JACC advances最新文献

{"title":"Developing a Multilevel Polypill Implementation Bundle for Patients With Heart Failure With Reduced Ejection Fraction.","authors":"Justin C Chen, Colette DeJong, Mansi Agarwal, Amaris M Hairston, Matthew S Durstenfeld, Byron Powell, Virginia McKay, Mark D Huffman, Priscilla Y Hsue, Anubha Agarwal","doi":"10.1016/j.jacadv.2025.102195","DOIUrl":"https://doi.org/10.1016/j.jacadv.2025.102195","url":null,"abstract":"<p><strong>Background: </strong>A polypill that contains multiple guideline-directed medical therapies for heart failure with reduced ejection fraction (HFrEF) has been proposed to improve HFrEF outcomes. The factors affecting implementation of a polypill-based strategy for HFrEF are unknown.</p><p><strong>Objectives: </strong>This study aims to identify determinants that could affect a polypill-based strategy for HFrEF, design a multilevel HFrEF polypill implementation bundle, and illustrate how the bundle could improve outcomes.</p><p><strong>Methods: </strong>From April to December 2023, we conducted a convergent parallel mixed methods study at Washington University in St. Louis and the University of California-San Francisco to gather patient (N = 9) and provider (N = 22) perspectives on a polypill-based approach to HFrEF care guided by the Consolidated Framework for Implementation Research v2.0. We then used the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change Matching Tool to select strategies for a multilevel implementation bundle and mechanism mapping to elucidate how the bundle could improve patient outcomes.</p><p><strong>Results: </strong>Stakeholder interviews revealed four themes that affect implementation of a polypill-based approach to HFrEF. The current state of HFrEF care was the organizing theme, influenced by 3 additional themes: awareness of new innovations, assessing innovation appropriateness, and building competency in HFrEF care. Based on these themes, we developed a multilevel HFrEF polypill implementation bundle with 7 domains and illustrate how the bundle could improve outcomes with a directed acyclic graph.</p><p><strong>Conclusions: </strong>This study illustrates the development of a multilevel HFrEF polypill implementation bundle that can be further tailored to improve HFrEF care in undertreated populations globally.</p>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":" ","pages":"102195"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253974","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":"Long-Term Survival Advantage of Total Arterial Revascularization in Elderly Patients Following Coronary Artery Bypass Grafting.","authors":"Justin Ren, Christopher M Reid, Julian A Smith, Colin Royse, Dion Stub, Wiliam Chan, David M Kaye, Jason E Bloom, Nilesh Srivastav, Andrea Bowyer, David H Tian, Lavinia Tran, Jenni Williams-Spence, Doa El-Ansary, Alistair Royse","doi":"10.1016/j.jacadv.2025.102226","DOIUrl":"https://doi.org/10.1016/j.jacadv.2025.102226","url":null,"abstract":"<p><strong>Background: </strong>Despite the evidence of clinical benefit, total arterial revascularization (TAR) remains underutilized in elderly patients undergoing coronary artery bypass grafting due to concerns about perceived surgical complexity and limited life expectancy.</p><p><strong>Objectives: </strong>The objective of the study was to evaluate long-term survival of TAR vs conventional non-TAR grafting strategies in elderly (≥70 years) and younger (<70 years) patients using a binational cardiac surgery registry.</p><p><strong>Methods: </strong>The study included patients who underwent primary isolated coronary artery bypass grafting with at least 2 grafts between 2001 and 2020. The endpoint was long-term all-cause mortality. Patients were stratified into 2 age groups, <70 years and ≥70 years. Within each cohort, survival outcomes were compared between those who received TAR, and those who received non-TAR involving at least 1 saphenous vein graft. Secondary analyses further divided the non-TAR group into patients receiving multiple arterial grafting or single arterial grafting. Baseline differences were adjusted using inverse probability treatment weighting, followed by Cox proportional hazard modeling.</p><p><strong>Results: </strong>Among 59,641 patients, TAR was associated with significantly improved survival compared to non-TAR in both elderly (HR: 0.87; 95% CI: 0.81-0.92; P < 0.001) and younger age groups (HR: 0.80; 95% CI: 0.73-0.88; P < 0.001). A clear hierarchy in survival was also demonstrated, with the highest survival observed in patients undergoing TAR, followed by non-TAR-multiple arterial grafting, and the lowest in those receiving non-TAR-single arterial grafting.</p><p><strong>Conclusions: </strong>TAR improves long-term survival in both elderly and younger patients. These findings challenge the assumption that limited life expectancy precludes arterial grafting and support broader implementation of TAR in appropriately selected older patients. Randomized clinical trials evaluating TAR are warranted to validate these observational findings.</p>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":" ","pages":"102226"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253970","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":"Predicting Temporal Trends and Hospital-Level Variation in Calcium Modification Strategies Adoption in Percutaneous Coronary Intervention.","authors":"Omar M Abdelfattah, Omar Chaabo, Joe Aoun, Umamahesh Rangasetty, Alpesh R Shah","doi":"10.1016/j.jacadv.2025.102159","DOIUrl":"https://doi.org/10.1016/j.jacadv.2025.102159","url":null,"abstract":"<p><strong>Background: </strong>The adoption patterns of novel cardiovascular interventional technologies significantly impact patient care and health care resource allocation. This study analyzes and projects the adoption trends of intravascular lithotripsy (IVL) compared to coronary atherectomy (CA).</p><p><strong>Objectives: </strong>The objective of the study was to investigate the predicted utilization trends of various calcium modification strategies by year 2035.</p><p><strong>Methods: </strong>Leveraging data from multiple U.S.-based registries (2009-2022), we developed Monte Carlo simulations (n = 100,000 simulated iterations) to model adoption trends and hospital-level variations. Logistic growth models were used to project technology adoption rates through 2035.</p><p><strong>Results: </strong>IVL showed rapid adoption with a projected terminal rate of 32.41% by year 2035 (95% CI: 28.76% to 36.06%) and mean annual growth of 2.5% (95% CI: 2.1% to 2.9%). CA (rotational and orbital) adoption is projected to reach 4.5 to 5.5% by 2035 (10% to 90% CI: 3.8% to 6.2%). Hospital-level analysis revealed increasing variability in adoption patterns, with high-volume centers (>10% CA use) increasing from 8.6% (2020) to 29.6% (2035).</p><p><strong>Conclusions: </strong>This analysis demonstrates divergent adoption patterns between IVL and CA, with IVL showing more rapid uptake. The findings highlight important implications for clinical practice, resource allocation, and health care policy.</p>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11 Pt 1","pages":"102159"},"PeriodicalIF":0.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253922","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":"Development and Validation of Novel Residual Risk Scores for Patients With ASCVD.","authors":"Olga Mineeva, Chunying Li, Franco Giulianini, Simeon Häfliger, Vadim Bubes, Gunnar Raetsch, Samia Mora, Olga V Demler","doi":"10.1016/j.jacadv.2025.102162","DOIUrl":"https://doi.org/10.1016/j.jacadv.2025.102162","url":null,"abstract":"<p><strong>Background: </strong>Despite clinical need, personalized risk scores for established atherosclerotic cardiovascular disease (ASCVD) are scarce.</p><p><strong>Objectives: </strong>The objective of the study was to develop and validate 10-year residual risk scores for cardiovascular death in patients with established ASCVD.</p><p><strong>Methods: </strong>Prospective observational cohort study. Models developed and validated in U.K. Biobank (UKB) (baseline 2006-2010; follow-up through 2021) and externally validated in Mass General Brigham cohort (MGB) (baseline 2007; follow-up through 2018). Analyzed on October 2022-February 2024. Eligible participants had established ASCVD. Guideline-based clinical factors plus additional biomarkers and self-reported health ratings.</p><p><strong>Primary outcome: </strong>10-year cardiovascular death. Elastic-net Cox and gradient-boosted tree models. C statistics and goodness-of-fit assessed in holdout set.</p><p><strong>Results: </strong>UKB: 32,994 participants (mean age 61; 11,727 [35.5%] women; 2,660 [8.0%] cardiovascular deaths), with 9,899 (30%) randomly selected as a holdout validation set. MGB: 54,969 patients (mean age 71; 22,738 [41.4%] women; 6,927 [12.6%] cardiovascular deaths). Median follow-up: 10 years (IQR 10-10) in UKB; 9.4 years (5-10) in MGB. We developed 2 residual risk scores, RRS16 and RRS24, incorporating 16 and 24 algorithmically selected factors. RRS16 used routinely available factors; RRS24 also included self-reported health and additional biomarkers. RRS16 achieved C statistics of 0.752 (95% CI: 0.736-0.768) in UKB and 0.750 (0.744-0.756) in MGB, outperforming the 2018 the American Heart Association (AHA) guideline model (0.658 [0.642-0.674] in UKB, 0.580 [0.574-0.586] in MGB). RRS24 achieved 0.784 (0.768-0.800) in UKB. Both models well calibrated (P > 0.1). RRS16 calculator: https://mora.bwh.harvard.edu/rrs16/.</p><p><strong>Conclusions: </strong>RRS16 and RRS24 outperformed AHA guideline model in estimating the residual risk in patients with established ASCVD. Both are clinically applicable but require further validation in diverse populations.</p>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11 Pt 1","pages":"102162"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253917","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":"Patient-Reported Outcomes in Older Adults With Transthyretin Amyloid Cardiomyopathy","authors":"Tessa Zeis MD ,&nbsp;Vincent Chen MD ,&nbsp;W.H.Wilson Tang MD ,&nbsp;Parag Goyal MD ,&nbsp;Mazen Hanna MD ,&nbsp;Abdulla Damluji MD, PhD, MBA ,&nbsp;Trejeeve Martyn MD, MSc","doi":"10.1016/j.jacadv.2025.102204","DOIUrl":"10.1016/j.jacadv.2025.102204","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102204"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222920","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":"Macrovascular Hemodynamics and Peripheral Perfusion in Cardiogenic Shock","authors":"Leah B. Kosyakovsky MD, MSc ,&nbsp;William B. Earle MD ,&nbsp;Colter Wichern MD ,&nbsp;Carla Boyle BS ,&nbsp;Conrad Macon MD ,&nbsp;Rebecca Mathew MD ,&nbsp;Benjamin Hibbert MD, PhD ,&nbsp;Joaquin E. Cigarroa MD ,&nbsp;Jeffrey A. Marbach MBBS, MS","doi":"10.1016/j.jacadv.2025.101964","DOIUrl":"10.1016/j.jacadv.2025.101964","url":null,"abstract":"<div><div>Despite significant advances in care over the past few decades, mortality among patients with cardiogenic shock (CS) remains up to 50%. Given the persistently high mortality, there is an urgent need for both better prognostic tools and treatment strategies. The pathophysiology of CS has major contributions from both macrovascular and microvascular dysfunction, but therapies are titrated toward the more readily measurable metrics (ie, mean arterial pressure, cardiac index, etc) under the assumption that both macrovascular and microvascular dynamics will respond to intervention in tandem. However, emerging evidence suggests that macrovascular and microvascular circulatory functions are not always aligned, particularly in those with critical illness. This review summarizes the significance of different macrovascular and microvascular metrics in CS, drawing from a robust field of evidence to demonstrate the promising role that microvascular tissue perfusion markers play in management of patients with CS and summarize the current understanding of this burgeoning field.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 101964"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700549","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":"In-Hospital Mortality Risk Among Transfers to Cardiac Intensive Care Units","authors":"Nicholas Phreaner MD ,&nbsp;Miguel Alvarez Villela MD ,&nbsp;Courtney E. Bennett DO ,&nbsp;Benjamin B. Kenigsberg MD ,&nbsp;Xuan Ding MD, PhD ,&nbsp;Rasheed O. Durowoju MD ,&nbsp;Anna Fenerty BS ,&nbsp;Boyangzi Li MD, PhD ,&nbsp;Miguel A. Martillo Correa MD ,&nbsp;Venu Menon MD ,&nbsp;Raunak M. Nair MD ,&nbsp;L. Kristin Newby MD, MHS ,&nbsp;Mary-Tiffany Oduah MD ,&nbsp;Alexander I. Papolos MD ,&nbsp;David A. Morrow MD, MPH ,&nbsp;Lori B. Daniels MD, MAS","doi":"10.1016/j.jacadv.2025.102046","DOIUrl":"10.1016/j.jacadv.2025.102046","url":null,"abstract":"<div><h3>Background</h3><div>Patients treated in tertiary cardiac intensive care units (CICUs) often arrive via transfer from other hospitals. This “transfer population” is poorly described and has been largely excluded from trials in critical care.</div></div><div><h3>Objectives</h3><div>The aim of this study was to characterize patients who are transferred from other hospitals to advanced CICUs.</div></div><div><h3>Methods</h3><div>The Critical Care Cardiology Trials Network is an investigator-initiated network of predominantly North American CICUs. Consecutive CICU admissions during annual 2-month snapshots were submitted to the coordinating center (TIMI Study Group) and stratified by transfer vs nontransfer status. Adjustment was made for age, sex, study site, and Sequential Organ Failure Assessment score.</div></div><div><h3>Results</h3><div>A total of 21,215 admissions (2017-2023) were included in the analysis. Transfers accounted for 38% of admissions and 42% of patient-CICU-days. The primary reason for admission was more likely to be acute coronary syndrome (36% vs 15% for nontransfers, <em>P</em> &lt; 0.001). Transfers were more likely to have shock (35% vs 32%, <em>P</em> = 0.031) and to receive mechanical ventilation (26% vs 17%, <em>P</em> &lt; 0.001), renal replacement therapy (8% vs 5%, <em>P</em> &lt; 0.001), and invasive monitoring (42% vs 34%, <em>P</em> &lt; 0.001). Transfers with shock more frequently received mechanical circulatory support (15% vs 8%, <em>P</em> &lt; 0.001). In-hospital mortality was higher among transfers, accounting for 44% of all deaths (15% vs 11%, <em>P</em> &lt; 0.001; adjusted OR: 1.15 [1.04-1.27]).</div></div><div><h3>Conclusions</h3><div>Transfers account for more than 1 of 3 admissions to tertiary CICUs, require more complex care, and have higher mortality compared to nontransfers. These findings have implications for designing regional systems of care, hand-off communication, risk-adjusted reporting, and plans of care for this high-risk cohort.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102046"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981204","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":"Full Issue PDF","authors":"","doi":"10.1016/S2772-963X(25)00650-7","DOIUrl":"10.1016/S2772-963X(25)00650-7","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102211"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145195781","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":"Medical Education and Critical Care Cardiology in the Modern Era","authors":"Rebecca Garber MD ,&nbsp;Satish Mishra MD ,&nbsp;Adam Mikolajczyk MD ,&nbsp;Amit Goyal MD, MAS ,&nbsp;Daniel Ambinder MD ,&nbsp;Catherine Vanchiere MD, MA","doi":"10.1016/j.jacadv.2025.101804","DOIUrl":"10.1016/j.jacadv.2025.101804","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 101804"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176095","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":"Moving From the Epidemiology to the Treatment of Respiratory Failure in Patients With Cardiogenic Shock","authors":"P. Elliott Miller MD, MHS ,&nbsp;Omar El Charif MD ,&nbsp;Mark Jacobs MD","doi":"10.1016/j.jacadv.2025.101970","DOIUrl":"10.1016/j.jacadv.2025.101970","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 101970"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700551","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}