Cardiology

Pediatric ACC unit reconfigured to cardiology leadership reduced complications and ICU back‑transfers

Single‑center prospective QI in a 26‑bed pediatric ACC unit compared 483 baseline and 973 intervention encounters. Transitioning unit leadership to cardiology with NPs, resident integration, multidisciplinary rounds, and in‑house fellows lowered mean complications from 23.6% to 16.0%. Back transfers to ICU fell (11.4% to 6.9%) and discharge time modestly improved, while overall LOS and 7‑day readmissions were unchanged. Patient and family experience scores improved and mean LOS for medical patients declined, but findings are from one high‑volume center and need replication. 1

Higher heart rate and β‑blocker interruption predict worse outcomes after uncomplicated MI

Secondary analysis of 3,698 stable post‑MI patients (LVEF ≥40%) stratified by prerandomization HR tertiles (<60, 60–<68, ≥68 bpm). Higher HR tertiles had greater rates of death, MI, or stroke (T3 versus T1 adjusted HR 1.55), and all‑cause mortality rose across tertiles. Randomized interruption of β‑blockers increased on‑treatment HR by about 10–13 bpm and was consistently associated with worse outcomes across HR and EF categories. The data support continuation of β‑blockers in stabilized post‑MI patients, recognizing this is a secondary analysis of a randomized strategy trial. 2

Pivotal device trials rarely integrate equity, diversity, and inclusion in design or analysis

Scoping review of 74 pivotal device studies found age and sex almost always reported, but race/ethnicity appeared in only 35.1% of reports. Only 18.9% performed age‑based subgroup analyses and 14.8% sex‑based analyses; PROGRESS‑Plus variables were reported in 9.5%. Explicit EDI framing was absent in most trials and no study used CONSORT‑Equity or population benchmarking, limiting external validity for diverse populations. Regulatory and clinical interpretation of device evidence should account for these representativeness gaps before broad application. 3