Journal of the American College of Cardiology最新文献

{"title":"Exercise Prescriptions for Cardiovascular Health in Adults: 2026 ACC Scientific Statement: A Report of the American College of Cardiology.","authors":"Jonathan Myers, Theresa M Beckie, Sebastien Chastin, Jerome L Fleg, Dalane W Kitzman, Paul D Thompson, Meagan Murphy Wasfy","doi":"10.1016/j.jacc.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.09.008","url":null,"abstract":"<p><p>Regular physical activity and structured exercise are foundational for cardiovascular prevention and treatment, yet exercise prescription remains inconsistently integrated into routine cardiovascular care. This American College of Cardiology scientific statement provides contemporary, practical guidance for clinicians on prescribing exercise across the spectrum of cardiovascular health and disease. The statement reviews evidence supporting physical activity, exercise training, and cardiorespiratory fitness as powerful determinants of cardiovascular outcomes, emphasizing that the greatest absolute benefits occur when inactive individuals begin moving and that additional benefits accrue with higher volumes and intensity, within appropriate clinical limits. It summarizes approaches to aerobic, resistance, balance, and flexibility training; highlights the role of cardiac rehabilitation and supervised, home-based, hybrid, and virtual models; and addresses individualized exercise prescription for patients with coronary artery disease, peripheral artery disease, heart failure, cardiomyopathies, hypertension, overweight and obesity, adult congenital heart disease, and older age. The statement also discusses when exercise testing is useful to assess safety, guide intensity, establish baseline fitness, and monitor responses, while recognizing that routine preparticipation testing is not required for most asymptomatic individuals. Wearable devices and digital tools are reviewed as adjuncts to self-monitoring, goal setting, and cardiac rehabilitation extension, with attention to equity, access, and digital literacy. Key implementation priorities include improving clinician training, embedding physical activity counseling into cardiovascular care, tailoring prescriptions to patient goals and functional capacity, and expanding research on long-term adherence, clinical outcomes, diverse populations, and scalable delivery models. Exercise should be prescribed as a core component of cardiovascular prevention and disease management.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194636","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":"Is the Sarcopenic Obesity Index a Pathophysiological Phenotype or Merely a Ratio?","authors":"Tian Chen, Yang Liu, Di Wu","doi":"10.1016/j.jacc.2026.07.048","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.07.048","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"88 15","pages":"e2471"},"PeriodicalIF":22.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182578","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":"High Risk for What?: Sensor Phenotypes in ALLEVIATE-HF.","authors":"Zhican Liu, Lingling Zhang, Mingyan Jiang","doi":"10.1016/j.jacc.2026.06.044","DOIUrl":"10.1016/j.jacc.2026.06.044","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"e2467-e2468"},"PeriodicalIF":22.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818761","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":"AHA/ACC/ESC/WHF Expert Consensus Document: Second Universal Definition of Heart Failure (2026).","authors":"Mary Norine Walsh, Lars Kober, Karen Sliwa, Marianna Adamo, Anubha Agarwal, Amitava Banerjee, Biykem Bozkurt, Maja Cikes, Albertino Damasceno, Akshay S Desai, G Michael Felker, Gail Hogan, Koichiro Kinugawa, Michelle Kittleson, Carolyn S P Lam, Theresa McDonagh, Marco Metra, Wilfried Mullens, Antonio Luiz P Ribeiro, Yolanda Vaughn, Amanda Vest","doi":"10.1016/j.jacc.2026.05.036","DOIUrl":"10.1016/j.jacc.2026.05.036","url":null,"abstract":"<p><p>Heart failure (HF) remains a pressing health concern, with rising prevalence globally. Subjectivity and ambiguity in the definition of HF and its antecedent stages have limited research, global surveillance, and prevention programs. To address this, several cardiac societies and foundations convened to standardize the definition of HF in 2021 and designated stage B or pre-HF to identify individuals at risk of developing HF. In subsequent years, substantial progress and changes have been made in aspects of preventing HF, improving HF diagnosis and management, and recognizing the importance of the affected individual's voice. Global differences and disparities in HF are better understood, as are causes and comorbidities leading to differences in care, which are also influenced by access to care. This consensus document presents the Second Universal Definition of Heart Failure, aiming to standardize terminology and facilitate a uniform approach for clinicians, researchers, health systems, and policymakers. In this definition, the classification of HF phenotypes moves away from rigid left ventricular ejection fraction cutoffs, instead grouping HF into reduced, preserved, and improved ejection fraction categories to better reflect clinical realities. A universal classification of HF causes is also proposed. The document also addresses the dynamic trajectories of HF-improvement, remission, and recovery-and highlights the impact of social determinants and geographic variation on HF risk and outcomes. By providing a comprehensive, standardized framework for HF definition and classification, this document seeks to improve prevention, early detection, and management of HF worldwide, ultimately enhancing patient care and advancing global cardiovascular health.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1797-1812"},"PeriodicalIF":22.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345698","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":"Management of Heart Failure With Preserved Ejection Fraction: 2026 ACC Expert Consensus Decision Pathway: A Report of the American College of Cardiology Solution Set Oversight Committee.","authors":"Michelle M Kittleson, Gurusher S Panjrath, Katie Bates, Khadijah K Breathett, Dave L Dixon, James L Januzzi, Selma F Mohammed","doi":"10.1016/j.jacc.2026.06.018","DOIUrl":"10.1016/j.jacc.2026.06.018","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1817-1846"},"PeriodicalIF":22.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579059","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":"Global, Regional, and National Burden of Myocarditis and Its Impairment, 1990-2023.","authors":"","doi":"10.1016/j.jacc.2026.07.039","DOIUrl":"10.1016/j.jacc.2026.07.039","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The impact of recent trends in the burden of myocarditis has not been reported in detail.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aims to estimate the global, regional, and national burden of myocarditis from 1990 to 2023, using data from the GBD (Global Burden of Disease, Injuries, and Risk Factors Study) 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;As part of the GBD 2023, the authors used all available administrative health facility and vital registration data to estimate myocarditis prevalence, incidence, disability-adjusted life years (DALYs), mortality, and mortality-to-incidence ratio (MIR) for every country, stratified by age, sex, and quintiles of a Socio-demographic Index (SDI). The MIR represents the relative mortality burden compared with disease incidence at the population level. The prevalence of heart failure attributable to myocarditis was estimated using a model-based attribution approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In 2023, the global age-standardized rates of prevalence, incidence, DALY, and mortality of myocarditis were 4.84 (95% uncertainty interval [UI]: 3.98-5.80), 12.46 (95% UI: 9.86-15.70), 8.41 (95% UI: 5.63-12.59) and 0.21 (95% UI: 0.14-0.29) per 100,000 population, respectively. Although global age-standardized prevalence and incidence rates remained stable from 1990 to 2023, the absolute number of incident cases increased by 54.28% from 0.67 million (95% UI: 0.52-0.85 million) to 1.04 million (95% UI: 0.83-1.32 million). Age-standardized DALYs and mortality rates decreased by 62.48% and 60.00%, respectively, over the same period. The MIR decreased across all age groups from 1990 to 2023 and remained highest among the youngest and oldest populations, with the ratio in those &lt;5 years of age declining from 17.82% in 1990 to 6.32% in 2023. Across SDI strata, incidence rates remained stable from 1990 to 2023, while mortality rates declined in all quintiles and remained lowest in high SDI regions, whereas the MIR decreased from 2.33 in 1990 to 1.30 in 2023. In 2023, prevalence was highest in the high SDI quintile (6.30 [95% UI: 5.15-7.48] per 100,000 population) and lowest in the low-middle SDI quintile (4.10 [95% UI: 3.38-5.02]), reflecting disparities aligned with health resource availability. Age-standardized prevalence rates of heart failure attributable to myocarditis declined from 2.33 (95% UI: 1.90-2.90) per 100,000 population in 1990 to 1.76 (95% UI: 1.41-2.29) in 2023, with a U-shaped distribution across age groups showing the highest burden in those &lt;5 years of age and &gt;75 years of age in 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although age-adjusted DALYs and mortality rates of myocarditis decreased globally from 1990 to 2023, incidence and prevalence remained stable, suggesting potential improvements in outcomes over time. However, absolute burden has grown due to population growth and aging, and important disparities persist across age groups and SDI strata. These findings h","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1730-1760"},"PeriodicalIF":22.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881002","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":"Early Discharge Strategy Including Subcutaneous Furosemide in Hospitalized Heart Failure.","authors":"Ross T Campbell, Joanna Osmanska, Kieran F Docherty, Fozia Z Ahmed, Andrew L Clark, Louise Clayton, John G F Cleland, Christopher Critoph, Matthew Dewhurst, Nick Hartshorne-Evans, Roy S Gardner, Kate Gatenby, Kaushik Guha, Colette E Jackson, Paul Kalra, Andrea Lees, Kirsty Martin, Liane McGlynn, Kirstie Mowat, Pieter Muntendam, Joanne O'Donnell, Anna Placzek, Colum Owens, Robin Ray, Henry O Savage, Rebekah Schiff, Iain Squire, Chih Wong, Ken Wong, Alex McConnachie, John J V McMurray, Mark C Petrie","doi":"10.1016/j.jacc.2026.07.047","DOIUrl":"10.1016/j.jacc.2026.07.047","url":null,"abstract":"<p><strong>Background: </strong>Patients hospitalized for heart failure often require prolonged intravenous diuretic therapy, contributing to costs and risks associated with inpatient care.</p><p><strong>Objectives: </strong>We evaluated whether an early discharge strategy using subcutaneous furosemide delivered via a wearable minipump could increase days alive and out of hospital (DAOH).</p><p><strong>Methods: </strong>In this multicenter, open-label, randomized, active-controlled trial in the United Kingdom, 172 patients hospitalized for heart failure requiring ongoing parenteral diuretics were randomly assigned to an early discharge strategy or usual care. Patients in the early discharge group received pH-neutral subcutaneous furosemide via a wearable, patient-operated minipump; postdischarge care included a review every 3 days while receiving subcutaneous furosemide. Both groups had a 2-week clinic review. The primary outcome was DAOH at 30 days after randomization.</p><p><strong>Results: </strong>A total of 92 patients were assigned to early discharge and 80 to usual care. The early discharge strategy resulted in 4.0 more DAOH at 30 days (95% CI: 2.1-5.8 days; P < 0.001). Index hospitalization was shorter by a mean of 5.5 days (95% CI: 7.4-3.6 days; P < 0.001). The benefit in DAOH was sustained at 60 days (difference 4.2 days; 95% CI: 0.9-7.6 days), despite more heart failure readmissions in the early discharge group (13 [14%] patients vs 5 [6%] patients; OR: 2.45; 95% CI: 0.81-7.43). Serious adverse events occurred in 25% and 23% of patients, respectively. Device-related problems occurred with 3% of minipump placements, but none were serious.</p><p><strong>Conclusions: </strong>An early discharge strategy using a subcutaneous furosemide minipump increased DAOH compared with usual care. (Use of a Novel SUBCUTaneous Preparation of Furosemide to Facilitate Early Supported Discharge of Patients With Heart Failure [SUBCUT-HF II]; NCT05419115).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"88 15","pages":"1781-1793"},"PeriodicalIF":22.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182553","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":"Toward Targeted Population-Level Screening for Heart Failure.","authors":"Safia Chatur, Muthiah Vaduganathan","doi":"10.1016/j.jacc.2026.08.042","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.08.042","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"88 15","pages":"1777-1780"},"PeriodicalIF":22.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182654","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":"Home Sweet Home: Redefining the Destination of Heart Failure Care.","authors":"Nisha A Gilotra, Maxwell Ditlevson","doi":"10.1016/j.jacc.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.08.005","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"88 15","pages":"1794-1796"},"PeriodicalIF":22.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182610","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":"Regulatory Considerations for Generative AI: The FDA Asks for Help.","authors":"Harlan M Krumholz","doi":"10.1016/j.jacc.2026.08.043","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.08.043","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"88 15","pages":"1727-1729"},"PeriodicalIF":22.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182573","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}