There is an epidemic of obesity in adults in rural America. It is estimated that about 19% of the population resides in rural areas, which encompasses 97% of America's total landmass. Although rural America makes up a fraction of America's total population, it has been estimated that the prevalence of obesity is approximately 6.2 times higher than in urban America. This illustrates an apparent disparity that exists between the rural population and urban populations that needs to be examined.The prevalence of obesity, especially in rural America, is a growing concern in the medical community in recent years. Obesity has been identified as a significant risk factor for cardiovascular disease, cancer, and type 2 diabetes mellitus, which are leading causes of morbidity and mortality in the US. To better understand the disparity in the prevalence of adult obesity between rural and urban America, researchers have identified risk factors that are associated with the high incidence and prevalence of obesity in the rural American adult population. Low income and lack of physical activity have been identified as factors that predispose rural Americans to increased risk of obesity, arguing that low-income Americans may not have access to the resources available to assist them in weight reduction. With rural Americans being at an income disadvantage, it creates a risk for obesity, which further predisposes them to chronic diseases such as hypertension, obstructive sleep apnea (OSA), diabetes, and coronary artery disease.As obesity continues to rise among the American population, the burden on the rural population is incredibly evident. Despite ongoing efforts by the US government and strategies implemented by the Common Community Measures for Obesity Prevention, there is still much to be done to tackle the epidemic. With an existing strategy in place, such as the 12 Common Community Measures for Obesity Prevention (COCOMO) strategies to fight obesity with physical activity, Americans are a step closer to conquering this epidemic. However, until other disparities such as income are addressed, rural Americans may continue to be severely impacted by the rising incidence of obesity and subsequent higher mortality rates from associated diseases.

Introduction: Depression and Anxiety are prevalent among patients with cardiovascular diseases. However, their impact on important clinical outcomes, such as length of hospital stay (LOS) and mortality, is incompletely understood. Objective: Examine the magnitude and impact of major depressive disorder (MDD) and anxiety on LOS and in-hospital mortality in patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI). Hypothesis: Patients with MDD or anxiety will have poorer clinical outcomes after PCI. Methods: Data were obtained from the National Inpatient Survey (NIS). Admissions in 2017 with a primary diagnosis of ACS and undergoing PCI were identified based on ICD10 codes. Patients with MDD or anxiety were further delineated with ICD10 codes. The association between MDD or anxiety and LOS and in-hospital mortality was analyzed using linear and logistic regression models, respectively. Various sociodemographic (age, race, sex, income), clinical (history of hypertension, hyperlipidemia, stroke, peripheral artery disease, valvular heart disease, chronic kidney disease, anemia, obesity, smoking) and hospital-level (region, location, payer type) factors were adjusted for in the analysis. Results: Among 130,712 patients admitted for ACS who underwent PCI, the prevalence of MDD and anxiety were 8.7% (n=11,303) and 10.8% (n=14,066), respectively. Patients were on average aged 67 years (SD=13.5), 38% were females, and 73% non-Hispanic White. Overall, the mean LOS was 4.4 days (SD=5.4) and 4.7% of patients died while hospitalized. Patients with MDD (4.6 vs 4.4, p=0.001) or anxiety (4.7 vs 4.4, p=0.001) had longer LOS than those without these conditions. Contrary to our hypothesis, patients with MDD (OR: 0.82; 95% CI: 0.73-0.91) or anxiety (OR: 0.72; 95% CI: 0.64-0.79) had significantly lower odds of mortality than those without MDD or anxiety after adjusting for several factors of prognostic importance. Conclusions: Among ACS patients who underwent PCI, MDD and anxiety were associated with increased LOS but paradoxically lower in-hospital mortality. These findings reinforce the need for future investigations to evaluate the impact of psychological factors on clinical outcomes in ACS patients who undergo PCI.

Background: Body mass index (BMI), has been shown to be related to major adverse cardiovascular events, and overall mortality after percutaneous coronary intervention (PCI). However, the relationship between BMI, and important cardiovascular outcomes, as well as healthcare utilization have not been extensively explored in a national sample. Objectives: Examine the relationship between BMI and in-hospital mortality, cardiogenic shock, cardiac arrest, length of hospital stay (LOS), and cost of hospitalization. Methods: Adults who had a primary diagnosis of Acute Myocardial Infarction (AMI) who underwent a PCI were identified from the 2016 and 2017 National Inpatient Sample using ICD10 codes. BMI was classified BMI into: <20 kg/m 2 , 20-29.9 kg/m 2 (reference), 30-34.9 kg/m 2 (Obesity class I), 35-39.9 kg/m 2 (Obesity class II) and ≥40 kg/m 2 (Obesity class III). Weighted multivariable logistic and linear regression models were used as appropriate. Results: Among 22,953 patients who had AMI and PCI done with reported BMI, 67.9% were male, and 76.2% were Non-Hispanic White. Compared to the reference group, obesity class I, II and III, showed an incremental higher odd of mortality, while patients with BMI <20 kg/m 2 had non-significant lower odds of mortality (Table). Obesity class I and II had lower odds of cardiogenic shock compared to the reference group, while those in the extremes i.e. <20 kg/m 2 and ≥40 kg/m 2 showed no significant difference (Table).The odds of cardiac arrest were not significantly different across the various BMI categories (Table). Obesity class III patients had significantly higher mean LOS and cost of hospitalization compared to the reference group (Table). Conclusion: Our study highlights the relationship between BMI and important clinical outcomes after PCI. These findings buttress the need for healthcare providers to identify high risk patients for worse outcomes after PCI and institute targeted interventions for improved clinical outcomes.

Background: Heart failure is a chronic cardiovascular condition with associated high morbidity, mortality and health-related costs. The disparities of varying sociodemographic factors associated with clinical outcomes in patients with preserved ejection fraction heart failure (HFpEF) is yet to be extensively studied. Aim: To evaluate gender and racial disparities in length of hospital stay (LOS), cost of hospitalization, and in-hospital (IH) mortality in patients with HFpEF. Method: Adults (>18 years) with a primary diagnosis of Acute on Chronic Diastolic dysfunction were identified from the 2016 and 2017 National Inpatient Sample using ICD 10 codes. The relationship between gender or racial groups (Non-Hispanic Whites (NHW)-Ref, Non-Hispanic Blacks (NHB), Hispanics, Asian/Pacific Islanders and Native Americans and study clinical outcomes were assessed using weighted multivariable logistic and linear regression models as appropriate. Results: Among patients with HFpEF (n=595,936), 59.8% were females; 73.4%, 15.6%, 6.6%, 1.9%, and 2.5% were NHW, NHB, Hispanics, Native Americans, and Asians/Pacific Islanders respectively. Females had lower IH mortality [adjusted OR (aOR) 0.9; 95% CI: 0.87 - 0.92) compared to males. Compared to NHW, NHB (aOR 0.81; 95%CI: 0.77 - 0.84) and Hispanics (aOR 0.91; 95%CI: 0.86 - 0.96) had lower odds of IH mortality, while IH mortality in Asian/Pacific Islander and Native American was not significantly different from NHW. Females had lower LOS (mean difference(mD) -0.34 days; 95%CI -0.38 to -0.30) and lower hospital cost (mD -$1967; 95%CI: -2097 to -1838) than males. NHB had similar rates of LOS (mD 0.04days; 95%CI: -0.02 - 0.11) and hospital cost (mD -$176; 95%CI: -412 - 60) compared to NHW. Hispanics had similar rates of LOS but higher hospital cost (mD 0.07 days; 95%CI -0.04 - 0.18; mD $1182; 95%CI: 754 - 1609), Asians/Pacific Islander (mD 0.32 days; 95%CI: 0.14 - 0.49, mD $2846; 95%CI 2173 - 3519) and Native American had a higher LOS and hospital cost compared to NHW (mD 0.49 days; 95%CI: 0.33 - 0.64, mD $2793; 95%CI: 2048 - 3539). Conclusion: Our study highlights racial and gender disparities in important clinical outcomes among patients with HFpEF, buttressing the need to tailor intervention to higher risk groups.

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