Online health communities (OHCs) provide vital peer support and health information to individuals managing chronic conditions. However, sustained user engagement remains challenging, with many users reducing activity over time despite the ongoing benefits these platforms offer. While some individuals may improve or become more knowledgeable, sustained engagement remains critical because ongoing participation fosters trust, peer support, and continuous access to evolving health information that may persist beyond initial recovery or learning. Hence, it is important to consider how community needs evolve as users' health needs and information-seeking behaviors change to inform how we support users through different stages of their health and participation journeys.

The aim of the study is to examine user engagement in a large OHC, identifying perceived stage-based behaviors, motivation, barriers, and design opportunities that could facilitate progression between stages and enhance long-term participation.

We conducted semistructured interviews with 19 members of the American Heart Association Support Network Community. Participants were patients or survivors managing various cardiovascular diseases. Using narrative thematic analysis, we examined users' perceived engagement motivation, behavior, challenges, and design opportunities across different stages of their community involvement.

This study highlighted 4 distinct engagement stages: discovery (crisis-driven initial engagement), exploration (navigation and orientation), commitment (active engagement and information management), and integration (sustained engagement and mentorship). Key barriers included information architecture complexity, concerns about misinformation, limited support for role transitions, and decreased participation as health management improved. Participants identified opportunities through which OHCs could increase long-term engagement, including adaptive recommendation systems, health information literacy programs, structured role transition support, and alternative engagement modalities, such as synchronous interactions and health tracking tools.

User engagement in OHCs is dynamic and evolves with changes in health status, knowledge, and personal circumstances. Supporting sustained engagement requires stage-appropriate interventions, including personalized content delivery, health information literacy education, structured pathways for role transitions, and diversified engagement options. These findings provide actionable insights for designing OHCs that better support users throughout their health journey.

Early differentiation of acute cerebrovascular conditions is important for timely clinical management, while blood-based markers that could complement established diagnostic approaches remain under investigation. This exploratory case-control study evaluated the circulating expression and diagnostic performance of seven candidate microRNAs (miRNAs) in acute ischemic stroke (AIS), hemorrhagic stroke (HS), and transient ischemic attack (TIA) during the first 12 h after symptom onset. The study included 200 participants: 50 patients with AIS, 50 with HS, 50 with TIA, and 50 controls. Plasma was collected from the clinical groups at 3-4.5 h and 12 h after symptom onset and from controls at a single time point. Expression levels of let-7e-5p, miR-21-5p, miR-107, miR-125b-5p, miR-130a-3p, miR-143-3p, and miR-222-3p were measured using real-time quantitative polymerase chain reaction (RT-qPCR). Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis and binary logistic regression. let-7e-5p showed the most consistent expression pattern, with lower levels in AIS, HS, and TIA than in controls at both sampling time points. miR-107 was lower in AIS and HS than in controls at both time points, whereas miR-125b-5p showed a predominantly AIS-related pattern. Among comparisons with controls, let-7e-5p yielded the highest individual area under the ROC curve (AUC), reaching 0.867 for AIS at 12 h, whereas miR-222-3p yielded the highest individual AUC for AIS versus HS (0.833 at 12 h). Multi-miRNA models did not significantly improve discrimination over the best-performing individual markers. In the complete-case subset, adding let-7e-5p to a model comprising routinely available clinical variables was associated with a higher AUC for AIS versus controls (0.982) than either component alone. Overall, the observed expression and discrimination patterns support further investigation of circulating miRNAs as complementary markers in acute cerebrovascular disease. Prospective evaluation in larger, independent cohorts, including patients with stroke-mimicking conditions, is needed to determine their diagnostic performance and incremental value in real-world clinical settings.

Adiponectin circulates as multimers with potentially distinct biological roles, yet most human studies report total adiponectin, which may mask multimer-specific metabolic information. This study aimed to determine whether circulating low- (LMW) and medium-molecular-weight (MMW) adiponectin and their relative pattern are associated with cardiometabolic, behavioral, and chrononutrition characteristics in adults undergoing screening for the RIO Study.

In this cross-sectional study, 112 adults who completed the screening assessment for the RIO Study underwent anthropometric/body-composition assessment, fasting biochemistry, self-reported physical activity and sitting time, and chrononutrition evaluation. Serum adiponectin multimers were quantified by Western immunoblotting; under the present experimental conditions, only low-molecular-weight (LMW) and medium-molecular-weight (MMW) multimers were consistently detectable. Associations were assessed using Pearson correlations, adjusted multiple linear regression, and principal component analysis (PCA). Exploratory correlations suggested associations of MMW adiponectin and the MMW/LMW ratio with several anthropometric and metabolic variables. However, after multivariable adjustment, most associations with adiposity and lipid variables were attenuated, whereas inverse associations with GGT and ALT persisted. MMW adiponectin remained inversely associated with GGT (β=-0.37, p < 0.001) and ALT (β=-0.32, p = 0.002). Physically active participants had higher MMW adiponectin and MMW/LMW ratios than inactive participants (FDR-adjusted p < 0.05). Exploratory PCA identified five components with eigenvalues >1, together explaining 66.6% of the total variance. LMW and MMW adiponectin contributed to the multivariate structure, including a shared adiponectin-related component.

In this cardiometabolic screening cohort, MMW adiponectin and the MMW/LMW ratio showed persistent inverse associations with selected liver-enzyme measures, particularly GGT and ALT, after adjustment for potential confounders. These exploratory findings support further investigation of LMW and MMW adiponectin as metabolic biomarkers using longitudinal and interventional designs.

Insufficient evidence exists for the association between serum dimerized plasmin fragment D (D-dimer), a biomarker for screening thromboembolic diseases, and adverse outcomes in patients with heart failure (HF).We investigated the association between serum D-dimer and the risk of readmission and all-cause mortality in patients with HF.

We enrolled 1575 patients hospitalized with HF in China between 2016 and 2019. We explored the smooth curve of the nonlinear relationship between serum D-dimer and adverse outcomes. Logistic regression and saturation threshold analyses were also conducted.

Smooth curve analysis revealed an inverted U-shaped association between serum D-dimer concentrations and 6-month all-cause mortality. The turning point for serum D-dimer concentration in patients with HF in the highest 6-month mortality risk group was 7.6 mg/L. Among patients with a D-dimer concentration below 7.6 mg/L, each 1-mg/L increase in D-dimer concentration independently contributed to a 20% higher risk for all-cause mortality, independent of other clinical covariates. Regarding readmission risk, smooth curve analysis supported an obvious relationship between serum D-dimer and 6-month readmission risk. Surprisingly, each 1-mg/L increase in D-dimer concentration was independently associated with a 4% lower risk for readmission within 6 months.

Elevated serum D-dimer concentrations have a strong association with increased risk for 6-month mortality, providing evidence for early risk stratification in HF prognosis.

Abnormal oxygenation may influence thrombosis, but evidence in catheterized critically ill patients remains limited. We examined whether the first arterial partial pressure of oxygen (PaO2) measured within 24 hours after qualifying invasive venous catheter insertion was associated with documented acute upper-body deep or central venous thrombosis during hospitalization. This retrospective observational cohort study used the Medical Information Mart for Intensive Care IV database, version 2.2 (MIMIC-IV v2.2) (2008-2019). Adult intensive care unit admissions were included when a qualifying invasive venous catheter was present and an arterial PaO2 measurement was obtained after insertion, within 24 hours, and while the catheter remained in situ. PaO2 was analyzed continuously and categorically (≤80, 81-100, and >100 mmHg). Logistic regression models sequentially adjusted for patient characteristics, laboratory measurements, catheter characteristics, measurement timing, inspired oxygen concentration, respiratory support, and non-respiratory organ dysfunction. Multiple imputation addressed missing covariate data, and patient-clustered robust standard errors accounted for repeated admissions. The cohort included 11,277 hospital admissions from 10,789 patients; 195 admissions (1.73%) had the primary outcome. In the unadjusted model, higher PaO2 was associated with lower odds of the outcome (odds ratio [OR] per 10-mmHg increase, 0.970; 95% confidence interval [CI], 0.952-0.987), but this association attenuated after adjustment. In the fully adjusted model, PaO2 was not associated with the outcome (OR, 1.008; 95% CI, 0.989-1.027; P = 0.430). Most secondary analyses supported the primary result, although the 60-minute sensitivity analysis yielded adjustment-dependent estimates. In the complete cohort, a single early post-insertion PaO2 measurement was not independently associated with documented acute upper-body deep or central venous thrombosis. These findings do not support PaO2-based thrombosis risk stratification or modification of oxygen therapy for thrombosis prevention. Future studies should incorporate repeated oxygenation measurements and accurately timed, imaging-confirmed thrombotic outcomes.

The optimal timing of mitral valve (MV) surgery in patients with asymptomatic severe primary mitral regurgitation (MR) remains uncertain because randomized clinical trials are lacking.

To evaluate the association of early MV surgery with long-term survival in patients with asymptomatic severe primary MR using a target trial emulation framework.

This cohort study used a clinical valve registry from 3 tertiary hospitals in South Korea between 2000 and 2022. Patients with asymptomatic severe primary MR were analyzed using a clone-censor-weight approach to emulate a target trial. A 6-month grace period after diagnosis was used to define treatment strategies. This analysis was conducted from September 2024 to January 2025.

Early MV surgery (within 6 months of diagnosis) vs watchful waiting.

The primary outcome was all-cause mortality and the secondary outcome, a composite of all-cause mortality or heart failure hospitalization. Inverse probability of censoring-weighted estimates of the per-protocol effect size included restricted mean survival time (RMST) differences as the primary measure and hazard ratios (HRs) as secondary measures.

Among 802 patients (mean [SD] age, 55 [16] years; 476 men [59%]), 344 underwent early surgery, and 458 received watchful waiting. During a median (IQR) follow-up of 7.4 (4.1-11.6) years, 27 deaths occurred in the early surgery group and 103 in the watchful waiting group. At 5 years, early surgery was associated with an RMST gain of 66 days (95% CI, 19-129 days). The survival benefit persisted up to 15 years. Early surgery was also associated with a lower risk of all-cause mortality compared with watchful waiting (HR, 0.69; 95% CI, 0.41-0.94; P = .02). Similar associations were observed in patients without left ventricular decompensation (HR, 0.61; 95% CI, 0.31-0.96; P = .04) and in those with degenerative MR (HR, 0.66; 95% CI, 0.36-0.98; P = .04).

In this multicenter cohort study with a target trial framework, early surgery was associated with improved long-term survival among patients with asymptomatic severe primary MR. These findings support consideration of earlier surgical intervention in contemporary clinical practice.

Long-term nursing home residents with atrial fibrillation (AF) and activities of daily living (ADL) disability are at high risk of bleeding and death, making the net benefit of anticoagulation uncertain.

To compare the association of oral anticoagulant (OAC) use vs nonuse with ischemic stroke and major bleeding in long-term nursing home residents with AF and ADL disability.

This cohort study used US Medicare claims linked with the Minimum Data Set (January 1, 2013, to December 31, 2022). Nursing home residents with nonvalvular AF and impairment in 3 or more ADLs were included. Three cohorts comparing use of apixaban, rivaroxaban, or warfarin with nonuse were constructed using incidence-density sampling.

Initiation of apixaban, rivaroxaban, or warfarin use.

Primary outcomes were ischemic stroke, major bleeding, and their composite. Propensity score (PS) matching balanced 111 covariates. Adjusted rate ratios (ARRs) with 95% CIs were estimated. Tipping-point analyses assessed the relative weighting ischemic stroke vs major bleeding required to favor anticoagulation. Direct active-comparator analyses compared apixaban with rivaroxaban and warfarin.

The study comprised 26 940 nursing home residents (median [IQR] age, 82 [74,88] years; 17 504 [65.0%] female), including PS-matched cohorts of 7600 residents receiving apixaban, 2654 receiving rivaroxaban, and 3216 receiving warfarin. Compared with nonuse, use of all OACs was associated with lower rates of ischemic stroke (apixaban: ARR, 0.53; 95% CI, 0.38-0.73; rivaroxaban: ARR, 0.48; 95% CI, 0.27-0.87; warfarin: ARR, 0.47; 95% CI, 0.25-0.88) and higher rates of major bleeding (apixaban: ARR, 1.62; 95% CI, 1.29-2.03; rivaroxaban: ARR, 2.68; 95% CI, 1.84-3.93; warfarin: ARR, 3.02; 95% CI, 2.15-4.25). Only apixaban was not associated with a higher composite outcome (ARR, 1.08; 95% CI, 0.90-1.30), whereas rivaroxaban (ARR, 1.62; 95% CI, 1.20-2.18) and warfarin (ARR, 1.99; 95% CI, 1.50-2.63) were associated with higher rates. Findings were consistent across frailty strata, although stroke reduction with apixaban was attenuated among frail individuals. Tipping-point analyses indicated a more favorable benefit-risk balance for apixaban than for rivaroxaban or warfarin.

Among nursing home residents with AF and ADL disability, OAC use was associated with lower ischemic stroke but higher major bleeding rates than nonuse. Apixaban demonstrated the most favorable benefit-risk profile among the OACs evaluated. These findings may inform individualized anticoagulation decisions.

The effects of benzodiazepines (BZDs) for insomnia on heart failure (HF) remain unclear, particularly among high-risk populations. Relevant studies were retrieved by searching seven databases from inception to August 7, 2025. Hazard ratios (HRs) or risk ratios estimated for related HF outcomes were extracted. Meta-analyses were conducted using a random-effects model, and study quality was assessed using the Newcastle-Ottawa Scale (NOS). Eleven studies met the inclusion criteria, with follow-up durations ranging from 180 days to 15 years. The meta-analysis demonstrated that BZD use was associated with increased risks of HF incidence (HR = 1.41, 95% confidence interval (CI) 1.16-1.72) and HF hospitalization (HR = 1.29, 95% CI 1.01-1.65) compared to non-use. BZD use also suggested an increased risk of HF hospitalization and rehospitalization compared to antipsychotics, z-drugs, and suvorexant. Benzodiazepine use was associated with an increased risk of HF-related outcomes. Since most of the included studies were observational, these findings indicate associations rather than causal relationships. BZDs should be used with caution among populations at risk of HF when treating insomnia.

Heart failure with preserved ejection fraction (HFpEF) clinical trials suffer from high rates of attrition due to a biological mismatch between preclinical models and patients. While clinical HFpEF is fundamentally driven by advanced age, female sex, systemic inflammation, and progressive myocardial stiffness, preclinical screening still relies predominantly on young male rodents or foetal-like pluripotent stem cell derivatives. In this perspective, we propose a modular and testable geriatric engineering framework for reconstructing the myocardial features of this disease in vitro. The framework integrates four pathogenic drivers: inducible nuclear senescence to mimic ageing-like phenotypes, post-menopausal estrogen withdrawal, programmable biomaterial-driven stiffness, and macrophage-mediated immune activation. De-risking HFpEF drug development requires deliberately engineering this target pathophysiology, ensuring candidate compounds are evaluated against the biology of the ageing myocardium. Because such platforms isolate myocardial phenotypes from the broader multisystem clinical syndrome, we outline the strict model inputs, functional outputs, and clinical benchmarking criteria required to establish their translational validity.

The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for managing patients with acute coronary syndromes (ACS) is the first major update since the 2013-2015 ST-elevation myocardial infarction (STEMI) and non-ST elevated myocardial infarction (NSTEMI) guidelines. It brings both conditions together into a single framework. This review covers the most important new and revised recommendations and points out where evidence is still lacking.

New findings show that several significant updates are based on recent large-scale trials. The use of bivalirudin with high-dose infusion after percutaneous coronary intervention (PCI) is now given a Class I recommendation for primary PCI in the case of STEMI, as a result of the BRIGHT-4 trial. Complete revascularization is also now recommended as Class I for stable STEMI patients who have multivessel disease, according to the COMPLETE trial. For a selected group of patients with refractory cardiogenic shock resulting from a myocardial infarction, the percutaneous microaxial flow pump has received a new Class IIa recommendation from the DanGer Shock trial, while the intra-aortic balloon pump and extracorporeal membrane oxygenation are classified as Class III for routine use. Intracoronary imaging (intravascular ultrasound and optical coherence tomography) is now given a Class I recommendation for complex PCI, based on the data of the RENOVATE-COMPLEX-PCI, OCTOBER, and OCTIVUS trials. The guidelines also suggest specific low-density lipoprotein cholesterol (LDL-C) targets, and non-statin drugs should be added if the LDL-C level remains above 70 mg/dL even when maximum statin therapy is used. Regarding antiplatelet therapy, ticagrelor or prasugrel is now preferred to clopidogrel in the case of ACS-PCI, and it is formally recommended to switch to P2Y12 monotherapy at one month in patients at high risk for bleeding as an alternative to standard DAPT. The updates indicate a shift towards more potent antiplatelet therapy at hospital presentation, use of radial access when feasible, more use of imaging-guided PCI, stricter lipid targets, and more refined antiplatelet approaches at the time of discharge. That said, significant gaps in the evidence still exist. It has not yet become clear whether physiology-guided revascularization of non-culprit arteries in patients with STEMI or NSTEMI is better than angiography-guided PCI-a question that is currently being investigated in the randomized COMPLETE-2 trial. The optimal time to provide mechanical circulatory supper in cases of cardiogenic shock remains uncertain. The recent neutral findings from intracoronary imaging studies such as OPTIMAL and IVUS-CHIP might alter the existing Class I recommendation. Lastly, new data from the HOST-EXAM, and SMART CHOICE 3, studies suggest that P2Y12 monotherapy may be better than aspirin for the long-term prevention of major adverse cardiovascular events, and this could influence future guideline recommendations for long term antiplatelet therapies in the chronic phase.