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Background: Clinical guidelines have concluded that there are insufficient data to provide recommendations for the hemoglobin threshold for the use of red cell transfusion in patients with acute myocardial infarction (MI) and anemia. After the recent publication of the Myocardial Infarction and Transfusion (MINT) trial, we performed an individual patient-level data meta-analysis to evaluate the effect of restrictive versus liberal blood transfusion strategies., Methods: We conducted searches in major databases. Eligible trials randomly assigned patients with MI and anemia to either a restrictive (i.e., transfusion threshold of 7-8 g/dl) or liberal (i.e., transfusion threshold of 10 g/dl) red cell transfusion strategy. We used individual patient data from each trial. The primary outcome was a composite of 30-day mortality or MI., Results: We included 4311 patients from four trials. The primary outcome occurred in 334 patients (15.4%) in the restrictive strategy and 296 patients (13.8%) in the liberal strategy (relative risk [RR] 1.13, 95% confidence interval [CI], 0.97 to 1.30). Death at 30 days occurred in 9.3% of patients in the restrictive strategy and in 8.1% of patients in the liberal strategy (RR 1.15, 95% CI, 0.95 to 1.39). Cardiac death at 30 days occurred in 5.5% of patients in the restrictive strategy and in 3.7% of patients in the liberal strategy (RR 1.47, 95% CI, 1.11 to 1.94). Heart failure (RR 0.89, 95% CI, 0.70 to 1.13) was similar in the transfusion strategies. All-cause mortality at 6 months occurred in 20.5% of patients in the restrictive strategy compared with 19.1% of patients in the liberal strategy (hazard ratio 1.08, 95% CI, 1.05 to 1.11)., Conclusions: Pooling individual patient data from four trials did not find a definitive difference in our primary composite outcome of MI or death at 30 days. At 6 months, a restrictive transfusion strategy was associated with increased all-cause mortality. (Partially funded by a grant from the U.S. National Heart, Lung, and Blood Institute [R01HL171977].).

Background: Hepatic steatosis (HS) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥ 7.5% are associated with increased risk for cardiovascular events., Aim: To assess underlying coronary artery disease (CAD) and major adverse cardiovascular event (MACE) among those with and without HS at different ASCVD risk., Methods: We evaluated stable chest pain patients receiving coronary computed tomography (CT) in the PROMISE trial. HS and CAD endpoints were defined on coronary CT. MACE was defined as unstable angina, non-fatal myocardial infarction, and all-cause death. Multivariable Cox regression, adjusting for CAD characteristics, assessed the association of HS with MACE for ASCVD < 7.5%., Results: One thousand two hundred and four of 3702 (32.5%) patients were at ASCVD < 7.5% and 20.3% (244/1204) of them had HS. Individuals with HS were younger (54.3 ± 5.2 vs. 55.8 ± 5.2; p < 0.001), more often males (40.2% [98/244] vs. 27.1% [260/960]; p < 0.001), had more risk factors/person (2.06 ± 0.89 vs. 1.93 ± 0.91; p = 0.047). CAD characteristics were similar between HS vs. non-HS patients at ASCVD < 7.5% and ASCVD ≥ 7.5% (all p > 0.05). Patients with HS had greater MACE rate compared to non-HS patients (ASCVD < 7.5%: 3.75%[9/244] vs. 1.5% [14/960]; p = 0.027 and ASCVD ≥ 7.5%: 4.7% [33/696] vs. 3.1% [56/1802]; p = 0.043). In patients without HS, MACE rate was higher in the ASCVD ≥ 7.5% vs. < 7.5% (3.1% [56/1802] vs. 1.5% [14/960]; p = 0.011). In patients with HS, MACE rates were not significantly different between ASCVD ≥ 7.5% vs. < 7.5% (4.7% [33/696] vs. 3.7% [9/244]; p = 0.484). In ASCVD < 7.5%, HS predicted MACE (aHR:2.34, 95%CI:1.01-5.43; p = 0.048), independent of CAD characteristics., Conclusions: Individuals with HS at ASCVD < 7.5% risk had similar CAD characteristics as patients without HS at < 7.5% ASCVD risk, yet experienced comparable MACE rates as those at ASCVD ≥ 7.5%., (© 2024 John Wiley & Sons Ltd.)

Transcatheter tricuspid valve replacement (TTVR) has emerged as a promising intervention for the treatment of severe tricuspid regurgitation with complex valve morphology. This consensus document provides a comprehensive overview of the current state of orthotopic TTVR, focusing on patient selection, procedural details, and follow-up care. Clinical outcomes from initial studies and compassionate use cases are discussed, highlighting the effectiveness of TTVR in reducing tricuspid regurgitation, inducing reverse right ventricular remodeling, and enhancing patients' quality of life. This review paper also addresses potential complications and challenges associated with TTVR, such as new-onset conduction disturbances, bleeding complications, and afterload mismatch, and provides expert recommendations for the periprocedural management, anticoagulation strategies, and long-term follow-up. With the commercial approval of the first TTVR system in the United States and Europe, it intends to serve as a reference for clinicians and researchers involved in the evolving field of transcatheter tricuspid valve interventions., Competing Interests: Funding Support and Author Disclosures Dr Hausleiter has received research support and speaker honoraria from Edwards Lifesciences. Dr Stolz has received speaker honoraria from Edwards Lifesciences. Dr Lurz has received institutional fees and research grants from Abbott Cardiovascular, Edwards Lifesciences, and Medtronic. Dr Rudolph has received research support and speaker honoraria from Abbott Vascular, Boston Scientific, and Edwards Lifesciences. Dr Hahn has received speaker fees from Abbott Structural, Baylis Medical, Edwards Lifesciences, and Philips Healthcare; has institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Boston Scientific, Edwards Lifesciences, Medtronic, and Novartis; and is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. Dr Estevez-Loureiro is a consultant for and has received fees form Abbott Vascular, Edwards Lifesciences, Boston Scientific, Venus Medtech, and Jenscare. Dr Davidson has received institutional research grant support from Edwards Lifesciences and Abbott Vascular; and is an uncompensated advisor to Edwards Lifesciences. Dr Zahr has received grant support/research support from Edwards Lifesciences and Medtronic; and has received consultant fees/honoraria from Edwards Lifesciences and Medtronic. Dr Kodali has received institutional research grants from Edwards Lifesciences, Medtronic, and Abbott; has received consulting fees from Abbott, Admedus, and Meril Lifesciences; and has equity options from Biotrace Medical and Thubrikar Aortic Valve Inc. Dr Makkar has received research grants from Edwards Lifesciences, Abbott, Medtronic, and Boston Scientific; has served as national principal investigator for Portico (Abbott) and Acurate (Boston Scientific) US investigation device exemption trials; has received personal proctoring fees from Edwards Lifesciences; and has received travel support from Edwards Lifesciences, Abbott, and Boston Scientific. Dr Cheung is a member of the eligibility Committee of the TRINITY CE Trial; and is a consultant for Abbott, Medtronic, Boston Scientific, and Jenscare. Dr Lopes has received research support from Bristol Myers Squibb, GlaxoSmithKline, Medtronic, and Pfizer; and has received consulting fees from Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi-Sankyo, GlaxoSmithKline, Medtronic, Merck, Pfizer, and Portola. Dr Maisano has received grant or research institutional support from Abbott, Biotronik, Boston Scientific, Edwards Lifesciences, Medtronic, NVT, Terumo, and Venus; has received consulting fees and honoraria (both personal and institutional) from Abbott, Cardiovalve, Edwards Lifesciences, Medtronic, Mtex, Occlufit, Simulands, Squadra, Valgen, Venus, and Xeltis; has received royalty income from Edwards Lifesciences; and is shareholder (including share options) of 4Tech, Magenta, and Transseptal Solutions. Dr Fam is a consultant to Edwards, Abbott, Medtronic, and Venus Medtech. Dr Latib has served on the advisory board for Medtronic, Abbott Vascular, Boston Scientific, Edwards Lifesciences, Shifamed dyne, Philips, and NeoChord Inc. Dr Windecker has received research, travel, or educational grants to the institution without personal remuneration from Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Braun, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardinal Health, CardioValve, Cordis Medical, CorFlow Therapeutics, CSL Behring, Daiichi-Sankyo, Edwards Lifesciences, Farapulse, Fumedica, Guerbet, Idorsia, Inari Medical, Infraredx, Janssen-Cilag, Johnson and Johnson, MedAlliance, Medicure, Medtronic, Merck Sharp and Dohme, Miracor Medical, MonarQ, Novartis, Novo Nordisk, Organon, OrPha Suisse, Pharming Tech, Pfizer, Polares, Regeneron, Sanofi, Servier, Sinomed, Terumo, Vifor, and V-Wave; has served as an advisory board member and/or a member of the steering or executive groups of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Boston Scientific, Biotronik, Bristol Myers Squibb, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Recardio, Sinomed, Terumo, and V-Wave, with payments to the institution but no personal payments; and is a member of the steering or executive committee groups of several investigator-initiated trials that receive funding from industry without impact on his personal remuneration. Dr Praz has received a research grant to the institution from Abbott Vascular; and has been compensated for travel expenses by Abbott Vascular, Edwards Lifesciences, Medira, Siemens Healthineers, and InQB8 Medical Technologies. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Discrepancies often exist between patient-reported symptoms and diagnostic test findings in patients with suspected obstructive coronary artery disease (CAD)., Objectives: To quantify the association between patient-reported symptoms and the diagnosis of severe stenosis in patients with suspected obstructive CAD., Methods: Two large-scale cohorts of patients with new-onset symptoms suggestive of obstructive CAD were evaluated. Chest discomfort was assessed by typicality, location, type, exertional/stress factors, and relief with rest/nitroglycerine. Patients underwent non-invasive diagnostic testing (coronary computed tomographic angiography (CCTA) or functional testing), followed by test-result-driven invasive coronary angiography (ICA). Severe stenosis was defined as ≥70 ​% diameter stenosis on ICA. Sensitivity analyses included CCTA stenosis, functional abnormalities, and revascularization., Results: Of 14,410 patients, 2093 (14.5 ​%) were referred for ICA, and 765 (5.3 ​%) were diagnosed with severe stenosis. Patients with typical angina (n ​= ​224) had higher odds of being diagnosed with severe stenosis on ICA (OR and 95 ​% CIs: 2.84 [2.40-3.34]) than those with atypical or non-anginal symptoms. In patients diagnosed with severe stenosis on ICA, those with exertional/stress factors (n ​= ​418; OR [95 ​% CI]: 2.50 [2.16-2.90]) and relief with rest/nitroglycerine (n ​= ​318, 2.28; [1.96-2.65]) had higher odds compared to those without. Patients reporting pressure or burning pain had higher odds of severe stenosis. Associations were consistent across sex and age groups, and sensitivity references., Conclusions: Exertional/stress-related chest discomfort and relief with rest/nitroglycerine increased the odds of severe stenosis in patients with suspected CAD undergoing test-result-driven ICA, while location and type of chest pain were less associated, with no differences across sex or age groups., Competing Interests: Declaration of competing interest None related to this manuscript. The authors report the following general conflicts: LDR acknowledges support from Danish Cardiovascular Academy, (grant number PD5Y-2023001-DCA) which is funded by the Novo Nordisk Foundation (grant number NNF20SA0067242) and The Danish Heart Foundation. MB has been a member of advisory boards and has had research collaborations with Novo Nordisk, AstraZeneca, Bayer, Sanofi, Boehringer Ingelheim, Novartis, BMS-Pfizer, and Acarix. PSD has received research funding from HeartFlow. SW has received support from the Novo Nordisk Foundation Clinical Emerging Investigator grant (NNF21OC0066981). The remaining authors have declared no relevant relationships to the contents of this paper., (Copyright © 2025 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Background: Mortality in cardiogenic shock (CS) remains high. Significant inter-hospital heterogeneity in critical care therapies have been described, which reflects the lack of high-quality evidence to guide optimal treatment. We aimed to describe differences in practices and clinical outcomes among patients with CS in the United States (US) and Canada., Methods: The Critical Care Cardiology Trials Network (CCCTN) is a research network of tertiary cardiac intensive care units (CICUs). Data collection spanned from 2017-2022. The analysis included 34 American and 8 Canadian sites. The outcomes of interest included baseline clinical differences, use of critical care monitoring and therapies, and all-cause in-hospital mortality between US and Canadian patients with CS admitted to CICUs., Results: Among 23,299 admissions, 19% had CS (n=4336, 88% US vs 12% Canada). The proportion of patient who received invasive hemodynamics (US: 80.8% vs. Canada: 74.8%, p=0.0015), vasoactive medications (US: 88.9% vs. Canada: 82.1%, p<0.0001), temporary mechanical circulatory support (tMCS) (US: 39.4% vs. Canada: 23.1%, p<0.0001) were more frequent in US centers. Intra-aortic balloon pump was the most common tMCS device in both countries. After multivariable adjustment, in-hospital mortality was higher in Canada vs US (37.1% vs 29.4%, OR 1.47, 95% CI 1.18-1.83)., Conclusions: In a contemporary registry, management of CS was heterogenous between the US and Canada, with higher use of invasive monitoring and MCS in the US. While adjusted mortality was lower in the US, the effects of these treatments cannot be reliably determined without randomized trial data., (Copyright © 2025. Published by Elsevier Inc.)

Dimeric IgA (dIgA) is the dominant antibody in many mucosal tissues. It is actively transported onto mucosal surfaces as secretory IgA (sIgA) which plays an integral role in protection against enteric pathogens, particularly in young children. Therapeutic strategies that deliver engineered, potently neutralizing antibodies directly into the infant intestine through breast milk could provide enhanced antimicrobial protection for neonates. Here, we developed a murine model of maternal protective transfer against human rotavirus (RV) using systemic administration of a dimeric IgA monoclonal antibody (mAb). First, we showed that systemically administered dIgA passively transferred into breast milk and the stomach of suckling pups in a dose-dependent manner. Next, we optimized the recombinant production of a potently RV-neutralizing, VP4-specific dIgA (mAb41) antibody. We then demonstrated that systemic administration of dIgA and IgG mAb41 in lactating dams conferred protection from RV-induced diarrhea in suckling pups, with dIgA resulting in lower diarrhea incidence from IgG. Systemic delivery of engineered antimicrobial dIgA mAbs should be considered as an effective strategy for sIgA delivery to the infant gastrointestinal tract via breast milk to increase protection against enteric pathogens., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [J.E.C. has served as a consultant for Luna Biologics, is a member of the Scientific Advisory Board of Meissa Vaccines and is Founder of IDBiologics. The Crowe laboratory at Vanderbilt University Medical Center has received unrelated sponsored research agreements from Takeda Vaccines, IDBiologics and AstraZeneca. S.R.P. provides individual consulting services to Moderna, Merck, Dynavax, GSK, and Pfizer on CMV vaccines. Merck Vaccines and Moderna have provided grants and contracts for S.R.P. sponsored programs.]., (Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with an increased risk of cardiovascular disease (CVD) and premature mortality. The risk of CVD is closely associated with RA disease activity, and achieving RA remission using disease-modifying anti-rheumatic drugs (DMARDs) can significantly mitigate this risk. However, despite the availability of highly effective DMARDs, many veterans fail to achieve sustained RA remission., Areas Covered: We will discuss DMARD adherence in U.S. veterans with RA as it relates to RA disease activity and CVD risk, describe factors associated with DMARD non-adherence in individuals with RA, and discuss intervention strategies to improve DMARD adherence. For this review, the authors performed an extensive literature search using Embase, PubMed, Google Scholar, MEDLINE, Cochrane Library, Web of Science, and Duke University library resources., Expert Opinion: Barriers to DMARD adherence in veterans with RA are multifactorial and include patient-related factors, systemic barriers, and suboptimal adherence screening practices. Additional research is needed to create validated screening tools for DMARD adherence, train rheumatology providers on how to assess DMARD adherence, develop effective interventions to promote veteran self-efficacy in DMARD management, and to learn how to sustainably utilize multidisciplinary resources to support DMARD adherence in veterans with RA.

Background: Risk estimation is an essential component of cardiovascular disease prevention among people with HIV. We aimed to characterise how well atherosclerotic cardiovascular disease (ASCVD) risk scores used in clinical guidelines perform among people with HIV globally., Methods: In this prospective cohort study leveraging REPRIEVE data, we included participants aged 40-75 years, with low-to-moderate traditional cardiovascular risk, not taking statin therapy. REPRIEVE participants were enrolled from sites in 12 countries across Global Burden of Disease Study (GBD) regions. We assessed the performance of the pooled cohort equations (PCE) risk score for ASCVD and the data-collection on adverse effects of anti-HIV drugs (D:A:D) risk score. We calculated C statistics, observed-to-expected (OE) event ratios, and Greenwood-Nam-D'Agostino goodness-of-fit (GND) statistics, overall and in subgroups by race, sex, and GBD regions (clustering low-income and middle-income countries and high-income countries). We did a recalibration for PCE risk score among people with HIV in high-income countries. REPRIEVE was registered with ClinicalTrials.gov, NCT02344290., Findings: We included 3893 participants, recruited between March 26, 2015, and July 31, 2019. The median age was 50 years (IQR 45-55), with 2684 (69%) male and 1209 (31%) female participants. 1643 (42%) were Black or African American, 1346 (35%) participants were White, 566 (15%) were Asian, and 338 (9%) were recorded as other race. Overall, discrimination of the PCE risk score was moderate (C statistic 0·72 [95% CI 0·68-0·76]) and calibration was good (OE event ratio 1·11; GND p=0·87). However, calibration suggested overprediction of risk in low-income and middle-income countries and corresponding underprediction in high-income countries. When restricted to high-income countries, we found underprediction (OE event ratio >1·0) among women (2·39) and Black or African American participants (1·64). Findings were similar for the D:A:D risk score (C statistic 0·71 [0·65-0·77]; OE event ratio 0·89; p=0·68). Improved calibration of the PCE risk score in high-income countries was achieved by multiplying the original score by 2·8 in Black or African American women, 2·6 in women who were not Black or African American, and 1·25 in Black or African American men., Interpretation: Among the global cohort of people with HIV in REPRIEVE, the PCE risk score underpredicted cardiovascular events in women and Black or African American men in high-income countries and overpredicted cardiovascular events in low-income and middle-income countries. Underprediction in subgroups should be considered when using the PCE risk score to guide statin prescribing for cardiovascular prevention among people with HIV in high-income countries. Additional research is needed to develop risk scores accurate in predicting ASCVD among people with HIV in low-income and middle-income countries., Funding: US National Institutes of Health, Kowa Pharmaceuticals America, Gilead Sciences, and ViiV Healthcare., Competing Interests: Declaration of interests SKG reports grant support through his institution from the NIH, Kowa Pharmaceuticals America, Gilead Sciences, and ViiV Healthcare for the conduct of the study; personal fees from Theratechnologies and ViiV; and service on the Scientific Advisory Board of Marathon Asset Management, all outside the submitted work. MVZ reports grant support through her institution from the NIH/National Institute of Allergy and Infectious Diseases (NIAID) and Gilead Sciences, relevant to the conduct of the study, as well as grants from the NIH/NIAID and the NIH/National Heart, Lung, and Blood Institute (NHLBI); support for attending the Conference on Retroviruses and Opportunistic Infections and the International Workshop for HIV and Women from the conference organising committee when she served as an abstract reviewer and/or speaker; and participation in the DSMB for NIH-funded studies, outside the submitted work. VAT reports grants from the NIH/National Institute of Aging (NIA) and NIH/NHLBI, outside of the submitted work. AK reports grants from NIH/NIAID, NIH/NHLBI, NIH/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and NIH/NIA, outside of the submitted work. TU reports grants from NIH/NHLBI and Kowa Pharmaceuticals during the conduct of the study, as well as grants from NIH/NIAID and NIH/NIA, outside the submitted work. JSC reports consulting fees from Merck and Company and Resvirlogix, outside the submitted work. JLC reports honoraria for presentations for Gilead, MSD, and ViiV, and honoraria from Gilead Sciences for Advisory Board membership, all outside the submitted work. EG reports institutional research support for clinical trials from Gilead Sciences and ViiV Healthcare. JAA reports grants from Massachusetts General Hospital during the conduct of the study; institutional research support for clinical trials from Emergent Biosolutions, Gilead Sciences, Glaxo Smith Kline, Janssen, Merck, Pfizer, Regeneron, and ViiV Healthcare; personal fees for advisory boards from Glaxo Smith Kline/ViiV, Invivyd, Merck and Regeneron; and participation on the DSMB for Kintor Pharmaceuticals, all outside the submitted work. CDM reports institutional research support by Lilly and honoraria from ViiV Healthcare, Gilead Sciences, and Pfizer for Advisory Board membership, all outside the submitted work. CJF reports research grant support through his institution from Gilead Sciences, ViiV Healthcare, GSK, and Merck, all outside the submitted work. MTL reports grant support through his institution from the NIH/NHLBI and Kowa Pharmaceuticals America for the conduct of the study. He also reports research support to his institution from the American Heart Association, AstraZeneca, Ionis, Johnson & Johnson Innovation, MedImmune, the National Academy of Medicine, the NIH/NHLBI, and the Risk Management Foundation of the Harvard Medical Institutions Incorporated, outside of the submitted work. HJR reports grants from Kowa Pharmaceuticals during the conduct of the study, as well as grants from NIH/NIAID, NIH/NHLBI, NIH/NIDDK, and NIH/NIA, outside of the submitted work. All other authors declare no competing interests., (Copyright © 2025 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Physical inactivity is a major risk factor for noncommunicable diseases, particularly among older adults. We examined changes in cardiovascular risk factors among older adults in a community-based fitness program in Miami-Dade County, FL. Methods: We used repeated measures linear mixed models to examine participants' cardiovascular risk factor changes over 28 months. Outcomes (body mass index, blood pressure, pulse, arm/leg strength, and mobility) were modeled accounting for park, individual, time, and sociodemographic factors (2017-2019). Results: The study included 210 participants (mean age 71 years; 86% female; 52% Hispanic, 38% non-Hispanic Black). Participation was positively associated with reductions in cardiovascular risk, including improvements in systolic and diastolic blood pressure (-0.83 and -0.39 mmHg, respectively), mobility (-0.07 s) and arm strength (0.5 arm curls). Differences were observed in arm curls across sex and pulse across poverty areas. Conclusion: Participating in a park-based fitness program was associated with improved older adults' cardiovascular health., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Risk-benefit tradeoffs between restrictive versus liberal red blood cell transfusion strategies may vary across individuals. This exploratory analysis aimed to derive and evaluate individualized treatment effects of defined transfusion strategies in patients with acute MI and anemia with the goal of minimizing adverse cardiovascular outcomes., Methods: This study analyzed 3,447 (98.4%) patients randomized in the MINT (Myocardial Ischemia and Transfusion) trial between April 2017 to April 2023. Outcomes for this analysis included 30-day death or recurrent MI, death, and major adverse cardiovascular events (MACE, a composite of death, MI, stroke, and ischemia-driven unscheduled revascularization). Machine learning methods were used to identify baseline patient characteristics that informed the individualized treatment effect of a restrictive versus liberal transfusion strategy for each patient. The expected population risk of an outcome under a scenario in which patients received their optimal treatment, as indicated by the individualized treatment effect, was contrasted with expected risks for universally applying a restrictive strategy or a liberal strategy to all patients., Results: Baseline characteristics did not inform individualized treatment effects on 30-day death and death or MI, suggesting minimal heterogeneity in treatment effect on these outcomes. An algorithm for estimating the individualized treatment effect on 30-day MACE included 12 baseline factors. If all patients received the optimal treatment as indicated by their estimated individualized treatment effect, the predicted risk of 30-day MACE in the sample population was 15.2% (95% CI 14.2% to 16.2%). This corresponded to 4.0 (difference: -4.0%, 95% CI -5.8, -2.1) and 2.3 (difference: -2.3%, 95% CI -3.7, -0.9) percentage point risk reductions compared to applying a restrictive or liberal strategy to everyone respectively., Conclusions: The MINT trial average treatment effect, favoring a liberal strategy, may be optimal to minimize risk of 30-day death and death or MI for acute MI patients with anemia represented in the MINT sample as no individualized treatment effects were estimated on these outcomes. However, individualized transfusion strategy decisions have potential to reduce risk of 30-day MACE. External validation of the MACE algorithm is required before clinical use., Trial Registration: ClinicalTrials.gov, NCT02981407, https://clinicaltrials.gov/study/NCT02981407., (Copyright © 2025. Published by Elsevier Inc.)

Rationale: Ansa cervicalis stimulation (ACS) of the infrahyoid muscles has been proposed as a neurostimulation therapy for obstructive sleep apnoea (OSA). ACS stabilises the pharynx by pulling it caudally, but its specific effects on flow limitation caused by palatal, oropharyngeal lateral wall, tongue base, or epiglottis collapse remains unclear., Objectives: To quantify the effect of ACS on collapsibility of different pharyngeal flow-limiting structures., Methods: Participants with OSA underwent bilateral ACS during drug-induced sleep endoscopy. Maximum inspiratory airflow was assessed over a range of positive airway pressures while ACS was applied. The flow-limiting structure for each breath was classified based on manometric and endoscopic findings and a linear mixed-effects model characterised their response to ACS. The influence of patient characteristics was explored with univariate models., Measurements and Main Results: 41 participants yielded 1761 breaths for analysis. On average, bilateral ACS decreased the observed pharyngeal critical closing ( P CRIT ) and opening ( P OPEN ) pressures by -3.0 (95% CI -3.6--2.3) and -3.7 (-4.4--3.0) cmH 2 O, respectively (p<0.001). During tongue base obstruction, modelled ACS effects for P CRIT and P OPEN were -2.0 (-2.7--1.4) and -3.1 (-3.8--2.4) cmH 2 O, respectively (p<0.001). Greater reductions were generally observed for other flow-limiting structures. A lower apnoea-hypopnea index was associated with a greater decrease in P OPEN (p<0.01). Other patient characteristics, including body mass index, did not influence P CRIT or P OPEN (p>0.05)., Conclusions: Bilateral ACS decreased collapsibility of all airway flow-limiting structures. ACS generally had greater effects on palatal, oropharyngeal lateral wall and epiglottic collapse than the tongue base., Competing Interests: Conflict of interest: A.R. Schwartz is a scientific advisor for Apnimed, HuMannity Foundation, Invicta Medical, Itamar/Zoll, LivaNova, Lunair, Nyxoah SA, Periodic Breathing LLC, Respicardia/Zoll and Sonosa. C.J. Lindsell reports grants from NIH and Department of Defense and research funds from the CDC, biomeme, Novartis, bioMerieux, AstraZeneca, AbbVie, Entegrion Inc. and Endpoint Health, outside the submitted work, patents for risk stratification in sepsis and septic shock issued to Cincinnati Children's Hospital Medical Center, service on data safety monitoring board or advisory boards unrelated to the current work, stock options in Bioscape Digital unrelated to the current work, and is editor in chief of the Journal of Clinical and Translational Science. D.T. Kent has received research support from Invicta Medical, Inspire Medical System, and Nyxoah SA, is a consultant to Invicta Medical and Nyxoah SA, is a scientific advisory board member with Nyxoah SA, and is an inventor on patent pending PCT/US2020/021359 and related work licensed by Nyxoah SA that is relevant to this work. The remaining authors have no potential conflicts of interest to disclose., (Copyright ©The authors 2025.)

Background: Patients with abnormal (positive) exercise electrocardiography, but normal stress echocardiography (+ECG/-Echo), have an increased risk of adverse cardiovascular events compared with patients with a normal (negative) ECG and a normal stress Echo (-ECG/-Echo). However, it is unclear if +ECG/-Echo discordance is associated with a greater burden of subclinical coronary atherosclerosis., Methods: Project Baseline Health Study participants who underwent a stress Echo and coronary artery calcium (CAC) scan were stratified by stress Echo result: -ECG/-Echo or +ECG/-Echo. Multivariable regression investigated the association between stress Echo results and CAC burden. Event-free survival from a composite of adverse cardiovascular events was compared between groups., Results: Among 1630 asymptomatic participants in this observational cohort study, 1503 (92.2%) had a -ECG/-Echo, 105 (6.4%) had a +ECG/-Echo, and 22 (1.3%) had a +Echo. The +ECG/-Echo group had a significantly greater burden of coronary atherosclerosis than the -ECG/-Echo group (mean CAC score, 198±470 versus 53±186; P <0.001; CAC log , 2.2±2.7 versus 1.2±2.0; P <0.001). The -ECG/-Echo group was more likely to have CAC=0 compared with the +ECG/-Echo group (65.9% versus 53.3%; P =0.01), whereas the +ECG/-Echo group more commonly had CAC ≥100 (28.6% versus 11.4%; P <0.001). After adjustment, CAC log scores were 52% higher in the +ECG/-Echo group than in the -ECG/-Echo group ( P =0.002). Compared with the -ECG/-Echo group, the +ECG/-Echo group was 4.5× more likely to have a CAC score ≥400 (adjusted odds ratio, 4.54 [95% CI, 1.95-10.05]; P <0.001). After a median follow-up of 4.3 years, a trend toward increased adverse cardiovascular events was observed among participants with +ECG/-Echo., Conclusions: Individuals with a +ECG/-Echo have a higher burden of subclinical coronary atherosclerosis than those with a -ECG/-Echo, which may explain, at least in part, the increased risk for adverse cardiac events in this population. Further study is needed to determine the optimal strategy for mitigating cardiovascular risk in these patients., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03154346.

Background: In-hospital mortality risk prediction is an important tool for benchmarking quality and patient prognostication. Given changes in patient characteristics and treatments over time, a contemporary risk model for patients with acute myocardial infarction (MI) is needed., Methods: Data from 313 825 acute MI hospitalizations between January 2019 and December 2020 for adults aged ≥18 years at 784 sites in the National Cardiovascular Data Registry Chest Pain-MI Registry were used to develop a risk-standardized model to predict in-hospital mortality. The sample was randomly divided into 70% development (n=220 014) and 30% validation (n=93 811) samples, and 23 separate registry-based patient characteristics at presentation were considered for model inclusion using stepwise logistic regression with 1000 bootstrapped samples. A simplified risk score was also developed for individual risk stratification., Results: The mean age of the study cohort was 65.3 (SD 13.1) years, and 33.6% were women. The overall in-hospital mortality rate was 5.0% (n=15 822 deaths). The final model included 14 variables, with out-of-hospital cardiac arrest, cardiogenic shock, and ST-segment elevation MI as the strongest independent predictors of mortality. The model also included age, comorbidities (dyslipidemia, diabetes, prior percutaneous coronary intervention, cerebrovascular disease, and peripheral artery disease), heart failure on admission, heart rate, systolic blood pressure, glomerular filtration rate, and hemoglobin. The model demonstrated excellent discrimination (C-statistic, 0.868 [95% CI 0.865-0.871]) and good calibration, with similar performance across subgroups based on MI type, periods before and during the COVID-19 pandemic, and hospital volume. The simplified risk score included values from 0 to 25, with mortality risk ranging from 0.3% with a score of 0 to 1 up to 49.4% with a score >11., Conclusions: This contemporary risk model accurately predicts in-hospital mortality for patients with acute MI and can be used for risk standardization across hospitals and at the bedside for patient prognostication.

Background: Chronic kidney disease (CKD) is associated with higher risk of myocardial infarction and anemia. Among patients with anemia and CKD who experience myocardial infarction, it remains uncertain if a liberal red blood cell transfusion threshold strategy (hemoglobin cutoff [Hgb] < 10 g/dL) is superior to a restrictive transfusion threshold (Hgb 7-8 g/dL) strategy., Methods: Among the 3,504 patients enrolled in the Myocardial Ischemia and Transfusion (MINT) trial with non-missing creatinine, we compared baseline characteristics and 30-day and 6-month outcomes of patients without CKD (N = 1279), CKD with eGFR 30-60 mL/min/1.73 m2 (N = 999), CKD with eGFR < 30 mL/min/1.73 m2 (N = 802), and CKD requiring dialysis (N = 415) by assigned transfusion strategy., Results: No statistically significant interactions were observed between CKD stage and assigned transfusion strategy. Among non-dialysis dependent patients with an eGFR < 30 mL/min/1.73 m2, a restrictive transfusion strategy was associated with a higher risk of 30-day death or recurrent myocardial infarction (risk difference [RD], 5.8%, 95% CI 0.4% to 11.2%) compared to a liberal transfusion strategy. Among patients with an eGFR 30-60 mL/min/1.73 m2, a restrictive strategy was associated with a similar risk of 30-day death or recurrent myocardial infarction (RD, 3.7%, 95% CI -0.9% to 8.2%) compared to a liberal transfusion strategy. Among patients with CKD requiring dialysis, a restrictive strategy was also associated with a similar risk of 30-day death or recurrent myocardial infarction (RD, -2.6%, 95% CI -10.0% to 4.8%) compared to a liberal transfusion strategy., Conclusions: In patients with CKD included in this MINT subgroup analysis, a liberal transfusion strategy was not worse than a restrictive transfusion strategy and was associated with less harm in subgroups not receiving dialysis., (Copyright © 2025 by the American Society of Nephrology.)

Quality indicators (QIs) are standardized metrics that can be used to quantify health care delivery and identify important areas for practice improvement. Nine QIs pertaining to the diagnosis and management of eosinophilic esophagitis (EoE) were recently established. We therefore aimed to identify existing gaps in care using these QIs. This is a retrospective, multicenter study utilizing recently established EoE QIs to evaluate practice patterns among adult gastroenterologists in the diagnosis and management of EoE. Three patient cohorts of 30 patients each presenting with dysphagia, food impaction, and new diagnosis of EoE, respectively, were obtained, yielding 120 patients per site to assess for every QI. Summary statistics were reported across two main themes: diagnosis and management. Subsequent analysis of gaps in care was then performed. The domain of diagnosis of EoE (QI 1 and 2) had the most notable gap in care with only 55% of the presenting patients undergoing appropriate evaluation for EoE. The domain of management of EoE had overall higher QI fulfillment-however it also contained significant intra-category variation in care. Notably, while 79% of patients had clinical follow-up within 1 year from remission, only 54% underwent surveillance endoscopy within 2 years of remission. In contrast, 100% of patients with symptomatic strictures independent of histologic response underwent endoscopic dilation (QI 4). Management approaches for EoE are evolving and variation in care delivery exists. We identified significant gaps in both diagnosis of EoE especially amongst patients presenting with index food impaction and long term management of EoE, when retrospectively evaluating care patterns using newly established QIs. This is the first study of its kind to utilize these previously established QIs to objectively identify care gaps that exist in EoE amongst several institutions. These findings also highlight the importance of QIs and standardization of management of complex chronic diseases like EoE to help bridge these gaps and provide a framework to measure adherence to these best practices., (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Implementation of semaglutide weight loss therapy has been challenging due to drug supply and cost, underscoring a need to identify those who derive the greatest absolute benefit., Objectives: Allocation of semaglutide was modeled according to coronary artery calcium (CAC) among individuals without diabetes or established atherosclerotic cardiovascular disease (CVD)., Methods: In this analysis, 3,129 participants in the MESA (Multi-Ethnic Study of Atherosclerosis) without diabetes or clinical CVD met body mass index criteria for semaglutide and underwent CAC scoring on noncontrast cardiac computed tomography. Cox proportional hazards regression assessed the association of CAC with major adverse cardiovascular events (MACE), heart failure (HF), chronic kidney disease (CKD), and all-cause mortality. Risk reduction estimates from the SELECT (Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity) trial (median follow-up: 3.3 years) were applied to observed incidence rates for semaglutide 5-year number-needed-to-treat calculations., Results: Mean age was 61.2 years, 54% were female, 62% were non-White, mean body mass index was 31.8 kg/m 2 , and 49% had CAC. Compared with CAC = 0, CAC ≥300 conferred a 2.2-fold higher risk for MACE (HR: 2.16 [95% CI: 1.57-2.99]; P < 0.001). Higher risks for HF (HR: 2.80 [95% CI: 1.81-4.35]; P < 0.001), CKD (HR: 1.59 [95% CI: 1.15-2.22]; P = 0.006), and all-cause mortality (HR: 1.35 [95% CI: 1.08-1.69]; P = 0.009) comparing CAC ≥300 vs CAC = 0 were also observed. There were large 5-year number-needed-to-treat differences between CAC = 0 and CAC ≥300 for MACE (653 vs 79), HF (1,094 vs 144), CKD (1,044 vs 144), and all-cause mortality (408 vs 98)., Conclusions: Measurement of CAC may enhance value of care with weight loss dose semaglutide in those without diabetes or clinical CVD, improving allocation of a limited health care resource., Competing Interests: Funding Support and Author Disclosures This research was supported by R01HL071739 and R01HL146666 and MESA was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS). Dr Razavi was supported by the National Heart, Lung, and Blood Institute grant F32HL172499. Dr Razavi was supported by National Heart, Lung, and Blood Institute grants F32HL172499 and L30HL175751. Dr Dzaye has received support from National Institutes of Health grant T32 HL007227. Dr Blaha has received grants from the National Institutes of Health, U.S. Food and Drug Administration, and the American Heart Association; grants and personal fees from Amgen, Bayer, Eli Lilly, and Novo Nordisk; and personal fees from Novartis, Roche, Merck, Boehringer Ingelheim, Vectura, Agepha, and AstraZeneca outside the submitted work. Dr Shapiro has received grants (to institution) from PCORI, DCRI, Amgen, Boehringer Ingelheim, 89Bio, Esperion, Genentech, Novartis, Ionis, Merck, and New Amsterdam; Scientific Advisory Boards with Amgen, Agepha, Ionis, Novartis, Precision BioScience, Novo Nordisk, and New Amsterdam; and has received fees as a consultant with Ionis, Novartis, Regeneron, Aidoc, Shanghai Pharma Biotherapeutics, and Kaneka. Dr Al-Mallah has received grants from Siemens; and consultation fees from Jubulant. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Stroke prevention with direct-acting oral anticoagulant agents in patients with atrial fibrillation confers a risk of bleeding and limits their use. Asundexian, an activated factor XI (XIa) inhibitor, is an oral anticoagulant that may prevent strokes with less bleeding., Methods: In a phase 3, international, double-blind trial, we randomly assigned high-risk patients with atrial fibrillation in a 1:1 ratio to receive asundexian at a dose of 50 mg once daily or standard-dose apixaban. The primary efficacy objective was to determine whether asundexian is at least noninferior to apixaban for the prevention of stroke or systemic embolism. The primary safety objective was to determine whether asundexian is superior to apixaban with respect to major bleeding events., Results: A total of 14,810 randomly assigned patients were included in the intention-to-treat population. The mean (±SD) age of the patients was 73.9±7.7 years, 35.2% were women, 18.6% had chronic kidney disease, 18.2% had a previous stroke or transient ischemic attack, 16.8% had received oral anticoagulants for no more than 6 weeks, and the mean CHA 2 DS 2 -VASc score (range, 0 to 9, with higher scores indicating a greater risk of stroke) was 4.3±1.3. The trial was stopped prematurely at the recommendation of the independent data monitoring committee. Stroke or systemic embolism occurred in 98 patients (1.3%) assigned to receive asundexian and in 26 (0.4%) assigned to receive apixaban (hazard ratio, 3.79; 95% confidence interval [CI], 2.46 to 5.83). Major bleeding occurred in 17 patients (0.2%) who received asundexian and in 53 (0.7%) who received apixaban (hazard ratio, 0.32; 95% CI, 0.18 to 0.55). The incidence of any adverse event appeared to be similar in the two groups., Conclusions: Among patients with atrial fibrillation at risk for stroke, treatment with asundexian at a dose of 50 mg once daily was associated with a higher incidence of stroke or systemic embolism than treatment with apixaban in the period before the trial was stopped prematurely. There were fewer major bleeding events with asundexian than with apixaban during this time. (Funded by Bayer; OCEANIC-AF ClinicalTrials.gov number, NCT05643573; EudraCT number, 2022-000758-28.)., (Copyright © 2024 Massachusetts Medical Society.)

Context: There has been growing interest in the role of complementary and alternative medicine (CAM) as part of end-of-life care., Objectives: This study prospectively examined the prevalence, predictors and outcomes of ingestible CAM use among cancer patients in their last year of life in Singapore., Methods: This study (N = 427) utilized data across 12 months (four time points) prior to patient death. Utilizing mixed effects logistic regressions, we examined sociodemographic, clinical (symptom burden) and treatment-related factors associated with CAM use. Subsequently, the association between patient quality of life (i.e., physical, social, emotional, functional well-being) and CAM use were examined., Results: Half of the patients (50%) reported using CAM at least once in the last year of life while 36% of patients reported using CAM in the last 3 months of life. Among CAM users, 67% reported using western herbal supplements while 56% reported using traditional Chinese medicine. Further, 27-28% of patients used CAM consistently (i.e., for six months or more). Most patients (73%) reported using CAM as a complementary treatment. Patients who were ethnically Chinese (OR: 5.59, 95% CI: 2.29-13.69), reported less financial difficulties (OR: 0.82, 95% CI: 0.69-0.98), and believed in other curative treatments for cancer (OR: 2.39, 95% CI: 1.00-5.70) were more likely to use CAM. Controlling for time, CAM use (β: 0.60, CI: 0.01-1.19) was associated with higher social well-being., Conclusions: A significant proportion of terminal cancer patients reported using CAM as a complementary treatment in the last year of life., (Copyright © 2025 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

This study reports a comprehensive environmental scan of the generative AI (GenAI) infrastructure in the national network for clinical and translational science across 36 institutions supported by the CTSA Program led by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) at the United States. Key findings indicate a diverse range of institutional strategies, with most organizations in the experimental phase of GenAI deployment. The results underscore the need for a more coordinated approach to GenAI governance, emphasizing collaboration among senior leaders, clinicians, information technology staff, and researchers. Our analysis reveals that 53% of institutions identified data security as a primary concern, followed by lack of clinician trust (50%) and AI bias (44%), which must be addressed to ensure the ethical and effective implementation of GenAI technologies., Competing Interests: Competing interestsI.G.C. is a member of the Bayer Bioethics Council, the Chair of the ethics advisory board for Illumina, and an advisor for World Class Health. He was also compensated for speaking at events organized by Philips with the Washington Post, by the Doctors Company and Danaher, attending the Transformational Therapeutics Leadership Forum organized by Galen Atlantica. He has been retained as an expert in health privacy, gender-affirming care, and reproductive technology lawsuits. Y.Z. serves as the editor but is not involved in the decision-making process for this paper., (© The Author(s) 2025.)

Implantable cardioverter-defibrillators (ICDs) are recommended to reduce the risk of sudden cardiac death (SCD) in patients with heart failure with reduced ejection fraction (HFrEF). The landmark studies leading to the current guideline recommendations preceded the 4 pillars of guideline-directed medical therapies (GDMTs). Therefore, some have questioned the role of ICDs for primary prevention in current clinical practice. In this paper, the authors provide an overview of the current ICD recommendations, including the instrumental clinical trials, the risk of SCD as observed in clinical trials vs real-world scenarios, disparities in ICD use among different patient populations, the impact of contemporary GDMT on outcomes, and ongoing and future trials and methodologies to help identify patients who are at an increased risk of SCD and who may benefit from an ICD. The authors also propose a pragmatic guidance for clinicians when they engage in the shared decision-making discussions for primary ICD implantation., Competing Interests: Funding Support and Author Disclosures Dr Yehya has received speaking honoraria and consulting fees from Bayer, Merck, Novo Nordisk, AstraZeneca, and scPharmaceuticals. Dr Sauer has received research funding and consulting or speaking honoraria from Amgen, Abbott, Bayer, Boston Scientific, CSL Vifor, AstraZeneca, Impulse Dynamics, Fire1, uLink, Story Health, General Prognostics, Acorai, Edwards Lifesciences, Rivus, Pfizer, 35Pharma, and Regeneron; and owns stock in ISHI, a privately held digital health company. Dr Bozkurt has received consulting fees from Abbott, Abiomed, American Regent, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cardurion, Cytokinetics, Daiichi Sankyo, Johnson and Johnson, Lantheus, Liva Nova, Merck, Regeneron, Renovacor, Respicardia/Zoll, Roche, Sanofi-Aventis, and Vifor. Dr Fonarow has received consulting fees from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Eli Lilly, Johnson and Johnson, Medtronic, Merck, Novartis, and Pfizer. Nasrien Ibrahim has received consulting fees from Applied Therapeutics and Cytokinetics. Dr Tung has received speaking honoraria and consulting fees from Medtronic, Abbott, Biotronik, Boston Scientific. All other authors have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This study was designed to test hypotheses regarding the path dependence of health-outcome values in the form of linear additivity of health-state utilities and diminishing marginal utility of health outcomes., Methods: We employed a discrete-choice experiment to quantify patient treatment preferences for major depressive disorder. In a series of choice questions, participants evaluated seven symptom-improvement sequences and out-of-pocket costs over 6-week durations. Money-equivalent values were derived from a deductive latent-class mixed-logit analysis., Results: The discrete-choice experiment was completed by 751 respondents with self-reported major depressive disorder recruited from an online commercial panel. The class-membership probability was 0.83 for latent-class preferences consistent with supporting relative importance weights for all symptom-improvement sequences in the study design. First, we found strong support for diminishing marginal utility in symptom-improvement sequences. The money-equivalent value of an initial week of normal mood was $147 (95% confidence interval: $128, $166) and a second week of normal mood was $70 ($49, $91). Furthermore, for short treatment durations where conventional discounting was not a factor, equivalent changes in health status were valued more highly for an earlier onset of effect: holding subsequent symptom patterns constant, $338 (211, 454) versus $70 (49, 91) for improvements starting in week 2 versus week 3 and $147 ($128, $166) versus $29 (-$4, $64) for improvements starting in week 3 versus week 4., Conclusions: Our findings imply that conventional quality-adjusted life-year calculations in which health values are assumed to be path independent can understate the value of health improvements that appear earlier in a sequence., Competing Interests: Declarations. Funding: Financial support for this study was provided entirely by a research agreement between Duke University and Janssen Scientific Affairs, LLC. The funding agreement ensured the authors’ independence in designing the study, conducting the analysis, and writing and publishing the report. Conflict of interest: John J. Sheehan is employed by the sponsor. F. Reed Johnson, Semra Ozdemir, and Matthew Wallace have no competing interests to declare that are relevant to the content of this article. Jui-Chen Yang reports consulting fees from Duke University to conduct this study. Ethics approval: We received institutional review board approval from the Duke University Health System. Consent to participate: Informed consent was obtained from participants at the start of the pretest interviews. Consent to participate in the web-enabled survey was collected by the survey vendor. Consent for publication: Not applicable. Availability of data and material: Because of restrictions from our ethics committee, data will be available upon reasonable request by contacting the corresponding author. Code availability: Please contact the corresponding author for any requests for any study materials including codes. Author contributions: All authors made substantial contributions to the conception of and drafting or revising the manuscript. All authors approved the final version submitted., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Dysphagia is a swallowing impairment with adverse health consequences. The impact of preoperative dysphagia on postoperative outcomes is not known. This study will examine the association between preoperative dysphagia and postoperative outcomes., Methods: This is a retrospective, observational study of patients ≥50 years of age undergoing surgery not directly involving the swallowing mechanism (i.e., oral cavity, larynx, pharynx, or esophagus). The National COVID Cohort Collaborative (N3C) database from January 1st, 2020 to August 31st, 2023 was used. The N3C database comprises electronic health record (EHR) data from more than 75 US health systems and harmonizes these data in a centralized resource. The main predictor was dysphagia with or without malnutrition in the 3 months prior to surgery. Logistic regression models assessed the association between our main predictor and outcomes of mortality, readmission, and medical/surgical complications adjusted for covariates. A negative binomial regression model was used for length of stay (LOS)., Results: 380,869 adults ≥50 years old were included, mean age 66.0 (SD = 9.2), 52.6 % male. 7.9 % had dysphagia and/or malnutrition 3 months preoperatively including 3.0 % preoperative dysphagia alone, 3.8 % preoperative malnutrition alone, and 1.1 % both. Adjusted models demonstrated higher odds of mortality (1-year mortality odds ratio (OR) 1.37, 95 % confidence interval (CI) 1.29 to 1.44), readmission (90-day readmission OR 1.19, 95 % CI 1.14 to 1.24), and medical/surgical complications (OR 1.35, 95 % CI 1.28 to 1.42) among patients with 3 months preoperative dysphagia with or without malnutrition compared to patients with neither condition., Conclusion: Patients with 3 months preoperative dysphagia with and without malnutrition had poor postoperative outcomes. These findings highlight the rationale for integrating dysphagia screening and intervention into routine preoperative protocols to mitigate the risk of adverse postoperative outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Harrison Jones reports a relationship with Sanofi Genzyme that includes: funding grants. Harrison Jones reports a relationship with Aspire Products LLC that includes:. Harrison Jones reports a relationship with Pattern Health that includes: consulting or advisory. Harrison Jones reports a relationship with Amicus Therapeutics that includes: consulting or advisory. Harrison Jones reports a relationship with Northern Speech Services that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to identify preoperative patient/facility factors associated with postoperative and total episode-related costs using renal colic as a model surgical condition to improve value-based payment models., Methods: Using state Healthcare Cost and Utilization Project data, we performed a retrospective cohort study examining perioperative costs for individuals presenting to an emergency department for renal colic and who ultimately underwent definitive surgical management. We estimated multivariable ordered and binary logistic regressions to examine the association between preoperative and operative cost quartiles on the probability of specific postoperative cost quartiles after accounting for hospital and individual factors. We also performed logistic regressions to identify patients who deviated from predicted perioperative cost pathways., Results: Among 2736 individuals included in our analysis, episode-related costs ranged from $4536 (bottom quartile) to $26,662 (top quartile). Individuals in the highest preoperative cost quartile experienced an 11.7% higher probability of remaining in the highest postoperative cost quartile relative to those in the lowest preoperative cost quartile (95% CI, 0.0709-0.163; P < .001). Delays in surgery (95% CI, 0.0869-0.163; P < .001) and Medicaid vs private insurance (95% CI, 0.01-0.0728; P < .01) were associated with a 12.5% and 4.1% higher probability of being in the top quartile of preoperative costs, respectively. Treating facility experience with value-based payment models did not influence perioperative costs., Conclusions: Using renal colic as a model surgical condition, our novel findings suggest that preoperative costs are associated with both postoperative and total episode-related costs and should be accounted for when designing future value-based payment models.

Purpose: To ensure that research on kidney stones provides meaningful impact for the kidney stone community, patients and caregivers should be engaged as stakeholders in clinical trial design, starting at study inception. This project aimed to elicit, refine, and prioritize research ideas from kidney stone stakeholders to develop a patient-centered research agenda for clinical trials., Materials and Methods: The Kidney Stone Engagement Core, a group of patients, caregivers, advocates, clinicians, and researchers, executed an iterative process of surveys and focus groups to elicit and refine research themes, which were then translated into research questions. A separate group of patients, caregivers, and clinicians prioritized these questions through parallel modified Delphi and crowdsourced digital platforms. A research agenda was developed by the Kidney Stone Engagement Core based on the highest rated questions during a hybrid virtual/in-person capstone session., Results: A total of 70 individuals (57 patients and caregivers, 13 researchers and clinicians) participated in the elicitation, 20 individuals (15 patients and caregivers, 5 researchers and clinicians) participated in refinement, and an additional 80 individuals (81 patients and caregivers, 9 researchers and clinicians) participated in prioritization. Key novel themes emerged from elicitation and refinement: ureteral stents, genetic evaluation, shared surgical decision-making, key subgroups, cumulative disease burden, genetic evaluation, and psychosocial support. Stakeholders generated 6 proposed trials from these themes focused on surveillance, surgical intervention, and medical prevention., Conclusions: Patients and caregivers valued comparative effectiveness kidney stone research that focused on individualized care, shared decision-making, and improvement of patient-reported experiences. This process provided actionable recommendations for future patient-centered clinical trials within kidney stone disease.

Objective: Describe the epidemiology and clinical characteristics of infants in the neonatal intensive care unit (NICU) with acyclovir exposure and herpes simplex virus (HSV) infection., Study Design: Our primary analysis was to evaluate the prevalence of HSV infection among infants in the NICU who received acyclovir. We compared characteristics of infants with and without HSV and used multivariable regression analyses to assess associations between infection and clinical outcomes., Result: Of 1,057,061 infants, 17,910 (2%) received acyclovir. Of those who received acyclovir, 1090 (5%) had HSV. Infection was associated with lower gestational age and lower birth weight. Multivariable models demonstrated that infected infants had higher mortality, greater postmenstrual age at discharge, and longer length of stay., Conclusion: Infants in the NICU who received acyclovir and have HSV are more likely to be born at lower gestational age, have lower birth weight, and have higher morbidities and mortality., Competing Interests: Ethics approval and consent to participate: All methods were performed in accordance with relevant guidelines and regulations. Data were extracted and consolidated into the de-identified Pediatrix Clinical Data Warehouse. Approval was obtained from the Duke University Medical Center Institutional Review Board with a waiver of informed consent (IRB number Pro00051915). Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objectives: To determine baseline prevalence of proteinuria and albuminuria among participants from the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) and evaluate associated risk factors., Design: Cross sectional analysis of a baseline sample of participants from the REPRIEVE Trial., Methods: REPRIEVE is an international primary cardiovascular prevention randomized controlled trial (RCT) of pitavastatin calcium vs. placebo among people with HIV (PWH) on antiretroviral therapy (ART). A representative subset (2791 participants) had urine collected at study entry. Urine protein to creatinine ratios (uPCR) and albumin to creatinine ratios (uACR) were classified as normal, moderately increased and severely increased. These were dichotomized to Normal or Abnormal for log-binomial regression analysis. Demographic, cardiometabolic, and HIV-specific data were compared among those with normal versus abnormal results., Results: Overall, median age 49 years, 41% female sex, 47% black or African American race, 36% had estimated glomerular filtration rate (eGFR) less than 90 ml/min/1.73 mm 2 . For uPCR, 27% had moderately or severely increased values. For uACR, 9% had moderately or severely increased values. In the fully adjusted model for proteinuria, female sex, older age, residence in sub-Saharan Africa or East Asia, lower BMI, lower CD4 + cell count, and use of tenofovir disoproxil fumarate (TDF) were associated with abnormal values. In the fully adjusted model for albuminuria, a diagnosis of hypertension (HTN) was associated with abnormal values., Conclusion: Abnormal proteinuria and albuminuria remain common (27 and 9%) despite controlled HIV. Lower current CD4 + count and TDF use were strongly associated with proteinuria. Certain modifiable comorbidities, including HTN and smoking, were associated with abnormal values. In PWH with preserved eGFR, urine measures identify subclinical kidney disease and afford the opportunity for intervention., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The optimal approach towards managing serum potassium (sK + ) and hemodialysate potassium concentrations is uncertain. To study this, adults receiving hemodialysis for three months or more with hyperkalemia (pre-dialysis sK + 5.1-6.5 mmol/l) had cardiac monitors implanted and were randomized to either eight weeks of 2.0 mmol/l potassium/1.25 mmol/l calcium dialysate without sodium zirconium cyclosilicate (SZC) (2.0 potassium/noSZC) or 3.0 mmol/l potassium/1.25 mmol/l calcium dialysate combined with SZC (3.0 potassium/SZC) on non-dialysis days to maintain pre-dialysis sK + 4.0-5.5 mmol/l, followed by treatment crossover for another eight weeks. The primary outcome was the rate of adjudicated atrial fibrillation (AF) episodes of at least 2 minutes duration. Secondary outcomes included clinically significant arrhythmias (bradycardia, ventricular tachycardia, and/or asystole) and the proportion of sK + measurements within an optimal window of 4.0-5.5 mmol/l. Among 88 participants (mean age: 57.1 years; 51% male; mean pre-dialysis sK + : 5.5 mmol/l) with 25.5 person-years of follow-up, 296 AF episodes were detected in nine patients. The unadjusted AF rate was lower with 3.0 potassium/SZC versus 2.0 potassium/noSZC; 9.7 vs. 13.4/person-year (modeled rate ratio 0.52; 95% confidence interval 0.41-0.65). Clinically significant arrhythmias were reduced with 3.0 potassium/SZC vs. 2.0 potassium/noSZC (6.8 vs. 10.2/person-year modeled rate ratio 0.47; 0.38; 0.58). Fewer sK + measurements outside the optimal window occurred with 3.0 potassium/SZC (modeled odds ratio: 0.27; 0.12-0.35). Hypokalemia was less frequent (33 vs. 58 patients) with 3.0 potassium/SZC compared with 2.0 potassium/noSZC. Thus, in patients with hyperkalemia on maintenance hemodialysis, a combination of hemodialysate potassium 3.0 mmol/l and SZC on non-hemodialysis days reduced the rates of AF, other clinically significant arrhythmias, and post-dialysis hypokalemia compared with hemodialysate potassium 2.0/noSZC., (Copyright © 2024 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)

Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention is necessary for preventing stent thrombosis and ensuring long-term cardiovascular protection. It is important to be thoughtful in balancing thrombotic and bleeding risk when deciding therapy regimen and duration. Revascularization randomized trials have studied many specific, at-risk populations; however, women remain underrepresented. Although there is evidence to support shortened DAPT duration in women, especially those at higher bleeding risk or on chronic oral anticoagulation, we need trials specifically enrolling and focusing on women., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Importance: The differences between the use of fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) in the long term are unknown., Objective: To compare long-term outcomes of iFR- and FFR-based strategies to guide revascularization., Design, Setting, and Participants: The DEFINE-FLAIR multicenter study randomized patients with coronary artery disease to use either iFR or FFR as a pressure index to guide revascularization. Patients from 5 continents with coronary artery disease and angiographically intermediate severity stenoses who underwent hemodynamic interrogation with pressure wires were included. These data were analyzed from March, 13, 2014, through April, 27, 2021., Main Outcome Measures: Five-year major adverse cardiac events (MACE) (a composite of all-cause death, nonfatal myocardial infarction, and unplanned revascularization), as well as the individual components of the combined end point., Results: At 5 years of follow-up, no significant differences were found between the iFR (mean age [SD], 65.5 [10.8] years; 962 male [77.5%]) and FFR (mean age [SD], 65.2 [10.6] years; 929 male [74.3%]) groups in terms of MACE (21.1% vs 18.4%, respectively; hazard ratio [HR], 1.18; 95% CI, 0.99-1.42; P = .06). While all-cause death was higher among patients randomized to iFR, it was not driven by myocardial infarction (6.3% vs 6.2% in the FFR study arm; HR, 1.01; 95% CI, 0.74-1.38; P = .94) or unplanned revascularization (11.9% vs 12.2% in the FFR group; HR, 0.98; 95% CI, 0.78-1.23; P = .87). Furthermore, patients in whom revascularization was deferred on the basis of iFR or FFR had similar MACE in both study arms (17.9% in the iFR group vs 17.5% in the FFR group; HR, 1.03; 95% CI, 0.79-1.35; P = .80) with similar rates of the components of MACE, including all-cause death. On the contrary, in patients who underwent revascularization after physiologic interrogation, the incidence of MACE was higher in the iFR group (24.6%) compared with the FFR group (19.2%) (HR, 1.36; 95% CI, 1.07-1.72; P = .01)., Conclusions and Relevance: At 5-year follow up, an iFR based-strategy was not statistically different than an FFR strategy to guide revascularization in terms of MACE, nonfatal myocardial infarction, and unplanned revascularization., Trial Registration: ClinicalTrials.gov Identifier: NCT02053038.

Choosing between revision endoscopic sinus surgery (ESS) versus biologic therapy for recurrent chronic rhinosinusitis with nasal polyposis (CRSwNP) is a complex, multifaceted decision that involves not only clinical and financial factors but also patient preferences. Currently, there are no quantitative studies investigating patient preferences for CRSwNP treatment options. Increased awareness of patient-centered approaches to treatment warrant further investigation.

This state-of-the-art review examines disparities in the diagnosis, management, and outcomes of cardiac arrhythmias globally. These arrhythmias include atrial fibrillation, ventricular tachyarrhythmias underlying sudden cardiac death, and bradyarrhythmias associated with sinus node and atrioventricular node disease. Arrhythmias in low- and middle-income countries often result in higher mortality rates due to complex and poorly documented risk factors, lack of clinical expertise among health care personnel, lack of sufficient infrastructure, and challenges in access to care. Innovative approaches like repurposing pacemakers, mobile clinics, use of digital technology, and training initiatives are being explored to address these issues. This article highlights the importance of diagnosis of arrhythmias in varying resource settings, access to care in those settings, and ongoing efforts to expand access to care., Competing Interests: Dr Jackson has served as a consultant to Biosense Webster, Johnson & Johnson, Pfizer, and Sanofi; and has received honoraria from PRIME Education. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Aims: In the EMPACT-MI trial, empagliflozin reduced heart failure (HF) hospitalizations but not mortality in acute myocardial infarction (MI). Contemporary reports of clinical event rates with and without type 2 diabetes mellitus (T2DM) in acute MI trials are sparse. The treatment effect of empagliflozin in those with and without T2DM in acute MI is unknown., Methods and Results: A total of 6522 patients with acute MI with newly reduced left ventricular ejection fraction (LVEF) to <45%, congestion, or both, were randomized to empagliflozin 10 mg or placebo. The primary endpoint was time to first HF hospitalization or all-cause death. Rates of endpoints with and without T2DM and the efficacy and safety of empagliflozin according to T2DM status were assessed. Overall, 32% had T2DM; 14% had pre-diabetes; 16% were normoglycaemic; 38% had unknown glycaemic status. Patients with T2DM, compared to those without T2DM, were at higher risk of time to first HF hospitalization or all-cause death (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.06-1.95) and all-cause death (HR 1.70; 95% CI 1.13-2.56). T2DM did not confer a higher risk of first HF hospitalization (HR 1.22, 95% CI 0.82-1.83). Empagliflozin reduced first and total HF hospitalizations, but not all-cause mortality, regardless of presence or absence of T2DM. The safety profile of empagliflozin was the same with and without T2DM., Conclusion: Patients with acute MI, LVEF <45% and/or congestion who had T2DM were at a higher risk of mortality than those without T2DM. Empagliflozin reduced first and total HF hospitalizations regardless of the presence or absence of T2DM., (© 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Abstract: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in people with HIV (PWH) and increases the risk of hepatic fibrosis and hepatocellular carcinoma. We sent an online survey to providers of the American Academy of HIV Medicine. Of respondents (n = 214, 8% response rate), 65% reported screening for NAFLD in PWH, with 28% routinely screening all patients. Most respondents refer patients to hepatology if workup suggests another coexisting liver disease or cirrhosis, with the primary goals of referral being additional diagnostic testing (60%) or specific treatments (75%). The most common barriers to screening were feeling unsure of what tests to order (28%) and how to conclusively diagnose NAFLD (29%). Most respondents were interested in society guidelines (73%) and NAFLD education for patients (57%) and providers (55%). Our findings support the development of NAFLD clinical practice guidelines for HIV providers and the inclusion of PWH in clinical trials of novel agents., (Copyright © 2024 Association of Nurses in AIDS Care.)

Aims: The interstitial space is the major compartment in which the excess fluid is located, forming peripheral congestion in acute decompensated heart failure (ADHF). The lymphatic system is responsible for the constant drainage of the compartment. In ADHF, the inefficiency of this system causes extravascular fluid accumulation, underscoring the crucial role of lymphatic system failure in ADHF's pathophysiology. The eLym™ System is a transcutaneous device designed to facilitate lymph drainage by creating a low-pressure zone in the thoracic duct area, theoretically allowing more efficient decompression of the lymphatic system., Methods and Results: The safety and feasibility of the eLym™ System for the Decongestion of Excess Lymphatic Fluid via the Thoracic Duct in Acute Decompensated Heart Failure: DELTA-HF Study is a prospective, multicentre, single-arm study designed to evaluate the safety and feasibility of the WhiteSwell eLym™ System in the treatment of fluid overload in ADHF. A maximum of 50 subjects may be enrolled and undergo the treatment. Inclusion criteria include the presence of congestion, a home diuretic dose ≥80 mg furosemide (or equivalent) and elevated natriuretic peptides. The key exclusion criteria include anatomical abnormalities and the inability to undergo systemic anticoagulation. The study endpoints include the safety (short- and long-term) and feasibility of the procedure. Several congestion indexes will be prospectively assessed. Descriptive statistics will summarize the study results. The study was registered in clinicaltrial.gov (NCT05747196)., Conclusions: The results of the DELTA-HF study will provide information about the safety and feasibility of the eLym™ System and will provide first-in-human clinical signals of its use in ADHF patients., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Objective: This study will evaluate the feasibility and preliminary effectiveness of the COACH (Community Health Worker Optimization of Antihypertensive Care in HIV) intervention, which integrates hypertension management into existing HIV care for people living with HIV (PLWH) in Tanzania., Methods: The study will be conducted at two HIV Care and Treatment Centers (CTCs) in Tanzania. In a single-arm pre-post feasibility trial, 100 PLWH with hypertension will be enrolled and will receive the six-month intervention. The COACH intervention includes six monthly hypertension educational sessions delivered by community health workers (CHWs) and integrated within HIV CTC visits, monthly blood pressure monitoring, follow up care coordination, fully subsidized antihypertensive medications, a standardized antihypertensive treatment algorithm, and training for providers. The intervention's implementation outcomes will be evaluated using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework, and the primary study outcome (reach of the intervention) will be the proportion of all scheduled intervention sessions attended by participants, a measure of feasibility. Secondary clinical effectiveness outcomes will include adherence to antihypertensive medication, blood pressure control, body mass index, cardiovascular risk, and hypertension knowledge., Significance: The COACH intervention has the potential to significantly improve hypertension management among PLWH in Tanzania by leveraging the existing HIV care infrastructure and CHWs. This study will provide crucial insights into the feasibility and potential effectiveness of the intervention in integrating hypertension care into HIV services, informing larger-scale implementation and policy changes in Tanzania and other resource-limitted settings., Trial Registration: Clinical trials.gov Identifer: NCT06503991., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Min Htike et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In this secondary analysis of 386 subjects with Gram-negative bacteremia enrolled in the RAPIDS GN trial, rapid antibiotic susceptibility testing had a greater benefit on the management of bacteremia caused by antibiotic-resistant compared to antibiotic-susceptible isolates, especially for Escherichia coli, Klebsiella species , and Proteus species.IMPORTANCERapid blood culture diagnostics are costly, and their use has not demonstrated clear clinical benefit for patients with Gram-negative sepsis, possibly because prior trials did not enroll sufficient numbers of patients with antibiotic-resistant infections. This analysis of patients with sepsis previously enrolled in a randomized controlled clinical trial demonstrates that rapid susceptibility testing of bacteria from blood cultures had the greatest impact for patients with antibiotic-resistant infections. Specifically, after rapid testing results were reported, patients infected with resistant bacteria received appropriate antibiotic therapy more quickly than patients with susceptible bacteria. These findings highlight the need to evaluate blood culture diagnostics in areas with high antibiotic resistance where these diagnostics are likely to have the greatest impact.

Background: Despite the global public health threat posed by carbapenem-resistant Enterobacter spp., clinical and molecular epidemiological studies on international isolates remain scarce. Historically, the taxonomy of Enterobacter has been challenging, limiting our understanding of the clinical characteristics and outcomes of carbapenemase-producing Enterobacter spp. infections., Methods: Hospitalized patients enrolled in the CRACKLE-2 study (ClinicalTrials.gov, NCT03646227) from 2016-2018 with cultures positive for carbapenemase-producing Enterobacter spp. were included. Clinical and microbiologic data were collected from health records. Whole genome sequencing was performed, and the population structures of selected predominant clones were analyzed., Results: We enrolled 136 hospitalized patients with carbapenemase-producing Enterobacter spp. from 30 hospitals in 7 countries. Among the 136 isolates, eleven Enterobacter species were identified, with most isolates belonging to E. xiangfangensis (n=81, 60%) and E. hoffmannii (n=17, 13%), and carrying blaKPC (n=106, 78%) and blaNDM (n=12, 9%). Clinical characteristics and outcomes were similar among patients with E. xiangfangensis, E. hoffmannii or the other Enterobacter spp. 30-day mortality was 20% and older age at enrollment (adjusted odds ratio 1.42, 95% confidence interval 1.08-1.87) was associated with increased mortality. Sequence type (ST)171 E. xiangfangensis, ST78 E. hoffmannii, and ST93 E. xiangfangensis were the predominant clones, and the acquisition of fluoroquinolone resistance-associated mutations and carbapenemase-encoding plasmids contributed to their formation and global dissemination., Conclusions: Our findings demonstrated that E. xiangfangensis and E. hoffmannii are common species among international carbapenemase-producing Enterobacter spp., potentially linked to the clonal spread of a few predominant clones that have acquired fluoroquinolone resistance and carbapenemase-encoding plasmids., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: Little research has investigated the relationship between musculoskeletal pain and body mass index (BMI) in the context of pain-associated psychological distress. This study aims to determine if independent associations exist between BMI, obesity, demographic variables, and psychological distress in patients presenting with hip pain., Materials and Methods: Using a retrospective cross-sectional study design, 428 patients completed the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) and were categorized into pain-associated psychological distress phenotypes using latent class analysis. Participants were stratified into five BMI categories outlined by the Centers for Disease Control and Prevention (CDC) using descriptive statistics. Multinomial logistic regression was employed to determine a relationship between psychological distress phenotype and BMI (first as a continuous variable, then as a categorical variable), age, gender, race, and veteran status as candidate variables., Results: Four psychological distress phenotypes were generated: high distress (n = 172, 40.2%), low distress (n = 114, 26.6%), negative pain coping (n = 98, 22.9%), and low self-efficacy and acceptance (n = 44, 10.3%). BMI analyses identified 4 participants (0.9%) as being underweight (BMI < 18.5), 146 participants (34.1%) with recommended weights (18.5 < BMI < 24.9), 133 (31.1%) as overweight (25 < BMI < 29.9), 113 (26.4%) with obesity (30 < BMI < 39.9), and 32 (7.5%) with severe obesity (BMI > 40). Additionally, 54.0% of participants with obesity and 59.4% of participants with severe obesity had high psychological distress. As a continuous and categorical variable, elevated BMI was independently associated with membership in the high distress phenotype (p < 0.001). The overweight (p = 0.043), obesity (p < 0.001), and severe obesity (p = 0.034) subgroups and Black/African American participants (p = 0.020) were also all significantly associated with high distress., Conclusions: Elevated BMI and obesity are associated with high psychological distress in patients with hip pain. These results may inform operative, nonoperative, and behavioral health treatment pathways for patients with comorbid obesity and hip pain, as well as provide direction for prospective studies to address obesity and psychological distress among patients with musculoskeletal pain., Competing Interests: Declarations. Conflict of interests: The Author(s) declare(s) that there is no conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Importance: Angiotensin receptor-neprilysin inhibition (ARNI) improves mortality among patients with heart failure with reduced ejection fraction (HFrEF), ie, those with an EF of 40% or less., Objective: To describe national longitudinal trends in ARNI prescribing patterns among hospitalized patients with HFrEF., Design, Setting, and Participants: Using data from the Get With The Guidelines-Heart Failure (GWTG-HF) registry, hospitalized patients with HFrEF at 614 participating hospitals were identified. Rates of ARNI, angiotensin converting enzyme inhibitor (ACEI), and angiotensin II receptor blocker (ARB) prescription at discharge were evaluated across 3 time periods. Adjusted logistic regression and piecewise logistic regression were used to evaluate the impact of publication dates on ARNI prescription rates., Exposures: ARNI prescribing patterns in hospitalized patients with HFrEF., Main Outcomes and Measures: Rates of ARNI, ACEI, and ARB prescription at discharge were evaluated across 3 time periods as follows: (1) period 1 included the US Food and Drug Administration (FDA) approval of sacubitril-valsartan to the day before the PIONEER-HF (Comparison of Sacubitril-Valsartan vs Enalapril on Effect on N-Terminal Pro-Brain Natriuretic Peptide in Patients Stabilized From an Acute Heart Failure Episode) trial publication (July 7, 2015-November 10, 2018); (2) period 2 included the day of the PIONEER-HF trial publication to the day before publication of the 2021 Update to the 2017 Consensus for Optimization of Heart Failure Treatment (November 11, 2018-January 10, 2021); and (3) period 3 included the day of the 2021 update publication to the last available data at the time of analysis (January 11, 2021-December 31, 2022)., Results: A total of 114 333 hospitalized patients (mean [IQR] age, 67.0 [57.0-78.0] years; 74 765 male [65.4%]) were included in this study. Rates of ARNI prescribed at discharge increased from 1.1% (27 of 2451) during July 7, 2015, to September 30, 2015, to 55.4% (1957 of 3536) during October 1, 2022, to December 31, 2022. ACEI or ARB prescription at discharge fell from 88.3% (2612 of 2957) to 45.9% (2033 of 4434) over the same period, whereas ACEI, ARB, or ARNI prescription increased from 71.1% (2639 of 3713) to 84.7% (3990 of 4711). In adjusted logistic regression models, compared with period 1, patients discharged during period 2 and period 3 were found to have a 3.81-fold (95% CI, 3.65-3.98) and 9.15-fold (95% CI, 8.79-9.52) increased odds of ARNI prescription at discharge, and a 0.46 (95% CI, 0.45-0.48) and 0.25 (95% CI, 0.24-0.26) decreased odds of ACEI or ARB prescription at discharge., Conclusions and Relevance: Results of this cross-sectional study reveal that in the 7 years after FDA drug approval of sacubitril-valsartan, rates of ARNI or ACEI, ARB, or ARNI prescription at discharge increased, and rates of ACEI or ARB prescription decreased. Overall prescription of ARNI at discharge was 55.4% in eligible patients at the end of the study, suggesting remaining opportunity for continued improvement in ARNI prescription.