Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Patient Perspectives on a Polypill Strategy for Heart Failure With Reduced Ejection Fraction: A Convergent-Parallel Mixed Methods Study Embedded in a Randomized Clinical Trial.","authors":"Neil Keshvani, Juan David Coellar, Meera J Patel, Myriam Bustillo-Rubio, Emilie Ruiz, Libertad Gracia, Anubha Agarwal, Thomas J Wang, Heather Kitzman, Ambarish Pandey","doi":"10.1161/CIRCOUTCOMES.125.012834","DOIUrl":"10.1161/CIRCOUTCOMES.125.012834","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with reduced ejection fraction guideline-directed medical therapy remains underused, particularly in socioeconomically disadvantaged populations. It has been proposed that the use of combination pills (polypills) may facilitate prescribing of guideline-directed medical therapy and increase adherence. Understanding patient perspectives on implementation barriers and facilitators to the use of polypills is needed for developing effective strategies.</p><p><strong>Methods: </strong>A convergent, parallel, mixed-methods study was conducted with participants who participated in a phase II randomized controlled trial of a heart failure with reduced ejection fraction polypill (POLY HF) in Dallas, TX. Six focus groups were conducted with participants from both polypill and usual care arms, followed by brief surveys. Qualitative data were analyzed using directed content analysis organized by a socioecological framework to identify barriers and facilitators across individual, interpersonal, and systems levels. Descriptive statistics characterized medication burden and polypill preferences.</p><p><strong>Results: </strong>Study participants (n=41) included trial participants (n=36, mean 53 years, 53% Black race, 39% Hispanic) and caregivers (n=5). Quantitative data revealed substantial medication burden, with 58% taking ≥6 medications and 50.0% reporting missed doses, primarily due to forgetting (44%). 88.6% expressed interest in a polypill approach, and 83% believed it would improve adherence. Qualitative analysis identified multilevel implementation barriers and facilitators. Individual-level barriers included pill size concerns and uncertainty about polypill contents, while facilitators encompassed reduced pill burden, psychological benefits of taking fewer medications, and perceived health improvements. Interpersonal facilitators included caregiver enthusiasm for simplified medication management and strong provider trust. Systems-level barriers centered on cost concerns, while institutional trust facilitated acceptance. Mixed-methods integration revealed convergent findings. Quantitative medication burden aligned with qualitative themes of regimen complexity, while high quantitative interest in polypills was contextualized by practical implementation considerations regarding formulation and delivery.</p><p><strong>Conclusions: </strong>In socioeconomically disadvantaged patients with heart failure with reduced ejection fraction, a polypill strategy demonstrated strong patient acceptability, supporting further implementation research.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04633005.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012834"},"PeriodicalIF":6.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regionalization of Mitral Transcatheter Edge-to-Edge Repair: Balancing Access and Expertise.","authors":"Yasser M Sammour, John T Saxon","doi":"10.1161/CIRCOUTCOMES.125.012886","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012886","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"18 12","pages":"e012886"},"PeriodicalIF":6.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing the OUTPACE Framework for Health Care Quality Improvement.","authors":"Michele Bolles, Heather M Alger, Mitchell S V Elkind, Howard Haft, Sabra C Lewsey, Mariell Jessup, Karen E Joynt Maddox, Chiadi E Ndumele, Clyde W Yancy, Christine Rutan, Michelle Congdon, Katherine Overton, Lynn Serdynski, Kathie Thomas, Gregg C Fonarow","doi":"10.1161/CIRCOUTCOMES.125.012211","DOIUrl":"10.1161/CIRCOUTCOMES.125.012211","url":null,"abstract":"<p><p>Equitable, timely, and evidence-based care remains a central goal across health care ecosystems, yet significant quality gaps, care variability, and health disparities persist. Professional societies, including the American Heart Association, have long developed clinical practice guidelines to provide standardized, evidence-based recommendations across the cardiovascular care continuum. These guidelines are operationalized into quality measures to monitor care, identify gaps, and guide improvement. Professional societies, agencies, and health systems have applied implementation science strategies, such as education, data sharing, and evaluation, to improve care quality and achieve quality measures defined in the clinical practice guidelines. American Heart Association's Get With The Guidelines programs target inpatient quality measures for stroke, heart failure, atrial fibrillation, resuscitation, and coronary artery disease, complemented by ambulatory quality improvement programs to support seamless care transitions. Decades of Get With The Guidelines implementation have enabled American Heart Association teams and volunteers to refine these programs, improving guideline adherence at local, regional, and national levels. Lessons learned informed the development of the Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand Framework, designed to guide successful quality improvement initiatives. While existing quality improvement frameworks provide structured approaches, many are costly, slow, or siloed, limiting rapid-cycle, data-driven innovation across diverse health systems. The Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand framework addresses these limitations as an adaptable model, applicable across care settings, disease areas, patient populations, system size, budgets, and target end points. Here, we illustrate the Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand framework through 2 recent American Heart Association programs: Target: Aortic Stenosis and the IMPLEMENT-HF initiative, demonstrating its utility in guiding effective, scalable quality improvement.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012211"},"PeriodicalIF":6.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Rehabilitation Trends Among Commercially Insured Adults in the United States, 2017-2023.","authors":"Lisa M Pollack, Lyudmyla Kompaniyets, Anping Chang, Michael P Thompson, Steven J Keteyian, Haley Stolp, Hilary K Wall, Laurence S Sperling, Sandra L Jackson","doi":"10.1161/CIRCOUTCOMES.125.012067","DOIUrl":"10.1161/CIRCOUTCOMES.125.012067","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) reduces morbidity and mortality among individuals with heart disease. Although the COVID-19 pandemic disrupted health services, its impact on CR participation remains poorly understood-especially among commercially insured populations, for whom CR utilization trends are poorly documented.</p><p><strong>Methods: </strong>This cross-sectional time series study of enrollees aged 18 to 64 years with ≥1 CR-qualifying event (acute myocardial infarction, coronary artery bypass graft, heart valve repair/replacement, percutaneous coronary intervention, or heart/heart-lung transplant) during 2017 to 2022, with follow-up through 2023, used MarketScan commercial claims data. Adjusted analyses used Poisson log-linear models with robust standard errors to examine trends in enrollment and completion (≥36 sessions), and generalized linear models with negative binomial distribution and log-link function to examine trends in days to enrollment and number of sessions.</p><p><strong>Results: </strong>The sample included 143 870 unique individuals aged 18 to 64 years with a CR-qualifying event. Of the sample, the mean age was 53.9 (SD, 8.1), and 70% were men. On average, from 2017 to 2023, enrollment was 24.2%, days to enrollment were 46.3 (SD, 51.4 days), the number of sessions was 13.9 (SD, 12.8), and completion was 9.6%. Compared with year 2017, 2020 was associated with a 12% lower prevalence of enrollment (adjusted prevalence ratio, 0.88 [95% CI, 0.85-0.90]), 6-day longer time to enrollment on average (adjusted difference, 6.04 [95% CI, 4.36-7.72]), 1.2 fewer sessions on average (adjusted difference, -1.24 [95% CI, -1.72 to -0.75]), and 13% lower prevalence of completion (prevalence ratio, 0.87 [95% CI, 0.78-0.97]). All metrics rebounded to prepandemic levels, except days to enrollment (4 days longer in 2022 versus 2017; adjusted difference, 3.78 [95% CI, 2.22-5.34]).</p><p><strong>Conclusions: </strong>Among commercially insured adults <65 years, only one-quarter of eligible individuals participated in CR. CR metrics worsened during the COVID-19 pandemic in 2020, but most rebounded to prepandemic levels. These findings highlight an opportunity for health systems and public health initiatives to support broader CR uptake.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012067"},"PeriodicalIF":6.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Neighborhood Violent Crime With Hypertension-Related Emergency Department Visits in Chicago.","authors":"Michelle A Chen, Alexa A Freedman, Tao Jiang, Xiaoning Huang, Sadiya S Khan, Gregory E Miller","doi":"10.1161/CIRCOUTCOMES.125.012192","DOIUrl":"10.1161/CIRCOUTCOMES.125.012192","url":null,"abstract":"<p><strong>Background: </strong>Living in neighborhoods with a greater burden of violence is associated with higher cardiovascular disease risk. However, the interpretation of place-based findings is impeded by methodological challenges. To address challenges related to the influence of correlated neighborhood exposures, we utilized a case-crossover design to examine whether patients were more likely to have experienced a violent crime in their neighborhood during the month before their hypertension-related emergency department (ED) visit, compared with control periods 1 year before and after.</p><p><strong>Methods: </strong>Participants were patients who made ED visits to a single hospital in the Northwestern Medicine Health System between 2016 to 2019 and had a valid address in Chicago. Neighborhood violent crime was quantified at the block group level and modeled as both a dichotomous exposure (testing for an absolute effect, where any crime increases hypertension risk) and a continuous exposure (testing for a relative effect, where crime increases relative to the area norms increase hypertension risk). The primary outcome was a hypertension-related ED visit. Conditional logistic regression (without covariate adjustment) was the principal analytic method.</p><p><strong>Results: </strong>The sample (N=22 173) had a mean age = 66.0 years and was 52.7% female; 39.9% White, 35.7% Black, 12.4% Hispanic. Among the patients, 51.5% lived in block groups where a violent crime occurred in the month before the ED visit (ie, case period); 50.7% lived in block groups where a violent crime occurred during the control periods. Neighborhood violent crime was associated with a greater likelihood of a hypertension-related ED visit, both when observing absolute changes in violent crime (odds ratio, 1.05 [95% CI, 1.01-1.09]) and relative changes in violent crime (odds ratio, 1.03 [95% CI, 1.01-1.05]).</p><p><strong>Conclusions: </strong>This research has clinical and policy implications related to the importance of public safety and the potential cardiovascular-related risks following exposure to neighborhood violent crime.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012192"},"PeriodicalIF":6.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making Your Blood Boil: Challenges and Opportunities for Using Emergency Department Data to Understand the Impact of Structural Inequities on Health.","authors":"Rama A Salhi, Kori S Zachrison","doi":"10.1161/CIRCOUTCOMES.125.012927","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012927","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"18 12","pages":"e012927"},"PeriodicalIF":6.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Quality in Cardiac Arrest via Resuscitation Academy Training (IQ-CART): Study Protocol for a Mixed-Methods Study With a Focus on Low-Performing EMS Agencies.","authors":"Paul S Chan, Kimberly C Dukes, Jessica Sperling, Michael Sayre, Thomas Rea, Bryan McNally, Saket Girotra","doi":"10.1161/CIRCOUTCOMES.125.012571","DOIUrl":"10.1161/CIRCOUTCOMES.125.012571","url":null,"abstract":"<p><strong>Background: </strong>Given the large variation in out-of-hospital cardiac arrest (OHCA) survival, the Resuscitation Academy has developed a comprehensive training and mentorship program for emergency medical service (EMS) agencies to improve OHCA care. This study will evaluate whether Resuscitation Academy training is associated with higher OHCA survival at EMS agencies, particularly those with lower OHCA survival.</p><p><strong>Methods: </strong>Within the Cardiac Arrest Registry to Enhance Survival, we will conduct a prospective mixed-methods study of EMS agencies participating in Resuscitation Academy training between October 2024 and December 2026 with ≥2 years of OHCA data collection and ≥20 OHCAs annually. Enrollment of EMS agencies with low baseline OHCA survival and diverse sociodemographic and socioeconomic characteristics will be prioritized, with a goal of 100 enrolled agencies. Changes in OHCA survival (primary outcome: survival to hospital admission) between EMS agencies enrolled in the Resuscitation Academy, compared with control agencies, will be compared using a difference-in-difference analysis. We will also quantify changes in processes of care within individual Resuscitation Academy domains to identify those most strongly associated with survival improvement. Finally, we will identify facilitators and barriers to implementation of Resuscitation Academy recommendations through in-depth semistructured interviews with key stakeholders (EMS director, medical director, dispatchers, quality improvement director, and paramedics).</p><p><strong>Results: </strong>As of December 31, 2024, 15 EMS agencies have been prospectively enrolled. Twelve (80.0%) had below median OHCA survival rates to hospital admission (<24.9%), 5 (33.3%) had catchment areas that were majority (>50% of residents in the EMS catchment area) Black or Hispanic, and 7 (46.7%) served communities with below median annual household income (<$71 623) levels.</p><p><strong>Conclusions: </strong>This study will provide key insights for a potential intervention to improve OHCA survival, especially at EMS agencies with lower survival. Moreover, it may serve as a roadmap for the evaluation of future health policy investments to improve OHCA care and reduce disparities.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012571"},"PeriodicalIF":6.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12741751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized Comparison of Online Motivational Themes in Clinical Trial Recruitment.","authors":"Tamunotonye Harry, Zaib Hussain, Jingyi Cao, Ruth-Alma N Turkson-Ocran, Stephen P Juraschek, Erin D Michos, Hailey N Miller, Timothy P Lahey, Timothy B Plante, Yuanyuan Feng","doi":"10.1161/CIRCOUTCOMES.125.012945","DOIUrl":"10.1161/CIRCOUTCOMES.125.012945","url":null,"abstract":"<p><strong>Background: </strong>Targeted, digital recruitment strategies such as tailored websites using motivational themes may improve recruitment in clinical trials, but their effectiveness remains unclear. We hypothesized that themes emphasizing community well-being, personal health benefits, or access to perks would increase engagement and prescreening sign-ups compared with a standard contribution to science message in a clinical trial focused on Black adults.</p><p><strong>Methods: </strong>We implemented A/B testing of website themes for recruitment in two randomized trials testing the dietary approaches to stop hypertension diet intervention on blood pressure among Black adults. Website themes were derived from predeveloped motivational categories and included (1) contribution to science (control group), (2) community well-being, (3) personal blood pressure improvement, and (4) access to perks (groceries or cash). A/B randomization directed visitors to a theme randomly between June and December 2024. Using an open-source Web analytics platform, we captured data on 2 primary outcomes: (1) sign-up rate defined as the proportion of unique visitors who completed the trial's prescreening form and (2) engagement defined as (a) mean pageviews per session and (b) mean time spent on site per session. We compared themes using the Welch <i>t</i> tests with statistical significance assessed as 2-tailed <i>P</i><0.05.</p><p><strong>Results: </strong>Among 11 484 visitors over 6 months, the themes of community well-being (13.8%), personal blood pressure improvement (14.1%), and access to perks (13.1%) all attracted higher sign-up rates than contribution to science (11.1%; <i>P</i><0.05 for all comparisons). All alternative themes also led to significantly higher mean pageviews compared with the contribution to science theme (<i>P</i><0.05 for all comparisons), while mean time on site was similar across all themes (range, 52-55 seconds with <i>P</i>>0.05 for all comparisons). There were no statistical differences noted across the 3 alternative motivational themes for these outcomes.</p><p><strong>Conclusions: </strong>Tailored websites with digital messages emphasizing community well-being, personal health benefits, and access to perks significantly improved engagement and prescreening sign-up rates, demonstrating that they may enhance recruitment within cardiovascular research.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifiers: NCT05393232 and NCT05121337.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012945"},"PeriodicalIF":6.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Guideline-Directed Medical Therapies and Clinical Management in Patients With Prevalent Versus Incident Heart Failure: A Danish Nationwide Study From 1996 to 2022.","authors":"Emma Kidholm Boysen, Lars Køber, Mads Kristian Ersbøll, Trine Kiilerich Lauridsen, Jesper Jensen, Emil Wolsk, Jens Jakob Thune, Mette Rauhe Mouridsen, Christian Ditlev Tuxen, Peter Godsk Jørgensen, Morten Lamberts, Emil Fosbøl, Nadia Dridi, Morten Petersen, Nis Ottesen Stride, Anders Barasa, Caroline Garred, Simon Larsen, Morten Schou, Mariam Elmegaard","doi":"10.1161/CIRCOUTCOMES.125.012117","DOIUrl":"10.1161/CIRCOUTCOMES.125.012117","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012117"},"PeriodicalIF":6.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uptake, Geographic Access, and Outcomes of Transcatheter Mitral Valve Repair in the United States.","authors":"Atsuyuki Watanabe, Hiroki A Ueyama, Yoshihisa Miyamoto, Hiroshi Gotanda, Tsuyoshi Kaneko, Azeem Latib, Dhaval Kolte, Suzanne J Baron, Eric Secemsky, Roger J Laham, Yusuke Tsugawa, Toshiki Kuno","doi":"10.1161/CIRCOUTCOMES.125.012134","DOIUrl":"10.1161/CIRCOUTCOMES.125.012134","url":null,"abstract":"<p><strong>Background: </strong>The dissemination of novel procedures should attempt to strike a balance between access and procedure quality. This study aimed to evaluate the temporal trends and geographic dispersion of mitral transcatheter edge-to-edge repair (M-TEER) sites and to examine the associations of site volume and site-to-population density with patient outcomes.</p><p><strong>Methods: </strong>We used the Medicare administrative databases in the United States to identify sites performing M-TEER in patients aged 65 to 99 years from 2017 to 2020 and examined the annualized volume and site-to-population density (per million beneficiaries in each corresponding hospital referral region). A hierarchical Cox regression analysis accounting for site-level clustering was performed to assess the association of site volume and density with 30-day and 1-year all-cause mortality.</p><p><strong>Results: </strong>We identified 456 sites performing M-TEER in 16 810 patients (median [interquartile range] age, 81 [75-86] years; female, 47%). The case number of M-TEER increased by 54% from 3125 in 2017 to 4820 in 2020, while sites performing M-TEER increased by 71% from 252 in 2017 to 432 in 2020, corresponding to a decline in the median patient-to-site distances from 37.1 kilometers (interquartile range, 14.4-105.0) to 28.6 kilometers (interquartile range, 12.8-74.9). Higher site volume (every 10 cases/y) was associated with lower 30-day (adjusted hazard ratio, 0.94 [95% CI, 0.91-0.99]) and 1 year (adjusted hazard ratio, 0.98 [95% CI, 0.96-1.00]) mortality, while there was insufficient evidence to determine the association between higher site density (every 1 site/million-beneficiaries) and 30-day (adjusted hazard ratio, 1.00 [95% CI, 0.99-1.02]) and 1-year (adjusted hazard ratio, 1.00 [95% CI, 0.99-1.01]) mortality.</p><p><strong>Conclusions: </strong>Although sites performing M-TEER have been rapidly expanding, we did not find associations between higher regional site density and patient mortality. Continuous careful planning in disseminating M-TEER while ensuring adequate procedure volume per site may optimize patient outcomes.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012134"},"PeriodicalIF":6.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}