搜索结果：Global cardiology science & practice

Cardiovascular disease (CVD) remains a leading global health burden. Cardiac rehabilitation (CR) is essential to reducing morbidity and improving patient outcomes. Since the COVID-19 pandemic, CR delivery worldwide has evolved, yet these changes have not been systematically charactemkjrized. The objective of this study was to characterize globally: (1) the delivery of core CR components, including risk factors assessed, patient education practices, and program resources; (2) differences in these elements by country income classification and relative to the initial 2016 Global CR Audit. A cross-sectional Audit update was conducted. Program-level data were collected from May 1st to September 1st 2025 using a REDCap survey adapted from previous Audits. Eligible respondents were leads of phase II/post-discharge CR programs providing at least an initial assessment, structured aerobic exercise, and &#x2265;1 additional core component. ICCPR associations and local leaders supported program identification. Main outcomes were core components delivered (10 assessed), risk factors assessed (14 assessed), patient education dose (hours/patient/program), and program resources (17 assessed). Generalized linear mixed models (GLMM) tested differences by income classification and (when applicable) changes since 2016. Of 7,025 programs identified globally, 1,505 (62% median country response rate) initiated a survey from 90/113 (80%) countries with CR. The median number of core components offered was 8/program (p25, p75&#x2009;=&#x2009;6, 10), with upper-middle income countries offering significantly more components overall (median&#x2009;=&#x2009;9), and also high-income countries offering more than low-income countries (8 versus 6, p&#x2009;<&#x2009;0.001; decade change not tested). Programs assessed 11 risk factors/program (median; p25, p75&#x2009;=&#x2009;8, 12). This significantly differed by country income class (GLMM p&#x2009;<&#x2009;0.001), with programs in lower-middle income countries assessing fewer risk factors than those in both upper-middle-income (mean difference&#x2009;=&#x2009;2.2; p&#x2009;<&#x2009;0.001) and high-income countries (mean difference&#x2009;=&#x2009;1.6, p&#x2009;<&#x2009;0.001). There were significant increases in 2025 for glucose, sleep apnea and sedentariness, among others (ps&#x2009;<&#x2009;0.01). Patient education dose was 3 hours/supervised program (median; p25, p75&#x2009;=&#x2009;1, 7), a significant reduction in many high-income countries since 2016 (p&#x2009;=&#x2009;0.01). Globally, gym space, resistance training equipment, and individual assessment/counseling space were the most common resources (all&#x2009;>90%; median&#x2009;=&#x2009;11; p25, p75&#x2009;=&#x2009;8, 14). Resource availability differed significantly by country income class (GLMM p&#x2009;<&#x2009;0.001), with programs in upper-middle-income countries reporting more resources than those in high-income (mean difference&#x2009;=&#x2009;1.5), lower-middle-income (mean difference&#x2009;=&#x2009;2.6), and low-income countries (mean difference&#x2009;=&#x2009;4.8; all p&#x2009;<&#x2009;0.001). While there were no significant differences in total resources, resistance training equipment, electronic patient charts, body composition analyzers, and stress testing with O2 were more available in 2025, and the availability of administrative office space and group education room less so (ps&#x2009;<&#x2009;.01). Limitations include potential selection and ascertainment bias from incomplete program identification as well as variable, modest program response rates, limited representation from low-income settings, reliance on self-reported survey data, as well as measurement differences across Audit cycles, which may affect generalizability and precision of findings. CR programs worldwide continue to deliver guideline-concordant care, with education potentially shifting modality. However, modest inequities persist for resource-constrained programs.

Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C-related burden is critical for guiding prevention and treatment strategies. To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends. This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals. Population-level LDL-C concentrations. Population-attributable fractions, counts, and rates (all ages and age standardized per 100&#x202f;000) of LDL-C-attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals. In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C-attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings. Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.

Ischemic heart disease (IHD) presents a growing global health burden across diverse geographic and socioeconomic settings. Clinical practice guidelines are typically developed by professional societies in high-income countries, often with limited consideration of implementation barriers in other healthcare settings. We sought to understand clinicians' use of IHD guidelines in their practice, perceived deficiencies, implementation barriers, and differences between doctors practicing in high-income countries (HIC) or in low-/middle-income countries (LMIC). An internet-based, international survey of physicians treating patients with IHD, (July 26, 2025-November 15, 2025), inquiring about participants' demographics, experience, and views of IHD guidelines as related to their practice. Responses were provided by 587 clinicians from 97 countries. Approximately half (51.8%) considered the IHD guidelines as mostly or fully applicable in their country, a view more preponderant in HIC (67.3%) than in LMIC (48.8%; p&#xa0;=&#xa0;0.0125). Most (63.2%) thought IHD guidelines were highly applicable in HIC, but only 9.0% deemed the same for LMIC. The greatest barriers to guideline implementation were their being mostly relevant for HIC (72%), and cost, with the latter selected more frequently by the LMIC than the HIC group (61.7% v 20.4%; p&#xa0;<&#xa0;0.00001). Desires for future guidelines included availability in digital format, and inclusion of co-authors from LMIC. Survey respondents indicated that current IHD guidelines do not address the needs of clinicians and patients in LMIC as effectively as they do for those in HIC. Respondents advocated for future guidelines to have specific recommendations for differing socio-economic environments, and consideration of cost reimbursement.

Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021-30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). In 2023, there were 50&#xb7;9 million (95% UI 46&#xb7;1-56&#xb7;1) road injury incident cases, 1&#xb7;34 million (1&#xb7;04-1&#xb7;58) deaths, and 75&#xb7;3 million (59&#xb7;8-89&#xb7;2) DALYs globally. Road injuries were the leading global cause of death among males aged 10-39 years. Between 1990 and 2023, age-standardised incidence decreased by 38&#xb7;3% (95% UI 36&#xb7;9-39&#xb7;7) and mortality decreased by 32&#xb7;3% (6&#xb7;1-49&#xb7;0), but progress varied widely by World Bank income group. Mortality in low-income countries (43&#xb7;8 [95% UI 31&#xb7;7-56&#xb7;0] deaths per 100&#x2008;000 population) was approximately six times higher than in high-income countries (7&#xb7;5 [7&#xb7;1-7&#xb7;9] deaths per 100&#x2008;000), despite the high-income countries showing the highest age-standardised incidence rates (858&#xb7;1 [95% UI 781&#xb7;9-947&#xb7;1] cases per 100&#x2008;000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the USA, saw increases. More severe injuries tended to occur in low-income and middle-income countries. Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post-crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential. Gates Foundation.

Inflammation is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Contemporary global data on the prevalence of high inflammatory risk (high-sensitivity C-reactive protein [hsCRP] &#x2265;2&#x202f;mg/L), remain limited. We evaluated the global prevalence and characteristics of patients with high inflammatory risk among ASCVD patients, with and without chronic kidney disease (CKD). POSEIDON (NCT06122961) measured clinical and laboratory characteristics in 13,475 patients with ASCVD across 317 sites in 18 countries (2023-2025). The primary outcome was prevalence of hsCRP &#x2265;2&#x202f;mg/L, stratified by CKD status (estimated glomerular filtration rate <60 or &#x2265;60&#x202f;mL/min/1.73&#x202f;m2); also assessed were factors associated with hsCRP &#x2265;2&#x202f;mg/L and the correlation between hsCRP and interleukin (IL)-6. Among ASCVD patients with CKD (n&#x202f;=&#x202f;5757; mean age 75 years, 25.9% women), 39.3% had elevated hsCRP; among those without CKD (n&#x202f;=&#x202f;7718, mean age 67 years, 21.6% women), 28.3% had elevated hsCRP. Factors associated with hsCRP &#x2265;2&#x202f;mg/L were smoking, high body mass index, comorbid autoimmune disease, heart failure, polyvascular disease, and dyslipidaemia in both groups, and female sex and hypertension in those without CKD. IL-6 levels were significantly higher in patients with hsCRP &#x2265;2&#x202f;mg/L than without for both groups. Variability was observed in the prevalence of elevated hsCRP by country/region. High inflammatory risk is common, affecting &#x223c;30% of patients with ASCVD globally and &#x223c;40% of those with concomitant CKD, despite standard therapies. Routine hsCRP assessment may help characterize inflammatory risk, with implications for optimizing current preventive strategies, while awaiting potential benefits of future targeted therapies in these high-risk patients.

To characterize CR: (1) referral practices, (2) systematic referral barriers, (3) wait listing, (4) program-level approaches to mitigating patient access barriers, as well as (5) CR reimbursement sources; compared by country income classification and Audit decade. A cross-sectional, observational Audit update. Program-level data were collected (May-September 2025) via REDCap survey. Participants were leads from phase II/post-discharge CR programs offering at least initial assessment, structured aerobic exercise, and &#x2265;1 other core component. ICCPR-member Societies and other local leaders facilitated program identification. Survey items pertaining to program and patient costs were standardized to 2025 international dollars using purchasing power parity (PPP) to facilitate comparisons. 1,505/7,025 CR programs identified globally initiated a survey from 90/113 countries with CR. Of programs situated in a hospital, 87% had inpatient cardiology services, most commonly referring before discharge (62%). Programs offered tailored CR information to patients (61%) in multiple formats/modalities. Wait times were consistent with 2016 at 3 weeks. Programs contacted no-shows (67%) and discussed patient-related barriers (63%), with access optimization strategy variation by income class (p<0.05). The most common funding sources were government (63%), patients (45%), and insurance (26%); patient funding was more common in non-high-income countries. Total mean delivery cost was 1,237.6PPP&#xb1;1972.9/patient/program, with 50% of patients paying 60% of that cost (both varied significantly by income class; p<.05). Programs estimated 50% of patients did not attend CR due to cost (significantly higher in non-HICs: p<0.001). Programs are implementing evidence-based patient engagement approaches, but reimbursement inequities undermine access globally.

Immune checkpoint inhibitors (ICIs) have transformed oncologic practice, but their expanding use has heightened concern about potentially fatal cardiovascular toxicity. This bibliometric study mapped the global research landscape and temporal evolution of ICI-associated cardiotoxicity from 2016 to 2025. Records were retrieved from the Web of Science Core Collection on January 1, 2026. After excluding letters, conference abstracts, editorials, and other non-research items, 1,127 original articles and reviews were analyzed. A thesaurus file standardized synonyms, abbreviations, spelling variants, and singular-plural forms before keyword co-occurrence analysis. VOSviewer and CiteSpace were used to evaluate publication trends, collaboration networks, citation structures, keyword clusters, temporal patterns, and burst terms. The corpus involved 67 countries, 2,430 institutions, and 8,842 authors. Annual output increased from 9 publications in 2016 to 236 in 2025, representing a 26.2-fold rise and a compound annual growth rate of 43.8%; cumulative publication output was well fitted by a quadratic polynomial model (R2&#x2009;=&#x2009;0.9973). China produced the most publications, whereas the United States achieved the highest citation count. The University of Texas MD Anderson Cancer Center, Javid Moslehi, and Frontiers in Oncology were the leading institution, author, and journal, respectively; The New England Journal of Medicine was the most frequently co-cited journal. Keyword mapping delineated three domains: immune-mediated cardiovascular phenotypes, PD-1/PD-L1-related mechanisms, and multidisciplinary risk management. Temporal and burst analyses indicated a shift from toxicity recognition toward mechanistic elucidation, diagnostic standardization, risk stratification, and cardiovascular outcome assessment. Emerging low-frequency but rapidly strengthening terms highlight growing attention to combination-regimen safety, patient-level risk assessment, evidence synthesis, and long-term cardiovascular outcomes.

Vulnerable carotid plaques can lead to stroke or TIA; thus, classifying these plaques by ultrasound is crucial. Deep learning improves classification, but requires large labeled datasets, and expert annotation is labor-intensive. Training with limited labeled data alongside unlabeled data can boost deep learning in ultrasound plaque classification, and pseudo-label-based semi-supervised learning provides a viable approach. However, current pseudo-label-based methods overly focus on individual sample confidence, neglecting inter-sample relationships, resulting in data underutilization and imbalanced pseudo-label distribution. To address this issue, we propose a novel deep semi-supervised learning algorithm utilizing global and local pseudo-label filtering (GLPF) to enhance the classification of carotid ultrasound images. Global feature pseudo-label filtering uses the feature distribution of labeled samples to adjust the bias in feature extraction for unlabeled samples caused by unreliable pseudo-labels. Local feature pseudo-label filtering utilizes the local similarity between samples along with the model's confidence in predictions to provide reliable pseudo-labels for samples near the decision boundary. Furthermore, to alleviate the impact of imbalanced pseudo-label distribution, pseudo-label balance correction is proposed to dynamically adjust the learning difficulty of each class based on the number of pseudo-labels. The experiments were evaluated on 1270 ultrasound carotid plaque images from Zhongnan Hospital of Wuhan University. The results demonstrate our model's superiority over advanced semi-supervised methods (i.e., MixMatch, FixMatch, FlexMatch, AdaMatch and FreeMatch) when labeled data is available at 10%, 30%, and 50% of the total. These findings highlight the efficacy and precision of the GLPF algorithm in classifying carotid plaques with limited labeled training data, indicating its potential for identifying vulnerable carotid plaques in clinical practice.

Elite athletes develop physiological cardiac remodeling, involving both ventricular and atrial chambers, as well as wall thickening. We propose a Global Athletic Heart Index (GAHI) which integrates both ventricular and atrial changes, aiming to define with a simplified marker the physiologic cardiac remodeling and its relationship with aerobic performance in athletes. 641 healthy Olympic athletes (mean age 25.5&#xb1;5.3 years; 51% male) underwent transthoracic echocardiography and cardiopulmonary exercise testing (CPET). GAHI was calculated as the mean ratio of each chamber dimension to its sex-specific upper limit of normal. Athletes were classified as GAHI >1 (global cardiac remodeling) or &#x2264;1. VO&#x2082; max >85% of predicted was considered and indicator of preserved aerobic capacity. Sensitivity, specificity, and predictive values of GAHI >1 for identifying preserved VO&#x2082; max were evaluated. Linear regression analyses assessed the association of GAHI with peak VO&#x2082; and O&#x2082; pulse. Overall, 155 athletes (24.2%) had GAHI >1. Endurance athletes were overrepresented in this group (51% vs. 13%, p<0.0001). GAHI >1 was associated with larger LV and RV dimensions, higher LV mass, balanced biatrial enlargement, and preserved systolic and diastolic function. CPET revealed higher peak VO&#x2082;, O&#x2082; pulse, and workload (all p<0.0001). Linear regression analyses demonstrated significant positive associations between GAHI and peak VO&#x2082; (R&#xb2;=0.24, p<0.0001) and O&#x2082; pulse (R&#xb2;=0.20, p<0.0001). Using a dichotomous threshold, GAHI >1 identified athletes with VO&#x2082; max>85% with 25.7% sensitivity, 93.9% specificity, 98.1% positive predictive value, and 9.5% negative predictive value. GAHI is an integrative marker of balanced cardiac remodeling closely associated with aerobic performance. A GAHI >1 reliably identifies athletes with balanced structural adaptations and preserved exercise capacity. GAHI may serve as a practical tool for athlete screening and individualized cardiovascular assessment.

Clinical practice guidelines (CPGs) are intended to improve health and reduce disease burden, yet their global status and their association with disease burden remain unknown. This longitudinal ecological study analyzes the quantity and quality of CPGs and explores their associations with disease burden. From 1995 to 2023, 10,657 CPGs were published, with the number of CPGs in 2023 being 5.15 times the number of CPGs in 1995. Europe contributed 40.2% of all CPGs, while CPGs from Africa accounted for only 0.8% of and showed minimal growth. Treatment CPGs contributed the most (45.0%), while diagnosis CPGs showed the fastest growth. Prevention CPGs (8.4%) and nursing CPGs (5.3%) and rehabilitation CPGs were less common, with rehabilitation CPGs showing the slowest growth. The 3-year update rate of CPG is 23.8%. Quality assessment of 1633 CPGs using AGREE II revealed substantial variation across domains. Overall 37.8% CPGs achieved scores above 70% per domain, while the "applicability" domain had the lowest median score (36%). Cross-region CPGs and CPGs for neoplasms exhibited the highest AGREE II scores, with the median score exceeding 70% in 3/6 domains. In contrast, CPGs from Asia and CPGs for cardiovascular diseases did not exceed the 70% threshold in any domain. Neither the quantity nor the quality of CPGs was significantly associated with disease burden at the national level. In conclusion, this study reveals that the quantity of CPGs has increased over the past three decades, although geographic and thematic differences remain. Future opportunities for CPG development include improving the AGREE II scores and focusing on less represented areas including rehabilitation, nursing and prevention.

Surgical site infections (SSIs), infections at or near surgical incisions, represent 20-30% of nosocomial infections globally, with higher prevalence in low- and middle-income countries such as Syria. This study assessed SSI prevalence in two Syrian hospitals alongside a nationwide evaluation of surgical healthcare workers' knowledge, practices, compliance, and barriers to WHO/CDC SSI prevention guidelines. A cross-sectional survey was conducted among 375 healthcare workers in surgical settings across Syria. A structured questionnaire collected data on demographics, educational background, work experience, self-reported practices, knowledge of WHO guidelines, and perceived barriers to implementation. Composite knowledge and practice scores were calculated. Data were analyzed using descriptive statistics, Pearson correlation, and ANOVA. Adherence to basic preventive practices was high, including hand preparation (89.33%) and intraoperative sterilization (91.47%). However, gaps persisted in avoiding preoperative shaving, appropriate antibiotic prophylaxis timing and duration, and postoperative antibiotic discontinuation. Major barriers included lack of role models (68%), inadequate training (63%), and staff shortages. Pearson analysis revealed positive correlations between compliance and practice scores (r&#x2009;=&#x2009;0.5203, p&#x2009;<&#x2009;0.001) and compliance and knowledge scores (r&#x2009;=&#x2009;0.3372, p&#x2009;<&#x2009;0.001). Crucially, the weakest correlation was found between knowledge and practice scores (r&#x2009;=&#x2009;0.2662, p&#x2009;<&#x2009;0.001), highlighting a prominent know-do gap. Hospital-reported SSI prevalence was 9.5% in one hospital and 1.47% in the other. This study identified suboptimal knowledge and inconsistent implementation of high-impact SSI prevention practices among Syrian surgical healthcare workers despite strong adherence to basic aseptic measures. Targeted training, improved surveillance systems, and institutional support are needed to strengthen guideline adherence and reduce preventable SSIs.

The Singapore National Precision Medicine (NPM) program is a three-phase whole-of-nation effort designed to develop scalable, evidence-based solutions for precision health tailored to Asia's diverse populations. Here we present NPM phase II (2020-2025), highlighting how large-scale precision medicine initiatives can drive new research insights, enable healthcare innovations and create economic value. Key achievements include the PRECISE-SG100K population dataset, which reflects Singapore's unique multi-ancestry Asian population; the successful translation of research findings into mainstream national healthcare using familial hypercholesterolemia as a use case; and the establishment of strategic public-private partnerships with diverse industry sectors. We also outline phase III (2025-2031), which aims to establish whole-genome sequencing as a foundational element of a patient's lifelong healthcare record for 10% of the population. NPM provides a model for how smaller countries, despite limited populations and finite resources, can contribute meaningfully to global scientific movements while preserving strategic independence and addressing national health challenges.

Cone dystrophy with supernormal rod responses (CDSRR) is a rare autosomal recessive hereditary retinal dystrophy caused by biallelic KCNV2 variants. Accurate prevalence data remain limited because current estimates rely on clinically ascertained cases. This study aimed to estimate its population prevalence by integrating curated variant evidence and large-scale population genomics resources. The key methodological feature of this study is a multi-tiered pathogenicity framework combined with estimation of a biologically plausible prevalence range: Known pathogenic variants define conservative estimates, whereas probably pathogenic variants and strong variants of uncertain significance define broader estimates. Allele frequencies were analyzed in 807,162 individuals from the gnomAD database and 144,127 Russian genomes from GDB and EvogenDB. A Bayesian framework was applied to calculate disease prevalence from aggregated carrier frequencies across predefined variant tiers. Conservative estimates based on known pathogenic variants, were 1 in 343,926 globally and 1 in 1,911,347 in Russia. Including broader tiers increased estimates to 1 in 14,620 and 1 in 32,764, respectively. Compared to previous clinically ascertained prevalence of 1 in 865,000, these estimates define a wider biologically plausible prevalence range and are consistent with possible clinical underascertainment. This tier-based approach accounts for uncertainty in variant classification when estimating rare disease prevalence.

Hepatology is experiencing major shifts in disease etiologies and raising demand for multidisciplinary care. However, a globally harmonized framework defining core training content remains lacking. We aimed to develop a globally informed expert consensus framework for the content of core hepatology training, in order to provide a structured foundation for curriculum development. A two-round modified Delphi using the RAND/UCLA Appropriateness Method (RAM) was conducted. A comprehensive list of curriculum items was developed from international training standards, refined by a steering committee, and rated by a stratified international panel. Consensus was determined using medians and a disagreement index (DI), which classified curriculum items as essential, desirable, or optional. 456 experts completed Round 1, of whom 78.7% also completed Round 2. Consensus was strongest for foundational knowledge and core diagnostic skills, including interpretation of abnormal liver function and liver screening test results, and non-invasive fibrosis assessment (both DI=0). Management of major liver diseases was consistently prioritized as essential. Procedures with the highest endorsement for independent performance were paracentesis, transient elastography, variceal screening, and endoscopic variceal therapy. Consensus was limited for conventional ultrasonography and advanced interventions, reflecting regional variability in resources and scope of practice. Most experts (79.1%) supported formal training in research methodology, and the median recommended fellowship length was 24 months. Subgroup differences were mainly observed in selected resource-dependent or highly specialized items. This global consensus offers a priority-stratified outline of core hepatology training content providing a practical foundation for curriculum development and staged implementation across diverse health systems. Our study provides a consensus-based, priority-stratified framework for core hepatology training content that may inform curriculum development and local adaptation, given the growing global burden of liver disease and the heterogeneity of training standards. This framework may support curriculum mapping and local adaptation for trainees, program directors, professional societies, and policymakers, including in settings where structured hepatology training pathways are still evolving. In practical terms, these findings may assist educators and institutions in reviewing and refining national curricula and training structures. However, specific implementation decisions, including accreditation requirements and procedural training standards, will need to be adapted to local regulatory and resource contexts. Recognizing that these recommendations are based on expert consensus rather than outcome data and may be variably implementable in resource-limited settings, the next steps are pilot implementation in diverse settings, evaluation of trainee and patient outcomes, and iterative revision, supported by coordinated efforts from societies, governments, and training institutions.

Lactate is a critical prognostic biomarker in observational studies of cardiac intensive care. In research settings, lactate is an integral component of prognostic models such as the IABP-SHOCK II risk score. However, lactate measurements are frequently missing due to heterogeneous clinical and logistical factors, potentially introducing systematic bias and compromising the validity of epidemiological inferences. In practice, missing lactate values are often replaced by indicator variables or excluded entirely, potentially hampering the analytical validity of research results. We illustrate a methodological framework to address missing lactate values in clinical research settings. We used data from 17,993 admissions recorded between 2017 and 2021 across 35 cardiac intensive care units participating in the Critical Care Cardiology Trials Network registry to characterize the mechanism of lactate missingness and to develop a structured model for multiple imputation. To assess the practical implications of this imputation procedure, we evaluated risk reclassification when using imputed lactate for computing the IABP-SHOCK II risk score. Missingness was associated with patient severity, confirming the data were not missing completely at random. Identified predictors of lactate missingness were included in the multiple imputation model. The inclusion of imputed lactate in the IABP-SHOCK II risk score resulted in significant reclassification of risk, demonstrating the magnitude of bias inherent in na&#xef;ve imputation (event-specific net reclassification ranging from -0.13% to 2.70% across shock populations). Missing lactate measurements are a source of selection and measurement bias in critical care registries. A structured imputation framework mitigates bias and improves the reliability of real-world evidence in cardiovascular epidemiology. Lactate is a blood marker that helps clinicians assess how sick a patient is and is commonly used in risk prediction tools for patients with cardiogenic shock. However, lactate measurements are often missing in clinical registries because testing practices vary across hospitals and patient groups. When lactate values are missing, researchers often either exclude those patients from analyses or assume that the missing value is low. Both approaches can introduce bias and may lead to inaccurate estimates of patient risk. In this study, we developed and evaluated a structured approach for handling missing lactate values using multiple imputation, a statistical method that estimates likely values based on other available clinical information. Using data from the Critical Care Cardiology Trials Network registry, we assessed how accounting for missing lactate affected risk classification in patients with cardiogenic shock. We found that replacing missing lactate values using a principled imputation approach led to meaningful changes in risk classification and identified additional patients at higher risk of death who would not have been recognized using standard approaches. The results were robust across multiple sensitivity analyses. These findings suggest that appropriate handling of missing biomarker data can improve the validity of registry-based research and may lead to more accurate assessment of patient risk when complete data are unavailable.

An Unprecedented Confluence of Science, Selfless Service, and the World Heart Federation's Mission of Cardiovascular Health for All&#xa0; On 29 September 2025, the World Heart Federation (WHF) marked the silver jubilee-25 years-of World Heart Day in what might seem an unlikely setting for a global cardiovascular organization: Prasanthi Nilayam in Puttaparthi, India, an internationally recognized epicenter of free, world-class medical care and humanistic service. The choice was deliberate. For an organization whose mission is 'cardiovascular health for everyone, everywhere,' it was most fitting to celebrate this milestone in a place where that principle has been quietly practiced, at scale and at no cost, for decades. For most of its history, the WHF has marked World Heart Day through campaigns centered initially only in its headquarters in Geneva, and subsequently in capitals and at multilateral fora, where global policy is debated and shaped. By contrast, Prasanthi Nilayam sits closer to village life than to ministries of health, and closer to patients' daily realities than to conference halls. Precisely for that reason, it offered a real-life model of how values-driven policy translates into free, high-quality cardiovascular care, prevention, and community engagement on the ground. The timing was equally symbolic: the 25th anniversary of World Heart Day coincided with the centenary celebrations of Sri Sathya Sai Baba, whose guiding maxim-'Love All, Serve All; Help Ever, Hurt Never'-has, for decades, animated an integrated, free-of-cost healthcare ecosystem that mirrors the WHF's founding pledge that cardiovascular health should be a right, not a privilege, regardless of background, religion, caste, or means.

The Cardiovascular-Kidney-Metabolic (CKM) framework recognizes the interconnected biological, clinical, and societal drivers of cardiovascular disease, chronic kidney disease, diabetes, and obesity. To advance an integrated perspective, aligned with the kidney community focus, the International Society of Nephrology (ISN) convened an International Expert Forum bringing together a global and multidisciplinary team of leaders in this field. This meeting report synthesizes key discussions spanning CKM risk stratification, lifestyle interventions, guideline-directed medical therapies, emerging late-stage therapeutics, and models of care delivery. Participants emphasized the importance of early, integrated case-finding; long-term, joint kidney-cardiovascular risk assessment; and timely use of evidence-informed therapies to reduce kidney disease progression, kidney failure, and cardiovascular events. Persistent gaps including therapeutic inertia, fragmented care, and global inequities in access to care were highlighted, alongside promising multidisciplinary and system-level care models. Emerging therapies targeting residual risk further underscore the need for adaptive implementation strategies. Aligned with ISN's mission, this forum represents a foundational step toward connecting disciplines, bridging evidence-to-practice gaps, and building global capacity to improve equitable CKM outcomes.

Pulmonary arterial hypertension (PAH) is a progressive disease leading to right ventricular (RV) hypertrophy and failure. This study aims to evaluate the prognostic value of combining the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio with right ventricular myocardial work (RVMW) parameters in patients with PAH, to improve early risk stratification. A total of 43 PAH patients diagnosed via right heart catheterization were enrolled. Echocardiography-derived TAPSE/sPAP ratio and RVMW parameters, including right ventricular global work efficiency (RVGWE), global work index (RVGWI), global constructive work (RVGCW), and global wasted work (RVGWW), were measured. Clinical worsening events were recorded during a median 515-day follow-up. Statistical analyses included correlation tests, Firth penalized logistic regression, receiver operating characteristic (ROC) curves, and Kaplan-Meier survival analysis. The TAPSE/sPAP ratio correlated negatively with RVGCW (r = -0.346, p = 0.023) and RVGWW (r = -0.417, p = 0.005), but not with RVGWE or RVGWI. Clinical worsening events occurred in 25.6% of patients, with significantly lower TAPSE/sPAP ratio (0.16 vs. 0.24 mm/mmHg), RVGWE (72.0% vs. 88.5%), and RVGWI (431.0 vs. 641.0 mmHg%) in the Event group (all p < 0.05). Multivariate Firth penalized logistic regression was used for combining TAPSE/sPAP ratio with RVGWE. ROC analysis demonstrated that the combination of TAPSE/sPAP and RVGWE yielded superior predictive power (AUC = 0.949, p < 0.001) compared to individual parameters. Non-invasive assessment of TAPSE/sPAP ratio and RVGWE provides significant prognostic value in PAH. Their combination enhances early risk prediction, offering a practical tool for clinical management.

Many toolkits have been developed globally to help researchers design and conduct inclusive clinical trials, but their usability for Canada's diverse population remains unclear. This scoping review aims to evaluate existing toolkits and assess their appropriateness in supporting inclusive clinical trials in Canada. We will conduct a comprehensive search of peer-reviewed and grey literature from April to August 2025 across multiple databases, including MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, Scopus, and Web of Science. Search terms will combine inclusion, diversity, equity, and accessibility with terms for toolkits and clinical trials. Two independent reviewers will screen titles and abstracts using predefined inclusion and exclusion criteria, and full-text reviews will be conducted for eligible studies. Data will be extracted using a standardized form, focusing on toolkit content. We will summarize findings in a matrix and will present the extracted data in a tabular format, allowing easy comparison across toolkits. This scoping review aims to assess the relevance and usability of existing toolkits that support inclusive clinical trials, with a specific focus on their applicability to the clinical trials context. Given Canada's diverse population, vast geography, and low participation rates among underrepresented groups, it is essential to determine whether current global resources meet local needs. The findings will help identify content gaps and inform the development of a tailored IDEA toolkit to support equitable and representative clinical research across Canada. The protocol was registered on the Open Science framework. The findings will be presented at relevant conferences, and the manuscript will be submitted to peer-reviewed journals. https://doi.org/10.17605/OSF.IO/UDQBJ.