More children are undergoing congenital or non-congenital cardiac surgery today which can impact outcomes for subsequent thoracic surgery. However, post-lung transplant (LTx) outcomes of children with previous cardiac surgery are unknown, so we explored this important issue using a publicly available database.

A retrospective analysis was performed using the Scientific Registry of Transplant Recipients (SRTR). First-time pediatric LTx candidates without and with history of prior cardiac surgery, excluding previous cardiothoracic transplantation, from 2003 to 2024 were enrolled into our study. Univariate analyses, multivariable Cox regression, and Kaplan-Meier plots were performed for a comprehensive analysis.

We identified 1333 and 144 LTx candidates without and with prior cardiac surgery (52 with congenital surgery, 92 with non-congenital surgery) with more children with cardiac surgery being listed for LTx over time. There were 811 LTx recipients without prior cardiac surgery compared to 63 with prior cardiac surgery (14 congenital, 49 non-congenital). Children with prior congenital cardiac surgery were much younger, and pulmonary vascular disease (PVD) was the most common indication for LTx. Prior non-congenital cardiac surgery did not negatively impact short- or long-term post-LTx outcomes in children. However, history of congenital cardiac surgery was associated with high waitlist mortality (31% compared to 15% (no surgery) and 21% (non-congenital surgery), p < 0.001) and worse long-term outcomes (HR 1.89; 95% CI 1.01, 3.53, p = 0.048).

There is an increasing number of children with previous cardiac surgery undergoing LTx especially in the setting of congenital heart disease with subsequent PVD.

Elevated low-density lipoprotein cholesterol (LDL-C) leads to atherosclerotic plaque buildup and drives cardiovascular disease. Despite the availability of effective therapies for LDL-C reduction, elevated LDL-C is common in the United States.

To measure the success of a pharmacist-led telephonic outreach program designed to proactively address individuals with hyperlipidemia who were not being treated in accordance with cholesterol guidelines and collaborate with their primary care clinicians (PCCs) to increase guideline-based care.

The 3-month outreach occurred from September through November 2023. Health plan members with 1 inpatient or 2 outpatient claims for hyperlipidemia within the previous year were determined using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Members not managed in accordance with the 2018 American Heart Association/American College of Cardiology (ACC)/Multisociety Guideline and 2022 ACC Expert Consensus Decision Pathway, based on available claims data, received a personalized action recommendation. The outreach team contacted the member and scheduled a phone call with a pharmacist. If the member agreed to the pharmacist's clinical recommendation, the outreach team contacted the member's PCC directly (by fax or e-mail). PCCs were responsible for the final clinical decision and action.

Of 14,979 members who met the inclusion criteria, 883 were selected at random for contact by the outreach team. Of these, 667 members (76%) accepted a call with a pharmacist and were considered the intervention group. An additional 5,266 members who were not contacted and did not share a PCC with someone in the intervention group were included as the control group. In the intervention group, 92.4% of members accepted the guideline-based hyperlipidemia recommendation, allowing the pharmacist to contact their PCC. The overall percentage of members moving toward guideline-recommended care in the intervention group (25.5%) was approximately twice that in the control group (11.1%). Members could undergo an LDL-C test if they had no LDL-C result available, initiated lipid-lowering therapy (LLT) if they were not already being treated for hypercholesterolemia, or intensified their existing statin regimen or added a nonstatin LLT. The difference in proportion of members remaining on no statin throughout the program was significantly lower in the intervention group (-7.9% [95% CI = -11.3% to -4.5%]) vs the control group. At the end of the pilot, 8.7% (58 of 667) of intervention group members received LLT in accordance with current guidelines vs 6.0% (316 of 5,266) in the control group.

This study demonstrated that a health plan-driven, pharmacist-led, educational outreach program increased movement toward guideline-based LDL-C management in a 3-month pilot. Similar programs could increase the proportion of members receiving guideline-based care in a variety of chronic disease settings.

Aortic stenosis (AS) increases left ventricular (LV) afterload and systolic pressure (LVSP). Left ventricular myocardial work (LVMW) enables early detection of LV dysfunction. Recent evidence suggests that ID may reduce LVMW parameters, raising the question of whether ID further impairs LV systolic performance in patients with AS undergoing transcatheter aortic valve implantation (TAVI).

We evaluated 100 patients with severe AS scheduled for TAVI between March 2021 and November 2022. All underwent ID screening according to the classic and novel ID definitions and echocardiographic assessment of LVMW before TAVI and at the 1-year follow-up.

Elimination of AS was observed within the 1-year follow-up in the whole population. Despite stable ejection fraction (EF) and global longitudinal strain (GLS), LVMW indices such as global work index (GWI) and global constructive work (GCW) significantly decreased from baseline in the entire population. However, when comparing ID and non-ID patients after the procedure, a statistically significant decrease in GWI and GCW was noted at the 1-year follow-up only in the TSAT > 20% group, not in the TSAT < 20% group. We also noted a significant correlation between TSAT status and echocardiographic as well as LVMW indices. When the classic ID definition was used, all LVMW parameters changed similarly in both groups during follow-up.

TAVI significantly influenced the majority of LVMW indices in the overall study population. Using the standard ID definition, ID had no impact on differences in LVMW indices. However, when defined by TSAT < 20%, patients with ID showed no significant post-TAVI changes in LVMW indices.

Heart failure is becoming an increasingly cause of hospital admissions in the pediatric population, linked to significant morbidity and mortality. Despite advances, end-stage heart disease still causes significant symptoms, extended hospitalizations, and reduced quality of life. Pediatric palliative care (PPC), aimed at improving quality of life through symptom management, emotional support, and advanced care planning, can benefit these children. This project aimed to establish specialized PPC services for children with heart failure, regardless of their care goals, at a tertiary care and transplant center in Saudi Arabia. This project is presented with a retrospective review spanning from July 1, 2019, to June 30, 2024. The steps toward integration included (1) assessing gaps, (2) developing services, (3) setting up a referral system, (4) raising awareness, (5) implementing the program, and (6) measuring outcomes. Of the 47 children included, the average age was 10 years (SD = 4), half had a transplant, and 20 (42.6%) died during the period. The main issues were family distress (100%), children's mood issues and anxiety (59.6%), and pain (40.4%). Implementing PPC improves quality of life and ensures medical care aligns with family values. Children's emotional distress, parental anxiety over the disease's unpredictable course, and aggressive end-of-life care are key issues to address.

Growth differentiation factor-15 (GDF-15) is a stress-responsive biomarker implicated in inflammation and myocardial injury. Its prognostic value for mortality risk in acute heart failure (AHF) remains uncertain. This meta-analysis evaluated the association between elevated admission circulating GDF-15 levels and subsequent mortality in patients hospitalized with AHF.

PubMed, Embase, and Web of Science were systematically searched for prospective or retrospective cohort studies and post-hoc trial analyses enrolling adult AHF patients with blood GDF-15 measured on admission. Risk ratios (RRs) for all-cause mortality comparing high versus low GDF-15 categories were pooled using random-effects models incorporating the influence of potential heterogeneity.

Ten studies with 3724 patients with AHF were included. Overall, high admission GDF-15 levels were significantly associated with increased mortality risk during follow-up (RR = 2.82, 95% CI: 2.39-3.32; p < 0.001), with no evidence of between-study inconsistency (I² = 0%). Sensitivity analyses confirmed robustness (leave-one-out RR range: 2.73-3.00), and results remained consistent in high-quality studies (NOS ≥ 8; RR = 2.72, 95% CI: 2.26-3.27). Subgroup analyses demonstrated similar associations across Asian and Western cohorts, prospective and retrospective designs, different sampling times (at admission to within 48 h), assay methods (ELISA vs. ECLIA), cutoff definitions, follow-up duration, and adjustment for BNP/NT-proBNP (all p for subgroup differences >0.05). No significant publication bias was detected (Egger's p = 0.59).

Elevated circulating GDF-15 levels at admission are strongly associated with increased mortality risk in patients with AHF, supporting its potential role in early risk stratification.

Hypertension is more prevalent among individuals with disabilities than in the general population. This study analyzed long-term trends in disparities in hypertension care quality and the incidence of hypertensive complications among individuals with and without disabilities.

This retrospective cohort study followed 52,743 hypertensive patients aged 20 or older with disabilities newly diagnosed in 2010, along with 47,564 age- and sex-matched patients without disabilities, from 2011 to 2019. Hypertension care quality was assessed using indicators of medication adherence and the completion of three complication-monitoring tests at recommended frequency: blood test, urine test, and electrocardiogram (ECG). Hypertensive complications included major cardiovascular and cerebrovascular events, kidney diseases, and all-cause mortality. Logistic regression was repeated annually to assess hypertension care quality, and Cox-proportional model was used to estimate the risk of hypertension-related complications.

Hypertensive patients with disabilities consistently demonstrated lower medication adherence throughout the study period (adjusted odds ratio [aOR], 0.90-0.96, depending on the year), but a higher likelihood of undergoing screenings at recommended frequency (e.g., aOR for blood test, 1.31-1.39, for urine test, 1.24-1.33, and for ECG, 1.30-1.37). The risk of complications remained significantly higher among hypertensive patients with disabilities, even after adjusting for care quality indicators (e.g., adjusted hazard ratio for cardiovascular events: 1.36, 95% confidence interval: 1.31-1.41). Subgroup analyses revealed that the excess risks for complications varied across different sociodemographic groups.

These findings underscore the need for comprehensive strategies to enhance medication adherence among hypertensive patients with disabilities. Additionally, other factors beyond medication adherence and monitoring test completion that contribute to the increased risk of complications require further exploration.

Cardiac rehabilitation (CR) is a critical secondary prevention strategy for patients with acute myocardial infarction (AMI). Although CR has been covered by the National Health Insurance in Korea since 2017, real-world participation remains suboptimal. We assessed trends in CR participation over the past 5 years and identified factors associated with non-participation in treatment.

This retrospective observational study analyzed data from the National Health Insurance Service claims database between 2018 and 2022. Patients aged ≥ 40 years who were hospitalized for AMI and received acute-phase interventions, such as thrombolysis, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG), were included. CR participation was defined as having at least one claim for education, assessment, or treatment services. Multivariable logistic regression was conducted to identify factors associated with non-participation in CR treatment, focusing on patients who received care at CR-providing institutions, to minimize confounding related to institutional availability.

In total, 109,436 patients were included. Overall participation rates in CR education, assessment, and treatment increased from 2018 to 2022. However, sustained participation in outpatient treatment remained low, with only 5.7% of patients in 2022 completing ≥ 11 treatment sessions. Factors associated with lower treatment participation included the absence of prior education and assessment, lower socioeconomic status, undergoing PCI rather than CABG, and receiving care at non-tertiary hospitals. Regional disparities and inadequate institutional infrastructure further contributed to reduced access to CR services.

Although CR participation among patients with AMI in Korea has gradually increased, treatment continuity remains suboptimal. To enhance CR utilization, policy efforts should prioritize reducing patient burden, addressing provider-level barriers, and promoting equitable access through financial support mechanisms and infrastructure expansion.

Andexanet alfa is a reversal agent for factor Xa (FXa) inhibitors (rivaroxaban and apixaban) and is available for the treatment of severe FXa inhibitor-associated bleeding. However, an increase in thrombotic events after administration has been reported.

This multicenter Dutch observational study aimed to provide insights into the characteristics, usage patterns, and clinical outcomes of the Dutch patient population treated with andexanet alfa.

We included all patients treated with on- and off-label andexanet alfa from 6 of the 11 hospitals in the Netherlands that prescribed andexanet alfa between June 2019 and December 2023. Data were collected by LOGEX, a Dutch healthcare data company, using healthcare administrative data and questionnaires completed by clinicians at participating centers. Patient characteristics, details related to andexanet alfa administration, and 30-day clinical outcomes, including thrombotic events and all-cause mortality, were collected.

A total of 217 patients received andexanet alfa, including 192 treated on-label and 25 off-label. In the on-label group, the median age was 77 years (IQR, 69-82 years), and intracranial hemorrhage was the most common indication for reversal (61%). Most patients received a low dose (≤1000 mg) and were administered andexanet alfa within 4 hours of hospital admission (79%). The overall 30-day cumulative incidence of thrombotic events was 4.6%, and no thrombotic events occurred after anticoagulation was reinitiated. All-cause mortality was 34%, with similar rates between the on- and off-label groups.

Andexanet alfa was primarily prescribed for the reversal of FXa inhibitors in patients with intracerebral hemorrhage. We observed a lower incidence of thrombotic events than reported in clinical trials.

To evaluate associations between endoscopic features and hospitalization outcomes in IgA vasculitis (IgAV) with gastrointestinal (GI) involvement, focusing on endoscopic subtypes associated with prolonged hospitalization.

We analyzed 132 IgAV patients with GI involvement and complete endoscopic data at a large-volume center (January 2019 to December 2024). Clinical manifestations, endoscopic characteristics, laboratory data, and abdominal imaging findings at admission were reviewed. Prolonged length of stay (LOS) was defined as LOS exceeding the 75th percentile (>13 days). Multivariable logistic regression and gamma regression (log link) were used to examine factors associated with prolonged LOS and LOS as a continuous outcome. Sensitivity analyses additionally adjusted for treatment variables and renal involvement. Laboratory parameters were compared across endoscopic subgroups in exploratory analyses.

The median age of the patients was 18 years (IQR: 15.0-45.5), with a male-to-female ratio of 2:1. Abdominal pain was the most common presenting symptom. Bowel wall thickening was the most frequent finding on abdominal imaging. The most prevalent endoscopic finding was congestion/edema, followed by erosions, ulcers, and petechiae/ecchymosis. Endoscopic ulceration (OR 2.40, 95% CI 1.09-5.27, p=0.029) and multi-segment GI involvement (OR 2.58, 95% CI 1.20-5.58, p=0.016) were independently associated with prolonged LOS. Gamma regression showed that ulceration was associated with a 27.7% longer LOS (RR 1.277, 95% CI 1.047-1.564, p=0.018) and multi-segment involvement with a 34.7% longer LOS (RR 1.347, 95% CI 1.035-1.748, p=0.025). The association with ulceration remained significant after adjusting for treatment factors, whereas the association with multi-segment involvement was attenuated. The association of ulceration with LOS was more pronounced in patients aged ≤18 years. In sensitivity analyses, additional adjustment for renal involvement did not materially change the associations between endoscopic features and LOS.

In IgAV with GI involvement, endoscopic ulceration is the endoscopic feature most consistently associated with longer hospitalization, and the association appears stronger in patients aged ≤18 years. Multi-segment involvement shows a weaker association that attenuates after treatment adjustment. Overall, these findings support the clinical value of endoscopic phenotyping to inform clinical assessment and should be interpreted as associations rather than prognostic predictions.

Neonatal brain injury, such as hypoxic-ischemic encephalopathy (HIE), is a leading cause of infant mortality and long-term neurodevelopmental disabilities. Current clinical therapeutic strategies are limited by the blood-brain barrier (BBB), the complexity of the injury cascade, and the narrow therapeutic window. Nanomedicine has shown potential in preclinical studies for overcoming these barriers by leveraging its unique nanoscale characteristics and engineerability design to load, stabilize, and deliver vulnerable biomacromolecules across the compromised BBB to the lesion site. This review presents the first systematic horizontal comparison and critical evaluation of the major nanoplatforms employed in neonatal brain injury therapy. Based on data derived primarily from animal models, we analyze the heterogeneity across studies in model systems, administration routes, and efficacy endpoints, revealing common challenges in the field regarding long-term safety, manufacturability, and reproducibility. This review aims to provide guidance for selecting appropriate nanoplatforms to facilitate the translational advancement of this field toward clinical applications.