Virtual Poster Session for Saint Luke's Research Day 2026

Saint Luke's Research Day 2026

Saint Luke's Research Department

WELCOME TO THE 2026 SAINT LUKE'S RESEARCH DAY VIRTUAL POSTER SESSION!


'Research Day' celebrates and highlights innovative work by Saint Luke's researchers. This platform allows you to view projects by staff, fellows & residents in all healthcare professions at all Saint Luke's entities.


We encourage you to explore this remarkable work in each category listed under 'Tracks'

More info: https://www.saintlukeskc.org/ResearchDay

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Poster: Open Management of a Symptomatic Superior Mesenteric Artery Aneurysmal Dissection

Open Management of a Symptomatic Superior Mesenteric Artery Aneurysmal Dissection

Devan Girish, BA; Amin Shabaneh, MD; John Pate, DO; Neal Talukdar, DO; Anthony Grieff, MD

Abstract
Background

Superior mesenteric artery aneurysms (SMAAs) are rare but carry a significant risk of rupture, with reported mortality rates after rupture approaching 25% to 70%. Clinical presentation is often nonspecific, including abdominal pain, weight loss, and decreased appetite, leading to delays in diagnosis. While endovascular repair is preferred when anatomically feasible, aneurysms involving multiple branch vessels often require open surgical reconstruction.

Case Description

We present the case of a 37-year-old male who presented with worsening diffuse abdominal pain for three days. His past medical history includes hypertension, methamphetamine use, tobacco use, mitral valve prolapse, and prior ascending hemi-arch repair for type A aortic dissection, consistent with underlying aneurysmal degeneration. CT angiography revealed a descending thoracic aortic dissection with an associated distal hemiarch aneurysm and a 2.5 cm proximal SMA aneurysm with a distal dissection flap. Multiple jejunal branches originated from the aneurysmal segment of the SMA.

Given the concern for visceral malperfusion and potential rupture, he was taken to the operating room for open SMA aneurysm repair. A midline laparotomy was performed, and the SMA aneurysm was identified at the base of the transverse mesocolon, densely adherent to the posterior peritoneum.

After obtaining proximal and distal SMA control and controlling multiple jejunal branches, the aneurysm was opened longitudinally, revealing a dissection flap with two perfusing lumens. An interposition reconstruction was performed using a rifampin-soaked Dacron conduit with an end-to-end distal anastomosis to the ileocolic artery beyond the dissected segment. The jejunal branches were reimplanted using Carrel patches anastomosed to the graft.

Results

Intraoperative assessment demonstrated strong Doppler signals in all reconstructed branch vessels with excellent flow through the reconstructed SMA. There was preserved perfusion throughout the small bowel mesentery with no evidence of visceral malperfusion.

Conclusion

SMAAs are not well studied in the literature, and there remains a lack of consensus in their management. This case highlights the complexity of treating SMAAs with associated dissection, particularly when multiple branch vessels are involved. In anatomically challenging cases, open reconstruction with branch reimplantation offers a safe and effective approach to restore mesenteric perfusion.

Lay Summary

Superior mesenteric artery aneurysms occur when a blood vessel supplying the intestines becomes enlarged and weakened. Although rare, they are dangerous because they can rupture, causing life-threatening complications. Symptoms such as abdominal pain and weight loss are often vague, which can delay diagnosis.

This case describes a young man with a complex aneurysm and a tear in this artery. Because several smaller vessels branched from the damaged area, minimally invasive repair was not possible. Surgeons performed an open operation to remove the damaged segment and rebuild it using a synthetic graft. The smaller vessels were preserved by removing them with small patches of surrounding tissue, similar to cutting out a button with fabric attached, and sewing them onto the graft to maintain blood flow.

Open surgical repair with vessel reimplantation is safe and effective for complex intestinal artery aneurysms. Documenting such cases helps guide treatment, standardize care, and improve outcomes.
Presented by
Girish, Devan, BA
Institution
University of Missouri - Kansas City School of Medicine; St. Luke's Hospital
Poster: Dorsal Column Neurostimulator Placement in Self-Medicating Patient for Failed Back Syndrome

Dorsal Column Neurostimulator Placement in Self-Medicating Patient for Failed Back Syndrome

Jourdan Penman, DO; Jonathan Holland, DO; Tyler Concannon, MD

Abstract
Background

Chronic pain is strongly associated with increased alcohol use due to self-medication and negative reinforcement mechanisms 1. While direct interventional studies are limited, mechanistic and clinical evidence suggests that improved pain control may reduce the motivation for alcohol consumption in this population 1. Alcohol use has been shown to provide short-term analgesia but worsen long-term outcomes due to its impact on the safety, efficacy, and overall outcomes of spinal cord stimulation (SCS) therapy.

Objective

This case evaluates the use of SCS therapy in providing patients with failed back syndrome more effective pain relief, leading to improvement in quality of life, functional outcomes, and patient satisfaction.

Results

After agreeing to a significant reduction in alcohol for nearly 16 months and repeat psychiatry evaluation, the patient was approved for, and proceeded with, SCS trial and implantation. At one week trial follow-up, patient reported “excellent improvement” to his pain and activity, with greater than 90% improvement. Six weeks after surgical implantation of the generator, the patient reported continued 90% reduction of pain symptoms and alcohol consumption.

Conclusion

This case demonstrates the utility of SCS therapy in providing patients with failed back syndrome more effective pain relief, leading to improvement in quality of life, functional outcomes, and patient satisfaction 3 The adequate treatment of this patient’s pain symptoms may likely have contributed to reducing his overall alcohol dependence.

Lay Summary

A 74-year-old with chronic low back pain and failed back syndrome experienced worsening symptoms after chiropractic adjustment. His history included multiple surgeries and unsuccessful treatments such as epidural steroid injections, radiofrequency ablations, and lumbar decompression and fusion. Imaging revealed severe foraminal stenosis and chronic radiculopathy. Despite interest in spinal cord stimulator (SCS) therapy, initial psychiatric evaluation advised against it due to long-standing alcohol use for pain self-management. Chronic pain is associated with increased alcohol consumption, which may worsen long-term outcomes and complicate SCS effectiveness. After significantly reducing alcohol intake for 16 months and receiving psychiatric clearance, the patient underwent SCS trial and implantation. He reported over 90% improvement in pain and function during the trial and sustained relief six weeks post-implantation, alongside reduced alcohol use. This case highlights the importance of addressing substance use in patient selection and suggests that effective pain control with SCS may improve both functional outcomes and alcohol dependence.
Presented by
Penman, Jourdan, DO
Institution
University of Missouri Kansas City, Department of Anesthesiology
Poster: Time to Bystander CPR and Survival Outcomes in Pediatric Out-of-Hospital Cardiac Arrest

Time to Bystander CPR and Survival Outcomes in Pediatric Out-of-Hospital Cardiac Arrest

Mohammad Abdel Jawad, MD; Ma’in Abumuhfouz, MD; John A. Spertus, MD, MPH; Kevin F. Kennedy; Paul S. Chan, MD, MSc

Abstract
Background

Bystander cardiopulmonary resuscitation (CPR) is a key link in the chain of survival for out-of-hospital cardiac arrest (OHCA). While bystander CPR initiation within 10 minutes is associated with improved survival in adults, the association between the timing of bystander CPR initiation and survival in children is unknown.

Objective

We analyzed over 10,000 pediatric cardiac arrest cases across the United States to learn how many children received CPR from a bystander.

Methods

We conducted a retrospective cohort study using data from the Cardiac Arrest Registry to Enhance Survival to examine the association between time to bystander CPR initiation and survival in pediatric (<18 years) patients with non-traumatic OHCA from 2013 to 2023. Time to bystander CPR was estimated from the 9-1-1 call timestamp and bystander-report of time of CPR initiation. The primary outcome was survival to hospital discharge; the secondary outcome was favorable neurological survival (defined as survival without severe neurological deficits). Multivariable hierarchical logistic regression models evaluated the association between time to bystander CPR and survival outcomes, adjusting for demographic and cardiac arrest characteristics.

Results

Of 10,991 pediatric OHCA cases, 5,446 (49.5%) received bystander CPR. Median time to bystander CPR was 3.0 minutes (IQR:1.0-9.0). Overall, 1,677 (15.3%) survived to discharge, and 1,420 (12.9%) had favorable neurological survival. As compared with patients without bystander CPR, there was a graded inverse relationship between time to bystander CPR and survival to discharge during the first 5 minutes of initiation (0-1 minute: adjusted odds ratio [aOR], 1.91 [95% CI: 1.65–2.20]; 2-3 minutes: aOR, 1.98 [1.63-2.40]; 4-5 minutes: aOR, 1.37 [1.09-1.72]; 6-7 minutes: aOR, 0.76 [0.51-1.13]; 8-9 minutes: aOR, 0.67 [0.41-1.08]; ≥ 10 minutes: aOR, 0.59 [0.46-0.77]). A similar pattern was observed between time to bystander CPR and favorable neurological survival, with two-fold higher odds among those with bystander CPR initiated at 0-1 minute (aOR, 2.00 [1.72–2.32]) and 2-3 minutes (aOR, 2.06 [1.68-2.52]) and no benefit when initiated after 5 minutes.

Conclusions

In children with OHCA, there was a graded inverse relationship between time to bystander CPR and survival outcomes, with higher survival when bystander CPR was initiated during the first 5 minutes. These findings underscore the critical importance of early CPR initiation and the need for continued efforts to enhance bystander response.

Lay Summary

When a child’s heart suddenly stops outside the hospital, quick action from nearby people can save a life. This study looked at how the timing of bystander CPR affects survival in children. We analyzed over 10,000 pediatric cardiac arrest cases across the United States. About half of the children received CPR from a bystander.

The results showed that the sooner CPR was started, the better the chances of survival. Children who received CPR within the first 3 minutes were about twice as likely to survive with good brain function compared to those who did not receive CPR. The benefit decreased with each passing minute and was no longer seen when CPR started after 5 minutes.

These findings highlight that every minute counts. Rapid recognition of cardiac arrest and immediate CPR by bystanders can greatly improve survival and brain outcomes in children.
Presented by
Abdel Jawad, Mohammad, MD
Institution
UMKC / MAHI - Heart Failure Fellow - Department of Cardiovascular Medicine
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Poster: Direct Oral Anticoagulants Versus Warfarin in Atrial Fibrillation with End-Stage Renal Disease: A 5-Year Propensity Matched Analysis of Real-World Outcomes

Direct Oral Anticoagulants Versus Warfarin in Atrial Fibrillation with End-Stage Renal Disease: A 5-Year Propensity Matched Analysis of Real-World Outcomes

Ma'in Abumuhfouz, MD; Saeed Suleiman, MD; Talal Asif, MD

Abstract
Background

Atrial fibrillation (AF) is a common heart rhythm disorder that increases the risk of stroke. Patients with end-stage kidney disease (ESRD) are especially vulnerable, but choosing the safest blood thinner for them is challenging.

Objective

To compare long-term effectiveness and safety of DOACs versus warfarin in patients with AF and ESRD using a large real-world database.

Methods

Adults (≥18 years) with ESRD (ICD-10 N18.6/Z99.2) and AF (I48.x) receiving a DOAC (apixaban, rivaroxaban, and dabigatran) or warfarin between 2020-2025 were identified from the TriNetX Global Network. Index date was first anticoagulant prescription. Propensity score matching (1:1) was performed on demographics, comorbidities, dialysis status, HAS-BLED components, and concurrent medications. Outcomes included all-cause mortality, ischemic stroke, hemorrhagic stroke, systemic embolism, and gastrointestinal bleeding. Kaplan-Meier analysis and Cox regression generated hazard ratios (HRs).

Results

After propensity score matching matching, 14,820 DOAC-treated and 14,820 warfarintreated patients were included (standardized mean differences <0.1 across all covariates). Over a median follow-up of 4.1 years, DOAC use was associated with lower all-cause mortality (HR 0.82, 95% CI 0.79–0.86; p<0.001), lower hemorrhagic stroke (HR 0.73, p=0.004), lower gastrointestinal bleeding (HR 0.88, p=0.01), lower systemic embolism (HR 0.71, p<0.001), and similar ischemic stroke risk (HR 0.92, p=0.11).

Conclusion

In this large, propensity-matched ESRD cohort with AF, DOAC therapy was associated with lower mortality and reduced major bleeding and embolic complications compared with warfarin, without increasing ischemic stroke risk. These findings support the growing real-world evidence favoring DOACs in ESRD, while highlighting the need for prospective trials to guide optimal anticoagulation in this population.

Lay Summary

Atrial fibrillation (AF) is a common heart rhythm disorder that increases the risk of stroke. Patients with end-stage kidney disease (ESRD) are especially vulnerable, but choosing the safest blood thinner for them is challenging. Warfarin has been used for decades, while newer drugs called direct oral anticoagulants (DOACs) are increasingly prescribed, though their benefits in this high-risk group are still being studied. In this study, we compared DOACs and warfarin using real-world data over five years to understand which treatment is safer and more effective for patients with both AF and ESRD. We found that patients taking DOACs had lower rates of death, serious bleeding, and blood clots, while the risk of stroke was similar between the two groups. These findings suggest that DOACs may be a safer option for many patients with kidney failure. Future research will help confirm these results and guide treatment decisions in this vulnerable population.
Presented by
Abumuhfouz, Ma'in, MD
Institution
UMKC
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Poster: Pulsed Field Ablation Versus Radiofrequency Ablation for Ventricular Tachycardia: A Propensity-Matched Comparative Outcomes Analysis of Real World Data

Pulsed Field Ablation Versus Radiofrequency Ablation for Ventricular Tachycardia: A Propensity-Matched Comparative Outcomes Analysis of Real World Data

Ma'in Abumuhfouz, MD; Saeed Suleiman, MD; Talal Asif, MD

Abstract
Background

Ventricular tachycardia (VT) is a serious heart rhythm problem that can lead to fainting, heart failure, or even sudden death.

Objective

To evaluate the safety and effectiveness of PFA compared with RFA for the treatment of VT in a large, real-world cohort.

Methods

Adults (≥18 years) with VT (ICD-10 I47.2) undergoing catheter ablation between 2020– 2025 were identified in the TriNetX Global Network. Procedure identification used CPT/ICD-10-PCS codes for ventricular ablation, with PFA procedures identified using emerging device-specific terminology. Patients receiving combined energy modalities or repeat ablation on the index date were excluded. Propensity score matching (1:1) was performed using demographics, structural heart disease, LVEF, ischemic and nonischemic etiology, comorbidities, and antiarrhythmic drug use. Outcomes included acute procedural complications, periprocedural stroke, tamponade, coronary injury, 30- day VT recurrence, and 1-year all-cause mortality. Cox regression generated hazard ratios (HRs).

Results

From 12,460 total VT ablation cases, 1,184 (9.5%) underwent PFA and 11,276 (90.5%) underwent RFA. After 1:1 matching, 1,120 PFA patients were compared with 1,120 RFA patients. PFA was associated with significantly fewer procedural complications (4.1% vs 7.8%; HR 0.54, 95% CI 0.39–0.75; p<0.001), including lower rates of coronary injury (0.2% vs 1.1%; p=0.02) with similar rates of tamponade (1.0% vs 1.3%; p=0.45). PFA was also associated with lower 30-day VT recurrence (11.2% vs 15.9%; HR 0.70; p=0.003). One-year all-cause mortality did not differ significantly between groups (8.3% vs 9.1%; HR 0.92; p=0.28).

Conclusion

In this large propensity-matched real-world cohort, PFA for VT was associated with fewer procedural complications and lower early VT recurrence compared with RFA, while demonstrating similar 1-year mortality. These findings support PFA as a promising and potentially safer alternative to RFA for VT ablation, though prospective trials are needed to validate long-term outcomes.

Lay Summary

Ventricular tachycardia (VT) is a serious heart rhythm problem that can lead to fainting, heart failure, or even sudden death. One common treatment is a procedure called ablation, where doctors target and destroy the small areas in the heart causing the abnormal rhythm. Traditionally, this is done using heat (radiofrequency ablation, RFA). A newer approach, pulsed field ablation (PFA), uses short electrical pulses and may be safer. In this one of a kind study, we compared these two treatments using real-world patient data to understand which works better and has fewer risks. We found that PFA was linked to fewer complications during the procedure and a lower chance of the abnormal rhythm returning within the first month. Survival at one year was similar for both treatments. These results suggest that PFA could be a safer alternative for patients which could potentially impact clinical practice going forward. Future studies will help confirm its longterm benefits and guide its wider use in healthcare.
Presented by
Abumuhfouz, Ma'in, MD
Institution
UMKC
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Poster: Underutilization of Statins in Younger Cirrhotic Patients Despite Hepatoprotective Benefits

Underutilization of Statins in Younger Cirrhotic Patients Despite Hepatoprotective Benefits

Mohammad Adam, MD; John Helzberg, MD

Abstract
Background

Statins are increasingly recognized as safe in patients with chronic liver disease and compensated cirrhosis, with emerging evidence suggesting hepatoprotective properties beyond their cardiovascular benefits. Despite these findings, statins remain underutilized in cirrhotic patients due to persistent concerns regarding hepatotoxicity. The comparative effects of lipophilic and hydrophilic statins on hepatic decompensation and hepatocellular carcinoma (HCC) remain incompletely understood.

Objective

To investigate the association between statin therapy and liver-related outcomes, including hepatic decompensation and HCC, in a large propensity-matched cohort of patients with compensated cirrhosis, while comparing the effectiveness of lipophilic versus hydrophilic statins.

Methods

Design: Retrospective cohort study using the TriNetX Global Network database. Population: Adults aged ≥18 years with compensated cirrhosis identified using ICD-10 codes (K70.30, K74.3–K74.6).

Exclusion Criteria: Prior hepatic decompensation and hepatocellular carcinoma. Matching: Patients were propensity score-matched 1:1 based on demographics, comorbidities, and laboratory parameters.

Outcomes: Primary outcomes included composite hepatic decompensation (ascites, hepatic encephalopathy, hepatorenal syndrome, variceal bleeding, and spontaneous bacterial peritonitis), as well as the incidence of HCC. Statistical Analysis: Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Kaplan–Meier survival analyses and forest plots were used for visualization.

Results

Before propensity matching, younger cirrhotic patients were less likely to receive statin therapy despite correlations with Child-Pugh A and B disease severity. Following 1:1 matching, 166,644 patients were included with balanced baseline characteristics. Statin use was associated with a significantly reduced risk of composite hepatic decompensation (HR 0.78; p < 0.01) and lower incidence of HCC (HR 0.71; p < 0.01). Forest plot analysis demonstrated the greatest benefit in reducing ascites and variceal bleeding (HR 0.71), while hepatic encephalopathy showed the smallest reduction in risk (HR 0.86). Subgroup analysis revealed that lipophilic statins were associated with a slightly reduced benefit for HCC prevention (HR 1.10; p = 0.033) and no statistically significant improvement in hepatic decompensation outcomes (HR 0.99; p = 0.13) compared with hydrophilic statins.

Conclusion

In this large, real-world propensity-matched cohort of over 300,000 patients, statin therapy demonstrated significant hepatoprotective effects in patients with compensated cirrhosis. Statin use was associated with reduced risks of hepatic decompensation and hepatocellular carcinoma, with hydrophilic statins showing modest additional benefit. These findings support the appropriate use of statins in eligible patients with compensated cirrhosis despite ongoing concerns regarding hepatotoxicity. Further prospective studies are warranted to clarify the role of statins in the prevention and progression of liver disease.
Presented by
Adam, Mohammad, MD, MSc
Institution
Saint Luke's and UMKC
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Poster: Traumatic Severe Tricuspid Regurgitation Following Motor Vehicle Collision

Traumatic Severe Tricuspid Regurgitation Following Motor Vehicle Collision

Anjali Bhardwaj, MD; Sanjana Perumalla, MD; Anjali Mannava, MD; Colin Kenny, MD; Paramdeep Baweja, MD

Abstract
Background

Traumatic tricuspid regurgitation (TR) is an uncommon complication of blunt chest trauma and may be under recognized, particularly when presenting with transient arrhythmias. Early identification is critical to guide management and prevent long-term right heart dysfunction.

Case Presentation

A 44-year-old male presented as a level 1 trauma activation following a high-speed motor vehicle collision with multiple injuries, including femur and rib fractures, pulmonary contusions, and pleural effusion. During early hospitalization, he developed atrial fibrillation with rapid ventricular response, which resolved within 24 hours with rate control. Laboratory findings revealed elevated troponin consistent with myocardial contusion. Infectious evaluation, including blood cultures and serologies, was negative. Transthoracic echocardiography demonstrated right ventricular dilation with reduced systolic function, a flail tricuspid leaflet, and severe TR. Transesophageal echocardiography confirmed severe TR with suspected torn chordae and right atrial dilation. Follow-up imaging one month later showed preserved left ventricular function, normalization of right ventricular size, and persistent moderate-to-severe TR.

Methods

The patient was managed in the intensive care unit with telemetry monitoring and short-term intravenous amiodarone with resolution of atrial fibrillation. No emergent surgical intervention was pursued due to hemodynamic stability and absence of right heart failure. He underwent orthopedic repair of his femur fracture and supportive care for thoracic injuries. The patient was discharged with outpatient cardiac monitoring and multidisciplinary follow-up. At follow-up, he remained stable with mild exertional dyspnea and persistent TR and is undergoing evaluation for elective tricuspid valve repair or replacement. Conclusions

This case highlights traumatic TR as a rare but significant sequela of blunt chest trauma, often associated with myocardial contusion and transient arrhythmias. Echocardiography, particularly transesophageal imaging is essential for diagnosis. In hemodynamically stable patients without right heart failure, conservative management with close follow-up and planned surgical evaluation is appropriate. Early recognition and timely referral are key to optimizing outcomes and preventing progression to right ventricular dysfunction.

Lay Summary

Blunt chest injuries from car accidents can sometimes damage the heart in ways that are not immediately obvious. One rare complication is injury to the tricuspid valve, which helps control blood flow through the right side of the heart. If this valve is damaged, it can leak (called regurgitation), potentially leading to long-term heart problems if not recognized early. This case describes a 44-year-old man who developed a temporary abnormal heart rhythm and was later found to have severe tricuspid valve damage after a car crash. Our goal is to highlight how careful heart imaging can detect this condition, even when symptoms are mild. The patient was safely managed without emergency surgery and is being monitored for planned repair. This case emphasizes the importance of early diagnosis and follow-up, which can help prevent future heart failure and improve outcomes for trauma patients.
Presented by
Bhardwaj, Anjali, MD
Institution
University of Missouri- Kansas City
Poster: Prioritizing Endpoints in Heart Failure Trials: A Survey of Clinical Trialists

Prioritizing Endpoints in Heart Failure Trials: A Survey of Clinical Trialists

Omar Cantu Martinez, MD; Mirza S. Khan, MD; John A. Spertus, MD; Andrew A. Girard, MD; Nobuhiro Ikemura, MD; Tanawat Attachaipanichd, MD; Kensey Gosch; Paul S. Chan, MD

Abstract
Background

Primary endpoints in heart failure (HF) trials have evolved beyond traditional “hard” outcomes (death and hospitalization) to include patient-reported health status (symptoms, function, and quality of life). Composite endpoints and time-to-event analyses may inadequately reflect the relative importance of individual outcomes, particularly when events differ in clinical significance or when patient-reported outcomes are incorporated. Win-ratio methods allow hierarchical prioritization of endpoints, but the selection and ordering of endpoints remain subjective.

Objective

We sought to evaluate how HF trialists prioritize common clinical and patient-centered endpoints when constructing hierarchical outcomes.

Methods

We conducted a cross-sectional survey of investigators involved in phase 3 or 4 HF trials of sodium-glucose cotransporter 2 inhibitors or renin-angiotensin-aldosterone system inhibitors enrolling ³400 patients and registered on ClinicalTrials.gov as of May 5, 2023. Eligible trialists (n=167) were invited via email; 58 responded (34.7%). Participants allocated 100 points across endpoints in three scenarios reflecting (1) primary endpoints (death, HF hospitalization/emergency department visit, health status), (2) secondary endpoints (KCCQ, BNP, 6-minute walk test, left ventricular ejection fraction, NYHA class), and (3) health status domains (symptoms, physical function, social limitations, quality of life). Relative importance (RI) was calculated by dividing the mean points for each endpoint by those of the highest-weighted endpoint (reference), and differences were assessed using log-ratio tests under a compositional data framework.

Results

Respondents were experienced trialists (93% ³10 years; 90% principal investigators), predominantly physicians (86%) and HF specialists (72%). In the primary set, death received the highest weighting (46.0±12.8), followed by HF hospitalization (31.1±10.6; RI=0.68) and health status (22.9±12.2; RI=0.50). Among secondary endpoints, KCCQ improvement was ranked highest (33.5±14.9), followed by BNP (RI=0.57), 6-minute walk test (RI=0.49), left ventricular ejection fraction (RI=0.47), and NYHA class (RI=0.45). Within health status domains, symptoms were prioritized highest. Differences across all sets were statistically significant (p<0.001).

Conclusions

HF trialists prioritize death above HF-related events and health status, while KCCQ is the most valued secondary endpoint and symptoms the most important health status domain. Substantial variability in endpoint weighting highlights ongoing challenges of composite and hierarchical endpoint design. These findings provide empirical guidance for constructing clinically informed win-ratio hierarchies in future HF trials.

Lay Summary

Heart failure trials have traditionally focused on outcomes like death and hospitalizations. Recently they also include how patients feel, function, and live day-to-day. The challenge is that when they are combined, it’s not always clear which ones matter most, as this can affect how we interpret a study that can change our prescribing practice. We surveyed experienced heart failure trialists to understand how they rank these outcomes. Survival was ranked highest, followed by avoiding hospitalizations. Improvement in the Kansas City Cardiomyopathy Questionnaire (KCCQ), a patient-reported outcome tool that captures patients’ symptoms and daily functioning, was ranked highest amongst commonly used secondary measures. Importantly, there was wide variation in how trialists weighted all outcomes. These findings can help improve how clinical trials are designed. A key next step is to include patient perspectives to better align research with what matters to patients most in everyday life.
Presented by
Cantu Martinez, Omar, MD
Institution
Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City’s Healthcare Institute for Innovations in Quality, Kansas City, Missouri, USA; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Poster: Concurrent use of Tarlatamab and Risankizumab in Crohn's Disease with Neuroendocrine Carcinoma

Concurrent use of Tarlatamab and Risankizumab in Crohn's Disease with Neuroendocrine Carcinoma

Chitramalya Dan, MD; Blake Buzard, PharmD; Lindsey Douglass, PharmD; Beth Gustafson, PharmD; Jacob Wodtke, PharmD; Laith Al-Momani, MD; Marc Roth, MD​

Abstract
Background

Tarlatamab is a first-in-class Delta-like ligand 3 (DLL3)-targeting bi-specific T-cell engager (BiTE), approved for extensive-stage small-cell lung cancer (ES-SCLC) after platinum-based chemotherapy and is being extensively studied in various DLL3-expressing neuroendocrine carcinomas (NECs). Risankizumab is an IL-23 p19 subunit inhibitor approved for moderate to severe Crohn's disease (CD). The exact mechanism of tarlatamab  in modulating the tumor microenvironment and its interaction with other immunomodulatory agents are not well-understood. However, mechanistically there are concerns when combining tarlatamab with immunosupression, such as loss of anti-tumor activity, safety, immunologic compatibility, loss of control over autoimmune condition/flare-ups and increased infection risk. 

Objective

Study the novel use of later line tarlatamab monotherapy for extensive-stage metastatic DLL3-positive (30%) neuroendocrine carcinoma (NEC) of rectal origin, concurrently with risankizumab, in a patient with CD. Methods

Tarlatamab was given for five cycles until progressive disease was observed. Well-documented adverse effects of tarlatamab, including  CRS,  neutropenia,  fatigue, anemia, and thrombocytopenia were observed.

Results

Crohn’s disease remained in remission throughout the entire duration and no infections or neurotoxicity were encountered.  Conclusion

This case report suggests concurrent use of tarlatamab in patients on immunomodulatory agents may be a safe approach without flare-ups of underlying autoimmune condition or increased risk of infections, as would be mechanistically suggested, with preserved anti-tumor effect. 

Lay Summary

Treating patients with cancer who also have autoimmune diseases such as Crohn’s disease is challenging. Cancer medications boost the immune system to target and kill cancer cells. In contrast, autoimmune conditions like Crohn’s disease are treated with medications that suppress the immune system. Using these treatments together comes with risks including reduced effectiveness of cancer therapy, flare-ups of the autoimmune condition, and an increased risk of infections.

This report describes a patient with advanced neuroendocrine cancer and Crohn’s disease treated simultaneously with tarlatamab (to boost anti-cancer immunity) and risankizumab (to control Crohn’s disease). The patient had expected side effects, but their cancer remained in control, Crohn’s disease stayed in remission, and no serious infections occurred.

These findings suggest that this combination may be safe in select patients. Further research is needed to confirm this and guide treatment decisions for individuals with both cancer and autoimmune disease.
Presented by
Dan, Chitramalya, MD
Institution
Saint Lukes’ Hospital of Kansas City
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Poster: Optimizing Post-Bronchoscopy Care: Is Routine Chest Imaging Necessary?

Optimizing Post-Bronchoscopy Care: Is Routine Chest Imaging Necessary?

Motaz Daraghma, MD; Joseph Ayoub, MD; Matthew Aboudara, MD

Abstract
Background

Pneumothorax may complicate navigational bronchoscopy in 1–3% of patients. Routine chest radiographs are often performed after navigational bronchoscopy for biopsy of lung nodules to evaluate for pneumothorax (PTX). Although most PTXs are small and self-resolving, a subset of patients may develop non-resolving PTXs requiring chest tube placement and hospitalization. Some studies suggest these radiographs may not be necessary in asymptomatic patients, which may save costs and reduce radiation exposure.

Objective

We conducted a Quality Improvement (QI) project to evaluate whether symptom-guided chest imaging is as safe as routine imaging for patients undergoing navigational bronchoscopy.

Methods

This QI project compared two cohorts of 200 patients each. The first was a historical control group that received routine post-bronchoscopy chest radiographs, while the second was an intervention group managed with symptom-guided imaging. Patients in the intervention cohort underwent chest radiographs only if they developed symptoms such as hypoxia, chest pain, or dyspnea, or if intraprocedural risk factors were present, such as a concerning biopsy trajectory, pleural proximity, or unexplained intraprocedural hypoxia. Exclusion criteria included bronchoscopic lung volume reduction, identified intraprocedural PTX, cryobiopsy for ILD, severe bleeding, post-procedure respiratory failure, and high-risk complications. Data were collected and managed using REDCap hosted at Saint Luke’s Hospital of Kansas City. The primary outcome was PTX rate, while secondary outcomes included chest tube placement, hospitalization, delayed PTX, and cost savings.

Results

Baseline demographic and procedural characteristics were comparable between cohorts. The overall PTX rate was 3.5% in the control cohort (7/200) and 2.0% in the intervention cohort (4/200). No delayed PTX events occurred in either group. In the intervention cohort, only 21 of 200 (10.5%) underwent post-procedure chest radiographs, among whom four PTXs were confirmed. Chest tube placement was required in three patients from each group, all hospitalized. There were no patient deaths and no missed clinically significant PTX events.

Conclusions

A symptom-guided approach to post-bronchoscopy chest imaging was safe and reduced unnecessary radiographs. This strategy minimizes radiation exposure, lowers costs to the patient and hospital system, and optimizes hospital resources without compromising patient safety. Further multicenter studies may help validate these results and support broader implementation.

Lay Summary

When doctors investigate suspicious spots in the lungs, they often use a procedure called bronchoscopy — a thin, flexible scope with a camera on the end that is passed through the mouth into the airways to take a small tissue sample. After this procedure, patients routinely receive a chest X-ray to check for a rare complication called a pneumothorax (a collapsed or leaking lung), even when they feel completely fine. This adds radiation exposure, cost, and delays — most of the time for no clinical benefit.

Our team at Saint Luke's Hospital of Kansas City asked: can we safely skip the chest X-ray if a patient has no symptoms following a bronchoscopy that biopsied a finding in the lung? We compared 200 patients who received routine X-rays with 200 patients who only received a x-rayone if they showed warning signs such as chest pain, low oxygen, or shortness of breath.

We found no difference in safety outcomes between the two groups. By moving to a symptom-guided approach, we reduced post-procedure X-rays by nearly 90%, lowering unnecessary radiation exposure and healthcare costs while keeping patients equally safe. This approach could be widely adopted across hospitals, improving efficiency and patient experience without compromising care.
Presented by
Daraghma, Motaz, MD
Institution
Saint Luke's
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Poster: Minimally Invasive Sacroiliac Intervention for Chronic Sacroiliac Joint Pain and Dysfunction: A Case Report

Minimally Invasive Sacroiliac Intervention for Chronic Sacroiliac Joint Pain and Dysfunction: A Case Report

Vincent Eaton, MD; Tyler Concannon, MD

Abstract
Background

Sacroiliac joint dysfunction is a commonly underrecognized source of chronic low back pain that burdens the healthcare system1. Patients refractory to common conservative therapies may benefit from SI joint fusion as a minimally invasive, safe, and more accessible way to treat chronic low back and SI joint pain.

Objective

Evaluate the effectiveness of PainTEQ system as a minimally invasive SI joint fusion technique that allows for stabilization of the joint while minimizing dangers of more invasive techniques, doing so without drilling, and minimizing tissue disruption2.

Case Study

A 54-year-old female with a history of chronic low back and buttock pain presented with symptoms consistent with SI joint dysfunction. Pain was localized to the right side of her lower back and pain was described as sharp, was exacerbated by walking, standing, and lifting, and was mildly improved by rest and over-the-counter medications. Patient had a 6-week trial of physical therapy without improvement. Patient underwent a diagnostic/therapeutic SI joint injection with a strong response and 100% improvement of pain for eight hours before her pain returned to baseline. On physical exam, patient had tenderness over right SI joint space, positive right FABER maneuver, positive right thigh thrust, and positive right Gaenslen’s maneuver. After discussion with patient, plan was made to undergo a sacroiliac joint fusion using the PainTEQ system.

Results

Upon completion of surgery, patient reported improvement in pain, function, and tolerated activity better from one week post-operatively.

Conclusion

This case demonstrates that posterior SI joint fusion using the PainTEQ system may provide effective pain relief and functional improvement in patients with refractory SI joint dysfunction. Studies have proven that this is a safe and effective procedure to decrease, and potentially resolve, pain that originates from SI joint dysfunction3,4. This not only improves the patient quality of life, but also lessens the cost burden on healthcare in the short-term setting1. Further studies are warranted to evaluate long-term outcomes, cost impact, and comparative efficacy versus alternative fusion techniques.

Lay Summary

Sacroiliac joint dysfunction is a commonly underrecognized and undertreated source of chronic low back pain that further burdens the healthcare system. Patients refractory to common conservative therapies may benefit from SI joint fusion as a minimally invasive, safe, and more accessible way to treat chronic low back and SI joint pain. The PainTEQ system is a minimally invasive SI joint fusion technique that allows for stabilization of the SI joint while minimizing dangers of more invasive techniques, doing so without drilling, and minimizing tissue disruption. Studies have proven that this is a safe, effective, and dependable procedure to decrease, and in some cases completely resolve, pain that originates from SI joint dysfunction. This not only improves the patient quality of life, but also lessens the cost burden on healthcare in the short-term setting. Further studies are warranted to evaluate long-term outcomes, cost impact, and comparative efficacy versus alternative fusion techniques.
Presented by
Eaton, Vincent, MD
Institution
UMKC
Poster: Use of Guideline Directed Medical Therapy in Heart Failure with Mildly Reduced Ejection Fraction Compared with Reduced and Preserved Ejection Fractions: Insights from GWTG-HF

Use of Guideline Directed Medical Therapy in Heart Failure with Mildly Reduced Ejection Fraction Compared with Reduced and Preserved Ejection Fractions: Insights from GWTG-HF

Andrew A. Girard, MD; Omar Cantu Martinez, MD; Uchechukwu Ikeaba, MS; Mohammad Abdel Jawad, MD; Nobuhiro Ikemura, MD, PhD; Karen Chiswell, PhD; Stephen J. Greene, MD; Gregg C. Fonarow, MD; Paul S. Chan, MD, MSc; Andrew J. Sauer, MD; John A. Spertus, MD, MPH

Abstract
Background

The 2022 ACC/AHA/HFSA heart failure (HF) guideline classifies HF subtypes into reduced (HFrEF; ≤40%), mildly reduced (HFmrEF; 41-49%), and preserved (HFpEF; ≥50%) ejection fractions. Compared with prior guidelines, the use of guideline-directed medical therapy (GDMT) effective for HFrEF, rather than HFpEF, was recommended for those with HFmrEF. GDMT prescribing patterns in HFmrEF, as compared with HFrEF and HFpEF, has not been well described.

Objective

This study seeks to describe GDMT prescribing patterns at discharge in patients hospitalized with acute HF, stratified by HF subtype.

Methods

Data from July 1st, 2021, to December 31st, 2024 in the Get With The Guidelines-HF registry were used to describe quarterly trends and site level variability in quadruple therapy for HFrEF and HFmrEF (renin-angiotensin system inhibitors [RASi], β-blockers, mineralocorticoid receptor antagonists [MRA], and sodium-glucose cotransporter-2 inhibitors [SGLT2i]) and triple therapy for HFpEF (RASi, β-blocker, and MRA) at hospital discharge. Adjusted hierarchical models were constructed to describe site-level variability using median odds ratios (MOR)

Results

Among 372,197 patients from 603 sites (HFrEF: 162,755 [43.7%]; HFmrEF: 36,708 [9.9%]; HFpEF: 172,734 [46.4%]), the use of quadruple and triple therapy increased over time for all HF subtypes (HFrEF: 6.2% to 35.2%; HFmrEF: 1.75% to 13.8%; HFpEF: 0.6% to 7.4%; all p <0.001) at similar rates (interaction p >0.05). Site-level variability was similar across HF subtypes (MOR [95% CI]; HFrEF: 1.94 [1.86-2.04]; HFmrEF: 1.85 [1.74-1.99]; HFpEF: 2.00 [1.89-2.13]). Trends in quadruple/triple GDMT use were primarily driven by increasing MRA (HFrEF: 42.1% to 58.8%; HFmrEF: 22.8% to 36.1%; HFpEF: 17.4% to 27.8%; all p <0.001) and SGLT2i (HFrEF: 11.9% to 62.7%; HFmrEF: 6.0% to 44.1%; HFpEF: 3.7% to 32.1%; all p <0.001) use.

Conclusions

Although discharge GDMT prescriptions increased over time, quadruple therapy use in HFmrEF was much lower than in HFrEF, with substantial variability across hospitals. Better dissemination of HFmrEF management strategies is needed to increase the rate and consistency of guideline-recommended care.

Lay Summary

Real-world use of guideline directed medical therapy (GDMT) in heart failure with mildly reduced ejection fraction (HFmrEF) are not well described. Furthermore, the updated 2022 heart failure guideline recommended that HFmrEF patients receive GDMT effective in heart failure with reduced ejection fraction (HFrEF) rather than heart failure with preserved ejection fraction (HFpEF). To better understand the use of GDMT at hospital discharge in patients with HFmrEF, Get With the Guidelines – HF registry data from 7/1/21 to 13/31/24 were used to compare GDMT prescribing patterns in HFmrEF with those of HFrEF and HFpEF. Quarterly trends in quadruple and triple therapy increased over time for all HF subtypes (HFrEF: 6.2 to 35.214.7%; HFmrEF: 1.75 to 13.88.6%; HFpEF: 0.6% to 7.43.9%; all p <0.001), while substantial site-level variability in GDMT prescribing was present in HFmrEF (aMOR 1.85 [1.74-1.99]). These data provide support for efforts that standardize care and increase GDMT use in HFmrEF.
Presented by
Girard, Andrew, MD
Institution
University of Missouri - Kansas City's Health Care Institute for Innovations in Quality
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Poster: Optimizing Placement of Disposable Lead-free Pad to Reduce Radiation Exposure to the Primary Operator During Coronary Angiography and Percutaneous Coronary Intervention

Optimizing Placement of Disposable Lead-free Pad to Reduce Radiation Exposure to the Primary Operator During Coronary Angiography and Percutaneous Coronary Intervention

Steven Lewis, MD; David G. Gonzalez-Sanchez, MD; Michael Thompson, MD; Samarthkumar Thakkar, MD; Dany Jacob, MD; Steven Laster, MD, Adnan Chhatriwalla, MD; Dmitri Baklanov, MD; David Safley, MD

Abstract
Background

Occupational exposure to ionizing scatter radiation remains a significant hazard for operators performing cardiac catheterization procedures. A sterile, disposable lead-free radiation attenuation pad has been shown to reduce operator exposure when placed on the patient; however, the optimal orientation of this pad remains unclear.

Objective

This study evaluates whether vertical versus horizontal pad orientation affects operator radiation exposure.

Methods

We conducted a prospective, single-center study over 12 weeks, including patients undergoing diagnostic coronary angiography with or without percutaneous coronary intervention. Two catheterization laboratories were randomly assigned weekly to either vertical or horizontal pad orientation. A mobile radiation shield was used in all procedures. Outcomes included fluoroscopy time, total radiation dose (mGy), dose area product (DAP), and operator exposure measured by personal dosimeter (μrem). Relative exposure indices were calculated as μrem/DAP and μrem/mGy. Comparisons between groups were performed using Welch’s t-test and chi-square testing.

Results

A total of 199 cases were analyzed (vertical: n=106; horizontal: n=93). Baseline characteristics were similar between groups. Fluoroscopy time (19.4±15.6 vs 18.9±17.3 minutes, p=0.86), total radiation dose (444.4±401.9 vs 436.5±370.8 mGy, p=0.89), and DAP (61.1±58.2 vs 64.7±58.2, p=0.66) were comparable. Absolute operator exposure did not differ significantly (189.7±200.3 vs 184.2±229.9 μrem, p=0.86). Relative exposure per DAP (3.5±3.2 vs 3.4±3.5, p=0.93) and per radiation dose (0.3±0.4 vs 0.4±0.7 μrem/mGy, p=0.10) were also similar between groups.

Conclusions

Pad orientation (vertical vs horizontal) did not significantly impact operator radiation exposure across all measured metrics. These findings suggest that, when standard shielding strategies are employed, pad orientation may have limited influence on radiation reduction. Optimization efforts may be better directed toward comprehensive shielding techniques and procedural factors rather than pad orientation alone.

Lay Summary

Radiation exposure is a daily concern for doctors performing heart catheterization procedures, as repeated exposure over time can affect long-term health. A lightweight, disposable pad placed on the patient has been designed to reduce this exposure, but it is unclear whether the way the pad is positioned makes a difference.

In this study, we compared two ways of placing the pad—vertically and horizontally—during real-world procedures and measured how much radiation the doctor received.

We found that radiation exposure was similar regardless of how the pad was positioned. This suggests that the exact orientation of the pad may not be as important as previously thought when other protective measures are used. These results highlight that focusing on overall radiation safety strategies may be more impactful than adjusting pad position alone.
Presented by
Gonzalez Sanchez, David, MD
Institution
Saint Luke's Mid America Heart Institute
Poster: Disparities in Cardiovascular Hospitalizations by Sex, Race, and Geography in Kansas City, Missouri (2016–2022)

Disparities in Cardiovascular Hospitalizations by Sex, Race, and Geography in Kansas City, Missouri (2016–2022)

David G. Gonzalez-Sanchez, MD; Ma’in Abumuhfouz, MD; Saeed Suleiman, MD; Rebecca Adler, DO;Talal Assif, MD

Abstract
Background

Cardiovascular disease (CVD) remains the leading cause of hospitalization and mortality in the United States. While national data highlight disparities across sex, race, and socioeconomic status, local-level analyses are essential to identify high-risk populations and inform targeted interventions.

Objective

This study evaluates differences in CVD-related hospitalizations across demographic and geographic subgroups in Kansas City, Missouri, from 2016 to 2022.

Methods

We performed a retrospective analysis of hospitalization data from Kansas City, Missouri (2016–2022). Encounters containing ICD-10-CM codes for acute ischemic heart disease (I21, I22, I24) and cardiac arrest (I46) were identified. Hospitalization proportions were calculated as the percentage of total hospitalizations and stratified by sex, race, ethnicity, year, and census tract of residence. Geographic variation was assessed using census tract–level data as a proxy for neighborhood-level differences.

Results

Significant disparities in CVD-related hospitalizations were observed across demographic groups. Males had a higher proportion of hospitalizations compared with females (2.20% vs 1.27%). By race, Native Hawaiian/Pacific Islander (1.95%), Black or African American (1.88%), and American Indian/Alaska Native (1.70%) populations demonstrated higher hospitalization proportions compared with White (1.64%) and Asian (1.11%) populations, while multiracial individuals had the lowest proportion (0.99%). Hispanic/Latino patients had lower hospitalization proportions compared with non-Hispanic patients (0.95% vs 1.71%). Geographic variation was evident, with census tract–level hospitalization proportions ranging from 1.29% to 1.67%, suggesting clustering of disease burden in specific neighborhoods. Temporal trends showed relatively stable rates from 2016–2020 (1.35%–1.64%), a marked increase in 2021 (4.67%), and a return to baseline in 2022 (1.41%).

Conclusions

CVD-related hospitalizations in Kansas City demonstrate important disparities by sex, race, ethnicity, and geography. Higher hospitalization proportions among males and certain racial groups, along with geographic clustering, highlight inequities in cardiovascular health. These findings underscore the need for targeted, community-based prevention strategies and equitable access to care. Future studies should integrate socioeconomic and environmental factors to better understand and address drivers of these disparities.

Lay Summary
Presented by
Gonzalez Sanchez, David, MD
Institution
Department of Internal Medicine, University of Missouri Kansas City, KC, MO
Poster: Paramagnetic Rim Lesions as Outcome Measures in Multiple Sclerosis Therapeutic Clinical Trials: A Scoping Review

Paramagnetic Rim Lesions as Outcome Measures in Multiple Sclerosis Therapeutic Clinical Trials: A Scoping Review

Sarah Habib, MS IV; Afsaneh Shirani, MD, MSCI

Abstract
Background

PRLs are chronic active MS lesions characterized by a rim of iron-laden, activated microglia and macrophages at the lesion edge, visible on susceptibility-based MRI sequences. They represent sites of ongoing, compartmentalized inflammation and limited tissue repair, and their presence correlates with disability progression. Their persistence and association with chronic tissue loss have led to growing interest in PRLs as potential outcome measures in MS therapeutic trials.

Objective

To review therapeutic clinical trials in multiple sclerosis (MS) that have applied paramagnetic rim lesions (PRLs) as outcome measures of treatment response.

Design/Methods

Therapeutic trials were identified through a structured search of ClinicalTrials.gov using the term “paramagnetic rim lesions”, supplemented by PubMed searches. The search was last updated in August 2025. Trials were included if PRLs were specified as a primary, secondary, or exploratory/tertiary outcome. Extracted parameters included study phase, design, sample size, population, intervention(s), comparator(s), duration, outcomes, and PRL imaging methodology. Data were organized into a standardized summary table to facilitate comparison of trial characteristics, and use of PRLs as outcome measures.

Results

Seven MS therapeutic clinical trials incorporated PRLs as outcome measures. Most were phase II studies with small to moderate sample sizes, evaluating agents such as anakinra, tolebrutinib, vancomycin, metformin, foralumab, and the SetPoint neurostimulation device. PRLs were designated as the primary outcome in two trials and as a secondary or exploratory outcome in the remainder: PRLs were assessed using 3T or 7T MRI. Completed studies demonstrated no significant reduction in PRL burden.

Conclusion

PRLs are increasingly incorporated into MS therapeutic trials, though most studies remain in early phases and use them as secondary or exploratory outcomes. Current evidence suggests PRLs are largely unresponsive to short-term treatment, underscoring their potential as markers of smoldering pathology. Standardization of MRI acquisition and analysis methods is needed before PRLs can serve as validated outcome measures in future trials.

Lay Summary

Multiple sclerosis (MS) is a disease where the immune system attacks the brain and spinal cord. A specific type of brain lesion, called a paramagnetic rim lesion (PRL), reflects ongoing, long-standing inflammation and has been linked to worse disability and disease progression. Using specialized MRI techniques, researchers can detect these lesions and are exploring their use as markers to evaluate how well treatments work. In this review, we examined clinical trials in MS that have used PRLs to assess treatment effects. Although PRLs are gaining attention, most studies so far have been small and in early stages. Different MRI techniques have been used, and there is not yet a consistent approach.

Overall, current evidence suggests that PRLs tend to remain stable over time, even with treatment. This makes them potentially useful for understanding persistent inflammation, but more research is needed before they can be routinely used in clinical trials.
Presented by
Habib, Sarah, MS-IV
Institution
Saba University School of Medicine
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Poster: Safety and Efficacy of Middle Meningeal Artery Embolization in Patients with Chronic Subdural Hematoma on Antithrombotic Therapy: A Single-Institution Cohort Study

Safety and Efficacy of Middle Meningeal Artery Embolization in Patients with Chronic Subdural Hematoma on Antithrombotic Therapy: A Single-Institution Cohort Study

Benigno Polo, MD; Dylan Glaser MS, CINM; Susanna Hatcher, MD, MS; Sydney Hermanson; Ahmad K. Almekkawi, MD; Stephanie Kolahowsky-Hayner, PhD; Lisa Toelle, MD; Alyssa Fesmire, MD; Carlos A. Bagley, MD, MBA; Leo Andrew Benedict, MD

Abstract
Background

Middle meningeal artery embolization (MMAE) has emerged as a promising treatment for chronic subdural hematoma (cSDH). However, outcomes in patients on antithrombotic therapy remain poorly characterized.

Objective

To evaluate the safety and efficacy of MMAE in patients with cSDH on antithrombotic therapy compared to those not on antithrombotic therapy.

Methods

Retrospective cohort study of 57 consecutive patients with cSDH treated with MMAE at a single institution. Patients were stratified by antithrombotic status (antiplatelet or anticoagulant therapy vs. none). Primary outcome was treatment failure, defined as a composite of rebleeding, hematoma expansion, or need for rescue intervention. Secondary outcomes included 30-day mortality, functional outcomes, and complications.

Results

Of 57 patients, 27 (47.4%) were on antithrombotic therapy (20 antiplatelet, seven anticoagulant). Treatment failure rates were similar between groups (11.1% vs 13.3%, p=1.000). Rebleeding rates (11.1% vs 10.0%, p=1.000), 30-day mortality (3.7% vs 3.3%, p=1.000), and functional outcomes were comparable. Notably, no thromboembolic events occurred in either group.

Conclusions

MMAE appears safe and effective in patients with cSDH on antithrombotic therapy, with no increased risk of bleeding or thromboembolic complications. These findings support consideration of MMAE as a treatment option in this challenging patient population. Lay Summary

Chronic subdural hematoma is a common neurosurgical condition often impacting elderly patients, especially in those who take antithrombotic medications. The pathophysiology of chronic subdural hematomas involves the formation of neomembranes that are primarily perfused by branches of the middle meningeal artery. Surgical intervention remains the gold standard for treatment, however recurrence rates following surgical treatment range from 10-20%. Middle meningeal artery embolization (MMAE) is emerging as a promising treatment for chronic subdural hematomas. This was a retrospective cohort study of patients with chronic subdural hematomas who underwent MMAE at Saint Luke’s Hospital. We found that MMAE appears safe and effective in patients with chronic subdurals who are on antithrombotic therapy. Treatment failure rates were similar between patients on antithrombotic therapy (11.1%) and those not on antithrombotic therapy (13.3%), with no significant differences in rebleeding, hematoma expansion, or need for rescue treatment.
Presented by
Hatcher, Susanna, MD, MS
Institution
Saint Luke's Hospital Kansas City
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Poster: Temporal Trends, Cardiovascular Complications, and Outcomes in Patients Receiving CAR T-Cell Therapy: A 6-Year Nationwide Analysis

Temporal Trends, Cardiovascular Complications, and Outcomes in Patients Receiving CAR T-Cell Therapy: A 6-Year Nationwide Analysis

Karnav Modi, MD; Himil Mahadevia, MD; Raj Shah, MD; Deepthi Vodnala, MD; Talal Asif, MD; Taiyeb Khumri, MD; Furha Cossor, MD

Abstract
Background

Chimeric antigen receptor (CAR) T-cell therapy has transformed the treatment of relapsed or refractory hematologic malignancies, offering durable responses in heavily pretreated populations. Despite its growing use, real-world data on cardiovascular complications and inpatient outcomes remain limited.

Objective

In this study, will analyze national hospital data from 2017 to 2022 to examine trends and complications associated with CAR T-cell therapy.

Methods

We utilized the National Inpatient Sample (NIS) from 2017 to 2022 to identify hospitalizations involving CAR T-cell therapy using ICD-10-PCS codes. Temporal trends in utilization, in-hospital mortality, cardiovascular complications, and other clinical outcomes were assessed. Survey-weighted regression models were used to evaluate trends over time, adjusting for demographic and hospital-level characteristics. Cardiovascular outcomes included arrhythmias, conduction disorders, acute myocardial infarction, stroke, cardiogenic shock, and major adverse cardiovascular and cerebrovascular events (MACCE).

Results

A total of 13,370 weighted hospitalizations involving CAR T-cell therapy were identified, with utilization increasing markedly from 70 cases in 2017 to 4,335 in 2022. The overall in-hospital mortality rate was 3.4%, with a modest decline over time. Cardiovascular complications were observed in a notable proportion of patients, with arrhythmias occurring in 20.2%, acute myocardial infarction in 0.5%, stroke in 1.0%, cardiogenic shock in 0.2%, and MACCE in 4.5%. Atrial fibrillation was the most common arrhythmia subtype (11.1%), followed by conduction abnormalities (3.9%). The prevalence of arrhythmias increased significantly with advancing age, reaching 48.3% in patients older than 80 years. Non-cardiovascular complications included acute kidney injury in 14.4%, with 1.7% requiring renal replacement therapy. Cytokine release syndrome was observed in 61.0% of patients in 2021 and 62.1% in 2022, while immune effector cell–associated neurotoxicity syndrome was documented in 24.2% in 2022. Mean length of hospital stay was 18.3 days, declining over time, whereas inflation-adjusted hospitalization costs increased substantially from $83,939 in 2017 to $378,507 in 2022.

Conclusions

CAR T-cell therapy utilization has increased rapidly across the United States, accompanied by relatively low in-hospital mortality but a significant burden of cardiovascular complications, particularly arrhythmias. These findings underscore the importance of cardiovascular risk stratification, vigilant monitoring, and multidisciplinary care in patients undergoing CAR T-cell therapy, especially among older and high-risk populations.

Lay Summary

CAR T-cell therapy is an advanced cancer treatment that has improved outcomes for patients with difficult-to-treat blood cancers. As its use increases across the United States, it is important to understand not only how well it works but also its potential risks.

In this study, we analyzed national hospital data from 2017 to 2022 to examine trends and complications associated with CAR T-cell therapy. We found that its use has increased significantly and that the risk of death during hospitalization remains relatively low. However, some patients experience heart-related side effects, most commonly abnormal heart rhythms, particularly in older individuals.

These findings highlight the need for careful heart monitoring before and after treatment. As CAR T-cell therapy continues to expand, improving awareness and early management of these complications may enhance patient safety. Future research should focus on identifying high-risk patients and developing strategies to reduce these side effects.
Presented by
Modi, Karnav, MD
Institution
University of Missouri - Kansas City | Saint Luke's Hospital of Kansas City
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Poster: Imaging Cardiac Amyloid: Does PET Outperform Cardiac MRI? A Meta-Analysis

Imaging Cardiac Amyloid: Does PET Outperform Cardiac MRI? A Meta-Analysis

Poojan Prajapati, MBBS; Anjali Bhardwaj, MBBS; Mohamad Fael, MD; David G. Gonzalez-Sanchez, MD; Talal Asif, MD

Abstract
Background

Cardiac amyloidosis is an increasingly recognized cause of heart failure where early diagnosis is critical for management and prognosis. Cardiac Magnetic Resonance (CMR) detects indirect structural and tissue changes such as extracellular volume expansion and late gadolinium enhancement, whereas Positron Emission Tomography (PET) enables direct molecular imaging of amyloid deposition. Differences in cost, radiation exposure, and availability make comparison clinically relevant, and no prior meta-analysis has directly compared their diagnostic accuracy.

Objective

Two advanced imaging tests are commonly used: Cardiac MRI, which shows structural changes in the heart, and PET scans, which can directly detect protein buildup. In this study, we combined results from multiple studies to compare how well these tests diagnose cardiac amyloidosis.

Methods

A systematic review following PRISMA guidelines searched PubMed, Embase, Scopus, and Cochrane through February 2026. Studies evaluating diagnostic performance of both modalities were included, including transthyretin and light-chain cardiac amyloidosis. Pooled sensitivity and specificity were calculated using meta-analytic models, and relative sensitivity and specificity were compared using risk ratios.

Results

Of 72 screened records, 15 studies were fully reviewed and 10 met inclusion criteria. Pooled sensitivity was similar between modalities (CMR 90%, PET 90%), with no significant difference on relative analysis (RR 0.98, 95% CI 0.91-1.05; p = 0.59). Pooled specificity was numerically higher for PET (99%) compared with CMR (89%); however, relative specificity analysis showed no statistically significant difference (RR 0.98, 95% CI 0.87-1.10; p = 0.72).

Conclusion

CMR and PET demonstrate comparable sensitivity and specificity for detection of cardiac amyloidosis. Although PET showed numerically higher pooled specificity, relative analysis found no significant difference between modalities. PET and CMR provide complementary strengths through direct molecular imaging and tissue characterization, supporting a multimodality approach to improve diagnostic confidence in suspected cardiac amyloidosis.

Lay Summary

Cardiac amyloidosis is a condition where abnormal proteins build up in the heart, leading to heart failure if not detected early. Early and accurate diagnosis is important because treatment can improve outcomes.

Two advanced imaging tests are commonly used: Cardiac MRI, which shows structural changes in the heart, and PET scans, which can directly detect protein buildup. In this study, we combined results from multiple studies to compare how well these tests diagnose cardiac amyloidosis.

We found that both tests perform similarly in detecting the disease, with PET showing slightly higher ability to rule it out, though the difference was not significant. These findings suggest both tests are valuable and can complement each other, helping doctors choose the most appropriate test based on patient needs.
Presented by
Prajapati, Poojan, MBBS
Institution
University of Missouri - Kansas City
Poster: PCABs or PPIs: Which Better Prevents Upper GI Bleeding? A Meta-Analysis

PCABs or PPIs: Which Better Prevents Upper GI Bleeding? A Meta-Analysis

Poojan Prajapati, MD; Vatsa Bhavsar, MD; Mayank Goyal, MD; Muhammad Shah Miran, MD

Abstract
Background

Upper gastrointestinal (GI) bleeding is a common and serious complication. Proton pump inhibitors (PPIs) are standard for prevention, but potassium-competitive acid blockers (PCABs) offer more rapid and potent acid suppression, faster onset of action, and the advantage of reliable oral administration compared with intravenous PPIs. Most evidence for PCABs comes from Asian studies, including post–endoscopic submucosal dissection (ESD) patients, while US data remain limited. Comparative effectiveness across broader populations is not well established.

Objective

Compare proton pump inhibitors (PPIs) and the newer drugs known as potassium-competitive acid blockers (PCABs) to see which better prevents bleeding.

Methods

Following PRISMA guidelines, we searched PubMed, Cochrane, Embase, and Scopus through October 2025 using the following terms (vonoprazan OR “TAK 438” OR “potassium competitive acid blocker”) AND (“proton pump inhibitor” OR PPI OR omeprazole OR lansoprazole OR pantoprazole) AND (“gastrointestinal bleeding” OR “peptic ulcer bleeding” OR “re bleeding” OR “post ESD bleeding”). Studies comparing PCABs with PPIs for GI bleeding prevention were included. The primary outcome was incidence of GI bleeding. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random- or fixed-effects models. Subgroup analyses included randomized controlled trials (RCTs) only and analyses excluding post-ESD patients.

Results

Of 22 screened records, 10 studies (97,377 patients: 37,944 PCAB, 50,003 PPI) met inclusion criteria. Across all patients, PCABs showed a non-significant reduction in GI bleeding (RR 0.79, 95% CI 0.59–1.07; p = 0.13). In RCTs only, bleeding trended lower with PCABs (RR 0.57, 95% CI 0.29–1.13; p = 0.108). Excluding post-ESD patients, the effect was attenuated (RR 0.87, 95% CI 0.67–1.13; p = 0.3).

Conclusion

PCABs demonstrate a trend toward lower GI bleeding compared with PPIs, particularly in randomized controlled trials, though differences were not statistically significant. The benefit appears less pronounced when post-ESD patients are excluded. Given their rapid onset, potent acid suppression, and ease of oral administration, further large, high-quality studies are needed to clarify the role of PCABs in preventing GI bleeding across diverse patient populations.

Lay Summary

Upper gastrointestinal (GI) bleeding can be a serious and sometimes life-threatening condition. Medications called proton pump inhibitors (PPIs) are commonly used to prevent it, but newer drugs known as potassium-competitive acid blockers (PCABs) may work faster and more effectively. We reviewed available studies comparing these two treatments to see which better prevents bleeding. Our findings suggest that PCABs may reduce the risk of bleeding compared to PPIs, but the difference was not statistically significant. More research, especially in diverse populations, is needed. If confirmed, PCABs could offer a faster, more convenient option for preventing GI bleeding in everyday clinical practice.
Presented by
Prajapati, Poojan, MBBS
Institution
University of Missouri - Kansas City
Poster: Early Palliative Care and Symptom-Directed Care Utilization in Pancreatic Cancer: A National Epic Cosmos Analysis

Early Palliative Care and Symptom-Directed Care Utilization in Pancreatic Cancer: A National Epic Cosmos Analysis

Srinivasan, Varshini, MBBS, PGY1 Internal Medicine

Abstract
Background

Pancreatic cancer is associated with high symptom burden and frequent acute care utilization. Although early palliative care improves quality of life in advanced malignancies, real-world data describing its timing and downstream impact in pancreatic cancer remain limited.

Objective

Evaluate if early implementation of palliative care may improve coordination of symptom-focused care and represent an actionable quality-of-care target in pancreatic cancer.

Methods

We conducted a retrospective cohort study using Epic Cosmos (2015–2025). Adults (≥18 years) with pancreatic cancer were identified using ICD-10 code C25. Early palliative care was defined as a documented palliative care encounter (ICD-10 Z51.5) within 0–2 months of cancer diagnosis. Patients were categorized as early palliative care versus not-early palliative care (late or no palliative care). A landmark approach was applied, with outcomes assessed beginning 2 months after diagnosis to mitigate immortal time bias. Outcomes included opioid use, antiemetic use, occupational/physical therapy (OT/PT) utilization, emergency department (ED) encounters resulting in inpatient admission, and inpatient length of stay.

Results

Among 4,641 patients with pancreatic cancer, 464 (10.0%) received early palliative care, 365 (7.9%) received palliative care later, and 3,812 (82.1%) had no documented palliative care encounter. Compared with patients without early palliative care, early palliative care recipients demonstrated higher utilization of symptom-directed interventions, including opioids (40.6% vs 22.5%), antiemetics (37.2% vs 20.3%), and occupational/physical therapy services (6.2% vs 3.2%). Early palliative care was associated with a higher proportion of emergency department encounters resulting in inpatient admission (52.5% vs 23.6%), consistent with earlier consolidation of symptom-driven care. Mean inpatient length of stay was similar between groups (6.0 vs 6.2 days). Overall survival appeared comparable between groups; however, survival estimates in EHR-based analyses are limited by residual confounding and timing constraints.

Conclusions

In a large national EHR cohort, early palliative care within two months of pancreatic cancer diagnosis was infrequently used but was associated with greater engagement in symptom-directed medications and supportive services, as well as a distinct downstream pattern of acute care utilization. These findings suggest that earlier integration of palliative care may improve coordination of symptom-focused care and represent an actionable quality-of-care target in pancreatic cancer.

Lay Summary

Pancreatic cancer often causes serious symptoms such as pain, nausea, and fatigue, which can greatly affect daily life and lead to frequent hospital visits. Palliative care focuses on relieving these symptoms and improving quality of life, but it is not always offered early in the course of illness.

This study found that only about 1 in 10 patients received early palliative care. Those who did were more likely to receive treatments for pain and nausea and to use supportive services like physical or occupational therapy. They also had more hospital admissions through the emergency department, likely reflecting more proactive symptom management.

Future efforts could focus on encouraging earlier use of palliative care, improving patient and family awareness, and developing systems to connect patients with supportive care soon after diagnosis. Overall, this study highlights an opportunity to improve care by integrating supportive services earlier in treatment.

Overall, this study highlights a clear opportunity to improve care for people with pancreatic cancer by integrating supportive services earlier in their treatment journey
Presented by
Srinivasan, Varshini, MBBS, PGY1 Internal Medicine
Institution
Saint Luke's & UMKC
Poster: Using the Seattle Angina Questionnaire in Identifying Coronary Microvascular Dysfunction on PET Scans in Patients with ANOCA

Using the Seattle Angina Questionnaire in Identifying Coronary Microvascular Dysfunction on PET Scans in Patients with ANOCA

Manvita Tatavarthy, MD, MS; Dany Jacob, MD; Yoon Joo Cho, MS; Philip G. Jones, MS; Brett Sperry, MD; Anna Grodzinsky, MD; Timothy Bateman, MD; John Spertus, MD, MPH

Abstract
Background

Nuclear stress testing is the cornerstone of epicardial coronary disease diagnosis, but some patients experience angina despite normal myocardial perfusion and epicardial coronaries due to coronary microvascular disease (CMD). The relationship between patient-reported health status and CMD is unknown. We evaluated associations of Seattle Angina Questionnaire-7 (SAQ-7) with myocardial blood flow reserve (MBFR) on PET scans to see if the SAQ-7 could serve as an early screening tool for CMD.

Objective

Determine whether the Seattle Angina Questionnaire (SAQ), a patient questionnaire regarding chest pain and related symptoms, can help predict coronary microvascular dysfunction (CMD).

Methods

Patients from a single-system prospective registry of patients with normal perfusion on PET who completed the SAQ-7 were included. CMD was defined as normal myocardial perfusion with abnormal MBFR (≤ 1.80). A multivariable logistic regression model examined predictors of CMD, including SAQ-7 physical limitation (SAQ-PL) and angina frequency (SAQ-AF) domains.

Results

Compared to patients with MBFR > 1.80, those with MBFR ≤ 1.80 were more likely to have hypertension, diabetes and higher Agatston scores. Lower SAQ- PL (greater physical limitation) and higher SAQ-AF (less frequent angina) scores were independently associated with a greater likelihood of CMD (Figure). Conclusions

Greater physical limitation and less frequent angina were independently associated with abnormal MBFR. While it is possible that patients with CMD limit their activity to minimize symptoms, further research is needed to understand these associations and develop better strategies for evaluating these patients.

Lay Summary

This project investigates whether the Seattle Angina Questionnaire (SAQ), a patient questionnaire regarding chest pain and related symptoms, can help predict coronary microvascular dysfunction (CMD). This condition can be a cause of chest pain, even when stress tests or coronary angiograms don’t show blockages in the large arteries of the heart and is unsurprisingly hard to diagnose with these standard tests. Specifically, CMD is caused when the small arteries of the heart, rather than the large arteries, have blockages. Given the difficulty of diagnosis, being able to use the SAQ as a predictor for CMD may help patients receive referrals for appropriate testing and obtain a diagnosis much earlier. In our study we were able to identify certain patterns in the results of the SAQ, which he hope to incorporate into a screening tool in the future.
Presented by
Tatavarthy, Manvita, MD MS
Institution
Saint Luke's Mid America Heart Institute/UMKC
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Poster: TMP/SMX vs Alternative PJP Prophylaxis: A Retrospective Analysis of Post-Kidney Transplant UTI Risk

TMP/SMX vs Alternative PJP Prophylaxis: A Retrospective Analysis of Post-Kidney Transplant UTI Risk

Brandon Florey, PhamD; Bre Clark, PharmD, BCTXP; Lindsey Dezotell, PharmD, BCPS; Lauren Rice, PharmD, BCTXP; Colton Essex, PharmD

Abstract
Background

Urinary tract infections (UTIs) are the most common infectious complication following kidney transplantation and represent a major source of morbidity. Trimethoprim-sulfamethoxazole (TMP/SMX) serves as first-line prophylaxis against Pneumocystis jirovecii pneumonia (PJP) and also provides uropathogen coverage. Intolerance to TMP/SMX frequently necessitates use of alternatives (dapsone, atovaquone, pentamidine) that lack urinary antibacterial activity, yet comparative UTI data across these agents remain limited.

Objective

Evaluate whether the choice of PJP prophylaxis – TMP/SMX versus alternative agents – is associated with differences in the incidence of urinary tract infections among kidney transplant recipients.

Methods

This single-center, retrospective cohort study included adults who underwent kidney transplantation at Saint Luke’s Hospital of Kansas City from 2015-2025 and received the same PJP prophylaxis agent for 80% of the 180-day follow-up period. The primary outcome was treated UTI incidence within 180 days, comparing TMP/SMX to a composite group of dapsone, atovaquone, and pentamidine. Secondary outcomes included total UTIs treated, UTI-related hospitalizations, and UTI incidence by prophylactic agents.

Results

Of 598 patients, 468 received TMP/SMX and 130 received alternatives. The primary endpoint of cumulative 6-month UTI incidence was 25.2% for TMP/SMX and 35.4% in the alternative group (aHR 1.5, 95% CI 1.06-2.12, p=0.02). The mean number of UTIs was also lower with TMP/SMX (0.5 ± 1.1 vs 0.9 ± 1.6, p<0.001). Individual comparisons of TMP/SMX versus dapsone and atovaquone did not reach statistical significance (p=0.08 and p=0.06, respectively). Incidence of UTI-related hospitalizations were not statistically different between groups (aHR 1.77, 95% CI -0.31-1.46, p = 0.2).

Conclusions

TMP/SMX prophylaxis is associated with significantly lower UTI incidence in the first 6 months post-kidney transplant. These findings support TMP/SMX as the preferred prophylactic agent and highlights the need for optimized antibacterial strategies in patients requiring alternative PJP prophylaxis.

Lay Summary

After a kidney-transplant, patients take medications to prevent a serious lung infection called Pneumocystis pneumonia. The most common medication used is TMP/SMX (Trimethoprim-sulfamethoxazole). However, some patients cannot tolerate it and must use alternatives like dapsone, atovaquone, or pentamidine. Unlike TMP/SMX, these alternatives do not have antibacterial properties like TMP/SMX and may not protect against urinary tract infections (UTIs) – the most common infection after kidney transplant.

We studied 598 kidney transplant patients and found that those on TMP/SMX had significantly fewer UTIs in the first six months after transplant compared to those on alternatives (25.2% vs 35.4%). This suggests that TMP/SMX does more than prevent lung infections, it also helps prevent UTIs compared to the alternatives. These findings help highlight the need for better strategies to prevent UTIs in patients who cannot take TMP/SMX.
Presented by
Florey, Brandon, PharmD
Institution
Saint Luke's
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Poster: Comparison of Various Dosing Strategies of Alteplase With or Without Dornase Alfa for the Treatment of Empyema or Complicated Parapneumonic Effusion​

Comparison of Various Dosing Strategies of Alteplase With or Without Dornase Alfa for the Treatment of Empyema or Complicated Parapneumonic Effusion​

Christina Nguyen, PharmD; Tyler Barnes, PharmD, BCPS; Tim Berry, PharmD, BCCCP; Audrey Wenski, PharmD; BCCCP

Abstract
Background

Complicated parapneumonic effusions and empyemas are severe complications of pneumonia often requiring antibiotics and pleural drainage. Intrapleural tissue plasminogen activator (tPA, alteplase) and deoxyribonuclease (DNase, dornase alfa) have been proposed to improve drainage by disrupting loculations and reducing fluid viscosity. Although prior randomized data demonstrated improved outcomes with combination therapy, optimal dosing strategies remain unclear, with substantial variability in clinical practice.

Objective

This retrospective study aims to evaluate whether specific dosing strategies of intrapleural alteplase, with or without dornase alfa, are associated with treatment success, defined as discharge without thoracic surgical intervention.

Secondary outcomes include bleeding events, in-hospital mortality, total hospital length of stay, post-treatment length of stay, and chest tube output.

Methods

Adult patients admitted to Saint Luke’s Hospital of Kansas City between April 2014 and August 2025 who received at least one dose of intrapleural alteplase for complicated parapneumonic effusion or empyema will be included. The primary analysis will compare outcomes between alteplase alone and combination therapy. Secondary analyses will assess alternative dosing regimens, cumulative dosing, and adherence to established protocols. Data will also be analyzed by year of treatment to account for changes in technology, clinical practice, and institutional procedures over time.

This study seeks to clarify the relationship between intrapleural fibrinolytic dosing strategies and treatment success, providing evidence to guide optimal, safe, and effective management of complicated parapneumonic effusions and empyemas. Findings may help inform standardized, evidence-based approaches to intrapleural therapy.

Results

Results of this study are still in progress.

Conclusion

A conclusion will be provided once results are available.

Lay Summary

Parapneumonic effusion refers to the accumulation of fluid within the pleural space, most often in the setting of pneumonia or another pulmonary infection. When this fluid becomes infected and left untreated, membranes can organize into a dense peel that encases the lung and prevents full expansion. Historically, the management of complicated parapneumonic effusions and empyema relied on antibiotics with or without surgical intervention to drain infected fluid and break up loculations, but recent studies have explored the use of alteplase and dornase instead of surgery. However, the optimal dosing regimen for this therapy remains uncertain. Considerable variability exists in dose selection, frequency, and duration across institutions. This study aims to address this gap by evaluating whether specific dosing strategies of alteplase and/or dornase alfa are associated with greater treatment success, defined as discharge without the need for thoracic surgery while also assessing safety concerns like bleed risk.
Presented by
Nguyen, Christina, PharmD
Institution
Saint Luke's Hospital of Kansas City
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Poster: Evaluation of Cost Saving Strategies for Multidose Inhalers in a Health System

Evaluation of Cost Saving Strategies for Multidose Inhalers in a Health System

Josh Scheck, PharmD, Scott Aldrige, PharmD, BCPS

Abstract
Background

Chronic obstructive pulmonary disease (COPD) and asthma affect millions of Americans and often require complex outpatient regimens involving multidose inhalers (MDIs) and nebulizers. When patients are admitted to the hospital, these therapies are typically continued based on their pre-admission medication lists. However, MDIs are among the most expensive medications used in the inpatient setting, with per-canister costs ranging from approximately $50 to $300.

Significant waste occurs during hospitalization due to misplaced inhalers during patient transport, failure to transfer inhalers between units, accidental disposal, or patient discharge before the canister is fully used. These inefficiencies increase pharmacy workload due to replacement dispensing and may delay respiratory therapy administration, negatively affecting workflow and patient care efficiency.

Objective

The purpose of this study is to evaluate and implement a cost-saving strategy to reduce inpatient MDI waste and overall inhaler expenditures within our institution. This initiative is being developed in collaboration with the System Pharmacy and Therapeutics (P&T) Committee, pulmonology, and respiratory therapy services to ensure clinical appropriateness and stakeholder alignment.

Methods

TThis implementation study is being conducted at a small academic medical center. Multiple cost-mitigation strategies were evaluated to determine the best fit for our health system. These included switching from MDIs to nebulizers, delaying inhaler initiation until hospital day 2 to confirm patient stability, and loading inhalers into automated dispensing cabinets to improve dispensing and tracking.

Results

The chosen strategy was to store multidose inhalers in automated dispensing cabinets to improve access for staff and reduce medication loss during patient transfers. Other strategies, such as a full transition to nebulizers or delayed initiation of inhalers, were not adopted due to a lack of anticipated cost savings or concerns about patient satisfaction.

Conclusion

This change is currently being implemented at Saint Luke’s, and purchasing data, along with employee satisfaction, will be evaluated after a defined post-implementation period.

Lay Summary

All health systems face challenges related to lost medications within the hospital, which can lead to delays in patient care and increased costs for both patients and institutions. One of the most common sources of medication waste in hospitals is multidose inhalers. These inhalers typically contain a 7–14 day supply of doses, while most patients have hospital stays lasting only 3–6 days. As a result, multiple inhalers are often dispensed due to loss during patient transfers or accidental disposal.

Our project aimed to identify strategies to improve inhaler dispensing and storage to reduce waste. Several approaches were evaluated through discussions with a multidisciplinary team. The selected intervention was to store inhalers in automated dispensing cabinets to improve tracking and accessibility. Costs and outcomes will be evaluated over time to assess the impact of this change.
Presented by
Scheck, Josh, PharmD
Institution
Saint Luke's
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Poster: Intravenous Versus Enteral Famotidine For Stress ulcer Prophylaxis in Critically Ill Patients

Intravenous Versus Enteral Famotidine For Stress ulcer Prophylaxis in Critically Ill Patients

Lakin Adams, PharmD; Adham Mohamed, PharmD, BCCCP; Emily Nicholson, PharmD, BCCCP; Kyle Klindworth, PharmD, BCCCP

Abstract
Background

Critically ill patients are at increased risk of stress ulcers due to many factors. The Society of Critical Care Medicine and American Society of Health-System Pharmacists Guidelines for Stress Ulcer Prophylaxis (SCCM/ASHP) recommend stress ulcer prophylaxis (SUP) for all critically ill patients with risk factors for upper gastrointestinal (GI) bleed, defined as: coagulopathy, shock, or chronic liver disease. Guidelines recommend SUP with either proton pump inhibitors (PPI) or histamine-2 receptor antagonists (H2RA) with no identified preference for agent or route of administration. Current practice within the health system includes administering medications enterally as soon as the patient can tolerate. This is achieved using a linked order, allowing nurse-driven administration based on patient status. Bioavailability of many medications may be impaired in critical illness, potentially altering efficacy of SUP.

Objective

This study will investigate the difference in efficacy between intravenous (IV) and enteral famotidine for SUP in critically ill patients.

Methods

This study was a single health system, multi-center, retrospective cohort study (n=19,894). We included all ICU patients 18 years or older receiving famotidine for SUP. Patients who received PPI prior to admission or prior to famotidine treatment, died within 24 hours of ICU admission or had diagnosis of GI bleed prior to ICU admission were excluded. Outcomes were analyzed using multi-variable regression and Cox-regression as appropriate.

Results

The primary outcome of incidence of treatment failure was defined as one or more of the following: escalation to continuous infusion or twice daily PPI, endoscopic intervention, or new GI bleed diagnosis, occurred in 15.3% of patients, odds ratio (OR) 2.822 (95%CI 2.531-3.146) when patients received 100% of their famotidine doses IV. Secondary outcomes included in-hospital mortality (OR 3.338) and need for blood transfusion after receipt of famotidine (OR 0.823). Subgroup analysis performed with groups defined as ≥80% of doses given either IV or enteral, found that patients who received ≥80% IV had higher severity of illness and higher instance of GI bleed risk factors.

Conclusion

Results of this study indicate that patients with higher severity of illness may be more likely to receive more famotidine doses IV and may have higher instance of famotidine treatment failure.

Lay Summary

Critically ill patients are at risk of stress ulcers due to a variety of factors. These ulcers can quickly develop into gastrointestinal bleeding, which can increase both hospital length of stay and overall mortality risk. The Society of Critical Care Medicine and American Society of Health-System Pharmacists Guidelines for Stress Ulcer Prophylaxis (SCCM/ASHP) recommend stress ulcer prophylaxis (SUP) for all critically ill patients with risk factors for upper GI bleed. Guidelines recommend use of either a proton pump inhibitor (PPI) or histamine-2 receptor antagonist (H2RA), such as famotidine, but do not indicate a preference for agent or route (IV vs enteral). While there have been some studies to assess difference in efficacy between IV and enteral PPI administration, no such evidence exists to compare dosage forms of famotidine. This study will investigate the difference in efficacy between IV and enteral famotidine for stress ulcer prophylaxis in critically ill patients.
Presented by
Adams, Lakin, PharmD
Institution
Saint Luke's Hospital of Kansas City
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Poster: Impact of Inpatient IV Iron Administration in Iron-Deficient Patients Admitted for Unrelated Diagnoses

Impact of Inpatient IV Iron Administration in Iron-Deficient Patients Admitted for Unrelated Diagnoses

Kayla Batdorf, PharmD; Scott Aldridge, PharmD; Brooke Abernathy, PharmD

Abstract
Background

Despite iron deficiency affecting over 2 billion people worldwide and approximately 14% of adults in the United States, no standardized protocol exists for the timing or method of treatment. When iron deficiency is diagnosed during hospitalization, therapy with IV iron replacement can be commenced immediately or postponed until after discharge. Whether patients benefit more from treatment of iron deficiency during hospitalization or after discharge may lead to different clinical outcomes. Inpatient treatment during periods of inflammation may reduce efficacy or increase infection risk, but it could also decrease loss to follow-up.

Objective

This study aims to evaluate the clinical risks and benefits of intravenous (IV) iron administration during hospitalization compared with delayed outpatient treatment.

Methods

We conducted an investigator-initiated, multi-hospital retrospective cohort study within a single health system, including patients identified as iron deficient between October 1, 2022, and September 30, 2025. Patients were stratified based on whether or not they had reported IV iron during hospitalization.

The primary endpoint was hospital readmission at 90 days. Secondary endpoints included mortality at 90 days, emergency department encounters at 90 days, percentage of iron deficit repletion, change in hemoglobin from initial measurement to discharge, length of stay, incidence of inpatient blood transfusion, and occurrence of positive inpatient cultures. Multivariable logistic regression will be performed to adjust for clinically relevant factors, including age, sex, baseline ferritin, active bleeding, and primary diagnosis. These findings aim to inform clinical decision making regarding the optimal timing of IV iron therapy and improving patient outcomes.

Results

There was no statistically significant difference between the readmission rate at 90 days between those who received and those who did not receive iron during inpatient admission. There was also no statistically significant difference between emergency department encounters. There was a statistically significant difference in mortality at 90 days with a statistically lower reported mortality rate in the IV iron treated group.

Conclusion

Further subgroup analysis is underway to determine which patient populations may benefit most from inpatient IV iron treatment during admission after being classified as iron deficient.

Lay Summary

Iron deficiency or low iron affects over 2 billion people worldwide and around 14% of adults in the United States. While it can cause symptoms like weakness, fatigue, headache, and dizziness, iron deficiency is often discovered as a secondary diagnosis for patients during treatment of their primary hospitalized condition(s). Moreover, once diagnosed, there is currently no guided protocol on how to treat it, further complicating paths for patients moving forward. There can be both risks and benefits to treating during a hospital stay or waiting until after a patient leaves to treat their low iron including risk of infection, convenience, efficacy, and length of hospital stay. The purpose of this study is to look at the risks and benefits of different clinical approaches for patients found with iron deficiency.
Presented by
Batdorf, Kayla, PharmD
Institution
Saint Luke's Hospital of Kansas City
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Poster: Delayed Initiation of Basiliximab Post Adult Heart Transplantation

Delayed Initiation of Basiliximab Post Adult Heart Transplantation

Rafael Costa Paganoni, PharmD; Kedra Blunck, PharmD, BCPS; Harley Moore, PharmD; Leah Sanchez, PharmD, BCCCP; Charles H. Hayes III, PharmD, BCCCP, FACC

Abstract
Background

The International Society of Heart and Lung Transplantation guideline recommend induction therapy with a polyclonal antibody preparation in order to delay calcineurin inhibitor (CNI) initiation in the presence of pre-operative renal insufficiency or when there is evidence of AKI within the first two days post-operatively. No specific recommendations are made regarding basiliximab. No published data exist addressing the delayed administration (any time after post-op day 0) of basiliximab in primary HT recipients who have unanticipated AKI.

Objective

Our study aims to assess the safety and efficacy of delayed basiliximab induction in HT recipients with post-operative AKI as a CNI-sparing method.

Methods

This is a retrospective, single-center, observational cohort study that will include adult HT recipients who receive basiliximab as a CNI-sparing method. The primary endpoint is any rejection episode requiring antirejection therapy through 12 months post-transplantation. Secondary endpoints include but are not limited to: (1) time to rejection episode requiring antirejection therapy, (2) death by any cause through 12 months, and (3) infection through 12 months.

Results

The baseline characteristics were well balanced between the two groups. Majority of patients were while males with a median age of 53 years of age.

12-month rates of rejection, survival, and infection were similar between both groups (14.7% vs 23.1%, P=0.3; 88.2% vs 92.3%; 50% vs 56.4%). There was no difference between the two groups for the outcomes of RRT requirement post HT (23.5% vs 20.5%) and duration of RRT (11.5 days vs 24 days, P=0.4). Patients in the standard group achieved therapeutic levels of tacrolimus faster post transplantation (21 days vs 15 days, P=0.024). On the other hand, the statistical significance was lost for the outcome of time to therapeutic levels of tacrolimus after first drug administration (18 days vs 11 days, P=0.053). No difference was observed between the two groups for percentage of time patients had therapeutic levels of tacrolimus during the first year (72% vs 66%). Conclusion

As a conclusion, despite differences in time to therapeutic tacrolimus levels after transplant, delayed basiliximab administration resulted in no difference in rates of rejection or infection at 12 months when compared to standard administration of the drug.

Lay Summary

Our project was designed to assess the safety and efficacy of delayed basiliximab administration in heart transplantation recipients with post-operative renal dysfunction when we want to delay initiation of tacrolimus. Guidelines have no recommendations for the use of basiliximab in this context. We analyzed our current practice at Saint Luke’s and expect our data will facilitate protocol updates. Additionally, we hope this pilot project will lead to future larger studies looking at the immunological risk and benefits of using basiliximab for such specific indication.
Presented by
Costa Paganoni, Rafael, PharmD
Institution
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Poster: Outcomes in Renal Transplant Recipients Receiving Four Drug Immunosuppression with Belatacept VS.. Three Drug Immunosuppression

Outcomes in Renal Transplant Recipients Receiving Four Drug Immunosuppression with Belatacept VS.. Three Drug Immunosuppression

Emily Do, PharmD; Lindsey DeZotell, PharmD; Breanna Clark, PharmD; Colton Essex, PharmD; Lauren Rice, PharmD

Abstract
Background

Immunosuppression requires careful consideration of patient specific factors and tolerability. The standard maintenance immunosuppression regimen in renal transplant recipients includes a calcineurin inhibitor (CNI), mycophenolate, and prednisone. Belatacept is an alternative to CNI if patients present with intolerability to this class – most commonly neurotoxicity or nephrotoxicity.

Patients at high immunological risk, exhibit CNI intolerance, or have continued rejection on three-drug immunosuppression (3IS) may be initiated on four-drug immunosuppression (4IS), which is the standard maintenance immunosuppression in addition to belatacept. This is a multimodal approach to reduce CNI-related side effects, preserve renal function, and prevent rejection. There is limited evidence on the clinical implications of 4IS in renal transplant recipients.

Objective

The purpose of this study is to evaluate the safety of 4IS with belatacept in renal transplant recipients compared to 3IS.

Methods

A single-center, retrospective cohort study will be conducted from January 1, 2017 to August 31, 2025. Patients will be analyzed based on their immunosuppression regimen of mycophenolate, prednisone, and either belatacept, tacrolimus, or both. Those in the 4IS group will be matched with patients in the 3IS comparator group. The primary outcome will be a composite score of infections, malignancy, and patient death at 6 and 12 months after initiating 4IS. Secondary outcomes include graft loss, rejection, and number of hospitalizations within 12 months of therapy initiation, and change in renal function and absolute lymphocyte counts at 1,3,6, and 12 months after initiation.

Results

There is limited evidence on the clinical implications of 4IS.​ The results of this study will provide data on safety outcomes for renal transplant recipients on 4IS. ​

Conclusion

Further research is warranted​

Lay Summary

Renal transplant recipients require immunosuppression medications indefinitely to prevent rejection. The standard regimen includes a calcineurin inhibitor (CNI), mycophenolate, and prednisone. Belatacept is another immunosuppression agent that can be used if patients are at high risk for rejection or exhibit intolerance to CNI. Patients may be switched to belatacept or belatacept will be added to create a four-drug immunosuppression regimen (4IS). This will reduce CNI-related side effects – most commonly neurotoxicity or nephrotoxicity, preserve renal function, and prevent rejection. There is limited evidence on the clinical implications of 4IS in renal transplant recipients. The results of this study will provide data on the safety outcomes for patients on 4IS in comparison to the standard immunosuppression regimen and inform clinicians on additional strategies to optimize therapies to prevent rejection, while maintaining safety.
Presented by
Do, Emily, PharmD, MPH
Institution
Saint Luke's Hospital
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Poster: Fresh Frozen Plasma vs Prothrombin Complex Concentrate for the Reversal of Warfarin-Associated Gastrointestinal Bleeding

Fresh Frozen Plasma vs Prothrombin Complex Concentrate for the Reversal of Warfarin-Associated Gastrointestinal Bleeding

John Hyde, PharmD; Adham Mohamed, PharmD, BCCCP; Joe Blunck, PharmD, BCCCP; Lauren Stillman, PharmD

Abstract
Background

While current guidelines increasingly recommend prothrombin complex concentrate (PCC) for major bleeding, evidence supporting its use in gastrointestinal (GI) bleeding remains limited and conflicting. Previous studies reliably show faster INR correction with PCC, while some new literature raises concerns about increased mortality.

Objective

The purpose of this study is to evaluate and compare the safety and effectiveness of fresh frozen plasma (FFP) and PCC for warfarin reversal in patients presenting with warfarin-associated GI bleeding.

Methods

Outcomes related to anticoagulation reversal, hemostasis, adverse events, and clinical outcomes were assessed in order to inform institutional practice and protocol optimization.

This multi-center retrospective cohort study was conducted within a single health system using data obtained from Saint Luke’s electronic medical records. The study period spanned April 1, 2014, through August 31, 2025, with follow-up from the day of admission through 28-day post-admission period. Adult patients (≥18 years) with documented active upper or lower GI bleeding requiring reversal with PCC or FFP and prior warfarin use were included. Patients were excluded for anticoagulant use other than warfarin, intracranial or intraspinal hemorrhage, traumatic or post-surgical bleeding etiology, Jehovah’s Witnesses, or reversal outside the health system. The primary endpoint is the total volume of blood products (excluding FFP) received within 48 hours of initial warfarin reversal agent administration.

Secondary endpoints included time to INR ≤1.5, thromboembolic events within 30 days, time to procedure, in-hospital and ICU mortality, and hospital and ICU length of stay.

Results

Results of this study are still in progress.

Conclusion

A conclusion will be provided once results are available.

Lay Summary

Warfarin is a commonly used blood thinner, but it can sometimes cause serious bleeding in the gastrointestinal tract. When this happens, quick reversal of its effects is essential to stop the bleeding. Two main treatments are used: fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). While PCC works faster in some cases, there are concerns it may carry higher risks, and it’s not clear which option is best for gastrointestinal bleeding. This study aims to compare how safe and effective FFP and PCC are for patients with this type of bleeding.

Researchers reviewed past patient records to look at outcomes like how quickly bleeding was controlled, how much blood transfusion was needed, and whether complications occurred. The findings will help guide clinicians in choosing the safest and most effective treatment in this patient population, improving patient care and potentially shaping future hospital guidelines.
Presented by
Hyde, John, PharmD
Institution
Saint Luke's Hospital of Kansas City
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Poster: Rate of Continuation of Midodrine for Vasopressor Weaning at ICU and Hospital Discharge

Rate of Continuation of Midodrine for Vasopressor Weaning at ICU and Hospital Discharge

Lindsey Rowatt, PharmD; Courtney Chedester, PharmD; Shelby Shemanski, PharmD

Abstract
Background

IIntravenous vasopressors for hemodynamic support is a primary indication for intensive care unit (ICU) admission. Even after resuscitation and treatment of underlying causes of shock, patients may continue to require vasopressors. Ongoing vasopressor support therefore prolongs ICU length of stay. The oral alpha-1 adrenergic agonist, midodrine, may be used off-label to reduce time to vasopressor discontinuation. The MIDAS trial found no difference in median time to discontinuation of vasopressors after starting midodrine when compared to placebo. Midodrine use did result in more bradycardia events. Few studies have evaluated the effect of continuation of midodrine after ICU discharge. One retrospective study found that midodrine was continued for a median of 5 days beyond ICU discharge in 67% of patients. Additionally, hospital discharge on midodrine was associated with a 1.6-fold higher risk of death in the next year. Harm related to adverse effects and increased mortality seen with hospital discharge on midodrine demonstrates the need to evaluate trends for use of midodrine for vasopressor weaning and implications to continuing discharge.

Objective

The purpose of this study is to evaluate rates of midodrine continuation at ICU and hospital discharge when it is initiated for vasopressor weaning.

Methods

This is a retrospective, multi-center, single health system study evaluating rates of midodrine continuation at ICU and hospital discharge when it is initiated for vasopressor weaning. Adult patients started on midodrine in a Saint Luke’s Health System ICU who received vasopressors prior to midodrine initiation from April 2014 to July 2025 will be included. Patients who died before ICU discharge, have midodrine on a prior to admission medication list, were administered less than 3 doses of midodrine, have a diagnosis of neurogenic shock, or use midodrine for intradialytic hypotension will be excluded. The primary endpoint of this study is rate of midodrine continuation upon ICU and hospital discharge when midodrine was initiated for vasopressor weaning. Secondary endpoints include ICU and hospital length of stay, adverse outcomes with midodrine, new initiation of anti-hypertensive medications while on midodrine, risk factors associated with midodrine continuation, and risk factors associated with midodrine adverse effects.

Results

This study included 385 patients who were initiated on midodrine for vasopressor weaning in an ICU. The most common cause of shock was sepsis in the population. About 54% of patients continued midodrine at ICU discharge. About 54% of patients then continued or resumed midodrine at hospital discharge. Hospital mortality was similar between those who continued midodrine at ICU discharge compared to those who did not stay on midodrine. Older age was found to be associated with a higher odds of midodrine continuation at ICU discharge (OR 1.015, 95% CI [1.001-1.029]).

Conclusion

Given the high rate of continuation of midodrine initiated for vasopressor weaning at ICU and hospital discharge, the project’s authors will implement a protocol to reassess need for midodrine after ICU transfer.

Lay Summary

Intravenous medications for blood pressure support is a common indication for intensive care unit (ICU) admission. Continued requirements for these medications to maintain blood pressure may prolong ICU length of stay. Midodrine, an oral medication that raises blood pressure, may be used to reduce time on these blood pressure support medications. Studies have shown that hospital discharge on midodrine is associated with increased risk for death. Harm related to adverse effects of midodrine demonstrates the need to evaluate trends for use of midodrine to liberate patients from blood pressure support. This study evaluated rates of midodrine continuation at ICU and hospital discharge. The study found that midodrine was continued at ICU discharge in about 54% of patients and continued or resumed at hospital discharge in about 54% of patients. Given this study demonstrated a high rate of midodrine continuation at ICU and hospital discharge, the research team will work to implement a protocol to prevent unnecessary midodrine use. Researchers will then perform a pre/post protocol analysis to evaluate protocol impact on midodrine continuation practices.
Presented by
Rowatt, LIndsey, PharmD
Institution
Saint Luke's
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Poster: Investigating Hypertension Medication Adherence Utilizing proportion of Days Covered

Investigating Hypertension Medication Adherence Utilizing proportion of Days Covered

Dana Abdel Jawad, DNP, MPH, APRN, FNP-C; Robert Elledge, DNP, APRN, AGACNP-BC; Jamie Harrington, DNP, APRN, CNM, FNP-BC, FACNM; Theresa Lockwood, Pharm.D., BCACP; Kristin Repp, Pharm.D., BCPS; Marci Ebberts, MSN, APRN, FNP-C, CCRN

Abstract
Background

Hypertension affects nearly half of adults in the United States and remains a leading contributor to cardiovascular morbidity, mortality, and rising healthcare costs. Although effective pharmacologic therapies are widely available, medication nonadherence continues to limit optimal blood pressure control. Estimates suggest that 20-50% of patients do not take medications as prescribed, underscoring the need for scalable interventions to improve adherence particularly for renin-angiotensin-aldosterone system (RAS) inhibitors, a cornerstone of hypertension management.

Objective

This study aimed to evaluate the effectiveness of targeted telephone outreach on improving medication adherence and to characterize patient-reported barriers among adults identified as nonadherent to prescribed RAS inhibitors, defined by a proportion of days covered (PDC) ≤ 80%.

Methods

A retrospective analysis was conducted using pharmacy refill data, electronic health record (EHR) demographics, and documentation from telephone outreach performed by Population Health Specialists between January and July 2025. A total of 465 patients met criteria for nonadherence based on a PDC threshold. Of these, 131 patients were successfully reached and engaged in a structured phone call intervention focused on adherence support and barrier identification. Pre- and post-intervention adherence outcomes were analyzed using the McNemar test, with descriptive statistics used to summarize reported barriers.

Results

Patients who participated in the telephone outreach demonstrated a statistically significant improvement in medication refill adherence following the intervention (p < 0.001). Among reported reasons for nonadherence, clinical barriers such as medication discontinuation, needing a medication refill, or adverse effects, were more frequently cited than administrative barriers, including data lags, medication stockpiles, or needing to update insurance.

Conclusion

Telephone-based outreach was associated with statistically significant improvements in adherence to RAS medications in a Midwest patient population identified through PDC-based screening. These findings highlight the value of proactive, patient-centered communication strategies and underscore the importance of addressing both clinical and behavioral factors when designing interventions to improve medication adherence. Incorporating a more holistic, individualized assessment of barriers may enhance the effectiveness of population health initiatives targeting chronic disease management.

Lay Summary

High blood pressure is common in the United States, yet many patients do not take their medications as prescribed, increasing their risk of heart disease and stroke. This study evaluated potential barriers for medication adherence and whether a structured phone call could improve medication refills in patients with low proportion of days covered (PDC), a measure of how often patients have access to their medication.

Researchers identified 465 patients not regularly refilling prescriptions for renin-angiotensin-aldosterone system inhibitors; 131 were reached by phone. During these calls, Population Health Specialists discussed medication use and identified barriers.

Patients who received a phone call were significantly more likely to refill their medications. Most barriers were clinical, such as discontinued prescriptions or needing refills, while administrative issues like delays in data reporting were noted.

These findings suggest that phone outreach can improve adherence and highlighted limitations of relying on PDC alone to measure medication adherence.
Presented by
Abdel Jawad, Dana, DNP, MPH, APRN, FNP-C
Institution
Saint Luke's Hospital of Kansas City, Department of Nursing
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Poster: HOB Elevated CPR

HOB Elevated CPR

Jonathan Bonnett, RN, BSN, CCRN; Dominick Berkstresser, BSN, RN; Shelby Lynne, BSN, RN; Zach Ehlen, BSN, RN; Lynda Rose, BSN, RN, CCRN; Jamie Buttram, MSN, RN, CCRN; Yoon J. Cho, MS; Marci Ebberts, MSN, APRRN, CCRN

Abstract
Background

Acute Brain Injury (ABI) patients with increased ICP benefit from head of bed (HOB) elevation. In cardiac arrest, CPR is performed with HOB flat, but animal studies suggest CPR can be effective with HOB elevated using an automated device. The ability of nurses to deliver effective manual CPR with HOB elevated remains unclear.

Objective

Study the feasibility of safe manual CPR with HOB elevated.

Methods

29 ICU and Emergency nurses delivered two 2-minute rounds of continuous chest compressions to a manikin with a CPR feedback device, measuring depth and rate of compressions. Each nurse completed one round with HOB flat and one with HOB elevated to 30°, in randomized order, with a 2-minute rest between. The primary endpoint compared depth and rate of compressions with HOB flat and elevated to the recommended range (depth 2-2.5 inches and rate 100-120/min).

Results

With HOB flat, mean compression rate was 108.55 +/- 4.72/min; with HOB elevated, 107.56 +/- 6.02/min - both within guidelines. Mean compression depth was 3.06 +/- 0.57 in. (flat) and 2.62 +/- 0.44 in. (elevated). Compression depth varied and shallower compressions appeared more frequently with HOB elevated, but this was closer to the recommended depth. Most participants maintained proper rate in both positions.

Conclusion

Nurses were able to perform manual CPR with HOB elevated to 30°, maintaining guideline-compliant rate and depth. Compression depth tended to be excessive when HOB was flat but more appropriate when elevated. These findings support the feasibility of safe manual CPR with HOB elevated—a practice that may offer benefits in patients with increased ICP.

Lay Summary

When someone has a serious brain injury, raising the head of the bed can help reduce pressure in the brain and improve blood flow. However, during cardiac arrest, CPR is typically done with the patient lying flat. This raises an important question: can CPR still be done effectively if the head is elevated?

In this study, nurses performed CPR on a simulation mannequin with the bed flat and with the head raised to 30 degrees. We measured how well they maintained proper compression depth and rate. We found that nurses were able to deliver effective CPR in both positions.

The rate of compressions stayed within recommended guidelines, and compression depth was closer to the ideal range when the head was elevated. These findings suggest that performing CPR with the head elevated may be a safe option, especially for patients with brain injuries.

More research is needed to determine how this approach affects real patient outcomes.
Presented by
Bonnett, Jonathan, RN BSN CCRN
Institution
Saint Luke's
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Poster: Incidence and Predictive Factors of Intensive Care Unit Delirium in Patients with Acute Stroke: A Secondary Data Analysis

Incidence and Predictive Factors of Intensive Care Unit Delirium in Patients with Acute Stroke: A Secondary Data Analysis

Katie Callahan, BSN, RN; Sue Lasiter, PhD, RN; Steven Chesnut, PhD

Abstract
Background

For patients admitted to Intensive Care Units (ICUs) with acute stroke, ICU delirium can compound an already complex hospitalization. The incidence of ICU delirium in patients with acute stroke ranges from 12% to 75%. Development of delirium has been associated with increased length of ICU stay, increased healthcare costs, impaired cognition, and decreased functional independence. Prediction models would facilitate recognition of those at greatest risk for delirium, improve understanding of acute delirium events, and enhance early implementation of interventions. Current models for predicting delirium in acute stroke patients have limited generalizability and clinical applicability.

Objective

The purpose of this secondary data analysis was to determine the incidence of ICU delirium in acute stroke patients and to examine relationships between underexplored factors that may be associated with the development of delirium in this population.

Method

Supported by prevention theory, a retrospective, descriptive, correlational study was conducted. Using data extracted from the electronic medical record, descriptive statistics were used to analyze demographic data and the incidence of delirium. A binary logistic regression statistical analysis was employed to determine the extent to which factors can predict ICU delirium in adult patients admitted to the ICU with acute stroke.

Results

Results indicated a total of 501 of the 2,388 (20.98%) stroke patients in this sample developed delirium at least once during their hospitalization, Of the 501 patients that developed delirium, 42.12% did so within 24 hours of ICU admission, and 60.68% did so within 48 hours of ICU admission.

Conclusion

The final regression model suggested factors significantly associated with development of delirium included type of stroke; history of vision impairment, schizophrenia, or dementia; first RASS score; first MORSE Fall Risk Scale score consistent with “High Fall Risk;” first blood glucose above normal limits; placement of nasogastric tube, peripheral line, or peripherally inserted central catheter within 24 hours of ICU admission; transferring to IR or Neuro OR within 24 hours of ICU admission; and occurrence of fever > 100F. Though these factors are mostly non-modifiable in nature, these data do support a better understanding of the critically ill acute stroke patients most at risk for developing delirium.

Lay Summary

Delirium is a common and serious complication in stroke patients admitted to the ICU, contributing to extended ICU stays, cognitive and functional impairment, and increased mortality. Determining factors capable of predicting delirium could improve our ability to prevent and treat delirium. We sought to determine the incidence of delirium and evaluated factors that commonly occur in ICUs to determine predictive ability. Approximately 20% of patients admitted to the ICU with acute stroke developed delirium, and 60% of those that developed delirium did so within 48 hours of ICU admission. We found that past medical history, high fall risk score, altered level of consciousness, elevated blood glucose, placement of nasogastric tubes or peripheral lines, and transferring to procedures outside the ICU within 24 hours of admission could increase stroke patients’ risk of developing delirium. These findings support a better understanding of critically ill stroke patients most at risk for developing delirium.
Presented by
Callahan, Katie, BSN, RN
Institution
University of Missouri-Kansas City School of Nursing and Health Studies
Poster: Defining Trauma in Stroke: A Concept Analysis to Advance Trauma‑Informed Approach

Defining Trauma in Stroke: A Concept Analysis to Advance Trauma‑Informed Approach

Erin Doan, PhD, AGACNP-BC, ANP-BC; Kelly Bush, MSN, MBA, AGACNP-BC

Abstract
Background

Stroke care continues to advance, yet major disparities persist across race, socioeconomic status, geography, and access to timely treatment. Populations most affected by stroke also carry higher lifetime exposure to trauma, including adverse childhood experiences, structural inequities, and chronic stressors shaped by the social drivers of health. These trauma histories influence how individuals interpret threat, loss of control, and vulnerability during acute neurological events. Despite this overlap, trauma‑informed approaches are not routinely integrated into stroke workflows. A central barrier is that trauma in stroke remains poorly defined, limiting the ability to operationalize Trauma‑Informed Care (TIC) across the stroke continuum. Empirical studies consistently show that survivors experience stroke as a traumatic event marked by sudden threat to multiple domains of life.

Objective

To define trauma in stroke by integrating survivor and caregiver narratives and applying SAMHSA’s Trauma‑Informed Care (TIC) principles as analytic categories.

Methods

Guided by the research question, “How does incorporating survivor and caregiver narratives reshape the conceptual understanding of trauma in stroke care, and what implications does this have for designing trauma‑informed systems?” a hybrid theory‑building approach was used. Walker and Avant’s eight‑step method structured the concept analysis; SAMHSA’s trauma framework informed coding categories; and Braun and Clarke’s reflexive thematic analysis guided data interpretation. A targeted literature review identified qualitative, mixed‑methods, and observational studies containing narrative accounts of stroke onset, acute care, hospitalization, rehabilitation, and early recovery. Data were extracted, coded, and synthesized to identify antecedents, defining attributes, consequences, and TIC gaps. Model, borderline, related, and contrary cases were developed to refine conceptual boundaries and support construction of an integrated conceptual model.

Results

Twelve articles were reviewed. Trauma in stroke emerged as a multifaceted, ongoing experience beginning at acute onset and shaped by prior trauma, neurobiological vulnerability, and coping styles. Antecedents, defining attributes, consequences, and TIC gaps were identified and incorporated into a preliminary conceptual model and working definition of trauma in stroke.

Conclusions

This analysis offers a working definition and conceptual model of trauma in stroke. A systematic review will further refine the construct and strengthen theoretical clarity and clinical applicability.

Implications:

Findings position trauma as a core component of the stroke experience and provide a framework for integrating TIC across acute care, rehabilitation, and follow‑up to improve communication, reduce emotional harm, and enhance recovery, equity, and patient experience.

Lay Summary

Stroke is a time sensitive frightening medical emergency. Survivors often describe the sudden loss of control, changes in their body, confusion, and fear of dying as overwhelming. These reactions can be even stronger for people who have experienced trauma earlier in life which is common in stroke survivors or who face ongoing stress, discrimination, or limited access to care.

This project reviewed survivor and caregiver stories to better understand what trauma looks like during and after a stroke. We found that trauma can come from the stroke itself, from how the brain and body react, and from how the healthcare system responds. These experiences can affect recovery, relationships, and long‑term health.

By defining trauma in stroke more clearly helps guide the development of trauma‑informed approach, care that supports safety, trust, communication, and healing for every patient. The use of this type of care can prevent additional harm during healthcare interactions.
Presented by
Doan, Erin, PhD
Institution
Saint Luke's Neurology, Saint Luke's Health System, BJC
Poster: Advanced Practice Provider Fellowship: Growth, Culture, and Curriculum from First to Most Recent Fellow

Advanced Practice Provider Fellowship: Growth, Culture, and Curriculum from First to Most Recent Fellow

Erin Doan, PhD, AGACNP-BC, ANP-BC; Amy Poindexter, MSN, AGACNP-BC; Patrick Kirk, MSN, FNP-C

Abstract
BACKGROUND

New graduate APPs often face role ambiguity, limited structural support, and high turnover, nearly twice that of physicians. A national neurologist shortage further strains access to care. In response, Saint Luke’s Health System launched a structured fellowship aligned with the American Academy of Neurology’s (AAN) call for collaborative care models to support clinical readiness, identity formation, and retention.

OBJECTIVE

To describe the development, evolution, and institutional impact of a neurology Advanced Practice Provider (APP) fellowship program, as experienced and shaped by the lead APP, the first fellow, and the most recent graduate.

METHODS

Initiated in 2019, the 9-month fellowship hired APPs into budgeted roles with asynchronous enrollment based on departmental needs. It expanded to include experienced APPs and hybrid fellows. Core components included APP co-director leadership, milestone-based salary adjustments, protected education,, weekly mentorship, and optional stress assessments. Fellows accessed resident didactics, AAN’s Continuum journal review, peer-led teaching, and multidisciplinary sessions. Additional foundational activities included shadowing APP/physician experts, monthly meetings on ethics, legal training, professionalism, career development, and a flexible peer support comprehensive program tailored to clinical focus.

Results

Twenty-one fellows across seven subspecialties (Movement, Cognitive, Neuroimmunology, Epilepsy, Headache, Vascular, Neuromuscular) graduated with 100% two-year retention and 90% retention at seven years. APPs evolved into educators, co-developing curricula, mentoring, and leading peer teaching. Physician engagement increased, strengthening a collaborative teaching culture. APP Journal club participation fostered leadership and department engagement. Fellows reported increased confidence in safe, effective practice. Unanticipated outcomes included APP-led research, system-wide committee work, statewide service and expanded leadership roles.

Conclusion

This fellowship model offers a scalable, emotionally attuned framework for integrating APPs into neurology. Its evolution reflects institutional responsiveness, interdisciplinary leadership, and a commitment to sustainable workforce development. Future iterations may include dedicated time for clinic logistics review and mentorship from APPs with efficient workflows based on survey data by neuroscience multidisciplinary feedback.

Lay Summary

Saint Luke’s Health System created a neurology fellowship to help new Nurse Practitioners and Physician Associates (NPs and PAs) transition confidently into their jobs. Many new NPs and PAs enter the workforce with limited support, unclear expectations, and high stress, especially in fields like neurology where provider shortages and community demands are increasing. The fellowship, launched in 2019, offers a structured six‑month learning period with protected education time, weekly mentorship, and opportunities to learn alongside physicians, residents, and experienced NPs and PAs. Fellows participate in classes, case discussions, journal reviews, and hands‑on shadowing across neurology subspecialties.

Over eight years, 21 fellows have completed the program, representing seven areas of neurology. Retention has been strong, and graduates have become educators, mentors, and leaders. The program has strengthened teamwork, expanded NP and PA involvement in research and committees, and improved confidence among new clinicians. Future survey data will guide program improvements.
Presented by
Doan, Erin, PhD <etompkins@saintlukeskc.org>
Institution
Saint Luke's Neurology, Health System, BJC
Poster: Resuscitating the ICU Bundle

Resuscitating the ICU Bundle

Madji Hamarshi, MD, FCCM; Rebecca VanScoy, ACNP, MSN; Shelby Shemanski, PharmD, BCCP; David Milan, BSN, RN, SCRN; Eryn Acton, BSN, RN, CCRN; Aimee Ostermeyer, BSN, RN

Abstract
Background

The Ventilator Rounding Tool (VRT) is an EBP tool designed to promote ICU liberation by addressing pain, oversedation, delirium, mechanical ventilation, and immobility. During the COVID-19 pandemic, care practices shifted toward deep sedation, leading many nurses to perceive deep sedation as standard practice. In MSTICU, RNs expressed uncertainty regarding the purpouse and clinical impact of VRT documentation. Although RNs routinely use a sedation algorithm to titrate sedatives, interdisciplinary efforts were needed to reinforce VRT use and promote light sedation. The aim of this quality improvement initiative was to increase RN comfort with the VRT and sedation protocols and to reinforce their role in improving patient outcomes.

Objective

This study compared patient outcomes before and after the quality improvement project focusing on re‑educating ICU nurses

Methods

Our interdisciplinary team divided VRT education into focused quarterly initiatives throughout 2024. Q1 education focused on RASS/CAM-ICU assessment. We provided group education during staff meetings, followed by individualized bedside teaching sessions, paring RNs with an APP and ClRN. In Q2, Critical Care Pharmacists led education on our sedation titration & vacation algorithms with concurrent sedation reviews emphasizing light sedation goals. In Q3, education focused on progressive mobility and enteral feeding protocols using bedside rounding and real‑time teaching.

Adult patients in the MSTICU requiring mechanical ventilation were included; thhose requiring tracheostomy were excluded. Baseline data from October-December 2023 was compared with post-intervention data from 2024. The primary outcome was duration of continuous sedative infusions (propofol and/or fentanyl). Secondary outcomes included ICU length of stay, ventilator days, and PRN opioid administration. Continuous variables were analyzed using a one‑tailed Wilcoxon rank‑sum test (p≤0.05), and categorical variables using Pearson chi‑square testing.

Results

50 patients were included pre‑intervention and 336 post‑intervention, with similar baseline characteristics. Most patients received both fentanyl and propofol (72% vs 74%). Use of dexmedetomidine decreased from 50% to 32% (p<0.015). Median duration of continuous sedatives decreased from 34.5 to 24 hours (p=0.07). Median fentanyl infusion time significantly decreased from 31.2 to 18 hours (p=0.015), while propofol duration remained unchanged. Median PRN fentanyl administration decreased from 450 mcg to 350 mcg (p=0.049). Ventilator time decreased from 50 to 38.7 hours (p=0.07), and ICU length of stay was significantly reduced from 4.4 to 3.6 days (p=0.019).

Conclusion

Re-engaging nurses through education promoting light sedation was associated with reduced sedative exposure and shorter ICU stays, supporting the impact of nursing engagement and multidisciplinary teamwork on patient outcomes.

Lay Summary

Patients in the intensive care unit (ICU) often need medications to keep them comfortable while on a breathing machine. However, too much sedation can slow recovery, increase confusion, and keep patients in the ICU longer. The Ventilator Rounding Tool (VRT) was created to help care teams regularly check pain, sedation level, mobility, and readiness to come off the ventilator. During the COVID‑19 pandemic, deep sedation became more common, and many nurses felt unsure about how and why to use the VRT.

This quality improvement project focused on re‑educating ICU nurses through team‑based teaching sessions that emphasized lighter sedation, daily sedation breaks, and early mobility. The study compared patient outcomes before and after this education initiative.

After the program, patients spent less time on continuous sedation medications, required fewer extra pain medications, and had shorter ICU stays. These findings suggest that educating and engaging nurses can improve patient recovery and highlight the value of teamwork in ICU care.
Presented by
Milan, David, BSN, RN, SCRN
Institution
Saint Luke's Hospital
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Poster: Evaluation of Nurse Leader Self-Care Pilot Program: A Quality Improvement Project

Evaluation of Nurse Leader Self-Care Pilot Program: A Quality Improvement Project

Kadie Showalter, MSN, RN, NE-BC, CPN, DNP Student; Jan Sherman, PhD, RN, NNP-BC; Jennifer O’Connor, PhD, RN, CFCN, CNE; Kristin Carlson, DNP, RN, OCN, CNML

Abstract
Background

The impending nursing shortage will create significant vacancies and loss of experience in nursing leadership, with turnover costs ranging from $132,000 to $228,000 per leader. While turnover intentions are multifactorial, burnout has been identified as a primary contributor. This quality improvement (QI) project evaluated the impact of structured self-care activities on self-perceived burnout among nurse leaders.

Objective

Evaluate the effectiveness of self-care interventions in reducing burnout and turnover intention among nurse leaders.

Methods

Pre-posttest design using Copenhagen Burnout Inventory (CBI). Participants attended group-based self-care sessions. Session-specific and overall satisfaction were measured using Likert-scale surveys. Pre-posttest CBI scores were analyzed using the Wilcoxon signed-rank test, with degree of change assessed using the Vargha-Delaney A.

Results

Fourteen participants enrolled; 10 completed the intervention and post-test measures. High satisfaction across sessions (median scores 4.00-5.00), with high overall satisfaction (median = 5.00).

Post-intervention CBI scores demonstrated reduced self-perceived burnout, with the greatest improvement in personal burnout, including a statistically significant reduction in physical exhaustion (p = .025, A = 0.75) and moderate-to-large reduction across additional indicators. Statistical significance and generalizability were limited due to small sample size.

Conclusions

Structured self-care interventions may reduce leader burnout, particularly personal burnout; however, organizational-level strategies are needed to address work-related and client-related burnout. Expanding structured self-care programming may improve nurse leader well-being and retention.

Lay Summary

Nurse leaders play an important role in keeping hospitals running smoothly and ensuring quality patient care, but many leaders experience high levels of stress and burnout. This project evaluated whether simple self-care activities could help reduce burnout for nursing leaders.

A small group of nurse leaders participated in several group sessions focusing on different domains of self-care. After the program, participants reported feeling less burned out, especially in terms of emotional and physical exhaustion. They also reported high satisfaction with the group sessions.

While the number of participants was small, the results suggest that structed, self-care programs may be a helpful and practical way to support nurse leaders. However, self-care alone is not enough─ healthcare organizations also need to address workplace challenges the contribute to stress. Expanding these types of programs may improve well-being and retention efforts.
Presented by
Showalter, Kadie, MSN, RN, NE-BC, CPN; DNP Student
Institution
Saint Luke's
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Poster: Trauma Informed Care and Restraint-Related Nurse Injuries: A Quality Improvement Project

Trauma Informed Care and Restraint-Related Nurse Injuries: A Quality Improvement Project

Melissa Timmons, DNP, RNBC

Abstract
Overview

Restraint use in high-acuity settings is associated with increased risk of workplace violence, contributing to nurse injury, burnout, and compromised patient care. This project aimed to determine whether a structured trauma-informed care approach could reduce violent restraint incidents among nurses caring for critically ill adults over a 12-week period.

Objective

This quality improvement project evaluated the effectiveness of implementing the Missouri Department of Health and Senior Services (MoDHSS) Trauma-Informed Toolkit in reducing restraint-related nurse injuries in a medical-surgical trauma intensive care unit (MSTICU).

Methods

Guided by the Plan-Do-Check-Act framework, the intervention included education and training of registered nurses, distribution of pocket reference cards, and implementation of a standardized debriefing process following restraint events. Restraint-related nurse injury data were collected through incident reporting systems and compared pre- and post-implementation. A post implementation self-report audit tool was also used to assess adherence to trauma-informed practices.

Results

Following implementation, restraint-related nurse injuries decreased to zero during the 12-week project period, compared to reported injuries prior to the intervention. Although only 4% of participants completed the self-report audit tool, all respondents indicated consistent use of the Trauma-Informed Toolkit in clinical practice. The low response rate limits the generalizability of self-reported findings but suggests strong uptake among engaged participants. Implementation of the MoDHSS Trauma-Informed Toolkit was associated with improved nurse safety outcomes in a high-risk clinical setting.

Conclusion

These findings support considerations of future integration of trauma-informed care principles into routine practice, staff onboarding, and ongoing education. Limitations include the short project duration and low survey response rate.

Future research should examine long-term sustainability, broader staff engagement, and replication across diverse healthcare settings to strengthen evidence for widespread adoption.

Lay Summary

Healthcare workers, especially nurses in intensive care units, can be injured when caring for patients who become agitated and require physical restraints. These incidents not only harm staff but can also affect the quality of patient care and contribute to burnout. This project aimed to see whether using a trauma-informed approach, care that recognizes how past experiences affect behavior, could reduce these injuries.

Over 12 weeks, registered nurses in a medical-surgical trauma intensive care unit (MSTICU) were trained to use a toolkit designed to improve communication, reduce patient distress, and safely manage difficult situations. After the training, there were no reported nurse injuries related to restraint use. These results suggest that trauma-informed care can improve safety for healthcare workers and patients. Expanding this approach across hospitals and studying its long-term impact could help create safer, more supportive healthcare environments nationwide.
Presented by
Timmons, Melissa, DNP, RNBC
Institution
BJC Health Saint Lukes
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Poster: Vedolizumab Exposure and the Prevalence of Multiple Sclerosis in Inflammatory Bowel Disease: A Large Real-World Analysis

Vedolizumab Exposure and the Prevalence of Multiple Sclerosis in Inflammatory Bowel Disease: A Large Real-World Analysis

Afsaneh Shirani, MD, MSCI; Olaf Stuve, MD, PhD

Abstract
Background

Emerging experimental and human data suggest that autoreactive T cells may undergo pathogenic “licensing” within the gut before trafficking to the central nervous system (CNS) and contributing to multiple sclerosis (MS). Disruption of gut-associated immune activation may therefore have implications for CNS autoimmunity. Vedolizumab, a gut-selective monoclonal antibody targeting α4β7 integrin and approved for inflammatory bowel disease (IBD), provides a unique clinical context to explore the gut–CNS immune axis.

Objective

To evaluate whether exposure to vedolizumab is associated with differences in MS prevalence among patients with Crohn’s disease (CD) or ulcerative colitis (UC).

Methods: We conducted a retrospective observational study using Epic Cosmos, a large de-identified electronic health record platform comprising data from hundreds of healthcare systems, primarily in the United States with additional international representation, encompassing approximately 300 million patients. Individuals with CD (ICD-10: K50) or UC (ICD-10: K51) and a concomitant MS diagnosis (ICD-10: G35) between August 21, 2010, and August 20, 2025 were identified. We then examined a subset of vedolizumab-treated IBD patients, excluding those with a diagnosis of MS prior to vedolizumab initiation, and calculated the proportion diagnosed with MS within five years of exposure. Prevalence estimates with 95% confidence intervals (CIs) were calculated and compared using chi-square testing. Results

Among 1,027,704 patients with CD, 8,098 (0.79%; 95% CI 0.77–0.81%) had MS. In contrast, among vedolizumab-treated CD patients, 125 (0.22%; 95% CI 0.18–0.26%) were diagnosed with MS within five years of exposure (p<0.001). Similarly, among 1,294,362 patients with UC, 9,564 (0.74%; 95% CI 0.73–0.76%) had MS, whereas only 109 vedolizumab-treated UC patients (0.17%; 95% CI 0.14–0.20%) developed MS within five years (p<0.001).

Conclusions

In this large real-world analysis, MS prevalence was substantially lower among vedolizumab-treated IBD patients compared with the overall IBD population. While causality cannot be inferred and confounding by indication and diagnostic limitations remain important considerations, these findings are biologically plausible and hypothesis-generating. They support further investigation into the role of gut-associated immune mechanisms in MS pathogenesis and the potential relevance of gut-selective immune modulation in CNS autoimmunity.

Lay Summary

Multiple sclerosis (MS) is a disease in which the body’s own immune system attacks the brain and spinal cord. Scientists are still learning what triggers this immune attack, but there is growing evidence that the gut—often called the “second brain”—may play an important role. Immune cells known as T cells can become activated, or “licensed,” in the gut before traveling through the bloodstream to other parts of the body, including the brain. In this study, we asked whether blocking immune cell movement from the gut might reduce the risk of developing MS. We focused on a drug called vedolizumab, which is approved for treating inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis. Vedolizumab works by preventing certain immune cells from leaving the gut and entering circulation. Using a large, nationwide U.S. database of electronic health records (Epic Cosmos), we analyzed data from more than 2.3 million people with IBD between 2010 and 2025. We found that approximately 0.7–0.8% of patients with Crohn’s disease or ulcerative colitis also had a diagnosis of MS. However, a smaller proportion of patients treated with vedolizumab—about 0.17–0.22%—had an MS diagnosis recorded within five years after starting the drug. Because this was an observational study using health records, it cannot determine whether vedolizumab causes a lower risk of MS. The observed differences may be influenced by other factors, such as treatment selection or differences in healthcare use. However, these findings suggest a potential association between gut-targeted immune therapy and MS that warrants further study. They also support growing interest in the connection between the gut and the brain through the immune system, often referred to as the gut–brain axis. Future research, including prospective and mechanistic studies, will be needed to better understand these relationships and their implications.
Presented by
Shirani, Afsaneh, MD, MSCI
Institution
Saint Luke’s Marion Bloch Neuroscience Institute, Kansas City, MO; University of Missouri-Kansas City, MO