Pub Date : 2025-11-01DOI: 10.1001/jamacardio.2025.3384
Gerald S Bloomfield
{"title":"WHO STEPS and the Future of Cardiovascular Disease Prevention.","authors":"Gerald S Bloomfield","doi":"10.1001/jamacardio.2025.3384","DOIUrl":"10.1001/jamacardio.2025.3384","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"1087-1089"},"PeriodicalIF":14.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1001/jamacardio.2025.3521
Robert M Califf
{"title":"Evidence About Benefits and Risks of Vaccines: Challenges in Science, Medicine, Public Health, and Culture.","authors":"Robert M Califf","doi":"10.1001/jamacardio.2025.3521","DOIUrl":"10.1001/jamacardio.2025.3521","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"1089-1091"},"PeriodicalIF":14.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1001/jamacardio.2025.3337
Astrid Duus Mikkelsen, Rasmus Paulin Beske, Lisette Okkels Jensen, Hans Eiskjær, Norman Mangner, Amin Polzin, Christian Schulze, Carsten Skurk, Peter Nordbeck, Benedikt Schrage, Vasileios Panoulas, Sebastian Zimmer, Andreas Schäfer, Thomas Engstrøm, Lene Holmvang, Martin Frydland, Anders Bo Junker, Henrik Schmidt, Nanna Louise Junker Udesen, Kristian Wachtell, Christian Juhl Terkelsen, Axel Linke, Jesper Kjærgaard, Jacob Eifer Møller, Christian Hassager
Importance: Microaxial flow pump treatment improves survival in selected patients with infarct-related cardiogenic shock; however, treatment carries substantial risks, and benefit may vary by patient subgroup. Systolic blood pressure (SBP) has been proposed as a modifier of the survival benefit.
Objective: To investigate whether SBP at randomization modifies the survival benefit of microaxial flow pump treatment in ST-segment elevation myocardial infarction-related cardiogenic shock.
Design, setting, and participants: This was a post hoc analysis of the Danish-German (DanGer) Shock open-label randomized clinical trial among adult patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock, conducted between 2013 and 2023 at 14 tertiary invasive cardiac centers in Denmark, Germany, and the United Kingdom. Data analysis was performed from January 7 to April 7, 2024.
Intervention: Microaxial flow pump therapy plus standard care vs standard care alone.
Main outcomes and measures: All-cause mortality at 180 days according to randomization SBP.
Results: Of 355 patients included in the DanGer Shock trial, 351 patients had available SBP at randomization (median [IQR] age, 69 [59-76] years; 277 [79%] male). In a dichotomized regression analysis, microaxial flow pump treatment significantly reduced mortality for SBPs lower than 82 mm Hg compared with standard care alone (odds ratio [OR], 0.34; 95% CI, 0.18-0.63; P < .001). This was not evident for higher pressures (OR, 0.96; 95% CI, 0.53-1.70; P = .90; P for interaction = .02). Kaplan-Meier survival analysis and spline regression analysis supported these findings (P for interaction = .02; P for nonlinearity = .01).
Conclusions and relevance: Randomization SBP was associated with the survival benefit of microaxial flow pump treatment, with the most hypotensive patients deriving the largest survival benefit. Early SBP may help identify patients most likely to gain a net benefit from microaxial flow pump treatment. Findings are hypothesis generating.
{"title":"Systolic Blood Pressure and Microaxial Flow Pump-Associated Survival in Infarct-Related Cardiogenic Shock: A Post Hoc Analysis of the DanGer Shock Randomized Clinical Trial.","authors":"Astrid Duus Mikkelsen, Rasmus Paulin Beske, Lisette Okkels Jensen, Hans Eiskjær, Norman Mangner, Amin Polzin, Christian Schulze, Carsten Skurk, Peter Nordbeck, Benedikt Schrage, Vasileios Panoulas, Sebastian Zimmer, Andreas Schäfer, Thomas Engstrøm, Lene Holmvang, Martin Frydland, Anders Bo Junker, Henrik Schmidt, Nanna Louise Junker Udesen, Kristian Wachtell, Christian Juhl Terkelsen, Axel Linke, Jesper Kjærgaard, Jacob Eifer Møller, Christian Hassager","doi":"10.1001/jamacardio.2025.3337","DOIUrl":"10.1001/jamacardio.2025.3337","url":null,"abstract":"<p><strong>Importance: </strong>Microaxial flow pump treatment improves survival in selected patients with infarct-related cardiogenic shock; however, treatment carries substantial risks, and benefit may vary by patient subgroup. Systolic blood pressure (SBP) has been proposed as a modifier of the survival benefit.</p><p><strong>Objective: </strong>To investigate whether SBP at randomization modifies the survival benefit of microaxial flow pump treatment in ST-segment elevation myocardial infarction-related cardiogenic shock.</p><p><strong>Design, setting, and participants: </strong>This was a post hoc analysis of the Danish-German (DanGer) Shock open-label randomized clinical trial among adult patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock, conducted between 2013 and 2023 at 14 tertiary invasive cardiac centers in Denmark, Germany, and the United Kingdom. Data analysis was performed from January 7 to April 7, 2024.</p><p><strong>Intervention: </strong>Microaxial flow pump therapy plus standard care vs standard care alone.</p><p><strong>Main outcomes and measures: </strong>All-cause mortality at 180 days according to randomization SBP.</p><p><strong>Results: </strong>Of 355 patients included in the DanGer Shock trial, 351 patients had available SBP at randomization (median [IQR] age, 69 [59-76] years; 277 [79%] male). In a dichotomized regression analysis, microaxial flow pump treatment significantly reduced mortality for SBPs lower than 82 mm Hg compared with standard care alone (odds ratio [OR], 0.34; 95% CI, 0.18-0.63; P < .001). This was not evident for higher pressures (OR, 0.96; 95% CI, 0.53-1.70; P = .90; P for interaction = .02). Kaplan-Meier survival analysis and spline regression analysis supported these findings (P for interaction = .02; P for nonlinearity = .01).</p><p><strong>Conclusions and relevance: </strong>Randomization SBP was associated with the survival benefit of microaxial flow pump treatment, with the most hypotensive patients deriving the largest survival benefit. Early SBP may help identify patients most likely to gain a net benefit from microaxial flow pump treatment. Findings are hypothesis generating.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT01633502.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"1157-1165"},"PeriodicalIF":14.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-29DOI: 10.1001/jamacardio.2025.4053
Daniel J Rader,Sarah Schmidt
{"title":"Should Familial Hypercholesterolemia Be Included in Newborn Screening?","authors":"Daniel J Rader,Sarah Schmidt","doi":"10.1001/jamacardio.2025.4053","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4053","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"26 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-29DOI: 10.1001/jamacardio.2025.4047
Amy L Peterson,Vanessa Horner,Michael R Lasarev,Xiao Zhang,Stephen E Humphries,Robert D Steiner,Megan Benoy,Jessica Tumolo,Patrice K Held,Xiangqiang Shao
ImportanceNewborn screening for familial hypercholesterolemia (FH) would dramatically increase the diagnosis of a common, potentially fatal but highly treatable genetic condition in newborns and relatives.ObjectiveTo report the results of genetic testing of residual newborn screening dried blood spots (DBS) with biomarkers suggesting high risk for FH as an initial step toward development of multitier newborn screening for FH.Design, Setting, and ParticipantsA cross-sectional study design from July 2021 to July 2022 was used to test residual DBS from newborns with sample collection between 24 and 72 hours of life for total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B. Principal component analysis identified biomarker combinations that accounted for the greatest variance. Mahalanobis distance was calculated to generalize the idea of a standardized z score of a single variable to several correlated variables; approximately 8% of samples with the greatest positive Mahalanobis distance were selected for genetic FH testing. The study included a population-based screening for newborns in Wisconsin. Study data were analyzed from July 2022 to June 2024.ExposuresNewborn residual DBS were tested for total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B, with a subset tested for pathogenic variants in 8 genes associated with FH.Main Outcomes and MeasuresPrevalence of pathogenic variants for FH in a population-based sample of newborn screening DBS.ResultsOf 59 927 total newborns, DBS samples were obtained from 10 004 newborns (mean [SD] age, 27.8 [5.6] hours; 5142 male [51.4%]). From 10 004 specimens tested, principal component analysis demonstrated the combination of low-density lipoprotein cholesterol and apolipoprotein B accounted for the greatest variance, and 768 specimens were selected for genetic testing. A pathogenic variant for FH was found in 16 samples yielding a population-based prevalence of 1 in 625 (1.6 per 1000; 95% CI, 0.91-2.60 per 1000) newborns. Pathogenic variants were distributed throughout the entire range of Mahalanobis scores selected for genetic testing.Conclusions and RelevanceThis cross-sectional study found that screening newborns for FH using first-tier biochemical testing with reflex second-tier genetic testing was feasible and, in this population, identified 1 in 625 newborns with FH. Further refinement and validation are needed before implementation in newborn screening. Routine newborn screening for FH would substantially increase diagnosis of this common, potentially fatal, yet readily treatable condition while providing opportunities for cascade screening.
{"title":"Genetic Diagnosis of Familial Hypercholesterolemia in Residual Newborn Dried Blood Spots.","authors":"Amy L Peterson,Vanessa Horner,Michael R Lasarev,Xiao Zhang,Stephen E Humphries,Robert D Steiner,Megan Benoy,Jessica Tumolo,Patrice K Held,Xiangqiang Shao","doi":"10.1001/jamacardio.2025.4047","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4047","url":null,"abstract":"ImportanceNewborn screening for familial hypercholesterolemia (FH) would dramatically increase the diagnosis of a common, potentially fatal but highly treatable genetic condition in newborns and relatives.ObjectiveTo report the results of genetic testing of residual newborn screening dried blood spots (DBS) with biomarkers suggesting high risk for FH as an initial step toward development of multitier newborn screening for FH.Design, Setting, and ParticipantsA cross-sectional study design from July 2021 to July 2022 was used to test residual DBS from newborns with sample collection between 24 and 72 hours of life for total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B. Principal component analysis identified biomarker combinations that accounted for the greatest variance. Mahalanobis distance was calculated to generalize the idea of a standardized z score of a single variable to several correlated variables; approximately 8% of samples with the greatest positive Mahalanobis distance were selected for genetic FH testing. The study included a population-based screening for newborns in Wisconsin. Study data were analyzed from July 2022 to June 2024.ExposuresNewborn residual DBS were tested for total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B, with a subset tested for pathogenic variants in 8 genes associated with FH.Main Outcomes and MeasuresPrevalence of pathogenic variants for FH in a population-based sample of newborn screening DBS.ResultsOf 59 927 total newborns, DBS samples were obtained from 10 004 newborns (mean [SD] age, 27.8 [5.6] hours; 5142 male [51.4%]). From 10 004 specimens tested, principal component analysis demonstrated the combination of low-density lipoprotein cholesterol and apolipoprotein B accounted for the greatest variance, and 768 specimens were selected for genetic testing. A pathogenic variant for FH was found in 16 samples yielding a population-based prevalence of 1 in 625 (1.6 per 1000; 95% CI, 0.91-2.60 per 1000) newborns. Pathogenic variants were distributed throughout the entire range of Mahalanobis scores selected for genetic testing.Conclusions and RelevanceThis cross-sectional study found that screening newborns for FH using first-tier biochemical testing with reflex second-tier genetic testing was feasible and, in this population, identified 1 in 625 newborns with FH. Further refinement and validation are needed before implementation in newborn screening. Routine newborn screening for FH would substantially increase diagnosis of this common, potentially fatal, yet readily treatable condition while providing opportunities for cascade screening.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"23 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-29DOI: 10.1001/jamacardio.2025.4007
Rajeev K Pathak,Adrian D Elliott,Dennis H Lau,Melissa E Middeldorp,Dominik Linz,John L Fitzgerald,Aashray Gupta,Jonathan P Ariyaratnam,Varun Malik,Jean Jacques Noubiap,Walter P Abhayaratna,Jonathan M Kalman,Prashanthan Sanders
ImportanceAtrial fibrillation (AF) ablation outcomes demonstrate attrition over time. Although observational studies have reported reduced arrhythmia recurrence after AF ablation with aggressive lifestyle and risk factor modification, evidence from randomized clinical trials is lacking.ObjectiveTo determine the impact of risk factor and weight management on AF ablation rhythm outcomes.Design, Setting, and ParticipantsThis was an open-label, multicenter, randomized clinical trial with 12-month follow-up conducted from July 2014 to September 2018. The setting included 3 sites in Adelaide, South Australia. Included in the analysis were consecutive patients with nonpermanent symptomatic AF undergoing first-time catheter ablation with a body mass index (BMI) greater than or equal to 27 (calculated as weight in kilograms divided by height in meters squared) and 1 or more additional cardiometabolic risk factors. Data were analyzed from September 2023 to August 2024.InterventionsPatients were randomized 1:1 to lifestyle and risk factor management (LRFM) or usual care (UC) at catheter ablation. The LRFM group was treated in a structured, physician-led tailored clinic to reduce modifiable risk factors. The UC group was given information on management of risk factors by their treating physician but were not enrolled into the risk factor modification clinic. Both groups received guideline-directed care for management of AF by a team blinded to randomization. Pulmonary vein isolation was undertaken in each patient with additional ablation considered at the discretion of the electrophysiologist.Main Outcomes and MeasuresProportion of patients free from AF in the 12-month period after ablation.ResultsOf 122 participants (mean [SD] age, 60 [10] years; 82 male [67%]; mean [SD] BMI, 33 [5]), 62 were randomized to LRFM, and 60 were randomized to UC. Primary end point at 12 months after ablation was observed in 38 patients (61.3%) in the LRFM group and 24 (40%) in the control group (P = .03). The hazard for recurrent arrhythmia over 12 months was 0.53 (95% CI, 0.32-0.89) for LRFM vs UC. AF symptom severity was significantly improved in the LRFM group compared with the UC group (mean difference, -2.0; 95% CI, -3.7 to -0.3). Patients in the LRFM group achieved a significantly improved risk factor profile compared with those in the UC group (mean difference, body weight, -9.0 kg; 95% CI, -11.1 to -6.8 kg and waist circumference, -7.0 cm; 95% CI, -9.4 to -4.5 cm were lower at 12 months in the LRFM group; systolic BP was lower at 12 months in the LRFM group, -10.8 mm Hg; 95% CI, -16.1 to -5.5 mm Hg, although there was no difference in diastolic BP, -3.5 mm Hg; 95% CI, -7.2 to 0.2 mm Hg).Conclusions and RelevanceAmong patients with AF, elevated BMI, and 1 or more additional cardiometabolic risk factors, aggressive risk factor management reduced arrhythmia recurrence over the 12-month period after catheter ablation. These findings demonstrate the importance of LRFM for the
{"title":"Aggressive Risk Factor Reduction Study for Atrial Fibrillation Implications for Ablation Outcomes: The ARREST-AF Randomized Clinical Trial.","authors":"Rajeev K Pathak,Adrian D Elliott,Dennis H Lau,Melissa E Middeldorp,Dominik Linz,John L Fitzgerald,Aashray Gupta,Jonathan P Ariyaratnam,Varun Malik,Jean Jacques Noubiap,Walter P Abhayaratna,Jonathan M Kalman,Prashanthan Sanders","doi":"10.1001/jamacardio.2025.4007","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4007","url":null,"abstract":"ImportanceAtrial fibrillation (AF) ablation outcomes demonstrate attrition over time. Although observational studies have reported reduced arrhythmia recurrence after AF ablation with aggressive lifestyle and risk factor modification, evidence from randomized clinical trials is lacking.ObjectiveTo determine the impact of risk factor and weight management on AF ablation rhythm outcomes.Design, Setting, and ParticipantsThis was an open-label, multicenter, randomized clinical trial with 12-month follow-up conducted from July 2014 to September 2018. The setting included 3 sites in Adelaide, South Australia. Included in the analysis were consecutive patients with nonpermanent symptomatic AF undergoing first-time catheter ablation with a body mass index (BMI) greater than or equal to 27 (calculated as weight in kilograms divided by height in meters squared) and 1 or more additional cardiometabolic risk factors. Data were analyzed from September 2023 to August 2024.InterventionsPatients were randomized 1:1 to lifestyle and risk factor management (LRFM) or usual care (UC) at catheter ablation. The LRFM group was treated in a structured, physician-led tailored clinic to reduce modifiable risk factors. The UC group was given information on management of risk factors by their treating physician but were not enrolled into the risk factor modification clinic. Both groups received guideline-directed care for management of AF by a team blinded to randomization. Pulmonary vein isolation was undertaken in each patient with additional ablation considered at the discretion of the electrophysiologist.Main Outcomes and MeasuresProportion of patients free from AF in the 12-month period after ablation.ResultsOf 122 participants (mean [SD] age, 60 [10] years; 82 male [67%]; mean [SD] BMI, 33 [5]), 62 were randomized to LRFM, and 60 were randomized to UC. Primary end point at 12 months after ablation was observed in 38 patients (61.3%) in the LRFM group and 24 (40%) in the control group (P = .03). The hazard for recurrent arrhythmia over 12 months was 0.53 (95% CI, 0.32-0.89) for LRFM vs UC. AF symptom severity was significantly improved in the LRFM group compared with the UC group (mean difference, -2.0; 95% CI, -3.7 to -0.3). Patients in the LRFM group achieved a significantly improved risk factor profile compared with those in the UC group (mean difference, body weight, -9.0 kg; 95% CI, -11.1 to -6.8 kg and waist circumference, -7.0 cm; 95% CI, -9.4 to -4.5 cm were lower at 12 months in the LRFM group; systolic BP was lower at 12 months in the LRFM group, -10.8 mm Hg; 95% CI, -16.1 to -5.5 mm Hg, although there was no difference in diastolic BP, -3.5 mm Hg; 95% CI, -7.2 to 0.2 mm Hg).Conclusions and RelevanceAmong patients with AF, elevated BMI, and 1 or more additional cardiometabolic risk factors, aggressive risk factor management reduced arrhythmia recurrence over the 12-month period after catheter ablation. These findings demonstrate the importance of LRFM for the","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"54 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1001/jamacardio.2025.3932
Wenli Ni,Lina Benson,Petter Ljungman,Federica Nobile,Susanne Breitner,Siqi Zhang,Jeroen de Bont,Lars H Lund,Gianluigi Savarese,Alexandra Schneider,Stefan Agewall
ImportancePatients with heart failure may be particularly susceptible to nonoptimal temperature exposure, but the associations between short-term low and high temperature exposure and mortality in this population remain unclear, especially in Sweden-a high-latitude country where no nationwide study has been conducted.ObjectiveTo investigate the associations between short-term exposure to low and high ambient temperatures and all-cause and cardiovascular mortality among Swedish patients with heart failure.Design, Setting, and ParticipantsThis nationwide, time-stratified case-crossover study was conducted in Sweden among 250 640 patients with heart failure who died from any cause from 2006 to 2021, identified from the Swedish National Patient Register and the Cause of Death Register.ExposureDaily mean ambient temperature was assessed at 1 × 1-km spatial resolution. To account for regional adaptation, temperature exposures were defined using municipality-specific percentiles, with low and high temperatures corresponding to the 2.5th and 97.5th percentiles, respectively.Main Outcomes and MeasuresThe primary outcome was all-cause and cardiovascular mortality among patients with heart failure.ResultsThe mean (SD) age at death among patients with heart failure was 84.3 (9.4) years, with 121 061 female patients (48.3%). Short-term exposure to ambient temperature demonstrated a U-shaped association with both all-cause and cardiovascular mortality. For all-cause mortality, odds ratios (ORs) were 1.130 (95% CI, 1.074-1.189) for low temperatures and 1.054 (95% CI, 1.017-1.093) for high temperatures over the entire study period. For cardiovascular mortality, low temperatures were associated with an OR of 1.160 (95% CI, 1.083-1.242) over the entire study period, and high temperatures with an OR of 1.084 (95% CI, 1.014-1.159) during 2014-2021. The mortality risk associated with high temperatures was more pronounced during the 2014-2021 period compared to 2006-2013. Male patients, those with comorbid diabetes, and diuretic users were more susceptible to low temperatures, whereas high temperature was more strongly associated with mortality in patients with comorbid atrial fibrillation or flutter and those exposed to elevated ozone levels.Conclusions and RelevanceThis nationwide Swedish time-stratified case-crossover study indicates that short-term exposure to both low and high temperatures was associated with increased risk of all-cause and cardiovascular mortality in patients with heart failure. The mortality risk associated with high temperatures appears to be increasing over time, emphasizing the need for adaptation, even in high-latitude regions.
{"title":"Short-Term Exposure to Low and High Temperatures and Mortality Among Patients With Heart Failure in Sweden.","authors":"Wenli Ni,Lina Benson,Petter Ljungman,Federica Nobile,Susanne Breitner,Siqi Zhang,Jeroen de Bont,Lars H Lund,Gianluigi Savarese,Alexandra Schneider,Stefan Agewall","doi":"10.1001/jamacardio.2025.3932","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3932","url":null,"abstract":"ImportancePatients with heart failure may be particularly susceptible to nonoptimal temperature exposure, but the associations between short-term low and high temperature exposure and mortality in this population remain unclear, especially in Sweden-a high-latitude country where no nationwide study has been conducted.ObjectiveTo investigate the associations between short-term exposure to low and high ambient temperatures and all-cause and cardiovascular mortality among Swedish patients with heart failure.Design, Setting, and ParticipantsThis nationwide, time-stratified case-crossover study was conducted in Sweden among 250 640 patients with heart failure who died from any cause from 2006 to 2021, identified from the Swedish National Patient Register and the Cause of Death Register.ExposureDaily mean ambient temperature was assessed at 1 × 1-km spatial resolution. To account for regional adaptation, temperature exposures were defined using municipality-specific percentiles, with low and high temperatures corresponding to the 2.5th and 97.5th percentiles, respectively.Main Outcomes and MeasuresThe primary outcome was all-cause and cardiovascular mortality among patients with heart failure.ResultsThe mean (SD) age at death among patients with heart failure was 84.3 (9.4) years, with 121 061 female patients (48.3%). Short-term exposure to ambient temperature demonstrated a U-shaped association with both all-cause and cardiovascular mortality. For all-cause mortality, odds ratios (ORs) were 1.130 (95% CI, 1.074-1.189) for low temperatures and 1.054 (95% CI, 1.017-1.093) for high temperatures over the entire study period. For cardiovascular mortality, low temperatures were associated with an OR of 1.160 (95% CI, 1.083-1.242) over the entire study period, and high temperatures with an OR of 1.084 (95% CI, 1.014-1.159) during 2014-2021. The mortality risk associated with high temperatures was more pronounced during the 2014-2021 period compared to 2006-2013. Male patients, those with comorbid diabetes, and diuretic users were more susceptible to low temperatures, whereas high temperature was more strongly associated with mortality in patients with comorbid atrial fibrillation or flutter and those exposed to elevated ozone levels.Conclusions and RelevanceThis nationwide Swedish time-stratified case-crossover study indicates that short-term exposure to both low and high temperatures was associated with increased risk of all-cause and cardiovascular mortality in patients with heart failure. The mortality risk associated with high temperatures appears to be increasing over time, emphasizing the need for adaptation, even in high-latitude regions.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"1 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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