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In This Issue of JAMA Cardiology
April 2016


JAMA Cardiol. 2016;1(1):1. doi:10.1001/jamacardio.2015.0002


It is well known that mortality rates from heart disease and stroke are higher in black adults compared with white adults. Fox and coauthors developed risk prediction models based on 5301 black adults enrolled in the longitudinal Jackson Heart Study, with a median follow-up period of 9 years. The authors report that adding variables such as ankle-brachial index, brain natriuretic peptide, and left ventricular systolic function to standard risk factors did not result in substantial reclassification compared with the Framingham Risk Score or the American College of Cardiology/American Heart Association Pooled Cohort risk equations. In an Editorial, Goff and Lloyd-Jones point out that the results reinforce the utility of the Pooled Cohort risk equations and the importance of implementing current guidelines in black adults.


Current selection of patients for transcatheter aortic valve replacement (TAVR) is based on risk models developed in patients undergoing surgical valve replacement. Edwards and coauthors developed a risk prediction model for in-hospital mortality after TAVR based on 13 718 consecutive patients enrolled in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry; the model was then validated in 6868 subsequent patients. Discrimination and calibration indices were more favorable than those of other models used in TAVR populations. In an Invited Commentary, Mauri and O’Gara note that future iterations should be developed to predict postdischarge outcomes, particularly as TAVR is disseminated to lower-risk patients.

Invited Commentary

The indications for anticoagulation for atrial fibrillation are well established in evidence-based guidelines. In a provocative report, Hsu and coauthors show in 429 417 outpatients with atrial fibrillation enrolled in the American College of Cardiology National Cardiovascular Data Registry’s PINNACLE Registry in US cardiology practices that prescriptions for oral anticoagulants did not surpass 50%, even in those with moderate or high CHADS2 and CHA2DS2-VASc scores. Commenting on these striking findings in an Invited Commentary, Piccini and Fonarow point out that beyond documenting these quality gaps, the challenge will be implementing meaningful and effective quality improvement initiatives to deliver therapies to those who will benefit most from them.

Invited Commentary

Author Audio Interview

Current knowledge of the normal adaptation of the heart to long-term intense exercise conditioning comes from previous studies of cardiac remodeling in competitive athletes. Engel and coauthors investigated cardiac structure and function in 526 athletes in the National Basketball Association, whose height and body surface area greatly exceed those of participants in all earlier investigations. These data provide unique insights into the extremes of left ventricular dilation and hypertrophy in highly trained athletes as well as the relation between aortic diameter and body size. In an Invited Commentary, Baggish discusses that such normative data are at the core of many of the sports cardiology debates including the role of preparticipation screening.

Invited Commentary