Circulation. Population health and outcomes最新文献

{"title":"Supplement Use and Diet Quality Among U.S. Adults by Eligibility for Lipid-Lowering Therapy.","authors":"Sridhar Mangalesh, Sharanya Kaushik, Aditya Karthikeyan, Ermin Tale, Vaibhav Vats, Zaha Waseem, Qudsiya Asif Aleem Afridi, Adir Alper, Sriram Sunil Kumar, Lori Lemberg, Robert J Ostfeld","doi":"10.1161/CIRCOUTCOMES.126.014316","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.126.014316","url":null,"abstract":"<p><p><b>Background:</b> The 2026 American Heart Association/ American College of Cardiology (AHA/ACC) dyslipidemia guideline advises against supplements for lipid lowering. Whether supplement use reflects broader engagement in cardiovascular prevention, including healthy eating, remains uncertain. We examined supplement use and selected dietary characteristics across lipid-lowering therapy (LLT) treatment and eligibility groups. <b>Methods:</b> We conducted a cross-sectional analysis of National Health and Nutrition Examination Survey data (2015-2020) from adults aged 30-75 years. Participants were classified as current LLT users or untreated adults. Untreated adults were further classified as recommended, reasonable/selectively consider, or not routinely recommended for LLT, using the 2026 AHA/ACC guideline. Outcomes were self-reported heart health or cholesterol supplement use and dietary misalignment burden, defined as the number of unmet benchmarks across nine selected recall-day indicators informed by 2026 AHA dietary guidance. Analyses incorporated the complex survey design and fasting subsample weights to generate national estimates and compare supplement use across burden categories. <b>Results:</b> We analyzed 3,743 participants, representing 147.3 million US adults; 49.0% were female, and 25.0% were receiving LLT. Overall, 11.3% [9.4-13.6] reported supplement use. Supplement use was highest among adults receiving LLT (19.5% [14.9-25.1]) and lowest among untreated adults for whom LLT was not routinely recommended (3.6% [2.6-5.1]). Among untreated adults for whom LLT was recommended, 4.2 million (12.8% [10.5-15.4]) used supplements. Dietary inadequacies were common across measured domains and LLT eligibility strata; the weighted median misalignment burden was 7 (IQR 6-8). Supplement use did not differ significantly across dietary misalignment burden categories. <b>Conclusions:</b> Millions of US adults recommended for LLT were untreated while using heart health or cholesterol supplements, and supplement use did not differ significantly across selected dietary misalignment burden categories. Proactive assessment of supplement use may help redirect prevention counseling toward guideline-directed LLT and heart-healthy dietary patterns.</p>","PeriodicalId":521248,"journal":{"name":"Circulation. Population health and outcomes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149330075","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":"Sleep and Cardiometabolic Disease: A Wearable-Electronic Health Record Study in the US All of Us Research Program.","authors":"Anh Khoa Tran, Minh Tuan Viet Nguyen","doi":"10.1161/CIRCOUTCOMES.126.014445","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.126.014445","url":null,"abstract":"<p><p><b>Background:</b> Sleep health spans duration, quality, regularity, and timing, yet Life's Essential 8 scores sleep by duration alone, and regularity studies used about 1 week of data. How these dimensions, measured over months, relate to incident cardiometabolic disease is unknown, as is whether nightly sleep-cycle structure adds information. <b>Methods:</b> This cohort study included US adults in the All of Us Research Program with linked Fitbit and electronic health records (2009-2023). We derived 11 sleep metrics over a 180-day baseline (≥90 valid nights). Incident diagnoses, grouped into phecodes, were counted after a 180-day washout to limit reverse causation. Primary analyses related these metrics to prespecified endpoints, including a CVD composite (myocardial infarction, heart failure, cardiomyopathy, or ischemic stroke), heart failure, hypertension, and type 2 diabetes. Cox models adjusted for demographic, socioeconomic, lifestyle, and comorbidity factors. Exploratory analyses examined wearable-estimated sleep cycles (7,199 participants; 1,017,812 sleep-stage nights). <b>Results:</b> Among 10,362 participants (median age, 53 years; 70% female), 230 developed the CVD composite (median follow-up, 3.7 years). Each 1-SD (29-minute) higher night-to-night variability in sleep duration was associated with higher CVD composite risk (hazard ratio, 1.24 [95% CI, 1.09-1.41]), as was higher variability in bedtime (1.23 [1.10-1.37]), waketime (1.20 [1.09-1.32]), and midpoint (1.21 [1.09-1.35]); mean sleep duration was not (0.96 [0.85-1.08]). Variability in sleep duration was also associated with heart failure (1.32 [1.13-1.55]), hypertension (1.16 [1.08-1.25]), and type 2 diabetes (1.20 [1.07-1.35]). More sleep cycles were associated with lower atrial arrhythmia risk (0.72 [0.58-0.89]), independent of sleep duration, regularity, and timing (0.58 [0.44-0.77]). <b>Conclusions:</b> Night-to-night irregularity in sleep duration and timing was associated with the CVD composite, heart failure, hypertension, and type 2 diabetes; mean duration was not associated with the CVD composite. More wearable-estimated sleep cycles were associated with lower atrial arrhythmia risk beyond conventional sleep metrics, a novel finding requiring confirmation.</p>","PeriodicalId":521248,"journal":{"name":"Circulation. Population health and outcomes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149330074","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":"Sustained Improvement in Interstage Survival and Outcomes Within the National Pediatric Cardiology Quality Improvement Collaborative.","authors":"Andrew H Van Bergen, Pierce Kuhnell, David W Brown, Carole M Lannon, Nancy A Rudd, Jeffrey B Anderson, Katherine E Bates","doi":"10.1161/CIRCOUTCOMES.125.013073","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.013073","url":null,"abstract":"<p><strong>Background: </strong>Infants with hypoplastic left heart syndrome remain at high risk during the interstage between stage 1 and stage 2 surgical palliations. As a multicenter Learning Health Network, the National Pediatric Cardiology Quality Improvement Collaborate uses collaborative research and improvement to improve hypoplastic left heart syndrome outcomes for infants. We evaluated whether our previously reported improvement in interstage survival from 90.5% to 94.8% was sustained over time.</p><p><strong>Methods: </strong>Infants enrolled in the National Pediatric Cardiology Quality Improvement Collaborate clinical registry who underwent stage 1 surgical palliation and were discharged home during the interstage period were included. Patient demographics, hypoplastic left heart syndrome anatomic type, and neonatal hospitalization data in phase 1 (2008-2016) and phase 2 (2016-2025) were compared. Statistical process control was used to analyze rates of interstage survival, major adverse event readmissions, and growth failure.</p><p><strong>Results: </strong>A total of 5495 patients (phase 1-2199, phase 2-3296) were enrolled from 77 centers, of which 38.7% were female and 11.2% had a major syndrome. The phase 2 cohort had a higher prevalence of RV-PA conduit (phase 1: 55.2% versus phase 2: 64.3%; <i>P</i><0.001), lower median NEONATE score (9 versus 3; <i>P</i><0.001), higher digoxin prescription (28.9% versus 74.7%; <i>P</i><0.001), and longer median length of stay compared with phase 1 (28 versus 34 days; <i>P</i><0.001). Improvement in interstage survival noted in phase 1 was sustained throughout phase 2 at 94.8%. Major adverse event readmissions declined early in phase 2 and were maintained (1.74 versus 0.9/100 interstage patients). Adequate growth was statistically different but clinically stable over time (mean weight <i>Z</i> score at stage 2 admission -1.5 versus -1.42; <i>P</i><0.019).</p><p><strong>Conclusions: </strong>National Pediatric Cardiology Quality Improvement Collaborate sustained significant improvements in interstage outcomes through continued adherence to improvement processes, collaborative learning, and promoting best practices over time, including utilization of digoxin and NEONATE score.</p>","PeriodicalId":521248,"journal":{"name":"Circulation. Population health and outcomes","volume":" ","pages":"e013073"},"PeriodicalIF":0.0,"publicationDate":"2026-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149330076","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":"ACHD Care Wheel: A Stakeholder- and Theory-Driven Framework to Improve Specialized Adult Congenital Heart Disease Care.","authors":"Anushree Agarwal, Katelyn Macholl, Alice Qian, Juhi Mehta, Pranav Ahuja, Karina Buenrostro, Kevin Sun, Daniel Dohan, Michelle Gurvitz, Megumi J Okumura","doi":"10.1161/CIRCOUTCOMES.126.014082","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.126.014082","url":null,"abstract":"<p><p><b>Background:</b> Patients with adult congenital heart disease (ACHD) experience significant gaps in guideline-recommended care, associated with higher morbidity and mortality compared to those without care gaps. We evaluated barriers and facilitators to specialized care to inform patient-centered solutions. <b>Methods:</b> We purposively sampled ACHD patients and clinicians from UCSF and across the United States and conducted semi-structured interviews in 2023-2024. Patients were ≥18 years, spoke English or Spanish, and could provide informed consent; clinicians were cardiologists or other staff involved in ACHD care. Zoom interviews were conducted using Capability, Opportunity, Motivation, and Behavior (COM-B)-informed guides and were recorded, professionally transcribed, and translated when applicable. Data were analyzed using inductive coding and rapid qualitative analysis, with independent dual coding, consensus resolution, concurrent analysis, and member checking. Identified categories were subsequently mapped to the Theoretical Domains Framework and COM-B. <b>Results:</b> We interviewed 54 participants (37 patients, 17 clinicians). For patients, the median age was 32 years; 57% were women, 62% were people of color, and 35% had gaps in care of ≥3 years. Findings were organized into six interdependent categories: healthcare system and institutional structure; knowledge and education; sources of support; personal development; identity and personal resources; and ACHD's placement in one's life. Two novel findings emerged: a paradoxical facilitating role of parental language barriers and the complex impact of caregiver support on patients' independent care skills. We developed the ACHD Care Wheel, a theory-guided framework to support the design and evaluation of future interventions. <b>Conclusions:</b> The ACHD Care Wheel is a stakeholder-derived, theory-grounded framework for developing and evaluating interventions to improve ACHD care. Interventions targeting the three priority categories (healthcare system and institutional structure, knowledge and education, and sources of support) are likely to produce effects across multiple domains simultaneously, offering a theoretically grounded path forward for this growing population.</p>","PeriodicalId":521248,"journal":{"name":"Circulation. Population health and outcomes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149330073","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":"Interrelationships Between Kansas City Cardiomyopathy Questionnaire Domains, Age, and Sex for Patients With Heart Failure: Findings From the CHAMP-HF and CORC Registries.","authors":"Andrew A Girard, Philip G Jones, Zhuxuan Fu, Charles F Sherrod, Omar Cantu Martinez, Stephen J Greene, Justin M Bachmann, Gregg C Fonarow, Javed Butler, John A Spertus, Suzanne V Arnold","doi":"10.1161/CIRCOUTCOMES.126.013486","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.126.013486","url":null,"abstract":"<p><strong>Background: </strong>Although Kansas City Cardiomyopathy Questionnaire (KCCQ) domains independently quantify patients' symptoms, physical and social functioning, and quality of life, the interrelationships between domains (eg, symptoms impacting physical limitations) have not been described, nor whether these vary by age or sex.</p><p><strong>Methods: </strong>Cross-sectional data from adult outpatients with heart failure and reduced ejection fraction from 2 multicenter US registries, the Change the Management of Patients With Heart Failure Registry (2015-2017) and Cardiovascular Outcomes Research Consortium (2001-2002), were used to fit recursive path analysis models relating age, sex, and KCCQ domain scores. The interrelationships of these factors were quantified using unstandardized and standardized effect estimates. Unstandardized effects denote the linear effect of the independent variable on the dependent variable in units specific to both variables. Standardized effects are unitless and are obtained by multiplying the unstandardized effect by the ratio of the standard deviations of the dependent and independent variables.</p><p><strong>Results: </strong>The analytic cohorts included 4839 patients from the Change the Management of Patients With Heart Failure Registry (mean age, 66.1±12.5 years, 29.3% women) and 547 patients from the Cardiovascular Outcomes Research Consortium (mean age, 66±12 years, 23.8% women). Standardized effect estimates revealed moderate to strong interrelationships among the KCCQ domains (effect size range, 0.34-0.70). Symptoms were strongly associated with all other domains (range, 0.61-0.70). Quality of life was most associated with symptoms and social limitations (range: 0.48-0.60), and less so with physical limitations (effect size=0.34). By comparison, the associations of age and sex with KCCQ domains were much smaller (effect sizes <0.2), and no interactions by age and sex were found.</p><p><strong>Conclusions: </strong>KCCQ domains were strongly interrelated, and these relationships did not differ appreciably by age or sex. These data enhance the interpretation of KCCQ domain scores in research and clinical practice; in particular, symptoms and social limitations may be key drivers of impaired quality of life in heart failure. Targeted interventions prioritizing these domains may most effectively improve patients' overall health status.</p>","PeriodicalId":521248,"journal":{"name":"Circulation. Population health and outcomes","volume":" ","pages":"e013486"},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229837","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":"State-Level Disparities in Medicare Coverage and Costs of Low-Density Lipoprotein Cholesterol Treatment: Changes Between 2023 and 2026.","authors":"Grant M Young, Kannu Bansal, Shivam Desai, Ralph J Riello, Michael A Fuery, Katherine A A Clark, Kamil F Faridi, Nihar R Desai","doi":"10.1161/CIRCOUTCOMES.126.013506","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.126.013506","url":null,"abstract":"","PeriodicalId":521248,"journal":{"name":"Circulation. Population health and outcomes","volume":" ","pages":"e013506"},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229865","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":"National Survival Estimates After Surgical Repair of Congenital Heart Disease.","authors":"Michael P Fundora, Kimberlee Gauvreau, Yanxu Yang, Jeffrey P Jacobs, Matthew E Oster, Kathy J Jenkins, Lazaros Kochilas","doi":"10.1161/CIRCOUTCOMES.125.013189","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.013189","url":null,"abstract":"<p><strong>Background: </strong>Survival estimates after congenital heart surgery (CHS) in the United States are essential for planning healthcare services for this growing, resource-intensive patient population. However, the absolute number of individuals living after interventions for congenital heart disease is unknown because nationally representative survival estimates are unavailable. Understanding postoperative survival from a representative national sample is a critical first step toward estimating the size and future healthcare needs of this population. This study aimed to develop nationally representative long-term survival estimates after CHS in the United States, focusing on benchmark procedures defined by the Society of Thoracic Surgeons.</p><p><strong>Methods: </strong>We used 3 US data sets of children aged 0 to 20 years at the time of their benchmark CHS from 1998 to 2002 and surviving to hospital discharge. The Pediatric Cardiac Care Consortium (PCCC), a multi-institutional clinical registry, was matched to the National Death Index to determine mortality through December 2019. The Kids' Inpatient Database 2000, a nationally representative administrative claims data set, was used to derive age- and sex-specific weights. Kaplan-Meier curves were estimated from the PCCC-National Death Index cohort for benchmark operations, and Kids' Inpatient Database 2000 weights were applied. Unweighted PCCC survival estimates were also compared with those of Boston Children's Hospital, a large tertiary care center.</p><p><strong>Results: </strong>Nationally representative survival curves were generated for 7 benchmark CHS from 7973 cases; 3802 (48%) were female, and 4505 (57%) were infants at the time of CHS. These weighted national survival curves closely mirrored the unweighted curves derived from PCCC-National Death Index. Unweighted survival estimates from PCCC also closely approximated those from BCH, with only modest differences observed for selected lesions.</p><p><strong>Conclusions: </strong>The weighted PCCC-National Death Index methodology provides the first nationally representative estimates of long-term survival after benchmark congenital heart disease in the United States. These estimates provide an important resource for healthcare planning and research for the growing population of individuals with congenital heart disease.</p>","PeriodicalId":521248,"journal":{"name":"Circulation. Population health and outcomes","volume":" ","pages":"e013189"},"PeriodicalIF":0.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drivers of Black-White Disparities in Hypertension Risk After Pregnancy: Findings From CARDIA.","authors":"Jaclyn D Borrowman, Xuan Cai, Abbi D Lane, Emily W Harville, Kiarri N Kershaw, Mercedes R Carnethon","doi":"10.1161/CIRCOUTCOMES.126.013605","DOIUrl":"10.1161/CIRCOUTCOMES.126.013605","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is the leading risk factor for cardiovascular disease, with disparities observed by race. Few studies have examined how intersecting social and sex-based biological determinants influence hypertension incidence among parous individuals and across racial groups. The objective of this study was to examine whether female-specific cardiovascular disease risk factors (eg, adverse pregnancy outcomes), individual-level (eg, education), and structural-level (eg, neighborhood) social drivers of health (SDoH), beyond traditional cardiovascular disease risk factors (eg, physical activity), explain the Black-White disparity in hypertension following pregnancy.</p><p><strong>Methods: </strong>Parous individuals in CARDIA (Coronary Artery Risk Development in Young Adults), a longitudinal cohort study beginning in 1985 to 1986, without hypertension before their first pregnancy were included. Race was self-reported at enrollment. Blood pressure was measured at each examination, with hypertension incidence defined as the first elevated blood pressure (systolic ≥130 mm Hg or diastolic ≥80 mm Hg) or initiation of antihypertensive medication after baseline. Participant follow-up time began at the next exam following their first live delivery. Cox proportional hazards models with time-varying covariates calculated hazard ratios and 95% CIs. To quantify how much each set of covariates explained the Black-White difference in hypertension risk, the percentage reduction in the race coefficient was calculated following the addition of female-specific cardiovascular disease risk factors and SDoH in multivariable-adjusted regression models.</p><p><strong>Results: </strong>Among 1653 participants (29.4±6.1 years), Black women (n=924) had higher hypertension incidence than White women (n=729): 41.4 versus 18.5 per 1000 person-years, respectively; and an earlier median age at onset (42 versus 48 years). Following traditional risk factors, individual-level SDoH explained the largest disparity (7.52%), followed by female-specific factors (2.26%) and structural-level SDoH (1.50%). Black women remained at higher risk after adjustment (hazard ratio, 2.72 [95% CI, 2.17-3.41]).</p><p><strong>Conclusions: </strong>Parous Black women face substantially higher hypertension rates than White women, persisting after accounting for traditional risk factors, female-specific risk factors, and SDoH.</p>","PeriodicalId":521248,"journal":{"name":"Circulation. Population health and outcomes","volume":" ","pages":"e013605"},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Anticoagulation Among Patients With Atrial Fibrillation or Atrial Flutter in the United States.","authors":"Pishoy Gouda, Josephine Harrington, Kelly Arps, Gretchen Sanders, Angel Marks, Karen Chiswell, Paul Hofmann, Keith Marsolo, Kirubel Asfaw, Rosa Coppolecchia, John H Alexander, Jonathan Piccini, Christopher B Granger, Heidi T May, Elizabeth Chrischilles, Benjamin A Steinberg, Alanna M Chamberlain, Jeffrey Van Wormer, W Schuyler Jones, Manesh R Patel","doi":"10.1161/CIRCOUTCOMES.126.013494","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.126.013494","url":null,"abstract":"<p><strong>Background: </strong>Oral anticoagulation (OAC) remains underused in patients with atrial fibrillation or flutter at high risk of ischemic stroke. We aimed to characterize documented OAC prescribing at diagnosis and during 1-year follow-up and identify factors associated with baseline OAC prescribing.</p><p><strong>Methods: </strong>Using electronic health records from 7 US health systems participating in the National Patient-Centered Clinical Research Network between 2015 and 2019, we identified patients with newly diagnosed atrial fibrillation at high risk of ischemic stroke (CHA₂DS₂-VASc score ≥2 for men or ≥3 for women). The primary outcomes were documented OAC prescription at baseline and during 1-year follow-up. Exposures included demographic, clinical, and health-system characteristics. Multivariable logistic regression was used to identify factors associated with baseline OAC prescribing and loss of documented OAC prescribing during follow-up.</p><p><strong>Results: </strong>Among 161 295 patients (median age, 76 years [interquartile range, 68-82]; 70 327 [43.6%] women), 92 518 (57.4%) had a documented OAC prescription at baseline, increasing from 56.6% in 2015 to 62.6% in 2019. Among those with a documented baseline OAC prescription, 45.6% had no documented OAC prescription during 1-year follow-up. Among 68 777 patients without a documented baseline OAC prescription, 12.5% had an OAC prescription documented during follow-up. Dementia (odds ratio, 0.58 [95% CI, 0.56-0.61]), prior major bleeding (odds ratio, 0.69 [95% CI, 0.63-0.75]), and renal disease (odds ratio, 0.84 [95% CI, 0.81-0.88]) were associated with lower odds of baseline OAC prescribing, whereas heart failure was associated with higher odds (odds ratio, 1.40 [95% CI, 1.37-1.43]).</p><p><strong>Conclusions: </strong>Among patients with newly diagnosed atrial fibrillation at high risk for ischemic stroke, OAC prescribing at diagnosis was suboptimal, and loss of documented OAC prescribing was common during the first year. Baseline OAC use was more strongly associated with bleeding risk, frailty, and comorbidity burden, and less consistently aligned with ischemic stroke risk.</p>","PeriodicalId":521248,"journal":{"name":"Circulation. Population health and outcomes","volume":" ","pages":"e013494"},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140336","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":"When Context Becomes Risk: Interpreting Social Deprivation in Contemporary Cardiovascular Prediction Models.","authors":"Affan Irfan","doi":"10.1161/CIRCOUTCOMES.126.013890","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.126.013890","url":null,"abstract":"","PeriodicalId":521248,"journal":{"name":"Circulation. Population health and outcomes","volume":" ","pages":"e013890"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149123932","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}