CirculationPub Date : 2025-10-22DOI: 10.1161/circulationaha.125.076263
Anping Cai,Antoni Bayes-Genis,Joanne Ryan,Yingqing Feng,James L Januzzi,Andrew M Tonkin,Jiazhen Zheng,Mark R Nelson,Johannes T Neumann,Robyn L Woods,Cammie Tran,Aletta E Schutte,Ambarish Pandey,Lin Yee Chen,Lin Liu,Junguo Zhang,John J McNeil,Lawrence Beilin,Hung-Fat Tes,Gianfranco Parati,Zhen Zhou
{"title":"Heart Stress and Blood Pressure Management in Older Adults: Post Hoc Analysis of the ASPREE Trial.","authors":"Anping Cai,Antoni Bayes-Genis,Joanne Ryan,Yingqing Feng,James L Januzzi,Andrew M Tonkin,Jiazhen Zheng,Mark R Nelson,Johannes T Neumann,Robyn L Woods,Cammie Tran,Aletta E Schutte,Ambarish Pandey,Lin Yee Chen,Lin Liu,Junguo Zhang,John J McNeil,Lawrence Beilin,Hung-Fat Tes,Gianfranco Parati,Zhen Zhou","doi":"10.1161/circulationaha.125.076263","DOIUrl":"https://doi.org/10.1161/circulationaha.125.076263","url":null,"abstract":"BACKGROUNDBlood pressure (BP) management in older adults is complex because of age-related physiological changes and uncertainty around ideal systolic BP (SBP) targets. Heart stress (HS), defined by age-adjusted elevation in NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, may improve cardiovascular disease (CVD) risk stratification and support more individualized BP management.METHODSWe conducted a post hoc analysis of ASPREE (Aspirin in Reducing Events in the Elderly) involving 11 941 community-dwelling older adults without CVD at enrollment (mean age, 75.1 years; 53.5% women). HS was defined by NT-proBNP ≥150 pg/mL for participants 65 to 74 years of age and ≥300 pg/mL for participants ≥75 years of age. Participants were categorized into 4 groups by hypertension and HS status. The primary outcome was total CVD events (a composite of nonfatal myocardial infarction, fatal or nonfatal stroke, coronary heart disease death, or hospitalization for heart failure). Associations between hypertension and SBP with total CVD events were examined by HS status using Cox proportional-hazards models and restricted cubic spline. SBP was evaluated categorically (<120, 120-129, 130-139, 140-159, or ≥160 mm Hg) and continuously. A landmark sensitivity analysis excluded participants with CVD events or censoring in the first 2 years, with follow-up starting at year 3.RESULTSHS was present in 25.8% of participants. Compared with the reference group (no hypertension or HS), adjusted hazard ratios (95% CI) for total CVD events were 1.41 (1.18-1.70) for hypertension + no HS, 1.79 (1.34-2.39) for no hypertension + HS, and 2.32 (1.89-2.84) for hypertension + HS (Ptrend<0.001). Among participants without HS, the lowest incidence of total CVD events occurred at SBP 130 to 139 mm Hg, showing a U-shaped association across SBP levels (Pnonlinearity=0.011). Among participants with HS, risk increased linearly with SBP (Plinear trend=0.85) and was lowest at SBP <120 mm Hg. Landmark analyses yielded generally consistent findings.CONCLUSIONSHS is common in older adults and jointly associated with hypertension and increased CVD risk. The SBP-CVD relationship differs by HS status, suggesting a potential value of HS for guiding individualized BP management. Prospective studies are warranted to determine whether HS-guided strategies improve BP control and reduce CVD risk in older adults.","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"115 1","pages":""},"PeriodicalIF":37.8,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CirculationPub Date : 2025-10-22DOI: 10.1161/cir.0000000000001372
Marina Del Rios,Jason A Bartos,Ashish R Panchal,Dianne L Atkins,José G Cabañas,Dazhe Cao,Katie N Dainty,Cameron Dezfulian,Aaron J Donoghue,Ian R Drennan,Jonathan Elmer,Karen G Hirsch,Ahamed H Idris,Benny L Joyner,Beena D Kamath-Rayne,Monica E Kleinman,Michael C Kurz,Javier J Lasa,Henry C Lee,Mary E McBride,Tia T Raymond,Jon C Rittenberger,Stephen M Schexnayder,Edgardo Szyld,Alexis Topjian,Jane G Wigginton,Jeanette K Previdi
{"title":"Part 1: Executive Summary: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.","authors":"Marina Del Rios,Jason A Bartos,Ashish R Panchal,Dianne L Atkins,José G Cabañas,Dazhe Cao,Katie N Dainty,Cameron Dezfulian,Aaron J Donoghue,Ian R Drennan,Jonathan Elmer,Karen G Hirsch,Ahamed H Idris,Benny L Joyner,Beena D Kamath-Rayne,Monica E Kleinman,Michael C Kurz,Javier J Lasa,Henry C Lee,Mary E McBride,Tia T Raymond,Jon C Rittenberger,Stephen M Schexnayder,Edgardo Szyld,Alexis Topjian,Jane G Wigginton,Jeanette K Previdi","doi":"10.1161/cir.0000000000001372","DOIUrl":"https://doi.org/10.1161/cir.0000000000001372","url":null,"abstract":"This executive summary provides an overview of the 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which is organized around the Utstein Formula for Survival and provides updated recommendations aimed at improving survival rates and neurological outcomes following cardiac arrest. This executive summary outlines key changes, emphasizing the importance of high-quality chest compressions, early defibrillation, and the integration of advanced resuscitation techniques. These Guidelines also highlight critical post-cardiac arrest care strategies, including targeted temperature management and hemodynamic stabilization. Additionally, they stress the need for population-specific resuscitation approaches, particularly for pediatric patients, pregnant individuals, and individuals with cardiac arrest due to special circumstances. A strong focus is placed on continuous training and education for both medical professionals and lay rescuers to enhance the implementation and effectiveness of these lifesaving interventions. The 2025 Guidelines also highlight the importance of an integrated system of people, protocols, policies, and resources to achieve quality improvement in cardiac arrest care. An overview of ethical considerations relevant to emergency cardiovascular care, resuscitation, and approaches to decision-making surrounding cardiac arrest is also included. By following these updated recommendations, the American Heart Association seeks to optimize resuscitation efforts and improve patient outcomes in cardiac emergencies.","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"10 1","pages":"S284-S312"},"PeriodicalIF":37.8,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CirculationPub Date : 2025-10-22DOI: 10.1161/cir.0000000000001380
Dazhe Cao,Ann M Arens,Sheryl L Chow,Sarah Rae Easter,Robert S Hoffman,Anthony T Lagina,Eric J Lavonas,Kaustubha D Patil,Lauren D Sutherland,Janice A Tijssen,George Sam Wang,Carolyn M Zelop,Amber J Rodriguez,Ian R Drennan,Mary E McBride
{"title":"Part 10: Adult and Pediatric Special Circumstances of Resuscitation: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.","authors":"Dazhe Cao,Ann M Arens,Sheryl L Chow,Sarah Rae Easter,Robert S Hoffman,Anthony T Lagina,Eric J Lavonas,Kaustubha D Patil,Lauren D Sutherland,Janice A Tijssen,George Sam Wang,Carolyn M Zelop,Amber J Rodriguez,Ian R Drennan,Mary E McBride","doi":"10.1161/cir.0000000000001380","DOIUrl":"https://doi.org/10.1161/cir.0000000000001380","url":null,"abstract":"https://www.ahajournals.org/journal/circ In these guidelines, the American Heart Association provides updated guidance for resuscitation of adults and children in cardiac arrest or with a life-threatening condition due to special circumstances, including anaphylaxis, asthma, cardiac arrest in the cardiac intervention suite, cardiac arrest following cardiac surgery, drowning, electrocution, gas embolism, high-consequence respiratory pathogens, hyperkalemia, hyperthermia, hypothermia, left ventricular assist device failure, pregnancy, pulmonary embolism, and poisoning due to benzodiazepines, β-blockers, calcium channel blockers, cocaine, cyanide, digoxin and related cardiac glycosides, local anesthetic systemic toxicity, methemoglobinemia, opioids, organophosphates and carbamates, sodium channel blockers, sympathomimetics, and volatile hydrocarbons. Recommendations are also provided for alternatives to cardiopulmonary resuscitation and the use of extracorporeal membrane oxygenation for poisoned patients. Adults and children with these conditions require modification of basic life support and advanced life support. These guidelines are based on systematic evidence reviews and provide separate graded recommendations for adults and children.","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"108 1","pages":"S578-S672"},"PeriodicalIF":37.8,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Bailout Intracranial Angioplasty or Stenting After Thrombectomy for Acute Large Vessel Occlusion: 1-Year Outcomes of ANGEL-REBOOT.","authors":"Feng Gao,Xu Tong,Ming Wei,Xiaoxi Yao,Lei Li,Yuesong Pan,Baixue Jia,Thanh N Nguyen,Ming Yang,Dapeng Sun,Ganghua Feng,Guangxiong Yuan,Chenghua Xu,Zhengzhou Yuan,Yue Wan,Jing Wang,Ping Jing,Xinguang Yang,Zhilin Wu,Wei Hu,Yuanfei Jiang,Chaobin Wang,Changming Wen,Jianjun Tang,Xiang Luo,Yingchun Wu,Ruile Shen,Tuanyuan Zheng,Yaxuan Sun,Mingze Chang,Yan Liu,Yang Haihua,Di Li,Bo Yin,Weihua Jia,Dongjun Wan,Guodong Xu,Zaiyu Guo,Dianjing Sun,Yang Wang,Jixin Duan,Liyu Wang,Guoqing Wang,Liping Wei,Gaoting Ma,Xiaochuan Huo,Dapeng Mo,Ning Ma,Zeguang Ren,Liping Liu,Xingquan Zhao,Yilong Wang,Jens Fiehler,Yongjun Wang,Zhongrong Miao, ","doi":"10.1161/circulationaha.125.075429","DOIUrl":"https://doi.org/10.1161/circulationaha.125.075429","url":null,"abstract":"BACKGROUNDThe long-term benefits of bailout intracranial angioplasty or stenting (BAOS) after thrombectomy in patients with acute large vessel occlusion remain unclear. This study compared BAOS with standard therapy in patients with large vessel occlusion with unsuccessful recanalization (expanded Thrombolysis In Cerebral Infarction score 0-2a) or >70% residual stenosis after thrombectomy.METHODSANGEL-REBOOT (Randomized Study of Bailout Intracranial Angioplasty Following Thrombectomy for Acute Large Vessel Occlusion) was a multicenter, open-label, blinded-end point, randomized trial conducted across 36 Chinese hospitals. Patients ≥18 years of age with anterior or posterior circulation large vessel occlusion within 24 hours of stroke onset were enrolled. After identification of thrombectomy failure or high-grade residual stenosis, patients were randomly assigned to the BAOS group (intervention) or the standard therapy group (control), in which thrombectomy was continued or terminated. The use of tirofiban was permitted in both groups during and after the procedure. In the intention-to-treat population, the primary outcome was analyzed using an assumption-free ordinal analysis (Wilcoxon-Mann-Whitney test) to compare the modified Rankin Scale scores (ordinal variable ranging from 0 to 6) between groups at 1-year follow-up, from which the generalized odds ratio was derived. Secondary outcomes included stroke recurrence in the treated artery and all-cause mortality within 1 year, analyzed using Cox proportional hazards models.RESULTSA total of 348 patients were randomly assigned (176 to the BAOS group and 172 to the standard therapy group) and followed for 90 days, from December 19, 2021, to June 2, 2023. Of these, 326 patients (166 in the BAOS group and 160 in the standard therapy group) completed the 1-year follow-up. Compared with standard therapy, BAOS significantly improved the 1-year modified Rankin Scale score distribution (generalized odds ratio, 1.34 [95% CI, 1.05-1.73]; P=0.02). Fewer stroke recurrences in the treated artery occurred in the BAOS group than in the standard therapy group (7 of 166 [4%] versus 21 of 160 [13%]; hazard ratio, 0.30 [95% CI, 0.13-0.71]; P=0.006). One-year mortality rates were similar between groups (25 of 166 [15%] versus 27 of 160 [17%]; hazard ratio, 0.87 [95% CI, 0.50-1.50]).CONCLUSIONSAmong Chinese patients with large vessel occlusion with unsuccessful recanalization or high-grade residual stenosis after thrombectomy, BAOS was associated with reduced disability and stroke recurrence after 1 year compared with standard therapy.REGISTRATIONURL: https://www.clinicaltrials.gov; Unique identifier: NCT05122286.","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"22 1","pages":""},"PeriodicalIF":37.8,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CirculationPub Date : 2025-10-21Epub Date: 2025-10-22DOI: 10.1161/CIR.0000000000001378
Cameron Dezfulian, José G Cabañas, Jason R Buckley, Rebecca E Cash, Remle P Crowe, Ian R Drennan, Melissa Mahgoub, Candace N Mannarino, Teresa May, David D Salcido, Anezi I Uzendu, Melissa A Vogelsong, Joshua A Worth, Saket Girotra
{"title":"Part 4: Systems of Care: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.","authors":"Cameron Dezfulian, José G Cabañas, Jason R Buckley, Rebecca E Cash, Remle P Crowe, Ian R Drennan, Melissa Mahgoub, Candace N Mannarino, Teresa May, David D Salcido, Anezi I Uzendu, Melissa A Vogelsong, Joshua A Worth, Saket Girotra","doi":"10.1161/CIR.0000000000001378","DOIUrl":"https://doi.org/10.1161/CIR.0000000000001378","url":null,"abstract":"<p><p>Improving survival and quality of life after cardiac arrest requires integrated systems of people, protocols, policies, and resources along with ongoing data acquisition and review. Such systems of care, which are highly influenced by the environment in which they operate, produce efficiency and effectiveness in responding to cardiac arrest. Part 4 of the <i>2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care</i> focuses on systems of care, emphasizing elements that are relevant to a broad range of resuscitation situations. The chapter follows the Chain of Survival, beginning with prevention and preparedness to resuscitate, proceeding to early identification of cardiac arrest, and moving to effective resuscitation through to post-cardiac arrest care, survivorship, and recovery. This Part provides cardiac arrest systems of care guidelines on how to train specific personnel, protocols that have been demonstrated to be effective, as well as the incorporation of nonhuman resources to optimize cardiac arrest care with ongoing debriefing and quality improvement strategies. Specific to out-of-hospital cardiac arrest, included are recommendations about emergency medical services team composition and transport recommendations, community initiatives to promote lay rescuer response, public access defibrillation and naloxone, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about cardiac arrest prevention and code team composition. Specific recommendations about extracorporeal membrane oxygenation cardiopulmonary resuscitation, transport to specialized cardiac arrest centers, organ donation, survivorship systems, and performance measurement across the continuum of resuscitation situations are also included.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"152 16_suppl_2","pages":"S353-S384"},"PeriodicalIF":38.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CirculationPub Date : 2025-10-21Epub Date: 2025-10-22DOI: 10.1161/CIR.0000000000001360
Ian R Drennan, Katherine M Berg, Bernd W Böttiger, Yew Woon Chia, Keith Couper, Conor Crowley, Sonia D'Arrigo, Charles D Deakin, Shannon M Fernando, Rakesh Garg, Asger Granfeldt, Brian Grunau, Karen G Hirsch, Mathias J Holmberg, Peter J Kudenchuk, Eric J Lavonas, Carrie Kah-Lai Leong, Neville Vlok, Peter T Morley, Ari Moskowitz, Robert W Neumar, Tonia C Nicholson, Nikolaos I Nikolaou, Jerry P Nolan, Brian J O'Neil, Shinichiro Ohshimo, Michael Parr, Helen Pocock, Claudio Sandroni, Tommaso Scquizzato, Jasmeet Soar, Michelle Welsford, Carolyn M Zelop, Markus B Skrifvars
{"title":"Advanced Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations.","authors":"Ian R Drennan, Katherine M Berg, Bernd W Böttiger, Yew Woon Chia, Keith Couper, Conor Crowley, Sonia D'Arrigo, Charles D Deakin, Shannon M Fernando, Rakesh Garg, Asger Granfeldt, Brian Grunau, Karen G Hirsch, Mathias J Holmberg, Peter J Kudenchuk, Eric J Lavonas, Carrie Kah-Lai Leong, Neville Vlok, Peter T Morley, Ari Moskowitz, Robert W Neumar, Tonia C Nicholson, Nikolaos I Nikolaou, Jerry P Nolan, Brian J O'Neil, Shinichiro Ohshimo, Michael Parr, Helen Pocock, Claudio Sandroni, Tommaso Scquizzato, Jasmeet Soar, Michelle Welsford, Carolyn M Zelop, Markus B Skrifvars","doi":"10.1161/CIR.0000000000001360","DOIUrl":"https://doi.org/10.1161/CIR.0000000000001360","url":null,"abstract":"<p><p>The International Liaison Committee on Resuscitation conducts continuous reviews of new, peer-reviewed published cardiopulmonary resuscitation science and publishes more comprehensive reviews every 5 years. The Advanced Life Support Task Force chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations addresses all resuscitation evidence reviewed by the task force in the past year, as well as brief summaries of topics reviewed since 2020, to provide a comprehensive update. Newly updated topics this year include defibrillator pad placement, mechanical cardiopulmonary resuscitation devices, mechanical circulatory support after return of spontaneous circulation, intravenous versus intraosseous access, vasopressor choice and hemodynamic targets after return of spontaneous circulation, treatment of cardiac arrest related to hyperkalemia and opioid toxicity, and neuroprotective drugs, among others. Task Force members have assessed, discussed, and debated the certainty of the evidence based on Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task force lists priority knowledge gaps for further research.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"152 16_suppl_1","pages":"S72-S115"},"PeriodicalIF":38.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CirculationPub Date : 2025-10-21Epub Date: 2025-10-22DOI: 10.1161/CIR.0000000000001364
Janet E Bray, Michael A Smyth, Gavin D Perkins, Rebecca E Cash, Sung Phil Chung, Julie Considine, Katie N Dainty, Vihara Dassanayake, Guillaume Debaty, Maya Dewan, Bridget Dicker, Natasha Dodge, Fredrik Folke, Takanari Ikeyama, Carolina Malta Hansen, Nicholas J Johnson, George Lukas, Anthony Lagina, Siobhan Masterson, Peter T Morley, Laurie J Morrison, Ziad Nehme, Tatsuya Norii, Violetta Raffay, Giuseppe Ristagno, Aloka Samantaray, Federico Semeraro, Baljit Singh, Christopher M Smith, Christian Vaillancourt, Katherine M Berg, Theresa M Olasveengen
{"title":"Basic Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations.","authors":"Janet E Bray, Michael A Smyth, Gavin D Perkins, Rebecca E Cash, Sung Phil Chung, Julie Considine, Katie N Dainty, Vihara Dassanayake, Guillaume Debaty, Maya Dewan, Bridget Dicker, Natasha Dodge, Fredrik Folke, Takanari Ikeyama, Carolina Malta Hansen, Nicholas J Johnson, George Lukas, Anthony Lagina, Siobhan Masterson, Peter T Morley, Laurie J Morrison, Ziad Nehme, Tatsuya Norii, Violetta Raffay, Giuseppe Ristagno, Aloka Samantaray, Federico Semeraro, Baljit Singh, Christopher M Smith, Christian Vaillancourt, Katherine M Berg, Theresa M Olasveengen","doi":"10.1161/CIR.0000000000001364","DOIUrl":"https://doi.org/10.1161/CIR.0000000000001364","url":null,"abstract":"<p><p>The International Liaison Committee on Resuscitation conducts continuous review of new, peer-reviewed published cardiopulmonary resuscitation science, and publishes more comprehensive reviews every 5 years. The Basic Life Support Task Force chapter of the <i>2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations</i> addressed all published resuscitation evidence reviewed by the Basic Life Support Task Force science experts since 2020. Topics addressed by systematic reviews in the last year include chest compression-only cardiopulmonary resuscitation, starting cardiopulmonary resuscitation with compressions or airway and breathing, chest compression and ventilation ratios, durations of cardiopulmonary resuscitation cycles, hand positioning during compressions, head-up cardiopulmonary resuscitation, ventilation feedback devices, and pad and paddle size and placement. Members from the Basic Life Support Task Force have assessed, discussed, and debated the quality of the evidence, based on Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task force lists priority knowledge gaps for further research.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"152 16_suppl_1","pages":"S34-S71"},"PeriodicalIF":38.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CirculationPub Date : 2025-10-21Epub Date: 2025-08-30DOI: 10.1161/CIRCULATIONAHA.125.076704
Wojciech Szczeklik, Jakub Fronczek, Zbigniew Putowski, Anna Włudarczyk, Jacek Górka, Bożena Seczyńska, Dominika Gryszówka, Agnieszka Widawska, Szymon Białka, Piotr Palaczyński, Michał Borys, Paweł Kutnik, Tomasz Czarnik, Anna Szczepańska, Marcin Możański, Marcin Mieszkowski, Katarzyna Kotfis, Janusz Trzebicki, Łukasz Sadowski, Joanna Sołek-Pastuszka, Paweł Grudzień, Wojciech Mudyna, Agnieszka Misiewska-Kaczur, Radosław Owczuk, Bartosz Kudliński, Dorota Studzińska, Jarosław Pawlik, Adam Makowski, Mirosław Ziętkiewicz, Mikołaj Przydacz, Waldemar Goździk, Wojciech Gola, Przemysław Jasiewicz, Zhiguo Zhao, Yu Shyr, P J Devereaux
{"title":"Ivabradine in Patients Undergoing Noncardiac Surgery: A Randomized Controlled Trial.","authors":"Wojciech Szczeklik, Jakub Fronczek, Zbigniew Putowski, Anna Włudarczyk, Jacek Górka, Bożena Seczyńska, Dominika Gryszówka, Agnieszka Widawska, Szymon Białka, Piotr Palaczyński, Michał Borys, Paweł Kutnik, Tomasz Czarnik, Anna Szczepańska, Marcin Możański, Marcin Mieszkowski, Katarzyna Kotfis, Janusz Trzebicki, Łukasz Sadowski, Joanna Sołek-Pastuszka, Paweł Grudzień, Wojciech Mudyna, Agnieszka Misiewska-Kaczur, Radosław Owczuk, Bartosz Kudliński, Dorota Studzińska, Jarosław Pawlik, Adam Makowski, Mirosław Ziętkiewicz, Mikołaj Przydacz, Waldemar Goździk, Wojciech Gola, Przemysław Jasiewicz, Zhiguo Zhao, Yu Shyr, P J Devereaux","doi":"10.1161/CIRCULATIONAHA.125.076704","DOIUrl":"10.1161/CIRCULATIONAHA.125.076704","url":null,"abstract":"<p><strong>Background: </strong>Perioperative beta blockade lowers heart rate and decreases the risk of myocardial infarction but increases the risk of hypotension, death, and stroke. Ivabradine, a selective heart rate-lowering agent, may prevent prognostically important myocardial injury after noncardiac surgery (MINS) without causing hemodynamic instability.</p><p><strong>Methods: </strong>In this multicenter, double-blind, placebo-controlled trial, we assigned patients ≥45 years of age with, or at risk of, atherosclerotic disease undergoing noncardiac surgery to receive ivabradine (5 mg orally twice daily for up to 7 days, starting 1 hour before surgery) or placebo. The primary outcome was MINS within 30 days from randomization.</p><p><strong>Results: </strong>All of the 2101 participants who underwent randomization were included in the intention-to-treat population. MINS occurred in 178 of 1050 patients (17.0%) in the ivabradine group and in 159 of 1051 patients (15.1%) in the placebo group (relative risk, 1.12 [95% CI, 0.92 to 1.37]; <i>P</i>=0.25). Enrollment was halted at the prespecified interim analysis because of a conditional power of 6%, below the futility boundary of 20%. The intraoperative mean heart rate was lower in the ivabradine group by 3.2 beats per minute than in the placebo group (95% CI, -4.07 to -2.36), with no difference in intraoperative mean arterial pressure.</p><p><strong>Conclusions: </strong>Among patients undergoing noncardiac surgery, ivabradine did not reduce the occurrence of MINS.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05279651.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1126-1135"},"PeriodicalIF":38.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CirculationPub Date : 2025-10-21Epub Date: 2025-10-20DOI: 10.1161/CIRCULATIONAHA.125.074224
Sara J King, Adam Furst, Jun Fan, Tania P Chen, David J Maron, Paul Heidenreich, Shriram Nallamshetty, Neil M Kalwani, Jonathan H Ward, Anthony Lozama, Fatima Rodriguez, Alexander T Sandhu
{"title":"Comparison of the Pooled Cohort and the PREVENT Cardiovascular Disease Risk Equations in the Veterans Health Administration.","authors":"Sara J King, Adam Furst, Jun Fan, Tania P Chen, David J Maron, Paul Heidenreich, Shriram Nallamshetty, Neil M Kalwani, Jonathan H Ward, Anthony Lozama, Fatima Rodriguez, Alexander T Sandhu","doi":"10.1161/CIRCULATIONAHA.125.074224","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.125.074224","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"152 16","pages":"1183-1185"},"PeriodicalIF":38.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CirculationPub Date : 2025-10-21Epub Date: 2025-10-20DOI: 10.1161/CIRCULATIONAHA.125.077572
{"title":"Highlights From the <i>Circulation</i> Family of Journals.","authors":"","doi":"10.1161/CIRCULATIONAHA.125.077572","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.125.077572","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"152 16","pages":"1174-1178"},"PeriodicalIF":38.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}