Saint Vincent Hospital

354 Background: Prostate cancer (PC) epidemiology has undergone substantial transformation over the past three decades, influenced in part by the evolving USPSTF screening recommendations. We aim to characterize these temporal trends in PC incidence and mortality across age strata using Surveillance, Epidemiology, and End Results (SEER) and the Global Burden of Disease (GBD) databases. Methods: SEER provides case-reported, population-based cancer data covering 45.9% of the U.S. population, while GBD provides modeled estimates representing 100% national coverage. Using SEER from 1975 to 2022, age-standardized incidence rates (ASIR) and mortality rates (ASMR) per 100,000 were extracted with age, race, and stage stratification (Historic Stage A data; 1992–2019). Complementary GBD data for the U.S. were analyzed for age-specific incidence (ASpIR), mortality (ASpMR) and disability-adjusted life years (DALYs) (1990–2022). Results: In SEER, ASIR of PC increased sharply among young men (<55 years), peaking between 2000 and 2009 before declining by 2020–2022. Among men aged 45–49 years, ASIR increased from 5.6 (1975–1979) to 42 (2000–2009) before falling to 22 by 2020–2022. Among the 50–54 age group, ASIR rose from 24 to 148 and then declined to 102 over the same timeframe. Conversely, ASIR among men aged ≥70 years declined markedly after the 1990s peak (from 1,137 to 476 in ages 85–89). Localized-stage ASIR in men aged 50–54 years rose from 70 (1990–1999) to 133 (2000–2009), then fell to 63 (2010–2019), while distant-stage ASIR increased modestly from 2.7 to 4.0 before dropping subsequently. Black men aged 50–54 years exhibited a more pronounced growth in ASIR (from 50 to 234) than White men (24 to 91) with PC. Despite these shifts, ASMR for men aged 50–54 remained stable (4.7 in 1975–1979 vs. 4.9 in 2020–2022). GBD data echoed these trends, showing a 70% rise in ASpIR among men 20–54 (10 to 17) and a 17% decrease among men ≥55 (808 to 587) from 1990–2022. ASpMR decreased in older men (−43%) and remained stable in younger cohorts (−2%) over the same timeframe. DALYs showed similar age-related divergence (Table 1). Conclusions: PC incidence in younger men in the U.S. peaked in the early 2000s and declined thereafter, coinciding with the USPSTF’s 2012 recommendation against routine PSA screening and subsequent revisions in 2018. SEER data revealed persistent racial disparities among black young men with PC. Overall, PC incidence has increased markedly in men under 55 years over the past five decades, while it has declined substantially in older age groups. This epidemiological shift toward younger onset disease, warrants investigation into emerging risk factors and screening recommendations. Age stratified trends in prostate cancer in the US, 1990–2022 (GBD). GBD 20-54 (1990– 2022; % change) 55+ (1990– 2022; % change) ASpIR 10–17, 70% 808–587, -27% ASpMR 0.64–0.63, -2% 163–94, -43% DALY 33–37, -12% 3319–1879, -43%

The systematic review and meta-analysis explored the effects of aerobic exercise on cognition and sleep quality in individuals with insomnia. The research was important to identify effectiveness of mild, brisk, moderate and aerobic exercise among adults diagnosed with insomnia. The researchers searched multiple databases using PubMed, Cochrane, EBSCO, PsycINFO, Medline, and ScienceDirect to identify relevant journal articles. The keywords used for various search combinations were “insomnia,” “sleep,” “cognition,” “REM sleep,” and “aerobic exercise,” with the use of the Boolean operator “AND” and “OR” with terms associated with “quality of sleep.” Studies included qualitative and quantitative studies using the eligibility criteria as outlined in the PRISMA. registries.The research analyzed exercise in a routine for a person with insomnia improves their sleep quality and has a beneficial impact on their cognition. An interesting finding showed that daily aerobic exercise had a significant impact on enhancing the quality of sleep. A compelling finding revealed that sleep efficiency resulted in improved sleep latency which resulted in a decreased timeframe for falling asleep. An interesting finding was that sleep hygiene education was effective in improving the quality of sleep and mood among adults. An expected outcome was that age may play an important role in managing insomnia. An unexpected finding was that increased aerobic activity levels more than 150 minutes per week may benefit persons with insomnia. Though further research is needed to broaden knowledge about exercise on cognition and sleep quality, this systematic review contributes to the body of literature.

Heart failure continues to portend significant morbidity and mortality within the United States. Data regarding the efficacy of mineralocorticoid receptor antagonists (MRAs) in heart failure with preserved ejection fraction (HFpEF) remains unclear. Finerenone, a non-steroidal MRA, has demonstrated reduction in hospitalizations in this population. However, the comparative efficacy of different MRA classes in these patients remains elusive. We conducted a retrospective observational cohort study using the TriNetX research network. We applied 1:1 propensity score matching to compare patients with HFpEF initiated on finerenone versus spironolactone. We examined 1-year risks of heart failure exacerbation, acute kidney injury, electrolyte derangements, and cardiovascular outcomes. We identified 254,417 patients with HFpEF and MRA use. After propensity score matching, each cohort contained 491 patients. Analysis revealed that finerenone use was associated with a significantly lower risk of heart failure exacerbation (HR = 0.63 [95% CI: 0.54, 0.74], p < 0.001), all-cause mortality (HR = 0.38 [95% CI: 0.23, 0.64], p < 0.001), and hypokalemia (HR = 0.58 [95% CI: 0.40, 0.85], p = 0.001). The aforementioned results, along with a reduction in AKI risk, were statistically significant after stratified subgroup analysis by DM and CKD. In this large real-world HFpEF cohort, finerenone use was associated with lower risks of heart failure exacerbation and all-cause mortality compared with spironolactone. These observational findings are hypothesis-generating and warrant confirmation in randomized trials.

Catheter-based therapies for pulmonary embolism (PE), including endovascular mechanical thrombectomy (MT) and catheter-directed thrombolysis (CDT), are increasingly being used in clinical practice. However, real-world comparative data between these two modalities are scarce. We aimed to evaluate and compare the outcomes of MT and CDT in patients with PE. This retrospective cohort study utilized the 2021 National Readmission Database (NRD) to identify adults with a primary diagnosis of PE who underwent either MT or CDT. The primary outcome was in-hospital mortality, while secondary outcomes included major bleeding, cardiac arrest, vascular complications, and post-discharge readmissions. Propensity-score matching was applied, followed by logistic and Cox-proportional hazard regression analyses. Subgroup analyses were conducted based on hospital procedural volume. After propensity-score matching, 7376 patients who underwent MT and 7355 who underwent CDT were included. MT was associated with higher odds of in-hospital mortality (4.4% vs. 3.4%; OR: 1.31, 95% CI: 1.01-1.68; P = 0.04) and major bleeding (6.3% vs. 3.6%; OR: 1.79, 95% CI: 1.39-2.32; P < 0.001) compared with CDT. No significant differences were observed in post-discharge mortality, although all-cause readmissions were higher in the MT group. Higher hospital procedural volumes were associated with lower in-hospital mortality and lower major bleeding rates in both MT and CDT. Endovascular CDT was associated with lower in-hospital mortality and major bleeding compared to MT in PE. As hospital procedural volume increased, both these outcomes improved, while difference in outcomes between MT and CDT reduced.

Abstract Background The evolution of artificial intelligence (AI) and large language models (LLMs) offers promising opportunities in infection management. Sepsis identification using AI has been integrated into many Electronic Medical Recording systems and applications for diagnostics and antimicrobial stewardship are emerging. This pilot study assessed ChatGPT-4® as a clinical decision aid for the management of septic shock and severe pneumonia.Flowchart showing methodology of pilot studyTable showing comparison of Physician and Chat-GPT4 performance Methods A retrospective study was conducted at Saint Vincent Hospital, Worcester on 50 cases (2023-2024). Physician-documented investigations and antibiotics were compared with ChatGPT-4® outputs generated using standard prompts with full blinding. Infectious Diseases Society of America guidelines served as the standard. Paired t-tests and McNemar’s test evaluated investigation appropriateness and antibiotic selection accuracy respectively, using Statistical Analysis Software® Version 9.4.Fig 3:Clinical template used to input H&amp;P data into ChatGPT-4 Results Severe Pneumonia: Physicians recommended more appropriate investigations (mean difference 1.45 out of 4 tests) and antibiotics (0.91 more/case) compared to ChatGPT-4®, with no significant difference in MRSA or Pseudomonas coverage. Septic Shock: Physicians outperformed ChatGPT-4® in investigations (mean difference 1 out of 3 tests) and antibiotic choices (1 more/case), with greater accuracy for MRSA coverage; concordance was noted for Multi-Drug Resistant (MDR) organisms. Conclusion Physicians outperformed ChatGPT-4 across both conditions. However, ChatGPT-4® demonstrated comparable pathogen-specific antimicrobial selection and accuracy in MDR coverage, suggesting potential with diagnosis-specific prompting and antimicrobial stewardship. The results highlight the enduring importance of physician-led decision-making in an era increasingly shaped by AI. LLMs still face limitations including data privacy concerns and need for individualized contextual judgement that prevent their autonomous use. However, with refinement and responsible implementation, LLMs may evolve into a trusted aid to enhance physician decision-making, especially in areas with limited access to specialist care. This study has led to a prospective trial exploring ChatGPT-4’s use with real-time, targeted prompts throughout hospitalization. Disclosures All Authors: No reported disclosures

362 Background: Primary small cell carcinoma of the esophagus (SCEC) is a rare and aggressive malignancy, representing &lt;1% of esophageal cancers. Given its rarity, treatment strategies are largely extrapolated from small cell lung cancer. The role of radiotherapy (RT) across disease stages in SCEC, and how outcomes compare with adenocarcinoma and squamous cell carcinoma (SCC), remains poorly defined. Methods: The SEER 18 registries (2000–2022) were queried for patients with histologically confirmed esophageal carcinoma. Histology was grouped as SCEC (ICD-O-3: 8041/3, 8043/3, 8044/3, 8045/3), adenocarcinoma, or SCC. Patients with unknown survival time, non-first primaries, or missing treatment information were excluded. Overall survival (OS) was estimated using Kaplan–Meier methods and compared using log-rank tests. Analyses included SCEC patients treated with RT without surgery, stratified by SEER historic stage (localized, regional, distant), and comparisons across histologic subtypes. Multivariable Cox regression was used to calculate adjusted hazard ratios (HRs). Results: Among 56,126 patients with esophageal carcinoma, SCEC accounted for 403 (0.7%), adenocarcinoma for 66.4%, and SCC for 32.8%. Median OS for SCEC was 9 months (95% CI 8–10), significantly inferior to adenocarcinoma (11 mo, 95% CI 11–12, p &lt;0.001) but not different from SCC (8 mo, 95% CI 8–9). In SCEC patients without surgery, median OS was 6 mo (95% CI 4–8) without RT versus 13 mo (95% CI 11–16) with RT ( p &lt;0.001). Stage-stratified outcomes are summarized in the table: localized SCEC showed a marked OS benefit with RT (7 vs 48 mo, HR 0.18, 95% CI 0.07–0.44, p &lt;0.001). For regional disease, OS was 8 vs 15 mo (HR 0.41, 95% CI 0.15–1.12, p =0.08), and for distant disease, 6 vs 10 mo (HR 0.70, 95% CI 0.46–1.07, p =0.10). Comparisons with non-SCEC histologies revealed that localized SCEC patients receiving RT achieved superior survival (48 mo) compared with 16 mo for both adenocarcinoma and SCC. Conclusions: SCEC is an exceptionally rare esophageal malignancy with poor outcomes relative to adenocarcinoma and SCC. RT provides a substantial survival advantage in localized SCEC, while its effect diminishes in regional and distant disease. These findings support stage-directed RT and highlight the need for prospective studies to optimize treatment in this rare cancer. Overall survival in small cell carcinoma of the esophagus (SCEC) with and without radiotherapy (RT) by stage. Subgroup Median OS without RT (mo) Median OS with RT (mo) HR (95% CI) p value All SCEC (no surgery) 6 (95% CI 4–8) 13 (95% CI 11–16) – &lt;0.001 Localized SCEC 7 48 0.18 (0.07–0.44) &lt;0.001 Regional SCEC 8 15 0.41 (0.15–1.12) 0.08 Distant SCEC 6 (95% CI 3–8) 10 (95% CI 8–13) 0.70 (0.46–1.07) 0.10

Abstract Background Community-acquired pneumonia (CAP) is the second most common cause of hospitalization in the United States and frequently involves atypical pathogens such as Mycoplasma pneumoniae (Mp). Current guidelines recommend empiric atypical coverage for CAP without necessitating specific Mp testing. Despite this, routine Mp serology testing (IgM) is frequently ordered. We conducted a retrospective study to assess whether routine Mp serologic testing impacts clinical management or outcomes in hospitalized CAP patients.Univariate vs. Multivariate Analysis: Mycoplasma Serology and Critical Care OutcomesUnivariate vs. Multivariate Logistic Regression for Critical Care Outcomes Methods A retrospective chart review of patients &amp;gt;18 years, admitted to a community hospital from January 2023 to January 2024 with CAP was done. Patients were categorized based on whether Mp serology was performed. Data related to demographics, Charlson Comorbidity Index [CCI], Pneumonia Severity Index [PSI], smoking status, hospital length of stay, ICU admission, mechanical ventilation (MV) requirement and pressor use was collected. Outcomes were compared using logistic and linear regression models after adjusting for the covariates using Statistical Analysis Software® Version 9.4. The significance was set at 5%.Predictors of Length of Stay: Multivariate Linear Regression Coefficients Results Serology testing was not significantly associated with differences in hospital length of stay (mean 7.0 vs. 6.3 days; p = 0.2841). ICU admission rates were similar between groups, with a non-significant trend toward increased ICU use among those tested (OR = 1.21; p = 0.6603). Likewise, the need for pressor support was slightly higher in the serology-tested group, though this did not reach statistical significance (OR = 1.20; p = 0.7589). In total, 49 Mycoplasma serology tests were performed, contributing approximately $5,000 in additional direct healthcare costs. Conclusion Routine Mycoplasma pneumoniae testing in hospitalized patients with CAP was not associated with improved clinical outcomes. Instead, the use of serologic testing in low-suspicion cases appeared to increase resource utilization without a clear diagnostic or therapeutic benefit. Given the limited value in such contexts, these findings support a more judicious application of Mycoplasma serology testing, emphasizing clinical judgment to guide diagnostic decisions in support of high-value, cost-effective care. Disclosures All Authors: No reported disclosures

Background: Anxiety disorders are common, but their role in cardiovascular risk is underrecognized. Traditional risk factors for coronary heart disease (CHD), such as hypertension and diabetes, are well established, but anxiety may independently influence future heart disease. Emerging evidence suggests anxiety can predict events such as myocardial infarction. We aimed to quantify the association between anxiety disorders and the risk of developing CHD in adults without prior heart disease. Hypothesis and Objectives: We hypothesized that anxiety disorders increase CHD incidence and aimed to determine whether anxiety is an independent risk factor for heart disease. We also examined anxiety subtypes such as generalized anxiety disorder (GAD) and post-traumatic stress disorder (PTSD) for differential associations with CHD. Methods: We conducted a systematic review and meta-analysis. We searched MEDLINE, Scopus, Embase, and Google Scholar for English-language studies from 2010 to 2023. Eligible studies included adults with anxiety (diagnosed by standardized criteria) and measured incident CHD outcomes in individuals free of CHD at baseline. Two reviewers independently extracted data. A random-effects meta-analysis estimated pooled hazard ratios with 95% confidence intervals; heterogeneity was assessed by I2 statistic. Results: A total of ten studies (n=546,802) met inclusion criteria. The pooled hazard ratio for incident CHD (primarily myocardial infarction) in participants with anxiety versus without anxiety was 1.35 with a 95% confidence interval of 1.20–1.52 (p&lt;0.001), indicating a significant association. Subgroup analysis identified generalized anxiety disorder and post-traumatic stress disorder as anxiety subtypes most strongly linked to higher CHD risk. Statistical heterogeneity was moderate (I2=39%, p=0.11). Most studies adjusted for traditional cardiovascular risk factors. Conclusions: These findings provide strong evidence that anxiety disorders, particularly GAD and PTSD, are independently associated with higher CHD risk. Integrating mental health assessment with cardiovascular prevention could help identify modifiable risk factors. We conclude that addressing anxiety may be important in CHD prevention strategies.

Background: Patients with Type 2 myocardial infarction (MI) often exhibit unique characteristics and outcomes compared to those with Type 1 MI. Additionally, individuals with Type 2 MI are often underdiagnosed and undertreated in relation to their Type 1 counterparts. There is limited data regarding the clinical outcomes of patients with Myocardial Infarction Type 1 (MI1) versus those with Myocardial Infarction Type 2 (MI2), particularly among those with acute decompensated heart failure (ADHF). The objective of our study is to compare in-hospital outcomes, including inpatient mortality, cardiogenic shock, ablation procedures, total costs, and total length of stay. Methods: The National Inpatient Sample (2016-2021) was utilized to identify patients hospitalized for ADHF by querying ICD-10 codes. A propensity score matching approach, adjusted for demographics and comorbidities, was employed to calculate the adjusted odds ratio (aOR) and regression coefficients, along with their corresponding 95% confidence intervals (CI) and p-values. Results: A total of 330,354 survey-weighted hospitalizations for ADHF with underlying MI were identified, of which 69.5% were due to Type 1 MI and 30.5% were due to Type 2 MI. Patients with Type 1 MI experienced a higher rate of inpatient mortality (aOR, 1.02 [95% CI, 1.022-1.027]; p &lt; 0.001), sudden cardiac arrest (aOR, 1.03 [95% CI, 1.030-1.034]; p &lt; 0.001), cardiogenic shock (aOR, 1.05 [95% CI, 1.050-1.055]; p &lt; 0.001), mechanical circulatory support (aOR, 1.051 [95% CI, 1.049-1.052]; p &lt; 0.001), and ventricular fibrillation (aOR, 1.01 [95% CI, 1.014-1.016]; p &lt; 0.001) after propensity score matching. Additionally, total costs, total length of stay, and overall hospitalization rates have been progressively increasing over the years. Conclusions: Patients admitted with ADHF who have underlying Type 2 MI experience more favorable in-hospital clinical outcomes compared to those with Type 1 MI.