Lucas S. Zier

What We Wanted to Find Out: We wanted to learn what patients at a city hospital for people with lower incomes think about artificial intelligence (AI) in their healthcare. We looked at what they knew about AI, if they trusted it, and what good or bad things they thought it might bring. How We Did It: We asked 313 patients between November 2024 and January 2025 to fill out a survey. We asked them about their knowledge of AI, if they would trust AI to help doctors make decisions, and if they wanted things to be clear and supervised. We used numbers to see if knowing more about AI made them think it was more helpful. We also read their written comments to understand what built their trust. What We Found: Most patients (84%) knew about AI from everyday things like phones or smart speakers. But less than half knew about AI being used in healthcare to help doctors. Patients who knew more about AI also thought it was more helpful. Most patients said they needed AI to be clear (92%), doctors to check it (82%), and for it to be proven safe and effective to trust it. What This Means: This study is among the first to examine how patients at a safety-net hospital feel about AI in healthcare. Patients generally like the idea of AI helping doctors, but they really want it to be clear how AI is used and for doctors to still be in charge. Our Main Point: To make sure AI in healthcare is fair and trustworthy for everyone, it’s very important to teach patients about it and involve them in how it’s used.

Objectives: To implement a technology-based, systemwide readmission reduction initiative in a safety-net health system and evaluate clinical, care equity, and financial outcomes. Study Design: Retrospective interrupted time series analysis between October 2015 and January 2023. Methods: The readmission reduction initiative standardized inpatient care for patients through a novel, electronic health record–integrated, digitally automated point-of-care decision-support tool. A predictive artificial intelligence algorithm was utilized to identify patients at the highest risk of readmission in both the inpatient and outpatient settings, allowing a population health team to perform proactive outpatient management in medical and social domains to avoid readmission. Results: Readmission rates declined from 27.9% in the preimplementation period to 23.9% in the postimplementation period (,P, < .004) by the end of 2023. A significant gap in readmission rates between Black/African American patients and the general population was eliminated over the course of the evaluation period. Survival analysis demonstrated a reduction in all-cause mortality in the postimplementation period (HR, 0.82; 95% CI, 0.68-0.99; ,P, = .037). Improvement in readmission rates allowed the health system to retain $7.2 million of at-risk pay-for-performance funding. Conclusions: This technology-based readmission reduction initiative demonstrated efficacy in reducing readmission rates, closing equity gaps, improving survival, and leading to a positive financial impact in a safety-net health system. This approach could be an effective model of technology-based, value-based care for other resource-limited health systems to meet pay-for-performance metrics and retain at-risk funding while improving clinical and equity outcomes.

BACKGROUND: Ischemic cardiomyopathy is the leading cause of heart failure (HF). Most patients do not undergo coronary assessment after HF diagnosis. There are no randomized clinical trials of coronary assessment after HF diagnosis. METHODS: Using an electronic health record cohort of all individuals with HF within the San Francisco Health Network from 2001 to 2019, we identified factors associated with coronary assessment. Then, we studied the association of coronary assessment within 30 days of HF diagnosis with all-cause mortality and a composite of mortality and emergent angiography using a target trial emulation observational comparative-effectiveness approach. Target trial emulation is an approach to causal inference based on creating a hypothetical randomized clinical trial protocol and using observational data to emulate the protocol. We used propensity scores for covariate adjustment. We used national death records to improve the ascertainment of mortality and included falsification end points for the cause of death. RESULTS: Among 14 829 individuals with HF (median, 62 years old; 5855 [40%] women), 3987 (26.9%) ever completed coronary assessment, with 2467/13 301 (18.5%) with unknown coronary artery disease status at HF diagnosis assessed. Women, older individuals, and people without stable housing were less likely to complete coronary assessment. Among 5972 eligible persons of whom 627 underwent early elective coronary assessment, coronary assessment was associated with lower mortality (hazard ratio, 0.84 [95% CI, 0.72–0.97]; P =0.025), reduced risk of the composite outcome (hazard ratio, 0.86 [95% CI, 0.73–1.00]), higher rates of revascularization (odds ratio, 7.6 [95% CI, 5.4–10.6]), and higher use of medical therapy (odds ratio, 2.5 [95% CI, 1.7–3.6]), but not the falsification end points. CONCLUSIONS: In a safety-net population, disparities in coronary assessment after HF diagnosis are not fully explained by coronary artery disease risk factors. Early coronary assessment is associated with improved HF outcomes possibly related to higher rates of revascularization and guideline-directed medical therapy but with low certainty that this finding is not attributable to unmeasured confounding.

Spontaneous Coronary Artery Dissection (SCAD) is an important cause of myocardial infarction that typically affects women without traditional cardiovascular risk factors. It is the most common cause of myocardial infarction in pregnant and postpartum women. SCAD is often underdiagnosed due to the lack of clinician familiarity, and patients with pregnancy-associated SCAD often have more severe clinical presentations than those without. We present a case of SCAD in a multiparous woman who presented with acute chest pain in the postpartum period.

Pulmonary hypertension (PH) is a known consequence of sickle cell disease (SCD) and is associated with increased mortality and more frequent episodes of acute chest syndrome (ACS). Pulmonary pressures are known to increase during ACS, and right ventricular (RV) failure has been described as a significant cause of mortality in this condition. Management of ACS includes exchange transfusion, pain control, and prevention of hypovolemia and hypoxemia. However, in patients with a history of precapillary PH in whom ACS is complicated by persistent RV failure and cardiogenic shock, RV afterload reduction with pulmonary vasodilators may be an effective treatment strategy. Here, we present a case of a young man with SCD-associated PH and ACS who was successfully managed with inhaled and oral pulmonary vasodilators in the setting of persistent elevations in pulmonary vascular resistance leading to acute RV failure and cardiogenic shock.