INTRODUCTION:Improving the prompt recognition of acute coronary syndrome symptoms in the prehospital period may reduce total ischemic time and improve patient outcomes. This study aimed to evaluate the occurrence, severity, and changes in patient-reported symptoms between the prehospital period and the emergency department and determine whether symptoms predicted an acute coronary syndrome diagnosis and/or adverse patient outcomes (eg, death). METHODS:Individuals who were ≥21 years old and transported by emergency medical services with nontraumatic chest pain or anginal equivalent symptoms were eligible. Patients completed the Acute Coronary Syndrome Symptom Checklist in the ambulance and on arrival to the emergency department. Chi-square, t tests, and logistic regression were used, adjusting for age, sex, and race, to estimate associations between symptoms and acute coronary syndrome diagnoses and adverse events within 30 days. RESULTS:The sample included 206 individuals. Chest pain was the chief complaint at T1 and T2. Participants reporting chest pressure, shoulder pain, palpitations, lightheadedness, and chest pain were significantly younger than participants without these symptoms. Sweating at T1 was associated with increased odds of an acute coronary syndrome diagnosis (odds ratio, 3.24, P = .01). At T2, chest discomfort and unusual fatigue were predictive of acute coronary syndrome diagnosis (odds ratio, 2.59 and 2.98; P < .045 and P < .03, respectively). Patients experiencing shortness of breath at either T1 or T2 had significantly increased odds of adverse events (odds ratio, 3.96 and 3.26, respectively; P = .02 and P = .04). Six symptoms decreased by ED arrival. DISCUSSION:Chest symptoms, sweating, fatigue, and shortness of breath should trigger concern for acute coronary syndrome in clinicians. Results indicate the importance of calling emergency medical service, which was associated with a prehospital reduction in symptoms.

Background:Artificial intelligence (AI) chatbots, driven by advances in natural language processing, can analyze and generate human language through computational linguistics and machine learning. Despite the rapid development of large language models, little investigation has been conducted to assess whether AI chatbot-delivered educational conversations can achieve a similar level of efficacy as human-delivered conversations. Objective:This study aims to evaluate and explore the potential efficacy of human-delivered conversations versus AI chatbot conversations in increasing women's knowledge and awareness of symptoms and response to a heart attack in the United States. Methods:This is a secondary analysis of 2 datasets collected from the AI Chatbot Development Project. Women aged 25 years or older were recruited through flyers and social media. The first dataset contained conversational data where a research interventionist engaged in educational conversations with participants (human dataset), whereas the second dataset contained conversational data where an AI chatbot named HeartBot engaged in the same educational conversations with participants (HeartBot dataset). Knowledge and awareness of symptoms and response to a heart attack were measured at the pre- and post-interaction with either the human or HeartBot. Perceived message effectiveness and conversational quality were measured at the post-survey. Ordinal logistic regression analyses were conducted to explore factors predicting participants' knowledge, adjusting for age, race or ethnicity, intervention group type, education, word count, message effectiveness, and message humanness. Results:A total of 171 participants (mean age=41.06 y, SD=12.08) in the Human dataset and 92 participants (mean age=45.85 y, SD=11.94) in the HeartBot dataset completed the study. Both human-delivered conversations and HeartBot conversations were associated with significant improvements in participants' ability to recognize heart attack symptoms (adjusted odds ratio [AOR] 15.19, 95% CI 8.46-27.25, P<.001; AOR 7.18, 95% CI 3.59-14.36, P<.001), differentiate between symptoms (AOR 9.44, 95% CI 5.60-15.91, P<.001; AOR 5.44, 95% CI 2.76-10.74, P<.001), call emergency services (AOR 6.87, 95% CI 4.09-11.55, P<.001; AOR 5.74, 95% CI 2.84-11.60, P<.001), and seek emergency care within 60 minutes of symptom onset (AOR 8.68, 95% CI 4.98-15.15, P<.001; AOR 2.86, 95% CI 1.55-5.28, P<.001), even after adjusting for covariates. Comparing the 2 datasets via interaction tests showed a statistically significant improvement in human-delivered conversations versus HeartBot conversation for all but the calling an ambulance question (P=.09). Conclusions:The study's findings provide new insights into the fully automated AI HeartBot, compared to the human-driven text message conversations, and suggest that it has potential in improving women's knowledge and awareness of heart attack symptoms and appropriate response behaviors. Nevertheless, the current evidence remains preliminary. A randomized controlled trial is warranted to validate this study's findings.

Background Associations among perceived social support (PSS), physical activity (PA), and health-related quality of life (HRQoL) in individuals with ischemic heart disease (IHD) are well established. However, little is known about these associationsin patients with IHD experiencing hopelessness. Objective The objective of this study is to explore the associations among PSS, PA, and HRQoL in patients with IHD reporting moderate to severe hopelessness. Methods Using a cross-sectional design, secondary data were collected from 156 participants enrolled in a randomized controlled trial while hospitalized in the Midwestern United States. Data were collected 2 weeks after hospital discharge, including the Cardiac Rehabilitation Exercise Participation Tool, ENRICHD Social Support Inventory, EuroQol 5-Dimension 5-Level, and a demographic form. Linear models were used to assess associations among the variables, and Macro process mediation was completed to explore potential mediation. Results Most participants were male, had some college education or higher, and non-Hispanic White. Over half of the sample were married and not employed (eg, disabled, retired). Higher PSS and higher PA were each separately associated with higher HRQoL after adjusting for relevant covariates (PSS: r partial = −0.24, P = .005; PA: r partial = −0.23, P = .003). Engagement in PA ( r partial = −0.19, 95% bootstrap CI, −0.34 to −0.03; P = .02) partially mediated the relationship between PSS and HRQoL ( r partial = −0.18, 95% bootstrap CI, −0.35 to −0.01; P = .03) showing a 22% partial mediation with indirect effect at −0.05 (95% CI bootstrap, −0.11 to −0.002). Conclusion Even among patients with high perceptions of hopelessness, better perceived social support and more engagement in physical activity are associated with better HRQoL. Longitudinal research in larger and more diverse samples is needed to examine the relationships among PSS, PA, and HRQoL in patients with IHD reporting hopelessness.

BACKGROUND:Hopelessness is present in up 52% of patients with ischemic heart disease (IHD) and is associated with increased morbidity and mortality. Lower perceived social support (PSS) has been associated with greater hopelessness in a pilot study of patients with IHD reporting moderate-severe hopelessness but has not been examined in a larger sample reporting none-severe levels of hopelessness and while controlling for covariates. OBJECTIVE:The aim of this study was to determine the relationship between PSS and hopelessness in patients with IHD. METHODS:Using a cross-sectional design, 178 participants were enrolled while hospitalized for an IHD event at 1 large hospital in the United States. Data collection occurred 2 weeks after hospital discharge using the State-Trait Hopelessness Scale, ENRICHD Social Support Inventory, Patient Health Questionnaire-9, a demographic form, and a medical record abstraction form. Linear models were used to assess the association between variables in unadjusted models and models adjusted for demographic and medical history. RESULTS:Most participants were male (67%), married (67%), and non-Hispanic White (92%) and underwent coronary artery bypass surgery (61%). There was a moderate inverse correlation between PSS and state ( r = -0.31, P < .001) and trait ( r = -0.28, P < .001) hopelessness in unadjusted models. The relationships remained significant in adjusted models and did not differ by sex, type of IHD event, or marital status. CONCLUSIONS:Lower PSS was associated with greater hopelessness in patients with IHD. Assessing PSS and hopelessness during hospitalization for an IHD event may enable clinicians to provide targeted interventions to reduce risk of hopelessness and improve secondary prevention in patients with IHD.

Background:Heart disease remains a leading cause of death for women in the United States, but awareness and knowledge about it are declining. Artificial intelligence (AI) chatbots have great potential to educate women. Objective:This study aimed to evaluate the potential efficacy of HeartBot to increase women's awareness and knowledge of heart attack symptoms and care-seeking behavior. Methods:In this nonrandomized pilot, quasi-experimental study, 92 women aged ≥25 years without a history of heart disease completed the HeartBot interaction via SMS text messaging. The study was remotely conducted from October 2023 to January 2024. HeartBot, a fully automated AI chatbot, covered 15 topics of heart attack awareness, knowledge, symptoms, and care seeking in a single session. The mean length of the HeartBot interaction was 13.0 (SD 7.80) minutes. The primary outcomes consist of four questions: (1) recognizing signs and symptoms of a heart attack, (2) telling the difference between the signs and symptoms of a heart attack, (3) calling an ambulance or dialing 911 when experiencing heart attack symptoms, and (4) getting to an emergency room within 60 minutes after the onset of symptoms of a heart attack. Women were asked to answer the 4 questions before and after the HeartBot interaction on a scale of 1 to 4, with a higher score indicating higher levels of awareness and knowledge of heart attack risks and symptoms. Results:The mean age of the sample was 45.9 (SD 11.9) years. In total, 59.8% (55/92) of the sample identified as belonging to racial or ethnic minority groups. The mean length of the HeartBot interaction was 13.0 (SD 7.80) minutes. In ordinal logistic regression models, women showed significant improvements across the 4 self-reported outcomes (ie, heart attack symptoms and calling 911) even after controlling for potential confounding factors (outcome 1: adjusted odds ratio [aOR] 7.10, 95% CI 3.52-13.16; outcome 2: aOR 5.47, 95% CI 2.77-10.78; outcome 3: aOR 5.75, 95% CI 2.86-11.59; and outcome 4: aOR 2.85, 95% CI 1.54-5.25; P<.001 for all 4 outcomes). Conclusions:HeartBot led to a substantial increase in awareness and knowledge of heart attack risks and symptoms in women. These findings suggest that HeartBot is a promising approach to improving heart health education. A randomized controlled trial of HeartBot is warranted to establish its efficacy and safety for the clinical setting.

BACKGROUND:Triage nurses are responsible for determining the urgency with which patients are evaluated and treated. How triage nurses make decisions is critical to providing effective care. OBJECTIVE:The aims were to (1) analyze the psychometric properties of the Nurses' Cardiac Triage Instrument in a large, national sample of emergency department nurses, and (2) make recommendations for refining the instrument. METHODS:Data were obtained from a descriptive, survey study. Participants were recruited from the Emergency Nurses Association website using stratified random sampling. Participants completed the Nurses' Cardiac Triage Instrument. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were performed. RESULTS:Emergency nurses (n = 414) had a mean age of 41.7 years (SD, 12.0 years) and had a median of 8.0 years (interquartile range, 11.0 years) of emergency department experience. The CFA demonstrated a poor fit with the original factor structure (χ2[402] = 1872.59, P = .000, root mean square error of approximation = .094, comparative fit index = .585, Tucker-Lewis Index = .551, standardized root mean square residual = .086). Therefore, the dataset was divided into 2; EFA and CFA were conducted. Factor 3 (nurse action) showed ceiling effects and was excluded from analysis. EFA and subsequent CFA resulted in 7 factors explaining 63.49% of the variance. CONCLUSIONS:Factors 1 and 2 (patient presentation and nurses' reasoning process) of the original Nurses' Cardiac Triage Instrument were validated by EFA and CFA. Factor 3 items could be used as outcome measures in the future. This study supports further testing to compare purported versus actual nurse actions.

Background: Risk factors for cardiovascular disease (CVD) among young and middle-aged women have increased while knowledge and awareness of CVD remain low. To reverse these trends, it is important to assess whether knowledge and awareness of CVD are associated with intent to change behavior. Aims: Describe the relationship between stage of behavior change and awareness, knowledge, and perceptions of CVD among women 25-55 years and identify the predictors of stage of behavior change. Methods: A cross-sectional, descriptive study of women ages 25-55 living in the United States without a self-reported CVD history was conducted. Participants were recruited through flyers and social media campaigns. Awareness was measured with the question, “What is the leading cause of death for women in the United States?” Knowledge, perceptions, and stage of behavior change were measured with the Heart Disease Fact Questionnaire, Health Beliefs Related to CVD, and the Precaution Adoption Process Model surveys, respectively. All data were collected online via REDCap. Results: A total of 149, primarily minority women, were included (mean=37.15±7.86 years). Over half (53.7%) of the sample had not decided to make changes in their behavior to reduce their likelihood of CVD. A binary logistic regression of stage of behavior change on awareness, knowledge, and perceptions of CVD showed that the perception subscales of susceptibility and severity were significantly associated with intent to change behavior (OR 1.247, p<0.001 and OR .809, p=.004 respectively). Awareness and knowledge of CVD were not associated with stage of behavior change. There were no significant sociodemographic and health condition predictors of stage of behavior change, although susceptibility and severity remained significant when controlling for these covariates (OR 1.242, p=.002 and OR=.801, p=.004, respectively). Conclusions: Young and middle-aged women who believed that they were susceptible to CVD and did not perceive CVD as a serious condition were more likely to report an intent to change their behavior to reduce their risk of CVD. These may be key factors to leverage when educating young and middle-aged women on heart disease in order to facilitate heart healthy behaviors.

BACKGROUND:Attention control is an important part of clinical trials, allowing the influence of attention to be parsed from the effects of the intervention. Poor control group design can lead to unintended outcomes, overestimate the effectiveness of an intervention, or threaten a potentially beneficial treatment. The aims of this paper were to describe the development of a novel attention control using TED Talks and provide recommendations for the design of an attention control condition. METHODS:Twenty-four TED Talks were selected for inclusion in the control condition. The talks ranged from 6.0 to 19.1 minutes for a total length of 4 hours and 12 minutes (mean = 10 minutes, 30 seconds). Topics included education, technology, health, space, human behavior, sanitation, parenting, cliff climbing, public speaking, happiness, obituaries, procrastination, and age diversity. We then developed 3 to 4 simple questions reflecting the content of the Talk. Responses ranged from true/false to 4 multiple-choice answers. Four to five videos were selected for each attention control session and bundled to create an approximately 90-minute attention control condition to match the intervention (acupuncture) session (45 minutes × 10 sessions). DISCUSSION:We developed an attention control condition that met crucial requirements of (1) equivalent attention to that of the experimental group, (2) a design that can hold the participant's interest, (3) standardization to avoid potentially confounding outcomes, and (4) the evaluation of expectancy. CONCLUSION:Investigators can develop a rigorous attention control condition using TED Talks guided by our protocol.

Artificial intelligence (AI) chatbots, driven by advances in natural language processing (NLP), can analyze and generate human language through computational linguistics and machine learning. Despite the rapid development of large language models, little investigation has been conducted to assess whether AI chatbot-delivered educational conversation can achieve a similar level of efficacy as human-delivered conversation. To evaluate and compare the potential efficacy of human-delivered conversation versus AI chatbot conversation in increasing women’s knowledge and awareness of symptoms and response to heart attack in the United States. This is a secondary analysis of two data sets collected from the AI Chatbot Development Project. Women aged 25 years or older were recruited through flyers and social media. The first dataset contained conversational data where a human researcher engaged in educational conversations with women (Human dataset), whereas the second dataset contained conversational data where an AI chatbot named HeartBot engaged in the same educational conversations with women (HeartBot dataset). Knowledge and awareness of symptoms and response to heart attack were measured at the pre-and post-interaction with either the human or HeartBot. Perceived message effectiveness and conversational quality were measured at the post-survey. Ordinal logistic regression analyses were conducted to explore factors predicting women’s knowledge, adjusting for age, race/ethnicity, interaction group type, education, word count, message effectiveness, and message humanness. A total of 171 women (mean age=41 years, SD=12.08) in the Human dataset and 104 women (mean age=46 years, SD=11.86) in the HeartBot dataset completed the baseline survey. Both human-delivered conversations and HeartBot conversation significantly improved participants’ ability to recognize heart attack symptoms (AOR 15.19, 95% CI 8.46-27.25, p=0.000000000000000000075; AOR 7.18, 95% CI 3.59-14.36, p=0.000000025), differentiate between symptoms (AOR 9.44, 95% CI 5.60-15.91, p=0.000000000000000034; AOR 5.44, 95% CI 2.76-10.74, p=0.0000011), call emergency services (AOR 6.87, 95% CI 4.09-11.05, p= 0.000000000000035; AOR 5.74, 95% CI 2.84-11.60, p= 0.0000011), and seek emergency care within 60 minutes of symptom onset (AOR 8.68, 95% CI 4.98-15.15, p=0.000000000000027; AOR 2.86, 95% CI 1.55-5.28, p=0.00078) respectively, even after adjusting for covariates. Comparing the two via interaction tests showed a statistically significant improvement of human-delivered conversation vs. HeartBot conversation for all but the calling an ambulance question (p=0.089). Our findings indicate that HeartBot holds promise in increasing heart attack knowledge and awareness among women in a cost-effective manner. Future research should employ rigorous experimental designs, such as randomized controlled trials, and evaluate their effectiveness in improving heart health knowledge and subsequent behavior changes.

BACKGROUND:Heart disease is the leading cause of death (LCOD) for women in the United States. However, despite decades of public health campaigns, awareness of heart disease among women, especially those with racial/ethnic minority backgrounds and young women, significantly declined from 2009 to 2019. OBJECTIVES:The aim of this study was to compare the differences in heart disease awareness as the LCOD among Black, Hispanic, White, and Asian/Other women groups. METHODS:In this cross-sectional, online survey study, 422 community-dwelling women were analyzed. Heart disease as the LCOD was categorized as the correct answer. We implemented log-linear models via a Poisson regression to estimate unadjusted and adjusted relative risks [RRs] of race in predicting correct knowledge of LCOD. RESULTS:The mean age was 41.2 (±12.9) years. The sample represents 39.8 % Hispanic, 28.4 % White, 19.9 % Black, 11.9 % Asian/others. After adjusting for age and cardiovascular disease risks, Black and Hispanic women, as compared to White women, had significantly lower awareness of heart disease as the LCOD [(Adjusted RR=0.69, 95 % CI: 0.52, 0.92); (Adjusted RR= 0.78, 95 % CI: 0.78 -0.94), respectively]. Additionally, physical inactivity and hypertension medication intake were significantly associated with this level of awareness (P < 0.5). CONCLUSION:Lower heart disease awareness in Black and Hispanic women persists. It is crucial to develop more effective approaches to close this disparity. Testing new methods, such as applying artificial intelligence to send more culturally appropriate and personalized messages, is urgently needed to raise women's awareness of their heart disease risk.

Background: Adults with moderate-to-complex congenital heart disease (CHD) show psychosocial and neurocognitive deficits, particularly in mood, anxiety, and cognitive domains. However, sex differences in neuropsychological outcomes remain underexplored. Objective: To examine sex-based differences in cognitive and psychosocial outcomes in adults with CHD compared to age- and sex-matched healthy controls. Methods: 80 adults (20 female CHD, 20 male CHD, 20 female controls, 20 males controls) were recruited. Cognitive tests were administered (Montreal Cognitive Assessment [MoCA], Wechsler Abbreviated Scale of Intelligence [WASI-II]) and questionnaires assessing anxiety, depression, and perceived social support were completed. Group comparisons were completed using independent samples t-tests, and the relationships between psychosocial and cognitive variables were examined using Pearson correlations. Results: The CHD group showed significantly worse neurocognitive performance in multiple domains (visuospatial/executive function (VISEXEC), attention, language, WASI-II full-scale IQ, verbal comprehension (VCI), perceptual reasoning (PRI) subscales), and higher anxiety and depression scores compared to controls (all p values < .030). The male CHD group performed significantly worse on the MoCA (p < .001), VISEXEC (p < .001), VCI (p = .05), PRI (p < .001), full-scale IQ (p = .002), and reported greater anxiety, depression, and lower social support (p = .049) compared to male controls. The female CHD group had significantly lower scores on the MoCA (p = .003), executive function (p = .001), attention (p = .002), WASI-II subtasks matrix reasoning (p < .001), vocabulary (p = .006), block design (p = .007), with no differences found in psychosocial measures compared to controls. In correlational analyses, among males with CHD, greater social support was associated with better executive function (r = 0.49, p < .03). Conclusions: Sex differences in adults with CHD are apparent in some cognitive and psychosocial domains compared to controls. Findings highlight the significance of social support and its association with executive function in adult males with CHD.

PURPOSE:The coronavirus disease-2019 (COVID-19) pandemic negatively impacted mental health outcomes. This study aimed to 1) quantify the relationship between perceived impact of COVID-19 and hopelessness in patients with ischemic heart disease (IHD) and 2) identify potential mediators of the relationship. METHODS:Participants (n = 110) were recruited from 1 hospital in the Midwestern United States. Data on the perceived impact of COVID-19, state and trait hopelessness, depression, perceived social support (PSS), health-related quality of life (HRQoL), and well-being were collected 2 weeks post-hospitalization from 2020 to 2023. Linear models were used to evaluate associations between variables in adjusted and unadjusted models. RESULTS:Most participants were male (69%), non-Hispanic White (95%), married (64%), and with some college education (66%). Hopelessness showed a modest association with perceived COVID-19 impact (state = 0.23; trait = 0.30), as did anxiety (0.40), HRQoL (0.20), PSS (-0.24), fatigue (0.25), and pain interference (0.25), in adjusted and unadjusted models. Food access, family income/employment, social support access, and stress were associated with hopelessness and perceived COVID-19 impact. The strongest evidence for mediation between hopelessness and perceived COVID-19 impact was anxiety (66% mediation state; 50% mediation trait). CONCLUSIONS:In this first study to report hopelessness levels in patients with IHD during the COVID-19 pandemic, the relationship between hopelessness and perceived COVID-19 impact was supported and mediated by anxiety. During a pandemic, food access, social support, family income/employment, and stress in patients with IHD may increase feelings of hopelessness. Further research is required to examine the hopelessness and anxiety relationship.

BACKGROUND:The COVID-19 pandemic added challenges to patient assessment and triage in the emergency department (ED).OBJECTIVE:The aim of this study was to describe the effects of the COVID-19 pandemic on ED triage nurse decisions for patients with potential acute coronary syndrome (ACS).METHODS:This was a secondary analysis of data from a descriptive, electronic, survey-based study. Participants were asked 2 questions: whether the COVID-19 pandemic had affected their triage and/or assessment practices for patients with potential ACS and, if so, how. Descriptive statistics were used to compare the characteristics of participants. A qualitative descriptive approach was used to analyze responses to the open-ended questions about the pandemic's effect on the triage process.RESULTS:Participants from across the United States had a mean age of 41.7 (12.3) years; 358 (80.6%) were women. The participants had a median of 10.0 (interquartile range, 16.0) years of experience as a registered nurse, with a median of 7.0 (interquartile range, 11.0) years of ED experience. A total of 180 of 444 participants (40.5%) indicated that the COVID-19 pandemic affected their triage processes and assessment of potential ACS patients; 156 (86.7%) provided a response to the open-ended question. Responses revealed 4 themes: (1) delays in triage and treatment, (2) ambiguous patient presentation, (3) heightened awareness of COVID-19 complications and sequelae, and (4) process changes.CONCLUSIONS:Forty percent of ED triage nurses participating reported that triage processes for patients with potential ACS were affected by the COVID-19 pandemic. Most expressed barriers that resulted in delayed assessment and treatment of patients and often resulted from overlapping cardiac symptoms and COVID-19.

Introduction: Non-ST elevation myocardial infarction (NSTEMI) represents about 70% of ACS cases, and nearly one-third of these patients have an occluded coronary artery that may benefit from revascularization. The 13-item ACS Symptom Checklist is a validated tool designed for rapid assessment of Acute Coronary Syndrome (ACS) symptoms. We aimed to evaluate the effectiveness of the ACS Symptom Checklist in differentiating NSTEMI patients with and without an occluded artery. Methods: All NSTEMI patients treated at the University of Rochester Medical Center between 2015-2023 (n=3515) were included. The 13-items from the ACS Symptom Checklist were extracted using natural language processing (NLP) before coronary angiography or within 24 hours of presentation. An occluded coronary artery was one requiring revascularization with percutaneous coronary intervention. Chi-Square was used to assess the sensitivity and specificity of each symptom for an acutely occluded coronary artery. We used logistic regression models to assess the odds of an acutely occluded artery after controlling for age, obesity, and diabetes and stratified by sex. Results: Patients were predominantly male (58%, n=2048), older (69 + 13 years), and White (85%, n=2988), and 15% (n=524) underwent revascularization. Diabetes (18%, n=629) and obesity (40%, n=1387) were common comorbidities. Upper back pain (10.5% vs. 14.1%, p=0.03), palpitations (19.3% vs. 23.9%, p=0.02), arm pain (21.0% vs 16.7%, p=0.05), unusual fatigue (8.9% vs. 22.2%, p<0.01) significantly differentiated between NSTEMI patients with and without an occluded coronary artery as observed in Table 1. Among men, less upper back pain (OR=0.559, 95% CI 0.361-0.865), palpitations (OR=0.678, 95% CI 0.503-0.915), and unusual fatigue (OR=0.365 95% CI 0.270-0.493) were significant predictors of coronary occlusion. Only a higher likelihood of arm pain (OR=1.184, 95% CI 0.893-1.569) predicted occlusion. Results were similar for women. Conclusion: Only arm pain, a common symptom of ischemia, predicted an occluded coronary artery in patients with NSTEMI and there were few sex differences. NLP confirmed that the presence of arm pain can cue clinicians into the probability of ischemia in this large sample of patients. Prospective studies are needed to validate these findings.

The role of gut microbe-derived metabolites in the development of metabolic syndrome (MetS) remains unclear. This study aimed to evaluate the associations of gut microbe-derived metabolites and MetS traits in the cross-sectional Metabolic Syndrome In Men (METSIM) study. The sample included 10,194 randomly related men (age 57.65 ± 7.12 years) from Eastern Finland. Levels of 35 metabolites were tested for associations with 13 MetS traits using lasso and stepwise regression. Significant associations were observed between multiple MetS traits and 32 metabolites, three of which exhibited particularly robust associations. N-acetyltryptophan was positively associated with Homeostatic Model Assessment for Insulin Resistant (HOMA-IR) (β = 0.02, p = 0.033), body mass index (BMI) (β = 0.025, p = 1.3 × 10−16), low-density lipoprotein cholesterol (LDL-C) (β = 0.034, p = 5.8 × 10−10), triglyceride (0.087, p = 1.3 × 10−16), systolic (β = 0.012, p = 2.5 × 10−6) and diastolic blood pressure (β = 0.011, p = 3.4 × 10−6). In addition, 3-(4-hydroxyphenyl) lactate yielded the strongest positive associations among all metabolites, for example, with HOMA-IR (β = 0.23, p = 4.4 × 10−33), and BMI (β = 0.097, p = 5.1 × 10−52). By comparison, 3-aminoisobutyrate was inversely associated with HOMA-IR (β = −0.19, p = 3.8 × 10−51) and triglycerides (β = −0.12, p = 5.9 × 10−36). Mendelian randomization analyses did not provide evidence that the observed associations with these three metabolites represented causal relationships. We identified significant associations between several gut microbiota-derived metabolites and MetS traits, consistent with the notion that gut microbes influence metabolic homeostasis, beyond traditional risk factors.

Introduction: Hope has been positively associated with behavior change in individuals screened for cardiovascular risk, and negatively associated with fatal ischemic heart disease (IHD). Hopelessness is associated with increased risk of mortality or nonfatal myocardial infarction in patients with IHD, and negatively associated with physical activity outcomes. Hope and hopelessness are sometimes considered to be ends of a continuum, yet the relationship between hope and hopelessness is not commonly examined in IHD patients. Aim: To determine the relationship between the State-Trait Hopelessness Scale (STHS) and Snyder Adult State and Adult Trait Hope Scales in a sample of patients with IHD. Hypotheses: 1) There would be an inverse relationship between hopelessness and hope as measured by the scales and 2) discriminant validity of the instruments would be confirmed. Methods: A total of 156 participants were enrolled as part of a 3-group randomized controlled trial testing an intervention to promote physical activity and reduce hopelessness. Data were collected two weeks after hospital discharge. Correlations and partial correlations were computed for all combinations of scales. Principal component analysis (PCA) was conducted on hope and hopelessness scales. Results: A total of 106 participants (68%) had moderate or high trait hope, and 92 (59%) had moderate or high state. Moderate or severe hopelessness was reported by 93 participants (59.6%) for state hopelessness and 108 participants (69.2%) for trait. There were moderately strong negative correlations (r=-0.54 to -0.66, p=<0.001) between the total STHS and the Snyder Hope scales for both full and short versions of the STHS. Correlations were virtually unchanged when adjusted for age, sex, cardiac diagnosis, and marital status (r=-0.5 to -0.63, p<0.001) indicating that as hopelessness increases, hope decreases. PCA revealed 4 factors that explained 64.7% of the variance in scores while demonstrating conceptual distinctions between the STHS and Snyder Hope scales. Conclusions: As hypothesized, as hopelessness increased, hope decreased; however, we found a proportion of patients with hopelessness who still expressed hope for the future. Discriminant validity was supported by inverse correlations and factor analyses indicating conceptual distinctions between the two instruments. Interventions to reduce hopelessness for patients with IHD may be successful since hope and hopelessness are not mutually exclusive.

Background: Acute coronary syndrome (ACS) requires rapid identification and intervention. Early recognition of symptoms, detection of ischaemic markers in electrocardiograms (ECGs) and timely reperfusion therapy all reduce the total ischaemic time. In 2020, SARS-CoV-2 emerged as a new threat to people with cardiac disease: calls to emergency departments, emergency department visits and hospital admissions for acute cardiac conditions decreased, possibly because patients delayed seeking care because of fear of SARS-CoV-2 exposure. The hypothesis of this study was that patients presenting with ACS during the pandemic would have more ischaemic features and longer prehospital time intervals than those presenting before the pandemic. However, there were no significant differences between pre-pandemic and pandemic groups regarding incidence of ECG ischaemic markers, elevated troponin, adverse outcomes or prehospital time intervals. Non-ST-elevation myocardial infarction was significantly higher in the pandemic sample, which suggests that patients with less severe symptoms sought treatment during the pandemic.

BACKGROUND:Congenital heart disease (CHD) is the most common birth defect worldwide. Neurocognitive deficits and psychiatric disorders, which can impact daily life, have been reported in over 50% of adolescents and young adults with moderate to complex CHD. OBJECTIVE:Conduct a systematic review of sex, clinical, psychological and social determinants of health (SDoH) factors affecting neurocognition in adults with CHD post-cardiac surgery. METHODS:PubMed, Cumulated Index to Nursing and Allied Health Literature, and Embase were searched for relevant studies over the past 5 years. Thirteen articles met inclusion criteria of: 1) CHD post-cardiac surgery, 2) age ≥ 18 years, and 3) used a validated measure of neurocognition. RESULTS:A total of 507 articles were identified. After screening, 30 articles underwent full text review yielding 13 eligible articles. Twelve articles reported deficits in multiple domains including executive function, intellectual functioning, visuospatial ability, and verbal fluency in more complex CHD. Only three studies examined cognition based on sex, with female and lower parental SES associated with worse cognitive outcomes. Most studies were from Europe, predominantly sampled Caucasian participants, had heterogeneous samples of CHD complexity, and lacked standardized cognitive measures which limited generalizability of findings. CONCLUSIONS:Adults with CHD present with a wide variety of cognitive deficits, with some associations with sex, clinical history, and SDoH factors. It remains unclear to what degree these factors affect cognition in adults with moderate to complex CHD. Future longitudinal studies should focus on age-related effects on cognition and potential health care disparities in diverse CHD samples.

Background Lower perceived social support is associated with hopelessness in patients with ischemic heart disease (IHD). Higher perceived social support is associated with higher heart rate variability (HRV) in adults following a stressful event, but the relationship between HRV and hopelessness has not been examined in patients with IHD. The purpose of this research was to evaluate the relationships among HRV, perceived social support, and hopelessness in patients with IHD. Methods and Results Ninety‐four participants were enrolled while hospitalized for an IHD event at a large hospital in the United States. Data collection occurred 2 weeks after hospital discharge and included the State–Trait Hopelessness Scale, ENRICHD Social Support Inventory, Patient Health Questionnaire‐9, a demographic form, and a short‐term HRV measurement taken at rest. Linear models were used to assess associations between variables in unadjusted and adjusted models. Most participants were men (67%), married (75%), and non‐Hispanic White (96%) and underwent coronary artery bypass surgery (57%). There were inverse correlations between high frequency HRV and state hopelessness (r=−0.21, P=0.008) and root mean square of successive differences between normal heartbeats HRV and state hopelessness (r=−0.20, P=0.012) after adjusting for important covariates. High frequency and root mean square of successive differences between normal heartbeats did not show evidence of mediating the relationship between perceived social support and hopelessness. Conclusions There were significant inverse correlations between parasympathetic measures of HRV and hopelessness. Assessing high frequency and root mean square of successive differences between normal heartbeats during early recovery following an IHD event could provide promising evidence for understanding a possible precursor to hopelessness and targets for future interventions. Registration Information: clinicaltrials.gov. Identifiers: NCT03907891, NCT05003791.

Introduction: Heart disease is the leading cause of death (LOCD) in women in the United States. Despite public campaigns, women's awareness of heart disease as the LCOD of death for women significantly decreased from 65% in 2009 to 44% in 2019. Significant declines were observed in Black, Hispanic, and young women. Aims: This pilot trial aims to evaluate the acceptability/usability and potential efficacy of the fully automated artificial intelligence (AI) HeartBot program to increase awareness and knowledge of heart attacks in women. Methods: In this pre-and post- trial, 102 women were asked to complete the baseline survey and then interact with the HeartBot. The HeartBot is an AI-based text-driven conversational agent, available 24 hours a day, 7 days a week, and fully automated (Figure 1). After 4 weeks of the interaction, women were asked to complete the post-survey. The primary outcomes include four questions (recognizing the signs and symptoms of a heart attack, telling the difference between the signs or symptoms of a heart attack and other medical problems, calling an ambulance or dialing 911, and getting to an emergency room within 60 minutes after the onset of your symptoms of a heart attack). Wilcoxon signed rank tests and ordinal logistic regression models were used to evaluate the HeartBot program. Results: The mean (SD) age was 46 (12) years; 60.6% of the sample was women with racial/ethnic backgrounds; 41.3% reported commercially available chatbot use (i.e. Siri) in the past 30 days. 88.5% of the sample completed the trial and the majority accepted HeartBot use. The mean (SD) length of the HeartBot interaction was 13 (11) minutes. Overall, the Wilcoxon signed-rank test indicated a significant increase in all outcomes of heart attack awareness and knowledge from the baseline and the post-Heartbot interaction ( p < 0.05) (Figure 2). In the ordinal regression model, this significance of the outcomes remains even when controlling for potential confounding factors ( p < 0.05). Conclusion: To the best of our knowledge, this was the first pilot trial to demonstrate the potential efficacy of the HeartBot program in the short term in women with diverse racial/ethnic backgrounds. However, a full-scale randomized controlled is warranted.