Promises and Perils of Consumer Mobile Technologies in Cardiovascular Care: JACC Scientific Statement.

Direct-to-consumer (D2C) wearables are becoming increasingly popular in cardiovascular health management because of their affordability and capability to capture diverse health data. Wearables may enable continuous health care provider-patient partnerships and reduce the volume of episodic clinic-based care (thereby reducing health care costs). However, challenges arise from the unregulated use of these devices, including questionable data reliability, potential misinterpretation of information, unintended psychological impacts, and an influx of clinically nonactionable data that may overburden the health care system. Further, these technologies could exacerbate, rather than mitigate, health disparities. Experience with wearables in atrial fibrillation underscores these challenges. The prevalent use of D2C wearables necessitates a collaborative approach among stakeholders to ensure effective integration into cardiovascular care. Wearables are heralding innovative disease screening, diagnosis, and management paradigms, expanding therapeutic avenues, and anchoring personalized medicine.

Evidence-Based Cardiovascular Disease Medicines' Availability in Low-Cost Generic Drug Programs in the United States : A Cross-Sectional Study.

BACKGROUND: Low-cost generic programs (LCGPs) that expand access to affordable cardiovascular disease (CVD) medicines can assist patients in achieving desired cardiovascular outcomes. It is important that LCGPs offer CVD medicines that promote evidence-based prescribing. OBJECTIVE: To evaluate LCGPs' coverage of evidence-based CVD medications using a clinical framework that examines coverage of core treatments, coverage of options with the highest-quality evidence, and the variety of medication options and strengths that create choices and allow dosing titration. DESIGN: Cross-sectional study. SETTING: Publicly available LCGPs in March and April 2023 in the United States. PARTICIPANTS: 19 LCGPs. MEASUREMENTS: Proportion of LCGPs that offered evidence-based CVD medicines within a clinical framework for 6 CVDs (atrial fibrillation, heart failure, hyperlipidemia, hypertension, post-acute coronary syndrome secondary prevention, and stable angina) according to 4 availability metrics (breadth, choice, high-quality evidence, and titratability). RESULTS: The availability of CVD medication varied by program, drug, and CVD condition. Some programs had more breadth and choice of coverage for most CVDs (H-E-B, Kroger, Mark Cuban Cost Plus Drug Company, and Walmart), whereas many had more focused coverage and others markedly limited offerings. Nearly all LCGPs offered angiotensin-converting enzyme inhibitors, ß-blockers, thiazides, and moderate-intensity statins, but availability was low for higher-cost or lower-use generics (antiplatelets and antiarrhythmics). Core pharmacotherapy coverage and choices were limited for atrial fibrillation and heart failure but widely available for hypertension and hyperlipidemia. LIMITATION: In-depth cost analysis was not investigated. CONCLUSION: Coverage of evidence-based medications for the 6 CVDs investigated varied by LCGP and condition. Because high availability of core CVD pharmacotherapy can enhance optimal disease state management, LCGPs should identify existing limitations in their coverage and continuously revise their formularies to improve the comprehensiveness of CVD medication coverage. PRIMARY FUNDING SOURCE: None.

Racial and Ethnic Differences in the Management of Atrial Fibrillation.

Atrial fibrillation (AF) is the most common clinical arrhythmia, and it results in adverse outcomes and increased healthcare costs. Racial and ethnic differences in AF management, although recognized, are poorly understood. This review summarizes racial differences in AF epidemiology, genetics, clinical presentation, and management. In addition, it highlights the underrepresentation of racial and ethnic populations in AF clinical trials, especially trials focused on stroke prevention. Specific strategies are proposed for future research and initiatives that have potential to eliminate racial and ethnic differences in the care of patients with AF. Addressing racial and ethnic disparities in healthcare access, enrollment in clinical trials, resource allocation, prevention, and management will likely narrow the gaps in the care and outcomes of racial and ethnic minorities suffering from AF.

La fibrillation auriculaire (FA) est la forme clinique d'arythmie la plus fréquente, et elle entraîne des résultats défavorables ainsi qu'une augmentation du coût des soins de santé. Les différences liées à la race et à l'origine ethnique qui existent dans la prise en charge de la FA, bien que reconnues, sont mal comprises. Le présent article de synthèse résume les différences liées à la race observées sur le plan de l'épidémiologie, de la génétique, du tableau clinique et de la prise en charge de la FA. En outre, il met en lumière la sous-représentation de groupes raciaux et ethniques dans les études cliniques sur la FA, en particulier celles axées sur la prévention des accidents vasculaires cérébraux. Des stratégies ad hoc sont proposées pour que la recherche et les initiatives futures favorisent l'éradication des différences liées à la race et à l'origine ethnique dans les soins prodigués aux patients atteints de FA. Le fait de s'attaquer aux disparités liées à la race et à l'origine ethnique qui touchent l'accès aux soins de santé, l'inscription aux essais cliniques, l'allocation des ressources, la prévention et la prise en charge des patients permettra probablement de réduire les lacunes en matière de soins et de résultats chez les personnes atteintes de FA issues de minorités raciales et ethniques.

Cardiovascular Care in Women Veterans.

Cardiovascular disease is the number one cause of death for women in the United States. Of the 1.3 million active duty service members, 16.3% are currently women, and the number of women veterans is expected to increase. Women veterans have higher rates of cardiovascular disease than civilian women and present a unique population. We focus on 5 key areas regarding cardiovascular disease care for women veterans: (1) the rapidly changing demographic; (2) prevalence of traditional risk factors; (3) prevalence of less traditional risk factors (eg, homelessness, military sexual trauma, and mental health disorders); (4) treatment and outcomes of cardiovascular disease; and (5) the current state and future directions of research in this area. This review is a call to action for continued improvements in the cardiovascular care and research for this rapidly growing, at-risk, and under-represented population. Visual Overview: A visual overview is available for this article.