The principal aim of our study is to provide a comprehensive overview of the trends in vascular intestinal disorder (VID) mortality with respect to different demographic factors and identify which patient populations are at the highest risk for mortality. Secondarily, we aim to examine and discuss the underlying reasons behind disparities in mortality rates.

Retrospective ecological study.

Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research Multiple Causes of Death database of US residents.

375 938 patients residing in the USA ≥15 years old with VID listed on their death certificate between 1999 and 2022.

None.

Age-adjusted mortality rate (AAMR) across the overall population and stratified by gender, race, census region and urban/rural location.

There were 375 938 deaths overall, with 61.5% of deaths occurring in females and 38.5% in males. The overall AAMR was highest in 1999 and lowest in 2018, increasing from 2019 to 2021. American Indian and Alaska Native patients had the highest overall AAMR for the majority of the study period. In contrast, Asian or Pacific Islander individuals had the lowest overall AAMR. On average, AAMR was highest in the Midwest and lowest in the Northeast. For most of the study period, AAMR in rural areas remained higher than in urban areas.

While VID mortality has decreased overall, this study has revealed several nuances demonstrating disproportionately higher mortality among certain demographic groups and geographic areas. Efforts to improve preventative care, early diagnoses and effective interventions for these groups are necessary and would make a significant impact on the overall mortality from VID in the USA.

We compared mean and artery-specific pericoronary adipose tissue attenuation (PCATa) between rheumatoid arthritis (RA) patients and controls and examined whether clinical factors and coronary plaque burden were associated with PCATa similarly in both groups. We also explored differences in PCATa around plaque-free arteries between RA and controls.

This cross-sectional analysis included 147 patients with RA and 118 age-matched and sex-matched controls with complete coronary CT angiography data. PCATa and plaque counts (total, non-calcified, mixed or calcified) were assessed at a single time point. Models adjusted for age, sex, cardiovascular risk factors and epicardial adipose tissue volume.

Mean and artery-specific PCATa around right coronary (RCA) and left circumflex (LCx) arteries were higher in RA than controls (B=0.35 (95% CI 0.12 to 0.58), B=0.39 (95% CI 0.14 to 0.63) and B=0.25 (95% CI 0.03 to 0.48), respectively). Mean PCATa was higher in males than females (p<0.01). Age and dyslipidaemia influenced PCATa differently in RA versus controls (p for interaction=0.032 and 0.021). Mean and LCx-PCATa were associated with total and mixed plaque counts in RA but not in controls (p for interaction=0.040 and 0.021, respectively). Per-artery PCATa did not differ between RA and controls without atherosclerosis. Among participants with atherosclerosis, PCATa around plaque-free LCx and RCA vessels was higher in RA than controls (p<0.05).

PCATa was higher in RA than controls. Mean PCATa was higher in men and associated with coronary atherosclerosis in RA but not in controls. PCATa differences around plaque-free LCx and RCA vessels between RA and controls were observed among participants with plaque elsewhere.

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis and primarily affects the joints. While therapeutic advances have substantially reduced the risk of long-term disability, concerns remain regarding disease-related morbidity. Therefore, we aimed to evaluate incidence, prevalence, mortality rates (MRs), standardised mortality ratios (SMRs) and causes of death in RA in north-eastern Italy from 2012 to 2020.

A retrospective population-based study was conducted in the Veneto region (4.8 million residents) using linked data from the population registry, healthcare co-payment exemptions, hospital discharge records and mortality data. Prevalence and incidence rates were stratified by age and sex. SMRs were calculated by comparing patients with RA to the general population. Causes of death were classified by the International Classification of Diseases Tenth Revision (ICD-10).

We identified 37 996 patients with RA (prevalence 0.54%) and 12 875 incident cases (incidence rate 33.1/100 000). Incidence was twice as high in females. Among prevalent cases, 7 435 deaths occurred (MR 32.2/1000), while among incident cases there were 1288 deaths over the 8-year study period (MR 21.3/1000). The median age at death was 83 (77-88) years. The overall SMR was 1.28 (95% CI 1.21 to 1.35), higher in patients under 45 years of age (2.15, 95% CI 0.93 to 4.24). Leading causes of death were cardiovascular diseases (37.1%), cancer (20.6%) and infections (10.9%).

This study provides updated data on epidemiology and mortality of RA in Italy, offering insights for healthcare planning and resource allocation. The analysis of causes of death provides additional perspectives for a multidimensional approach to disease management.

Patients with single ventricles after bidirectional Glenn (BDG) are placed on ACE inhibitors (ACEIs) to reduce afterload and to decrease systemic to pulmonary collateral flow (SPC). The objective is to determine if ACEI use in BDG patients improves SPC and ventricular function.

Single-centre retrospective study of BDG patients who underwent cardiac magnetic resonance (CMR) from 2010 to 2024. Demographics, medication, ventricular function and flow data were collected. Patients included were >1 year old and on ACEI for >3 months prior to CMR.

A total of 320 BDG patients were studied, 137 were treated with ACEI with no difference in age, sex, medications (except for ACEI) or body surface area. SPC as a percentage of aortic flow was not different in the ACEI group, whether right (RV) or left ventricle (LV) dominant. Ejection fraction (EF) was lower and end- diastolic volume (EDV) was higher in BDG on ACEI for the entire group and for RV dominant. Although LV EDV was higher with those on ACEI, there was no difference in EF. There was no difference in ventricular dilation or EF on echocardiogram prior to starting drug. SPC positively correlated with EDV. SVC flow was lower for those on ACEI.

BDG patients treated with ACEI did not demonstrate decreased SPC. There was a suggestion of no improvement of ventricular performance. Cerebral blood flow is decreased in BDG on ACEI using SVC flow. Findings suggest that routine ACEI use in single ventricle patients post BDG should be considered with caution and age-appropriate and clear indications along with measurable therapeutic targets should be considered.

We aimed to evaluate the effectiveness and safety of Care Anywhere with Community Paramedics (CACP), a mobile community paramedic intervention delivering a broad range of clinical services in the home, in preventing or shortening hospitalizations.

In this multicenter, pragmatic, randomized controlled trial, we randomized 240 adults from ambulatory, emergency department (ED), or hospital settings requiring acute care-administered services to CACP or usual care. The trial was conducted from January 2022 to March 2023. The primary outcome was days alive out of hospital/ED within 30 days. Secondary outcomes were 30-day ED and unplanned hospital use, death, health-related quality of life, program satisfaction, medication errors, and falls with injury.

A total of 119 patients were randomized to CACP and 121 to usual care. Mean (SD) age was 68 (14) and 69 (15) years, respectively, 37% and 46% lived in rural areas, the mean (SD) Elixhauser comorbidity index was 10.0 (4.4) and 8.9 (3.7), and 84% and 86% had an unplanned hospitalization in the past 6 months. There was no difference between the CACP and usual care arms in the primary outcome (26.7 [6.6] vs 27.9 [4.2] days; P = .1) or secondary outcomes. The mean satisfaction score was greater for CACP (4.2 [0.8] vs 3.9 [0.9]; P = .02), and 94% were very/extremely likely to recommend CACP to others.

The CACP program, which enrolled highly complex patients with heterogeneous care needs, did not decrease 30-day acute care use compared with alternative usual care pathways, but it improved patient satisfaction and was preferred by most participants. Future research is needed to better tailor community paramedic services to those most likely to benefit.

Incorporating genetic risk factors to assess health risk and inform screening is critical for advancing precision medicine. The Electronic Medical Records and Genomics (eMERGE) Network conducted a large-scale study returning genome-informed risk assessments (GIRAs) to 23,840 participants (ages 3-75) across ten clinical sites. Risk for 11 common conditions was assessed using polygenic risk scores (PRSs), monogenic variants, and family history, with results placed in the electronic health record and returned to participants. Non-high-risk and family history-only high-risk results were delivered via patient portal, secure email, or mail. High-risk results involving PRSs, monogenic variants, or BOADICEAs (integrated breast cancer risk scores) were attempted to be returned one-on-one (1:1) via phone, video, or in person. Here, we evaluate the frequency and drivers of high-risk GIRAs, the feasibility of completing 1:1 returns, and factors associated with completing 1:1 delivery. Nearly 35% of participants (8,305) received high-risk results, most (76%) for a single condition. The most common triggers were family history and high PRS. Of those with high-risk GIRAs, 4,911 qualified for 1:1 return, with return completion rates equaling 78.5% for adults and 67.5% for children. The primary barrier to completing a 1:1 return session was the inability to contact participants. Among variables potentially impacting return success, homeownership, "good health," highest education level, and lack of health insurance all were significantly associated with successful 1:1 return with large effect sizes. This study demonstrates the feasibility of large-scale GIRA return in diverse clinical settings and highlights barriers that may impact equitable delivery of high-risk results.

Doppler ultrasound measurements have been recorded since the 1970s across the world and provide a valuable data resource for learning, analysis, and potential training of deep learning algorithms to recognise and grade venous gas emboli (VGE) allowing assessment of decompression sickness (DCS) risk.

We collected a 'big database' of Doppler recordings and associated metadata. Audio tapes with recorded Doppler data were converted to digital files, then cut into individual recordings and matched with their metadata, including subject and pressure profile information. The audio signals and their Doppler grades were then processed further for suitability to train an algorithm to identify VGE.

A total of 10,099 Doppler ultrasound recordings were compiled. Divers (n = ≤ 311; 170 identified, ≤ 141 unidentified) were male, with a median age of 31.5 years among the 170 identified divers. The maximum depth of the dives included ranged from 24 m (80 feet) to 91.4 m (300 feet). The timing of the Doppler measurements ranged from two minutes post-dive to 594 min post-dive, with a median time of 52 min. Breathing gases included air, nitrox, and heliox. DCS was noted in only 12 individuals. The dataset centred around lower VGE loads (Spencer Grades 0, I, and II).

This database represents a landmark in DCS investigation as the audio dataset and metadata collected have been released under a public domain license for further use. The large number of data points has also allowed the development of a deep learning algorithm that can grade bubble loads without a human operator.

Frailty is a progressive, dynamic clinical syndrome characterized by reduced physiological reserves and increased vulnerability to stressors, leading to adverse outcomes in older adults. Despite its clinical significance, routine detection of frailty remains challenging owing to subtle presentations and time constraints during assessments. Longitudinal studies are essential for capturing its biological trajectory and identifying early biomarkers.

This scoping review aims to systematically identify and map biomarkers-including inflammatory, hormonal, metabolic, genetic, and imaging-based markers-investigated for their longitudinal associations with frailty in older adults. Studies involving older adults with comorbid conditions (eg, cancer, infectious diseases, cardiovascular diseases) will also be included when frailty is assessed as an outcome.

We will conduct a comprehensive literature search in 6 databases (PubMed, CINAHL, Cochrane Library, Scopus, Web of Science, and Embase). We will include longitudinal studies that examine the association between objectively measured biomarkers and frailty, as assessed with validated tools, in older adults. Studies published in English, Korean, or Chinese will be considered, with no restriction on publication date.

We identified 3315 records after duplicate removal in an exploratory search conducted in July 2024, indicating a substantial body of literature for review. We plan to complete this review by December 2026.

This review will identify and describe longitudinal biomarkers that precede frailty in older adults, highlighting their potential for personalized clinical application. Anticipated limitations include reliance on observational study designs, methodological heterogeneity, and limited causal inference.

PRR1-10.2196/83312.

Established treatments for granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) include the use of immunosuppressive agents for remission induction followed by maintenance therapy. However, patients continue to experience disease progression, organ damage, and adverse events related to current therapies. Avacopan, an oral selective C5a receptor antagonist, was approved by the European Commission in January 2022 for the treatment of adult patients with severe, active GPA or MPA in combination with rituximab (RTX) or cyclophosphamide (CYC). In the pivotal phase 3 ADVOCATE (Avacopan Development in Vasculitis to Obtain Corticosteroid Elimination and Therapeutic Efficacy) study, avacopan was noninferior to prednisone taper in achieving remission at week 26 and superior in sustaining remission at week 52; furthermore, a greater improvement in estimated glomerular filtration rate with avacopan was also observed at week 52. The AvacoStar study will generate data on the benefit and risk and safety profile of avacopan in patients in a real-world context, including in those where treatment may potentially continue beyond 1 year.

The primary objective of AvacoStar is to evaluate the incidence of defined medical events of special interest in patients with antineutrophil cytoplasmic antibody-associated vasculitis commencing avacopan. These include liver injury, cardiac safety, serious infections, and malignancy.

AvacoStar is a noninterventional, multinational, prospective postauthorization safety study. It will enroll up to 500 patients in Germany and the United Kingdom in 2 groups of approximately 250 participants each: those treated with avacopan (plus a standard of care at local investigators' discretion; usually an RTX- or CYC-based regimen) and a second cohort treated with a CYC- or RTX-based induction regimen without avacopan. Avacopan and the standard of care will be prescribed in the usual manner in accordance with the corresponding summary of product characteristics under the sole decision of the investigator. The treatment decision will fall within current established practice. Eligible participants will be aged ≥18 years with severe, active GPA or MPA as determined by the investigator at the time of commencing avacopan or non-avacopan standard-of-care induction therapy. Patients will be followed for up to 7 years.

This study has been enrolling patients since September 11, 2023. The final report is expected in the second half of 2031; interim reports are planned every 24 months after the first patient first visit.

The AvacoStar study will be the largest European prospective real-world evidence comparative study conducted to date that evaluates the long-term safety of avacopan in severe, active GPA or MPA. This study is expected to yield important insights on the use of avacopan in severe, active GPA or MPA in a real-world setting.

Heart failure (HF) is a progressive chronic condition associated with reduced physical and functional capacity, psychological burden, cognitive decline, and diminished quality of life (QOL). Although exercise-based cardiac rehabilitation is beneficial, participation remains low due to accessibility, physical constraints, and motivational barriers. Virtual reality (VR)-based interventions, including immersive platforms and exergaming, may enhance accessibility and engagement and promote physical activity through interactive experiences. However, evidence regarding their effectiveness in patients with HF remains fragmented.

This systematic review synthesized current evidence on the effects of VR-based interventions on physical activity, psychosocial outcomes, and self-management behaviors in patients with HF.

We systematically searched PubMed, CINAHL, Embase, and Scopus for studies published within the past 10 years. Randomized controlled trials (RCTs) and non-RCT interventional studies involving adults with HF who participated in VR-based interventions were eligible. Outcomes included physical activity or exercise capacity, psychological well-being, self-management, and QOL. The reviewers screened articles, extracted data, and assessed risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials for RCTs and the Risk of Bias in Nonrandomized Studies of Interventions tool for non-RCTs. The review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRISMA-S (PRISMA extension for reporting literature searches) guidelines.

A total of 10 studies met the inclusion criteria, comprising 7 (70%) RCTs and 3 (30%) non-RCTs. Studies were conducted across multiple countries and predominantly included older adults (mean age ≥65 years). Most interventions were home based, with exergaming as the most frequent modality, followed by immersive VR cycling and digital coaching programs, delivered over 4 to 12 weeks. Across studies, VR-based interventions were associated with improvements in exercise capacity (n=6, 60% of the studies), physical activity (n=5, 50%), and QOL (n=4, 40%). Three of the studies (30%) reported reductions in depressive symptoms, whereas effects on anxiety and self-efficacy were inconsistent. Adherence and usability were high across studies, and no intervention-related adverse events were reported. However, the risk of bias was rated as "some concerns" or "high" in several domains, and heterogeneity in intervention design and outcome measurement, along with small samples, limited pooled synthesis and overall certainty of evidence.

VR-based interventions show promise as accessible and engaging approaches to promote physical activity and support rehabilitation in patients with HF, particularly in home-based settings. Across the included studies, VR interventions were generally associated with improvements in exercise capacity, physical activity, QOL, and depressive symptoms, with high adherence and no reported safety concerns. However, interpretation is limited by heterogeneity in intervention design, small sample sizes, and methodological constraints. Future research should prioritize larger, rigorously designed trials to support sustained clinical impact.