Journal of the American Heart Association最新文献

{"title":"Applications of Human-Centered Design to Food Is Medicine Interventions: The THRIVE Pilot Trial.","authors":"Khadijat Adeleye, Kennedy McDaniel, Irma Iribe, Adeline Assani-Uva, Janice Dugbartey, Aminata Sinyan, Bijaya Bhattarai, Samantha DeMarco, Tosin Tomiwa, Mojisola Olusola-Bello, Chelsea Akubo, Faith E Metlock, D'Janee Kyeremeh, Adrián McMahon, Maya Kramer-Johansen, India Washington, Peiyu Chen, Christy Rodriguez, Mia Johnson, William Xiao, Samuel Gledhill, Samuel Yeboah-Manson, Natania Kurien, Lydia Vassiliadi, Jennifer Freeman, Anna Maria Izquierdo-Porrera, Lessly Palencia, Valerie K Sullivan, Yvonne Commodore-Mensah, Oluwabunmi Ogungbe","doi":"10.1161/JAHA.125.041846","DOIUrl":"https://doi.org/10.1161/JAHA.125.041846","url":null,"abstract":"<p><strong>Background: </strong>Food Is Medicine interventions show promise for improving cardiovascular health outcomes, particularly for addressing disparities affecting Black and Hispanic populations. However, their development often lacks community co-creation. Human-centered design approaches can enhance the acceptability and feasibility of interventions through co-design processes. We aimed to co-design the THRIVE program (Adaptive Personalized Dietitian Coaching and Messaging With Produce Prescriptions to Improve Healthy Dietary Behaviors) among Black and Hispanic adults with hypertension living in healthy food priority areas in Maryland.</p><p><strong>Methods: </strong>Using social cognitive theory and the human-centered design double-diamond framework, 3 iterative co-design sessions were conducted. The first session included an orientation/listening (virtual), followed by 2 in-person prototyping and process mapping sessions. Participants included community residents with hypertension, health care providers, local food system representatives, and community organization leaders. Data collection included detailed session notes, post-session surveys, prototypes, and documentation of visual outputs. Content analysis identified key implementation themes.</p><p><strong>Results: </strong>Thirty-six community stakeholders (29 female, 6 male, 17 English-speaking, 18 Spanish-speaking/bilingual) participated. Three primary themes emerged: (1) health care system integration, emphasizing personalized dietitian support with cultural competency; (2) food access and education, highlighting flexible produce prescription programs with practical nutrition education; and (3) community empowerment, emphasizing peer support networks. Process evaluation demonstrated high engagement, with 100% reporting valued contributions and 92% recommending similar approaches for future cardiovascular interventions.</p><p><strong>Conclusions: </strong>Human-centered design effectively guided community engagement in the development of a contextually tailored Food Is Medicine intervention. Integrating human-centered design with implementation science creates more effective, equitable, and sustainable health interventions for addressing complex health challenges.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041846"},"PeriodicalIF":5.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692462","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":"Community-Level Compact City Design, Health Care Provision, and Outcomes of Patients With Stroke.","authors":"Yukihiro Imaoka, Nice Ren, Soshiro Ogata, Shogo Watanabe, Tomoya Itatani, Eri Kiyoshige, Hirotoshi Imamura, Kunihiro Nishimura, Syoji Kobashi, Yasuyuki Kaku, Koichi Arimura, Hitoshi Fukuda, Masafumi Ihara, Tsuyoshi Ohta, Yuji Matsumaru, Nobuyuki Sakai, Takanari Kitazono, Shigeru Fujimoto, Kuniaki Ogasawara, Koji Yoshimoto, Akitake Mukasa, Koji Iihara","doi":"10.1161/JAHA.125.041293","DOIUrl":"https://doi.org/10.1161/JAHA.125.041293","url":null,"abstract":"<p><strong>Background: </strong>The optimal scale of urbanization for stroke health care provision and the potential impact of compact city design on stroke outcomes remain unclear. We investigated the impact of zip code area-level compact city design using the walkability index (WI) and its mediators on stroke outcomes.</p><p><strong>Methods: </strong>This nationwide retrospective study used data from patients with stroke from the J-ASPECT study (2017-2022). WI was calculated as the average of 3 <i>Z</i>-scored city design elements (population density, road connectivity, and variation in walkable facilities) from 113 1156 zip code areas in Japan. The association between WI and in-hospital mortality, functional independence at discharge, and medical costs was assessed using multivariable mixed-effects logistic regression model.</p><p><strong>Results: </strong>Overall, 555 296 patients (median age, 75 [interquartile range, 66-83] years; female, 42.5%) from 818 hospitals were included. Higher WI was significantly associated with decreased in-hospital mortality (odds ratio [OR], 0.94 [95% CI, 0.92-0.96]) and increased functional independence (OR, 1.03 [95% CI, 1.02-1.04]). The highest WI group was associated with decreased mortality, primarily mediated by management in intensive or stroke care units (proportion mediated, 0.46 [95% CI, 0.35-0.63]), and the highest WI group was associated with increased functional independence, mediated by short road distance to the hospital (proportion mediated, 0.30 [95% CI, 0.21-0.44]).</p><p><strong>Conclusions: </strong>Zip code area-level compact city design was associated with decreased in-hospital mortality and increased functional independence. Compact city design at community level, even without large-scale urbanization, may contribute to improving stroke care provision and outcomes in increasingly urbanized societies.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"eJAHA2025041293T"},"PeriodicalIF":5.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692463","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":"Maintaining Stable, Adequate Sleep: Instrumental to Cardiometabolic Health.","authors":"Marie-Pierre St-Onge, Sanja Jelic","doi":"10.1161/JAHA.125.043464","DOIUrl":"https://doi.org/10.1161/JAHA.125.043464","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043464"},"PeriodicalIF":5.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676529","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":"Variant-Specific Late Gadolinium Enhancement Patterns Influence Clinical Outcomes in <i>LMNA</i>-Related Cardiomyopathy.","authors":"Matteo Castrichini, Ramin Garmany, Konstantinos C Siontis, Jeremy D Collins, John P Bois, Naveen L Pereira, David J Tester, Martina Gluscevic, Trung Huynh, Raquel Neves, Andrew N Rosenbaum, Michael J Ackerman, John R Giudicessi","doi":"10.1161/JAHA.124.041230","DOIUrl":"https://doi.org/10.1161/JAHA.124.041230","url":null,"abstract":"<p><strong>Background: </strong>Disease-causative variants in <i>LMNA</i>-encoded lamin A/C cause a genetic cardiomyopathy characterized by atrioventricular block, atrial fibrillation, ventricular arrhythmias, and systolic dysfunction. The influence of <i>LMNA</i> variant type/localization on late gadolinium enhancement (LGE) patterns and clinical outcomes remains unclear.</p><p><strong>Methods: </strong>Retrospective analysis of 822 genotype-positive patients with arrhythmogenic/dilated cardiomyopathy was used to identify those with disease-causative variants in <i>LMNA</i>. Data on LGE distribution and prevalence of advanced heart failure, thromboembolic and sudden cardiac death/major ventricular arrhythmia events were extracted from the electronic record and analyzed by variant type/localization.</p><p><strong>Results: </strong>Among the 72/116 (62%) <i>LMNA</i> variant-positive patients with cardiac magnetic resonance imaging data, LGE was observed in 40/72 (56%) cases. Most exhibited a nonischemic, midmyocardial or subepicardial pattern (73%), and 6/40 (15%) showed a unique \"pseudo-infarct\" transmural pattern, predominantly affecting the apical segments. All 6 patients with this distinct LGE pattern harbored C-terminal IgD (immunoglobulin-like domain) variants (p.Arg471His or p.Arg541His). In patients with clinically manifest disease (76/116), those with IgD-localizing variants had a lower prevalence of atrioventricular block (25% versus 72%, <i>P</i>=0.002) and atrial fibrillation (50% versus 81%, <i>P</i>=0.019) but higher rates of thromboembolic events (42% versus 16%, <i>P</i>=0.038). During a median follow-up of 37 months, IgD variant presence independently predicted sudden cardiac death/major ventricular arrhythmia (hazard ratio, 2.391 [95% CI, 1.046-5.464]; <i>P</i>=0.039).</p><p><strong>Conclusions: </strong><i>LMNA</i> missense variants localizing to IgD present a distinct apical pseudo-infarct LGE pattern associated with increased risk of ventricular arrhythmias and thromboembolic events but reduced atrioventricular block and atrial fibrillation. Multicenter studies are warranted to develop variant-specific risk-stratification strategies in cardiac laminopathy.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"eJAHA2025041230T"},"PeriodicalIF":5.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676535","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":"Angiography-Derived Indices of Coronary Microvascular Resistance: Context Is Key.","authors":"Roberto Scarsini, Giovanni Luigi De Maria","doi":"10.1161/JAHA.125.043463","DOIUrl":"https://doi.org/10.1161/JAHA.125.043463","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043463"},"PeriodicalIF":5.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676527","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":"Nighttime Blood Pressure Matters Even in Heart Failure.","authors":"Christine Chow, William J Healy, Younghoon Kwon","doi":"10.1161/JAHA.125.043451","DOIUrl":"https://doi.org/10.1161/JAHA.125.043451","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043451"},"PeriodicalIF":5.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676530","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":"Unlocking Potential: The Untapped Resources to Expand the Field of Adult Congenital Heart Disease Providers.","authors":"Abigail Khan, Anitra Romfh","doi":"10.1161/JAHA.125.043295","DOIUrl":"https://doi.org/10.1161/JAHA.125.043295","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043295"},"PeriodicalIF":5.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676534","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":"Adult Congenital Heart Disease as a Career? Examining Encouraging and Deterring Factors in the Global ACHD Survey.","authors":"Katia Bravo-Jaimes, M H D Osama Srour, Petra Jenkins, Raquel Luna-Lopez, Oktay Tutarel, Geetha Kandavello, Carlos-Eduardo Guerrero-Chalela, Edgar García-Cruz, Judith Ackerman, Amalia Elizari, Miriam Valdez-Ramos, Blanche Cupido, Dominica Zentner, Murad Almasri, Sabrina Phillips, Christopher J McLeod, Luke J Burchill, Celia Kamath, Renee P Bullock-Palmer, Jonathan Windram","doi":"10.1161/JAHA.125.041276","DOIUrl":"https://doi.org/10.1161/JAHA.125.041276","url":null,"abstract":"<p><strong>Background: </strong>There is a global mismatch between the number of adults with congenital heart disease and adult congenital heart disease (ACHD) cardiologists, potentially impacting patient outcomes. This survey explores factors influencing trainees and cardiologists' career choices in ACHD.</p><p><strong>Methods: </strong>An online, anonymous global survey on demographics, ACHD as a career choice, encouraging and deterring factors assessed via a 5-point Likert scale and open-ended questions on recommending ACHD was distributed through targeted emails and social media. Responses meeting a 75% completion criterion were analyzed using descriptive statistics and thematic analysis.</p><p><strong>Results: </strong>Among 811 included responses, most were from women (53.5%), aged 31 to 40 years (48.3%), White individuals (43.3%), non-Hispanic individuals (85%), from outside the ACHD field (79.0%), and from North America (42.7%). Only 30.9% of non-ACHD physicians considered specializing in ACHD despite 78.9% recommending it. Encouraging factors included awareness of ACHD significance, mentor influence, and clinical exposure. Key deterrents were inadequate financial incentives, limited job opportunities, and lengthy training. Regional variations showed that longer training duration and lack of compensation incentives were the main deterrents in North America. Suggested solutions included structured training programs, salary improvements, and early ACHD exposure during medical education.</p><p><strong>Conclusions: </strong>Less than a third of respondents considered ACHD as a career largely due to inadequate financial incentives, limited job opportunities, and long training duration. Addressing these barriers could enhance recruitment and help meet the growing demands of the ACHD population.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041276"},"PeriodicalIF":5.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676526","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":"Renal Denervation Improves Uremic Cardiomyopathy in Rats With Chronic Kidney Disease.","authors":"Philipp Markwirth, Simina-Ramona Selejan, Mathias Hohl, Stefan J Schunk, Andreas Müller, Stefan Wagenpfeil, Lea Wagmann, Florian Kahles, Mert Tokcan, Markus Therre, Emiel P C van der Vorst, Matthias Rau, Heidi Noels, Julia Wollenhaupt, Felix Mahfoud, Michael Böhm","doi":"10.1161/JAHA.124.038785","DOIUrl":"https://doi.org/10.1161/JAHA.124.038785","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is an independent cardiovascular risk factor. Patients with CKD develop uremic cardiomyopathy characterized by activation of the sympathetic nervous system, left ventricular hypertrophy, and accumulation of uremic toxins such as indoxyl sulfate (IS). The aim of this study was to assess the effects of renal denervation (RDN) on uremic cardiomyopathy in a rat model of CKD.</p><p><strong>Methods: </strong>Sprague-Dawley rats were fed a standard chow (control group, n=6) or a 0.25% adenine-enriched chow (n=16) for 16 weeks to induce CKD. After 4 weeks, CKD rats with CKD were subjected to bilateral RDN (AD-RDN, n=8) or to sham operation (AD, n=8). Blood pressure measurements, echocardiography, and cardiac magnetic resonance imaging were deployed during the experiment. Left ventricular hypertrophy was evaluated histologically. IS was measured using ELISA. In H9C2 cardiomyoblasts, the hypertrophic effects of IS were characterized in vitro.</p><p><strong>Results: </strong>In AD rats, left ventricular septal wall thickness (2.37±0.036 versus 1.91±0.014 mm in CTRL, <i>P</i> <0.0001), E/A ratio, and cardiomyocyte size were significantly increased. Following RDN, left ventricular wall thickness (<i>P</i> <0.0001 versus AD), E/A ratio (<i>P</i> <0.0001 versus AD), and myocyte hypertrophy were significantly reduced. Plasma IS was increased in AD (0.79±0.07 versus 0.2±0.12 μg/mg in the control group, <i>P</i>=0.0044) and reduced in AD-RDN (<i>P</i>=0.0073 versus AD). Urinary IS remained unchanged after RDN, whereas hepatic concentration of IS decreased after RDN (<i>P</i>=0.023). Plasma IS correlated with left ventricular hypertrophy (r=0.779, <i>P</i> <0.0001). Stimulation of H9C2 cardiomyoblasts with IS or serum from AD rats showed an increase in cell size (<i>P</i>=0.0015), whereas AD-RDN serum showed no effect.</p><p><strong>Conclusions: </strong>In a rat model of CKD, improved cardiac function following RDN was associated with reduced plasma concentrations of IS. To the present, IS remains a persistent clinical concern in patients with CKD due to its inefficient removal by conventional hemodialysis and its significant role in promoting both kidney and myocardial disease. Thus, RDN may ameliorate uremic cardiomyopathy by reducing IS and potentially represents a treatment option for patients with CKD and cardiovascular disease. Clinical trials are warranted to investigate the effects of RDN on cardiovascular outcomes in patients with CKD.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038785"},"PeriodicalIF":5.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676532","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":"Nighttime Systolic Blood Pressure Determined by Pulse Transit Time Predicts Cardiac Events in Patients With Heart Failure.","authors":"Naoto Ohashi, Yu Sato, Akiomi Yoshihisa, Ryohei Takeishi, Tomofumi Misaka, Tetsuro Yokokawa, Takamasa Sato, Masayoshi Oikawa, Atsushi Kobayashi, Kazuhiko Nakazato, Yasuchika Takeishi","doi":"10.1161/JAHA.124.039917","DOIUrl":"https://doi.org/10.1161/JAHA.124.039917","url":null,"abstract":"<p><strong>Background: </strong>The optimal systolic blood pressure (SBP) target for heart failure (HF) patients has not been established. Although the association between daytime SBP and prognosis has been reported in patients with HF, the prognostic impact of nighttime SBP remains unclear.</p><p><strong>Methods: </strong>We conducted continuous nighttime SBP measurements noninvasively using pulse transit time in 366 patients with HF (median age, 72 years; male sex, 195), and followed up for cardiac events (HF hospitalization or cardiac death). Average values of nighttime pulse transit time -based SBP were used in the present study. The patients were divided into tertile groups based on nighttime pulse transit time-based SBP: high-SBP group (median SBP, 136 mm Hg; n=122), middle-SBP group (median SBP, 117 mm Hg; n=122), and low-SBP group (median SBP, 100 mm Hg; n=122).</p><p><strong>Results: </strong>During a median follow-up period of 1083 days after nighttime pulse transit time-based SBP measurement, 71 patients experienced a cardiac event. Kaplan-Meier analysis showed the highest incidence of cardiac events in the low-SBP group. Multivariate Cox proportional hazard analysis also showed that the lowest SBP tertile was associated with a higher risk of cardiac events compared with the highest SBP tertile as reference (hazard ratio, 2.100 [95% CI, 1.121-3.933]; <i>P</i>=0.021).</p><p><strong>Conclusions: </strong>Low nighttime SBP was associated with an increased cardiac event rate in patients with HF.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039917"},"PeriodicalIF":5.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676531","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}