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The United States is facing a growing health care affordability crisis. In 2024, national health expenditures totalled $5.3 trillion, or $15 474 per person, accounting for 18.0% of the U.S. economy. Spending on health care continues to rise, propelled by high prices for services, drugs, and devices; growing administrative complexity; chronic underinvestment in prevention, primary care, and public health; and the mounting burden of chronic conditions such as cardiovascular disease. Patients, even those with insurance, frequently face financial hardship, delayed or foregone care, and medical debt because of gaps in coverage and inadequate consumer protections. Addressing this crisis will require coordinated action across the health care system, guided by evidence and a commitment to shared responsibility among key stakeholders. This Presidential Advisory from the American Heart Association draws on interviews and listening sessions with patients, clinicians, payers, employers, health system leaders, and public health experts to examine the many dimensions of affordability and offer a practical framework for action. The Advisory presents 5 core principles to guide efforts to address the affordability crisis: ensuring access to high-quality care without financial hardship; minimizing cost sharing for high-value services; creating shared accountability across the health care system; investing in the workforce, infrastructure, and data systems needed to support progress; and addressing the social and structural factors that make care less affordable for many communities. The evidence, tools, and expertise to combat the health care affordability crisis already exist. What is needed now is the collective will to act.

The 2024 guideline addresses perioperative cardiovascular risk in adults aged over 18 years planning noncardiac procedures, focusing on those with risk factors or conditions that increase perioperative risk. It emphasizes guideline-directed medical therapy, which includes clinical evaluation, targeted testing, and appropriate medical or interventional treatments for both short-term and long-term benefits. The guideline stresses the need for ongoing care and lifestyle modifications beyond the surgical period to reduce risk and improve long-term outcomes. Elevated risk is defined as a greater than 1% chance of major adverse cardiovascular events, but extensive preoperative testing is discouraged for low-risk procedures.

Acute heart failure (AHF) remains a leading cause of hospitalization and mortality despite therapeutic advances. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown benefits in chronic HF, but their role when initiated during hospitalization for AHF remains uncertain. A literature search was conducted across main databases through September 10, 2025 to identify randomized controlled trials (RCTs) evaluating in-hospital initiation of SGLT2 inhibitors in patients with AHF. Primary outcomes were all-cause death and worsening HF; secondary outcomes included cardiovascular death, HF rehospitalization, and safety endpoints. Random-effects model was used to estimate risk ratios (RRs) with 95% confidence intervals (CIs). Eight RCTs including 4,096 patients were analysed with a weighted median follow-up of 60 days. In-hospital initiation of SGLT2 inhibitors significantly reduced all-cause death (RR 0.61, 95% CI 0.47-0.81) and worsening HF events (RR 0.67, 95% CI 0.48-0.94) compared to control group. The risk of cardiovascular death was significantly lower with SGLT2 inhibitors (RR 0.68, 95% CI 0.47-0.99). No significant effect on HF rehospitalizations was observed (RR 0.87, 95% CI 0.70-1.09). Safety outcomes, including acute kidney injury, hypotension, hypoglycemia, urinary tract infection, and serious adverse events were comparable between groups. Trial sequential analysis confirmed firm evidence for mortality reduction, while further trials are needed for worsening HF. In-hospital initiation of SGLT2 inhibitors in patients with AHF lowers mortality and worsening HF without increasing adverse events. Further evidence from large scale RCTs with longer follow-ups is required to reach a definitive conclusion. Acute heart failure is a serious condition that often leads to repeated hospitalizations and a high risk of death. We reviewed all available clinical trials to understand whether starting a class of medications called SGLT2 inhibitors during the hospital stay can help these patients. Across eight trials involving more than 4,000 patients, in-hospital treatment with SGLT2 inhibitors lowered the chances of death and reduced episodes of worsening heart failure. Importantly, these medicines did not increase side-effects such as kidney problems, low blood pressure, or infections. Although they did not significantly reduce hospital readmissions, the overall benefits were consistent and appeared within weeks of treatment. These findings support starting SGLT2 inhibitors safely during hospitalization for acute heart failure to improve patient outcomes.

To compare associations of nonexercise estimated cardiorespiratory fitness (eCRF), the American Diabetes Association Risk Test (ADART), and body mass index (BMI) with incident prediabetes and type 2 diabetes in adults with normoglycemia. Participants were 10,715 healthy men and women aged 20-81 years from the Aerobics Center Longitudinal Study. eCRF was calculated in metabolic equivalents using sex-specific equations including age, BMI, resting heart rate, blood pressure, and smoking status. Incident prediabetes and type 2 diabetes were identified by fasting glucose or diagnosis. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for risk factors. Over a median follow-up of 5.1 years for prediabetes and 6.7 years for type 2 diabetes, 3912 and 320 cases occurred, respectively. Compared with unfit participants, fit individuals had a lower risk of prediabetes (HR: 0.83; 95% CI: 0.77-0.90) and type 2 diabetes (HR: 0.72; 95% CI: 0.55-0.95). Associations were significant in men for both outcomes and in women for prediabetes only. ADART and BMI predicted prediabetes but not type 2 diabetes after adjustment. eCRF demonstrated reliability as a noninvasive risk assessment tool for determining prediabetes and type 2 diabetes risk, particularly in men, highlighting its potential value for early risk assessment in lower-risk populations. All tools effectively assessed prediabetes risk.

Heart failure (HF) contributes to significant morbidity, mortality, and economic burden across the United States. This burden disproportionately impacts racially and ethnically minoritized groups, women, those from socioeconomically disadvantaged backgrounds, and rural patients. Interventional HF is a burgeoning field that has the potential to transform HF health equity. As device-based and catheter-directed therapies continue to evolve and become more accessible, interventional HF possesses a promising opportunity to bridge gaps in care across 4 key domains: ambulatory remote monitoring, valvular heart disease, revascularization, and cardiogenic shock. This review aims to explore the current state of interventional HF across these domains, elucidate inequities that persist, and highlight opportunities in research and practice to improve HF outcomes for all patients. Across all 4 domains, there have been landmark advancements in therapies and procedures to improve health outcomes, yet gaps in referral and implementation of devices and procedures persist. Additionally, underrepresentation from both the race and sex perspectives continues to plague research endeavors. Intentional regulatory mandates, inclusive clinical research recruitment, and iterative implementation science are needed to enhance the opportunity of interventional HF to transform health equity in HF.

•In clinical practice, significant treatment heterogeneity exists among patients with heart failure with preserved ejection fraction (HFpEF).•The heterogeneity of HFpEF has also been demonstrated via responder analyses in neutral HFpEF trials.•Identification of responder and nonresponder groups in HFpEF trials can provide novel insights into HFpEF pathophysiology.•Atrial shunt and splanchnic nerve ablation trials have identified novel latent pulmonary vascular disease and preload subtypes, respectively.•Stress-based phenotyping (e.g., exercise) should be considered in future HFpEF trials to help uncover pathophysiologic subtypes.

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The human heart beats 60-80 times a minute, which can amount to more than 3 billion heartbeats in one's lifetime. Each heartbeat is initiated by the sinoatrial node (SAN), a highly complex structure consisting of specialized cells that spontaneously fire action potentials (APs), propagating throughout the heart. Its automaticity is orchestrated by ion channels and transporters that contribute to the membrane and Ca2+ clocks, collectively known as the 'coupled clock'. Their activity is tightly regulated by autonomic and hormonal signalling pathways, most prominently β-adrenergic receptor (β-AR) signalling, which increases heart rate via activation of adenylyl cyclase (AC) and subsequent production of 3',5'-cyclic adenosine monophosphate (cAMP). In contrast, parasympathetic signalling through muscarinic M2 receptors reduces cAMP levels and activates inwardly rectifying K+ currents, thereby slowing pacemaker activity. The current topical review discusses recent literature encompassing the mechanisms of SAN regulation in health and disease, including cardiac arrhythmia syndrome such as catecholaminergic polymorphic ventricular arrhythmia, autoimmune cardiac ion channelopathies, and SAN dysfunction in heart failure (HF). SAN dysfunction in HF frequently manifests as bradyarrhythmia, a complication that significantly increases the morbidity and mortality of HF patients and confers an increased risk of sudden cardiac death. Recent studies support the previously unrecognized roles of mitochondrial-sarcoplasmic reticulum connectomics in SAN dysfunction commonly seen with HF. In addition, the roles of distinct AC isoforms that are preferentially expressed and compartmentalized in the SAN to serve a specialized function will be discussed. Finally, the review will consider recent advances in the development of biological pacemakers.

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Acute chest syndrome (ACS) is a leading cause of mortality in Sickle Cell Disease (SCD), often characterized by rapid respiratory decline and acute pulmonary hypertension (PH). While exchange transfusion is the standard of care for severe cases, delayed access to hemoglobin (Hb) electrophoresis often hinders real-time monitoring of therapeutic efficacy. We propose that POCUS guided assessments of pulmonary arterial pressures via tricuspid regurgitation jet velocities can serve as a real-time hemodynamic tool to direct serial exchange transfusions thereby preventing right heart failure and mortality in severe acute chest syndrome. A 20-year-old male patient with HbSS (baseline HbS 28.7%, on hydroxyurea) presented with shortness of breath, severe hip/back pain and acute hemolysis (Hb 8.3 g/dL, bilirubin 7.4 mg/dL, LDH 484 U/L). Despite treatment for ACS and an initial exchange transfusion, his oxygen requirements escalated from simple nasal cannula to high-flow nasal cannula. Repeated imaging showed worsening infiltrates, and Point-of-Care Ultrasound (POCUS) revealed acute PH (TR jet velocity > 4 m/s). Following the second exchange transfusion, the patient's tachycardia, dyspnea, and oxygen requirements rapidly improved. Follow-up Point-of-Care Ultrasound (POCUS) demonstrated an improved and now trace tricuspid regurgitation. Subsequent electrophoresis confirmed the first exchange only reduced HbS to 49%, while the second achieved a therapeutic level of 20.9% (recommended target HbS of <30% by American Society of Hematology). This case demonstrates that acute elevations in pulmonary artery pressure can serve as a critical surrogate marker for ongoing sickling when electrophoresis results are delayed. The patient's TRV of 3.74 m/s placed him in a high-mortality cohort (P < 0.001). Given that POCUS provides high diagnostic accuracy (AUC 0.87), it may be utilized as a real-time hemodynamic monitor to guide the necessity of serial exchange transfusions in the absence of immediate HbS% quantification. In severe ACS, achieving a target HbS &#x2264; 30% is vital, and bedside echocardiography may identify patients requiring immediate repeat exchange transfusion to prevent right heart failure and death.

Women are less likely to have a stroke compared with men, but certain sex-specific risk factors can increase their risk for ischemic or hemorrhagic stroke later in life. The 2024 American Heart Association and American Stroke Association guideline for primary prevention of stroke emphasizes female-specific factors that increase risk for stroke, including adverse pregnancy outcomes, premature and early menopause, endometriosis, and certain hormone therapies (eg, combined hormonal contraceptives). This review explores these sex-specific risk enhancers and highlights the importance of a detailed gynecologic and obstetric history when assessing stroke risk in women.

The 2025 pediatric advanced life support guidelines, developed by the American Heart Association and the American Academy of Pediatrics, are a resource for healthcare professionals caring for infants and children under 18 years of age in peri-arrest and other emergency care situations. The new guidelines address evolving pediatric cardiac arrest patterns, characterized predominantly by respiratory failure or shock, with persistent disparities in out-of-hospital survival and neurological outcomes. Major revisions include setting a blood pressure target above the 10th centile post-cardiac arrest, administering epinephrine after two attempts of defibrillation in a shockable rhythm, and administering early epinephrine in non-shockable cardiac arrest, as well as preventing hyperthermia. It also emphasizes evidence-based strategies such as early high-quality cardiopulmonary resuscitation (CPR), targeted post-arrest care, continuous electroencephalogram for neurological monitoring, and IV sotalol as an option for refractory supraventricular tachycardia. Long-term survivor support and family presence during resuscitation are integrated as vital aspects of care. While core recommendations-such as CPR technique, ventilation strategies, and shock management-are reaffirmed, the update provides a robust framework for multicentric harmonization. The adoption of these updated protocols in promises enhanced resuscitation outcomes, consistent neurological recovery, and the development of context-specific best practices in pediatric emergency care.

The American Heart Association recently introduced the cardiovascular-kidney-metabolic concept, but the impacts of frailty status on the disease trajectories remain unknown. We aimed to investigate the role of frailty status in the trajectories from being free of cardiometabolic-kidney disease (CMKD) to first CMKD (FCMKD), then to cardiometabolic-kidney multimorbidity (CMKM), and finally to death. In this prospective cohort study, we included 392&#x2009;902 participants aged 37-73 years from the UK Biobank. We assessed frailty using the Fried criteria's frailty phenotype, based on five individual components. We used multistate models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Among 392&#x2009;902 participants, 53&#x2009;845 developed FCMKD, 8025 developed CMKM, and 25&#x2009;538 died during a median follow-up of 13.49 years. Frailty was associated with a higher risk of transition from healthy to FCMKD (HR&#x2009;=&#x2009;2.08; 95% CI&#x2009;=&#x2009;1.99-2.17) than from FCMKD to CMKM (HR&#x2009;=&#x2009;1.47; 95% CI&#x2009;=&#x2009;1.34-1.62) (P&#x2009;<&#x2009;0.001). Frailty showed a stronger association for healthy to death than that of transitions from FCMKD or CMKM to death (HR&#x2009;=&#x2009;2.52; 95% CI&#x2009;=&#x2009;2.34-2.72, P&#x2009;<&#x2009;0.001). When splitting FCMKD into four CMKDs, the risks of disease-specific transitions associated with frailty varied, with the higher risk for chronic kidney disease to CMKM observed than that for other CMKDs to CMKM (HR&#x2009;=&#x2009;2.11; 95% CI&#x2009;=&#x2009;1.66-2.68). Consistent associations were also observed for pre-frailty. Both frailty and pre-frailty played key but different roles in disease transitions from healthy to FCMKD, to CMKM, and further to death, and had diverse impacts on disease-specific transitions of CMKDs. Our findings underscore the significance of early detection and interventions for frailty to prompt the comprehensive care of CMKM.

The American College of Cardiology (ACC) launched the Clinical Trials Research (CTR) program in 2019 to increase representation of historically underrepresented early-career investigators in cardiovascular research. In 2024, ACC introduced REACH (Research, Equity, and Access for Cardiac Health), a new subcohort within CTR focused on addressing disparities in structural heart disease research and recruitment. This analysis aimed to evaluate the diversity of the 2024-2025 CTR and REACH cohorts and assesses the program's short-term impact on research engagement, mentorship, and professional development. This was a cross-sectional voluntary survey of 22 items offered to all participants following completion of the program in March 2025. Responses were collected anonymously to ensure confidentiality, with data encrypted during transit and stored securely. Among the 2024-2025 ACC CTR cohort, 48 of 51 participants (94.1%) completed the survey, with equal sex distribution (50% women, 50% men) and 25% identifying as Hispanic. Reported short-term outcomes included 52% gaining new mentorship outside their institution, 23% receiving speaking invitations to national meetings, 81% forming new collaborations, and 79% identifying new research opportunities. In the ACC CTR REACH cohort, 60% reported new external mentorship, 40% received national speaking invitations, 60% formed collaborations, and 88% accessed at least 1 new research opportunity. The 2024-2025 ACC CTR and REACH programs fostered mentorship, collaboration, and research engagement among early-career investigators while advancing diversity in sex and ethnicity.

Cardiovascular health factors are associated with cognitive decline and risk of dementia, including Alzheimer disease (AD); however, this has been mostly studied in late life. We investigated whether vascular and lifestyle factors are associated with AD plasma and imaging biomarkers in midlife. We investigated 1,406 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study with information on vascular and lifestyle factors framed from the American Heart Association (AHA) "life's essential 8" (LE8) guidelines for cardiovascular health at early midlife (mean age 45.0 &#xb1; SD 3.6) and AD biomarkers in late midlife (mean age 60 &#xb1; SD 3.5). LE8 was calculated and categorized into poor (0-49), intermediate (50-79), and ideal (80-100) cardiovascular health, based on 8 components including smoking, diet, body mass index (BMI), sleep, fasting glucose, blood pressure, cholesterol, and physical activity. We assessed the AD plasma biomarkers phosphorylated tau 217 (ptau-217) and amyloid beta 42/40 ratio (A&#x3b2;42/40) and the Spatial Pattern of Abnormality for Recognition of Early AD (SPARE-AD), an algorithm that characterizes AD-like brain atrophy on brain MRI. We used linear regression to examine the association between LE8 and log transformed and standardized AD biomarker measures adjusting for age, sex, race, education, and kidney function. Compared to ideal LE8, intermediate (67.9% of participants) and poor (12.6%) LE8 was associated with lower A&#x3b2;42/40 (adjusted mean difference: -2.37, 95% CI: -2.38 to -2.36 and -2.38, 95% CI: -2.40 to -2.36, respectively). There was no association between the LE8 group and ptau-217 level. Moreover, compared to ideal LE8 participants, those with poor LE8 had higher SPARE-AD atrophy pattern (adjusted mean difference: -0.71, 95% CI: -0.81 to -0.62). These findings indicate that poor cardiovascular health in midlife, as defined by the AHA LE8, is linked to less favorable early AD biomarker profiles, particularly reflecting greater amyloid burden and structural brain changes.

Patients with interstitial lung disease (ILD) are at elevated risk of postoperative pulmonary complications (PPCs), including acute exacerbation, which carry high mortality. Surgical decision-making in this population requires careful preoperative risk stratification, medical optimization, and tailored intra- and postoperative management. This review summarizes current evidence to guide perioperative care for patients with ILD. The ARISCAT (Assess Respiratory Risk in Surgical Patients in Catalonia) risk index is widely used for PPC prediction but likely underestimates risk in ILD. Recent studies highlight the high prevalence of comorbid obstructive sleep apnea in ILD, supporting the need for routine screening. Updated American College of Rheumatology guidelines inform perioperative antirheumatic drug management, while International Society for Heart and Lung Transplantation consensus recommendations guide care of patients with pulmonary hypertension and right heart failure, a common comorbid condition. Emerging evidence suggests that perioperative antifibrotic therapy is safe and may reduce the risk of acute exacerbation, although further investigation is needed. Regional anesthesia can be a feasible alternative to general anesthesia when possible, for further risk mitigation in this patient population. Intraoperative lung-protective ventilation and use of the lowest oxygen concentration that maintains safe oxygen saturation remain critical, while judicious fluid management, postoperative extubation to high-flow nasal cannula or noninvasive ventilation, early mobilization, and multimodal analgesia may further reduce PPC risk. Perioperative management of ILD patients is complex due to heightened vulnerability to PPCs. Current evidence supports adapting general perioperative strategies while incorporating disease-specific considerations. As therapeutic advances extend survival, further prospective studies are needed to establish evidence-based perioperative guidelines for this high-risk group.

Life's Essential 8 (LE8) provides a multidimensional framework to assess cardiovascular health (CVH) in aging populations. The objective of this study was to describe LE8 component scores and their variation by age, sex, and psychosocial factors in middle-aged and older adults from C&#xe1;diz, Spain. Cross-sectional data were analyzed from 495 adults aged 50-79&#xa0;years (59.4% women; 34.7%&#x2009;&#x2265;&#x2009;65&#xa0;years). LE8 scores were calculated following American Heart Association guidelines. Group comparisons used t-tests, ANOVA, and chi-square tests to explore differences across demographic and psychosocial variables. Age- and sex-adjusted linear regressions were fitted for CVH, health behaviors (HB), and health factors (HF). Most participants showed moderate CVH, HB, and HF scores (76.6%; 53.1%; 62.2%). Diet quality had the lowest mean (40.8&#x2009;&#xb1;&#x2009;31.7), while physical activity and sleep health were the highest (88.3&#x2009;&#xb1;&#x2009;30.6 and 85.0&#x2009;&#xb1;&#x2009;22.2). Middle-aged adults presented higher CVH and HF scores (mean differences [MD]: 2.5&#x2009;&#xb1;&#x2009;0.3; 7.8&#x2009;&#xb1;&#x2009;1.5), whereas older adults scored better in HB (MD: 2.8&#x2009;&#xb1;&#x2009;1.4). Women exhibited higher CVH, HB, and HF scores than men (MD: 3.6&#x2009;&#xb1;&#x2009;0.3; 2.8&#x2009;&#xb1;&#x2009;0.4; 4.4&#x2009;&#xb1;&#x2009;0.4), with middle-aged women showing the most favorable CVH profile (73.0&#x2009;&#xb1;&#x2009;10.5) and older men the least favorable (66.4&#x2009;&#xb1;&#x2009;11.0). Higher self-rated health (&#x3b2;&#x2009;=&#x2009;0.240; R2&#x2009;=&#x2009;0.096) and educational attainment (&#x3b2;&#x2009;=&#x2009;0.235; R2&#x2009;=&#x2009;0.090) were the strongest correlates of CVH (both P&#x2009;<&#x2009;0.001). LE8 scoring revealed an intermediate CVH profile, with disparities by age, sex, and psychosocial context. Middle-aged women showed the most favorable profiles, while self-rated health and educational attainment emerged as key psychosocial markers for CVH assessment.

Gut dysbiosis and gut-derived metabolites have been linked to pulmonary arterial hypertension. However, associations between specific microbes, and corresponding metabolites, with pulmonary arterial hypertension disease severity is limited. This was a prospective cohort study of patients with pulmonary arterial hypertension undergoing right heart catheterization, with pulmonary artery blood subject to nuclear magnetic resonance metabolomics, and simultaneous stool sample shotgun metagenomics. Validation of metabolite levels with disease severity was done in an independent cohort of pulmonary arterial hypertension patients with blood samples from right heart catheterization testing. The presence of Lactobacillus species in the gut microbiome of pulmonary arterial hypertension patients was associated with less severe pulmonary hemodynamics and echocardiographic right ventricular dysfunction. Higher threonine levels were associated with more favorable pulmonary hemodynamic characteristics in both prospective and independent validation cohorts of pulmonary arterial hypertension patients. Detectable Lactobacillus species in the gut microbiome of pulmonary arterial hypertension patients are associated with more favorable pulmonary hemodynamic and right ventricular characteristics. Circulating gut-derived metabolites may also be involved. Further investigation into the relationship between gut microbial Lactobacillus, circulating metabolites, disease severity, and clinical outcomes in pulmonary arterial hypertension may be warranted.

In cardiac arrest management, cognitive aids provide prompts to encourage recall of critical information, which may improve clinical performance. Whether cognitive aids influence provider workload, cognitive load, teamwork dynamics, or leadership during cardiac arrest remains unknown. In this study, we evaluated the effect of using a multi-faceted decision support system with augmented reality-based cognitive aids (i.e. InterFACE-AR) vs. the American Heart Association (AHA) Pediatric Advanced Life Support (PALS) pocket card on provider workload and cognitive load, teamwork, and leadership during simulated pediatric cardiac arrest. We conducted secondary analysis of data collected from a prospective, randomized controlled trial comparing the use of the InterFACE-AR system to the AHA PALS pocket card during simulated pediatric cardiac arrest. Participants were recruited in groups of 3 to perform the roles of team leader, medication nurse, and documenting nurse. All teams completed a 12-min simulated cardiac arrest scenario. Provider workload (NASA-RTLX) and cognitive load (Paas score) were captured from participants after the scenario. Teamwork (TEAM score) and leadership performance (CALM score) were assessed via video review. A total of 18 simulation sessions were analyzed (Control: n&#x2009;=&#x2009;9; InterFACE-AR: n&#x2009;=&#x2009;9), involving 54 participants in total. Team leaders using the InterFACE-AR system had lower RTLX (mean difference [MD]: -15.0; 95% confidence interval [CI]: -27.0 to -4.6, p&#x2009;=&#x2009;0.022) and Paas score (MD: -2.4; 95%CI: -3.6 to -1.4, p&#x2009;<&#x2009;0.001), while documenting nurses showed similar reductions (RTLX -13.7, 95%CI: -26.7 to -0.4, p&#x2009;=&#x2009;0.049; Paas -1.6, 95%CI: -2.8 to -0.1, p&#x2009;=&#x2009;0.046) compared with those using PALS pocket card. Medication nurses demonstrated no statistically significant differences in RTLX (p&#x2009;=&#x2009;0.098) or Paas score (p&#x2009;=&#x2009;0.194). Teams using the InterFACE-AR system achieved significantly higher TEAM scores compared to those using PALS pocket card only (39.2 vs 35.8, MD: 3.4, 95%CI: 0.8 - 5.9, p&#x2009;=&#x2009;0.030). CALM scores did not differ significantly between groups. Use of an AR-based decision support system during simulated pediatric cardiac arrest reduces workload and cognitive load for the team leader and documenting nurse, but does not affect workload or cognitive load of medication nurses. Use of the InterFACE-AR system seems to improve teamwork performance but does not influence leadership performance of team leaders. ClinicalTrials.gov. Identifier: NCT06376643.