Despite the availability of safe, effective and low-cost diagnosis and treatment options for atherosclerotic cardiovascular disease (ASCVD) and a significant decrease in death rates in the past several decades, ASCVD remains the leading cause of morbidity and mortality in the USA. Scalable, evidence-based strategies have not achieved a level of success that optimally lowers cardiovascular risk. In this case study, we describe the first three years of the ASCVD Risk Reduction Initiative at a large academic health system, an effort to develop, evaluate and scale a heart disease prevention programme for patients whose modifiable risk remains high despite having access to care. The Initiative models a learning health system, combining traditional randomised controlled trials with quality improvement projects, iterative rapid cycle testing, data analyses, incorporation of learnings from concurrent projects at other institutions and user research to test a variety of approaches to cardiovascular risk reduction. This approach could be generalised to other important population health improvement challenges. In this article, we detail our pilot study process, results to date and challenges experienced in this example of care delivery innovation in action.

Hypertension is a major global health challenge, and effective health education is crucial for improving patients' self-management. Traditional health education approaches are often limited by insufficient personalization, accessibility, and scalability. Artificial intelligence (AI), including natural language processing, machine learning, and large language models (LLMs), offers promising solutions to address these limitations. However, evidence regarding AI applications in hypertension health education has not been comprehensively synthesized.

This scoping review aimed to summarize the current evidence on AI applications in hypertension health education, and identify research gaps to inform future research and practice.

This review followed the Joanna Briggs Institute methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Six databases (PubMed, Embase, Web of Science, Cochrane Library, CINAHL, and Scopus) were searched from January 2015 to June 2026. Eligibility criteria were developed using the participant-concept-context framework. Two reviewers independently conducted study screening and data extraction. Study designs were classified using the Mixed Methods Appraisal Tool framework. Consistent with scoping review methodology, no formal quality assessment was performed. Findings were synthesized narratively and presented using evidence gap maps, tables, and figures.

A total of 24 studies from 11 countries were included, comprising 6 randomized controlled trials, 4 nonrandomized trials, 11 quantitative descriptive studies, and 3 mixed methods studies. Most studies were published between 2024 and 2026. In total, 3 AI application scenarios were identified: rule-based health education, data-driven adaptive health education, and generative AI-driven health education. Natural language processing was the most widely applied technology, and LLM-based applications increased rapidly after 2023. However, generative AI studies were predominantly proof-of-concept evaluations and lacked randomized clinical validation. Health education was rarely implemented as a standalone intervention and was typically embedded within multifunctional AI platforms. Outcomes were categorized using the Digital Health Scorecard Framework across 4 domains: technology, clinical, usability, and cost. Technical accuracy and blood pressure outcomes were the most frequently reported measures, whereas no study evaluated economic outcomes.

This first scoping review of AI applications in hypertension health education identified a mismatch between rapid advances in generative AI and the limited availability of rigorous clinical evidence. Three major research gaps were identified: (1) the lack of standardized core outcome sets covering technical, behavioral, clinical, and implementation domains; (2) limited development of hybrid architectures integrating LLM with structured medical knowledge bases; and (3) the absence of evaluation frameworks that satisfy both regulatory and implementation requirements. AI appears most suitable as a complement to, rather than a replacement for, clinician-delivered education. Future research should prioritize rigorous clinical validation, economic evaluation, multicultural adaptation, and health literacy equity to ensure that AI-driven health education reduces rather than exacerbates disparities in hypertension control.

Patients with multivessel coronary artery disease often receive 12 months of dual antiplatelet therapy (DAPT) after stenting to reduce the risk of ischemic events. Whether extending DAPT beyond 12 months in event-free patients with multivessel disease provides a benefit is uncertain.

We conducted an open-label, randomized trial at 97 centers in China. Patients 18 to 75 years of age with multivessel coronary artery disease who had no major ischemic or bleeding events while receiving DAPT for 12 months after implantation of a drug-eluting stent were randomly assigned in a 1:1 ratio to receive an additional 12 months of DAPT (clopidogrel plus aspirin) or aspirin monotherapy. The primary efficacy end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The primary safety end point was clinically relevant or major bleeding (i.e., a bleeding event of Bleeding Academic Research Consortium [BARC] type ≥2; BARC types range from 0 to 5, with higher values indicating greater severity of bleeding).

A total of 8250 patients were randomly assigned to receive extended DAPT (4125 patients) or aspirin monotherapy (4125 patients). The median follow-up was 34.3 months. A primary efficacy end-point event occurred in 222 patients in the DAPT group and in 266 patients in the aspirin-monotherapy group (36-month Kaplan-Meier cumulative incidence, 5.8% vs. 6.8%; hazard ratio, 0.82; 95% confidence interval [CI], 0.69 to 0.98; P = 0.03). Clinically relevant or major bleeding occurred in 51 patients in the DAPT group and in 57 patients in the aspirin-monotherapy group (36-month Kaplan-Meier cumulative incidence, 1.4% vs. 1.5%; hazard ratio, 0.89; 95% CI, 0.61 to 1.30; P = 0.54).

Among patients with multivessel coronary artery disease who were in stable condition 12 months after implantation of a drug-eluting stent, extending DAPT with clopidogrel and aspirin for an additional 12 months led to a lower risk of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke than continuing aspirin alone, without an increased risk of bleeding. (Funded by the National Natural Science Foundation of China and others; DAPT-MVD ClinicalTrials.gov number, NCT04624854.).

There is a paucity of information about the association between nativity and stroke prevalence among Black individuals in the United States.

We assessed stroke prevalence among individuals who identified as Black in the 2000-2018 National Health Interview Survey. Respondents were stratified by age (25-55 or 56-74 years) and location of birth (United States; Caribbean, South, and Central America [CSCA]; and Africa). Factors associated with stroke prevalence were assessed using logistic regression, adjusting for sociodemographic and medical characteristics.

Among 64,717 respondents who identified as Black, 88.3% were born in the United States, 8.0% were born in CSCA, and 3.7% were born in Africa. Prevalence of stroke was 4.3%, 1.5% and 0.8%, respectively. Foreign born individuals had lower odds of stroke (adjusted OR 0.44, 0.34-0.57 for CSCA and 0.39, 0.23-0.63 for Africa). The odds of stroke were lowest for those who had recently immigrated at the time of the survey (adjusted OR < 15 years 0.27, 95% CI 0.15-0.47).

Among individuals who identify as Black, there may be a healthy immigrant effect. Homogenizing racial and ethnic groups may mask key epidemiologic trends and limit targeted interventions.

Post-stroke shoulder pain (PSSP) is a common complication that negatively affects functional recovery and rehabilitation outcomes. Despite the availability of evidence-informed management strategies, clinical practice may vary across settings, particularly in lower-and middle-income countries.

To investigate current assessment and management practices for PSSP among physical and occupational therapists in Vietnam and to identify potential evidence and practice gaps as well as the barriers to effective care.

A cross-sectional survey was conducted online among rehabilitation professionals working in stroke care in 14 hospitals across all regions of Vietnam. A structured questionnaire was designed to capture the actual practice information on assessment approaches, treatment strategies, preventive measures, and perceived barriers to PSSP management. Descriptive statistics were used to summarize responses, and comparisons between levels of clinical experience were performed. The results were also analyzed for their alignment with the evidence-informed rehabilitation principles.

A total of 214 therapists (191 physical therapists and 23 occupational therapists) participated in the online survey. Most respondents reported that 25%-75% of their stroke patients experienced shoulder pain. Common assessment methods included shoulder subluxation, patient-reported pain, and range-of-motion evaluation. Only 53.74% of respondents reported using standardized outcome measures. Preventive strategies such as positioning and sling usage were widely implemented (70.64%). In treatment, 37.38% of therapists emphasized modalities, while 35.98% used combined approaches and 26.64% focused on mobility-based exercise. Key barriers included lack of long-term follow-up (65.42%), time constraints (45.79%), and inconsistent treatment approaches (45.79%).

The findings revealed considerable variation in PSSP assessment and management practices among rehabilitation professionals in Vietnam, with a substantial proportion of respondents reporting treatment approaches centered on passive modalities. System-level barriers, including limited follow-up and time constraints, were frequently perceived by respondents as influencing their clinical practice. These findings may help inform future initiatives related to professional training, practice standardization, and development of context-specific guidelines for post-stroke shoulder pain management.

Stroke, a leading cause of global mortality and disability, requires accurate prediction of discharge outcomes to support early care planning. We developed an explainable artificial intelligence (AI) framework to predict four discharge categories (home, specialized care, home with help, expired) and identify key predictors.

This single-center retrospective study included 1,731 patients with ischemic stroke, hemorrhagic stroke, or transient ischemic attack (TIA). Twenty routinely available electronic health record variables were used. Ten classifiers were compared using stratified 5-fold cross-validation, and the final model was calibrated with training-set out-of-fold predictions and interpreted using SHapley Additive exPlanations (SHAP).

The multilayer perceptron (MLP) achieved the highest mean cross-validated macro-F1 score and was selected as the best-performing model. On the independent hold-out test set, the MLP achieved an accuracy of 0.646, macro-specificity of 0.873, macro-precision of 0.559, macro-sensitivity of 0.557, and macro-F1 of 0.548. Class-wise area under the receiver operating characteristic curve (AUC) values were 0.901 for home, 0.874 for specialized care, 0.674 for home with help, and 0.889 for expired. SHAP analysis identified admission National Institutes of Health Stroke Scale (NIHSS), length of stay, age, and primary diagnosis as shared predictors across all discharge categories. The SHAP age-threshold analysis identified 72.0 years as a clinically relevant threshold associated with a lower likelihood of home discharge and higher likelihoods of specialized care, home with help, and expired discharge status. The model also highlighted clinically actionable or addressable domains, including blood glucose, depression, insurance type, last known well time, anticoagulant use, and treatment-related variables.

This interpretable AI-based framework identified clinically relevant predictors of stroke discharge disposition within this single-center retrospective dataset. These findings may inform future decision-support development; however, clinical implementation, resource optimization, and health-system impact require prospective multicenter validation.

Unhealthy lifestyle behaviors are significant and adjustable contributors to cardiometabolic abnormalities among cancer survivors. Combined lifestyle interventions (CLIs), addressing multiple behaviors simultaneously, may offer superior cardioprotective effects. This systematic review and meta-analysis synthesized evidence on existing CLIs and evaluated their effectiveness in reducing cardiometabolic risk.

A comprehensive search was performed in PubMed, Web of Science, EMBASE, CINAHL, the Cochrane Library, CNKI, Wanfang, SinoMed, and Yiigle until December 3, 2025, following the PRISMA checklist. Standardized mean difference (SMD) and 95% confidence intervals (95% CI) were estimated using random-effects models. Heterogeneity and publication bias were also assessed.

Of the 7649 articles screened, 25 met criteria, and 21 were included in meta-analysis. Interventions primarily focused on diet and exercise, with several also incorporating psychological support, alcohol abstinence, or weight management. Studies mainly targeted breast and prostate cancer survivors, with varied cardiometabolic outcomes. CLIs demonstrated greater improvements in body mass index (n = 16, SMD = -0.27, 95% CI = -0.38 to -0.15, P < 0.001), fasting blood glucose (n = 12, SMD = -0.29, 95% CI = -0.54 to -0.04, P = 0.021), low-density lipoprotein (n = 8, SMD = -0.15, 95% CI = -0.30 to -0.01, P = 0.039), diastolic blood pressure (n = 10, SMD = -0.12, 95% CI = -0.20 to -0.04, P = 0.003), and triglycerides (n = 10, SMD = -0.26, 95% CI = -0.43 to -0.08, P = 0.004). Subgroup analyses showed limited differences across intervention types, except for effects on fasting blood glucose levels.

CLIs are associated with modest but statistically significant improvements in cardiometabolic risk management among cancer survivors. Further studies may prioritize more consistent frameworks for defining CLIs, while incorporating digital health technologies and evidence-based behavior change strategies to enhance intervention effectiveness and sustainability.

Registered on PROSPERO (CRD420251013007).

Aphasia is a language impairment resulting from stroke. While numerous studies have explored the association between supratentorial white matter damage and post-stroke aphasia using diffusion tensor imaging (DTI), the role of infratentorial structures, particularly the cerebellum, remains underinvestigated. Evidence suggests that the cerebellum may play a supportive role in language processing, but its contribution across different aphasia types is not well understood. This study aimed to explore cerebellar white matter involvement in individuals with Broca's, conduction, and anomic aphasia using DTI. Using OpenNeuro data from 155 post-stroke patients, including patients with Broca's, anomic, and conduction aphasia, we examined cerebellar DTI metrics in relation to language function assessed by the Western Aphasia Battery (WAB). We examined the association between WAB scores and DTI findings using a linear regression model adjusted for age at onset and sex. Our study observed a significant difference among three groups of post-stroke patients with aphasia regarding their performance on the WAB test. Unlike individuals with conduction and anomic aphasia, post-stroke patients with Broca's aphasia exhibited associations between QA (Quantitative Anisotropy) and RDI (Restricted Diffusion Imaging) in the superior,middle, and bilateral inferior cerebellar peduncles with WAB-AQ. However, these associations did not remain significant after FDR correction. These findings suggest a potential role for cerebellar pathways in language impairment in post-stroke Broca's aphasia. Future research should apply advanced imaging and broader language assessments to clarify the role of the cerebellum in aphasia severity.

To evaluate whether pre-treatment coronary artery aneurysm (CAA) Z-score, inflammatory markers, and incomplete Kawasaki disease (KD) status are associated with intravenous immunoglobulin (IVIG) retreatment and early coronary outcomes in infants aged < 6 months. We retrospectively reviewed infants aged < 6 months who were treated with IVIG for KD between 2011 and 2024. Clinical, laboratory, treatment, and serial echocardiographic data were collected, and patient-level maximal coronary Z-scores were calculated. The primary outcome was additional IVIG; the secondary outcome was CAA Z-score (≥ 2.5) at approximately 1 month after illness onset. Among 76 infants (median age, 4.3 months), 17/76 (22.4%) required additional IVIG, 14/76 (18.4%) had CAA at approximately 1 month after illness onset, and 3/76 (3.9%) had residual CAA at or after 6 months. Additional IVIG was independently associated with pre-treatment CAA (Z ≥ 2.5), earlier illness day at initial IVIG, and higher neutrophil-to-lymphocyte ratio; the multivariable model showed good discrimination (area under the curve [AUC] 0.84). For CAA at 1 month, both a baseline-only model including pre-treatment CAA Z-score, albumin, and illness day at initial IVIG (AUC 0.91, 95% confidence interval [CI] 0.84-0.97) and a course-aware model including pre-treatment CAA Z-score and additional IVIG (AUC 0.90, 95% CI 0.84-0.97) showed high discrimination. CAA at 1 month with Z-max ≥ 5.0 was associated with residual CAA risk.

 In infants aged < 6 months with KD, pre-treatment coronary involvement and higher inflammatory burden were strongly associated with additional IVIG, whereas pre-treatment coronary disease severity, lower albumin, and an early refractory course were strongly associated with CAA at 1 month.

• Infants aged < 6 months with Kawasaki disease (KD) have higher non-response to intravenous immunoglobulin (IVIG) and more coronary artery abnormalities (CAA). • Guidelines recommend early transthoracic echocardiography and coronary Z-score assessment, but infant-specific prognostic data remain limited.

• In this infant-only cohort, pre-treatment CAA Z-score ≥ 2.5 and neutrophil-to-lymphocyte ratio ≥ 2.15 were associated with additional IVIG. • Pre-treatment CAA Z-score, lower albumin, and an early refractory course were the factors most strongly associated with CAA at 1 month.

Idiopathic and recurrent pericarditis are increasingly recognised as autoinflammatory conditions driven by the NLRP3 inflammasome and interleukin-1 signalling. Despite this shift in understanding, the misuse of high-dose corticosteroids has often led to a 'massacre of the innocents', transforming acute events into chronic, steroid-dependent diseases. This narrative review analyses the evolution of corticosteroid use in pericarditis, emphasising the transition from aggressive loading doses to the low-dose, 'rheumatological' strategies codified in the 2025 European Society of Cardiology (ESC) guidelines.Evidence confirms that medium-dose prednisone (0.2-0.5 mg/kg/day), when integrated into triple therapy with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine, reduces recurrence rates and iatrogenic toxicity compared to traditional high-dose regimens (1.0 mg/kg/day). A critical challenge remains the tapering process; rapid withdrawal triggers inflammatory rebounds, necessitating meticulous, long-lasting (months-years), C-reactive protein (CRP)-guided reductions as small as 5 to 1.25 mg every two to six weeks, similar to the tapering used in polymyalgia rheumatica. Chronic maintenance with low-dose prednisone (≤5 mg/day) may be considered in selected cases, with a good risk-benefit balance. The elderly usually require medium dosages (e.g. prednisone 12.5-25 mg), pregnant women no more than 10 mg, while children should avoid chronic corticosteroid therapy. CRP-negative cases may benefit from low doses (5 mg). Given the long-term duration of therapy, bone protection therapy is essential yet underutilised, while protonpump inhibitors should be used only for concomitant NSAIDs therapy. Corticosteroids are generally ineffective in chronic idiopathic pericardial effusions with normal CRP.In conclusion, modern management redefines corticosteroids as a precision tool rather than a blunt anti-inflammatory agent.