Abstract 13987: Underutilization of Oral Anticoagulant Therapy in At-Risk Patients With Atrial Fibrillation—Insights From a Multistate Healthcare System

Introduction: Oral anticoagulant (OAC) therapy significantly reduces the risk of thromboembolism among at-risk patients with atrial fibrillation (AF). Current guidelines provide strong support for an OAC in men and women with AF and CHA2DS2-VASc scores of \u3e2 and \u3e3, respectively. In spite of this, previous data has suggested that up to 40% of these patients are not treated in accordance with guideline recommendations. Hypothesis: We hypothesized that OAC therapy continues to remain significantly underutilized among at-risk patients with AF in real-world settings. Methods: We sought to evaluate the prevalence of OAC underuse and contributing factors in an ambulatory population of at-risk AF patients within a large multistate healthcare system. EHR and coding (ICD-10) data were used to identify patients with AF, calculate their CHA2DS2-VASc score, and define their current antithrombotic regimen. Demographics were assessed to allow for comparison between those receiving an OAC from those who were not. Chi square or Fisher exact tests were used to examine differences between groups. Results: Data was pulled from our EHR on 8/1/18, identifying 147,455 unique patients with AF, of which 102,728 (76.3%) had a CHA2DS2-VASc score \u3e2 (excluding female gender) (Table). Compared to those on an OAC, patients on antiplatelet therapy were more likely to have coronary artery disease, peripheral vascular disease, and prior MI (p Conclusions: In a contemporary, non-registry setting, OAC underuse remains substantial among at-risk patients with AF. Further investigation into tools that facilitate implementation of guideline-directed medical therapy is needed to limit preventable thromboembolic events in this population

Abstract 14012: Opportunities to Improve the Efficacy and Safety of Oral Anticoagulant Therapy in Atrial Fibrillation—Insights From a Multistate Healthcare System

Introduction: Vitamin K antagonists (VKAs) effectively reduce thromboembolic risk in atrial fibrillation (AF), but are limited by a narrow therapeutic window. Patients with reduced time in the therapeutic range (TTR) also face an increased risk of bleeding and ischemic events. Based in part on this, current guidelines give preference to direct-acting oral anticoagulants (DOACs) over VKAs in AF. Hypothesis: We hypothesized that DOACs are underutilized among those on oral anticoagulant therapy and that TTR remains suboptimal for large numbers of individuals on VKAs in real-world settings. Methods: We sought to evaluate a) the breakdown of OAC type and b) TTR for those on VKAs in an ambulatory population of at-risk AF patients within a large multistate healthcare system. EHR and coding (ICD-10) data were used to identify patients with AF, calculate their CHA2DS2-VASc score, and define their current antithrombotic regimen. For those on a VKA, TTR was assessed with the Rosendaal method and reported as mean values. Demographics were assessed to allow for comparison between those receiving a DOAC and a VKA, as well as, those with high (\u3e70%) vs. low ( Results: Data was pulled from our EHR on 8/1/18, identifying 147,455 unique patients with AF, of which 102,728 (76.3%) had a CHA2DS2-VASc score \u3e2 (excluding female gender). Among these at-risk patients, 61,698 (60.1%) were receiving an OAC, of which 47.8% were on a VKA and 52.2% were on a DOAC. The mean TTR was 56.3%, with 37.1%, 49.9% and 60.8% with TTRs \u3e70%, \u3e60%, and \u3e50%, respectively. Patients on a DOAC were more likely to be female and less likely to have heart failure, coronary artery disease, peripheral vascular disease, diabetes and renal disease (p70% were more likely to be male and less likely to have heart failure, diabetes, and renal disease (p Conclusions: In a contemporary, non-registry setting, VKAs continue to be used in nearly half of at-risk patients on an OAC for AF, with a suboptimal TTR in nearly two thirds. Further investigation is needed into tools that facilitate interchange from a VKA to a DOAC, particularly among those with a suboptimal TTR

Forecasting confined spatiotemporal chaos with genetic algorithms

A technique to forecast spatiotemporal time series is presented. it uses a Proper Ortogonal or Karhunen-Lo\`{e}ve Decomposition to encode large spatiotemporal data sets in a few time-series, and Genetic Algorithms to efficiently extract dynamical rules from the data. The method works very well for confined systems displaying spatiotemporal chaos, as exemplified here by forecasting the evolution of the onedimensional complex Ginzburg-Landau equation in a finite domain.Comment: 4 pages, 5 figure

Stochastic synchronization in globally coupled phase oscillators

Cooperative effects of periodic force and noise in globally Cooperative effects of periodic force and noise in globally coupled systems are studied using a nonlinear diffusion equation for the number density. The amplitude of the order parameter oscillation is enhanced in an intermediate range of noise strength for a globally coupled bistable system, and the order parameter oscillation is entrained to the external periodic force in an intermediate range of noise strength. These enhancement phenomena of the response of the order parameter in the deterministic equations are interpreted as stochastic resonance and stochastic synchronization in globally coupled systems.Comment: 5 figure

Epigenetic Gene Promoter Methylation at Birth Is Associated With Child’s Later Adiposity

Objective: fixed genomic variation explains only a small proportion of the risk of adiposity. In animal models, maternal diet alters offspring body composition, accompanied by epigenetic changes in metabolic control genes. Little is known about whether such processes operate in humans.Research design and methods: using Sequenom MassARRAY we measured the methylation status of 68 CpGs 5? from five candidate genes in umbilical cord tissue DNA from healthy neonates. Methylation varied greatly at particular CpGs: for 31 CpGs with median methylation ?5% and a 5–95% range ?10%, we related methylation status to maternal pregnancy diet and to child’s adiposity at age 9 years. Replication was sought in a second independent cohort.Results: in cohort 1, retinoid X receptor-? (RXRA) chr9:136355885+ and endothelial nitric oxide synthase (eNOS) chr7:150315553+ methylation had independent associations with sex-adjusted childhood fat mass (exponentiated regression coefficient [?] 17% per SD change in methylation [95% CI 4–31], P = 0.009, n = 64, and ? = 20% [9–32], P < 0.001, n = 66, respectively) and %fat mass (? = 10% [1–19], P = 0.023, n = 64 and ? =12% [4–20], P = 0.002, n = 66, respectively). Regression analyses including sex and neonatal epigenetic marks explained >25% of the variance in childhood adiposity. Higher methylation of RXRA chr9:136355885+, but not of eNOS chr7:150315553+, was associated with lower maternal carbohydrate intake in early pregnancy, previously linked with higher neonatal adiposity in this population. In cohort 2, cord eNOS chr7:150315553+ methylation showed no association with adiposity, but RXRA chr9:136355885+ methylation showed similar associations with fat mass and %fat mass (? = 6% [2–10] and ? = 4% [1–7], respectively, both P = 0.002, n = 239).Conclusions: our findings suggest a substantial component of metabolic disease risk has a prenatal developmental basis. Perinatal epigenetic analysis may have utility in identifying individual vulnerability to later obesity and metabolic diseas

Singularites in the Bousseneq equation and in the generalized KdV equation

In this paper, two kinds of the exact singular solutions are obtained by the improved homogeneous balance (HB) method and a nonlinear transformation. The two exact solutions show that special singular wave patterns exists in the classical model of some nonlinear wave problems

Exposure to the Chinese Famine in Early Life and the Risk of Metabolic Syndrome in Adulthood

Objective: To examine whether exposure to the Chinese famine during fetal life and early childhood is associated with the risks of metabolic syndrome and whether this association is modified by later life environment. Research Design and Methods: We used data of 7,874 adults born between 1954 and 1964 from the 2002 China National Nutrition and Health Survey. Famine exposure groups were defined as nonexposed; fetal exposed; and early childhood, midchildhood, or late childhood exposed. Excess death rate was used to determine the severity of the famine. The ATP III criteria were used for the definition of metabolic syndrome (three or more of the following variables: elevated fasting triglyceride levels, lower HDL cholesterol levels, elevated fasting glucose levels, higher waist circumference, high blood pressure). Results: In severely affected famine areas, adults who were exposed to the famine during fetal life had a higher risk of metabolic syndrome, as compared with nonexposed subjects (odds ratio 3.13 [95% CI 1.24–7.89, P = 0.016]). Similar associations were observed among adults who were exposed to the famine during early childhood, but not for adults exposed to the famine during mid- or late childhood. Participants who were born in severely affected famine areas and had Western dietary habits in adulthood or were overweight in adulthood had a particularly high risk of metabolic syndrome in later life. Conclusions: Exposure to the Chinese famine during fetal life or infancy is associated with an increased risk of metabolic syndrome in adulthood. These associations are stronger among subjects with a Western dietary pattern or who were overweight in adulthood

Markov analysis of stochastic resonance in a periodically driven integrate-fire neuron

We model the dynamics of the leaky integrate-fire neuron under periodic stimulation as a Markov process with respect to the stimulus phase. This avoids the unrealistic assumption of a stimulus reset after each spike made in earlier work and thus solves the long-standing reset problem. The neuron exhibits stochastic resonance, both with respect to input noise intensity and stimulus frequency. The latter resonance arises by matching the stimulus frequency to the refractory time of the neuron. The Markov approach can be generalized to other periodically driven stochastic processes containing a reset mechanism.Comment: 23 pages, 10 figure