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Still Searching for the Right Intervention to Improve Transitions of Care for Patients With Heart Failure

In this issue of JAMA Internal Medicine, Masterson Creber et al present the results of the Mighty-Heart randomized clinical trial, which compares 2 transitional care interventions delivered to patients discharged home after a heart failure hospitalization. Participants were randomized to receive a care coordination telephone call from a health system nurse within 48 to 72 hours after discharge or the same telephone call plus a mobile integrated health program that consisted of ongoing nurse care coordination and the availability of community paramedic home visits and telehealth visits with emergency medicine physicians (arranged by the nurse). Among 2003 participants recruited from 11 hospitals in New York, New York, there were no differences between the study groups in the coprimary outcomes of the Kansas City Cardiomyopathy Questionnaire overall summary score or 30-day all-cause hospital readmission, with one-fifth of participants in both groups readmitted within 30 days.

Should Familial Hypercholesterolemia Be Included in Newborn Screening?

Newborn screening has revolutionized the early diagnosis of genetic conditions and enabled early therapeutic interventions, which have dramatically improved the outcomes for numerous disorders. The advent of tandem mass spectrometry in the 1990s opened the possibility of cost-effective multiplex screening for a multitude of disorders on the same sample. In the early 2000s, as it still is now, newborn screening was a state-based program, with some states screening for only 4 disorders while others screened for more than 30. This geographical variability prompted the US federal government to task the American College of Medical Genetics to develop national guidelines, including a uniform condition panel. The Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC) was created as a part of this mission and worked to review current evidence to create the Recommended Universal Screening Panel (RUSP). In the original report, 29 conditions were identified based on a scoring system as primary targets for screening (core panel) with an additional 25 conditions that could be identified while screening for the core panel conditions. Familial hypercholesterolemia (FH) was considered but not recommended as a part of the original core panel. Several other disorders that originally scored lower than FH, including mucopolysaccharidosis type I and Pompe disease, among others, have since been added to the RUSP as new treatments have become available, and there are currently 37 core conditions that are formally recommended on the RUSP.

Defibrillators in Private Homes

Defibrillation is a highly effective treatment for ventricular fibrillation and pulseless ventricular tachycardia when delivered promptly after the onset of cardiac arrest. As time in cardiac arrest progresses, shockable rhythms degenerate to nonshockable rhythms, global organ damage worsens, and the likelihood of successful resuscitation and neurological recovery diminishes. Reducing the time to defibrillation is therefore crucial to survival and good recovery. A key strategy to reducing time to defibrillation is harnessing the community response to deliver bystander-initiated defibrillation using an automated external defibrillator (AED). Public access defibrillator programs, where AEDs are placed in public places, have been highly effective. However, only 20% of out-of-hospital cardiac arrests occur in a public place. The majority occur in the home, where access to AEDs is limited. Strategies to enable timely community defibrillation in the home setting, such as provision of AEDs in private homes, have the potential to extend the benefits of early defibrillation and save thousands more lives.

Shot Through the Heart—Can RSV Vaccination Reduce Risk of Cardiovascular Outcomes?

Respiratory syncytial virus (RSV) causes severe disease in older adults at rates similar to seasonal influenza, particularly among those with chronic heart and lung disease, including congestive heart failure, chronic obstructive pulmonary disease (COPD), and bronchiolitis. Patients may present with signs and symptoms of viral pneumonia but commonly present with decompensated heart failure or COPD exacerbations, with RSV as the inciting event leading to worsening of their underlying disease. Recently, adults hospitalized with RSV have been shown to have a higher risk of invasive mechanical ventilation and death compared with those with influenza or COVID-19 who had received vaccination.

Digitoxin — A Reminder for Digoxin

Cardiac glycosides are among the oldest medications in cardiovascular care, prized for their actions as positive inotropic agents and modulators of atrioventricular conduction. In heart failure with reduced ejection fraction, their mechanistic rationale was so convincing that digitalis became a mainstay of treatment long before the initiation of large-scale trials...