JAMA cardiology最新文献

{"title":"Hypertension, Diabetes, and High Cholesterol Awareness Among US Adults.","authors":"Daniel Y Johnson, Lucas X Marinacci, Rishi K Wadhera","doi":"10.1001/jamacardio.2025.1536","DOIUrl":"10.1001/jamacardio.2025.1536","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215842","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":"AHA PREVENT Equations and Lipoprotein(a) for Cardiovascular Disease Risk : Insights From MESA and the UK Biobank.","authors":"Harpreet S Bhatia, Matthew Ambrosio, Alexander C Razavi, Pamela L Alebna, Calvin Yeang, Jared A Spitz, Jaideep Patel, Michael Y Tsai, Laurence Sperling, Michael D Shapiro, Sotirios Tsimikas, Anurag Mehta","doi":"10.1001/jamacardio.2025.1603","DOIUrl":"10.1001/jamacardio.2025.1603","url":null,"abstract":"<p><strong>Importance: </strong>Lipoprotein(a) [Lp(a)] is independently associated with atherosclerotic cardiovascular disease (ASCVD) risk but is not included in the new American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) equations for CVD risk assessment.</p><p><strong>Objective: </strong>To evaluate the performance of these equations in individuals with elevated Lp(a).</p><p><strong>Design, setting, and participants: </strong>Cohort study involving 314 783 participants from the multicenter Multi-Ethnic Study of Atherosclerosis (MESA, 2000-2018; n = 6670) and the population-based UK Biobank (UKB, 2006-2022; n = 308 113) without known cardiovascular disease with available Lp(a) measurements. Analyses were conducted March 25, 2025.</p><p><strong>Exposure: </strong>Elevated Lp(a) level of 125 nmol/L or higher.</p><p><strong>Main outcomes and measures: </strong>Coronary heart disease (CHD), ASCVD, heart failure (HF), and total CVD. Participants were categorized as low (<5%), borderline (5% to <7.5%) intermediate (7.5% to <20%), and high (≥20%) risk of each outcome. Ten-year observed event rates were calculated, and the association between elevated Lp(a) and outcomes overall and by risk category was evaluated in age- and sex-adjusted Cox proportional hazards models. Improvement in risk prediction with the addition of elevated Lp(a) was evaluated using continuous and categorical net reclassification improvement (NRI) (using the above cut points).</p><p><strong>Results: </strong>Among the 314 783 participants (mean [SD] age, 62.1 [10.2] years and 3523 females [53%] in MESA; mean [SD] age, 56.3 [8.1] years; 169 648 females [55%] in the UKB), observed 10-year ASCVD event rates generally fell within the bounds of predicted risk categories regardless of Lp(a) level, although participants with elevated Lp(a) had higher event rates than did those with nonelevated Lp(a) (hazard ratio [HR], 1.30; 95% CI, 1.22-1.38) with similar results for CHD, HF, and total CVD. For CHD, the strongest association was among low-risk individuals (P for interaction = .31). The addition of elevated Lp(a) values to PREVENT modestly improved ASCVD risk prediction (category-free NRI, 0.058; 95% CI, 0.043-0.065; categorical NRI, 0.006, 95% CI, 0.004-0.011) with the greatest improvement in borderline-risk; when Lp(a) was evaluated continuously, the greatest improvement in prediction was among individuals at low risk. For CHD, the greatest improvement in prediction was in low- and high-risk individuals.</p><p><strong>Conclusions and relevance: </strong>In this analysis of 2 cohort studies, the novel PREVENT equations performed well for risk prediction overall, including among individuals with elevated Lp(a). However, Lp(a) values remain independently associated with higher risk, and Lp(a) may improve personalized risk assessment, particularly among specific subgroups.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215827","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":"Genetic Testing in Early-Onset Atrial Fibrillation.","authors":"Olivia G Anderson, Thomas P Cappola, Sharlene M Day","doi":"10.1001/jamacardio.2025.0915","DOIUrl":"10.1001/jamacardio.2025.0915","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"533-534"},"PeriodicalIF":14.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012778","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":"Error in Figure 2.","authors":"","doi":"10.1001/jamacardio.2025.1212","DOIUrl":"10.1001/jamacardio.2025.1212","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"635"},"PeriodicalIF":14.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020949","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":"FFR-Guided Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Diabetes.","authors":"Kuniaki Takahashi, Hisao Otsuki, Frederik M Zimmermann, Victoria Y Ding, Thomas Engstrøm, Hans Gustav Hørsted Thyregod, Branko Beleslin, Svetozar Putnik, Luke Tapp, Thomas Barker, Simon Redwood, Christopher Young, G Jan-Willem Bech, Gerard J F Hoohenkerk, Bernard De Bruyne, Nico H J Pijls, William F Fearon","doi":"10.1001/jamacardio.2025.0095","DOIUrl":"10.1001/jamacardio.2025.0095","url":null,"abstract":"<p><strong>Importance: </strong>Outcomes in patients with diabetes after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown.</p><p><strong>Objectives: </strong>To investigate the relative treatment effect of PCI vs CABG according to diabetes status with respect to major adverse cardiac and cerebrovascular events (MACCE) at 3 years and to evaluate the impact of the SYNTAX score.</p><p><strong>Design, setting, and participants: </strong>This is a prespecified subgroup analysis of the FAME (Fractional Flow Reserve vs Angiography for Multivessel Evaluation) 3 trial, an investigator-initiated, randomized clinical trial conducted at 48 centers worldwide. The FAME 3 trial enrolled patients with 3-vessel coronary artery disease not involving the left main undergoing coronary revascularization between August 2014 and December 2019. Data analysis was conducted in August 2023. Clinical follow-up was performed at hospital discharge and at 1 month, 6 months, 1 year, 2 years, and 3 years after randomization.</p><p><strong>Intervention: </strong>Either FFR-guided PCI with current-generation DES or CABG.</p><p><strong>Main outcomes and measures: </strong>The primary end point was MACCE, defined as the composite of all-cause death, myocardial infarction, stroke, or repeat revascularization at 3 years.</p><p><strong>Results: </strong>Of 1500 total patients enrolled, mean (SD) patient age was 65.1 (8.4) years, and 265 patients (17.7%) were female. The FAME 3 trial included 428 patients with diabetes (28.5%). Patients with diabetes, especially those receiving insulin, had a higher risk of MACCE at 3 years compared with those without diabetes. Regarding relative treatment effect, the risk of MACCE was higher after FFR-guided PCI compared with CABG in both patients with diabetes (hazard ratio [HR], 1.44; 95% CI, 0.91-2.28; P = .12) and those without diabetes (HR, 1.50; 95% CI, 1.08-2.07; P = .02), with no significant interaction (P for interaction = .94). In patients with a low SYNTAX score (<23), there was no significant difference in MACCE between PCI and CABG, while in patients with an intermediate to high SYNTAX score (≥23), PCI had a higher risk of MACCE than CABG, regardless of diabetes status.</p><p><strong>Conclusions and relevance: </strong>In this subgroup analysis of the FAME 3 randomized clinical trial, the relative benefit of CABG compared with FFR-guided PCI was similar among patients with and without diabetes.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02100722.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"603-608"},"PeriodicalIF":14.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604742","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":"Finerenone for Heart Failure and Risk Estimated by the PREDICT-HFpEF Model: A Secondary Analysis of FINEARTS-HF.","authors":"Kirsty McDowell, Kieran F Docherty, Ross T Campbell, Alasdair D Henderson, Pardeep S Jhund, Brian L Claggett, Akshay S Desai, James Lay-Flurrie, Lucas Hofmeister, Andrea Scalise, Carolyn S P Lam, Mark C Petrie, Morten Schou, Michele Senni, Sanjiv J Shah, Jacob A Udell, Faiez Zannad, Bertram Pitt, Muthiah Vaduganathan, Scott D Solomon, John J V McMurray","doi":"10.1001/jamacardio.2025.0025","DOIUrl":"10.1001/jamacardio.2025.0025","url":null,"abstract":"<p><strong>Importance: </strong>Patients with heart failure (HF) and mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF) have a spectrum of risk, and the effect of therapies may vary by risk.</p><p><strong>Objectives: </strong>To validate the Prognostic Models for Mortality and Morbidity in HFpEF (PREDICT-HFpEF) in the phase 3 randomized clinical trial Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) and to evaluate the effect of finerenone, compared with placebo, across the spectrum of risk in these patients.</p><p><strong>Design, setting, and participants: </strong>The FINEARTS-HF trial was conducted across 653 sites in 37 countries. Participants were adults 40 years and older with symptomatic HF and left ventricular EF of 40% or greater randomized between September 2020 and January 2023.</p><p><strong>Intervention: </strong>Finerenone (titrated to 20 mg or 40 mg) or placebo.</p><p><strong>Main outcomes and measures: </strong>The 3 PREDICT-HFpEF risk scores for the composite outcome of cardiovascular death or HF hospitalization, cardiovascular death, and all-cause death, respectively, were calculated. Predicted risk was compared with observed outcomes. Model performance was assessed using the Harrell C statistic. The rates of the predicted outcomes (plus the composite of cardiovascular death and worsening HF events, which was the primary end point in the trial) were examined according to quintiles of risk score, as was the effect of finerenone according to risk quintiles.</p><p><strong>Results: </strong>A total of 6001 patients (mean [SD] age, 72 [9.6] years; 3269 male [54.5%]) were randomized in the FINEARTS-HF trial. The C statistics for cardiovascular death or HF hospitalization, cardiovascular death, and all-cause death at 2 years were 0.71 (95% CI, 0.69-0.72), 0.68 (95% CI, 0.66-0.71), and 0.69 (95% CI, 0.67-0.71), respectively. The risk of the composite outcomes was approximately 8- to 10-fold higher in those in the highest compared with the lowest risk quintile. The relative risk reduction with finerenone compared with placebo was consistent across the spectrum of risk for all outcomes examined (eg, interaction P value for primary outcome = .24).</p><p><strong>Conclusions and relevance: </strong>Results of the FINEARTS-HF randomized clinical trial demonstrate that the PREDICT-HFpEF models performed well in terms of calibration and discrimination. Baseline risk did not modify the benefit of finerenone.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04435626.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"535-544"},"PeriodicalIF":14.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556818","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":"Valsartan and Cardiac Remodeling in Early-Stage Hypertrophic Cardiomyopathy: The VANISH Randomized Clinical Trial Cardiac Magnetic Resonance Substudy.","authors":"John W Ostrominski, Brian L Claggett, Michael Jerosch-Herold, Anna Axelsson Raja, Sharlene M Day, Mark W Russell, Kenneth Zahka, Alexandre C Pereira, Steven D Colan, Anne M Murphy, Charles Canter, Richard G Bach, Matthew T Wheeler, Joseph W Rossano, Anjali T Owens, Luisa Mestroni, Matthew R G Taylor, Amit R Patel, Ivan Wilmot, Jonathan H Soslow, Jason R Becker, Neal K Lakdawala, Henning Bundgaard, Jose D Vargas, Carolyn Y Ho","doi":"10.1001/jamacardio.2024.5677","DOIUrl":"10.1001/jamacardio.2024.5677","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Valsartan has been shown to attenuate phenotypic progression among individuals with early-stage sarcomeric hypertrophic cardiomyopathy (HCM). Myocardial tissue characterization by cardiac magnetic resonance (CMR) imaging may enhance mechanistic insights, but whether valsartan influences these parameters remains uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the treatment effects of valsartan on myocardial structure, function, and tissue parameters in early-stage sarcomeric HCM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This prespecified CMR substudy of the VANISH (Valsartan for Attenuating Disease Evolution in Early Sarcomeric Hypertrophic Cardiomyopathy) randomized clinical trial evaluated treatment effects of valsartan vs placebo on myocardial structure, function, and tissue parameters and was conducted from April 2014 through July 2019 at 17 international sites. Individuals aged 8 to 45 years with early-stage HCM aged between 8 and 45 years and with no or minimal symptoms were eligible for inclusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Treatment with placebo or valsartan (80 mg per day for children weighing &lt;35 kg, 160 mg per day for children weighing ≥35 kg, or 320 mg per day for adults aged 18 years or older).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was mean change in CMR parameters between baseline and year 2, including indexed extracellular volume (iECV), indexed intracellular volume (iICV), and late gadolinium enhancement (LGE). Mean between-group differences in CMR parameters between baseline and year 2 were evaluated using multivariable mixed-effects linear regression models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 137 of 178 VANISH participants (77.0%) underwent CMR imaging at baseline and year 2. Among these participants, mean (SD) age was 23 (10) years, and 51 participants (37.2%) were female. Baseline characteristics and CMR parameters were well balanced between treatment groups. Higher LGE, iECV, and iICV at baseline were associated with higher cardiac biomarker levels and more pronounced cardiac remodeling. Between baseline and year 2, valsartan appeared to increase left ventricular (LV) end-diastolic volume index (mean difference [MD], 3.3 mL/m2; 95% CI, 0.4-6.2; P = .03), suggesting treatment benefit, but did not significantly impact LV mass index (MD, -2.9 g/m2; 95% CI, -6.1 to 0.2; P = .07) or LV ejection fraction. Similarly, valsartan appeared to reduce decline in right ventricular volumes. Valsartan appeared to significantly reduce iICV progression (MD, -5.0 mL/m2; 95% CI, -9.7 to -0.4; P = .03), but did not impact iECV (MD, 0.0 mL/m2; 95% CI, -1.4 to 1.3; P = .95) or LGE progression (MD, 0.5%; 95% CI, -0.4 to 1.3; P = .30).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;These findings enhance mechanistic insights into the effect of valsartan in early-stage HCM, showing potential benefits on biventricular remodeling and myocardial ","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"617-623"},"PeriodicalIF":14.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556885","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":"10.1001/jamacardio.2025.0483","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"523-524"},"PeriodicalIF":14.8,"publicationDate":"2025-06-01","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":"555-563"},"PeriodicalIF":14.8,"publicationDate":"2025-06-01","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":"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":"10.1001/jamacardio.2025.0381","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare changes in quality measures for patients at outpatient cardiology practices before and after their participation in a Medicare Shared Savings Program ACO.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Primary end points included 15 quality measures for coronary artery disease, heart failure, atrial fibrillation, and hypertension.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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":"545-554"},"PeriodicalIF":14.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966472/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}