JACC This Week

JACC: Associate Editor Michelle M. Kittleson, MD, PhD, FACC, talks with authors Scott Solomon, MD, FACC and. Marianna Fontana, MD, about their study published in JACC and presented at AHA. Outpatient worsening heart failure (HF) (oral diuretic intensification or initiation) is simple to assess and has been shown to be prognostic of mortality in patients with ATTR-CM. In this pre-specified analysis of a contemporary ATTR-CM population, patients with outpatient worsening HF had an increased risk of all-cause mortality and CV events and all-cause mortality, as well as greater deterioration in assessments of functional capacity, health status, and quality of life. Vutrisiran significantly reduced the risk of outpatient worsening HF and the composite of outpatient worsening HF, all-cause mortality, and recurrent CV events compared with placebo.

JACC Deputy Editor Erica S. Spatz, MD, FACC, joins author Rishi Wadhera, MD, to discuss his paper on rural and urban differences in cardiovascular mortality in the United States, and the impact of the COVID-19 pandemic.

JACC Associate Editor Muthiah Vaduganathan, MD speaks with author Ambarish Pandey, MD about the LookAHEAD trial published in JACC and presented at AHA. Among adults with T2D and overweight/obesity in the Look Action for Health in Diabetes (AHEAD) trial, an intensive lifestyle intervention targeting weight loss led to sustained reductions in hs-cTnT at 1- and 4-year follow-up, and a rise in NT-proBNP at 1 year that attenuated at 4 years. After accounting for baseline biomarker levels and baseline and changes in risk factors, longitudinal increase in NT-proBNP was associated with higher risk of ASCVD and incident HF. In contrast, increase in hs-cTnT was significantly associated with ASCVD but not incident HF.

JACC: Associate Editor Celina Yong, MD, interviews author Jacob Eifer Møller, PhD about his DANGER SHOCK paper presented at AHA and published in JACC. The DanGer Shock trial demonstrated reduced mortality in patients with STEMI-related cardiogenic shock treated with a microaxial flow pump (mAFP). This secondary analysis assessed whether age affected survival benefits. Mortality increased incrementally with age, and age was independently associated with outcome. Spline analysis suggested that the risk of mortality was higher in the standard-care group for patients below 77 years, whereas patients aged 77 or older had a higher predicted risk in the mAFP group. Thus, elderly patients may not attain the same benefit from routine treatment with a mAFP as younger patients.

JACC Associate Editor Marc P. Bonaca, MD, FACC, has a discussion with author Sotirios Tsimikas, MD, FACC about this study on phospholipids presented at AHA and published in JACC. In MESA, both OxPL-apoB and Lp(a) were independently associated with prevalent AVC with a significant interaction between the two (p less than 0.01). OxPL-apoB and Lp(a) were associated with incident AVC at 9.5 years when evaluated independently (interaction p less than 0.01). The OxPL-apoB*Lp(a) interaction demonstrated higher odds of prevalent and incident AVC for OxPL-apoB with increasing Lp(a) levels. In the meta-analysis, both OxPL-apoB and Lp(a) were independently associated with faster increase in Vmax, but when evaluated together, only OxPL-apoB remained significant. OxPL-apoB is an independent predictor of the presence, incidence and progression of AVC and established AS and represents a novel therapeutic target for CAVD.

JACC Associate Editor Xiaoxi Yao, MPH, MS, PhD, FACC, interviews author Shaan Khurshid, MD and Ezimamaka Ajufo, MD, about their study on sedentary behavior presented at AHA and published in JACC. Beyond serving as a marker for insufficient physical activity, sedentary behavior may directly affect risk of future cardiovascular (CV) disease. In 89,530 UK biobank participants, greater accelerometer-measured sedentary time was associated with higher incidence of adverse CV events. Associations with sedentary time were particularly robust for HF and CV mortality, where risk inflected at approximately 10.6 hours/day and remained apparent even among individuals meeting guideline-recommended levels of moderate-to-vigorous physical activity. Future guidelines focused on sedentary behavior should emphasize the importance of avoiding excess sedentary behavior, even among individuals who are active.

JACC Associate Editor Seng Chan You, MD, and author Hiroki Ueyama, MD discuss this study presented at AHA and published in JACC. NCDR study finds a steady decline in P2Y12 inhibitor pretreatment for NSTE-ACS in the US, but significant variability persists among operators, institutions, and regions. This practice was not associated with any benefits but was linked to a longer length of stay among those undergoing CABG, underscoring the importance of maintaining efforts to integrate evidence into clinical practice.

JACC Associate Editor Jason H. Wasfy, MD, MPhil, FACC interviews author Vinay Kini, MD, FACC about this hospital integration study published in JACC and presented at AHA. Cardiologist employment by hospitals is increasing, but the impact on care quality is not well understood. The study identified cardiologists who cared for acute myocardial infarction or heart failure patients between 2008-2019. Outcomes were compared for patients treated by cardiologists who switched to hospital employment versus cardiologists who remained independent. The proportion of hospital-employed cardiologists increased from 26% in 2008 to 63% in 2019. The study found no differences in clinical outcomes (e.g., 30-day mortality) or most quality-of-care metrics between patients treated by hospital-employed versus independent cardiologists. The results do not support purported benefits of hospital employment on care quality.

JACC Deputy Editor Erica S. Spatz, MD, FACC, joins author Rishi Wadhera, MD, to discuss his paper on rural and urban differences in cardiovascular mortality in the United States, and the impact of the COVID-19 pandemic.

In this episode, Dr. Valentin Fuster reviews a study on the impact of long-term drug treatment discontinuation in heart failure patients with reduced ejection fraction. He breaks down four pathways of drug withdrawal—ranging from immediate clinical worsening to long-term deterioration—emphasizing the importance of avoiding unnecessary interruptions in treatment to prevent significant health risks.