Mount Sinai Morningside-West Internal Medicine Residency Program Research Week Abstract Book

1st Annual Mount Sinai Morningside and Mount Sinai West Internal Medicine Residency Research Week

PROGRAM AND ABSTRACTS May 26-29, 2020

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TABLE OF CONTENTS

Introduction Selection Committee and Oral Presentations List of Abstracts/Posters Abstracts with Virtual Posters List of Abstracts 2019-2020 Abstracts 2019-2020 Index of Virtual Posters Index of Resident Authors

3 4-5 6-19 20-97 98-107 108-152 153-157 158-160

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Mount Sinai Morningside/West Internal Medicine Residency First Annual Virtual Research Week May 26-29, 2020 Welcome to the Mount Sinai Morningside/West Internal Medicine Residency’s First Annual Virtual Research Week. Due to the challenges of COVID-19, what was supposed to be an in person event has taken on a virtual platform. Morressier.com has given authors the ability to upload their posters, abstracts, and a short video “round” to present their work. Residents in the program have been able to submit their best scholarly work from five categories: Basic Science, Case Report, Clinical Research, Medical Education and Quality Improvement.

All accepted abstracts were reviewed by a selection committee. The abstracts were blinded and evaluated based on updated criteria relevant to the submissions including: Presentation, Appropriate Methods, Significance, Case Description, Discussion/Conclusion of Case and Innovation/Scientific Rigor.

For our First Annual Research Week, six abstracts out of 65 received have been selected to be presented as Oral Presentations. These Oral Presentations will be shown via a live Zoom meeting on May 28, 2020.

This presentation will be recorded and available on Morressier.com shortly after it has concluded.

In addition, we will be using Twitter as a live, real time platform for authors to discuss their research work with viewers. Many of the authors can be reached on Twitter using the QR code associated with their poster.

We wish to thank the Selection Committee, the authors who submitted their work, and each Faculty mentor that has provided invaluable guidance and support throughout the year. Congratulations to all of our authors for their dedication to research and for sharing their innovative work with our community.

Georgina Osorio, MD, MPH

I also want to thank Dr. Georgina Osorio, our Associate Program Director for Research, and Nicole Littman, our program coordinator, for turning our previously planned Research Day into a virtual week in record time!

John A. Andrilli, MD, FACP Program Director Internal Medicine Residency Mount Sinai Morningside/West

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Mount Sinai Morningside and Mount Sinai West Internal Medicine Residency Research Week

Selection Committee 2019-2020

Selection committee members did not participate in the discussion or voting for abstracts in which they were involved or with which they had any additional conflict of interest.

Mount Sinai Morningside and Mount Sinai West Internal Medicine Residency Research Week Selection Committee 2019-2020 Selection committee members did not participate in the discussion or voting for abstracts in which they were involved or with which they had any additional conflict of interest.

COMMITTEE MEMBERS Georgina Osorio, MD, MPH, Chair John Andrilli, MD Deborah Edelman, MD Karim El-Hachem, MD Tamara Goldberg, MD Adiac Espinosa, MD Marcelo Hernandez, MD Maanit Kohli, MD Dipal Patel, MD Alejandro Prigollini, MD Basera Sabharwal, MD Valeria Santibanez, MD Avinash Singh, MD Vasundhara Singh, MD Geeta Varghese, MD Erica Vero, MD Heather Viola, MD 4

Abstracts selected to be oral presentations on Thursday, May 28, 2020 at 12PM. BASIC SCIENCE Paulino Tallon de Lara*, PGY1 ABSTRACT #59: CD39+PD-1+CD8+ T CELLS MEDIATE METASTATIC DORMANCY IN BREAST CANCER th *17 Biennial Congress Metastasis Research Society Gold Poster Award, 2019; Charles Rodolphe Brupbacher Young Investigator Award, 2019; American Association for Cancer Research (AACR)-Sanofi Scholar-in-Training Award, 2020

CASE REPORT Yeraz Khachatoorian, PGY1 ABSTRACT#33: THE LOST ART OF PHYSICAL EXAMINATION (PE)

CLINICAL RESEARCH Sridevi Rajeeve*, PGY3 ABSTRACT#49: PEGASPARGASE CAN SAFELY BE ADMINISTERED IN ADULTS AGE 40 AND OLDER WITH ACUTE LYMPHOBLASTIC LEUKEMIA *American Society of Hematology Opportunities for the Next Generation of Research Scientists (ASH HONORS) Award 2019-2020 Recipient

CLINICAL RESEARCH Michelle Lee, PGY1 ABSTRACT#36: CLINICAL CHARACTERISTICS OF EARLY NONCRITICAL HOSPITALIZED PATIENTS WITH CORONAVIRUS DISEASE 2019

QUALITY IMPROVEMENT Xavier Vela Parada, PGY2 ABSTRACT#61: IMPROVING RATES OF EPOETIN ALPHA ADMINISTRATION IN ESRD PATIENTS AT TWO TEACHING HOSPITALS

MEDICAL EDUCATION Bertin Salguero Porres*, PGY3 ABSTRACT#51: A SIMULATION-BASED MECHANICAL VENTILATION CURRICULUM FOR MULTILEVEL LEARNERS IN AN INTERNAL MEDICINE RESIDENCY PROGRAM – A PILOT STUDY *Institute for Medical Education, Icahn School of Medicine Blue Ribbon 2020 Recipient

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List of Abstracts with Virtual Posters

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS IMPELLA USE IS ASSOCIATED WITH HIGHER INPATIENT MORTALITY THAN INTRAAORTIC BALLOON PUMP IN ISCHEMIC CARDIOGENIC SHOCK Robert Abed1, Nikhil Bachoo1, Claire Huang Lucas1, Ashish Correa1, Eyal Herzog1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the New York State Chapter of the American College of Cardiology; Riverhead, New York, United States held on August 2, 2019.

IMPROVING HYPERTENSION CONTROL AMONG AN UNDERSERVED URBAN PATIENT POPULATION Shruti Anand1, Yeriko Santillan1, Ameesh Isaath1, Tamara Goldberg1, Dipal Patel1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Mid-Atlantic Regional Meeting; Pittsburgh, Pennsylvania, United States held on November 15, 2019.

URIC ACID LEVEL IS ASSOCIATED WITH SEVERITY OF HEART FAILURE WITH PRESERVED EJECTION FRACTION Ana Belen Arevalo Molina1, Alba Munoz1, Faris Haddadin1, Karan Sud1, Gustavo Contreras1, Shane Murray1, Yousaf Ali1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Will be submitted to the American College of Rheumatology (ACR) Annual Meeting; Washington DC, United States on November 6-11, 2020.

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AN UNUSUAL THROMBOTIC EVENT IN ACUTE COVID-19 INFECTION Javier Arreaza1, Raul Chibas1, A Correa1, Johanna Contreras1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

THE IMPACT OF CHRONIC KIDNEY DISEASE IN WOMEN UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT: ANALYSIS FROM THE WOMEN'S INTERNATIONAL TRANSCATHETER AORTIC VALVE IMPLANTATION (WIN-TAVI) REGISTRY Dhrubajyoti Bandyopadhyay1, Samantha Sartori2, Usman Baber2; Davide Cao2, Rishi Chandiramani2, Didier Tchétché3, Anna Sonia Petronio4, Julinda Mehilli5, Thierry Lefèvre6, Patrizia Presbitero7, Piera Capranzaro8, Gennaro Sardella9, Nicolas M. Van Mieghem10, Jaya Chandrasekhar2, Nicholas Dumonteil11, Chiara Fraccaro12, Daniela Trabattoni13, Ghada W. Mikhail14, Christoph Naber15, Annapoorna Kini2, MarieClaudeMorice6, Bimmer E. Claessen2, Alaide Chieffo16, Roxana Mehran2 1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, United States; 3Clinique Pasteur, Toulouse, France; 4AOUP Cisanello, University Hospital, Pisa, Italy; 5Ludwig-Maximilians-University of Munich, Munich, Germany; 6Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France; 7Istituto Clinico Humanitas, Milan, Italy; 8 University of Catania, Catania, Italy; 9Policlinico "Umberto I," Sapienza University of Rome, Rome, Italy; 10Erasmus Medical Center, Thoraxcenter, Rotterdam, Netherlands; 11Rangueil University Hospital, Toulouse, France; 12University of Padova, Padova, Italy; 13Centro Cardiologico Monzino, IRCCS, Milan, Italy; 14Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom; 15Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus, Essen, Essen, Germany; 16 San Raffaele Scientific Institute, Milan, Italy

Published in the Catherization and Cardiovascular Interventions. 2020.

PMID: 31977142

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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PATIENTS HOSPITALIZED WITH NEUTROPENIC FEVER WHO HAVE CONCOMITANT HEART FAILURE WITH REDUCED EJECTION FRACTION (HFREF) HAVE A HIGHER RISK OF ACUTE KIDNEY INJURY AND VENTRICULAR TACHYCARDIA: A NATIONWIDE STUDY Hassan Beydoun1, Faris I Haddadin1, Johnassis Jimenez, Vivek A Modi1, Alba Munoz Estrella1, Dhrubajyoti Bandyopadhyay1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Pontificia Universidad Catolica Madre y Maestra, Santiago, Dominican Republic

Presented at the American Heart Association (AHA) Annual Meeting; Chicago, Illinois, United States held on November 10-12, 2019.

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ASSESSING THE SAFETY AND CLINICAL OUTCOMES OF BETA-BLOCKERS IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION WITH CONCOMITANT COCAINE USE. A META-ANALYSIS Kirtipal Bhatia1, Vivek Modi1, Aditya Joshi1, Bharat Narasimhan1, Celine Soudant2, Guneesh Uberoi1, Lingling Wu1, Syed Waqas Haider1, Arieh Fox1,2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

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DETECTION OF SUB-SURFACE HIGH-GRADE DYSPLASIA FOLLOWING RADIOFREQUENCY ABLATION (RFA) OF BARRETT’S ESOPHAGUS Makda Bsrat1, Gassan Kassim1, Melissa Hershman1, Amy Tan1, Jason Rubinov1, Roshanak Allaly1, Michael S. Smith1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, Texas, United States held on October 25-30, 2019.

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CONCURRENT ACUTE MYOCARDIAL INFARCTION AND CEREBROVASCULAR ACCIDENT CAUSED BY LIBMAN-SACKS ENDOCARDITIS IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS Bing Chen1, Ashish Correa1, Linling Wu1, Priya Chokshi1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Mid-Atlantic Regional Meeting; Pittsburgh, Pennsylvania, United States held on November 15, 2019.

PROVIDER BARRIERS TO LINKING PATIENTS WITH COMMUNITY HEALTH COACHES AT AN URBAN CLINIC Kun Chen1, Tamara Goldberg1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting; Washington, DC, United States held on May 8-11, 2019.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS TWO CASES OF ATYPICAL PRESENTATIONS OF MYCOPLASMA PNEUMONIAE INFECTIONS Laura Chen1, Sarah Shihadeh1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Submitted to the Society of Hospital Medicine (SHM) Annual Meeting; San Diego, California, United States that will be held on April 15-18, 2020.

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IMPACT OF DAY OF ADMISSION AND TIME TO DIAGNOSTIC ARTHROCENTESIS ON MORTALITY AND OTHER OUTCOMES IN SOLID- ORGAN TRANSPLANT RECIPIENTS WITH SEPTIC, ARTHRITIS Gustavo Contreras Anez1, Ana B Arevalo1, Shane E. Murray1, Yiming Luo2, Christian Olivo Freites1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, United States

Presented at the Infectious Diseases Society of America (IDSA) Annual Meeting; Washington, DC, United States held on October 2-6, 2019.

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AN UNCOMMON PRESENTATION, AN UNUSUAL ASSOCIATION: A STROKE, DEMYELINATING DISORDER OR AN INFECTION? Sathish Pondaiah1, Ricardo de la Villa Pagan Anez1, Alejandro Díaz-Chávez1, Christine F. Stavropoulos1, Raymonde Jean1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; San Antonio, Texas, United States held on October 6-10, 2018.

14 THE AGONY AND THE ECSTASY: MDMA-INDUCED HYPERTHERMIA, ACUTE LIVER INJURY, DIC, AND RHABDOMYOLYSIS Caroline Dooley1, Jonathan Stoever1, Keith Rose2 1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Hackensack University Medical Center, Hackensack, NJ, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

LOWER ESOPHAGEAL SPHINCTER AND PERISTALTIC PRESSURES INCREASE WITH AGE IN PATIENTS WITHOUT A MAJOR ABNORMALITY ON HIGH RESOLUTION ESOPHAGEAL MANOMETRY Maan El Haabi1, Xiaocen Zhang1, Paulino Tallón de Lara1, Elijah Verheyen1, Michael S. Smith1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Accepted to the Digestive Diseases Week (DDW) Meeting; Chicago, Illinois, United States that was scheduled to be held from May 2-5, 2020.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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A CASE REPORT OF KOUNIS SYNDROME PRESENTING WITH A RASH, VERY LATE STENT THROMBOSIS AND CORONARY EVAGINATIONS Tomohiro Fujisaki1,2, Tomitaka Higa2, Yoichi Uechi2, Naoya Maehira2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Makiminato Chuo Hospital, Urasoe, Okinawa, Japan

Published in the European Heart Journal-Case Reports. 2020: 4(1): 1-5.

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SAFETY AND EFFICACY OF SYSTEMIC THROMBOLYTIC THERAPY IN PREGNANCY COMPLICATED BY PULMONARY EMBOLISM: AN ANALYSIS OF THE NATIONWIDE INPATIENT SAMPLE Mohammed Ghanbar1, Yuzhou Lou1, Adil Shujaat1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Physicians (ACP) Annual Meeting; Philadelphia, Pennsylvania, United States held on April 11-13, 2019.

EXAMINING INTERNATIONAL REGULATORY CLOUD STORAGE FRAMEWORKS TO EXPAND ACCESS TO RADIOLOGY IN GLOBAL HEALTH SETTINGS Julia Goldberg1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the 2019 RAD-AID Conference; Washington, DC, United States held on November 2, 2019.

DOUBLE-BARREL BILATERAL ILIAC ARTERY STENTING USING BILATERAL RADIAL ARTERY ACCESS Mike Gorenchtein1, Joseph Puma1, Justin Ratcliffe1,2

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Transcatheter Cardiovascular Therapeutics (TCT); San Francisco, California, United States held on September 25-29, 2019.

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THE PREVALENCE AND PREDICTORS OF RESISTANT HYPERTENSION IN HIGH-RISK OVERWEIGHT AND OBESE PATIENTS: A CROSS-SECTIONAL STUDY BASED ON THE 2017 ACC/AHA GUIDELINES Faris Haddadin1, Karan Sud1, Alba Munoz Estrella1, Sananda Moctezuma1, Lingling Wu1, Joshua Berookhim1, Claire Huang Lucas1, Dipal Patel1, Edgar Argulian1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in the Journal of Clinical Hypertension. 2019: 21(10): 1507-1515.

PMID: 31448866 MYELODYSPLASTIC SYNDROMES: TRENDS IN MORTALITY, COSTS OF HOSPITALIZATIONS, LENGTH OF STAY, AND RATE OF COMPLICATIONS Shivani Handa1, Giulia Petrone1, Kamesh Gupta2, Ahmad Khan3, Jasdeep Singh Sidhu4, Sridevi Rajeeve1 1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Baystate Medical Center, Springfield, MA, United States; 3West Virginia University-Charleston Division, Charleston, WV, United States; 4Interfaith Medical Center, Brooklyn, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting; Orlando, Florida, United States held on December 7-10, 2019.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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DETERMINANTS OF PATIENT-REPORTED PERFORMANCE OF BIOLOGICAL TREATMENT IN AXIAL SPONDYLOARTHRITIS: A QUESTIONNAIRE-BASED CROSSSECTIONAL STUDY Julianna Hirsch1, Michal Nudel3, Shira Ginsburg4, Haya Hussein4, Karina Zilber4, Lisa Kaly4, Doron Rimar2,4, Nina Boulman2,4, Abid Awisat4, Hily Wollach3, Michael Rozenbaum2,4, Itzhak Rosner2,4, Gleb Slobodin2,4 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; 3Mifrakim Tze’irim, the Israeli Association of Young Patients with Rheumatic Diseases; 4Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel

Presented at the American College of Rheumatology (ACR) Annual Meeting; San Diego, California, United States held on October 26-29, 2017.

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UNINTENDED BENEFIT OF VACCINES? PNEUMOCOCCAL VACCINATION REDUCES 30 DAY RE-ADMISSION AMONG PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Jacqueline Sheehan1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New York, New York, United States held on October 19-23, 2019.

WHAT CAME FIRST, THE CHICKEN OR THE BLEED? A FOCUS ON SUSPECTED SMALL BOWEL GI BLEEDS Rida Jamil1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented as a Morning Report Case, Mount Sinai Morningside-West Internal Medicine Residency Program, New York, New York, United States; 2019-2020.

A PERNICIOUS PRESENTATION Kirtipal Bhatia1, Jonathan Albert Jamito1, Ana Belen Arevalo Molina1, Shivani Handa1, Yasmin Herrera1, David Weininger Cohen1, Krystle Hernandez1 1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the New York Chapter of the American College of Physicians Resident and Medical Student Forum Annual Meeting; Albany, New York, United States held on February 29, 2020.

NON-HODGKIN LYMPHOMA: A RISK FACTOR FOR IN-HOSPITAL MORTALITY IN PATIENTS HOSPITALIZED WITH OPPORTUNISTIC INFECTIONS Karan Jatwani1, Karan Chugh2, Rakesh Sharma3, Shraddha Jatwani2 1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2St. Vincent, Evansville, IN, United States; 3PGIMER, Chandigarh, India

Presented at the American Society of Bone Marrow Transplantation Annual Meeting; Houston, Texas, United States held on February 20-24, 2019.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS INSURANCE DISPARITY IN THE UNITED STATES CANCER SURVIVORS’ SMOKING RATES: A TREND STUDY FROM NHIS 2000-2017 Changchuan Jiang1, Binbin Zheng-Lin1, Yannan Zhao2, Biyun Wang2, Xi-Chun Hu2

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Fudan University Shanghai Cancer Center Shanghai, China

Presented at the American Society of Clinical Oncology (ASCO) Annual Meeting; Chicago, Illinois, United States held on May 31-June 4, 2019.

ENDOCRINE EMERGENCIES Vipul Jindal1 1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented as a Senior Lecture, Noon Conference Mount Sinai Morningside- West Internal Medicine Residency Program, New York, New York, United States; 2019-2020.

OUTCOMES OF LIVER TRANSPLANTATION FOR BUDD-CHIARI SYNDROME IN THE MELD ERA Gaurav Kakked1, Parth Trivedi1, Alana Persaud2, Ritu Agarwal1, Ahmet Gurakar3, Thomas D Schiano1, Behnam Saberi1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Rutgers New Jersey Medical School, Newark, NJ, United States: 3John Hopkins School of Medicine, Baltimore, MD, United States

Presented at the American Association for the Study of Liver Diseases (AASLD) Annual Meeting; Boston, Massachusetts, United States held on November 8-12, 2019.

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A DIAGNOSIS OF SCHIZOPHRENIA IS ASSOCIATED WITH LOWER UTILIZATION OF STENTS AND CORONARY ARTERY BYPASS GRAFTS AMONG PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: A NATIONWIDE ANALYSIS USING THE NATIONAL INPATIENT SAMPLE DATABASE OF 2014 Wojciech Rzechorzek1, Mario Rodriguez1, Ruchit Shah1, Scott Kaplin1, Swiri Konje1, Jacqueline Tamis-Holland1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

PUBLICATION TRENDS IN GASTROENTEROLOGY AND HEPATOLOGY OVER THE PAST 40 YEARS: AN ARTIFICIAL INTELLIGENCE ANALYSIS Gassan Kassim1, Yiftach Barash2, Eyal Klang2, Ryan Ungaro1, Jean-Frederic Colombel1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel

Accepted to the Digestive Diseases Week (DDW) Meeting; Chicago, Illinois, United States that was scheduled to be held from May 2-5, 2020.

THE LOST ART OF PHYSICAL EXAMINATION Yeraz Khachatoorian1, Angad Uberoi1, Sarah Shihadeh1 1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Accepted to the Society of Hospital Medicine (SHM) Annual Meeting; San Diego, California, United States that was scheduled to be held from April 15-18, 2020.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS PERICARDIOCENTESIS AND PERICARDIOTOMY: A NATIONAL COMPARISON OF UTILIZATION, COST AND OUTCOMES Swiri Konje1, Lingling Wu1, Wojciech Rzechorzek1, Alba Munoz Estrella1, Eyal Herzog1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting; Chicago, Illinois, United States held on November 10-12, 2019.

HOME-BASED CARDIAC REHABILITATION AND MORTALITY IN PATIENTS WITH CARDIOVASCULAR DISEASE: RESULTS FROM THE SAN FRANCISCO HEALTHY HEART PROGRAM Nirupama Krishnamurthi1, David W. Schopfer2, Hui Shen2,3, Mary A. Whooley2,3

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2University of California, San Francisco, CA, United States; 3San Francisco Veterans Affairs (VA) Health Care System, San Francisco, CA, United States

Presented at the American Association of Cardiovascular and Pulmonary Rehabilitation Annual Meeting; Portland, Oregon, United States held on September 18-21, 2019.

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CHARACTERISTICS OF EARLY COVID-19 PATIENTS IN NYC Michelle Lee1, Mona Fayad1, Tarub S. Mabud1, Paulino Tallรณn de Lara1, Adiac Espinosa Hernandez1, Gustavo Contreras Anez1, Maanit Kohli1, Nikhil Chadha1, Raymonde Jean1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

IMPACT OF ASYMPTOMATIC HIV INFECTION AND AIDS ON THE OUTCOME OF PATIENTS ADMITTED WITH HEART FAILURE IN 2016 Jan Menezes Lopes1, Claire Huang Lucas1, Georgina Osorio1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

SYNTHESIZING MARKERS OF KIDNEY INJURY IN ACUTE DECOMPENSATED HEART FAILURE: SHOULD WE EVEN KEEP LOOKING? Alexander S. Manguba1, Xavier Vela Parada1, Steven G. Coca2, Anuradha Lala2,

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in Current Heart Failure Report. 2019; 16(6): 257-273. PMID: 31768917.

TELLING GREAT STORIES: IMPROVING COMMUNICATION SKILLS AND RESIDENT WELL-BEING THROUGH STORYTELLING Zoe McKinnell1 1

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the 18th Annual Innovations in Medical Education Conference: Transforming Health Professions Education through Innovation; Los Angeles, California, United States held on February 14-15, 2020.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS INTERPLAY OF PULMONARY ARTERY SYSTOLIC PRESSURE AND PULMONARY VASCULAR RESISTANCE ON POST-TRANSPLANT SURVIVAL Vivek Amit Modi1, Jeremy Mazurek2, Edo Birati2, Jonathan Menachem3; Johanna Contreras1, Arieh Fox1,4

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; 3Vanderbilt University School of Medicine, Nashville, TN, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Accepted to the International Society for Heart and Lung Transplantation Annual Meeting; Montreal, Canada that was scheduled to be held from April 22-25, 2020.

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INCREASED RATES OF CARDIOVERSION AND ABLATION IN PATIENTS WITH ATRIAL FIBRILLATION AND SLEEP APNEA COMPARED TO PATIENTS WITH ATRIAL FIBRILLATION ALONE: A NATIONWIDE STUDY Alba Munoz Estrella1, Faris Haddadin1, Dhrubajyoti Bandyopadhyay1, Hassan Beydoun1, Vivek Modi1, Eyal Herzog1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; New Orleans, Louisiana, United States held on March 16-18, 2019.

CHECKPOINT INHIBITORS: WHEN T- CELLS ATTACK Shane Murray1, Varun Bhalla2, Ana B Arevalo1, Gustavo Contreras1, Seema Malkana2, Emilie Chan2, Margrit Wiesendanger2

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Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the 10th Annual Graduate Medical Education (GME) Research day at the Icahn School of Medicine; New York, New York, United States held on June 7th, 2019.

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RIGHT VENTRICULAR GLOBAL LONGITUDINAL STRAIN PREDICTS CARDIOVASCULAR MORTALITY AND HEART FAILURE HOSPITALIZATION IN PATIENTS WITH FUNCTIONAL TRICUSPID REGURGITATION Roberto Carlos Ochoa Jimenez1, Andrada Camelia Guta2,3, Marcc Previtero2, Chiara Palermo2, Patrizia Aruta2, Luigi P, Badano2, Denisa Muraru2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2University of Padova, Padua, Italy; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Presented at the European Society of Cardiology (ESC) Annual Meeting; Paris, France held on August 31-September 3, 2019.

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DEVELOPMENT OF A LINEAR MIXED-EFFECT PHARMACODYNAMIC MODEL TO QUANTIFY THE EFFECTS OF FREQUENTLY PRESCRIBED ANTIMICROBIALS ON QT INTERVAL PROLONGATION IN HOSPITALIZED PATIENTS Andras Farkas1, Krystina L. Woods1, Francesco Ciummo2, Ami Shah1, Joseph Sassine1, Christian Olivo Freites1, Gergely Daraczi3, Arsheena Yassin1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Long Island University Pharmacy, Hackensack, NJ, United States; 3Optimum Dosing Strategies, Budapest, Hungary

Presented at the Infectious Diseases Society of America (IDSA) Annual Meeting; Washington, DC, United States held on October 2-6, 2019.

14

LIST OF ABSTRACTS WITH VIRTUAL POSTERS PERSONALIZED MANAGEMENT OF THYROID STORM PRECIPITATED BY COCAINE ABUSE Elizabeth Jasola Omoniyi1, Tai Ho Shin1

45

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Association of Clinical Endocrinologists Annual Meeting; Los Angeles, California, United States held on April 24-28, 2019.

IN-HOSPITAL MORTALITY IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT IN RELATION TO THE PRESENCE OF HEART FAILURE IN THE UNITED STATES: AN ANALYSIS OF THE NATIONAL INPATIENT SAMPLE Hardikkumar Patel1, Kevin Buda2, Rutu Patel3

46

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Hennepin County Medical Center, Minneapolis, MN, United States; 3AMC MET Medical College, Ahmedabad, India

Presented at the Heart Failure Society of America Annual Meeting; Philadelphia, Pennsylvania, United States held on September 13-16, 2019.

IMPACT OF CLOSTRIDIUM DIFFICILE INFECTION ON GASTROINTESTINAL MALIGNANCIES Stuthi Perimbeti1, Rishi Shrivastav1, Prateeth Pati2, Kristine Marie Ward3, Michael Styler3, Maneesh Rajiv Jain3, Neilanjan Nandi3

47

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2University of Pittsburgh Medical Center, Pittsburgh, PA, United States; 3Drexel University College of Medicine, Philadelphia, PA, United States

Presented at the Gastrointestinal Cancers Symposium (GI ASCO); San Francisco, California, United States held on January 17-19, 2019.

48

SICKLE CELL DISEASE AND VENOUS THROMBOEMBOLISM: HOSPITAL MORTALITY, LENGTH OF STAY AND COST Michael Rainone1, Stuthi Perimbeti1, Rishi Shrivastav1, Jeffrey A. Glassberg1, Lawrence Cytryn1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting; Orlando, Florida, United States held on December 7-10, 2019.

PEGASPARGASE CAN SAFELY BE ADMINISTERED IN ADULTS AGE 40 AND OLDER WITH ACUTE LYMPHOBLASTIC LEUKEMIA Ryan J. Daley1, Sridevi Rajeeve2, Charlene C. Kabel1, Jeremy J. Pappacena3, Sarah E. Stump1, Jessica A. Lavery1, Martin S. Tallman1, Mark B. Geyer1, Jae H. Park1

49

1

Memorial Sloan Kettering Cancer Center, New York, NY, United States; 2Mount Sinai MorningsideWest Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3 Allegheny Health Network, Pittsburg, PA, United States

Presented at the American Society of Hematology (ASH) Annual Meeting; Orlando, Florida, United States held on December 7-10, 2019.

15

LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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IMPACT OF SOCIO-DEMOGRAPHIC FACTORS ON A 30-DAY READMISSION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION Wojciech Rzechorzek1, Basera Sabharwal1, Faris Haddadin1, David Weininger1, Bing Yue1, Mariam Khandaker1, Alba Munoz1, Shawn Lee1, Syed Ahsan1, Alejandro Lemor1, Allison Selby1, Jacqueline Tamis-Holland1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association Quality of Care and Outcomes Research Annual Meeting; Arlington, Virginia, United States held on April 5-6, 2019.

A SIMULATION-BASED MECHANICAL VENTILATION CURRICULUM FOR MULTILEVEL LEARNERS IN AN INTERNAL MEDICINE RESIDENCY PROGRAM – A PILOT STUDY Bertin D. Salguero1, Joseph P. Mathew1, Priscilla Loanzon1, James S. Salonia1

51

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Accepted to the 17th Annual Education Research Day, Institute for Medical Education (IME) at the Icahn School of Medicine; New York, NY, United States that was scheduled to be held on April 21, 2020.

ETHICO-LEGAL CHALLENGES OF DRUG PACKING - A CASE REPORT Elijah Verheyen1, Tal Shachi1, Karan Sud1, Bashar Mourad1, Paru Patrawalla1 1

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53

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in the American Journal of Medicine. 2018: 131(8): e321-e322.

PMID: 29654719 SEPTAL ALCOHOL ABLATION VERSUS MYECTOMY FOR HYPERTROPHIC CARDIOMYOPATHY: NATIONAL DATABASE ANALYSIS OF INITIAL ENCOUNTER AND 90 DAYS READMISSION Ruchit Shah1, Xin Wei1, Bing Yue1, Karan Sud1, Swiri Konje1, Joseph A. Puma1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting; Chicago, Illinois, United States held on November 10-12, 2019.

54

RIGHT BUNDLE BRANCH BLOCK (RBBB) IS ASSOCIATED WITH POOR PROGNOSIS IN PATIENT WITH ANTERIOR WALL ST ELEVATION MYOCARDIAL INFARCTION (AW-STEMI): A NATIONWIDE STUDY USING THE NATIONAL INPATIENT SAMPLE (NIS) 1999-2014 Rishi Shrivastav1, Prateeth Pati2, Stuthi Perimbeti1, Jacqueline Tamis-Holland1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2University of Pittsburgh Medical Center, Pittsburgh, PA, United States

Presented at the American Heart Association (AHA) Annual Meeting; Chicago, Illinois, United States held on November 10-12, 2019.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

55

YOUNG-ONSET PANCREAS CANCER (PC) IN PATIENTS LESS THAN OR EQUAL TO 50 YEARS OLD AT MEMORIAL SLOAN KETTERING (MSK):DESCRIPTORS, GENOMICS, AND OUTCOMES Anna M. Varghese1, Isha Singh2, Ritu Raj Singh1, Marinela Capanu1, Joanne F. Chou1, Winston Wong1, Zsofia Kinga Stadler1, Erin E. Salo-Mullen1, Christine A. IacobuzioDonahue1, David Paul Kelsen1, Wungki Park1, Kenneth H. Yu, Eileen Mary O’Reilly1 1

Memorial Sloan Kettering Cancer Center, New York, NY, United States; 2Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Weill Cornell Medical College, New York, NY, United States

Presented at the Gastrointestinal Cancers Symposium (GI ASCO); San Francisco, California, United States held on January 23-25, 2020.

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MULTIMODALITY CARDIAC IMAGING APPROACH FOR MANAGEMENT OF UNUSUAL CASE OF MISSED SINUS VENOSUS ASD Michel Skaf1, Syed Waqas Haider1, Ashish Correa1, Saman Setareh-Shenas1, Soheila Talebi1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

57

CD33 SPLICE SITE GENOTYPE WAS NOT ASSOCIATED WITH OUTCOMES OF PATIENTS RECEIVING THE ANTI-CD33 DRUG CONJUGATE SGN-CD33A Michele Stanchina1, 2, Alessandro Pastroe2, Sean Devlin2, Christopher Famulare2, Eytan Stein2, Justin Taylor2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States

Published in the Journal of Hematology & Oncology. 2019: 12: 85.

PMID: 31439003 EPIDEMIOLOGY, TREATMENT, AND OUTCOMES IN LOCALLY ADVANCED SPINDLE CELL LUNG CANCER Shivani Handa1, Michelle Sterpi1, Kathan Mehta2

58

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY; 2University of Kansas, Kansas City, KS, United States

Accepted to the American Society of Clinical Oncology (ASCO) Annual Meeting; that will be held virtually from May 29-31, 2020.

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CD39+PD-1+CD8+ T CELLS MEDIATE METASTATIC DORMANCY IN BREAST CANCER Paulino Tallón de Lara1,2,3, Héctor Castañón Cuadrado2,3, Marijne Vermeer2,3, Nicolás Núñez2,3, Virginia Cecconi2,3, Karina Silina2,3, Joaquín Urdínez3, Farkhondeh Movahedian Attar2,3, Isabelle Glarner2,3, Bettina Sobottka-Brillout3, Holger Moch3, Sonia Tugues2,3, Burkhard Becher2,3, Maries van den Broek2,3 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Comprehensive Cancer Center, Zurich, Switzerland; 3 Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland

Presented at the American Association for Cancer Research Annual Meeting; that was held virtually from April 24-29, 2020.

17

LIST OF ABSTRACTS WITH VIRTUAL POSTERS NATURAL HISTORY OF PATIENTS UNDERGOING THERAPEUTIC ENDOSCOPIES FOR ACUTE GASTROINTESTINAL BLEEDING Leen Khoury1, Patrick Tobin-Schnittger2, Nicholas Champion1, Vasiliy Sim1, Asaf Gave1, Samuel Hawkins1, Melissa Panzo1, Stephen Cohn1

60

1

Northwell Health at Staten Island University Hospital, Staten Island, NY, United States; 2Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Surgeons Clinical Congress Annual Meeting; San Francisco, California, United States held on October 27-31, 2019.

IMPROVING RATES OF EPOETIN ALPHA ADMINISTRATION IN ESRD PATIENTS AT TWO TEACHING HOSPITALS- A QI INITIATIVE Xavier Fernando Vela Parada1, Lorenz Leuprecht2, Karim El-Hachem2

61

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Weill Cornell Medical College, New York, NY, United States

Presented at the American Society of Nephrology Annual Meeting (Kidney Week); Washington, DC held on November 5-10, 2019.

ASSESSING THE SAFETY AND CLINICAL OUTCOMES OF BETA-BLOCKERS IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION WITH CONCOMITANT COCAINE USE. A META-ANALYSIS Guneesh Uberoi1, Kirtipal Bhatia1, Vivek Modi1, Bharat Narasimhan1, Arieh Fox1,2

62

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

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OUTCOMES OF ACUTE HEART FAILURE IN PATIENTS WITH AMYLOID OR SARCOID CARDIOMYOPATHY: A 10 YEAR NATIONWIDE ANALYSIS David Cohen Weninger1, Mario R. Rodriguez1, Basera Sabharwal1, Chayakrit Krittanawong1, Ricardo De la Villa Pagan1, Xin Wei1, Carlos Godoy Rivas2, Eyal Herzog1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY; 2Cleveland Clinic, Cleveland, OH, United States

Presented at the Heart Failure Society of America Annual Meeting; Nashville, Tennessee, United States held on September 15-18, 2018.

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INOTUZUMAB OZOGAMICIN IS AN EFFECTIVE SALVAGE THERAPY IN RELAPSED/REFRACTORY B-CELL ACUTE LYMPHOBLASTIC LEUKEMIA WITH HIGH-RISK MOLECULAR FEATURES, INCLUDING TP53 LOSS Xiaochuan Yang1,2, Amber C. King2, Charlene Kabel2, Christopher J. Forlenza2, Jae H. Park2, Mark Blaine Geyer2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY; 2 Memorial Sloan Kettering Cancer Center, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting; Orlando, Florida United States held on December 7-10, 2019.

18

LIST OF ABSTRACTS WITH VIRTUAL POSTERS IMPACT OF A PULMONARY EMBOLISM RESPONSE TEAM ON PATIENT OUTCOMES INCLUDING 30-DAY READMISSION RATES James Salonia1, Avinash Singh1, David J. Steiger1,2, Janet M. Shapiro1, Jason Filopei2, Sean Zajac1, Madeline R. Ehrlich2, Adil Shujaat1,2

65

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, LA, United States held on October 19-23, 2019.

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ARE PATIENTS STARVING? A SYNOPSIS ON FASTING TIME IN HOSPITALIZED PATIENTS AND PROPOSAL ON QUALITY IMPROVEMENT Xiaocen Zhang1, Ramya Patel1, Bing Chen1, Makda Bsrat1, Gassan Kassim1, Jessica Patel1, Brian Markoff1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Accepted to the Society of Hospital Medicine Annual Meeting; San Diego, California, United States that was scheduled to be held from April 15-18, 2020

19

Abstracts With Virtual Posters

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ABSTRACT #1 CLINICAL RESEARCH CARDIOVASCULAR DISEASE IMPELLA USE IS ASSOCIATED WITH HIGHER INPATIENT MORTALITY THAN INTRAAORTIC BALLOON PUMP IN ISCHEMIC CARDIOGENIC SHOCK Robert Abed1, Nikhil Bachoo1, Claire Huang Lucas1, Ashish Correa1, Eyal Herzog1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the New York State Chapter of the American College of Cardiology; Riverhead, New York, United States held on August 2, 2019 BACKGROUND/INTRODUCTION: To our knowledge, there has been no conclusive evidence so far to guide the choice between impella and intraaortic balloon pump (IABP) in patients with ischemic cardiogenic shock.

This work aims to compare in-hospital outcomes among patients presenting with ischemic cardiogenic shock treated without mechanical support, with impella, or with IABP. METHODS: Data was obtained from the 2016 NIS database. The primary outcome was inpatient mortality.

Secondary outcomes were hospital length of stay and total hospital charges. A series of univariate and multivariate regression analyses were conducted on STATA 15.1.

RESULTS: In this dataset, 11710 observations met the criteria of adults, acute ischemia and cardiogenic shock.

Among these, 7727 were treated without mechanical support, 649 were treated with impella, and 3,334 were treated with IABP. Patients treated with impella had higher inpatient mortality (OR 1.75; 95% CI 1.46 - 2.11), whereas patients treated with IABP had lower inpatient mortality (OR 0.77; 95% CI 0.70 - 0.85). In addition, compared with no mechanical support and IABP, the use of impella was associated with higher hospital costs (β1=198269, p<0.001).

CONCLUSION: Among patients was an ischemic cardiogenic shock, compared with no mechanical support, inpatient mortality was higher with impella and lower with IABP use. In addition, impella use was associated with increased hospital costs without a change in hospital length of stay. Lastly, IABP was associated with an increased length of stay. Despite the limitations of the NIS dataset, this work should prompt further research to validate the use of impella.

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ABSTRACT #2 QUALITY IMPROVEMENT CARDIOVASCULAR DISEASE IMPROVING HYPERTENSION CONTROL AMONG AN UNDERSERVED URBAN PATIENT POPULATION Shruti Anand1, Yeriko Santillan1, Ameesh Isaath1, Tamara Goldberg1, Dipal Patel1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Mid-Atlantic Regional Meeting; Pittsburgh, Pennsylvania, United States held on November 15, 2019 BACKGROUND/INTRODUCTION: Poorly-controlled hypertension is associated with increased risk of adverse cardiovascular outcomes and thus is an important healthcare quality metric for primary care practices. Yet achieving blood pressure goals among socially-complex, economically-disadvantaged patient populations can be challenging due to cost-related non-adherence, poor health literacy and other social determinant barriers.

Indeed, by early 2019, only 59% of hypertensive patients at our inner-city community health clinic had a blood pressure less than 140/90. The goal of this resident-driven quality improvement (QI) project was to increase blood pressure control among our hypertensive patients to a network target of 75% over 6 months.

METHODS: Our project was implemented at the Ryan Adair Center, a Federally Qualified Health Center located in Central Harlem that serves as a primary care practice site for Internal Medicine residents. The patient population consists predominantly of Black and Latino patients, most of whom are on Medicaid and live well below the federal poverty line. Our target population was hypertensive patients. We used the Plan-Do-Study-Act method to carry out our clinic-based project. PGY1's at the site served as the QI project leaders with faculty oversight. Cycle 1 focused on nurse education regarding proper blood pressure measurement. Cycle 2 focused on home blood pressure monitoring including patient education on proper technique and the importance of maintaining a daily log. Cycle 3 focused on assessment of health literacy via a patient questionnaire. Cycle 4 focused on provider education by ensuring that our patients were prescribed an appropriate medication regimen based on ACC/AHA Guidelines. Cycle 5 focused on referring patients with continued poor control to community health coaches to identify barriers like nutrition, medication access, and health literacy.

RESULTS: Using our clinic's online hypertensive registry (DRVS), we tracked on a monthly basis the percentage of hypertensive patients who had controlled blood pressure (<140/90). Percent of patients at goal went from 59% in February 2019 to 73% in July 2019.

CONCLUSION: Through this project, we demonstrated a meaningful improvement in hypertensive control among an economically-disadvantaged, racially diverse urban patient population. Accurate nurse measurements, engagement of patients in self-management and resident education on evidence-based medication standards have all contributed to this success. Study limitations include the small number and incomplete questionnaires collected on Cycle 3 regarding education level and health literacy of our hypertensive patients. Future directions will explore the impact of community health coaches in hypertension control and use of standard questionnaire to assess health literacy.

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ABSTRACT #3 CLINICAL RESEARCH CARDIOVASCULAR DISEASE/RHEUMATOLOGY URIC ACID LEVEL IS ASSOCIATED WITH SEVERITY OF HEART FAILURE WITH PRESERVED EJECTION FRACTION Ana Belen Arevalo Molina1, Alba Munoz1, Faris Haddadin1, Karan Sud1, Gustavo Contreras1, Shane Murray1, Yousaf Ali1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Will be submitted to the American College of Rheumatology (ACR) Annual Meeting; Washington DC, United States on November 6-11, 2020.

BACKGROUND/INTRODUCTION: Hyperuricemia has been shown to have an impact in the left atrium and left ventricle remodeling leading to the development of heart failure (HF). Experimental studies have shown that hyperuricemia stimulates the circulating and local renin-angiotensin-aldosterone system (RAAS) in the cardiovascular system. This results in cardiomyocyte hypertrophy, myocardial oxidative stress, interstitial fibrosis and impaired diastolic relaxation. Ultimately patients with hyperuricemia may also develop heart HF with preserved ejection fraction (HFpEF), which represents up to half of HF cases and it may become the predominant phenotype of HF within the next decade.

METHODS: We conducted a cross sectional study to determine the correlation between serum uric acid levels and the severity of HFpEF. Hyperuricemia was defined as a mean serum uric acid level equal or more than 7.0 mg/dL. 161 patients with a diagnosis of hyperuricemia were screened by chart review from 1/2016 to 12/2018 following these inclusion criteria: 1) reported hyperuricemia at least one year before the echocardiogram (TTE) was performed, 2) echocardiographic parameters to classify the severity of diastolic dysfunction. Fisher’s exact test was used for qualitative variables and Pearson chi-square test for quantitative variables. Multiple regression analysis, including potential confounders factors (age, gender, race, use of uric acid lowering agents, use of Losartan, low-dose Aspirin, diuretic agent, use of more than 3 blood pressure lowering agents, history of comorbid conditions related to diastolic dysfunction (HTN, resistant HTN, atrial fibrillation, DM, obesity, CKD), presence of gout and mean EF) was performed. Calculation of coefficient ratios and their 95% confidence interval for the association between mean uric acid level and grade of severity of diastolic dysfunction was performed. P value <0.05 was considered statistically significant. STATA (IC-15.1; Stata Corp) was used for the statistical analysis.

RESULTS: Out of the 161 patients, 56 patients met our inclusion criteria of which 78.6 % had a mean uric acid level above 7 mg/dL. For normal left ventricle function and Grade I diastolic dysfunction mean age was 65.8 (±13.6) years and mean uric acid level was 8.06 (±0.29) mg/dL, as compared to 60.1 (±20.8) years and mean uric acid of 9.36 (±1.09) mg/dL for Grade II and III diastolic dysfunction. 47.5% of patients with normal and impaired relaxation were on a uric acid lowering agent versus 62.5% of patients in the group with higher grade diastolic dysfunction. 85% of the low-grade diastolic dysfunction group had a co-existing diagnosis of Gout versus 93.7% of the group with grade II and III diastolic dysfunction. The difference of mean uric acid level between Grade III diastolic dysfunction and normal diastolic function was of 4.99 mg/dL (p< 0.001), 3.86 mg/dL (p=0.009) for Grade I and 3.83 mg/dL (p=0.020) for Grade II diastolic dysfunction. The risk of severe diastolic dysfunction increases by 0.053 (95%-CI: 0.001-0.106; p= 0.047) for every unit of increase in mean of uric acid level.

CONCLUSION: There is a directly proportional correlation between level of uric acid and the severity of diastolic dysfunction. The group with higher diastolic dysfunction had a higher prevalence of gout concurring with what previous studies have said about the presence of gout and the increase risk for HF development.

Further prospective studies are needed to confirm this relationship. It remains unclear whether introduction of uric acid lowering therapy will prevent worsening of diastolic heart failure.

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ABSTRACT #4 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW CARDIOVASCULAR DISEASE/HEMATOLOGY/INFECTIOUS DISEASES AN UNUSUAL THROMBOTIC EVENT IN ACUTE COVID-19 INFECTION Javier Arreaza1, Raul Chibas1, Ashish Correa1, Johanna Contreras1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

INTRODUCTION: A left ventricle (LV) thrombus is a known complication after an acute myocardial infarction (MI), with an incidence as high as 15% in ST segment elevation MI. Studies have shown an increased risk of acute cardiac injury with more severe cases of coronavirus disease 2019 (COVID-19), demonstrated by abnormal cardiac biomarkers with 4 times higher of a mortality risk. However, the etiology of acute cardiac injury is a matter of some debate. During the present COVID-19 pandemic, nearly 20-31% of hospitalized patients had arterial and venous thromboembolic events even on thromboprophylaxis. In COVID-19 patients presenting with LV thrombi and acute myocardial, the relationship between these two pathologies is unclear, and the frequency of co-existence has not been defined.

CASE PRESENTATION: We present a case of an 86 year-old male with one week of a worsening dry cough, dyspnea on exertion and generalized fatigue. Vitals were stable with an oxygen saturation on room air between 93-96%. He has a history of type 2 diabetes mellitus, hypertension, hyperlipidemia, coronary artery disease with previous stents placement, heart failure (HF) with last transthoracic echocardiogram (TTE) revealing an ejection fraction (EF) of 40-45%, and chronic kidney disease. Physical exam was unrevealing with clear breath sounds bilaterally and normal heart sounds. On imaging, found to have a chest X-ray showing mild interstitial changes but no focal opacities. ECG showed left bundle branch block unchanged from previous ECG. Initial labs revealed a Troponin-I 20.3 ng/ml and a BNP 2,968.3 pg/ml (with previous baseline of 700s in previous admissions), creatinine 2.05mg/dl (at baseline), LDH 326 u/L, D-dimer 2.21 Mcg/ml, CRP 256 mg/L, IL-6 35 pg/ml, Ferritin 403ng/ml. Severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) PCR was positive. Patient was then started on aspirin and heparin drip. Hospital admission was decided due to the clinical presentation and labs showing the increased troponin-I and BNP from baseline. A TTE was performed showing left ventricle hypertrophy with severe dysfunction (EF 25%), diffuse hypokinesis with an akinetic apex, and the presence of a laminated mural left ventricular wall apical thrombus measuring 1.7cm (Figure 1). These findings led to the diagnosis of Non-ST segment elevation MI, with new found LV thrombus. On hospital floors he received HF goal directed medical therapy with metoprolol and sacubitril-valsartan. He also received furosemide IV, nitroglycerin, atorvastatin and doxycycline. Patient had an evident medical improvement and discharge was planned with warfarin with close follow up with Cardiology as outpatient.

Figure 1: Left Ventricular Thrombus

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DISCUSSION: This is an interesting case of a COVID-19 patient presenting with symptoms seemingly related to viral pneumonia, found to have both acute myocardial injury as evidenced by elevated troponins, and an acute thrombotic event based on the finding of an LV thrombus. The association between COVID-19 and increasing VTE events in infected patients has been well established in previous studies. But no evidence has been described for LV thrombus. While COVID-19 has been shown to be associated with acute myocardial injury, the exact mechanisms are unclear. There are number of hypothesized causes including type 1 MI due to plaque rupture, demand ischemia, vasculopathies and direct myocardial injury. In this patient, with troponin elevation and regional wall motion abnormalities, there is a high suspicion of a type 1 MI â&#x20AC;&#x201C; but the patient had no evidence of angina or ischemic ECG changes. Further, COVID-19 is frequently associated with thrombotic events (both arterial system thrombi and VTE). In this patient, the mechanism of LV thrombus formation is speculative â&#x20AC;&#x201C; it is presumably related to apical akinesis, but it is possible that a COVID-19-related pro-thrombotic state triggered LV thrombus formation. Could such a pro-thrombotic state have led to coronary thrombi and caused an MI? Continued investigation and tracking of such cases will likely illuminate the index pathophysiologic event. For the management of thrombotic events in the setting of COVID-19, studies suggest the use of low molecular weight heparin as the treatment of choice. Conversely, the only evidence-based management for LV thrombus is warfarin, and as in our case heparin drip was used, as for the history of chronic kidney disease and high suspicion for the need of a cardiac intervention acutely, to properly bridge to warfarin.

CONCLUSION: Considering that COVID-19 is associated with an increased risk of thrombotic events in the inpatient setting, is recommended to have a high index of suspicion for LV thrombus in acute COVID-19 infection in patients with high troponin. It is important to consider therapeutic anticoagulation early on admission.

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ABSTRACT #5 CLINICAL RESEARCH CARDIOVASCULAR DISEASE/NEPHROLOGY THE IMPACT OF CHRONIC KIDNEY DISEASE IN WOMEN UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT: ANALYSIS FROM THE WOMEN'S INTERNATIONAL TRANSCATHETER AORTIC VALVE IMPLANTATION (WIN-TAVI) REGISTRY Dhrubajyoti Bandyopadhyay1, Samantha Sartori2, Usman Baber2; Davide Cao2, Rishi Chandiramani2, Didier Tchetche3, Anna Sonia Petronio4, Julinda Mehilli5, Thierry Lefevre6, Patrizia Presbitero7, Piera Capranzaro8, Gennaro Sardella9, Nicolas M. Van Mieghem10, Jaya Chandrasekhar2, Nichola Dumonteil11, Chiara Fraccaro12, Daniela Trabattoni13, Ghada W. Mikhail14, Christoph Naber15, Annapoorna Kini2, Marie-Claude Morice6, Bimmer E. Claessen2, Alaide Chieffo16, Roxana Mehran2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Clinique Pasteur, Toulouse, France; 4AOUP Cisanello, University Hospital, Pisa, Italy; 5Ludwig-Maximilians-University of Munich, Munich, Germany; 6Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France; 7Istituto Clinico Humanitas, Milan, Italy; 8University of Catania, Catania, Italy; 9Policlinico "Umberto I," Sapienza University of Rome, Rome, Italy; 10Erasmus Medical Center, Thoraxcenter, Rotterdam, Netherlands; 11Rangueil University Hospital, Toulouse, France; 12University of Padova, Padova, Italy; 13Centro Cardiologico Monzino, IRCCS, Milan, Italy; 14 Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom; 15Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus, Essen, Essen, Germany; 16San Raffaele Scientific Institute, Milan, Italy.

Published in the Catherization and Cardiovascular Interventions. 2020. PMID: 31977142 BACKGROUND/INTRODUCTION: The prevalence of both chronic kidney disease (CKD) and aortic stenosis (AS) increase with age. Although baseline CKD is frequent in patients undergoing transcatheter aortic valve replacement (TAVR), its significance among women is largely unknown.

METHODS: WIN-TAVI is a multinational, prospective registry of women undergoing TAVR for severe AS. We included patients with available baseline estimated glomerular filtration rate (eGFR) and completed 1- year follow-up. Patients were categorized into three groups based on their eGFR: No CKD (normal kidney function to stage 2 CKD: eGFR ≥60 ml/min/1.73 m2); (b) mild CKD (stage 3a CKD: eGFR = 45-59 ml/min/1.73 m2); and (c) moderate/severe CKD (stage ≥3b CKD: eGFR <45 ml/min/1.73 m2). All events were adjudicated according to the Valve Academic Research Consortium (VARC)-2 criteria.

RESULTS: Out of 852 women undergoing TAVR, 326 (38.3%) had no CKD, 225 (26.4%) had mild CKD, and 301 (35.3%) had moderate/severe CKD. Women with higher stage of CKD at baseline were more likely to have a history of hypertension, diabetes, atrial fibrillation, anemia, chronic lung disease, hemodialysis, prior percutaneous coronary intervention, and pacemaker implantation. After multivariate adjustment, moderate/severe CKD was associated with a greater risk of 1-year VARC-2 safety endpoints [hazard ratio (HR) 1.68, 95% confidence interval (CI): 1.10-2.60], all-cause death (HR 2.00, 95% CI: 1.03-3.90), and composite of death, myocardial infarction, stroke or life-threatening bleeding (HR 1.70, 95% CI: 1.04-2.76). There were no differences in 30-day and 1-year VARC-2 efficacy and 30-day VARC-2 safety outcomes.

CONCLUSION: CKD is associated with substantial and independent risk for mortality and morbidity at 1-year follow-up in women undergoing TAVR.

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ABSTRACT #6 CLINICAL RESEARCH CARDIOVASCULAR DISEASE/HEMATOLOGY/ONCOLOGY PATIENTS HOSPITALIZED WITH NEUTROPENIC FEVER WHO HAVE CONCOMITANT HEART FAILURE WITH REDUCED EJECTION FRACTION (HFREF) HAVE A HIGHER RISK OF ACUTE KIDNEY INJURY AND VENTRICULAR TACHYCARDIA: A NATIONWIDE STUDY Hassan Beydoun1, Faris I Haddadin1, Johnassis Jimenez2, Vivek A Modi1, Alba Munoz Estrella1, Dhrubajyoti Bandyopadhyay1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Pontificia Universidad Catolica Madre y Maestra, Santiago, Dominican Republic

2

Presented at the American Heart Association (AHA) Annual Meeting; Chicago, Illinois, United States held on November 10-12, 2019 BACKGROUND/INTRODUCTION: Many patients with malignancies are at risk of developing neutropenic fever mostly as a side effect of therapeutic regimens that affect the bone marrow. Some of the patients receiving radio or chemotherapy are also at high risk of developing HFrEF as a consequence of treatment. It is not uncommon for cancer patients to have comorbid neutropenic fever and HFrEF. There is limited data on the outcomes in patient developing neutropenic fever in the setting of comorbid HFrEF. METHODS: This is a retrospective cohort study using the 2015 National Inpatient Sample (NIS) of adults (> 18 years) admitted for neutropenic fever and having HFrEF as a secondary diagnosis based on ICD-9 and ICD-10 codes. Mortality was the primary outcome, while length of stay (LOS), acute kidney injury (AKI) and development of ventricular tachycardia were our secondary outcomes. We used multivariate linear regression on STATA 14 adjusted for cofounders of age, gender, race, Charlson Comorbidity Index, hospital region, size and teaching status.

RESULTS: We identified 125,375 patients (mean age=59 years; 51% females) who were admitted with neutropenic fever among which 1650 had concomitant HFrEF (mean age 69).On multivariate linear regression there was no significant difference in adjusted all-cause mortality (OR: 1.1, 95%-CI 0.72-1.70, P=0.65). In terms of secondary outcomes, there was no significant difference in length of stay (mean of 9.39 days for both, P=0.25).

However, there was significant increase in acute kidney injury (OR: 2.1; 95%-CI 1.64-2.67, P<0.001) and ventricular tachycardia risk (OR: 5.0; 95%-CI 3.01-8.27, P<0.001) in patients with concomitant HFrEF. CONCLUSION: Patients with neutropenic fever and concomitant HFrEF had an increased risk of AKI and ventricular tachycardia during admission compared to patients without HFrEF. This could be explained by the fact that HFrEF patients are already at more risk of arrhythmias because of their structural heart disease and are also at higher risk of AKI since their contractile heart function is impaired which puts them at higher risk of poor organ perfusion which explains the higher risk of AKI which in this case is most likely prerenal in origin.

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ABSTRACT #7 CLINICAL RESEARCH CARDIOVASCULAR DISEASE ASSESSING THE SAFETY AND CLINICAL OUTCOMES OF BETA-BLOCKERS IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION WITH CONCOMITANT COCAINE USE. A METAANALYSIS Kirtipal Bhatia1, Vivek Modi1, Bharat Narasimhan1, Aditya Joshi1, Karan Sud1, Lingling Wu1, Guneesh Uberoi1, Celine Soudant2, Syed Waqas Haider1, Arieh Fox1,2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: Beta-blockers (BB) reduce mortality in Heart Failure with reduced ejection fraction (HFrEF). Current guidelines do not list cocaine use as contraindication to BB therapy in HFrEF but acknowledge that its safety and benefits are uncertain. We performed a Meta-Analysis to examine the safety and clinical outcomes of BB therapy in patients with cocaine use and HFrEF. METHODS: We performed a systematic search of electronic databases from their inception to date [Embase (Ovid), Medline All (Ovid) and Web of Science Core Collection] to identify citations addressing patients with cocaine use and HFrEF treated with or without BB as part of goal-directed medical therapy (GDMT). The primary outcome was major adverse cardiac events (MACE), which were a composite of mortality and HF readmission.

Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect model.

RESULTS: Out of a total of 600 citations, 31 were selected for full-text review. Three retrospective cohort studies with a total of 570 patients were included in the final analysis. The study showed that the probability of having a MACE was significantly lower in patients treated with BB as part of GDMT, compared to patients treated with GDMT without beta-blockers (RR: 0.54, CI-0.40 to 0.71, p< 0.0001). Heterogeneity among studies was low (I2=0%). Carvedilol was the most commonly prescribed BB across studies.

CONCLUSION: Beta-blockers are not only safe but reduce the composite risk of mortality and HF readmissions in patients with HFrEF and concomitant cocaine use.

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ABSTRACT #8 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY DETECTION OF SUB-SURFACE HIGH-GRADE DYSPLASIA FOLLOWING RADIOFREQUENCY ABLATION (RFA) OF BARRETTâ&#x20AC;&#x2122;S ESOPHAGUS Makda Bsrat1, Gassan Kassim1, Melissa Hershman1, Amy Tan1, Jason Rubinov1, Roshanak Allaly1, Michael S. Smith1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, Texas, United States held on October 25-30, 2019.

BACKGROUND/INTRODUCTION: Barrett's esophagus (BE) occurs when an abnormal, intestinal-type epithelium replaces the stratified squamous epithelium that normally lines the distal esophagus. BE is associated with an increased risk of esophageal adenocarcinoma. Radiofrequency ablation (RFA) is an endoscopic treatment modality shown to be safe and effective in inducing reversion to squamous epithelium. This procedure is highly effective in removing Barrett's mucosa and associated dysplasia and in preventing progression of disease. We report a case of development of high-grade dysplasia after RFA of low grade dysplasia Barrett's esophagus.

CASE PRESENTATION: 72-year old Chinese male with short-segment Barrett's esophagus (C0-M1) who was found to have low grade dysplasia was treated with RFA. Patient was lost to follow up after the procedure but came to Gastroenterology clinic two years later. Patient had no surveillance esophagogastroduodenoscopy (EGD) done after the RFA. At the time of the visit patient denied heart burn, dysphagia or weight loss. Patient was then scheduled for surveillance endoscopy with white light and narrow band imaging (NBI). Endoscopy revealed salmon-colored mucosa, suspicious for residual Barrett's esophagus with biopsy showing Barrett's esophagus with high grade dysplasia at the EG junction. Repeat EGD was done with VLE which demonstrated 2 wide and deep areas of sub-surface abnormalities, both of which were real-time laser marked and then resected with band ligator and snare endoscopic mucosal resection (EMR) technique. EMR showed evidence of high-grade adenomatous dysplasia. Patient later underwent successful liquid nitrogen spray cryotherapy of an irregular Z-line and the adjacent distal esophagus, which was the site of previously treated short segment Barrett's esophagus. Then repeat EGD three months later with ablation cryotherapy of mildly irregular Z-line.

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DISCUSSION: Patients with low grade dysplasia BE are frequently treated with RFA. The use of radiofrequency ablation decreases the risk of progression of low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma. Recurrence of BE after RFA for low grade dysplasia is rarely reported but can occur as seen in this case. These findings highlight the need for continued surveillance with biopsies of visible lesions after RFA. Although there are no definitive guidelines for the appropriate surveillance intervals after ablation for low grade dysplasia, current recommendations are at 3 and 12 months after the last treatment and if there is sustained eradication of intestinal metaplasia at that stage to stop surveillance. Although our patient was lost to follow up for 2 years after the RFA, published literature on the durability of RFA shows that risk of progression in these patients is small.

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ABSTRACT #9 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW CARDIOVASCULAR DISEASE CONCURRENT ACUTE MYOCARDIAL INFARCTION AND CEREBROVASCULAR ACCIDENT CAUSED BY LIBMAN-SACKS ENDOCARDITIS IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS Bing Chen1, Ashish Correa1, Lingling Wu1, Priya Chokshi1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Mid-Atlantic Regional Meeting; Pittsburgh, Pennsylvania, United States held on November 15, 2019.

CASE PRESENTATION: A 36-year-old African American female with a 3-year history of systemic lupus erythematous (SLE) (+ANA/anti-Smith/anti-dsDNA/RNP, low C3/C4, +anticardiolipin IgM/Lupus anticoagulant, +Coombs, +pericarditis, +synovitis, +nephritis) on prednisone and plaquenil but noncompliant with medical therapy, recent lupus flare, and newfound aortic valvular thickening refusing further workup presented with left chest pressure. Patient was hemodynamically stable. On exam, she had a positive systolic murmur.

Electrocardiogram (EKG) showed acute STEMI. Patient underwent urgent cardiac catheterization which showed single-vessel coronary artery disease (CAD) with right circumflex artery (RCA) total occlusion with evidence of spasm and thrombus. PCI was performed with multiple thrombectomies with red thrombus specimens removed.

Transthoracic echocardiogram (TTE) showed a 2.0 x 1.2 cm mass on the aortic valve, moderate aortic regurgitation, left ventricular ejection fraction (LVEF) 40-45%, and severely hypokinetic inferior and inferoseptal walls. Blood cultures were negative. Brain MRI showed 5-6 small acute right insular cortex and parietal cortical infarcts likely cardioembolic with a normal neurological exam. Libman-Sacks endocarditis (LSE) was diagnosed clinically. Aortic valve replacement was initially planned but later aborted due to the need for triple valve surgery given transesophageal echocardiogram TEE findings of worsening valvular diseases such as severe mitral regurgitation (MR), severe tricuspid regurgitation (TR), and moderate to severe right ventricular (RV) dysfunction.

Patient remained stable with systematic anticoagulation, dual antiplatelet, and lupus management. She left against medical advice on hospital day 19 with further management as an outpatient.

DISCUSSION: Libman-Sacks endocarditis is a form of noninfectious endocarditis which is characterized by the deposition of sterile platelet and fibrin deposition on the heart valves. It is a rare condition and is often associated with malignancies, SLE, and antiphospholipid syndrome. LSE were present in up to 50% SLE patients on autopsy. In a transesophageal echocardiographic study of valvular disease associated with SLE, valvular vegetations were present in 43% patients initially and 34% at follow up. TEE is superior to TTE for detection of LSE4. LSE can be complicated by embolic cerebrovascular disease, peripheral arterial embolism, and superimposed infectious endocarditis. Acute myocardial infarction caused by LSE vegetation in SLE patients was rarely reported. The treatment for LSE includes systematic anticoagulation, surgery, and management of underlying disease. LSE should be strongly suspected when valve dysfunction develops or abnormal cardiac exam presents during the course of SLE. Appropriate and timely anticoagulation needs to be initiated to prevent mortality related to cardiac and CNS embolic events as in our patient.

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ABSTRACT #10 INNOVATIONS IN CLINICAL PRACTICE AND MEDICAL EDUCATION GENERAL INTERNAL MEDICINE PROVIDER BARRIERS TO LINKING PATIENTS WITH COMMUNITY HEALTH COACHES AT AN URBAN CLINIC Kun Chen1, Tamara Goldberg1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting; Washington, DC, United States held on May 8-11, 2019.

BACKGROUND/INTRODUCTION: Though clinical-community partnerships have increasingly emerged to address social determinant barriers for patients, best practices to+ engage providers and patients with such services are not well studied. To understand provider-perceived barriers in engaging patients with community health coach services. To increase referrals to community health coaching services.

METHODS: The Ryan Adair Community Health Center is a Federally Qualified Health Center (FQHC) in Manhattan that serves as a training site for our internal medicine residents who rotate through the clinic in quartiles every two weeks. The center recently partnered with a local community-based organization (CBO) which provides free community health coaching services to patients with common chronic conditions. A resident physician-champion was selected to spend time with the CBO and focus on ways to create awareness of this service among resident providers. To increase referrals, the physician-champion disseminated information about the CBO services and referral instructions via email reminders, postings in exam rooms, and intermittent verbal announcements during pre-clinic huddles. We then tracked referrals to the CBO over a six-month period and surveyed residents about their awareness of the services offered and referral process. The number of referrals generated by providers to the community-based organization was tracked over a six-month period. Providerperceived barriers were assessed via survey administration.

RESULTS: Over the course of a six-month period, five referrals were generated from our clinic to the CBO. 69% (22 out of 32) of resident providers completed the survey. 45% of respondents (n=10) were unaware of the CBO and services offered, 55% (n=12) did not know the criteria for a referral, and 25% (n=5) reported making referrals to the CBO. Providers noted that the most common reasons for patient refusal of services when offered was patient preference to try to manage their disease on their own and perceived time commitment.

CONCLUSION: The data above highlights that provider unawareness is a key barrier in connecting patients to community-based resources. Neither email reminders nor postings in clinic were high-yield contributors in generating referrals, as evidenced by the number of resident providers who were either unaware of the CBO or did not know the criteria for a referral. Key next steps include engaging other members of the clinic team in advocating for the CBO within the daily work flow, ensuring consistency of daily reminders at all huddles, and addressing reasons for patient refusal when a referral is offered. This innovation is a small step in the long-term goal of connecting patients with CBOs to improve health outcomes by addressing the social determinants of health. At our urban clinic, we recognize the importance of our relationship with the CBO and will continue to address both provider and patient barriers in making referrals. We recognize that the solutions to many of the health problems that our patients face may be found in the same communities that they reside in.

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ABSTRACT #11 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES TWO CASES OF ATYPICAL PRESENTATIONS OF MYCOPLASMA PNEUMONIAE INFECTIONS Laura Chen1, Sarah Shihadeh1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Submitted to the Society of Hospital Medicine (SHM) Annual Meeting; San Diego, California, United States that was scheduled to be held from April 15-18, 2020.

BACKGROUND/INTRODUCTION: Mycoplasma pneumoniae is an atypical bacterium that commonly causes respiratory tract infections. However, about 25% of M. pneumoniae infections affect organs outside of the pulmonary system. We outline two cases of extra-pulmonary M. pneumonia at a New York City hospital.

CASE 1 A 57-year old male with well-controlled HIV presented with headache, fever, myalgia for 4 days. Vital signs and physical exam were normal. CT head without contrast, CSF culture, blood cultures, and blood smear for parasites were negative. Admission labs revealed Na 130 mEq/L, ALP 223 U/L, AST 202 U/L, ALT 150 U/L, WBC 3.7 K/μL, and platelets 50 K/μL. Labs were normal a month prior. He continued to have high fevers and increased transaminases until peak AST 1242 U/L, ALT 1064 U/L, and ALP 437 U/L while bilirubin remained normal. Viral and autoimmune hepatitis were ruled out. Serum beta-D- glucan, Histoplasma urine antigen, galactomannan antigen, CMV, HSV, VZV, EBV heterophile, dengue, Lyme, Rocky Mountain Spotted Fever, Chikungunya, West Nile, Leptospira, Anaplasma phagocytophilum, Ehrlichia chaffeensis, Babesia microti antibodies were negative. M. pneumoniae IgM was 773 U/mL and IgG 2108 U/mL. Doxycycline was started. A liver biopsy performed a month later revealed resolving acute hepatitis.

CASE 2 A 46-year old healthy male presented with headache, fever, night sweats, and myalgia for 5 days and a maculopapular rash for 3 days. Vital signs reveal tachycardia. Physical exam was significant for a diffuse flat, blanching, erythematous maculopapular rash on the trunk, extremities, and palms (Image 1). Admission labs revealed Na 124 mEq/L, ALT 55 U/L, AST 30 U/L, ALP 39 U/L, and platelets 90 K/μL. CT head without contrast, chest radiograph, CSF biofire panel, CSF culture, blood cultures, blood smear for parasites, HIV, and syphilis RPR were negative. Viral hepatitis and Rubeola were ruled out. Serum Lyme, Rocky Mountain Spotted Fever, West Nile, Babesia microti, Anaplasma phagocytophilum antibodies were negative. M. pneumoniae IgM was 907 U/mL. Treatment with doxycycline resolved all symptoms.

CONCLUSION: M. pneumoniae can affect organ systems outside of the pulmonary system. It is important to recognize M. pneumoniae as an etiology of acute hepatitis, skin eruptions, and thrombocytopenia after common causes have been excluded.

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ABSTRACT #12 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY/RHEUMATOLOGY IMPACT OF DAY OF ADMISSION AND TIME TO DIAGNOSTIC ARTHROCENTESIS ON MORTALITY AND OTHER OUTCOMES IN SOLID-ORGAN TRANSPLANT RECIPIENTS WITH SEPTIC ARTHRITIS: A NATIONWIDE ANALYSIS Gustavo Contreras Anez1, Ana B Arevalo1, Shane E. Murray1, Yiming Luo2, Christian Olivo Freites1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, United States

2

Presented at the Infectious Diseases Society of America (IDSA) Annual Meeting; Washington, DC, United States held on October 2-6, 2019 BACKGROUND/INTRODUCTION: Multiple cases have been reported assessing the outcomes for solid-organ transplant recipients (SOTR) admitted to the hospital with septic arthritis of a native joint (SANJ); however, there are no data evaluating the outcome of these patients when they are admitted on the weekend compared with the rest of the week.

METHODS: The NIS database of the year 2016 was utilized to identify all SOTR with SANJ using ICD-10 codes.

SOTR status was defined as those adults with a history of a transplanted organ including heart, lungs, a combined heart and lung, liver, kidney, intestine or pancreas. Admissions between midnight Friday and midnight Sunday were classified as weekend admissions. Early arthrocentesis was defined as percutaneous arthrocentesis performed within 24 hours of admission. Odds ratios (OR) were calculated for primary and secondary outcomes including in-hospital mortality rate, rates of diagnostic arthrocentesis and early arthrocentesis, length of stay and total hospital charges. These results were compared after univariable and multivariable logistic regression adjusted for age, gender, race, day of admission, Charlson comorbidity index and median household yearly income in the patientâ&#x20AC;&#x2122;s zip code. We used STATA-15 for statistical analysis.

RESULTS: We identified 319 SOTR with SANJ. Compared with SOTR admitted with SANJ on weekdays, those admitted on weekends had increased in-hospital mortality rates (odds ratio [OR] 11; 95% [CI] 1.2â&#x20AC;&#x201C;97.9, p<0.05), but similar, length of stay (p>0.05) and hospital charges (p>0.05). However, regardless of the day of admission those who received an early arthrocentesis had a lower length of stay (p<0.05), and lower total hospital charges (p<0.05).

CONCLUSION: Our study showed that compared with SOTR admitted with SANJ on weekdays, those admitted on weekends had increased mortality rates but similar length of stays and total hospital charges. However, patients who received an early arthrocentesis had a significantly lower length of stay and hospital charges regardless of the day of admission. These results add weight to the hypothesis of negative outcomes in weekend admissions. Moreover, we believe that our findings require further investigation to establish the role of early arthrocentesis in the management of septic arthritis.

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ABSTRACT #13 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES AN UNCOMMON PRESENTATION, AN UNUSUAL ASSOCIATION: A STROKE, DEMYELINATING DISORDER OR AN INFECTION? Sathish Pondaiah1, Ricardo de la Villa Pagan Anez1, Alejandro DĂ­az-ChĂĄvez1, Christine F. Stavropoulos1, Raymonde Jean1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; San Antonio, TX, United States held on October 6-10, 2018.

BACKGROUND/INTRODUCTION: Rhomboencephalitis, a rare manifestation of listeria is seen in immunocompetent young adults. Reverse Takotsubo (r-TTC) is an unusual association described with listeria rhomboencephalitis (LRE).

CASE PRESENTATION: A 42-year-old Brazilian female with medical history of migraine presented with headache, nausea, vomiting, photophobia, left facial numbness and fevers for four days. Physical findings remarkable for bilateral horizontal nystagmus, left facial numbness and left upper extremity dysdiadochokinesia.

Multiple lower cranial nerves were involved subsequently leading to compromised airway, hypoxia, oro-tracheal intubation and mechanical ventilation. She was treated with ceftriaxone, vancomycin and acyclovir initially. Later ampicillin and DS-TMP/SMZ were added based on the MRI-brain results. MRI revealed a ring-enhancing central T1 hypointense lesion in the left cerebral peduncle with extension to posterolateral pons and medulla suspicious for listeria rhomboencephalitis (LRE). Chest CT was suggestive of pulmonary edema. Echocardiography (TTE) revealed LV global hypokinesis sparing the apex suggestive of reverse Takotsubo (r-TTC). Given her worsening hemiparesis and altered mentation, dexamethasone was initiated on day 4 and continued for seven days. Blood and CSF cultures were negative. However, CSF PCR confirmed the diagnosis of listeria. Subsequently all antimicrobials were discontinued except ampicillin and DS-TMP/SMZ. A gradual recovery of mentation and hemiparesis was evident. TTE on day 9 showed improvement in the ejection fraction (50-55%). She underwent tracheostomy and subsequently weaned from mechanical ventilation. She was then discharged to acute rehabilitation where she completed 6 weeks of DS-TMP/SMZ and ampicillin.

DISCUSSION: Mortality with LRE is high and approaches 51%. CSF culture is the gold standard for diagnosis.

Real time PCR, a reliable diagnostic modality is relatively new but not widely available. MRI-brain is the preferred radiological investigation. Prognosis depends on timely diagnosis and therapy. R-TTC, a form of stress-induced myocardial injury is reversible with recovery from the inciting illness. The role of dexamethasone is controversial and lacks supporting evidence except as reported in case series. In retrospect, corticosteroid was probably beneficial in our patient. Increased penetration into the meninges and bactericidal properties of the ampicillin plus DS-TMP/SMZ combination is an effective therapy for LRE.

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ABSTRACT #14

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ABSTRACT #15 CLINICAL VINGETTE/CASE REPORT/CLINICAL REVIEW PULMONARY/CRITICAL CARE THE AGONY AND THE ECSTASY: MDMA-INDUCED HYPERTHERMIA, ACUTE LIVER INJURY, DIC, AND RHABDOMYOLYSIS Caroline Dooley1, Jonathan Stoever1, Keith Rose2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Hackensack University Medical Center, Hackensack, NJ, United States

2

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

CASE PRESENTATION: A 35 year-old male with past medical history of anxiety presented to the emergency department with altered mental status after ingesting cocaine, MDMA, and alcohol. He was febrile to 106.9F, with a heart rate of 183 bpm and otherwise normal vital signs. He had a generalized tonic-clonic seizure and was given lorazepam and midazolam, followed by levetiracetam and was intubated. Poison control was consulted and in addition to supportive care, recommended direct cooling via an ice bath for profound hyperthermia. Although the liver enzymes were initially only mildly abnormal, (AST 53 u/L, ALT 48 u/L, total bilirubin 0.4mg/dL), within several hours had increased dramatically, peaking at AST 7,285 u/L, ALT 5,954 u/L, T Bili 4.4mg/dL. By the following day, the patient had stabilized, was normothermic and successfully extubated.

Over the course of the next several days he developed acute kidney injury, disseminated intravascular coagulation (DIC) with marked thrombocytopenia and rhabdomyolysis with creatine kinase peaking at 16,000 u/L. The patient additionally developed hallucinations and asterixis consistent with hepatic encephalopathy, and was transferred to a liver transplant center. He received continuous infusion of N-acetylcysteine while undergoing workup for emergent liver transplant. However, over the next several days his liver function improved, with resolution of encephalopathy and organ dysfunction. He was discharged home 10 days after presentation.

DISCUSSION: MDMA toxicity is associated with cardiac arrhythmias, rhabdomyolysis, DIC, hyperthermia, and acute renal failure. It has also been reported to cause liver injury with rare instances of acute liver failure. Liver injury can range from mild hepatitis to fulminant hepatic failure. The effect appears to be idiosyncratic, as the degree of liver damage appears unrelated to the dose or duration of exposure. Liver injury may present acutely, coinciding with hyperthermia, or delayed. Multiple theories of liver injury have been proposed: hyperthermia with ischemic mechanisms similar to in heatstroke, direct cytotoxicity from MDMA metabolites or contaminants, or MDMA metabolism effects from genetic variation in cytochrome p450. Supportive care and close monitoring are considered the standard of care. It is important to note that relapse and progression to fulminant hepatitis can occur upon re-exposure to ecstasy and patients should be cautioned regarding further use.

CONCLUSION: Use of MDMA is known to cause hyperthermia, acute liver injury, and rhabdomyolysis.

Treatment is primarily supportive, but early referral to a transplant center should be considered.

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ABSTRACT#16 CLINICAL RESEARCH GASTROENTEROLOGY LOWER ESOPHAGEAL SPHINCTER AND PERISTALTIC PRESSURES INCREASE WITH AGE IN PATIENTS WITHOUT A MAJOR ABNORMALITY ON HIGH RESOLUTION ESOPHAGEAL MANOMETRY Maan El Haabi1, Xiaocen Zhang1, Paulino Tallon de Lara1, Elijah Verheyen1, Michael S. Smith1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Accepted to the Digestive Diseases Week (DDW) Meeting; Chicago, Illinois, United States that was scheduled to be held from May 2-5, 2020.

BACKGROUND/INTRODUCTION: Disturbances of esophageal motility tend to occur more frequently with age.

However, the effect of aging on esophageal function is not clearly understood. The aim of this study was to determine the impact of age on parameters measured using high resolution esophageal manometry (HREM).

METHODS: All esophageal HREM studies performed at a large referral-based motility center between April 2013 and October 2019 were reviewed. Patients with a confirmed significant lower esophageal sphincter (LES) abnormality or other major peristaltic disorder based on Chicago Classification v3.0 (CC3) were excluded from further analysis. Patients with a CC3 diagnosis of ineffective esophageal motility (IEM), and patients with no CC3 diagnosis, were further subdivided into the 3 age groups: age less than 50 years, age 50-64 years, and age at least 65 years.

RESULTS: A total of 1188 esophageal HREM reports were reviewed. The most common indications for these studies were dysphagia (67%) and reflux (42%). After excluding the 396 patients who were found to have a CC3 major disorder of peristalsis, the remaining 792 cases were sub-classified by age (Table 1). Of note, a statistically higher percentage of patients had a hiatal hernia in the oldest group (71.6%, p=0.01), though the largest mean hernia size was in the middle age group (2.06 cm, p=0.04) (Table 2). There were statistically significant increases in multiple parameters with increase in age, including LES mean basal pressure, mean and median integrated residual pressure, distal contractile integral, and LES intra-bolus average maximum pressure (all p-values < 0.05). There was no statistical difference with respect to distal latency, contractile front velocity or upper esophageal sphincter mean basal pressure. All statistically significant results were replicated even after removing patients with IEM from the analysis, so that the study population had no patients with either a major or minor CC3 diagnosis.

CONCLUSION: There is a statistically significant increase in both LES and peristaltic pressures as age increases in a population without a CC3 major abnormality. These findings go against the conventional wisdom that muscle tone decreases with age, which would lead to decreases in both lower esophageal sphincter tone as well as peristaltic strength. The results of this study suggest that perhaps a decrease in sphincter and/or esophageal wall compliance may, as age advances, play a relatively greater role in affecting manometric parameters. Future Chicago Classification versions may benefit from incorporation of age-related parameters, rather than a single set of normal values, to maximize the utility of these studies in evaluating patients of all ages.

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ABSTRACT #17 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW CARDIOVASCULAR DISEASE A CASE REPORT OF KOUNIS SYNDROME PRESENTING WITH A RASH, VERY LATE STENT THROMBOSIS AND CORONARY EVAGINATIONS Tomohiro Fujisaki1,2, Tomitaka Higa2, Yoichi Uechi2, Naoya Maehira2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Makiminato Chuo Hospital, Urasoe, Okinawa, Japan

2

Published in the European Heart Journal-Case Reports. 2020: 4(1): 1-5.

CASE PRESENTATION: Very late stent thrombosis (ST) is a concern in the era of drug-eluting stents (DESs), and ST is associated with peri-DES coronary artery aneurysmal lesions or coronary evaginations. An increasing number of cases of concurrent systemic allergic reaction and ST have been reported as Kounis syndrome (KS) in the literature. The number of patients with very late ST caused by KS is small, and further investigation of the potential pathophysiology is required. We report a case of KS that manifested as systemic urticaria followed by very late ST 14 years after placement of two sirolimus-eluting stents (SESs). Three months after the event of ST, coronary evaginations at the stented segments were detected on intravascular optical coherence tomography.

Fig 1. Erythematous skin lesions

Fig 2. ST at the two sirolimuseluting stents (arrows) in the LAD artery.

Fig 3.The optical coherence tomography image obtained at 3month follow-up confirmed some evaginations (A2, B2, and C2) that were covered with thrombi that were not fully visualized in the acute phase (A1, B1, and C1). The arrowheads signify thrombi, and ‘e’ indicates an evagination.

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DISCUSSION: Coronary evaginations are associated with local hypersensitivity, stent mal-apposition, uncovered strut, and flow disturbance that may predispose to ST. Systemic allergic reactions are known to promote platelet adhesion and aggregation. This case of KS suggests a pathophysiology in which the synergic effects between the coronary evaginations and a systemic allergic reaction may contribute to very late ST. We propose the hypothesis that systemic stimuli could elicit ST around prepared evaginations, especially in patients with sirolimus-eluting stents.

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ABSTRACT#18 CLINICAL RESEARCH PULMONARY/CRITICAL CARE SAFETY AND EFFICACY OF SYSTEMIC THROMBOLYTIC THERAPY IN PREGNANCY COMPLICATED BY PULMONARY EMBOLISM: AN ANALYSIS OF THE NATIONWIDE INPATIENT SAMPLE Mohammad Ghanbar1, Yuzhou Lou1, Adil Shujaat1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Physicians (ACP) Annual Meeting; Philadelphia, Pennsylvania, United States held on April 11-13, 2019.

BACKGROUND/INTRODUCTION: Pulmonary embolism (PE) during pregnancy is the sixth leading cause of maternal mortality in the US. Whereas the use of systemic thrombolytic therapy (TT) for hemodynamically unstable PE is the standard of care in the non-pregnant population, its use in pregnancy is limited due to concerns of maternal and fetal complications including major bleeding. There is limited literature on its use and no large cohort study.

METHODS: The Nationwide Inpatient Sample (NIS) database was used to identify 50,270,033 women with pregnancy-related codes admitted from 2010 to 2016. Pregnant women diagnosed with PE were identified and outcomes were compared between those treated with TT and those not treated with such therapy. Analysis was done using STATA 2015.

RESULTS: 4,352 pregnant women with PE were identified, of whom 71 were treated with TT, which represents a 20% stratified sample size making the real estimation to be around 21,760 for PE cases and 355 for those treated with TT. The mean age of the TT group was 28 years, 56% were Caucasian, and 69% were admitted to a teaching hospital. There was no case of intracranial hemorrhage or antepartum bleeding in the TT group, compared to 0.09% (0.03% - 0.2%) and 0.5% (0.4% â&#x20AC;&#x201C; 0.8%), respectively, in the other group. The rate of postpartum bleeding was similar between the two groups at 8% (4% - 17%) compared to 9% (9%-11%) in the regular treatment group. However, the rate of blood transfusions was higher at 23.60% compared to 8.91% (p<0.01) in the regular treatment group. There was no case of abortion in the TT group compared to only 12 cases in the other group. Significantly, more patients in the TT group required intensive care unit (16.7% vs. 5.37%) and intubation (15.28% vs. 5.04%; p<0.01). There was no significant difference in the use of vasopressors. The mean hospital length of stay was prolonged in the TT group (7.77 vs. 5.41 days; p<0.01). The mean maternal mortality rate was higher in the TT group (12.66% vs.1.37%; p<0.01).

CONCLUSION: To the best of our knowledge this is the largest cohort of pregnant women with PE treated with systemic thrombolytic therapy. The rates of peri-partum bleeding and fetal demise were not higher in those treated with such therapy; however, the need for blood transfusion was greater with such therapy. Nevertheless, maternal mortality was high despite the use of thrombolytic therapy.

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ABSTRACT #19 CLINICAL RESEARCH RADIOLOGY EXAMINING INTERNATIONAL REGULATORY CLOUD STORAGE FRAMEWORKS TO EXPAND ACCESS TO RADIOLOGY IN GLOBAL HEALTH SETTINGS Julia Goldberg1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the 2019 RAD-AID Conference; Washington, DC, United States held on November 2, 2019.

BACKGROUND/INTRODUCTION: RAD-AID works to expand access to radiology services around the globe.

In many sites this may include introducing basic X-ray and ultrasound services to health care, and in others it may involve developing innovative technological advances to basic imaging services already provided to patients. During the past year, RAD-AID has been planning to expand cloud IT architectures to many of these sites. Incorporating cloud storage for digital information and patient data reflects many advancements in the provision of health care, from expanding access to imaging in rural areas where there may not physically be radiologists to improving health data efficiencies by organizing data to best provide care to patients. RAD-AID has been working to implement these services in countries across the world, including sites in South America, Africa, and Asia. A key component of this project expansion is ensuring that using the cloud for patient data, and storing patient health information in a secure cloud, is in line with the country’s internal regulatory policies and laws.

METHODS: This research examines regulations on cloud services and health data of ten countries where RADAID works closely with local partners on technological advancement in radiology, including Laos, Guyana, Nigeria, Nepal, Rwanda, Vietnam, Ghana, Tanzania, Ethiopia, and India. Internet searches for original text of government regulations and policies, news articles, and discussions with physicians working in these countries formed the basis for this research.

RESULTS: Laos’ 2017 Law on the Protection of Electronic Data prohibits against “[circulating data] without authorization from the owner.” Guyana’s 2007 Regulations Made Under the Health Facilities Licensing Act mandate that every healthcare facility is required to have policies in place to maintain the confidentiality of patient records. Nigeria has further specific mandates included in The National Health Act, 2014 regarding confidential patient data, patient consent to access medical data, and control measures to protect this data. RAD-AID is in the process of implementing cloud storage in these three countries; similar laws also exist in other countries where RAD-AID may implement this new storage platform with local partners.

CONCLUSION: Many countries have broad national policies about patient privacy but few specific policies about using the cloud for data storage in healthcare. However, many countries are in the process of creating governmental policies as they relate to the cloud. In close collaboration with in-country partners, global health teams should be aware of these regulations to ensure that the implementation of new health technology protects patient data and expands access to care, while also being guided by the country’s policies on health data and cloud infrastructure.

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ABSTRACT #20 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW CARDIOVASCULAR DISEASE DOUBLE-BARREL BILATERAL ILIAC ARTERY STENTING USING BILATERAL RADIAL ARTERY ACCESS Mike Gorenchtein1, Joseph Puma1, Justin Ratcliffe1,2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Transcatheter Cardiovascular Therapeutics (TCT); San Francisco, California, United States held on September 25-29, 2019.

CASE PRESENTATION: A 72 year-old female with hypertension, dyslipidemia, and a 40 pack-year smoking history presented for evaluation of severe bilateral buttock and thigh claudication (Rutherford III) and was found to have bilateral common iliac artery (CIA) disease. Lifestyle-limiting pain persisted for 3 months despite medical management that included supervised exercise therapy, aspirin, and cilostazol. The patient refused vascular bypass and was subsequently referred for endovascular treatment of bilateral CIA stenosis. Angiography and/or other diagnostic tests: Magnetic resonance angiography demonstrated significant bilateral CIA stenosis along with a right CIA 0.2 cm penetrating ulcer. An abdominal aortogram with intravascular ultrasound performed 3 months after a trial of medical therapy confirmed 60% occlusion of the left ostial CIA and 80% occlusion of the right ostial CIA, with a peak-to-peak gradient of >30 mmHg on catheter pullback in each of the arteries.

Procedure: Both radial arteries were accessed with 6-Fr sheaths (Terumo) and then exchanged with long 119 cm R2P Destination Slender sheaths (Terumo). Both CIA stenoses were crossed with 0.035-inch Storq Soft wires (Cordis). Kissing balloons were deployed (5.0x20) followed by double-barrel stenting with two 7 mm x 26 mm Lifestream balloon expandable vascular covered stents (Bard). Each stent was post-dilated with 9 mm x 2 cm balloon to 8 atm. Post-intervention angiograms demonstrated <10% residual stenosis of both CIAs. The patient was able to ambulate after the procedure and was discharged on a statin, aspirin, and clopidogrel. The patient endorsed significant symptom improvement at 7-day and 30-day follow-up.

CONCLUSION: This is one of the first cases of double-barrel bilateral iliac artery stenting via bilateral radial artery access and may provide an alternative option to common femoral artery access.

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ABSTRACT #21 CLINICAL RESEARCH CARDIOVASCULAR DISEASES THE PREVALENCE AND PREDICTORS OF RESISTANT HYPERTENSION IN HIGH-RISK OVERWEIGHT AND OBESE PATIENTS: A CROSS-SECTIONAL STUDY BASED ON THE 2017 ACC/AHA GUIDELINES Faris Haddadin1, Karan Sud1, Alba Munoz Estrella1, Sananda Moctezuma1, Lingling Wu1, Joshua Berookhim1, Claire Huang Lucas1, Dipal Patel1, Edgar Argulian1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in the Journal of Clinical Hypertension. 2019: 21(10): 1507-1515. PMID: 31448866 BACKGROUND/INTRODUCTION: Obesity is significantly associated with uncontrolled blood pressure and resistant hypertension (RH). There are limited studies on the prevalence and determinants of RH in patients with higher body mass index (BMI) values. Since the hypertension guidelines changed in 2017, the prevalence of RH has become unknown and now is subject to be estimated by further studies.

METHODS: We conducted a cross-sectional study in an urban Federally Qualified Health Center in New York City aiming to estimate the prevalence of RH in high-risk overweight and obese patients based on the new hypertension definition, BP threshold â&#x2030;Ľ130/80 mm Hg, and also to describe the associated comorbid conditions in these patients.

RESULTS: We identified 761 eligible high-risk overweight and obese subjects with hypertension between October 2017 and October 2018. Apparent treatment-RH was found in 13.6% among the entire study population.

This represented 15.4% of those treated with BP-lowering agents. True RH confirmed with out-of-office elevated BP was found in 6.7% of the study population and 7.4% among patients treated with BP-lowering agents.

Prevalence was higher with higher BMI values. Those with true RH were more likely to be black, to have diabetes mellitus requiring insulin, chronic kidney disease stage 3 or above and diastolic heart failure.

CONCLUSION: In conclusion, obesity is significantly associated with RH and other significant metabolic comorbid conditions.

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ABSTRACT #22 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY MYELODYSPLASTIC SYNDROMES: TRENDS IN MORTALITY, COSTS OF HOSPITALIZATIONS, LENGTH OF STAY, AND RATE OF COMPLICATIONS Shivani Handa1, Giulia Petrone1, Kamesh Gupta2, Ahmad Khan3, Jasdeep Singh Sidhu4, Sridevi Rajeeve1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Baystate Medical Center, Springfield, MA, United States; 3West Virginia University- Charleston Division, Charleston, WV, United States; 4Interfaith Medical Center, Brooklyn, NY, United States

2

Presented at the American Society of Hematology (ASH) Annual Meeting; Orlando, Florida, United States held on December 7-10, 2019.

BACKGROUND/INTRODUCTION: Myelodysplastic syndromes (MDS) most commonly occur in the elderly and are associated with bone marrow failure and potential transformation to acute myeloid leukemia. Our study is the first report aimed to analyze trends in mortality, costs of hospitalization, length of stay (LOS), and the rate of complications in patients with MDS over the past decade.

METHODS: We queried the Nationwide Inpatient Sample (NIS) database to obtain data on patients hospitalized with MDS between 2005-2014. Patient characteristics including age, sex, insurance and hospital characteristics such as location, teaching status were recorded. Data regarding mortality, LOS and total hospitalization charges was examined and the trend was analyzed over the 10-year interval. We also determined the incidence of common in-hospital complications with comparisons made between academic vs. non-academic institutions.

RESULTS: Over the 10-year interval, a total of 885,726 admissions were identified (mean age=76.2 years; 47.6% females). Majority of patients were treated at non- teaching hospitals (56%) and covered by Medicare (84%). In-hospital mortality increased, with a mortality rate of 5.7% in 2005 and 6.1% in 2014. Comparison between teaching and non-teaching hospitals did not show a statistically significant difference in terms of mortality (p=0.782). Mean LOS remained relatively constant (mean LOS=6.7 days; p=0.382), however there was a substantial increase in the hospitalization charges. The overall hospital cost was $29795 in 2004 which increased by over 100% to $59656 in 2014. After adjusting for inflation by CPI healthcare index, the total cost was still higher by 49%. Teaching hospitals had significantly higher charges ($57,592 vs $37,674; p=0.000) as well as LOS (7.28 days vs 5.75 days; p=0.000) than non-teaching hospitals. The rates of hospital acquired pneumonia and bacteremia have decreased significantly over the study period (p=0.001), whereas rate of C. difficile infections increased from 0.42% to 0.67% and UTIs increased from 7.8% to 9.1%. The rate of ICU admissions has also increased from 0.67% in 2005 to 1.51% in 2014 (p=0.001). The number of patients receiving in-hospital blood product transfusions has risen significantly from 30,564 in 2005 to 37,360 in 2014 (22.2% rise).

Similarly, the number of admissions for major bleeding complications has increased by 34.6% from 1,378 in 2005 to 1,855 in 2014. Rates of major bleeding (p=0.0002) were lower at academic institutions whereas those of neutropenic fever (p=0.0000) were lower at non-teaching hospitals. Differences in the occurrence of pneumonia, sepsis and rate of blood transfusions were not statistically significant between the two.

CONCLUSION: Our study suggests that the overall mortality from MDS has increased over the past decade.

Early recognition and diagnosis of MDS can partly explain this finding. However, lack of standard treatment approach for symptomatic MDS patients (with the exception of lenalidomide in 5q deletion), likely contributes to the substantial rise in admissions for transfusions, bleeding complications as well as the death rate. The significant decline in pneumonia and bacteremia could be secondary to increased use of antibiotic prophylaxis whereas use of antibiotics at the same time has probably led to a rise in C. difficile infections. Our study also highlights a staggering increase in hospitalization costs. Since MDS is mostly a disease of the elderly, the rate of hospitalizations and the associated financial burden is only expected to rise as the population continues to age. This emphasizes the need for research into disease altering chemotherapy, better outpatient care and transfusion accessibility to prevent hospitalizations.

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ABSTRACT #23 CLINICAL RESEARCH RHEUMATOLOGY DETERMINANTS OF PATIENT-REPORTED PERFORMANCE OF BIOLOGICAL TREATMENT IN AXIAL SPONDYLOARTHRITIS: A QUESTIONNAIRE-BASED CROSSSECTIONAL STUDY Julianna Hirsch1, Michal Nudel3, Shira Ginsburg4, Haya Hussein4, Karina Zilber4, Lisa Kaly4, Doron Rimar2,4, Nina Boulman2,4, Abid Awisat4, Hily Wollach3, Michael Rozenbaum2,4, Itzhak Rosner2,4, Gleb Slobodin2,4 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; 3Mifrakim Tze’irim, the Israeli Association of Young Patients with Rheumatic Diseases; 4Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel 2

Presented at the American College of Rheumatology (ACR) Annual Meeting; San Diego, California, United States held on October 26-29, 2017.

BACKGROUND/INTRODUCTION: The majority of clinical trials have reported similar efficacy of biological medicines in patients with AS and non-radiographic AxSpA, with rates of desired response (partial remission or ASDAS Inactive Disease) ranging from 20% to 60%, depending on the study inclusion criteria and patients’ characteristics. Factors predicting favorable outcome following administration of biological therapy may include shorter disease duration, younger age, HLA B27 positivity, lower level of functional disability, elevated serum levels of CRP and active inflammation on MRI. Recently, new data on the worse response of AxSpA patients to biological therapy in those with higher body mass index (BMI) or concomitant fibromyalgia have been reported.

The goal of the present study was to examine possible correlation between some features of disease as well as patient-related variables, including BMI, educational background, employment, mood status and dietary preferences with self-reported success of biologic agents in an Israeli cohort of patients with AxSpA. METHODS: Patients with a clinical diagnosis of AxSpA, either followed in the Rheumatology Unit of Bnai Zion Medical Center (BZMC) or members of Mifrakim Tz’eirim, the Israeli Association of Young Patients with Rheumatic Diseases (MT), were requested to fill out questionnaires concerning the efficacy of their current treatment, basic demographic and disease-related data, dietary habits, mood status, physical activity and current work status. Efficacy of treatment was estimated as percentage of global improvement in the disease status.

Improvement of 70% or more was considered as clinically significant. Variables of interest were compared between groups of patients, those who achieved or failed to achieve clinically significant improvement. t-test, chi square or exact Fisher tests were used for group comparisons, as appropriate. Values of p≤0.05 were considered significant. The study was approved by BZMC Helsinki Committee.

RESULTS: Of 264 patients with AxSpA, followed in the Rheumatology Unit of BZMC and affiliated clinics, 107 patients were available and agreed to fill out the questionnaires by phone or via e-mail. Seventy-three of those patients had the diagnosis of AS and 34 were diagnosed with non-radiographic AxSpA. Ninety more patients were enrolled from MT, all of them filled out questionnaires via e-mail; their precise details of diagnosis of AxSpA were not available. While patients from MT were younger, more educated and predominantly female, the main diseaserelated clinical data obtained were not statistically different between the cohorts, except of the prevalence of uveitis. The utilization rate of biologic medicines was higher in the BZMC cohort (84% vs 68%, p=0.007), but reports on the performance of biologics did not differ statistically between two cohorts (p=0.123). Further analysis was performed for the whole group of 197 patients with AxSpA. Of those, 151 patients were treated with biological medicines during the study period. One hundred patients reported efficacy of the biological treatment of 70% or more. Available disease-related data and details, acquired from the questionnaires, were compared between this group of 100 patients and the second group of 51 patients who failed to achieve 70% improvement.

Fifty-one patients who failed to achieve 70% improvement were older at disease onset, suffered more frequently from widespread, articular and heel pain, fatigue, were less educated and employed, as compared to 100 patients who improved at 70%.

CONCLUSION: Awareness of factors, correlating with success of biological treatment may enable better management and matching for treatment expectations.

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ABSTRACT #24 CLINICAL RESEARCH PULMONARY/CRITICAL CARE/INFECTIOUS DISEASES UNINTENDED BENEFIT OF VACCINES? PNEUMOCOCCAL VACCINATION REDUCES 30 DAY READMISSION AMONG PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Jacqueline Sheehan1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New York, New York, United States held on October 19-23, 2019.

BACKGROUND/INTRODUCTION: To determine the relationship between in-hospital pneumococcal vaccination (PV) on thirty-day readmission, mortality, morbidity, and health care resource utilization in patients admitted to the hospital in the United States with community acquired pneumonia (CAP).

METHODS: A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for the year 2014. Adults (â&#x2030;Ľ18 years) with a principal diagnosis of CAP and a procedure diagnosis of IV were identified using ICD-9 codes as described in the literature. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for readmission were identified using Coxâ&#x20AC;&#x2122;s proportional hazards model.

RESULTS: In total, 825,906 hospital admissions with a primary diagnosis of CAP were identified, of which 2.50% (18,394) received in-hospital pneumococcal vaccination. After PS matching with similar demographic and clinical characteristics, 9,777 CAP patients with pneumococcal vaccination were paired with 9,777 CAP patients without pneumococcal vaccination. The overall 30-day rate of readmission was 11.9%. The most common reason was pneumonia (98.1%). Patients readmitted had a significant higher mortality compared to the hospital was higher than those for index admissions (7.69% vs 3.32%, p<0.001). A total of 489,247 hospital days was associated with readmission, and the total health care in-hospital economic burden was $1 billion (in costs) and $3.67 billion (in charges). In-hospital pneumococcal vaccination (Hazard Ratio 0.745, CI 0.64-0.86, p<0.001), advanced age, higher Charlson comorbidity score, atrial fibrillation, acute respiratory failure, acute kidney injury, and in-hospital oxygen use were associated higher risks of readmission.

CONCLUSION: In this study, 11.9% of CAP patients were readmitted to the hospital within 30 days of discharge and the most common cause is pneumonia.

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ABSTRACT #25 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY WHAT CAME FIRST, THE CHICKEN OR THE BLEED? A FOCUS ON SUSPECTED SMALL BOWEL GI BLEEDS Rida Jamil1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented as Morning Report Case, Mount Sinai Morningside-West Internal Medicine Residency Program, New York, New York, United States; 2019-2020.

CASE PRESENTATION: A 78 year-old man presented to the hospital with black stools for 8 days, fatigue and dyspnea on exertion for 1 month. Lab studies were significant for anemia and physical exam revealed dark stools on digital rectal exam. Of note, he had a similar presentation 2 months prior, complained of melena and was found to have symptomatic anemia. He received three units of packed red cells and underwent an EGD, two colonoscopies, an upper GI series, and a bleeding scan; no source of bleed or stigmata of recent bleeding was identified. Likely presumption was small bowel arterio-venous malformation which could not be visualized on exams. His hemoglobin remained stable and he was discharged with outpatient Gastroenterology follow-up.

After discharge, he had a capsule endoscopy which showed no active bleeding or high-risk lesions identified to explain the patient's GI bleed. During this current hospital stay, he underwent a CT scan which illustrated a 1.7 cm linear high attenuation density within the lumen of the mid small bowel, most consistent with a foreign body, possibly a chicken bone. Planned to consult surgery for diagnostic laparoscopy if foreign body was confirmed. A repeat CT-enterography was done and findings were suggestive of migration of previously seen radiopaque densities in the small bowel to the distal left colon/sigmoid colon. Surgery was thus deferred; patient and his family were upset not finding a source once again. He continued to have episodes of melena and required two more blood transfusions. Eventually, he had nuclear medicine scan done which was negative; he was discharged home with a stable hemoglobin and outpatient follow up.

CONCLUSION: The case illustrates the challenges faced with identifying GI bleeds in the small bowel. In patients with GI bleeding, approximately 5-10% will not have a source identified with standard endoscopic and radiographic evaluation; in approximately 75% of these patients, the source is in the small bowel with 25% attributed to missed lesion in either upper or lower GI tracts.

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ABSTRACT #26 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY A PERNICIOUS PRESENTATION Kirtipal Bhatia1, Jonathan Albert Jamito1, Ana Belen Arevalo Molina1, Shivani Handa1, Yasmin Herrera1, David Weininger Cohen1, Krystle Hernandez1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the New York Chapter of the American College of Physicians Resident and Medical Student Forum Annual Meeting; Albany, New York, United States held on February 29, 2020.

CASE PRESENTATION: A 52-year-old African American male with a past medical history of gastric ulcer presented to the emergency department with progressively worsening exertional dyspnea and fatigue over the past two months. Physical examination was significant for a heart rate of 105 bpm and icteric sclera. Initial laboratory analysis revealed a hemoglobin of 3.9 g/dl, platelet count of 54 X 103/ml, and white blood cell count of 5.8 X 103/ml, with a mean corpuscular volume of 110 fL. Peripheral smear revealed schistocytosis, teardrop cells, and anisopoikilocytosis. No hypersegmented neutrophils were seen. PT/INR and aPTT were normal. Total bilirubin was 2.8 mg/dl with a direct component of 0.9 mg/dl, lactate dehydrogenase (LDH) was 6,975 IU/L and haptoglobin levels (< 8 mg/dl) were undetectable. Abdominal ultrasound showed no hepatosplenomegaly and normal biliary ducts. Additional labs revealed a corrected reticulocyte count of 0.4 %, and direct coombs was negative. D-dimer, fibrinogen levels, ADAMTS13 levels, hemoglobin electrophoresis, and serum Immunoelectrophoresis were normal. However, vitamin B12 level was low (< 150 pg/ml) with elevated methylmalonic acid levels of 3853 mmol/L (MMA) and normal folate levels. The anti-intrinsic factor antibody was positive, and the diagnosis of pernicious anemia was made. The patient was transfused three units of pack red blood cells and started on 1000 mcg of intramuscular B12 injection daily. LDH, haptoglobin, hemoglobin, platelet count, and reticulocyte count all improved with high dose vitamin B12 therapy.

DISCUSSION: Our patient presented with symptomatic anemia, thrombocytopenia, schistocytes, elevated LDH, low haptoglobin, and indirect hyperbilirubinemia concerning for microangiopathic hemolytic anemia (MAHA).

However, ADAMTS13 levels, coagulation profile, and fibrinogen levels were normal, ruling out disseminated intravascular coagulopathy (DIC) and thrombotic thrombocytopenic purpura (TTP). The patientâ&#x20AC;&#x2122;s inadequate bone marrow response, signified by a low reticulocyte count, along with the low vitamin B12 levels and elevated MMA, confirmed vitamin B12 deficiency as the cause for his anemia. Intramedullary hemolysis resulting in pseudo-thrombotic microangiopathy may occur in 2.5 percent of patients with severe vitamin B12 deficiency and can mimic TTP. Pernicious anemia is the most common cause of severe B12 deficiency. It occurs due to an autoimmune response against the gastric mucosa, resulting in the formation of autoantibodies to intrinsic factor secreted by parietal cells. Lifelong treatment with parenteral or oral B12 supplementation is indicated, and initiation of treatment results in a marked improvement in markers of hemolysis and cell counts.

CONCLUSION: Intramedullary hemolysis is an uncommon presentation of severe vitamin B12 deficiency. Due to the starkly differing management strategies, differentiation between MAHA and vitamin B12 deficiency is of utmost importance. Therefore, physicians should always include B12 deficiency as a differential for a patient presenting with features of MAHA and an inadequate bone marrow response.

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ABSTRACT #27 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY NON-HODGKIN LYMPHOMA: A RISK FACTOR FOR IN-HOSPITAL MORTALITY IN PATIENTS HOSPITALIZED WITH OPPORTUNISTIC INFECTIONS Karan Jatwani1, Karan Chugh2, Rakesh Sharma3, Shraddha Jatwani2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; St. Vincent, Evansville, IN, United States; 3PGIMER, Chandigarh, India

2

Presented at the American Society of Bone Marrow Transplantation Annual Meeting; Houston, Texas, United States held on February 20-24, 2019.

BACKGROUND/INTRODUCTION: Opportunistic infections (OI) are defined as infections that are more frequent or more severe because of immunosuppression. Infections such as tuberculosis, PCP, CMV, Histoplasmosis, and Blastomycosis are categorized as OI. Conditions involving immunosuppression are associated with increased risk of OI including HIV infections, Hematopoietic stem cell transplantation, autoimmune diseases like systemic lupus erythematous (SLE) and rheumatoid arthritis (RA). There is data to support that presence of an underlying malignancy can itself increase the risk of infections. Considering a limited amount of studies evaluating non-Hodgkinâ&#x20AC;&#x2122;s Lymphoma (NHL) as a risk factor for opportunistic infection and its effects on mortality.

Our objective is to describe the demographics and mortality trends for hospitalized patients with OI with underlying NHL and understand the factors associated with mortality.

METHODS: Nationwide Inpatient Sample (NIS) database was used to extract data for all the adult admissions with OI from 2010-2014. Admissions were stratified into two groups based on the status of NHL. NIS: largest all payer inpatient public database in the United States. Approximately 143 million discharges from >4000 hospitals.

Inclusion criteria: Primary Diagnosis ICD 9 codes for OI which included tuberculosis (010-018), non-tubercular mycobacteria (031), Cytomegalovirus (078.5), Herpes Zoster (053), Candidiasis (112.4), Toxoplasmosis (130), Pneumocystis (136.3), Cryptococcosis (117.5), Listerosis (027.0), Nocardiosis (039), Aspergillosis (117.3), Coccidiomycosis (114), Histoplasmosis (115), Blastomycosis (116.0). Secondary Diagnosis: ICD-9 Codes for Non-Hodgkinâ&#x20AC;&#x2122;s Lymphoma.

RESULTS: A total of 181,016 admissions with a primary diagnosis of OI which included all the ICD-9 codes as mentioned above. The diagnosis were identified from 2010 to 2014. A total of 4442 admissions had an underlying diagnosis of NHL. Patients with OI having secondary diagnosis NHL, were noted to have increased inpatient mortality when adjusted for age, sex, race, insurance status, type of hospital (teaching v/s non-teaching), HIV status. Transplant status with an odds ratio of 1.34 (1.02-1.74) (p=0.0 3; p<0.05).

CONCLUSION: This is a first nationwide study to our knowledge which is evaluating NHL as an independent risk factor for mortality in patients who were admitted in the hospital for opportunistic infections. OI when presented with NHL are more in older age compared to general population, have a preponderance for males, and present more to the teaching hospitals. With approximately 20,000 deaths estimated for 2018 from NHL. More studies are needed to look for preventive steps that need to be taken for prevention of opportunistic infections in patients with underlying NHL. Given the limiting factors of database, it is hard to know if the patients were actively receiving therapy which could have predisposed them to immunocompromised state.

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ABSTRACT #28 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY INSURANCE DISPARITY IN THE UNITED STATES CANCER SURVIVORS’ SMOKING RATES: A TREND STUDY FROM NHIS 2000-2017 Changchuan Jiang1, Binbin Zheng-Lin1, Yannan Zhao2, Biyun Wang2, Xi-Chun Hu2 1

Mount Sinai Morningside-West Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Fudan University Shanghai Cancer Center, Shanghai, China

Presented at the American Society of Clinical Oncology (ACO) Annual Meeting; Chicago, Illinois, United States held on May 31-June 4, 2019.

BACKGROUND/INTRODUCTION: Smoking rates have been decreasing in the U.S over the last decade.

Smoking cessation is a critical part of cancer treatment and survivorship care. However, little is known about the trend of smoking rates in U.S. cancer survivors and how it varied by individuals’ insurance coverages.

METHODS: We conducted a retrospective study to evaluate the temporal trend of smoking rates using the National Health Interview Survey from 2008 through 2017. Adult cancer survivors (n=20,122) were included in the analysis. The outcomes were self-reported current smoking behavior. Insurance coverage was categorized into any private (age ≤65), other coverage (age ≤65), uninsured (age ≤65), Medicare + any private (age >65), and other coverage (age >65). We combined every two years data to improve statistical power in the subgroup analysis. Weighted analyses were performed with SAS 9.4 to account for the complex design.

RESULTS: The smoking rates in cancer survivors decreased from 18.4% in 2008 to 12.5% in 2017. However, the smoking rates varied remarkably by insurance status (p<0.001). There was a decreasing trend of smoking rates in participants with any private (age ≤65) (17.3% in 2008/2009 to 12.0% in 2016/2017), Medicare + any private (age >65) (7.5% in 2008/2009 to 5.9% in 2016/2017), and other coverage (age >65) (13.2% in 2008/2009 to 9.2% in 2016/2017) whereas the current smoking rates remains high in cancer survivors with other coverage (age ≤65) (40.1% in 2008/2009 to 34.4% in 2016/2017) and uninsured (age ≤65) (43.4% in 2008/2009 to 43.1% in 2016/2017).

CONCLUSION: Cancer survivors report less smoking behaviors over the last decade which is similar to the general population. However, the smoking rate remains dangerously high in non-elderly cancer survivors without any private insurance.

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ABSTRACT #29 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW ENDOCRINOLOGY ENDOCRINE EMERGENCIES Vipul Jindal1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented as a Senior Lecture, Noon Conference Mount Sinai Morningside-West Internal Medicine Residency Program, New York, New York, United States; 2019-2020.

BACKGROUND/INTRODUCTION: The endocrine system regulates various metabolic functions in the body.

Disturbances can lead to devastating outcomes, especially for the critically ill patient. Diagnosis and management of endocrine emergencies can be challenging, and any delay in treatment may be life threatening.

The most prevalent endocrine emergencies are discussed here, with focus on the appropriate management in the general or intensive care setting.

DIAGNOSIS AND MANAGEMENT: Diabetic Ketoacidosis/Hyperosmolar hyperglycemic state (DKA/HHS): Treatment is based on a triad of IV insulin therapy, aggressive fluid resuscitation and careful watch of electrolytes. Proper intensive care unit (ICU) triage is paramount. Keep serum glucose at <140 mg/ dL for premeal and at <180 mg/dL for random glucose level. All patients should be on basal or basal-bolus regimen, and keep in mind that hyperglycemia may be as bad as hypoglycemia for long term outcomes.

Thyroid storm: Usually precipitated by a stressor-like infection, surgery or myocardial infarction. May result in severe autonomic dysfunction, heart failure and cardiac arrest. Diagnoses requires TSH, Free T3 and Free T4.

After starting a beta-blocker, focus on decreasing thyroid hormone productions with a thionamides (preferably PTU). Block peripheral conversion with Propranolol or intravenous (IV) hydrocortisone and prevent further organification of iodine with Oral Lugolâ&#x20AC;&#x2122;s Iodine.

Pituitary Apoplexy: Suspect it in the setting of existing adenoma or as the result of postpartum hemorrhage (Sheehanâ&#x20AC;&#x2122;s syndrome). Proceed with head CT and MRI, immediate glucocorticoids replacement (IV) and consult neurosurgery for urgent decompression.

CONCLUSION: Timely detection and treatment is required when facing an endocrine emergency. Having a good knowledge of the different clinical presentations, effectively stabilizing the patient and quickly identifying the need for critical care are key to achieve good outcomes. In some cases, such as with myxedema coma, treatment should not be delayed to wait for diagnosis confirmation, as it could rapidly progress to death. Take-home points for DKA/HHS are the need of proper ICU triage and keeping strict glycemic goals. In patients with pituitary apoplexy, a prompt diagnosis and treatment with IV hydrocortisone can be lifesaving.

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ABSTRACT #30 CLINICAL RESEARCH GASTROENTEROLOGY OUTCOMES OF LIVER TRANSPLANTATION FOR BUDD-CHIARI SYNDROME IN THE MELD ERA Gaurav Kakked1, Parth Trivedi1, Alana Persaud2, Ritu Agarwal1, Ahmet Gurakar3, Thomas D Schiano1, Behnam Saberi1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Rutgers New Jersey Medical School, Newark, NJ, United States: 3John Hopkins School of Medicine, Baltimore, MD, United States

2

Presented at the American Association for the Study of Liver Diseases (AASLD) Annual Meeting; Boston, Massachusetts, United States held on November 8-12, 2019.

BACKGROUND/INTRODUCTION: Budd Chiari syndrome (BCS) is a rare condition caused by the obstruction of hepatic venous outflow tract. It has a heterogeneous clinical presentation ranging from asymptomatic cases to fulminant liver failure. There is limited recent data on the characteristics and outcomes of patients undergoing liver transplantation (LT) in patients with BCS. METHODS: We used the Scientific Registry of Transplant Recipients (SRTR) database (2002-2018). We restricted our analysis to the MELD era. Our aim was to determine trends and long-term outcomes in recipients of liver transplant for BCS. Kaplan Meier curve and Log rank test were used to assess survival. Cox regression was used to determine predictors of mortality after liver transplant.

RESULTS: A total of 789 patients listed for liver transplant had a diagnosis of BCS out of which 358 patients received liver transplant. A total of 99 patients were removed from the waiting list without getting a liver transplant and the causes of removal were death (20.4%), improvement in condition (30.43%) and loss to follow up (8%).

A total of 281 (78.49%) patients were alive after a median post liver transplant follow up of 6.9 years with the median survival of 14.7 years.

CONCLUSION: The outcomes of liver transplant in BCS patients in the MELD era are acceptable. The association of TIPS with increased hazards of death in liver transplant recipients needs further evaluation.

Prospective studies are needed to confirm the findings of this study.

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ABSTRACT #31 CLINICAL RESEARCH CARDIOVASCULAR DISEASE A DIAGNOSIS OF SCHIZOPHRENIA IS ASSOCIATED WITH LOWER UTILIZATION OF STENTS AND CORONARY ARTERY BYPASS GRAFTS AMONG PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: A NATIONWIDE ANALYSIS USING THE NATIONAL INPATIENT SAMPLE DATABASE OF 2014 Wojciech Rzechorzek1, Mario Rodriguez1, Ruchit Shah1, Scott Kaplin1, Swiri Konje1, Jacqueline Tamis-Holland1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

BACKGROUND/INTRODUCTION: Studies have shown that a diagnosis of schizophrenia is associated with lower utilization of stents and higher mortality among patients with an acute myocardial infarction. We wished to investigate difference in outcomes and utilization of other procedures in a large unselected population of patients presenting with acute myocardial infarction (AMI).

METHODS: We performed a retrospective cohort study, using the 2014 Nationwide Inpatient Sample (NIS) database, which is representative of all nonfederal acute care hospitals nationwide and has been broadly used to estimate the burden of cardiac diseases. We identified adult patients, admitted with AMI and schizophrenia using ICD-9-CM codes. ICD-9-CM codes were also used to identify treatment modalities and events, except for in-hospital mortality, total charges from the length of stay and mean length of stay. We performed univariate analysis of age, sex, race, hospital region, hospital teaching status, insurance type, hospital bed size, Charlson Comorbidity Index and other relevant comorbidities and we included variables with p<0.2 in multivariate logistic regression models for treatment modalities and events. Proportions were compared with weighted Pearson chi square statistic and continuous variables with student t-test. P values were two-sided with 0.5 as threshold for statistical significance.

RESULTS: As compared to patients without schizophrenia, patients with schizophrenia were younger, and more likely to have other comorbidities. Patients with schizophrenia were less aggressively treated with revascularization therapies included, stent implantations (OR=0.48 (0.49-0.58), p<0.001) early stent implantation (AMI: stent within 24 hours: OR=0.50, 95% CI=0.40-0.61), p<0.001, or coronary artery bypass grafts OR=0.61, 95% CI=0.41-0.91, p=0.0017. Hospital mortality was similar between the two groups. Although the hospital length of stay was longer in patients with schizophrenia (Coef=0.97, 95% CI=0.34-1.60, p=0.003), total charges were lower (Coef=-$12241, 95% CI=19346-5137), presumably due to lower rates of revascularization.

CONCLUSION: Patients with schizophrenia appear to be less aggressively treated. It is possible that the lower rates of revascularization may in part be related to a lower rate of significant coronary artery disease requiring revascularization. Despite the less frequent revascularization, adjusted mortality is similar between the two groups.

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ABSTRACT #32 CLINICAL RESEARCH GASTROENTEROLOGY PUBLICATION TRENDS IN GASTROENTEROLOGY AND HEPATOLOGY OVER THE PAST 40 YEARS: AN ARTIFICIAL INTELLIGENCE ANALYSIS Gassan Kassim1, Yiftach Barash2, Eyal Klang2, Ryan Ungaro1, Jean-Frederic Colombel1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel

2

Accepted to the Digestive Diseases Week (DDW) Meeting; Chicago, Illinois, United States that was scheduled to be held from May 2-5, 2020.

BACKGROUND/INTRODUCTION: Gastroenterology and hepatology as a field has undergone rapid advances in past years. Over time, the topics of interest can shift given clinical and scientific priorities. By using artificial intelligence (AI), we aimed to understand publication trends in the field of gastroenterology and hepatology over the past 40 years.

METHODS: We analyzed MEDLINE/PubMed data from 1977 through 2017. All the publications in gastroenterology and hepatology literature were collected. We also collected the number of times each paper was cited. We included all articles with abstracts longer than 50 words. We used Latent Dirichlet allocation (LDA), a state-of-the-art AI algorithm for topic modeling to analyze all abstracts and generate topics. These topics were manually assigned to 45 gastroenterology and hepatology conditions and 6 gastroenterology organ systems: Esophagus, Stomach, Small Bowel, Large Bowel, Liver & Biliary tract, and Pancreas. The algorithm then matched each abstract to the defined conditions and organs. The absolute number of citations and publications were arranged per decade, organ system, and condition. Relative ratios of citations to publications (expressed as impact factor IF) for each decade, organ system, and condition were calculated and compared.

RESULTS: We included 200,472 articles published in gastroenterology and hepatology journals over the past four decades. There was a sharp increase in the number of citations to publications in each decade. The latter two decades (1998-2017) had a much higher citations to publications ratios compared to the first two decades (1978-1997). The first decade had a C/P ratio of 4.3, the second decade had a C/P ratio of 5.4, the third had a C/P ratio of 9.7, and the fourth decade had a C/P ratio of 7.7 (Figure 1). When comparing publications based on organs, the C/P ratio for each organ system was higher in the last 2 decades compared to the first 2 decades.

(Figure 2). The top 5 conditions with the highest citations to publications ratio in the last 2 decades were different from the top 5 conditions in the first 2 decades. In the first 2 decades, lower gastrointestinal bleeding was the topic with the highest C/P ratio 19.3, followed by irritable bowel syndrome (IBS) (C/P ratio 16.5), microbiome (C/P ratio 9.8), constipation (C/P ratio 9.4), and inflammatory bowel disease (IBD) (C/P ratio 8.6) (Figure 3A). In the last 2 decades, microbiome was the topic with the highest citations to publications ratio (C/P ratio 25.9), followed by nonalcoholic steatohepatitis (NASH) (C/P ratio 17.4), Eosinophilic esophagitis EoE (C/P ratio 17.4), IBS (C/P ratio 15.6), and IBD (C/P ratio 14.4) (Figure 3B). IBS, IBD, and microbiome were the three conditions to remain consistently within the top 5 conditions across the 4 decades.

CONCLUSION: The field of gastroenterology and hepatology is rapidly evolving. The number of publications rose dramatically over the past 40 years, with shifting topics of interest over time. When looking at the top 5 conditions, our analysis highlights the increasing interest in microbiome and diseases that are rising in incidence (NASH, EoE, IBD, IBS). Microbiome and NASH have become among the most cited topics in the field.

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Figure 1: Number of citations relative to publications (C/P ratio) per each decade for the fields of gastroenterology and hepatology 12

9.7

10

7.7

C/P ratio

8

6

5.4 4.3

4

2

0 1978-1987

1988-1997

1998-2007

2008-2017

Figure 2: Citations to publications ratios â&#x20AC;&#x201C; C/P ratio â&#x20AC;&#x201C; based on defined organ systems stratified by decades 16

14.4

14

12.4

C/P ratio

12 10 8 6

10.3

10 8.4 7.2 5.6 4.8

7.3 6.1 5.2 4.4

4

8.8 7.9

7.9 6.6 5.2

3.74.1

10

6.7 5.4

6.4

1978-1987 1988-1997 1998-2007

3.9

2008-2017

2 0 Esophagus

Stomach

Liver & Biliray tract

Pancreas

Small Bowel

Large Bowel

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Figure 3A: Top 5 conditions with the highest number of citations relative to publications â&#x20AC;&#x201C; C/P ratio during the first two decades (1978-1997) 25

20

19.3

C/P ratio

16.5 15

10

9.8

9.4

Microbiome

Constipation

8.6

5

0 Lower GI bleed

IBS

IBD

Figure 3B: Top 5 conditions with the highest number of citations relative to publications â&#x20AC;&#x201C; C/P ratio during the second two decades (1998-2017) 30 25.9 25

C/P ratio

20

17.4 15.6

15

14.6

14.4

IBS

IBD

10

5

0 Microbiome

NASH

EoE

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ABSTRACT #33 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE THE LOST ART OF PHYSICAL EXAMINATION (PE) Yeraz Khachatoorian1, Angad Uberoi1, Sarah Shihadeh1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Accepted to the Society of Hospital Medicine (SHM) Annual Meeting; San Diego, California, United States that was scheduled to be held from April 15-18, 2020.

CASE PRESENTATION: A 58-year-old male patient was brought by EMS after he was found to have an episode of syncope preceded by nausea, vomiting, and dizziness while he was on his way to the supermarket. His past history was significant for hypertension (HTN), end-stage renal disease (ESRD) on chronic hemodialysis, and a recent diagnosis of stage IV squamous cell carcinoma of the right tonsil (with right jugular chain lymphadenopathy (LAN)). He had undergone a prophylactic left sided tonsillectomy a week prior to admission.

The patient was found to have a HR: 30s beats per minute (bpm) with BP: 80s/40s mmHg. EKG: junctional bradycardia with HR: lower 40s bpm which immediately resolved after 0.5 mg atropine and IV fluids. Hospital course was notable for an episode of dizziness with telemetry showing sinus bradycardia with HR: 30s bpm, which was accompanied by hypotension with systolic BP: 60s mmHg. The patient was transferred to the CCU for closer heart rhythm monitoring. An electrophysiology (EP) study was performed which was negative for SA-AV nodal or His-Purkinje conduction system disease. An implantable loop recorder was placed with EP follow-up in 2 weeks. During his hospital stay, it was noted that the patient would sleep only on one side. When questioned about it, he reported that he would become dizzy if he slept on his right side. This prompted a thorough exam of his neck which revealed enlarged lymph nodes (LNs) at the base of the right neck. With a negative EP study ruling out intrinsic conduction system disease, recent angiography negative for significant coronary obstruction, and no offending medications, carotid sinus syndrome (CSS) due to compression of carotid sinus with right-sided LNs was presumed to be responsible for syncope episodes.

DISCUSSION: With advances in modern medicine, there has been a steady shift of the epicenter of patient care from the bedside to documentation rooms filled with computers. In a study conducted at a major academic medical center, two-thirds of internal medicine residents reported that they spend in excess of 4 hours daily while in the hospital setting on documentation and clerical duties, with only slightly more than a third of residents spending this same amount of time in direct patient care. While technology, electronic medical records (EMRs) and sophisticated diagnostic tests have aided in the overall improvement of patient outcomes, it is essential to keep in mind that their purpose is to supplement a thorough history/PE, and not to replace them. In this case, the PE missed the extensive cervical LAN, and it wasnâ&#x20AC;&#x2122;t until patient reported feeling dizziness if he lies on the right side that the LNs were examined and the question regarding CSS secondary to LN compression was raised.

This finding was a reminder of the importance of detailed PE which unfortunately sometimes can be missed during daily clinical practice.

CONCLUSION: Thorough PE is an important part of clinical diagnosis, in this case it could have possibly prevented the patientâ&#x20AC;&#x2122;s subsequent decompensation, and also decreased overall cost to the healthcare system by avoiding unnecessary testing and decreased length of stay. Some measures we suggest bringing the focus of medical education back to the basics include bedside rounding by the medical team, and a greater focus on examination skills training and assessment in medical school.

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ABSTRACT #34 CLINICAL RESEARCH CARDIOVASCULAR DISEASE PERICARDIOCENTESIS AND PERICARDIOTOMY: A NATIONAL COMPARISON OF UTILIZATION, COST AND OUTCOMES Swiri Konje1, Lingling Wu1, Wojciech Rzechorzek1, Alba Munoz Estrella1, Eyal Herzog1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting; Chicago, Illinois, United States held on November 10-12, 2019 BACKGROUND/INTRODUCTION: Pericardiocentesis and pericardiotomy remain the two main treatment modalities for cardiac tamponade and malignant pleural effusions. However, there is little current evidence comparing the rates of utilization of pericardiocentesis with pericardiotomy. The objective of this study was to compare the trends in outcomes, utilization and cost.

METHODS: The Nationwide Inpatient Sample database was queried to identify admissions with pericardiocentesis and pericardiotomy from 2007 to 2015. The primary outcome was the trend of utilization of both procedures over a 9-year period. Secondary outcomes included in-hospital mortality, length of stay (LOS), complications rates and annual cost. Procedure related complications were identified as defined by the Agency for Healthcare Research and Quality.

RESULTS: The incidence of pericardiocentesis increased significantly from 24054 to 29310 (18%) while that of pericardiotomy decreased significantly from 37684 to 28369 (15%). Unadjusted in-hospital mortality decreased significantly for both procedures (p trend <0.001) and there was no significant difference in the trend of length of stay (LOS). The annual expenditure for pericardiocentesis decreased significantly by 37% ($86 to $137 thousand) compared to an increase of 45% (from $110 to $201 thousand) for pericardiotomy during the study period. Procedure related complications increased significantly in both pericardiocentesis and pericardiotomy by 16% (p trend <0.001).

CONCLUSION: In this observational study, we showed that within the 9-year period, there was an increase use of pericardiocentesis and decrease in pericardiotomy. The increase in the utilization rates of pericardiocentesis was reflected in the increase in annual expenditure over time. The decrease in rates of pericardiotomy however did not match the increase in annual expenditure. In hospital mortality decreased over time whilst complication rates increased significantly. LOS remained stable.

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ABSTRACT #35 CLINICAL RESEARCH CARDIOVASCULAR DISEASE HOME-BASED CARDIAC REHABILITATION AND SURVIVAL IN PATIENTS WITH CARDIOVASCULAR DISEASE: RESULTS FROM THE SAN FRANCISCO HEALTHY HEART PROGRAM Nirupama Krishnamurthi1, David W. Schopfer2, Hui Shen2,3, Mary A. Whooley2,3 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; University of California, San Francisco, CA, United States; 3San Francisco Veterans Affairs (VA) Health Care System, San Francisco, CA, United States

2

Presented at the American Association of Cardiovascular and Pulmonary Rehabilitation Annual Meeting; Portland, OR, United States held on September 18-21, 2019.

BACKGROUND/INTRODUCTION: In an effort to increase participation in cardiac rehabilitation (CR), the Veterans Health Administration (VA) Office of Rural Health has implemented new home-based cardiac rehabilitation (HBCR) programs at selected VA facilities. HBCR programs have been shown to be equally effective to traditional facility-based programs in clinical trials and Cochrane meta-analysis. However, the realworld effect of HBCR on mortality is unknown.

METHODS: We evaluated all patients who were referred to and eligible for outpatient (Phase II) CR between 2013-2018 at the San Francisco VA. Patients who chose to attend facility-based CR and those who died within 30 days of hospitalization were excluded. Patients were followed through June 30, 2019. We used Coxproportional hazards regression models with inverse probability treatment weighting to compare mortality in HBCR participants vs. non-participants.

RESULTS: Of the 1,120 patients (mean age 68, 98% male, 76% White) who were referred to and eligible, 492 (44%) participated in HBCR. During a median follow-up of 3.3 years, 133 patients (12%) died. As compared with the 628 non-participants, mortality was lower among the 492 HBCR participants (8% vs. 15%; p<0.01). In an inverse probability weighted cox regression analysis adjusted for patient demographics and comorbid conditions, mortality remained 35% lower among HBCR participants versus non-participants [HR 0.65, 95% CI 0.44, 0.97, p=0.04].

CONCLUSION: Among patients eligible for CR, participation in HBCR was associated with 35% lower mortality.

Although we cannot rule out the possibility of unmeasured confounding, participation in HBCR remained associated with lower mortality after inverse-probability weighted analyses. These findings suggest that HCBR may benefit patients who cannot attend traditional CR programs.

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ABSTRACT #36 CLINICAL RESEARCH INFECTIOUS DISEASE CLINICAL CHARACTERISTICS OF EARLY NONCRITICAL HOSPITALIZED PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19): A SINGLE-CENTER RETROSPECTIVE STUDY IN NEW YORK CITY Michelle Lee1, Mona Fayad1, Tarub S. Mabud1, Paulino Tallรณn de Lara1, Christian Olivo1, Adiac Espinosa Hernandez1, Gustavo Contreras Anez1, Maanit Kohli1, Nikhil Chadha1, Raymonde Jean1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND: Covid-19 first originated in Wuhan, China, in December 2019. As of April 9, 2020, New York State had become the single largest global epicenter of COVID-19. We aim to characterize patients with COVID19 admitted to a general medical unit of an academic hospital during the initial epidemic in New York City in March 2020.

METHODS: This is a retrospective chart review of a single academic hospital in New York City. The first patients (n = 33) with RT-PCR-confirmed COVID-19 admitted from the emergency department to a general medicine unit between March 11th to March 27th, 2020. Patient demographic, clinical, laboratory, and radiographic investigations, treatments, and clinical outcomes were retrospectively extracted from the electronic medical record, and followed until April 10th, 2020. Patients were divided into severe and non-severe sub-cohorts.

Statistics were descriptive in nature.

RESULTS: The study cohort (median age 68 years, 67% male) presented with subjective fevers (82%), cough (88%), and dyspnea (76%). The median incubation period was 3 days. Most cases met SIRS criteria upon admission (76%). Patients had elevated inflammatory markers. Patients were treated with antimicrobials, corticosteroids, hydroxychloroquine, and varying levels of supplemental oxygen. Mortality was 15% and 18% of the cohort required intensive care services.

CONCLUSION: Patient age, presenting clinical symptoms, comorbidity profile, laboratory biomarkers, and radiographic features are consistent with findings published from China. Severe patients had peaks in inflammatory biomarkers later in the hospitalization, which may be useful to trend. Further studies are necessary to create guidelines to better risk-stratify COVID-19 patients based on clinical severity.

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ABSTRACT #37 CLINICAL RESEARCH CARDIOVASCULAR DISEASE/INFECTIOUS DISEASE IMPACT OF ASYMPTOMATIC HIV INFECTION AND AIDS ON THE OUTCOME OF PATIENTS ADMITTED WITH HEART FAILURE IN 2016 Jan Menezes Lopes1, Claire Huang Lucas1, Georgina Osorio1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: HIV infection is associated with increased cardiovascular morbidity.

However, it is still poorly understood whether there are significant differences between individuals with asymptomatic HIV infection and HIV/AIDS. METHODS: This is a retrospective cohort study in which we used the 2016 National Inpatient Sample database.

We included patients â&#x2030;Ľ 18 years-old who were admitted to hospitals throughout the United States in 2016 whose primary diagnosis was heart failure (HF). Stata was utilized for statistical analysis. Logistic regression was used to compare the variables with the concomitant diagnosis of HIV/AIDS or asymptomatic HIV infection.

RESULTS: 807,764 patients with heart failure were included of those 2,020 patients were diagnosed with asymptomatic HIV infection and 1,975 patients with HIV/AIDS. The majority of were male (51.2%) with the discrepancy higher in both asymptomatic HIV (64.1%) and HIV/AIDS (70.6%) patients. Asymptomatic HIV and HIV/AIDS patients were significantly younger than HIV-negative patients (mean age: 56.3 and 54.1 years vs.

71.9 years), of Black race (68.7% and 64.6% vs. 18.5%), and more likely to come from low-income areas.

Cardiovascular risk factors were less prevalent in the HIV positive population, except for ESRD. There was no statistically significant difference in the prevalence of cardiogenic shock or left heart catheterization/ percutaneous coronary intervention (LHC/PCI) among the groups. The in-hospital mortality rate, LOS, or costs were not significantly different.

CONCLUSION: In this retrospective cohort study we found that patients admitted with heart failure and coexisting HIV infection were younger, more likely to be Black, and with fewer cardiovascular risk factors, however there were no significant difference in the occurrence of coronary intervention during the hospitalization or in-hospital mortality.

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ABSTRACT #38 CLINICAL RESEARCH CARDIOVASULAR DISEASE/NEPHROLOGY SYNTHESIZING MARKERS OF KIDNEY INJURY IN ACUTE DECOMPENSATED HEART FAILURE: SHOULD WE EVEN KEEP LOOKING? Alexander S. Manguba1, Xavier Vela Parada1, Steven G. Coca2, Anuradha Lala2, 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Published in Current Heart Failure Report. 2019; 16(6): 257-273. PMID: 31768917 BACKGROUND/INTRODUCTION: Numerous studies have evaluated the utility of blood and urine biomarkers in acute decompensated heart failure both for early diagnosis of acute kidney injury, and for short- and long-term prognosis.

METHODS: A narrative review was done through a search of the literature on biomarkers of kidney injury in the setting of acute decompensated heart failure, with emphasis on recent findings in the last 5 years. Studies that focused on the utility of biomarkers for early diagnosis of worsening renal function or for prognostication of outcomes were included in the review.

RESULTS: The current body of evidence does not support routine use of any of these biomarkers for the purposes of diagnosis of acute kidney injury or for prognosis after hospitalization for acute decompensated heart failure. All studies are observational in nature and as such, are likely limited by numerous confounders, the most important of which is modification of decongestive therapy in response to worsening renal function. More recent evidence suggests that worsening renal function or kidney injury does not always portend poor outcomes after hospitalization for heart failure.

CONCLUSION: There is currently no conclusive evidence to recommend the routine use of biomarkers of kidney injury in acute decompensated heart failure. More importantly, there is emerging evidence that worsening renal function or kidney injury in the setting of diuresis for acute decompensated heart failure does not always portend poor outcomes.

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ABSTRACT #39 MEDICAL EDUCATION TELLING GREAT STORIES: IMPROVING COMMUNICATION SKILLS AND RESIDENT WELL-BEING THROUGH STORYTELLING Zoe McKinnell1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the 18th Annual Innovations in Medical Education Conference: Transforming Health Professions Education through Innovation; Los Angeles, California, United States held on February 14-15, 2020.

BACKGROUND/INTRODUCTION: A storytelling curriculum for physicians that cultivates communication techniques, increases empathy and promotes a humanistic health care culture. Effective communication among health care providers has repeatedly been proven to be essential in providing top notch care. Furthermore, in a field where workplace burnout is on the rise, especially among young physicians, strong social relatedness has been shown to be one of the key factors associated with resident well-being. Storytelling draws on both the factual and emotional components of practicing medicine and enables physicians to share the pertinent experiences which helped shape their clinical practice. There is currently limited published evidence of storytelling curricula for residency programs, however programs do exist in several medical schools. Storytelling programs in medical schools have been shown to be an important, unconventional means of enhancing communication, collaboration and professional development.

METHODS: This intervention will focus on the 150 internal medicine residents in our program and take place over two years. Storytelling sessions will typically be one hour in length and will be held during noon conferences once a month. Sessions will be open to all residents and led by experienced storytelling facilitators. The goals of these sessions are to increase awareness of storytelling, engage residents, and provide them with a platform to process and reflect on impactful moments. The sessions will involve ice breaker games, activities which prompt residents to tell stories, and a story told by a medical professional, patient or care provider. In addition, smaller more intensive sessions will be held bi-monthly to coach residents who have a story to tell publicly to the group.

In these sessions, residents will hone their stories and learn techniques to speak publicly with confidence. The goal over the course of the first year is to coach a cohort of residents on effective storytelling techniques so that they can become facilitators the following year. We also hope to develop a roster of activities that can be transcribed into a reproducible curricula. Monthly storytelling sessions will be evaluated through the review of resident responses to standardized questionnaires which pull questions from previous surveys which measure comfort with public speaking, empathy and human connection. Examples of standardized surveys include the Jefferson Scale of Empathy and the Human Connection Scale. In addition, attendance will be recorded and measured in two ways â&#x20AC;&#x201C; we will measure total attendance and unique attendees. We will compare overall scores on surveys at the beginning and end of the year taken by residents who attended 2 or more sessions.

CONCLUSION: A storytelling curriculum will enable residents to voice and acknowledge their experiences, communicate confidently and passionately, foster social relatedness and ultimately improve physician wellness.

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ABSTRACT #40 CLINICAL RESEARCH PULMONARY/CRITICAL CARE INTERPLAY OF PULMONARY ARTERY SYSTOLIC PRESSURE AND PULMONARY VASCULAR RESISTANCE ON POST-TRANSPLANT SURVIVAL Vivek Amit Modi1, Jeremy Mazurek2, Edo Birati2, Jonathan Menachem3; Johanna Contreras1, Arieh Fox1,4 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; 3Vanderbilt University School of Medicine, Nashville, TN, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

Accepted to the International Society for Heart and Lung Transplantation Annual Meeting; Montreal, Canada that was scheduled to be held from April 22-25, 2020.

BACKGROUND/INTRODUCTION: Pulmonary Vascular Resistance (PVR) > 3WU is a relative contraindication to heart transplant. However, previous analysis have not shown an association between (PVR) and posttransplant survival. Alternatively, Pulmonary Artery Systolic pressure (PASP) > 50mmHg has been associated with post-transplant survival. We explored the interplay between (PVR) and PASP and their effect on posttransplant survival independently and in conjunction with each other to understand their interaction on predicting post-transplant survival.

METHODS: Adults (≥ 18 years) who underwent heart transplantation in the United States between 2010 and 2015 were retrospectively identified from the United Network for Organ Sharing registry. Pre-transplant PASP was classified as low (PASP < 50 mmHg) and high (PASP > 50 mmHg). Pre-transplant PVR was divided into low (PVR < 3 WU) and high (PVR > 3 WU). The effects of PASP and PVR were studied on post-transplant 1-year survival and long-term survival both independently and in combination. Univariate and multivariate cox regression was used to derive hazard ratios for survival.

RESULTS: Data from 12658 heart transplant recipients (mean age 53.11 ± 0.11 years; 73.6% male; 66.6% Caucasian) were analyzed. During a mean follow-up of 3 years, there were 2158 (17%) deaths. Mean PASP in high and low PASP group were respectively 63 mmHg and 35 mmHg. Mean PVR in high and low PVR group were 4.53 WU and 1.63 WU respectively. Difference in PVR did not have any independent effect on 1-year mortality (HR: 1.07, CI: 0.95 – 1.20, p=0.25) or crude overall survival (HR: 1.06, CI: 0.97 – 1.15, p=0.175). Pretransplant elevated PASP independently predicted worse 1-year mortality (HR: 1.14, CI: 1.01 – 1.29, p=0.02) but not overall survival (HR: 1.08, CI: 0.99-1.19, p=0.05). Pre-transplant elevated PASP in combination with high PVR predicted worse 1-year survival (HR: 1.32, CI: 1.11 – 1.59, p=0.002) and overall survival (hazard ratio 1.17, CI 1.03–1.34, p=0.015) in cox regression analysis. High PASP did not predict worse 1-year (HR: 0.98, CI: 0.83 – 1.17, p=0.9) and overall mortality (HR: 1.007, CI: 0.89 – 1.13, p=0.9) in subgroup of patients with PVR<3 WU. Multivariate analysis yielded similar results.

CONCLUSION: Elevated pre-transplant PASP (>50mmHg) in conjunction with PVR ≥ 3 WU is associated with a decrease in one year and overall survival when compared to patients without elevated pre- transplant PASP and PVR ≥ 3 WU. In patients with PVR<3 WU PASP is not a predictor of post- transplant survival. This suggested that PASP (>50mmHg) in conjunction with PVR ≥ 3 WU defines a high-risk subgroup for poor post-transplant outcomes.

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ABSTRACT #41 CLINICAL RESEARCH CARDIOVASCULAR DISEASE INCREASED RATES OF CARDIOVERSION AND ABLATION IN PATIENTS WITH ATRIAL FIBRILLATION AND SLEEP APNEA COMPARED TO PATIENTS WITH ATRIAL FIBRILLATION ALONE: A NATIONWIDE STUDY Alba Munoz Estrella1, Faris Haddadin1, Dhrubajyoti Bandyopadhyay1, Hassan Beydoun1, Vivek Modi1, Eyal Herzog1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; New Orleans, Louisiana, United States held on March 16-18, 2019.

BACKGROUND/INTRODUCTION: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias associated with increased morbidity and mortality. It is associated with structural heart disease, hypertension, diabetes and sleep apnea (SA). The relation between AF and sleep apnea has been well documented. We aim to determine the impact of SA on the outcomes of AF. The end-points include: all-cause mortality, rate of radiofrequency ablation (RFA), rate of direct current cardioversion (DCCV), hospital length of stay (LOS), and total hospital charge (THC).

METHODS: This is a retrospective cohort study using the 2016 National Inpatient Sample (NIS) of adults (>18 years) hospitalized for AF as the admitting diagnosis and SA as a secondary diagnosis based on ICD-10 codes.

Rates of DCCV and RFA were the primary outcomes, while mortality, LOS, THC, history of heart failure and thromboembolic events (stroke and TIA) were our secondary outcomes. Multivariate linear regression adjustment for confounders of age, gender, race, socioeconomic status, hospital region, size, teaching status and Charlson index. STATA 15 was used for data analysis.

RESULTS: 243,594 patients were admitted with AF in 2016, of which 41,769 had sleep apnea (17%). Mean age was 65 for those with AF and SA, compared to 72 for AF alone. On multivariate linear regression the group of AF with concomitant SA had increased rates of DCCV (OR: 1.51, 95%-CI 1.42-1.60; p=0.001) and RFA (OR: 1.71, 95%-CI 1.54-1.90; p=0.001). In terms of secondary outcomes, the group with concomitant SA showed to have increased THC (coef: 3,952, 95%-CI 2,384-5,519; p=0.001) and history of heart failure (OR: 1.32, 95%-CI 1.24-1.39; p=0.001). On the other hand, all-cause mortality (OR: 0.69, 95%- CI 0.51-0.94; p=0.001), and AF complications, such as history of stroke (OR: 0.47, 95%-CI 0.30-0.74; p 0.001) or TIA (OR: 1.05, 95%-CI 0.771.43; p<0.756) were not increased in frequency, the same for LOS (coef 0.01, 95%-CI -0.07-0.09; p=0.808).

CONCLUSION: Patients admitted with AF and concomitant history of SA had higher rates of DCCV and RFA, which could be a consequence of a disease more resistant to medical management. Higher rates of procedures could be the reason for higher total hospital charges on these patients. Younger patients were admitted for AF when SA was a secondary diagnosis when compared to AF alone. More resistant disease may lead to increased history of complications, such as heart failure, without affecting all-cause mortality.

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ABSTRACT #42 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY CHECKPOINT INHIBITORS: WHEN T- CELLS ATTACK Shane Murray1, Varun Bhalla2, Ana B Arevalo1, Gustavo Contreras1, Seema Malkana2, Emilie Chan2, Margrit Wiesendanger2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the 10th Annual Graduate Medical Education (GME) Research day at the Icahn School of Medicine; New York, New York, United States held on June 7th, 2019.

BACKGROUND/INTRODUCTION: Immune checkpoint inhibitors (ICI’s) have transformed the therapeutic landscape in cancer immunotherapy. Several agents are now available which target key negative regulators of immune activation, such as programmed cell death protein 1 (PD 1). Immune checkpoints also have an important role in immune self-tolerance and in the pathophysiology of autoimmune disease (AD). ICI’s can lead to aberrant activation of the immune system against self-antigens producing inflammatory side effects known as immune related adverse effects irAE’s). These irAE’s resemble autoimmune diseases at a molecular, histopathologic and clinical level. ICI’s are increasingly associated with flares of underlying autoimmune diseases and de novo inflammation in patients prone to autoimmunity.

CASE PRESENTATION: 70 year-old male with a past medical history of asthma, metastatic PDL 1 positive esophageal adenocarcinoma, eosinophilic granulomatosis with polyangiitis (EGPA) who presented with chief complaint of poor oral intake and left foot drop. Past Medical History: Diagnosed with EGPA several years ago with nasal polyps, bilateral leg purpura, reduced sensation in right hand and left foot drop. S/p treatment with pulse dose steroids and cyclophosphamide with successful remission. Maintained on azathioprine for maintenance therapy until about 1 year ago, when chemotherapy was initiated for his esophageal cancer. About 2 months prior to his hospitalization, the patient was advanced to monthly pembrolizumab infusions. History of Present Illness: About 1 month prior to admission, he developed a loss of sensation in his left foot with pruritus, and was discovered to have significant eosinophilia, suggestive of a possible EGPA flare. Physical exam: Left foot drop and decreased sensation in the distribution of the superficial femoral nerve. Laboratory studies: mild normocytic workup with additional neuropathy workup unremarkable. Hospital Course: He was given pulse dose steroids for presumed EGPA. His symptoms and examination showed signs of mild improvement over the following days with increased sensation. Unfortunately, the patient ultimately died while hospitalized secondary to complications of a hospital acquired pneumonia.

DISCUSSION: Anti PD-1 antibodies are now approved for patients with several cancers. The treatments have favorable toxicity profiles, however irAE’s can occur and can be severe. Trials with ICI’s to date have excluded patients with pre-existing AD and currently little data exists regarding safety and efficacy of anti-PD-1 antibodies in patients with pre-existing AD. To our knowledge this is the first documented case of an EGPA flare in the setting of ICI use. While discontinuance of maintenance azathioprine may have contributed to his flare, the patient had been off the medication for one year. The timing of his presentation to Pembrolizumab initiation suggests to us it was the more likely culprit.

CONCLUSION: ICI’s are can trigger autoimmune disease flares through aberrant activation of the immune system. Uncertainty exists over the safety of ICI’s in patients with AD. Further research is needed to understand the true significance of IrAE’s in patient with underlying AD.

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ABSTRACT #43 CLINICAL RESEARCH CARDIOVASCULAR DISEASE RIGHT VENTRICULAR GLOBAL LONGITUDINAL STRAIN PREDICTS CARDIOVASCULAR MORTALITY AND HEART FAILURE HOSPITALIZATION IN PATIENTS WITH FUNCTIONAL TRICUSPID REGURGITATION Roberto Carlos Ochoa Jimenez1, Andrada Camelia Guta2,3, Marcc Previtero2, Chiara Palermo2, Patrizia Aruta2, Luigi P, Badano2, Denisa Muraru2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; University of Padova, Padua, Italy; 3Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

2

Presented at the European Society of Cardiology (ESC) Annual Meeting; Paris, France held on August 31, 2019 to September 3, 2019.

BACKGROUND/INTRODUCTION: Functional tricuspid regurgitation (FTR) and its increasing severity are wellknown factors associated with increased morbidity and mortality in patients with pulmonary artery hypertension or left heart diseases. To assess the main clinical and echocardiographic determinants of outcome in patients with various causes of FTR. METHODS: A total of 140 patients (pts) (72±14 years, 40% men) with FTR of diverse etiologies underwent complete 2D and additional 3D echocardiography acquisitions and were followed for a median of 5.2 years (interquartile range 2.1 - 6.7 years). Severe FTR was defined by ≥2 parameters: (1) coaptation defect; (2) vena contract ≥7; (3) PISA radius >9 mm; (4) hepatic vein systolic flow reversal. The primary composite outcome was defined as death from cardiovascular causes and hospitalization due to right-sided heart failure (HF).

RESULTS: 74 pts (53%) developed the primary composite outcome. Death occurred in 31 pts (22%), while hospitalization due to right-sided HF occurred in 66 pts (47%). At baseline, patients who developed the primary composite outcome, compared to those who did not, had more symptoms, more severe FTR, higher pulmonary systolic pressure (60±27 vs 43±16 mmHg), larger right atrium (69±34 vs 51±22 mL/mm2), right ventricular (RV) basal diameter (29±6 vs 24±4 mm/m2), larger RV end-diastolic (102±45 vs 76±25 mL/m2) and end-systolic (62±37 vs 43±17 mL/m2) volumes, larger tricuspid annulus area (7.7±1.8 vs 6.8±1.8 cm2/m2), lower RV systolic function (RVEF [42±11 vs 46±8%], TAPSE [18±4 vs 21±4], S' [11±3 vs 12±2], RV global longitudinal strain (RVGLS) [16±5 vs 19±4], RV free wall longitudinal strain [19±7 vs 23.5]); all p-values <0.03. There were no significant differences in age, body size or comorbidities. After multivariable Cox regression analysis, FTR grade severity [hazard ratio (HR)=2.95, 95% confidence interval (CI) 2.14–4.06, p<0.001] and RVGLS (HR= 0.91, 95% CI 0.86–0.95) were the only independent predictors of mortality. A cutoff of −17.5 for RVGLS had 57% sensitivity, 73% specificity and a HR of 2.34 (95% CI of 1.42–3.88, p=0.001). The Kaplan Meier survival curve showed that patients with an RVGLS ≥−17.5 had a higher probability of developing the primary composite outcome, especially at an earlier phase of the follow up when compared to those with higher LS (log rank test chi-square=13.0, p<0.001) (Figure). At the end of follow up, 60% of patients with a RVGLS ≥-17.5 did not developed the primary composite outcome vs 29% in the group with a LS lower than −17.5.

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Kaplan-Meier curve of outcome by RVGLS

CONCLUSION: In patients with FTR, a decreased RVGLS, with a cutoff of â&#x2C6;&#x2019;17.5, proved to be an independent prognostic factor for the development of HF hospitalizations and death from cardiovascular causes.

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ABSTRACT #44 CLINICAL RESEARCH INFECTIOUS DISEASE DEVELOPMENT OF A LINEAR MIXED-EFFECT PHARMACODYNAMIC MODEL TO QUANTIFY THE EFFECTS OF FREQUENTLY PRESCRIBED ANTIMICROBIALS ON QT INTERVAL PROLONGATION IN HOSPITALIZED PATIENTS Andras Farkas1, Krystina L. Woods1, Francesco Ciummo2, Ami Shah1, Joseph Sassine1, Christian Olivo Freites1, Gergely Daraczi3, Arsheena Yassin1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Long Island University Pharmacy, Hackensack, NJ, United States; 3Optimum Dosing Strategies, Budapest, Hungary

2

Presented at the Infectious Diseases Society of America (IDSA) Annual Meeting; Washington, DC, United States held on October 2-6, 2019.

BACKGROUND/INTRODUCTION: Torsades de pointes is a life-threatening ventricular tachycardia associated with prolongation of the QT interval. Many diseases and medications have been implicated as potentially prolonging the QT interval, but little data exists regarding the means of quantifying this risk. The aim of this study was to describe the impact of commonly used antimicrobials on the QT interval in hospitalized patients.

METHODS: Demographic, diseases, laboratory, medication administration history and ECG recording data were collected from the electronic records of adult patients admitted, from July 2018 to December 2018, to two urban hospitals. A model for the QT interval comprised of four sub-models: gender, heart rate, circadian rhythm, and the drug and disease effects. Fixed and random effects with between occasion variability were estimated for the parameters. A Bayesian approach using the NUTS in STAN was used via the brms package in the RÂŽ software.

RESULTS: Data from 1,353 patients were used with baseline characteristics shown in Table 1. Observed vs. predicted plots based on the training (Figure 1A) and validation data set (Figure 1B) showed a great fit. The parameters for QTc0, Îą, gender, and circadian rhythm were accurately identified (Table 2). Similarly, the model correctly described the expected impact of acute or chronic diseases on the QT interval. Uncertainty interval estimates (Figure 2) show that patients treated with fluconazole and levofloxacin are likely to present with a QT interval [mean (95% CI) of 6.84 (0.22, 21.45) and 5.05 (0.15, 16.70), respectively], that is > 5 ms longer vs. no treatment, the minimum cutoff that should evoke further risk assessment of QT interval prolongation.

CONCLUSION: The model developed correctly describes the impact baseline risk factors have on the QT interval. Point estimates of QT interval prolongation show that patients treated with fluconazole and levofloxacin may be at considerable risk; while those treated with azithromycin or ciprofloxacin are more likely to be at an insignificant risk for QT interval prolongation during hospital admission. Further workup to quantify the impact of concomitant treatment with these and other at-risk medications is underway.

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ABSTRACT #45 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW ENDOCRINOLOGY PERSONALIZED MANAGEMENT OF THYROID STORM PRECIPITATED BY COCAINE ABUSE Elizabeth Jasola Omoniyi1, Tai Ho Shin1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Association of Clinical Endocrinologists Annual Meeting; Los Angeles, California, United States held on April 24-28, 2019 BACKGROUND/INTRODUCTION: Thyroid storm is a rare, but life-threatening condition often precipitated by poorly controlled hyperthyroid disease, thyroid surgery, infection, trauma or acute load of iodine.

CASE PRESENTATION: A 27-year-old man visiting from Ireland with a past medical history of poorly controlled Graves' disease for past 5 years presented to ED with altered mental status, fever and new onset atrial fibrillation with tachycardia to 180 beats per minute. Physical exam was significant for obtundation, bilateral exophthalmos and lid lag. Burch-Wartofsky Score was 90, highly suggestive of thyroid storm. Labs revealed undetectable level of Thyroid Stimulating Hormone (TSH) and markedly elevated thyroid hormones including total and free T3 and T4. Additionally, antibody panels including Thyroid Stimulating Immunoglobulin, Thyroperoxidase and TSH Receptor antibodies were all overtly positive. Notably urine toxicology was positive for cocaine. Patient was intubated for airway protection and transferred to the ICU. He was started on propylthiouracil, later switched to methimazole, stress doses of hydrocortisone and potassium iodine solution. Calcium channel blocker was used for rate control in setting of cocaine intoxication, and was later transitioned to propanolol. Methimazole was titrated down as his thyroid function tests and symptoms improved throughout his hospital course.

CONCLUSION: While thyroid storm is a rare disease with very high mortality rate even with or without the treatment, scarce reports have shown thyroid storm triggered by cocaine abuse. Prompt recognition and prioritizing personalized management is necessary for treating this disease.

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ABSTRACT #46 CLINICAL RESEARCH CARDIOVASCULAR DISEASE IN-HOSPITAL MORTALITY IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT IN RELATION TO THE PRESENCE OF HEART FAILURE IN THE UNITED STATES: AN ANALYSIS OF THE NATIONAL INPATIENT SAMPLE Hardikkumar Patel1, Kevin Buda2, Rutu Patel3 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Hennepin County Medical Center, Minneapolis, MN, United States; 3AMC MET Medical College, Ahmedabad, India

2

Presented at the Heart Failure Society of America Annual Meeting; Philadelphia, Pennsylvania, United States on September 13-16, 2019.

BACKGROUND/INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is an increasingly common method of valve replacement in patients that are not candidates for open heart surgery. As TAVR is reserved for patients with intermediate risk, most patients who undergo TAVR are older. Although comorbid conditions are often present in these patients, there is a dearth of national studies evaluating outcomes in the presence of heart failure. We investigate whether the presence of heart failure impacts hospital utilization and mortality.

METHODS: The 2016 National Inpatient Sample (NIS) was used to find all patients that underwent TAVR in 2016, comparing those with to those without heart failure (based on ICD-10- CM Codes). The codes for chronic systolic and diastolic heart failure were used, in addition to the code for combined systolic and diastolic heart failure to create a subgroup of heart failure patients. The codes for percutaneous endoscopic aortic valve replacement and other non-chronic forms of heart failure were excluded. STATA Version 15.1 (College Station, TX) was used for statistical analysis. Multivariate regression was used to calculate weighted nationwide estimates of hospital mortality, length of stay, and total charge. We adjusted for patient (age, sex, ethnicity, and Charlson Comorbidity Index), socioeconomic (median household income, insurance provider), and hospital factors (hospital bed size, region, teaching status, day and month of admission).

RESULTS: A total of 40,005 patients who underwent TAVR in 2016 were identified. Of those, 12,080 had chronic heart failure. There was a significantly decreased length of stay (coefficient - 1.97, p=0.000), total hospital cost (coefficient= -20685.16, p=0.000), and mortality (OR: 0.453, p=0.001) in patients with heart failure undergoing TAVR when compared to those without (Table 1).

CONCLUSION: Our study was the first to show decreased total hospital cost, length of stay, and in-hospital mortality among heart failure patients undergoing TAVR compared to those without heart failure. Further studies are required to elucidate the etiology of this difference.

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ABSTRACT #47 CLINICAL RESEARCH INFECTIOUS DISEASE/HEMATOLOGY/ONCOLOGY IMPACT OF CLOSTRIDIUM DIFFICILE INFECTION ON GASTROINTESTINAL MALIGNANCIES Stuthi Perimbeti1, Rishi Shrivastav1, Prateeth Pati2, Kristine Marie Ward3, Michael Styler3, Maneesh Rajiv Jain3, Neilanjan Nandi3 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; University of Pittsburgh Medical Center, Pittsburgh, PA, United States; 3Drexel University College of Medicine, Philadelphia, PA, United States

2

Presented at the Gastrointestinal Cancers Symposium (GI ASCO); San Francisco, California, United States held on January 17-19, 2019 BACKGROUND/INTRODUCTION: According to the Centers for Disease Control and Prevention, there were half a million documented cases with 83,000 re-infections and 29,000 deaths due to Clostridium Difficile Infection (CDI) in the year 2011. The influence of CDI on outcomes in gastrointestinal (GI) malignancies is not well described, although the incidence is known to be higher in this subgroup of patients.

METHODS: National Inpatient Sample 1999-2014 was analyzed to identify adult admissions (>18 years of age) using ICD-9-CM codes with a primary diagnosis of esophageal (EC), Gastric (GC), Colorectal (CRC), Small intestinal (SIC), Hepatobiliary (HCC) and Pancreatic (PC) cancers. ICD-9 code 00845 was used to stratify these for the presence of CDI. We performed Chi-Square test to determine the in-hospital mortality percentage, and Cox Proportional Hazard model to control for confounders and determine the Hazard Ratio (HR) of death within 30 days of admission during hospitalization in patients with and without CDI. RESULTS: No significant difference was found in the median age for the onset of CDI among various GI cancers.

Except small intestinal malignancies, mortality was significantly higher in patients with CDI and all other types of GI malignancies: Esophageal (19.5% vs 11%), gastric (12% vs 9%), colorectal (9% vs 4%), hepatocellular (17% vs 14%), and pancreatic (13.9% vs 11.6 %). After controlling for various confounders and medical comorbidities, the hazard of mortality was significantly higher in patients with esophageal (62%), gastric (86%), colorectal (43%), hepatocellular (79%) and pancreatic (83%) in patients with CDI compared to those without CDI. CONCLUSION: Despite controlling for potential confounders, patients with GI cancers and CDI are at an increased risk of death compared to those without CDI. Taking the more detrimental effects of CDI in this subgroup of patients into consideration, healthcare professionals should strive to avoid the inordinate use of antibiotics and strictly maintain current guidelines designed to prevent spread. It may be prudent to treat these patients as severe CDI, even if current criteria are not met. More scientific research is warranted in analyzing the specific outcomes of CDI in GI cancer patients and if more aggressive therapy for CDI is warranted, considering the limitations of this study.

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ABSTRACT #48 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY SICKLE CELL DISEASE AND VENOUS THROMBOEMBOLISM: HOSPITAL MORTALITY, LENGTH OF STAY AND COST Michael Rainone1, Stuthi Pavani Perimbeti1, Rishi Shrivastav1, Jeffrey A. Glassberg1, Lawrence Cytryn1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting; Orlando, Florida, United States held on December 7-10, 2019 BACKGROUND/INTRODUCTION: It is estimated that there are 100,000 Americans living with Sickle Cell Disease (SCD). Patients with SCD experience a number of complications that frequently require hospitalization.

SCD is a prothrombotic state that is commonly complicated by venous thromboembolism (VTE) and recurrent VTE. The National Heart, Lung and Blood Institute does not include VTE as one of the complications of SCD in their latest guidelines, and the topics of prophylaxis and treatment of VTE in SCD are not discussed. There are no guidelines specifically designed for the prophylaxis or treatment of VTE in the SCD population, and traditionally management guidelines for VTE in the general population are followed. Recent information on national prevalence, mortality, length of stay, and cost for hospitalized patients with SCD complicated by VTE is limited.

METHODS: We used data from the Healthcare Cost and Utilization Project's National Inpatient Sample (NIS) from 1999-2014 to examine these variables. The data on SCD from 1999-2014 was analyzed using ICD-9-CM codes for SCD (ICD-9-CM: 282.41, 282.42, 282.6, 282.60, 282.62, 282.63, 282.64, 282.68, 282.69) in the primary diagnosis field, and VTE (ICD-9-CM: 453.40, 453.41, 453.42, 453.82, 453.83, 415.11, 415.19) in the secondary diagnosis field which includes codes for venous thrombosis and pulmonary embolism. Univariate and bivariate statistical analysis was performed using the chi-square test. Multivariate analysis was performed using cox proportional hazard regression. The alpha was set at 0.05.

RESULTS: Over a 15-year period, from 1999-2014, a total of 217,791 (weighted N = 1,073,215) admissions with SCD were identified. A total of 7,898 admissions were associated with VTE. Mean age at admission of those with VTE was 27.42 (+/- 0.05) years and those without VTE was 34.00 (+/- 0.51) years. In patients with SCD and VTE, the average inpatient mortality was 3.08% (p < 0.0001) versus mortality of 0.27% in patients that did not have VTE. The hazard ratio for mortality was 4.18 (CI: 2.95-5.93) (p < 0.0001). Length of stay in the SCD with VTE group was 10.45 days (+/- 0.43) versus 5.09 days (+/- 0.02) (p <0.0001) in SCD without VTE. Overall hospital cost was higher in those with VTE at $60,055 (+/- $1,940) versus $28,729 (+/- 232.97) (p < 0.0001) in those without VTE. CONCLUSION: Patients with SCD and VTE experience significant morbidity, mortality, prolonged hospitalization and increased cost associated with this complication of the disease as was observed in this study. Furthermore, patients who experience VTE are significantly younger than those who do not, with mean age of 27 versus 34.

After controlling for multiple confounders like age, race, sex, income, comorbidities, the presence of VTE is associated with a significantly higher risk of mortality in SCD. Currently, there are no prophylaxis or treatment guidelines designed specifically for patients with SCD and VTE. We recommend the use of antithrombotic prophylaxis or therapy in patients with SCD be evaluated in prospective studies.

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ABSTRACT #49 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY PEGASPARGASE CAN SAFELY BE ADMINISTERED IN ADULTS AGE 40 AND OLDER WITH ACUTE LYMPHOBLASTIC LEUKEMIA Ryan J. Daley1, Sridevi Rajeeve2, Charlene C. Kabel1, Jeremy J. Pappacena3, Sarah E. Stump1, Jessica A. Lavery1, Martin S. Tallman1, Mark B. Geyer1, Jae H. Park1 1

Memorial Sloan Kettering Cancer Center, New York, NY, United States; 2Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Allegheny Health Network, Pittsburg, PA, United States

Presented at the American Society of Hematology (ASH) Annual Meeting; Orlando, Florida, United States held on December 7-10, 2019 BACKGROUND/INTRODUCTION: Asparaginase (ASP) has demonstrated a survival benefit in pediatric patients (pts) with acute lymphoblastic leukemia (ALL) and is now part of standard-of-care frontline treatment.

As a result, asparaginase preparations have been incorporated into the treatment of adult ALL to improve outcomes. Pegaspargase (PEG-ASP), a modified version of asparaginase with prolonged asparagine depletion, appears to be safe in adults up to age 40, but is associated with a unique spectrum of toxicities, the risks of which appear to increase with age. Therefore, the safety of PEG-ASP remains a significant concern in older adults with ALL. METHODS: We conducted a single center retrospective chart review of pts age ≥40 years who received PEGASP as part of frontline induction/consolidation or reinduction, between 3/2008 and 6/2018 at Memorial Sloan Kettering Cancer Center. The primary objective was to evaluate the tolerability and toxicity of PEG-ASP based on the incidence and severity of ASP- related toxicities (hypersensitivity reactions, hypertriglyceridemia, hyperbilirubinemia, transaminitis, pancreatitis, hypofibrinogenemia, etc) according to the Common Terminology Criteria for Adverse Events, version 4.03. Laboratory values recorded were either the peak or the nadir, the more appropriate for toxicity assessment, within a 4-week period following PEG-ASP administration. Secondary objectives were to determine the total number of doses of PEG-ASP administered in comparison to the number of doses intended, and to characterize the rationale for PEG-ASP discontinuation when applicable. Fisher's exact test was used to compare the incidence of PEG-ASP toxicities with respect to patient and treatment characteristics (regimen, age, BMI, gender, Philadelphia chromosome positive (Ph+) vs. negative (Ph-), presence of extramedullary disease, PEG-ASP dose). P-values were not adjusted for multiple comparisons.

RESULTS: We identified 60 pts with ALL (40 B-ALL and 20 T-ALL) who received at least one dose of PEG-ASP. Nine pts were Ph+. The median patient age at initiation of the treatment was 53 years, (range, 40 to 80 years), and 19 patients had a BMI ≥30 kg/m2. Forty-four patients received treatment for newly diagnosed ALL, and 16 patients for relapsed disease. Among the 44 patients with newly diagnosed ALL, 27 patients received PEG-ASP as part of pediatric or pediatric-inspired regimens at doses of 2000 - 2500 units/m2, and 1 patient received a modified dose of 1000 units/m2 due to age. The remaining 16 patients received PEG-ASP at doses of 1000 2000 units/m2 for consolidation, per established adult regimens (ALL-2 and L-20). Grade 3/4 ASP-related toxicities with a >10% incidence included: hyperbilirubinemia, transaminitis, hypoalbuminemia, hyperglycemia, hypofibrinogenemia, and hypertriglyceridemia. Frontline treatment regimens in which PEG-ASP was used in consolidation cycles only (ALL-2, L-20) were associated w/ a lower incidence of hyperbilirubinemia (p=0.009) and hypertriglyceridemia (p<0.001) compared to those regimens that included PEG-ASP during induction (pediatric/pediatric-inspired regimens) (Table 2). Younger age (40-59 vs. ≥60 years) was associated with a greater risk of hypertriglyceridemia (p<0.001) and higher PEG-ASP dose (≥2000 vs. <2000 units/m2) was associated with a greater risk of hypertriglyceridemia and hypofibrinogenemia (p=0.002 and p=0.025, respectively). Thirty-eight patients (63%) received all intended doses of PEG-ASP. Six patients stopped PEGASP to proceed to allogeneic hematopoietic stem cell transplantation (5 in CR1, 1 in CR2), and 7 patients stopped for hypersensitivity reactions. Hepatotoxicity was the only ASP-related toxicity that led to PEG-ASP 77

discontinuation occurring in 5 patients (hyperbilirubinemia, N=4; transaminitis, N=1). The total number of intended doses of PEG-ASP based on regimens used was 186, and 112 were administered.

CONCLUSION: PEG-ASP was incorporated into the treatment of 60 adult ALL patients age â&#x2030;Ľ40 years, with manageable toxicity. Seven patients discontinued PEG-ASP due to hypersensitivity reactions and 5 discontinued due to hepatotoxicity, but other reported toxicities did not lead to PEG-ASP discontinuation and the majority of the patients completed all intended doses of PEG- ASP. This study suggests that with careful monitoring, PEGASP can safely be administered in adults â&#x2030;Ľ40 years of age.

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ABSTRACT #50 QUALITY IMPROVEMENT CARDIOVASCULAR DISEASE IMPACT OF SOCIO-DEMOGRAPHIC FACTORS ON A 30-DAY READMISSION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION Wojciech Rzechorzek1, Basera Sabharwal1, Faris Haddadin1, David Weininger1, Bing Yue1, Mariam Khandaker1, Alba Munoz1, Shawn Lee1, Syed Ahsan1, Alejandro Lemor1, Allison Selby1, Jacqueline TamisHolland1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association Quality of Care and Outcomes Research Annual Meeting; Arlington, Virginia, United States held on April 5-6, 2019.

BACKGROUND/INTRODUCTION: A significant number of patients with acute myocardial infarction (AMI) are readmitted within 30 days of discharge from the hospital (30-Re-admit). This substantially impacts healthcare costs. The available risk scores for 30-Re-admit are not specific for an AMI diagnosis and few incorporate sociodemographic variables. We investigated the impact of socio-demographic factors on 30-Re-admit.

METHODS: We analyzed adult patients enrolled in a Quality Improvement Program (QIP) aimed to improve the post discharge care of patients with an AMI. Patients discharged to subacute rehab, or discharged prior to enrollment were excluded. The QIP included 30-minute counseling on care after an AMI, an educational pamphlet, 48-hour phone call, and mandatory 1-2-week post discharge office appointment. We examined the univariate predictors of 30-Readmit including demographic, clinical and psychosocial variables related to education, employment, language, and support at home. Variables with p<0.2, were included in the multivariate logistic regression model.

RESULTS: Among 173 patients enrolled in our QIP, (Age 65 Âą 0.9 years; female 31%), 21 (12%) had 30-Readmit. The univariate predictors of 30-Re-admit are included in the table (refer to poster). Being married, or having a domestic partner was associated with an 80% lower chance of 30-Re-admit, and was the only independent predictor of 30-Re-admit, while a high hospital risk score was associated with an over 7-fold higher 30-Re-admit.

CONCLUSION: Married patients or those living with a domestic partner are less likely to be re-admitted after an AMI. Given this information, it is possible that providing a stronger support network for those patients without a spouse/partner may improve 30-Re-admit.

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ABSTRACT #51 MEDICAL EDUCATION PULMONARY/CRITICAL CARE A SIMULATION-BASED MECHANICAL VENTILATION CURRICULUM FOR MULTILEVEL LEARNERS IN AN INTERNAL MEDICINE RESIDENCY PROGRAM – A PILOT STUDY Bertin D. Salguero1, Joseph P. Mathew1, Priscilla Loanzon1, James S. Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Accepted to the 17th Annual Education Research Day, Institute for Medical Education (IME) at the Icahn School of Medicine; New York, NY, United States that was scheduled to be held on April 21, 2020.

BACKGROUND/INTRODUCTION: There exists a lack of a validated curriculum and adequate education in mechanical ventilation (MV) among Internal Medicine (IM) Residency Programs. Current education is limited to informal teachings by the critical care physicians during intensive care unit (ICU) rotations. Additionally, it is a challenge to incorporate hands-on training for multilevel learners that vary in their clinical experience and learning needs. This study aimed to evaluate a novel, multilevel learners simulation-based mechanical ventilation course for IM residents.

METHODS: The project aimed to evaluate the effectiveness of a multilevel learners’ MV curriculum for IM residents in improving their comfort level and knowledge. The MV curriculum was developed from a needs assessment survey of the IM residents and faculty consensus using a modified Delphi technique. The final education curriculum was composed of three parts 1) didactic lecture on MV concepts, 2) supervised hands-on training with the ventilator 3) targeted case-based simulation for each level of learners: alarm interpretation for PGY 1, ventilator manipulation for PGY 2, and advanced MV concepts for PGY 3. The evaluation method had a two-fold purpose: 1) to measure the application of knowledge for each level of learners utilizing multiple-choice questionnaires, pre, and post-training, and 2) to determine the statistical difference between pre- and post-MV training comfort level through a questionnaire using a Likert-like scale (0 = very poor and 10 = very good). All questionnaires were administered immediately before and after training.

RESULTS: A total of 79 residents participated in the study: PGY1 26 (33%), PGY2 27 (34%) and PGY3 26 (33%). 100% of the participating residents completed the surveys, of which only 7 (9%) had completed an IM residency in the past. The survey questionnaire evaluated the residents’ comfort level (attitude) and knowledge (cognitive). Components of the comfort level included (1) ordering basic parameters of ventilation improved from 5/10 to 7/10, (2) troubleshooting common ventilator alarms increased from 4/10 to 6/10 and (3) recognizing emergency situations improved from 4/10 to 6/10. In the knowledge section, increase in the correct answers was the primary metric. A mean increase of 27% was noted between pre- and post-training scores across all learners.

The PGY 1 scores increased from 69% to 97.5%, while PGY 2 improved from 56% to 86% and PGY 3 from 49% to 86%.

CONCLUSION: A multilevel learners’ simulation-based MV curriculum provides IM residents with hands-on learning experience that can improve their comfort level in troubleshooting clinically relevant MV issues while also improving their knowledge of complex MV concepts. A multilevel learner- centered approach can provide meaningful education for IM learners with varying levels of knowledge and experience.

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ABSTRACT #52 CLINICAL VIGINETTE/CASE REPORT/CLINICAL REVIEW PULMONARY/CRITICAL CARE ETHICO-LEGAL CHALLENGES OF DRUG PACKING – A CASE REPORT Elijah Verheyen1, Tal Shachi1, Karan Sud1, Bashar Mourad1, Paru Patrawalla1 1

Mount Sinai Morningside-West Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in the American Journal of Medicine. 2018: 131(8): E321-E322. PMID: 29654719

INTRODUCTION: Body-packers who swallow or insert packets of illicit drugs into body cavities are at risk for acute toxicity and gastrointestinal obstruction. We present a case of body-packing that exposed the challenging ethical and legal aspects of care. We bring them to the forefront of discussion because there are no specific guidelines for handling these complex situations.

CASE DESCRIPTION: A 50-year-old woman visiting from Colombia with history of hypothyroidism presented with syncope. She was hemodynamically stable but obtunded with pinpoint pupils, hypopneic and in hypoxic respiratory failure that improved with Narcan. Physical examination was otherwise unremarkable. She required intubation for airway protection in the setting of altered mental status of unclear etiology and required no additional sedation. Her urine drug screen was positive for opiates, yet the patient and her husband denied opiate use. She was placed on continuous Narcan infusion and an orogastric tube needed to be placed for initiation of feedings. Attempts to irrigate the orogastric tube were unsuccessful despite confirmation of placement. Follow-up abdominal radiography revealed gastric and pan-colonic foreign bodies. Subsequent abdominal and pelvic CT confirmed high-attenuation foreign bodies throughout the gastrointestinal tract, consistent with drug-filled packets. Diagnosis of opiate overdose in the setting of ruptured heroin packets was made. Surgical and gastrointestinal consultants recommended conservative medical management. Ultimately the drug packets were expelled with an aggressive bowel regimen. The patient made a stable recovery.

DISCUSSION: Without prior experience or specific hospital policy in place, the team was forced to confront unprecedented ethico-legal aspects of care. We struggled to find a way to maintain a viable doctor–patient relationship that would allow for care without bias, a way to uphold patient confidentiality, and a way to cooperate with law enforcement and their investigation. In our case, social work, case management, hospital security, and hospital administration were alerted. Hospital administration worked with local law enforcement to address any legal aspects of the case, and the patient care team maintained their primary responsibility to the patient’s health. We propose a need to establish hospital-based guidelines to assist healthcare professionals better navigate the care of patients in these situations.

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ABSTRACT #53 CLINICAL RESEARCH CARDIOVASCULAR DISEASE SEPTAL ALCOHOL ABLATION VERSUS MYECTOMY FOR HYPERTROPHIC CARDIOMYOPATHY: NATIONAL DATABASE ANALYSIS OF INITIAL ENCOUNTER AND 90 DAYS READMISSION Ruchit Shah1, Xin Wei1, Bing Yue1, Karan Sud1, Swiri Konje1, Joseph A. Puma1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting; Chicago, Illinois, United States held on November 10-12, 2019.

BACKGROUND/INTRODUCTION: Septal myectomy (SM) is the guideline recommended therapy for hypertrophic cardiomyopathy (HCM), while septal alcohol ablation (SA) emerge as an attractive alternative, there has yet been a large database review comparing the two methods.

METHODS: This retrospective cohort study used the 2014 Nationwide Readmissions Database (NRD) of adult patients undergoing SM or SA. Patients are identified using ICD-9 codes.

RESULTS: Compared with previous publication, exponential growth in SA is observed, leading to an increased proportion of SA in the total septal reduction pool. Demographic review found SA patients had a shorter length of stay, lower cost and in-patient mortality rate. SA had lower 90-day readmission rate than SM. Furthermore, we looked into mitral valve disease and complete bundle branch block requiring pacemaker. There is a significantly higher rate of MV repair or replacement with SM, while only 0.52% of patients in SA group required MVR. It shows that clinicians are being vigilant recognizing MR disease that need concurrent treatment. While PPM requirement has been reported as the Achillesâ&#x20AC;&#x2122;s heel of SA, our study did not reveal a significantly higher rate of PPM requirement in either initial encounter or readmission. However, upon reviewing the top 10 common readmission diagnosis for both group, arrhythmia appears more frequently in SA group.

CONCLUSION: SA is superior to SM in mortality rate. SA is non-inferior to SM in readmission rate.

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ABSTRACT #54 CLINICAL RESEARCH CARDIOVASCULAR DISEASE RIGHT BUNDLE BRANCH BLOCK (RBBB) IS ASSOCIATED WITH POOR PROGNOSIS IN PATIENT WITH ANTERIOR WALL ST ELEVATION MYOCARDIAL INFARCTION (AW-STEMI): A NATIONWIDE STUDY USING THE NATIONAL INPATIENT SAMPLE (NIS) 1999- 2014 Rishi Shrivastav1, Prateeth Pati2, Stuthi Perimbeti1, Jacqueline Tamis-Holland1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; University of Pittsburgh Medical Center, Pittsburgh, PA, United States

2

Presented at the American Heart Association (AHA) Annual Meeting; Chicago, Illinois, United States held on November 10-12, 2019.

BACKGROUND/INTRODUCTION: Blood supply to the right bundle comes from the left coronary circulation, which also supplies other major dominant areas of the myocardium. Intuitively, RBBB in the setting of AW-STEMI would indicate more extensive myocardial involvement and thus portend a worse prognosis. Limited previous studies on RBBB in AW-STEMI have demonstrated adverse outcomes, however large-scale observational studies are still lacking. We hypothesized that as compared to patients without RBBB, the presence of RBBB in patients with AW-STEMI would be associated with increased morbidity and mortality.

METHODS: The NIS was analyzed to identify adult admissions (>18 years of age) with a primary diagnosis of AW-STEMI (ICD-9 codes 410.0 and 410.1) between 1999 and 2014 (N=219,302 weighted N=1,075,874). Using ICD-9 code 426.4, these admissions were further stratified for RBBB. Using Chi-Square test, we performed bivariate analysis to determine in-hospital mortality across various categorical variables. Multivariate analysis using Cox Proportional Hazard regression was then performed to control for confounders and determine the hazard of acute heart failure (428.21 and 428.23), complete heart block (426.0), implantation of a permanent pacemaker (37.71, 37.81, 37.82, 37.83 and 00.51) and in-hospital mortality for patients with AW-STEMI and RBBB as compared to patients with AW-STEMI and no RBBB. RESULTS: Out of the 1,075,874 admissions with primary diagnosis of AW-STEMI, about 1.78% (19,153) had RBBB. The mean age of patients with and without RBBB was 69.49 years and 68.46 years (p<0.001) respectively. As compared to patients with AW-STEMI and no RBBB, mortality was significant higher for patients with AW-STEMI and RBBB [9.19% (97,138) vs 15.30% (2930); p<0.0001]. After adjustment, RBBB in the setting of AW-STEMI was associated with a 60% percent increase in the risk of in-hospital mortality (Hazard Ratio 1.60, 95% CI 1.54-1.66; p<0.001) and a higher likelihood for other complications.

CONCLUSION: The presence of RBBB in the setting of an AW-STEMI is a significant independent predictor of poor prognosis, including a higher rate of acute heart failure, complete heart block and the need for a permanent pacer, as well as a higher in-hospital mortality.

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ABSTRACT #55 CLINICAL VIGENETTE/CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY YOUNG-ONSET PANCREAS CANCER IN PATIENTS LESS THAN OR EQUAL TO 50 YEARS OLD AT MEMORIAL SLOAN KETTERING (MSK): DESCRIPTORS, GENOMICS, AND OUTCOMES Anna M. Varghese1, Isha Singh2, Ritu Raj Singh1, Marinela Capanu1, Joanne F. Chou1, Winston Wong1, Zsofia Kinga Stadler1, Erin E. Salo-Mullen1, Christine A. Iacobuzio-Donahue1, David Paul Kelsen1, Wungki Park1, Kenneth H. Yu, Eileen Mary O’Reilly1, 3 1

Memorial Sloan Kettering Cancer Center, New York, NY, United States; 2Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Weill Cornell Medical College, New York, NY, United States

Presented at the Gastrointestinal Cancers Symposium (GI ASCO); San Francisco, California, United States held on January 23-25, 2020.

BACKGROUND/INTRODUCTION: For individuals ≤ 50 years old, cancer incidence is increasing, particularly gastrointestinal and obesity related cancers (Sung, Lancet Public Health 2019). Limited details are known about young onset pancreatic cancer. Herein, we report the epidemiologic, pathologic, and molecular characteristics of pancreatic cancer in patients (pts) ≤ 50 years.

METHODS: MSK institutional database was queried for medical and treatment history, genomics, and outcomes in pts ≤ 50 years old diagnosed with pancreatic cancer between January 2008 and July 2018. Neuroendocrine cancers were excluded. Overall survival (OS) from date of pancreatic cancer diagnosis was estimated using Kaplan-Meier methods.

RESULTS: N=450 patients ≤ 50 years old with a diagnosis of pancreatic cancer were identified. Ninety-six percent had adenocarcinoma, and 4% had acinar cell carcinoma/other histology. Table summarizes demographics. Median OS was 16 months in the entire cohort and 11.3 months in stage IV disease. For N = 236 pts diagnosed after 2014, 119 (50%) underwent successful somatic testing with at least one alteration identified, and 21/119 tumors were RAS wild-type with identification of several actionable alterations (NRG1 fusions (n=2), NTRK fusions (n=2), IDH1 R132C (n=1), and microsatellite unstable tumors (n=1). N = 114 pts had germline testing (routine after 2015), and 33/114 (29%) had pathologic germline alterations, including BRCA1/2 (n=18), CHEK2 (n=3), PALB2 (n=3), ATM (n=2), MLH1 (n=1), and MSH3 (n=1).

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CONCLUSION: Pathogenic germline alterations are present in a substantial percentage of pts with young onset pancreatic cancer, and actionable somatic alterations were seen frequently in the subgroup of young onset pancreatic cancer RAS-wild type tumors. These observations underpin the need for germline and somatic profiling in pancreatic cancer.

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ABSTRACT #56 CLINICALVIGNETTE/CASE REPORT/CLINICAL REVIEW CARDIOVASCULAR DISEASE MULTIMODALITY CARDIAC IMAGING APPROACH FOR MANAGEMENT OF UNUSUAL CASE OF MISSED SINUS VENOSUS ASD Michel Skaf1, Syed Waqas Haider1, Ashish Correa1, Saman Setareh-Shenas1, Soheila Talebi1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: Atrial septal defects (ASDs) are the second most common congenital lesion in adults after bicuspid aortic valves. Precise diagnosis of ASD extent and type warrants multimodality imaging for optimal management.

CASE PRESENTATION: 74 year-old female presented with persistent dyspnea 6 months after transcatheter closure of 1.3 cm ostium secundum ASD. Transthoracic echocardiogram (TTE) revealed significant right sided dilation with severe TR, unchanged from TTE prior to intervention. TEE to evaluate device position and possible residual shunt was performed. A defect at inferior portion of the interatrial septum just at the orifice of the inferior vena cava, far from well seated Amplatzer was seen. Evaluation of shunt severity was not possible by TTE given aneurysmal dilation of main pulmonic artery (4.7 cm). Severe TR limited measurement of pulmonary artery pressure by TTE. To determine the utility of surgery, cardiac MRI was done that revealed significant right to left shunt (Qp/Qs 2.18), preserved RV systolic function in-spite of significant dilation and no anomalous pulmonary venous drainage or unroofed coronary sinus. Right heart catherization showed only moderate pulmonary artery hypertension (50 mmHg). Above tests guided decision to opt for surgical intervention, and patient underwent successful pericardial patch closure.

CONCLUSION: This case highlights how multiple ASDs can masquerade as single ASD and can be missed.

Multimodality imaging is crucial in correct diagnosis and guidance of best clinical management.

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ABSTRACT #57 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY CD33 SPLICE SITE GENOTYPE WAS NOT ASSOCIATED WITH OUTCOMES OF PATIENTS RECEIVING THE ANTI-CD33 DRUG CONJUGATE SGN-CD33A Michele Stanchina1,2, Alessandro Pastroe2, Sean Devlin2, Christopher Famulare2, Eytan Stein2, Justin Taylor2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States

Published in the Journal of Hematology & Oncology. 2019: 12: 85. PMID: 31439003 BACKGROUND/INTRODUCTION: We tested whether a single nucleotide polymorphism (SNP) that affects splicing of CD33 predicted response to treatment in adults with acute myeloid leukemia (AML) who received the novel CD33 antibody-drug conjugate SGN-CD33A. METHODS: Twenty patients with CD33+ AML who received SGNCD33A either as monotherapy (10â&#x20AC;&#x201C;50 mcg/kg) or in combination with hypomethylating agents (10 mcg/kg SGN-CD33A and standard doses of hypomethylating agent) were tested for the CD33 SNP genotype (rs12459419) using TaqMan SNP genotyping (Applied Biosystems, CA). Clinical characteristics of disease, prior treatments, and outcome data were collected and analyzed for association of the SNP genotype with response rate, the primary objective. Event-free and overall survivals were secondary objectives assessed by the Kaplan-Meier estimator. We included adults with de novo and secondary AML who had either experienced disease relapse or declined intensive chemotherapy.

RESULTS: Compared with patients in previous studies, our patients were generally older and were not treated in combination with chemotherapy. Notably, CD33 SNPs are germline mutations, so these could result in different expression of CD33 in off target tissue. An alternative hypothesis, therefore, is that increased toxicity in the CC genotype would offset the drugsâ&#x20AC;&#x2122; benefit; however, neither our study nor the other adult study showed any difference in response rates between genotypes. This lack of any benefit for the CC genotype in adult AML suggests that age-related or other biological differences between adult and pediatric AML may explain disparate results between these groups.

CONCLUSION: This genotype, for the CD33 splice site SNP rs12459419, was not associated with clinical response (30% CR/CRi in both groups), event-free survival, or overall survival.

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ABSTRACT #58 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY EPIDEMIOLOGY, TREATMENT, AND OUTCOMES IN LOCALLY ADVANCED SPINDLE CELL LUNG CANCER Shivani Handa1, Michelle Sterpi1, Kathan Mehta2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY; 2University of Kansas, Kansas City, KS, United States

Accepted to the American Society of Clinical Oncology (ASCO) Annual Meeting; that will be held virtually from May 29-31, 2020.

BACKGROUND/INTRODUCTION: Spindle cell lung cancer (SpCC) is a rare type of NSCLC which portends a poor prognosis. Due to the rarity of diagnosis, there is a dearth of information about the epidemiology and overall survival for these patients.

METHODS: We performed a retrospective analysis using the SEER database from 1975-2016 to study the demographics, treatment modalities and outcomes for patients with locally advanced SpCC. Data regarding age, sex, race, pathological grade, staging, treatment, overall and disease specific survival was extracted.

Hazards ratios were calculated to identify any difference in mortality between patients who received surgery alone versus those who received adjuvant chemotherapy or radiation.

RESULTS: A total of 936 cases of SpCC were identified, out of which 367 (39%) patients had locally advanced disease. 84% cases were diagnosed after the age of 60, with peak incidence occurring in the 70-74 years of age group. 87% were Caucasians, and 56% were males. 68% of the tumors were poorly differentiated. In terms of the treatment modalities for locally advanced SpCC, surgical resection was performed only in 58.5% cases. 27% patients received systemic chemotherapy, out of which 50% was in the adjuvant setting after surgery. 32 % patients received radiation therapy, only 38.5% of which was in the adjuvant setting. No statistically significant difference in mortality was seen in patients who received surgery alone vs adjuvant RT vs adjuvant chemotherapy. However, pts who did not receive surgery had a higher odds of mortality (OR =4.2, p value=0.0001). Similarly, pts who only received chemotherapy alone had a higher odds of mortality vs those who received chemotherapy along with surgery (OR=3.4, p=0.045). Overall survival was 25% for patients with localized disease, 9.5% for regional and only 2.6% for distant metastatic disease. For locally advanced SpCC, the observed cumulative 1-year survival was 54.8 % and declined to 29.2% after 5 years.

CONCLUSION: Majority of the spindle cell carcinoma cases are poorly differentiated and present at an advanced stage at the time of diagnosis. For locally advanced SpCC, surgical resection can improve survival.

Randomized trials are needed to test efficacy of adjuvant therapies.

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ABSTRACT #59 BASIC SCIENCE HEMATOLOGY/ONCOLOGY CD39+PD-1+CD8+ T CELLS MEDIATE METASTATIC DORMANCY IN BREAST CANCER Paulino Tallón de Lara1,2,3, Héctor Castañón Cuadrado2,3, Marijne Vermeer2,3, Nicolás Núñez2,3, Virginia Cecconi2,3, Karina Silina2,3, Joaquín Urdínez3, Farkhondeh Movahedian Attar2,3, Isabelle Glarner2,3, Bettina Sobottka-Brillout3, Holger Moch3, Sonia Tugues2,3, Burkhard Becher2,3, Maries van den Broek2,3 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Comprehensive Cancer Center, Zurich, Switzerland; 3 Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland

2

Presented at the American Association for Cancer Research Annual Meeting; that was held virtually held April 24-29, 2020.

BACKGROUND/INTRODUCTION: Although metastatic disease can be present already at diagnosis in breast cancer, in most patients it appears months or years after resection of the primary tumor. This is thought to be due to the ability of some tumor cells to remain dormant after metastatic seeding. It is not known how dormancy is controlled, but there is evidence for tumor cell-intrinsic and -extrinsic mechanisms including immune defense.

METHODS AND RESULTS: Here we found in preclinical models of breast cancer and in patient samples that metastatic dormancy is fully controlled by T cells. Through high-parametric single-cell mapping, we identified a discrete population of CD39+PD-1+CD8+ T cells present both in primary tumors and in spontaneous dormant metastasis, whereas this population is hardly found in aggressively metastasizing tumors. Surprisingly, despite expressing many exhaustion markers, this population was rich in effector molecules and cytokines that induced dormancy in tumor cells. Of note, the adoptive transfer of purified CD39+PD-1+CD8+ T cells prevented metastatic outgrowth. In human breast cancer, the frequency of CD39+PD-1+CD8+ T cells also correlated with survival, thus providing a novel stratifying biomarker and therapeutic target for the treatment of breast cancer.

CONCLUSION: We discovered that primary breast tumors induce a systemic immune response that generates CD39+PD-1+CD8+ T cells than induce metastatic dormancy in distal disseminated tumor cells in the lungs.

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ABSTRACT #60 CLINICAL RESEARCH GASTROENTEROLOGY NATURAL HISTORY OF PATIENTS UNDERGOING THERAPEUTIC ENDOSCOPIES FOR ACUTE GASTROINTESTINAL BLEEDING Leen Khoury1, Patrick Tobin-Schnittger2, Nicholas Champion1, Vasiliy Sim1, Asaf Gave1, Samuel Hawkins1, Melissa Panzo1, Stephen Cohn1 1

Northwell Health at Staten Island University Hospital, Staten Island, NY, United States; 2Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Surgeons Clinical Congress Annual Meeting; San Francisco, California, United States held on October 27-31, 2019 BACKGROUND/INTRODUCTION: When endoscopy is performed for acute gastrointestinal (GI) bleeding, therapeutic endoscopic procedures are infrequently required (only 6% of cases). We sought to determine the natural history of GI hemorrhage in patients who have undergone therapeutic endoscopy.

METHODS: We queried our hospital database for inpatients with acute GI bleeding who underwent therapeutic endoscopy between 2015 and 2017. The primary endpoints were recurrence of bleeding and the subsequent need for repeated endoscopic interventions, angioembolization or surgery. Demographic information was collected.

RESULTS: We reviewed 205 hospitalized patients: mean age was 70 years old, 58% were male, and mean hemoglobin was 9 g/dL. Patients had medical conditions predisposing them to bleeding in 59% and history of previous GI bleeding in 37% of cases. Sixty percent were on anti-platelet/anti-coagulation medications and 10% were receiving non-steroidal anti-inflammatory medications (NSAIDS). Blood transfusions were given to 78% of patients, with an average of 2.3 units of packed red blood cells (PRBC) transfused per patient before intervention.

Recurrence of hemorrhage after therapeutic endoscopy was seen in 9% of patients. Only 2% underwent a second therapeutic endoscopic procedure; and 5% had surgery or angioembolization (half of these patients then had a further recurrence of bleeding). In total, seven patients died (3%).

CONCLUSION: Recurrence of gastrointestinal bleeding after therapeutic endoscopies is uncommon (9%).

Surgery and angioembolization are not commonly necessary, but when employed are only successful in 50% of cases.

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ABSTRACT #61 QUALITY IMPROVEMENT NEPHROLOGY IMPROVING RATES OF EPOETIN ALPHA ADMINISTRATION IN ESRD PATIENTS AT TWO TEACHING HOSPITALS- A QI INITIATIVE Xavier Fernando Vela Parada1, Lorenz Leuprecht2, Karim El-Hachem2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Weill Cornell Medical College, New York, NY, United States

2

Presented at the American Society of Nephrology Annual Meeting (Kidney Week); Washington, DC held on November 5-10, 2019.

BACKGROUND/INTRODUCTION: Adequate management of anemia in ESRD patients has important clinical implications for both patients and the healthcare system at large. It improves quality of life, prevents readmissions, decreases the need for transfusions while simultaneously improving efficiency of care. Following a switch in the process of Epoetin Alpha (EPO) administration in two city hospitals (A and B) from IV administration during dialysis to subcutaneous administration on the general floors, we noted rates of 19.5% and 14.5% of missed EPO doses at hospitals A and B respectively. Unrefrigerated, un-administered EPO doses are discarded leading to a significant waste and worsening hemoglobin levels. The aim of this QI initiative was to understand the causes and reduce missed EPO doses to <10% over 9 months.

METHODS: We utilized the PDSA performance improvement model to manage this project. A multidisciplinary team including Nephrology, Nursing, Pharmacy and IT was created. We identified the most common cause of missed doses as an inpatient dialysis schedule switch (from Monday/Wednesday/Friday to Tuesday/Thursday/Saturday or vice versa) without a coinciding change in the EPO order. Our first intervention was the creation of an EMR alert notifying nurses to administer the dose as ordered regardless of patients' dialysis schedule and asking them to discuss with nephrology if they were to hold a dose. At month 5, we tested a second intervention: a collaborative nursing education about anemia management at Hospital B only, facilitated by a nephrologist and a nurse educator.

RESULTS: The results of the study are summarized in Figure 1. Following the creation of an EMR alert, there was only a mild and un-sustained improvement in our rates at both hospitals. Following nursing education at Hospital B, there was a sustained improvement in our rates at Hospital B but not at Hospital A. CONCLUSION: While technology plays an important tool providing scale and efficiency in QI initiatives, the role of targeted Nursing Education remains an effective measure to prevent waste and sustain change.

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ABSTRACT #62 CLINICAL RESEARCH CARDIOVASCULAR DISEASE ASSESSING THE SAFETY AND CLINICAL OUTCOMES OF BETA-BLOCKERS IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION WITH CONCOMITANT COCAINE USE. A METAANALYSIS Guneesh Uberoi1, Kirtipal Bhatia1, Vivek Modi1, Bharat Narasimhan1, Arieh Fox1,2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: Current guidelines do not list cocaine use as a contraindication for betablockers (BB) in heart failure and reduced ejection fraction (HFrEF) but acknowledge that the safety and benefits of beta-blocking therapy are uncertain. We aimed at investigating current literature comparing the safety and clinical outcomes of BB in patients with cocaine use and HFrEF. METHODS: We performed a systematic search of electronic databases (Embase, Medline, Scopus, and web of science) to identify citations addressing patients with cocaine use and HFrEF treated with or without BB as part of goal-directed medical therapy (GDMT). The primary outcome was major adverse cardiac events (MACE), which were a composite of mortality and HF readmission. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect model.

RESULTS: Out of a total of 600 citations, 31 were selected for full-text review. Three cohort studies, with a total of 570 patients, were included in the final analysis. The study showed that the probability of having a MACE was significantly lower in patients treated with BB, compared to patients treated with GDMT without beta-blockers (RR- 0.54, CI-0.40 to 0.71, p< 0.0001). Heterogeneity among studies was low (I2=0%). Carvedilol was the most common BB used across studies.

CONCLUSION: Beta-blockers are not only safe but reduce the composite risk of mortality and HF readmissions in patients with HFrEF and concomitant cocaine use.

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ABSTRACT #63 CLINICAL RESEARCH CARDIOVASCULAR DISEASE OUTCOMES OF ACUTE HEART FAILURE IN PATIENTS WITH AMYLOID OR SARCOID CARDIOMYOPATHY: A 10 YEAR NATIONWIDE ANALYSIS David Cohen Weninger1, Mario R. Rodriguez1, Basera Sabharwal1, Chayakrit Krittanawong1, Ricardo De la Villa1, Xin Wei1, Carlos Godoy Rivas2, Eyal Herzog1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY; Cleveland Clinic, Cleveland, OH, United States

2

Presented at the Heart Failure Society of America Annual Meeting; Nashville, Tennessee, United States held on September 15-18, 2018.

BACKGROUND/INTRODUCTION: Ischemic Cardiomyopathy is the leading cause of heart failure in the United States. Restrictive cardiomyopathy etiologies like sarcoid and amyloid are less common causes of heart failure and in hospital outcome descriptions are scant across the literature. This study was conducted in order to describe the outcomes of acute heart failure exacerbations in patients with sarcoid or amyloid cardiomyopathy.

METHODS: A retrospective analysis using the 2005-2014 United States Nationwide Inpatient Sample was performed. Patients above 18 years with primary diagnosis of acute heart failure (AHF), systolic heart failure (SHF) and diastolic heart failure (DHF) were included. Secondary diagnosis of Sarcoid Cardiomyopathy (SCM) or Amyloid Cardiomyopathy (ACM) was generated. End-stage renal disease patients were excluded. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay, cost of stay, shock, utilization of mechanical ventilation, acute kidney injury requiring dialysis (AKID), use of non-invasive ventilation (NIV), cardiac arrest, and short term mechanical circulatory support. Diagnoses were identified using ICD-9- CM codes.

Multivariate logistic regression analysis adjusting for age, race, gender, hospital location was done using STATA 15.

RESULTS: 2,821,201 patients with primary diagnosis of AHF were identified. In AHF cohort 2,893 patients had a history of ACM, corresponding to 42% patients with SHF and 58% patients with DHF. The SCM cohort was composed of 1,905 with AHF of which 83% had SHF and 17% had DHF. Mean age in ACM with AHF was 73 years. 63% were males. In the SCM, 52 % males with mean age of 53 years. ACM patients had increased mortality in the AHF (OR 2.5 p<0.001), SHF (OR 2.0; p=0.04) and DHF (OR 3.2; p<0.001). Increased odds of mechanical ventilation in the AHF (OR 1.62; p=0.04) group along with decreased risk of NIV utilization in the AHF (OR 0.36; p<0.001) and DHF (OR 0.30; p=0.005). Short (OR 4.1; p<0.001) and long (OR3.63 p=0.003) mechanical circulatory support utilization was also increased. Odds of cardiac arrest was also increased in the AHF (OR 3.8; p<0.001) and DHF (OR 5.7; p<0.001) groups as well as length of stay and total charge. In SCM patients, there was no statistically significant increase in mortality across 3 subgroups of heart failure. Odds of cardiogenic shock was also increased in the AHF (OR 4.6; p<0.001) and SHF (OR 5.5; p<0.001) groups along with increased odds of long term mechanical circulatory support utilization.

CONCLUSION: In patients with AHF, mortality is increased in those with ACM compared to those without. SCM is associated with increased mechanical support use and development of shock. More studies are needed regarding outcomes of these cardiomyopathies.

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ABSTRACT #64 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY INOTUZUMAB OZOGAMICIN IS AN EFFECTIVE SALVAGE THERAPY IN RELAPSED/REFRACTORY BCELL ACUTE LYMPHOBLASTIC LEUKEMIA WITH HIGH- RISK MOLECULAR FEATURES, INCLUDING TP53 LOSS Xiaochuan Yang1,2, Amber C. King2, Charlene Kabel2, Christopher J. Forlenza2, Jae H. Park2, Mark Blaine Geyer2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting; Orlando, Florida, United States held on December 7-10, 2019 BACKGROUND/INTRODUCTION: Adults with (w/) B-cell acute lymphoblastic leukemia (B-ALL) exhibit high rates of complete response (CR) to induction chemotherapy, but relapse is common. Inotuzumab ozogamicin (IO), an antibody-drug conjugate targeting CD22, achieves high rates of CR in patients (relapsed/refractory, R/R) B-ALL and is FDA-approved for R/R B-ALL in adults. It remains unknown whether cytogenetic and molecular features associated w/ decreased response rate and poor prognosis following conventional chemotherapy are associated w/ response to IO. As such, we investigated the relationship between several high-risk genetic alterations and outcome following IO treatment in pts w/ R/R B-ALL. METHODS: We reviewed electronic medical records of pts of all ages w/ R/R B-ALL or chronic myeloid leukemia in lymphoid blast phase (CML-LBP) receiving IO at Memorial Sloan Kettering Cancer Center (MSK) between 1/2011-4/2019. The primary objective was to assess whether recurrent cytogenetic or molecular features were associated w/ achievement of CR or CR w/ incomplete hematologic recovery (CRi), w/ or w/o measurable residual disease (MRD), and disease free (DFS) and overall survival (OS) following IO. Secondary objectives included association of baseline clinical features, including central nervous system (CNS) or other extramedullary (EM) disease, w/ outcomes post-IO. MRD was defined as any unequivocal evidence of B-ALL detectable by RTPCR (Ph+ ALL) or flow cytometry (FACS). Genomic alterations were defined by MSK IMPACT-Heme (Cheng, J Mol Diagn, 2015), FoundationOne Heme, or similar platforms. A set of selected high-risk (HR) features in Philadelphia chromosome-negative (Ph-) B-ALL was defined prior to the analysis (HR: mutations/loss of TP53, IKZF1/3, CDKN2A, CREBBP; activating RAS mutations; “Ph-like” profile). DFS and OS were computed using Kaplan-Meier methods and compared between groups using log-tank tests.

RESULTS: 32 pts (13F, 19M) w/ R/R B-ALL (n=31) or CML-LBP (n=1) treated w/ IO were identified. IO was given as monotherapy in 27 pts and w/ other systemic therapy in 5 pts (mini- hyper-CVD-like regimen, n=4; ponatinib, n=1). Median age at start of IO was 45 years (range 3- 78). 10 pts had undergone prior allogeneic hematopoietic cell transplantation (alloHCT). Seven and 15 pts had a history of CNS disease or other EM involvement by B-ALL, respectively, including 3 and 6 pts immediately prior to IO, respectively. Pts received a median 3 lines of salvage prior to IO, including prior CD19-targeted immunotherapy (blinatumomab and/or CART cells) in 24 pts (Table 1). Among 27 pts w/ Ph- B-ALL, 12 had the selected HR features (Table 2). Five pts had Ph+ ALL (n=4) or CML-LBP (n=1) and 5/5 harbored ABL1 kinase domain point mutations (4/5 w/ T315I mutation).

22 pts had at least one successful molecular profiling panel. 29 patients had initial cytogenetic studies, of whom 28 patients had evaluable karyotypes. 23 pts had best response to IO of CR/CRi (MRD-, n=15; MRD+, n=8). 9 pts had no objective response to ≥1 cycle of IO. Of the 12 Ph- pts w/ selected HR mutations, 11 achieved CR/CRi. Notably, 6/6 pts w/ TP53 mutation/deletion and 5/5 pts w/ IKZF1/3 mutations (3/3 pts w/ both TP53 & IKZF mutations) achieved CR/CRi. Both pts w/ Ras mutations and 2/3 w/ Ph-like B-ALL achieved CR/CRi. 7/11 HR responders underwent alloHCT post-IO (3 had undergone pre-IO alloHCT). Pts w/ Ph- B-ALL w/ HR mutations demonstrated similar CR/CRi rate and OS to pts w/ Ph- B-ALL w/o defined HR mutations (Fig 1A-B). In contrast, only 1/5 pts w/ Ph+ ALL achieved CR/CRi (was MRD+) and 4/5 showed persistent B-ALL. OS was superior among pts w/ Ph- vs Ph+ B-ALL post-IO (8.0 v 1.9 months, p=0.0068, Fig 1C). Among pts w/ EM disease 94

immediately prior to IO, 3/6 achieved CR/CRi, including CR in 1 pt w/ a cardiac mass. Median DFS was 3.2 months vs. not reached following achievement of MRD+ vs MRD- CR, respectively (p=ns, Fig 1D).

CONCLUSION: HR molecular features associated w/ poor response to chemotherapy were not associated w/ inferior response rate and overall prognosis following IO in this small series. Notably, pts w/ Ph+ ALL (all w/ ABL1 mutations) exhibited suboptimal response, possibly as pts received IO only in advanced disease states following TKI failure. This small report supports investigation of IO in frontline therapy for pts w/ B-ALL w/ HR mutations to spare unnecessary toxicities of chemotherapy and bridge successfully to alloHCT.

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ABSTRACT #65 CLINICAL RESEARCH PULMONARY/CRITICAL CARE IMPACT OF A PULMONARY EMBOLISM RESPONSE TEAM ON PATIENT OUTCOMES INCLUDING 30DAY READMISSION RATES James Salonia1, Avinash Singh1, David J. Steiger1,2, Janet M. Shapiro1, Jason Filopei2, Sean Zajac1, Madeline R. Ehrlich2, Adil Shujaat1,2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, LA, United States held on October 19-23, 2019.

BACKGROUND/INTRODUCTION: The rationale for Pulmonary Embolism Response Teams (PERT) is to optimize care for patients at high risk of mortality from acute Pulmonary Embolism (PE), by providing real-time, multidisciplinary consultation. We hypothesized that a PERT-based approach would optimize PE management and decrease readmission rates.

METHODS: We performed a retrospective analysis of all 54 consecutive PERT activations in 2018 from 2 urban tertiary academic hospitals to determine the impact of PERT-guided therapy. We analyzed patient characteristics and focused on significant outcomes including in-hospital mortality, major bleeding (as defined by the International Society of Thrombosis and Hemostasis 2015), 30-day readmission rates, and clinic follow-up.

RESULTS: The median age was 64 years, with 52% of patients being women. 18% of patients were classified as High-Risk (HR) based on the European Society of Cardiology (ESC) classification. There were 6 in-hospital deaths (11%), all of which were HR. Cause of death was PE (n = 4, 7%), major bleeding (n = 1, 2%) and pneumonia (n = 1, 2%). Major bleeding occurred in 4 (7%) patients, 1 of which was fatal. Two patients on systemic anticoagulation (AC) alone and one post-catheter directed thrombolysis (CDT) developed major bleeding, requiring inferior vena cava (IVC) filter placement. Survival at 30-days of all PERT-activations was 87%. Six (12%) patients were re-admitted within 30-days, four (8%) of which were from non-PE-related etiologies (pneumonia, urinary tract infection, seizure, and bowel obstruction). Of those re- admitted with PE-related etiologies, one (2%) expired from massive PE, and one (2%) had non- fatal AC-related gastrointestinal bleeding.

Thirty-three (70%) patients were seen within thirty- days at either an Internal Medicine or Pulmonary clinic.

CONCLUSION: Our data demonstrates comparable outcomes of PERT-managed acute PE patients, as compared to data from other PERT centers, with minimal PE-related mortality, major bleeding, and low rate of recurrent PE and/or re-admissions. Longer term follow-up is needed to evaluate cardiac function and subsequent development of chronic thromboembolic pulmonary hypertension (CTEPH), bleeding risk from extended AC, and to ensure appropriate IVC filter retrieval.

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ABSTRACT #66 QUALITY IMPROVEMENT GASTROENTEROLOGY ARE PATIENTS STARVING? A SYNOPSIS ON FASTING TIME IN HOSPITALIZED PATIENTS AND PROPOSAL ON QUALITY IMPROVEMENT Xiaocen Zhang1, Ramya Patel1, Bing Chen1, Makda Bsrat1, Gassan Kassim1, Jessica Patel1, Brian Markoff1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Accepted to the Society of Hospital Medicine (SHM) Annual Meeting; San Diego, California, United States that was scheduled to be held from April 15-18, 2020 BACKGROUND/INTRODUCTION: Hospitalized patients are often kept fasting for various reasons, including clinical conditions, procedures and imaging, or dysphagia. Studies have demonstrated the harm of excessive fasting, including increased post-operative delirium, thirst and hunger, and patient dissatisfaction. Accordingly, recent guidelines have promoted a more liberal preoperative fasting strategy, namely, allowing clear liquids up to 2 hours prior to elective surgery. Despite the guideline updates, nil per os (NPO) after midnight is still the mainstay of clinical practice for patients receiving elective procedures requiring anesthesia. We conducted a quality improvement (QI) project aimed at shortening unnecessary fasting time in hospitalized patients, with a target population of patients waiting for left heart catheterization (LHC).

METHODS: The QI project was conducted in a 400-bed tertiary teaching hospital in New York City. Patients on the cardiology teams who had an active NPO order at 7-9AM in expectation of LHC were eligible for the study.

The patient demographics, clinical scenario, LHC time, number of missed meals, and NPO hours were recorded.

Also, a 5-question survey regarding knowledge on fasting requirements and perception of causes for unnecessarily long NPO orders was conducted among the Internal Medicine residents.

RESULTS: A total of 154 patients were enrolled between 4/2019-8/2019. The median patient age was 67-years and 57 patients (37.0%) were female. Forty-two patients (27.3%) had a reason other than pending LHC to be fasting. The main indication for LHC was NSTEMI (47 patients, 30.5%), followed by heart failure with suspected ischemia (38, 24.7%), atypical chest pain with risk factors (33, 21.4%), unstable angina (20, 13.0%), demand ischemia (6, 3.9%) and others. The median waiting time between LHC and ED presentation time was 2 days.

The median number of missed meals were 2 and median NPO hours were 18. One hundred residents (32 PGY1, 30 PGY2, 38 PGY3) responded to the questionnaire. Only 36% correctly identified black coffee and 45% soda as clear liquids. When asked what they thought was the cause for excessive NPO orders, 70% chose ‘concern for earlier procedure and possible delays’ and 52% chose ‘it is easy to forget ordering a diet’.

CONCLUSION: Hospitalized patients are often kept NPO for prolonged time. There is room improvement in the residents’ knowledge on the requirement for fasting prior to procedures.

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List of Resident Research/Scholarly Work 2019-2020*

*Does not include presentations already submitted as poster

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LIST OF ABSTRACTS 2019-2020* CARDIOVASCULAR IMPACT OF HYPERURICEMIA IN PATIENTS WITH PSORIATIC ARTHRITIS Ana B. Arevalo1, Faris Haddadin1, Gustavo Contreras1, Shane Murray1, Yousaf Ali1 1

67

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Rheumatology (ACR) Annual Meeting; Atlanta, Georgia, United States held on November 8-13, 2019.

CARDIOVASCULAR IMPACT OF HYPERURICEMIA IN PATIENTS WITH PSORIATIC ARTHRITIS Ana B. Arevalo1, Faris Haddadin1, Shane Murray1, Gustavo Contreras1, Yiming Luo2, Yousaf Ali1

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1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, United States

Presented at the American College of Rheumatology (ACR) Annual Meeting; Atlanta, Georgia, United States held on November 8-13, 2019.

AN ELUSIVE MIMICKER OF ABDOMINAL AORTIC ANEURYSM Abraham Derman1, Mayank Yadav2, Mohammad Asad1, Manoj Bhandari2, Jonathan N. Bella2, Jacqueline Tamis-Holland1,2, Patrick Lam1 1

69

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside and BronxCare Hospital Center, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

DE-ESCALATION OF ASPIRIN FOR PRIMARY PREVENTION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN THE PRIMARY CARE SETTING Joshua Berookhim1, Michael Kahen1, Gabriela Bernal1, Subrat Das1, Brian Berookhim1, Dipal Patel1

70

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association Quality of Care and Outcomes Research Annual Meeting that was held virtually from May 15-16, 2020.

IS THERE AN OBESITY PARADOX IN PATIENTS UNDERGOING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), NATIONAL INPATIENT SAMPLE STUDY 2014 Bing Chen1, Shah Suraj1, Chieng-Chang Lee2

71

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2National Taiwan University Hospital, Taipei, Taiwan

Accepted at the Digestive Disease Week (DDW); Chicago, IL, United States that was scheduled to be held May 2-5, 2020.

*does not include those with posters submitted by author 99

LIST OF ABSTRACTS 2019-2020*

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ALCOHOLIC CIRRHOSIS IS RELATED WITH HIGHER MORTALITY IN SEPTIC PATIENTS COMPARED WITH NON-ALCOHOLIC CIRRHOSIS, NATIONAL INPATIENT SAMPLE STUDY 2016 Bing Chen1, Omar Mahmoud1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM), Mid-Atlantic Regional Annual Meeting; Pittsburgh, PA, United States held on November 15, 2019.

NON-ARTERITIC ANTERIOR ISCHEMIC NEUROPATHY IN A MALE-TO-FEMALE TRANSGENDER PERSON Erin Flynn1

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1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Millennial Eye Annual Meeting; Louisville, KY, United States held on September 6, 2019.

ETIOLOGIES AND PREDICTORS OF 30-DAY READMISSION IN PATIENTS UNDERGOING INDUCTION CHEMOTHERAPY FOR ACUTE MYELOID LEUKEMIA Shivani Handa1, Kamesh Gupta2, Jasdeep Singh Sidhu3, Giulia Petrone1, Sridevi Rajeeve1, Karan Jatwani1

74

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Baystate Medical Center, Springfield, MA, United States; 3Interfaith Medical Center, Brooklyn, NY, United States

Accepted at the American Society of Hematology (ASH) Annual Meeting; Orlando, FL, United States held on December 7-10, 2019.

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IS SMOKING WORTH THE RISK? INCREASED THIRTY-DAY READMISSION AMONG SMOKERS WITH PULMONARY EMBOLISM: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Jacqueline Sheehan1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

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MISSED OPPORTUNTIES FOR IN-HOSPITAL VACCINATIONS? INFLUENZA VACCINATION REDUCES 30-DAY READMISSION AMONG PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Jacqueline Sheehan1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

*does not include those with posters submitted by author 100

LIST OF ABSTRACTS 2019-2020*

77

OBESITY PARADOX? IMPROVED IN-HOSPITAL MORTALITY IN PATIENTS ADMITTED FOR SEPSIS VERSUS SEPTIC SHOCK: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Jacqueline Sheehan1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

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PROTECTIVE METABOLIC RESERVES? IMPROVED IN-HOSPITAL MORTALITY IN PATIENTS ADMITTED FOR ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Jacqueline Sheehan1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

OBESE PATIENTS WHO UNDERWENT CARDIOPULOMONARY RESUSCITATION HAVE INCREASED 30-DAY READMISSION AND TOTAL HOSPITAL COST Kam Sing Ho1, Lingling Wu1, Bharat Narasimhan1, James Salonia1

79

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting; Philadelphia, Pennsylvania, United States held on November 16-18, 2019.

ADRENAL INSUFFIENCY AND COPD Kam Sing Ho1, Paaras Kohli1, Shabnam Nasserifar1, Jacqueline Sheehan1, James Salonia1

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1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Thoracic Society (ATS) Annual Meeting; that was held virtually from May 15-20, 2020.

ACUTE PULMONARY EMBOLISM-DON’T IGNORE ASPIRIN Kam Sing Ho1, Paaras Kohli1, Shabnam Nasserifar1, Jacqueline Sheehan1, Joseph Poon1, Yasmin Herrera1, Archana Pattupara1, Lingling Wu1, Bharat Narasimhan1, James Salonia1

81

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Thoracic Society (ATS) Annual Meeting; that was held virtually from May 15-20, 2020.

82

E-CIGARETTE-ASSOCIATED LUNG INJURY IS NOT THAT NEW: BEFORE THE 2019 VAPING CRISIS – INCIDENCE OF E-CIGARETTE-ASSOCIATED LUNG INJURY BASED ON CDC ICD-10-CM CODING GUIDELINES Kam Sing Ho1, Shabnam Nasserifar1, Jacqueline Sheehan1, Archana Pattupara1, Bharat Narasimhan1, Lingling Wu1, Raymonde Jean1, Jennifer Fung1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Thoracic Society (ATS) Annual Meeting; that was held virtually from May 17-19, 2020. *does not include those with posters submitted by author 101

LIST OF ABSTRACTS 2019-2020* HALTING SEPSIS WITH ASPIRIN? Kam Sing Ho1, Paaras Kohli1, Shabnam Nasserifar1, Jacqueline Sheehan1, Yasmin Herrera1, Joseph Poon1, Bharat Narasimhan1, Lingling Wu1, James Salonia1

83

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Thoracic Society (ATS) Annual Meeting; that was held virtually from May 17-19, 2020.

THIRTY-DAY READMISSION AMONG PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME AND EFFECTS ON OUTCOMES Kam Sing Ho1, Jacqueline Sheehan1, James Salonia1

84

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the European Respiratory Society (ERS) International Congress Annual Meeting; Madrid, Spain held from September 28 to October 2, 2019.

THIRTY-DAY READMISSION AMONG PATIENTS WITH NON-VENTILATOR HOSPITAL ACQUIRED PNEUMONIA AND EFFECTS ON OUTCOMES Kam Sing Ho1, Jacqueline Sheehan1, James Salonia1

85

86

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the European Respiratory Society (ERS) International Congress Annual Meeting; Madrid, Spain held on September 28 to October 2, 2019.

INCREASED 30-DAY READMISSION AND RESOURCE UTILIZATION AMONG SEPTIC PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Shabnam Nasserifar1, Jacqueline Sheehan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Critical Care Medicine Annual Meeting; Orlando, FL, United States held on February 16-19, 2020.

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OUTCOME OF ATRIAL FIBRILLATION IN PATIENT WITH HFrEF VS HFpEF: A 5-YEAR NATIONWIDE ANALYSIS Claire Huang Lucas1, Bing Yue1, Robert Abed1, Nikhil Bachoo1, Lingling Wu1, Jan M. Lopes1, Xin Wei2, Eyal Herzog1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Virginia Commonwealth University Health, Richmond, VA, United States

Presented at the American Heart Association (AHA) Annual Meeting; Philadelphia, Pennsylvania, United States held on November 16-18, 2019.

*does not include those with posters submitted by author 102

LIST OF ABSTRACTS 2019-2020*

88

TRENDS AND IMPACT OF IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IMPLANTATIONS IN PATIENTS WITH CARDIAC AMYLOIDOSIS: A 16-YEAR ANAYLSIS Ameesh Isath1, Deepak Padmanabhan2, Stuthi Perimbeti1, Ashish Correa1, Bharat Narasimhan1, Anwar Chahal2, Shenthar Jayaprakash3, Samuel Asirvatham2, Davendra Mehta1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mayo Clinic, Rochester, MN, United States; 3Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru Area, India

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

89

TRENDS AND IMPACT OF IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IMPLANTATIONS IN PATIENTS WITH CARDIAC AMYLOIDOSIS: A 16-YEAR ANAYLSIS Ameesh Isath1, Deepak Padmanabhan2, Stuthi Perimbeti1, Bharat Narasimhan1, Ashish Correa1, Claire Huang Lucas1, Anwar Chahal2, Davendra Mehta1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mayo Clinic, Rochester, MN, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

90

TRENDS IN THE USE OF INTRACARDIAC ECHOCARDIOGRAPHY DURING CATHETER ABLATION FOR ATRIAL FIBRILLATION FROM 2001-2014 AND ITS IMPACT ON OUTCOMES Ameesh Isath1, Deepak Padmanabhan1, Stuthi Perimbeti1, Bharat Narasimhan1, Ashish Correa1, Claire Huang Lucas1, Anwar Chahal2, Davendra Mehta1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mayo Clinic, Rochester, MN, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

A RARE CASE OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA WITH INTRAMURAL GASTRIC METASTASIS Gassan Kassim1, Yingheng Liu1, Michael S. Smith1

91

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States held on October 25-30, 2019.

LOCALIZED AL-TYPE INTESTINAL AMYLOIDOSIS PRESENTING AS REFRACTORY IRON DEFICIENCY ANEMIA AND RIGHT LOWER QUADRANT ABDOMINAL PAIN Gassan Kassim1, Makda Bsrat1, Neelesh Rastogi1, Srilakshmi Atluri1, Michael S. Smith1

92

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States held on October 25-30, 2019.

*does not include those with posters submitted by author 103

LIST OF ABSTRACTS 2019-2020* MAJOR ESOPHAGEAL BLEEDING SECONDARY TO MECHANICAL INJURY FROM ESOPHAGEAL DEVIATION DURING PULMONARY VEIN ISOLATION Gassan Kassim1, Makda Bsrat1, Melissa Hershman1, Rifat Mamun1, Ray Dong1,

93

Michael S. Smith1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States held on October 25-30, 2019.

RIGHT UPPER QUADRANT PAIN IN A YOUNG WOMAN ISN’T ALWAYS BILIARY IN ORIGIN: A CASE OF FITZ-HUGH–CURTIS SYNDROME (FHCS) Gassan Kassim1, Yingheng Liu1, Michael S. Smith1

94

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States held on October 25-30, 2019.

95

A DIAGNOSTIC CHALLENGE: PREGNANCY, CHEST PAIN, AND ZERO CALCIUM SCORE Sananda Moctezuma1, Saman Setareh-Shenas1, Paul Leis1, Scott Kaplan1, Robert Kernberg1, Eyal Herzog1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

96

LEFT ATRIAL APPENDAGE OCCLUSION DEVICES IN VALVULAR ATRIAL FIBRILLATION – A SAFE OPTION? Bharat Narasimhan1, Lingling Wu1, Ameesh Isath1, Subrat Das1, Kirtipal Bhatia1, Ashish Correa1, Davendra Mehta1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

UNDER-RECOGNIZED CARDIOVASCULAR DISEASE IN SYSTEMIC SARCOIDOSIS Bharat Narasimhan1, Ameesh Isath1, Lingling Wu1, Stuthi Perimbeti1, Banveet Khetarpal2, Kamala Ramya Kallur1, Davendra Mehta1

97

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2University of Nevada, Las Vegas, NV, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

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HYPERCALCEMIA IS A PREDICTOR OF WORSE IN-HOSPITAL OUTCOMES IN PATIENTS WITH SUPRA-VENTRICULAR TACHYCARDIA (SVT); A 2016 NATIONAL INPATIENT SAMPLLE ANALYSIS (NIS) Robert Abed1, Rawann Nassar1, Patrick Lam1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020. *does not include those with posters submitted by author 104

LIST OF ABSTRACTS 2019-2020* ACUTE MYELOID LEUKEMIA AND CIRRHOSIS: TRENDS IN UTILIZATION OF INDUCTION, CHEMOTHERAPY, RATE OF HOSPITALIZATIONS, AND MORTALITY Giulia Petrone1, Shivani Handa1, Kamesh Gupta2, Ahmad Khan3, Sridevi Rajeeve1

99

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Baystate Medical Center, Springfield, MA, United States; 3West Virginia University-Charleston Division, Charleston, WV, United States

Accepted at the American Society of Hematology (ASH) Annual Meeting; Orlando, FL, United States held on December 7-10, 2019.

BASELINE CHARACTERISTICS, MANAGEMENT, AND OUTCOMES OF PATIENTS WITH INFECTIVE ENDOCARDITIS Wojciech Rzechorzek1, Guneesh Uberoi1, Kirtipal Bhatia1, Ruchit Shah1, Lingling Wu1, Robert J. Kornberg1

100

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting; Philadelphia, PA, United States held on November 16-18, 2020.

MORE THAN A TICKLE IN THE THROAT: A CASE OF COUGH INDUCED LARYNGEAL FRACTURE Bertin D. Salguero1, Jonathan Stoever1, Keith Rose2

101

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Hackensack University Medical Center, Hackensack, NJ, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

A CONTEXTUAL NEEDS ASSESSMENT OF MECHANICAL VENTILATION EDUCATION OF INTERNAL MEDICINE RESIDENTS: BARRIERS, CHALLENGES AND OPPORTUNITIES Bertin D. Salguero1, James Salonia1,2, Priscilla Loanzon1,2, Joseph P. Mathew1,2

102

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Center for Advanced Medical Simulation (CAMS) at Mount Sinai West, Icahn School of Medicine, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

JEJUNAL GIST: AN UNUSUAL CAUSE OF ACUTE MASSIVE GASTROINTESTINAL BLEEDING Yingheng Liu1, Suraj Shah1, Ilan Weisberg2

103

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States held on October 25-30, 2019.

*does not include those with posters submitted by author 105

LIST OF ABSTRACTS 2019-2020*

104

IMPROVING PALLIATIVE CARE DELIVERY IN THE MEDICAL INTENSIVE CARE UNIT: A QUALITY IMPROVEMENT PROJECT Jacqueline Sheehan1, Kam Sing Ho1, Charles Gaulin2, Setareh Alipour3, Gustavo Contreras Anez1, Jennifer Fung1, Christie Mulholland1, Howard Anthony Arabelo1, Janet Shapiro1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States; 3 University of Connecticut Health, Farmington, CT, United States

Accepted at the Annual Assembly of Hospice and Palliative Care; San Diego, CA, United States that was scheduled to be held from March 18-21, 2020.

105

PALLIATIVE CARE CONSULTATION REDUCES 30-DAY READMISSION RATES FOR HOSPITALIZED PATIENTS WITH END-STAGE CHRONIC OBSTRUCTIVE PULMONARY DISEASE Jacqueline Sheehan1, Kam Sing Ho1, Charles Gaulin2, Setareh Alipour3, Karan Jatwani1, Paaras Kohli1, Jennifer Fung1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States; 3 University of Connecticut Health, Farmington, CT, United States

Accepted at the Annual Assembly of Hospice and Palliative Care; San Diego, CA, United States that was scheduled to be held from March 18-21, 2020.

106

PALLIATIVE CARE CONSULTATION REDUCES 30-DAY READMISSION RATES FOR HOSPITALIZED PATIENTS WITH MALIGNANT PLEURAL EFFUSION Jacqueline Sheehan1, Kam Sing Ho1, Setareh Alipour2, Karan Jatwani1, Paaras Kohli1, Jennifer Fung1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2University of Connecticut Health, Farmington, CT, United States

Accepted at the Annual Assembly of Hospice and Palliative Care; San Diego, CA, United States that was scheduled to be held from March 18-21, 2020.

INCREASED 30-DAY READMISSION AMONG ACUTE MYOCARDIAL INFARCTION WITH MAJOR DEPRESSIVE DISORDER: A PROPENSITY SCORE MATCH ANALYSIS Lingling Wu1, Bharat Narasimhan1, Kam Sing Ho1

107

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting; Philadelphia, Pennsylvania, United States held on November 16-18, 2019.

108

ATRIAL FIBRILLATION IS INDEPENDENTLY ASSOCIATED WITH ADVERSE HOSPITAL OUTCOMES AND COMPLICATION AMONG PATIENTS ADMITTED FOR INFLUENZA Lingling Wu1, Faris Haddidin1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the European Society of Cardiology (ESC) Congress; Paris, France held on August 31, 2019 to September 4, 2019.

*does not include those with posters submitted by author 106

LIST OF ABSTRACTS 2019-2020* ESSENTIAL THROMBOCYTOSIS IS ASSOCIATED WITH WORSE OUTCOMES IN PATIENTS PRESENTED WITH ACUTE MYOCARDIAL INFARCTION: A PROPENSITY SCORE ANALYSIS OF THE NATIONAL INPATIENT SAMPLE Lingling Wu1, Baoqiong Liu2, Yingying Zheng3

109

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Florida Hospital, Orlando, FL, United States; 3Brady School of Medicine at East Carolina University, Greenville, NC, United States

Presented at the European Society of Cardiology (ESC) Congress; Paris, France held on August 31, 2019 to September 4, 2019.

110

SENTINEL LYMPH NODE SAMPLING AND EMPIRIC CHEMORADIATION AS AN ORGAN SPARING APPROACH AFTER ENDOSCOPIC RESECTION OF INTERMEDIATE RISK EARLY FOREGUT CANCERS: A US PILOT STUDY Stavros N Stavropoulos1, Xiaocen Zhang2, Erin Ly3, Mengdan Xie2, Maaz B Badshah1, Iosif Galibov, Jessica L Widmer1, Rani J Modayi1 1

New York University, New York, NY, United States; 2Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3University of Buffalo, Buffalo, NY, United States

Accepted at the Digestive Disease Week (DDW); Chicago, IL, United States that was scheduled to be held May 2-5, 2020.

*does not include those with posters submitted by author 107

Abstracts 2019-2020

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ABSTRACT #67 CLINICAL RESEARCH RHEUMATOLOGY CARDIOVASCULAR IMPACT OF HYPERURICEMIA IN PATIENTS WITH PSORIATIC ARTHRITIS Ana B. Arevalo1, Faris Haddadin1, Gustavo Contreras1, Shane Murray1, Yousaf Ali1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Rheumatology (ACR) Annual Meeting; Atlanta, Georgia, United States held on November 8-13, 2019.

BACKGROUND/INTRODUCTION: Inflammatory joint diseases (IJD) such as psoriatic arthritis (PsA) have an increased risk of cardiovascular disease (CVD) since inflammation plays a pivotal role in the pathogenesis of coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (Afib). Ischemic heart disease and HF are the main causes of the increased and premature mortality among patients with IJD. Additionally, patients with PsA have a prevalence of hyperuricemia (HUC) of 32%, 3 times greater as compared with the general population, which may be related to increased cell turnover as well as the release of pro-inflammatory cytokines and tumor necrosis factor. HUC not only is a risk factor for gout but also may contribute independently to accelerated CAD. Prolonged exposure to high levels of uric acid (UA) has been shown to result in oxidative stress causing endothelial dysfunction, ionic channel changes, atrial and ventricular remodeling. There is experimental evidence indicating that uric acid stimulates renin-angiotensin-aldosterone system (RAAS), and it is associated with an increase in cardiac tissue xanthine oxidase activity, all of which induce cardiomyocyte hypertrophy, myocardial oxidative stress, interstitial fibrosis and impaired diastolic relaxation. The aim of this study is to assess the correlation of HUC and the clinical expression of CVD in patients with PsA. METHODS: This is a retrospective cohort study using the 2016 National Inpatient Sample (NIS) of adults diagnosed with PsA based on ICD-10 codes, to detect the prevalence of cardiovascular (CV) conditions such as CAD, atrial fibrillation, and HF with preserved ejection fraction (HFpEF) in patients with concomitant HUC or gout versus age matched controls. Chi square was used for point prevalence and multivariate linear regression adjusted for age, gender, race, CAD, diabetes mellitus, HTN, hyperlipidemia (HLD), smoking, chronic kidney disease (CKD) and Charlson comorbidity index for prevalence odds ratio (POR). We used STATA-15 for statistical analysis.

RESULTS: We identified 37,315 patients with PsA, of whom 2,165 had concomitant HUC or gout (5.80%).

Mean age was 61 years, 57% were females. Our results showed that PsA with concomitant HUC or gout compared to PsA without HUC or gout was associated with a higher rate of Afib (17.8% vs 6.1%, p<0.001), CAD (35.1% vs 19.4%, p<0.001) and HFpEF (7.2% vs 3.1%, p<0.001). Furthermore, patients with PsA and HUC/gout appeared to have more risk of developing atrial fibrillation (POR 1.79; 95%-CI 1.31-2.45; p<0.001) and HFpEF (POR 1.56; 95%-CI 1.08-2.26; p=0.018), compared to patients with normal uric acid after multivariate-adjustment for risk factors. No statistical difference in CAD was identified between the two groups (POR 1.21; 95%-CI 0.94-1.55; p=0.131) after multivariate linear regression adjustment for confounders.

CONCLUSION: This study showed that HUC is independently associated with CVD, mainly with atrial fibrillation and HFpEF in patients with PsA. It remains to be seen if a treat to target approach with normalization of UA in patients with PsA will result in improved CV outcomes. We believe that our findings merit further investigation and that this study adds weight to the hypothesis of UA as a potential risk factor for CVD. Prospective studies are needed to establish the role of serum uric acid level as a biomarker or predictor for CVD, including CAD, atrial fibrillation, and HFpEF in patients with PsA.

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ABSTRACT #68 CLINICAL RESEARCH RHEUMATOLOGY CARDIOVASCULAR IMPACT OF HYPERURICEMIA IN PATIENTS WITH PSORIATIC ARTHRITIS Ana B. Arevalo1, Faris Haddadin1, Shane Murray1, Gustavo Contreras1, Yiming Luo2, Yousaf Ali1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, United States

2

Presented at the American College of Rheumatology (ACR) Annual Meeting; Atlanta, Georgia, United States held on November 8-13, 2019.

BACKGROUND/INTRODUCTION: Senile systemic amyloidosis (SSA) derived from wild-type transthyretin (TTR) is a debilitating autosomal dominant disease leading to motor disability within 5 years and fatal within a decade without treatment. It is a common condition of old individuals, especially men. The main presentation is by cardiac involvement. SSA is, however, a systemic disease, and amyloid deposits may appear in many other tissues such as cartilage and ligaments. Lumbar spinal stenosis is also a condition of elderly individuals in whom narrowing of the lumbar spinal canal leads to nerve compression of the lower extremities. Neuropathy caused by TTR amyloidosis had been frequently misdiagnosed as CIDP, para-proteinaemic peripheral neuropathy and other causes of acquired neuropathy.

METHODS: This is a retrospective cohort study using the 2016 National Inpatient Sample (NIS) of adults hospitalized for Cardiac Amyloidosis (CA) as the admitting diagnosis and lumbar spinal stenosis (LS) as a secondary diagnosis based on ICD-10 codes. Multivariate linear regression adjustment for confounders of age, gender and race was made. STATA 15 was used for data analysis.

RESULTS: 1068 patients were admitted with cardiac amyloidosis in 2016, of which 90 patients had lumbar spinal stenosis (8.42%), 25 were females (27.77%), 65 males (72.2%), 65 were non-African American (72.2%) and 25 individuals were African American (27.77%). Mean age was 78.8 for those with CA and lumbar spinal stenosis, compared to 72.37 for CA and 68.3 for LS alone. Univariate linear regression showed a significant relation between these two conditions (OR:2.48; 95%CI:1.49-4.12; p-value:<0.001). Multivariate linear regression adjusted to age, race and gender also showed a significant correlation (OR: 1.70; 95%CI:1.03-2.82; p-value:<0.04). Subgroup analysis demonstrated an increased risk for developing lumbar spinal stenosis along with cardiac amyloidosis with the increase of age (OR: 1.09 per year of age; 95%-CI 1.06-1.12; p-value: <0.001) and for African-Americans (OR: 3.8; 95%CI:1.37-10.6; p-value:<0.01). However, this association is less frequent in the female gender (OR: 0.028; 95%CI:0.1-0.77; p-value:<0.01).

CONCLUSION: We conclude that lumbar spinal stenosis is quite frequent in patients with cardiac amyloidosis due to TTR deposit therefore patients with lumbar back pain in the setting of restrictive cardiomyopathy deemed to be secondary to TTR, need a confirmatory tissue biopsy to avoid misdiagnosis because diverse treatment options are available, including tafamidis or patisiran, which all appear to be effective in early disease stages.

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ABSTRACT #69 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW CARDIOVASCULAR DISEASE AN ELUSIVE MIMICKER OF ABDOMINAL AORTIC ANEURYSM Abraham Derman1, Mayank Yadav2, Mohammad Asad1, Manoj Bhandari2, Jonathan N. Bella2, Jacqueline Tamis-Holland1,2, Patrick Lam1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Morningside and BronxCare Hospital Center, New York, NY, United States

2

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

CASE PRESENTATION: A 73-year-old male, smoker with comorbidities of chronic obstructive pulmonary disease and heart failure with reduced ejection fraction presented to the emergency room with a complaint of a pulsating abdomen that began one day following permanent pacemaker (PPM) generator change. Patient denied chest or abdominal pain, dizziness, syncope, trauma. On exam, he was not in distress and lying comfortably. A pulse 93 beats per minute and bilaterally symmetrical and blood pressure was 101/60 mmHg. Abdomen was visibly pulsating; non-tender and pulsations were synchronous with the pulse. No obvious mass could be felt.

DISCUSSION: Although there was a temporal relation of the current presentation with the PPM generator change, no manipulation was done to the intracardiac leads during the procedure. A pulsating abdomen in a patient with a history of smoking and heart disease, requires an investigation to rule out rapidly expanding abdominal aortic aneurysm (AAA). A bedside ultrasound was performed and ruled out any significant AAA. An additional reassuring clue was that the pulsation seemed to cease when the patient changed position, which altered the position of coronary sinus (CS) lead with respect to phrenic nerve, which is usual suspect. Device interrogation confirmed the suspicion. The CS lead was stimulating the left phrenic nerve that in turn led to diaphragmatic contractions which were synchronous with the pulse. The vector reprogramming of the CS lead, led to immediate cessation of the abdominal pulsations. Patient was safely discharged home later that day.

CONCLUSION: This case illustrates the importance of good history taking, critical analysis of new symptoms with priority to rule out most life-threatening condition first while simultaneously assessing for less concerning reversible causes. The effective and timely use of bedside ultrasound proved versatile and crucial to rule out AAA and avoided contrast and radiation exposure of computed tomography.

111

ABSTRACT #70 CLINICAL RESEARCH CARDIOVASCULAR DISEASE DE-ESCALATION OF ASPIRIN FOR PRIMARY PREVENTION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN THE PRIMARY CARE SETTING Joshua Berookhim1, Michael Kahen1, Gabriela Bernal1, Subrat Das1, Brian Berookhim1, Dipal Patel1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association Quality of Care and Outcomes Research Annual Meeting that was held virtually from May 15-16, 2020.

BACKGROUND: For several decades, aspirin (ASA) has been used as primary prevention against ASCVD in adults. In 2018, three major trials (ASPREE, ARRIVE, and ASCEND) redefined our understanding of ASA and showed a net harm rather than benefit when ASA is used for primary prevention of ASCVD. These trials greatly impacted the current 2019 ACC/AHA Primary Prevention Guidelines, which now recommend the following: (a) Low-dose ASA might be considered for primary prevention of ASCVD in select higher ASCVD adults aged 40-70 years who are not at increased bleeding risk and (b) Low-dose ASA should not be administered for primary prevention of ASCVD among adults over the age of 70. The objective of the project was to re-evaluate the use and indications of ASA in our patient population and appropriately remove ASA when no longer indicated. With proper resident education and intervention, we hypothesized that we could reduce the number of inappropriate ASA prescriptions by 10%.

RESULTS: During a 6-month observational period, 254 patients at Ryan Health/Adair (a federally qualified health center which also serves as a primary care site for an internal medicine residency clinic) were found to be taking ASA, and of those 140 patients were found to be on ASA for primary ASCVD prevention. The interventions included implementation of an algorithm that reflected the most up to date guidelines. The intervention lasted 3 months. Any patient that was found to be on ASA inappropriately was discontinued.

During this period ASA was successfully removed from 25 patientsâ&#x20AC;&#x2122; medication list, with an overall reduction by 17.9%. Of the 25 patients, 20% were over the age of 70, 80% were between the ages of 40-70, and 48% were male. In the remaining 115 patients in which ASA was continued, 27.8% were over the age of 70, 69.6% were between the ages of 40-70, 2.6% were under the age of 40, and 49.6% were male. The successful ASA removal group comprised of 44% Hispanic/Latino, 44% African American, 4% White, and 8% Unidentified. The ASA non-removal group comprised of 34.8% Hispanic/Latino, 44.3% African American, 5.2% White, and 15.7% Unidentified. Additionally, 80% of the patient taken off ASA spoke English, while only 69.6% of patient in the ASA non-removal group spoke English.

CONCLUSION: Several differences were found between the two groups. Some key limitations between the two groups included (a) unclear past medical history leading to physicians being uncomfortable with removing ASA, (b) inability to speak in patientâ&#x20AC;&#x2122;s native language to facilitate proper discussion about ASA removal, and (c) patient refusal to stop ASA. Next steps include further cardiac testing (CT coronaries, stress test) to better characterize the risk of patients with unclear history. However, overall, there is likely a net benefit in prioritizing ASA removal in the primary care setting now that it is no longer recommended in key populations.

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ABSTRACT #71 CLINICAL RESEARCH GASTROENTEROLOGY/HEMATOLOGY/ONCOLOGY IS THERE AN OBESITY PARADOX IN PATIENTS UNDERGOING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), NATIONAL INPATIENT SAMPLE STUDY 2014 Bing Chen1, Shah Suraj1, Chieng-Chang Lee2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; National Taiwan University Hospital, Taipei, Taiwan

2

Accepted at the Digestive Disease Week (DDW); Chicago, IL, United States that was scheduled to be held May 2-5, 2020.

BACKGROUND/INTRODUCTION: The obesity paradox is a phenomenon that obesity appears to be associated with lower mortality in some diseases and procedures. A significant proportion of patients undergoing ERCP are obese, but whether the obesity paradox exists in those patients or not is not clear. In this study, we aim to investigate the relationship between obesity and the mortality of patients undergoing ERCP. METHODS: The 2014 National Inpatient Sample database was analyzed by using ICD-9 codes for hospitalizations with a procedure code as therapeutic or diagnostic ERCP. Excluded hospitalizations included patients with age<20 or underweight, and elective admissions. The selected patients were categorized into normal weight (BMI:19.0~24.9), overweight (BMI:25.0~29.9), and obesity, which was further classified as grade 1 (BMI:30.0~34.9), grade 2 (BMI:35.0~39.9) and grade 3 (BMI:>=40.0 or morbid obesity). The primary outcome of interest was all-cause mortality and the secondary outcomes were the length of stay and total cost of the hospitalization. The odds ratios (ORs) or coefficient (Coef.) of in-hospital outcomes of obese/overweight patients were calculated relative to those with normal weight. Multivariate regression was used to adjust for age, gender, race, incomes, insurance, hospital characteristics, comorbidities, types of ERCP, and indications of ERCP. We repeated the above analysis in a restricted cohort by excluding patients who were smokers, alcoholics, or had any comorbidities defined by the Charlson Comorbidity Index. STATA 14 was used for analysis.

RESULTS: There were a total of 151,380 patients undergoing ERCP met the inclusion criteria, of which 20,045 (13.24%) were obese, 3,140 (2.07%) were overweight, and 128,470 (84.87%) were normal weight. Compared with normal-weight patients, patients with obesity were younger, more likely to be female, with a higher rate of choledocholithiasis, and lower Charlson Comorbidity Index. The adjusted odd ratios (aORs) were 0.63 (95% CI, 0.30-1.36) for overweight, 1.00 (95% CI, 0.72-1.41) for obesity (all grades combined), 0.62 (95% CI, 0.291.29) for grade 1 obesity, and 1.49 (95% CI, 1.01-2.19) for grade 3 obesity. There was a mortality benefit in grade 2 obesity [0.13% vs 1.44%, aOR: 0.13 (95% CI, 0.02-0.93)], however, the mortality was not statistically different [0.34% vs 0.33%, aOR: 3.20 (95% CI, 0.33-31.33)] in the restricted analysis.

CONCLUSION: Grade 3 obesity was associated with significantly higher mortality compared with patients with normal weight. There is no obesity paradox in hospitalized patients undergoing ERCP. The observed mortality benefit in grade 2 obesity was not present in the restricted analysis while excluding potential confounders like smoking and other chronic wasting conditions such as chronic kidney diseases in which patients tend to lose weight as the disease progresses.

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ABSTRACT #72 CLINICAL RESEARCH GASTROENTEROLOGY ALCOHOLIC CIRRHOSIS IS RELATED WITH HIGHER MORTALITY IN SEPTIC PATIENTS COMPARED WITH NON-ALCOHOLIC CIRRHOSIS, NATIONAL INPATIENT SAMPLE STUDY 2016 Bing Chen1, Omar Mahmoud1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM), Mid-Atlantic Regional Annual Meeting; Pittsburgh, PA, United States held on November 15, 2019.

BACKGROUND/INTRODUCTION: Previous studies have shown that patients with cirrhosis are prone to develop sepsis, sepsis-induced organ failure, and death. In this study, we aimed to investigate if there are any different effects of the alcoholic cirrhosis compared with non-alcoholic cirrhosis on the in-hospital outcomes of patients admitted for sepsis.

METHODS: In this retrospective study, we analyzed the 2016 National Inpatient Sample database using ICD10 codes for hospitalizations with principal diagnosis as sepsis and a secondary diagnosis as alcoholic cirrhosis or non-alcoholic cirrhosis. Excluded hospitalizations included patients with age<18, elective admissions, and sepsis which was related to obstetric complications. The primary outcomes of interest were mortality, length of stay, total cost, acute kidney injury, acute respiratory failure, and mechanical ventilation use. Multivariate regression was used to adjust for age, gender, race, incomes, insurance, hospital characteristics, and comorbidities. We used STATA 14 for analysis.

RESULTS: There were a total of 69,390 patients admitted for sepsis with a secondary diagnosis of cirrhosis, of which 28,225 had alcoholic cirrhosis. Compared with septic patients with non-alcoholic cirrhosis, patients with alcoholic cirrhosis were overall younger (56.8 years old vs 63.6 years old, p<0.01), more likely to be male (52.1% vs 47.9%, p<0.01), and had higher rate of spontaneous bacterial peritonitis (15.1% vs 7.2%, p<0.01).

In terms of primary outcome of interest, we observed higher mortality (24.5% vs 19.8%, adjusted odds ratio: 1.34, p<0.01) in alcoholic cirrhosis group. We also found a longer length of stay (9.3 days vs 8.2 days, adjusted coefficient: 0.91 days, p<0.01), higher total cost ($27,932 vs $22,784, adjusted coefficient: 4,017 dollars, p<0.01), more acute kidney injury (53.4% vs 48.6%, adjusted odds ratio: 1.48, p<0.01), more acute respiratory failure (30.9% vs 25.4%, adjusted odds ratio: 1.25, p<0.01), and more use of mechanical ventilation (27.5% vs 19.2%, adjusted odds ratio 1.97, p<0.01).

CONCLUSION: Alcoholic cirrhosis was associated with higher rate of complications and higher in-hospital morality in patients admitted for sepsis compared with non-alcoholic cirrhosis. A more comprehensive strategy with adequate treatment is needed to ensure optimal outcomes in those patients.

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ABSTRACT #73 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW OPHTHALMOLOGY NON-ARTERITIC ANTERIOR ISCHEMIC NEUROPATHY IN A MALE-TO-FEMALE TRANSGENDER PERSON Erin Flynn1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Millennial Eye Annual Meeting; Louisville, KY, United States held on September 6, 2019.

BACKGROUND/INTRODUCTION: Hormone therapy for gender reassignment has been linked to both cardiovascular and cerebrovascular disorders depending on whether it is initiated for virilization or feminization.

However, little literature exists concerning neurological and/or ophthalmologic complications of hormone therapy in transgender patients. A male-to-female (MTF) transgender patient developed non-arteritic anterior ischemic optic neuropathy (NAION) eighteen months after initiation of hormone therapy including spironolactone and estradiol. Systemic hypotension as a side effect of spironolactone and prothrombotic effects of exogenous estrogen maybe explain NAOIN in this case.

CASE PRESENTATION: A 68-year-old MTF transgender woman born with XY chromosomes presented with painless vision loss in their left eye upon awakening. Eighteen months prior, the patient started spironolactone 100 mg oral tablet twice daily for anti-virilization and a weekly transdermal estrogen patch 0.1mg/24 hr. Vital signs were remarkable for a low BP of 99/59; baseline BP six months prior was 120/74. General and neurological examinations were intact with a body mass index of 24.22. Ophthalmic exam revealed a visual acuity of 20/20 in both eyes. A left relative afferent pupillary defect (RAPD) was present. Humphrey visual field testing demonstrated a moderate, generalized constricted visual field in the left eye with a mean deviation of 11.3. Ocular coherence tomography (OCT) using the Zeiss Cirrus spectral-domain OCT revealed average nerve fiber layer thickness of 79 microns OD and 202 microns OS. Fundus photographs showed an unremarkable right optic disc with a cup-to-disc ratio of 0.15 and a diffusely swollen optic disc OS with splinter hemorrhages. Macular OCT was normal bilaterally. CT-Head showed no midline shift, mass effect, abnormal density, or intracranial hemorrhage. The patient was diagnosed with NAION. Due to potential hypotension contributing to the onset of NAION, the spironolactone, dose was halved. The estrogen therapy was not changed. Six months later, the patientâ&#x20AC;&#x2122;s acuity remained 20/20 OU with 1+RAPD OS. Fundus exam remained unchanged OD and mild atrophy was noted OS. Repeat Humphrey visual field 24-2 showed improvement with a residual inferior arcuate defect.

DISCUSSION: We present a case of NAION possibly as a secondary effect of spironolactone and/or estrogen therapy prescribed for gender reassignment. No cases of spironolactone and NAION were found in an online PubMed literature search. Several cases of NAION attributed to long-term estrogen therapy or an overdose of estrogen compounded by a significant smoking history have been reported. A 45-year-old MTF transgender patient who had been undergoing therapy with levonorgestrel and ethinyl estradiol for 11 years developed bilateral retinal vein occlusions. Similarly, a case report was published involving a MTF patient with a significant smoking history who developed bilateral NAION and multiple cortical infarcts after taking an overdose of transdermal estradiol with an estrogen level of >5,000 pg/ml (normal <400 pg/ml). A handful of case reports link long-term estrogen therapy for gender-reassignment with NAION; one presented a MTF patient who developed thrombosis after 15 years of estrogen therapy with no PMH of HTN or hyperlipidemia.

There are also two documented cases of NAION developing after estrogen therapy for infertility in young, nontransgender patients. Both cases involved clomiphene citrate, a selective estrogen receptor agonist. In one case, a 35 year-old male developed NAION after a one year course of clomiphene citrate at 25 mg daily. This patient had no cardiovascular history, no genetic conditions predisposing to thrombosis, and denied the use of phosphodiesterase inhibitors. Although an estrogen receptor modulator, clomiphene citrate increases fertility in males by stimulating the production of testosterone in the body. The other case involved a 31-year-old female who developed NAION in her right eye after completing a five-day course of clomiphene citrate 50 mg daily for primary infertility. These cases illustrate that estrogen therapy for infertility, at lesser dosages and shorter durations than those for gender reassignment, can predispose young individuals to NAION. Although the direct cause(s) of NAION remain unknown, spironolactone and/or estrogen therapy in MTF transgender patients may increase the risk of NAION. Therefore, these patients should be encouraged to avoid tobacco products and maintain a healthy lifestyle in the hope of lowering their risk of NAION.

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ABSTRACT #74 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY ETIOLOGIES AND PREDICTORS OF 30-DAY READMISSION IN PATIENTS UNDERGOING INDUCTION CHEMOTHERAPY FOR ACUTE MYELOID LEUKEMIA Shivani Handa1, Kamesh Gupta2, Jasdeep Singh Sidhu3, Giulia Petrone1, Sridevi Rajeeve1, Karan Jatwani1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Baystate Medical Center, Springfield, MA, United States; 3Interfaith Medical Center, Brooklyn, NY, United States

2

Accepted at the American Society of Hematology (ASH) Annual Meeting; Orlando, FL, United States held on December 7-10, 2019.

BACKGROUND/INTRODUCTION: Early readmissions are important indicators of quality of health-care.

National-level data is currently lacking for patients admitted for induction chemotherapy for acute myeloid leukemia (AML). Our study is to investigate characteristics and predictors of 30-day hospital readmission in patients with AML after receiving induction chemotherapy.

METHODS: We analyzed the 2016 United States National Readmission Database, the latest and largest readmission database available so far. The authors identified hospitalizations for patients using ICD-10 codes for "encounter for chemotherapy" or a procedure code for administration of antineoplastic agent as the primary diagnosis with a secondary diagnosis of acute myeloid leukemia or myeloid sarcoma. We excluded patients who had a personal history of chemotherapy or those in remission or relapse in order to avoid counting patients admitted for consolidation/ re-induction chemotherapy. A readmission was defined as the first admission to any hospital for any non-traumatic diagnosis within 30 days of discharge after the index admission. Same day admissions and discharges were excluded. The primary outcome was 30-day readmission rate. Secondary outcomes were 30-day mortality rate, most common reasons for readmission, readmission mortality rate and resource utilization (length of stay and hospitalization costs). Independent risk factors for readmission were identified using multivariate regression analysis.

RESULTS: A total of 18,140 admissions were identified for induction chemotherapy. The median age was 64.1 years and 45% of patients were female. The all cause 30-day readmission rates were 30.1%. The in-hospital and 30-day mortality rate were 3.9% and 4.8%, respectively. The in-hospital mortality rate for readmitted patients was 3.8%. The top five causes for unplanned readmissions were neutropenia (7.2%), sepsis (6.1%), pneumonia (2.6%), acute kidney injury (2.5%) and neoplasm related pain (2.3%). Mean total charges were higher during index admission than readmission ($118,449 vs $49,087, p=.000). Table 1 shows the base patient characteristics and Table 2 shows the odds ratios of the various factors tested as independent predictors of readmission. Independent predictors of readmission were younger age, low income, Medicaid, uninsured or Private Insurance, co-morbidities, urban hospital and length of stay during index hospitalization.

The total hospital days associated with readmission were 102,924 days, with a total healthcare economic burden of $303 million.

CONCLUSION: Our study reveals that there is a significant readmission rate in this study population generating a substantial financial burden. 30-day readmissions are primarily due to neutropenia and infectious etiologies including sepsis and pneumonia. This emphasizes the urgent need for organizing better outpatient follow up for patients after hospitalization as well as increased awareness for antibiotic prophylaxis. Further research into development of clinical models for risk stratification is also required.

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ABSTRACT #75 CLINICAL RESEARCH PULMONARY/CRITICAL CARE IS SMOKING WORTH THE RISK? INCREASED THIRTY-DAY READMISSION AMONG SMOKERS WITH PULMONARY EMBOLISM: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Jacqueline Sheehan1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

BACKGROUND/INTRODUCTION: To determine the relationship between tobacco dependence and thirtydays readmission, mortality, morbidity, and health care resource utilization in patients admitted to hospitals in the in the United States with pulmonary embolism (PE).

METHODS: A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for the year 2014. Adults (â&#x2030;Ľ18 years) with a principal diagnosis of pulmonary embolus and a secondary diagnosis of tobacco dependence were identified using ICD-9 codes as described in the literature. The primary outcome was the rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for readmission were identified using Coxâ&#x20AC;&#x2122;s proportional hazards model.

RESULTS: In total, 171,233 hospital admissions among adults with a primary diagnosis of pulmonary embolus were identified, of which 34.2% (58,628) had tobacco dependence. After PS matching with similar demographic and clinical characteristics, 24,262 pulmonary embolus patients with tobacco dependence were paired with 24,262 pulmonary embolus patients without tobacco dependence. The 30-day rate of readmission among smokers and nonsmokers with pulmonary embolus was 11.0% and 8.9% (p<0.001). The most common readmission for both groups was pulmonary embolus (69.6%). Patients readmitted had a significant higher morality compared index admissions (6.27 % vs 3.16%, p<0.001). A total of 78,592 hospital days was associated with readmission, and the total health care in-hospital economic burden was $168 million (in costs) and $615 million (in charges). Tobacco dependence (HR 1.29, 95%CI:1.04-1.59, p <0.01) was an independent predictor associated with higher risks of readmission. Other factors included female gender, atrial fibrillation, inhospital oxygen requirement, Medicare insurance, and higher Charlson comorbidity. On the contrary, private insurance and higher income status were associated lower risk of readmission included.

CONCLUSION: In this study, 11.0% of smokers and 8.9% of nonsmokers with pulmonary embolus were readmitted to the hospital within 30 days of discharge (p<0.001) and the most common cause was pulmonary embolus. Tobacco dependence was an independent predictor that was associated with higher readmission rate.

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ABSTRACT #76 CLINICAL RESEARCH PULMONARY/CRITICAL CARE MISSED OPPORTUNITIES FOR IN-HOSPITAL VACCINATIONS? INFLUENZA VACCINATION REDUCES 30-DAY READMISSION AMONG PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Jacqueline Sheehan1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

BACKGROUND/INTRODUCTION: To determine the relationship between influenza vaccines administered inhospital and the rate of hospital readmission within 30 days, mortality, morbidity, and health care resource utilization in patients admitted to the hospital in the United States with community acquired pneumonia (CAP).

METHODS: A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for the year 2014. Adults (â&#x2030;Ľ18 years) with a principal diagnosis of CAP and a procedure diagnosis of influenza vaccination were identified using ICD-9 codes as described in the literature. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for readmission were identified using Coxâ&#x20AC;&#x2122;s proportional hazards model.

RESULTS: In total, 825,906 hospital admissions with a primary diagnosis of CAP were identified, of which 1.91% (14,047) received in-hospital influenza vaccination. After PS matching with similar demographic and clinical characteristics, 9,777 CAP patients with influenza vaccination were paired with 9,777 CAP patients without influenza vaccination. The 30-day rate of readmission was 11.9%. The most common reason was pneumonia (98.1%). Patients readmitted had a significant higher rate of death than those for index admissions (7.69% vs 3.32%, p<0.001). A total of 489,247 hospital days was associated with readmission, and the total health care in-hospital economic burden was $1 billion (in costs) and $3.67 billion (in charges). In-hospital influenza vaccination (Hazard Ratio 0.821, 95%CI:0.69-0.98, p<0.028) was an independent predictor associated lower risk of readmission. Other factors included private insurance and high-income status. On the contrary, advanced age, Medicare insurance, higher Charlson comorbidity score, atrial fibrillation, acute respiratory failure, and in-hospital oxygen use were associated higher risks of readmission.

CONCLUSION: In this study, 11.9% of CAP patients were readmitted to the hospital within 30 days of discharge and the most common cause is pneumonia.

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ABSTRACT #77 CLINICAL RESEARCH PULMONARY/CRITICAL CARE OBESITY PARADOX? IMPROVED IN-HOSPITAL MORTALITY IN PATIENTS ADMITTED FOR SEPSIS VERSUS SEPTIC SHOCK: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Jacqueline Sheehan1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

BACKGROUND/INTRODUCTION: This study was conducted to determine the relationship between obesity and the rate of hospital readmission within 30 days, mortality, morbidity, and health care resource utilization in patients admitted to the hospital in the United States with sepsis.

METHODS: A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Adults (≥18 years) with a principal diagnosis of sepsis and septic shock and a secondary diagnosis of obesity were identified using ICD-9 codes as described in the literature. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for readmission were identified using Cox’s proportional hazards model.

RESULTS: In total, 1,924,860 admissions with sepsis and 430,180 septic shock admissions were identified, of which 15.23% and 15.37% of patients were obese, respectively. After PS matching, 370,655 obese patients with sepsis were paired with 370,655 non-obese patients with sepsis. Similarly, 370,655 obese patients with septic shock were paired with 370,655 non-obese patients with septic shock. Among obese patients with sepsis, in-hospital morality (OR 0.723, 95%CI:0.649-0.805, p<0.001) were lower in comparison to non-obese patients with sepsis. However, medical comorbidities were higher among obese patients with sepsis, including atrial fibrillation, acute respiratory failure (ARF), and acute kidney injury (AKI). Similarly, the in-hospital morality among obese patients with septic shock (OR 0.723, 95%CI:0.649-0.805, p<0.001) were lower in comparison to non-obese patients with septic shock. However, medical comorbidities were higher, including atrial fibrillation, ARF, and AKI. Obese patients admitted with sepsis had a longer mean LOS (8.0 days vs 7.7 days, p<0.001) and a higher mean total hospital cost ($20,155 vs $19,151, p<0.02) when compared to the non-obese patients admitted with sepsis. However, the mean total hospital charge ($81,881 vs $77,943, p<0.06) was not significant between the two groups. For septic shock, obese patients had similar mean LOS (11.6 days vs 10.9 days, p<0.20), mean total hospital charge ($151,866 vs $146,010, p<0.4), and mean total hospital cost ($36,734vs $34,329, p<0.08) as the non-obese patients.

CONCLUSION: In this study, the reduced in-hospital mortality in obese patients with sepsis and septic shock supports the “obesity paradox”.

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ABSTRACT #78 CLINICAL RESEARCH PULMONARY/CRITICAL CARE PROTECTIVE METABOLIC RESERVES? IMPROVED IN-HOSPITAL MORTALITY IN PATIENTS ADMITTED FOR ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Jacqueline Sheehan1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

BACKGROUND/INTRODUCTION: To determine the relationship between obesity and the rate of hospital readmission within 30 days, mortality, morbidity, and health care resource utilization in patients admitted to the hospital in the United States with acute exacerbation of chronic obstructive pulmonary disease (A-COPD).

METHODS: A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Adults (≥ 18 years) with a principal diagnosis of A-COPD and a secondary diagnosis of obesity were identified using ICD-9 codes as described in the literature. The primary outcome was in-hospital mortality.

Secondary outcomes were complications of A-COPD, length of hospital stay (LOS), and total hospitalization costs and charges. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders2. Independent risk factors for readmission were identified using multivariate logistic regression model.

RESULTS: In total, 2,150,061 hospital admissions with a primary diagnosis of A-COPD were identified, of which 17.56% (377,640) were obese. After PS matching with similar demographic and clinical characteristics, 370,655 obese patients with A-COPD were paired with 370,655 non-obese patients with A-COPD. Among obese patients with A-COPD, in-hospital morality (OR 0.66, 95%CI:0.59-0.72, p<0.001) was lower in comparison to non-obese patients with A-COPD. However, medical comorbidities were higher among obese patients with A-COPD, including atrial fibrillation, acute respiratory failure, acute kidney injury, renal dialysis, and oxygen use. Obese patients admitted with A-COPD had a longer mean LOS (7.2 days vs 6.7 days, p<0.001), a higher mean total hospital charge ($67,501 vs $61,721, p<0.001), and a higher mean total hospital cost ($16,821 vs $15,872, p<0.001) when compared to the non-obese patients admitted with A-COPD. CONCLUSION: Obesity has been associated with improved survival in patients with existing chronic diseases —a phenomenon referred to as “obesity paradox”. A postulated hypothesis suggests that higher metabolic reserves may be beneficial in acute illnesses. In this study, the reduced in-hospital mortality in obese patients with A-COPD support the “obesity paradox”.

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ABSTRACT #79 CLINICAL RESEARCH CARDIOVASCULAR DISEASE OBESE PATIENTS WHO UNDERWENT CARDIOPULOMONARY RESUSCITATION HAVE INCREASED 30-DAY READMISSION AND TOTAL HOSPITAL COST Kam Sing Ho1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting; Philadelphia, Pennsylvania, United States held on November 16-18, 2019.

BACKGROUND/INTRODUCTION: This study was conducted to determine the relationship between obesity and thirty-days readmission, mortality, morbidity, and health care resource utilization in patients who underwent cardiopulmonary resuscitation (CPR) during their hospitalization in the in the United States.

METHODS: A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for the year 2014. Adults (≥ 18 years) with a primary diagnosis of CPR, along with a secondary diagnosis of obesity were identified using ICD-9 codes as described in the literature. The primary outcome was the rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the 1:1 nearest neighbor matching without replacement was utilized to adjust for confounders. Independent risk factors for readmission were identified using a Cox proportional hazards model.

RESULTS: In total, 113,394 hospital admissions among adults with a primary and secondary diagnosis of CPR were identified, of which 14.8% were obese. 1:1 PS matching was performed based on demographic (age, gender, hospital status, etc.) and clinical characteristics (Charlson comorbidity score). The 30-day rate of readmission among obese and non-obese with CPR were 4.94% and 2.82% (p<0.001). The most common readmission for both groups was unspecified sepsis (17.3%), followed by acute respiratory failure (6.6%).

During the index admission for CPR, the length of stay (LOS) among obese and non-obese patients were similar (10.3 vs 9.4 days, p=0.16). However, the total cost for the obese patients was statistically different ($33,232 vs $33,692, p<0.001). Most importantly, obese patients’ in-hospital mortality rate during their index admission was significant higher (58.7% vs 6.72%, p<0.001). Amongst those readmitted, obese patients similarly had a significantly longer LOS than their non-obese counterparts (8.1 vs 4.5 days, p<0.001) and their total cost for the readmission was more expensive ($19,027 vs $10,572, p<0.001). But, obese patients’ inhospital mortality rate during their readmission was not significant different (0.34 % vs 0.08%, p=0.09). Obesity (HR 1.77, 95%CI:1.06-1.16, p<0.02) was an independent predictor associated with higher risks of readmission.

Private insurance was an independent that reduced readmission rates.

CONCLUSION: In this study, obese patients admitted with CPR have a higher 30 days of readmission rate, total hospital cost, and in-hospital mortality (p<0.02) than their non-obese counterparts.

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ABSTRACT #80 CLINICAL RESEARCH PULMONARY/CRITICAL CARE ADRENAL INSUFFIENCY AND COPD Kam Sing Ho1, Paaras Kohli1, Shabnam Nasserifar1, Jacqueline Sheehan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Thoracic Society (ATS) Annual Meeting; that was held virtually from May 15-20, 2020.

BACKGROUND/INTRODUCTION: Corticosteroids, whether inhale or systemic, are the cornerstones in the treatment of chronic obstructive pulmonary disease (COPD). The incidence of corticosteroid-induced adrenal suppression varies by the administration route and duration of therapy and is a potentially life-threatening condition. The impact of adrenal insufficiency on acute exacerbations of COPD has not been well studied. This study was conducted to determine the relationship between adrenal insufficiency and in-hospital mortality, morbidity, and health care resource utilization in patients admitted to the hospital in the United States with acute exacerbation of COPD (AE-COPD).

METHODS: A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2016. Adults (â&#x2030;Ľ18 years) with a principal diagnosis of COPD and a secondary diagnosis of adrenal insufficiency were identified using ICD-10 codes as described in the literature. The primary outcome was inhospital mortality. Secondary outcomes were length of hospital stay (LOS), and total hospitalization costs.

Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for mortality were identified using multivariate logistic regression model.

RESULTS: In total, 1,334,220 hospital admissions with a primary diagnosis of AE-COPD were identified, of which 0.63% (7,952) had a secondary diagnosis of adrenal insufficiency. Among patients with adrenal insufficiency, the in-hospital morality (6.36%, SD 0.56%) was high than those without adrenal insufficiency (3.30%, SD 0.07%; p<0.001). Those with adrenal insufficiency also has a lower length of stay (9.95 days vs 5.04 days, p<0.001) and a higher total hospital cost ($21,006 vs $11,965, p<0.001). Based on propensity matching, adrenal insufficiency (OR 1.61, SD 0.26; p<0.001) was associated with higher 30-day readmission.

CONCLUSION: In this retrospective study, individuals with adrenal insufficiency had higher 30-readmission rate, in-hospital mortality than those without adrenal insufficiency.

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ABSTRACT #81 CLINICAL RESEARCH PULMONARY/CRITICAL CARE ACUTE PULMONARY EMBOLISM-DONâ&#x20AC;&#x2122;T IGNORE ASPIRIN Kam Sing Ho1, Paaras Kohli1, Shabnam Nasserifar1, Jacqueline Sheehan1, Joseph Poon1, Yasmin Herrera1, Archana Pattupara1, Lingling Wu1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Thoracic Society (ATS) Annual Meeting; that was held virtually from May 15-20, 2020.

BACKGROUND/INTRODUCTION: Venous thromboembolism (VTE) has been traditionally associated with red blood cell; whereas arterial thrombi are rich in platelets. However, new studies show that VTE activates platelets, leading to release of vasoactive mediators (i.e. serotonin, adenosine diphosphate, prostaglandins, and thromboxane A2). Experimental studies further illustrate the benefit of aspirin in pulmonary embolism (PE) by reducing thromboxane B2, pulmonary dead space, and pulmonary vascular resistance. Despite these evidences, the role of aspirin in the treatment of PE remain unclear. This study was conducted to determine the relationship between use of aspirin and in-hospital mortality, morbidity, and health care resource utilization in patients admitted to the hospital in the United States with pulmonary embolism.

METHODS: A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2016. Adults (â&#x2030;Ľ18 years) with a principal diagnosis of PE and a secondary diagnosis of long term (current) use of aspirin were identified using ICD-10 codes as described in the literature. The primary outcome was inhospital mortality. Secondary outcomes were length of hospital stay (LOS), and total hospitalization costs.

Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for mortality were identified using multivariate logistic regression model.

RESULTS: In total, 178,579 hospital admissions with a primary diagnosis of PE were identified, of which 12.35% (22,049) was on aspirin. Among patients on long term use of aspirin, the in-hospital morality (1.96%, SD 0.21%) was lower than those without aspirin (3.03%, SD 0.11%; p<0.001). The aspirin cohort also has a lower length of stay (4.20 days vs 4.47 days, p<0.001) and a lower total hospital cost ($10,120 vs $11,256, p<0.001). Based on propensity matching, long term aspirin use (OD 0.39, SD 0.16; p<0.001) was associated with lower mortality; whereas old age and high Charlson Comorbidity Index were associated with higher mortality.

CONCLUSION: In this retrospective study, individuals already on long term use of aspirin had improved survival than those without if they were admitted with pulmonary embolism. Current therapies focus on using anticoagulants but patients with PE have persistent high mortality and recurrent rate. To date, the use of aspirin remains unclear and may provide additional antithrombotic protection.

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ABSTRACT #82 CLINICAL RESEARCH PULMONARY/CRITICAL CARE E-CIGARETTE-ASSOCIATED LUNG INJURY IS NOT THAT NEW: BEFORE THE 2019 VAPING CRISIS – INCIDENCE OF E-CIGARETTE-ASSOCIATED LUNG INJURY BASED ON CDC ICD-10-CM CODING GUIDELINES Kam Sing Ho1, Shabnam Nasserifar1, Jacqueline Sheehan1, Archana Pattupara1, Bharat Narasimhan1, Lingling Wu1, Raymonde Jean1, Jennifer Fung1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Thoracic Society (ATS) Annual Meeting; that was held virtually from May 17-19, 2020.

BACKGROUND/INTRODUCTION: Lung injury has been associated with e-cigarette products. As of August 2019, 215 possible cases of e-cigarette, or vaping, product use associated lung injury (EVALI) had been reported to CDC by 25 state health departments. Based on limited evidence, CDC released recommendations on e-cigarettes. To better capture possible cases of EVALI, CDC subsequently published ICD-10-CM coding guidance, endorsed by Medicare and Medicaid. To date, it has not been applied to real life encounters. This study was conducted determine the incidence of hospitalization related to e-cigarette and EVALI in the United States. Furthermore, patient characteristics, clinical symptoms, and health resource utilization of e-cigarette consumers and EVALI cases were determined.

METHODS: A retrospective analysis was conducted using the AHRQ-HCUP Nationwide Inpatient Sample for the year 2016. E-cigarette encounters were identified using F17.29, as outlined by CDC coding guidance.

EVALI encounters were identified among patients with a primary diagnosis of lung related complications (J68.0, J69.1, J80, J82, J84.114, J84.89, J68.9) with a secondary diagnosis of e-cigarette use. Primary objective was incidence of hospitalization related to e-cigarette use and EVALI. Secondary objectives included patient characteristics, clinical symptoms, reasons for admission, outcomes such as in-hospital mortality, and health resource utilization (length of stay and total hospitalization cost).

RESULTS: In total, 68,149 non-elective hospital admissions related to e-cigarette utilization and 6 cases of EVALI were identified in 2016. Among the EVALI cases, the average age was 54.6 years and predominantly male. Most patients had a low Charlson Comorbidity Index, private insurance, higher income ($70,000+), and were admitted to urban teaching hospitals with large bed capacity. The most common symptom was nonspecific abdominal pain. The average length of stay was 11 days (SD 2.3 days) and the total hospital cost was $18, 938 (SD $3,649). Among the non-elective hospital admissions related to e-cigarette use, the average age was similarly 57.5 years old and male predominant. The majority had a low-income status, were admitted to urban teaching hospitals with large bed capacity, had a higher Charlson Comorbidity Index. The average length of stay was 4.7 days (SD 0.05 days) and the total hospital cost was $12,217 (SD $156).

CONCLUSION: This is the first study to apply CDC’s ICD-10-CM coding guidance to a national registry. This study evaluated the prevalence of cases prior to the “Vaping Crisis of 2019”, suggesting that EVALI cases may have been overlooked in the past and underscores the importance of asking patients about their use of ecigarettes and vaping products.

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ABSTRACT #83 CLINICAL RESEARCH PULMONARY/CRITICAL CARE HALTING SEPSIS WITH ASPIRIN? Kam Sing Ho1, Paaras Kohli1, Shabnam Nasserifar1, Jacqueline Sheehan1, Yasmin Herrera1, Joseph Poon1, Bharat Narasimhan1, Lingling Wu1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Thoracic Society (ATS) Annual Meeting; that was held virtually from May 17-19, 2020.

BACKGROUND/INTRODUCTION: The septic inflammatory cascade involves the activation of NFκB (TNF and IL-6), lipid mediators, and platelets. Previous studies have showed that aspirin may reduce inflammation associated with infection by inhibiting NFκB, increasing lipoxin, and inhibiting platelets. This study was conducted to determine the relationship between use of aspirin and in-hospital mortality, morbidity, and health care resource utilization in patients admitted to the hospital in the United States with sepsis.

METHODS: A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2016. Adults (≥18 years) with a principal diagnosis of sepsis and a secondary diagnosis of long term (current) use of aspirin were identified using ICD-10 codes as described in the literature. The primary outcome was in-hospital mortality. Secondary outcomes were length of hospital stay (LOS), and total hospitalization costs. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for mortality were identified using multivariate logistic regression model.

RESULTS: In total, 1,802,034 hospital admissions with a primary diagnosis of sepsis were identified, of which 10.86% (195,749) was on aspirin. Among septic patients on aspirin, in-hospital morality (7.26%, SD 0.21) was lower than those without aspirin (10.12%, SD 0.13; p<0.001). Similar trends were observed after propensity match - aspirin [7.24% (SD 0.22) vs 9.11% (SD 0.56), p<0.001], respectively. The aspirin cohort also has a lower length of stay (6.08 vs 7.38 days, p<0.001) and a lower total hospital cost ($14,328 vs $18,524, p<0.001). Similar trends were also seen after propensity match-6.08 vs 7.38 days (p<0.001), ($14,302 vs $18,754 (p<0.001). Based on multivariate logistic regression, septic patients with protein malnutrition and adrenal insufficiency were associated with high mortality.

CONCLUSION: In this retrospective study, aspirin use was associated with improved survival in patients presenting with sepsis. A postulated hypothesis suggests that aspirin inhibits the pro-inflammatory cascade mediated by NFκB, TNF, IL-6 and increases levels of the potent anti-inflammatory mediators lipoxin and resolvins. Currently, the ANTISEPSIS randomized clinical trial is underway to investigate whether administration of low-dose aspirin reduces mortality due to sepsis.

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ABSTRACT #84 CLINICAL RESEARCH PULMONARY/CRITICAL CARE THIRTY-DAY READMISSION AMONG PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME AND EFFECTS ON OUTCOMES Kam Sing Ho1, Jacqueline Sheehan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the European Respiratory Society (ERS) International Congress Annual Meeting; Madrid, Spain held from September 28 to October 2, 2019.

BACKGROUND/INTRODUCTION: We determine the rate of hospital readmission within 30 days of acute respiratory distress syndrome (ARDS) and its impact on mortality, morbidity, and health care use in the United States. A retrospective study was conducted using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2014 (14.9 million hospital stays at 2048 hospitals in 22 states).

METHODS: 76,932 hospital admissions among adults were identified for ARDS and discharged. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity (shock and prolonged mechanical ventilation) and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using logistic regression analysis.

RESULTS: The 30-day rate of readmission was 12%. Only 10% of readmissions were due to recurrent ARDS, while the most common reason was sepsis (20%). The rate of death among patients readmitted to the hospital (7.2%) was lower than that for index admissions (7.9%) (p<.01). A total of 61,518 hospital days was associated with readmission, and the total health care in-hospital economic burden was $144 million (in costs) and $545 million (in charges). Independent predictors of readmission were advanced age, female, Medicaid insurance, higher Charlson comorbidity score, lower income, and septic or cardiogenic shock.

CONCLUSION: In this retrospective study of patients hospitalized for ARDS, readmission is associated with a high mortality, morbidity, and resource use.

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ABSTRACT #85 CLINICAL RESEARCH PULMONARY/CRITICAL CARE THIRTY-DAY READMISSION AMONG PATIENTS WITH NON-VENTILATOR HOSPITAL ACQUIRED PNEUMONIA AND EFFECTS ON OUTCOMES Kam Sing Ho1, Jacqueline Sheehan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the European Respiratory Society (ERS) International Congress Annual Meeting; Madrid, Spain held on September 28 to October 2, 2019.

BACKGROUND/INTRODUCTION: We determine the rate of hospital readmission within 30 days of nonventilator hospital acquired pneumonia (NV-HAP) and its impact on mortality, morbidity, and health care use in the United States. A retrospective study was conducted using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2014 (14.9 million hospital stays at 2048 hospitals in 22 states).

METHODS: 86,601 adult hospital admissions were identified for NV-HAP and discharged. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity (shock and prolonged mechanical ventilation) and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using logistic regression analysis.

RESULTS: The 30-day rate of readmission was 12.6%. 51% of readmissions were due to recurrent pneumonia, followed by sepsis (40%). The rate of death among patients readmitted to the hospital (21%) was lower than that for index admissions (26%) (p<.01). A total of 189,293 hospital days was associated with readmission, and the total health care in-hospital economic burden was $426 million (in costs) and $1.57 billion (in charges). Independent predictors of readmission were advanced age, income, insurance, discharged from university hospitals, discharge to rehabilitation facility, and advanced Charlson comorbidity index.

CONCLUSION: In this retrospective study of patients hospitalized for NV-HAP, readmission is associated with a high mortality, morbidity, and resource use.

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ABSTRACT #86 CLINICAL RESEARCH PULMONARY/CRITICAL CARE INCREASED 30-DAY READMISSION AND RESOURCE UTILIZATION AMONG SEPTIC PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM: A PROPENSITY SCORE MATCH ANALYSIS Kam Sing Ho1, Shabnam Nasserifar1, Jacqueline Sheehan1, James Salonia1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Critical Care Medicine Annual Meeting; Orlando, FL, United States held on February 16-19, 2020.

BACKGROUND/INTRODUCTION: The study was conducted to determine the relationship between subclinical hypothyroidism and thirty-days readmission, mortality, morbidity, and health care resource utilization in patients admitted to hospitals in the in the United States with Sepsis.

METHODS: A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for the year 2014. Adults (â&#x2030;Ľ18 years) with a primary diagnosis of Sepsis, along with a secondary diagnosis of subclinical hypothyroidism (SCH) were identified using ICD-9 codes as described in the literature. The primary outcome was the rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the 1:1 nearest neighbor matching without replacement was utilized to adjust for confounders. Independent risk factors for readmission were identified using a Cox proportional hazards model.

RESULTS: In total, 1.9 million hospital admissions among adults with a primary diagnosis of Sepsis were identified, of which 0.2% had secondary diagnosis of SCH. Demographic (age, gender, hospital status, etc.) and clinical characteristics (Charlson comorbidity score) were variables utilized in PS matching to adjust for confounders. The 30-day rate of readmission among patients admitted with Sepsis with and without SCH were 16.53% and 12.72% (p<0.001). Similarly, after PS, the adjusted 30-day readmission rate were 9.43% vs 5.5% (p<0.03), respectively. The most common overall reason for readmission was sepsis (19.2%). During the index admission for Sepsis, patients with SCH had a higher in-hospital mortality rate than the non-SCH group (14.92% vs 13.15%, p<0.003). After PS, the mortality between the two groups were similar (15.4% vs 13.7%, p=0.51). The unadjusted length of stay (p=0.07) and total cost (p=0.15) between the two groups were similar.

After PS, the length of stay was statistically different (11.8 vs 9.3 days, p<0.03). During readmission, patients with SCH had a higher in-hospital mortality rate (14.92% vs 13.15%, p<0.003). After PS, the mortality between the two groups were similar (10.8% vs 11.4%, p=0.93). The unadjusted length of stay (p=0.11) and total costs for the readmission (p=0.19) during readmission were not statistically significant. However, after PS, the SCH group had long LOS (p<0.001) and higher total cost (p<0.001) than their counterparts. SCH (HR 1.61, 95%CI: 1.11-2.34, p<0.01) was an independent predictor associated with higher risks of readmission. Other medical comorbidities which also increased risk of readmission include endocarditis and advanced Charlson comorbidity score.

CONCLUSION: In this study, SCH patients admitted with sepsis have a higher 30 days of readmission rate and index admission in-hospital mortality than their counterparts.

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ABSTRACT #87 CLINICAL RESEARCH CARDIOVASCULAR DISEASE OUTCOME OF ATRIAL FIBRILLATION IN PATIENT WITH HFrEF VS HFpEF: A 5-YEAR NATIONWIDE ANALYSIS Claire Huang Lucas1, Bing Yue1, Robert Abed1, Nikhil Bachoo1, Lingling Wu1, Jan M. Lopes1, Xin Wei2, Eyal Herzog1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Virginia Commonwealth University Health, Richmond, VA, United States

2

Presented at the American Heart Association (AHA) Annual Meeting; Philadelphia, Pennsylvania, United States held on November 16-18, 2019.

BACKGROUND/INTRODUCTION: Atrial fibrillation and heart failure are intercorrelated, and represent an increasing cardiovascular cause for hospital admission in the past decade. There is limited data regarding Atrial fibrillation related morbidity and mortality comparing heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).

METHODS: We reviewed the Nationwide Inpatient Sample from 2010 to 2014 to identify patients with principal diagnosis of atrial fibrillation and with diastolic or systolic heart failure as secondary diagnosis. Two population subgroups were formed (HFrEF vs HFpEF). A multivariate regression was performed to analyze the impact on primary outcome (in hospital mortality) and secondary outcomes (length of stay, total charges, shock, acute kidney injury and cardiac arrest).

RESULTS: We identified 216,439 hospitalizations with atrial fibrillation as principal diagnosis and heart failure as secondary diagnosis. Among those, 80,114 were identified in the group HFpEF and 74,303 for HFrEF, while the rest was filtered as unspecified heart failure. In the multivariate regression model, HFrEF was associated with 15% higher inpatient mortality compared with HFpEF (p-value<0.01). Similarly, the HFrEF group has a statistically higher incidence of shock, AKI, and cardiac arrest with a longer length of stay and higher cost compared to the HFpEF group (all p-value<0.01).

CONCLUSION: For patients admitted for atrial fibrillation, the HFrEF comorbidity was associated with increased odds of in hospital mortality, shock, cardiac arrest, AKI along with increased length of stay and total charges when compared with the HFpEF comorbidity. Our study suggests that atrial fibrillation with HFrEF warrants more aggressive management.

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ABSTRACT #88 CLINICAL RESEARCH CARDIOVASCULAR DISEASE TRENDS AND IMPACT OF IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IMPLANTATIONS IN PATIENTS WITH CARDIAC AMYLOIDOSIS: A 16-YEAR ANAYLSIS Ameesh Isath1, Deepak Padmanabhan2, Stuthi Perimbeti1, Ashish Correa1, Bharat Narasimhan1, Anwar Chahal2, Shenthar Jayaprakash3, Samuel Asirvatham2, Davendra Mehta1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mayo Clinic, Rochester, MN, United States; 3Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru Area, India

2

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: Ventricular arrhythmias are common in patients with cardiac amyloidosis and are associated with increased mortality. The role of implantable cardiac defibrillator (ICD) in this population however remains unclear.

METHODS: We queried the National Inpatient Sample between 1999 and 2014 and cardiac amyloidosis was defined as ICD-9-CM code 277.39 and 425.7. ICD implantation was identified using procedural ICD-9 codes 37.94 to 37.98, 00.51 and 00.54. Bivariate analysis was done using Chi-square test and multivariate analysis was performed using cox proportional hazard regression.

RESULTS: There was a total of 145,920 cardiac amyloidosis hospitalizations in the United States and 1381 (0.94%) patients underwent ICD implantations. The rate of ICD implantations increased from 0.48% in 1999 to 0.65% in 2014. In-hospital mortality was significantly lower in patients who received ICD implantation (3.7% vs 8%; p=0.0078). Iatrogenic cardiac complications were higher in cardiac amyloidosis patients who received an ICD (1.8% vs 0.4%; p<0.0002). Patients who received an ICD during the hospitalization had a higher cost of stay compared to patients who did not ($161274 ± 9010 vs $56828 ± 589; p<0.0001) even when accounting for estimated cost of ICD. This was also associated with a significantly longer length of stay (10 ± 0.7 vs 7.7 ± 0.1 days; p<0.0001).

CONCLUSION: ICD implantation in patients with cardiac amyloidosis improves in hospital mortality however is associated with risk of complications, increased length of stay and hospital cost.

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ABSTRACT #89 CLINICAL RESEARCH CARDIOVASCULAR DISEASE TRENDS AND IMPACT OF IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IMPLANTATIONS IN PATIENTS WITH CARDIAC AMYLOIDOSIS: A 16-YEAR ANAYLSIS Ameesh Isath1, Deepak Padmanabhan2, Stuthi Perimbeti1, Bharat Narasimhan1, Ashish Correa1, Claire Huang Lucas1, Anwar Chahal2, Davendra Mehta1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mayo Clinic, Rochester, MN, United States

2

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: Patients with cardiac amyloidosis have increased mortality, which can be explained in part by increased risk of arrhythmias. However, the burden of arrhythmias in cardiac amyloidosis, their predictors and impact on in-hospital outcomes is unclear.

METHODS: We queried the National Inpatient Sample and cardiac amyloidosis was identified using ICD-9-CM codes 277.39 and 425.7. Twelve common arrhythmias were extracted using appropriate validated ICD-9-CM codes. Bivariate analysis was done using chi-square test and multivariate analysis was performed using cox proportional hazard regression.

RESULTS: There was a total of 145,920 cardiac amyloidosis hospitalizations between 1999 and 2014 in the United States and 56,199 (38.5%) of these had arrhythmias. The prevalence of arrhythmias remained consistent from 41.5% in 1999 to 40.2% in 2014. The most common arrhythmia was atrial fibrillation (25.4%).

Inpatient mortality was significantly higher in cardiac amyloidosis patients with arrhythmias (10.4% vs 6.5%, p<0.001). Heart failure and thyroid disorders were noted to be independent predictors of arrhythmias in patients with cardiac amyloidosis (Hazard ratio [95%CI]: 1.76[1.69-1.82], 1.32[1.26-1.38]). Cardiac amyloidosis patients with arrhythmias also had increased cost of hospitalization and length of stay ($65046 ± 1079 vs $53322 ± 687, 8.3 ± 0.1 vs 7.4 ± 0.1 days respectively; p<0.0001).

CONCLUSION: A significant proportion of patients with cardiac amyloidosis have cardiac arrhythmias and are associated with worse in-hospital outcomes, increased length of stay, and cost of hospitalization.

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ABSTRACT #90 CLINICAL RESEARCH CARDIOVASCULAR DISEASE TRENDS IN THE USE OF INTRACARDIAC ECHOCARDIOGRAPHY DURING CATHETER ABLATION FOR ATRIAL FIBRILLATION FROM 2001-2014 AND ITS IMPACT ON OUTCOMES Ameesh Isath1, Deepak Padmanabhan1, Stuthi Perimbeti1, Bharat Narasimhan1, Ashish Correa1, Claire Huang Lucas1, Anwar Chahal2, Davendra Mehta1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mayo Clinic, Rochester, MN, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: Intracardiac echocardiography (ICE) during atrial fibrillation (AF) ablation offers real time information to guide trans-septal access, for monitoring the lesion and recognition of pericardial bleed. We describe the trends in the use of ICE, its in-hospital outcomes and impact on complications.

METHODS: We queried the National Inpatient Sample from 2001-2014 for a principal diagnosis of AF based on ICD-9-CM 427.31 during which a catheter ablation procedure code (37.34) was performed. ICE was identified using ICD-9-CM procedure code (37.28). Mortality and complications were also extracted using ICD9-CM codes. Analysis of variance and Chi-square test was used for Bi-variate analysis.

RESULTS: There was an estimated total 299,152 patients who underwent AF ablation from 2001 to 2014. Of these, 46,688 (15.6%) patients had ICE done. The use of ICE significantly increased from 0.08% in 2001 to 15.7% in 2014. Patients in whom ICE was performed had 28% lower risk of in-hospital mortality when compared to patients in whom ICE was not used. (Hazard ratio (HR) [95% Confidence interval (CI); 0.72[0.710.73]). Complication rates were also significantly lesser in the group which used ICE (9.35% vs 10.41%; p<0.0001). Pericardial complications which included pericardial effusion, tamponade and need for pericardiocentesis was also significantly lesser in the ICE group (1.41% vs 2.45%; p<0.0001). The use of ICE during AF ablation resulted in significantly higher cost of hospitalization ($98,436 ± 597 vs $81,300 ± 310; p<0.0001), but this was offset by a decreased length of hospital stay (2.1 ±0.02 vs 4 ± 0.02 days; p<0.0001).

CONCLUSION: The use of ICE during catheter ablation for AF has increased over the years and is associated with lower in-hospital mortality and procedural complications but an increased cost of hospitalization.

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ABSTRACT #91 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY A RARE CASE OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA WITH INTRAMURAL GASTRIC METASTASIS Gassan Kassim1, Yingheng Liu1, Michael S. Smith1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States held on October 25-30, 2019.

BACKGROUND/INTRODUCTION: Esophageal cancer makes up about 1% of all cancers diagnosed in the United States. Gastric metastasis from esophageal cancer is relatively rare. Four different types of metastatic mechanisms were reported: 1) via peri-gastric lymph nodes; 2) gastric intramural metastasis; 3) direct invasion of the gastric wall, and 4) intra-epithelial spread to the gastric epithelium. Here we present a case with intramural gastric metastasis in a patient with esophageal squamous cell carcinoma.

CASE PRESENTATION: A 76-year-old Indian male with past medical history significant for idiopathic pulmonary fibrosis and coronary artery disease, recently started on aspirin and clopidogrel, presented with new onset fatigue and five days of black tarry stools. Hemoglobin (Hgb) on admission was 7.1 g/dL. Despite transfusion of one unit of packed red blood cells, repeat Hgb dropped to 6.6 g/dL. Emergent upper endoscopy was performed for suspected active gastrointestinal bleeding in the setting of blood thinner use. Endoscopy showed a 3 cm, non-bleeding, fungating and ulcerated mass in the middle third of the esophagus, as well as a 4-5 cm fungating, infiltrative and ulcerated gastric mass in the cardia with stigmata of recent bleeding (adherent clot). Removal of the clot revealed underlying oozing from the ulcer bed which was treated successfully with dilute epinephrine injection followed by hemostatic clip placement. Forceps biopsies of both the esophageal and cardia masses were obtained. Histopathology of both lesions revealed keratinized squamous cell carcinoma. CT of the chest, abdomen and pelvis showed no evidence of other metastatic disease. Oncology consultation was scheduled to discuss potential chemotherapy, radiation, and endoscopic interventions.

DISCUSSION: Esophageal cancer with intramural gastric metastasis is very rare compared to other mechanisms of tumor spread. The prognosis is very poor with the mean survival time reported to be 8.6 months. Conventional chemotherapy or radiotherapy after surgery were ineffective in improving prognosis in current report, suggesting other techniques could provide a benefit when used adjunctively or in combination with more traditional approaches.

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ABSTRACT #92 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY LOCALIZED AL-TYPE INTESTINAL AMYLOIDOSIS PRESENTING AS REFRACTORY IRON DEFICIENCY ANEMIA AND RIGHT LOWER QUADRANT ABDOMINAL PAIN Gassan Kassim1, Makda Bsrat1, Neelesh Rastogi1, Srilakshmi Atluri1, Michael S. Smith1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States held on October 25-30, 2019.

BACKGROUND/INTRODUCTION: Amyloidosis is characterized by extracellular deposition of abnormally folded proteins creating insoluble fibrils, which disrupt tissue structure and function. Amyloidosis can be either systemic or localized. Localized amyloidosis is defined by the production of precursor proteins in the same location as amyloid deposition. We present a case of biopsy-proven localized AL intestinal amyloidosis.

CASE PRESENTATION: A 91-year-old female with a past medical history significant for hypertension and iron deficiency anemia not improving with oral iron presented with progressively worsening dyspnea on minimal exertion, with diffuse weakness and fatigue. She denied any NSAID use. Hemoglobin on admission was 3.8 g/dL, improving to 6.4 g/dL after transfusion of 3 units of packed red blood cells. Upper endoscopy showed very friable mucosa with contact bleeding in the duodenum, along with patchy areas of abnormal mucosa in the 2nd portion (Figure 1). Duodenal biopsies were consistent with amyloidosis based on Congo red and crystal violet stains. Liquid chromatography tandem mass spectrometry was performed on peptides extracted from the specimen and indicated AL (lambda)-type amyloid deposition. Cardiac MRI showed no evidence of infiltrative heart disease or amyloid deposition. Bone survey showed no lytic lesion, and a marrow biopsy showed no morphologic evidence of plasma cell neoplasm with normal karyotype. Urine immunofixation electrophoresis showed no abnormalities. Urine and serum protein electrophoresis showed no monoclonal protein. With no evidence of systemic amyloidosis, diagnosis of localized intestinal amyloidosis was made. No systemic therapy was indicated. Patient was treated with IV iron transfusions. At a subsequent admission, she presented with subacute right lower quadrant pain. CT abdomen/pelvis with oral and intravenous contrast showed thickening of the distal small bowel with shouldering. Lesion was presumed to be secondary to intestinal amyloidosis. Patient refused further invasive interventions.

DISCUSSION: Localized AL-type intestinal amyloidosis is rarely diagnosed. Common symptoms are nonspecific and can include erosion, ulceration, bleeding, malabsorption, intractable diarrhea, obstruction or ischemia. This patient presented with recurrent symptomatic iron deficiency anemia refractory to oral iron repletion. Intestinal amyloidosis should be considered in similar presentations.

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ABSTRACT #93 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY MAJOR ESOPHAGEAL BLEEDING SECONDARY TO MECHANICAL INJURY FROM ESOPHAGEAL DEVIATION DURING PULMONARY VEIN ISOLATION Gassan Kassim1, Makda Bsrat1, Melissa Hershman1, Rifat Mamun1, Ray Dong1, Michael S. Smith1

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States held on October 25-30, 2019.

BACKGROUND/INTRODUCTION: Radiofrequency catheter ablation and pulmonary vein isolation (PVI) are electrophysiologic interventions frequently performed for the management of atrial fibrillation (AF). Given the anatomic proximity of the esophagus and left atrium, the former is prone to thermal injury which can lead to peri-esophageal nerve injury, pain, dysphagia, and atrio-esophageal fistula formation. Mechanical deflection of the esophagus away from the ablation site is being used to minimize such complications. We present a case of major esophageal bleeding secondary to mechanical trauma in the setting of esophageal deviation during AF ablation.

CASE PRESENTATION: 60 yo female with past medical history significant for obstructive sleep apnea, pulmonary hypertension, AF with multiple direct current cardioversion attempts, underwent elective PVI using an esophageal deviation stylet (EsoSure, Northeast Scientific, Waterbury, CT). After PVI, a small amount of blood was noted as a result of suction using an orogastric tube. CT chest ruled out esophageal pathology including perforation. Subsequent upper endoscopy showed small mucosal tears in middle third of esophagus and at the esophago-gastric junction (EGJ). She was discharged on daily proton pump inhibitor and remained on anticoagulation. Five days later, she presented to the emergency room with complaints of weakness, fatigue, melena and non-radiating substernal sharp chest pain. Blood pressure was 64/35. Hemoglobin was 6.4 g/dL compared to 10.3 g/dL upon discharge. Shortly after arrival, the patient had an episode of large volume hematemesis. She was urgently intubated for airway protection and volume resuscitation was initiated.

Emergent upper endoscopy reveled an actively bleeding superficial mucosal tear at the EGJ which was treated successfully with epinephrine injection followed by hemostatic clip placement. After transfusion of 3 units of packed red blood cells, repeat Hgb improved to 8.8 g/dL and remained stable. Patient was extubated, remained clinically stable and was discharged.

DISCUSSION: Mechanical displacement of the esophagus away from an atrial ablation site is being used more frequently in electrophysiologic interventions, as it reduces ablation-related esophageal thermal injury.

Despite newer esophageal retractors which retain less heat and are less bulky, vigilance should be practiced to avoid mechanical esophageal trauma.

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ABSTRACT #94 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY RIGHT UPPER QUADRANT PAIN IN A YOUNG WOMAN ISN’T ALWAYS BILIARY IN ORIGIN: A CASE OF FITZ-HUGH–CURTIS SYNDROME (FHCS) Gassan Kassim1, Yingheng Liu1, Michael S. Smith1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States held on October 25-30, 2019.

BACKGROUND/INTRODUCTION: Fitz-Hugh–Curtis syndrome (FHCS) is a rare complication of pelvic inflammatory disease (PID) causing inflammation of the liver capsule and peri-hepatic peritoneal surfaces. It usually is caused by Neisseria gonorrhoeae or Chlamydia trachomatis ascending from genital tract infections.

Here we present a case of right upper quadrant (RUQ) abdominal pain initially thought to be biliary in origin, with the etiology ultimately thought to be FHCS. CASE PRESENTATION: A 24-year-old woman with no significant past medical history presented to the emergency department with RUQ abdominal pain for one week. The pain was described as sharp, constant, “pinching and pulling” in quality, worsened by coughing and deep breathing, and associated with nausea and vomiting. While she reported being sexually active, there were no genital or urinary symptoms or any history of sexually transmitted infections. Physical examination was notable for RUQ tenderness with positive Murphy’s sign. Pelvic exam was negative for cervical motion tenderness (CMT), adnexal or uterine tenderness, cervical or vaginal discharge. Labs were significant only for leukocytosis of 13.5K/uL and an elevated total bilirubin to 1.7 mg/dL, both of which resolved within 24 hours. Abdominal ultrasound and magnetic resonance cholangiopancreatography showed no evidence of cholecystitis or gallstones. Given persistent symptoms despite improving blood work and unremarkable imaging, the leading concern was biliary colic or sludge.

Diagnostic laparoscopy was performed, showing an injected peri-hepatic diaphragmatic peritoneum and focal adhesions between the liver capsule and anterior abdominal wall, suggesting FHCS. Of note, all gynecologic organs were inspected and appeared normal. Gallbladder was removed during the procedure as a precaution, and pain resolved shortly after surgery. Nucleic acid amplification test for Chlamydia trachomatis ultimately was positive, confirming the diagnosis of FHCS. DISCUSSION: FHCS usually presents with RUQ abdominal pain that mimics hepatobiliary etiologies, and usually is associated with symptoms of PID including pelvic/lower abdominal pain, vaginal discharge or CMT. This case of FHCS is atypical in that the patient presented only with RUQ pain in the absence of PID symptoms, which may be due to bacteria bypassing pelvic structures on the way to the liver capsule. FHCS should be considered in the differential diagnosis of RUQ abdominal pain in young women of reproductive age.

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ABSTRACT #95 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW CARDIOVASCULAR DISEASE A DIAGNOSTIC CHALLENGE: PREGNANCY, CHEST PAIN, AND ZERO CALCIUM SCORE Sananda Moctezuma1, Saman Setareh-Shenas1, Paul Leis1, Scott Kaplan1, Robert Kernberg1, Eyal Herzog1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: Despite a low pre-test probability of coronary artery disease (CAD) in women of childbearing age, Spontaneous Coronary Artery Dissection (SCAD) remains the most common cause of acute coronary syndrome (ACS) in the gravid patient.

CASE PRESENTATION: A 39 year-old female G1P1, pregnancy complicated by pre-eclampsia and gestational diabetes, was diagnosed with peripartum dilated cardiomyopathy. Echocardiography revealed a newly reduced ejection fraction (EF 10%). Cardiac CT angiogram showed normal coronaries, and a calcium score of zero. She was started on neurohormonal blockade therapy, and discharged with a wearable cardioverter defibrillator. Two days after initial presentation, while visiting her pre-term newborn, the patient experienced chest pain, and was found to have markedly elevated cardiac biomarkers. Given the constellation of high-risk features for SCAD, and despite prior normal coronary anatomy, the patient was referred for urgent cardiac catheterization. Coronary angiography revealed a LCx-LPL type 1 SCAD. She was admitted to the CCU for conservative medical management with continued anticoagulation, dual antiplatelet therapy, and neurohumoral blockade. She was discharged after cardiac optimization, with a wearable defibrillator.

DISCUSSION: SCAD in pregnancy occurs most frequently in the first month post-partum. A low threshold of suspicion for SCAD in this patient population is key to avert misdiagnosis, regardless of a seemingly low phenotypic probability of CAD, or even prior normal non-invasive imaging. Standard management for ACS should be started, and immediate referral for percutaneous coronary intervention should be made.

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ABSTRACT #96 CLINICAL RESEARCH CARDIOVASCULAR DISEASE LEFT ATRIAL APPENDAGE OCCLUSION DEVICES IN VALVULAR ATRIAL FIBRILLATION – A SAFE OPTION? Bharat Narasimhan1, Lingling Wu1, Ameesh Isath1, Subrat Das1, Kirtipal Bhatia1, Ashish Correa1, Davendra Mehta1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: Left atrial appendage occlusion devices (LAAC) have been a valuable addition in the management of atrial fibrillation (AF). The seminal studies have been restricted to non-valvular AF (NVAF). In this study, analyze the outcomes and efficacy of LAAC in the largely unclear setting of valvular AF (VAF).

METHODS: We queried the National Readmission database-2016 using ICD-10 codes to identify patients undergoing LAAC procedures. These patients were then subcategorized into VAF (Mitral stenosis / Prosthetic valve) and NVAF cohorts and compared using the Chi-Square test. Multivariate analysis was performed using Cox proportional hazard regression.

RESULTS: A total of 5340 LAAC procedures were identified of which 411 were performed on VAF patients.

The VAF cohort was slightly older with more comorbidities and higher CHA₂DS₂-VASc Scores. Higher vascular (5.3 vs 1.9, p=0.02) and respiratory complications (5.7 vs 1.8, p<0.001) along with a higher incidence of device failure (0.1 vs 1.4%, p<0.001) was noted in the VAF group. Interestingly, 30d readmissions were equivalent in both groups.

CONCLUSION: Our findings indicate that LAAC is a relatively safe procedure in the setting of VAF and at least in the initial 30d appears to perform as well as the NVAF group. However, long term follow-up is required before more formal conclusions can be made.

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ABSTRACT #97 CLINICAL RESEARCH CARDIOVASCULAR DISEASE UNDER-RECOGNIZED CARDIOVASCULAR DISEASE IN SYSTEMIC SARCOIDOSIS Bharat Narasimhan1, Ameesh Isath1, Lingling Wu1, Stuthi Perimbeti1, Banveet Khetarpal2, Kamala Ramya Kallur1, Davendra Mehta1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; University of Nevada, Las Vegas, NV, United States

2

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: Cardiac involvement in sarcoidosis appears to be more common than previously thought. We analyzed the burden of cardiac disease in systemic sarcoidosis without established cardiac involvement (SS).

METHODS: We queried the National Inpatient Sample between 1999â&#x20AC;&#x201C;2014 using ICD-9 codes to identify patients with SS from which those with cardiac involvement were excluded. These patients were then analyzed against age, sex and comorbidity matched controls using Chi square analysis.

Multivariate analysis was performed using Cox proportional hazard regression.

RESULTS: The SS group (weighted n=10,15,479) had higher rates of almost all forms of cardiovascular disease including heart failure, atrial and ventricular arrhythmias. Conduction abnormalities like SA, AV dysfunction and bundle branch blocks were significantly more common in the SS group. Of note, ischemic heart disease was significantly more common in the control group.

CONCLUSION: Systemic sarcoidosis even in the absence of established cardiac involvement carries a significant risk of cardiovascular arrhythmia and conduction abnormalities. Whether this is a testament to the high prevalence of undiagnosed cardiac sarcoidosis or if the systemic process itself increases cardiac risk remains unclear. Our findings indicate that more aggressive screening is warranted in this high-risk population.

139

ABSTRACT #98 CLINICAL RESEARCH CARDIOVASCULAR DISEASE HYPERCALCEMIA IS A PREDICTOR OF WORSE IN-HOSPITAL OUTCOMES IN PATIENTS WITH SUPRAVENTRICULAR TACHYCARDIA (SVT); A 2016 NATIONAL INPATIENT SAMPLE ANALYSIS (NIS) Robert Abed1, Rawann Nassar1, Patrick Lam1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting; Chicago, Illinois, United States that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: To our knowledge, there is no strong evidence highlighting the effect of hypercalcemia on SVT outcomes. Using the 2016 NIS, this work aims to compare in-hospital outcomes among patients with SVT with or without concurrent hypercalcemia.

METHODS: Data was obtained from the 2016 NIS database. The primary outcome was in-patient mortality.

Secondary outcomes were hospital length of stay and total hospital charge. A series of univariate and multivariate regression analyses were conducted on STATA 15.1.

RESULTS: In this dataset, 66,068 observations met the criteria for in-patients who were diagnosed with SVT. Among these, 436 patients had hypercalcemia, versus 65,632 in whom serum calcium levels was not elevated.

Among patients who experienced SVT, those with hypercalcemia demonstrated higher inpatient mortality (OR 2.00; 95%CI: 1.47-2.72) as compared to those without elevated serum calcium levels. Furthermore, those with hypercalcemia experienced on average an additional 3.05 days of hospitalization as compared to those without elevated serum calcium levels (β1 = 3.05, 95%CI: 1.81-4.28 days). Lastly, those with elevated serum calcium levels incurred higher costs of hospitalization, averaging $25,513 more than those without elevated serum calcium levels (95%CI: $8,192-$42,835).

CONCLUSION: Among inpatients who experienced SVT, those with elevated serum calcium levels had higher inpatient mortality, increased length of hospital stay, as well as increased total cost of hospitalization as compared to those without hypercalcemia. Despite the restrictions of our study, we believe that these significant findings should encourage further investigation into the role of serum calcium levels in patients with SVT, both as a marker to predict mortality, as well as a key target of inpatient therapeutic approach.

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ABSTRACT #99 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY ACUTE MYELOID LEUKEMIA AND CIRRHOSIS: TRENDS IN UTILIZATION OF CHEMOTHERAPY, RATE OF HOSPITALIZATIONS, AND MORTALITY Giulia Petrone1, Shivani Handa1, Kamesh Gupta2, Ahmad Khan3, Sridevi Rajeeve1

INDUCTION,

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Baystate Medical Center, Springfield, MA, United States; 3West Virginia University-Charleston Division, Charleston, WV, United States

2

Accepted at the American Society of Hematology (ASH) Annual Meeting; Orlando, FL, United States held on December 7-10, 2019.

BACKGROUND/INTRODUCTION: The presence of underlying cirrhosis poses a serious challenge in treatment of newly diagnosed acute myeloid leukemia (AML) patients. In current practice, patients with significant hyperbilirubinemia are precluded from optimal induction and consolidation therapy. Allogenic stem cell transplant is also not a viable option for these patients. This is the first study aimed at evaluating the safety and trends of utilization of chemotherapy in subset of patients with newly diagnosed AML and comorbid cirrhosis, using the Nationwide Inpatient Sample (NIS).

METHODS: We designed a retrospective study using the NIS data, the largest US inpatient database which includes approximately 76 million patients from 2005 to 2014. The authors identified hospitalizations for induction chemotherapy using the primary discharge diagnosis of 'encounter for chemotherapy' (ICD-9 codes V58.1, V58.11 and V58.12) or procedure codes for 'administration of antineoplastic agent' (0010, 0015, 9925, 9928) and a secondary diagnosis of acute myeloid leukemia, myeloid sarcoma or acute monocytic leukemia.

We excluded patients with relapsed disease or in remission. Amongst this population, patients with a diagnosis of cirrhosis including alcoholic, non-alcoholic and biliary cirrhosis were examined to find the differences in baseline characteristics, annual trends in the number of hospitalizations for chemotherapy and total hospitalization charges. We used logistic regression to calculate the aOR for in-hospital mortality among these patients.

RESULTS: Between 2005 and 2014, a total of 514,032 admissions were identified with a primary diagnosis of chemotherapy for AML. A total of 1,310 (0.25%) admissions had an underlying diagnosis of cirrhosis. The number of hospitalizations for induction chemotherapy in patients with cirrhosis and AML had a statistically significant increase from 62 in 2005 to 195 in 2014. Interestingly, hospitalization for AML patients without cirrhosis has remained largely constant with 52,673 AML patients admitted in 2005 and 55,925 in 2014 (5.8% increase). In-hospital mortality in patients with cirrhosis and undergoing induction chemotherapy for AML was 14.5% (n=9) in 2005, decreasing to almost half at 7.1% in 2014 (n=14). In-patient mortality for AML patients without cirrhosis undergoing chemotherapy has also decreased, from 4.18% (n=2,205) in 2005 to 3.91% (n=2,190) in 2014. Patients with AML and cirrhosis were less likely to undergo treatment at academic centers (81.8%) than those without cirrhosis (87.1%, p=0.046), and they were less likely to possess private insurance (39.3% vs 33.3%, p=0.000). Mortality rate was higher in patients with AML and cirrhosis (12.2%, n=161) than in those without cirrhosis (4.5%, n=23369). The adjusted OR for mortality in patients with cirrhosis was 2.01 (p=0.001), with older age (p=0.00) and caucasian race (p=0.01) being significant confounders. Average hospital cost for each admission for patients with AML and cirrhosis was ($223,723.6Âą$16,169), significantly higher than for those without cirrhosis ($129,383).

CONCLUSION: Our study highlights the fact that the management of patients with AML and cirrhosis continues to be a dilemma. With the advances in chemotherapy over the last decade, there has been a positive trend with an increase in the number of hospitalizations for induction chemotherapy in patients with AML and cirrhosis as well as a decrease in mortality. Moreover, since cirrhosis is more prevalent in the lower socioeconomic strata, these patients are less likely to have private insurance or receive treatment at an academic center, which may contribute to suboptimal care. The increase in mortality in patients with AML and cirrhosis compared to those without cirrhosis can be explained by a compounding effect of AML on pre-existing complications of cirrhosis. Further research is needed to develop standard guidelines and non-hepatotoxic chemotherapeutic agents.

141

ABSTRACT #100 CLINICAL RESEARCH CARDIOVASCULAR DISEASE/INFECTIOUS DISEASES BASELINE CHARACTERISTICS, MANAGEMENT, AND OUTCOMES OF PATIENTS WITH INFECTIVE ENDOCARDITIS Wojciech Rzechorzek1, Guneesh Uberoi1, Kirtipal Bhatia1, Ruchit Shah1, Lingling Wu1, Robert J. Kornberg1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American Heart Association (AHA) Annual Meeting; Philadelphia, PA, United States held on November 16-18, 2020.

BACKGROUND/INTRODUCTION: The impact of sex on patient characteristics, management, and outcomes in infective endocarditis has not been extensively studied in a large unselected sample of patients. According to Duke Endocarditis Database female patients were more likely to have diabetes mellitus and end-stage renal disease (ESRD) on hemodialysis and after adjustment for these comorbidities, there was no difference in mortality and surgical management.

METHODS: In a retrospective case-control study, using the 2014 Nationwide Inpatient Sample (NIS), we analyzed adult patients with infectious endocarditis. We performed univariate analysis of age, sex, race, hospital location, hospital teaching status, insurance type, hospital bed size, Charlson Comorbidity Index and other relevant comorbidities and we included variables with p0.2 in the multivariate logistic regression model.

RESULTS: A total of 67988 patients with infective endocarditis were examined. The mean age of female patients (51%) was 66 years and 65 for male patients. Male patients were more likely to have high Charlson Comorbidity Index, CKD, ESRD and diabetes mellites with complications. There was no difference in the incidence of heart failure, shock and in-hospital mortality between male and female patients with infectious endocarditis. Though, female patients were less likely to undergo mitral valve replacement (OR=0.59, 95%CI= 0.47-0.73; p<0.001) and aortic valve replacement (OR=0.31, 95%CI= 0.24-0.40; p<0.001) with no difference in tricuspid valve replacement (OR=1.42, 95%CI=0.76-2.65; p=0.27). Finally, female patients were more likely to receive a palliative care consult (OR=1.08, 95%CI=1.02-1.16; p=0.016), had shorter hospital stay (OR= 0.20, 95%CI= -0.03- -0.01; p<0.001) and smaller total charges (Coef. = -10295.06, 95% CI -12420.38- -8169.74; p<0.001).

CONCLUSION: Male patients with infective endocarditis have more comorbidities than female patients with no difference in adjusted in-hospital mortality. Yet, female patients undergo fewer valve replacement surgeries, which could explain shorter hospital stay and lower total costs.

142

ABSTRACT #101 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW PULMONARY/CRITICAL CARE MORE THAN A TICKLE IN THE THROAT: A CASE OF COUGH INDUCED LARYNGEAL FRACTURE Bertin D. Salguero1, Jonathan Stoever1, Keith Rose2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Hackensack University Medical Center, Hackensack, NJ, United States

2

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

BACKGROUND/INTRODUCTION: Non-traumatic rupture of the larynx is a very rare entity occurring when strong coughing or sneezing causes rupture of the laryngeal cartilage. This same pathology is more commonly seen in traumatic injuries, particularly with hanging or strangulation victims, but nontraumatic presentations are exceedingly rare. We present the fifth case reported in the literature.

CASE PRESENTATION: A 48-year-old male travelling from Brazil presented to our emergency department (ED) with complaints of neck swelling. His past medical history is significant for gastroesophageal reflux disease (GERD) and asthma. He had a recent worsening in his GERD symptoms when he was changed from daily Esomeprazole to Ranitidine, precipitating complaints of increased heartburn and a dry cough. On the day of the presentation, the patient began to experience further worsening cough as well as neck swelling. In the ED, vital signs were normal, mild swelling was noticed over the thyroid cartilage with subtle crepitus. There was no tenderness or hoarseness. Neck X-ray showed thickening of the anterior neck space. Neck computed tomography (CT) without contrast demonstrated a minimally displaced fractures of the thyroid cartilage with overlying soft tissue edema and subcutaneous emphysema extending distally. Swallowing evaluation and esophagram were normal. The patient was observed on the medical ward for two days where he clinically improved and was discharged home on Esomeprazole. The patient was lost to follow up when he returned to Brazil.

DISCUSSION: Review of the four published cases of non-traumatic rupture of the larynx in the literature reveal that all of the cases have been in middle aged men. Two cases were associated with sneezing and two were associated with coughing. Clinical presentations were with complaints of odynophagia, dysphagia and/or dysphonia. In all cases, imaging revealed anterior fractures associated with subcutaneous emphysema. Our patient shared all of these demographic and imaging characteristics, however our patient presented with a chief complaint of neck swelling without these other complaints. Management of these cases is conservative, typically with spontaneous resolution not requiring surgical intervention. Non-traumatic laryngeal fracture is a very rare entity, typically occurring in middle age men, induced by severe coughing or sneezing.

143

ABSTRACT #102 MEDICAL EDUCATION PULMONARY/CRITICAL CARE A CONTEXTUAL NEEDS ASSESSMENT OF MECHANICAL VENTILATION EDUCATION OF INTERNAL MEDICINE RESIDENTS: BARRIERS, CHALLENGES AND OPPORTUNITIES Bertin D. Salguero1, James Salonia1,2, Priscilla Loanzon1,2, Joseph P. Mathew1,2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Center for Advanced Medical Simulation (CAMS) at Mount Sinai West, Icahn School of Medicine, New York, NY, United States

2

Presented at the American College of Chest Physicians (CHEST) Annual Meeting; New Orleans, Louisiana, United States held on October 19-23, 2019.

BACKGROUND/INTRODUCTION: The lack of validated curriculum and adequate education in mechanical ventilation (MV) among Internal Medicine (IM) residents has been reported in the literature. Despite being required knowledge by the American Board of Internal Medicine, considerable variability exists in knowledge and skill acquisition of IM residents in mechanical ventilation. MV education is limited to informal teachings by the critical care physicians during intensive care unit rotations. Given this backdrop, a contextual needs survey assessment was conducted identifying MV education barriers, challenges and opportunities.

METHODS: An electronic survey was administered using Google Survey to all categorical IM residents in our IM residency program who had completed at least 1 medical ICU rotation. Preliminary interns were excluded. A Likert-type scale was utilized to measure the responses.

RESULTS: Fifty three of the 126 categorical residents completed the survey (42%). The respondents were PGY-1 (32.1%), PGY-2 (39.6%), and PGY-3 (28.3%). Ninety-four percent of the residents reported no previous formal training on MV. The survey measured three key points: barriers, challenges, and opportunities. The barriers were identified as: 1) lack of basic resources to learn about MV (28%); 2) pressure to not manipulate the ventilator (28%); 3) low priority from the residency program (21%), and; 4) variable ICU learning opportunities (17%). The challenges included: 1) Inconsistent teaching during ICU rounds: 26.5% consistently taught compared to 50% reported occasionally; 2) Knowledge and skills acquisition methods: 50% during ICU rounds, 25% from manuscripts/textbooks, and 10% equally from peers and on-line didactics. The opportunities indicating interest for a formal MV curriculum were identified as: 1) importance of MV education rated at 8.5/10; 2) self-perceived knowledge deficit: non-invasive MV at 4.5/10 and 4/10 for invasive MV; 3) motivation to learn MV; 4) anticipated expectation of ventilator management as a hospitalist (12%), and 5) the opportunity to teach essential curricular contents selected by the senior ICU faculty: management of most common ventilator modes, trouble shooting of most frequent alarms, and change of settings based on arterial blood gases.

CONCLUSION: Education on mechanical ventilation is of considerable importance to IM residents. The consistency and methods of education vary. Despite frequent use of MV, most IM residents perceived significant knowledge gaps of both invasive and non-invasive ventilation. Barriers were clearly identified such as lack of optimal setting and time for teaching, educational resources, and hands-on practice.

144

ABSTRACT #103 CLINICAL VIGNETTE/CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY JEJUNAL GIST: AN UNUSUAL CAUSE OF ACUTE MASSIVE GASTROINTESTINAL BLEEDING Yingheng Liu1, Suraj Shah1, Ilan Weisberg2 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States held on October 25-30, 2019.

BACKGROUND/INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are rare, making up 0.1-3% of all gastrointestinal (GI) tumors. While most commonly found in the stomach, GISTs in jejunum are among the rarest subtypes. The majority of GISTs present with occult GI hemorrhage. Here we present a case of massive GI bleeding due to a jejunal GIST in a young woman with BRCA2 gene mutation.

CASE PRESENTATION: A 30-year-old woman presented with 1 day of melena and symptomatic anemia.

Medical history was notable for BRCA2 gene mutation. Family history was significant for colon cancer in her maternal grandfather and breast cancer in her maternal aunt. On admission, there was melena in the rectal vault and her abdomen was soft, non-tender with no palpable masses. She was anemic with hemoglobin 6.8 g/dL. Emergent EGD revealed no blood or source of bleeding identified. After a rapid bowel preparation, an urgent colonoscopy showed melena in the entire colon and examined terminal ileum, however no culprit lesion was identified. Patient was hemodynamically unstable subsequently so an urgent computed tomography angiogram was performed and revealed active GI bleeding from the jejunal artery. A 3.1 Ă&#x2014; 2.2 cm mass with peripheral hemorrhage in the left upper quadrant was seen. The patient then underwent emergent embolization of two jejunal branches. An exploratory laparotomy was subsequently performed with resection of a proximal jejunal mass. Histology confirmed a spindle-cell GIST with positive staining for c-kit (CD117). Given the size, low-grade, and mitotic rate of 1/50 high-power field, no adjuvant therapy was needed. Magnetic resonance imaging surveillance was recommended.

DISCUSSION: Bleeding jejunal GIST is a rare cause of acute massive GI bleeding. GISTs can be particularly difficult to diagnose because of their endoscopic inaccessibility. The majority of GISTs are thought to be a result of activating mutations of proto-oncogenes c-KIT (CD117) or PDGFR-alpha. These then increase tyrosine kinase receptor activity and result in the proliferation of stem cells. No reports yet suggest a direct association between a BRCA2 germline mutation and small bowel neoplasms. This case highlights a dramatic presentation of massive hemorrhage from a GIST, especially when confined to the small bowel. Further studies are needed to establish whether an association exists between BRCA mutations and GIST as well as other small bowel neoplasms.

145

ABSTRACT #104 QUALITY IMPROVEMENT PULMONARY/CRITICAL CARE/PALLIATIVE CARE IMPROVING PALLIATIVE CARE DELIVERY IN THE MEDICAL INTENSIVE CARE UNIT: A QUALITY IMPROVEMENT PROJECT Jacqueline Sheehan1, Kam Sing Ho1, Charles Gaulin2, Setareh Alipour3, Gustavo Contreras Anez1, Jennifer Fung1, Christie Mulholland1, Howard Anthony Arabelo1, Janet Shapiro1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Memorial Sloan Kettering Cancer Center, New York, NY, United States; 3University of Connecticut Health, Farmington, CT, United States 2

Accepted at the Annual Assembly of Hospice and Palliative Care; San Diego, CA, United States that was scheduled to be held from March 18-21, 2020.

BACKGROUND/INTRODUCTION: Approximately one in five deaths in the United States occurs during or shortly after admission to the intensive care unit (ICU). Enhancing palliative care delivery in the ICU reduces length of stay (LOS), facilitates transition to lower acuity settings, and strengthens continuity of care. Our baseline data indicated that many patients who met triggers and survived the medical ICU (MICU) did not receive palliative care consultative services. This study was conducted to evaluate the impact of a modified trigger-based consultative model on palliative care delivery in MICU. METHODS: All patients admitted to the Mount Sinai St. Lukeâ&#x20AC;&#x2122;s MICU February 1, 2018 to May 31, 2019 who met triggers for palliative care, were reviewed and directly communicated between MICU and palliative care attendings. The primary outcome was the total number of palliative care consultations that originated from the MICU. Secondary outcomes included time from hospital and MICU admission to consultation, LOS, and mortality. Variables were compared to the preintervention period, February 1, 2018 to May 31, 2018, using a two tailed t-test. Statistical analysis was performed using StataÂŽ version 15.

RESULTS: Palliative care consultations originating from the MICU significantly increased from 35 to 54 (p<0.04) following the intervention. Time from hospital and MICU admission to consultation was similar in both groups (8.31 vs. 5.9 days, p=0.52 vs. 5.5 vs. 4.4 days; p=0.79). Hospital and MICU LOS did not change following the intervention (20.8 vs. 19.2 days, p=0.43; 13.4 vs. 11 days, p=0.34). Overall mortality was comparable following the intervention (65.7% vs. 61.1%, p=0.06) CONCLUSION: The implementation of a modified trigger-based palliative care consultative model in the MICU increased palliative care delivery. Assessing the impact of palliative care delivery on symptom management, emotional support and disposition is warranted.

146

ABSTRACT #105 CLINICAL RESEARCH PULMONARY/CRITICAL CARE/PALLIATIVE CARE PALLIATIVE CARE CONSULTATION REDUCES 30-DAY READMISSION RATES FOR HOSPITALIZED PATIENTS WITH END-STAGE CHRONIC OBSTRUCTIVE PULMONARY DISEASE Jacqueline Sheehan1, Kam Sing Ho1, Charles Gaulin2, Setareh Alipour3, Karan Jatwani1, Paaras Kohli1, Jennifer Fung1

1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Memorial Sloan Kettering Cancer Center, New York, NY, United States; 3University of Connecticut Health, Farmington, CT, United States

2

Accepted at the Annual Assembly of Hospice and Palliative Care; San Diego, CA, United States that was scheduled to be held from March 18-21, 2020.

BACKGROUND/INTRODUCTION: End-stage chronic obstructive disease (COPD) has a high level of symptom burden, requirement for long-term oxygen therapy and frequent exacerbations that require hospitalization. Research to date is limited regarding the delivery and impact of palliative care services in patients with end-stage COPD. This study was conducted to determine the relationship between in-hospital palliative consultation on hospital readmission in patients with end-stage COPD in the United States.

METHODS: A retrospective study was conducted using the AHRQHCUP Nationwide Readmission Database for 2014. Adults (â&#x2030;Ľ18 years) with a diagnosis of end-stage COPD that received an in-hospital palliative consultation were identified using ICD-9 codes described in literature. The primary outcome was rate of readmission within 30-days of discharge. Secondary outcomes were reasons for readmission, and mortality and morbidity rates. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for readmission were identified using Coxâ&#x20AC;&#x2122;s proportional hazards model.

RESULTS: In total, 233,184 hospital admissions with a diagnosis of end-stage COPD were identified, of which 6.87% (16,038) received in-hospital palliative care consultation. PS matching was performed based on age, gender, hospital status, and Charlson comorbidity score. The overall 30-day rate of readmission in patients with end-stage COPD was 16.9%. Palliative care consultation was an independent predictor associated with a lower risk of readmission (Hazard Ratio 0.521, 95%CI: 0.398-0.682; p<0.001).

CONCLUSION: In-hospital palliative care consultation in patients with end-stage COPD reduces hospital readmission.

147

ABSTRACT #106 CLINICAL RESEARCH PULMONARY/CRITICAL CARE/PALLIATIVE CARE PALLIATIVE CARE CONSULTATION REDUCES 30-DAY READMISSION RATES FOR HOSPITALIZED PATIENTS WITH MALIGNANT PLEURAL EFFUSION Jacqueline Sheehan1, Kam Sing Ho1, Setareh Alipour2, Karan Jatwani1, Paaras Kohli1, Jennifer Fung1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; University of Connecticut Health, Farmington, CT, United States

2

Accepted at the Annual Assembly of Hospice and Palliative Care; San Diego, CA, United States that was scheduled to be held from March 18-21, 2020.

BACKGROUND/INTRODUCTION: Malignant pleural effusion has a high level of symptom burden resulting from progression of malignancy, leading to recurrent hospitalization. Research to date is limited regarding the delivery and impact of palliative care services in patients with malignant pleural effusion. The study was conducted to determine the relationship between in-hospital palliative consultation on hospital readmission in patients with malignant pleural effusion in the United States.

METHODS: A retrospective study was conducted using the AHRQHCUP Nationwide Readmission Database for 2014. Adults (â&#x2030;Ľ 18 years) with a diagnosis of malignant pleural effusion that received an in-hospital palliative consultation were identified using ICD-9 codes described in literature. The primary outcome was rate of readmission within 30-days of discharge. Secondary outcomes were reasons for readmission, and mortality and morbidity rates. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for readmission were identified using Coxâ&#x20AC;&#x2122;s proportional hazards model.

RESULTS: In total, 70,912 hospital admissions with a primary diagnosis of MPE were identified, of which 24.5% (17,370) received in-hospital palliative care consultation. PS matching was performed based on age, gender, hospital status, and Charlson comorbidity score. The overall 30-day rate of readmission in patients with malignant pleural effusion was 20.71%. Palliative care consultation was an independent predictor associated with a lower risk of readmission (Hazard Ratio 0.23, 95%CI: 0.177- 0.296; p<0.001).

CONCLUSION: In-hospital palliative care consultation in patients with malignant pleural effusion reduces hospital readmission.

148

ABSTRACT #107 CLINICAL RESEARCH CARDIOVASCULAR DISEASE INCREASED 30-DAY READMISSION AMONG ACUTE MYOCARDIAL INFARCTION WITH MAJOR DEPRESSIVE DISORDER: A PROPENSITY SCORE MATCH ANALYSIS Lingling Wu1, Bharat Narasimhan1, Kam Sing Ho1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting; Philadelphia, Pennsylvania, United States held on November 16-18, 2019.

BACKGROUND/INTRODUCTION: This study was conducted to determine the relationship between major depressive disorder (MDD) and thirty-days readmission, mortality, morbidity, and health care resource utilization in patients admitted to hospitals in the in the United States with acute myocardial infarction (AMI).

METHODS: A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for the year 2014. Adults (â&#x2030;Ľ 18 years) with a principal diagnosis of AMI and a secondary diagnosis of MDD were identified using ICD-9 codes as described in the literature. The primary outcome was the rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges).

Propensity score (PS) using the 1:1 nearest neighbor matching without replacement was utilized to adjust for confounders. Independent risk factors for readmission were identified using Coxâ&#x20AC;&#x2122;s proportional hazards model.

RESULTS: In total, 506,504 hospital admissions among adults with a primary diagnosis of AMI were identified, of which 6.6% had MDD. After PS matching with similar demographic and clinical characteristics, 4,005 AMI patients with MDD were paired with 4,005 AMI patients without MDD. The most common readmission for both groups was recurrence of myocardial ischemia (99%). During the index admission for AMI, the length of stay (LOS) among MDD patients was longer than those without MDD (6.5 vs 4.7 days, p<0.001). The total cost of hospital admission was not statistically significant among the two groups (MDD $22,507 vs non-MDD $20,892, p<0.11). During the index admission, the in-hospital mortality for AMI patients with or without MDD was 2.65% vs 1.59% (p<0.389). During the readmission for AMI, the length of stay (LOS) among MDD patients was significantly longer than those without MDD (7.5 vs 4.6 days, p<0.001). The total cost of hospital admission was not statistically significant among the two groups (MDD $13,854 vs non-MDD $10,654; p<0.06). During the readmission, the in-hospital mortality for AMI patients with or without MDD was 2.15% vs 1.30% (p<0.92).

MDD (HR 1.93, 95%CI:1.40-2.67; p<0.001) was an independent predictor associated with higher risks of readmission. Similarly, patients admitted with AMI with atrial also had an increased risk of readmission (HR 1.56, 95%CI:1.12-2.18; p<0.01).

CONCLUSION: In this study, AMI with MDD had an increased risk of readmission to the hospital within 30 days of discharge (p<0.001) and the most common cause was recurrent of myocardial infarction when compared to AMI patients without MDD. They also have a significant longer LOS.

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ABSTRACT #108 CLINICAL RESEARCH CARDIOVASCULAR DISEASE ATRIAL FIBRILLATION IS INDEPENDENTLY ASSOCIATED WITH ADVERSE HOSPITAL OUTCOMES AND COMPLICATIONS AMONG PATIENTS ADMITTED FOR INFLUENZA Lingling Wu1, Faris Haddidin1 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the European Society of Cardiology (ESC) Congress; Paris, France held on August 31, 2019 to September 4, 2019.

BACKGROUND/INTRODUCTION: Both influenza and atrial fibrillation are common conditions that cause significant morbidity and mortality. Studies have shown influenza was associated with development of atrial fibrillation. However, the impact of atrial fibrillation on hospital course of influenza admissions has not been studied. The study was conducted to examine the impact of atrial fibrillation on the hospital course of patient admitted for influenza.

METHODS: We use disease specific ICD-10 code to identify all adult patients admitted for influenza, with or without atrial fibrillation. Demographic characteristic of both group are described and compared. Between group comparisons were performed for continuous data using Student t test for parametric. Categorical variables were compared using Pearson chi squared test, p<0.05 was considered for statistical significance.

Mortality, intubation rate, utilization of cardiopulmonary resuscitation, length of stay and total hospital using multivariate linear regression adjusted for age, sex, race, hospital size, hospital location, hospital teaching status and Charlson comorbidity index.

RESULTS: Atrial Fibrillation was found in 8.31% (5,720) in total ACHF admissions (68,785). A significantly older presenting age (56.5 vs 52.12 years, p<0.001) and higher percentage of female (58.35% vs 51.99%, p<0.001) was observed in influenza patient with atrial fibrillation. Atrial fibrillation is associated with significantly increased inpatient mortality (3.75% vs 1.88%, OR 1.97 [1.32-2.92], p=0.001), which is independent of age, sex, race, and common comorbidity. A higher utilization of intubation (4.19% vs 1.89%, OR 1.82 [1.28-2.60], p=0.001) and cardiopulmonary resuscitation (1.57% vs 0.55 %, OR 4.01[1.40-11.48], p=0.01) are also noticed in patients with atrial fibrillation after adjusted for confounders. Lastly, among patient admitted for influenza, atrial fibrillation is also associated with prolonged length of stay (5.18 vs 3.98 days, p<0.001) and increased total hospital charge ($48.89 vs. $35.91 thousand dollars, p<0.001).

CONCLUSION: Atrial Fibrillation is prevalent among patient admitted because of influenza infection, Furthermore, atrial fibrillation is associated with increased mortality, higher rate of complication, prolonged length of hospital stay and increased health care cost.

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ABSTRACT #109 CLINICAL RESEARCH CARDIOVASCULAR DISEASE/HEMATOLOGY/ONCOLOGY ESSENTIAL THROMBOCYTOSIS IS ASSOCIATED WITH WORSE OUTCOMES IN PATIENTS PRESENTED WITH ACUTE MYOCARDIAL INFARCTION: A PROPENSITY SCORE ANALYSIS OF THE NATIONAL INPATIENT SAMPLE Lingling Wu1, Baoqiong Liu2, Yingying Zheng3 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Florida Hospital, Orlando, FL, United States; 3Brady School of Medicine at East Carolina University, Greenville, NC, United States 2

Presented at the European Society of Cardiology (ESC) Congress; Paris, France held on August 31, 2019 to September 4, 2019.

BACKGROUND/INTRODUCTION: Essential thrombocytosis (ET) is a rare disease characterized by vasomotor symptom, thrombotic event and paradoxical hemorrhage. Due to its rare occurrence, only limited data are available to examine impact of essential thrombocytosis on acute myocardial infarction (AMI). To evaluate whether essential thrombocytosis has negative impact on hospital outcome of AMI. METHODS: We use 2016 National Inpatient sample database to identify all the admission with a principal diagnosis of AMI. A matched cohort was then generated using propensity score using age, sex, race, location, insurance, income, hospital type, hospital location, Charlson comorbidity score. Prevalence, baseline characteristic of AMI patient with or without essential thrombocytosis was described and compared.

Univariable logistic regression model was used to measure mortality, rate of catheterization and transfusion.

RESULTS: Essential thrombocytosis was found in 0.28% (1,814) in total AMI admissions (641,854). Age (69.52 vs 69.70 years), female (48.04% vs 48.03%) and baseline comorbidities including STEMI (27.49% vs 25.08%), diabetes (33.03% vs 30.51%), heart failure (40.18 vs 45.89%) and chronic kidney disease (22.05% vs 26.28%) was found to be comparable between two groups (p>0.05). Compare to non-ET group, ET is associated with significantly higher hospital mortality (5.74% vs 2.43%, OR 2.44[1.09- 5.48], p=0.03), as well as prolonged length of stay (7.61 vs 4.30 days, p<0.01). Interestingly, ET is associated with lower utilization of cardiac catherization (37.46% vs 46.52%, p=0.01).

CONCLUSION: Essential thrombocytosis is infrequently observed in patient admitted for AMI. Furthermore, having essential thrombocytosis was associated with higher hospital mortality, longer hospital inpatient stay and lower utilization of cardiac catheterization.

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ABSTRACT #110 CLINICAL RESEARCH GASTROENTEROLOGY/HEMATOLOGY/ONCOLOGY SENTINEL LYMPH NODE SAMPLING AND EMPIRIC CHEMORADIATION AS AN ORGAN SPARING APPROACH AFTER ENDOSCOPIC RESECTION OF INTERMEDIATE RISK EARLY FOREGUT CANCERS: A US PILOT STUDY Stavros N Stavropoulos1, Xiaocen Zhang2, Erin Ly3, Mengdan Xie2, Maaz B Badshah1, Iosif Galibov, Jessica L Widmer1, Rani J Modayi1

1 New York University, New York, NY, United States; 2Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3University of Buffalo, Buffalo, NY, United States

Accepted at the Digestive Disease Week (DDW); Chicago, IL, United States that was scheduled to be held May 2-5, 2020.

BACKGROUND/INTRODUCTION: For low risk early foregut cancers, endoscopic submucosal dissection (ESD) is curative. For high-risk cancers, esophagectomy/gastrectomy is required for definitive staging and treatment. For ‘intermediate risk’ patients at ~5-20% risk of lymph node (LN) metastasis, however, local resection in conjunction with systemic therapy could rival radical surgery. In this context, after local resection, Sentinel LN sampling (SLNS) may offer added value compared to a ‘wait and watch’ or ‘empiric chemotherapy’ approach. SLNS has not been used in clinical practice after ESD of T1 Barrett’s cancers. For gastric cancers it represents an emerging technique limited to Asia. We report the 1st US pilot study on SLNS after ESD for these foregut cancers.

METHODS: Patients who had ESD for T1 Barrett’s or gastric carcinomas and met both criteria below were offered SLNS: 1) ESD pathology with high-risk T1 cancer (deep invasion; lymphovascular invasion, G3,4 grade). 2) Patient with high surgical risk or refusing surgery. Indocyanine green (ICG) was injected endoscopically in the submucosa around the ESD site intra-operatively and fluorescent LNs were harvested including paraesophageal/EGJ stations in Barrett’s patients. Pts with positive SLNs and high-risk patients with negative SLNs were offered adjuvant therapy.

RESULTS: 10 pts received ESD with SLNS. Mean age 70 (50-79). 9 males. The ASA class was 3 in 8 and 2 in 2 patients. There were 7 EGJ Barrett’s cancers (5 with T1a m3 invasion as the only risk factor) and 3 gastric cancers. We consider Barrett’s T1a m3 carcinomas as high-risk based on reports of LN involvement in up to 5%. Our finding of a positive SLN in 1/5 of these patients supports this. Median cancer size 1.3 cm (0.5-3.5).

Grade: G1 in 4 patients, G2 in 5 and G4 in 1. T stage was T1a m3 in 5 and T1b in 5. R0 ESD achieved in 8 patients. SLNS was successful in all patients and returned a median of 9 LNs (4-20). 9 pts discharged on the same day and 1 on the next day. No significant adverse events. 4 patients had positive SLNs (1 N1, 2 N2, and 1 N3) and received adjuvant chemotherapy +/- radiation. Of the 6 N0 patients 1 received a 2nd ESD for indeterminate lateral margin and one with SM2 Barrett’s cancer and only 4 SLNs sampled was offered chemotherapy. After a median follow-up of 30 months (range 15-64), 8 patients including all 6 with negative SLNs were in remission. 2/4 patients with positive SLNs died, one from disseminated cancer, and one while in remission, from unrelated cause.

CONCLUSION: This pilot study in patients with ESD of T1 Barrett’s and gastric cancers with high risk histologic features suggests potential feasibility of SLNS to risk-stratify and direct further treatment in patients in whom the standard of care of organ resection and lymphadenectomy is not possible due to high surgical risk or patient preference.

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Index of Virtual Posters

153

RESIDENT NAME

POSTER CATEGORY

POSTER

Abed, Robert

Clinical Research

1

Anand, Shruti

Quality Improvement

2

Arevalo Molina, Ana Belen

Clinical Research

3

Arreaza, Javier

Clinical Vignette/Case Report/Clinical Review

4

Bandyopadhyay, Dhrubajyoti

Clinical Research

5

Beydoun, Hassan

Clinical Research

6

Bhatia, Kirtipal

Clinical Research

7

Bsrat, Makda

Clinical Vignette/Case Report/Clinical Review

8

Chen, Bing

Clinical Vignette/Case Report/Clinical Review

9

Chen, Kun

Medical Education

10

Chen, Laura

Clinical Vignette/Case Report/Clinical Review

11

Contreras Anez, Gustavo

Clinical Research

12

De la Villa Pagan, Ricardo

Clinical Vignette/Case Report/Clinical Review

13

NOT SUBMITTED

14

Dooley, Caroline

Clinical Vignette/Case Report/Clinical Review

15

El Halabi, Maan

Clinical Research

16

Fujisaki, Tomohiro

Clinical Vignette/Case Report/Clinical Review

17

Ghanbar, Mohammed

Clinical Research

18

Goldberg, Julia

Clinical Research

19

154

RESIDENT NAME

POSTER CATEGORY

POSTER

Gorenchtein, Mike

Clinical Vignette/Case Report/Clinical Review

20

Haddadin, Faris

Clinical Research

21

Handa, Shivani

Clinical Research

22

Hirsch, Julianna

Clinical Research

23

Ho, Kam Sing

Clinical Research

24

Jamil, Rida

Clinical Vignette/Case Report/Clinical Review

25

Jamito, Jonathan Albert

Clinical Vignette/Case Report/Clinical Review

26

Jatwani, Karan

Clinical Research

27

Jiang, Changchuan

Clinical Research

28

Jindal, Vipul

Clinical Vignette/Case Report/Clinical Review

29

Kakked, Guarav

Clinical Research

30

Kaplin, Scott

Clinical Research

31

Kassim, Gassan

Clinical Research

32

Khachatoorian, Yeraz

Clinical Vignette/Case Report/Clinical Review

33

Konje, Swiri

Clinical Research

34

Krishnamurthi, Nirupama

Clinical Research

35

Lee, Michelle

Clinical Research

36

Lopes, Jan Menezes

Clinical Research

37

Manguba, Alexander

Clinical Research

38

McKinnell, Zoe

Medical Education

39 155

RESIDENT NAME

POSTER CATEGORY

POSTER

Modi, Vivek Amit

Clinical Research

40

Munoz Estrella, Alba

Clinical Research

41

Murray, Shane

Clinical Vignette/Case Report/Clinical Review

42

Ochoa Jimenez, Roberto Carlos

Clinical Research

43

Olivo Frietes, Christian

Clinical Research

44

Omoniyi, Elizabeth Jasola

Clinical Vignette/Case Report/Clinical Review

45

Patel, Hardikkumar

Clinical Research

46

Perimbeti, Stuthi

Clinical Research

47

Rainone, Michael

Clinical Research

48

Rajeeve, Sridevi

Clinical Research

49

Rzechorzek, Wojciech

Quality Improvement

50

Salguero, Bertin D.

Medical Education

51

Shachi, Tal

Clinical Vignette/Case Report/Clinical Review

52

Shah, Ruchit

Clinical Research

53

Shrivastav, Rishi

Clinical Research

54

Singh, Isha

Clinical Vignette/Case Report/Clinical Review

55

Skaf, Michel

Clinical Vignette/Case Report/Clinical Review

56

Stanchina, Michele

Clinical Research

57

Sterpi, Michelle

Clinical Research

58

156

RESIDENT NAME

POSTER CATEGORY

POSTER

Tallon de Lara, Paulino

Basic Science

59

Tobin-Schnittger, Patrick

Clinical Research

60

Vela Parada, Xavier Fernando

Quality Improvement

61

Uberoi, Guneesh

Clinical Research

62

Weininger, David Cohen

Clinical Research

63

Yang, Xiaochuan

Clinical Research

64

Zajac, Sean

Clinical Research

65

Zhang, Xiaocen

Quality Improvement

66

157

Index of Authors

158

INDEX OF RESIDENT AUTHORS Abed, Robert: 21, 129, 140 Anand, Shruti: 22 Arevalo Molina, Ana Belen: 23, 34, 50, 69, 109, 110 Arreaza Caraballo, Javier: 24-25 Bachoo, Nikhil: 21, 129 Bandyopadhyay, Dhrubajyoti: 26, 27, 68 Bernal, Gabriela: 112 Berookhim, Joshua: 45, 112 Beydoun, Hassan: 27, 68 Bhatia, Kirtipal: 28, 50, 92, 138, 142 Bsrat, Makda: 29-30, 97, 134, 135 Chen, Bing: 31, 97, 113, 114 Chen, Kun: 32 Chen, Laura: 33 Chibas Sandoval. Raul: 24 Contreras, Gustavo: 34, 63, 69, 109, 110, 146 Das, Subrat: 112, 138 De La Villa, Ricardo: 35, 93 Derman, Abraham: 111 Dooley, Caroline: 37 El Halabi, Maan: 38 Espinosa Hernandez, Adiac: 63 Fayad, Mona: 63 Flynn, Erin: 115 Fujisaki, Tomohiro: 40-41 Ghanbar, Mohammad: 42 Goldberg, Julia: 43 Gorenchtein, Mike: 44 Haddadin, Faris: 23, 27, 45, 68, 79, 109, 110, 150 Handa, Shivani: 46, 50, 88, 116, 141 Herrera, Yasmin: 50, 123, 125 Hirsch, Julianna: 47 Ho, Kam: 48, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 146, 147, 148, 149 Huang Lucas, Claire: 21, 45, 64, 129, 131, 132 Isath, Ameesh: 22, 130, 131, 132, 138, 139

Jamil, Rida: 49 Jamito, Jonathan Albert: 50 Jatwani, Karan: 51, 116, 147, 148 Jiang, Changchuan: 52 Jindal, Vipul: 53 Kahen, Michael: 112 Kakked, Gaurav: 54 Kaplin, Scott: 55 Kassim, Gassan: 29-30, 56-58, 97, 133, 134, 135, 136 Khachatoorian, Yeraz: 59 Kohli, Paaras: 122, 123, 125, 147, 148 Konje, Swiri: 55, 60-61, 82 Krishnamurthi, Nirupama: 62 Lee, Michelle: 63 Lopes, Jan: 64, 129 Mahmoud, Omar: 114 Manguba, Alexander: 65 McKinnell, Zoe: 66 Moctezuma, Sananda: 45, 137 Modi, Vivek: 28, 68, 92 Munoz Estrella, Alba: 23, 27, 45, 60-61, 68, 79 Murray, Shane: 23, 34, 69, 109, 110 Narasimhan, Bharat: 28, 48, 92, 117, 118, 119, 120, 121, 122, 123, 124, 125, 130, 131, 132, 138, 139, 149 Nassar, Rawann: 140 Nasserifar, Shabnam: 122, 123,124, 125, 128 Ochoa Jimenez, Roberto: 70-71 Olivo Freites, Christian: 34, 63, 72 Omoniyi, Elizabeth: 73 Patel, Hardikkumar: 74 Patel, Ramya: 97 Pattupara, Archana: 123, 124 Perimbeti, Stuthi: 75, 76, 83, 130, 131, 132, 139 Petrone, Giulia Eva Maria: 46, 116, 141 Poon, Joseph: 123, 125 Rainone, Michael: 76 159

INDEX OF RESIDENT AUTHORS Rajeeve, Sridevi: 46, 77, 116, 141 Rzechorzek, Wojciech: 55, 60-61, 79, 142 Sabharwal, Basera: 79, 93 Salguero Porres, Bertin: 80, 143, 144 Santillan, Yeriko: 22 Shachi, Tal: 81 Shah, Ruchit: 55, 82, 142 Shah, Suraj: 113, 145 Sheehan, Jacqueline: 48, 117, 118, 119, 120, 122, 123, 124, 125, 126, 127, 128, 146, 147, 148 Shrivastav, Rishi: 75, 76, 83 Singh, Avinash: 96 Singh, Isha: 84-85 Skaf, Michel: 86 Stanchina, Michele: 87 Sterpi, Michelle: 88 Tallon de Lara, Paulino: 38-39, 63, 89 Tobin-Schnittger, Patrick: 90 Uberoi, Angad: 59 Uberoi, Guneesh: 28, 92, 142 Vela Parada, Xavier: 65, 91 Weininger, David: 50, 79 Wu, Lingling: 28, 31, 45, 48, 60-61, 117, 118, 119, 120, 121, 123, 124, 125, 129, 138, 139, 142, 149, 150, 151 Xie, Mengdan: 152 Yang, Xiaochuan: 94 Zajac, Sean: 96 Zhang, Xiaocen: 97, 152 Zheng, Binbin: 52

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Thank you for attending the Mount Sinai Morningside/West Internal Medicine Residency 1st Annual Virtual Research Week!

Residency Leadership John A. Andrilli, MD, FACP Program Director Internal Medicine Residency

Georgina Osorio, MD, MPH Associate Program Director for Research Internal Medicine Residency

Lillian Galindo Program Administrator Internal Medicine Residency

Nicole Littman Program Coordinator Internal Medicine Residency

Residency Contact Information Email: slrmedresinfo@mountsinai.org Website: icahn.mssm.edu/education/residenciesfellowships/list/msslw-internal-medicineresidency Twitter: @MSM_MSW

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Official Publication of 1st Annual Mount Sinai Morningside and Mount Sinai West Internal Medicine Residency Research Week

Editors Georgina Osorio Nicole Littman Lillian Galindo

Associate Editors Valeria Santibanez Marcelo Hernandez Erica Vero

Editorial Board John Andrilli Deborah Edelman Adiac Espinosa Tamara Goldberg Dipal Patel Alejandro Prigollini Basera Sabharwal Geeta Varghese Avinash Singh Vasundhara Singh Heather Viola 163