Emergency department presentations of acute decompensated heart failure-related cardiogenic shock (ADHF-CS) are increasing and are associated with high short-term mortality. Early diagnosis is challenging due to variable clinical presentation, compensatory physiology, and limited availability of invasive hemodynamic monitoring. Point-of-care ultrasound enables quick, noninvasive assessment of cardiac output, right atrial pressure, and systemic vascular resistance. This review outlines a practical bedside echocardiographic approach to generate a rapid hemodynamic profile in suspected ADHF-CS, facilitating accurate phenotyping and targeted resuscitation strategies in the emergency setting.

Recent studies have demonstrated sex-related differences in secondary prevention pharmacotherapy in patients with acute myocardial infarction, although guidelines recommend the same preventive approach in both women and men. This study builds upon previous research by examining temporal trends in prescribing patterns of secondary prevention medications using contemporary, long-term data from Switzerland, with particular focus on sex-related disparities.

Acute myocardial infarction patients enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus project between 2003 and 2022 were included. For this retrospective analysis, optimal medical therapy was defined as the combination of all five guideline-recommended medications at discharge: aspirin; P2Y12 inhibitor; lipid-lowering drug; beta-blocker; angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Uni- and multivariable logistic regression analyses were performed.

Among 34,612 patients (75% men, n=25,913), women were older and had more comorbidities but were less frequently prescribed optimal medical therapy than men (51% vs 60%) across all age groups (all p <0.001), with the greatest gap occurring in patients <50 years of age. A marked increase in optimal medical therapy prescription (36% to 60%) was detected irrespective of age and sex, mainly due to greater prescription of dual antiplatelet therapy (71% to 91%) and lipid-lowering drugs (69% to 93%). The sex-related gap in optimal medical therapy prescription disfavouring women showed a fluctuating trend (0.7-14%) whereas there was a progressive and sustained reduction regarding the combination of dual antiplatelet therapy plus lipid-lowering drug, from 18% to 10% at the beginning and the end of the observation period, respectively. Multivariable analysis showed greater frequency of optimal medical therapy prescription in patients with STEMI (OR: 1.65, 95% CI: 1.57-1.73) and those treated with PCI (OR: 4.85, 95% CI: 4.49-5.24), whereas lower prescription frequencies were observed among female patients (OR: 0.90, 95% CI: 0.85-0.95) and older individuals (OR per additional year: 0.99, 95% CI: 0.98-0.99).

Although optimal medical therapy prescription increased gradually over time among both women and men, concerning sex disparities disfavouring women, particularly young women, remained. Targeted programmes to reduce sex-related differences in secondary prevention care are warranted.

The availability of an implantable left ventricular assist device (LVAD) has radically transformed the treatment of patients with advanced heart failure (HF). Studies have consistently shown improvements in survival and quality-of-life outcomes among advanced HF patients with LVADs in the past 30 years. However, during this period, much emphasis was placed on outcomes directly influenced by technological advancements and clinical management; the daily care of LVAD (self-management) remains complex and cognitively challenging to patients and their caregivers. Furthermore, preparation for hospital discharge varies across US VAD centers, and there is no objective measure to evaluate patients' and caregivers' self-management competencies. This article describes the development and initial validation of an LVAD Care Competency Assessment Tool (LCCAT)-Observer Form as an objective measure for evaluating patients' and caregivers' readiness for discharge in the context of self-management competencies. A plan for psychometric testing and future studies is outlined, and implications of clinical practice are discussed.

Atrial fibrillation (AF) is a major contributor to ischemic stroke, yet evidence on whether catheter ablation improves outcomes in patients with AF and a history of stroke remains limited. We emulated a target trial using observational data to estimate the effect of early catheter ablation vs medical therapy on clinical outcomes in this high-risk population.

We retrospectively included patients aged 18-85 years with AF and a history of ischemic stroke from 6 Chinese centers between January 2019 and December 2024. The primary outcome was major adverse cardiovascular events (MACEs). Secondary outcomes included all-cause rehospitalization, cardiovascular rehospitalization, all-cause death, and functional and cognitive outcomes assessed by modified Rankin Scale (mRS) and post hoc AD8 scores. A cloning-censoring-weighting approach was used to emulate a target trial comparing early ablation (within a 1-year grace period) and medical therapy in time-dependent outcomes, using weighted Kaplan-Meier curves. Restricted mean survival time (RMST) was used when the proportional hazards assumption was violated. mRS and AD8 were assessed after propensity score matching.

A total of 431 patients were included (median age, 70 years; 37% female), of whom 207 underwent early catheter ablation. The median follow-up was 3.0 years. At 36 months, early ablation was associated with a gain of 1.54 MACE-free months (95% CI 0.40-2.85; p = 0.016) and an absolute risk reduction of 11.17% (95% CI 5.81%-17.36%; p < 0.001). Cardiovascular rehospitalization showed a higher 36-month event-free survival rate in the ablation group (absolute difference 11.98%; 95% CI 2.26%-21.44%; p = 0.018). In the matched cohort (n = 250), ablation was associated with better mRS scores (adjusted odds ratio 0.31; 95% CI 0.19-0.51; p < 0.001) and, in a post hoc cognitive assessment using AD8, lower odds of cognitive impairment (adjusted odds ratio 0.42; 95% CI 0.24-0.72; p = 0.002).

In this target trial emulation analysis, catheter ablation was associated with a modestly lower long-term risk of MACE in patients with AF and a stroke history. Secondary analyses suggested exploratory associations between ablation and lower long-term cardiovascular rehospitalization, and better neurologic and cognitive outcomes. Major limitations include the retrospective design and potential residual confounding. Randomized trials with larger sample sizes are warranted.

This study provides Class III evidence that early catheter ablation in adult patients with AF and a history of ischemic stroke decreases the risk of MACEs compared with guideline-directed medical therapy.

Digital health interventions are increasingly used in medicine to manage chronic conditions. However, the effectiveness, feasibility, and consistency of these interventions in poststroke risk factor management and secondary prevention remain uncertain. We conducted a systematic review and meta-analysis to evaluate the effect of digital health-supported interventions on vascular risk factor control among stroke survivors. We systematically searched MEDLINE, Embase, and Cochrane CENTRAL from inception through September 2025 for randomized, single-arm, and observational studies evaluating digital health interventions, defined as mobile health applications, wearable devices, or combined platforms, among adults with ischemic stroke, hemorrhagic stroke, or transient ischemic attack. Outcomes of interest included systolic and diastolic blood pressure, lipid levels, weight, physical activity, medication adherence, quality of life, and clinical events. Random-effects meta-analyses were performed for outcomes reported by ≥ 3 studies. Feasibility outcomes, including recruitment, retention, adherence, and usability were synthesized qualitatively.

Twenty-nine studies encompassing 8,389 participants were included. Digital health interventions were associated with modest reductions in systolic blood pressure compared with control conditions, including usual care and minimal-intervention comparators (pooled between-group mean difference, -5.8 mm Hg; 95% CI -9.9 to -1.6). However, prediction intervals crossed the null value, and between-study heterogeneity was substantial. No consistent effects were observed for diastolic blood pressure, lipid levels, or weight. Reporting of physical activity, medication adherence, and quality-of-life outcomes was heterogeneous, precluding quantitative pooling, although most studies reported favorable trends. Overall feasibility was high, with an aggregate dropout rate of 3.6% (95% CI 3.2%-4.0%) and high user acceptability across studies. Most trials enrolled participants with mild functional impairment and short follow-up durations (median ≈3 months). Few studies were powered to assess recurrent stroke or mortality.

Digital health-supported interventions for secondary stroke prevention seem feasible and acceptable, with evidence of modest short-term improvements in blood pressure. However, clinical effectiveness across other vascular risk factors remains inconsistent. In addition, substantial heterogeneity, short follow-up, and limited high-quality evidence constrain causal inference and preclude conclusions regarding sustained clinical benefit.

Dizziness is a common emergency department (ED) concern, yet posterior-circulation strokes can be difficult to detect with standard clinical tools and neuroimaging alone. Quantitative video head impulse test (vHIT) provides an objective bedside measure of vestibulo-ocular reflex function and can help differentiate central from peripheral causes of acute dizziness.

We conducted a prospective, single-center feasibility and diagnostic-accuracy study of adults (18-90 years) presenting on an ED stroke pathway for acute dizziness. vHIT was performed within 48 hours of presentation, after completion of standard stroke evaluation. Two vestibular-trained clinicians, blinded to clinical and imaging data, classified vHIT as peripheral, central, equivocal, or poor quality. The reference standard (stroke vs nonstroke) was the final diagnosis adjudicated by stroke neurologists using all clinical information, noncontrast CT, and MRI when available. Diagnostic metrics for stroke were calculated for interpretable vHIT studies and in an intention-to-diagnose analysis.

Thirty patients underwent vHIT; 11 (36.7%) had acute ischemic stroke and 19 (63.3%) had nonstroke diagnoses. Interpretable vHIT results (central or peripheral pattern) were obtained in 23 of 30 patients (76.7%). Overall, vHIT patterns were central in 19 (63.3%), peripheral in 4 (13.3%), equivocal in 3 (10.0%), and poor quality in 4 (13.3%). Among strokes, 9 of 11 (81.8%) had a central pattern and none had a peripheral pattern. In the primary analysis of interpretable studies, vHIT sensitivity and negative predictive value for stroke were both 100%, while specificity was 28.6% and overall accuracy was 56.5%. In the intention-to-diagnose analysis including all patients, sensitivity and negative predictive value remained 100%, with specificity at 21.1% and accuracy at 50.0%.

Our findings suggest that vHIT was feasible in most ED stroke-pathway patients with acute dizziness and demonstrated high sensitivity and negative predictive value when a clearly peripheral pattern was present, supporting its potential role as an adjunctive rule-out tool. However, specificity was low, and nearly one-quarter of studies were equivocal or poor quality, limiting its use as a standalone diagnostic test. With further validation and larger studies, vHIT may help support more targeted use of hospital admissions, diagnostic workups, and ED stroke resources in patients without evidence of central pathology.

Hereditary angioedema (HAE) is a genetic disorder characterised by recurrent cutaneous or submucosal oedema. Most cases are caused by pathogenic SERPING1 variants (types I and II), while a smaller subset presents with normal C1-inhibitor (C1-INH) levels and function (HAE-nC1INH). Despite its potentially life-threatening attacks, HAE remains under-diagnosed owing to inconsistent screening practices, low clinical awareness, poor patient acceptance, and resource limitations, resulting in diagnostic delays and preventable morbidity. Although international guidelines recommend family screening to identify at-risk relatives, no standardised protocol exists for its systematic implementation. Cascade family screening offers a structured approach to trace and test all known at-risk relatives across generations. Complementing this strategy, dried blood spot (DBS) assays provide a less invasive, cost-effective alternative to conventional serological testing, with particular utility in resource-limited settings. In this review, we critically appraise current screening methodologies, synthesise emerging evidence on cascade family screening and DBS-based diagnostics, and propose an actionable clinical flowchart to standardise identification, testing, and patient education from index case detection through multi-generational family screening.

The success of catheter ablation depends not only on identification of arrhythmia mechanisms, mapping, and energy strategy, but also on catheter accessibility and stable manipulation. Robot-assisted catheter navigation enables remote control through magnetic fields, robotic sheaths, or mechanical actuation. However, with the development of three-dimensional electroanatomic mapping, low- and zero-fluoroscopy workflows, and newer ablation technologies, the key question has shifted from technical feasibility to whether these systems can overcome practical procedural constraints in specific clinical settings. This review synthesizes the clinical evidence for different robot-assisted catheter navigation technologies. Disease-specific comparative studies and long-term outcome data are derived mainly from robotic magnetic navigation. Current evidence consistently supports reduced conventional X-ray use with robotic navigation; in selected settings involving complex anatomy, abnormal vascular pathways, or limited catheter reachability, available studies show technical feasibility and procedural support, but consistent benefits in procedural efficiency, safety, and long-term patient outcomes have not been demonstrated. Its clinical value depends mainly on whether the dominant procedural limitation lies in catheter navigation and manipulation and is jointly influenced by the compatibility and availability of supporting technologies, the comparator, and center-specific workflow; procedural improvements do not necessarily translate into long-term patient benefit. Future studies should identify patients with a clear catheter-navigation need, distinguish the effect of robotic catheter navigation itself from that of the complete treatment strategy, and further evaluate its actual value for patients, operators, and healthcare systems.

Sleep disturbances are common after stroke and have been associated with rehabilitation outcomes. The clinical meaning of post-stroke sleep duration remains unclear, as longer sleep may be associated with different clinical and functional states, including greater disability. This exploratory study investigated the relationship between sleep and functional outcome during stroke rehabilitation, and the moderating role of baseline functional status.

Twenty-nine patients with stroke underwent a 10-day longitudinal monitoring protocol during rehabilitation. Functional independence and motor performance were assessed at the beginning (T0) and the end (T1) of the observation period using the Barthel Index, 10-Meter Walk Test, and 9-Hole Peg Test. Sleep was assessed throughout the monitoring period using sleep diaries, and actigraphy .

Functional independence improved from T0 to T1, whereas motor performance did not significantly change. In unadjusted analyses, longer actigraphy-derived total sleep time and longer self-reported total time in bed were correlated with lower Barthel Index scores at T1. Moderation analyses adjusted for prior rehabilitation days showed that longer total sleep time was positively associated with Barthel Index at T1 only in patients with higher baseline independence, while longer time in bed was positively associated at average and higher baseline levels.

The associations between sleep duration or time in bed and later post-rehabilitation functional independence vary according to baseline functional status. Given the small sample size and observational design, these findings should be interpreted cautiously and considered preliminary and hypothesis-generating.

Myeloperoxidase (MPO), a neutrophil-derived heme peroxidase involved in oxidative inflammatory responses, has been investigated as a biomarker for cardiovascular, hematological, and other inflammation-associated diseases. In this study, an aptamer-regulated rolling circle amplification (RCA)-CRISPR/Cas12a fluorescence assay was established for MPO detection in serum samples. Two aptamers, Apt-02 and Apt-14, were obtained with dissociation constants (K_D) of 57.76 and 56.88 nM, respectively, using MPO-depleted human serum as the counter-selection matrix during MB-SELEX. Apt-14 exhibited relatively good stability in serum and was therefore used in the assay development. Upon MPO binding, cDNA was released from the aptamer/cDNA duplex, initiating RCA and subsequently activating Cas12a-mediated trans-cleavage to amplify the fluorescence signal. Under the optimized conditions, the assay achieved a detection limit of 0.422 ng/mL with good selectivity. It also showed limited interference from the tested cardiovascular disease-related proteins and provided MPO levels in clinical serum samples that were consistent with ELISA results. The assay was also adapted to a lateral-flow strip using a biotin/FAM-labeled ssDNA reporter, enabling visual detection and reader-assisted semi-quantitative analysis.