Catheter ablation (CA) has become a first-line option for rhythm control strategy for atrial fibrillation (AF) and atrial flutter (AFL). We synthesize recent evidence regarding racial and ethnic disparities in CA utilization in the United States and examine the structural mechanism driving them.

Black patients are 28 to 36% less likely to undergo CA for AF or AFL compared to White patients, with similarly reduced odds (22 - 35%) observed among Hispanic and Asian patients for AF. While subgroup analysis from clinical trials like CABANA demonstrate survival benefits of CA among minority cohorts, real-world data reveal that the very populations that stand to benefit the most are the least likely to receive CA. Public insurance models, upstream referral bottlenecks, geographic specialty deserts, and clinician-level implicit bias serve as primary structural drivers of these disparities. Racial and ethnic gaps persist in CA utilization and outcomes for both AF and AFL. AF/AFL prevalence is influenced by racial and ancestral biology while CA access disparity is driven by race as a social construct. These two phenomena require fundamentally different investigative frameworks and intervention targets.

Myocardial ischemia-reperfusion (I/R) injury remains a major limitation in cardiovascular therapy, where restoration of blood flow paradoxically initiates oxidative stress, inflammation, mitochondrial dysfunction, and cardiomyocyte death. Although multiple pharmacological strategies have been investigated, clinical translation remains limited by inconsistent efficacy and incomplete pathway coverage. Quercetin, a naturally occurring flavonoid with pleiotropic biological activity, has attracted increasing interest as a potential modulator of I/R-associated injury. This systematic review evaluated current evidence regarding the cardioprotective effects and mechanistic actions of quercetin in myocardial I/R injury. A structured literature search identified 25 eligible studies comprising predominantly preclinical in vivo animal investigations, together with limited ex vivo, in vitro, and clinical evidence. Across studies, quercetin consistently reduced infarct size, attenuated myocardial injury biomarkers, and improved cardiac functional parameters. Mechanistically, these effects were associated with suppression of oxidative stress and inflammatory signaling, particularly through modulation of ROS generation, NF-κB activation, PI3K/Akt signaling, mitochondrial dysfunction, and apoptosis-related pathways. Several studies also demonstrated preservation of endogenous antioxidant systems and mitochondrial integrity. However, substantial heterogeneity in experimental design, limited mitochondrial-specific analyses, and the scarcity of comparative clinical studies remain major barriers to translation. Collectively, current evidence supports quercetin as a multi-pathway cardioprotective candidate in myocardial I/R injury, although further standardized and clinically oriented investigations are required to clarify its therapeutic relevance.

Hyperkalemia is a potentially life-threatening electrolyte disturbance, particularly in older adults with comorbidities. Hyperkalemia can trigger fatal arrhythmias and contribute to sudden cardiac death (SCD). However, national trends in hyperkalemia-related SCD remain poorly defined, especially in the aging US population.

We conducted a cross-sectional analysis using CDC WONDER mortality data from 1999 to 2020. Deaths were identified using ICD-10 codes for SCD (I46.1, I46.9) as the underlying cause and hyperkalemia (E87.5) as a contributing cause. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 US standard population. Joinpoint regression was used to assess temporal trends and estimate annual percentage changes (APCs). Analyses were stratified by sex, age, race/ethnicity, region, urbanization, and state.

Between 1999 and 2020, 36 607 hyperkalemia-related SCD deaths were recorded. The national AAMR more than doubled, from 0.65 to 1.32 per 100 000. Mortality was stable from 1999 to 2009 (APC -1.09%, p = 0.0566) but rose significantly from 2010 to 2020 (APC +5.02%, p < 0.0001). Males, Black individuals, and residents of the South and Midwest had the highest AAMRs and steepest increases. Rural areas consistently showed higher mortality than urban ones. Though most deaths occurred in older adults, significant increases were observed in younger adults (25-44 years) in the last decade. Nevada, Rhode Island, and California had the highest state-level rates.

Hyperkalemia-related SCD mortality has risen substantially, with marked disparities by sex, race, geography, and age. These trends underscore the need for improved potassium monitoring, risk stratification, and equitable healthcare access to reduce preventable deaths.

Respiratory syncytial virus (RSV) is increasingly recognized as a trigger for adverse outcomes in older adults with heart failure (HF). Following FDA approval of RSV vaccines for adults ≥ 60 years in 2023, real-world evidence in HF populations remains limited.

We conducted a multicenter retrospective cohort study using the TriNetX US Collaborative Network. Adults ≥ 60 years with HF were identified and stratified by RSV vaccination status from May 1, 2023, to January 01, 2026. Propensity score matching (1:1) was performed. The primary outcome was all-cause mortality. Secondary outcomes included respiratory failure, healthcare utilization, and cardiovascular events.

After PSM, 777 vaccinated and 777 unvaccinated HF patients were analyzed. All-cause mortality (HR 0.51, 95% CI, 0.33-0.79) and ICU admissions were significantly lower in vaccinated patients (2.7% vs. 5.8%, HR 0.46, 95% CI 0.25-0.86), while healthcare utilization was significantly higher in the vaccinated cohort (HR 1.85, 95% CI 1.65-2.08). No significant differences were observed in respiratory failure (7.3% vs. 9.4%, HR 0.87, 95% CI 0.61-1.23), inpatient or emergency visits (29.9% vs. 35.1%, HR 0.97, 95% CI 0.81-1.16), HF exacerbations, myocardial infarction, or stroke. Age-stratified subgroup analyses (60-75 and 75-90 years) showed consistent findings, with no significant cardiovascular differences and significantly higher healthcare utilization in vaccinated patients across both age groups.

In older adults with HF, RSV vaccination was associated with lower mortality and fewer ICU admissions, without a corresponding reduction in overall inpatient/emergency use or acute-care utilization. These findings are hypothesis-generating and may reflect prevention of severe respiratory illness.

Current physical activity guidelines often rely on self-reported or short-term device-based monitoring. We analysed long-term activity data via acceleration and continuous optical heart rate measurement and hypothesised a temporal association between volume and intensity and health-related outcomes in heart failure.

This prospective observational trial reanalysed longitudinal data from 156 patients with heart failure at baseline, 6 months, and 12 months. A multisensory activity tracker captured daily step count and continuous heart rate data over a 1-min sampling interval from patients with New York Heart Association (NYHA) Class I (n = 66) and Class II/III (n = 90) over 12 months. Linear mixed-effects models and univariate linear regression models were used to assess the associations between step count, moderate physical activity (MPA) and vigorous physical activity (VPA) and health-related outcomes [cardiorespiratory fitness, body composition, systemic inflammation levels, N-terminal pro brain natriuretic peptide (NTproBNP), and Kansas City Cardiomyopathy Questionnaire (KCCQ)].

Patients with NYHA I and NYHA II/III spent a median (interquartile range) of only 225 (105;412) vs 167 (72;326) min per week with MPA, 17 (7;44) vs 9 (4;23) min per week with VPA, and 8021 (6474;9910) vs 6438 (5181;8627) steps per day, respectively. VPA was positively associated with maximum oxygen uptake (ml/kg/min) (VO2max; β=3.815, 95% CI [1.430-10.186], P = .008), and MPA was inversely associated with NT-proBNP (pg/ml) (β=-0.189, 95% CI [-0.353 to -0.025], P = .024). For step count, a positive association with VO2max (ml/kg/min) (β=0.545, 95% CI [0.295-0.795], P < .001), and a negative association with fat mass (%) (β=-1.058, 95% CI [-1.441 to -0.674], P < .001), C-reactive protein (mg/l) (β=-0.057, 95% CI [-0.097 to -0.017], P = .005), and interleukin-6 (pg/ml) (β=-0.022, 95% CI [-0.043 to -0.001], P = .041) was observed. Absolute changes (Δ) for improved VO2max (ml/kg/min) (r = 0.197, P = .043) and reduced fat mass (%) (r = 0.205, P = .014) were associated with VPA between baseline and 12 months. No relationship was found with KCCQ.

Long-term device-based physical activity monitoring showed that patients with heart failure met recommendations for MPA, yet vigorous activity exceeding 60% of heart rate reserve was almost entirely absent. Higher aerobic physical activity was associated with greater VO2max, lower fat mass, reduced systemic inflammation (C-reactive protein and interleukin-6), and lower NT-proBNP, but not with KCCQ, whereas only VPA, unlike MPA, was associated with higher VO2max and lower fat mass.

Titration of guideline-directed medical therapy (GDMT) in heart failure (HF) is recommended by current guidelines. Recent data show that titration is not performed in most patients because of barriers related to healthcare systems, patient factors, and therapeutic inertia, leading to worse patient outcomes.

Nurse-led titration of GDMT for HF may increase the uptake of recommended HF therapies and doses. In Italy, only a few seminal experiences regarding multi-professional management of HF therapy have been reported, and huge disparities regarding this issue persist across European countries. This article describes the operational aspects required to implement a nurse-led GDMT titration program. Italian medical-legal aspects are also discussed, and an operational flow chart is provided. The main prerequisites are dedicated training and the adoption of management protocols, which, pending national educational plans and protocols, should start at the level of local institutions. These requirements should be complemented by detailed medical prescriptions specifying, for each patient, the timing and methods of titration, any other assessments to be performed, and the resulting actions.

A multi-professional strategy to manage HF patients involving nurse-led titration of GDMT for HF is suggested as a possible way to improve guideline uptake in real-world practice. This paper aims to describe how to implement it in daily practice in countries such as Italy, where nurse-led titration is not yet standard of care.

Acute kidney injury (AKI) is a frequent complication in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), significantly increasing mortality. The Huaxi Fall Risk Assessment (H-FRA) scale, a multidimensional bedside tool, may indirectly reflect AKI risk through factors like impaired mobility and systemic vulnerability. This study investigated the association between H-FRA and AKI in AMI patients.

This multicenter retrospective cohort study utilized data from 2,883 AMI patients treated with PCI across seven Chinese tertiary hospitals (January 2017 - February 2019). Patients were stratified into low, intermediate, and high fall-risk groups based on H-FRA tertiles at admission. Baseline serum creatinine was the first value measured upon admission. Multivariable logistic regression adjusted for confounders (age, sex, comorbidities, lab values). Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis, sensitivity and specificity.

AKI incidence significantly increased across H-FRA groups (low-risk: 4.8%, intermediate-risk: 18.3%, high-risk: 41.3%, p < 0.001). After adjustment, high H-FRA risk was independently associated with AKI (adjusted odds ratio [OR] 2.12, 95% confidence interval [CI] 1.24-3.92, p < 0.001). Each 1-point H-FRA increase raised AKI risk by 30% (OR 1.30, 95% CI 1.14-1.48, p < 0.001). The H-FRA demonstrated moderate predictive performance (area under the curve [AUC] 0.731, 95% CI 0.714-0.748, p < 0.0001).

The H-FRA is independently associated with AKI in patients with AMI. The H-FRA may serve as a useful and simple bedside tool for identifying AMI patients at increased risk of AKI. However further prospective validation is required.

CardioPharmaGENET COST Action network aims to advance personalized medicine in cardiovascular care by leveraging pharmacogenomics (PGx) to optimize drug therapies. In cardiovascular medicine, this approach is especially critical, given the significant patient variability in drug responses to therapies. The main goal is to establish a pan-European network that addresses several key challenges that hinder the widespread adoption of PGx in cardiovascular care. These challenges include the lack of a centralized knowledge hub for clinicians and policymakers, insufficient integration of PGx into clinical practice, and inconsistent policy frameworks across Europe. The project also seeks to utilize AI and machine learning to streamline the analysis of large-scale genomic data and enhance clinical decision-making. The network includes five working groups (WG) to tackle these issues: WG1 evaluates the current landscape of cardiovascular PGx, identifying key gaps in research, clinical integration, and available resources; WG2 develops optimized guidelines for applying PGx in cardiovascular therapies, focusing on patient stratification based on genetic and demographic profiles; WG3 focuses on advancing digital and AI tools to improve PGx data analysis and implementation in clinical settings; WG4 analyzes regulatory frameworks across Europe, proposing policy changes to facilitate seamless integration of PGx into healthcare systems; WG5 handles communication, dissemination, and stakeholder engagement, ensuring that findings and guidelines are accessible to all stakeholders, including clinicians, researchers, and policymakers. By addressing these challenges, the network will help bridge the gap between PGx research and clinical practice, improving cardiovascular patient outcomes and promoting equitable healthcare access across Europe. This manuscript represents the COST Association-approved Memorandum of Understanding of COST Action CA24165 CardioPharmaGENET.

To systematically evaluate the short-term and long-term (≥3 months post-treatment) efficacy and safety of acupuncture for post-stroke dysphagia (PSD), providing comprehensive evidence for clinical rehabilitation strategies.

Conducted in strict adherence to the PRISMA guidelines, a comprehensive search of Web of Science, PubMed, Embase, the Cochrane Library, VIP, Wanfang, CNKI, and CBM was performed from inception to March 18, 2026 for randomized controlled trials (RCTs) published in English or Chinese. Two independent reviewers performed study selection, data extraction, and risk of bias assessment. Meta-analysis was conducted utilizing Review Manager 5.4 and Stata 18.0.

A total of 23 RCTs involving 2,224 patients were included. For short-term outcomes, acupuncture interventions significantly improved the Water Swallowing Test (WST) effective rate (RR = 1.50, 95% CI [1.31, 1.73], p < 0.001) and reduced Standardized Swallowing Assessment (SSA) scores (MD = -3.33, 95% CI [-4.46, -2.19], p < 0.001). These significant clinical benefits were robustly sustained for long-term outcomes (≥ 3 months follow-up), as evidenced by the WST effective rate (RR = 1.38, 95% CI [1.21, 1.58], p < 0.001), objective SSA scores (MD = -4.92, 95% CI [-6.54, -3.31], p < 0.001), and subjective SWAL-QOL scores (MD = 23.56, p = 0.010). Subgroup analyses indicated that initiating acupuncture during the subacute/recovery phase yielded pronounced WST improvements. Regarding stimulation modalities, while electroacupuncture showed a marginal potential advantage for the WST (p = 0.08), no statistically significant superiority was established for the objective SSA scores (p = 0.56). Acupuncture-related adverse events were confined to mild local reactions (RD = 0.11, p < 0.001).

Acupuncture is a safe and potentially effective approach for post-stroke dysphagia, improving both short-term swallowing function and quality of life. Notably, these benefits appear to be sustained for at least 3 months post-treatment. Nevertheless, the overall certainty of evidence for short-term efficacy ranges from low to moderate, and the certainty for long-term sustained efficacy ranges from low (WST and SSA) to very low (SWAL-QOL), primarily due to inherent performance bias, publication bias, and imprecision due to limited long-term sample sizes, rather than clinical inconsistency.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420261345975, identifier (CRD420261345975).

Food-drug interactions (FDIs) and drug-nutrient interactions (DNIs) can significantly affect therapeutic outcomes and patient safety. Clinical nutrition specialists play a key role in identifying and managing these interactions; however, their knowledge, attitudes, and practices (KAP) regarding FDIs and DNIs remain insufficiently explored in Saudi Arabia.

A cross-sectional study was conducted among 353 licensed clinical nutrition specialists across Saudi Arabia. Data were collected using a validated self-administered questionnaire. Three separate multivariable linear regression models were developed to examine factors associated with knowledge, attitudes, and practices. Forest plots were generated to visualize the adjusted associations.

Clinical nutrition specialists had a mean knowledge score of 6.44 ± 4.08 out of 15, a mean attitude score of 31.38 ± 6.17 out of 40, and a mean practice score of 20.26 ± 5.96 out of 30. Higher knowledge scores were associated with having a doctoral degree, previous attendance at FDIs/DNIs training courses, exposure to FDIs/DNIs topics during university education, and managing patients with digestive or cardiovascular diseases. Attitude scores showed a mixed relationship with education and training: they were higher among those with a Master's degree but lower among those with a doctoral degree or prior formal training, and were also associated with employment in the private sector, management of cardiovascular diseases, and knowledge scores. Better practice scores were associated with higher knowledge and attitude scores, whereas a longer time since graduation was associated with lower practice scores; neither educational attainment nor formal training remained independently associated with practice scores in the adjusted model.

Saudi clinical nutrition specialists demonstrated positive attitudes but had important knowledge and practice gaps regarding FDIs and DNIs. Higher educational attainment and formal training were consistently associated with greater knowledge, but their relationship with attitudes was inconsistent, and neither was independently associated with practice. These domain-specific patterns highlight the importance of strengthening undergraduate curricula, pairing continuing professional development with attention to its effect on practitioner attitudes, and improving access to clinical decision-support tools.