Worse Mortality Research Articles

P-728. Temporal Patterns of Hospitalizations and Clinical Outcomes Associated With Viral Lower Respiratory Tract Disease in 2015–2023: A US Claims Analysis

Abstract Background Although the seasonality of specific respiratory viral infections is well understood, the temporal pattern of severe viral lower respiratory tract disease (LRTD) and its potential consequences have not been well-described. Here we examined the temporal patterns of viral LRTD hospitalizations and associated composite clinical outcomes (invasive mechanical ventilation [IMV]/extracorporeal membrane oxygenation [ECMO] or death) in US clinical practice.Figure 1.Temporal patterns of viral LRTD hospitalizations from 2015–2019. Methods We analyzed data from US adults with a hospitalization and accompanying viral LRTD diagnostic claim (indicated by ICD codes) using Optum’s de-identified Clinformatics® Data Mart Database (2015–2023). IMV/ECMO associated with the hospitalizations was identified through CPT-4, HCPCS and ICD procedure codes. A time-series analysis using raw data was used to construct temporal patterns of viral LRTD-associated hospitalizations, and a composite clinical outcome of IMV/ECMO or death. Data were analyzed separately for 2015–2019 and 2020–2023 due to the impact of COVID-19.Figure 2.Temporal patterns of IMV/ECMO or death from 2015–2019. Results For each year from 2015–2019, peaks generally started towards the end of the calendar year for both viral LRTD hospitalizations (Figure 1) and IMV/ECMO or death (Figure 2). Higher peaks were seen for the 2017–2018 season compared to other years. In 2020–2023 (after the start of the coronavirus pandemic) there were multiple peaks seen throughout each year, with the largest peaks in both hospitalizations (Figure 3) and IMV/ECMO or death (Figure 4) at the end of 2020 and 2021. After the onset of the coronavirus pandemic, the annual peak of IMV/ECMO or death increased relative to the annual peak of hospitalizations (annual peak numbers of IMV/ECMO or death were 7.7–11.2% of the peak number of hospitalizations in 2015–2019, and 14.8–41.6% in 2020–2023). This suggests greater severity of illness and worse mortality among severe viral LRTD in 2020–2023.Figure 3.Temporal patterns of viral LRTD hospitalizations from 2020–2023. Conclusion Viral LRTD hospitalizations and clinical outcomes place substantial burden on healthcare systems. This considerable variation and unpredictable nature makes healthcare resource planning difficult.Figure 4.Temporal patterns of IMV/ECMO or death from 2020–2023. Disclosures Susan J. Johnson, PhD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds (Public Company) Ekaterina Maslova, ScD, AstraZeneca: Employee of AstraZeneca|AstraZeneca: Stocks/Bonds (Private Company) Malin Fageras, PhD, AstraZeneca: Full time employee|AstraZeneca: Stocks/Bonds (Private Company) Gopal Dalal, PhD, AstraZeneca: Advisor/Consultant|AstraZeneca: Employee of ZS Associates India Pvt. Ltd. and contracted to AstraZeneca at time of study Hashmath Ulla T. A. Syed, PhD, AstraZeneca: Advisor/Consultant|AstraZeneca: Employee of ZS Associates India Pvt. Ltd. and contracted to AstraZeneca at time of study Srishti Mishra, PhD, AstraZeneca: Advisor/Consultant|AstraZeneca: Employee of ZS Associates India Pvt. Ltd. and contracted to AstraZeneca at time of study Stefan Franzen, PhD, AstraZeneca: Stocks/Bonds (Private Company) Nadir Yehya, MD, AstraZeneca: Advisor/Consultant

Diverse NKT cells regulate early inflammation and neurological outcomes after cardiac arrest and resuscitation.

Neurological injury drives most deaths and morbidity among patients hospitalized for out-of-hospital cardiac arrest (OHCA). Despite its clinical importance, there are no effective pharmacological therapies targeting post-cardiac arrest (CA) neurological injury. Here, we analyzed circulating immune cells from a large cohort of patients with OHCA, finding that lymphopenia independently associated with poor neurological outcomes. Single-cell RNA sequencing of immune cells showed that T cells with features of both innate T cells and natural killer (NK) cells were increased in patients with favorable neurological outcomes. We more specifically identified an early increase in circulating diverse NKT (dNKT) cells in a separate cohort of patients with OHCA who had good neurological outcomes. These cells harbored a diverse T cell receptor repertoire but were consistently specific for sulfatide antigen. In mice, we found that sulfatide-specific dNKT cells trafficked to the brain after CA and resuscitation. In the brains of mice lacking NKT cells (Cd1d-/-), we observed increased inflammatory chemokine and cytokine expression and accumulation of macrophages when compared with wild-type mice. Cd1d-/- mice also had increased neuronal injury, neurological dysfunction, and worse mortality after CA. To therapeutically enhance dNKT cell activity, we treated mice with sulfatide lipid after CA, showing that it improved neurological function. Together, these data show that sulfatide-specific dNKT cells are associated with good neurological outcomes after clinical OHCA and are neuroprotective in mice after CA. Strategies to enhance the number or function of dNKT cells may thus represent a treatment approach for CA.

Impact of moderate or severe mitral and tricuspid valves regurgitation after transcatheter aortic valve replacement

BackgroundTricuspid regurgitation (TR) and mitral regurgitation (MR) are common valvular conditions encountered in patients undergoing transcatheter aortic valve replacement (TAVR). This retrospective study investigates the impact of moderate or severe TR and MR on all-cause mortality in one-year post-TAVR patients. MethodsConsecutive patients who underwent TAVR at the 3 academic tertiary care centers in our health system between 2012 and 2018 were identified. Patients were stratified into 2 groups based on valvular regurgitation severity: moderate/severe MR vs. no/mild MR, and moderate/severe TR vs. no/mild TR. Primary outcome was all-cause mortality at 1-year and 5-year follow up, and secondary outcome was in-hospital death. Logistic regression analysis was conducted to assess the relationship between moderate/severe MR or TR and all-cause mortality at 1-year and 5-year follow-up. ResultsWe included a total of 1,071 patients who underwent TAVR with mean age 80.9 ± 8.6 years, 97% white, and 58.3% males. Moderate or severe MR group included 52 (4.88%) patients while mild or no MR group included 1,015 (95.12%) patients. There was no significant difference between both groups in TAVR procedure success rate (100% vs. 97.83%, p=0.283), in-hospital mortality (0 vs. 1.08%, p=0.450), or mortality at 1-year follow up (15.38% vs. 14.09%, p=0.794). At 5-year follow up, moderate/severe MR group had higher mortality (61.4% vs. 49.5%, p=0.046). In multivariable logistic regression analysis, moderate or severe MR did not show significant correlation with all-cause mortality at 1-year and 5-year follow up. Moderate or severe TR group included 86 (8.03%) patients while mild or no TR group included 985 (91.97%) patients. There was no difference between both groups in TAVR procedure success (98.8% vs. 97.9%, p=0.54) or in-hospital mortality (0% vs. 1.1%, p=0.33). At 1-year follow up, patients with moderate or severe TR had higher mortality (26.7% vs. 13.2%, p=0.001) compared to patients with mild or no TR. Same finding was noted with extended follow up at 5-years (68.3% vs. 48.7%, p<0.001). In multivariable cox regression analysis, moderate/severe TR was associated with higher all-cause mortality at 1-year (OR 1.94, 95% CI [01.09, 3.44], p=0.0.023) and at 5-year (OR 1.46, 95% CI [1.092, 1.952], p=0.0.011) follow up. Patients with combined moderate/severe MR and TR have even higher mortality compared to either moderate/severe valve regurgitation alone or mild/no valve regurgitation at 5-year follow up. ConclusionAt long term follow up, moderate/severe TR, but not MR, is associated with higher mortality in patients underwent TAVR. Combined moderate/severe TR and MR had even worse mortality. Careful assessment of multi-valvular heart disease prior to the procedure is warranted.

Abstract 4136889: Impact of hypercholesterolemia definitions on prevalence and prognosis of patients without standard modifiable cardiovascular risk factors and ST-segment elevation myocardial infarction.

Background: In patients with acute myocardial infarction (AMI), recent studies have intriguingly reported that up to a quarter of AMI patients have none of the 4 main standard modifiable cardiovascular (CV) risk factors (SMuRFs) (i.e. hypertension (HTN), diabetes mellitus (DM), hypercholesterolemia (HC), and smoking) and have worse mortality. Hypothesis: We tested the hypothesis that the prevalence and prognosis of SMuRF-less patients varies with the definition of risk factors. Aim: Using a French nationwide MI cohort, we aimed to compare SMuRF-less ST-segment elevation MI (STEMI) patients according to 2 HC definitions, given the possibility of using several HC criteria. Methods: The French Cohort of Myocardial Infarction Evaluation (FRENCHIE) is a large ongoing AMI cohort, collecting data from all patients hospitalized for AMI &lt; 48 h of symptom onset in 21 French centers. STEMI patients without prior CAD admitted in 2019 to 2022 were studied. DM was defined as prior DM diagnosis, HbA1c&gt;7% or anti-diabetic medications, ongoing or at discharge, HTN was defined as treated or previous HTN diagnosis and smoking was defined as current smoking within the past month. Restrictive HC (RHC) was defined as either a previous diagnosis of HC or statin therapy. Permissive HC (PHC) was defined as previous diagnosis of HC or lipid-lowering therapy, or LDL-C &gt; 135 mg/dL or total Cholesterol &gt; 213 mg/dL. Results: Among 8008 patients (mean age 61.5± 12.9y, 22.6% women), 41.4% were smokers, 17.4% had diabetes, and 38.5% HTN. According to HC definitions, the prevalence of HC almost doubled, ranging from 30.3% for RHC to 61.0% for PHC. Consequently, the prevalence of SMuRF-less was divided by ≈ two (21.1% vs 11.3%, respectively), depending on the definition of HC used. Age and sex-adjusted logistic regression analysis showed that PHC, but not RHC, was associated with lower odds of in-hospital death ( figure ). Moreover, having multiple SMuRFs was associated with higher risk of mortality than no SMuRF when using RHC, but not with PHC definition. Conclusion: The prevalence and impact on acute mortality of being SMURFless varies largely with the definition of HC. More research is needed, using HC standardized definitions to explore these patients. Frenchie: was supported in part by the RHU iVASC grant ANR-16-RHUS-00010 from the French National Research Agency (ANR) as part of the Investissements d’Avenir program. The FRENCHIE cohort is registered with ClinicalTrials.gov, NCT04050956.

Evaluating machine learning model bias and racial disparities in non-small cell lung cancer using SEER registry data.

Despite decades of pursuing health equity, racial and ethnic disparities persist in healthcare in America. For cancer specifically, one of the leading observed disparities is worse mortality among non-Hispanic Black patients compared to non-Hispanic White patients across the cancer care continuum. These real-world disparities are reflected in the data used to inform the decisions made to alleviate such inequities. Failing to account for inherently biased data underlying these observations could intensify racial cancer disparities and lead to misguided efforts that fail to appropriately address the real causes of health inequity. Estimate the racial/ethnic bias of machine learning models in predicting two-year survival and surgery treatment recommendation for non-small cell lung cancer (NSCLC) patients. A Cox survival model, and a LOGIT model as well as three other machine learning models for predicting surgery recommendation were trained using SEER data from NSCLC patients diagnosed from 2000-2018. Models were trained with a 70/30 train/test split (both including and excluding race/ethnicity) and evaluated using performance and fairness metrics. The effects of oversampling the training data were also evaluated. The survival models show disparate impact towards non-Hispanic Black patients regardless of whether race/ethnicity is used as a predictor. The models including race/ethnicity amplified the disparities observed in the data. The exclusion of race/ethnicity as a predictor in the survival and surgery recommendation models improved fairness metrics without degrading model performance. Stratified oversampling strategies reduced disparate impact while reducing the accuracy of the model. NSCLC disparities are complex and multifaceted. Yet, even when accounting for age and stage at diagnosis, non-Hispanic Black patients with NSCLC are less often recommended to have surgery than non-Hispanic White patients. Machine learning models amplified the racial/ethnic disparities across the cancer care continuum (which are reflected in the data used to make model decisions). Excluding race/ethnicity lowered the bias of the models but did not affect disparate impact. Developing analytical strategies to improve fairness would in turn improve the utility of machine learning approaches analyzing population-based cancer data.

Prevalence and Outcomes of Sepsis in Patients With Colon Carcinoma: Organism-Specific Analysis.

Background Sepsis is a challenging condition, especially in patients with malignancy, that is associated with worse mortality and increased complications. This study aimed to analyze the prevalence of sepsis, its complications, healthcare outcomes, and associated organism-specific mortality in patients with colorectal carcinoma using the National Inpatient Sample database. Methodology We included patients aged >18 years with a primary diagnosis of colon cancer. The patients were divided into two groups, those with sepsis and those without sepsis. Confounders were adjusted using multivariate regression analysis. We examined outcomes including mortality, hospital charges, length of stay, and other associated complications. Results Out of 876,769 patients diagnosed with colon cancer, 2,579 (0.2%) had methicillin-resistant Staphylococcus aureus (MRSA) sepsis, 1,004 (0.1%) had Staphylococcus aureus sepsis, and 6,439 (0.7%) had Escherichia coli sepsis. Patients with sepsis exhibited significantly longer hospital stays, the highest with Staphylococcus aureus and Enterococcus, as well as increased healthcare costs compared to those without sepsis. The highest mortality rates were associated with Staphylococcus aureus (n = 169/1,004, 17%), followed by Pseudomonas (n = 150/940, 16%) and MRSA (n = 374/2,579, 14%). Sepsis also led to higher rates of complications, including acute kidney injury and septic shock. Conclusions Through this study, we aim to highlight the need for early diagnosis and targeted management of colon cancer patients who develop sepsis during their hospital course. Future research should focus on the underlying pathophysiology and effective interventions to improve outcomes for patients with colorectal carcinoma and sepsis.

Association of Seizure Control with Mortality, Cognition, and Function in People With Dementia.

The effects of seizure control on outcomes in persons with dementia (PWD) remain unclear. Our study aimed to investigate the impact of seizure control on mortality, function, cognition, and mood among PWD. This longitudinal, multicenter study is based on 39 Alzheimer's disease centers (ADCs) in the United States from September 2005 to December 2021. PWD were grouped by seizure status into recurrent (seizures in the past year), remote (prior seizures but none in the past year), and no seizures (controls). The primary outcome was all-cause mortality among seizure groups. We used Weibull survival analysis to assess the mortality risks by seizure status after adjusting for age, sex, education, race, ethnicity, hypertension, diabetes, hyperlipidemia, degree of cognitive impairment, dominant Alzheimer's disease (AD) mutation, brain trauma, stroke, Parkinson's disease, alcohol abuse, and depression. Cognition (Clinical Dementia Rating), function (physical dependence and nursing home residence), day-to-day activities (Functional Assessment Scores), and mood (Geriatric Depression Scale) were compared among seizure groups after adjusting for dementia duration and age. Among 26,501 participants, 374 (1.4%) had recurrent seizures and 510 (1.9%) had remote seizures. In multivariable survival analysis, recurrent seizures were associated with a higher mortality risk than remote and no seizures (adjusted hazard ratio [aHR], 95% confidence interval [95% CI]; recurrent aHR = 1.79, 95% CI = 1.51 to 2.12; remote aHR = 1.17, 95% CI = 0.98 to 1.38). Median time-to-death for recurrent, remote, and no seizures was 2.4, 4.0, and 4.7 years, respectively. People with recurrent seizures had worse cognition, day-to-day function, and physical dependence than those with remote seizures and controls. PWD with poorly controlled recurrent seizures have worse mortality, functional, and cognitive outcomes than PWD with remote and no seizures. These findings underscore the need for timely identification and management of ongoing seizures in PWD. ANN NEUROL 2024.

Longitudinal outcomes after financial toxicity and health-related social risks screening and referral.

17 Background: Financial toxicity (FT) is associated with delayed/omitted care, reduced quality of life, and worse mortality. Routine screening for FT and health-related social risks (HRSR) is recommended during clinical care, but there is limited longitudinal evidence on outcomes after patients screen positive and are referred for assistance. Methods: FT and HRSR screening for patients with breast, gynecologic, gastrointestinal, or thoracic cancers was implemented at an urban comprehensive cancer center. Screening included the Comprehensive Score for Financial Toxicity (COST) tool (0-44, lower scores=worse FT) and a HRSR checklist to identify food, housing, and transportation insecurity. COST score ≤16-20 or reported HRSR was a “positive” screen and counseling referral was offered: patients could accept the referral by identifying their current concerns. Analysis sample was limited to receiving chemotherapy, radiotherapy, or surgery 120 days prior to baseline survey and had a follow-up survey 4-12 months later. Data were collected 10/2022-12/2023. Results: 2196 patients met inclusion criteria, median time between surveys was 5.5 months (IQR 4.4, 6.9). 20% (n=438) screened positive and accepted referral; 11% (n=246) screened positive and declined referral; the remaining 69% (n=1512) screened negative. Sociodemographic factors of age (median 58 vs 62, p&lt;.001), sex (82% vs 74% female, p =.015), and race (31% vs 17% racial/ethnic minority, p&lt;.001) were associated with accepting vs declining referral. Those who accepted referral had lower COST scores (median 10 vs 19) and more HRSR (39% vs 20% housing; 32% vs 18% food; 37% vs 17% transportation) at baseline (all p≤.001). At follow-up, both cohorts had COST decrease, indicating worsened FT [mean difference (95% CI): accepted referral -2.0 (-2.8, -1.2) vs declined referral -2.8 (-4.0, 1.5)]. Across all collected HRSR, those who accepted referral had small benefits in previously reported HRSR, however were more likely to have newly designated HRSR (Table shows changes). Conclusions: Screening for FT and HRSR identified one-third of patients on recent cancer treatment with financial or social needs. Those who accepted financial assistance referral had significantly higher FT and more reported HRSR. Although referral did appear to have some benefit on initial needs, new HRSR were identified at follow-up. Future work will focus on optimizing available assistance to meet ongoing patient needs during and after cancer treatment. Accepted Referraln = 438 (%) Declined Referraln = 246 (%) Housing Resolved need 67 (15) 31 (13) New need 54 (12) 15 (6.1) Stable unmet need 102 (23) 18 (7.3) Stable no need 215 (49) 182 (74) Food Resolved need 64 (15) 31 (13) New need 69 (16) 16 (6.5) Stable unmet need 77 (18) 14 (5.7) Stable no need 228 (52) 185 (75) Transportation Resolved need 73 (17) 34 (14) New need 56 (13) 20 (8.1) Stable unmet need 87 (20) 8 (3.3) Stable no need 222 (51) 184 (75)

Maternal immigrant status and survival among children with congenital heart disease

ObjectiveTo examine associations between maternal immigrant status and survival of children with congenital heart disease (CHD). ApproachA retrospective population-based cohort study of hospital live births between April 2002 to September 2020 in Ontario, Canada was conducted at ICES. We identified children aged 0-17 years with a diagnosis of CHD from inpatient and health services datasets. The exposure was maternal immigrant status obtained from the IRCC permanent resident database. The outcome was time-to-death from after birth to &lt;18 years olds. Multilevel Cox hazard regression models generated hazard ratios (HR) for associations between maternal immigrant status and children’s deaths while accounting for hospitals as a cluster factor and adjusting for maternal age at birth, neighbourhood income and education quantiles, comorbidities, a composite of severe maternal morbidity, gestational age at birth, birth weight, and infant sex. ResultsRelative to children born to non-immigrant mothers, the adjusted HR for death was 1.17 (95% CI:1.06-1.30) in children whose mothers were immigrants, and 1.33 (95% CI:1.07-1.65) in those from refugees. Moreover, compared to children residing in neighbourhoods with the highest income and educational levels, the adjusted HR of death for children who lived in neighbourhoods with the lowest income and educational level was 1.52 (95% CI: 1.24-1.88) and 1.47 (95% CI: 1.18-1.83) respectively. ConclusionChildren with CHD born to immigrant and refugee mothers, and those living in low socioeconomic status neighbourhoods had worse mortality. Health policy decision makers should target children with CHD from immigrant/refugee families and disadvantaged neighbourhoods to improve their survival.

Risk Factors and Outcomes Associated With the Development of Persistent Acute Kidney Injury in Non-Renal Solid Organ Transplant Recipients: Systematic Review and Meta-Analysis.

Persistent acute kidney injury (pAKI), compared with acute kidney injury (AKI) that resolves in <72h, is associated with worse prognosis in critically ill patients. Definitions and prognosis of pAKI are not well characterized in solid organ transplant patients. Our aims were to investigate (a) definitions and incidence of pAKI; (b) association with clinical outcomes; and (c) risk factors for pAKI among heart, lung, and liver transplant recipients. We systematically reviewed the literature including PubMed, Embase, Web of Science, and Cochrane from inception to 8/1/2023 for human prospective and retrospective studies reporting on the development of pAKI in heart, lung, or liver transplant recipients. We assessed heterogeneity using Cochran's Q and I2. We identified 25 studies including 6330 patients. AKI (8%-71.6%) and pAKI (2.7%-55.1%) varied widely. Definitions of pAKI included 48-72h (six studies), 7days (three studies), 14days (four studies), or more (12 studies). Risk factors included age, body mass index (BMI), diabetes, preoperative chronic kidney disease (CKD), intraoperative vasopressor use, and intraoperative circulatory support. pAKI was associated with new onset of CKD (odds ratio [OR] 1.41-11.2), graft dysfunction (OR 1.81-8.51), and long-term mortality (OR 3.01-13.96), although significant heterogeneity limited certainty of CKD and graft dysfunction outcome analyses. pAKI is common and is associated with worse mortality among liver and lung transplant recipients. Standardization of the nomenclature of AKI will be important in future studies (PROSPERO CRD42022371952).

The burden of hyperkalaemia on hospital healthcare resources

Hyperkalaemia is associated with prolonged hospital admission and worse mortality. Hyperkalaemia may also necessitate clinical consults, therapies for hyperkalaemia and high-dependency bed utilisation. We evaluated the ‘hidden’ human and organisational resource utilisation for hyperkalaemia in hospitalised patients. This was a single-centre, observational cohort study (Jan 2017–Dec 2020) at a tertiary-care hospital. The CogStack system (data processing and analytics platform) was used to search unstructured and structured data from individual patient records. Association between potassium and death was modelled using cubic spline regression, adjusted for age, sex, and comorbidities. Cox proportional hazards estimated the hazard of death compared with normokalaemia (3.5–5.0 mmol/l). 129,172 patients had potassium measurements in the emergency department. Incidence of hyperkalaemia was 85.7 per 1000. There were 49,011 emergency admissions. Potassium > 6.5 mmol/L had 3.9-fold worse in-hospital mortality than normokalaemia. Chronic kidney disease was present in 21% with potassium 5–5.5 mmol/L and 54% with potassium > 6.5 mmol/L. For diabetes, it was 20% and 32%, respectively. Of those with potassium > 6.5 mmol/L, 29% had nephrology review, and 13% critical care review; in this group 22% transferred to renal wards and 8% to the critical care unit. Dialysis was used in 39% of those with peak potassium > 6.5 mmol/L. Admission hyperkalaemia and hypokalaemia were independently associated with reduced likelihood of hospital discharge. Hyperkalaemia is associated with greater in-hospital mortality and reduced likelihood of hospital discharge. It necessitated significant utilisation of nephrology and critical care consultations and greater likelihood of patient transfer to renal and critical care.

Development, Progression, and Mortality of Suspected Interstitial Lung Disease in COPDGene.

Rationale: Some with interstitial lung abnormalities (ILA) are suspected to have interstitial lung disease (ILD), a subgroup with adverse outcomes. Rates of development and progression of suspected ILD and their effect on mortality are unknown. Objectives: To determine rates of development, progression, and mortality in those with suspected ILD and assess effects of individual ILD and progression criteria. Methods: Participants from COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) with ILA characterization and FVC at enrollment and 5-year follow-up were included. ILD was defined as ILA and fibrosis and/or FVC < 80% predicted. Prevalent ILD was assessed at enrollment and incident ILD and progression were assessed at 5-year follow-up. Computed tomography (CT) progression was assessed visually and FVC decline as relative change. Multivariable Cox regression tested associations between mortality and prevalent ILD, incident ILD, and progression groups. Measurements and Main Results: Of 9,588 participants at enrollment, 268 (2.8%; 51% of ILA) had prevalent ILD. Those with prevalent ILD had 51% mortality after median 10.6 years, which was higher than those with ILA without prevalent ILD (henceforth ILA) (33%; hazard ratio [HR], 2.0; P < 0.001). The subgroup of prevalent ILD with only fibrosis criteria (FVC ≥ 80%) had worse mortality (58%) than ILA (HR, 2.2; P < 0.001). A total of 98 participants with prevalent ILD completed 5-year follow-up: 33% had stable CT and relative FVC decline <10%, 6% had FVC decline ≥10% only, 39% had CT progression only, and 22% had both CT progression and FVC decline ≥10%. Mortality rates were 31%, 50%, 45%, and 45%, respectively; those with only CT progression had worse mortality than those with ILA (HR, 2.6; P = 0.005). At 5-year follow-up, incident ILD occurred in 148/4,842 participants without prevalent ILD (5.5/1,000 person-years) and had worse mortality than ILA (HR, 2.4; P < 0.001). Conclusion: Rates of mortality and progression are high among those with suspected ILD in COPDGene; fibrosis and radiologic progression are important predictors of mortality.

Endovascular Aortic Balloon control versus open Aortic cross Clamp in open ruptured abdominal Aortic aneurysm repair

To determine 30-day mortality of endovascular aortic balloon control compared with open aortic cross clamp in open surgical repair (OSR) of ruptured abdominal aortic aneurysms (rAAAs). A retrospective cohort review was performed of all adult patients who underwent OSR of an infrarenal rAAA between 2001 and 2018 at a single tertiary care center. A total of 174 patients were identified, of which 21 patients received endovascular aortic balloon control and 137 patients received an open aortic cross clamp. Primary outcome was 30-day mortality. Two-variable multivariate logistic regression was adjusted for preoperative blood pressure and age. Endovascular aortic balloon control was nonsignificantly associated with lower mortality (adjusted odds ratio [OR]=0.75 (95% confidence interval [CI] 0.24 to 2.38), P=0.63), and when placed under local anesthesia showed a trend toward improved mortality (adjusted OR=0.34 (95%CI 0.06 to 1.77), P=0.19). Balloon placement under general anesthesia was nonsignificantly associated with worse mortality (adjusted OR=2.50 (95%CI 0.35 to 9.13), P=0.46). There is no significant difference in mortality with the use of endovascular aortic balloon control in rAAA patients undergoing OSR, and it may be considered as an alternative approach to open aortic cross clamp in properly selected patients.

Machine-learning clustering analysis identifies novel phenogroups in patients with ST-elevation acute myocardial infarction

BackgroundMachine learning clustering of patients with ST-elevation acute myocardial infarction (STEMI) may provide important insights into their risk profile, management and prognosis. MethodsAll adult discharges for STEMI in the National Inpatient Sample (October 2015 to December 2019) were included, excluding patients with prior myocardial infarction. Machine-learning clustering analysis was used to define clusters based on 21 clinical attributes of interest. Main outcomes of the study were cluster-based comparison of risk profile, in-hospital clinical outcomes and utilization of invasive management. Binomial hierarchical multivariable logistic regression with adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) was used to detect the between-cluster differences. ResultsOut of overall 470,960 STEMI cases, the machine-learning analysis revealed 4 different clusters with 205,640 (cluster 0: ‘behavioural risk cluster’), 146,400 (cluster 1: ‘least comorbidity cluster’), 45,100 (cluster 2: ‘diabetes with end-organ damage cluster’) and 73,820 (cluster 3: ‘cardiometabolic cluster’) cases. Attributes with the highest importance for clustering were hypertension and diabetes. After multivariable adjustment, patients from ‘diabetes with end-organ damage cluster’ exhibited the worst mortality, MACCE and ischemic stroke (p < 0.001 for all), as well as the lowest utilization of invasive management (p < 0.001 for all), in comparison to other clusters. Patients from ‘behavioural risk cluster’ exhibited the best in-hospital prognosis and the highest utilization of invasive management, compared to other clusters (p < 0.001 for all). ConclusionsMachine learning driven clustering of inpatients with STEMI reveals important population subgroups with distinct prevalence, risk profile, prognosis and management. Data driven approaches may identify high risk phenogroups and warrants further study.

The relationship between comprehensive geriatric assessment on the pneumonia prognosis of older adults: a cross-sectional study

BackgroundThe mortality of pneumonia in older adults surpasses that of other populations, especially with the prevalence of coronavirus disease 2019 (COVID-19). Under the influence of multiple factors, a series of geriatric syndromes brought on by age is one of the main reasons for the poor prognosis of pneumonia. This study attempts to analyze the impact of geriatric syndrome on the prognosis of pneumonia.MethodsThis is a prospective cross-sectional study. Patients over 65 years old with COVID-19 and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative community-acquired pneumonia (SN-CAP) were included in the research. General characteristics, laboratory tests, length of stay (LOS), and comprehensive geriatric assessment (CGA) were collected. Multivariate regression analysis to determine the independent predictors of the severity, mortality, and LOS of COVID-19. At the same time, the enrolled subjects were divided into three categories by clustering analysis of 10 CGA indicators, and their clinical characteristics and prognoses were analyzed.ResultsA total of 792 subjects were included in the study, including 204 subjects of SN-CAP (25.8%) and 588 subjects (74.2%) of COVID-19. There was no significant difference between non-severe COVID-19 and SN-CAP regarding mortality, LOS, and CGA (P > 0.05), while severe COVID-19 is significantly higher than both (P < 0.05). The Barthel Index used to assess the activities of daily living was an independent risk factor for the severity and mortality of COVID-19 and linearly correlated with the LOS (P < 0.05). The cluster analysis based on the CGA indicators divided the geriatric pneumonia patients into three groups: Cluster 1 (n = 276), named low ability group, with the worst CGA, laboratory tests, severity, mortality, and LOS; Cluster 3 (n = 228), called high ability group with the best above indicators; Cluster 2 (n = 288), named medium ability group, falls between the two.ConclusionThe Barthel Index indicates that decreased activities of daily living are an independent risk factor for the severity, mortality, and LOS of geriatric COVID-19. Geriatric syndrome can help judge the prognosis of pneumonia in older adults.

Implementing financial toxicity and health-related social risks screening and referral.

11006 Background: Financial toxicity (FT), or cancer-related economic hardship, is associated with delayed/skipped care, reduced quality of life, and worse mortality. Screening for FT and health-related social risks (HRSR) as part of assessment for social determinates of health is currently being integrated into clinical care, but there is limited research on outcomes after patients screen positive for FT or HRSR. Methods: We conducted FT and HRSR screening for patients receiving treatment for breast, gynecologic, gastrointestinal, or thoracic cancer at an urban comprehensive cancer center. Screening included the 11-item Comprehensive Score for Financial Toxicity (COST) tool (scored 0-44, lower scores = worse FT) and a HRSR checklist to identify food, housing, medicine, and transportation insecurity. A COST score ≤20 or any endorsed HRSR was considered a positive screen, and financial/assistance counseling referral was offered. Multivariable logistic regression assessed associations of accepting referral, after controlling for demographic and clinical characteristics. Data were collected 09/2022-08/2023. Results: 28,606 patients completed screening, of which 32% (n = 9106) screened positive. Median COST was 16.0. Identified HRSR were: 23% food, 25% housing, 21% medicine, and 24% transportation insecurity. Of positive screens, 51% (n = 4683) requested some form of financial counseling. Associations with accepted referral include: higher FT (β = 1.15, 95% CI: 1.13, 1.16), younger age (β = 1.01, 95% CI: 1.008, 1.02), more essential needs (β = 1.19, 95% CI: 1.13, 1.25), non-White race/ethnicity (β = 1.70, 95% CI: 1.49, 1.93), and stage 3 (β = 1.29, 95% CI: 1.08, 1.53) or stage 4 (β = 1.26, 95% CI: 1.07, 1.49) diagnoses (vs. stage 0/1). Needs of patients who requested counseling included concerns relating to out-of-pocket expenses (68%), non-medical expenses (39%), health insurance coverage (23%), and paying for prescription medication (18%; not mutually exclusive). Of financial counseling sessions with available dispositions (n = 2336/4683, 50%), outcomes (not mutually exclusive) included general counseling (29%), referral to specific assistance programs (e.g., copay assistance, reduced cost care program; 15%), and insurance navigation (15%). One-third of patients requesting counseling did not respond to contact attempts; 21% reported no longer being interested in counseling upon contact. Conclusions: Screening for FT and HRSR was feasible, and one-third of patients were identified as at risk for FT or having an unmet essential need. Patients known to have worse FT outcomes (those with later-stage disease, younger age, higher FT, minoritized groups) were more likely to accept financial counseling; however, only one-half of those at risk accepted help. Future work will focus on improving workflows to ensure assistance meets patient needs, including addressing patient stigma around requesting help.

Early Celecoxib Use in Spontaneous Intracerebral Hemorrhage is Associated with Reduced Mortality.

Hemorrhagic strokes constitute 10-15% of all strokes and have the worst mortality and morbidity of all subtypes. Mortality and morbidity of spontaneous intracerebral hemorrhage (sICH) are often secondary to the effects of inflammation, brain edema, and swelling. Studies have shown that celecoxib, a selective cyclooxygenase 2 (COX-2) inhibitor, reduces perihematomal edema formation and inflammation. This study aimed to examine the impact of celecoxib on sICH outcomes. TriNetX, a multi-institutional research database, was retrospectively queried to identify patients with sICH. Outcomes in patients who received celecoxib within 5days (cohort 1) were analyzed and compared to those in patients who did not receive celecoxib (cohort 2). The primary end point was mortality within 1year of sICH. Secondary end points included ventilator dependence, tracheostomy, percutaneous endoscopic gastrostomy tube placement, craniotomy, deep venous thrombosis, pulmonary embolism, ischemic stroke, transient ischemia attack, myocardial infarction, and seizures. Further analysis was performed to assess these outcomes for patients treated with ibuprofen, a nonselective COX inhibitor. After propensity score matching, 833 patients were identified in each cohort based on celecoxib use. Mortality at 1year was significantly reduced in patients with sICH receiving celecoxib compared to those who did not (13.33% vs. 17.77%; p = 0.0124). Risks of ventilator dependence, tracheostomy, percutaneous endoscopic gastrostomy tube placement, craniotomy, deep venous thrombosis, pulmonary embolism, ischemic stroke, transient ischemia attack, myocardial infarction, and seizures were not significantly increased in patients who received celecoxib within 5days of sICH compared to those who did not receive celecoxib. There was no significant difference in mortality between patients based on ibuprofen administration. There exists a growing interest in using COX-2 as a potential target strategy for neuroprotection in patients with sICH, with some evidence of a mortality benefit in small cohort studies. This study shows that early celecoxib use is associated with decreased mortality in patients with sICH.

Is it time to consider a “time-out” before primary prevention implantable cardioverter-defibrillator placement in currently or recently hospitalized older patients with heart failure?

BackgroundTrajectories of mortality after primary prevention implantable cardioverter-defibrillator (ICD) placement for older patients with heart failure during or soon after acute hospitalization have not been assessed. ObjectiveThe purpose of this study was to compare trajectories of mortality after primary prevention ICD placement during or soon after acute cardiac or non-cardiac hospitalization. MethodsWe identified older patients with heart failure undergoing primary prevention ICD placement using 20% Medicare data (2008–2018). Placement settings were as follows: (1) Current-H—during current hospitalization, (2) Recent-H—within 90 days of hospitalization, or (3) Chronic stable. Hospitalization was categorized as cardiac vs non-cardiac. Interval mortality rates and hazard ratios (HRs) using Cox regression were estimated at 0–30, 31–90, and 91–365 days after ICD placement. ResultsOf the 61,710 patients (mean age 76 years; 35% female; 85% white), 19% (11,947), 25% (15,147), and 56% (34,616) had ICDs in Current-H, Recent-H, and Chronic stable settings. Mortality rates (per 100 person-years) were highest during 0–30 days, with 38 (34–42) and 22 (19–24) for Current-H and Recent-H, which declined to 21 (20–22) and 16 (15–17) during 91–365 days, respectively. Compared to Chronic stable, HRs were highest during 0–30 days post–ICD placement (5.5 [4.5–6.8] for Current-H and 3.4 [2.8–4.2] for Recent-H) and decreased during 91–365 days (2.0 [1.8–2.1] for Current-H and 1.6 [1.5–1.7] for Recent-H). HR pattens were similar for cardiac and non-cardiac hospitalizations. ConclusionPrimary prevention ICD placement during or soon after hospitalization for any reason was associated with worse mortality with diminishing risks after 90 days. Hospitalization likely identifies a sicker population in whom early mortality with or without ICD may be higher. Our results support careful consideration regarding ICD placement during the 90 days after hospitalization.

(886) - Worse Mortality and Graft Loss in Left versus Right Lung Transplants from Split Lung Donors

(886) - Worse Mortality and Graft Loss in Left versus Right Lung Transplants from Split Lung Donors

The symptom to assessment pathway for suspected chronic limb-threatening ischaemia (CLTI) affects quality of care: a process mapping exercise

BackgroundDelays in the pathway from first symptom to treatment of chronic limb-threatening ischaemia (CLTI) are associated with worse mortality and limb loss outcomes. This study examined the processes used by...