In this mini focus issue of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz explores the evolving landscape of cardiac amyloidosis care. From structural and biomarker findings in the HELIOS-B substudy to broader discussions on access, treatment sequencing, and multidisciplinary care, this episode highlights new momentum in ATTR-CM management. Also covered: a sham-controlled trial on compression therapy for vasovagal syncope and pooled trial data on DOAC use in frail older adults with atrial fibrillation. Fast-moving insights, practical takeaways, and a clear message—amyloidosis is no longer rare and mysterious, but a condition we can monitor, modify, and manage.

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, and Nobuhiro Ikemura, MD, welcome Yuichi Saito, MD, of Chiba University Hospital, to discuss recent trends in out-of-hospital cardiac arrest (OHCA) among Japan’s oldest populations. Using data from the All-Japan Utstein Registry, Dr. Saito and the Japanese Circulation Society Resuscitation Science Study (JCS-ReSS) Group highlight that OHCA cases in nonagenarians are steadily increasing. Despite prehospital resuscitation efforts, outcomes—particularly neurologically favorable survival—remain poor in this age group. The study underscores the urgent need for a national conversation on resuscitation strategies in a super-aging society.

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD, welcome Dr. Kunihiro Matsushita of Johns Hopkins University to discuss findings from the ARIC study on cumulative cardiovascular risk and healthy arterial aging. Dr. Matsushita highlights that maintaining favorable levels of cholesterol, blood pressure, and avoiding smoking from mid- to late-life is strongly associated with the absence of coronary artery calcium (CAC) at older age—a marker of healthy arterial aging. The study emphasizes the long-term impact of sustained risk factor control and its implications for preventive cardiology and public health.

In this JACC Deep Dive, Editor-in-Chief Harlan M. Krumholz, MD, SM, discusses a large real-world study by Min et al. examining heart failure with improved ejection fraction (HFimpEF) in over 24,000 patients. The study found that while EF improvement is common (30%), true remission is rare and relapse occurs in about 25% of cases—highlighting the need for continued guideline-directed medical therapy (GDMT) even after apparent recovery. Listen to the podcast, find out what reviewers and editors liked about the paper, and get more insight into our dedicated focus issue on heart failure.

In this focus issue on Heart Failure in Practice, JACC Editor-in-Chief Dr. Harlan Krumholz examines how contemporary research continues to refine and at times challenge our understanding of heart failure management. This week’s episode features a first-of-its-kind trial on dual therapy with SGLT2 inhibitors and MRAs, new real-world data on heart failure with improved EF, and sobering insights into what happens when foundational therapies are withdrawn. Also explored: sex-specific risks in genetic cardiomyopathies, the limitations of standard stroke prediction tools, and the case for modernizing ICD eligibility criteria. As always, the episode concludes with a synthesized summary of key takeaways for clinicians.

Cardiac electrophysiology is rapidly evolving, blending procedural expertise with innovations in pharmacotherapy, device design, and lifestyle medicine. This week's Editor's Page spotlights key studies from JACC that challenge long-standing practices—from lifestyle strategies for atrial fibrillation to the role of defibrillation testing and device comparisons. We also explore disparities in cardiac arrest outcomes and complex real-world cases that push clinical boundaries. Tune in for a dynamic look at the future of arrhythmia care.

Interventional cardiology is rapidly evolving, with advances in imaging, devices, and techniques driving both innovation and rising expectations for safety and patient-centered outcomes. This week's editor's page highlights cutting-edge research and expert commentary on topics such as plaque vulnerability, stent performance, imaging-guided interventions, and long-term outcomes, reflecting both progress and ongoing challenges in the field. By bringing together this wealth of new science, the issue aims to inform clinical practice, encourage thoughtful decision-making, and inspire continued innovation in cardiovascular care.

In this JACC Deep Dive, Harlan M. Krumholz, MD, SM, FACC, discusses a new study in the July 8 issue of JACC, authored by Saket Girotra MD, SM, et al. In the study, which links national registry and Medicare data, the authors found striking hospital-level variation in cardiac arrest rates and outcomes—and identified better nurse staffing as a key factor in both preventing arrests and improving survival. Behind the scenes, the manuscript underwent multiple rounds of revision, with close collaboration between editors and authors to strengthen the analysis, add new visualizations, and clarify key takeaways. The study underscores the need to invest in systems and staffing that detect clinical deterioration before it becomes irreversible.

In this JACC Deep Dive, Harlan M. Krumholz, MD, SM, FACC reviews a study by Covani, et al that uses OCT imaging in over 1,500 ACS patients to show how increasing cardiovascular risk factor burden—like smoking, diabetes, and hypertension—is strongly associated with vulnerable plaque features such as thin caps, inflammation, and rupture. The findings were most pronounced in STEMI patients and reinforce the biological impact of cumulative risk. Reviewers found the core results intuitive but pushed for deeper mechanistic insights, leading to a stronger final paper with improved clarity, additional analyses, and a more nuanced understanding of how traditional risk factors shape plaque instability.

Validation of AHA PREVENT in healthcare populations| JACC Deep Dive In this JACC Deep Dive, JACC Editor in Chief Harlan M. Krumholz, MD, SM, explores a study led by Dr. Pradeep Natarajan that evaluates how well the new AHA PREVENT risk equations predict cardiovascular events across four major U.S. health systems. The study found wide variation in performance—PREVENT was well-calibrated at Penn Medicine but significantly underestimated risk at Mass General Brigham and Vanderbilt, particularly among women and minority groups. Reviewers praised the importance and rigor of the work but raised key questions about model calibration, fairness in outcome comparisons, and whether truly "plug-and-play" risk tools are realistic across diverse healthcare environments.