Characteristics of Antiphospholipid Antibody Positive Patients in AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking

OBJECTIVE: To describe baseline characteristics of antiphospholipid antibody (aPL)-positive patients, overall and by clinical and laboratory subtypes, enrolled in an international registry. METHODS: AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking Registry includes persistently aPL-positive adults. We evaluated baseline sociodemographic and aPL-related (APS classification criteria and "non-criteria") characteristics of patients overall and in subgroups (aPL-positive without APS, APS overall, thrombotic APS [TAPS] only, obstetric APS [OAPS] only, and both TAPS/OAPS). We assessed baseline characteristics of patients tested for three aPL (lupus anticoagulant test [LA], anticardiolipin antibody [aCL], and anti-β2 -Glycoprotein-I [aβ2 GPI]) by aPL profiles (LA only, single, double, and triple aPL positivity). RESULTS: Of 804 aPL-positive patients (mean age: 45 ± 13y; female: 74%; white 68%; other systemic autoimmune diseases: 36%), 80% were classified as APS (55% TAPS, 9% OAPS, and 15% TAPS/OAPS). In the overall cohort, 71% had vascular thrombosis, 50% with pregnancy history had obstetric morbidity, and 56% had at least one non-criteria manifestation. Among those with three aPL tested (n: 660), 42% were triple aPL positive. While single, double and triple aPL positive subgroups had similar frequencies of vascular, obstetric, and non-criteria events, these events were lowest in the single aPL subgroup consisting of aCL or aβ2 GPI only. CONCLUSION: Our study demonstrates the heterogeneity of aPL-related clinical manifestations and laboratory profiles in a multicenter, international cohort. Within single aPL-positivity, LA may be a major contributor to clinical events. Future prospective analyses, using standardized core laboratory aPL tests, will help clarify aPL risk profiles and improve risk stratification

VEGF attenuates development from cardiac hypertrophy to heart failure after aortic stenosis through mitochondrial mediated apoptosis and cardiomyocyte proliferation

<p>Abstract</p> <p>Background</p> <p>Aortic stenosis (AS) affects 3 percent of persons older than 65 years and leads to greater morbidity and mortality than other cardiac valve diseases. Surgery with aortic valve replacement (AVR) for severe symptomatic AS is currently the only treatment option. Unfortunately, in patients with poor ventricular function, the mortality and long-term outcome is unsatisfied, and only a minority of these patients could bear surgery. Our previous studies demonstrated that vascular endothelial growth factor (VEGF) protects cardiac function in myocardial infarction model through classic VEGF-PI3k-Akt and unclear mitochondrial anti-apoptosis pathways; promoting cardiomyocyte (CM) proliferation as well. The present study was designed to test whether pre-operative treatment with VEGF improves AS-induced cardiac dysfunction, to be better suitable for AVR, and its potential mechanism.</p> <p>Methods</p> <p>Adult male mice were subjected to AS or sham operation. Two weeks later, adenoviral VEGF (Ad-VEGF), enhanced green fluorescence protein (Ad-EGFP, as a parallel control) or saline was injected into left ventricle free wall. Two weeks after delivery, all mice were measured by echocardiography and harvested for further detection.</p> <p>Results</p> <p>AS for four weeks caused cardiac hypertrophy and left ventricular dysfunction. VEGF treatment increased capillary density, protected mitochondrial function, reduced CMs apoptosis, promoted CMs proliferation and eventually preserved cardiac function.</p> <p>Conclusions</p> <p>Our findings indicate that VEGF could repair AS-induced transition from compensatory cardiac hypertrophy to heart failure.</p

AB1388 CHARACTERISTICS ASSOCIATED WITH MYCHART ACTIVATION AND REASONS FOR NON-USE AMONG RHEUMATOLOGY CLINIC PATIENTS

BackgroundElectronic patient portals, such as MyChart by Epic, allow patients to view their medical records, request medication refills, and communicate with their health care providers. Factors associated with portal use include being younger, female, White, having private insurance, and having chronic illness.1The Hospital for Special Surgery (HSS) rheumatology clinic serves primarily patients with public insurance (Medicaid, which insures low-income adults, and Medicare, which insures adults &gt;65 years old and those with eligible chronic illness/disability). These patients may be at increased risk for poor health outcomes due to clinical and socioeconomic factors and they are less likely to use MyChart than patients seen in HSS private practices. Increased MyChart use may benefit this high-risk group and improve health equity.ObjectivesThis study aims to identify characteristics associated with MyChart activation and reasons for its underutilization among patients seen in the HSS rheumatology clinic.MethodsWe identified all patients aged ≥ 18 years seen in the HSS rheumatology clinic at least twice between January 15, 2019 and January 14, 2021, with at least one visit occurring between July 15, 2020 and January 14, 2021. MyChart status (active vs. inactive) and sociodemographic and clinical variables were extracted from the electronic health record (EHR). We used chi-square tests and t-tests to compare characteristics between patients with and without active MyChart; p-value &lt;0.05 was considered significant (Table 1). In addition, 10 rheumatology fellows were prompted on 3 occasions over 6 weeks to informally survey their own clinic patients with inactive MyChart accounts by asking: “What is your primary reason for not using MyChart?”.Table 1.Baseline Characteristics of Hospital for Special Surgery Rheumatology Clinic Patients Stratified by MyChart Activation StatusMyChart Active (N=726)MyChart Inactive (N=501)p-valueAge, yrs - Mean (SD)50.3 (15.6)60.0 (15.3)&lt;0.01Female - N (%)601 (82.8)412 (82.2)0.80Race - N (%)0.37•White/Caucasian275 (37.9)184 (36.7)•Black/African American185 (25.5)135 (27.0)•Asian58 (8.0)25 (5.0)•Other189 (26.0)145 (28.9)•Unknown18 (2.5)11 (2.2)Ethnicity - N (%)0.27•Hispanic/Latino294 (40.5)226 (45.1)•Not Hispanic/Latino422 (58.1)268 (53.5)•Unknown10 (1.4)7 (1.4)Preferred language - N (%)&lt;0.01•English611 (84.2)332 (66.3)•Spanish72 (9.9)134 (26.8)•Other43 (5.9)35 (7.0)Needs interpreter - N (%)106 (14.6)156 (31.1)&lt;0.01ResultsThere were 1,227 patients included (93.2% with Medicaid and/or Medicare insurance). Compared to patients with inactive MyChart (42.9%), those with active MyChart (57.1%) were younger (50.3 ± 15.6 vs. 60.0 ± 15.3 years, p&lt;0.01). The majority of patients in both groups was female. There was no significant difference in race or ethnicity between groups. Patients without active MyChart were less likely to identify English as their preferred language and more likely to require an interpreter for clinic visits (Table 1).The rheumatology fellows collectively asked 16 clinic patients with inactive MyChart their primary reason for non-use. The most commonly cited reason was difficulty using the technology (n=8; 50.0%); others included visual impairment (n=2; 12.5%), preference for using the telephone (n=2; 12.5%), concerns about security/spam (n=2; 12.5%), not having a smart phone/computer (n=1; 6.3%), and having a language barrier (n=1; 6.3%).ConclusionIn the HSS rheumatology clinic, patients who did not have active MyChart were older and less likely to be English-speaking than those who did. The most common barrier to MyChart use reported by patients was difficulty with the technology. This pilot data suggests a need for interventions to facilitate patient-provider communication, specifically targeting older and non-English-speaking rheumatology clinic patients, with the goal of advancing patient engagement and health equity.References[1]Ancker JS, et al. J Gen Intern Med. 2011 June 7. doi: 10.1007/s11606-011-1749-y.Disclosure of InterestsCaroline Siegel: None declared, Anne Bass: None declared, Deanna Jannat-Khah Shareholder of: AstraZeneca, Walgreens, Cytodyn, Omar Bruce: None declared, Justin Olmscheid: None declared, Nilasha Ghosh: None declared, Sebastian E. Sattui Grant/research support from: AstraZeneca, Monica Schwartzman: None declared, Diane Zisa: None declared, Amit Lakhanpal: None declared, Kevin Yip: None declared, Linda Yue: None declared, Juliet Aizer Grant/research support from: Pfizer and Lilly, Jessica Berman: None declared</jats:sec

Type 2 diabetes treatment and progression of chronic kidney disease in Italian family practice

Aims: Progressive chronic kidney disease represents a dreadful complication of type 2 diabetes mellitus (T2DM). We tested the pattern of use and the renal effects of old glucose-lowering drugs in T2DM patients cared for by Italian general practitioners (GPs). Methods: Data of 2606 T2DM patients were extracted from the databases of GPs, who do not have access to the most recent glucose-lowering drugs in Italy. The rate of kidney function decline was calculated by CKD-EPIcr, based on two consecutive creatinine values. Results: Metformin was used in 55% of cases, either alone or with sulfonylureas/repaglinide, across the whole spectrum of CKD (from 66% in stage G1 to only 8% in G4). Sulfonylurea use peaked at 21\u201322% in stage G2\u2013G3a, whereas repaglinide use significantly increased from 8% in G1 to 22% in G4. The median rate of CKD decline was 12 1.64&nbsp;mL/min/1.73&nbsp;m2 per year; it was higher in G1 ( 12 3.22 per year) and progressively lower with CKD severity. 826 cases (31.7%) were classified as fast progressors (eGFR decline more negative than 12 5&nbsp;mL/min/1.73&nbsp;m2 per year). The risk of fast progressing CKD was associated with increasing BMI, albuminuria, and sulfonylurea use, alone (OR, 1.47; 95% confidence interval, 1.16\u20131.85), or in association with metformin (OR, 1.40; 95% CI 1.04\u20131.88). No associations were demonstrated for metformin, cardiovascular and lipid lowering drug use. Conclusion: In the setting of Italian family practice, sulfonylurea use is associated with progressive CKD in patients with T2DM. Metformin, at doses progressively reduced according to CKD stages, as recommended by guidelines, is not associated with fast progression