JAMA cardiology最新文献

{"title":"Comment on Aspirin Avoidance in Patients With LVADs.","authors":"Xiaoping Wang","doi":"10.1001/jamacardio.2025.2344","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2344","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"90 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684360","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":"Time to Implement a Polypill-Based Public Health Service.","authors":"Nicholas Wald","doi":"10.1001/jamacardio.2025.2255","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2255","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"8 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640195","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":"Time to Implement a Polypill-Based Public Health Service-Reply.","authors":"Ciaran N Kohli-Lynch,Thomas J Wang,Brandon K Bellows","doi":"10.1001/jamacardio.2025.2258","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2258","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"3 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640090","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":"Temporal Patterns in Out-of-Hospital Cardiac Arrest Incidence and Outcome.","authors":"Owen McBride,Amy Poel,Catherine R Counts,Megin Parayil,Camilla Osborne,Chris Drucker,Mickey Eisenberg,David Murphy,Peter Kudenchuk,Michael Sayre,Thomas Rea","doi":"10.1001/jamacardio.2025.2247","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2247","url":null,"abstract":"ImportanceIncidence and outcome of out-of-hospital cardiac arrest (OHCA) have implications for public health and community strategies to reduce risk and improve resuscitation.ObjectiveTo examine temporal patterns in OHCA incidence and outcome.Design, Setting, and ParticipantsThis was a retrospective cohort investigation conducted in King County, Washington, between 2001 and 2020. Adults with OHCA treated by emergency medical services (EMS) were included in the analysis. Study data were analyzed from May 2024 to April 2025.ExposuresIncidence and clinical outcome of OHCA.Main Outcomes and MeasuresAnnual incidence was calculated per 100 000 person-years and stratified by sex, age group (<65 years and ≥65 years), and initial rhythm (shockable, nonshockable) with change estimated as average annualized change (AAC) percentage. Resuscitation was assessed according to 5-year groups. Temporal trends were evaluated using Poisson regression for incidence and survival to hospital discharge.ResultsThere were 25 118 individuals (median [IQR] age, 65 [53-78] years; 15 994 male [63.7%]) with OHCA treated by EMS during 30 884 504 person-years; survival was 17.7%. Overall incidence was 81.3 per 100 000 person-years, 20.9 for shockable and 59.8 for nonshockable OHCA. There was no evidence of linear temporal change in overall incidence: 88.7 in 2001, 82.1 in 2020 (AAC, -0.5%; 95% CI, -0.9% to 0%). However, temporal patterns depended on rhythm and demographic characteristics. For example, shockable rhythm incidence declined (28.6 in 2001 and 17.9 in 2020; AAC, -2.3%; 95% CI, -2.9% to -1.5%), but change was null among nonshockable arrest (59.8 in 2001 and 63.7 in 2020; AAC, 0.3%; 95% CI, -0.1% to 0.8%). Overall survival to hospital discharge improved over time: 14.7% (859 of 5847 individuals; 2001-2005), 17.4% (1024 of 5885 individuals; 2006-2010), 19.3% (1232 of 6376 individuals; 2011-2015), and 18.9% (1322 of 7010; 2016-2020; P < .001 test for trend). Survival increased from 35% (591 of 1689 individuals) during the 2001 to 2005 period to 47.5% (768 of 1617 individuals) during the 2016 to 2020 period among shockable OHCA and from 6.4% (265 of 4135 individuals) during the 2001 to 2005 period to 10.1% (536 of 5323 individuals) during the 2016 to 2020 period among nonshockable OHCA (P < .001 tests for trend). Temporal improvement was observed in prehospital resuscitation (survival to hospital admission) and in-hospital survival (discharge among those admitted to hospital; P < .001 tests for trend). Outcome improvements corresponded to temporal increase in bystander cardiopulmonary resuscitation (55.5% in 2001-2005 to 73.9% in 2016-2020) and early automated external defibrillator application by non-EMS personnel (2.2% in 2001-2005 to 10.9% in 2016-2020; P < .001 tests for trend).Conclusions and RelevanceResults suggest that the overall OHCA incidence did not change over time, although there were differential temporal patterns among clinical subgroups. Survival improved o","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"666 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640089","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":"Medication Adherence in Hypertension: A Cluster Randomized Clinical Trial.","authors":"Saul Blecker,Devin M Mann,Tiffany R Martinez,Hayley M Belli,Yunan Zhao,Aamina Ahmed,Cassidy Fitchett,Christina Wong,Harris R Bearnot,Corrine I Voils,Antoinette M Schoenthaler","doi":"10.1001/jamacardio.2025.2155","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2155","url":null,"abstract":"ImportanceMedication nonadherence is present in nearly half of patients with hypertension but is underrecognized in clinical care. Data linkages between electronic health records and pharmacies have created opportunities for scalable assessment of medication adherence at the point of care.ObjectiveTo test the effectiveness of a multicomponent intervention that identified patients with uncontrolled hypertension and medication nonadherence using linked electronic health record-pharmacy data combined with team-based care to address adherence barriers.Design, Setting, and ParticipantsTEAMLET (Leveraging Electronic Health Record Technology and Team Care to Address Medication Adherence) was a pragmatic, 2-arm, cluster randomized clinical trial conducted between October 2022 and November 2024 in 10 primary care sites in New York. The study included adults with uncontrolled hypertension and low medication adherence, defined as proportion of days covered (PDC) less than 80%. Data analysis was performed from November 2024 to January 2025.InterventionThe intervention consisted of the following: (1) automated identification of patients with medication nonadherence at the time of the visit; (2) prompting of medical assistants to screen for barriers to adherence; (3) clinical decision support alerting the primary care physicians and nurse practitioners to barriers to adherence; and (4) adherence discussion between the primary care physician or nurse practitioner and the patient. The comparator was usual care.Main Outcomes and MeasuresThe primary outcome was change in PDC from baseline to 12 months.ResultsAmong 1726 patients (mean [SD] age, 67.2 [13.9] years; 887 [51.4%] female), the mean (SD) baseline PDC was 33.2% (30.5%) overall (32.4% [30.4%] in the intervention group and 34.0% [30.6%] in the control group). The mean (SD) PDC at 12 months was 51.1% (39.5%) for the intervention group and 53.1% (39.6%) for the control group. No difference was found in the change in PDC from baseline to 12 months between the intervention and control groups (mean [SD] absolute change in PDC, 18.5 [41.1] vs 18.2 [40.9] percentage points, respectively; adjusted difference, -0.15 percentage point; 95% CI, -4.06 to 3.76 percentage points). Change in systolic blood pressure and patients who became adherent (PDC ≥80%) at 12 months were also similar between groups.Conclusions and RelevanceIn this pragmatic trial, an intervention that combined team-based primary care with automated identification of patients with antihypertensive medication nonadherence did not lead to improvements in adherence or blood pressure.Trial RegistrationClinicalTrials.gov Identifier: NCT05349422.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"13 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586687","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":"Sodium-Glucose Cotransporter 2 Inhibitor Use for Heart Failure in US Ambulatory Cardiovascular Care.","authors":"Abdelghani El Rafei,Kensey Gosch,Evan S Manning,Alireza Ghajar,Sridharan Raghavan,Thomas M Maddox,Pamela N Peterson,Lisa Fleming,Suzanne V Arnold,Paul S Chan,Stephen J Greene,Gregg C Fonarow,Philip G Jones,Larry A Allen,Paul L Hess","doi":"10.1001/jamacardio.2025.2145","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2145","url":null,"abstract":"ImportanceSodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy reduces risk of heart failure (HF) events and cardiovascular death among individuals with HF. Trends of SGLT2i use in cardiovascular ambulatory care in the US remain unknown.ObjectiveTo evaluate the rate of SGLT2i use among patients with HF in the cardiovascular ambulatory care setting.Design, Setting, and ParticipantsThis was a retrospective cohort study conducted from July 1, 2019, through June 30, 2023. Included for analysis were patients with HF enrolled in the National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) registry, a national ambulatory cardiovascular care quality improvement registry. Study data were analyzed from February 15, 2024, through January 15, 2025.Main Outcomes and MeasuresPatient-level and practice-level prescription of SGLT2i therapy.ResultsOf 759 915 patients (mean [SD] age, 70 [14] years; 359 270 women [47.3%]; 49 252 Black individuals [14.6%]; 278 303 White individuals [82.7%]) with HF at 191 US sites, 76 927 (10.1%) were prescribed SGLT2i. Among patients with available ejection fraction (EF) data, 20 544 (17.9%) with HF with reduced EF (HFrEF) and 36 615 (8.9%) with HF with mildly reduced EF (HFmrEF) or HF with preserved EF (HFpEF) were prescribed SGLT2i. Rates of SGLT2i use for all patients with HF increased from 4.6% in the third quarter of 2019 to 16.2% in the second quarter of 2023, from 5.1% to 28.5% for those with HFrEF, and from 4.5% to 12.8% for those with HFmrEF or HFpEF (P for trend <.001). SGLT2i was less commonly used for older persons (IQR age, 80 years vs 63 years; OR, 0.76; 95% CI, 0.75-0.77), female sex (OR, 0.79; 95% CI, 0.77-0.81), and higher systolic blood pressure (OR, 0.78; 95% CI, 0.77-0.79), whereas history of type 2 diabetes was associated with markedly higher use (OR, 3.21; 95% CI, 3.15-3.28). After adjustment for patient- and practice-level characteristics, significant variation in SGLT2i use across sites was present (90th vs 10th percentile risk practice, adjusted OR, 4.40; 95% CI, 3.76-5.52).Conclusions and RelevanceAlthough this study found that SGLT2i use had increased among ambulatory patients with HF during the study period, the majority of eligible patients did not receive this therapy. Older age, female sex, and higher blood pressures were associated with lower SGLT2i use with significant unexplained variation in use across practices. Systematic efforts to improve SGLT2i therapy use are warranted.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"97 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586563","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":"Prognostic Implications of Type and Location of LMNA Cardiomyopathy Genetic Variants.","authors":"Sadiya S Khan,Lisa M Castillo,Sharlene M Day","doi":"10.1001/jamacardio.2025.2068","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2068","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"39 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533510","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":"Location of LMNA Variants and Clinical Outcomes in Cardiomyopathy.","authors":"Ashwin Bhaskaran,Rabah Ben Yaou,Adam S Helms,Abdallah Fayssoil,Pascale Richard,Tanya Stojkovic,Frédéric Anselme,Fabien Labombarda,Cathy Chikhaoui,Annachiara De Sandre-Giovannoli,Isabelle Jeru,France Leturcq,Corinne Vigouroux,Mohamed Dembele,Perry Elliott,Konstantinos Savvatis,Katja Zeppenfeld,Hassina Bouguerra,Philippe Charron,Saurabh Kumar,Gisèle Bonne,Karim Wahbi,Neal K Lakdawala","doi":"10.1001/jamacardio.2025.2069","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2069","url":null,"abstract":"ImportancePrior studies have suggested that patients with nonmissense (ie, truncating) variants causing LMNA cardiomyopathy have worse arrhythmic outcomes compared to those with missense variants. However, the effect of the spatial distribution of missense and truncating variants on clinical outcomes remains poorly understood.ObjectiveTo determine the association of the spatial distribution of missense and truncating LMNA variants with cardiac outcomes.Design, Setting, and ParticipantsThis multicenter, retrospective, observational cohort study used data from an international registry (from January 2013 on) and data derived from tertiary cardiomyopathy centers (January 2000 and June 2017). Patients with likely pathogenic/pathogenic LMNA variants and no prior malignant ventricular arrhythmia (VA) were eligible for inclusion. Data analysis was completed from March 2022 to March 2025.Main Outcomes and MeasuresThe primary outcome of time to VA was defined as sudden cardiac death, appropriate implantable cardioverter-defibrillator therapy, or other manifestations of hemodynamically unstable VA. The secondary composite outcome of advanced heart failure was defined as nonsudden cardiac death, implantation of a left ventricular assist device, or cardiac transplant. Outcomes were stratified by type of variant (missense or truncating), affected transcript position (head, rod, or tail), and location on the LMNA gene.ResultsA total of 718 patients were included, among whom mean (SD) age was 41.1 (14.3) years, 381 patients (53.1%) were female, and mean (SD) baseline left ventricular ejection fraction was 55.8% (13.3%). Over a median follow-up of 4.2 years, 223 patients experienced the primary outcome of malignant VA and 109 experienced the secondary outcome of advanced heart failure. Patients with truncating variants had a higher risk of VA (hazard ratio [HR], 1.72; 95% CI, 1.19-2.48; P = .004) but no difference in advanced heart failure (HR, 0.94; 95% CI, 0.64-1.40; P = .77) compared with patients with missense variants. There were no significant differences in the primary and secondary outcomes when stratifying truncating variants by location on the LMNA gene or transcript position. In contrast, on multivariable analysis, missense variants affecting the tail domain of LMNA (HR, 0.35; 95% CI, 0.16-0.78; P = .02) and located in exons 7 through 12 (HR, 0.39; 95% CI, 0.17-0.89; P = .035) were associated with a significantly lower risk of the primary outcome of malignant VA.Conclusions and RelevanceIn this retrospective cohort study, truncating LMNA variants were associated with worse arrhythmic outcomes independent of variant position, whereas missense variants affecting the tail domain and located in exons 7 through 12 had better arrhythmic and heart failure outcomes. Understanding the mechanisms underlying these differences may have future therapeutic implications.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"23 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533344","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":"Supine Blood Pressure and Cardiovascular Risk-Reply.","authors":"Duc M Giao,Stephen P Juraschek","doi":"10.1001/jamacardio.2025.1933","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1933","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"69 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533499","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":"Supine Blood Pressure and Cardiovascular Risk.","authors":"Janis M Nolde,Marcio Galindo Kiuchi,Markus P Schlaich","doi":"10.1001/jamacardio.2025.1930","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1930","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"150 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533501","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}