Sanghvi, Urja

e24014 Background: Cardio-oncology traditionally focuses on cardiotoxicity prevention and acute cardiovascular-events. However, the functional, vocational, and mental health challenges that define daily survivorship remain largely hidden, representing a critical gap in holistic care. Methods: Utilizing the 2024 National Health Interview Survey (NHIS), we analyzed a nationally representative cohort of U.S. adults (≥18 years) across four groups: (1) Controls (no cancer or CVD), (2) CVD only, (3) cancer only, and (4) cardio-oncology. We evaluated five patient-centered metrics reflecting quality of life: functional and work limitations, assistive equipment use, personal assistance needs, and overall disability. Multivariable regression models, using Taylor series linearization for complex survey weighting, were adjusted for age, sex, race, hypertension, diabetes, hyperlipidemia, smoking, psychological distress (K6 score), and insurance status. Results: Among 32,599 adults (Weighted N = 259.7M), 2.9% lived with cardio-oncology multi-morbidity (weighted N = 5.34M; mean age 73y). After multivariable adjustment, functional limitations were highest in the cardio-oncology (63.6%, OR 2.34 [95%CI 1.89-2.88]), exceeding both CVD only (OR 1.99) and cancer only (OR = 1.26) groups. This population was also at the highest risk of disability (OR 2.74) and work limitations (31.7%, OR = 2.53). One in five cardio-oncology survivors reported severe mobility impairment (difficulty walking/steps), with a need for assistive equipment (OR = 2.86) and personal assistance (OR = 1.38). Conclusions: Cardio-oncology survivors face a functional and vocational burden significantly exceeding that of cancer or CVD alone. Care models must expand beyond event prevention to integrate routine functional screening and early rehabilitation to preserve quality of life in this high-risk population. Adjusted odds ratios by disease phenotype. Outcome CVD Only (vs. Control) Cancer Only (vs. Control) Cardio-Oncology (vs. Control) OR (95% CI) OR (95% CI) OR (95% CI) Functional limitation 1.99 (1.75–2.28) 1.26 (1.14–1.39) 2.34 (1.89–2.88) Uses special equipment 2.56 (2.20–2.98) 1.26 (1.08–1.46) 2.86 (2.32–3.53) Needs assistance 1.51 (1.17-1.94) 0.84 (0.64-1.12) 1.38 (0.99-1.92) Work limitation 2.12 (1.88-2.39) 1.19 (1.07-1.33) 2.53 (2.11-3.03) Disability 2.20 (1.90–2.56) 1.11 (0.96–1.29) 2.74 (2.26–3.32) Note: Models adjusted for age, sex, race, hypertension, diabetes, hyperlipidemia, smoking status, psychological distress, and insurance type. Reference group = Adults with no history of cancer or CVD. CVD = Cardiovascular disease; OR = Odds Ratio; CI = Confidence Interval.

e23005 Background: Cardiovascular disease (CVD) is the leading non-cancer cause of death among cancer survivors. Managing this risk increasingly requires a transition from traditional generic therapies (e.g., statins, ACEi) to novel agents (e.g., SGLT2i, GLP-1RA). While these drugs are clinically recommended for survivors comorbidities, their population level economic impact has not been well defined. Methods: We analyzed the 2016–2023 Medical Expenditure Panel Survey (MEPS-HC) to identify U.S. adults with a history of cancer (n=5,165; weighted ~54.3M) and non-cancer controls (n=217,834). We evaluated utilization, total prescription expenditures, and out-of-pocket (OOP) costs across 10 cardioprotective drug classes: statins, ACE inhibitors, ARBs, aspirin, antiplatelets, ezetimibe, GLP-1RA, SGLT2i, PCSK9i, and colchicine. surgery-weighted Pearson chi-square tests and design-based F-statistics accounted for the complex sampling design. Results: Cancer survivors were older (mean age ~68 vs 46 years), with higher prevalence of hypertension (54.5% vs 31.5%), diabetes (18.7% vs 8.1%), and dyslipidemia (56.1% vs 23.1%) than controls (all p<0.001). Survivors more frequently used traditional cardioprotective therapies, including statins (43.7% vs 23.1%) and ACE/ARBs (35.8% vs 18.2%). Aspirin use remained common and stable with negligible expenditures and OOP costs, reflecting its role as a low-cost foundational therapy. Antiplatelet use was higher among survivors and associated with modest but persistent OOP spending. Between 2016 and 2023, mean annual per-patient statin expenditures declined by 65% ($177 to $61). In contrast, expenditures for novel agents increased substantially. Mean per-person SGLT2 inhibitor expenditures rose from $0.36 to $211.55, while GLP-1RA utilization increased from 2.0% to 20.5%. These shifts increased patient cost sharing: survivor OOP costs increased 40-fold for SGLT2 inhibitors ($0.35 to $13.91) and more than four-fold for GLP-1 receptor agonists ($3.69 to $15.83). Socioeconomic disparities were evident, with PCSK9 inhibitor users reporting higher family incomes than non-users ($123,069 vs $85,530), and ezetimibe utilization was higher among Black compared with White survivors (14.8% vs 9.5%; p<0.05). Conclusions: Among U.S. cancer survivors, declining costs of generic cardioprotective therapies have been fully offset by rising expenditures and OOP burdens from newer agents. Access to high-value therapies increasingly reflects socioeconomic disparities more than clinical risk alone. Reducing patient cost sharing will be essential to prevent financial barriers from worsening adherence and long-term cardiovascular outcomes in survivorship.

Background: Cardiac arrest is a major global health concern, contributing significantly to mortality rates. While conventional cardiopulmonary resuscitation (CPR) has long been the standard care approach, emerging research indicates that extracorporeal cardiopulmonary resuscitation (ECPR) may provide superior survival advantages. Studies suggest that timely application of ECPR can lead to improved outcomes, particularly in terms of survival rates and neurological recovery. The comparative efficacy of ECPR is further corroborated by various randomized controlled trials (RCTs), as well as retrospective and prospective studies. Search Methods: We conducted a comprehensive search of databases including PubMed, Google Scholar, Cochrane Library, PLOS One, ClinicalTrials.gov, and ScienceDirect from 2014 to 2025. Our analysis included 3 RCTs, 3 prospective, and 5 retrospective studies (n=154,216). Inclusion criteria involved patients undergoing cardiac arrest managed in inpatient or outpatient settings. Meta-analysis was performed using Review Manager (RevMan) version 5.4, calculating safety endpoints as odds ratios for ROSC, favorable neurological outcomes , and survival rates. Results: Findings indicated that ECPR was associated with a significantly higher rates of ROSC (OR 0.36, 95% CI [0.24–0.54], p<0.00001) and favorable neurological outcome (OR 0.47 , 95% CI [0.37–0.60], p<0.00001). The Survival at 6 months was significantly better in the ECPR group (OR 0.21, 95% CI [0.12–0.36], p<0.00001). Although CCPR showed higher odds for survival to ICU (OR 1.31, 95% CI [0.86–2.00], p=0.21) and discharge (OR 1.42, 95% CI [0.90–2.25], p=0.13), these did not reach statistical significance. Conclusion: ECPR shows improved ROSC and neurological outcomes over conventional CPR, with higher six-month survival rates, emphasizing the need to adopt ECPR in cardiac arrest management.

Background: Stroke is a devastating complication of transcatheter aortic valve replacement (TAVR). Cerebral embolic protection devices (CEPD) have been introduced to reduce TAVR-related stroke by capturing or deflecting debris during the procedure. While these devices can capture embolic material, their clinical benefit in preventing stroke remains uncertain. We aimed to determine whether the use of CEPD during TAVR reduces the incidence of periprocedural stroke. Methods: We performed a systematic review and meta-analysis of studies comparing TAVR with versus without CEPD. We searched PubMed, Embase, and ClinicalTrials.gov for RCTs (randomized controlled trials) comparing CEPDs to no protection in TAVR patients from 2011 to May 2025. Nine RCTs involving a total of 11,608 patients (CEPD group n=5,953; control n=5,655) were included. Stroke outcomes were defined according to Valve Academic Research Consortium-2 (VARC-2) criteria and categorized as- all stroke, disabling stroke, or non-disabling stroke. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using a fixed-effects model. Heterogeneity also was measured. Results: Stroke rates were low and did not differ significantly between the CEPD (n=343) and control (n=319) groups. The incidence of all strokes was 1.96% with CEPD vs 1.88% without CEPD (RR 0.97, 95% CI 0.75–1.15; p=0.50). Disabling stroke occurred in 0.79% of CEPD patients vs 0.95% of controls (RR 0.79, 95% CI 0.57-1.10; p=0.16). Non-disabling stroke occurred in 1.26% of patients in both groups (RR 1.06, 95% CI 0.8 -1.40; p=0.64). There was no significant heterogeneity across trials is (0) for all endpoints. Notably, the largest trial in the analysis (BHF PROTECT-TAVI, n=7,635) showed no difference in stroke rates with CEPD, aligning with the overall results. Subgroup analyses revealed a trend toward fewer disabling strokes with CEPD use, but this trend was not statistically significant. Conclusion: We found no significant stroke risk reduction with the use of CEPDs during TAVR. While a trend toward fewer disabling strokes was observed, it was not statistically significant. Routine use of CEPDs is not supported, and selective use in high-risk patients warrants further large RCTs.

Background: Antithrombotic regimens play a pivotal role in averting complications and ischemic incidents post-percutaneous coronary intervention (PCI) in MI (myocardial infarction) patients. Bivalirudin stands as a viable alternative to unfractionated heparin in this cohort, demonstrating the efficacy and safety profiles. Aim: We aimed to compare the efficacy and safety of bivalirudin versus unfractionated heparin in post-percutaneous coronary intervention (PCI) in MI (myocardial infarction) patients. Research Question : What is the efficacy and safety of Bivalirudin compared to unfractionated heparin in patients with MI undergoing PCI, specifically in terms of major bleeding, cardiovascular mortality, and other major adverse cardiovascular events? Methods: We systematically searched PubMed, including MEDLINE, Embase, Cochrane Library, Google Scholar, ClinicalTrials.gov, and EBSCOhost/CINAHL, from January 1, 2000, through May 29, 2024, for randomized controlled trials (RCTs) that evaluated Bivalirudin versus unfractionated heparin and with a study population of patients with MI undergoing PCI. Data extraction was done using a spreadsheet, and data analysis was done using RevMan 5.4.1 for meta-analysis. The primary efficacy and safety endpoints were major bleeding, major cardiovascular events, cardiovascular mortality, all-cause mortality, myocardial infarction, stent thrombosis, and stroke. Results: Our analysis included 11 RCTs, encompassing a total of 40,919 participants. When compared with unfractionated heparin, bivalirudin was associated with a significant reduction in major bleeding events (RR 0.66 [0.55 to 0.80]; p < 0.0001) and cardiovascular mortality (RR 0.79 [0.67 to 0.92]; p < 0.003). However, there were no significant differences between Bivalirudin and unfractionated heparin in terms of major adverse cardiovascular events (RR 1.02 [0.91 to 1.13]; p = 0.76), all-cause mortality (RR 0.89 [0.78 to 1.01]; p = 0.08), MI (RR 0.99 [0.85 to 1.15]; p = 0.90), stent thrombosis (RR 1.12 [0.53 to 2.40]; p = 0.76), or stroke (RR 0.96 [0.73 to 1.26]; p = 0.75). Conclusion: Our meta-analysis indicates that in patients with MI undergoing PCI, Bivalirudin is associated with lower rates of major bleeding and cardiovascular mortality compared to unfractionated heparin. However, there were no significant differences observed in major adverse cardiovascular events, all-cause mortality, MI, stroke, or stent thrombosis between the two treatment groups.

Background: Persistent atrial fibrillation (AF) presents a significant management challenge, particularly in patients with concurrent heart failure. The effectiveness of catheter ablation compared to medical therapy for these patients remains under debate. Aim: This meta-analysis aims to evaluate the outcomes of catheter ablation versus medical therapy for managing persistent AF. Research Question: How does catheter ablation compare to medical therapy in managing persistent AF considering outcomes like arrhythmia recurrence, hospitalizations, cardiac function, exercise capacity, and mortality? Methods: We performed a meta-analysis of randomized controlled trials (RCTs) comparing catheter ablation with medical therapy in patients with persistent AF. Data sources included PubMed, Embase, Cochrane Library, Clinicaltrial.gov, Google Scholar, and CINAHL/EBSCOHOST, with studies selected based on predefined inclusion criteria. Primary outcomes assessed were recurrence of atrial arrhythmias, hospitalizations, changes in left ventricular ejection fraction (LVEF), changes in 6-minute walk test (6MWT) distance, and all-cause mortality. The data extraction was done using a spreadsheet, and the data analysis was done using RevMan 5.4.1: for meta-analysis Results: A total of 10 RCTs involving 1812 patients were included in the analysis. Compared to medical therapy, catheter ablation significantly reduced the recurrence of atrial arrhythmias (risk ratio [RR] = 0.43, 95% confidence interval [CI]: 0.29-0.63, P < 0.0001). Hospitalization rates due to heart failure were also lower in the ablation group (RR = 0.57, 95% CI: 0.44-0.73, P < 0.001). Improvements in LVEF were observed with a mean difference (MD) of 5.98% (95% CI: 3.81% to 8.15%, P < 0.00001). The performance on the 6MWT was better in the catheter ablation group, with an MD of 28.83 meters (95% CI: 8.61 to 49.05 meters, P = 0.005). Additionally, catheter ablation was associated with a reduction in all-cause mortality (RR = 0.60, 95% CI: 0.45-0.80, P = 0.00006). Conclusion: This meta-analysis demonstrates that catheter ablation is superior to medical therapy in managing persistent atrial fibrillation. Catheter ablation offers significant benefits in reducing atrial arrhythmia recurrence, lowering hospitalization rates, improving cardiac function and exercise capacity, and reducing mortality. These findings support the consideration of catheter ablation as a preferred treatment strategy for patients with persistent AF.