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Myocardial infarction Type II (T2MI) is a prevalent cause of troponin elevation secondary to a variety of conditions causing stress/demand mismatch. The impact of T2MI on outcomes in patients hospitalized with COVID-19 is not well studied. The Nationwide Inpatient Sample database from the year 2020 was queried to identify COVID-19 patients with T2MI during the index hospitalization. Clinical Modification (ICD-10-CM) codes ‘U07.1’ and ‘I21.A1’ were used as disease identifiers for COVID-19 and T2MI respectively. Multivariate adjusted Odds ratio (aOR) and propensity score matching (PSM) was done to compare outcomes among COVID patients with and without T2MI. The primary outcome was in-hospital mortality. A total of 1,678,995 COVID-19-weighted hospitalizations were identified in the year 2020, of which 41,755 (2.48%) patients had T2MI compared to 1,637,165 (97.5%) without T2MI. Patients with T2MI had higher adjusted odds of in-hospital mortality (aOR 1.44, PSM 32.27%, 95% CI 1.34–1.54) sudden cardiac arrest (aOR 1.29, PSM 6.6%, 95% CI 1.17–1.43) and CS (aOR 2.16, PSM 2.73%, 95% CI 1.85–2.53) compared to patients without T2MI. The rate of coronary angiography (CA) in T2MI with COVID was 1.19%, with significant use of CA among patients with T2MI complicated by CS compared to those without CS (4% vs 1.1%, p < 0.001). Additionally, COVID-19 patients with T2MI had an increased prevalence of sepsis compared to COVID-19 without T2MI (48% vs 24.1%, p < 0.001). COVID-19 patients with T2MI had worse cardiovascular outcomes with significantly higher in-hospital mortality, SCA, and CS compared to those without T2MI. Long-term mortality and morbidity among COVID-19 patients who had T2MI will need to be clarified in future studies.

Highlights • IMRT is associated with favorable toxicity rates for patients with anal cancer. • Outcomes were favorable for those with T3-4 tumors or lymph node involvement. • Current smokers are at a higher risk of severe dermatologic toxicity. • Overall treatment duration greater than 39 days is associated with recurrence., Introduction To report long-term efficacy and adverse events (AEs) associated with intensity modulated radiotherapy (IMRT) for patients with anal canal squamous cell carcinoma (ASCC). Materials and methods This was a retrospective review of patients with ASCC who received curative-intent IMRT and concurrent chemotherapy (98%) between 2003 and 2019. Overall survival (OS), colostomy-free survival (CFS), and progression-free survival (PFS) were estimated using the Kaplan-Meier method. The cumulative incidence of local recurrence (LR), locoregional recurrence (LRR), and distant metastasis (DM) were reported. Acute and late AEs were recorded per National Cancer Institute Common Terminology Criteria for AEs. Results 127 patients were included. The median patient age was 63 years (interquartile range [IQR] 55–69) and 79% of patients were female. 33% of patients had T3-4 disease and 68% had clinically involved pelvic or inguinal lymph nodes (LNs). The median patient follow-up was 47 months (IQR: 28–89 months). The estimated 4-year OS, CFS, and PFS were 81% (95% confidence interval [CI]: 73%–89%), 77% (95% CI: 68%–86%), and 78% (95% CI: 70%–86%), respectively. The 4-year cumulative incidences of LR, LRR, and DM were 3% (95% CI: 1%–9%), 9% (95% CI: 5%–17%), and 10% (95% CI: 6%–18%), respectively. Overall treatment duration greater than 39 days was associated with an increased risk of LRR (Hazard Ratio [HR]: 5.2, 95% CI: 1.4–19.5, p = 0.015). The most common grade 3+ acute AEs included hematologic (31%), gastrointestinal (GI) (17%), dermatologic (16%), and pain (15%). Grade 3+ late AEs included: GI (3%), genitourinary (GU) (2%), and pain (1%). Current smokers were more likely to experience grade 3+ acute dermatologic toxicity compared to former or never smokers (34% vs. 7%, p

Lymph node (LN)–positive cervical cancer is associated with a poor prognosis. We report outcomes for women with LN-positive cervical cancer treated with intensity-modulated radiation therapy (IMRT) with dose-escalated simultaneous integrated boost (SIB) to involved LNs. Between 2005 and 2017, 59 women with LN-positive, non-metastatic, cervical cancer underwent definitive chemoradiotherapy (CRT) with an image-guided LN boost to a median dose of 56.25 Gy in 25 fractions. Acute and late adverse events (AEs) were recorded per common terminology criteria for adverse events. The Kaplan-Meier method was used to estimate the overall survival (OS), progression-free survival (PFS), and locoregional control (LRC). Median age was 49 years (IQR 37–56). Women had involved LNs in the pelvis (56%) or pelvis and para-aortic (PA) LNs (44%), with a median of 3 (IQR 2–6) grossly involved LNs per patient. Median follow-up was 30 months (IQR 11–45). Estimated 3-year OS, PFS, and LRC were 67% (95% CI, 51%–84%), 60% (95% CI, 45%–76%), and 89% (95% CI, 76%–99%), respectively. PA LN involvement (HR 2.51; 95% CI, 1.05–5.99; p = 0.04) and the presence of ≥ 4 grossly involved LNs (HR 2.79; 95% CI, 1.16–6.71; p = 0.02) were associated with a higher risk of disease progression on univariate analysis. The incidence of treatment-related acute grade 3+ acute GI or GU AEs was 3%, while late GI or GU treatment-related AEs occurred in 12%. Chemoradiation with a LN-directed SIB for women with LN-positive cervical cancer is well tolerated and is associated with excellent oncologic outcomes. In this report, we evaluated the oncologic efficacy and adverse events associated with definitive chemoradiotherapy with a simultaneous integrated boost to grossly involved lymph nodes for women with lymph node–positive cervical cancer. We have identified acceptable rates of adverse events and excellent oncologic outcomes, even in a very high risk cohort of women with cervical cancer.

A left ventricular assist device (LVAD) is used to support patients with end-stage heart failure. To examine the role of comorbidities and complications in predicting in-hospital mortality since the introduction of continuous flow (CF)-LVAD. The Nationwide Inpatient Sample was queried from 2010 to 2014 using International Classification of Disease-9 code for LVAD among patients 18 years or older. The sample consisted of 2,359 patients (mean age = 55 ± 13.7 years, 76.8% men, 59.3% Caucasian). Comparative analysis revealed mortality did not differ from 2010 to 2014 (p = 0.653). Increases in comorbidities of atrial fibrillation, acute kidney injury, mechanical ventilation, body mass index ≥ 25, cerebrovascular disease, and mild liver disease were evidenced over the 5-year period (p values ≤ 0.049). Multivariate analysis showed that significant predictors of mortality were comorbid hemodialysis (AOR = 7.62, 95% CI [4.78, 12.27]), cerebrovascular disease (AOR = 5.38, 95% CI [3.49, 8.26]), mechanical ventilation (AOR = 3.83, 95% CI [2.84, 5.18]), mild liver disease (AOR = 1.96, 95% CI [1.38, 2.76]), and acute kidney injury (AOR = 1.62, 95% CI [1.16, 2.28]). Predictive complications included disseminated intravascular coagulation (AOR = 6.41, 95% CI [2.79, 6.84]), sepsis (AOR = 4.37, 95% CI [2.79, 6.84]), septic shock (AOR = 3.9, 95% CI [2.11, 7.59]), and gastrointestinal bleed (AOR = 1.81, 95% CI [1.11, 2.93]). CF-LVADs have not reduced mortality, possibly due to utilization in patients with comorbid conditions. Future trials are necessary for improved patient selection and reduced post-procedural complications.

There is limited evidence demonstrating whether cannabis, cocaine, amphetamine, or other stimulants use contributes to heart failure (HF) readmissions. We used the National Readmissions Database years 2016-2018 to identify patients with HF with and without substance use disorder (SUD) (defined as a composite of cannabis, cocaine, or other stimulant use disorders). The main outcome was to assess the risk of 30-day readmissions in HF patients with and without SUD. Of 978,217 HF hospitalizations that met the inclusion criteria, 34,717 (3.5%) had concomitant SUD. HF patients with SUD had significantly higher hazard for 30-day all-cause readmissions (adjusted hazard ratio [aHR] 1.16 [1.12-1.21]; P0.01) compared to HF patients without SUD. In conclusion, HF patients with SUD have an elevated risk of 30-day all-cause readmissions, mainly driven by cocaine and other stimulant disorders. Screening for substance use in hospitalized HF patients as well as timely referral for treatment are important to prevent HF readmissions.

Introduction: Socioeconomic status (SES) and race is closely interlinked. There is limited data regarding trends of atrial fibrillation (AF) hospitalizations in black and non-black adults based on SES. Methods: We queried the National Inpatient Sample database from January 2004 to December 2018 to identify patients admitted with AF. We used ICD-9-CM and ICD-10-CM diagnosis codes to identify all patients who were ≥18 years of age and hospitalized with a primary discharge diagnosis of AF. Our cohort was categorized into black and non-black groups, and SES using median household income (MHI) as a surrogate, into low SES (MHI 0-50) and high SES (MHI 51-100). AF hospitalizations per 1 million US population were calculated using US census population ≥18 years of age for each year. We estimated AF hospitalizations per 1 million blacks and non-blacks and trends in AF hospitalizations of black and non-black adults stratified by SES utilizing MHI. Cochran Armitage Test was utilized to estimate temporal trends. Results: Total admissions for AF per 1 million adults in the US population has increased (Figure 1). Among patients hospitalized with AF, the proportion of black adults is increasing. In those of low SES, both black and non-black patients have had increases in AF hospitalizations. However, in those of high SES, non-black patients have had steady improvement while black patients have remained at about the same rate of hospitalizations from 2004 to 2018 (Figure 2). Conclusions: Trends of AF hospitalizations have increased or not improved in low and high MHI-SES black adults, respectively. Identifying causes of these health disparities can improve healthcare quality in black adults with AF.

Introduction: Race and socioeconomic status (SES) is interconnected. There is scarce data analyzing trends of atrial fibrillation (AF) in-hospital mortality in black and non-black adults based on SES. Methods: We queried the National Inpatient Sample database from January 2004 to December 2018 to identify patients admitted with AF. We used ICD-9-CM and ICD-10-CM diagnosis codes to identify all patients who were 18 years of age or older and hospitalized with a primary discharge diagnosis of Atrial Fibrillation. Our cohort was further categorized by race, into black and non-black groups, and socioeconomic status (SES) using median household income (MHI) as a surrogate, into low SES (MHI 0-50) and high SES (MHI 51-100). We excluded all patients with incomplete data on age, gender, race, MHI and in-hospital mortality status. Also, in order to reduce the possibility of data duplication, the patients with an indicator for transfer to another acute-care facility were excluded. Cochran-Armitage Test was utilized to estimate temporal trends. Results: Black and non-black adults have had improvement of in-hospital mortality, although black adults still have higher trends as compared to non-black counterparts (p Conclusions: Trends of AF in-hospital mortality between black and non-black individuals are comparable despite a significantly smaller proportion of blacks in our study. There is a dynamic interplay among social and health risk factors associated with AF in black individuals and further studies are required to better understand this relation.

Introduction Atrial fibrillation (AF) is the most common arrhythmia encountered in a hospital setting. However, there is little data on the relationship of socioeconomic status (SES) and the utilization of catheter ablation amongst patients admitted with AF. Methods The National Inpatient Sample database was queried from 2003 to 2014 using ICD 9 revised diagnosis codes to identify patients who were hospitalized with a primary diagnosis of AF. SES was determined by median household income (MHI) and divided into quartiles (0–25th, 26–50th, 51–75th, and 76–100th). Trends were analyzed using Cochran Armitage test. Results We analyzed 3,618,133 patients with AF that were admitted from 2003 to 2014 (median age: 72 [IQR 61 – 81], female 52.6%). Trends stratified by MHI to compare catheter ablation rates of all 12 years revealed significant differences (Figure 1). A multivariable logistic regression accounting for sociodemographic factors revealed an increasing trend of catheter ablation utilization with higher MHI (Figure 1). Conclusion Over a 12-year period, patients admitted to the hospital with AF with higher MHI were found to have increasing rates of catheter ablation utilization due to AF. Conversely, a decline in catheter ablation rates were noted in patients with lower MHI. Funding Acknowledgement Type of funding sources: None.

Purpose To report reconstructive outcomes of patients treated with post-mastectomy intensity modulated proton therapy (IMPT) following immediate breast reconstruction (IBR). Materials and methods Consecutive women with breast cancer who underwent implant-based IBR and post-mastectomy IMPT were included. Clinical characteristics, dosimetry, and acute toxicity were collected prospectively and reconstruction complications retrospectively. Results Fifty-one women were treated between 2015 and 2017. Forty-two had bilateral reconstruction with unilateral IMPT. The non-irradiated contralateral breasts served as controls. Conventional fractionation (median 50 Gy/25 fractions) was administered in 37 (73%) and hypofractionation (median 40.5 Gy/15 fractions) in 14 (27%) patients. Median mean heart, ipsilateral lung V20Gy, and CTV-IMN V95% were 0.6 Gy, 13.9%, and 97.4%. Maximal acute dermatitis grade was 1 in 32 (63%), 2 in 17 (33%), and 3 in 2 (4%) patients. Surgical site infection (hazard ratio [HR] 13.19, 95% confidence interval [CI] 1.67–104.03, p = 0.0012), and unplanned surgical intervention (HR 9.86, 95% CI 1.24–78.67, p = 0.0068) were more common in irradiated breasts. Eight of 51 irradiated breasts and 2 of 42 non-irradiated breasts had reconstruction failure (HR 3.59, 95% CI 0.78–16.41, p = 0.084). Among irradiated breasts, hypofractionation was significantly associated with reconstruction failure (HR 4.99, 95% CI 1.24–20.05, p = 0.024), as was older patient age (HR 1.14, 95% CI 1.05–1.24, p = 0.002). Conclusions IMPT following IBR spared underlying organs and had low rates of acute toxicity. Reconstruction complications are more common in irradiated breasts, and reconstructive outcomes appear comparable with photon literature. Hypofractionation was associated with higher reconstruction failure rates. Further investigation of optimal dose-fractionation after IBR is needed.

Purpose The goal of this study was to assess global cerebral glucose uptake in subjects with known cardiovascular risk factors by employing a quantitative 18F-fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT) technique. We hypothesized that at-risk subjects would demonstrate decreased global brain glucose uptake compared to healthy controls. Methods We compared 35 healthy male controls and 14 male subjects at increased risk for cardiovascular disease (CVD) as assessed by the systematic coronary risk evaluation (SCORE) tool. All subjects were grouped into two age-matched cohorts: younger (mean) was measured by mapping regions of interest of the entire brain across the supratentorial structures and cerebellum. Wilcoxon's rank-sum test was used to assess the differences in Avg SUV meanbetween controls and at-risk subjects. Results Younger subjects demonstrated higher brain Avg SUV meanthan older subjects. In addition, in both age strata, the 10-year risk for fatal CVD according to the SCORE tool was significantly greater in the at-risk groups than in healthy controls (younger: P = 0.0304; older: P = 0.0436). In the younger cohort, at-risk subjects demonstrated significantly lower brain Avg SUV meanthan healthy controls (P = 0.0355). In the older cohort, at-risk subjects similarly had lower Avg SUV meanthan controls (P = 0.0343). Conclusions Global brain glucose uptake appears to be influenced by chronic cardiovascular risk factors. Therefore, FDG-PET/CT may play a role in determining the importance of CVD on brain function and has potential for monitoring the efficacy of various therapeutic interventions.

Introduction: Stroke is a known complication of hypertrophic obstructive cardiomyopathy (HOCM) and this complication is more common in patients with accompanying atrial fibrillation (AF). However, data regarding gender related differences with respect to this complication is sparse. Objective: We sought to understand the gender differences in rates of stroke in patients with HOCM with and without AF. Methods: The Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 codes 425.1 and 425.11 for HOCM in all diagnosis fields. AF was identified by ICD-9 code 427.31. We excluded patients with an indicator for transfer to another acute-care facility to reduce the possibility of data duplication. Chi-square was used for statistical analysis. Results: From 2010 to 2014, we identified 73,347 patients with HOCM (Mean age 63.76 ± 16.5 years; females 59% and Caucasians 67.5%). The overall rate of ischemic stroke in this cohort was 2153 (2.9%). Rate of ischemic stroke between males and females was similar (2.9% vs 3%; p Conclusion: Although stroke rates were higher in HOCM patients with AF, stroke rates were similar in both genders of HOCM patients with and without AF. It is important to consider anticoagulation in these patients to reduce the risk of stroke.

Introduction: Rheumatoid arthritis (RA) is an autoimmune disease associated with increased risk of atherosclerosis. Leptin may indirectly contribute to atherogenesis, but its role in RA is not clear. Hypothesis: We aimed to study the correlation between leptin and inflammation in the abdominal aorta (AA) assessed by 18F-FDG PET/CT in RA patients. Methods: We retrospectively analyzed the data of 18 RA patients (mean age 56.0±11.9, 14 male). All patients were administered 18F-FDG intravenously, and full-body PET/CT scans were acquired 180 minutes later. Regions of interest were delineated around the wall of the AA, with a superior border at the aortic hiatus of the diaphragm and an inferior border at the bifurcation of iliac arteries. Mean standard uptake values per axial slice were averaged to calculate the average SUVmean (aSUVmean). BMI, visceral fat area (VFA), and serum logarithmically transformed leptin (ln-leptin) were obtained. Patients were divided into low- and high-BMI groups, with a cutoff of 25 kg/m2. Results: Mean BMI (kg/m2) and VFA (cm2) between the low- and high-BMI groups were 21.7 vs. 31.4 (p Conclusion: In our study, higher serum leptin levels moderately correlated with 18F-FDG uptake in the AA, which reflects inflammation and atherogenic activity. Future studies are warranted to further elucidate the role of leptin in co-morbid atherosclerosis in patients with RA.

Introduction: The prevalence of sarcoid cardiomyopathy (SCM) with female predominance is well known. However, gender differences amongst individual races remains poorly studied. Hypothesis: We sought to determine and compare within each gender and race, the rates of arrhythmias, implantable cardiac devices, and in-hospital mortality in patients with SCM after excluding those with a history of coronary artery disease. Methods: The Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 diagnosis code (135) for sarcoidosis among patients >18 years old. We combined it with code (425.8) for cardiomyopathy in other diseases including sarcoid and sarcoid heart muscle disease. We excluded patients with a history of prior myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft. Results: From 2010 to 2014, we identified 9,063 patients with SCM (mean age = 53.11 ± 11.28 years; men 51.8% and black 52.5%). Upon comparison of gender within races, event rates per 100 patients were (white male, white female, black male, black female; p-value): atrial fibrillation (20.7, 18.8, 18, 16.1; p=0.172), ventricular fibrillation (VF) (4.1, 1.7, 2.3, 2.1; p Conclusion: White males had higher rates of VF, VT, CHB, but they also had a lower in-hospital mortality and SCA rates likely due to higher procedural rates such as EMB, ICD, CRT-D, catheter ablation and OHT as compared to others.

Introduction: The geriatric population represents over half of the patients who receive permanent pacemakers (PPM). There are complications associated with the use of PPM in the elderly. Hypothesis: There is limited data on the use of PPM in the elderly population. We aimed to analyze complications and trends associated with various PPM device implantations in the geriatric population over the age of 80. Methods: We used the National Inpatient Sample Database for the years 2010 to 2014 using the International Classification of Diseases-9 procedure code for PPM Implantation and diagnosis codes for complications associated with pacemaker use in patients above the age of 80 years. Results: We identified a total of 265,001 hospitalizations from 2010 to 2014 where patients above the age of 80 years received PPM implantation. Among those who received the PPM, 68 % of patients had Sinus Node Dysfunction (SND) and in-hospital mortality associated with PPM implantation of 1.8%. The majority of this cohort consisted of Caucasians (83%) and males (50%). They had a mean length of stay of 4.4±4.2 (mean ± SD) days. Various types of pacemakers implanted included dual chamber (72 %), single chamber (15 %), and biventricular (13 %). Complications associated with PPM implantation were venous thromboembolism (1%), cardiac tamponade (0.2%), sepsis and severe sepsis (1.1%), septic shock (0.3%), pneumothorax (0.2%), pacemaker hematoma (1.4%). Conclusion: As observed in our study, dual chamber pacemaker is the most commonly used implantable device in age 80+ geriatric patient population. This study identified a variety of PPM-related complications, of which pacemaker hematoma was the most common. Although there are associated complications with the use of this device, the benefits outweigh the risks as age should not be considered a barrier to receive a PPM.

Introduction: Without timely reperfusion therapy, acute myocardial infarction (AMI) can lead to mechanical complications (MC) such as papillary muscle rupture (PMR), ventricular septal rupture (VSR), free wall rupture (FWR). Mechanical circulatory support (MCS) devices such as intra-aortic balloon pump (IABP), Impella and extracorporeal membrane oxygenation (ECMO) are used in cardiogenic shock associated with AMI-MC. Hypothesis: As per the SHOCK-II trial use of MCS in MI complicated cardiogenic shock showed no difference in mortality. We sought to determine the rates of AMI-MC, MCS device placements and outcomes associated with them. Methods: The Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 codes with a primary diagnosis of AMI. We also used diagnosis and procedure codes for MC and MCS devices. We excluded patients with NSTEMI. Results: From 2010 to 2014, we identified 3158 hospitalizations related to AMI-MC with a mean age of 64±13.4 years. Majority were men 69% with 75% Caucasian with an in-hospital mortality rate of 37%. Use of MCS was most common in males (67%), Caucasians (77%), and with an age group of 50-70 years (54%). Of these patients, PMR was noted in 13%, VSR in 31% and FWR in 56%. Rates of MCS devices were 38% (IABP 35%, Impella 3% and ECMO 4%). Overall use of MCS for FWR, VSR, PMR were 15%, 61%, 80%. Percentage of MC requiring IABP, Impella, ECMO were as follows; FWR (15%, 0.6%, 0.3%), VSR (58%, 7%, 6%), PMR (70%, 5%, 12%). Patients that received cardiac transplant was 0.2%. In-hospital mortality among patients who received MCS to those who did not receive MCS were 59% vs 24%; p Conclusions: Based on the results, FWR was the most common MC. MCS were most commonly used in PMR followed by VSR, with IABP being the most common type. Patients on MCS had increased in-hospital mortality compared to those without MCS. Large randomized trials are needed to determine the effectiveness of these devices in predicting outcomes associated with AMI-MC

Introduction Influenza vaccination is associated with lower risk of death as well as major adverse cardiovascular events, including acute myocardial infarction (AMI), heart failure and stroke. Purpose The impact of Influenza vaccination on in-hospital mortality in patients with AMI with a prior history of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) is largely unknown. We hypothesize that such individuals who develop AMI have better outcomes if they had received influenza vaccine. Methods We analyzed the United States National Inpatient Sample Database from 2010–2014 to identify patients with primary discharge diagnosis of AMI (STEMI, NSTEMI) with a history of prior PCI or CABG. In this cohort, patients with influenza vaccination were identified using ICD-9 code V04.81. The primary outcome was in-hospital mortality. Chi-square test and multivariate regression model controlling for age, gender, race, type of AMI and co-morbidities were employed for statistical analysis. Results A total of 495,619 patients with ACS were identified who had prior PCI or CABG and 6525 had positive influenza vaccination status. Influenza vaccination was independently associated with lower risk of in-hospital mortality in patients with AMI (aOR = 0.253, 95% CI: 0.196–0.328; p Conclusion Vaccination against influenza was associated with lower risk of in-hospital mortality in patients with prior PCI or CABG who developed AMI. Figure 1 Funding Acknowledgement Type of funding source: None

Introduction/Background Sarcoidosis is a granulomatous disease with various cardiac manifestations such as arrhythmias, heart block, heart failure and sudden cardiac death. Objective We sought to determine and compare the rates of arrhythmias, implantable cardiac devices in patient with sarcoid heart disease (SHD) after excluding those with a history of coronary artery disease Methods The United States Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 diagnosis code (135) for sarcoidosis among patients >18 years. We combined it with code (425.8) for cardiomyopathy in others disease including sarcoid and sarcoid heart muscle disease. We excluded patients with a history of prior myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft. Results From 2010 to 2014, we identified 9,063 patients with SHD (Mage = 53.11±11.28 years; men 51.8% and black 52.5%). The overall in-hospital mortality rate was 227 (2.5%). Average Length of stay (LOS) (M ± SD) was 6.15±8.964. Various arrhythmias include atrial fibrillation 1,659 (18.4%), ventricular fibrillation 223 (2.5%), ventricular tachycardia 2,248 (24.7%), complete heart block 506 (1.5%) and second degree Mobitz type II 45 (0.5%). Rates of implantable cardiac devices included implantable cardioverter-defibrillator (ICD) 881 (9.7%), Cardiac Resynchronization Therapy Defibrillator (CRT-D) 83 (3.6%), PPM 172 (1.9%). Rates of Endomyocardial biopsy were 257 (2.8%). Overall rates of sudden cardiac arrest was 161 (1.8%). On comparing the two groups, sarcoidosis without cardiac involvement and sarcoid heart disease the rates of arrhythmias, implantable cardiac devices, in-hospital mortality and sudden cardiac arrest were as follows: atrial fibrillation (9.4 vs 18.3; p Conclusions Based on the results of our study, we conclude that SHD is associated with a variety of cardiac arrhythmias and conduction defects. Sarcoidosis with cardiac involvement is associated with increased rates of atrial fibrillation, ventricular fibrillation, ventricular tachycardia, complete heart block, and second degree Mobitz type II. They also had a higher rate of pacemaker implantation, ICD, CRT-D and had a overall higher rate of sudden cardiac arrest. Based on the results of our study we conclude that sarcoidosis with cardiac involvement has worse outcomes and hence, early diagnosis and prompt treatment can prevent the progression of the disease. Funding Acknowledgement Type of funding source: None

Introduction Complete heart block (CHB), also known as third-degree heart block, occurs when there is complete dissociation of the atria and ventricles. CHB during pregnancy is extremely rare and one possible mechanism may be related to the stretching of the atria during pregnancy causing conduction defects Purpose There is limited data on the rates of CHB and pacemaker (PPM) use in pregnant patients, with only a few case reports published. In this study we sought to define the rates of permanent pacemaker implantation for CHB complicating pregnancy. Methods The Nationwide Inpatient Sample was queried from 2010 to 2014 using the International Classification of Diseases, 9th revision diagnosis codes for pregnancy and CHB and procedure codes for PPM in any procedure field for patients 18 years or older. Results From 2010 to 2014, we identified 20,451,108 pregnancies in patients above the age of 18 years. The overall rates of CHB were 643 (0.0031%). The sample consisted of 643 patients (Mage= 29.28±6.42 years) with CHB, the majority of whom were Caucasians 328 (51%). Average length of stay (LOS) (M ± SD) was 4.94±7.859 and total hospitalization charges were 51,715.04±112,345.98 ($). Moreover, the occurrence of other conditions which could lead to the development of CHB was: sarcoidosis 0 (0%), systemic lupus erythematosus 5 (0.8%), prior myocardial infarction 25 (3.8%), Lyme disease 0 (0%). Among patients with CHB, PPM implantation was done in 60 (9.3%), and TVP were 5 (0.8%). The overall composite mortality rates were 21 (3.2%). On comparing the non-PPM group to the PPM group, rates of in-hospital mortality were 3.6% vs 0%; p=0.059, LOS were 4.49±5.01 vs 12.50±15.35; p Conclusions The overall rates of CHB were 3.1 in 100,000 pregnancies. There were no reported in-hospital deaths among pregnant patients with CHB who received PPM and TVP. Relatively lower rates of PPM implantation in these patients might indicate that CHB during pregnancy is less severe and patients may have a stable narrow complex junctional escape rhythm. PPM implantation is recommended for those who are symptomatic or have a slow wide QRS complex rhythm indicating a block below the bundle of His.With this study we attempt to better define the occurrence of CHB during pregnancy, which could lead to better understanding and management of this condition. Funding Acknowledgement Type of funding source: None

Introduction Heart failure has been increasing in prevalence over the past decade. Respiratory infections have been associated with exacerbations of underlying heart failure. Hence, vaccinations against these infections may serve to be an effective intervention to improve overall outcomes. Purpose We sought to compare the in-hospital mortality in patients with heart failure who received influenza and pneumococcal vaccine. Methods We analysed the United States National Inpatient Sample Database from 2010–2014 to identify patients with primary discharge diagnosis of heart failure. We identified pneumococcal vaccine with ICD 9 code V03.82 and influenza vaccine with ICD-9 code V04. 81. We excluded patients who were transferred out to prevent duplication of data. Chi-Square test was used for statistical analysis. Results The sample consisted of 587,018 patients with heart failure from 2010 to 2014 (Mage= 70.53±14.6 years), the majority of whom were male (60.1%) and Caucasian (53.2%). Upon comparing the group that received the influenza vaccine to the group that did not receive the influenza vaccine, rates of in-hospital mortality in patients with heart failure were 1.3% vs 3.6%; p Conclusions Despite the growing awareness regarding vaccinations in patients with heart failure the rates of vaccination in heart failure patients remain low. Our study findings indicate that patients who received influenza and pneumococcal vaccine had lower in-hospital mortality. The results of our study indicate that these vaccines have a significant impact in improving outcomes in heart failure patients. Funding Acknowledgement Type of funding source: None

Introduction Takotsubo Cardiomyopathy (TCM) is characterized by reversible left ventricular dysfunction and predominantly affects post-menopausal women. However, it is rarely identified as a cause of acute heart failure in pregnancy. Objective We aimed to determine patient characteristics and in-hospital outcomes of TCM occurring in pregnancy. Methods We retrospectively analyzed the United States - National Inpatient Sample (NIS) Database from 2010–2014 to assess TCM in pregnant women ≥18 years using international classification of diseases 9th revision clinical modification (ICD-9-CM) codes. We compared patient demographics, co-morbidities and in-hospital outcomes between pregnant and non-pregnant women with TCM aged 18–49 years. Patients with a diagnosis of peripartum cardiomyopathy were excluded. Chi-square test and Student-t test or Mann- Whitney U test were used for categorical and continuous variables with normal and skewed distribution, respectively. Results TCM occurred at a younger age in pregnant women compared to non-pregnant women (Age [Mean ±SD]: 31.2±7.2 years vs. 41.8±7.1 years; p Conclusion There was no in-hospital mortality observed in pregnant women who developed TCM, however, they had increased rates of cardiogenic shock, mechanical ventilation, ventricular fibrillation and had longer hospitalizations. Funding Acknowledgement Type of funding source: None

Introduction Infection related hospitalizations are common among patients with heart failure (HF), including those that could be prevented with appropriate vaccinations. Objective We aimed to determine the risk of vaccine preventable diseases (VPDs) in patients with HF. Methods We performed a population based retrospective cohort study using the United States- National Inpatient Sample (NIS) Database from 2010 to 2014. We identified patients who were admitted to the hospital with vaccine preventable diseases, namely influenza, varicella zoster infection (VZV), pneumococcal infection, meningococcal infection, diphtheria, pertussis, tetanus, hepatitis A (Hep A) and hepatitis B (Hep B) using international classification of diseases 9th revision clinical modification (ICD-9-CM) codes. In this cohort, we then identified patients with HF. Descriptive statistics were used to estimate the frequencies of various VPDs in patients with heart failure. A multivariate regression model adjusting for age, gender, race, immunosuppression (Diabetes, HIV, Organ transplantation, Malignancy) was employed to determine the risk of VPDs in patients with HF. Results Among a total of 11, 64,528 patients admitted with VPDs, HF was present in 1, 01,915 (8.8%).The most common VPD in patients with HF was VZV (30.7%), followed by influenza (28.2%), pneumococcal infection (20.9%) and Hep B (18.5%). Other VPDs were less common: Hep A (1.8%), diphtheria (0.4%), pertussis (0.2%), tetanus (10 patients) and meningococcal infection (0.1%). On multivariate analysis, patients with HF had increased risk of hospitalization due to influenza (aOR=1.20, 95% CI: 1.18–1.21; p Conclusion In our study, patients with HF had a higher risk of hospital admissions secondary to influenza and pneumococcal infections and a lower risk of VZV, Hep B, Hep A, meningococcal infection, diphtheria, and tetanus related admissions when compared with non-HF patients. Funding Acknowledgement Type of funding source: None

Introduction Sarcoidosis is a granulomatous disease with multiorgan involvement. Cardiac involvement may be asymptomatic or present clinically as heart failure, arrhythmias or even sudden cardiac death. Objective We compared gender differences in prevalence of arrhythmias and associated outcomes in patients with sarcoidosis without established coronary artery disease. Methods The United States Nationwide Inpatient Sample was queried from 2010 to 2014 to identify patients with sarcoidosis using ICD-9 diagnosis code in patients >18 years. We excluded patients with a prior history of myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft. Chi-square test was used for statistical analysis. Results The sample consisted of 308,064 patients (Mage = 55.65±11.28 years); they were mostly women 945 (65.2%) and black 957 (46.7%). In-hospital mortality in this cohort was 1,574 (2.5%). The most common arrhythmias was atrial fibrillation 29,850 (9.7%). Prevalence of ventricular fibrillation was 669 (0.2%), ventricular tachycardia 6,184 (2%), complete heart block 1462 (0.5%) and second degree Mobitz type II 245 (0.1%). Sudden cardiac death occurred in 2,059 (0.7%). Rates of various cardiac devices implanted were: implantable cardiac defibrillator (ICD) 1,452 (0.5%), cardiac resynchronization therapy-defibrillator (CRT-D) 553 (0.2%), pacemaker 1259 (0.4%). Rates of endomyocardial biopsy (EMB), radionuclide imaging, and cardiac magnetic resonance imaging were 470 (0.2%), 879 (0.3%), and 224 (0.1%), respectively. Based on gender (male vs. female), the rates of arrhythmias, cardiac device implantation and utilization of diagnostic modalities were: atrial fibrillation (41% vs 59%; p Conclusion In our study, in-hospital death was more common in females. Females had higher rates of atrial fibrillation compared to males who were found to have a higher burden of ventricular tachycardia. Males had higher rates of ICD and CRT-D placement. Males also had EMB performed more commonly than females. Funding Acknowledgement Type of funding source: None

Background Complete heart block (CHB) is considered to be a relatively rare complication of Takotsubo cardiomyopathy (TC), a condition characterized by transient left ventricular systolic dysfunction. Purpose We aim to investigate the incidence, in-hospital mortality and trends of permanent pacemaker (PPM) placement in patients with TC-related CHB. Methods We utilized the United States National Inpatient Sample (NIS) data from 2010–2014 to identify adult patients (≥18 years) with TC (ICD 9 code: 429.83). CHB cases were identified using ICD-9 code 426.0. Annual incidence of CHB, in-hospital mortality and trends of PPM placement were analyzed. Cochran-Armitage test was employed and p values were calculated for trend. Results A total of 56,431 patients with TC were identified, of which 495 (0.7%) had CHB (median age 71 years, 85% women). Incidence of TC-related CHB was 0.5% in 2010 and 0.8% in 2014. However, trend analysis did not show an increase in the incidence (ptrend=0.12). In-hospital mortality was higher in patients with CHB (7.5% vs. 2.9%, aOR = 1.9, 95% CI= 1.29–2.8, p=0.001). Temporary transvenous pacemaker (TTVP) was used in 158 (40.1%) and PPM in 217 (54.9%) patients. Trend analysis showed a significant increase in the PPM placement from 41.9% in 2010 to 76.2% in 2014 and a simultaneous decrease in use of TTVP (ptrend Median length of stay (4 vs. 3 days, p Conclusion TC-related CHB is uncommon, but independently associated with increased in-hospital mortality. The majority of these patients required PPM, implicating a non-reversible feature of the conduction system abnormality. Funding Acknowledgement Type of funding source: None

Introduction Prior to the utilization of continuous flow devices in 2010, Gastrointestinal (GI) bleeding was a common adverse event related to LVADs. Background Given the drastic increase in the use of new LVADs with continuous flow (CF), we sought to determine if CF-LVADs are associated with an increased number of GI bleeds and higher mortality. Methods We analysed the data from a national inpatient sample database using the International Classification of Disease (ICD)-9 procedure code for LVAD use in end-stage heart failure among patients 18 years or older. Included were 2,359 patients with a mean age of 55±13.7 years and 77% males and 59% Caucasians. Results The Incidence of GI bleed from 2010 to 2014 was 7.46%. There was no significant yearly change in the incidence over five years (p=0.793). After controlling for age, sex, and length of stay (LOS), hierarchical multivariate logistic regression revealed that significant predictors of GI bleed were acute kidney injury (AOR=1.87, 95% CI: 1.26, 2.80), peripheral vascular disease (AOR=1.77, 95% CI: 1.02, 2.94), body mass index ≥25 (AOR=0.46, 95% CI: 0.22, 0.87), hemiplegia and paraplegia (AOR=3.01, 95% CI: 1.17, 7.05), moderate or severe liver disease (AOR=2.40, 95% CI: 0.97, 5.34), peptic ulcer disease (PUD) (AOR=18.13, 95% CI: 7.86, 42.38), surgical aortic valve replacement (AOR=2.46, 95% CI: 1.12, 5.15), and venous thromboembolism (AOR=2.58, 95% CI: 1.57, 4.15). Conclusion Earlier studies showed an increase in the rate of GI bleed in CF-LVADs when compared to pulsatile flow devices. However, our study has indicated that CF-LVADs display no improvement in rates of GI bleed over five years, but that there was an increased likelihood of mortality in patients with GI bleed. These findings pose further questions in regard to considering newer device designs and improved patient selection criteria. Funding Acknowledgement Type of funding source: None

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes coronavirus disease 2019 (COVID-19) has resulted in a global health crisis. Prior to the arrival of this viral pandemic, the world was already plagued with a significant burden of cardiovascular disease. With the introduction of the novel virus, the world now faces a double jeapordy. Early reports have suggested an increased risk of death in individuals with underlying cardio-metabolic disorders. The exact effects of COVID-19 on the cardiovascular system are not well determined, however lessons from prior viral epidemics suggest that such infections can trigger acute coronary syndromes, arrhythmias and heart failure via direct and indirect mechanisms. In this article, we aimed to discuss the effects and potential underlying mechanisms of COVID -19 as well as potential implications of treatments targeted against this virus on the cardiovascular system.El síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) que causa la enfermedad por coronavirus (COVID-19) ha provocado una crisis en la salud global. Antes de la llegada de esta pandemia, se tenia una carga importante de enfermedad cardiovascular a nivel mundial. Con la introducción del nuevo virus, el mundo ahora se enfrenta a un doble peligro. Los primeros informes han sugerido un mayor riesgo de muerte en personas con trastornos cardio-metabólicos de base. Los efectos causados por el COVID-19, en el sistema cardiovascular aun no están bien determinados, sin embargo, el conocimiento sobre otras epidemias virales previamente ocurridas en el mundo, sugieren que estas infecciones pueden desencadenar síndromes coronarios agudos, arritmias e insuficiencia cardíaca a través de mecanismos directos e indirectos. En este artículo, nuestro objetivo fue analizar los efectos y los posibles mecanismos subyacentes de COVID -19, así como las posibles implicaciones de los tratamientos dirigidos contra este virus en el sistema cardiovascular.