Given the obesity epidemic, access to obesity specialists such as endocrinologists and obesity medicine physicians is paramount to avoid long-term complications, but geographic distribution of obesity specialists in United States (US) counties with respect to obesity prevalence is unclear. A cross-sectional analysis was conducted on 3230 US counties categorized by metropolitan status using data from the US Census, CDC Atlas, and NPI registry. 240 counties were excluded due to incomplete data, yielding 2990 counties. Predictors of obesity specialists per 100 K adults with obesity was determined using regression analysis. By county, the median demographic composition was: 50.0% men, 82.3% White, and 41.6 years old. The average percentage of adults with obesity was 37.5% (SD 4.5%) and the average number of obesity specialists per 100k adults with obesity was 5.3 (SD 13.7). However, substantial variation exists by metropolitan status on the ratio of obesity specialists/100 K adults with obesity, that ranged from 29.3 (SD 27.6) in large central metro, 9.1 (SD 17.6) in fringe metro, 10.1 (SD 18.3) in medium/small metro to 2.0 (SD 7.2) in non-metro counties, P < 0.001 for trend. Approximately 70% of US counties lacked obesity specialists. Regression modeling adjusted for demographics, socioeconomic status, and total physicians per county showed nonmetropolitan status as a negative independent predictor of obesity specialist presence. With a majority of US counties lacking access to obesity specialists and nonmetropolitan status negatively predicting access, we highlight the need for more obesity specialists in those communities or the general upskilling of primary physicians to treat obesity.

Despite advances in drug and device technology, health care delivery, and research infrastructure, cardiogenic shock (CS) continues to have nearly 50% in‐hospital mortality. In patients with CS, both the initial severity of Society for Cardiovascular Angiography and Intervention CS and its subsequent trajectory predicts the clinical outcomes. Accordingly, delayed initial recognition and failure to escalate or deescalate treatment can significantly affect the outcomes of CS. Traditional assessment methods, with the exception of blood pressure measurement, require a high index of suspicion and frequent reassessment by the clinical team. Electronic medical record‐based detection has been successfully implemented in acute and critical care patients with septic shock and acute kidney injury. In CS, electronic medical record‐based studies have largely focused on using models to predict outcomes in patients with CS, with limited data on electronic medical record‐based tools to assist with either predicting CS or providing real time alerts when escalation or de‐escalation might be indicated. Early detection of CS may be associated with detection of earlier Society for Cardiovascular Angiography and Intervention stages of CS and potentially prevent deterioration to higher stages. In this review, we seek to highlight a blueprint for electronic medical record‐based detection of CS that focuses on reproducibility, convenience, clinical decision support, and research aspects.

BACKGROUND:Coronary artery bypass grafting (CABG) ineligibility is associated with increased mortality in patients undergoing PCI. Limited data exist about CABG-eligible patients who decline surgery and opt for PCI. METHODS:National Cardiovascular Data Repository CathPCI data from 2018 to 2024 at two high-volume PCI centers was used to identify patients that had surgical consultation prior to PCI. Baseline characteristics and in-hospital outcomes were compared between patients who were turned down for surgery (CABG-ineligible) and those who were offered surgery but declined (CABG-eligible). RESULTS:The cohort included 388 patients (313 CABG-ineligible and 75 CABG-eligible). CABG-ineligible patients were younger (70.4 vs 73.4 years; p = 0.01) and had higher rates of chronic lung disease, diabetes, and frailty, but with no difference in lesion complexity between the groups. PCI in the CABG-ineligible group was more likely urgent, emergent, or salvage, including STEMI and NSTEMI. Overall, PCI technical success was high, 92.9%, and in-hospital mortality was 4.8% in CABG-ineligible versus 2.7% in the CABG-eligible group (p = 0.54). There was no difference in bleeding, myocardial infarction, cardiogenic shock, cardiac arrest, or new-onset dialysis. CONCLUSIONS:Among patients who underwent PCI after referral for CABG, technical success was high and in-hospital mortality was acceptable in patients who were deemed eligible or ineligible for CABG. Further study is warranted to examine long-term outcomes of PCI in CABG-ineligible patients versus those who decline CABG.

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality worldwide. This review explores the evolving evidence base surrounding ASCVD prevention, particularly regarding nontraditional biomarkers, risk scores, and cardiovascular imaging modalities. Additionally, this review examines cardiovascular risk scores, including the PREVENT and MESA-CHD scores, which incorporate both traditional and nontraditional factors, thereby aspiring to offer a more equitable and precise risk assessment. Advances in cardiovascular imaging techniques, such as coronary artery calcium scoring and cardiac magnetic resonance imaging, are also discussed for their utility and potential. By integrating these advanced markers and imaging modalities, primary care clinicians can better identify and manage patients at risk, ultimately improving outcomes and reducing the burden of cardiovascular disease.

Introduction: Given the obesity epidemic, access to obesity specialists such as endocrinologists and obesity medicine physicians is paramount for adequate treatment to avoid long-term complications. However, geographic distribution of obesity specialists in United States (US) counties and its relationship with obesity prevalence is unclear. Methods: A cross-sectional analysis was conducted on 3230 US counties categorized by metropolitan status (large central metropolitan, fringe central metropolitan, medium and small metropolitan, and nonmetropolitan). We merged data from the US Census, CDC Atlas, the NPI registry, American Community Survey, US Bureau of Labor Statistics, and the National Center of Health Statistics to form the dataset. 232 counties were excluded from our analysis due to incomplete data on the CDC Atlas (150 from continental US, 82 from US territories including Guam, the US Virgin Islands, and Puerto Rico) to form a final study sample of 2998 counties. Predictors of obesity specialists per 100K adults with obesity by county was determined using regression analysis. Results: The median demographic composition of the 2,998 US counties is: 50.0% men, 82.3% White, with a median age of 41.6 years. The average percentage of adults with obesity per county was 28.3% (SD 6.5%) and the average number of obesity specialists per county was 5.0 (SD 14.8) per 100K adults with obesity per county. However, substantial variation exists by metropolitan status on the ratio of obesity specialists/100K adults with obesity per county, that ranged from 25.1 (SD 26.1) in large central metro, 8.4 (SD 20.1) in fringe metro, 9.5 (SD 20.8) in medium/small metro to 2.0 (SD 7.9) in non-metro counties, P<0.001 for trend. A total of 70.2% of US counties did not have obesity specialists (Figure 1). Regression modeling adjusted for demographics, socioeconomic status, and total number of physicians per county showed the independent predictors of obesity specialists in US counties to be education, household income, male sex, and nonmetropolitan status. Conclusions: Significant heterogeneity exists on access to obesity specialists across US counties, especially in nonmetropolitan counties, suggesting the need for more obesity specialists in our communities with inadequate access or the general upskilling of physicians who treat obesity.

We prove existence and uniqueness of a global in time self-similar solution growing up as t→∞ for the following reaction-diffusion equation with a singular potential posed in dimension N≥2, with m>1, σ∈(−2,0) and 1 1 and p>1, showing an interesting effect induced by the singular potential |x|σ. This result is also applied to reaction-diffusion equations with general potentials V(x) to prevent finite time blow-up via comparison.

Clinicians increasingly recognize that long-term effects of social determinants of health (SDOH) play vital roles in the development and progression of various chronic health conditions. This especially holds true in the world of cardiology, where the progression of conditions such as atherosclerotic cardiovascular disease (ASCVD) takes decades to manifest [1]. While the ability to prevent and treat atherosclerotic disease has blossomed over the last thirty years, these advances have not always been shared across all segments of the American population [2,3].

The Indian Health Service (IHS) is but the latest effort to honor the constitutional and treaty commitment made to deliver health care to American Indians and Alaska Natives in the United States. The agency currently serves over 2.5 million American Indians and Alaska Natives through IHS-operated health facilities, as well provides funding support for contractual delivery of health services by Tribes to their constituents. Not unlike its predecessors, however, the IHS is struggling to fulfill its stated mission. Access to specialty care remains limited through the agency, particularly for Urban Indians, due to limited fiscal support of the Purchase-Referred Care Program. As a result of chronic underfunding stemming from Congressional inaction, the agency faces perennial understaffing and leadership turnover. In addition, the IHS is structurally unprepared to address the progressive urbanization of Alaska Natives and American Indians, more of whom now live in New York City than in North Dakota. Given these challenges, a renewed approach is warranted. In this essay, we review the history of the IHS, examine its current fiscal challenges, outline the ongoing demographic shift of AI/AN toward urban centers, and call for the creation of a Federal Indian Health Insurance Plan. Offered as a benefit to all American Indians and Alaska Natives without cost-sharing, the plan would be applicable both on and off tribal lands. Funded through mandatory appropriations, the plan would significantly increase fiscal support for AI/AN health programs and work to reduce health disparities affecting AI/ANs in the United States.

Rachel Gold, PhD, MPH; Annie E. Larson, PhD; JoAnn M. Sperl-Hillen, MD; David Boston, MD; Christina R. Sheppler, PhD; John Heintzman, MD; Carmit McMullen, PhD; Mary Middendorf, BS; Deepika Appana, BS; Vijayakumar Thirumalai, BTech; Ann Romer, MS; Julianne Bava, MSN; James V. Davis, BA; Nadia Yosuf, MPH; Jenny Hauschildt, MPH; Kristin Scott, MPH; Susan Moore, BS; Patrick J. O'Connor, MD, MA, MPH