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Nutrition insecurity is a major driver of poor cardiovascular health in Indigenous communities. Medically tailored meals that reclaim traditional foods may improve heart failure outcomes and quality of life. Community-based participatory methods were used to design Medically Utilized Tailored Traditional Foods to Optimize Nutrition in Heart Failure (MUTTON-HF), a culturally and medically tailored meal program incorporating traditional Navajo foods and recipes. To determine the efficacy of a culturally and medically tailored meal program on the incidence of hospitalizations and emergency department visits. This pragmatic, open-label randomized clinical trial was conducted from May to November 2025 at 2 Indian Health Service sites in rural Navajo Nation. Eligible patients were adults with heart failure who were receiving care at the study sites and had a hospitalization or emergency department visit during the last 12 months. All patients were followed for 12 weeks for outcomes, death, and adverse events. The data were analyzed from December 2025 to February 2026. Patients were randomized in a 1:1 ratio to 8 weeks of a culturally and medically tailored meal program or usual dietary advice. The primary end point was the proportion of patients with an all-cause hospitalization or emergency department visit within 90 days. Secondary outcomes included hospitalizations or emergency department visits separately, and for heart failure specifically, and change in Kansas City Cardiomyopathy Questionnaire scores, food insecurity, financial strain, blood pressure, and weight from enrollment to 8 weeks. A total of 206 patients (mean [SD] age, 65.8 [14.2] years; 87 female individuals [42%] and 119 male individuals [58%]; 203 American Indian individuals [99%], 2 American Indian or Alaskan Native and White individuals [0.97%], and 1 White individual [0.03%]; ejection fraction, 48%) were randomized. The primary outcome was significantly less frequent in the intervention arm (43 [40.6%] vs 57 [57.0%]; relative risk, 0.72; 95% CI, 0.54-0.96; P = .02), which was driven mainly by reduced hospitalizations (13 [12.3%] vs 26 [26.0%]). There was a lower incidence of heart failure hospitalizations specifically (4 [3.8%] vs 13 [13.0%]). The Kansas City Cardiomyopathy Questionnaire score and food security measures had significantly greater increases in the intervention arm while measures of financial strain, weight, and blood pressure significantly decreased in the intervention arm. Adverse events were uncommon. In this randomized clinical trial, an Indigenous Food is Medicine intervention reduced the incidence of hospitalization and emergency department visits among patients with heart failure. Community-based interventions that leverage protective assets of Native communities are needed to advance Indigenous health. ClinicalTrials.gov Identifier: NCT06549699.

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Beginning in January 2025, the sociopolitical context in which immigrant patients seek and receive health care has changed significantly. To explore the perspectives of primary care physicians regarding their own well-being and the health and well-being of their immigrant patients after anti-immigrant policy changes in January 2025. This qualitative study used virtual semistructured interviews with primary care physicians across the US (recruited using purposive and snowball sampling) who were providing health care to immigrant patients. The study was conducted between July and September 2025. The audio from the physician interviews was recorded, transcribed, and analyzed using thematic analysis. Themes and subthemes derived from interviews. There were 38 participants interviewed (mean age, 40.3 [SD, 10.8] years; 27 women [71.1%]; by specialty: 24 [63.2%] internal medicine, 13 family medicine [34.2%], and 1 internal medicine-pediatrics [2.6%]). The identified themes and subthemes were (1) drivers of physician moral injury (ethical and professional values conflict, compounded burden on immigrant identities, workforce strain, powerlessness, navigating dynamic policies, altering clinical decision-making); (2) patient vulnerability and health consequences (complex decision-making within mixed-status families, ripple effects on US citizens and broader communities, pervasive fear and hesitancy of accessing care, physical and mental health deterioration); (3) contrasting responses from health care systems (restricting health care, institutional silence and suppression of immigration-specific support, adapting through flexibility in care delivery, guiding through proactive communication and partnerships); and (4) physician empowerment (engaging in multilevel advocacy, leveraging trust, role modeling for trainees and peers, protecting patient privacy). In this qualitative study, physicians experienced moral injury stemming from anti-immigrant policies starting in January 2025, which was compounded for those with immigrant identities and because of health care systems' varying responses to these policies. Physicians perceived that changes in immigration policy had adversely affected immigrant and US citizens. Despite these challenges, physicians and health care systems have adapted to support patients and staff, which has mitigated moral injury.

This JAMA Internal Medicine Patient Page describes use of continuous glucose monitors, as well as their benefits and drawbacks.

Extending the health span requires shifting from disease-centered to preventive, function-oriented medicine. To support healthy longevity, the World Health Organization (WHO) developed intrinsic capacity (IC), a composite of physical and mental capacities an individual can mobilize; however, molecular drivers of age-related IC decline remain poorly understood. To investigate cross-sectional and longitudinal associations of accelerated epigenetic and inflammatory aging with global IC and, secondarily, to examine domain-specific IC, sex differences, and interactions between epigenetic and inflammatory aging. This population-based cohort study included participants aged 20 years or older from the longitudinal INSPIRE Lifespan Translational Cohort. The 3-year prospective cohort study was initiated in October 2019. Data analysis was conducted from June to December 2025. At baseline, accelerated epigenetic aging was measured using Horvath Pan Tissue, Horvath Skin and Blood, Hannum, PhenoAge, and GrimAge clocks; accelerated inflammatory aging was measured with the iAge clock. Global IC was operationalized as a 5-domain construct: cognition (Mini-Mental State Examination), mobility (Short Physical Performance Battery), psychology (Patient Health Questionnaire for depression), vitality (grip strength), and sensory (WHO simple eye chart; whisper test) capacity and evaluated annually. Among 970 participants (median [IQR] chronological age, 64 [48-77] years; 602 [62.1%] female) with a median (IQR) follow-up time of 3.01 (2.97-3.04) years, accelerated epigenetic aging was associated with lower global IC, with a greater detrimental outcome associated with advancing chronological age (interaction with linear: β = -1.17; 95% CI. -2.02 to -0.33; false-discovery rate [FDR]-adjusted P = .04) and quadratic (β = -0.39; 95% CI, -0.71 to -0.08; FDR-adjusted P = .04) terms of chronological age. Accelerated inflammatory aging showed comparatively weaker associations with lower global IC across aging (eg, interaction with linear chronological age: β = -0.45; 95% CI, -0.77 to -0.12; FDR-adjusted P = .04). The co-occurrence of both biological aging processes resulted in greater functional impairment. The greater detrimental association of accelerated epigenetic aging with global IC was evident predominantly in male participants. In domain-specific IC analyses, mobility showed the greatest vulnerability. In this cohort study of participants spanning the adult lifespan, accelerated epigenetic aging was associated with lower global IC, with a greater detrimental outcome as chronological age advanced. Accelerated inflammatory aging showed weaker associations. These findings have meaningful implications for precision medicine, highlighting the potential of biomarkers derived from epigenetic and, to a lesser extent, inflammatory aging clocks to support early identification of high-risk individuals and guide targeted healthy longevity interventions.

This JAMA Clinical Guidelines Synopsis summarizes the American College of Gastroenterology’s (ACG) 2025 clinical guideline update on management of ulcerative colitis in adults.

This JAMA Insights examines the use of nicotine pouches in the US, including adverse effects, comparisons with cigarette and e-cigarette use, and concerns regarding increased use among adolescents and young adults.

This JAMA Patient Page describes cyclosporiasis symptoms, diagnosis, treatment, and prevention.

This JAMA Clinical Guidelines Synopsis summarizes the 2026 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on management of dyslipidemia.

This cross-sectional study characterizes beneficiaries who received care through Medicare’s largest voluntary payment models from 2013 to 2022.

Troponin monitoring is recommended for the early detection of immune checkpoint inhibitor (ICI)-associated myocarditis, but its utility as a universal screening tool for all cardiovascular (CV) toxic effects in patients with cancer treated with ICIs remains uncertain. To evaluate whether systematic troponin screening is associated with reduced major adverse CV events (MACEs) and mortality in patients receiving ICI therapy for cancer. This retrospective, multicenter cohort study assessed adults treated with ICIs between January 1, 2017, and December 31, 2022, at 2 tertiary oncology centers. Patients undergoing systematic troponin screening (&#x2265;2 measurements during the first trimester of ICI therapy not prompted by symptoms) were compared with those undergoing clinical assessment without screening. Cross-sectional follow-up was undertaken between June 1, 2023, and June 30, 2024. ICI therapy for solid cancer. The primary outcomes included adjudicated MACEs (ICI-associated myocarditis, acute coronary syndrome, heart failure requiring hospitalization, sudden cardiac death, and CV death). Multivariate Cox proportional hazards regression, Fine-Gray competing risk models, and propensity score matching were applied, with death from cancer considered a competing risk. Of 859 patients (mean [SD] age, 70.1&#x2009;[10.8] years; 517 [60.2%] male; 585 [68.1%] with lung cancer), 40 (4.7%) developed MACEs, including 6 (0.7%) with ICI-associated myocarditis; 484 (56.3%) died at a median follow-up of 3.3 (IQR, 1.3-7.2) months, mainly from cancer (436 [90.1%]). Routine troponin screening was associated with lower mortality combined with MACEs in multivariable models (hazard ratio, 0.56 [95% CI, 0.45-0.70]) (P&#x2009;<&#x2009;.001) but was not associated with MACEs after competitive risk analysis (hazard ratio, 0.56 [95% CI, 0.20-1.55]) (P&#x2009;=&#x2009;.27) or in a propensity score-matched cohort of 354 patients (hazard ratio, 0.49 [95% CI, 0.20-1.24]) (P&#x2009;=&#x2009;.13). In this cohort study, systematic troponin screening was not associated with MACEs in an older population with metastatic solid cancer after competitive risk analysis or propensity score matching. These findings suggest that the benefits of universal troponin monitoring are questionable among unselected patients with cancer who are receiving ICIs; further investigation is needed to determine whether risk-adapted screening improves outcomes while avoiding unnecessary interruptions of treatment.

The electrocardiogram (ECG) is a cornerstone of cardiovascular care. Traditionally, it has relied on expert visual interpretation and rule-based systems to define the presence of disease. However, the integration of artificial intelligence (AI) has transformed the ECG into a high-dimensional biomarker capable of detecting signatures of both overt and subclinical disease. This review explores the historical progress of the technology from its inception to its diverse range of AI applications in the clinic and in research. We examine fundamental methodological advancements, including a range of deep learning methods, and the use of ECG images and wearable and portable devices for scaling these innovations globally. We also provide the full spectrum of AI-enabled care via applications for electrocardiograms, including (i) assistance to clinicians to perform interpretation of ECGs, (ii) augmenting their ability to detect latent signatures of disease from ECG, and (iii) prognostic and predictive applications of AI-ECG in cardiovascular care. Finally, we address critical challenges regarding model transparency, phenotypic selectivity, and the gap in the development of AI-ECG applications and their actual implementation. To realize the full potential of AI for ECGs, the field needs to evolve from singular AI-ECG tools evaluated in retrospective studies toward robust foundation models with broader multimodal integration and evaluation in rigorously performed randomized clinical trials. By unlocking latent physiological data, AI-ECG serves as a scalable engine for cardiovascular precision care.

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Although adding immune checkpoint inhibitors to neoadjuvant chemotherapy improves outcomes in high-risk early-stage breast cancer, opportunities remain to further enhance response. Dual checkpoint blockade offers a potential strategy to further enhance efficacy. To evaluate the combination of anti-programmed cell death 1 protein (PD-1) cemiplimab and anti-lymphocyte activation gene 3 (LAG-3) added to neoadjuvant therapy in ERBB2-negative early-stage, high-risk breast cancer. The I-SPY2 (Investigation of Serial Studies to Predict Your Therapeutic Response With Imaging and Molecular Analysis 2) is an ongoing randomized clinical platform trial being conducted at multiple US clinical sites including patients with early-stage (II or III) ERBB2-negative, high-risk breast cancer. Participants, continuously enrolled since 2010, were adaptively randomized from February 2, 2020, to December 9, 2021, to one of several experimental neoadjuvant therapies or control groups based on receptor subtypes defined by hormone receptor (HR), ERBB2 status, and MammaPrint (Agendia Inc) molecular risk, categorized as high (MP1) or ultrahigh (MP2). Data were analyzed from January 1, 2022, to August 5, 2025. Both groups received weekly paclitaxel for 12 weeks, then doxorubicin and cyclophosphamide followed by surgery; concomitant with paclitaxel, the intervention group also received 4 doses of cemiplimab and fianlimab (PCF) every 3 weeks. Pathologic complete response (pCR). Treatments graduated when they achieved 85% bayesian probability of success in a subtype-specific phase 3 trial. Pathway-specific biomarkers were assessed for response prediction. A total of 78 participants (mean [SD] age, 47 [39-54] years) were randomized to the intervention group, with 350 participants (mean [SD] age, 48 [39-57] years) randomized to the historical control population. PCF graduated in all clinical signatures, with pCR rates vs control of 44% (95% CI, 34%-53%) vs 21% (95% CI, 17%-25%) in all ERBB2, 53% (95% CI, 39%-67%) vs 29% (95% CI, 22%-36%) in triple-negative, and 36% (95% CI, 23%-49%) vs 14% (95% CI, 9%-19%) in HR-positive and ERBB2-negative disease. Among the total participants, 16 (21%) experienced adrenal insufficiency, including hypophysitis (11% grade 3 or 4), mostly occurring after immunotherapy completion. PCF was found to be highly effective in the subset of patients with immune signature positive status (ImPrint positive). In this randomized clinical trial, the combination of PD-1 and anti-LAG-3 inhibition with standard NAC was effective in early-stage ERBB2-negative breast cancer, particularly in patients displaying a positive ImPrint immune signature. These results warrant further definitive trials. ClinicalTrials.gov Identifier: NCT01042379.

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This cross-sectional study examines the time to market launch for recently approved therapeutics likely eligible for 2 new mandatory service and delivery models in most-favored-nation countries following US launch.

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Portable high-efficiency particulate air (HEPA) filters effectively remove airborne microbes. To investigate whether HEPA filters reduce respiratory infection episodes in care home residents. This 2-arm cluster randomized clinical trial included care homes for older adults in England, with or without nursing and dementia care provision, and capacity for 20 or more residents in individual bedrooms. Data were collected between September 2021 and May 2024, with each care home participating for 1 winter. Up to 5 HEPA filters for communal areas (clean air delivery rate set at 160 m3/h) and up to 16 filters for bedrooms (clean air delivery rate set at 60 m3/h). Both groups continued usual infection prevention and control measures. The primary outcome was respiratory infection rate per winter per bedroom resident (exposed to bedroom and communal room filters). Secondary outcomes included staff absenteeism. All outcomes were also explored for residents exposed only to communal room filters. During the study period, 91 care homes were randomized, 47 to receive communal room filters, with 569 bedroom residents (median [IQR] age, 87 [81-92] years; 398 [70.0%] female), and 44 without communal room filters, with 589 residents without bedroom filters (median [IQR] age, 88 [82-92] years; 23 [71.8%] female). There was no evidence of a difference in the number of respiratory infections per winter per intervention vs control bedroom residents (0.99 vs 1.04; adjusted incident rate ratio, 0.92; 95% CI, 0.64-1.33; P&#x2009;=&#x2009;.67). There was also no evidence of a difference in the rates of staff absenteeism (adjusted incident rate ratio, 0.80 95% CI, 0.55-1.16; P&#x2009;=&#x2009;.24). Results were similar for the residents exposed only to communal room HEPA filters. In this cluster randomized clinical trial, there was no difference in resident respiratory infection rates in care homes with HEPA filters in communal areas and bedrooms. Care homes should continue existing recommended prevention measures to control respiratory and other infections. isrctn.org Identifier: ISRCTN63437172.

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