Publications

2026

Bene-Alhasan, Yakubu, Patience Saaka, Isaac Acquah, Sahithi R Kalluri, Samuel Mensah, Ahmad Alkhatib, Lida Koskina, et al. (2026) 2026. “Socioeconomic Correlates of Incident Heart Failure and Consequent Mortality: The All of Us Program.”. JACC. Heart Failure, 103012. https://doi.org/10.1016/j.jchf.2026.103012.
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BACKGROUND: Although socioeconomic status (SES) is a known determinant of cardiovascular disease, the independent risks of incident heart failure (HF) and consequent mortality portended by individual and neighborhood measures of SES remain less established.

OBJECTIVES: This study sought to evaluate the prospective associations of SES with HF in adults without HF and SES with all-cause mortality in those with HF.

METHODS: The authors identified adults from the National Institutes of Health-run All of Us Research Program (2018-present) who consented to share their electronic health records. Among 280,431 participants free of HF and 10,550 participants with prevalent HF, Cox proportional hazards models assessed associations of income, education, and Area Deprivation Index (ADI) with risks of incident HF and mortality.

RESULTS: Over 41 ± 23 months, 6,783 of 280,431 participants developed HF. Compared with household income ≥$200,000, risk was higher for $100,000 to <$200,000 (HR: 1.29; 95% CI: 1.12-1.48), $50,000 to <$100,000 (HR: 1.82; 95% CI: 1.60-2.09), $25,000 to <$50,000 (HR: 2.24; 95% CI: 1.95-2.57), and <$25,000 (HR: 3.02; 95% CI: 2.63-3.47). Relative to college graduates, risk was higher for those with some college (HR: 1.37; 95% CI: 1.28-1.46), General Educational Development (HR: 1.46; 95% CI: 1.36-1.58), and less than high school (HR: 1.40; 95% CI: 1.26-1.55). Compared with the least deprived tertile of ADI, risk was higher in the middle tertile (HR: 1.21; 95% CI: 1.14-1.29) and the most deprived tertile (HR: 1.18; 95% CI: 1.11-1.26). Non-White participants and residents of the most deprived ADI tertiles experienced less benefit from higher education. Among those with prevalent HF, each $10,000 increase in income was associated with 3% lower all-cause mortality.

CONCLUSIONS: Lower income, education, and high neighborhood deprivation independently associate with incident HF, whereas only income was associated with mortality. Higher education was less protective in non-White participants and individuals residing in deprived neighborhoods. Addressing these disparities is essential to reducing HF burden and consequent mortality.

Zou, Siyu, Sunan Gao, Stephen P Juraschek, Edgar R Miller, Kunihiro Matsushita, and Lawrence J Appel. (2026) 2026. “Effects of Dietary Patterns and Sodium Intake on Blood Pressure Variability: Results from the DASH and DASH-Sodium Trials.”. Journal of Hypertension 44 (5): 763-70. https://doi.org/10.1097/HJH.0000000000004210.
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BACKGROUND: In observational studies, blood pressure (BP) variability has been independently associated with adverse cardiovascular disease outcomes. The Dietary Approaches to Stop Hypertension (DASH) diet and sodium reduction lower BP and cardiovascular risk, but their effects on BP variability (BPV) are uncertain.

METHODS: This study assessed the effects of dietary patterns (DASH vs. Control) and sodium intake (higher vs. lower) on BPV, using both office and 24-h ambulatory BP measurements in the DASH and DASH-Sodium trials. In primary analyses, week-to-week office BPV and 24-h ambulatory BPV were quantified using variation independent of the mean (VIM). Between-group comparisons were performed using t-tests; interactive effects between dietary patterns and sodium intake were assessed using multivariate linear regression models.

RESULTS: In pooled analyses of both trials, there was no difference in week-to-week systolic BPV (difference in systolic VIM: 0.49, 95% CI -0.05-1.03) or 24-h systolic BPV (difference in systolic VIM: 0.37, 95% CI -0.13-0.87) between the DASH and Control diet groups. In the DASH-Sodium trial, VIM at higher and lower sodium levels did not differ (e.g. difference in VIM for week-to-week systolic BP: 0.31, 95% CI -0.10-0.72). No significant combined or interactive effects of diet and sodium level on BPV were observed.

CONCLUSION: While the DASH diet and reduced sodium intake lower absolute BP levels, these dietary interventions do not significantly affect BPV. These findings suggest that the BP-related benefits of the DASH diet and sodium reduction likely result from reducing absolute BP rather than reducing BPV.

Yildiz, Ferhat, Stephen J Bartels, Christy Cauley, Matthew Vrees, Benjamin F Crabtree, Edward R Marcantonio, Christine S Ritchie, et al. (2026) 2026. “Optimization of Care and Recovery in Older Colorectal Cancer Surgery Patients: A Hybrid Effectiveness-Implementation Pilot Study Protocol.”. Pilot and Feasibility Studies. https://doi.org/10.1186/s40814-026-01796-9.
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BACKGROUND: The exponential rise in colorectal cancer surgeries among older adults combined with 30-day readmission rates as high as 25% highlights the crucial need to optimize post-discharge care. While geriatrics surgery programs such as the Optimization of Senior Care and Recovery (OSCAR) model improve outcomes, they do not address the post-discharge transition. This study will address this gap by systematically integrating the OSCAR program with an evidence-based Care Transitions Intervention (CTI), using implementation science frameworks to guide adaptation. The resulting integrated model, OSCAR-S, will be evaluated in a pilot feasibility hybrid type 1 implementation-effectiveness trial.

METHODS: This three-phase project will apply implementation science frameworks to adapt and test an integrated care transition model (OSCAR-S) for older colorectal surgery patients. The first phase involves qualitative interviews with stakeholders to inform the adaptation of the combined model (OSCAR-S), guided by the ADAPT, Consolidated Framework for Implementation Research (CFIR), and FRAME frameworks. Subsequently, we will determine an optimal implementation strategy, guided by the Expert Recommendations for Implementing Change (ERIC). The final phase will include a pilot feasibility type I implementation-effectiveness trial. Guided by the RE-AIM framework and through a mixed methods approach, we will collect quantitative data from electronic medical records and qualitative data from post-implementation interviews to evaluate reach, effectiveness, adoption, implementation, and maintenance.

DISCUSSION: This study will offer insights into the adaptation, implementation, and assessment of an integrated care transition model (OSCAR-S) for older adults undergoing major colorectal surgery. The model integrates core components of two evidence-based interventions: OSCAR (geriatrics surgery co-management) and CTI (Care Transitions Intervention) programs. A novel aspect of this work is the application of multiple implementation science frameworks to guide this process. The findings will inform future strategies to optimize care transitions and postoperative outcomes, demonstrating how the implementation science approach can enhance the effectiveness and scalability of integrated care models.

TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov (NCT06752031). Registered December 30, 2024.

Liu, Tiange, Hanne Dahl Vonen, Ricardo Henao, Michael J Pencina, Kathryn M Rexrode, Chuan Hong, Johanna Quist-Nelson, et al. (2026) 2026. “Lifetime Adverse Pregnancy Outcome History and Cardiovascular Risk.”. Hypertension (Dallas, Tex. : 1979). https://doi.org/10.1161/HYPERTENSIONAHA.125.25916.
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BACKGROUND: Few studies have examined how multiple types of adverse pregnancy outcomes across women's reproductive lives relate to long-term cardiovascular disease.

METHODS: In 59 154 parous participants in Nurses' Health Study II, lifetime history of gestational diabetes, gestational hypertension, preeclampsia, preterm delivery, and low birthweight was self-reported, and cardiovascular events, including myocardial infarction, stroke, and coronary revascularization, were identified through June 2017. We used Cox proportional hazards models to estimate associations between adverse pregnancy outcomes and cardiovascular disease and quantified the extent to which these associations were explained by the later development of hypertension, diabetes, and hypercholesterolemia. We evaluated whether adding adverse pregnancy outcomes improved prediction of premature cardiovascular disease beyond established risk factors such as systolic blood pressure and diabetes.

RESULTS: Each adverse pregnancy outcome was associated with a higher risk of long-term cardiovascular disease. Only gestational hypertension (hazard ratio, 1.62 [95% CI, 1.36-1.92]) and preeclampsia (1.31 [1.11-1.55]) retained independent associations after accounting for the cooccurrence of other adverse pregnancy outcomes. Postpregnancy hypertension, diabetes, and hypercholesterolemia jointly accounted for substantial attenuation (58.4% [38.7%-75.8%]) of the association between adverse pregnancy outcomes in the first pregnancy and later cardiovascular disease. Adding adverse pregnancy outcomes only modestly improved discrimination and slightly improved reclassification.

CONCLUSIONS: Common adverse pregnancy outcomes, especially gestational hypertension and preeclampsia, are associated with higher future cardiovascular risk, with much of this association attenuated after accounting for subsequent cardiovascular risk factors. However, given the limited predictive gains, more nuanced integration of adverse pregnancy outcomes is needed to enhance their clinical utility in cardiovascular risk prediction.

Harry, Tamunotonye, Jingyi Cao, Zaib Hussain, Ruth-Alma N Turkson-Ocran, Stephen P Juraschek, Timothy P Lahey, Timothy B Plante, and Yuanyuan Feng. (2026) 2026. “Guide on Selection of Optimal Motivational Themes for Use in a Clinical Trial Recruiting Black US Adults: Survey Study.”. Journal of Medical Internet Research 28: e75857. https://doi.org/10.2196/75857.
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Publisher's Version

BACKGROUND: Black adults in the United States face significant cardiovascular health disparities, which are likely exacerbated by the underrepresentation of Black adults in cardiovascular clinical trials. The Black adult US population has experienced unique historical events, discriminatory practices, and practical obstacles that might contribute to this underrepresentation in clinical trials. An improved understanding of motivations that encourage or discourage participation in cardiovascular clinical trials can lead to more effective clinical trial recruitment and help mitigate these cardiovascular health disparities.

OBJECTIVE: This study aimed to determine, using an online survey, which motivational themes in clinical trial recruitment advertisements were most effective in encouraging Black adults to participate in a hypertension-focused trial. We also examined how trust in health care and various demographic factors influenced their decision to participate.

METHODS: We conducted an online survey with 829 self-identified Black adults in the United States, using a between-subject design to test 4 literature-derived motivational themes in clinical trial recruitment advertisements: (1) contribution to science, (2) helping the community, (3) lowering blood pressure, and (4) access to perks (US $500 worth of groceries or an equivalent cash amount). We assessed advertisement appeal, willingness to participate, and willingness to recommend clinical trial participation to others using cumulative link mixed models.

RESULTS: Demographic factors played a more significant role than motivational themes in predicting advertisement effectiveness. Adults aged 40-59 years and individuals diagnosed with high blood pressure were more likely to find the advertisements appealing and express willingness to participate. Urban residents engaged more with the advertisements compared to those in suburban or rural areas. Participants with liberal (odds ratio [OR] 1.37, 95% CI 1.01-1.85; P=.04) and conservative (OR 1.62, 95% CI 1.09-2.40; P=.02) political views were more willing to participate in the clinical trial compared to those with moderate views. However, the "lowering my blood pressure" theme was less effective among individuals who distrusted health care institutions (OR 0.40, 95% CI 0.16-0.97; P=.04) and also reduced willingness to recommend the trial (OR 0.36, 95% CI 0.15-0.85; P=.02). In addition, higher trust levels were unexpectedly associated with lower willingness to participate when exposed to this theme (OR 0.41, 95% CI 0.17-0.98; P=.04).

CONCLUSIONS: Demographic targeting (age, health status, and geographic location) is more critical than generic motivational messaging in recruiting Black adults to clinical trials. Successful digital health recruitment requires targeting specific demographic segments with tailored messages, as effectiveness varies significantly across sociodemographic factors. The online survey methodology offers researchers a rapid, scalable tool for pretesting recruitment strategies, though it should complement rather than replace community engagement. These insights can help reduce cardiovascular health disparities by improving clinical trial representativeness.

Anderson, Timothy S, Kristen M Kraemer, Marissa L McCann, Brianna X Wang, Julia H Lindenberg, and Gloria Y Yeh. (2026) 2026. “Pharmacist-Led Taper With Brief Mindfulness-Informed Cognitive Behavioral Therapy for Benzodiazepine Deprescribing in Older Adults: A Pilot Trial.”. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10356-z.
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BACKGROUND: Chronic benzodiazepine use remains common among older adults, despite limited evidence of benefit and substantial risks. Evidence-based approaches that are feasible in primary care settings are needed to support benzodiazepine deprescribing for older adults.

OBJECTIVES: To determine the feasibility, acceptability, and exploratory patient-centered outcomes of a team-based approach to benzodiazepine deprescribing in primary care.

DESIGN: Single-arm prospective clinical trial.

PARTICIPANTS: Adults age 65 and older prescribed long-term benzodiazepines recruited from four primary care clinics in an academic health system.

INTERVENTIONS: Ten-week virtual primary care embedded program consisting of pharmacist-guided tapering and three psychologist-led mindfulness-informed cognitive behavioral therapy (CBT) sessions.

MAIN MEASURES: Feasibility outcomes included enrollment, retention, and intervention adherence. Acceptability outcomes were collected through qualitative interviews. Exploratory efficacy outcomes included change in mean daily benzodiazepine dose, change in PROMIS anxiety score, and change in PROMIS sleep disturbance score.

KEY RESULTS: Seventeen participants (mean age 72, 29% female, mean 17 years of benzodiazepine use) enrolled and completed all six study visits (100% fidelity). Participants' mean (SD) baseline daily benzodiazepine dose was 9.0 (8.6) diazepam milligram equivalents. At completion, participants had a mean 60.5 percentage point reduction in benzodiazepine use (95% CI -69.9% to -51.3%; p < .001), with all participants reducing their dose and 3 stopping completely. Mean PROMIS anxiety scores decreased from 55.2 to 51.8 (-3.5 point change, 95% CI -6.5 to -0.7; p = 0.02) and mean PROMIS sleep disturbance scores were unchanged at week 10 (-1.7 point change, 95% CI -4.9 to 1.5; p = 0.30). Qualitative interviews indicated the program may target increased self-efficacy to reduce benzodiazepines and endorsed utility from both pharmacist- and psychologist-led components.

CONCLUSIONS: A primary care embedded virtual intervention involving pharmacist-led tapering and mindfulness-informed CBT sessions to support benzodiazepine deprescribing is feasible, acceptable, may reduce older adults' benzodiazepine use, and warrants multi-site testing.

GOV TRIAL NUMBER: NCT06119308.

GOV REGISTRATION DATE: 10/27/2023.