Clinical Cardiology最新文献

{"title":"Updated Meta-Analysis of Left Bundle Branch Area Pacing Versus Right Ventricular Pacing in Conduction System Disorders: Insights From New Evidence","authors":"Rehan Ishaque,&nbsp;George S. Abela,&nbsp;Ghazal Ishaque,&nbsp;Amina Akram,&nbsp;F. N. U. Reya,&nbsp;Furqan Tarique Memon,&nbsp;Hamza Danish,&nbsp;Amna Ikram,&nbsp;Zulfiqar Qutrio Baloch,&nbsp;Supratik Rayamajhi","doi":"10.1002/clc.70278","DOIUrl":"10.1002/clc.70278","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Right ventricular pacing (RVP) has long been the standard therapy for bradyarrhythmias but may induce ventricular dyssynchrony and adverse cardiac remodeling. Physiologic pacing strategies that preserve the native conduction system, particularly left bundle branch area pacing (LBBAP), have emerged as promising alternatives. This study aimed to evaluate the comparative efficacy and safety of LBBAP versus RVP through an updated meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, we systematically searched PubMed, Cochrane CENTRAL, and ClinicalTrials.gov for relevant studies published through June 2025. Studies comparing LBBAP and RVP in patients undergoing pacemaker implantation were included. Pooled estimates were calculated using random-effects models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 40 studies comprising 8290 patients were included. LBBAP was associated with significantly shorter QRS duration compared with RVP (30 studies, <i>n</i> = 5510; MD −35.56 ms, 95% CI −41.88 to −29.24; <i>p</i> &lt; 0.0001). Structural remodeling also favored LBBAP, with greater improvement in left ventricular ejection fraction (16 studies, <i>n</i> = 1693; MD +3.77%, 95% CI 2.43–5.12; <i>p</i> &lt; 0.0001) and greater reduction in left ventricular end-diastolic diameter (13 studies, <i>n</i> = 1666; MD −2.33 mm, 95% CI −3.59 to −1.07; <i>p</i> &lt; 0.0001). Clinically, LBBAP was associated with lower heart failure hospitalization (RR 0.38, 95% CI 0.29–0.52; <i>p</i> &lt; 0.0001) and reduced all-cause mortality (RR 0.55, 95% CI 0.41–0.72; <i>p</i> &lt; 0.0001), along with greater reduction in NT-proBNP levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LBBAP provides superior electrical synchrony, improved cardiac remodeling, and favorable clinical outcomes compared with RVP, while maintaining a comparable procedural safety profile.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoprotein(a) and the Risk of Heart Failure: A Dose-Response Meta-Analysis","authors":"Yongmei He,&nbsp;Jun Liu,&nbsp;Jingwei Zhuang,&nbsp;Hongjia Hu","doi":"10.1002/clc.70289","DOIUrl":"10.1002/clc.70289","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lipoprotein(a) [Lp(a)] is a genetically determined lipoprotein implicated in cardiovascular disease, but its role in heart failure (HF) remains uncertain. Observational studies indicate a link between elevated Lp(a) and HF risk, but the dose-response relationship remains unexplored. This meta-analysis aimed to quantify the association between circulating Lp(a) levels and HF incidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of PubMed, Embase, and Web of Science identified prospective cohort studies reporting hazard ratios (HRs) for HF incidence across different Lp(a) levels. A random-effects model was applied to pool effect estimates while accounting for heterogeneity, and restricted cubic splines assessed dose-response relationships.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five prospective cohort studies with 400 631 participants were included. During a mean follow-up duration of 11.0 years, 10 598 (2.6%) patients developed HF. A high Lp(a) level was associated with an increased HF risk (HR: 1.34, 95% CI: 1.14–1.59, <i>p</i> &lt; 0.001), with moderate heterogeneity (I² = 69%). Subgroup analysis showed a stronger association in studies using an Lp(a) cutoff of ≥ 50 mg/dL (HR: 1.68) compared to those with a cutoff of &lt; 50 mg/dL (HR: 1.16, p for subgroup difference &lt; 0.01), which completely explained the heterogeneity. The dose-response analysis revealed a nonlinear association (p for non-linearity = 0.001). HF risk increased nearly linearly below 55 mg/dL, then slowed, and plateaued at 160 mg/dL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Elevated Lp(a) is associated with an increased HF risk in a nonlinear pattern, with risk escalation slowing at higher concentrations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal AI in Cardiac Arrhythmia: From Pattern Recognition to Mechanistic Insight","authors":"Bara AbuBaha,&nbsp;Samia Aldwaik,&nbsp;Sarah Saife,&nbsp;Yousef Mahmoud-Barqawi,&nbsp;Layan Omar,&nbsp;Omar Sawafta,&nbsp;Mohannad Sawalha,&nbsp;Hafez Nassar,&nbsp;Zeyad Alqasem,&nbsp;Karmel Khuffash,&nbsp;Hossam Salameh,&nbsp;Mohammed AbuBaha","doi":"10.1002/clc.70293","DOIUrl":"10.1002/clc.70293","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cardiac arrhythmias remain a leading cause of cardiovascular morbidity and mortality worldwide, and conventional diagnostic tools such as electrocardiography and Holter monitoring may fail to detect transient or asymptomatic events. Recent advances in artificial intelligence (AI) and machine learning have enhanced arrhythmia detection, risk stratification, and treatment planning; however, most existing models rely primarily on statistical associations rather than underlying physiological mechanisms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This narrative review was conducted through a structured but non-systematic literature search of PubMed, Scopus, and Google Scholar, covering studies published between 2000 and 2025. Search terms included combinations of “cardiac arrhythmia,” “atrial fibrillation,” “causal inference,” “structural causal models,” “digital twins,” “mechanistic modeling,” “cardiac electrophysiology modeling,” and “artificial intelligence.” Peer-reviewed articles were included if they demonstrated methodological depth and addressed causal inference or mechanistic modeling approaches in cardiovascular research, particularly in arrhythmia detection, risk prediction, treatment optimization, or clinical validation frameworks. Studies were prioritized based on methodological rigor, translational relevance, and recency. Editorials lacking methodological detail, non-English publications, and studies relying solely on predictive models without incorporating causal or mechanistic components were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Causal artificial intelligence (Causal AI), offers a more mechanistically grounded framework for understanding arrhythmogenesis and therapeutic outcomes. Emerging evidence suggests that integrating clinical data with structural causal models, mechanistic modeling, and patient-specific digital twins can bridge the gap between predictive performance and physiological interpretability. These approaches show promise in predicting ablation success, guiding therapy, and improving individualized care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite this potential, clinical implementation remains limited due to data heterogeneity, validation challenges, and regulatory constraints.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “Epicardial Fat Thickness as a Marker of Coronary Artery Disease in Diabetics: A Single Center Study”","authors":"Mashal Naveed,&nbsp;Maheen Saeed,&nbsp;Muhammad Shahid Saddique,&nbsp;Mawra Naveed,&nbsp;Ahmad Furqan Anjum","doi":"10.1002/clc.70292","DOIUrl":"10.1002/clc.70292","url":null,"abstract":"&lt;p&gt;We read with great interest the article titled, “Epicardial Fat Thickness as a Marker of Coronary Artery Disease in Diabetics: A Single Center Study” by Akhter et al. [&lt;span&gt;1&lt;/span&gt;]. The authors aim to determine if echocardiographically measured epicardial fat thickness (EFT) provides a practical and dependable means of identifying coronary artery disease (CAD) in diabetic individuals. Their work contributes valuable evidence by proving that EFT is raised in diabetics associated with CAD. However, several methodological limitations remain that merit further attention.&lt;/p&gt;&lt;p&gt;First, all the EFT measurements were performed by a single cardiologist using a single method that results in the absence of reproducibility in the research. Lack of reproducibility raises concerns about the reliability and generalization of the findings [&lt;span&gt;2&lt;/span&gt;]. Therefore, in order to ensure the integrity of the work, reproducibility should be considered during EFT measurements.&lt;/p&gt;&lt;p&gt;Second, the EFT cut-off value used in this article is ≥ 5 mm. However, many studies have shown that epicardial fat is comparatively greater in people with type 2 diabetes [&lt;span&gt;3&lt;/span&gt;]. Therefore, this value is not preferable in people with type 2 diabetes because they may have different adipose tissue distribution, and so it can result in overestimation of CAD risk. Thus, it is recommended to use a disease-specific cut-off value to maintain the specificity of the research.&lt;/p&gt;&lt;p&gt;The third major limitation in this study that may influence the interpretation of its findings is the lack of data on and control for key medications that could confound the observed association. The use of statins, anti-hypertensive, and anti-diabetic drugs was not accounted for in the analysis. These medications are known to independently influence both EFT and CAD progression. For instance, statins are known to influence visceral fat distribution and reduce coronary atherosclerotic burden [&lt;span&gt;4&lt;/span&gt;]. If the effects of these medications are not considered, the study's findings could be misleading, potentially overstating or understating the true relationship between EFT and CAD.&lt;/p&gt;&lt;p&gt;Finally, important inflammatory and metabolic biomarkers such as adiponectin, interleukin-6 (IL-6), and high-sensitivity C-reactive protein are not measured in this study. These biomarkers are crucial in determining whether EFT directly causes CAD or merely reflects underlying systemic inflammation. Moreover, prior studies have shown a strong correlation between the presence and severity of CAD and elevated IL-6 levels and decreased adiponectin expression in epicardial fat [&lt;span&gt;5&lt;/span&gt;]. Thus, the physiological mechanisms that link EFT and CAD cannot be explained by the current study without these biomarkers. In order to better define the connection between EFT and CAD, future research should incorporate both biochemical markers measurement and imaging methods.&lt;/p&gt;&lt;p&gt;In conclusion, while the study demonstrates t","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover Image: Volume 49 Issue 4","authors":"Xinai Meng,&nbsp;Senlin Huang,&nbsp;Liwei He,&nbsp;Tian Liu,&nbsp;Yanjia Chen,&nbsp;Huahua Li,&nbsp;Xingfu Huang","doi":"10.1002/clc.70295","DOIUrl":"10.1002/clc.70295","url":null,"abstract":"<p>The cover image is based on the article Catheter Ablation for Frequent Premature Ventricular Contractions or Paroxysmal Supraventricular Tachycardia With Vagal Bradycardia: A New Clinical Application of Superior Vena Cava–Aorta Ganglionated Plexus Modification by Xinai Meng et al., https://doi.org/10.1002/clc.70282.\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Post-Ablational Angiotensin Receptor-Neprilysin Inhibitor on Atrial Fibrillation Recurrence: A Systematic Review and Meta-Analysis in Asian Population","authors":"Yangyang Wang,&nbsp;Wenjing Zhang,&nbsp;Yang Shao,&nbsp;Qiming Dong,&nbsp;Yunfei Gu,&nbsp;Hao Wang","doi":"10.1002/clc.70284","DOIUrl":"10.1002/clc.70284","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The efficacy of angiotensin receptor-neprilysin inhibitor (ARNI) in reducing recurrence risk of atrial fibrillation (AF) after ablation remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We summarized the results about ARNI in preventing AF recurrence after radiofrequency ablation. After PROSPERO registration, two researchers independently screened the literature and assessed the risk of bias in the included studies. The fixed effects model was used to merge the effect sizes, and the results were reported separately depending on whether the study was a RCT or a cohort study and on the follow-up duration. We further conducted subgroup analysis by comparing the effect of ARNI in reducing AF recurrence to that of angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker (ACEI/ARB) and to that of the Blank group. Publication bias and sensitivity analysis were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both in RCTs and cohort studies, constant usage of ARNI for 6 and 12 months partly reduced the AF recurrence after ablation (using 3-month ARNI in RCTs: RR = 0.56; 95% CI = 0.37–0.85; <i>p</i> = 0.006; using 6-month ARNI in RCTs: RR = 0.57; 95% CI = 0.39–0.82; <i>p</i> = 0.003; using 12-month ARNI in RCTs: RR = 0.65; 95% CI = 0.49–0.88; <i>p</i> = 0.005; using 6-month ARNI in cohort studies: RR = 0.44; 95% CI = 0.32–0.61; <i>p</i> &lt; 0.001). Subgroup analysis showed that, compared to ACEI/ARB or Blank, both in RCTs and cohort studies, ARNI was more effective in reducing the recurrence rate of atrial fibrillation after ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The using of ARNI may be effective in preventing the recurrence of AF after ablation, with ARNIs being shown to be more effective than ACEI/ARBs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological Considerations on the Prognostic Value of HALP Score in Rheumatic Mitral Stenosis.","authors":"Oğuzhan Yılmaz, Serkan Ünlü, Özden Seçkin","doi":"10.1002/clc.70327","DOIUrl":"https://doi.org/10.1002/clc.70327","url":null,"abstract":"","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":"e70327"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147763603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Cranberry Consumption on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Leyli Zahra Bahreyni, Mohammad Reza Amini, Leila Sheikhi, Ehsaneh Taheri, Pardis Rahimi, Mahnoush Mehrzad Samarin, Fatemeh Sheikhhossein, Sajjad Etesamnia, Negin Lohrasbi, Azita Hekmatdoost","doi":"10.1002/clc.70254","DOIUrl":"10.1002/clc.70254","url":null,"abstract":"<p><strong>Background: </strong>The aim of this paper, which includes a meta-analysis, is to elucidate the effects of cranberry consumption on systolic and diastolic blood pressure based on all relevant randomized controlled trials (RCTs).</p><p><strong>Materials and methods: </strong>A systematic literature search was performed across the ISI Web of Science, PubMed, Embase, the Cochrane Library, and Google Scholar databases, encompassing trials published until December 2024. Weighted mean differences (WMD) were calculated using random or fixed-effects models. Between-study heterogeneity was evaluated using Cochrane's test and the I² index. This study's registration number in PROSPERO is CRD420251028424.</p><p><strong>Results: </strong>A total of 1204 publications were reviewed, leading to the inclusion of 12 trials for qualitative synthesis and meta-analysis. The pooled effect size indicated statistically nonsignificant reductions of 1.31 mmHg for systolic blood pressure (SBP) (p = 0.19) and 1.31 mmHg for diastolic blood pressure (DBP) (p = 0.12). Stratified analysis showed that the reduction in SBP was statistically significant in studies where cranberry was provided in juice form, with a duration of 8 weeks or less, involving participants with a mean age of < 50 years, and predominantly in females. Furthermore, subgroup analysis indicated a significant reduction in DBP in studies that involved both genders, lasted more than 8 weeks, included participants with a normal body mass index, and had a mean age below 50 years.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis suggest that cranberry consumption was not effective in managing SBP and DBP.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":"e70254"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13093061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AsistIAM: Innovating the Acute Coronary Syndrome Approach in Primary Care Settings.","authors":"James S Díaz, José L Añorga, Lucelly López, Cristian Vera, Henry Andrade, Johanna M Vanegas","doi":"10.1002/clc.70313","DOIUrl":"10.1002/clc.70313","url":null,"abstract":"<p><strong>Background: </strong>Early management of acute coronary syndrome (ACS) is critical. Clinical guidelines are more consistently implemented in high-complexity hospitals; however, in rural and primary care settings multiple barriers limit timely diagnosis and treatment. This study aimed to develop and evaluate the usability of a mobile application designed to assist primary care physicians in the diagnostic approach and initial management of ACS.</p><p><strong>Methods: </strong>A mHealth tool named AsistIAM was developed with five modules: electrocardiogram pattern, reperfusion strategies, risk assessment, real-time georeferencing, and educational content. Usability was assessed on a 1-7 scale under in both simulated and real-world conditions. In the latter, a before-and-after study was performed with physicians from four rural primary healthcare centers and one referral hospital. In the pre-implementation phase, participants completed a survey identifying barriers to ACS care. After using the app, they complete the same survey to analyze changes.</p><p><strong>Results: </strong>A total of 18 participants evaluated the app in simulated conditions and 59 in real-world settings. Mean usability scores were high (6.52, in simulation and 6.18 in real-world). The best-rated items were ease of learning, interface satisfaction, and availability of functions. After app implementation, physicians reported improvements in ECG acquisition and interpretation (81.4%-100%), recognition of ST-elevation patterns (25.6%-39.2%), identification of referral centers (88.1%-98.0%), and correct use of fibrinolytics (errors 44.1%-17.6%).</p><p><strong>Conclusions: </strong>AsistIAM represents an innovative tool to strengthen regional networks, improve ACS management and support timely clinical decision-making. Usability results highlight its intuitive interface, functionality, and practical utility.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":"e70313"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age Differences in Acute Chest Pain Care in a Multisite US Cohort.","authors":"Nicklaus P Ashburn, Anna C Snavely, Lyle Paukner, Michael W Supples, Benjamin T Hutchison, David A Pearson, Simon A Mahler","doi":"10.1002/clc.70275","DOIUrl":"https://doi.org/10.1002/clc.70275","url":null,"abstract":"<p><strong>Background: </strong>This study aims to determine if differences in age affect safety and healthcare utilization among patients with chest pain in a multisite US ED cohort, after accounting for comorbidities and high-sensitivity troponin (hs-cTn).</p><p><strong>Methods: </strong>We conducted a multisite observational study using the Wake Forest Chest Pain Registry, which included patients ≥ 18 years old with chest pain across 25 EDs (01/01/2021 to 12/31/2021). Each site used an hs-cTn chest pain protocol. Patients were categorized as older (≥ 65 years), middle-aged (46-64 years), or young (18-45 years). The primary safety outcome was death or MI at 30 days. The primary healthcare utilization outcome was 30-day hospitalization. Multivariable logistic regression models assessed the association between age and outcomes, adjusting for sex, race, ethnicity, obesity, smoking, rurality, coronary disease, diabetes, hypertension, hyperlipidemia, insurance, site, and hs-cTn, with young patients as the reference.</p><p><strong>Results: </strong>Among 40 979 patients, 25.1% were older, 39.7% middle-aged, and 35.2% young. At 30 days, death or MI occurred in 7.3% (750/10 298) of older, 3.8% (611/16 260) of middle-aged, and 0.8% (108/14 421) of young patients. After adjustment, death or MI at 30 days was more common among older (aOR 1.57, 95% CI 1.17-2.12) and middle-aged (aOR 1.57, 95% CI 1.22-2.02) patients. Hospitalization at 30 days occurred in 56.3% (5799/10 298) of older, 35.4% (5761/16 260) of middle-aged, and 12.8% (1849/14 421) of young patients. With adjustment, hospitalization remained more common among older (aOR 2.51, 95% CI 2.27-2.78) and middle-aged (aOR 1.93, 95% CI 1.80-2.07) patients.</p><p><strong>Conclusion: </strong>After adjusting for comorbidities and hs-cTn results, older adults had higher rates of death or MI and hospitalization at 30 days.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 4","pages":"e70275"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}