American heart journal plus : cardiology research and practice最新文献

{"title":"A Pragmatic Trial Evaluating the Impact of the Anumana Clinical Decision Support Tool for Guideline-Directed Management of Heart Failure (ACT-HF): Clinical trial design and methods","authors":"Francisco Lopez-Jimenez ,&nbsp;Heather M. Alger ,&nbsp;Sarah P. Hackett ,&nbsp;Vinay Gundurao ,&nbsp;Ketan Mehta ,&nbsp;Prerak Jain ,&nbsp;Praveen Kumar-M ,&nbsp;Chinmay Padhye ,&nbsp;Arjun Puranik ,&nbsp;Kitzner Vassor ,&nbsp;Sunil Kumar Ravi ,&nbsp;Barbara Barry ,&nbsp;Ranee Chatterjee ,&nbsp;Chen Chow ,&nbsp;Rowena Dolor ,&nbsp;Stephen J. Greene ,&nbsp;Grace Lin ,&nbsp;David Rushlow ,&nbsp;Mark Stampehl ,&nbsp;Xuan Zhu ,&nbsp;Samir Awasthi","doi":"10.1016/j.ahjo.2025.100675","DOIUrl":"10.1016/j.ahjo.2025.100675","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure with reduced ejection fraction (HFrEF) is progressive and pervasive. Guidelines provide evidence-based recommendations to manage HFrEF, yet adherence to Guideline Directed Medical Therapy (GDMT) is low. An opportunity exists to improve adherence by delivering actionable data, reducing clinician information overload, and enhancing patient care. A Pragmatic Trial Evaluating the Impact of the Anumana Clinical Decision Support Tool for Guideline-Directed Management of Heart Failure (ACT-HF) will evaluate a clinical decision support software (CDSS) that integrates in electronic health records (EHR), automates chart review, and identifies care gaps.</div></div><div><h3>Methods</h3><div>Anumana's Guideline Navigator is an innovative, multi-module AI-enabled CDSS with automated chart review to rapidly analyze EHR data, detect care gaps, and provide alerts for eligible patients not receiving optimal GDMT. ACT-HF, a multi-center cluster pragmatic trial, will recruit and randomize clinician participants (≤250) from 2 health systems to receive intervention software or provide usual care. The trial will evaluate outpatient care for adults with documented HFrEF and not on optimal GDMT (&gt;2148). Outcomes will be evaluated at 90 days. Clinician participants may discuss results with patients, but patients will not have access to the CDSS.</div></div><div><h3>Results</h3><div>Primary outcome is change in GDMT medications; exploratory endpoints include clinical outcomes, resource utilization, and usability. Subgroup analyses include health system, clinician, and patient-level characteristics associated with outcomes.</div></div><div><h3>Conclusion</h3><div>Building on efforts to improve GDMT adherence, ACT-HF will test Anumana's Guideline Navigator in a multicenter study to evaluate outcomes and further refine the CDSS EHR integration EHR for improved clinical utility, workflow integration, and patient outcomes.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100675"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618660","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":"Predictive value of abnormal coronary computed tomography angiography in patients with Normal single-photon emission computed tomography scan","authors":"Rami M. Abazid ,&nbsp;Monerah A. Almohideb ,&nbsp;Mohammad A. Barry ,&nbsp;Osama Smettie ,&nbsp;Naveed Asad ,&nbsp;Yasmine T. Sallam ,&nbsp;Mohamed Abdelrazek ,&nbsp;Cigdem Akincioglu ,&nbsp;James Warrington ,&nbsp;Jonathan G. Romsa ,&nbsp;William C. Vezina","doi":"10.1016/j.ahjo.2025.100694","DOIUrl":"10.1016/j.ahjo.2025.100694","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to assess the prognostic value of abnormal coronary computed tomography angiography (CCTA) in patients with normal single-photon emission computed tomography (SPECT) study.</div></div><div><h3>Methods</h3><div>We retrospectively enrolled patients with normal SPECT scans and abnormal CCTA studies, who were categorized according to CCTA findings into obstructive with ≥50 %, and non-obstructive CAD &lt;50 % coronary artery stenosis. Major adverse cardiac events (MACE) was defined as cardiovascular death and non-fatal myocardial infarction.</div></div><div><h3>Results</h3><div>Among 1558 eligible patients, there were 1356 (87.1 %) patients with non-obstructive CAD and 202 (12.9 %) patients with obstructive CAD. Over a median follow-up of 10.4 ± 5.1 years, a total of 87 MACEs were reported. Patients with obstructive CAD were older (67.4 ± 8 vs. 60.3 ± 10 years, <em>p</em> &lt; 0.001), more often male (75.0 % vs. 54.6 %, p &lt; 0.001), and had a higher prevalence of diabetes mellitus (26.7 % vs. 17.2 %, <em>p</em> = 0.008) compared with those with non-obstructive disease. Despite normal SPECT findings, patients with obstructive CAD had significantly higher rates of MACE compared with those with non-obstructive CAD [25/202 (12.4 %) vs. 62/1356 (4.8 %), <em>p</em> &lt; 0.001]. Multivariable Cox regression confirmed age (HR 1.21, <em>p</em> = 0.04), diabetes (HR 1.35, <em>p</em> = 0.03), higher coronary calcium score (HR 1.49, <em>p</em> = 0.01), and the presence of obstructive CAD (HR 2.57, <em>p</em> &lt; 0.001) are independent predictors of mortality.</div></div><div><h3>Conclusion</h3><div>Obstructive CAD on CCTA is associated with significantly higher long-term risk of MACE in comparison to non-obstructive CAD in patients with normal SPECT.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100694"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736953","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":"The impact of diabetes on giant negative T-wave amplitude in apical hypertrophic cardiomyopathy patients","authors":"Simin Song ,&nbsp;Min Xu ,&nbsp;Jinmei Gao ,&nbsp;Xiu Feng ,&nbsp;Hongqin Huang ,&nbsp;Liping Wang","doi":"10.1016/j.ahjo.2025.100686","DOIUrl":"10.1016/j.ahjo.2025.100686","url":null,"abstract":"<div><div>Clinical observations indicate an attenuation of giant negative T-waves (GNTWs) in some patients with apical hypertrophic cardiomyopathy (ApHCM), a condition frequently comorbid with type 2 diabetes mellitus (T2DM). The objective of this study was to examine the effect of T2DM on the GNTWs amplitude in ApHCM. A retrospective cohort of 124 ApHCM patients from Changzhou First People's Hospital (2021–2024) was categorized into T2DM (<em>n</em> = 30) and non-T2DM (<em>n</em> = 94) groups per American Diabetes Association criteria. A comparative analysis of baseline characteristics was conducted using Kruskal-Wallis and χ² tests. The association between T2DM and maximal negative T-wave voltage (Tmax) was assessed via multivariable linear regression, while nonlinear relationships were explored with generalized additive models (GAM). The T2DM subgroup exhibited a higher prevalence of hypertension (83.3 % vs. 60.6 %, <em>p</em> = 0.022) and coronary artery disease (44.8 % vs. 19.4 %, <em>p</em> = 0.006). The T2DM group demonstrated significantly lower absolute magnitude of both R-waves [3.000 (2.118, 3.775) mV vs. 3.625 (2.615, 4.400) mV, <em>p</em> = 0.045] and GNTWs (Tmax) [− 0.600 (−0.700, 0.400) mV vs. −0.750 (−1.100, 0.500) mV, <em>p</em> = 0.016]. Multivariable analysis identified T2DM as an independent predictor of attenuated GNTWs (<em>β</em> = 0.272, <em>p</em> = 0.016). GAM confirmed a significant nonlinear inverse correlation between T2DM and T-wave amplitude (<em>p</em> &lt; 0.05). In conclusion, T2DM is independently associated with lower absolute magnitude of GNTWs in ApHCM, potentially obscuring characteristic electrocardiographic features. It is incumbent upon clinicians to take these diabetes-related confounding effects into account during diagnostic evaluation.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100686"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684871","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":"Triglyceride–glucose index predicts early, short-term, and long-term mortality after transcatheter aortic valve replacement","authors":"Haitham Abu Khadija ,&nbsp;Duha Najajra ,&nbsp;Mohammad Masu'd ,&nbsp;Nizar Abu Hamdeh ,&nbsp;Omar Ayyad ,&nbsp;Ameer Mahamid ,&nbsp;Max Bagan ,&nbsp;Ali Abdullah ,&nbsp;Jebrin Alkrinawi ,&nbsp;Alaa Zayed ,&nbsp;Abdalaziz Darwish ,&nbsp;Aesha L.E. Enairat ,&nbsp;Alena Kirzhner ,&nbsp;Tal Schiller ,&nbsp;Mohammad Alnees","doi":"10.1016/j.ahjo.2025.100684","DOIUrl":"10.1016/j.ahjo.2025.100684","url":null,"abstract":"<div><h3>Background</h3><div>Despite transforming care for severe aortic stenosis, TAVR is still followed by early and late mortality. The triglyceride–glucose (TyG) index, an insulin-resistance marker from routine triglyceride and glucose levels, may flag high-risk patients in Ashkenazi-Jewish and Mediterranean individuals. We examined whether baseline TyG predicts all-cause mortality at 30 days, 1 year, and 3 years post-TAVR.</div></div><div><h3>Methods</h3><div>We retrospectively studied patients with severe symptomatic aortic stenosis who underwent TAVR at a single tertiary center between 2010 and 2024. The TyG index was calculated from baseline triglyceride and glucose values. The primary endpoint was all-cause mortality at 1 year, with secondary endpoints of all-cause mortality at 30 days and 3 years. Cox proportional hazards models evaluated the association between TyG (per 1-unit increase) and mortality, adjusting for major clinical risk factors. Additionally, ROC curves were used to derive cohort-specific TyG thresholds for short-term and long-term mortality.</div></div><div><h3>Results</h3><div>Results: A total of 821 TAVR patients were included. All-cause mortality was 3.4 % at 30 days, 10.9 % at 1 year, and 19.7 % at 3 years. Higher baseline TyG was associated with significantly increased mortality risk at all time points. After multivariable adjustment, each 1-unit increase in TyG index conferred a higher hazard of 1-year death (adjusted HR 1.62, 95 % CI 1.21–2.16) and remained predictive of mortality at 30 days (HR 1.92, 95 % CI 1.08–3.42) and 3 years (HR 1.42, 95 % CI 1.14–1.77). ROC analysis identified distinct TyG thresholds for short-term and long-term outcomes, with an optimal cut-point of 9.012 for 30-day mortality, 9.15 for 1-year mortality, and 8.700 for 3-year mortality.</div></div><div><h3>Conclusions</h3><div>Baseline TyG index is an independent predictor of early, short-term, and long-term mortality after TAVR. The identification of cohort-specific TyG cut-points highlights population-specific metabolic risk calibration and supports the use of TyG as a simple and informative biomarker for refining risk stratification and follow-up intensity in TAVR recipients.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100684"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684874","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":"Increasing burden of lower extremity peripheral arterial disease in Sub-Saharan Africa, 1990–2021 - results from the global burden of disease study 2021","authors":"Ngare Nadjingar ,&nbsp;Vidmi Taolam Martin ,&nbsp;Peidong Zhang","doi":"10.1016/j.ahjo.2025.100679","DOIUrl":"10.1016/j.ahjo.2025.100679","url":null,"abstract":"<div><h3>Objective</h3><div>Lower extremity peripheral artery disease (PAD) is a growing public health challenge in sub-Saharan Africa (SSA), yet epidemiological data remain scarce compared to high-income regions. This study addresses this gap by analyzing trends in PAD burden across SSA from 1990 to 2021, leveraging the Global Burden of Disease (GBD) dataset to inform targeted interventions.</div></div><div><h3>Methods</h3><div>Using GBD 2021 data, we assessed PAD incidence, prevalence, disability-adjusted life years (DALYs), mortality, and associated risk factors across 46 SSA countries. Age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) were calculated, stratified by sex, age, and Socio-Demographic Index (SDI).</div></div><div><h3>Results</h3><div>From 1990 to 2021, SSA experienced sharp increases in PAD burden: incidence (≥132.7 %), prevalence (≥132.8 %), DALYs (≥202.9 %), and mortality (≥231.5 %), contrasting with global declines. These trends oppose global declines reported in recent studies, underscoring SSA's unique vulnerability to a diabetes-driven PAD burden. Age-standardized rates rose significantly (EAPCs: 0.12–2.24), with the highest DALY rates in Gabon (57.2/100,000) and Southern SSA. Diabetes accounted for 30.8 % of PAD-related DALYs (male-to-female ratio: 1.8:1), while aging (≥80 years) contributed to 33.9 % of deaths.</div></div><div><h3>Conclusions</h3><div>The divergent rise of PAD in SSA, which contrasts with global trends, demands region-specific solutions: (1) integrating PAD screening into diabetes programs, (2) aging-focused care, and (3) improved local data to address disparities in Gabon (highest DALYs) and conflict zones.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100679"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618662","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":"Symptom experience of women with ischemia and no obstructive coronary artery disease: A mixed-methods approach","authors":"Sneha Thandra ,&nbsp;Esha Dave ,&nbsp;Ana Leon ,&nbsp;Jingwen Huang ,&nbsp;Arielle Schwartz ,&nbsp;Scott Gaignard ,&nbsp;Melinda Higgins ,&nbsp;Laura P. Kimble ,&nbsp;Puja K. Mehta","doi":"10.1016/j.ahjo.2025.100696","DOIUrl":"10.1016/j.ahjo.2025.100696","url":null,"abstract":"<div><h3>Background</h3><div>Women with myocardial ischemia with no obstructive arteries (INOCA) often have coronary microvascular dysfunction (CMD) or coronary vasospasm. INOCA is associated with adverse cardiovascular event risk, recurrent angina hospitalizations, and reduced health-related quality of life (QoL).</div></div><div><h3>Objectives</h3><div>In this mixed-methods study we used qualitative data to understand angina burden, while considering overall symptom experience of patients living with INOCA.</div></div><div><h3>Methods</h3><div>Twenty-four women with INOCA confirmed by coronary angiography were enrolled. A majority (<em>n</em> = 20) had coronary function testing to diagnose CMD or vasospasm. In addition to demographics and risk factors, angina and QoL were evaluated using the Seattle Angina Questionnaire (SAQ) (scored 0–100, higher score being better), along with Duke Activity Score Index and PHQ-8. Qualitative telephone interviews were conducted, recorded, transcribed, and analyzed for themes to explore patients' experiences. Descriptive statistics were performed for quantitative data.</div></div><div><h3>Results</h3><div>Mean age was 53.2 ± 10.8 years and body mass index was 30.8 ± 6.9 kg/m². Cardiac risk factors were prevalent with 63 % having hypertension, 75 % hyperlipidemia, and 25 % diabetes. SAQ scores indicated high angina frequency (50.5 ± 21.2), low angina stability (35.2 ± 31.5), physical limitations (37.7 ± 24.3), and poor QoL (41.3 ± 23.2). Qualitative analysis identified four major themes: <em>Invisible inscrutable threat</em>, <em>Longing for a normal/safe life</em>, <em>Rejecting labels</em>, and “<em>It has a toll</em>”. All patients expressed both diagnosis related emotional burden and explicit frustration.</div></div><div><h3>Conclusions</h3><div>This study highlights the substantial emotional and physical challenges women living with INOCA experience, emphasizing critical care gaps. Research efforts should prioritize understanding pathophysiologic mechanisms and improving symptom management to better support patient QoL.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100696"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790152","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":"Sex-based differences in outcomes of mitral valve surgery: A meta-analysis of propensity score-matched studies with reconstructed time-to-event data","authors":"Leo Consoli ,&nbsp;Mir W. Majeed ,&nbsp;Eren Cetinel ,&nbsp;Pawel Lajczak ,&nbsp;Ilias G. Koziakas ,&nbsp;Hristo Kirov ,&nbsp;Torsten Doenst ,&nbsp;Tulio Caldonazo","doi":"10.1016/j.ahjo.2025.100682","DOIUrl":"10.1016/j.ahjo.2025.100682","url":null,"abstract":"<div><h3>Background</h3><div>Studies indicate worse outcomes for women undergoing mitral valve surgery, but this can be biased in the context of differences in risk profiles between sexes. We aimed to assess short- and long-term outcomes of mitral valve surgery in men and women using confounder-adjusted data.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and the Cochrane Library for eligible propensity-score-matched studies. Analysis was performed for short-term (&lt;30 days mortality and procedural complications) and long-term (&gt;1 year mortality, reoperation, and mitral regurgitation) endpoints. A pairwise random-effects meta-analysis was done for short-term outcomes, pooling risk ratios (RR) with 95 % confidence intervals (CIs). A meta-analysis of Kaplan-Meier derived individual patient data was conducted for long-term endpoints. Cox frailty regression analysis was used to obtain hazard ratios (HR).</div></div><div><h3>Results</h3><div>We included 12 studies (n = 55,616). No significant differences were observed in the short-term risks of death (RR 1.02; 95 % CI: 0.91–1.15; p = 0.72), stroke (RR 1.04; 95 % CI: 0.87–1.26; p = 0.65), kidney injury (RR 0.97; 95 % CI: 0.71–1.32; p = 0.85), atrial fibrillation (RR 0.96; 95 % CI: 0.81–1.14; p = 0.61), or pacemaker implantation (RR 0.93; 95 % CI: 0.84–1.02; p = 0.1). The hazards of long-term mortality (HR 0.97; 95 % CI: 0.91–1.03; p = 0.3) and reoperation (HR 1.65; 95 % CI: 0.39–6.91; p = 0.5) were similar between sexes. However, women had a higher hazard of recurrent mitral regurgitation (HR 1.61; 95 % CI: 1.08–2.37; p = 0.018).</div></div><div><h3>Conclusions</h3><div>This meta-analysis found no sex-based differences in short- or long-term mortality, reoperation rates, or procedural complications following mitral valve surgery. A higher hazard of recurrent mitral regurgitation was observed in women.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100682"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618661","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":"Improving the management of acute myocardial infarctions: There's an App for that","authors":"Katelyn J. Cullen ,&nbsp;Mathew Mercuri ,&nbsp;Hassan Mir ,&nbsp;Karen Mosleh ,&nbsp;Rafi Setrak ,&nbsp;Sanjit S. Jolly ,&nbsp;Michael Tsang ,&nbsp;Renu Syal ,&nbsp;James Nkurunziza ,&nbsp;Michelle Welsford ,&nbsp;JD Schwalm ,&nbsp;Madhu K. Natarajan","doi":"10.1016/j.ahjo.2025.100700","DOIUrl":"10.1016/j.ahjo.2025.100700","url":null,"abstract":"<div><h3>Background</h3><div>ST-Elevation Myocardial Infarction (STEMI) is a critical emergency. Managing care requires accurate diagnosis, shared communication between decision-makers, and timely transport and reperfusion at a hospital with capacity for such interventions. This study examines the implementation of a smartphone application (SMART AMI-ACS App) to facilitate real-time ECG sharing, enhancing communication and decision-making in STEMI management.</div></div><div><h3>Methods</h3><div>This multi-centre study evaluated the implementation, acceptability and uptake of the App among interventional cardiologists and emergency medicine (EM) physicians managing suspected STEMI patients between April 1st 2022 and March 31st 2023. Guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, STEMI registry data and post-implementation surveys from a large regional cardiac centre and its 13 partner emergency departments in Ontario, Canada, were used to assess App uptake and effectiveness.</div></div><div><h3>Results</h3><div>During the 12-month evaluation 254 (84 %) of the eligible 300 regional EM physicians downloaded the App, with &gt; 1400 ECG images sent from 724 patients. Users reported the App helped in communication and timing of care. No degradation of ECG images was observed. App use was associated with lower door-in-door-out (DIDO) times 48 min (IQR 31–67) vs 55 min (IQR 39–77) and lower proportion of non-STEMI cases accepted to interventional cardiology (22 % vs 39 %, <em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>Uptake of the SMART AMI-ACS App was positive and may be associated with lower non-STEMI cases and lower DIDO times. The App provided a secure channel for communication of information and point-of-care transfer of images across healthcare providers. Uptake of the App has expanded to other regions.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100700"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924661","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":"Nationwide trends and disparities in deaths from second- or third-degree atrioventricular block (1999–2022): A 24-year retrospective analysis of CDC WONDER data","authors":"Humza Saeed ,&nbsp;Samia Aziz Sulaiman ,&nbsp;Abdullah ,&nbsp;Priya Goyal ,&nbsp;Kamya Thakkar ,&nbsp;Wania Sultan ,&nbsp;Jawad Zafar Mayo ,&nbsp;Muhammad Khubaib Arshad ,&nbsp;Ajeet Singh ,&nbsp;Mohamed Daoud ,&nbsp;Hritvik Jain","doi":"10.1016/j.ahjo.2025.100680","DOIUrl":"10.1016/j.ahjo.2025.100680","url":null,"abstract":"<div><h3>Background</h3><div>AV block prevalence increases with age: first-degree affects 6 % of adults over 60 with low mortality, second-degree is more serious, and third-degree, though rare (0.02 % in the U.S.), has a 37 % five-year survival rate if untreated. Analyzing mortality trends in second- or third-degree AV blocks in the U.S. is vital for treatment and identifying at-risk populations.</div></div><div><h3>Methodology</h3><div>We analyzed death certificates from the CDC WONDER database (1999–2022) for second- and third-degree AV Block (ICD-10 codes I44.1 and I44.2) in individuals aged 25 and older. Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, sex, age, race/ethnicity and geographics.</div></div><div><h3>Results</h3><div>Between 1999 and 2022, 54,420 deaths were reported in patients with second- or third-degree AV block. The AAMR increased from 12.8 to 14.9, with a significant rise from 2013 to 2022 (APC: 7.26; 95 % CI: 6.13 to 9.96; <em>p</em> &lt; 0.001). Older adults had higher AAMRs (45.0) compared to middle-aged (2.1) and young adults (0.3). Men had higher AAMRs than women (11.3 vs. 8.6). Ethnoracial disparities showed the highest AAMRs in NH American Indian individuals (13.3), followed by NH Black (10.5), NH White (9.8), Hispanic (7.3), and NH Asian individuals (5.9). Non-metropolitan areas had higher AAMRs than metropolitan areas (11.7 vs. 9.2).</div></div><div><h3>Conclusions</h3><div>Mortality from second- and third-degree AV block has increased since 1999, particularly in the last decade, with higher rates in men, older adults, NH American Indian or Alaska Native individuals, and non-metropolitan areas, highlighting the need for further research to address these disparities.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100680"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555244","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":"Coronary artery disease and cancer: Shared risk factors, pathogenesis, and treatment effects","authors":"Nicole Charbel ,&nbsp;Karl Aramouni ,&nbsp;Sam Sater ,&nbsp;Firas Kreidieh","doi":"10.1016/j.ahjo.2025.100702","DOIUrl":"10.1016/j.ahjo.2025.100702","url":null,"abstract":"<div><div>As cancer survival improves, cardiovascular health has become an increasingly important concern, particularly given the elevated risk of coronary artery disease (CAD) in patients with cancer. This review examines the complex relationship between cancer and CAD, focusing on shared epidemiological trends, overlapping risk factors, converging pathophysiological mechanisms, and cancer treatment–related cardiovascular toxicities. Cancer and CAD share modifiable risk factors, including obesity, diabetes, hypertension, hyperlipidemia, smoking, alcohol use, physical inactivity, and poor diet, that may act synergistically to promote both conditions. In addition, biological processes such as chronic inflammation, oxidative stress, platelet activation, and clonal hematopoiesis of indeterminate potential further contribute to disease progression. Several cancer therapies, including antimetabolites, platinum-based agents, immune checkpoint inhibitors, tyrosine kinase inhibitors, and radiotherapy, have been implicated in vascular injury, plaque destabilization, and accelerated atherosclerosis, increasing the risk of CAD. Understanding these shared mechanisms is essential for reducing cardiovascular complications in patients with cancer. This review outlines the epidemiology, risk factors, and biological mechanisms linking CAD and cancer, and evaluates the cardiotoxic effects of commonly used cancer therapies.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100702"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924662","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}