Importance In the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial, a novel 12-week rehabilitation intervention demonstrated significant improvements in validated measures of physical function, quality of life, and depression, but no significant reductions in rehospitalizations or mortality compared with a control condition during the 6-month follow up. The economic implications

Importance Spontaneous coronary artery dissection (SCAD) has been associated with fibromuscular dysplasia (FMD) and other extracoronary arterial abnormalities. However, the prevalence, severity, and clinical relevance of these abnormalities remain unclear. Objective To assess the prevalence and spectrum of FMD and other extracoronary arterial abnormalities in patients with SCAD vs controls. Design

Importance Despite lower baseline fitness levels, women in cardiac rehabilitation (CR) do not typically improve peak aerobic exercise capacity (defined as peak oxygen uptake [peak Vo2]) compared with men in CR. Objective To evaluate the effect of high-intensity interval training (HIIT) and intensive lower extremity resistance training (RT) compared with standard moderate intensity continuous training

The comparison of the outcomes of different surgical techniques is the foundation of progress in cardiac surgery. Still, estimating treatment effects is a complex methodological challenge. Randomized trials have low risk of bias but limited external validity. On the other hand, observational studies have a higher risk of bias and confounders but are more representative of clinical practice. While in

As the number and price of novel medical treatments accelerate, there is heightened interest in determining their value. A price typically reflects a manufacturer’s estimate of society’s willingness to pay for their product. Treatments that improve survival appropriately command higher prices, although the correlation is not close, as noted by recent prices of proprotein convertase subtilisin/kexin

In the Original Investigation titled “Effect of a Self-care Intervention on 90-Day Outcomes in Patients With Acute Heart Failure Discharged From the Emergency Department: A Randomized Clinical Trial,”1 published in the February 2021 issue, an affiliation was omitted. A second affiliation for Sean P. Collins, MD, MSc, and Jin H. Han, MD, should have been given as “Geriatric Research, Education, and

Importance Ventricular tachycardia (VT) is associated with high mortality in patients with cardiac sarcoidosis (CS), and medical management of CS-associated VT is limited by high failure rates. The role of catheter ablation has been investigated in small, single-center studies. Objective To investigate outcomes associated with VT ablation in patients with CS. Design, Setting, and Participants This

Importance Despite the benefits of high-technology therapeutics, inequitable access to these technologies may generate disparities in care. Objective To examine the association between zip code–level racial, ethnic, and socioeconomic composition and rates of transcatheter aortic valve replacement (TAVR) among Medicare patients living within large metropolitan areas with TAVR programs. Design, Setting

Despite breakthrough science and innovative procedures, cardiovascular disease is rife with evidence-based racial disparities. Adopting quality initiatives, raising awareness, and inciting discussions about unconscious bias are recommended steps intended to narrow cardiovascular disease disparities. Progress is noted but a new challenge emerges. The implementation of transcatheter aortic valve replacement

Cardiovascular guidelines advise statin therapy for adults aged 20 to 75 years with low-density lipoprotein cholesterol (LDL-C) levels of 190 mg/dL or greater, with a goal of lowering LDL-C by at least 50%.1 Early-life accumulation of cholesterol exposure increases future cardiovascular risk independent of midlife2 and total cumulative cholesterol exposure,3,4 highlighting the importance of LDL-C management

Clinical guideline evidence matters. Recent 2018 American Heart Association/American College of Cardiology/Multisociety guidelines present strong evidence to support maximally tolerated statin therapy as a first step in patients aged 20 to 75 years with primary severe elevations of low-density lipoprotein cholesterol (LDL-C) of 190 mg/dL (to convert to millimoles per liter, multiply by 0.0259) or greater

Importance Atrial fibrillation (AF) is the most common arrhythmia. Although patients have reported that various exposures determine when and if an AF event will occur, a prospective evaluation of patient-selected triggers has not been conducted, and the utility of characterizing presumed AF-related triggers for individual patients remains unknown. Objective To test the hypothesis that n-of-1 trials

Importance Lipid management typically focuses on levels of low-density lipoprotein cholesterol (LDL-C) and, to a lesser extent, triglycerides (TG). However, animal models and genetic studies suggest that the atherogenic particle subpopulations (LDL and very-low-density lipoprotein [VLDL]) are both important and that the number of particles is more predictive of cardiac events than their lipid content

In 1979, Avogaro et al1 reported that apolipoprotein B (apoB) was a more accurate marker of the risk of a myocardial infarction than total cholesterol. In 1980, Sniderman et al2 reported that low-density lipoprotein (LDL) apoB was a more accurate marker of the risk of angiographic coronary lesions than LDL cholesterol (LDL-C). They inferred that the mass of cholesterol per apoB particle could vary

Importance Multiple guideline-recommended therapies for heart failure with reduced ejection fraction (HFrEF) are available and promoted by performance measures. However, contemporary data on the use of these therapies are limited. Objective To evaluate trends in guideline-directed medical therapy, implantable cardioverter-defibrillator (ICD) use, and risk-adjusted mortality among patients with recent-onset

Just be yourself. As a woman in cardiology, this is not so straightforward. Women have to constantly balance the dichotomy of warmth and competence. If you are warm, you are seen as less competent. If you are assertive, you are viewed as cold. How then, can you just be yourself? I am a Black woman, a mother, and a cardiology fellow. Throughout my training, I have faced many challenges including sexism

In the Original Investigation titled “Long-term Benefits and Harms Associated With Genetic Cholesteryl Ester Transfer Protein Deficiency in the General Population,”1 published online October 6, 2021, 3 of the 8 bars in the left graph of Figure 4 representing myocardial infarction, age-related macular degeneration (AMD), and dry AMD, respectively, and all 3 bars in the right graph of Figure 4 representing

Importance American Indian communities experience a high burden of coronary heart disease (CHD). Strategies are needed to identify individuals at risk and implement preventive interventions. Objective To investigate the association of blood DNA methylation (DNAm) with incident CHD using a large number of methylation sites (cytosine-phosphate-guanine [CpG]) in a single model. Design, Setting, and Participants

Importance Postmortem genetic testing of young individuals with sudden death has previously identified pathogenic gene variants. However, prior studies primarily considered highly penetrant monogenic variants, often without detailed decedent and family clinical information. Objective To assess genotype and phenotype risk in a diverse cohort of young decedents with sudden death and their families. Design

Importance The density of atherosclerotic plaque forms the basis for categorizing calcified and noncalcified morphology of plaques. Objective To assess whether alterations in plaque across a range of density measurements provide a more detailed understanding of atherosclerotic disease progression. Design, Setting, and Participants This cohort study enrolled 857 patients who underwent serial coronary

Importance Heart failure (HF) with preserved ejection fraction (HFpEF) is common, is frequently associated with ventricular wall thickening, and has no effective therapy. Transthyretin amyloid cardiomyopathy (ATTR-CM) can cause the HFpEF clinical phenotype, has highly effective therapy, and is believed to be underrecognized. Objective To examine the prevalence of ATTR-CM without and with systematic

Importance Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation for select patients with atrial fibrillation; however, women have been underrepresented in clinical trials of LAAO, and sex-specific subanalyses are limited. Objective To evaluate the sex differences in the baseline characteristics of patients undergoing LAAO implant and in the in-hospital outcomes after

Importance Millions of clinicians rely daily on automated preliminary electrocardiogram (ECG) interpretation. Critical comparisons of machine learning–based automated analysis against clinically accepted standards of care are lacking. Objective To use readily available 12-lead ECG data to train and apply an explainability technique to a convolutional neural network (CNN) that achieves high performance

Importance Sodium glucose cotransporter 2 inhibitors reduce morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). Clinicians may find estimates of the projected long-term benefits of sodium glucose cotransporter 2 inhibitors a helpful addition to clinical trial results when communicating the benefits of this class of drug to patients. Objective To estimate the

Importance Being born small for gestational age (SGA), approximately 10% of all births, is associated with increased risk of cardiovascular mortality in adulthood, but mechanistic pathways are unclear. Cardiac remodeling and dysfunction occur in fetuses SGA and children born SGA, but it is uncertain whether and how these changes persist into adulthood. Objective To evaluate baseline cardiac function

Importance Limited evidence suggests exercise reduces blood pressure (BP) in individuals with resistant hypertension, a clinical population with low responsiveness to drug therapy. Objective To determine whether an aerobic exercise training intervention reduces ambulatory BP among patients with resistant hypertension. Design, Settings, and Participants The Exercise Training in the Treatment of Resistant

Importance Patients with atrial fibrillation (AF) have impaired health-related quality of life primarily owing to symptoms related to AF episodes; however, quality of life can be influenced by AF therapies, AF complications, the frequency of follow-up visits and hospitalizations, illness perceptions, and patient factors, such as anxiety or depression. Objective To determine the association between

Hospitalizations for acute myocardial infarction (AMI) and stroke declined nationwide among adults during the early COVID-19 period, suggesting some patients did not receive timely care for these emergencies.1-4 Declines in AMI and stroke hospitalizations might be particularly large for Medicare patients who, because they are older or physically disabled and have more comorbidities, are both more likely

A healthy 45-year-old man presented to an emergency department after 3 days of fever, cough, and dyspnea. Computed tomography (CT) of the chest suggested a viral pneumonia and incidentally revealed mild coronary artery calcification (CAC) by qualitative assessment. After the (hypothetical) patient’s discharge, his primary care physician ordered a formal CAC score, which was 50 Agatston units (91st

In my second year of medical school, I participated in a simulation session with 5 other students. Dan, a state-of-the-art mannequin, white male, moulaged with an IV, worth about a quarter of a million dollars, with skin the color of mashed potato and roughly the same resistance as a Tupperware lid, blinked back at me. Unbeknownst to us, for the purposes of this session, Dan was programmed to “crash

The last decade has seen extraordinary progress in the development and refinement of artificial intelligence (AI)–enabled tools for clinical applications.1,2 In cardiovascular medicine, deep learning algorithms using data from echocardiography and electrocardiography (ECG) have demonstrated superhuman performance in tasks typically done by physicians1,3 and identified subtle phenotypes invisible to

Many therapies in cardiovascular disease, including heart failure (HF), are studied in clinical trials that report hazard ratios (HRs) over a follow-up period far shorter than the anticipated treatment duration. The HR has known limitations, and alternative measures, such as restricted mean survival time, have been advocated to summarize survival over limited follow-up.1 However, in chronic diseases

Importance In the last decade, immune checkpoint inhibitors (ICIs) have been approved for the treatment of many cancer types. Immune checkpoint inhibitor–associated myocarditis has emerged as a significant and potentially fatal adverse effect. Recognizing, diagnosing, and treating ICI-associated myocarditis poses new challenges for the practicing clinician. Here, the current literature on ICI-associated

A man in his early 70s with a history of permanent atrial fibrillation treated with atrioventricular junction ablation and biventricular pacemaker implantation was hospitalized with decompensated heart failure and acute kidney injury. His history was notable for nonischemic cardiomyopathy with ejection fraction of 40% and idiopathic pulmonary fibrosis, for which he underwent single-lung transplant

What is the reason for recurrent fever in a patient with a history of thoracic endovascular aortic repair? A woman in her 60s presented with recurrent high fever (>39 °C) and chills for 1 year. She had undergone thoracic endovascular aortic repair for acute type B aortic dissection 9 years ago. Blood cultures returned positive results for Eikenella corrodens. A whole-body scan with [18F]fluoro-2-deoxy-D-glucose

To the Editor Marcusa et al1 have examined the influence of baseline low-density lipoprotein cholesterol (LDL-C) levels on percentage LDL-C reduction with statins, ezetimibe, and PCSK9 inhibition. Using this mode of calculation, they report a higher percentage reduction in LDL-C with evolocumab in patients with lower baseline LDL-C levels, compared with a less marked percentage LDL-C reduction with

In Reply Funck-Brentano raises several questions regarding our analysis of the association between baseline low-density lipoprotein cholesterol (LDL-C) level and the percentage LDL-C reduction with different lipid-lowering therapies.1 He notes that for a given percentage reduction, the absolute reduction will vary depending on the baseline level. This mathematical truism misses the point. It has been

To the Editor In a recent Research Letter, Yang et al1 argue against public reporting of short-term percutaneous coronary interventions (PCI) mortality at the site level for physicians practicing at multiple sites. They state that in New York’s 2014-2016 Percutaneous Coronary Interventions report,2 15 physicians who performed PCI at multiple sites are outliers in one of the sites but only 4 of the

In Reply We appreciate comments on our recent Research Letter1 and the opportunity to respond to the points raised by Hannan and Cozzens. The New York State Department of Health reports are rigorously prepared documents with well-documented statistical methods. We concur with the methodologic points raised by Hannan and Cozzens, and we had acknowledged the report’s provision of the categorical outlier

In the Original Investigation titled “Contemporaneous Comparison of Outcomes Among Patients Implanted With a Leadless vs Transvenous Single-Chamber Ventricular Pacemaker,”1 published online July 28, 2021, the article was changed to open access with a CC-BY-NC-ND license. The article was corrected online.

Mission Statement: JAMA Cardiology publishes exceptional original research, state-of-the-art reviews, and informative opinions that advance the science and practice of cardiology, enhance cardiovascular health, and inform health care policy. JAMA Cardiology is the definitive journal for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. JAMA Cardiology focuses on

Importance Calcium-release deficiency syndrome (CRDS), which is caused by loss-of-function variants in cardiac ryanodine receptor 2 (RyR2), is an emerging cause of ventricular fibrillation. However, the lack of complex polymorphic/bidirectional ventricular tachyarrhythmias during exercise stress testing (EST) may distinguish it from catecholaminergic polymorphic ventricular tachycardia (CPVT). Recently

Importance The use of sacubitril/valsartan is not endorsed by practice guidelines for use in patients with New York Heart Association class IV heart failure with a reduced ejection fraction because of limited clinical experience in this population. Objective To compare treatment with sacubitril/valsartan treatment with valsartan in patients with advanced heart failure and a reduced ejection fraction

Women treated for breast cancer are electing to undergo implant-based reconstruction at increasing rates. In 2014, 54% of patients with invasive breast cancer underwent immediate postmastectomy reconstruction, up from 8% in 1995.1 Higher mastectomy uptake, laws mandating insurance coverage of mastectomy-related procedures, and innovations in reconstructive techniques have been the main drivers of this

To the Editor We read with great interest the article by Agarwal et al1 regarding national trends in heart failure hospitalizations and readmissions from 2010 to 2017. The authors found that the primary heart failure hospitalization declined from 2010 to 2014, followed by an increase from 2014 to 2017. However, it is important to note that 2014 is the time when Medicaid was expanded in many states

In Reply We welcome the letter by Kuno et al demonstrating their interest in our recent article describing national trends in heart failure (HF) hospitalizations and readmissions from 2010 to 2017,1 and we appreciate the comments they raised. We found that crude rates of overall and unique hospitalizations for HF declined from 2010 to 2014, followed by an increase from 2014 to 2017. Additionally, readmission

Importance The diagnostic value is unclear of a 0 coronary artery calcium (CAC) score to rule out obstructive coronary artery disease (CAD) and near-term clinical events across different age groups. Objective To assess the diagnostic value of a CAC score of 0 for reducing the likelihood of obstructive CAD and to assess the implications of such a CAC score and obstructive CAD across different age groups

Among asymptomatic middle-aged to older adults, one of the most sensitive, reliable, and reproducible ways of noninvasively identifying subclinical atherosclerosis is coronary artery calcium (CAC) testing. Numerous studies have demonstrated the robust association between presence and severity of CAC and future risk of cardiovascular disease (CVD).1,2 Conversely, the absence of CAC has been associated

Importance A growing body of evidence suggests that adverse pregnancy outcomes (APOs), including hypertensive disorders of pregnancy, gestational diabetes (GD), preterm birth, and intrauterine growth restriction, are associated with increased risk of cardiometabolic disease and cardiovascular disease (CVD) later in life. Adverse pregnancy outcomes may therefore represent an opportunity to intervene

To the Editor We read with great interest the study conducted by Nestelberger et al1 bringing valuable information in a growing field of translational medicine. As stated by the authors, early discrimination of myocardial infarction (MI) type is of major importance and remains an everyday clinical challenge. They reported early biomarkers to provide modest discrimination in the early diagnosis of MI

In Reply We thank Hayek and colleagues for their interest in our work on cardiovascular biomarkers in the early discrimination of type 2 myocardial infarction (T2MI) from type 1 MI (T1MI).1 We fully agree that patients with T1MI may present earlier than patients with T2MI, resulting in different stages of disease biology during the serial blood sampling in the emergency department (ED).

Importance Respiratory fluoroquinolone antibiotics are some of the most common medications with QT interval–prolonging potential prescribed to patients with hemodialysis-dependent kidney failure—individuals who have a very high risk of sudden cardiac death (SCD). To date, there have been no large-scale, population-specific studies evaluating the cardiac safety of respiratory fluoroquinolones in the

Days at home, an emerging patient-centered outcome that quantifies time spent alive and out of health care facilities, has not been fully described in trials evaluating transcatheter aortic valve replacement (TAVR). We sought to compare the total number of days spent at home within the first year among intermediate-risk patients participating in a randomized clinical trial of TAVR with a self-expanding

In the Original Investigation titled “Sex Differences in Procedural Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion: Insights From the NCDR LAAO Registry,”1 published online August 11, 2021, in JAMA Cardiology, there were errors in Table 3. Some of the crude numbers of the discharge prescription variations were incorrectly switched between women and men in the second and third columns

Importance Heart failure with reduced ejection fraction is a progressive clinical syndrome, and many patients’ condition worsen over time despite treatment. Patients with more severe disease are often intolerant of available medical therapies. Objective To evaluate the efficacy and safety of omecamtiv mecarbil for the treatment of patients with severe heart failure (HF) enrolled in the Global Approach

Importance Preterm delivery has been associated with future cardiometabolic disorders in women. However, the long-term risks of chronic hypertension associated with preterm delivery and whether such risks are attributable to familial confounding are unclear. Such knowledge is needed to improve long-term risk assessment, clinical monitoring, and cardiovascular prevention strategies in women. Objective

A young man nearing the end of his second decade with no significant medical history presented to the emergency department with a 1-day history of intermittent palpitations and chest pain associated with shortness of breath. On presentation, the patient appeared anxious with a heart rate of 101 beats per minute, respiratory rate of 20 breaths per minute, blood pressure of 151/79 mm Hg, and pulse oximetry

To the Editor We read with great interest the article by Roy et al1 describing a new 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) to rule out pulmonary embolism (PE). As recommended by the Scientific and Standardization Committee of the International Society of Thrombosis and Hemostasis,2 the authors predefined the acceptable upper limits of the 95% CI of failure rate at 1.93% and

In Reply We thank Freund et al for their interest in our article1 and for their contribution to the discussion. The 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) strategy leads to an overall very low false-negative rate, the upper limit of the 95% CI being below the threshold recommended by the Scientific and Standardization Committee of the International Society of Thrombosis and Hemostasis

Classic pathobiologic and contemporary hierarchal classification schemes for heart failure (HF) establish the progressive nature of the clinical syndrome of HF. Failure to disrupt this cascade results in the well-described and still pressing burden of morbidity and mortality. Compelling research now informs effective interventions for HF stages A, B, C, and D.1 Yet these 4 partitions are very broad