JAMA cardiology最新文献

{"title":"Encouraging Pharmacist Referrals for Evidence-Based Statin Initiation: Two Cluster Randomized Clinical Trials.","authors":"Alexander C Fanaroff, Qian Huang, Kayla Clark, Laurie A Norton, Wendell E Kellum, Dwight Eichelberger, John C Wood, Zachary Bricker, Andrea G Dooley Wood, Greta Kemmer, Jennifer I Smith, Srinath Adusumalli, Mary E Putt, Kevin G Volpp","doi":"10.1001/jamacardio.2025.0244","DOIUrl":"10.1001/jamacardio.2025.0244","url":null,"abstract":"<p><strong>Importance: </strong>Despite statins' benefit in preventing major adverse cardiovascular events, most patients with an indication for statin therapy are not appropriately treated. Clinicians' limited time and lack of systematic efforts to address preventive care likely contribute to gaps in statin prescribing.</p><p><strong>Objective: </strong>To determine the effect on statin prescribing of 2 interventions to refer appropriate patients to a pharmacist for lipid management.</p><p><strong>Design, setting, and participants: </strong>These 2 pragmatic cluster randomized clinical trials were conducted among 12 total primary care practices in a community health system. Trial 1 was a delayed-intervention design of a visit-based intervention with randomization at the clinician level in a single clinic, and trial 2 was a parallel-arm trial of an asynchronous intervention with randomization at the clinic level in 11 clinics. Patients who were assigned to a primary care clinician at a participating practice, had an indication for a high-intensity or moderate-intensity statin, and were either not prescribed a statin or prescribed an inappropriately low statin dose were eligible for inclusion.</p><p><strong>Intervention: </strong>Trial 1 tested an interruptive electronic health record alert that appeared during eligible patients' visits and facilitated referral to a pharmacist, while trial 2 tested an order for pharmacist referral placed by the study team for cosignature by the primary care clinician without regard to the timing of a clinic visit.</p><p><strong>Main outcome and measure: </strong>The primary outcome was the proportion of patients prescribed a statin.</p><p><strong>Results: </strong>Overall, 1412 patients were enrolled in trial 1 and 1950 in trial 2. Across both trials, mean (SD) patient age was 65.6 (9.9) years, and 1485 patients (44.2%) were female. Mean (SD) baseline 10-year risk of major cardiovascular events was 17.9% (9.4). In trial 1, the interruptive alert was not associated with a significant increase in statin prescriptions compared with usual care (15.6% vs 11.6%; unadjusted absolute difference, 3.9 percentage points; 95% CI, -0.4 to 8.3). In trial 2, semiautomated pharmacist referrals were associated with an increase in statin prescriptions by 16 percentage points compared with usual care (31.6% vs 15.2%; unadjusted absolute difference, 16.4 percentage points; 95% CI, 12.7-20.1).</p><p><strong>Conclusions and relevance: </strong>In these 2 cluster randomized clinical trials, visit-based interruptive alerts were not associated with a significant increase in statin prescribing compared with usual care, whereas a strategy of asynchronous semiautomated referral for pharmacist comanagement was associated with a substantial increase. This strategy of asynchronous semiautomated referrals for pharmacist involvement in lipid management could be a scalable and effective approach to increasing statin prescribing for patients at hig","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Valve Intervention for Asymptomatic Aortic Stenosis.","authors":"Rick A Nishimura, Patrick T O'Gara, Robert O Bonow","doi":"10.1001/jamacardio.2025.0483","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0483","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709809","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":"Asundexian or Apixaban in Patients With Atrial Fibrillation According to Prior Oral Anticoagulant Use: A Subgroup Analysis of the OCEANIC-AF Randomized Clinical Trial.","authors":"John H Alexander, Elizabeth J Lydon, Jonathan P Piccini, Thomas Viethen, Jonas Oldgren, Shaun G Goodman, Jan Steffel, Andrea M Russo, Isabelle C van Gelder, Keith C Ferdinand, Renato D Lopes, Hardi Mundl, Bela Benczur, Juan José Gómez-Doblas, Michael Glikson, Assen Goudev, Erik L Grove, Sigrun Halvorsen, Tuomas Kiviniemi, Anne-Céline Martin, Roopinder K Sandhu, Dragos Vinereanu, Frank W Rockhold, Valeria Caso, Rosa Coppolecchia, Manesh R Patel","doi":"10.1001/jamacardio.2025.0277","DOIUrl":"10.1001/jamacardio.2025.0277","url":null,"abstract":"<p><strong>Importance: </strong>In patients with atrial fibrillation (AF), oral anticoagulants (OACs) reduce the risk of stroke.</p><p><strong>Objective: </strong>To investigate if patients with less prior OAC exposure respond differently to a new OAC than patients with more OAC exposure.</p><p><strong>Design, setting, and participants: </strong>In this prespecified exploratory subgroup analysis of the Oral Factor 11a Inhibitor Asundexian as Novel Antithrombotic-Atrial Fibrillation (OCEANIC-AF) randomized clinical trial, patients enrolled in the OCEANIC-AF trial were categorized as OAC naive or OAC experienced based on whether they had 6 or fewer weeks or more than 6 weeks of prior OAC use. The effect of asundexian vs apixaban was then compared on outcomes among patients who were OAC naive and OAC experienced. The study setting included 1035 sites in 38 countries, and participants were those enrolled in the OCEANIC-AF trial. Data were analyzed from June to July 2024.</p><p><strong>Interventions: </strong>Asundexian, a novel factor XIa inhibitor, was compared with apixaban in patients with AF.</p><p><strong>Main outcomes and measures: </strong>The primary efficacy outcome was stroke or systemic embolism. The main safety outcome was major bleeding.</p><p><strong>Results: </strong>Of patients in the OCEANIC-AF trial, 2493 (17%) were OAC naive (mean [SD] age, 72.6 [8.6] years; 1464 male [59%]) and 12 317 (83%) were OAC experienced (mean [SD] age, 74.2 [7.5] years; 8132 male [66%]). In the asundexian arm, patients who were OAC naive had a stroke or systemic embolism rate of 0.8% (10 of 1238) compared with 1.4% (88 of 6177) in those who were OAC experienced. In the apixaban arm, patients who were OAC naive had a stroke or systemic embolism rate of 0.6% (7 of 1255) compared with 0.3% (19 of 6140) in those who were OAC experienced. Thus, patients who were OAC naive had a smaller increase in stroke or systemic embolism with asundexian compared with apixaban (hazard ratio [HR], 1.42; 95% CI, 0.54-3.73) than patients who were OAC experienced (HR, 4.66; 95% CI, 2.84-7.65; P for interaction =.03). Bleeding rates were lower among both OAC-naive patients (0.2% [2 of 1228]) and OAC-experienced patients (0.2% [15 of 6145]) assigned asundexian than among OAC-naive patients (1.0% [13 of 1249]) and OAC-experienced patients (0.7% [40 of 6115]) assigned apixaban.</p><p><strong>Conclusions and relevance: </strong>In the OCEANIC-AF randomized clinical trial, patients with AF who were OAC naive had a smaller increase in stroke or systemic embolism and a similar lower rate of bleeding with asundexian compared with apixaban than patients who were OAC experienced. The mechanism of these findings is unknown and deserves further research.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05643573.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint Associations of APOC3 and LDL-C–Lowering Variants With the Risk of Coronary Heart Disease","authors":"Wenxiu Wang, Rui Li, Zimin Song, Ninghao Huang, Tao Huang, Xinwei Hua, Yi-Da Tang","doi":"10.1001/jamacardio.2025.0195","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0195","url":null,"abstract":"ImportanceDespite substantial progress in low-density lipoprotein cholesterol (LDL-C)–lowering strategies, residual cardiovascular risk remains. Apolipoprotein C3 (APOC3) has emerged as a novel target for lowering triglycerides. Multiple clinical trials of small-interfering RNA therapeutics targeting APOC3 are currently underway.ObjectiveTo investigate whether genetically predicted lower APOC3 is associated with a reduction in cardiovascular risk and if the combined exposure to <jats:italic>APOC3</jats:italic> and LDL-C–lowering variants is associated with a reduction in the risk of coronary heart disease (CHD).Design, Setting, and ParticipantsThis was a population-based genetic association study with 2 × 2 factorial mendelian randomization. Included were participants of European ancestry in the UK Biobank. Data were analyzed from November 2023 to July 2024.ExposuresGenetic scores were constructed to mimic the effects of APOC3, 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR), and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors.Main Outcomes and MeasuresPlasma lipid and lipoprotein levels, CHD, and type 2 diabetes (T2D).ResultsThis study included 401 548 UK Biobank participants (mean [SD] age, 56.9 [8.0] years; 216 901 female [54.0%]). Genetically predicted lower APOC3 was associated with a lower risk of CHD (odds ratio [OR], 0.96; 95% CI, 0.93-0.98) and T2D (0.97; 95% CI, 0.95-0.99). Genetically lower APOC3 and PCSK9 were associated with a similar magnitude of risk reduction in CHD per 10-mg/dL decrease in apolipoprotein B (ApoB) level (APOC3: 0.70; 95% CI, 0.59-0.83; PCSK9: 0.71; 95% CI, 0.65-0.77). Combined exposure to genetically lower APOC3 and PCSK9 was associated with an additive lower risk of CHD (APOC3: 0.96; 95% CI, 0.92-0.99; PCSK9: 0.93; 95% CI, 0.90-0.97; combined: 0.90; 95% CI, 0.86-0.93). Genetically lower HMGCR was also associated with a lower risk of CHD, and the risk was further reduced when combined with APOC3 (0.93; 95% CI, 0.90-0.97).Conclusions and RelevanceGenetically predicted lower APOC3 was associated with a reduced risk of CHD that is comparable with that associated with lower PCSK9 per unit decrease in ApoB. Combined exposure to <jats:italic>APOC3</jats:italic> and LDL-C–lowering variants was associated with an additive reduction in CHD risk. Future studies are warranted to investigate the therapeutic potential of these combined therapies, particularly among high-risk patients who cannot achieve therapeutic targets with existing lipid-lowering therapies.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"91 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653586","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":"JAMA Cardiology Peer Reviewers in 2024.","authors":"","doi":"10.1001/jamacardio.2025.0242","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0242","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"e250242"},"PeriodicalIF":14.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657087","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":"Concomitant Mechanical Aspiration and Appendage Closure for Recalcitrant Left Atrial Appendage Thrombi","authors":"Maryam Saleem, Abhishek Maan, Daniel R. Musikantow, Chi Zhang, Yury Malyshev, Marc A. Miller, Srinivas R. Dukkipati, Parasuram M. Krishnamoorthy, Martin Goldman, Prakash Krishnan, Vivek Y. Reddy","doi":"10.1001/jamacardio.2025.0203","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0203","url":null,"abstract":"ImportanceIt is well appreciated that a small yet high-risk subset of patients with atrial fibrillation (AF) develops persistent left atrial appendage (LAA) thrombus despite optimal oral anticoagulation (OAC). In patients with either a heightened risk of bleeding precluding enhanced doses of OAC to dissolve the thrombus, or thromboembolism despite optimal OAC, there are limited nonsurgical options.ObjectivesTo introduce a novel management strategy for resistant LAA thrombus: percutaneous mechanical thrombus aspiration with cerebral protection, followed by LAA closure (LAAC).Design, Setting, and ParticipantsThis descriptive, prospective case series of 9 consecutive patients with persistent LAA thrombus was conducted between August 2023 and July 2024 at Mount Sinai Hospital. After placing a cerebral protection device (CPD) when anatomically feasible, balloon atrial septostomy was performed as needed to enhance transeptal access. A 20F mechanical aspiration device with a 15-mm funneled ostium was advanced to the LAA ostium, and manual vacuum aspiration of thrombus was performed. After ultrasonic confirmation of thrombectomy, an LAAC device was implanted.Main Outcomes and MeasuresPatient demographic, clinical, and intervention data were collected.ResultsNine patients (mean [SD] age, 74.7 [13.6] years; median [IQR] CHA<jats:sub>2</jats:sub>DS<jats:sub>2</jats:sub>-VASc [congestive heart failure, hypertension, age 75 years or older, diabetes, stroke, vascular disease, age 65-74 years, and female sex] score, 5 [2-8] points) presented with LAA thrombus in the context of contraindications to OAC. CPD was placed in 8 patients; one had prohibitive aortic arch anatomy. Given the patient’s high thrombotic burden and limited alternatives, the decision was to proceed without CPD, based on a risk-benefit assessment. Balloon atrial septostomy was performed in 8 patients. In 8 patients, complete thrombus removal was achieved, followed by successful LAAC device placement. One patient had a small residual distal thrombus, presumably organized, which was strongly adherent to the LAA myocardium; this was compressed against the wall with the LAAC device. One patient had a small thrombus fragment recovered from the CPD postprocedure. During both the index procedure and during follow-up (range, 4-15 months), there were no complications.Conclusions and RelevanceThis cases series found that temporary cerebral protection, percutaneous mechanical vacuum thrombectomy, and mechanical LAA closure was feasible in patients with persistent LAA thrombus despite optimal OAC. Larger studies will be needed to fully assess the efficacy and safety of this approach.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"25 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653587","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":"Peak Oxygen Uptake vs Ventilatory Efficiency.","authors":"Jiawei Du, Jinghua Hou","doi":"10.1001/jamacardio.2025.0216","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0216","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657095","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":"A Man in His 30s With Ponytail Coronary Artery Anomaly.","authors":"Leizhi Ku, Xiaojing Ma","doi":"10.1001/jamacardio.2025.0124","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0124","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657083","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":"JAMA Cardiology-The Year in Review 2024.","authors":"Robert O Bonow","doi":"10.1001/jamacardio.2025.0478","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0478","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657091","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":"Peak Oxygen Uptake Vs Ventilatory Efficiency-In Reply.","authors":"Matthew M Y Lee, Gregory D Lewis","doi":"10.1001/jamacardio.2025.0219","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0219","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657108","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}