Category: 8. Health

Sep 3 2025

Noninferiority was not demonstrated for death and ischemic events between P2Y12 inhibitor monotherapy and dual antiplatelet therapy (DAPT) given for 12 months after stenting in patients with acute coronary syndromes (ACS), according to late-breaking research presented in a Hot Line session today at ESC Congress 2025 and simultaneously published in New England Journal of Medicine.

DAPT consisting of aspirin plus a potent P2Y12 inhibitor for 12 months is recommended for patients with ACS (myocardial infarction [MI] and unstable angina) after percutaneous coronary intervention (PCI) with stent implantation.

Recent evidence suggests that withdrawal of aspirin after 1 to 3 months of DAPT, followed by P2Y12 inhibitor monotherapy may reduce bleeding while preventing recurrent ischemic events compared with 12 months of DAPT. We conducted the NEO-MINDSET trial to specifically investigate if P2Y12 inhibitor monotherapy could be used in the early phase, immediately after PCI and for the entire 12 months compared with DAPT for 12 months.”

Pedro Lemos, Principal Investigator, Professor from the Hospital Israelita Albert Einstein, Sao Paulo, Brazil

The open-label randomized controlled NEO-MINDSET trial was conducted across 50 sites in Brazil. Patients with ACS undergoing successful PCI with drug-eluting stents were randomized 1:1 within the first 4 days of hospitalisation to stop aspirin and receive potent P2Y12 inhibitor monotherapy (ticagrelor or prasugrel) or to DAPT (aspirin plus a potent P2Y12 inhibitor) for 12 months.

The first primary outcome was a composite of death, MI, stroke or urgent target-vessel coronary revascularisation, with an absolute risk difference of 2.5 percentage points set as the prespecified noninferiority margin. The second primary outcome was major or clinically relevant nonmajor bleeding, with superiority testing if the first primary outcome was noninferior.

The analysis population included 3,410 randomized patients who had a mean age of 59.6 years, with 29.3% being women.

The ischemic primary endpoint occurred in 7.0% of patients in the monotherapy group and 5.5% in the DAPT group (hazard ratio [HR] 1.28; 95% confidence interval [CI] 0.98 to 1.68), resulting in an absolute risk difference of +1.47 percentage points (95% CI −0.16 to 3.10), which did not meet the prespecified criteria for noninferiority (p=0.11).

Major or clinically relevant nonmajor bleeding occurred in 2.0% of patients in the monotherapy group and 4.9% in the DAPT group (risk difference −2.97 percentage points; 95% CI −4.20 to −1.73).

The incidence of all-cause death was 3.6% in the monotherapy group and 3.0% in the DAPT group (HR 1.24; 95% CI 0.85 to 1.79). Any bleeding occurred in 4.5% of patients in the monotherapy group and 9.0% in the DAPT group.

A landmark analysis on the ischemic primary endpoint revealed a risk difference of +1.5 percentage points during the first 30 days and 0.0 percentage points from 30 days to 12 months for P2Y12 inhibitor monotherapy vs. DAPT. For the bleeding primary endpoint, the risk difference was −0.8 percentage points during the first 30 days and −2.2 percentage points from 30 days to 12 months for monotherapy vs. DAPT.

Summarizing the findings, Professor Lemos concluded: “We failed to demonstrate the noninferiority of aspirin-free monotherapy initiated immediately after PCI with regard to the ischemic primary endpoint over 12 months. Results from the landmark analysis suggest that the excess ischemic risk with monotherapy occurred in the first 30 days, with comparable outcomes thereafter. Bleeding appeared to be lower at both 30 days and 12 months with monotherapy vs. DAPT.”

A powerful new pill has been shown to bring down stubbornly high blood pressure that resists standard treatments, according to results from a landmark global trial.

The drug, baxdrostat, lowered blood pressure by nearly 10 mmHg on average — enough to slash the risk of heart attack, stroke, and kidney failure.

Breakthrough Trial Shows New Hope

Around the world, an estimated 1.3 billion people live with high blood pressure (hypertension). In roughly half of these cases, the condition remains uncontrolled or does not respond to standard treatments. This group faces a sharply increased risk of heart attack, stroke, kidney problems, and early death. In the UK alone, about 14 million people are affected.

To address this challenge, researchers launched the international BaxHTN trial, directed by Professor Bryan Williams of the UCL Institute of Cardiovascular Science and sponsored by AstraZeneca. The study tested a new oral drug, baxdrostat, with close to 800 patients taking part across 214 medical centers worldwide.

Findings from the study were shared on August 30 at the European Society of Cardiology (ESC) Congress 2025 in Madrid and published at the same time in the New England Journal of Medicine.

Powerful Results in Resistant Patients

After 12 weeks of treatment, participants who received baxdrostat (1 mg or 2 mg once daily in pill form) experienced an average reduction in blood pressure of about 9 to 10 mmHg more than those given a placebo. This decrease is significant enough to meaningfully lower cardiovascular risk. Roughly 40 percent of patients taking baxdrostat achieved healthy blood pressure levels, compared with fewer than 20 percent of those on placebo.

Professor Williams, the trial’s Principal Investigator and lead presenter at ESC, said: “Achieving a nearly 10 mmHg reduction in systolic blood pressure with baxdrostat in the BaxHTN Phase III trial is exciting, as this level of reduction is linked to substantially lower risk of heart attack, stroke, heart failure and kidney disease.”

How the Pill Works Inside the Body

Blood pressure is strongly influenced by a hormone called aldosterone, which helps the kidneys regulate salt and water balance.

Some people produce too much aldosterone, causing the body to hold onto salt and water. This aldosterone dysregulation pushes blood pressure up and makes it very difficult to control.

Addressing aldosterone dysregulation has been a key effort in research over many decades, but it has been so far difficult to achieve.

Baxdrostat works by blocking aldosterone production, directly addressing this driver of high blood pressure (hypertension).

An Important Step Forward in Treatment

Professor Williams, Chair of Medicine at UCL, said: “These findings are an important advance in treatment and in our understanding of the cause of difficult-to-control blood pressure.

“Around half of people treated for hypertension do not have it controlled. However, this is a conservative estimate and the number is likely higher, especially as the target blood pressure we try to reach is now much lower than it was previously.^[1]

“In patients with uncontrolled or resistant hypertension, the addition of baxdrostat 1mg or 2mg once daily to background antihypertensive therapy led to clinically meaningful reductions in systolic blood pressure, which persisted up to 32 weeks with no unanticipated safety findings.

“This suggests that aldosterone is playing an important role in causing difficult-to-control blood pressure in millions of patients and offers hope for more effective treatment in the future.”

A Global Health Challenge

Historically, higher-income Western countries were reported to have far higher levels of hypertension; however, largely due to changing diets (adding less salt to food), the number of people living with the condition is now far higher in Eastern and lower-income countries. More than half of those affected live in Asia, including 226 million people in China and 199 million in India.^[2]

Professor Williams added: “The results suggest that this drug could potentially help up to half a billion people globally – and as many as 10 million people in the UK alone, especially at the new target level for optimal blood pressure control.”

Notes

1. The ESC 2024 hypertension guidelines recommended a target blood pressure of less than 130/80 mmHg. Prior to 2024 the target had been 140/90 mmHg.
2. Figures from Blood Pressure UK

Reference: “Efficacy and Safety of Baxdrostat in Uncontrolled and Resistant Hypertension” by John M. Flack, Michel Azizi, Jenifer M. Brown, Jamie P. Dwyer, Jakub Fronczek, Erika S.W. Jones, Daniel S. Olsson, Shira Perl, Hirotaka Shibata, Ji-Guang Wang, Ulrica Wilderäng, Janet Wittes and Bryan Williams, 29 August 2025, New England Journal of Medicine.
DOI: 10.1056/NEJMoa2507109

The study was supported by the NIHR Biomedical Research Centre at UCLH.

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Individuals with an increased risk for dementia due to Alzheimer’s disease can have impaired spatial orientation skills. DZNE researchers come to this conclusion based on a study involving around 100 older adults who were tasked with determining their position within a virtual environment. In this, participants with “subjective cognitive decline” (SCD) – a risk factor for Alzheimer’s disease – performed worse than members of the control group. In contrast, there were no significant differences in conventional tests of cognitive performance. In view of this, the current research results, published in the journal Science Advances, could pave the way for more sensitive testing methods. Potential areas of application include early diagnosis of Alzheimer’s and drug studies.

The term “subjective cognitive decline” (SCD) refers to the condition in which someone believes that their memory is deteriorating, despite standard tests showing no decline in mental performance.

This condition has been the focus of research in recent years, because people with SCD are known to be at an increased risk of developing Alzheimer’s dementia later in life. It is therefore reasonable to assume that SCD may indicate a preclinical stage of Alzheimer’s.”

Prof. Thomas Wolbers, research group leader at DZNE’s Magdeburg site and member of the Collaborative Research Centre “Neural Resources of Cognition”

Novel approach

In the current study, the team led by the Magdeburg-based neuroscientist explored an approach for detecting cognitive impairments that goes beyond conventional test methods. Experts from the US and the Czech Republic collaborated on this research. Together, they assessed what is known as path integration: This refers to the ability to determine position and navigate spatially based on body awareness and the perception of one’s movement. “For this task, we humans use special neuronal circuits. They are located in an area of the brain called the entorhinal cortex. Hence, in a sense, we carry a compass inside our heads,” says Wolbers. Alzheimer’s disease typically affects this area in its earliest stages, even before symptoms of dementia manifest. “This brings us full circle to our current study. To my knowledge, our findings are the first to show that SCD can be associated with subtle orientation problems. We hope this will lay the foundation for novel testing methods that can detect very early effects of Alzheimer’s disease,” says Wolbers.

A world without reference points

The study included 102 older women and men, aged between 55 and 89. Thirty of the participants had SCD. However, all study subjects scored within the normal range on conventional cognitive tests. For the actual experiment, they wore a virtual reality headset. Equipped with these, they walked through real space while simultaneously moving through a computer-generated environment: They saw an endlessly vast plain with no landmarks under a blue sky. However, the irregular texture of the ground enabled them to perceive their movements across the digital landscape. “Since there were no visual landmarks in this virtual world, the only way to orient oneself was with the help of the brain’s navigation system. This is precisely the ability we wanted to test,” says Dr. Vladislava Segen, first author of the current publication and a member of Wolbers’ research group.

Putting the brain’s compass to the test

The task began with the study participants following a ball that floated near the ground while moving along a curved trajectory until it finally came to a stop. Once the participants had caught up with the ball, they were asked to turn toward their original starting point and mark its presumed position. To do this, they used a virtual pointer that could be operated via a hand controller. The participants were also asked to align themselves with the direction they had been facing at the initial start of their path. “This allowed us to test how well the study subjects could remember their initial orientation,” says Segen. The ball then hovered on to the next stop, where the responses had to be repeated. With two stops per run, the total distance covered in real space was approximately six meters, and each participant completed about 70 trials. This allowed to collect extensive data on the movements of the study subjects and how accurately they performed their orientation tasks.

Less accurate with SCD

“Some found these tasks easier than others. They were certainly challenging. In general, there was a clear age-related effect with the oldest individuals showing larger errors. This applied regardless of whether SCD was existent or not,” says Segen. “However, when comparing the groups, it became obvious that participants with SCD performed worse overall. They were less accurate in path integration. Our data suggest that these orientation difficulties did not arise from movement dynamics, such as walking faster or looking at the ground more often while walking. The causes of the imprecise orientation were not related to motion, but cognitive in nature.”

Deeper insights with mathematical modeling

To identify the causes of this impairment in more detail, the research team applied complex mathematical modelling to the collected data. “The brain has to process various data to determine position. This includes correctly perceiving the speed at which you are moving and the direction in which you are going. With the help of our model, we were able to identify which sources of error had the greatest impact on position determination and which had only minor influence,” says Segen. One factor stood out, with its influence on position accuracy differing significantly between the two study groups. “To determine your position in space while moving, you have to constantly update your position in your mind. This requires you to remember previous positions. To do this, you unconsciously draw on a mental history. In people with SCD, this type of memory was particularly faulty. We therefore refer to this as memory leak. We suspect that functional disturbances in the entorhinal cortex are responsible for this”, explains Segen.

Clinical implications and future directions

The entorhinal cortex contains a special type of neurons called “grid cells”. Based on incoming sensory information, those cells generate a kind of coordinate system for the environment in which a person currently finds themselves. Studies by other research groups suggest that these neural circuits store a history of previous, successive locations in memory – similar to the sequence of images in a flipbook. “The evidence is converging that path integration is very sensitive to grid cell dysfunction and thus to preclinical stages of Alzheimer’s disease,” says Thomas Wolbers. Thus, the researchers want to further develop their experimental setup so that it can be used in clinical trials. “I am thinking, for example, about testing new drugs. When evaluating the effects of novel active substances, path integration could supplement existing assessments to provide a more detailed overall picture,” says Wolbers. “In the long term, I also see potential for use in clinical routine, specifically in the early diagnosis of Alzheimer’s disease. However, this technique first needs to be further tested and simplified. Also, we intend to relate our findings to biomarkers for Alzheimer’s disease derived from blood or cerebrospinal fluid. This should provide further insights into the capability of our approach for detecting neurodegeneration.”

Health Secretary Robert F. Kennedy Jr. appears to be pushing for more members for the influential government vaccine advisory panel that he recently gutted, weeks before it’s expected to consider childhood shot schedules and Covid booster recommendations.

Catherine Stein, a professor at Case Western University, said that government health officials have reached out to her about joining the Advisory Committee on Immunization Practices and that she’s accepted. They’re currently processing her paperwork, she said, which was extensive and included questions on her potential conflicts of interest.

Dual antiplatelet therapy (DAPT) was not more effective than aspirin alone for the prevention of major adverse cardiovascular events and increased major bleeding in patients with acute coronary syndrome (ACS) who underwent coronary artery bypass grafting (CABG), according to late-breaking research presented in a Hot Line session today at ESC Congress 20251 and simultaneously published in New England Journal of Medicine.

ESC Guidelines recommend DAPT with aspirin plus a P2Y12 inhibitor over single antiplatelet therapy for patients with ACS (heart attacks or unstable angina) who have undergone CABG.

These recommendations are mainly based on extrapolation of data from non-CABG studies, sub-studies of ACS trials and smaller randomised studies with surrogate endpoints. Data from larger randomised trials with clinically relevant endpoints are lacking. We conducted the TACSI trial to investigate whether 12 months of DAPT with ticagrelor and aspirin would reduce the risk of all-cause death and cardiovascular events compared with aspirin alone in ACS patients after CABG.”

Anders Jeppsson, Principal Investigator, Professor from Sahlgrenska University Hospital, Gothenburg, Sweden

The TACSI trial was an investigator-initiated pragmatic, open-label, registry-based randomised trial conducted in all 22 cardiothoracic surgery centres in Sweden, Denmark, Norway, Finland and Iceland. Patients undergoing their first isolated CABG were randomised 1:1 within 3-14 days to either DAPT (ticagrelor 90 mg twice daily plus aspirin 75 mg once daily) or aspirin only (75-160 mg daily according to local protocols) for 12 months. The primary efficacy endpoint of major adverse cardiovascular events (MACE) was a composite of all-cause death, myocardial infarction, stroke or new coronary revascularisation within 12 months. The primary safety endpoint was major bleeding.

The 2,201 patients included had a mean age of 66 years and 14.4% were women. The primary endpoint of MACE occurred in a similar proportion of patients in each group: 4.8% of patients in the DAPT group and 4.6% in the aspirin only group (hazard ratio [HR] 1.09; 95% confidence interval [CI] 0.74 to 1.60; log rank p=0.77). Major bleeding was more frequent in the DAPT group (4.9% vs. 2.0%; HR 2.50; 95% CI 1.52 to 4.11).

A key secondary endpoint of net adverse clinical events (the primary endpoint plus major bleeding) was higher in the DAPT group than in the aspirin group (9.1% vs. 6.4%; HR 1.45; 95% CI 1.07 to 1.97). A total of 0.7% of patients with DAPT and 0.2% with aspirin only died during the first year after randomisation (HR 4.01; 95% CI 0.85 to 18.9).

Concluding, Professor Jeppsson said: “Our 12-month data do not support the use of DAPT over aspirin alone in ACS patients after CABG, given the lack of improvement in MACE and the increased risk of major bleeding. However, further long-term follow-up is needed.”

Discontinuing oral anticoagulation (OAC) therapy resulted in a lower risk of a composite of stroke, systemic embolism or major bleeding than continuing OAC therapy in patients who had successful ablation for atrial fibrillation at least 12 months previously, according to results from a late-breaking trial presented in a Hot Line session today at ESC Congress 2025 and simultaneously published in The Journal of the American Medical Association.

Atrial fibrillation (AF) is a common type of arrhythmia characterised by an abnormal irregular heartbeat that can increase the risk of stroke and thromboembolism (blood clots). Ablation can be used to destroy small sections of heart tissue that may be causing abnormal heartbeats. Oral anticoagulation (OAC) is recommended in all patients for at least 2 months after AF ablation to reduce the risk of stroke or thromboembolism. Thereafter, guidelines recommend continuing OAC depending on the patient’s risk of stroke.

Explaining why the ALONE-AF trial was conducted, its Principal Investigator, Professor Boyoung Joung from Yonsei University, Seoul, South Korea, said: “Many patients who have had a successful ablation and have stroke risk factors remain on OAC for the rest of their lives, although there is no evidence from randomized trials to indicate that this is necessary. We compared direct OAC therapy with no OAC therapy among patients 1 year after successful AF ablation who had at least one risk factor for stroke.“

The ALONE-AF trial was an open-label randomized superiority trial conducted at 18 sites in South Korea. Eligible patients had non-valvular AF, had undergone their first catheter-based AF ablation, had no atrial arrhythmia recurrence for at least 12 months post-ablation and had at least one stroke risk factor as determined by the CHA2DS2-VASc score (CHA2DS2-VASc ≥1 for males or ≥2 for females). Patients were randomized 1:1 to receive direct OAC or no OAC therapy. Patients randomized to the OAC group received standard doses of apixaban, rivaroxaban or edoxaban, unless established dose-reduction criteria applied. The primary endpoint of net adverse clinical events was a composite of stroke, systemic embolism and major bleeding at 24 months.

The study population included 840 randomized patients who had a mean age of 64 years, with one-quarter (25%) being women.

At 24 months, OAC was associated with a higher risk of net adverse clinical events than no OAC (2.2% vs. 0.3%; absolute difference −1.9%; 95% confidence interval [CI] −3.5 to −0.3; log-rank p=0.024).

No significant difference was observed in the incidence of ischaemic stroke or systemic embolism at 24 months between the OAC and no-OAC groups (0.8% vs. 0.3%, respectively; absolute difference −0.5%; 95% CI −1.6 to 0.6). Major bleeding occurred in 1.4% of patients in the OAC group and 0% in the no-OAC group (absolute difference -1.4%; 95% CI −2.6 to −0.2).

Concluding, Professor Joung said: “In the first randomized trial to address this question, receiving no OAC treatment resulted in a lower risk of harmful events than OAC treatment. A limitation was that the trial was not designed to detect a potential difference in ischemic events, which occurred at a lower-than-expected rate. Our findings indicate that lifelong OAC might not be necessary in all patients who have had successful AF ablation at least 1 year previously. “

CHAMPAIGN, Ill. — Antibodies are the critical targeting agents of the immune system and the crux of immune therapy and vaccine development, but studying them is slow, expensive and labor-intensive. Now, researchers at the University of Illinois Urbana-Champaign have developed a new high-volume method that can rapidly build and test large numbers of antibodies at once. With it, they have already uncovered common aspects of how antibodies bind across variants of a key influenza target protein.

Dubbed the oPool+ display, the method could drastically accelerate antibody research and the development of new antibody-based treatments, immune therapies and vaccines, said Illinois biochemistry professor Nicholas Wu, leader of the study.

The researchers published their findings in the journal Science Translational Medicine.

“More than 150 different FDA-approved antibody therapeutics are being used in clinical settings to treat diseases from cancer to infectious disease to autoimmune diseases. With a rapid, high-throughput method like ours, if we can search for a potential antibody candidate that’s really good against a certain disease, then it has great potential in becoming an effective therapeutic,” said graduate student Wenhao “Owen” Ouyang, the first author of the study.

Traditionally, antibodies have been synthesized and studied one at a time — a daunting prospect, considering that the body can make trillions of different antibodies.

 “In a research lab, each antibody can take one person weeks to months to produce and analyze. So we asked, how can we scale this up in a way that we can further understand this extremely diverse class of molecules?” Ouyang said.

The researchers began by creating a library of antibodies against a key influenza immune target called hemagglutinin. Since individual immune responses vary, meaning different people can create different antibodies to the same target, the researchers included about 300 identified antibody variants from many different sources in their library. They then combined existing high-volume synthesis tools and a binding analysis platform, which allowed them to create the hundreds of antibodies and test them against an array of different hemagglutinin variants from assorted influenza mutations to characterize how the antibodies bound to the hemagglutinins.

“Instead of analyzing one antibody at a time, this approach let us evaluate thousands of antibody–antigen interactions in just a few days. It not only significantly accelerated the pace of our research but also lowered the cost, both of materials and labor,” said Wu, who also is a professor in the Carle Illinois College of Medicine at the U. of I. ““We can reduce 80-90% of the cost just from the materials and supplies alone.”

With the oPool+ display, the researchers built profiles of exactly what each antibody binds, which helps identify the best candidates for treatment development. They also identified features of hemagglutinin antibody activity that were shared across antibodies from many people.

”This is one of the key research areas for influenza vaccination research, because we would like to have a vaccine that works for everyone,” Ouyang said. “Each of our immune systems is actually quite different, so sometimes it is hard to have a broadly effective vaccine, solely because of the intrinsic differences between our bodies. With this platform, we found these common antibody features among different individuals very quickly.”

Next, the researchers plan to further expand the capacity of oPool+ display from hundreds to thousands or even tens of thousands of antibodies. The platform could be used to characterize antibodies against many other pathogens as well, whether viruses, bacteria or even cancer.

“If there’s another mysterious pathogen in the future that emerges the way COVID-19 did, then once we have identified the targets on the pathogen, we could characterize all antibody response against it in a very fast way and quickly identify candidates for antibody treatments or vaccines,” Ouyang said.

The researchers also plan to use oPool+ display to validate and refine artificial intelligence models that suggest antibody structures based on a target antigen.

“We could easily create an AI model that can make a lot of predictions, but we don’t really have an idea of how accurate they are because we haven’t had any way to systematically validate the results,” Ouyang said. “So we are excited about using AI to create predictions of antibodies and then validating them in real time with oPool+, and feeding the results back to the AI model to continually improve it.”

This work is supported by the U.S. National Institutes of Health, the Searle Scholars Program and the Howard Hughes Medical Institute Emerging Pathogens Initiative.

Procedure-related infection rates were similar with reconditioned and new pacemakers, according to late-breaking research presented in a Hot Line session today at ESC Congress 2025.

Explaining the rationale for Project My Heart Your Heart, Doctor Thomas Crawford from the University of Michigan, Ann Arbor, USA, said: “Patients in many low- and middle-income countries (LMICs) still have very limited access to cardiac pacing despite its routine use in higher-income countries. Indeed, access to pacemaker implantation is around 200-fold lower in Africa than in Europe. To facilitate the use of reconditioned devices, Project My Heart Your Heart has developed a comprehensive protocol for cleaning, functional testing and sterilisation, and has gained FDA approval for their export to countries whose governments have provided express permission for pacemaker importation. We initiated a clinical trial to investigate the safety of implanting pacemakers reconditioned using our protocol compared with new devices in several LMICs.”

A randomized controlled trial was conducted in Kenya, Mexico, Mozambique, Nigeria, Paraguay, Sierra Leone and Venezuela from May 2022 to June 2024. Adult patients with life expectancy of at least two years, a class I indication for pacemaker therapy and no financial means to acquire a new device were randomized 1:1 to receive a reconditioned pacemaker or a new pacemaker. The primary endpoint was procedure-related infection at 12 months.

The trial included 306 patients who had a mean age of around 71 years. Approximately half were female. Follow-up data at 12 months were available for 259 patients (84.9%).

Over 12 months, there were two pocket infections requiring explantation in the reconditioned pacemaker group and three in the new pacemaker group. There was one case of superficial cellulitis responsive to antibiotics in the new pacemaker group. Overall, the incidence of procedure-related infections at 12 months was 1.6% in patients in the reconditioned pacemaker group and 3.1% in the new group. The upper bound of the 90% confidence interval for the difference in infection rates between the groups was 2.2%, which is within the pre-specified noninferiority margin of 5%.

There were no device malfunctions in either group. Lead revisions occurred in nine patients in the reconditioned pacemaker group and five in the new group. Unrelated to the implantation procedure, there were four deaths in the reconditioned pacemaker group and two in the new group.

Concluding, Doctor Crawford said: “Our trial demonstrates the safety of pacemakers reconditioned using a specific protocol, with noninferior infection rates to new pacemakers and no malfunctions. The work of Project My Heart Your Heart serves as a blueprint that can be replicated by other organisations to enable wider pacemaker reuse. We would also like to expand into reconditioned implantable cardioverter-defibrillator devices, which are even more expensive and out of reach for many patients across the world.“