This review synthesizes the key scientific discussions and clinical insights presented at the Core Conference of GlomCon Hawaii 2025, held in Oahu, Hawaii, from September 23–25, 2025.
Congestion represents the principal clinical manifestation and hemodynamic hallmark of heart failure (HF), reflecting elevated cardiac filling pressures. It remains the leading cause of HF hospitalization and is consistently associated with adverse outcomes across all stages of the disease. Despite its major prognostic implications, the assessment of congestion remains suboptimal in both acute and chronic settings, with up to one-third of patients discharged while still fluid overloaded. This review, developed following the Critical Care Clinical Trialists (3CT) Workshop 2025, summarizes current and well-established approaches for evaluating congestion, and introduces new and emerging tools that may simplify its recognition and management while allowing for a more accurate and timely assessment. We further discuss how integrating clinical, imaging, hemodynamic, and patient-centered strategies may enable optimal congestion management and support a paradigm shift from reactive decongestion to proactive, individualized care.
Importance:Statin nonadherence is a leading, addressable driver of preventable cardiovascular events. Although health systems routinely use outreach to promote preventive care, most strategies are static and lack evidence from randomized clinical trials. Objective:To determine whether an adaptive, sequential digital outreach strategy improves short-term statin refill vs usual communication among adults with established atherosclerotic cardiovascular disease (ASCVD) or high ASCVD risk and recent nonadherence within a rapidly implemented, health system-embedded randomized clinical trial. Design, Setting, and Participants:Pragmatic, health system-embedded, prospective randomized open blinded end point (PROBE) clinical trial using a 2-stage sequential, multiple assignment, randomized trial (SMART) design. The trial was conducted via Kaiser Permanente Northern California, an integrated health care delivery system serving more than 4.6 million members. Eligible participants were adults 18 years or older with established ASCVD or high ASCVD risk, recent statin nonadherence, and eligibility for all study communication modalities. Interventions:Participants were randomized 1:1:1:1 to receive secure portal messaging, SMS/text messaging, nonsecure email, or usual communication. Initial nonresponders within 14 days underwent prespecified second-stage randomization to repeat the same outreach, switch communication modality, or receive usual communication. Main Outcomes and Measures:Rates of 14-day statin refill following each randomization, with 28-day follow-up. Results:Among 20 604 participants (mean [SD] age, 54.8 [9.0] years; 40.9% female; 27.8% Asian, 10.9% Black, 33.6% Hispanic; 15.3% with established ASCVD), initial digital outreach increased 14-day statin refill vs usual communication (14.4% vs 12.0%; adjusted risk difference, 2.3 percentage points [95% CI, 1.3-3.4]; adjusted risk ratio, 1.20 [95% CI, 1.10-1.30]). Among initial nonresponders, second-stage outreach further increased refill (13.0% vs 10.4%; adjusted risk difference, 2.5 percentage points [95% CI, 1.3-3.7]; adjusted risk ratio, 1.25 [95% CI, 1.11-1.39]). Switching communication modalities did not improve refill vs repeating the same modality (13.2% vs 12.5%; adjusted risk ratio, 1.06 [95% CI, 0.94-1.17]). Cumulative statin refill through 28 days was higher in those receiving any digital outreach vs usual communication (24.9% vs 21.2%; adjusted hazard ratio, 1.21 [95% CI, 1.13-1.30]). Results were consistent across prespecified subgroups. Conclusions and Relevance:Among adults with a statin indication and recent statin nonadherence, adaptive outreach improved short-term refill vs usual communication. A second outreach produced additional gains among initial nonresponders, although switching communication modalities provided no additional benefit. These findings support adaptive, sequential health system outreach strategies to improve cardiovascular prevention when integrated into population health programs. Trial Registration:ClinicalTrials.gov Identifier: NCT07522645.
This review synthesizes the key scientific discussions and expert insights on advancing clinical trials in glomerular diseases presented during the Satellite Symposium of GlomCon Hawaii 2025, held on September 22, 2025, in Oahu, preceding the Core Conference (September 23–25, 2025).
