No abstract

e13504 Background: Lung cancer is the leading cause of cancer-related mortality worldwide. USPSTF recommends annual lung cancer screening with low dose computed tomography (LDCT) for adults aged 50-80 years with 20-pack year smoking history and are currently smoking or have quit within the past 15 years. Unfortunately, adherence rates with screenings remain suboptimal. This study aimed to assess the compliance rates with LDCT recommendations in a community hospital and propose an implementation plan to enhance patient adherence. Methods: A retrospective study was conducted by analyzing the medical charts of 1090 patients who underwent LDCT screenings at Mercy Catholic Medical Center between January 2018 and June 2021. Medical records were reviewed to determine whether patients had appropriate follow-ups done based on the LUNG-RADs category with focus on those with higher LUNG-RADs designations. A survey was administered to current internal medicine residents to evaluate their understanding of screening guidelines. Based on the survey results and literature review, a plan to enhance adherence with screenings is proposed. Results: Total 1090 patients underwent LDCT screenings, comprising of 522 males and 568 females. 166 patients were assigned LUNG-RADs category 3, 4A, 4B, or 4X. Amongst these 166 patients, compliance rate with recommended follow-up imaging and/or biopsies was only 51.2% (95% confidence interval [CI], 44.0-59.0). 15% of patients had biopsies that were positive for malignancies. 70% of the residents participated in the survey. Only 57% demonstrated knowledge of the recommended age group for screening; only 47% knew the pack-year criteria for screening. Questions gauging the understanding of when to stop screening, implications of imaging findings, and estimated mortality reduction from LDCT screenings underscored the knowledge gap amongst physicians as a factor needing improvement. Conclusions: This study comprised of a patient population primarily from poor socioeconomic and educational background. Therefore, many of the patients in this study may not have fully comprehended the LDCT implications solely from receiving a letter with radiology impressions, leading to the high non-compliance rate observed. To enhance follow-ups, residents should be educated on LDCT screening indications and benefits so they can promote patient health better. After receiving LDCT results, providers should inform patients about the findings either via phone calls or in-person office visits and emphasize the importance of specific follow-ups. We propose the appointment of a designated coordinator to call patients who failed to follow-up to re-emphasize the importance and identify barriers to adherence (i.e., transportation, cost). Studies found an increase in adherence to screening from 22% to 66% after hiring a coordinator. Adherence rates can, thus, be improved by a collaborative team approach.

Background: There has been growing interest in studying demand ischemia as a cause of type 2 myocardial infarction (T2MI) in younger patients. Conventional cardiovascular risk factors and their association (and degree) are vaguely defined as predictors of T2MI. Women may be noted to have different predictors given their underrepresentation in clinical trials. Methods: We analyzed young female (18-44 years) hospitalizations from the National Inpatient Sample 2018 for multivariate-adjusted predictors (aOR, 95% confidence interval) of T2MI, STEMI and NSTEMI admissions, and divided the significance level into p<0.01, p<0.05 & p<0.1. Results: Young females (n=6,152,028) had 0.05% STEMI, 0.16% NSTEMI and 0.08% T2MI admissions. Predictors (Table 1) with the highest significance level of association for T2MI (p<0.01), compared to ST/NSTEMI (either 0.01<p<0.05 or not significant), were black race (aOR 1.49) and CHF (aOR 1.97), pulmonary circulation disorder (aOR 1.83) and OSA (aOR 1.62). Valvular heart disease, paralysis, COPD, deficiency anemia predicted a higher risk of T2MI admissions in young women (p<0.05) but not STEMI/NSTEMI admissions. Hypertension, prior MI, dyslipidemia, family history of coronary artery disease, peripheral vascular disease, coagulopathy and fluid-electrolyte disorder predicted a higher risk of T2MI or STEMI/NSTEMI. Collagen vascular disorders and obesity had a higher risk of T2MI/NSTEMI (p<0.01) but not of STEMI (p=0.07). DM, and cocaine abuse predicted higher odds of STEMI/NSTEMI but not of T2MI. Hypothyroid, liver disease, metastatic cancer, AIDS, depression, alcohol abuse and cannabis abuse did not predict a higher risk of T2MI or STEMI/NSTEMI. Hypothyroid, liver disease, metastatic cancer, AIDS, depression, alcohol and cannabis abuse did not predict higher odds of T2MI or STEMI/NSTEMI in young women. Conclusion: Predictors associated with T2MI in young females with a higher order of significance than ST/NSTEMI can be utilized to build a risk score for T2MI in young females.