JAMA最新文献

{"title":"Is Phage Therapy the Next Big Hope for Urinary Tract Infections?","authors":"Samantha Anderer, Jennifer Abbasi","doi":"10.1001/jama.2026.17683","DOIUrl":"https://doi.org/10.1001/jama.2026.17683","url":null,"abstract":"This Medical News article discusses recently launched clinical trials of bacteriophage therapy for recurrent and multidrug-resistant urinary tract infections (UTIs).","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Everyone Will Feel the $1 Trillion Cut in Medicaid","authors":"Derek C. Angus, Matthew B. O’Connor","doi":"10.1001/jama.2026.16498","DOIUrl":"https://doi.org/10.1001/jama.2026.16498","url":null,"abstract":"Proposed Medicaid cuts in the One Big Beautiful Bill Act and how they could affect patients, clinicians, and health care organizations are discussed by Derek C. Angus, MD, MPH, and Julie Donohue, PhD, professor and chair of health policy and management at the University of Pittsburgh, on this episode of the <jats:italic toggle=\"yes\">Healthy Dialogue</jats:italic> podcast.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory Season Virus Vaccines","authors":"Sandra Adamson Fryhofer, Andrea M. Garcia, Michael T. Osterholm, Rochelle P. Walensky","doi":"10.1001/jama.2026.18338","DOIUrl":"https://doi.org/10.1001/jama.2026.18338","url":null,"abstract":"This Perspective describes the Vaccine Integrity Project, established in 2025 in response to concerns about the stability and integrity of US vaccine policy due to disruptions to the work of the Advisory Committee on Immunization Practices; outlines the process for the 2026-2027 evidence review; and summarizes key findings regarding vaccine effectiveness and safety.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influenza Vaccine Effectiveness and Safety for the 2026-2027 Respiratory Season","authors":"Emily Senerth, Seyyedeh Mahsa Sheikholeslamian, Kapeena Sivakumaran, Michelle A. Watson, Rachel A. Lipson, Harseerat Saini, Jordan Falk, Neha Tangri, Ifeoluwa Babatunde, Melinda Wharton, Angela Ulrich, Leah E. Moat, Clare J. Stoddart, Sydney G. Redepenning, Rochelle P. Walensky, Nicole E. Basta, Rebecca L. Morgan","doi":"10.1001/jama.2026.18126","DOIUrl":"https://doi.org/10.1001/jama.2026.18126","url":null,"abstract":"Importance Influenza continues to cause significant mortality and morbidity in the US. Seasonal influenza vaccines reduce the severity of disease and prevent hospitalizations and death, especially among individuals at high risk. Objective To identify and summarize the most recently published research spanning several influenza seasons reporting on the epidemiology of influenza in the US and the effectiveness and safety of US-licensed seasonal influenza vaccines, updating a prior evidence review through August 2025. Evidence Review This systematic review searched Medline (PubMed), Embase, Cochrane CENTRAL, and Scopus from August 1, 2025, through June 30, 2026, for all English-language studies. Eligible publications reported on the epidemiology of influenza in the US or vaccine effectiveness and safety for any influenza vaccine formulation approved for use in the US. Data extraction included effectiveness and safety estimates reported among older adults; adults; during pregnancy; infants, children, and young adults; and persons who were immunocompromised. Risk of bias assessment was conducted. Findings The search identified 69 eligible studies: 21 randomized clinical trials (RCTs) and 23 observational studies with a comparator group, 7 product safety studies without a comparator group, and 18 descriptive studies of disease burden. Across multiple seasons, influenza vaccines were associated with reduced risk of influenza-related hospitalization (vaccine effectiveness [VE] ranging from 19.0%; 95% CI, 0.0%-34.0% to 43.0%; 95% CI, 30.0%-53.0%) and mortality (VE ranging from 29.0%; 95% CI, 16.0%-40.0% to 65.8%; 95% CI, 54.6%-76.9%) among older adults. Vaccines were also associated with reduced risk of severe influenza among infants, children, adolescents, and young adults; a case-cohort analysis of national surveillance data over 8 seasons (2016-2020 and 2021-2025) among infants, children, and adolescents aged 6 months to 17 years reported that VE was 80.0% (95% CI, 75.0%-84.0%) against laboratory-confirmed influenza-associated deaths. Vaccination during pregnancy was associated with a VE against symptomatic disease in infants of 44.4% (95% CI, 31.4%-54.9%) based on a retrospective cohort study from 2011 to 2022. RCT data published in 2025 for seasons 2022 to 2025 reported higher efficacy against hospitalization with the high-dose compared with standard-dose vaccine among older adults (relative VE, 43.6%; 95% CI, 27.5%-56.3%). A large self-controlled case series among 9 973 703 individuals receiving vaccines found no association with increased risk of serious adverse events, including Guillain-Barré syndrome, after the seasonal influenza vaccine was administered alone or when coadministered with respiratory syncytial virus or COVID-19 immunizations. Another self-controlled case series reported no association with increased risk of febrile seizure during the interval 0 to 7 days after vaccination. Conclusions and Relevance This systematic review found th","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Vaccine Effectiveness and Safety for the 2026-2027 Respiratory Season","authors":"Rachel A. Lipson, Emily Senerth, Michelle A. Watson, Harseerat Saini, Jordan Falk, Neha Tangri, Seyyedeh Mahsa Sheikholeslamian, Kapeena Sivakumaran, Ifeoluwa Babatunde, Melinda Wharton, Angela K. Ulrich, Leah E. Moat, Clare J. Stoddart, Elise J. Holmes, Rochelle P. Walensky, Nicole E. Basta, Rebecca L. Morgan","doi":"10.1001/jama.2026.18191","DOIUrl":"https://doi.org/10.1001/jama.2026.18191","url":null,"abstract":"Importance SARS-CoV-2 remains a substantial cause of respiratory illness, morbidity, and mortality. Evidence to date has demonstrated that COVID-19 vaccines reduce the risk of severe disease, including hospitalization and death. Objective This systematic review identifies and summarizes newly published studies reporting on the effectiveness and safety of COVID-19 vaccines and COVID-19 epidemiology in the US. Evidence Review Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, Embase, and Scopus were searched from August 1, 2025, through June 29, 2026. Studies were eligible if they reported on the effectiveness, efficacy, or safety of a US-licensed COVID-19 vaccine or SARS-CoV-2 epidemiology in the US. Findings From 11 829 identified references, 155 publications were eligible (15 randomized clinical trials, 84 observational studies with a comparator group, 38 product safety studies without a comparator group [single group], and 18 descriptive studies of disease burden). Consistent with prior evidence, studies reported that updated COVID-19 vaccines were associated with a reduction in the risk of hospitalization among both older adults (≥65 years; vaccine effectiveness [VE], 53.0%; 95% CI, 37.0%-65.0%; 2025-2026 season) and adults (18-64 years; VE, 54.0%; 95% CI, 1.0%-78.0%; 2024-2025 season). Maternal vaccination was associated with reduced risk of COVID-19–associated emergency department/urgent care encounters among individuals vaccinated (VE, 58.0%; 95% CI, 24.0%-77.0%) and with fewer COVID-19–related hospital contacts in the first 2 months of life among infants born subsequently (VE range, 50.0%-54.0%), regardless of trimester of vaccination. Vaccination was also associated with a significant reduction in COVID-19–related pediatric emergency department visits (9 months to 4 years; VE, 76.0%; 95% CI, 58.0%-87.0%). Vaccination was associated with a reduced risk of critical COVID-19 illness (intensive care unit admission or death) in immunocompromised adults (VE range, 32.0%-53.0%, depending on condition and other factors). Health care personnel who received 3 to 5 vaccine doses were less likely to develop laboratory-confirmed COVID-19 illness (VE, 41.0%; 95% CI, 34.0%-47.0%) and postacute COVID-19 symptoms (VE, 57.0%; 95% CI, 46.0%-66.0%) compared with those who received only 2 doses. Across adverse events of special interest (eg, stroke, thrombosis, myocarditis), safety profiles were consistent with those of previous reviews. No identified studies conducted under the updated guidance on extended dosing intervals for the primary series reported an increased risk of myocarditis or pericarditis. No new safety signals were reported in the recently published studies eligible for this updated review of US-licensed COVID-19 vaccines. Conclusions and Relevance COVID-19 vaccines were consistently associated with a reduction in the risk of hospitalization and other outcomes, including among individuals at high risk of severe COVID-19, such as i","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RSV Immunization Effectiveness and Safety for the 2026-2027 Respiratory Season","authors":"Emily Senerth, Seyyedeh Mahsa Sheikholeslamian, Ifeoluwa Babatunde, Jordan Falk, Michelle A. Watson, Harseerat Saini, Neha Tangri, Rachel A. Lipson, Kapeena Sivakumaran, Melinda Wharton, Angela K. Ulrich, Leah E. Moat, Clare J. Stoddart, Rochelle P. Walensky, Nicole E. Basta, Rebecca L. Morgan","doi":"10.1001/jama.2026.17871","DOIUrl":"https://doi.org/10.1001/jama.2026.17871","url":null,"abstract":"Importance Respiratory syncytial virus (RSV) is a leading cause of acute respiratory tract infection and a contributor to morbidity and mortality. Objective To synthesize evidence from recent randomized clinical trials and observational studies reporting on the effectiveness and safety of RSV vaccines and monoclonal antibodies and the epidemiology of RSV in the US. Evidence Review Databases including MEDLINE (PubMed), Embase, Cochrane CENTRAL, and Scopus were searched from August 1, 2025, through June 29, 2026, for studies evaluating the safety and effectiveness of US-licensed RSV vaccines or RSV monoclonal antibody products or describing RSV epidemiology. Data were extracted for older adults (≥60 years), adults, immunocompromised persons, infants, children, and individuals vaccinated during pregnancy. Reviewers assessed risk of bias (RoB) using Cochrane tools for randomized and observational studies. Findings A total of 75 eligible studies were identified, including 12 randomized clinical trials (RCTs), 33 observational studies with a comparator group, 16 observational studies without a comparator group, and 14 descriptive studies on RSV epidemiology. Among older adults, RSV vaccination was associated with a reduction in RSV-related hospitalization (vaccine effectiveness [VE], 83.3%; 95% CI, 42.9% to 96.9%). Point estimates for RSV VE against hospitalization and laboratory-confirmed RSV illness among older adults were significantly higher during the first season after vaccination compared with 12 to 18 months of follow-up in 1 study, although the difference was not significant when comparing VE after 1 season vs 2 seasons in another study. The VE for maternal vaccination (between 32-36 weeks’ gestation) ranged from 51.0% (95% CI, −29.6% to 83.3%) to 70.0% (95% CI, 37.0% to 86.0%) against RSV-related infant hospitalization. Estimates for effectiveness of nirsevimab among infants varied by timing ranged from 63.6% (95% CI, 26.9% to 81.9%) to 93.0% (95% CI, 83.0% to 97.0%) for RSV-related hospitalization within 6 to 12 months. No cases of Guillain-Barré syndrome (GBS) were identified across 3 RCTs; among older adults, 1 self-controlled case series reported a possible increased risk of GBS during the 42 days following vaccination. None of the comparative studies included in this review found an association of RSV vaccination during pregnancy with preterm birth or other adverse pregnancy outcomes. Conclusions and Relevance RSV immunizations were associated with reduced risk of severe RSV and RSV-related hospitalizations; evidence among older adults suggests that RSV VE may be lower in subsequent seasons. Reported adverse events of special interest (including GBS and preterm birth) were consistent with prior reviews. The results of this updated review are both consistent with previously reported evidence and provide new insight into several aspects of RSV immunizations.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Voltage Ablation in Persistent Atrial Fibrillation","authors":"Astrid Paul Nordin, Emmanouil Charitakis, Carina Carnlöf, Finn Åkerström, Ott Saluveer, Henrik Almroth, Lars O. Karlsson, Anders Hassel Jönsson, Csaba Herczku, Jari Tapanainen, Niklas Höglund, Emma Svennberg, Frieder Braunschweig, Tara Bourke, Jonas Schwieler, Hamid Bastani, Serkan Saygi, Fahd Asaad, Yusuf Türkmen, Mats Jensen-Urstad, Nikola Drca","doi":"10.1001/jama.2026.17274","DOIUrl":"https://doi.org/10.1001/jama.2026.17274","url":null,"abstract":"Importance Pulmonary vein isolation remains the foundational ablation approach for atrial fibrillation (AF), yet outcomes in persistent AF remain suboptimal. Targeting low-voltage zones identified by electroanatomical mapping offers a promising strategy for enhancing ablation success. Objective To determine whether adjunctive individualized low-voltage zone ablation improves arrhythmia outcomes and health-related quality of life beyond pulmonary vein isolation alone in patients with persistent AF and significant low-voltage zones. Design, Setting, and Participants Multicenter randomized clinical trial with 12 months of follow-up conducted at 5 Swedish ablation centers between May 18, 2020, and April 9, 2026. Of 936 adult patients undergoing first-time ablation and voltage mapping for persistent AF, 209 with low-voltage zones of 3.0 cm <jats:sup>2</jats:sup> or greater were randomized. Interventions Following pulmonary vein isolation, patients with significant low-voltage zones were randomized to either receive individualized adjunctive low-voltage zone ablation (n = 102) or receive no further ablation (n = 107). Main Outcomes and Measures The primary outcome was freedom from documented atrial arrhythmia without antiarrhythmic drugs at 12 months after 1 or 2 ablation procedures within 6 months. Secondary outcomes were time to first recurrence after a single procedure without antiarrhythmic drugs, health-related quality of life, and safety. Results Among the 209 randomized patients (median age, 72 years; 109 females [52.2%]), the primary outcome was achieved more frequently in the pulmonary vein isolation plus low-voltage zone ablation group than in the pulmonary vein isolation alone group. Arrhythmia-free survival was achieved in 69 patients (67.6%) vs 40 patients (37.4%), respectively (unadjusted difference, 30.3% [95% CI, 17.4%-43.2%]; odds ratio, 3.5 [95% CI, 2.0-6.2]; <jats:italic>P</jats:italic> &amp;amp;lt; .001). Time to first recurrence after a single ablation procedure without antiarrhythmic drugs also favored low-voltage zone ablation (hazard ratio, 0.4; 95% CI, 0.3-0.6; <jats:italic>P</jats:italic> &amp;amp;lt; .001). Improvements in health-related quality of life were greater in the low-voltage zone ablation group, whereas rates of serious adverse events were similar between groups. Conclusions and Relevance Adjunctive low-voltage zone ablation added to pulmonary vein isolation improved rhythm outcomes and health-related quality of life without increasing serious adverse events in patients with persistent AF and significant low-voltage zones. These findings support a low-voltage zone–guided ablation strategy in this population. Trial Registration ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://www.clinicaltrials.gov/study/NCT04377594\">NCT04377594</jats:ext-link>","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Vein Isolation Using Pulsed Field Ablation With vs Without Posterior Wall Isolation in Patients With Symptomatic Persistent Atrial Fibrillation","authors":"Laurent Roten, Jens Maurhofer, Philipp Krisai, Alexander Breitenstein, Pascal Koepfli, Ardan M. Saguner, Florian Franzeck, Patrizio Pascale, Thomas Kueffer, Sven Knecht, Corinne Jufer, Valon Spahiu, Nicolas Schaerli, Claudia Herrera Siklody, Gregor Thalmann, Nikola Kozhuharov, Boldizsar Kovacs, Felix Mahfoud, Dik Heg, Tiago V. Pereira, Helge Servatius, Hildegard Tanner, Michael Kühne, Christian Sticherling, Tobias Reichlin, Peter Jüni, Patrick Badertscher","doi":"10.1001/jama.2026.17598","DOIUrl":"https://doi.org/10.1001/jama.2026.17598","url":null,"abstract":"Importance Pulmonary vein isolation (PVI) is less effective in persistent than in paroxysmal atrial fibrillation (AF). Objective To determine whether adding posterior left atrial wall isolation (PWI) to pulsed field ablation (PFA)–based PVI reduces atrial tachyarrhythmia in patients with persistent AF. Design, Setting, and Participants This investigator-initiated, multicenter, randomized superiority trial with blinded end-point adjudication was conducted at 6 centers in Switzerland. Patients with symptomatic, persistent AF were enrolled from November 2023 to February 2025, with 1-year follow-up completed February 2026. Intervention Patients were randomized 1:1 to PFA-based PVI with PWI vs PFA-based PVI alone. All patients received an implantable cardiac monitor (ICM) after ablation. Main Outcomes and Measures The primary end point was first recurrence of atrial tachyarrhythmia during days 91 to 365 after ablation, detected by continuous ICM monitoring and adjudicated by an independent clinical events committee blinded to treatment allocation. There were 29 secondary end points, including atrial arrhythmia burden during days 91 to 365, time to arrhythmia recurrence during days 91 to 365 using different minimum episode durations, and a safety composite, which comprised cardiac tamponade requiring drainage, persistent phrenic nerve palsy lasting more than 24 hours, serious vascular complications requiring intervention, stroke or transient ischemic attack, atrioesophageal fistula, or death up to day 90. Results Among 206 randomized patients (mean [SD] age, 65.8 [9.2] years; 165 [80.1%] males; 102 randomized to PVI with PWI; 104 randomized to PVI alone), atrial tachyarrhythmia recurred in 51 of 102 patients (50.6%) assigned to PVI with PWI and in 63 of 104 patients (60.6%) assigned to PVI alone (rate ratio [RR], 0.75 [95% CI, 0.51-1.09]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .13). Of the 29 prespecified secondary outcomes, 22 were not significantly different. The mean atrial arrhythmia burden was 6.9% and 11.0%, respectively (difference, −4.1 percentage points; 95% CI, −8.0 to −0.2 percentage points; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .04). Across minimum episode durations of 1 hour or longer, 6 hours or longer, 1 day or longer, 2 days or longer, and 7 days or longer, RRs for PVI with PWI vs PVI alone were 0.64 (95% CI, 0.41-0.99), 0.62 (95% CI, 0.38-1.03), 0.37 (95% CI, 0.18-0.78), 0.40 (95% CI, 0.18-0.88), and 0.51 (95% CI, 0.22-1.23), respectively. The safety composite end point occurred in 2 patients assigned to PVI with PWI. Conclusions and Relevance In patients with persistent AF, adding PFA-based PWI to PVI did not significantly reduce atrial tachyarrhythmia recurrence lasting 30 seconds or longer compared with PVI alone. The findings for secondary end points are hypothesis generating and warrant further evaluation in a larger trial. Trial Registration ClinicalTrials.gov Identifier: &lt;jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Many Patients With Hypertension Newly Qualify for Medication Under New Guideline?","authors":"Samantha Anderer","doi":"10.1001/jama.2026.16822","DOIUrl":"https://doi.org/10.1001/jama.2026.16822","url":null,"abstract":"This Medical News article discusses the estimated population-level effects of the 2025 blood pressure guideline, which expanded antihypertensive treatment eligibility.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148836178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiogram-Based Deep Learning to Prioritize Testing for Transthyretin Amyloid Cardiomyopathy","authors":"Philip M. Croon, Bruno Batinica, Lovedeep S. Dhingra, Ryan B. Choi, Evangelos K. Oikonomou, Sumukh V. Shankar, Veer Sangha, Robert M. A. van der Boon, Michelle Michels, Maarten van Ettinger, Peter-Paul Zwetsloot, Sergio Teruya, Cesia Gallegos Kattan, Edward J. Miller, Navid Noory, Oscar M. Westin, Sie K. Fensman, Steen Hvitfeldt Poulsen, Avneet Singh, Sudarshan Balla, Anouk Achten, Charalambos Vlachopoulos, Alexios S. Antonopoulos, Nico Bruining, Julian D. Gillmore, Mathew S. Maurer, Frederick L. Ruberg, Marianna Fontana, Rohan Khera","doi":"10.1001/jama.2026.16785","DOIUrl":"https://doi.org/10.1001/jama.2026.16785","url":null,"abstract":"Importance Transthyretin amyloid cardiomyopathy (ATTR-CM) is a treatable cause of heart failure, but diagnosis is often delayed. Accessible tools to prioritize confirmatory evaluation could reduce missed diagnoses when cardiac imaging is limited. Objective To develop and validate a locally deployable artificial intelligence (AI)–enabled system that identifies patients for further ATTR-CM evaluation from routine electrocardiography (ECG) images. Design, Setting, and Participants This diagnostic test study used an AI-ECG model developed within Yale New Haven Health (using ECGs from August 2015-June 2023) and temporally validated (July 2023-July 2025). External validation included 5 multinational cohorts and 3 screening cohorts (older Black and Hispanic adults with heart failure; adults with prior carpal tunnel surgery; 99-3902 individuals per cohort). Exposure Use of AI-ECG for detecting ATTR-CM from routine ECG images or raw 12-lead signals. Main Outcomes and Measures Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and positive and negative predictive values for ATTR-CM confirmed by cardiac amyloid radionuclide imaging (CARI) or biopsy. An exploratory analysis evaluated sequential screening with AI-ECG followed by AI-enabled echocardiography. Results Development used 28 174 ECGs from 11 291 patients (293 with ATTR-CM). In internal validation (44 123 patients; mean age, 68.5 years; 49.7% female), AUROC was 0.84 (95% CI, 0.79-0.89), with sensitivity of 0.72 and specificity of 0.86 at the prespecified threshold, and was maintained in a specificity stress test among patients with features that mimic ATTR-CM (left ventricular hypertrophy or severe aortic stenosis without amyloid; AUROC, 0.81 [95% CI, 0.75-0.86]) and those referred for CARI (AUROC, 0.78 [95% CI, 0.73-0.84]). Across 5 external cohorts, AUROCs ranged from 0.78 to 0.89. In 3 screening cohorts, AUROCs were 0.76 (95% CI, 0.68-0.83) in the SCAN-MP study (n = 645) and 0.79 (95% CI, 0.65-0.93) and 0.91 (95% CI, 0.82-0.97) in 2 CACTUS study cohorts (n = 251, n = 121). Sequential AI-ECG and AI-enabled echocardiography increased the positive predictive value from 0.24 to 0.66 and reduced sensitivity from 0.84 to 0.68. Conclusions and Relevance Locally deployable AI applied to ECG images discriminated ATTR-CM across multinational retrospective and screening cohorts. This approach may provide an accessible first step to prioritize selected patients for echocardiography and confirmatory imaging, although intended use and calibration require prospective evaluation.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148836190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}