Publications

BACKGROUND: The real-world uptake of the 2021 Kidney Disease: Improving Global Outcomes (KDIGO) blood pressure (BP) guideline, which lowered the systolic BP target to <120 mmHg for patients with chronic kidney disease (CKD), is poorly understood. We examined the adoption of the 2021 KDIGO systolic BP target in clinical practice and its association with clinical outcomes.

METHODS: The study was based on data from the Mass General Brigham healthcare network, an integrated healthcare system spanning primary to tertiary care in New England. In serial cross-sectional analysis, we identified ∼50 000 patients with CKD stage 3-4 in each year from 2020 to 2024 and assessed the annual proportion of patients within the 2021 KDIGO systolic BP target. In longitudinal analysis, we identified 18 996 patients with incident CKD stage 3-4 in 2014-2019 and evaluated the association between systolic BP above vs. within the target and clinical outcomes.

RESULTS: In serial cross-sectional analysis, 18.3% of patients with CKD had systolic BP within the 2021 KDIGO target in 2020 (pre-guideline). The proportion changed only marginally after the guideline's publication-18.0% in 2021 (absolute difference, -0.3% [95% CI, -1.2 to 1.3]), 19.3% in 2022 (absolute difference, 1.0% [95% CI, -0.1 to 2.0]), 20.0% in 2023 (absolute difference, 1.7% [95% CI, 0.2 to 3.1]), and 21.9% in 2024 (absolute difference, 3.6% [95% CI, 1.9 to 5.3]). In longitudinal analysis, patients with systolic BP above the 2021 KDIGO target exhibited higher risks of cardio-kidney end points, lower risk of hypotension, and no differences in other safety end points compared to those within the target.

CONCLUSIONS: Adoption of the 2021 KDIGO BP guideline remained limited in real-world practice. As of 2024, nearly 4 in 5 patients with CKD had systolic BP above the new guideline target.

Background: Although guidelines recommend invasive management for non-ST-elevation myocardial infarction (NSTEMI), there is considerable variability in the application of these recommendations across different hospitals, reflecting a lack of standardized clinical pathways and highlighting ongoing uncertainty in real-world practice. We sought to describe site-level variability in the use and timing of invasive angiography for NSTEMI and their association with in-hospital outcomes. Methods: Using NCDR Chest Pain-MI registry data (2019-2024), the rates and timing of invasive coronary angiography, if any, were characterized among patients with NSTEMI. Hierarchical logistic regression models were created to describe hospital-level variability in management using median odds ratios (MORs), adjusted for patient and site characteristics. Inverse probability weighting was used to estimate the association between treatment strategy and in-hospital outcomes. Results: We included 287,275 patients with Type-1 NSTEMI from 541 hospitals (age 67.6±13.3 years, 36.4% women). Invasive coronary angiography was performed in 87.1%, of whom 56.9% within 24 hours. Among those treated invasively, 66.1% received percutaneous coronary intervention. Older patients with more comorbidities were paradoxically more likely to receive conservative management or delayed intervention (>24 hours). Site-level variability for invasive strategy (vs. conservative) was large [MOR 2.85 (2.64-3.10)], as was early invasive treatment [MOR 1.67 (1.62-1.74)], particularly on weekends/holidays [MOR 1.89 (1.81-1.98)]. The use of any invasive strategy was associated with lower in-hospital mortality versus conservative management [weighted OR 0.36 (0.31-0.42)]. This finding was consistent across all baseline risk categories (P-interaction <0.001). Conclusions: Patients with Type-1 NSTEMI and higher-risk clinical profiles were not consistently prioritized to undergo early invasive management with substantial variability across hospitals. Invasive management was associated with lower in-hospital mortality compared with conservative treatment. Future randomized studies in the modern PCI era are needed to confirm our findings, and identify which patients benefit most and when intervention should occur.

BACKGROUND: Cardiovascular disease remains the leading cause of morbidity and mortality in the United States. JACC Cardiovascular Statistics 2026 reports the most up-to-date data on cardiovascular health in the United States. The report covers major cardiovascular risk factors (hypertension, diabetes, obesity, cholesterol, and cigarette smoking) and conditions that collectively account for most cardiovascular deaths and disability: coronary heart disease, acute myocardial infarction, heart failure, peripheral artery disease, and stroke.

OBJECTIVES: JACC Cardiovascular Statistics was developed to provide a clear, comprehensive, and accessible snapshot of cardiovascular health in the United States. An annual synthesis of contemporary cardiovascular statistics is needed to inform patients, clinicians, researchers, public health professionals, policymakers, and the public.

METHODS: This report synthesizes data from multiple national sources, including population-based surveys, clinical registries, administrative datasets, and vital statistics. For each risk factor and condition, we evaluated trends in disease epidemiology, quality of care, and morbidity and mortality. Data are presented overall and, where available, stratified by age, sex, race and ethnicity, socioeconomic status, and geography. Findings are presented using a standardized, visually accessible framework.

RESULTS: Cardiovascular risk factors-hypertension, diabetes, obesity, cholesterol, and cigarette smoking-remain prevalent among U.S. adults, with persistent gaps in prevention and treatment. Across cardiovascular conditions-coronary heart disease, acute myocardial infarction, heart failure, peripheral artery disease, and stroke-long-term gains in mortality are slowing or reversing, with ongoing gaps in quality of care and persistent health disparities.

CONCLUSIONS: JACC Cardiovascular Statistics 2026 provides a comprehensive snapshot of cardiovascular health in the United States, serving as an annual benchmark to guide clinical practice, inform health policy, and promote accountability in efforts to improve cardiovascular health and outcomes for all.