Harindra C. Wijeysundera

Background: Timely access to cardiovascular procedures and specialist care is clinically important, yet methods used to establish wait-time benchmarks are not well characterized. This systematic review aims to identify, characterize, and critically appraise methods used to derive wait-time benchmarks for cardiovascular procedures and specialist cardiovascular care. It will assess whether benchmarks are supported by empirical outcome data, developed through transparent consensus processes, and informed by patient-specific risk stratification. It will also examine associations between waiting duration and outcomes and whether methods from other specialties are transferable to cardiovascular care. Methods: This systematic review will include adults awaiting cardiovascular procedures or specialist care and studies from other specialties describing transferable benchmark-development methods. Eligible sources will include guidelines, consensus statements, policy documents, health technology assessments, empirical studies, systematic reviews, and reports describing benchmark derivation, justification, or validation. MEDLINE, PubMed, Embase, Scopus, Web of Science, the Cochrane Library, Google Scholar, guideline repositories, health technology assessment databases, government and professional society websites, and grey literature will be searched from inception to the final search date, without language restrictions. Two reviewers will independently screen records, extract data, and assess quality, with disagreements resolved by consensus or a third reviewer. Primary outcomes will include derivation method, evidentiary basis, consensusprocess characteristics, benchmark structure, and associations between waiting duration and outcomes. Secondary outcomes will include methodological quality, clinical validation, implementation, practice concordance, stakeholder involvement, benchmark updating, and geographic and temporal variation. Findings will be synthesized narratively using descriptive statistics, summary tables, and evidence maps. Meta-analysis may be undertaken if at least three sufficiently homogeneous studies are available. Discussion: This review will clarify how cardiovascular wait-time benchmarks have been developed and validated, identify methodological gaps, and assess the transferability of approaches from other specialties. The findings may inform more transparent, evidence-based, risk-sensitive, and clinically meaningful wait-time benchmarks. Ethics approval and patient consent are not required because the review will use publicly available literature and documents. Findings will be disseminated through peer-reviewed publication, conference presentations, and engagement with cardiovascular and health-policy stakeholders.

Background: In August 2025, the American Heart Association and American College of Cardiology released updated hypertension guidelines. Under the new guidelines, therapy is advised at blood pressure ≥130/80 mm Hg in adults with diabetes, chronic kidney disease, or a Predicting Risk of Cardiovascular Disease Events‐estimated 10‐year cardiovascular disease risk ≥7.5%. The long‐term population‐level changes following these guidelines remains uncertain. Methods: We analyzed NHANES (National Health and Nutrition Examination Survey) 2009 to 2018 data linked to mortality through 2019. Hypertensive adults without baseline cardiovascular disease were included. Treatment eligibility was defined using guideline criteria. Cox models estimated associations between antihypertensive therapy and all‐cause and cardiovascular mortality. Simulation analyses projected lives saved under full and partial treatment uptake. Results: The weighted cohort represented 81.0 million US adults with hypertension. Of these, 22.8 million (28%) were guideline eligible for therapy; 13.1 million (57%) were treated, and 9.7 million (43%) remained untreated. Antihypertensive therapy was associated with a 23% reduction in all‐cause mortality (hazard ratio [HR], 0.77 [95% CI, 0.63–0.94]) and 50% reduction in cardiovascular mortality (HR, 0.50 [95% CI, 0.36–0.68]). At 10 years, universal treatment of eligible but untreated adults was projected to prevent ~200 900 all‐cause and ~ 162 600 cardiovascular deaths. Benefits were greatest in adults with diabetes. Conclusions: In this nationally representative cohort, nearly 1 in 3 US adults with hypertension were newly eligible for therapy under the guideline, yet >2 in 5 remained untreated. Extending treatment to all eligible adults could prevent >200 000 all‐cause and 160 000 cardiovascular deaths over the next decade.

Background: Early discharge (ED) within 48 h after transcatheter aortic valve implantation (TAVI) seems feasible and safe. The POLESTAR study demonstrated good 30-day outcomes of ED after TAVI using the ACURATE valve but also identified patients requiring prolonged hospitalization. Long-term outcomes after ED or prolonged hospitalization remain unknown. Aims: To determine the long-term impact of successful ED and prolonged hospitalization. Methods: POLESTAR was a prospective, multicentre, observational trial enrolling patients deemed eligible for ED prior to transfemoral TAVI with ACURATE Neo/Neo2. One-year outcomes were determined and compared between those who achieved ED and those who did not. The primary endpoint was a landmark analysis of major adverse cardiovascular events (MACE), including all-cause mortality, stroke, myocardial infarction, and cardiac rehospitalization, occurring between 30 days and oneyear post-procedure. Results: Among 252 patients from 15 sites in four countries, ED was achieved in 173 (69%) patients, while 79 (31%) required prolonged hospital stay (non-ED). One-year survival was 97%. Landmark 30-day analysis showed MACE occurring in 4.7% of ED patients vs 11.7% of non-ED patients at 1 year (HR 0.38[0.15–0.98] P = .045). Rehospitalization was numerically lower in the ED group (HR 0.56[0.27–1.19]; P = .13). Kansas City Cardiomyopathy Questionnaire (KCCQ) scores improved significantly in the full cohort (18.5 improvement; 95%CI: 15.9–21.0, P < .01), with no statistically significant difference between ED and non-ED cohorts (P for interaction = .30). Conclusions: An ED strategy after TAVI with ACURATE Neo was safe in selected patients without compromising longer-term outcomes or health-related quality of life. Patients who did not achieve ED experienced more MACE after 30 days (NCT03910751).

Background and Aims: Real-world evidence comparing percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in women with chronic severe coronary artery disease (CAD) is limited. This study aimed to compare long-term outcomes of PCI and CABG in women with chronic severe CAD. Methods: This propensity score-matched retrospective cohort study linked clinical and administrative databases in Ontario, Canada to identify women with chronic severe CAD undergoing PCI or CABG from 2012 to 2021. Major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause mortality, myocardial infarction (MI), stroke, or repeat revascularization, as well as the individual components of MACCE and cardiovascular readmission (MI, heart failure [HF], or stroke), were evaluated using the Cox proportional hazards model. Results: A total of 2469 and 3721 women underwent PCI and CABG, respectively. After propensity score matching, 2033 well-balanced pairs were identified. The mean (±SD) age of patients was 66.5 (±8.6) years. At a median follow-up of 5.1 (inter-quartile range: 2.9–7.5) years, MACCE was higher with PCI compared with CABG (hazard ratio [HR] 1.81, 95% confidence interval [CI]: 1.63–2.01], P < .001). All-cause mortality was higher with PCI compared with CABG (HR 1.34 [95% CI: 1.16–1.54], P < .001). Cardiovascular readmission (MI, HF, or stroke) was higher with PCI compared with CABG (HR 1.40 [95% CI: 1.32–1.49], P < .001). Conclusions: In women with chronic severe CAD, CABG appears to be associated with a long-term reduction in MACCE and all-cause mortality compared with PCI. These findings support consideration of CABG as the preferred revascularization strategy in appropriately selected women.