall incidence of AF was observed over time. The overall incidence rate ratio (95% CI) for 2023 vs 2013 was 1.07 (1.02-1.11), P=0.003. The incidence rates were higher in men compared to women and increased with older age ( Figure 1 ). However, differences in AF incidence by sex were greatest in the youngest age group and attenuated with older age (incidence rate ratio (95% CI): 2.18 (2.10-2.28) for ages 18-64 years, 1.76 (1.70-1.83) for ages 65-74 years, 1.38 (1.33-1.42) for ages 75-84 years, and 1.23 (1.18-1.28) for ages 85 years and older). Conclusion: In this 27-county region in the Midwest, although small in magnitude, a statistically significant increase in AF incidence was observed over time from 2013 to 2023. Furthermore, the incidence of AF was higher in men compared with women, especially in younger age groups.

Background: While green space exposure has been linked to improved cardiometabolic outcomes, the relationship between actual green space visitation and incident type 2 diabetes mellitus (T2DM) risk remains poorly defined. Population mobility data capturing neighborhood-level visitation patterns offer a novel approach to quantifying green space use. Using mobility-derived green space visitation data, we evaluated the association between neighborhood green space use and T2DM in a large U.S. healthcare system cohort. Methods: We identified adults (≥18 years) without baseline T2DM using the Houston Methodist Learning Health System Registry between 2016 and 2023. Annual green space visits per capita at the census tract level were derived from Advan Patterns mobility data for the year 2021 and linked to patient addresses. Incident T2DM was defined using diagnostic codes, diabetes medication prescriptions, or hemoglobin A1c ≥6.5% occurring after baseline. Cox proportional hazards models estimated associations between green space visitation and incident T2DM, using both quartile-based comparisons (Q4 vs Q1) and continuous models (per 10 visits), adjusted sequentially for demographics, insurance status, cardiometabolic risk factors, the CDC Social Vulnerability Index, and annual PM2.5 exposure. Results: Among 1,003,526 patients followed over 2.1 million person-years, 40,152 developed T2DM, yielding an overall incidence rate of 1.88 per 100 person-years. In quartile-based analysis, individuals in the highest quartile (Q4) of green space visits had a 21% lower risk of incident T2DM compared to the lowest quartile (Q1) after full adjustment (95% CI: 0.754–0.837; p&lt;0.001) (Figure). In continuous models, every 10 additional green space visits per year was associated with a 10.7% lower risk of T2DM (95% CI: 0.874–0.913]; p&lt;0.001). Conclusion: Greater green space visitation is associated with a lower risk of developing T2DM. These findings highlight the potential of green space use as a modifiable environmental factor in T2DM prevention. Promoting equitable access to green environments may represent a scalable public health strategy to reduce diabetes risk and advance environmental health equity through urban planning and community-based interventions.

Introduction: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, often fatal disease. A better understanding of demographic disparities in diagnosis and treatment is crucial to optimize care and improve outcomes across diverse patient (pt) populations. Objectives: To evaluate potential differences in initiation of tafamidis, the only approved ATTR-CM therapy at the time of the study, and subsequent clinical outcomes by gender and race. We hypothesized that significant demographic differences exist in treatment patterns and clinical outcomes. Methods: We conducted a retrospective cohort analysis using the US Komodo Healthcare Map ® (01/2016-06/2024). Pts with amyloidosis ICD-10-CM diagnosis codes were identified and followed from diagnosis to tafamidis initiation and cardiovascular-related hospitalization (CVH) or death. Cumulative incidence of treatment initiation and survival probabilities were stratified by gender and race. Results: We identified 11,311 pts with ATTR-CM (63.9% men [mean age, 73.5 y] and 36.1% women [mean age, 72.4 y]). After diagnosis, women had a significantly lower cumulative incidence of tafamidis initiation compared to men at all time points ( P &lt;0.001). At 3 mo after diagnosis, the cumulative incidence was 9.9% among women versus 19.9% among men; by 12 mo, this gap persisted (14.5% vs 28.5%). Race further compounded these disparities ( P &lt;0.001; Figure 1 ). At 12 mo, White men had the highest cumulative incidence of initiation (31.0%), followed by Black men (26.7%), Black women (22.0%), and White women (11.4%). CVH or death occurred in 57.7% of women versus 53.6% of men. Event-free survival at 12 mo was lowest in Black women (42.9%) versus Black men (46.8%), White women (48.6%), and White men (54.4%) ( P &lt;0.001; Figure 2 ). Black women experienced the shortest median (95% CI) time to CVH or death (8.0 mo [6.8-10.0]), followed by Black men (9.9 mo [8.8-12.0]), White women (11.0 mo [9.6-13.0]), and White men (15.0 mo [14.0-16.0]; Table ). Conclusion: This large-scale analysis of a US cohort suggests existing gender and racial disparities in tafamidis treatment initiation and outcomes in ATTR-CM. White women had the lowest rates of tafamidis initiation, while Black women had the worst clinical outcomes, highlighting a compounded disparity in treatment and survival by gender and race. These findings underscore the urgent need to address demographic-based disparities and ensure equitable care for all pts with ATTR-CM.

Background: Sex differences in the burden and management of cardiovascular disease (CVD) risk factors persist despite widespread prevention guidelines. Our study examines sex differences in the prevalence, treatment, and control of hypertension (HTN) using real-world, electronic health patient data from a large integrated health system. Methods: We conducted a retrospective cohort study using 2024 Northwell Health Allscripts TouchWorks electronic health record (EHR) system data. Adult patients (N = 268,167) with available EHR blood pressure (BP) measurements were included. We assessed stage of hypertension prevalence based on blood pressure levels; elevated BP defined as systolic BP 120-129 mmHg and diastolic BP &lt;80 mmHg, Stage 1 HTN defined as systolic BP between 130-139 mmHg and/or diastolic BP between 80-89 mmHg and Stage 2 HTN defined as defined as systolic BP 140 mmHg and/or higher or diastolic BP 90 mmHg or higher. Hypertension was defined based on diagnosis codes, antihypertensive medication use, and/or measured systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg. For patients who were taking anti-hypertensive medications, we defined HTN control as systolic BP &lt; 130 and diastolic BP &lt; 80 mmHg. We employed age-adjusted linear and logistic regression models to assess sex differences with HTN prevalence, treatment and control. Results: Overall, men had higher mean systolic (125.1 vs. 122.2 mmHg) and diastolic (75.5 vs. 74.9 mmHg) pressures than women (p &lt; 0.05). Men had a higher prevalence of elevated BP, Stage 1 HTN and Stage 2 HTN compared with women (12.9 vs. 11.8%, 32.5 vs. 31.1% and 16.9 vs. 14.0%, respectively, p value &lt; 0.05). Compared with women, men had a significantly higher prevalence of diagnosed HTN and a greater prevalence of anti-hypertensive use (figure). When treated with anti-hypertensive therapy, women were significantly less likely to have control of BP compared with men (figure). Conclusions: Rates of HTN control in our cohort were relatively low overall. Despite a lower burden of diagnosed HTN, women in our large and diverse health system were less likely to experience HTN control than men. Our findings underscore the need for targeted, sex-specific approaches to improve cardiovascular risk factor management in clinical care.

Introduction: The development of chronic hypertension (HTN) in the postpartum period increases cardiovascular disease risk later in life. Area Deprivation Index (ADI) is a validated measure that integrates neighborhood-based socioeconomic factors at the census block level and is associated with cardiovascular outcomes. The association between ADI, race, and postpartum HTN has not been well studied. Research Questions: Is there an association between ADI and the development of incident HTN in the postpartum period, and does ADI mitigate the association between race and postpartum HTN? Methods: This retrospective analysis examined electronic health record data of patients without a history of pre-pregnancy HTN who delivered between 2012-2020 within a large US-based healthcare system. ADI was grouped into quintiles, with the highest quintile representing the most socioeconomically disadvantaged group. High ADI (quintiles 4 and 5) was compared to lower ADI (quintiles 1-3). The outcome of incident HTN was assessed between 6 and 24 months postpartum based on diagnosis codes, blood pressure values, and medications. Logistic regression was used to model the association between covariates of interest and postpartum HTN. Results: The cohort consisted of 23,787 patients with mean age of 30.3 (SD 5.7) years and 37.4% identified as non-Hispanic Black. The incidence of chronic HTN varied across ADI quintiles (quintile 1 to 5): 1.6%, 2.4%, 3.0%, 4.1%, and 3.8%, respectively. Compared to the lowest ADI quintile, each ADI quintile was associated with incident HTN. After adjusting for demographic and clinical characteristics, Black patients had higher odds of postpartum HTN compared to White patients (Table 1). When ADI was added to the model, the effect estimate associated with Black race was slightly attenuated, however ADI was no longer significant (Table 2). Conclusions: Residing in a deprived neighborhood at the time of delivery is associated with incident chronic HTN in the postpartum period, however, this association does not persist after adjusting for race and other clinical characteristics. Furthermore, neighborhood deprivation does not entirely mitigate the impact of race on postpartum HTN. Additional factors that are not directly incorporated into the ADI framework, such as maternal stress and social support, racial segregation, and healthcare accessibility, may play a greater role in the association between race and incident chronic HTN in the postpartum period.

Background: Truncating variants in the TTN gene (TTNtv) are the most common genetic cause of non-ischemic (dilated) cardiomyopathy (CM) and are implicated in atrial fibrillation (AF). Frequently, AF is a sequela of CM; however, tachycardia-mediated cardiomyopathy (TMC) is an increasingly recognized clinical entity in which systolic dysfunction follows AF, with worse comorbidity and mortality than standalone AF. Restoration of normal sinus rhythm frequently restores systolic function. However, risk factors for the development of TMC have yet to be identified, and the contribution of TTNtv is unknown. Objective: Quantify the association of TTNtv with TMC in a large, healthcare-seeking general population. Methods: Individuals in the MyCode Community Health Initiative with exome sequencing were retrospectively assessed for the presence of AF (ICD-9/10 codes or EKG finding) and/or a TTNtv in highly expressed exons (&gt;90% spliced in; hiPSI). TMC was defined as the presence of ICD-9/10 codes for new diagnosis of non-ischemic CM 1 day to 6 months after diagnosis of paroxysmal or persistent AF. Firth’s bias-reduced logistic regression with 1000 bootstrap iterations was performed to assess association of AF, CM, and TMC with TTNtv presence, with adjustment for age, sex, and the first four principal components of ancestry. Results: Of 171k individuals in MyCode, 21,570 (12.6%; median age 77 [IQR 69—84]; 43% female) had documented AF and 857 individuals (0.5%) had a qualifying TTNtv, including 198 (0.9%) in the AF group (OR 2.2 [1.8—2.6]; p&lt;0.001). Of these AF+TTNtv individuals, 16 (8.1%) had TMC, whereas of 21,372 with AF and no TTNtv, 1,212 (5.7%) had TMC. AF+TTNtv individuals had significantly higher odds of having TMC compared to non-carriers (2.0 [1.2—2.9]; p=0.014; Figure). Phenotype analysis as currently defined demonstrated a PPV of 0.25, NPV of 0.90 w/ observed accuracy of 0.57, sensitivity of 0.73 and specificity of 0.54. Conclusion: In a healthcare-seeking population with exome sequencing, among those with AF, TTNtv presence was associated with 2-fold higher odds of developing ICD code-based TMC, suggesting that for individuals with TTNtv and AF, prompt treatment may be of particular importance. TMC is a complex phenotype that is difficult to define in electronic health records, thus future work will include refinement of the defined phenotype to improve specificity.

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in male service members and veterans. This study assessed the 10-year ASCVD risk in male military service members and veterans using the model construct of the VA women CVD risk score and the 2013 ACC/AHA ASCVD risk calculator using direct military health system and Veterans Affairs (VA) Electronic Health Records (EHR) data extracted from national VA corporate data warehouse (CDW) database. Research hypothesis: Military exposure at earlier life may lead to poorer health and ultimately decreased longevity. We hypothesize that military services in earlier life may alter aging trajectory and ASCVD risk—elevated risk of ASCVD events at a younger age than 40. Methods: We retrospectively followed 3.6 million Non-Hispanic (N-H) White (n=2,823,446) and Black (n=734,940) male military service members aged 20-79 from 2012 to 2024 (development cohort). Risk factors and ASCVD events (non-fatal myocardial infarction, non-fatal stroke, cardiac arrests, and cardiac deaths) were identified using diagnostic and procedural codes from Electronic Health Records (EHR) data. Following the same constructs of the VA women CVD risk score and the 2013 ACC/AHA ASCVD risk calculators, coefficients for risk factors were estimated for men by applying time-varying Cox models to the study male development cohort data. Results: N-H Black male service members, on average 3 years younger than their white counterparts, had significantly higher systolic blood pressure, total cholesterol, HDL-C, and were more likely to be treated with anti-hypertensive medications (Tables 1 and 2). We found a log-linear association of aging with increased risk of 10-year ASCVD event in military service male members starting at ages as young as 20 years old (Figure 1.A.) across both N-H White and Black groups in contrast with the ACC/AHA ASCVD risk score (Figure 1.B.). The VA CVD risk model performed well in predicting ASCVD events at 10 years for men (C statistics N-H White 0.72 and N-H Black 0.71), while the ACC/AHA ASCVD risk calculator showed a moderate performance (C statistics N-H White 0.69; N-H Black 0.69). Conclusions: Our results point to a log-linear association of aging with increased ASCVD risk in military males starting at age 20. We call to action the need to create a better cardiovascular risk calculator that adequately assesses young male (&lt;40 years old) military service members’ ASCVD risk.

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly being used for cardiac arrest refractory to conventional resuscitation. While data suggests the benefit of eCPR in select populations, there are scarce outcomes data for patients with in-hospital cardiac arrest (IHCA) compared to those with out-of-hospital cardiac arrest (OHCA). Research Question: Do outcomes of eCPR differ between IHCA and OHCA? Methods: Using the Nationwide Readmissions Database from 2016 to 2022, we analyzed in-hospital outcomes of adult patients who underwent eCPR for IHCA vs. OHCA using multivariable logistic regression and propensity score methods. The study cohort was identified using ICD-10 diagnostic and procedural codes. Results: Of 4,365 patients treated with eCPR for cardiac arrest, 3,252 (74.5%) had OHCA and 1,113 (25.5%) had IHCA. During the study period, the proportion of patients with OHCA receiving eCPR significantly increased (p-trend&lt;0.001). Patients with IHCA were older (54 vs. 53 years), more often female (37.8% vs. 33.1%) with a higher comorbidity burden, and less likely to have shockable rhythm. In-hospital mortality was higher in patients with IHCA compared to OHCA (66.5% vs. 56.4%, p&lt;0.001). The length of hospital stay was longer, and the cost of hospitalization was higher for patients with IHCA vs. OHCA. After adjustment for comorbidities, IHCA was associated with higher mortality based on regression (odds ratio [OR], 1.56; 95% CI [confidence interval], 1.23-1.98) and propensity score-matched (OR, 1.62; 95% CI, 1.25-2.10) analyses. IHCA was associated with less major bleeding (OR, 0.73; 95% CI, 0.55-0.98) and less anoxic brain injury (OR, 0.75; 95% CI, 0.60-0.95) but higher risk of sepsis (OR, 1.65; 95% CI, 1.29-2.10). Conclusion: In patients with cardiac arrest treated with eCPR, IHCA was associated with increased in-hospital mortality compared to OHCA. These findings suggest a need for further studies to guide patient selection in clinical practice for eCPR in IHCA.

Background: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in the United States, affecting over 26 million people. Further, patients with ASCVD and co-existing chronic kidney disease (CKD) have a greater risk of major adverse cardiovascular events (MACE) than patients without CKD. Clinical trials have documented a residual risk of MACE linked to systemic inflammation after guideline directed medical therapy. This study aims to examine the risk of MACE among patients with established ASCVD and co-existing stage 3-4 CKD with vs. without systemic inflammation. Methods: This retrospective study identified patients from the Komodo Healthcare Map (Jan 1, 2016 – Jun 30, 2024) based on diagnosis and procedure codes in medical claims. CKD and its stage were determined from medical claims or laboratory estimated glomerular filtration rate. Systemic inflammation was defined using high-sensitivity C-reactive protein (hsCRP) testing: with systemic inflammation, ≥1 hsCRP value of 2-10 mg/L; without systemic inflammation, all hsCRP values &lt;2 mg/L. HsCRP test results &gt;10 mg/L or conducted during acute illness were excluded. The study endpoints were revised 3-point MACE (non-fatal myocardial infarction [MI], non-fatal stroke or all-cause mortality) and 2-point MACE (non-fatal MI or non-fatal stroke). Survival analysis and Cox proportional hazard models were used. Results: Among 6,351 patients with ASCVD + stage 3-4 CKD and a qualifying hsCRP, 53% were of female sex, and the mean age was 71 years. Of the eligible patients, 3,600 (57%) had systemic inflammation. Patients with systemic inflammation had a higher mean comorbidity index (1.1 vs. 0.9) and greater prevalence of hypertension (74% vs. 68%), type 2 diabetes (41% vs. 34%), and obesity (20% vs. 13%) than those without systemic inflammation. After adjusting for baseline characteristics, systemic inflammation was associated with a 23% increase in the risk of revised 3-point MACE (HR 1.23, 95% CI 1.06-1.42) and a 28% increase in the risk of 2-point MACE (HR 1.28, 95% CI 1.07-1.54). Specifically, systemic inflammation significantly increased the risk of non-fatal MI, but not non-fatal stroke or all-cause mortality ( Figure 1 ). Conclusion: Systemic inflammation was associated with an increased risk of MACE in patients with ASCVD + stage 3-4 CKD. Clinical trials are needed to evaluate the potential of anti-inflammatory therapy to reduce the residual inflammation risk in this population.

Introduction: Substance use disorder (SUD) in pregnancy is associated with co-occurring psychological health conditions, and both are independently linked to an increased risk of adverse pregnancy outcomes (APOs). Previous studies have evaluated their effects on APOs in isolation, with limited research examining their combined effects. Research Question: What is the impact of SUD on APOs (hypertensive disorders of pregnancy, preterm delivery, fetal growth restriction, abruptio placentae, and gestational diabetes mellitus) among hospitalized pregnant women with psychological health conditions? Methods: Using ICD-10 codes for diagnoses and procedures, along with the National Inpatient Sample (NIS) data from 2016 to 2022, we identified the population hospitalized for pregnancy and delivery as well as those with a history of psychological disturbances (major depressive disorder, anxiety disorder, bipolar disorder, post-traumatic stress disorder, and adverse childhood experiences), and SUD (amphetamine/methamphetamine, cocaine, opioid, cannabis, or alcohol use disorder). Propensity scores for SUD were estimated using logistic regression based on sociodemographic and clinical variables. One-to-one greedy matching was used to create a balanced cohort. Logistic regression was then conducted on the matched sample to estimate odds ratios for APOs, comparing those with SUD to those without SUD. Results: There was a total of 1,154,465 weighted pregnancy and delivery-related hospitalizations with psychological concerns. After propensity score matching, 86,725 weighted pregnancy and delivery-related hospitalizations with SUD were matched with 89,460 hospitalizations without SUD. Compared to the group without SUD, the SUD group was associated with higher odds of all APOs OR: 1.21 (95% C.I.: 1.18 - 1.23), hypertensive disorders of pregnancy OR: 1.17 (95% C.I.: 1.14 - 1.20), preterm delivery OR: 1.57 (95% C.I.: 1.51 - 1.63), fetal growth restriction OR: 1.45 (95% C.I.: 1.40 - 1.51), and abruptio placenta OR: 1.79 (95% C.I.: 1.68 - 1.90) but not for gestational diabetes mellitus OR: 0.62 (95% C.I.: 0.59 - 0.64). Conclusions: SUD was associated with higher odds of all APOs except for gestational diabetes among pregnant patients with psychological health conditions. These patients may benefit from tailored interventions and support beyond routine screening. Further research is needed to evaluate the risk interactions between SUD and psychological conditions on APOs.

Background: Atherosclerotic cardiovascular disease is a leading cause of death globally, accounting for approximately a third of all deaths. Atherosclerosis is a systemic and progressive condition and contributes to ischemic heart disease, stroke, and peripheral artery disease. REACT (Early Cure for Atherosclerosis) is a large international initiative designed to improve the understanding, detection, and early treatment of subclinical atherosclerosis. Here, we aim to estimate the burden of clinical atherosclerotic disease in individuals aged 18–70 years. Research Questions: What is the frequency of clinical atherosclerosis throughout all vascular territories. Methods: A representative sample of Danish individuals aged 18-70 years was selected in December 2024 based on socioeconomic data through national registries. We defined clinical atherosclerosis using diagnosis ICD10 diagnostic codes and procedure codes for ischemic heart disease, stroke, and peripheral artery disease. We stratified the prevalence of atherosclerosis by age and sex and vascular territories. Risks were compared using risk ratios (RR) with 95% confidence intervals (95% CI). Results: We included data from 160,000 individuals with an equal sex distribution. The median age was 46 years (IQR 33-58 years). There were 9,825 individuals (6.1%) with a history of atherosclerotic disease. Figure 1 shows the prevalence of any clinical atherosclerosis and ischemic heart disease stratified by age and sex. The prevalence of any atherosclerotic disease increased from 0.3% in the youngest age-strata (18–29 years) to 17.3% in the oldest age-strata (60–70 years) and was significantly higher in all age strata in males, RR 1.6 (95% CI 1.5-1.6, p&lt;0.001). Ischemic heart disease was the most frequent atherosclerotic disease (n=5,665, 3.5% of the entire sample), followed by stroke (n=3,567, 2.2%), and peripheral artery disease (n=1,581, 1.0%). The mean age was similar for individuals with a history of ischemic heart disease and peripheral artery disease (60.7 years vs 60.8, p=0.75) but was lower for stroke (59.1 years, p&lt;0.001 for both comparisons). Conclusion: Among adults aged 18–70 years, clinical atherosclerotic disease was present in 6% of the population, with parallel increases in the three major vascular territories with increasing age, quantitatively dominated by coronary artery disease, and with male preponderance.