The American College of Cardiology (ACC), based in Washington, D.C., is a nonprofit medical association established in 1949. It bestows credentials upon cardiovascular specialists who meet its qualifications. Education is a core component of the college, which is also active in the formulation of health policy and the support of cardiovascular research.C.
AIM:The "2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults" is a de novo guideline that provides comprehensive recommendations for the evaluation, management, and follow-up of adult patients (≥18 years of age) with acute pulmonary embolism (acute PE). A key feature of this guideline is the introduction of the AHA/ACC Acute Pulmonary Embolism Clinical Categories, which enhance the precision of severity classification, prognosis assessment, and evidence-based therapeutic decision-making. METHODS:A comprehensive literature search was conducted from February 2024 to October 2024 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Select key studies published until April 2025 were added by the guideline writing committee as appropriate. STRUCTURE:The focus of this clinical practice guideline is an evidence-based and patient-centered approach for acute PE evaluation and management of the adult patient. This guideline encompasses the period from the onset of symptoms through clinical follow-up, focusing on risk outcomes assessment, clinical diagnosis of acute PE, appropriate use of adjunctive cardiovascular testing, and management in both the acute and early post-acute phases of PE. It addresses evidence-based diagnostic and management strategies (including pharmacological therapies, advanced interventional therapies, and in-hospital support) for acute PE and associated outcomes.
Occupational radiation exposure has a clear association with long-term health effects and has a particular impact on women, trainees, and supporting staff. There is a reliance on limited, traditional radiation protection and nonergonomic equipment, which carries associated orthopedic injury rates with adverse impacts on both individual career trajectories and health systems, and with significant challenges to widespread implementation of enhanced radiation protection devices. During the 2025 Society for Cardiovascular Angiography & Interventions Scientific Sessions in Washington, DC, a multidisciplinary Think Tank summit was convened and included representatives from multiple stakeholders, including other professional societies, advocacy groups, and industry partners. The focus of discussion was on the dual dangers of both ionizing radiation and the musculoskeletal injuries associated with current-generation protection equipment. This document summarizes the main points of discussion and outlines actionable next steps to advocate for more widespread implementation of enhanced radiation protection technologies and imaging systems in order to achieve ALARA+ (as low and as light as reasonably achievable).
Background Chronic musculoskeletal disorders (MSDs) are a leading cause of disability worldwide, and long-term treatment with nonsteroidal anti-inflammatory drugs, corticosteroids, and opioids is frequently limited by adverse effects. We developed the Unified Musculoskeletal Dysfunction Index (UMDI) and Unified Musculoskeletal Aging Index (UMAI) as multidomain quantitative tools to assess musculoskeletal dysfunction and estimate model-derived musculoskeletal biological age. Methods In this 16-week randomized controlled trial, 180 adults with chronic MSDs were randomized (1:1) to receive either a standardized oral and topical multi-target phytotherapeutic intervention or standard management. The primary outcome was the change in UMDI. Physical domains, including symptom and functional disability, gait, structural asymmetry, mobility restriction, and anthropometric risk, together with biological domains comprising inflammation, muscle–cartilage degeneration, bone turnover, cardiometabolic status, and neurovascular function, were integrated into the Composite Musculoskeletal Dysfunction Index (CMDI) and Composite Biological Musculoskeletal Index (CBMI) using random-effects standardized mean differences (Cohen's d ). Weighted integration of CMDI and CBMI generated the UMDI, from which the UMAI and model-derived musculoskeletal biological age were estimated. Treatment effects were evaluated using mixed-effects models. Results Compared with standard management, the phytotherapeutic intervention significantly improved all primary and secondary outcomes (all P < 0.001), except suprapatellar, infrapatellar, and thigh girth measurements, which did not differ significantly between groups . CMDI and CBMI effect sizes were 0.73 and 0.92, respectively. UMDI decreased from 2.64 to 0.846, UMAI from 0.264 to 0.0846, and model-derived musculoskeletal biological age from 68.55 to 64.10 years, reducing the biological age acceleration gap by 67.9%. Conclusions A standardized oral and topical multi-target phytotherapeutic intervention significantly improved multidomain clinical function and biological biomarkers in adults with chronic MSDs. The newly developed UMDI and UMAI provide integrated quantitative measures of treatment response and estimated musculoskeletal biological age, supporting their use as multidimensional outcome measures in phytotherapy research and musculoskeletal medicine.
BACKGROUND:Subtle gait alterations and inter-limb asymmetry may precede radiographic knee osteoarthritis (OA), but isolated biomechanical variables often lack sensitivity for early detection. We evaluated whether multidomain gait and strength measures improve discrimination of symptomatic individuals without radiographic OA. METHODS:One hundred seventeen symptomatic participants with Kellgren-Lawrence grade 0 knees and 60 age-matched controls underwent assessment of walking speed, step length, knee sagittal-plane range of motion, functional mobility, and knee flexor and extensor strength. Inter-limb asymmetry indices were calculated and aggregated into a Composite Mechanical Dysfunction Index. Circulating inflammatory and tissue-turnover markers were analysed as adjunct physiological measures. Between-group differences were quantified using standardized mean differences and cross-validated receiver operating characteristic analyses. FINDINGS:Compared with controls, symptomatic participants walked more slowly, had shorter step length, reduced knee range of motion, and greater mobility and strength asymmetry (all p < 0.001). Mechanical domains showed small-to-large effects (standardized mean differences up to approximately 1.05), with gait performance demonstrating the largest mechanical difference, whereas biological markers showed larger effects (up to ∼1.7). The composite mechanical index demonstrated excellent discrimination (cross-validated AUC 0.93-0.99). Addition of physiological markers yielded only modest improvement. A simplified four-domain mechanical model retained approximately 82% of full-model performance. INTERPRETATION:Multidomain gait and asymmetry measures identify clinically meaningful functional impairment in individuals with knee symptoms despite normal radiographs. Composite mechanical metrics provide an interpretable and scalable approach for early screening and may support targeted preventive strategies.
Background: Hospitalization is an ideal time to provide tobacco cessation counseling, but little is known about current practices of inpatient tobacco treatment in the United States. Objectives: The objective of the study was to describe the prevailing practices and perceptions regarding inpatient tobacco cessation treatment and counseling among U.S. Cardiologists. Methods: A 27-question survey was developed, pretested, and administered to 498 cardiologists through the American College of Cardiology CardioSurve program. Results: In total, 122 (24%) participants responded, of which 100 were eligible and completed the survey, achieving our expected response rate. The sample was generally representative of U.S. cardiologists. Cardiologists reported routinely screening for cigarette use (92%) but only a minority (20%) reported routinely referring patients for additional tobacco cessation support. Most cardiologists (74%) reported using the nicotine patch on occasion, but few ever used varenicline (31%) or bupropion (28%). A minority (12%) reported working at a hospital with an inpatient smoking cessation team, but many (41%) expressed interest in championing such a program. Administrative, financial, and time constraints were commonly reported barriers to successful deployment of an inpatient smoking cessation program. Conclusions: Although tobacco cessation is critical posthospitalization, most hospitals do not have tobacco cessation teams, and most cardiologists do not assist their patients in quit attempts. Although improving knowledge among cardiologists is important, policy changes to incentivize hospital-wide adoption of such programs is crucial to increase availability.
