Cancer Diagnostic Delay After Cell-Free DNA Multicancer Early Detection Testing
https://jamanetwork.com/journals/jama/fullarticle/2849767

This cross-sectional study uses data from cancer alliance regions in England to assess whether regional participation in a population-based screening trial of a cell-free DNA-based multicancer early detection test was associated with changes in cancer diagnostic delay rates.

Hazards of Incentivizing “Repeat Until Normal” as a Strategy for Blood Pressure Control
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2849751

Each day in the US, more than 100 000 patients with hypertension are seen in office-based health care visits. A familiar scene at many of these visits begins with an initial blood pressure (BP) measurement of around 143/85 mm Hg, often measured on the way to the patient room, or immediately on entering and settling in for the visit. A repeat BP measurement, after conversation and cuff adjustment, reads 138/82 mm Hg. Clinically, this is routine variability. Administratively, however, it differentiates controlled from uncontrolled hypertension and may determine whether a clinician meets an incentivized performance target with consequences for their income. When a single in-clinic reading carries such weight, what exactly are we incentivizing?

The Clinical Spectrum of Paroxysmal Atrioventricular Block
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2849749

To the Editor In a recent issue of JAMA Internal Medicine, Kawji presented an interesting case where premature atrial complexes triggered brief episodes of paroxysmal atrioventricular block (PAVB). The author provided a thorough explanation of the pathophysiology of bradycardia-dependent or phase 4 block. Kawji highlighted the importance of distinguishing phase 4 PAVB from vagally induced heart block. The former is characterized by the block being triggered by an abrupt lengthening of the P-P interval. Vagally mediated block, on the other hand, is characterized by gradual slowing of the sinus rate and atrioventricular conduction. Phase 4 block is an indication for pacemaker implantation, while pacing for vagally induced heart block is generally not warranted.

The Clinical Spectrum of Paroxysmal Atrioventricular Block—Reply
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2849748

In Reply I want to thank Littmann for their thought-provoking comments about my recently published article. Phase 3 block is commonly encountered during periods of tachycardia or acceleration-dependent rhythms and usually affects the right bundle in particular, due to its longer refractory period. It is commonly seen during atrial fibrillation (Ashman phenomenon), sometimes with premature atrial contractions conducted with aberration, during rapid atrial pacing in electrophysiological studies, and indeed possibly with any fast supraventricular rhythm. Phase 3 aberrant ventricular conduction is primarily physiological, as discussed previously by Morton et al and others over the years. However, left bundle-branch block aberration during tachycardia suggests underlying conduction tissue disease. During tachycardia, the presence of diseased His bundle will usually result in progressive heart block, maybe culminating in complete heart block. The electrocardiogram (ECG) discussed in the second reference provided by Littmann shows 2:1, not complete heart block during tachycardia. The ECG in the fifth reference does not show the rhythm preceding complete heart block, so we cannot determine the mechanism. The third and fourth references do not address the main message in my article.

Decision and Cost-Effectiveness Analyses Complement Results From Randomized Clinical Trials
https://jamanetwork.com/journals/jama/fullarticle/2849648

Decision analysis is a quantitative approach to decision-making under conditions of uncertainty that uses explicit statistically based methods to compare alternative strategies based on their expected outcomes. Cost-effectiveness analysis is a form of decision analysis that compares resource use and health outcomes of competing strategies. The cost-effectiveness analysis by Lee et al in this issue of JAMA estimates that adding 1-time Helicobacter pylori stool antigen testing (HPSA) to fecal immunochemical testing (FIT)–based colorectal cancer screening programs could yield greater life-years and lower costs than FIT alone due to reductions in gastric cancer mortality.

Blood Pressure Above Goal Among Adults With Hypertension in the US
https://jamanetwork.com/journals/jama/fullarticle/2849647

To the Editor We are dismayed by the number of US adults with uncontrolled blood pressure (BP), as reported in a recent Research Letter. We wish to bring additional attention to the current national quality performance measure target for high BP control of less than 140/90 mm Hg, which has been both outdated and stagnant since 2005. Since 2017, this measure has remained misaligned with national guidelines endorsed by the American Heart Association and the American College of Cardiology, which recommend control for adults with stage 2 and stage 1 confirmed high BP who are at increased risk for cardiovascular diseases (CVDs).

Blood Pressure Above Goal Among Adults With Hypertension in the US—Reply
https://jamanetwork.com/journals/jama/fullarticle/2849646

In Reply We agree with Dr Casey and colleagues that the 2025 American Heart Association/American College of Cardiology (AHA/ACC) multisociety guideline’s BP goal of less than 130/80 mm Hg should be the national goal. We also agree that the previous BP goal of 140/90 mm Hg, which is included in many national quality metrics, is outdated and that the higher BP levels in quality performance measures may contribute to gaps between evidence and clinical practice. Estimates suggest that achieving and maintaining a BP goal of 130/80 mm Hg among US adults could prevent 500 000 more cardiovascular disease events nationally during 10 years compared with a goal of 140/90 mm Hg.

Cost-Effectiveness of Fecal Immunochemical Testing Alone vs Co-Testing With Helicobacter pylori Stool Antigen
https://jamanetwork.com/journals/jama/fullarticle/2849645

This cost-effectiveness analysis assesses the lifetime health benefits and costs of invitation to 1-time Helicobacter pylori stool antigen testing added to biennial fecal immunochemical test (FIT) screening compared with FIT alone.

Advertising in AI-Powered Clinical Decision Support Tools
https://jamanetwork.com/journals/jama/fullarticle/2849644

This Viewpoint discusses advertising in artificial intelligence (AI)–powered clinical decision support tools and stresses the importance of adopting and policing advertising policies with strong ethical guardrails within these tools.

Complete Remission of Cavin-4 Immunoglobulin G Rippling Muscle Disease After Rituximab Therapy
https://jamanetwork.com/journals/jamaneurology/fullarticle/2849795

This case report describes a 65-year-old man who experienced complete remission of cavin-4 immunoglobulin G (IgG) rippling muscle disease after receiving rituximab therapy.

Variability in Clinical Performance of the FDA-Cleared Lumipulse p-Tau 217/β-Amyloid 42 Plasma Ratio
https://jamanetwork.com/journals/jamaneurology/fullarticle/2849794

This cross-sectional study evaluates the performance of the US Food and Drug Administration–cleared phosphorylated tau 217 (p-tau217) to β-amyloid 42 ratio cut points used to detect amyloid pathology associated with Alzheimer disease.

Standard-Dose Tenecteplase v Low-Dose Alteplase for Acute Ischemic Stroke From Large-Vessel Occlusion
https://jamanetwork.com/journals/jamaneurology/fullarticle/2849793

This randomized clinical trial attempts to determine whether standard-dose tenecteplase at 0.25 mg/kg achieves a higher rate of recanalization on the initial angiogram than low-dose alteplase at 0.6 mg/kg in patients scheduled for mechanical thrombectomy.

Precardioversion Heart Rhythm Monitoring Using Smartphone PPG
https://jamanetwork.com/journals/jamacardiology/fullarticle/2849970

This randomized clinical trial evaluates the efficacy and feasibility of smartphone-based precardioversion rhythm monitoring vs standard of care.

Finerenone Across Cardiovascular-Kidney-Metabolic Syndrome Stages
https://jamanetwork.com/journals/jamacardiology/fullarticle/2849969

This study evaluates the efficacy and safety of finerenone across cardiovascular-kidney-metabolic stages, and examines the effects of finerenone on cardiovascular-kidney-metabolic syndrome progression and regression over time.

Error in Results
https://jamanetwork.com/journals/jamacardiology/fullarticle/2849968

The Original Investigation titled “Chronic Kidney Disease Prevalence and Awareness Among US Adults,” published on November 8, 2025, was corrected to fix an error in the awareness of chronic kidney disease diagnosis among Hispanic adults reported in the Results; the correct values are 12.5% (95% CI, 10.5%-14.4%). This article was corrected online.

Notes From the Far End of the Stethoscope
https://jamanetwork.com/journals/jamacardiology/fullarticle/2849967

This essay describes the author’s experience going from clinician to patient and back again.

Patient Information: Ebola
https://jamanetwork.com/journals/jama/fullarticle/2849890

This JAMA Patient Page describes how Ebola is transmitted, how common the infection is and where outbreaks have occurred, risk factors and symptoms, and how it is diagnosed and treated.

Controversies About Osteoporotic Fracture Prevention Strategies
https://jamanetwork.com/journals/jama/fullarticle/2849851

This Viewpoint considers controversies regarding osteoporotic fracture prevention strategies, noting that some currently available medications, including estrogen, are underused and poorly understood.

Incentivizing Kidney Transplants While Safeguarding Equity
https://jamanetwork.com/journals/jama/fullarticle/2849850

This Viewpoint discusses the US Centers for Medicare & Medicaid Services’ Increasing Organ Transplant Access Model and outlines pathways to monitor the implementation of the model to ensure equitable access for all patients.

Trials and Health Policy
https://jamanetwork.com/journals/jama/fullarticle/2849859

Seldom are health policy decisions guided solely—or even primarily—by evidence from clinical trials. Indeed, there may be an inherent mismatch between the broad scope and rapid speed of most policy decisions and the deliberate specificity and methodical pace of traditional trial research. Policymakers often adopt or fund interventions for broad populations based on incomplete information, and under time pressure, budgetary constraints, and competing political demands. Clinical trialists, in contrast, may focus on generating internally valid answers to highly specific questions under carefully controlled conditions, a process that can take years of planning, data collection, and analysis. Not surprisingly, policymakers may perceive that the evidence generated by trials is too limited and arrives too late to guide many of the real-world decisions they make, while trialists may lament that sweeping policy actions are taken without robust experimental evidence demonstrating their effects.

Point-of-Care Ultrasound for the Diagnosis of Pneumonia
https://jamanetwork.com/journals/jama/fullarticle/2849858

This JAMA Insights explores the use of point-of-care ultrasound as a less expensive, more accessible alternative to chest radiography and computed tomography for diagnosing community-acquired pneumonia.