Cardiac rehabilitation (CR) reduces morbidity and mortality among individuals with heart disease. Although the COVID-19 pandemic disrupted health services, its impact on CR participation remains poorly understood-especially among commercially insured populations, for whom CR utilization trends are poorly documented.

Heart failure with reduced ejection fraction (HFrEF) guideline-directed medical therapy (GDMT) remains underutilized, particularly in socioeconomically disadvantaged populations. It has been proposed that the use of combination pills (polypills) may facilitate prescribing of GDMT and increase adherence. Understanding patient perspectives on implementation barriers and facilitators to the use of polypills is needed for developing effective strategies. A convergent, parallel, mixed-methods study was conducted with participants who participated in a Phase II randomized controlled trial of an HFrEF polypill (POLY-HF; NCT04633005) in Dallas, Texas. Six focus groups were conducted with participants from both polypill and usual care arms, followed by brief surveys. Qualitative data were analyzed using directed content analysis organized by a socioecological framework to identify barriers and facilitators across individual, interpersonal, and systems levels. Descriptive statistics characterized medication burden and polypill preferences. Study participants (n=41) included trial participants (n=36, mean 53 years, 53% Black race, 39% Hispanic) and caregivers (n=5). Quantitative data revealed substantial medication burden, with 58% taking ≥6 medications and 50.0% reporting missed doses, primarily due to forgetting (44%). 88.6% expressed interest in a polypill approach, and 83% believed it would improve adherence. Qualitative analysis identified multi-level implementation barriers and facilitators. Individual-level barriers included pill size concerns and uncertainty about polypill contents, while facilitators encompassed reduced pill burden, psychological benefits of taking fewer medications, and perceived health improvements. Interpersonal facilitators included caregiver enthusiasm for simplified medication management and strong provider trust. Systems level barriers centered on cost concerns, while institutional trust facilitated acceptance. Mixed-methods integration revealed convergent findings. Quantitative medication burden aligned with qualitative themes of regimen complexity, while high quantitative interest in polypills was contextualized by practical implementation considerations regarding formulation and delivery. In socioeconomically disadvantaged patients with HFrEF, a polypill strategy demonstrated strong patient acceptability, supporting further implementation research.

Given the large variation in out-of-hospital cardiac arrest (OHCA) survival, the Resuscitation Academy has developed a comprehensive training and mentorship program for emergency medical service (EMS) agencies to improve OHCA care. This study will evaluate whether Resuscitation Academy training is associated with higher OHCA survival at EMS agencies, particularly those with lower OHCA survival.

Targeted, digital recruitment strategies like tailored websites using motivational themes may improve recruitment in clinical trials, but their effectiveness remains unclear. We hypothesized that themes emphasizing community well-being, personal health benefits, or access to perks would increase engagement and pre-screening sign-ups compared to a standard contribution to science message in a clinical trial focused on Black adults. We implemented A/B testing of website themes for recruitment in GoFresh, a randomized trial testing the DASH diet intervention on blood pressure among Black adults. Website themes were derived from pre-developed motivational categories and included: (1) contribution to science (control group), (2) community well-being, (3) personal blood pressure improvement (4) access to perks (groceries or cash). A/B randomization directed visitors to a theme randomly between June and December 2024. Using an open-source web analytics platform, we captured data on two primary outcomes: 1) sign-up rate defined as the proportion of unique visitors who completed the trial's pre-screening form; and 2) engagement defined as (a) mean pageviews per session and (b) mean time spent on site per session. We compared themes using Welch's t-tests with statistical significance assessed as two-tailed p<0.05. Among 11,484 visitors over 6 months, the themes of community well-being (13.8%), personal blood pressure improvement (14.1%), and access to perks (13.1%) all attracted higher sign-up rates than contribution to science (11.1%) (p<0.05 for all comparisons). All alternative themes also led to significantly higher mean pageviews compared to the contribution to science theme (p<0.05 for all comparisons) while mean time on site was similar across all themes (range: 52 to 55 seconds with p>0.05 for all comparisons). There were no statistical differences noted across the three alternative motivational themes for these outcomes. Tailored websites with digital messages emphasizing community well-being, personal health benefits, and access to perks significantly improved engagement and prescreening sign-up rates, demonstrating that they may enhance recruitment within cardiovascular research. Unique Identifiers: NCT05393232, NCT05121337; URL: https://clinicaltrials.gov.

Invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) are common procedures for the diagnosis and treatment of coronary artery disease (CAD). These procedures are typically performed within the parameters of insurance coverage, but little is known about how insurance policies align with guidelines and landmark randomized clinical trials.

Although cardiovascular disease is the leading cause of death in the United States among Medicare beneficiaries, management of modifiable risk factors remains suboptimal. Medicare Advantage (MA) enrollment has increased substantially; therefore, understanding the quality of cardiovascular risk factor management in MA is critical. In this study, we evaluated whether cardiovascular risk factor management was better among MA compared with traditional Medicare (TM) beneficiaries.

Frailty before cardiovascular procedures is associated with poorer outcomes. While underutilized, cardiac rehabilitation (CR) is guideline-recommended for patients undergoing cardiovascular procedures and may help mitigate the effects of frailty. This study evaluated the association between preprocedural frailty and CR use, as well as the interaction of frailty and CR use on 1-year mortality.

In a universal health care system, geographic disparities in atrial fibrillation (AF) outcomes remain poorly understood. This study aimed to evaluate rural-urban differences in clinical outcomes among patients presenting to the emergency department (ED) with AF.

The potential J-shaped relationship whereby lower diastolic blood pressure (DBP) is associated with a higher risk of adverse cognitive outcomes has raised concerns regarding intensive systolic blood pressure (SBP) lowering. However, the current guidelines advocate a stricter SBP target of <130 mm Hg, with no clear consensus on a DBP target, especially with respect to brain health. The present study aimed to determine the relationship between treated DBP and cognitive function, as well as cerebral perfusion and structure, in adults who achieved an SBP <130 mm Hg.

The Target Stroke Phase III program is a national quality improvement initiative led by the American Heart Association, which sought to improve the quality of care for patients with acute stroke undergoing acute reperfusion therapy including endovascular thrombectomy (EVT).

Living in neighborhoods with a greater burden of violence is associated with higher cardiovascular disease risk. However, the interpretation of place-based findings is impeded by methodological challenges. To address challenges related to the influence of correlated neighborhood exposures, we utilized a case-crossover design to examine whether patients were more likely to have experienced a violent crime in their neighborhood during the month before their hypertension-related emergency department (ED) visit, compared with control periods 1 year before and after.

Equitable, timely, and evidence-based care remains a central goal across health care ecosystems, yet significant quality gaps, care variability, and health disparities persist. Professional societies, including the American Heart Association, have long developed clinical practice guidelines to provide standardized, evidence-based recommendations across the cardiovascular care continuum. These guidelines are operationalized into quality measures to monitor care, identify gaps, and guide improvement. Professional societies, agencies, and health systems have applied implementation science strategies, such as education, data sharing, and evaluation, to improve care quality and achieve quality measures defined in the clinical practice guidelines. American Heart Association's Get With The Guidelines programs target inpatient quality measures for stroke, heart failure, atrial fibrillation, resuscitation, and coronary artery disease, complemented by ambulatory quality improvement programs to support seamless care transitions. Decades of Get With The Guidelines implementation have enabled American Heart Association teams and volunteers to refine these programs, improving guideline adherence at local, regional, and national levels. Lessons learned informed the development of the Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand Framework, designed to guide successful quality improvement initiatives. While existing quality improvement frameworks provide structured approaches, many are costly, slow, or siloed, limiting rapid-cycle, data-driven innovation across diverse health systems. The Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand framework addresses these limitations as an adaptable model, applicable across care settings, disease areas, patient populations, system size, budgets, and target end points. Here, we illustrate the Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand framework through 2 recent American Heart Association programs: Target: Aortic Stenosis and the IMPLEMENT-HF initiative, demonstrating its utility in guiding effective, scalable quality improvement.

The dissemination of novel procedures should attempt to strike a balance between access and procedure quality. This study aimed to evaluate the temporal trends and geographic dispersion of mitral transcatheter edge-to-edge repair (M-TEER) sites and to examine the associations of site volume and site-to-population density with patient outcomes.