Recent Scientific Statement Research Articles

Nursing and Institutional Responsibilities for In-Hospital Stroke.

In-hospital stroke events occur less often than stroke outside of a health care facility; yet, the need for timely evaluation and treatment is the same regardless of geographic location. During hospitalization, nurses are generally the first to recognize possible symptoms of stroke and activate emergency protocols. Such actions in response to changes in patient condition are critical to optimal patient outcomes. A recent scientific statement from the American Heart Association notes that patients with in-hospital stroke are likely to experience delayed recognition of symptoms, less likely to receive intravenous thrombolysis therapy, and have worse outcomes compared with community-occurring stroke. The aim of this article is to expand upon that scientific statement to assist nurses and acute care hospitals in the United States and elsewhere with similar health care systems to create evidence-based, nurse-driven protocols for in-hospital stroke recognition and management.

Abstract MP47: Sleep Disordered Breathing is Adversely Associated With Cardiac Autonomic Modulation in Adolescents

Introduction: Sleep disordered breathing (SDB), as measured by the apnea/hypopnea index (AHI), is a known risk factor for cardiovascular disease (CVD) in adults. Although SDB is prevalent in pediatric populations, there has been less focus on SDB as a primary risk factor for CVD in youth. The recent AHA scientific statement on SDB and CVD in children and adolescents suggests that, in order to better understand the long-term CVD-related risk associated with SDB in youth, additional longitudinal studies incorporating noninvasive markers of CVD are needed. The current study aimed to fill this important gap. Hypothesis: We hypothesized that SDB is associated with decreased HRV in adolescents. Methods: We studied 421 subjects from the Penn State Child Cohort who were 8.7 (1.7) years old at baseline and were followed-up as adolescents 16.5 (2.3) years old. We estimated the AHI from 9-hour, in-lab polysomnography (PSG), and frequency and time-domain heart rate variability (HRV) indices from 24-h Holter EKG monitoring immediately following PSG. We stratified 24-h HRV data into daytime and nighttime periods. Linear regression analyses examined the association between AHI with 24-h HRV indices, while adjusting for age, sex, race/ethnicity, BMI percentile, and metabolic syndrome (MetS) score in adolescence as well as AHI and nighttime HRV indices in childhood. Results: While there were no significant associations between AHI and daytime (p=0.233) or nighttime (p=0.147) HR, there were significant associations with frequency and time-domain HRV indices. A higher AHI was associated with lower Log-HF, Log-LF, SDNN and RMSSD, yet higher LF/HF, for both daytime and nighttime periods (all p<0.05). For example, for each additional apnea or hypopnea per hour of sleep there was a decrease of -1.74ms (0.73) and -1.65ms (0.77) in SDNN during the daytime (p=0.018) and nighttime (p=0.033), respectively, even after adjusting for all covariates including MetS, childhood AHI and SDNN. More specifically, the 24-h SDNN of adolescents with an AHI≥5, indicative of moderate-to-severe SDB, was 10.9ms (4.4) lower than that of adolescents with an AHI=0 (p=0.014). Conclusions: SDB is associated with impaired cardiac autonomic balance in adolescence independently of MetS, prior SDB and prior HRV status. These data further support the role of SDB as an independent risk factor for CVD early in life.

Parametric Mapping Cardiac Magnetic Resonance Imaging for the Diagnosis of Myocarditis in Children in the Era of COVID-19 and MIS-C.

Myocarditis comprises many clinical presentations ranging from asymptomatic to sudden cardiac death. The history, physical examination, cardiac biomarkers, inflammatory markers, and electrocardiogram are usually helpful in the initial assessment of suspected acute myocarditis. Echocardiography is the primary tool to detect ventricular wall motion abnormalities, pericardial effusion, valvular regurgitation, and impaired function. The advancement of cardiac magnetic resonance (CMR) imaging has been helpful in clinical practice for diagnosing myocarditis. A recent Scientific Statement by the American Heart Association suggested CMR as a confirmatory test to diagnose acute myocarditis in children. However, standard CMR parametric mapping parameters for diagnosing myocarditis are unavailable in pediatric patients for consistency and reliability in the interpretation. The present review highlights the unmet clinical needs for standard CMR parametric criteria for diagnosing acute and chronic myocarditis in children and differentiating dilated chronic myocarditis phenotype from idiopathic dilated cardiomyopathy. Of particular relevance to today’s practice, we also assess the potential and limitations of CMR to diagnose acute myocarditis in children exposed to severe acute respiratory syndrome coronavirus-2 infections. The latter section will discuss the multi-inflammatory syndrome in children (MIS-C) and mRNA coronavirus disease 19 vaccine-associated myocarditis.

Association of Time Elapsed Since Ischemic Stroke With Risk of Recurrent Stroke in Older Patients Undergoing Elective Nonneurologic, Noncardiac Surgery

Perioperative strokes are a major cause of death and disability. There is limited information on which to base decisions for how long to delay elective nonneurologic, noncardiac surgery in patients with a history of stroke. To examine whether an association exists between the time elapsed since an ischemic stroke and the risk of recurrent stroke in older patients undergoing elective nonneurologic, noncardiac surgery. This cohort study used data from the 100% Medicare Provider Analysis and Review files, including the Master Beneficiary Summary File, between 2011 and 2018 and included elective nonneurologic, noncardiac surgeries in patients 66 years or older. Patients were excluded if they had more than 1 procedure during a 30-day period, were transferred from another hospital or facility, were missing information on race and ethnicity, were admitted in December 2018, or had tracheostomies or gastrostomies. Data were analyzed May 7 to October 23, 2021. Time interval between a previous hospital admission for acute ischemic stroke and surgery. Acute ischemic stroke during the index surgical admission or rehospitalization for stroke within 30 days of surgery, 30-day all-cause mortality, composite of stroke and mortality, and discharge to a nursing home or skilled nursing facility. Multivariable logistic regression models were used to estimate adjusted odds ratios (AORs) to quantify the association between outcome and time since ischemic stroke. The final cohort included 5 841 539 patients who underwent elective nonneurologic, noncardiac surgeries (mean [SD] age, 74.1 [6.1] years; 3 371 329 [57.7%] women), of which 54 033 (0.9%) had a previous stroke. Patients with a stroke within 30 days before surgery had higher adjusted odds of perioperative stroke (AOR, 8.02; 95% CI, 6.37-10.10; P < .001) compared with patients without a previous stroke. The adjusted odds of stroke were not significantly different at an interval of 61 to 90 days between previous stroke and surgery (AOR, 5.01; 95% CI, 4.00-6.29; P < .001) compared with 181 to 360 days (AOR, 4.76; 95% CI, 4.26-5.32; P < .001). The adjusted odds of 30-day all-cause mortality were higher in patients who underwent surgery within 30 days of a previous stroke (AOR, 2.51; 95% CI, 1.99-3.16; P < .001) compared with those without a history of stroke, and the AOR decreased to 1.49 (95% CI, 1.15-1.92; P < .001) at 61 to 90 days from previous stroke to surgery but did not decline significantly, even after an interval of 360 or more days. The findings of this cohort study suggest that, among patients undergoing nonneurologic, noncardiac surgery, the risk of stroke and death leveled off when more than 90 days elapsed between a previous stroke and elective surgery. These findings suggest that the recent scientific statement by the American Heart Association to delay elective nonneurologic, noncardiac surgery for at least 6 months after a recent stroke may be too conservative.

Epidemiology of obstructive sleep apnea: What is the contribution of hypertension and arterial stiffness?

Epidemiology of obstructive sleep apnea: What is the contribution of hypertension and arterial stiffness?

Echocardiography in the Era of COVID-19: Lessons for the Future.

Purpose of ReviewPoor cardiovascular outcomes are linked to COVID-19 in patients with or without prior cardiovascular disease or risk factors. Echocardiography, as a portable, versatile, and comprehensive imaging technique, has been on the frontlines. Yet sonographers and physician imagers are at increased risk of contracting or transmitting COVID-19.Recent FindingsRecent scientific statements incorporate triaging approaches to identify the appropriateness of imaging exam indications, coupled with triaging of indications. Additionally, focused protocols, procedures to reduce exposure, and point-of-care ultrasound play significant roles. Lessons learned during COVID-19 will apply to future pandemics.SummaryEchocardiography is a key diagnostic modality during pandemics in patients with or without prior cardiac diseases and risk factors. Attention to clinical questions, focused protocols, novel procedures, and future developments in imaging will contribute to safe and effective practice of echocardiography.

Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association.

Cardiogenic shock (CS) remains the most common cause of mortality in patients with acute myocardial infarction. The SHOCK trial (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) demonstrated a survival benefit with early revascularization in patients with CS complicating acute myocardial infarction (AMICS) 20 years ago. After an initial improvement in mortality related to revascularization, mortality rates have plateaued. A recent Society of Coronary Angiography and Interventions classification scheme was developed to address the wide range of CS presentations. In addition, a recent scientific statement from the American Heart Association recommended the development of CS centers using standardized protocols for diagnosis and management of CS, including mechanical circulatory support devices (MCS). A number of CS programs have implemented various protocols for treating patients with AMICS, including the use of MCS, and have published promising results using such protocols. Despite this, practice patterns in the cardiac catheterization laboratory vary across health systems, and there are inconsistencies in the use or timing of MCS for AMICS. Furthermore, mortality benefit from MCS devices in AMICS has yet to be established in randomized clinical trials. In this article, we outline the best practices for the contemporary interventional management of AMICS, including coronary revascularization, the use of MCS, and special considerations such as the treatment of patients with AMICS with cardiac arrest.

PCSK9 Inhibitors in Secondary Prevention-An Opportunity for Personalized Therapy.

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death worldwide. Low-density lipoprotein cholesterol (LDL-C) is the primary cause of ASCVD and reducing LDL-C levels with statin therapy significantly reduces ASCVD risk; however, significant residual risk remains. Two monoclonal antibodies (mAbs), alirocumab and evolocumab, that target proprotein convertase subtilisin/kexin-type 9 (PCSK9), reduce LDL-C levels by up to 60% when used in combination with statins and significantly reduce the risk of recurrent ASCVD events in both stable secondary prevention and acute coronary syndrome populations. Prespecified analyses of recent randomized controlled trials have shed light on how best to prioritize these therapies to maximize their value in select high-risk groups. These data have also informed recent clinical practice guidelines and scientific statements resulting in an expanded role for PCSK9-mAbs compared with previous guidelines, albeit there are notable differences between these recommendations. Ongoing research is exploring the long-term safety of PCSK9-mAbs and their role in the acute setting and patients without prior myocardial infarction or stroke. Novel therapies that inhibit PCSK9 synthesis via small interfering RNA, such as inclisiran, are also in development and may reduce LDL-C levels similar to PCSK9-mAbs, but with less frequent administration. Nonetheless, the PCSK9-mAbs are a breakthrough therapy and warrant consideration in very high-risk patients who are most likely to benefit. Such a personalized approach can help to ensure cost-effectiveness and maximize their value.

Misclassification of cricket in the American College of Cardiology (ACC) Task Force classification of sports

‘The Mitchell classification’1 is a widely known system published by the American College of Cardiology (ACC) to catalogue sports based on peak static and dynamic components achieved during competition.1 2...

Abstract P318: Prevalence and Trends of Type 2 Diabetes Mellitus and Prediabetes Among Community-Dwelling Heart Failure Patients in the U.S. 2005-2016: A National Health and Nutrition Examination Survey (NHANES) Analysis

Introduction: Recent scientific statements highlight the importance of understanding the effects of the coexistence of heart failure (HF) and type 2 diabetes mellitus (T2DM) on disease management decisions and patient outcomes. Various prevalence estimates of the T2DM burden among HF patients have been reported; however, national estimates are not available. The objective of the study was to assess the prevalence and trends of T2DM (total, diagnosed, and undiagnosed) and prediabetes among community-dwelling HF patients using nationally representative data. Methods: We included 473 participants (20+ years) with a diagnosis of HF using data from the 2005-2016 NHANES survey cycles. Diagnosed T2DM was defined by self-report of a previous physician diagnosis. Undiagnosed T2DM was defined by the absence of a physician diagnosis and the presence of ≥ 1 of 3 criteria: 1) Two-hour plasma glucose (2hPG) after oral glucose tolerance test (OGTT) ≥ 200 mg/dL, 2) Hemoglobin A1c (HbA1c) ≥ 6.5%, 3) Fasting plasma glucose (FPG) ≥ 126 mg/dL. Total T2DM was defined as having diagnosed or undiagnosed T2DM. Prediabetes was defined by the absence of T2DM and the presence of ≥ 1 of 3 criteria: 1) 2hPG after OGTT of 140 mg/dL to 199 mg/dL, 2) HbA1c of 5.7% to 6.4%, 3) FPG of 100 mg/dL to 125mg/dL. We stratified estimates by age-standardized socio-demographic characteristics. Trends of the prevalence of T2DM and prediabetes were examined using logistic regressions. Results: The prevalence rates of total, diagnosed, and undiagnosed T2DM and prediabetes among HF patients were 51.4% (95% CI, 46.0%-56.7%), 37.5% (31.7%-43.6%), 13.8% (10.0%-18.2%), and 36.0% (30.2%-42.1%), respectively. The prevalence of T2DM and prediabetes did not significantly change across individual survey cycles. Conclusion: Rates of T2DM and prediabetes among community-dwelling HF patients in the U.S have been persistently high over the past decade. These findings support the need for the prevention and targeted intervention of T2DM in HF patients.

Comparison of non-exercise cardiorespiratory fitness prediction equations in apparently healthy adults.

A recent scientific statement suggests clinicians should routinely assess cardiorespiratory fitness using at least non-exercise prediction equations. However, no study has comprehensively compared the many non-exercise cardiorespiratory fitness prediction equations to directly-measured cardiorespiratory fitness using data from a single cohort. Our purpose was to compare the accuracy of non-exercise prediction equations to directly-measured cardiorespiratory fitness and evaluate their ability to classify an individual's cardiorespiratory fitness. The sample included 2529 tests from apparently healthy adults (42% female, aged 45.4 ± 13.1 years (mean±standard deviation). Estimated cardiorespiratory fitness from 28 distinct non-exercise prediction equations was compared with directly-measured cardiorespiratory fitness, determined from a cardiopulmonary exercise test. Analysis included the Benjamini-Hochberg procedure to compare estimated cardiorespiratory fitness with directly-measured cardiorespiratory fitness, Pearson product moment correlations, standard error of estimate values, and the percentage of participants correctly placed into three fitness categories. All of the estimated cardiorespiratory fitness values from the equations were correlated to directly measured cardiorespiratory fitness (p < 0.001) although the R2 values ranged from 0.25-0.70 and the estimated cardiorespiratory fitness values from 27 out of 28 equations were statistically different compared with directly-measured cardiorespiratory fitness. The range of standard error of estimate values was 4.1-6.2 ml·kg-1·min-1. On average, only 52% of participants were correctly classified into the three fitness categories when using estimated cardiorespiratory fitness. Differences exist between non-exercise prediction equations, which influences the accuracy of estimated cardiorespiratory fitness. The present analysis can assist researchers and clinicians with choosing a non-exercise prediction equation appropriate for epidemiological or population research. However, the error and misclassification associated with estimated cardiorespiratory fitness suggests future research is needed on the clinical utility of estimated cardiorespiratory fitness.

A Survey of Family Medicine and Internal Medicine Faculty and House Officers’ Understanding and Experience with Left Ventricular Assist Devices

Introduction The number of patients with stage D heart failure (HF) requiring a left ventricular assist device (LVAD) is on the rise. The aim herein is to examine family medicine (FM), internal medicine (IM) faculty and house officers (HO) understanding and experience about LVAD. Methods A survey was distributed by email to FM, IM faculty and HO at the University of Michigan. The survey contained questions about LVAD survival and basic management of arresting LVAD patients. Results 111 completed the survey (23.8%). Respondents self-identified as HO (59.5%) and the rest were FM and IM faculty. Only 30.9% reported receiving education on LVADs during their training and 66.6% reported being somewhat familiar with LVAD therapy. However, only half felt that LVAD therapy is a good option for improving quality of life and only 32% felt that LVADs improved survival. Only 6% of respondents estimated correct 1-year survival post pump implant. 77% correctly identified the anticoagulation of choice and 47% reported the appropriate way to measure blood pressure. No respondents received instruction on how to run a code on LVAD patients during ACLS certification, only 6.3% were aware of the recent AHA scientific statement regarding unresponsive LVAD patient management, and only 9% felt comfortable running a code blue on an LVAD patient. 49% and 35%, respectively, report that chest compressions and defibrillation can be performed if indicated. HO had better knowledge than IM and FM faculty regarding arresting LVAD patient management (p Conclusions Substantial knowledge gaps about LVAD and basic LVAD management were identified among IM, FM faculty and HO at a large teaching hospital. Similar knowledge gaps may exist among the larger internal and family medicine communities as a whole.

Early Repolarization with a Constant ST-segment Elevation in Leads II, III, and AVF

Background: A recent scientific statement from the American Heart Association included ST-segment elevation in the absence of chest pain in the definition of early repolarization (ER). ST-elevation at J-point termination (Jt)-point was not taken into account in previous heritability studies. The relevance of ST-elevation at Jt point (especially in inferior leads) is not evident enough. Our aim was to assess the heritability of ER with ST-elevation in inferior leads among offspring of such patients and patients' follow-up results. Materials and Methods: A prospective study of 16 consecutive patients with inferior ST-elevation at Jt ≥0.1 mV, who have arrived to outpatient department most often due to chest pain not associated with coronary stenosis according to multislice computed tomography angiography, started in 2013. Repeated cardiologist evaluation included their 12 children in 2017. Comparisons were made with 16 age- and gender-matched control patients' rest 12-lead electrocardiograms (ECGs) from the outpatient department of year 2018. Impact of ST-elevation's localization and sex on heritability were assessed by odds ratio (OR) with 95% confidence interval (CI). Results: There were no significant changes of patients' (all men) health and ECGs during follow-up. Eight (66.7%) of their children were ECG-positive versus 1 (6.2%) control patient,P = 0.001. All siblings (from the same father) of 5 (62.5%) ECG-positive children were ECG-positive. Two of the 5 (male and female) underwent detailed evaluation, including cardiac magnetic resonance, without abnormalities. In cases of only inferior father's ST-elevation, OR, 3.00; 95%CI, 0.24-37.7, and for male children, OR, 7.00; 95%CI, 0.400-23, for presenting with this pattern. Conclusions: Constant inferior ST-elevation, even in cases of chest pain, maybe ER, heritable without structural abnormalities. Heritability may be greater for male offspring and in cases of only inferior father's ST-elevation. Longer studies are necessary to confirm that it is benign. We suggest the term “a constant ST-segment elevation (at Jt)” instead of “ST-segment elevation in the absence of chest pain,” with adding that it is possible latent, depending on the heart rate.

An Appraisal of Methods Recently Recommended for Testing Salt Sensitivity of Blood Pressure.

According to a recent Scientific Statement of the American Heart Association (AHA), salt sensitivity of blood pressure (BP) is a trait in which BP “changes parallel to changes in salt intake.”[1][1] It is said that salt sensitivity is “a risk factor for cardiovascular mortality and morbidity,

Go Red for Women Strategically Focused Research Network Centers.

Twenty years ago, the American Heart Association (AHA) pioneered a national initiative to raise awareness of cardiovascular disease (CVD) in women. In 1997, only 1 in 3 women recognized heart disease as their leading killer, and the percentage doubled within a decade.1 In 2004, the AHA adopted the Red Dress symbol to represent the cause and, in conjunction with the release of the first evidence-based guidelines for the prevention of heart disease in women, launched the Go Red for Women campaign. The Go Red for Women Strategically Focused Research Network represents another major milestone in the women and heart disease movement. Funded centers are listed in the Figure. Each center has synergistic population, clinical, and basic projects with a shared scientific theme. All centers train fellows and collaborate with each other in the Go Red for Women Strategically Focused Research Network to advance the mission and impact of the AHA. A recent AHA scientific statement highlighted the lack of sleep as an important contributor to obesity, hypertension, diabetes mellitus, and CVD.2 Women may be at particular risk of abnormal sleep and its consequences because of unique life stages and circumstances, such as caregiving responsibilities and hormonal changes. Despite the importance of sleep as a lifestyle risk factor, …

Abstract P204: Depressive Symptomatology, Anti-depressant Use and Hypertension in Young Adulthood

Objective: While depression symptoms have been associated with cardiovascular disease in adulthood, little is known of the effects of adolescent-onset depression and hypertension in young adulthood. Furthermore, few studies have examined whether use of anti-depressants is associated with hypertension among young adults. Research Design and Methods: We examined the relation between depression symptoms and hypertension in young adulthood in the National Longitudinal Study of Adolescent Health (N=13,722). Adolescents completed the Center for Epidemiologic Studies Depression (CESD)-20 during wave 1 (1994-1995, mean age 16) and the CESD-10 during follow-up wave 4 (2007-2008, mean age 29). Depression symptoms were characterized as a score of 16 or above for the CESD-20 and 11 or above for CESD-10. During follow-up participants were asked to provide to the interviewer all medications they were currently taking or had taken in the previous six months. Antidepressant and antihypertensive medications were identified from all medications provided. Blood pressure was measured during an in-home visit. Hypertension was defined as measured SBP of at least 140mmHg or DBP of at least 90mmHG measured in adulthood, or use of antihypertensive medications. Results: The prevalence of hypertension was 20%. In models adjusting for sociodemographic factors, high depression symptoms in either adolescence or young adulthood were not significantly associated with hypertension in young adulthood. Use of anti-depressants in young adulthood was associated with hypertension (OR 2.89, 95%CI 1.82, 4.56) this association remained even after adjusting for obesity. No interactions by gender were noted. Conclusions: In this nationally representative sample, antidepressant use was associated hypertension in young adulthood. In accordance with a recent AHA Scientific Statement, our findings suggest that young adults with depression should be monitored closely to prevent the development of risk factors, such as hypertension, which may accelerate the development of cardiovascular disease.

Abstract WP348: Palliative Care is Underutilized in Ischemic Stroke Patients With Poor Functional Outcome

Background and Purpose: Palliative care (PC) should be an essential component of stroke care, particularly in patients with severe strokes given their poor prognosis and symptom burden. Despite the potential benefits of PC, a recent AHA scientific statement found that PC use in stroke was understudied and poorly understood. Methods: We performed a retrospective review of consecutive ischemic stroke patients presenting to our comprehensive stroke center (CSC) from 3/14-4/15. Demographic and clinical data were collected. We compared the proportion of patients that received an inpatient PC consult to the proportion of patients with a discharge modified Rankin scale (mRS) score of 4-6 (unable to walk without assistance and unable to attend to own bodily needs without assistance) by NIHSS score on admission. Results: Of the 776 ischemic stroke patients admitted to our CSC, only 6% received a palliative care consult. Even among the 254 patients discharged with a mRS of 4-6, only 16% received an PC consult. Figure 1 displays discharge mRS 4-6 and PC consult proportions by NIHSS severity. Patients that received a PC consult were older (median age 75 vs. 65, p&lt;0.001), had more severe strokes (median NIHSS score 17 vs. 5, p&lt;0.001), and more inpatient complications (56.5% vs. 21.8%, p&lt;0.001). On average, PC consults occurred 3.5 days after admission (IQR 2,9). Of the 43 patients who received a PC consult, 78.3% had “do not resuscitate/do not intubate” (DNR/DNI) orders prior to the PC consult as compared to 95.7% after. Before the PC consult, 30.4% had “comfort care” (CC) orders. After the consult, the proportion with CC orders nearly doubled (58.7%). Conclusions: Our observations suggest that PC may be underutilized in ischemic stroke patients, particularly in those who may benefit from it the most. PC has great potential to diminish suffering through physical and psychological symptom management. Providers should at least consider PC consults for hospitalized stroke patients.

Correlation Between Arteriosclerosis and Periodontal Condition Assessed by Lactoferrin and α1-Antitrypsin Levels in Gingival Crevicular Fluid.

Patients with periodontal disease exhibit exacerbated atherosclerosis, aortic stiffness, or vascular endothelial dysfunction. However, in a recent scientific statement, the American Heart Association noted that neither has periodontal disease been proven to cause atherosclerotic vascular disease nor has the treatment of periodontal disease been proven to prevent atherosclerotic vascular disease. Therefore, the aim of the present study was to examine the correlation between periodontal condition and arteriosclerosis in patients with coronary artery disease (CAD), which is usually accompanied by systemic arteriosclerosis.We measured levels of gingival crevicular fluid lactoferrin (GCF-Lf) and α1-antitrypsin (GCF-AT) in 72 patients (67 ± 8 years, 56 men) with CAD. Furthermore, we evaluated the maximum intima-media thickness (max IMT) and plaque score of the carotid arteries as well as brachial-ankle pulse wave velocity (baPWV) and flow-mediated dilation (FMD) of the brachial artery, each of which is a parameter for determining arteriosclerosis status. The average level of GCF-Lf was 0.29 ± 0.36 µg/mL and that of GCF-AT was 0.31 ± 0.66 µg/mL, with significant correlation between the two (r = 0.701, P < 0.001). No significant difference in GCF-Lf and GCF-AT levels was observed between patients with single-, double-, and triple-vessel CAD. There were no significant correlations between the arteriosclerosis parameters (ie, max IMT, plaque score, baPWV, and FMD) and GCF-Lf or GCF-AT.No correlation between the GCF biomarkers and the severity of arteriosclerosis was detected. This result may suggest that worsening of the periodontal condition assessed by GCF biomarkers is not a major potential risk factor for arteriosclerosis.

Yoga and Hypertension

Hypertension is a major public health problem and is an impor tant risk factor for stroke, coronary heart disease and renal failure. The blood pressure is not well controlled with drug therapy in large number of individuals, especially in the developing countries. There is a need for less expensive nonpharmacological alternative methods to control blood pressure. Yoga may be such cost-effective alternative. Several uncon trolled and ran do mized control trials have evaluated short- and long-term effects of yoga/meditation-based techniques in prehypertension and mild hypertension. Though, the results are mixed and there are several methodological limitations in reported studies, majority of studies demonstrate a modest decrease in both systolic and diastolic blood pressure. This modest decrease may significantly decrease the stroke mortality and coronary heart disease in general population. A recent scientific statement of American Heart Association also suggests that it is reasonable for all individuals with blood pressure levels more than 120/80 mm Hg to consider alternative approaches like transcendental medication as adjunct method to lower blood pressure.

Abstract 19519: Closing the Cardiac Intensive Care Unit: Cost-Savings Associated with a “Closed” versus “Open” Model of Critical Care Delivery

Introduction: A recent AHA scientific statement highlighted the evolving complexity of critical care delivery for cardiac patients, and the emerging need for novel staffing models. In this document, a “closed” unit structure - in which a dedicated intensive care team treats all admitted patients - was specifically advocated. However, in light of escalating critical care costs within US hospitals, there is a pressing need to better understand the financial impact of different care platforms. Methods: In July 2013, our academic cardiac intensive care unit (CICU) was transitioned from an “open” to a “closed” model of care. In a before-and-after study design, consecutive admission records were reviewed from Aug 2012-Dec 2012 (“open” unit) and from Aug 2013-Dec 2013 (“closed” unit). Routinely collected financial and demographic data were examined, and the impact of case-mix index (CMI) on cost was evaluated. Results: In the “open” and “closed” models, there were 333 patient-visits accounting for 1,891 patient-days and 397 visits accounting for 2,558 patient-days, respectively. While demographics, payor mix, and fixed vs. variable cost distribution were unchanged (Table), the total cost-per-patient and cost-per-patient-day were lower within the “closed” CICU ($8,676 vs. $10,118 and $1,346 vs. $1,782, respectively) despite a greater average CMI (4.6 vs. 3.6). Total and 30d CICU readmission rates were also lower in the “closed” unit (Table). Readmissions in the "closed" unit resulted in greater cost-per-patient-day than new admits ($1,576 vs. $1,339). Conclusions: A “closed” CICU staffing model is associated with lower health care costs. This may be partly explained by lower CICU recidivism, but likely is multifactorial. Additional study will focus on the influence of resource use, critical care delivery to key sub-populations, and the development of effective strategies for further cost containment.