Introduction and Objectives Statin use for primary prevention of coronary artery disease (CAD) has historically been limited in patients with chronic liver disease due to concerns for increased adverse events with statin use in this population. We aimed to quantify the underutilization of statins among individuals with a history of HCV infection in a community health system to understand the clinical implications of statin underutilization in a diverse, generalizable population of patients infected with HCV. Materials and Methods We performed a single-center retrospective study of individuals with a history of HCV infection aged 40-75 years from 2019-2021. Statin eligibility was determined using the 2019 American College of Cardiology/American Heart Association (ACC/AHA) guidelines with the 2013 Pooled Cohort Equation used to determine atherosclerotic cardiovascular disease (ASCVD) risk. Baseline characteristics and adverse events of statin and non-statin users were compared, and factors associated with statin use were determined using multivariable logistical regression. Results Based on 2019 ACC/AHA guidelines, 752/1,077 (69.8%) subjects had an indication for a statin, 280/752 (37.2%) of which were treated with a statin. Cirrhosis was independently associated with statin underutilization. Diabetes, anti-hypertensive use, and Black race were all independently associated with statin use in subjects with an indication for therapy. Statin use was not associated with adverse events. Conclusions Statins were underutilized and well tolerated in the cohort of individuals with a history of HCV infection. This high-risk population would benefit from increased CAD screening and utilization of statins for the primary prevention of CAD.

Introduction: Safety net community hospitals (SNCH) care for patients with disproportionately high prevalence of adverse social and behavioral determinants of health (SBDH). We evaluated the impact of adverse SBDH on in-hospital mortality and 30-days readmission after a first atherosclerotic cardiovascular disease (ASCVD) event at a large urban SNCH. Methods: We performed a retrospective review of patients presenting with an ASCVD event (coronary heart disease, cerebrovascular disease, or peripheral artery disease) between 2015 and 2019. Adverse SBDH was defined as history of homelessness, mental illness, incarceration, or substance use disorder. We used logistic regression analysis to evaluate independent predictors of in-hospital mortality and 30-day readmission following ASCVD event. Results: A cohort of 1974 patients was identified, mean age 63.8 years with standard deviation (SD) of 14.5, patients with adverse SBDH were 8 years younger than those without any adverse SBDH (58.5 years,SD:12 vs. 66 years,SD:14.8; p<0.0001). Atleast one adverse SBDH was noted in 28% of the cohort. Using multivariable analysis, presence of SBDH was not an independent predictor of in-hospital mortality or 30-day readmission following ASCVD event. Age above 65 years tripled the likelihood of in-hospital mortality. Black race and age above 45 years were independent predictors of 30-days readmission. Patients on aspirin and antihypertensives prior to admission were less likely to die in the hospital (Table 1). Conclusions: In this cohort from a SCNH with 28% prevalence of adverse SBDH, the presence of any adverse SBDH did not impact in-hospital mortality or 30-day readmission. However, notably, patients with adverse SBDH presenting with an index ASCVD event were about a decade younger than those without adverse SBDH.

In December 2021, we searched for publicly available posts using the terms "hepatitis b" and "hep b". We removed duplicates from the top 55 posts for each term and coded N5103 posts using a validated misinformation codebook with 72 variables including: engagement (e.g., number of likes), user characteristics (e.g., # of followers, # following), profitability (e.g., for profit, selling product or service), and claims with misinformation (determined by medical experts). We applied two-tailed z-tests, chi-square tests, and linear regressions to examine associations between profitability and misinformation (outcome). Results: Nearly a quarter of posts (n524, 23%) contained misinformation about hepatitis B and/or hepatitis B treatment. Misinformation posts had more engagement on average (1,599 likes vs. 970 likes, p, 0.01), were following more accounts (1,127 vs. 889, p5, 0.01), but had fewer followers (mean: 22,920n vs. 70,442, p, 0.001) than accurate posts. Nearly one-third of posts about hepatitis B referenced a conspiracy theory (30%), were for-profit (29%), and were selling a product or service (34%) through Instagram. Significantly more misinformation posts were for profit (47% vs. 14%, p, 0.01) and were selling a product or service (43% vs. 13% p, 0.01) compared to accurate posts. For-profit accounts (b5713, 95% CI 25-1401, p50.04) and those selling a product or service (b5843, 95% CI 196-1490, p50.01) were following significantly more accounts than their counterparts. Conclusion: Online health misinformation poses direct threat to patients and has broader reach and engagement than accurate information. Hepatitis B misinformation may exacerbate health disparities, given that financial incentives are difficult to distinguish, however our findings suggest that a high number of "following" accounts may be a marker for accounts seeking profitability off of Hepatitis B misinformation on Instagram. More research is needed to understand how exposure to health information can influence patient/caregiver behavior and downstream clinical and financial outcomes.