American heart journal最新文献

{"title":"Early oral anticoagulation monotherapy after PCI: Insights from the POEM trial","authors":"Carlo A. Pivato MD, PhD ,&nbsp;Gianluca Mincione MD ,&nbsp;Leon Gramss MD ,&nbsp;Andrea Pacchioni MD ,&nbsp;Raffaele Piccolo MD, PhD ,&nbsp;Carmine Musto MD, PhD ,&nbsp;Gennaro Sardella MD ,&nbsp;Ciro Indolfi MD ,&nbsp;Giulia Antonelli MD ,&nbsp;Damiano Regazzoli MD ,&nbsp;Valeria Paradies MD, PhD ,&nbsp;Bernhard Reimers MD ,&nbsp;Gianluigi Condorelli MD, PhD ,&nbsp;Luca Testa MD, PhD ,&nbsp;Carlo Briguori MD, PhD ,&nbsp;Giulio Stefanini MD, MSc, PhD","doi":"10.1016/j.ahj.2025.107309","DOIUrl":"10.1016/j.ahj.2025.107309","url":null,"abstract":"<div><h3>Background</h3><div>In high-bleeding-risk (HBR) patients undergoing percutaneous coronary intervention (PCI), shortening dual antiplatelet therapy (DAPT) is essential, but the optimal approach in those requiring oral anticoagulation (OAC) is uncertain. We evaluated a 1-month dual antithrombotic regimen in HBR patients with and without OAC indication in a prespecified sub-analysis of the POEM trial.</div></div><div><h3>Method</h3><div>POEM enrolled HBR patients treated with a bioresorbable polymer everolimus-eluting stent. Patients were stratified by OAC indication: the non-OAC group (<em>n</em> = 281) received 1-month DAPT followed by single antiplatelet therapy; the OAC group (<em>n</em> = 158) received 1-month OAC plus a P2Y12 inhibitor followed by OAC monotherapy. Time-to-event outcomes were analyzed using the log-rank test, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox regression models. The primary analysis was conducted according to the intention-to-treat principle. A per-protocol analysis, excluding patients with DAPT duration &gt;1 month, was performed as a sensitivity analysis.</div></div><div><h3>Results</h3><div>At 1 year, the primary endpoint, a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis, occurred in 6.1% of the non-OAC group versus 2.6% of the OAC group (HR 0.41, 95% CI 0.14–1.22; <em>P</em> = .097). Secondary ischemic outcomes were similar. BARC type 3–5 bleeding was infrequent (2.6% vs 1.3%; <em>P</em> = .369). The per-protocol analysis showed consistent results.</div></div><div><h3>Conclusions</h3><div>In HBR patients after PCI, transition to OAC monotherapy at 1 month was associated with low ischemic and bleeding risks, comparable to single antiplatelet therapy. These findings support early OAC monotherapy as a feasible strategy warranting randomized investigation.</div></div><div><h3>Trial Registration</h3><div>EudraCT Number: 2016‐004510‐99; <span><span>clinicaltrials.gov</span><svg><path></path></svg></span>: NCT03112707.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107309"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145572642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective, multicenter, randomized controlled study on the efficacy and safety of intravascular ultrasound-guided drug-coated balloon for de novo small-vessel coronary lesions: Design and rationale of the DCB-IVUS trial","authors":"Jing Li MD ,&nbsp;Zhen-Yu Wang MD ,&nbsp;Ju Yan MD ,&nbsp;Wen-Hao Li MD ,&nbsp;Feng-Chao Wu MD ,&nbsp;Ji-Zhao Deng MD ,&nbsp;Li Yan MD ,&nbsp;Hao-Yu Wu MD ,&nbsp;Lei Liang MD","doi":"10.1016/j.ahj.2025.107307","DOIUrl":"10.1016/j.ahj.2025.107307","url":null,"abstract":"<div><h3>Background</h3><div>The effectiveness and safety of drug-coated balloon (DCB) have been extensively studied in the treatment of de novo small-vessel coronary lesions. Proper lesion preparation is essential prior to performing DCB angioplasty; however, the optimal approach for intravascular ultrasound (IVUS)-guided lesion preparation remains unclear. The safety and efficacy of IVUS-guided DCB treatment for de novo small-vessel coronary lesions continue to be uncertain. To address these gaps, this trial has been designed to evaluate the efficacy and safety of IVUS-guided DCB angioplasty for de novo small-vessel coronary lesions. Additionally, the trial seeks to establish optimal critical values for IVUS-derived lumen parameters (such as minimum lumen area, plaque burden, and the length and thickness of dissection) prior to the use of DCB for de novo small-vessel coronary lesions.</div></div><div><h3>Methods and Design</h3><div>This trial is designed to test the hypothesis that IVUS-guided DCB results in a lower rate of major adverse cardiac events (MACE) for de novo small-vessel coronary lesions. It is a prospective, multicenter, randomized controlled study involving 998 patients indicated for PCI with de novo coronary lesions suitable for DCB treatment. Participants will be randomly allocated in a 1:1 ratio to either the research group (IVUS-guided group) or the control group (angiography-guided group). The primary endpoint is defined as the incidence of MACE (comprising cardiac death, target vessel-related myocardial infarction, or ischemia-driven target lesion revascularization) at the 12-month follow-up. Secondary endpoints include clinical outcomes such as all-cause mortality, any myocardial infarction, or ischemia-driven target vessel revascularization at the 12-month follow-up. Additionally, periprocedural outcomes, including the angiographic success rate, clinical procedural success rate, and target vessel drug-eluting stent implantation rate, will also be assessed.</div></div><div><h3>Conclusions</h3><div>This clinical trial aims to provide evidence on whether IVUS-guided DCB reduces the incidence of MACE in de novo small-vessel coronary lesions.</div></div><div><h3>Trial Registration</h3><div>ChiCTR2300073877, URL: <span><span>https://www.chictr.org.cn/indexEN.html</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107307"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate changes in left ventricular cardiac mechanics following transcatheter aortic valve replacement for severe aortic stenosis – an in-vivo pressure-volume analysis study","authors":"Antoon J.M. van den Enden MD ,&nbsp;Mark M.P. van den Dorpel MD ,&nbsp;Giulio M. Mondellini MD ,&nbsp;Antonio M. Mattace-Raso BSc ,&nbsp;Rik Adrichem MD ,&nbsp;Marcello B. Bastos MD ,&nbsp;Jan J. Schreuder MD, PhD ,&nbsp;Mattie J. Lenzen PhD ,&nbsp;Isabella Kardys MD, PhD ,&nbsp;Marcel L. Geleijnse MD, PhD ,&nbsp;Rutger J. Nuis MD, PhD ,&nbsp;Joost Daemen MD, PhD ,&nbsp;Daniel Burkhoff MD, PhD ,&nbsp;Nicolas M. Van Mieghem MD, PhD","doi":"10.1016/j.ahj.2025.107302","DOIUrl":"10.1016/j.ahj.2025.107302","url":null,"abstract":"<div><h3>Background</h3><div>Severe aortic stenosis (AS) induces a disproportional pressure gradient across the aortic valve causing increased left ventricular (LV) afterload. Transcatheter Aortic Valve Replacement (TAVR) aims to immediately alleviate the aortic pressure gradient and thereby changing LV cardiac mechanics. The aim was to describe by in-vivo assessment of LV pressure-volume (PV) relationships how TAVR acutely affects LV cardiac mechanics.</div></div><div><h3>Methods</h3><div>In this prospective observational study in patients with severe AS, LV cardiac mechanics were evaluated with an LV conductance catheter before and after TAVR. The effects of transcatheter valve design, pre and postdilatation, use of rapid pacing (≥180 bpm) and LV ejection fraction (EF) were specifically addressed.</div></div><div><h3>Results</h3><div>In-vivo LV PV reconstructions were obtained in 61 patients. Stroke work (SW) and pressure volume area (PVA) were significantly lower following TAVR (decrease from median [25th-75th percentile] of 10,935.6 [6877.5-13490.8] to 6,878.0 [4,870.8-8,613.8] mmHg/mL, <em>P</em> &lt; .001 and from 17,831.5 [12,414.9-22,416.8] to 11,024.9 [8364.7-14705.0] mmHg/mL, <em>P</em> &lt; .001, respectively) with stable SW/PVA ratios. Overall, end-systolic and end-diastolic pressures and volumes were significantly lower after TAVR. Arterial Elastance, as an index for LV afterload also decreased (2.66 [2.01-3.87]-1.96 [1.25-2.72] mmHg/mL, <em>P</em> &lt; .001). LV contractility declined as illustrated by a reduction in End-systolic Elastance (2.22 [1.50-3.10]-1.58 [1.08-2.43] mmHg/mL, <em>P</em> &lt; .001). The trends in changing LV cardiac mechanics were similar for balloon- and self-expanding valves and were not affected by pre/post dilatation, rapid pacing or LV EF.</div></div><div><h3>Conclusions</h3><div>TAVR for severe AS resulted in immediate LV unloading, lower myocardial metabolic demand and impaired contractility.</div></div><div><h3>Trial Registration</h3><div>This observational study was registered at URL: <span><span>https://www.clinicaltrials.gov</span><svg><path></path></svg></span> with unique identifier: NCT06204783.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107302"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Long-term safety and outcomes after atrial shunting for heart failure with preserved or mildly reduced ejection fraction: 5-year and 3-year follow-up in the REDUCE LAP-HF I and II trials” [American Heart Journal (278)2024 Page Number:106-116]","authors":"Sheldon E Litwin ,&nbsp;Jan Komtebedde ,&nbsp;Barry A Borlaug ,&nbsp;David M Kaye ,&nbsp;Gerd Hasenfuβ ,&nbsp;Rami Kahwash ,&nbsp;Elke Hoendermis ,&nbsp;Scott L Hummel ,&nbsp;Maja Cikes ,&nbsp;Finn Gustafsson ,&nbsp;Eugene S Chung ,&nbsp;Rajeev C Mohan ,&nbsp;Aaron L Sverdlov ,&nbsp;Vijendra Swarup ,&nbsp;Sebastian Winkler ,&nbsp;Christopher S Hayward ,&nbsp;Martin W Bergmann ,&nbsp;Heiko Bugger ,&nbsp;Scott McKenzie ,&nbsp;Ajith Nair ,&nbsp;Sanjiv J Shah","doi":"10.1016/j.ahj.2025.107312","DOIUrl":"10.1016/j.ahj.2025.107312","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107312"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of supersaturated oxygen therapy on infarct size and microvascular obstruction following myocardial infarction: A systematic review and meta-analysis","authors":"Shanmukh Sai Pavan Lingamsetty MD ,&nbsp;Ravi Venkata Sai Krishna Medarametla MD ,&nbsp;Kesar Prajapati MD ,&nbsp;Sahas Reddy Jitta MD ,&nbsp;Mohamed Doma MD ,&nbsp;Harshith Thyagaturu MD ,&nbsp;Mangesh Kritya MD ,&nbsp;Jaswanth Jasti MD ,&nbsp;Mohan Chandra Vinay Bharadwaj Gudiwada MD ,&nbsp;Chenna Reddy Tera MD ,&nbsp;Tirumala Nischal Jasty MD ,&nbsp;Pradeep Kumar Devarakonda MD ,&nbsp;Vikramaditya Reddy Samala Venkata MD ,&nbsp;Mir B Basir DO ,&nbsp;Michael S Megaly MD, MSc ,&nbsp;Amir Lotfi MD ,&nbsp;Andrew M Goldsweig MD, MS","doi":"10.1016/j.ahj.2025.107311","DOIUrl":"10.1016/j.ahj.2025.107311","url":null,"abstract":"<div><h3>Background</h3><div>Supersaturated oxygen (SSO₂) therapy is an emerging intervention to minimize myocardial damage and improve outcomes in patients with ST-segment elevation myocardial infarction (STEMI). This meta-analysis evaluated the efficacy of SSO₂ therapy to reduce infarct size and microvascular obstruction (MVO).</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Cochrane databases were systematically searched for studies comparing percutaneous coronary intervention (PCI) plus SSO₂ to PCI alone for STEMI. Outcomes of interest included infarct size, MVO, and subsequent major adverse cardiovascular events (MACE), all-cause mortality, re-infarction, and target vessel revascularization (TVR). Mean differences (MD) with 95% confidence intervals (CIs) were calculated using random-effects models.</div></div><div><h3>Results</h3><div>Six studies (<em>n</em> = 1660) were included with 548 patients (33%) receiving SSO₂ therapy. Pooled analysis showed that PCI plus SSO₂ significantly reduced infarct size (MD −4.31; 95% CI −6.70 to −1.92; <em>P</em> &lt; .01) and MVO (SMD −0.72; 95% CI −1.11 to −0.34; <em>P</em> &lt; .01) compared with PCI alone. MACE, all-cause mortality, re-infarction, and TVR were comparable between the groups.</div></div><div><h3>Conclusion</h3><div>SSO₂ therapy significantly reduced infarct size and MVO in patients undergoing PCI for STEMI.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107311"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond cumulative exposure: The roles of glycemic variability and metabolic memory in cardiac dysfunction","authors":"Mohammed Ahmed Taha Aly ElDabour (محمد أحمد طه علي الدبور) ,&nbsp;Israa Yasser Salah Ahmed (إسراء ياسر صلاح احمد)","doi":"10.1016/j.ahj.2025.107305","DOIUrl":"10.1016/j.ahj.2025.107305","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107305"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter to the editor, titled: Beyond cumulative exposure: The roles of glycemic variability and metabolic memory in cardiac dysfunction","authors":"Yilin Yoshida PhD, MPH, FAHA","doi":"10.1016/j.ahj.2025.107306","DOIUrl":"10.1016/j.ahj.2025.107306","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107306"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine versus selective protamine administration to reduce bleeding after TAVI: Rationale and design of the POPular ACE TAVI trial","authors":"Daniël C. Overduin MD ,&nbsp;Dirk Jan van Ginkel MD ,&nbsp;Christophe Dubois MD, PhD ,&nbsp;Pierluigi Lesizza MD ,&nbsp;Gijs M. Broeze MSc ,&nbsp;Jose M. Montero-Cabezas MD, PhD ,&nbsp;Liesbeth Rosseel MD, PhD ,&nbsp;Frank van der Kley MD, PhD ,&nbsp;Puck JA van Nuland MD ,&nbsp;Thijs PM Smits MD ,&nbsp;Kimberley I. Hemelrijk MD ,&nbsp;Hugo M. Aarts MD ,&nbsp;Benno J.W.M. Rensing MD, PhD ,&nbsp;Leo Timmers MD, PhD ,&nbsp;Martin J. Swaans MD, PhD ,&nbsp;Uday Sonker MD ,&nbsp;Leo Veenstra MD ,&nbsp;Arnoud W.J. van 't Hof MD, PhD ,&nbsp;Joyce Peper PhD ,&nbsp;Jan G.P. Tijssen PhD ,&nbsp;Jurriën M. ten Berg MD, PhD","doi":"10.1016/j.ahj.2025.107296","DOIUrl":"10.1016/j.ahj.2025.107296","url":null,"abstract":"<div><h3>Background</h3><div>Unfractionated heparin is routinely used during transcatheter aortic valve implantation (TAVI) to reduce catheter thrombosis and thromboembolism. Protamine reverses the effect of heparin and may lower bleeding risk, but it can also trigger severe allergic reactions. Robust data on the safety and efficacy of routine protamine administration after TAVI is lacking.</div></div><div><h3>Methods</h3><div>The ``routine versus selective protamine administration to reduce bleeding complications after transcatheter aortic valve implantation (POPular ACE TAVI)'' is an investigator-initiated, multicenter, double-blind, placebo-controlled, randomized clinical trial. A total of 1000 patients will be randomized 1:1 to routine versus selective protamine administration, stratified by study site and antithrombotic therapy. Primary and secondary outcomes are defined according to the Valve Academic Research Consortium-3 (VARC-3) criteria. The primary outcome is a composite of all-cause mortality and clinically relevant bleeding (type 1-4) within 30 days after TAVI. Ranked secondary outcomes include clinically relevant bleeding; major, life-threatening or fatal bleeding (type 2-4); major vascular complications; cardiovascular mortality; and all-cause mortality. Safety outcomes include anaphylaxis and thromboembolic events defined as the composite of myocardial infarction, ischemic stroke, transient ischemic attack, or noncerebral distal embolization. Recruitment began in November 2023 and will continue until 1,000 patients are randomized. The trial will end after 30‑day follow‑up of the last patient.</div></div><div><h3>Conclusion</h3><div>The POPular ACE TAVI trial (NCT05774691) will evaluate whether routine protamine administration reduces all-cause mortality or clinically relevant bleeding after TAVI compared with selective use.</div></div><div><h3>Trial registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span>. Unique identifier NCT05774691.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107296"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145429951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in guideline directed medical therapy for rural and non-rural Veterans with heart failure with reduced ejection fraction","authors":"Alexandra B. Steverson MD, MPH ,&nbsp;Jun Fan MS ,&nbsp;Natasha Din MBBS, MAS ,&nbsp;Neil Kalwani MD, MPP ,&nbsp;Anubodh S. Varshney MD ,&nbsp;Aradhana Verma MD ,&nbsp;Hayden B. Bosworth PhD ,&nbsp;Tomasz Jurga PharmD ,&nbsp;Paul L. Hess MD, MHS ,&nbsp;Paul Heidenreich MD, MS ,&nbsp;Alexander Sandhu MD, MS","doi":"10.1016/j.ahj.2025.107300","DOIUrl":"10.1016/j.ahj.2025.107300","url":null,"abstract":"<div><h3>Background</h3><div>There is a high burden of hospitalizations and deaths annually due to heart failure (HF) in the United States despite effective medical therapy and rural areas may be disproportionately affected. We sought to compare guideline-directed medical therapy (GDMT) utilization between rural and non-rural Veterans with HF with reduced ejection fraction (HFrEF).</div></div><div><h3>Methods</h3><div>We performed a cross sectional cohort study of Veterans with HFrEF (LVEF ≤ 40%) on January 1, 2022. The VA is an integrated health system with reduced financial barriers, which has a high proportion of rural patients. We compared the frequency of medication fills among rural and non-rural Veterans for renin-angiotensin system inhibitors (RASi), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA) and sodium glucose co-transporter 2 inhibitors (SGLT2i). We used a continuous version of the 4-pillar score (C4P) to assess medical therapy intensity. We used multivariable logistic regression to identify patient characteristics associated with a high C4P score.</div></div><div><h3>Results</h3><div>Of 65,025 Veterans with HFrEF, 23,728 (36.5%) resided in a rural location, defined as RUCA (Rural–Urban Commuting Areas) code of greater than 1.1. Compared with non-rural, rural Veterans were more frequently White (82.5% vs 63.9%, <em>P</em> &lt; .01) and had a higher burden of comorbidities. Rural Veterans had longer drive times to primary (32 vs 15 minutes, <em>P</em> &lt; .01) and specialty (74 vs 36 minutes, <em>P</em> &lt; .01) care and were less likely to receive VA Cardiology care (44.4% vs 55.8%, <em>P</em> &lt; .01) or care at a high-complexity (level 1a) VA facility (36.4% vs 50.4%, <em>P</em> &lt; .01). Rural Veterans were less frequently prescribed &gt;50% target dose of RASi (19.9% vs 20.2%, <em>P</em> &lt; .01) and BBs (30.9% vs 32.2%, <em>P</em> &lt; .03) and less frequently prescribed SGLT2i (16.3% vs 18.9%, <em>P</em> &lt; .01) and MRA (27.8% vs 28.6%, <em>P</em> &lt; .03) therapy. Rural Veterans were significantly less likely to have a C4P score in the highest decile (OR 0.94, CI: 0.90-0.99) compared with non-rural Veterans.</div></div><div><h3>Conclusion</h3><div>Rural Veterans with HFrEF were slightly less likely be prescribed comprehensive GDMT. This small difference may be related to gaps in access to VA cardiology and high-complexity facilities. Novel interventions and quality initiatives are needed to decrease disparities in HFrEF care for rural Veterans.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107300"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145429935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards an understanding of best practice: The good, the bad and the future of cardiogenic shock teams","authors":"Balimkiz Senman MD ,&nbsp;Shashank S. Sinha MD, MSc ,&nbsp;Alexander G. Truesdell MD ,&nbsp;Israel Safiriyu MD ,&nbsp;Stavros Drakos MD, PhD ,&nbsp;Allison G. Dupont MD ,&nbsp;Mir Babar Basir DO ,&nbsp;P. Elliott Miller MD, MHS ,&nbsp;Aniket S. Rali MD ,&nbsp;Courtney Bennett DO ,&nbsp;Behnam Tehrani MD ,&nbsp;Jennifer Cowger MD, MS ,&nbsp;Shelley A. Hall MD ,&nbsp;Carolyn Rosner RN, BSN, MSN, NP-C, MBA ,&nbsp;Amy E. Hackmann MD ,&nbsp;David E. Wang MD ,&nbsp;Alexander I. Papolos MD ,&nbsp;Bernard S. Kadosh MD ,&nbsp;Saraschandra Vallabhajosyula MD, MSc ,&nbsp;Michelle Ferri MS, ACNP-BC ,&nbsp;Jason N. Katz MD, MHS","doi":"10.1016/j.ahj.2025.107310","DOIUrl":"10.1016/j.ahj.2025.107310","url":null,"abstract":"<div><div>Cardiogenic shock (CS) remains a high-mortality condition that demands rapid diagnosis, coordinated multidisciplinary management, and timely initiation of mechanical circulatory support. As more institutions implement dedicated CS teams, substantial heterogeneity has emerged in how these teams are structured, activated, and sustained. To better characterize this variability and begin defining the components of an optimal CS team, the Society of Critical Care Cardiology (SoCCC), in partnership with the Society for Cardiovascular Angiography and Interventions (SCAI), convened the Inaugural Cardiogenic Shock Teams Think Tank. Held on October 17, 2024, as a preconference program to SCAI SHOCK 2024 in Washington, DC, the meeting brought together national leaders in CS care, mechanical circulatory support, and resuscitation to identify shared challenges and propose practical solutions.</div><div>This manuscript summarizes key insights from this inaugural Think Tank, which represents the first in an ongoing series of collaborative efforts aimed at informing the standardization and optimization of CS teams nationwide. Specifically, we review the ideal composition and core competencies of a CS team; the rationale and emerging evidence supporting dedicated team-based CS care; activation algorithms and operational workflows; and common barriers to establishing and sustaining such teams. We also outline future directions and opportunities to strengthen collaborative infrastructure, refine clinical pathways, and enhance the reliability, responsiveness, and effectiveness of cardiogenic shock teams across diverse healthcare settings.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107310"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}