Evaluating the Strength and Quality of Evidence in American Heart Association/American Stroke Association's Guidelines for Aneurysmal Subarachnoid Hemorrhage and Spontaneous Intracerebral Hemorrhage.

BACKGROUND: Clinical practice recommendations guide healthcare decisions. This study aims to evaluate the strength and quality of evidence supporting the American Heart Association (AHA)/American Stroke Association (ASA) guidelines for aneurysmal subarachnoid hemorrhage (aSAH) and spontaneous intracerebral hemorrhage (ICH). METHODS: We reviewed the current AHA/ASA guidelines for aSAH and spontaneous ICH and compared with previous guidelines. Guidelines were classified based on the Class of recommendation (COR) and Level of evidence (LOE). COR signifies recommendation strength (COR 1: Strong; COR 2a: Moderate; COR 2b: Weak; COR 3: No Benefit/Harm), while LOE denotes evidence quality (LOE A: High-Quality; LOE B-NR: Moderate-Quality, Not Randomized; LOE B-R: Moderate-Quality, Randomized; LOE C-EO: Expert Opinion; LOE C-LD: Limited Data). RESULTS: For aSAH, we identified 84 recommendations across 15 guideline categories. Of these, 31% were classified as COR I, 30% as COR 2a, 17% as COR 2b, and 18% as COR 3. In terms of LOE, 7% were based on LOE A, 10% on LOE B-R, 65% on LOE B-NR, 14% on LOE C-LD, and 5% on LOE C-EO. Compared to previous guidelines, there was a 46% decrease in LOE A, a 45% increase in LOE B, and an 11% decrease in LOE C. For spontaneous ICH, 124 guidelines were identified across 31 guideline categories. Of these, 28% were COR I, 32% COR 2b, and 9% COR 3. For LOE, 4% were based on LOE A, 35% on LOE B-NR, and 42% on LOE C-LD. Compared to previous guidelines, there was a 78% decrease in LOE A, an 82% increase in LOE B, and a 14% increase in LOE C. This analysis highlights that less than a third of AHA/ASA guidelines are classified as the highest class of recommendation, with less than 10% based on the highest LOE. CONCLUSION: Less than a third of AHA/ASA guidelines on aSAH and spontaneous ICH are classified as the highest class of recommendation with less than 10% based on highest LOE. There appears to be a decrease in proportion of guidelines based on highest LOE in most recent guidelines.

Association of the Life's Essential 8 cardiovascular health score with periodontitis among US adults.

AIM: To investigate whether cardiovascular health (CVH) is associated with periodontitis. MATERIALS AND METHODS: We used data from the 2009 to 2014 National Health and Nutrition Examination Survey. We quantified CVH using Life's Essential 8, which includes four health behaviours (diet, smoking, physical activity and sleep) and four health factors (body mass index, blood cholesterol, glucose and pressure). We categorized scores as low (0-49), moderate (50-79) and high (80-100). We calculated subscores of health behaviours and factors and categorized them as low, moderate and high. We used logistic regression to assess the association of CVH with periodontitis, adjusting for age, gender, race/ethnicity, education, poverty index, marital status and health insurance. We computed odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: This study included 9296 adults ≥30 years old. Multivariable-adjusted models showed that subjects with moderate (OR, 0.62; 95% CI: 0.52-0.74) or high (OR, 0.43; 95% CI: 0.33-0.57) CVH had significantly lower odds of periodontitis compared to those with low CVH. These results were consistent in the health behaviours model, but the estimates in the health factors model were not significant. CONCLUSIONS: Improving CVH may help prevent periodontitis. Longitudinal studies are needed to confirm our findings.

An exploratory analysis of the metabolic syndrome and cardiovascular disease risk calculations in veterans with spinal cord injury and disorders.

OBJECTIVES: (1) To describe and compare cardiovascular and cardiometabolic disease risk scores using three existing risk calculators: Framingham Risk Score (FRS), American Heart Association (AHA) and Metabolic Syndrome Severity Score (MSSS) in Veterans with spinal cord injury and disorders (SCI/D); (2) To examine level of agreement between risk scores derived from three different risk scoring systems; and (3) To investigate whether the agreement among these methods is different for Veterans with Tetraplegia versus Paraplegia. DESIGN: Retrospective chart review. METHODS: Electronic medical records of 194 Veterans with SCI/D who were seen at the VAPAHCS SCI/D Center between August 2004 and June 2022 were reviewed. Cardiovascular disease (CVD) risk scores (FRS and AHA) along with a Metabolic Syndrome Severity Score (MSSS) were computed using web-based calculators. RESULTS: Moderate agreement between CVD risk scores (FRS and AHA) was observed; however, the agreement was poor between MSSS and both AHA and FRS. No differences were observed between the paraplegia and tetraplegia cohorts. From the AHA risk score, more than half the study population was found to be at high risk while less than half was considered high risk from the FRS and MSSS scores. CONCLUSIONS: Given the moderate association between AHA and FRS scores along with considerable variation in risk predictors, CVD risk prediction assessment tools should be interpreted cautiously in the SCI population. SCI-related clinical biomarkers and other clinically relevant risk factors should be taken into consideration to optimize risk estimation in persons with SCI/D.

Head-to-Head Comparison and Temporal Trends of Cardiac MRI Recommendations in ESC versus ACC/AHA Guidelines: A Systematic Review and Meta-Analysis.

Purpose To provide a comprehensive head-to-head comparison and temporal analysis of cardiac MRI indications between the European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines to identify areas of consensus and divergence. Materials and Methods A systematic review and meta-analysis was conducted. ESC and ACC/AHA guidelines published until May 2023 were systematically screened for recommendations related to cardiac MRI. The class of recommendation (COR) and level of evidence (LOE) for cardiac MRI recommendations were compared between the two guidelines and between newer versus older versions of each guideline using χ2 or Fisher exact tests. Results ESC guidelines included 109 recommendations regarding cardiac MRI, and ACC/AHA guidelines included 90 recommendations. The proportion of COR I and LOE B was higher in ACC/AHA versus ESC guidelines (60% [54 of 90] vs 46.8% [51 of 109]; P = .06 and 53% [48 of 90] vs 35.8% [39 of 109], respectively; P = .01). The increase in the number of cardiac MRI recommendations over time was significantly higher in ESC guidelines (from 63 to 109 for ESC vs from 65 to 90 for ACC/AHA; P = .03). The main areas of consensus were found in heart failure and hypertrophic cardiomyopathy, while the main divergences were in valvular heart disease, arrhythmias, and aortic disease. Conclusion ESC guidelines included more recommendations related to cardiac MRI use, whereas the ACC/AHA recommendations had higher COR and LOE. The number of cardiac MRI recommendations increased significantly over time in both guidelines, indicating the increasing role of cardiac MRI evaluation and management of cardiovascular disease. Keywords: Cardiovascular Magnetic Resonance, Guideline, European Society of Cardiology, ESC, American College of Cardiology/American Heart Association, ACC/AHA Supplemental material is available for this article. © RSNA, 2024.

American Academy of Pediatrics Recommended Cardiac Screening Questions in Preparticipation Physical Evaluation Forms.

To evaluate the utilization of the American Academy of Pediatrics' (AAP) cardiovascular screening questions within preparticipation physical evaluation forms from the 50 state high school athletic associations. We found that fewer than one-half of state forms incorporated all 10 AAP questions; moreover, a subset failed to adhere to criteria recommended by either the AAP or American Heart Association.

Projected Impact of Nonpharmacologic Management of Stage 1 Hypertension Among Lower-Risk US Adults.

BACKGROUND: The 2017 American College of Cardiology/American Heart Association blood pressure guideline classified 31 million US adults as having stage 1 hypertension and recommended clinicians provide counseling on behavioral change to the low-risk portion of this group. However, nationwide reductions in cardiovascular disease (CVD) and associated health care expenditures achievable by nonpharmacologic therapy remain unquantified. METHODS: We simulated interventions on a target population of US adults aged 35 to 64 years, identified from the 2015-2018 National Health and Nutrition Examination Survey, with low-risk stage 1 systolic hypertension: that is, untreated systolic blood pressure 130 to 139 mm Hg with diastolic BP <90 mm Hg; no history of CVD, diabetes, or chronic kidney disease; and a low 10-year risk of CVD. We used meta-analyses and trials to estimate the effects of population-level behavior modification on systolic blood pressure. We assessed the extent to which restricting intervention to those in regular contact with clinicians might prevent the delivery of nonpharmacologic therapy. RESULTS: Controlling systolic blood pressure to <130 mm Hg among the 8.8 million low-risk US adults with stage 1 hypertension could prevent 26 100 CVD events, avoid 2900 deaths, and save $1.7 billion in total direct health care costs over 10 years. Adoption of the Dietary Approaches to Stop Hypertension diet could prevent 28 000 CVD events. Other nonpharmacologic interventions could avert between 3800 and 19 500 CVD events. However, only 51% of men and 75% of women regularly interacted with clinicians for counseling opportunities. CONCLUSIONS: Among low-risk adults with stage 1 hypertension, substantial benefits to cardiovascular health could be achieved through public policy that promotes the adoption of nonpharmacologic therapy.

Percutaneous coronary intervention outcomes based on American College of Cardiology/American Heart Association coronary lesion classification over 14 years - Melbourne interventional group (MIG) registry.

BACKGROUND: The American College of Cardiology / American Heart Association (ACC/AHA) introduced a coronary lesion classification in 1988 to stratify coronary lesions for probability of procedural success and complications after coronary angioplasty. Our aim is to assess the validity of the ACC/AHA lesion classification in predicting outcomes of percutaneous coronary intervention (PCI) in a contemporary cohort of patients. METHODS: Consecutive PCI procedures performed between 2005 and 2018, were divided into three periods. At each period, the ACC/AHA lesion classification (A, B1, B2, C) was analysed with respect to procedural characteristics, in-hospital and 30-day outcomes, as well as long-term mortality by linkage to the National Death Index (NDI). RESULTS: In total, 21,437 lesions were included with 7399 lesions (2005-2009), 6917 lesions (2010-2014) and 7121 lesions (2015-2018). There was a progressive increase in the number of complex lesions treated over time with ACC/AHA type C (15 %, 21 % and 26 %, p < 0.01). The rate of PCI procedural success decreased with increase in the complexity of lesions treated across all three periods (p < 0.01). Further, in-hospital and 30-day major adverse cardiovascular events (MACE), major adverse cardiac and cerebrovascular events (MACCE) increased across all three time periods (all p < 0.05). CONCLUSIONS: Our study validates the ACC/AHA lesion classification as a meaningful tool for prediction of PCI outcomes. Despite advances in PCI techniques and technology, complex lesion PCI defined by this classification continues to be associated with adverse outcomes.

Salt Sensitivity of Blood Pressure.

The year 2024 marks the centennial of the initiation of the American Heart Association. Over the past 100 years, the American Heart Association has led groundbreaking discoveries in cardiovascular disease including salt sensitivity of blood pressure, which has been studied since the mid-1900s. Salt sensitivity of blood pressure is an important risk factor for cardiovascular events, but the phenotype remains unclear because of insufficient understanding of the underlying mechanisms and lack of feasible diagnostic tools. In honor of this centennial, we commemorate the initial discovery of salt sensitivity of blood pressure and chronicle the subsequent scientific discoveries and efforts to mitigate salt-induced cardiovascular disease with American Heart Association leading the way. We also highlight determinants of the pathophysiology of salt sensitivity of blood pressure in humans and recent developments in diagnostic methods and future prospects.

Association Between Life's Essential 8 Cardiovascular Health Metrics With Cardiovascular Events in the Cardiovascular Disease Lifetime Risk Pooling Project.

BACKGROUND: The American Heart Association recently launched updated cardiovascular health metrics, termed Life's Essential 8 (LE8). Compared with Life's Simple 7 (LS7), the new approach added sleep health as an eighth metric and updated the remaining 7 health factors and behaviors. The association of the updated LE8 score with long-term cardiovascular disease (CVD) outcomes and death is unknown. METHODS: We pooled individual-level data from 6 contemporary US-based cohorts from the Cardiovascular Lifetime Risk Pooling Project. Total LE8 score (0-100 points), LE8 score without sleep (0-100 points), and prior LS7 scores (0-14 points) were calculated separately. We used multivariable-adjusted Cox models to evaluate the association of LE8 with CVD, CVD subtypes, and all-cause mortality among younger, middle, and older adult participants. Net reclassification improvement analysis was used to measure the improvement in CVD risk classification with the addition of LS7 and LE8 recategorization based on score quartile rankings. RESULTS: Our sample consisted of 32 896 US adults (7836 [23.8%] Black; 14 941 [45.4%] men) followed for 642 000 person-years, of whom 9391 developed CVD events. Each 10-point higher overall LE8 score was associated with lower risk by 22% to 40% for CVD, 24% to 43% for congenital heart disease, 17% to 34% for stroke, 23% to 38% for heart failure, and 17% to 21% for all causes of mortality events across age strata. LE8 score provided more granular differentiation of the related CVD risk than LS7. Overall, 19.5% and 15.5% of the study participants were recategorized upward and downward based on LE8 versus LS7 categories, respectively, and the recategorization was significantly associated with CVD risk in addition to LS7 score. The addition of recategorization between LE8 and LS7 categories improved CVD risk reclassification across age groups (clinical net reclassification improvement, 0.06-0.12; P<0.01). CONCLUSIONS: These findings support the improved utility of the LE8 algorithm for assessing overall cardiovascular health and future CVD risk.

Clinical Guideline for Preimplantation Genetic Testing in Inherited Cardiac Diseases.

BACKGROUND: Preimplantation genetic testing (PGT) is a reproductive technology that selects embryos without (familial) genetic variants. PGT has been applied in inherited cardiac disease and is included in the latest American Heart Association/American College of Cardiology guidelines. However, guidelines selecting eligible couples who will have the strongest risk reduction most from PGT are lacking. We developed an objective decision model to select eligibility for PGT and compared its results with those from a multidisciplinary team. METHODS: All couples with an inherited cardiac disease referred to the national PGT center were included. A multidisciplinary team approved or rejected the indication based on clinical and genetic information. We developed a decision model based on published risk prediction models and literature, to evaluate the severity of the cardiac phenotype and the penetrance of the familial variant in referred patients. The outcomes of the model and the multidisciplinary team were compared in a blinded fashion. RESULTS: Eighty-three couples were referred for PGT (1997-2022), comprising 19 different genes for 8 different inherited cardiac diseases (cardiomyopathies and arrhythmias). Using our model and proposed cutoff values, a definitive decision was reached for 76 (92%) couples, aligning with 95% of the multidisciplinary team decisions. In a prospective cohort of 11 couples, we showed the clinical applicability of the model to select couples most eligible for PGT. CONCLUSIONS: The number of PGT requests for inherited cardiac diseases increases rapidly, without the availability of specific guidelines. We propose a 2-step decision model that helps select couples with the highest risk reduction for cardiac disease in their offspring after PGT.

Lipid Management in Kidney Transplant Recipients Per KDIGO and American Heart Association Guidelines: A Single-Center Experience.

Background: The 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommends statin treatment for all adult kidney transplant recipients (KTRs), except those aged <30 years of age and without prior cardiovascular risk factors (CVRF), but does not specify on-treatment low-density lipoprotein cholesterol (LDL) target levels. The 2018 American Heart Association (AHA) guidelines addressed the management of hyperlipidemia in the general population based on an individualized approach of the CVRF with a specific on-treatment LDL target. Objective: To analyze dyslipidemia management according to the recommendations of the KDIGO and AHA guidelines. Methods: This retrospective study included all KTRs who underwent transplantation between January 2017 and May 2020 at King Abdulaziz Medical Center, Riyadh, Saudi Arabia. The rate of statins prescription in general, rate of statins prescription among KTRs per their CVRF, and rate of achieving the proposed LDL goals, as defined by the AHA, were analyzed. Results: A total of 287 KTRs were included. Of the 214 (74.6%) patients aged ≥30 years, 80% received a statin. Statins were prescribed in 93% and 96% of KTRs with diabetes or coronary artery disease, respectively. In patients aged ≥30 years, LDL targets, per AHA guidelines, were achieved in 62% with a target of 2.6 mmol/l, and in 19% with a target of 1.8 mmol/l. Statin therapy resulted in non-significant changes in the mean LDL values from baseline to 12 months after transplantation (P = 0.607), even when only patients prescribed statin after transplantation were included (P = 0.34). Conclusion: By applying the KDIGO guidelines, a high rate of statin prescriptions was achieved among KTRs with multiple CVRF and KTRs in general. However, a significant proportion of these KTRs did not achieve the LDL targets proposed by the AHA guidelines, suggesting that higher-intensity statins would be required to achieve these targets.

[Interpretation of 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation guidelines]. / 2023美国心脏协会与美国儿科学会新生儿复苏指南要点更新解读.

In November 2023, the American Heart Association and the American Academy of Pediatrics jointly released key updates to the neonatal resuscitation guidelines based on new clinical evidence. This update serves as an important supplement to the "Neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care". The aim of this paper is to outline the key updates and provide guidance on umbilical cord management and the selection of positive pressure ventilation equipment and its additional interfaces in neonatal resuscitation.

Ideal cardiovascular health and cardiovascular-related events: a systematic review and meta-analysis.

AIMS: The aim of this study was to systematically review and quantitatively summarize the evidence on the association between Life Simple's 7 (LS7) and multiple cardiovascular diseases (CVDs) and cardiometabolic diseases (CMDs). METHODS AND RESULTS: EMBASE and PubMed were searched from January 2010 to March 2022 for observational studies that investigated the association between ideal cardiovascular health (CVH) with CVD or CMD outcomes in an adult population. Two reviewers independently selected studies according to the eligibility criteria, extracted data, and evaluated risk of bias. Data were analysed with a random-effects meta-analysis. This meta-analysis included 59 studies (1 881 382 participants). Participants with ideal CVH had a considerably lower risk of a variety of CVDs and CMDs as compared with those with poor CVH, varying from 40% lower risk for atrial fibrillation (AF) {hazard ratio [HR] = 0.60 [95% confidence interval (CI) 0.44-0.83]} to 82% lower risk for myocardial infarction [HR = 0.18 (95% CI 0.12-0.28)]. Intermediate CVH was associated with 27-57% lower risk in CVDs and CMDs compared with poor CVH, with the highest hazard for AF [HR = 0.73 (95% CI 0.59-0.91)] and the lowest hazard for peripheral arterial disease [HR = 0.43 (95% CI 0.30-0.60)]. CONCLUSION: Ideal and moderate CVH were associated with a lower incidence of CVDs and CMDs than poor CVH. Life Simple's 7 holds significant potential for promoting overall CVH and thereby contributing to the prevention of CVDs.

KEY FINDINGS: Higher Life's Simple 7 (LS7) score, meaning a healthier lifestyle score, was related to lower risks of cardiovascular diseases (CVDs). Promoting healthy lifestyle (higher LS7 score) could possibly lead to prevention of CVDs.

Healthy lifestyle is very important to prevent cardiovascular diseases (CVDs) and cardiometabolic diseases (CMDs), such as diabetes and kidney diseases. Therefore, in 2010, the American Heart Association introduced Life's Simple 7 (LS7), a scoring system using seven lifestyle factors to measure cardiovascular health in populations, and these factors are diet, physical activity, smoking, blood pressure, blood lipids, blood sugar, and weight. In this review, we investigated the relationship between LS7 score and CVDs or CMDs.

Chronic hypertension diagnosed by the American Heart Association and American College of Cardiology criteria is associated with increased risk of developing hypertensive disorders of pregnancy.

BACKGROUND: ACOG uses a systolic blood pressure (SBP) ≥140 or diastolic blood pressure (DBP) ≥90 documented at <20 weeks of gestation to define chronic hypertension. In the nonpregnant state, the American Heart Association (AHA) and the American College of Cardiology (ACC) define chronic hypertension using lower diagnostic thresholds of SBP ≥130 or DBP ≥80. It remains unclear whether using more conservative guidelines in pregnancy improves identification of those at risk for gestational hypertension (GHTN) or preeclampsia (PRE). OBJECTIVE: We sought to investigate whether subjects with chronic hypertension based on the American Heart Association and American College of Cardiology criteria had an increased risk for gestational hypertension and preeclampsia than those without chronic hypertension. STUDY DESIGN: We conducted a retrospective cohort study utilizing a clinical database at a diverse, large urban, safety-net hospital. Subjects aged 18 to 40 years with singleton gestations and first trimester prenatal care were included. We defined subjects that met the criteria for stage 1 chronic hypertension based on first trimester systolic blood pressure and diastolic blood pressure cutoffs satisfying the American Heart Association and American College of Cardiology criteria (systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg). Those who did not meet these criteria had a systolic blood pressure <130 mm Hg and a diastolic blood pressure <90 mm Hg. We did not include those with chronic hypertension based on the American College of Obstetricians and Gynecologists criteria in this cohort (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg at <20 weeks); therefore, those who met the American Heart Association and American College of Cardiology criteria solely consisted of subjects with systolic blood pressure of 130 to 139 mm Hg and diastolic blood pressure of 80 of 89 mm Hg. By doing this, we were able to specifically investigate the increased risk for this specific population, which remains unclear. Diagnoses of gestational hypertension and preeclampsia were based on the established American College of Obstetricians and Gynecologists criteria. Preeclampsia included those with and without severe features. Tests for normality were performed. Student t-tests or rank sum tests were performed as appropriate for continuous variables; chi-square or Fisher's exact tests were performed for categorical variables. Generalized linear models were performed to calculate risk ratios while controlling for appropriate confounders. RESULTS: Of N=3354 subjects, 18% (n=629) were diagnosed with stage 1 chronic hypertension based on American Heart Association and American College of Cardiology criteria. Those with American Heart Association and American College of Cardiology stage 1 chronic hypertension had increased rates of gestational hypertension (35.4% vs 20%; P<.001) and preeclampsia (22.3% vs 10%; P<.001) than those without Stage 1 chronic hypertension based on these criteria. When controlling for maternal age, race, first trimester body mass index, pregestational diabetes, and substance use, those with the American Heart Association and American College of Cardiology stage 1 chronic hypertension had an almost 1.5-fold higher adjusted risk ratio of experiencing gestational hypertension (adjusted risk ratio, 1.49±0.10; P<.001) and almost 2-fold increased adjusted risk ratio of experiencing preeclampsia (adjusted risk ratio, 1.98±0.19; P<.001). CONCLUSION: Our data suggest an increased risk for developing gestational hypertension and preeclampsia for subjects satisfying the American Heart Association and American College of Cardiology cutoff for stage 1 chronic hypertension. Future studies need to consider whether diagnosis of chronic hypertension in pregnancy should conform with American Heart Association and American College of Cardiology criteria, and if those with stage 1 chronic hypertension based on American Heart Association and American College of Cardiology criteria require the same preventative measures and interventions utilized by those diagnosed by American College of Obstetricians and Gynecologists criteria.

2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care

In this focused update, the American Heart Association provides updated guidance for resuscitation of patients with cardiac arrest, respiratory arrest, and refractory shock due to poisoning. Based on structured evidence reviews, guidelines are provided for the treatment of critical poisoning from benzodiazepines, ß-adrenergic receptor antagonists (also known as ß-blockers), L-type calcium channel antagonists (commonly called calcium channel blockers), cocaine, cyanide, digoxin and related cardiac glycosides, local anesthetics, methemoglobinemia, opioids, organophosphates and carbamates, sodium channel antagonists (also called sodium channel blockers), and sympathomimetics. Recommendations are also provided for the use of venoarterial extracorporeal membrane oxygenation. These guidelines discuss the role of atropine, benzodiazepines, calcium, digoxin-specific immune antibody fragments, electrical pacing, flumazenil, glucagon, hemodialysis, hydroxocobalamin, hyperbaric oxygen, insulin, intravenous lipid emulsion, lidocaine, methylene blue, naloxone, pralidoxime, sodium bicarbonate, sodium nitrite, sodium thiosulfate, vasodilators, and vasopressors for the management of specific critical poisonings.

Assessing readability and comprehension of web-based patient education materials by American Heart Association (AHA) and CardioSmart online platform by American College of Cardiology (ACC): How useful are these websites for patient understanding?

Cardiovascular diseases (CVD) are a leading cause of morbidity & mortality worldwide. Patient education materials help patients understand the disease and its management. Health literacy is an important challenge that may contribute to health inequities and disparities. The National Institute of Health and American Medical Association recommend patient education materials to be ≤6th-grade reading level. Objective: To evaluate readability and comprehension of patient education materials related to CVD, available at the American Heart Association (AHA) & CardioSmart web platform by the American College of Cardiology (ACC) websites. Method: We examined the readability and comprehension of 63 patient education materials (accessed June 2022) using: (a) Flesch Kincaid Readability Ease (FKRE): measures readability (0-100, goal > 70), (b) Flesch Kincaid Grade Level (FKGL) (goal = grade 7). We compared the AHA and ACC scores using descriptive and t-tests. P-value ≤ 0.05 was significant. Results: Sixty-three web pages of patient education materials (AHA 24, ACC 39) were reviewed in June 2022. Mean ± standard deviation (SD) FKRE was 54.9 ± 6.8 for all the web pages. FKRE 50-60 equates to "fairly difficult to read." Mean ± SD FKGL was 10.0 ± 1.3. AHA patient education materials content was significantly more difficult to read and comprehend, were longer, and had more complex words than ACC patient education materials. Conclusions: CVD-related patient education materials available online through leading national organizations are not congruent with the recommendations from national healthcare organizations. They are not as user-friendly as they can be. Urgent recognition of the gaps and unmet needs are indicated to optimize patient health literacy.