Hypertrophic cardiomyopathy, characterized by pathological thickening of the heart muscle, has long presented clinical challenges due to its heterogeneous progression and unpredictable outcomes. Affecting an estimated 1 in 500 to possibly 1 in 200 individuals, HCM is the leading inherited cardiovascular disease and the primary cause of sudden cardiac demise in otherwise healthy young adults, including athletes. The disease’s clinical manifestations can range from benign asymptomatic hypertrophy to fatal ventricular arrhythmias and progressive heart failure, underlining the critical need for accurate risk stratification tools.

Traditionally, risk assessment in HCM has relied on family history, symptoms, and simple imaging criteria such as echocardiography; however, these approaches often lack sensitivity and specificity. Kramer and colleagues embarked on a large-scale, longitudinal study involving nearly 2,700 HCM patients across the United States and Europe, with an average follow-up exceeding seven years. This extensive dataset presented an invaluable opportunity to refine prognostic methodologies by leveraging cutting-edge CMR technology coupled with molecular insights from blood-based assays.

Central to the study’s innovation is the enhanced application of cardiac magnetic resonance imaging to evaluate the left ventricle’s structural and functional parameters with high resolution. CMR enables precise quantification of ventricular mass, analysis of systolic function, and critically, detection of myocardial fibrosis via late gadolinium enhancement imaging. Fibrotic remodeling within the heart muscle has emerged as a pivotal substrate for arrhythmogenesis and mechanical deterioration, thus serving as a cornerstone for risk prediction.

Complementing imaging data, the research incorporated blood tests measuring levels of specific peptides indicative of pathological cardiac stress and remodeling. These biologically active peptides, small chains of amino acids fundamental to cellular signaling and structural integrity, offer quantifiable biochemical markers reflecting underlying disease activity. By correlating peptide concentrations with imaging findings, the study established a multifaceted biomarker model superior in forecasting clinically significant endpoints including sudden cardiac death, stroke, and progression to heart failure.

Notably, the combined MRI and biomarker strategy demonstrated enhanced prognostic accuracy even among patients who had already received treatment for arrhythmias, such as ablation or medication. This capacity to identify persistent high-risk profiles post-therapy is crucial for guiding decisions about prophylactic interventions, such as implantable cardioverter-defibrillators (ICDs). While ICDs save countless lives by detecting and interrupting life-threatening ventricular arrhythmias, their implantation carries risks and potential complications, emphasizing the value of selective use based on robust risk assessment.

The implications of this study are profound: patients deemed high-risk through the integrated diagnostic protocol can be triaged promptly for life-saving interventions, whereas low-risk individuals may avoid invasive procedures and associated burdens. This fine-tuning of patient management aligns with contemporary goals of personalized medicine, optimizing therapeutic benefit while minimizing harm and healthcare costs.

Kramer highlights that the new diagnostic paradigm supplements rather than replaces established clinical criteria, building upon prior histories and traditional parameters to create an enriched, multidimensional risk profile. The refinement of this approach promises to reduce the substantial number of “avoidable deaths” attributed to undetected or insufficiently treated HCM, a feat with widespread public health significance.

UVA Health’s distinction as Virginia’s sole HCM Center of Excellence underscores its commitment to pioneering research and exemplary clinical care. These centers represent a global network dedicated to progressive cardiomyopathy treatment, where findings such as those from Kramer’s team transition rapidly from bench to bedside, benefiting patients imminently.

The research findings appear in the prestigious Journal of the American Medical Association, cementing the study’s credibility and encouraging adoption of its methodologies by the medical community. Funding was provided by the National Institutes of Health’s National Heart, Lung, and Blood Institute, Oxford’s NIHR Biomedical Research Centre, Cytokinetics, and the Frederick Thomas Fund, reflecting broad support for advancing cardiovascular science.

As the medical field embraces integrative diagnostics combining molecular biology and imaging, the potential to unravel other enigmatic cardiovascular disorders grows. This study exemplifies the power of multidisciplinary efforts in tackling complex diseases and improving patient outcomes across diverse populations, marking a pivotal advancement in cardiology.

For physicians and patients alike, this research offers hope: measurable, actionable insights into hypertrophic cardiomyopathy’s risks that transcend convention. The promise of early detection, targeted intervention, and prevention of catastrophic cardiac events heralds a new era in heart disease management, one illuminated by technology and translational science.

Subject of Research: Hypertrophic cardiomyopathy risk stratification through combined cardiac MRI and peptide biomarker analysis.

Article Title: Advanced Imaging and Biomarker Integration Revolutionize Risk Prediction in Hypertrophic Cardiomyopathy.

News Publication Date: Information not provided.

Web References:

• Hypertrophic Cardiomyopathy Association: https://www.4hcm.org/
• UVA Cardiomyopathy Program: https://www.uvahealth.com/treatments/cardiomyopathy
• Journal Article DOI: http://dx.doi.org/10.1001/jama.2026.5633

References:

• Kramer, C. M., et al. “Risk Stratification in Hypertrophic Cardiomyopathy Using Cardiac MRI and Circulating Peptides.” Journal of the American Medical Association. DOI: 10.1001/jama.2026.5633

Image Credits: UVA Health

Keywords: cardiology, hypertrophic cardiomyopathy, cardiac MRI, biomarkers, heart failure, arrhythmia, ventricular fibrosis, personalized medicine, implantable defibrillators, cardiovascular disease, sudden cardiac death, cardiac risk stratification

The investigation into CTRP9’s function initiated from earlier studies that highlighted the importance of metabolic pathways in cardiovascular diseases. It has long been established that impaired lipid metabolism contributes to various forms of heart disease, and HFpEF is no exception to this rule. By examining the intricate relationship between CTRP9 levels and lipid profiles in patients, the research team discovered a compelling correlation. They found that diminished levels of CTRP9 were associated with unfavorable lipid profiles that exacerbate heart failure symptoms.

Mechanistically, CTRP9 appears to enhance lipid oxidation while simultaneously reducing lipogenesis. This dual action not only helps in restoring a healthy lipid profile but may also contribute to improved cardiac function. The heart, being a highly energy-dependent organ, relies significantly on fatty acids as a fuel source. Therefore, any disruption in lipid metabolism can lead to energy deficits, which ultimately affect heart performance. By modulating these metabolic pathways, CTRP9 emerges as a vital candidate for treatment strategies aimed at HFpEF.

In their study, Xin and colleagues utilized a combination of in vivo and in vitro experiments to substantiate their claims. One striking finding was that the administration of CTRP9 in experimental models of heart failure led to marked improvements in parameters such as cardiac output and muscle contractility. These benefits were attributed to the restoration of metabolic homeostasis, suggesting that CTRP9 not only acts as a metabolic regulator but also protects cardiac tissue from stress-induced damage.

Furthermore, the researchers investigated the signaling pathways involved in CTRP9’s action. They identified several key pathways that are activated upon CTRP9 treatment, including the AMP-activated protein kinase (AMPK) pathway, which is known for its role in cellular energy homeostasis. This discovery adds a layer of complexity to our understanding of CTRP9, indicating that its cardioprotective effects may also be linked to broader metabolic regulatory mechanisms.

In parallel with the metabolic insights, the study also delved into the inflammatory responses associated with heart failure. Chronic inflammation is a hallmark of HFpEF, and it exacerbates lipid metabolism disturbances. The administration of CTRP9 was shown to downregulate pro-inflammatory cytokines, providing another avenue through which CTRP9 can ameliorate heart failure symptoms. This finding not only underscores the multifaceted role of CTRP9 but also opens up opportunities for combination therapies that tackle both metabolic dysregulation and inflammation in heart failure patients.

As the research progresses, the authors encourage further clinical studies that could establish CTRP9 as a viable therapeutic agent for heart failure. Given the complexity of HFpEF and the limited treatment options currently available, the introduction of a novel treatment targeting lipid metabolism could have profound implications. The concept of leveraging metabolic regulators like CTRP9 to improve cardiac function represents a paradigm shift in how we approach heart disease management.

Looking forward, the implications of this research may extend beyond HFpEF. The connection between CTRP9 and lipid metabolism suggests that similar therapeutic strategies could be developed for other cardiovascular diseases characterized by metabolic disturbances. Moreover, understanding the precise molecular mechanisms underpinning CTRP9 action could unveil new therapeutic targets, potentially leading to a broader spectrum of treatments for various heart conditions.

In conclusion, the study conducted by Xin et al. highlights the significance of CTRP9 as more than just a biological marker; it positions CTRP9 as a potential cornerstone in the therapeutic landscape for heart failure with preserved ejection fraction. As research continues to unfold, the hope is that these findings will catalyze a new wave of innovative interventions that not only improve heart function but also enhance the quality of life for millions suffering from this debilitating condition.

Through innovative research and enhanced understanding of underlying mechanisms, the narrative surrounding heart failure is poised to evolve. The promise of CTRP9 ignites optimism not only in scientific circles but also among the patient community yearning for effective solutions in cardiovascular health.

Subject of Research: Cardiac Lipid Metabolism and Heart Failure

Article Title: CTRP9 ameliorates heart failure with preserved ejection fraction by regulating lipid metabolism

Article References:

Xin, J., Liu, R., Deng, M. et al. CTRP9 ameliorates heart failure with preserved ejection fraction by regulating lipid metabolism.
J Transl Med (2026). https://doi.org/10.1186/s12967-025-07661-2

Image Credits: AI Generated

DOI: 10.1186/s12967-025-07661-2

Keywords: Heart Failure, CTRP9, Lipid Metabolism, Ejection Fraction, Cardiovascular Disease, Metabolic Regulation, Inflammation.

A primary focus of this recent study led by experts including Yamamoto, Yajima, and Kawamura is the implementation of extracorporeal biventricular support via left mini-thoracotomy. This innovative technique presents a minimally invasive alternative to conventional surgical methods, granting medical professionals the ability to provide life-saving support with reduced trauma to the patient’s body. Not only does this approach enhance patient comfort, but it also diminishes recovery times, which is essential in critical care settings.

During the research, the team highlighted the intricacies involved in setting up a biventricular support system. It is vital for clinicians to ensure optimal positioning and integration of the device to facilitate proper management of both the left and right ventricles. The success of this approach increases the likelihood of successfully bridging patients to potential heart transplantation or achieving spontaneous recovery during the acute phase of heart failure.

The methods utilized in this study significantly diverge from traditional surgical protocols, emphasizing the use of a left mini-thoracotomy access point. By opting for this less invasive entryway, the researchers aimed to reduce the overall trauma associated with heart support procedures. As a result, patients not only experience decreased pain levels but also benefit from shorter hospital stays, improving overall patient management.

Moreover, the efficacy of extracorporeal biventricular support lies in its versatility. This system has the potential to be adapted for various patient needs, offering customized solutions for individuals depending on their specific heart conditions and clinical circumstances. The study meticulously documents how device specifications can be altered according to the severity of heart failure and individual anatomical differences.

Another crucial aspect of this research is the evaluation of the support system’s performance over extended periods. Previous support devices often encountered limitations regarding durability and effectiveness during prolonged usage. However, the team’s findings suggest that with ongoing monitoring and appropriate adjustments, the extracorporeal biventricular support system demonstrates sustained performance, thereby representing a promising route for long-term patient management.

Furthermore, the emotional and psychological toll experienced by patients with advanced heart disease cannot be overlooked. The ability to provide robust temporary support while reducing the surgical burden offers not just physical relief but potentially enhances the overall emotional well-being of patients hopeful of recovering from their condition. This comprehensive approach is what makes the findings of this study particularly noteworthy.

In light of the outcomes observed during the research, the authors stress the importance of multidisciplinary collaboration in managing patients on extracorporeal support. The integration of cardiologists, surgeons, pharmacists, and nursing staff comes together to provide an optimal environment for patient recovery, underscoring the progress being made in cardiac care.

As the medical field continues to evolve, further studies building upon the findings of Yamamoto and colleagues are essential. Continued exploration of new technologies and techniques may unearth additional benefits and applications that could transform the landscape of cardiac surgery and heart failure management.

The impressive advance of extracorporeal biventricular support through left mini-thoracotomy exemplifies how innovation can lead to improved patient care. With research like this paving the way, the future looks promising for individuals facing dire heart conditions. The intersection of technology and compassionate care has the potential to save lives, redefine the surgical approach to heart failure, and inspire further innovations in the years to come.

In conclusion, the intricacies of this groundbreaking study highlight the need for thorough understanding and dissemination of new cardiac support systems. As practitioners in the field continue to adopt and refine these techniques, the hope remains that such innovations will be integral in addressing the challenges associated with heart failure. The possibility of bridging patients to recovery or transplant is a testament to the tireless efforts of medical professionals striving to enhance the quality of care in the face of adversity.

The study’s implications are poised to resonate throughout the field for years to come, encouraging continued dialogue, research initiatives, and educational efforts focused on the ongoing challenges of heart disease. Indeed, the evolution of biventricular support systems serves as a potent reminder of the human spirit’s unwavering quest for progress in medicine and patient care.

Subject of Research: Extracorporeal biventricular support through left mini-thoracotomy

Article Title: Extracorporeal biventricular support through left mini-thoracotomy

Article References:

Yamamoto, M., Yajima, S., Kawamura, T. et al. Extracorporeal biventricular support through left mini-thoracotomy.
J Artif Organs 29, 5 (2026). https://doi.org/10.1007/s10047-025-01538-3

Image Credits: AI Generated

DOI: https://doi.org/10.1007/s10047-025-01538-3

Keywords: Extracorporeal support, biventricular support, heart failure, minimally invasive surgery, cardiac care innovations.

Hypertensive heart disease, characterized predominantly by pathological thickening of the left ventricular wall, poses an escalating risk worldwide. This maladaptive cardiac remodeling compromises heart function, escalating morbidity and mortality. Despite advances in antihypertensive therapies, reversal of established LVH remains elusive, driving an urgent need for novel interventions. Sacubitril/valsartan—a combined angiotensin receptor neprilysin inhibitor (ARNI)—has demonstrated marked benefits in heart failure with reduced ejection fraction, but its role in hypertensive cardiac remodeling demanded meticulous evaluation.

The REVERSE-LVH trial represents a pivotal step toward understanding sacubitril/valsartan’s impact beyond traditional heart failure endpoints. Conducted across multiple centers with stringent randomized control protocols, the trial enrolled hypertensive patients exhibiting quantifiable left ventricular hypertrophy as confirmed by cardiac magnetic resonance imaging (MRI). Participants were assigned either sacubitril/valsartan or standard antihypertensive therapy, with a treatment duration sufficient to capture meaningful structural and functional cardiac changes.

Cardiac MRI assessments revealed that sacubitril/valsartan induced a statistically significant reduction in left ventricular mass index compared to controls, indicating effective regression of hypertrophic remodeling. Notably, this regression was accompanied by improvements in myocardial strain parameters and diastolic function, suggesting enhanced myocardial mechanics and ventricular compliance. These mechanistic insights reinforce the drug’s multifaceted action—combating pathological growth stimuli and improving myocardial relaxation properties.

On a molecular level, sacubitril/valsartan’s dual action facilitates increased levels of natriuretic peptides through neprilysin inhibition while simultaneously blocking the detrimental effects of angiotensin II via receptor antagonism. The natriuretic peptide elevation exerts vasodilatory, antifibrotic, and natriuretic effects, counteracting maladaptive remodeling pathways triggered by persistent hypertension. This dual mechanism uniquely positions the ARNI to target the complex pathophysiology of hypertensive heart disease with greater efficacy than monotherapies.

Furthermore, biomarkers reflective of cardiac fibrosis and inflammation showed favorable modulation following sacubitril/valsartan treatment. Circulating levels of collagen turnover markers and proinflammatory cytokines decreased significantly, reinforcing the hypothesis of reduced pathological extracellular matrix expansion and inflammatory stress within the myocardium. Such shifts in the myocardial microenvironment are crucial to halting fibrosis progression and improving ventricular compliance.

Beyond structural improvements, patients receiving sacubitril/valsartan experienced noticeable enhancements in functional status and quality of life measures. Symptom burden related to exertional dyspnea and fatigue showed meaningful reduction. These patient-centric outcomes underscore the translational impact of reversing LVH—not merely as a surrogate imaging endpoint but as tangible improvements in cardiac performance and daily living.

The trial also carefully monitored safety and tolerability, confirming that sacubitril/valsartan was well tolerated with no unexpected adverse events in the hypertensive cohort. This safety profile encourages broader consideration of ARNI therapy as an option in hypertensive patients at elevated risk for cardiac remodeling, potentially shifting clinical paradigms in hypertension management.

These insights herald a paradigm shift in treating hypertensive heart disease. Historically, efforts to manage hypertensive LVH focused primarily on blood pressure reduction, anticipating indirect cardiac benefits. However, REVERSE-LVH illuminates the power of directly targeting myocardial remodeling pathways, enabling regression of hypertrophy even when blood pressure control alone proves insufficient.

Clinicians and researchers alike eagerly anticipate further investigations to delineate long-term cardiovascular outcomes and evaluate sacubitril/valsartan’s role in diverse hypertensive populations. Additionally, mechanistic studies exploring gene expression profiles and signaling cascade alterations induced by ARNI treatment promise to deepen understanding of hypertrophic reversal processes.

Beyond academic interest, these findings have practical healthcare implications. Hypertensive LVH is a widespread yet undertreated condition linked to heart failure, arrhythmias, and sudden cardiac death. Introducing sacubitril/valsartan into the therapeutic arsenal could substantially mitigate this disease burden and reshape preventive cardiology strategies.

Moreover, the trial’s integration of sophisticated imaging modalities and biomarker panels sets a new standard for evaluating cardiac remodeling therapeutics. This comprehensive approach enables precise quantification of myocardial changes at both tissue and molecular dimensions, facilitating nuanced drug assessment and personalized therapy tailoring.

While the REVERSE-LVH trial’s phase 2 results are illuminating, ongoing phase 3 studies designed to confirm efficacy and safety over extended follow-up will be decisive. Optimizing dosing strategies, understanding patient subgroups that derive maximum benefit, and integrating ARNI therapy with existing guideline-directed treatments remain critical next steps.

In summary, the REVERSE-LVH randomized trial offers a beacon of hope for patients battling hypertensive heart disease. By harnessing sacubitril/valsartan’s unique pharmacological profile, researchers have demonstrated, for the first time, that regression of adverse left ventricular remodeling is achievable in hypertension—a milestone with profound therapeutic and prognostic implications. As this research influences future clinical practice, it may redefine standards of cardiovascular care and improve outcomes for millions worldwide.

The convergence of molecular innovation and clinical rigor exemplified in this work stands as a testament to the transformative potential of translational science. Sacubitril/valsartan’s emergence as a disease-modifying agent in hypertensive cardiac pathology underscores the evolving landscape of cardiovascular therapeutics—one that transcends symptom management and targets root causes at the cellular level.

Undoubtedly, these findings will stimulate vibrant scientific discourse and inspire new avenues of exploration into how combination therapies can synergistically address multifactorial cardiac diseases. The REVERSE-LVH trial marks a watershed moment, encouraging hope, optimism, and progress in the fight against one of cardiology’s most pervasive challenges.

Subject of Research: Effects of sacubitril/valsartan on hypertensive heart disease, specifically left ventricular hypertrophy reversal.

Article Title: Effects of sacubitril/valsartan on hypertensive heart disease: the REVERSE-LVH randomized phase 2 trial.

Article References:

Lee, V., Dalakoti, M., Zheng, Q. et al. Effects of sacubitril/valsartan on hypertensive heart disease: the REVERSE-LVH randomized phase 2 trial.
Nat Commun 16, 6981 (2025). https://doi.org/10.1038/s41467-025-62203-0

Image Credits: AI Generated

Located at The Mount Sinai Hospital, the Fuster Heart Hospital faculty encompasses an elite group of cardiologists specializing in an array of subspecialties within cardiovascular medicine. Their expertise spans general cardiology, interventional cardiology, cardiac electrophysiology, heart failure management, valvular heart disease, women’s heart disease, adult congenital heart disease, vascular medicine, and cardiovascular genetics. The breadth and depth of this multidisciplinary team allow for comprehensive, nuanced patient care, integrating advanced diagnostic and therapeutic strategies. As one of only ten heart centers nationwide—and the sole recipient in New York—to earn the Pinnacle of Excellence Award®, Mount Sinai’s practice exemplifies top-tier quality on a national scale.

The Human Experience Pinnacle of Excellence Award® measures consistent high performance across several critical domains including patient experience, clinical quality, and engagement of both physicians and employees, using a rigorous data analysis spanning three full years—from April 2021 through March 2024. This extended evaluation period ensures that the honored institutions demonstrate sustained excellence rather than episodic success. Mount Sinai’s ability to maintain such standards is a testament to its institutional culture that prioritizes seamless care pathways, continuous quality improvement, and empathetic patient interactions.

Valentin Fuster, MD, PhD, President of the Mount Sinai Fuster Heart Hospital, reflects on this achievement as a reinforcement of their core mission to enhance patient experience through innovation and dedication. The hospital’s approach includes deploying cutting-edge technologies in cardiac imaging, interventional techniques, and personalized medicine, all while fostering strong patient-provider relationships. This duality of technical prowess and humanistic care creates an environment where patients feel both confident in the clinical expertise and respected as individuals.

Deepak L. Bhatt, MD, MPH, MBA, FACC, FAHA, FESC, MSCAI, Director of the Fuster Heart Hospital, highlights the institution’s seminal advancements in cardiovascular care, positioning it among the top 5 percent of healthcare providers nationally in patient experience measures over the award period. Press Ganey’s collaboration with over 41,000 healthcare facilities globally sets a high bar, making this distinction particularly significant. The recognition flows from integrative strategies that combine detailed patient feedback, comprehensive staff training, and data-driven clinical practices to enhance outcomes.

Mount Sinai’s standing as a global leader in cardiology is further corroborated by its top rankings. The Fuster Heart Hospital is ranked No. 4 nationally in cardiology, heart surgery, and vascular procedures by U.S. News & World Report®. Internationally, it is positioned No. 6 in Newsweek’s list of “The World’s Best Specialized Hospitals.” These rankings consider clinical outcomes, patient safety indices, research productivity, and innovation capacity, consolidating Mount Sinai’s reputation on both national and global stages.

The institution operates within the larger Mount Sinai Health System, the largest academic medical system in New York City. This network includes six hospitals, a premier medical school, and an extensive ambulatory infrastructure serving a diverse urban and regional population. Together, they form a hub of translational research, education, and clinical care delivery, striving to provide healthcare that is not only effective but equitable and accessible.

Mount Sinai’s research initiatives in cardiovascular medicine are distinguished by their emphasis on translational approaches that bridge fundamental biological discoveries and clinical application. Ongoing projects include genetic studies that illuminate the molecular underpinnings of cardiovascular disorders, development of novel electrophysiological mapping techniques, and investigations into vascular biology that inform new treatments for heart failure and coronary artery disease. This research ecosystem fosters continuous innovation, ensuring that patient care evolves in tandem with scientific advancements.

The faculty’s expertise in cardiovascular genetics is particularly noteworthy, as it enables tailored therapies for complex congenital and acquired heart diseases. Through precision medicine, genetic profiling guides therapeutic approaches, improving prognostic accuracy and optimizing treatment regimens. Additionally, specialized programs in women’s heart disease address sex-specific cardiovascular risk factors and manifestations, filling a critical gap in traditional cardiology.

Patient experience at Mount Sinai is enhanced by a sophisticated integration of data analytics and patient-reported outcomes. The health system employs advanced algorithms to monitor care quality metrics, enabling real-time adjustments that mitigate risks and improve satisfaction. Additionally, mentoring programs cultivate physician engagement, resilience, and communication skills, recognizing the centrality of caregiver well-being in sustaining patient-centered care.

Mount Sinai’s commitment to continuous improvement is evident in its repeated receipt of the Human Experience Pinnacle of Excellence Award®, having also been honored in 2023. This recurrent achievement signals an institutional paradigm where iterative learning, responsiveness to patient feedback, and strategic leadership converge to elevate healthcare delivery standards year after year.

In summation, the 2024 Human Experience Pinnacle of Excellence Award® recognizes Mount Sinai Fuster Heart Hospital as a paragon of clinical and experiential excellence in cardiovascular medicine. Through its interdisciplinary expertise, innovative research, and unwavering dedication to patient-centered care, Mount Sinai not only advances the frontiers of cardiology but also redefines the healthcare journey for its patients, setting a benchmark for institutions nationwide.

Subject of Research: Cardiovascular care, patient experience, and clinical quality in cardiology.

Article Title: Mount Sinai Fuster Heart Hospital Awarded 2024 Human Experience Pinnacle of Excellence for Outstanding Cardiovascular Care

News Publication Date: 2024

Web References:
https://www.mountsinai.org

Image Credits: Mount Sinai Health System

Keywords: Cardiology, Hospitals, Health care delivery, Circulatory system, Education research, Heart disease, Early educational intervention, Discovery research, Electrophysiology, Heart failure, Congenital heart disease, Human genetics

Patients living with heart failure and COPD contend daily with debilitating symptoms such as fatigue, breathlessness, and decreased functional capacity. These physical burdens are compounded by psychological factors including anxiety and depression, which further exacerbate their overall health status. Hospital readmissions within 30 days of discharge remain a critical challenge, contributing to patient distress and imposing financial penalties on healthcare facilities. Against this backdrop, novel interventions that can enhance both mental and physical wellbeing are urgently needed.

The research team embarked on a two-year project entitled Music Therapy to Address patient’s JOuRneys with CHronic illness, Outcome, and ReaDmission (MAJOR CHORD) to fill an evident gap in existing knowledge. Despite music therapy’s well-documented immediate effects on symptom relief during hospital stays, its long-term impact on patient health and hospital readmissions remains underexplored. MAJOR CHORD was designed to investigate the feasibility, fidelity, and acceptability of a hybrid intervention that could extend therapeutic benefits beyond hospitalization.

Supported by the Kulas Foundation, a leading funder in music therapy research, the MAJOR CHORD pilot study pioneers the delivery of both face-to-face and remote music therapy sessions specifically targeting this vulnerable population. Past funding initiatives by the Kulas Foundation have propelled research demonstrating music therapy’s efficacy in various contexts, including palliative care, surgical recovery, sickle cell disease, and pain management. This new focus on chronic respiratory and cardiovascular diseases underscores the versatility of music therapy as a clinical tool.

The pilot aimed to establish foundational evidence on whether such a hybrid model could be reliably implemented and whether patients would engage with the intervention consistently. Critical to this goal was ensuring sessions adhered closely to a rigorously developed protocol and that patients completed standardized surveys measuring stress, quality of life, and self-efficacy at multiple time points. Maintaining intervention fidelity was achieved via detailed checklists reviewed by the clinical team, ensuring therapeutic consistency was upheld throughout the study.

Participants were recruited from UH Cleveland Medical Center during their inpatient admission for heart failure or COPD exacerbations. They initially received two individualized, bedside music therapy sessions conducted by board-certified music therapists. Upon discharge, participants transitioned to two virtual sessions in their home environment, facilitating continuity of care while minimizing logistical barriers. This hybrid design sought to maximize accessibility and engagement, leveraging technology to extend therapeutic reach.

Patient-reported outcomes were collected at baseline, 15 days, and 30 days post-discharge, capturing the evolving impact of music therapy throughout hospitalization and recovery. A subset of participants also engaged in semi-structured interviews to provide qualitative insights into the intervention experience. These rich narratives highlighted the importance of the therapeutic relationship, the challenge of maintaining engagement post-discharge, and the positive mental health effects attributed to the sessions.

Results from the pilot were encouraging yet highlighted several operational challenges. Of the 113 patients approached, 20 were successfully enrolled in the study, with an 85% retention rate indicating strong participant commitment. Attendance to sessions stood at 57.5%, markedly higher for in-person sessions (75%) compared to virtual ones (40%), pointing to technological and engagement barriers in remote care delivery. Nevertheless, protocol adherence surpassed 80%, meeting high fidelity standards and underscoring feasibility.

Key obstacles identified included difficulties in post-discharge participant communication, technological challenges in accessing virtual sessions, and frequent rescheduling needs. Addressing these issues, the research team has since adopted several innovative strategies, including secure text messaging to improve communication, providing technical assistance for video platform navigation, and increasing direct contact frequency after hospital discharge. These adaptations aim to enhance patient engagement and data completeness in subsequent randomized controlled trials.

Importantly, mental health benefits emerged as a significant theme from qualitative analyses. Participants expressed that the music therapy sessions fostered a therapeutic alliance that supported emotional wellbeing during a vulnerable period. The intervention appeared to alleviate symptoms of anxiety and depression, offering a non-pharmacological avenue to bolster mental resilience in chronic illness management. This aligns with broader scientific recognition of psychosocial interventions as pivotal components of holistic patient care.

The forthcoming randomized controlled trial currently underway seeks to rigorously compare hybrid music therapy with usual care, assessing outcomes such as quality of life and hospital readmission rates. By building upon the pilot’s successes and addressing its limitations, this trial aspires to produce definitive evidence that could transform integrative care practices for chronic illness patients. The hybrid model’s potential scalability adds to its appeal as a sustainable clinical strategy.

This study’s significance extends beyond its immediate clinical implications; it highlights the evolving role of personalized, patient-centered interventions in modern healthcare. Music therapy, long relegated to adjunct or complementary status, is being systematically evaluated with scientific rigor to substantiate its health impacts. As healthcare systems grapple with rising chronic disease burdens, therapies that enhance patient experience and reduce system strain are invaluable.

Dr. Samuel Rodgers-Melnick, Principal Investigator at UH Connor Whole Health, emphasized the study’s pioneering nature: “This roadmap demonstrates that delivering music therapy consistently across in-person and virtual settings is not only feasible but also meaningful to patients. Our work paves the way to explore how sustained music therapy exposure can mitigate costly hospital readmissions.” Similarly, Dr. Kristi Artz, Vice President of Connor Whole Health, noted the intervention’s promise while acknowledging the need for refinement in virtual engagement post-discharge.

In conclusion, the MAJOR CHORD pilot study illuminates a promising path for hybrid music therapy interventions in chronic disease contexts, demonstrating feasibility, acceptability, and potential mental health benefits. By bridging the inpatient and outpatient care continuum through innovative therapy delivery, this research exemplifies how multidisciplinary approaches can enhance patient outcomes and healthcare efficiency. Future rigorous trials will be crucial to validate these findings and potentially reshape standards of care for patients with heart failure and COPD.

Subject of Research: Hybrid Music Therapy Intervention for Patients with Chronic Obstructive Pulmonary Disease and Heart Failure

Article Title: Refining a Hybrid Music Therapy Intervention for Chronic Obstructive Pulmonary Disease and Heart Failure: A Single Arm Pilot Study

News Publication Date: Not explicitly provided; assumed early 2025 based on article citation.

Web References:

• University Hospitals Connor Whole Health: http://www.uhhospitals.org/ConnorWholeHealth
• BMC Complementary Medicine and Therapies article: https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-025-04887-x

References:
Yu H, Foss A, Segall TL, Block S, Risser K, Razzak R, Zacharias M, Teba CV, Rodgers-Melnick SN. Refining a hybrid music therapy intervention for chronic obstructive pulmonary disease and heart failure: a single arm pilot study. BMC Complement Med Ther. 2025;25(1):139. doi: 10.1186/s12906-025-04887-x.

Image Credits: University Hospitals

Keywords: Music, Disease intervention, Medical research facilities, Chronic obstructive pulmonary disease, Scientific data

The implications of atrial fibrillation in relation to heart failure are multifaceted and critical. Atrial fibrillation, a common cardiac arrhythmia, can lead to various complications, including stroke and heart failure. The correlation between this condition and poorer prognosis underscores the necessity for effective interventions. Finerenone, a novel non-steroidal mineralocorticoid receptor antagonist, has gained attention for its ability to mitigate renal and cardiovascular outcomes in certain patient populations suffering from chronic kidney disease and heart failure with reduced ejection fraction.

In the context of this study, researchers posited that finerenone could potentially provide protective benefits against the heightened risks posed by atrial fibrillation. The study indicates that the drug’s efficacy was maintained across diverse subgroups, highlighting its role as a consistent therapeutic option for heart failure patients, regardless of their arrhythmic status. This finding is particularly empowering, as it suggests that clinicians may have an effective tool to manage heart failure complications while also addressing the challenges posed by atrial fibrillation.

Furthermore, the study magnifies the clinical significance of finerenone in light of escalating rates of cardiovascular diseases worldwide. With atrial fibrillation becoming a prevalent public health concern, the necessity for robust treatment modalities to enhance patient survival rates and quality of life becomes increasingly pressing. Finerenone stands out as it not only targets heart failure and chronic kidney disease but also seeks to reduce the complications arising from arrhythmias.

The analysis of the outcomes revealed critical insights regarding the dynamic interplay between finerenone and various risk factors associated with cardiovascular disorders. Patients with new-onset atrial fibrillation require vigilant management because their risk profiles differ substantially from those without this condition. The researchers noted that stratifying patients based on their arrhythmic status could enhance treatment precision, optimizing the use of finerenone and possibly extending its benefits to a broader demographic.

Moreover, the study advocates for a more nuanced understanding of drug interactions and patient-specific factors that can influence treatment responses. By comprehensively evaluating the relationship between finerenone and patient outcomes in the context of atrial fibrillation, clinicians can integrate this knowledge into their practice, tailoring interventions to meet individual patient needs effectively.

In light of these findings, healthcare providers are encouraged to include discussions surrounding atrial fibrillation when formulating treatment plans for patients with heart failure. The study has spurred further interest in exploring additional pharmacological options that may complement finerenone, ultimately striving for an interdisciplinary approach to cardiovascular care that encompasses both prevention and management of atrial fibrillation.

As we reflect on the study’s outcomes, the fundamental need for further inquiry into the mechanisms by which finerenone exerts its effects becomes evident. Future research could delineate the pathways involved and explore how they might intersect with other therapeutic agents. This could rationalize a multifactorial strategy in addressing not only heart failure but also the urgent need for effective atrial fibrillation management.

In conclusion, the research on finerenone presents an opportunity to enhance understanding and treatment of heart failure in the presence of atrial fibrillation. Such comprehensive studies foster knowledge that is vital not only for clinicians but also for patients navigating their cardiovascular health journeys. Insights gained from this study may reshape clinical guidelines, leading to improved outcomes for those at risk of or suffering from atrial fibrillation as part of their overall heart failure management strategy.

As more data emerge to illuminate the intricate relationships between cardiovascular health conditions, the medical community must remain vigilant and proactive in leveraging these insights to foster advancements in patient care.

The presentation of this study at the American College of Cardiology’s Annual Scientific Session further emphasizes its significance in the realm of cardiovascular research. The ongoing dialogue among researchers, clinicians, and healthcare professionals surrounding these critical findings serves as an impetus for continued exploration and innovation in cardiology.

In a healthcare landscape that constantly evolves, the potential applications of finerenone offer hope for enhanced quality of life in patients grappling with complex cardiovascular conditions, ultimately underscoring the value of targeted therapeutic strategies.

With the convergence of emerging data and advanced clinical practices, the future appears promising for the management of atrial fibrillation and associated cardiovascular disorders, heralding an era of precision medicine that prioritizes individualized patient care.

Subject of Research: Efficacy of finerenone in patients with heart failure and atrial fibrillation
Article Title: Efficacy of Finerenone Consistent Regardless of Atrial Fibrillation Status
News Publication Date: October 2023
Web References: N/A
References: N/A
Image Credits: N/A
Keywords: Atrial Fibrillation, Heart Failure, Finerenone, Cardiovascular Disorders, Chronic Kidney Disease, Mineralocorticoid Receptor Antagonist, Cardiac Arrhythmias, Risk Factors, Medical Treatments, Drug Therapy

As medical science continues to advance, it remains clear that while heart failure is currently incurable, effective management can lead to improved quality of life. Patients can engage in meaningful activities and maintain an enjoyable life with appropriate interventions. Emerging research underscores the importance of guideline-directed medical therapies (GDMT), which have been shown to enhance patient outcomes significantly. Evidence suggests that patients receiving GDMT experience lower mortality rates and reduced hospitalizations, leading to a substantial decrease in healthcare costs.

In response to the growing prevalence of heart failure and the associated burdens, the American Heart Association has launched a pioneering initiative—the Heart Failure Center Certification program. This groundbreaking effort seeks to elevate heart failure care standards globally. For the first time, the program is being introduced in 13 countries outside the U.S., highlighting a commitment to making evidence-based, high-quality heart failure care accessible to patients regardless of geographic location.

The Heart Failure Center Certification aims to recognize hospitals that demonstrate a dedication to improving heart failure care within their communities. By establishing a framework that promotes high-quality, evidence-based treatments, the certification program seeks to facilitate seamless transitions for patients from hospital to outpatient care. Such an integrated approach is pivotal to enhancing patient outcomes while lowering the risk of readmissions—a persistent threat in heart failure management.

Furthermore, the certification sets forth rigorous standards developed independently and overseen by organizations with the requisite clinical expertise. These standards focus not only on the technical aspects of care delivery but also on the critical need for patient-centered approaches that prioritize safety and quality of treatment. By fostering an environment that emphasizes collaboration among healthcare professionals, the certification program is positioned to drive excellence in heart failure management.

Dr. D.P. Suresh, a prominent figure in the American Heart Association community, articulates the vision behind the certification. His remarks highlight the necessity of coordinated heart failure programs that yield mutual benefits for hospitals and their patients. The overarching goal is to reduce cardiovascular disease morbidity and mortality globally, ultimately altering the landscape of heart healthcare for future generations.

The scientific evidence supporting the efficacy of structured heart failure programs is compelling. Studies indicate that hospitals equipped with comprehensive heart failure programs can significantly improve patient outcomes. This improvement often manifests as higher rates of guideline adherence, leading to reduced hospital stays and fewer complications. Enhanced support systems in these programs also empower patients to take a more active role in managing their health.

Chronic heart failure, a progressive condition, prompts complex clinical scenarios that necessitate ongoing education and support. The need for continuous quality improvement highlights the dynamic nature of healthcare. As our understanding of heart failure deepens, so too must the approaches to care evolve. Initiatives like the Heart Failure Center Certification are essential to fostering an environment of continuous learning and innovation.

The challenges posed by heart failure extend beyond the individual; they permeate health systems and economies on a global scale. Direct and indirect costs associated with heart failure, including hospital readmissions and long-term care requirements, create a significant burden. With an increasing aging population and rising prevalence of risk factors associated with heart disease, the need for proactive measures is more urgent than ever.

Realizing the vision of improved heart failure outcomes requires comprehensive strategies that encompass prevention, early detection, and effective management. Public health initiatives aimed at reducing risk factors such as hypertension, obesity, and diabetes play a crucial role. Education for both healthcare professionals and patients about the importance of early recognition and intervention can lead to better prognoses.

As healthcare evolves, so must the systems that deliver heart failure care. Innovative technologies and telehealth initiatives are emerging as powerful tools to bridge the gap between patients and healthcare providers. Remote monitoring and digital health solutions can optimize patient engagement and adherence to treatment plans. Such advancements are vital in the journey toward effective heart failure management in an increasingly connected world.

In conclusion, heart failure remains a complex and pressing global health issue that demands unwavering attention and innovative solutions. The American Heart Association’s Heart Failure Center Certification represents a pivotal step toward transforming heart failure care and ultimately improving patient outcomes. As healthcare providers collaborate and leverage evidence-based practices, there is optimism that significant strides can be made in the battle against heart failure for patients worldwide.

Subject of Research: Heart Failure Management and Care Enhancement
Article Title: Heart Failure: A Global Challenge Requiring Urgent Response and Innovation
News Publication Date: March 27, 2025
Web References: Heart Failure Certification
References: American Heart Association Announcements
Image Credits: American Heart Association
Keywords: Heart failure, cardiovascular disease, patient outcomes, healthcare improvement, American Heart Association, global health, disease management, telehealth, evidence-based treatment, health care certification.

IMACS, operated under the auspices of the International Society for Health and Lung Transplantation (ISHLT), is dedicated to improving care for patients facing advanced heart and lung diseases. It aims to bridge gaps in knowledge regarding the efficacy and utility of durable mechanical circulatory support (MCS) devices, which are designed to assist patients suffering from severe heart failure. The renewed focus on MCS devices is crucial, especially considering that approximately 4,000 of these devices are implanted annually across the globe, highlighting the need for comprehensive data collection and analysis.

MCS devices are engineered to either temporarily or permanently assist the heart in pumping blood, a vital function that may be compromised in patients with advanced stages of heart failure. The IMACS registry will specifically capture data related to durable devices which are built to function effectively for 30 days or more. This includes data on ventricular assist devices and total artificial hearts, both of which represent a critical component in the landscape of heart failure management. The registry’s data will help inform both medical professionals and patients about potential outcomes and effectiveness of these supportive technologies.

Historical insights reveal that the IMACS initiative commenced in 2012 and continued until 2019, at which point it was paused to enhance compliance with data privacy regulations. Now, as it relaunches, the registry seeks to collect data from a variety of national and continental MCS registries across different countries. This collaborative effort is anticipated to yield rich insights into patient demographics, clinical outcomes, and potential improvements in device technology. The global nature of the registry promises a diverse pool of data that can inform best practices in various healthcare settings.

The implications of the revived IMACS registry extend well beyond mere data collection; it represents a shift towards a more integrated and collaborative approach to cardiac care. Not only does it aim to collect patient outcomes, but it also envisions generating statistical summaries that participating healthcare institutions can use for benchmarking purposes. This comparative analysis will empower institutions to evaluate their practices against established data, fostering an environment of continuous improvement in patient care.

Dr. Daniel Goldstein, a distinguished figure in the field and the Chair of the IMACS Registry, emphasizes the groundbreaking potential of MCS devices. He notes the pressing reality that organ transplantation remains fraught with challenges, particularly given the limited availability of donor organs. The scalability of MCS technology may provide a solution by catering to a broader range of patients suffering from heart failure, thereby prolonging life and enhancing quality of life.

Moreover, the partnership between IMACS and ISHLT promises to fund vital research grants aimed at advancing the field of mechanical circulatory support therapy. By facilitating research into outcomes, operational standards, and best practices, this initiative is likely to spur innovation and refinement in medical technology. The collaboration promises to yield findings that can directly impact clinical practice and patient outcomes.

As the IMACS registry resumes its critical work, its first annual report featuring the newly collected data is expected to be presented at the ISHLT Annual Meeting in April 2025. This event will serve as a platform for unveiling the insights gained from the registry and how they may influence the future landscape of heart failure treatment. The anticipation around this report highlights the community’s eagerness for actionable data that can inform clinical decisions.

The ultimate objective of the IMACS initiative is to foster learning opportunities among countries and healthcare systems, allowing for regional comparisons of outcomes and methodologies. The hope is that by sharing knowledge and data, institutions worldwide can implement strategies that drive improvements and enhance survival rates among heart failure patients. Dr. Goldstein poignantly captures this sentiment by reflecting on the changing landscape of cardiac health, where advancements in intervention techniques are allowing patients to survive heart attacks but often leading to prolonged heart deterioration.

There is a pressing need for alternatives to transplantation, which is not a feasible solution for many patients due to various limiting factors, including medical eligibility and donor availability. Advances in MCS technology present an opportunity to create solutions that could serve a wider patient base while also being economically viable. By focusing on developing MCS devices that are both effective and accessible, the IMACS registry aims to make strides in achieving a critical win-win situation: improving patient survival while also enhancing quality of life.

The implications of this registry’s work are profound—not only for patients with advanced heart failure but also for the broader medical community as it grapples with how to best manage the increasing number of individuals suffering from cardiovascular disease. With a resurgence of commitment to data collection and research collaboration, the IMACS registry stands poised to revolutionize the approach to treating heart failure, potentially transforming care protocols and outcomes for future generations.

As the IMACS registry gears up for its re-launch, the cardiovascular health community looks forward to the insights that will emerge from its comprehensive data collection efforts. The potential of MCS devices to improve the lives of those living with heart failure hinges on the knowledge gleaned from this initiative, making it a critical endeavor for improving heart health on a global scale.

Subject of Research: Durable Mechanical Circulatory Support Devices
Article Title: International Registry for Mechanically Assisted Circulatory Support (IMACS) Re-launches to Enhance Heart Failure Outcomes
News Publication Date: February 5, 2025
Web References: N/A
References: N/A
Image Credits: N/A
Keywords: Mechanical Circulatory Support, Heart Failure, Cardiac Health, Data Registry, MCS Devices, Heart Transplantation, Cardiothoracic Surgery, ISHLT, Advanced Heart Disease, Patient Outcomes, Circulatory Support Technology.

Digoxin’s efficacy and cost-effectiveness were meticulously examined in the context of a recent study published in the prestigious journal “Heart.” Within this groundbreaking research, a clinical trial known as RATE-AF was scrutinized to ascertain the economic viability of digoxin relative to beta-blockers. The trial involved 160 patients, all of whom were randomly assigned either digoxin or beta-blockers over a duration of one year. Detailed evaluations were executed to explore various economic implications inherent in the treatment of these patients, particularly focusing on healthcare costs, quality of life, and hospital utilization.

The findings highlighted a stark contrast in adverse events between patients receiving digoxin and those treated with beta-blockers. The former group exhibited remarkably lower rates of hospital admissions and necessary consultations with general practitioners for heart-related issues. This impressive decline in adverse outcomes resulted in an average cost reduction of approximately £530 per patient annually. When the researchers extrapolated these findings to the larger UK NHS context, the total forecasted savings reached an impressive £102 million, representing a striking 6% reduction in the annual expenditure associated with atrial fibrillation treatments.

Professor Sue Jowett, Deputy Head of the Health Economics Unit at the University of Birmingham and the study’s corresponding author, emphasized the critical role that health economic assessments play in deploying effective treatments within the healthcare system. She noted that, based on the standard threshold of £20,000 per quality-adjusted life year, the likelihood of digoxin being a cost-effective treatment was a compelling 94%. This statistic underlines the profound implications of integrating trial findings into broader clinical practice, particularly for older patients managing chronic heart conditions.

From the perspective of public health, the implications of this research extend beyond mere economics. Professor Dipak Kotecha, who serves as the chief investigator of the RATE-AF trial, pointed out that the prevalence of cardiovascular conditions such as atrial fibrillation and heart failure is expected to escalate dramatically over coming decades. This projected increase presents not only a significant challenge for healthcare systems globally but also serves to underline the importance of cost-effective and safe treatment modalities.

Digoxin, however, often finds itself overshadowed by more contemporary medications. Many healthcare practitioners might be hesitant to consider a drug with a long history given the rapid innovations within pharmaceutical science. However, Kotecha’s assertion about the safe and efficient use of digoxin addresses this skepticism head-on. This rediscovery of digoxin’s validity as a treatment option underscores the importance of continuously re-evaluating established therapies in light of emerging evidence.

At the forefront of this analysis is the RATE-AF trial, which set a precedent for understanding drug comparisons in the context of heart rhythm disorders and their management. This randomized clinical trial not only addresses the clinical outcomes of medications administered to older patients but also looks critically at the economic factors that underlie frequent patient interactions in clinical settings. The careful consideration of both health outcomes and associated costs represents a significant advancement in the methods by which healthcare reform can be approached.

The results of this study advocate for a shift in treatment paradigms, encouraging more healthcare providers to consider the reintroduction of digoxin, particularly for populations where affordability is paramount. As the NHS continually seeks solutions to overcome the challenges posed by rising healthcare costs, comprehensive analyses like this remind decision-makers that sometimes, the most effective solutions lie in looking back to established medications that have stood the test of time.

In addition to its findings regarding healthcare costs, the study raises important ethical considerations surrounding patient care, particularly in economically strained healthcare systems. It underscores the necessity of balancing effective medical treatment with financial feasibility, ensuring that accessible healthcare options can be made available to those who need them most.

Furthermore, the implications of this study extend into the realm of drug research and development. As pharmaceutical companies navigate the complexities of building new medications, there is a compelling case for them to look into the repurposing of existing drugs. Digoxin serves as a prime example of how historical medicines can play a vital role in modern health challenges, tapping into a wealth of existing data and patient experience that can accelerate treatment development without the extensive costs associated with the conception of entirely new drugs.

As this discourse unfolds within the scientific community, it remains essential for researchers, practitioners, and policy-makers to maintain open lines of communication surrounding the evolving narrative of cardiovascular treatments. The interplay between economic viability and patient-centered care will ultimately shape future treatment modalities and our understanding of effective health interventions.

In conclusion, the promising data surrounding digoxin emphasizes not only the potential for substantial savings within the NHS but also reflects a broader trend towards a more economically conscious approach to healthcare. The substantial probability of digoxin being cost-effective compared to beta-blockers is a compelling argument for its reconsideration in treating older patients with atrial fibrillation and heart failure. By focusing on both clinical efficacy and systemic cost savings, healthcare providers can strive to achieve optimal outcomes for patients while ensuring sustainability within their medical practices.

Subject of Research: Cost-effectiveness of digoxin versus beta-blockers in treating atrial fibrillation and heart failure
Article Title: Cost-effectiveness of digoxin versus beta blockers in permanent atrial fibrillation: the Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) randomised trial
News Publication Date: (Not specified in the provided text)
Web References: Heart Journal
References: (Not specified in the provided text)
Image Credits: (Not specified in the provided text)
Keywords: Atrial fibrillation, heart failure, digoxin, beta-blockers, cost-effectiveness, NHS, cardiovascular medicine, economic analysis, RATE-AF trial.