Hospital Cohort Research Articles

Incidence of short-term community hospital stays and clinical profiles of patients: the Finnish Community Hospital Cohort Study

Objective A community hospital system covers the entire population of Finland. Yet there is little research on the system beyond routine statistics. More knowledge is needed on the incidence of hospital stays and patient profiles. We investigated the incidence of short-term community hospital stays and the features of care and patients. Design Prospective observational study. Setting Community hospitals in the catchment area of Kuopio University Hospital in Finland. Subjects Short-term (up to one month) community hospital stays of adult residents. Main outcome measures The outcome was the incidence rate of short-term community hospital stays according to age, sex and the first underlying diagnoses. Results A number of 13,482 short-term community hospital stays were analyzed. The patients’ mean age was 77 years. The incidence rate of short-term hospital stays was 28.6 stays per 1000 person-years among residents aged <75 years and 419.0 among residents aged ≥75 years. In men aged <75 years, the hospital stay incidence was about 40% higher than in women of the same age but in residents aged ≥75 years incidences did not differ between sexes. The most common diagnostic categories were vascular and respiratory diseases, injuries and mental illnesses. Conclusions The incidence rate of short-term community hospital stays increased sharply with age and was highest among women aged ≥75 years. Care was required for acute and chronic conditions common in older adults. Implications Community hospitals have a substantial role in hospital care of older adults.

Opportunistic Screening for Asymptomatic Left Ventricular Dysfunction With the Use of Electrocardiographic Artificial Intelligence: A Cost-Effectiveness Approach

BackgroundThe burden of asymptomatic left ventricular dysfunction (LVD) is greater than that of heart failure; however, a cost-effective tool for asymptomatic LVD screening has not been well validated. We aimed to prospectively validate an artificial intelligence (AI)–enabled electrocardiography (ECG) algorithm for asymptomatic LVD detection and evaluate its cost-effectiveness for opportunistic screening. MethodsIn this prospective observational study, patients undergoing ECG at outpatient clinics or health check-ups were enrolled in 2 hospitals in Taiwan. Patients were stratified into LVD (left ventricular ejection fraction ≤ 40%) risk groups according to a previously developed ECG algorithm. The performance of AI-ECG was used to conduct a cost-effectiveness analysis of LVD screening compared with no screening. Incremental cost-effectiveness ratio (ICER) and sensitivity analyses were used to examine the cost-effectiveness and robustness of the results. ResultsAmong the 29,137 patients, the algorithm demonstrated areas under the receiver operating characteristic curves of 0.984 and 0.945 for detecting LVD within 28 days in the 2 hospital cohorts. For patients not initially scheduled for ECG, the algorithm predicted future echocardiograms (high-risk, 46.2%; medium-risk, 31.4%; low-risk, 14.6%) and LVD (high-risk, 26.2%; medium-risk, 3.4%; low-risk, 0.1%) at 12 months. Opportunistic screening with AI-ECG could result in a negative ICER of −$7,439 for patients aged 65 years, with consistent cost-savings across age groups and particularly in men. Approximately 91.5% of the cases were found to be cost-effective at the willingness-to-pay threshold of $30,000 in the probabilistic analysis. ConclusionsThe use of AI-ECG for asymptomatic LVD risk stratification is promising, and opportunistic screening in outpatient clinics has the potential to reduce costs.

Electrocardiographic deep learning for predicting post-procedural mortality: a model development and validation study

Preoperative risk assessments used in clinical practice are insufficient in their ability to identify risk for postoperative mortality. Deep-learning analysis of electrocardiography can identify hidden risk markers that can help to prognosticate postoperative mortality. We aimed to develop a prognostic model that accurately predicts postoperative mortality in patients undergoing medical procedures and who had received preoperative electrocardiographic diagnostic testing. In a derivation cohort of preoperative patients with available electrocardiograms (ECGs) from Cedars-Sinai Medical Center (Los Angeles, CA, USA) between Jan 1, 2015 and Dec 31, 2019, a deep-learning algorithm was developed to leverage waveform signals to discriminate postoperative mortality. We randomly split patients (8:1:1) into subsets for training, internal validation, and final algorithm test analyses. Model performance was assessed using area under the receiver operating characteristic curve (AUC) values in the hold-out test dataset and in two external hospital cohorts and compared with the established Revised Cardiac Risk Index (RCRI) score. The primary outcome was post-procedural mortality across three health-care systems. 45 969 patients had a complete ECG waveform image available for at least one 12-lead ECG performed within the 30 days before the procedure date (59 975 inpatient procedures and 112 794 ECGs): 36 839 patients in the training dataset, 4549 in the internal validation dataset, and 4581 in the internal test dataset. In the held-out internal test cohort, the algorithm discriminates mortality with an AUC value of 0·83 (95% CI 0·79-0·87), surpassing the discrimination of the RCRI score with an AUC of 0·67 (0·61-0·72). The algorithm similarly discriminated risk for mortality in two independent US health-care systems, with AUCs of 0·79 (0·75-0·83) and 0·75 (0·74-0·76), respectively. Patients determined to be high risk by the deep-learning model had an unadjusted odds ratio (OR) of 8·83 (5·57-13·20) for postoperative mortality compared with an unadjusted OR of 2·08 (0·77-3·50) for postoperative mortality for RCRI scores of more than 2. The deep-learning algorithm performed similarly for patients undergoing cardiac surgery (AUC 0·85 [0·77-0·92]), non-cardiac surgery (AUC 0·83 [0·79-0·88]), and catheterisation or endoscopy suite procedures (AUC 0·76 [0·72-0·81]). A deep-learning algorithm interpreting preoperative ECGs can improve discrimination of postoperative mortality. The deep-learning algorithm worked equally well for risk stratification of cardiac surgeries, non-cardiac surgeries, and catheterisation laboratory procedures, and was validated in three independent health-care systems. This algorithm can provide additional information to clinicians making the decision to perform medical procedures and stratify the risk of future complications. National Heart, Lung, and Blood Institute.

Adverse events from topical corticosteroid use in chronic hand eczema — Findings from the Danish Skin Cohort

BackgroundTopical corticosteroids (TCS) are used to treat most patients with chronic hand eczema (CHE), but knowledge about TCS-related adverse events in CHE is limited. ObjectivesTo investigate patient-reported adverse events to TCS in CHE patients. MethodsData on adverse events related to TCS use in CHE patients were analyzed from the Danish Skin Cohort; a prospective survey of a hospital cohort. We assessed patients’ knowledge about TCS use and adverse event risks, and preference of TCS vs. a non-steroidal topical alternative. ResultsOf 724 adults with CHE (64.0% women; mean age 57.5 [standard deviation 12.8] years), 64.1% reported skin atrophy, 41.4% cracks/fissures, 23.9% bleeding, 45.9% pain/stinging sensation, 40.0% reduced hand dexterity, and 40.2% worsening of CHE signs or symptoms from using TCS. We observed CHE-severity-dependent associations (all groups; p<0.0001). Most patients (76.4%) would prefer a non-steroidal option, 10.9% were neutral/indifferent, and 12.7% would prefer TCS for CHE. The median numerical rating scale-score (ranging from 0-10) was 10 (interquartile range 6-10) for preferring a non-steroidal topical treatment. LimitationsDifferences across TCS formulations were unexplored. ConclusionTCS-related cutaneous adverse events were common. There is a desire from patients for novel steroid-free topical alternatives for CHE treatment.

Ceft-to-Ceft Study: Real-Life Experience with Ceftaroline and Ceftobiprole in Treatment of the Principal Infectious Syndromes in a Spanish Multicenter Hospital Cohort.

To compare the real-life effectiveness and safety of ceftaroline fosamil (ceftaroline-F) and ceftobiprole medocaril (ceftobiprole-M) for infections in hospitalized patients. This comparative, observational, retrospective, and multicenter Spanish study included patients receiving outpatient parenteral antimicrobial therapy (OPAT) and hospitalized patients treated for at least 48 h with ceftaroline-F or ceftobiprole-M between their first incorporation in the clinical protocol of each hospital and 31 July 2022. Ceftaroline-F was administered to 227 patients and ceftobiprole-M to 212. In comparison to the latter, ceftaroline-F-treated participants were younger (63.02 vs. 66.40 years, OR 1.1; 95%CI: 1.001-1.05) and had higher rates of septic shock (OR 0.27; 95%CI: 0.09-0.81) and higher frequencies of targeted (57.7 vs. 29.7%; OR: 0.35; 95%CI: 0.18-0.69) and combined (89.0 vs. 45.8%, OR: 0.13; 95%CI: 0.06-0.28) therapies that were second line or more (82.4% vs. 64.6%%; OR 0.35; 95%CI: 0.18-0.69), and higher rates of infections due to Gram-positive cocci (92.7 vs. 64.7%, p = 0.001), bacteremia (51.9 vs. 21.7%, p = 0.001), infective endocarditis (24.2 vs. 2.4%, p = 0.0001), and mechanical ventilation-associated pneumonia (8.8 vs. 2.4%, p = 0.0001). Ceftobiprole-M was more frequently administered against polymicrobial infections (38.1 vs. 14.0%, p = 0.001), those produced by Gram-negative bacilli (19.7 vs. 6.0%, p = 0.0001), nosocomial pneumonia (33 vs. 10.6%, p = 0.0001), and skin and soft-tissue infections (25.4 vs. 10.1%, p = 0.0001). Patients treated with ceftaroline-F had a longer hospital stay (36 (IQR: 19-60) vs. 19.50 (IQR: 12-30.75, p = 0.0001) days), with no difference in infection-related mortality at 14 (13.2 vs. 8.0%, p = 0.078) or 28 (4.8 vs. 3.3%, p = 0.415) days or in dropout rate for adverse effects (2.2 vs. 0.9%; p = 1). The fifth-generation cephalosporins, ceftaroline-F and ceftobiprole-M, are safe and effective in real life, with no difference between them in health outcomes.

Demographics and Clinical Characteristics of Burn Injuries in Nigeria: A Tertiary Hospital Cohort.

Burn injuries account for 4.8% of trauma deaths in Nigeria and annually for 20,000 deaths. This study was to catalogue the demographics of patient who presented at a referral center in Nigeria. In a retrospective study, we reviewed the records of all burn patients who presented over a 36-month period (January 2018 to December 2020). The clinical and demographic data was extracted using a self-designed questionnaire. Information obtained included biodata, etiology, time of presentation, first aid used, TBSA, length of hospital stay (LOHS), and outcome which was analyzed with SPSS version 28. A total of 112 burn patients presented at our facility, 87 male and 25 female (m: f = 3.5:1). Forty-four percent were children 10 years old and below. Though scalding with hot liquids was the commonest cause of injury in children, flame burn was the commonest etiology (57.1%). Inhalational injuries occurred in 14.2%. Raw eggs and pap were used as first aid by 23%. Most patients were discharged home, and 19.6% died. The prevalence of burn injuries remains high in developing countries. Most causes of burns are preventable. Dangerous traditional practices add to patient morbidity. Education on effective prevention strategies is important in reducing morbidity and mortality.

A hospital cohort study of epilepsy caused by neurocysticercosis in Lubumbashi (Democratic Republic of the Congo)

A hospital cohort study of epilepsy caused by neurocysticercosis in Lubumbashi (Democratic Republic of the Congo)

Modern robotics platform associated with reduced 90-day complications in hospital setting

BACKGROUND: Early complications in total knee arthroplasty (TKA) associated with modern robotics platforms integrated with digital balancing technology have not been investigated. OBJECTIVE: The objective was to compare 90-day complication rates between a manual technique and a modern robotic-assisted ligament balancing TKA platform. METHODS: 895 primary TKA procedures from a single surgeon were retrospectively reviewed (614 manual TKA, 281 using a modern robotics platform with an integrated digitally controlled ligament balancing device). Post-operative complications within the 90-day episode of care were recorded by the Michigan Arthroplasty Registry Collaborative Quality Initiative. Differences in complication rates between techniques were further divided into inpatient hospital, outpatient hospital, and ambulatory surgery center (ASC) cohorts. RESULTS: In the pooled hospital cohort and inpatient hospital cohort, ‘Return to OR’ was significantly lower for the robotic assisted group (1.3% vs 5.2% and 0% vs 4.9%, respectively, p&lt; 0.0370). Specifically, the need for manipulation under anesthesia (MUA) was reduced for the robotics group (0.0% vs 2.5%, p= 0.0352). No differences in overall complication rate or cause of complication was found between manual and robotics cases for the hospital outpatient and ASC cohorts (p⩾ 0.68). CONCLUSION: Within the hospital setting, robotic assisted ligament balancing technology was associated with reduced 90-day postoperative complications for ‘Return to OR’ and MUA.

Results from Lung Cancer Screening Outreach Utilizing a Mobile CT Scanner in an Urban Area

IntroductionLung cancer screening using low-dose (LD) CT reduces lung cancer–specific and all-cause mortality in high-risk individuals, although significant barriers to screening remain. We assessed the outreach of a mobile lung cancer screening program to increase screening accessibility and early detection of lung cancer. MethodsWe placed a mobile CT unit in a high-traffic area in New York City and offered free screening to all eligible patients. Characteristics of the mobile screening cohort were compared with those of our hospital-based screening cohort. ResultsBetween December 9, 2019, and January 30, 2020, a total of 216 patients underwent mobile LDCT screening. Compared with the hospital-based screening cohort, mobile screening participants were significantly more likely to be younger, be uninsured, and have lower smoking intensity and were less likely to meet 2013 US Preventive Services Task Force guidelines (but would meet their 2021 guidelines) and self-identify as White race and Hispanic ethnicity. Asian New Yorkers were substantially underrepresented in both hospital and mobile screening cohorts, compared with their level of representation in New York City. Two patients were diagnosed with lung cancer and were treated. Potentially clinically significant non–lung cancer findings were identified in 28.2%, most commonly moderate-severe coronary artery calcification and emphysema. ConclusionsMobile LDCT screening is useful and effective in detecting lung cancer and other significant findings and may engage a distinct high-risk patient demographic. Disproportionately low screening rates among certain high-risk populations highlight the imperative of implementing strategies aimed at understanding health behaviors and access barriers for diverse populations. Effective care-navigation services, facilitating high-quality care for all patients, are critical.

Sustainability determinants of an intervention to identify clinical deterioration and improve childhood cancer survival in Latin American hospitals: the INSPIRE study protocol

BackgroundMore than 90% of children with cancer live in low-resourced settings, where survival is only 20%. Sustainable evidence-based (EB) interventions yielding ongoing beneficial patient outcomes are critical to improve childhood cancer survival. A better understanding of factors promoting intervention sustainability in these settings is urgently needed. The aim of this study is to provide an empirical understanding of how clinical capacity for sustainability, or the resources needed to sustain an intervention, impacts the sustainment of Pediatric Early Warning System (PEWS), an EB intervention that improves pediatric oncology outcomes in low-resource hospitals by detecting clinical deterioration and preventing the need for more intense treatment.MethodsWe will conduct a prospective, longitudinal study of approximately 100 resource-variable hospitals implementing and sustaining PEWS participating in Proyecto EVAT, a quality improvement collaborative of Latin American pediatric oncology centers. Aim 1: We will evaluate how clinical capacity for sustainability changes over time through 5 to 9 prospective measurements of capacity via survey of clinical staff using PEWS (approximately n = 13 per center) during the phases of PEWS adoption, implementation, and sustainability using the Clinical Sustainability Assessment Tool (CSAT). Aim 2: We will determine the relationship between capacity and a) PEWS sustainment and b) clinical deterioration mortality among pediatric oncology patients at centers sustaining PEWS for 2 to 10 years using chart review and an existing patient outcomes registry. Aim 3: We will develop novel strategies to promote sustainability by gaining a deeper understanding of perceived challenges to building capacity and PEWS sustainment. In combination with quantitative outcomes, we will conduct 24 focus groups with staff (doctors, nurses, and administrators) from hospitals with both high (n = 4) and low capacity (n = 4). We will then use implementation mapping to generate theoretically driven, empirically-supported sustainability strategies.DiscussionThis study will advance implementation science by providing a theoretically driven, foundational understanding of factors that predict sustainability among a large, diverse cohort of hospitals. We will then use this knowledge to develop sustainability evidence-informed strategies that optimize capacity and promote long-term sustainment of PEWS and improvements in patient outcomes, thus promoting equity in childhood cancer care globally.

Clinical complications after a traumatic brain injury and its relation with brain biomarkers

We aimed to find out which are the most frequent complications for patients who suffer a traumatic brain injury (TBI) and its relation with brain biomarker levels. We conducted a hospital cohort study with patients who attended the Hospital Emergency Department between 1 June 2018 and 31 December 2020. Different variables were collected such as biomarkers levels after 6 h and 12 h of TBI (S100, NSE, UCHL1 and GFAP), clinical and sociodemographic variables, complementary tests, and complications 48 h and 7 days after TBI. Qualitative variables were analysed with Pearson’s chi-square test, and quantitative variables with the Mann–Whitney U test. A multivariate logistic regression model for the existence of complications one week after discharge was performed to assess the discriminatory capacity of the clinical variables. A total of 51 controls and 540 patients were included in this study. In the TBI group, the mean age was 83 years, and 53.9% of the patients were male. Complications at seven days were associated with the severity of TBI (p < 0.05) and the number of platelets (p = 0.016). All biomarkers except GFAP showed significant differences in their distribution of values according to gender, with significantly higher values of the three biomarkers for women with respect to men. Patients with complications presented significantly higher S100 values (p < 0.05). The patient’s baseline status, the severity of the TBI and the S100 levels can be very important elements in determining whether a patient may develop complications in the few hours after TBI.

The Clinical Characteristics of Psoriatic Arthritis: A Cross-Sectional St udy Based on the Psoriatic Arthritis Cohort of Sp ecial Hospital for Medical Rehabilitation – Naftalan, Croatia

The Clinical Characteristics of Psoriatic Arthritis: A Cross-Sectional St udy Based on the Psoriatic Arthritis Cohort of Sp ecial Hospital for Medical Rehabilitation – Naftalan, Croatia

Impact of ESC Guidelines implementation on lipid lowering strategy in a tertiary hospital cohort of STEMI patients: Can we aspire to do better than the EUROASPIRE V registry?

Abstract Background Treatment with LDL-C-lowering-drug therapy (LLT) is essential in the management of patients who have suffered an acute coronary syndrome. The latest 2019 ESC/EAS Guidelines for the management of dyslipidaemias recommend an LDL-C target of &amp;lt;55mg/dL and 50% reduction in these very high risk patients. However, the impact of these recommendations on contemporary LLT prescription is uncertain. Purpose To analyse the impact of the publication of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias on the prescription of LLT in our centre in patients who have suffered a ST elevation myocardial infarct (STEMI) and its impact on the achievement of treatment objectives and major adverse cardiovascular events (MACEs) in the first year of treatment. Methods All patients who suffered a STEMI at our centre in 2018 and 2021 were retrospectively registered. We compared baseline characteristics, ESC Guidelines objectives achievement at first follow-up visit and MACE in the first 1 year of treatment in both groups. The 2016 ESC Guidelines objective was defined as an LDL-C &amp;lt;70mg/dL and the 2019 ESC Guidelines objective was defined as an LDL-C &amp;lt;55 mg/dL. MACEs were defined as a combination of mortality, acute coronary syndrome, stroke, peripheral ischemia and need for revascularization. Those patients whose follow-up time until LDL-C after discharge was greater than 1 year were excluded from the final analysis. Results Of a total 726 STEMI patients, 520 patients were included in the final analysis. 239 in 2018 and 281 in 2021. No significant differences were found in baseline characteristics. LDL-C at admission was 115.7±39.3 mg/dL in 2018 and 110.6±38.6 mg/dL in 2021 (p 0.11). The prescription of ezetimibe in association with a high potency statin at discharge was significantly higher in 2021 (125 patients; 33.6%) compared to 2018 (17 patients; 5.07%) (p&amp;lt;0.001) and it was independently associated with the presence of prior lipid-lowering treatment (p &amp;lt; 0.011) and higher LDL-C at admission (p &amp;lt; 0.001). In 2018 there were 105 patients (50.24%) with LDL-C &amp;lt;70mg/dL and 52 patients (24.88%) with LDL-C &amp;lt;55mg/dL. This was significantly lower than in 2021, with 178 patients (66.67%) with LDL-C &amp;lt;70mg/dL and 112 patients (41.95%) with LDL-C &amp;lt;55mg/dL (p&amp;lt;0.001). MACEs after 1 year of treatment occurred in 27 patients (8.88%) in 2018 and in 31 patients (9.06%) in 2021 (p 0.935). Conclusions The adoption of the 2019 ESC/EAS Dyslipidaemia Guidelines recommendations has fostered a change in the LLT strategy in our centre leading to a greater number of patients reaching the LDL-C goal. Unfortunately, nearly 60% of them still have an LDL-C &amp;gt;55 mg/dL. This should prompt us to seek structured clinical pathways in order to improve our results.Figure 1

Abstract 16360: Myocardial Injury and Rapid Unsupervised Topological Clustering of Electronic Health Record Features Predict Death and Length of Stay During a COVID-19 Hospitalization

Background: Elevated troponin levels, a biomarker of myocardial injury (MI), has emerged as a predictor of acute COVID-19 outcomes. However, a lack of routine use in most patients makes it difficult to evaluate as a stand-alone predictor. We aimed to combine troponin levels and a new rapid, unbiased topological clustering pipeline to test for improvements in clinical risk stratification during COVID hospitalizations. Methods: SlicerDicer (SD) is an intuitive, anonymous clinical electronic health record (EHR) data exploration tool that helps characterize clinical outcomes in hospital cohorts. EHR data and outcomes were extracted with SD and clustered with Mapper Plus (MP), a clustering tool that identifies clinically relevant disjoint clusters. Initial clusters were further stratified by troponin level. Measured outcomes were in-hospital mortality rates (MR) and in-hospital length of stay (LOS). Results: 2692 patient records (2020-2021) with an overall MR of 6.3% and 97 clinical predictors were analyzed. MP identified 3 clusters with significant differences in MR (C1- 25.8%, C2- 4.2%, C3- 0.23%, P&lt;0.001) and LOS in hours (C1- 290, C2- 132, C3- 8.3, P&lt;0.001). Further stratification based on the troponin level reclassified the 3 MP clusters into 4 sub-clusters with distinctive MR (SC1- 32.6%, SC2- 17.3%, SC3- 2.3%, SC4-0.09%, P&lt;0.001) based on MI presence. Conclusions: Using SD-based anonymous EHR data and unsupervised topological clustering with MP during a COVID hospitalization provides a low-effort, robust pipeline that predicts in-hospital MR and LOS. When MP clusters were re-stratified by the presence of MI, new sub-clusters (4) showed reclassification of both high- and low-risk patients. This risk classification schema provides a new pragmatic and computational framework for selecting hospitalized patients with COVID that can benefit from further in-hospital therapies and mechanistic studies on the role of myocardial injury in COVID-19 prognosis.

Abstract 12614: Procedural Volume and Outcomes With Atrial Fibrillation Ablation: A Report From the NCDR AFib Registry

Introduction: Operator and hospital procedure volumes are associated with outcomes in many cardiac procedures. Objective: To determine the association between hospital/physician procedural volume and safety/success for atrial fibrillation (AF) ablation in the current era. Methods: Procedures reported to the NCDR AFib Registry between 7/2019 to 6/2022 were analyzed. Physician and hospital procedural volumes were annualized and stratified into quartiles (Q) to compare procedural success and major adverse events (MAE). Three level hierarchical (patient, hospital and physician) generalized linear models were used to assess the adjusted relationship between procedural volume and likelihood of acute outcomes. Results: A total of 70,296 first time AF ablation patients' at 186 US hospitals were studied. Mean age was 66.1 ± 10.3 years. 36% were women; mean CHA2DS2-VASc score was 2.7±1.6, and 57.4% were of paroxysmal AF. The median annual procedural volumes for hospitals and physicians were 230 and 66 respectively. Acute procedural success was 98.5% and the MAE rate was 1.0%. With Q4 (highest) hospital procedural volume as a reference, the adjusted likelihood of procedural success was significantly less among Q1 (OR: 0.44, CI: 0.3-0.7), Q2 (OR:0.50, CI:0.3-0.8) and Q3 (OR:0.60,CI:0.4-0.9). Similarly, for physician volume, the adjusted likelihood of success was less among Q1 (OR: 0.38,CI: 0.3-0.5), Q2 (OR: 0.51,CI: 0.4-0.7) and Q3 (OR:0.55,CI:0.4-0.7). With regards to MAE, compared to Q4, there was an inverse relationship to procedural volume for hospitals in Q1 (OR: 1.78, CI:1.3-2.5) but not in Q2 (OR: 1.06, CI 0.8-1.5) or Q3 (OR: 1.19, CI: 0.9-1.6) and for physicians in Q1 (OR: 1.93, CI 1.4-2.6) and Q2 (OR:1.49, CI: 1.1-2.0) but not in Q3 (OR: 1.22, CI: 0.9-1.6)(figure). Conclusions: In this national cohort of first time AF ablations, hospital and physician procedural volume were directly related to acute procedural success and inversely related to the rate of MAE.

Abstract 14555: Early Predictors That Identify Patients With Significant Left Main and Three-Vessel Coronary Artery Disease in Non-ST Elevation Acute Coronary Syndrome: Validating the MADISON Score

Introduction: In patients with non-ST elevation acute coronary syndrome (NSTE-ACS), identifying those with a high probability of having high-risk disease such as left main (LM) or three-vessel disease (3VD) could influence decisions to preload with P2Y12 inhibitors and timing of coronary angiography. The MADISON score was developed to predict LM/3VD on coronary angiography in patients with NSTE-ACS. In this study, we validated the MADISON score using data from an external cohort. Methods: The MADISON score was first developed using a retrospective cohort of 1700 patients presenting with NSTE-ACS at the University of Wisconsin-Madison (UW) (2011-2018). Those with prior CABG, cardiac arrest/shock, and bleeding on initial presentation were excluded from the analysis. Multivariable estimates were employed and model performance was assessed using receiver operating characteristic curve analysis. The score was then validated using a retrospective Houston Methodist Hospital (HMH) cohort of 622 patients (2019-2022). Results: The MADISON score variables and their adjusted odds ratios (95% CI) are presented in Figure 1A. Risk categories and corresponding LM/3VD probabilities are presented in Figure 1B. In the UW cohort, the area under the curve (AUC) was 0.68 (0.65-0.71) (Figure 2A). Interestingly, the AUC was also 0.68 (0.64-0.72) in the HMH validation cohort (Figure 2B). Conclusions: The MADISON score performed well and similarly between 2 large, independent cohorts in predicting patients most likely to have LM/3VD. The MADISON score is a simple and practical tool to guide decisions. Prospective validation of the score is planned to evaluate its impact on clinical outcomes.

Poor outcome of pediatric B-cell acute lymphoblastic leukemia associated with high level of CRLF2 gene expression in distinct molecular subtypes.

Overexpression of the cytokine receptor-like factor 2 (CRLF2) gene is the most common feature in the Philadelphia chromosome (Ph)-like subtype of B-cell acute lymphoblastic leukemia (B-ALL). However, the predictive value of CRLF2 overexpression for the prognosis of pediatric B-ALL patients remain controversial. The molecular mechanisms that upregulate CRLF2 expression level in patients has not been fully elucidated. In this study, the prognostic impact of CRLF2 expression level on molecular types of B-ALL in pediatric patients from Zhujiang Hospital (n = 111) was retrospectively analyzed. Youden index analysis was used to categorize CRLF2 expression into 3 groups, and these categories more precisely described the differences in the prognosis of patients with varying expression levels of CRLF2 in both the Zhujiang Hospital cohort and the TARGET cohort. We used the Zhujiang Hospital cohort as a discovery cohort to determine the cutoff value of CRLF2 expression. CRLF2-high patients accounted for approximately 6%. In addition, the percentage of bone marrow blast cells and initial white blood cell count in CRLF2-high patients were higher than those in CRLF2-low patients, and MRD turned negative slower. The results were validated in the TARGET cohort and indicated that CRLF2 overexpression could be subdivided by CRLF2 expression levels into 2 categories: CRLF2-high with a poor survival and CRLF2-medium with a good OS and EFS. Such heterogeneity was attributed to the different molecular mechanisms leading to CLRF2 upregulation, where the CRLF2 overexpression level was high in Ph-like B-ALL and medium in high hyperdiploid B-ALL. This study highlights the importance of the molecular mechanisms of the upregulation of CRLF2 expression in predicting the prognosis of pediatric B-ALL patients.

Statin therapy in individuals with intermediate cardiovascular risk

BackgroundAs intermediate cardiovascular risk group accounts for a large part of the total population, determining appropriate cholesterol target in this population is critical. Herein, we investigated the optimal low-density lipoprotein cholesterol (LDL-C) level in individuals with intermediate cardiovascular risk after statin therapy. MethodsThis was a nationwide observational and validation cohort study (median duration of follow-up: 7.5 and 8.7 years, respectively), using data from the Korean National Health Insurance Service and a tertiary hospital database. Among individuals who underwent regular health examinations, those with ≥2 cardiovascular risk factors except diabetes mellitus, LDL-C 100–189 mg/dL, and newly used statins were enrolled. Of the 358,694 screened people, 57,594 met the inclusion criteria, of whom 27,793 were finally analyzed. The study population was stratified according to post-treatment LDL-C levels as follows: <100, 100–119, 120–139, and ≥ 140 mg/dL. The primary outcome variable was composite cardiovascular events (myocardial infarction, coronary revascularization, and ischemic stroke). From the patients screened of Severance Hospital cohort, 1859 meeting inclusion criteria were used for validation. ResultsThe rates of composite events ranged from 7.74 to 9.10 (mean 8.38)/1000 person-years in the three lower LDL-C groups. Adjusted hazard ratios (aHRs) ranged from 0.78 to 0.95 in the three groups with lower LDL-C, and a lower event risk was more evident in the groups that achieved LDL-C levels <120 mg/dL (p = 0.001–0.009). The total mortality risk did not differ between groups. In the validation cohort, the mean rate of composite events was 10.83/1000 person-years. aHRs ranged from 0.52 to 0.78 in the groups with lower LDL-C, and a lower risk was more obvious in patients who achieved LDL-C levels <100 mg/dL (p = 0.006–0.03). ConclusionsIndividuals with intermediate cardiovascular risk who achieved LDL-C levels <120 mg/dL after statin therapy had lower event risk. This result provides clinically useful evidence on target LDL-C levels in this population.

Association between statin use and the prognosis of hepatocellular carcinoma after resection: a nationwide cohort study

The majority of patients with hepatocellular carcinoma (HCC) following hepatic resection experience tumor recurrence. Statin use is associated with a reduced risk of HCC development; however, the association between statin use and the prognosis of HCC after resection remains unclear. We aimed to investigate the effect of statin use on the prognosis after hepatic resection among patients with HCC. A nationwide cohort study was performed with data from the National Health Insurance Service Database in Korea. Among 65,101 HCC patients who underwent hepatic resection between January 2002 and December 2017, we included 21,470 patients. For validation, a hospital-based cohort of 3366 patients with very early or early-stage HCC who received curative-intent hepatic resection between January 2010 and December 2018 was analyzed. Recurrence-free survival (RFS) and overall survival (OS) was compared between statin users and non-users. Among the nationwide cohort of 21,470 patients, 2399 (11.2%) used statins and 19,071 (88.8%) did not. Among the hospital cohort of 3366 patients, 363 (10.8%) used statins and 3003 (89.2%) did not. In the propensity score-matched nationwide cohort, statin users had better RFS (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.56-0.64; P<0.001) and OS (HR, 0.49; 95% CI, 0.45-0.53; P<0.001), with a duration-response relationship. In the propensity score-matched validation hospital cohort, statin treatment was significantly associated with better RFS (HR, 0.73; 95% CI, 0.59-0.90; P=0.003) and OS (HR, 0.48; 95% CI, 0.32-0.72; P<0.001). The beneficial effects of statins were more prominent in non-cirrhotics, tumors sized ≥3cm, tumors with microscopic vascular invasion, or early HCC recurrence (<2 years after resection). Statin use was associated with a better prognosis in a population-based cohort of patients with HCC after hepatic resection, which was further validated in a large hospital-based cohort. Asan Institute for Life Sciences and Corporate Relations; Korean Association for the Study of the Liver.

Hospital and emergency department discharge against medical advice in Western Australian Aboriginal children aged 0-4 years from 2002 to 2018: A cohort study.

Discharge against medical advice (DAMA) is a priority issue for the health system. Little is known about the factors associated with DAMA for Aboriginal and/or Torres Strait Islander (Aboriginal) children in Australia. Investigate the associations between DAMA for hospital admissions and emergency department (ED) presentations and: (i) child, family and episode of service characteristics and (ii) 30-day readmission/ re-presentation. We conducted a cohort study of Aboriginal children born in Western Australia (2002-2013) who had ≥1 hospital admissions (n = 16,931) or ED presentations (n = 26,546) within the first 5 years of life. The outcome of interest was hospital and ED DAMA and adjusted odds ratio were derived using multilevel mixed-effects logistic regression. In the Hospital Cohort, there were 43,149 hospitalisations for 16,931 children, with 684 hospitalisations (1.6%) recorded as DAMA. In the ED Cohort, there were 232,082 ED presentations in 26,546 children, with 10,918 ED presentations (4.7%) recorded as DAMA. DAMA occurring in hospitals between 2014 and 2018, the adjusted odds decreased by 75% compared to the period between 2002 and 2005. The adjusted odds of ED DAMA increased by 46% over the same period. Hospital admissions in regional and remote hospitals were almost seven times the adjusted odds of DAMA compared with hospital admissions in Perth metropolitan hospitals. The adjusted odds of ED DAMA decreased by 12% for ED presentations in regional and remote hospitals compared to those in Perth metropolitan hospitals. There was no evidence of hospital DAMA being associated with hospital readmission within 30 days and limited evidence of ED DAMA being associated with re-presenting to an ED within 30 days. The study identified several important determinants of DAMA, including admission status, triage status, location and calendar year. These findings could inform targeted measures to decrease DAMA, particularly in regional and remote communities.