JAMA cardiology最新文献

{"title":"Hypertensive Disorders of Pregnancy and Long-Term Risk of Dilated Cardiomyopathy.","authors":"Upasana Tayal, Constantinos Kallis, Georgie M Massen, Nora Rossberg, Emily L Graul, Jennifer K Quint","doi":"10.1001/jamacardio.2025.0328","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0328","url":null,"abstract":"<p><strong>Importance: </strong>The impact of hypertensive disorders of pregnancy on developing dilated cardiomyopathy is unknown.</p><p><strong>Objective: </strong>To determine whether hypertensive disorders of pregnancy are associated with long-term risk of dilated cardiomyopathy.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study performed in England used the following linked electronic health records databases: Clinical Practice Research Datalink (CPRD) Pregnancy Register, CPRD Aurum (primary care), Hospital Episode Statistics Admitted Patient Care, and Office for National Statistics mortality data. Participants included an exposed cohort of 14 083 patients in their first pregnancy with hypertensive disorders of pregnancy (index date observed: January 1997 to December 2018; followed up until July 2023) and unexposed cohort of 70 415 with normotensive pregnancies randomly sampled from the Pregnancy Register (5:1 ratio).</p><p><strong>Exposure: </strong>Hypertensive disorder of pregnancy (preeclampsia, gestational hypertension).</p><p><strong>Main outcomes and measures: </strong>Cox proportional hazards models were fitted to estimate hazard ratios (HRs) of developing dilated cardiomyopathy.</p><p><strong>Results: </strong>The cohort included 14 083 individuals with a hypertensive disease of pregnancy during their first pregnancy and 70 415 individuals with normotensive first pregnancies. A first-time pregnancy complicated by a hypertensive disorder of pregnancy, compared with a normotensive first-time pregnancy, was associated with a 93% higher risk of developing dilated cardiomyopathy (adjusted HR, 1.93 [95% CI, 1.33-2.81]; P = .001; adjusted for maternal age). Dilated cardiomyopathy developed a median (IQR) of 5.1 (0.7-10.6) years post partum in those with HDP and 10.6 (4.2-15.8) years post partum in those with normotensive first pregnancies. The association remained significant after adjusting for maternal age, birth year, gestational diabetes, postpregnancy diabetes, postpregnancy hypertension, total parity, ethnicity, and socioeconomic status (adjusted HR, 1.55 [95% CI, 1.04-2.31]; P = .03). There was a dose response; there was a higher risk of DCM in those with preeclampsia (adjusted HR, 1.85 [95% CI, 1.24-2.76]; P = .002) and severe preeclampsia (adjusted HR, 4.29 [95% CI, 2.32-7.96]; P < .001). Maternal age (adjusted HR per year of age, 1.06 [95% CI, 1.03-1.08]; P < .001) and postpartum incident hypertension (adjusted HR, 1.68 [95% CI, 1.16-2.42]; P = .006) were independently associated with the development of DCM.</p><p><strong>Conclusions: </strong>Patients with hypertensive disorders of pregnancy had a greater risk of developing dilated cardiomyopathy. Older maternal age and postpartum hypertension were associated with higher risk of dilated cardiomyopathy after a hypertensive disorder of pregnancy. These findings support long-term clinical vigilance of patients with a history of hypertensive","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763620","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":"Adverse Pregnancy Outcomes and N-Terminal Pro-Brain Natriuretic Peptide Levels 2 to 7 Years After Delivery: The nuMoM2b Heart Health Study.","authors":"Priya M Freaney, Xiaoning Huang, Lucia C Petito, William A Grobman, Janet Catov, Alisse Hauspurg, C Noel Bairey Merz, Natalie Bello, Jin Kyung Kim, Abbi Lane, David M Haas, Lisa D Levine, Rebecca B McNeil, Eliza Miller, George Saade, Lauren Theilen, Lynn M Yee, Jasmina Varagic, Brian Mercer, Uma Reddy, Donald M Lloyd-Jones, Philip Greenland, Sadiya S Khan","doi":"10.1001/jamacardio.2025.0325","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0325","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763500","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":"Accountable Care Organization Participation and Cardiovascular Care Quality.","authors":"Erica S Spatz, D August Oddleifson, Jehanzeb Kayani, Kensey L Gosch, Philip G Jones, Rushabh H Doshi, Thomas M Maddox, Nihar R Desai","doi":"10.1001/jamacardio.2025.0381","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0381","url":null,"abstract":"<p><strong>Importance: </strong>The Medicare Shared Savings Program (MSSP) was introduced in 2012 to improve care quality and lower costs to Medicare. Under this program, accountable care organizations (ACOs) assumed responsibility for costs and care quality for a group of Medicare beneficiaries.</p><p><strong>Objective: </strong>To compare changes in quality measures for patients at outpatient cardiology practices before and after their participation in a Medicare Shared Savings Program ACO.</p><p><strong>Design, setting, and participants: </strong>This pre-post cohort study comparing quality prior to and after ACO participation evaluated the MSSP at 83 ACO outpatient cardiology practices compared with 332 non-ACO-participating cardiology practices, adjusted for secular trends, using 15 performance measures in the National Cardiovascular Data Registry PINNACLE (Practice Innovation and Clinical Excellence) Registry from January 1, 2013, through March 31, 2019. Data analysis was performed from 2022 to 2025.</p><p><strong>Exposures: </strong>Outpatient cardiology practice participation in the MSSP, which allows ACOs to share in the savings if predetermined cost targets are met, with payments adjusted based on a quality performance score.</p><p><strong>Main outcomes and measures: </strong>Primary end points included 15 quality measures for coronary artery disease, heart failure, atrial fibrillation, and hypertension.</p><p><strong>Results: </strong>During the study period, 2 390 244 patients (1 273 615 [53.3%] female; mean [SD] age, 58.5 [17.7] years) were cared for by 83 ACO practices, and 5 415 880 patients (2 810 204 [51.9%] female; mean [SD] age, 61.5 [16.3] years) were cared for by 332 non-ACO practices. Outpatient cardiology practice participation in an MSSP ACO was not associated with differential changes in various performance measures for coronary artery disease, heart failure, atrial fibrillation, and hypertension. There were no differential changes in the odds of β-blocker prescription, blood pressure control, antiplatelet prescription, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) prescription, low-density lipoprotein (LDL) profiles, or smoking cessation for coronary artery disease; left ventricular assessment, β-blocker prescription, ACEI or ARB prescription, or implantable cardioverter defibrillator use for heart failure; anticoagulation for atrial fibrillation; or blood pressure control for hypertension. Exploratory analyses extending follow-up to 24 months revealed an increase in β-blocker use for heart failure (adjusted odds ratio [aOR], 1.23; 95% CI, 1.02-1.49; P = .03) and a decline in LDL profiles less than 100 mg/dL (to convert to millimoles per liter, multiply by 0.0259; aOR, 0.71; 95% CI, 0.51-0.999; P = .049). Among a subset of traditional Medicare patients, there was an increase in implantable cardioverter defibrillator use by 12 months (aOR, 1.66; 95% CI, 1.12-2.45; P = .01) followi","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763458","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":"Leveraging Preexisting Cardiovascular Data to Improve the Detection and Treatment of Hypertension","authors":"Adam N. Berman, Michael K. Hidrue, Curtis Ginder, Linnea Shirkey, Japneet Kwatra, Anna C. O’Kelly, Sean P. Murphy, Jennifer M. Searl Como, Danielle Daly, Yee-Ping Sun, William T. Curry, Marcela G. del Carmen, Ron Blankstein, John A. Dodson, David A. Morrow, Benjamin M. Scirica, Niteesh K. Choudhry, James L. Januzzi, Jason H. Wasfy","doi":"10.1001/jamacardio.2025.0871","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0871","url":null,"abstract":"ImportanceHypertension is often underrecognized, leading to preventable morbidity and mortality. Tailored data systems combined with care augmented by trained nonphysicians have the potential to improve cardiovascular care.ObjectiveTo determine whether previously collected cardiovascular imaging data could be harnessed to improve the detection and treatment of hypertension through a system-level intervention.Design, Setting, and ParticipantsThe NOTIFY-LVH trial was a 2-arm, pragmatic randomized clinical trial conducted from March 2023 through June 2024 within the Mass General Brigham health care system, a multi-institutional network serving the greater Boston, Massachusetts, area. The study included individuals with a Mass General Brigham primary care affiliation who had left ventricular hypertrophy (LVH) on a prior echocardiogram, had no established cardiomyopathy diagnosis, and were not being treated with antihypertensive medications. Patients were followed for 12 months postintervention.InterventionPopulation health coordinators contacted clinicians of patients randomized to the intervention, notifying them of LVH and offering assistance with follow-up care. A clinical support pathway—including 24-hour ambulatory blood pressure monitoring or cardiology referrals—was provided to aid LVH evaluation.Main Outcomes and MeasuresThe primary outcome was the initiation of an antihypertensive medication. Secondary outcomes included new hypertension and cardiomyopathy diagnoses.ResultsA total of 648 patients were randomized—326 to the intervention and 322 to the control. Mean (SD) patient age was 59.4 (10.8) years and 248 patients (38.3%) were female. A total of 102 patients (15.7%) had a baseline diagnosis of hypertension and 109 patients (20.1%) had a mean outpatient blood pressure of 130/80 mm Hg or higher. Over 12 months, 53 patients (16.3%) in the intervention arm were prescribed an antihypertensive medication vs 16 patients (5.0%) in the control arm (adjusted odds ratio [OR], 3.76; 95% CI, 2.09-6.75; <jats:italic>P</jats:italic> < .001). Individuals in the intervention group were also more likely to be diagnosed with hypertension (adjusted OR, 4.43; 95% CI, 2.36-8.33; <jats:italic>P</jats:italic> < .001). Cardiomyopathy diagnoses did not significantly differ between groups.Conclusions and RelevanceIn the NOTIFY-LVH randomized clinical trial, a centralized population health coordinator–led notification and clinical support pathway for individuals with LVH on prior echocardiograms increased the initial treatment of hypertension. This work highlights the potential benefit of leveraging preexisting but potentially underutilized cardiovascular data to improve health care delivery through mechanisms augmenting the traditional ambulatory care system.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://www.clinicaltrials.gov/study/NCT05713916","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"29 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737023","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":"Mining the Electronic Medical Record for Hypertension Treatment-Hope or Hype?","authors":"Sadiya S Khan","doi":"10.1001/jamacardio.2025.0842","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0842","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752788","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":"Cardiovascular Health Among Rural and Urban US Adults—Healthcare, Lifestyle, and Social Factors","authors":"Michael Liu, Lucas X. Marinacci, Karen E. Joynt Maddox, Rishi K. Wadhera","doi":"10.1001/jamacardio.2025.0538","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0538","url":null,"abstract":"ImportanceImproving cardiovascular health in rural areas is a national priority in the US. However, little is known about the current state of rural cardiovascular health and the underlying drivers of any rural-urban disparities.ObjectiveTo compare rates of cardiometabolic risk factors and cardiovascular diseases between rural and urban US adults and to evaluate the extent to which health care access, lifestyle factors, and social risk factors contribute to any rural-urban differences.Design, Setting, and ParticipantsThis nationally representative cross-sectional study analyzed data from US adults aged 20 years or older residing in rural vs urban areas using the 2022 National Health Interview Survey. Data were analyzed between August 2024 and February 2025.ExposureCounty-level rurality.Main Outcomes and MeasuresThe primary outcomes were age-standardized rates of cardiometabolic risk factors (hypertension, hyperlipidemia, obesity, and diabetes) and cardiovascular diseases (coronary heart disease [CHD] and stroke).ResultsThe study population consisted of 27 172 adults, including 4256 adults (14.0%) residing in rural areas, 14 741 (54.8%) in small or medium metropolitan areas, and 8175 (31.2%) in urban areas. Mean (SD) participant age was 49.1 (17.8) years, and 4399 participants (50.8%) were female. Compared with their urban counterparts, rural adults were more likely to smoke, be insufficiently physically active, and have more social risk factors. Age-standardized rates of cardiometabolic risk factors were significantly higher in rural areas, including hypertension (37.1% vs 30.9%; rate ratio [RR], 1.20; 95% CI, 1.13-1.27), hyperlipidemia (29.3% vs 26.7%; RR, 1.10; 95% CI, 1.03-1.18), obesity (41.1% vs 30.0%; RR, 1.37; 95% CI, 1.27-1.47), and diabetes (11.2% vs 9.8%; RR, 1.15; 95% CI, 1.02-1.29). The same pattern was observed for CHD (6.7% vs 4.3%; RR, 1.58; 95% CI, 1.35-1.85), but no differences were observed for stroke. The magnitude of rural-urban disparities was largest among young adults (aged 20-39 years) for hypertension (RR, 1.44; 95% CI, 1.12-1.86), obesity (RR, 1.54; 95% CI, 1.34-1.77), and diabetes (RR, 2.59; 95% CI, 1.54-4.38). Rural-urban disparities in cardiovascular health were not meaningfully attenuated after adjustment for measures of health care access (insurance coverage, usual source of care, and recent health care utilization) and lifestyle factors (smoking and physical activity). However, accounting for social risk factors (poverty, education level, food insecurity, and home ownership) completely attenuated rural-urban disparities in hypertension (adjusted RR [aRR], 0.99; 95% CI, 0.93-1.06), diabetes (aRR, 1.02; 95% CI, 0.90-1.15), and CHD (aRR, 1.08; 95% CI, 0.91-1.29), but only partially attenuated disparities in obesity (aRR, 1.29; 95% CI, 1.20-1.39).Conclusions and RelevanceThis national cross-sectional study found substantial rural-urban disparities in cardiometabolic risk factors and cardiovascular diseases, which were ","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"18 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737022","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":"Rural America-Expanding the Lens of Health Disparities: Endorsing the Need for Health Equity Research.","authors":"Sadiya S Khan, Clyde W Yancy","doi":"10.1001/jamacardio.2025.0555","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0555","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752807","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":"Mode of Death in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction","authors":"Akshay S. Desai, Pardeep S. Jhund, Muthiah Vaduganathan, Brian L. Claggett, Jonathan W. Cunningham, Maria A. Pabon, Carolyn S. P. Lam, Michele Senni, Sanjiv Shah, Adriaan A. Voors, Faiez Zannad, Bertram Pitt, Flaviana Amarante, James Lay-Flurrie, Markus F. Scheerer, Andrea Lage, John J. V. McMurray, Scott D. Solomon","doi":"10.1001/jamacardio.2025.0860","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0860","url":null,"abstract":"ImportanceThe mode of death in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) remains poorly understood and may vary by EF.ObjectiveTo evaluate the mode of death according to EF and the treatment effect of finerenone on cause-specific mortality in patients with HFmrEF/HFpEF.Design, Setting, and ParticipantsThis was a prespecified secondary analysis of the Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) randomized clinical trial, which evaluated clinical outcomes in 6001 patients with HF and EF greater than or equal to 40% randomly assigned to finerenone or placebo. The mode of death in relation to baseline EF categories (&amp;amp;lt;50%, ≥50-&amp;amp;lt;60%, and ≥60%) was examined, and the effect of randomized treatment on cause-specific death in Cox regression models was assessed. Data analysis was conducted between September 2024 and January 2025.InterventionsFinerenone vs placebo.Main Outcomes and MeasuresMode of death as centrally adjudicated by a clinical end points committee.ResultsOf 1013 patients (16.9%; median [IQR] age, 76 [69-82] years; 594 male [58.6%]) who died during median (IQR) follow-up of 32 (23-36) months, mode of death was ascribed to cardiovascular causes in 502 (49.6%), noncardiovascular causes in 368 (36.3%), and undetermined cause in 143 (14.1%). Of cardiovascular deaths, 215 (42.8%) were due to sudden death, 163 (32.4%) to HF, 48 (9.6%) to stroke, 25 (5.0%) to myocardial infarction, and 51 (10.2%) to other cardiovascular causes. The proportion of all-cause, cardiovascular, and sudden death was higher in those with EF less than 50%. The proportion of deaths related to HF was similar across EF categories, and the proportion of deaths due to myocardial infarction, stroke, and other cardiovascular causes was low regardless of EF. Randomization to finerenone did not significantly reduce death or cause-specific death compared with placebo in any EF category.Conclusions and RelevanceAmong patients with HFmrEF/HFpEF in the FINEARTS-HF randomized clinical trial, higher proportions of cardiovascular and overall mortality in those with EF less than 50% were related principally to higher proportions of sudden death. A clear treatment effect of finerenone on cardiovascular or cause-specific mortality was not identified, although the trial was likely underpowered for these outcomes.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT04435626\">NCT04435626</jats:ext-link>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"62 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736540","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":"Finerenone and Atrial Fibrillation in Heart Failure","authors":"Shingo Matsumoto, Alasdair D. Henderson, Pardeep S. Jhund, Johann Bauersachs, Ovidiu Chioncel, Brian L. Claggett, Josep Comin-Colet, Akshay S. Desai, Gerasimos Filippatos, Carolyn S. P. Lam, Bertram Pitt, Markus Florian Scheerer, James Lay-Flurrie, Flaviana Amarante, Meike Brinker, Morten Schou, Michele Senni, Sanjiv J. Shah, Adriaan A. Voors, Faiez Zannad, Shelley Zieroth, Muthiah Vaduganathan, Scott D. Solomon, John J. V. McMurray","doi":"10.1001/jamacardio.2025.0848","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0848","url":null,"abstract":"ImportanceHeart failure (HF) with mildly reduced or preserved ejection fraction and atrial fibrillation (AF) are closely intertwined.ObjectiveTo examine the efficacy and safety of the nonsteroidal mineralocorticoid receptor antagonist finerenone in patients with HF with mildly reduced or preserved ejection fraction according to the absence or presence of AF and the type of AF (paroxysmal vs persistent or permanent).Design, Setting, and ParticipantsPrespecified analyses were conducted in the Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) randomized clinical trial. The trial was conducted across 653 sites in 37 countries. Participants were adults aged 40 years and older with symptomatic HF and left ventricular ejection fraction of 40% or greater, randomized between September 2020 and January 2023. Data analysis was conducted from September 1 to October 1, 2024.InterventionFinerenone (titrated to 20 mg or 40 mg) or placebo.Main Outcomes and MeasuresThe primary outcome was the composite of total HF events and cardiovascular death. New-onset AF or atrial flutter (AFL) was a prespecified exploratory outcome.ResultsAmong 5984 patients (mean [SD] age, 72.0 [9.6] years; 2724 [45.5%] female) with known AF status at baseline, 1384 (23.1%) had paroxysmal AF and 1886 (31.5%) had persistent or permanent AF. Patients with both types of AF were older and had worse HF status compared with those without AF (2714 patients [45.4%]). Both types of AF were associated with a higher unadjusted risk of the primary outcome compared with no AF (event rate per 100 person-years of follow-up, 20.3 [95% CI, 17.9-23.1] with paroxysmal AF, 19.8 [95% CI, 17.8-22.0] with persistent or permanent AF, and 11.9 [95% CI, 10.7-13.3] with no AF; rate ratio [RR], 1.62 [95% CI, 1.37-1.92] with paroxysmal AF and 1.66 [95% CI, 1.43-1.93] with persistent or permanent AF vs no AF); however, the associations were attenuated after adjustment for known prognostic variables. The benefit of finerenone on the primary outcome (overall RR, 0.84 [95% CI, 0.74-0.95]) was not modified by baseline AF status (RR, 0.80 [95% CI, 0.65-0.98] with no AF, 0.83 [95% CI, 0.65-1.06] with paroxysmal AF, and 0.85 [95% CI, 0.69-1.05] with persistent or permanent AF; &lt;jats:italic&gt;P&lt;/jats:italic&gt; for interaction = .94). New-onset AF or AFL occurred in 6.5% of patients and was associated with a higher subsequent adjusted risk of the primary outcome (rate ratio, 3.65 [95% CI, 2.57-5.18]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001). The subdistribution hazard ratio for new-onset AF or AFL among those receiving finerenone vs placebo was 0.77 (95% CI, 0.57-1.04; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .09).Conclusions and RelevanceThe efficacy of finerenone was consistent regardless of AF status. New-onset AF was associated with a substantially higher risk of subsequent outcomes.Trial RegistrationClinicalTrials.gov Identifier: &lt;jats:ext-link xmlns:xlink=\"http:/","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"37 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736461","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":"The Role of Cardiovascular Disease Journals in Reporting Sex and Gender in Research.","authors":"C Noel Bairey Merz, Robert O Bonow, Mercedes Carnethon, Filippo Crea, Joseph A Hill, Harlan M Krumholz, Roxana Mehran, Erica S Spatz","doi":"10.1001/jamacardio.2025.0788","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0788","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730096","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}