OBJECTIVES/GOALS: The purpose of this retrospective cohort study was to evaluate the impact of mental illness on first-time transcatheter aortic valve replacement (TAVR) and repeat TAVR (viv-AVR) outcomes including postoperative atrial fibrillation (POAF/AFL), as well as trends over time. METHODS/STUDY POPULATION: Using de-identified data reports from the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2005-2018, multivariate logistics models were used to predict endpoints including POAF, the Society of Cardiothoracic surgeon (STS) endpoint (MM), and 30-day readmission (READMIT) in patients with and without mental illness. The TAVR procedure was approved for high-risk patients after 2012, and intermediate-risk patients after 2016, indicting a need to analyze the two populations separately. Multivariate analysis was only conducted on the first-time TAVR patients because of the small n in the viv-TAVR population. RESULTS/ANTICIPATED RESULTS: After 2012, 13.05% (1,810/13,870) of patients undergoing TAVR and 20.83% (15/72) undergoing viv-TAVR were diagnosed with a mental illness before the procedure. After 2016, 15.59% (1,485/9,524) TAVR patients and 20.00% (11/55) viv-TAVR patients had a preoperative diagnosis of mental illness. Multivariate analysis showed that mentally ill patients did not have significant differences in rates of POAF, 30-day readmission, and 30-day composite outcomes when compared to patients without mental illnesses following TAVR procedures after 2012 and 2016. Patients with POAF after both 2012 and 2016 were significantly less likely to be mentally ill, Black, and Hispanic. DISCUSSION/SIGNIFICANCE: Of the mentally ill patients who underwent TAVR, there was no significant difference in short-term outcomes after 2012 vs. 2016, compared to patients without mental illnesses. The small number of mentally ill patients undergoing TAVR may point to provider bias as a contributor to this high selectivity, and further evaluation would be of clinical use.

Aim: The mental illness (MEI) impact upon risk-adjusted first-time aortic valve replacement (AVR) or repeat AVR (r-AVR) outcomes is unknown. Comparing patients with and without new-onset postoperative atrial fibrillation or atrial flutter (POAF/AFL), this retrospective cohort investigation evaluated if MEI impacted patients’ risk-adjusted AVR/r-AVR outcomes. Methods: Using de-identified New York Statewide Planning and Research Cooperative System (administrative) database reports, multivariable logistic regression models compared post-procedural POAF/AFL, 30-day readmission, and composite (i.e., 30-day operative mortality or morbidity) endpoints between MEI and non-MEI patients. Results: From 2005-2018, there were 36,947 first-time AVR patients and 242 r-AVR patients; of these, 13.18% AVR (n = 4,868) and 16.94% r-AVR (n = 41) patients had preprocedural MEI diagnoses. Compared to non-MEI patients, MEI patients had increased rates of transcatheter vs. surgical procedures and higher pre-procedural risks including alcoholism, illegal drug use, tobacco product use, suicidal ideation, or other comorbidities (e.g., valvular disease, atherosclerotic disease, hypertension obesity, and anemia); they were younger, female, and non-Black/non-Hispanic, and had non-commercial (e.g., government or self-pay) insurance. Contrasted to non-MEI patients, MEI patients had no different risk-adjusted new onset of POAF (AVR P = 0.575; r-AVR P = 0.497), 30-day readmission (AVR P = 0.163; r-AVR P = 0.486), and mortality/morbidity composite (AVR P = 0.848; r-AVR P = 0.295) rates. Conclusions: Despite MEI patients’ inherent higher pre-procedural AVR/r-AVR risk, no differences in the MEI vs. non-MEI risk-adjusted POAF/AFL, 30-day readmission, or composite rates were found; however, MEI patients more frequently were selected to receive transcatheter rather than open surgical procedures.

OBJECTIVES/GOALS: To date, no reviews have been published combining the topics of pre-operative mental illness and postoperative atrial fibrillation (POAF). For adult cardiac surgical procedures, therefore, this scoping review provides an overview of the published evidence for this novel topic. METHODS/STUDY POPULATION: A combination of MESH terms and text words were used to capture all papers analyzing any risk factors for atrial fibrillation development after any cardiovascular surgery, and thus, 4,203 search results were initially identified. Papers were manually screened for relevance, resulting in 69 articles that analyzed risk factors associated with POAF. As a separate analytical step, all included publications were used to identify additional citations and Web of Science PubMed identification number-based (i.e., PMID) specific backwards citation searches were performed to ensure comprehensive coverage. For each of the three articles analyzed, moreover, these PMIDs were further evaluated using individual google scholar searches to assure no other relevant literature was inadvertently found. RESULTS/ANTICIPATED RESULTS: For the 69 relevant articles found with multivariable risk models predicting new onset POAF during this scoping review, a wide variety of patient risk factors were reported. The statistically significant predictors reported for new POAF included age (57 papers), hypertension (22 papers), tobacco use (15 papers), LVEF-related characteristics (14 papers), COPD (13 papers), and patient gender (13 papers). All other factors were found to be significant 10 times or fewer; importantly, no multivariable models evaluated mental illness-related factors as predictors of new onset POAF. Only 3 articles even considered the potential influence of mental illnesses. DISCUSSION/SIGNIFICANCE: Mentally ill patients have been documented to have increased incidence of cardiovascular disease and adverse cardiac outcomes, however, very few articles evaluated mental illness associations with POAF. This comprehensive review has demonstrated the urgent need for new research focused on mental illness impacts.